Hey there, nice to meet you! I’m Ariana Ziminsky, Plymouth State University grad student in clinical mental health counseling with a goal to become an EMDR-certified clinician in the future. If you are curious about EMDR and are trying to understand what it’s all about, I’m here to help. Below are some the most common questions I’ve heard about EMDR, answered with the evidence base to back it up. You are invited to click your way through the dropdowns below to learn about EMDR one step at a time:
EMDR is an abbreviation for eye movement desensitization and reprocessing. EMDR is an evidence-supported, safe, and drug-free therapy technique to help people heal the underlying cause (as in, yes, the root cause) of many mental health issues, including symptoms associated with post-traumatic stress disorder (PTSD; Shapiro, 2017).
In dozens of studies, EMDR has been shown to be effective in lessening or eliminating symptoms such as
anxiety
depression
personality disorders
complex PTSD
panic disorder
excessive grief
survivor's guilt
sexual dysfunction
substance use disorders
chronic pain
body dysmorphic disorder
phantom limb pain
and more (Shapiro, 2017)
It’s prudent to acknowledge that this may sound like a “too good to be true” list. However, this list stands solid: More than 30 studies have demonstrated the effectiveness of EMDR (Shapiro, 2017), so much so that EMDR is now one of the top recommended treatments for PTSD by the World Health Organization (2023), the U.S. Department of Veteran Affairs (2024), and the U.S. Department of Defense (2023).
With that said, if EMDR is effective—and if, based on its name, EMDR includes eye movements—it begs the question:
How can eye movements heal the root cause of PTSD?
That answer lies in an explanation that is both as simple as a single thought but as complex as the human brain:
Eye movements (and other related techniques) can help process the thoughts, feelings, and sensations of previously unprocessed memories (Shapiro, 2017).
Unprocessed memories, described by Dr. Francine Shapiro (2017), the founder and developer of EMDR, are thoughts, feelings, beliefs, and sensations of an event stored in the brain in a way that helped the person survive at the time of the event but then prove to be dysfunctional for the person’s long-term mental health.
Or, in Shapiro’s words, “the cause [of such symptoms] is the unprocessed memories of these events that are physiologically stored with the cognitive, affective [emotional], and somatic [physical] elements that were originally experienced” (Shapiro, 2017, pp. 40-41)—meaning, an unprocessed memory contains within it the mental, emotional, and physical elements of the original event. The body has not processed the memory and put it calmly away in its filing cabinet; instead, the memory is sitting right there on the top of the desk, in everyday working space, and whenever a smell, sound, sight, taste, or touch reminds the brain that the memory is sitting there, unprocessed, the brain jumps into survival mode, prepared to defend its main host for survival (the human!) against a threat it thinks is still present—even though it happened long ago and the human is, in fact, safe in the moment.
These unfiled, unprocessed memories that are theorized to be at the root of many traumas and psychological symptoms function something like this, as Shapiro (2017) describes:
For starters, it appears that we are born with a natural information processing system through which most experiences get processed without issue. This is the filing system that the brain uses to process an event and then either discard or store the memories (including sensory elements) once the event has passed.
This system appears to be “configured to process the information and restore mental health in much the same way the rest of the body is geared physiologically to heal when injured” (p. 17).
When something is too disturbing, the processing system becomes overwhelmed, and the experience is encoded in the brain with the emotions, physical sensations, thoughts, and beliefs that were present at the time of the overwhelming event. This is now a stored, but unprocessed, memory.
This proves to be an issue when something then happens in the present that the brain connects to an unprocessed memory, and the emotions, sensations, thoughts, and beliefs of that past experience are activated in the person’s body and brain in the present moment.
Thus, it’s possible to enter a situation in the present and suddenly feel anxious, fearful, or insecure because the physical cues and perceptions of the present are linking in to an unprocessed memory that has those feelings encoded into it. This doesn’t happen on the conscious level—you aren’t likely to say, “Hey, I’m nervous about giving a speech because I was bullied during a book report in the fourth grade”—but the body and brain remember instinctively, and the related feelings, beliefs, and sensations arise without any conscious intent.
The purpose of EMDR, in this example, might be to process the memory of getting bullied. By processing the memory—allowing the body and brain to file it away correctly—sights, sounds, sensations and even smells in the present moment no longer have that unconscious, triggering link to the traumatic event of the past.
EMDR is a process that unfolds over several sessions, and it is typical to attend sessions weekly. Each EMDR session may be somewhat unique, but the treatment as a whole has a clear structure that it follows.
This structure has eight phases that the clinician would guide you through in your time together. (Only one phase—Phase 4—incorporates the eye movements that the name is famous for.) Each session incorporates one or more phases, so the “flavor” of the session, so to speak, depends on the phase you are in:
The phases are as follows:
Phase 1—Client History and Treatment Planning: In this phase, the clinician gathers relevant history. Current life circumstances are considered during this phase as well, and a detailed treatment plan is created.
Phase 2—Preparation: During this phase, the clinician would work to establish a baseline level of trust and comfort with you to ensure you are feeling safe with them, and they would also answer any questions you have about the EMDR process. You would also learn skills to help calm any sensations of distress that might come up during or between EMDR sessions.
Phase 3—Assessment: In this phase, you would begin to identify which memories (discussed during Phase 1) best relate to the distress that you wish to address. The clinician would also likely work with you to identify the negative beliefs associated with these memories as well as the positive thoughts that you would want to replace them with.
Phase 4—Desensitization: This is the eye movement phase of EMDR and includes several rounds of back-and-forth eye movements as well as any additional techniques (called interventions) that the clinician may incorporate as well.
Phase 5—Installation: During this phase, after the distress has lessened or disappeared, the clinician would guide you through a process of incorporating positive beliefs. This may be a belief you identified earlier, or it may be one that comes up spontaneously during Phase 4.
Phase 6—Body Scan: At this point, you’d likely be asked to notice if there are any leftover disturbances that appear as body sensations.
Phase 7—Closure: As a session comes to an end, the clinician would ensure you are brought to a state of emotional equilibrium. Although there may be more processing that needs to happen, closure allows for the distressing issue to be set aside in a healthy manner until the next processing session. You will also receive reminders that “disturbing images, thoughts, or emotions that may arise between sessions are evidence of additional processing, which is a positive sign” (p. 70). The skills learned during Phase 2 will help you manage those experiences, and the clinician may have other suggestions for you to try as well.
Phase 8—Re-evaluation: This happens at the start of each session once EMDR is under way. The clinician will ask you to reflect on the past session and on anything (including dreams or insights) that arose during the time between sessions. The information you provide is very important, as it can inform the clinician as to the next steps in your treatment plan.
It is also essential to note that, as a client of EMDR, you always have full control of the situation. You can request to stop at any time if memory processing gets to be too much (Shapiro, 2017). There’s no rush to the finish line and no gold star for being the first one done. Processing traumatic events from the past can take energy and internal resources, so EMDR is designed to happen at the pace that is right for you.
With regard to how long you might need to
If you experienced a mild to moderate short-term, acute trauma (a car accident, for example) and do not have a history of childhood trauma (abuse, neglect, etc.), then it’s likely that about three sessions of EMDR will be sufficient in processing the memory of the acute trauma (The Psychology Webinar Group, 2014).
If you are dealing with more chronic symptoms, such as ongoing depression or anxiety, and can identify core beliefs such as "I’m not good enough,” “I’m unsafe,” “I can’t trust anyone,” or “the world is dangerous place,” then more sessions will likely be needed, although EMDR is still designed to offer relatively rapid resolution of these core thoughts, beliefs, and sensations (The Psychology Webinar Group, 2014).
EMDR has been shown to be able to help a person ...
reduce or eliminate feelings of distress
erase negative beliefs such as “I’m helpless,” “I’m hopeless,” “I’m alone”
increase their ability to self-soothe
strengthen their sense of self
strengthen adaptive cognitions related to traumatic event(s) such as “I am resilient”
safely feel a full range of emotions, including empathy
intuitively set boundaries (The Psychology Webinar Group, 2014; Shapiro, 2017)
EMDR does not ...
require that they share descriptions of any traumatic event(s)
directly challenge a person's beliefs with any type of cognitive exercises
involve any type of extended exposure to events that are similar to the trauma
include assigned homework (The Psychology Webinar Group, 2014; Shapiro, 2017)
If you engage in EMDR as a client, you can expect that ...
You will always be empowered during the EMDR experience and can request to stop at any time.
You may experience dreams associated with the processing.
You may experience an increase in distress during the EMDR session as you work through a memory, and sometimes you may experience distress in the hours or even days after an EMDR session. This is a normal part of the process and generally subsides as your body and brain continue to process the old memory. Your therapist will ensure you have the support you need for this aspect of EMDR (The Psychology Webinar Group, 2014).
The healing effects of EMDR are shown to be permanent, however it is not uncommon for there to be a "layer of the onion" aspect, and so you may land upon new unprocessed memories after old ones are processed; as Shapiro (2017) describes, “this is not evidence of failure.... but, rather, a natural unfolding process” (Shapiro, p. 210).
The desired outcomes of EMDR often start out as simply the ease of suffering of symptoms related to PTSD and other diagnoses, but the overall vision often becomes more holistic as progress is made. As Dr. Shapiro explains,
“The therapeutic goals of EMDR is not only the elimination of suffering and symptoms but... to [be] a healthy adult. That includes the ability to self-soothe, feel a full range of emotions, and be able to maintain a sense of self and awareness and a larger sense being an integral member of a larger society. [To] interact and bond appropriately, [have a] sense of resilience [and a] positive outlook. [To be able to] set boundaries, empathize—all the things that we would be looking for in a healthy adult is what we’re looking for through the processing of the memories” (The Psychology Webinar Group, 2014).
There is some fancy neurology that happens behind the scenes with EMDR, but we don’t know exactly what it is (yet). However, we do have some basic understandings that can be helpful to take into account. Shapiro (2017) explains the mechanism of action, as best we know, using the following key points:
Every feeling you have is connected to a neural network in the brain.
Each neural network is a pathway that triggers the release of neurochemicals that make you feel a certain way.
An unprocessed memory is, in essence, a dysfunctional neural network.
A dysfunctional neural network triggers ...
uncomfortable sensations (labeled as anxiety, depression, rage, numbness, overwhelm, etc.)
undesired thoughts (rumination, self-criticism, judgment of self and others, etc.)
undesired behaviors (addiction, substance use disorder, overreaction, etc.)
A traumatic event is something that happens to you that your brain and nervous system are not able to fully process. This results in an unprocessed memory. The event couldn't be processed for one or more of several reasons:
It happened too fast (e.g., car accident, natural disaster).
You were helpless while it happened (e.g., any kind of physical attack or abuse).
It was repeated and continually overwhelming over a long period of time (e.g., verbal and emotional abuse).
It involved being neglected, abandoned, and ignored, sending your body and brain the message of “I am not safe!” (e.g., childhood neglect, neglect as an infant, etc.).
During an EMDR processing session, you would intentionally bring up an unprocessed memory that activates a neural network associated with the aforementioned ...
uncomfortable sensations
undesired thoughts
undesired behaviors
You would then be guided through a combination of ...
eye movements
back-and-forth tapping (with handheld buzzers or via a self-hug called the butterfly hug)
and/or other dual-attention practices (also referred to as bilateral stimulation)
During these events, the memory becomes processed (either fully or partially), and the uncomfortable sensations decrease in intensity or disappear in connection to that particular memory. Undesirable thoughts spontaneously shift to growth-oriented thoughts, and undesired behaviors begin to fade away as more desired, authentic actions take their place.
All of this happens in harmony as the body heals from the previously unprocessed memory and files it away through EMDR.
As a result, the neural networks that once launched ...
uncomfortable sensations
undesired thoughts
undesirable behaviors
are no longer running. They simply do not exist as they had in the past. This is what makes EMDR a permanent treatment. A cue that used to be a trigger for a distressing neural pathway in the past no longer triggers anything. As a result, you don’t get the resulting...
uncomfortable sensations
undesired thoughts
undesirable behaviors
and your brain and body are calmer, more peaceful, and far more relaxed overall.
Again, although the exact neurobiological mechanisms of how EMDR works in the body and brain remains unknown and highly debated (Mattera et al., 2022), Shapiro’s (2017) adaptive information processing (AIP) theory, which underlies EMDR, offers an overview of what may be happening:
“It appears that an innate information-processing system exists, and that pathologies occur because this mechanism is blocked. Therefore, if the traumatic memory is accessed and the system is activated, with EMDR therapy the information is taken to an adaptive resolution” (p. 17).
Shapiro explains further that, according to AIP theory,
“[EMDR] processing ... forg[es] new connections between the targeted dysfunctional memory network and the memory networks that contain more adaptive information ... You can look at it as a ‘digestion process’ ... What is useless is discarded and what’s useful that comes in changes that during processing. It changes those experiences to a learning experience, and they ... become the foundation for resilience” (The Psychology Webinar Group, 2014) .
Yes. The metaphor of pulling a splinter out of a cut and allowing the body’s natural healing process to take over is one of the common metaphors that describes how EMDR helps, according to Jennifer Fee, professional practitioner content specialist at the EMDR International Association (J. Fee, personal communication, November 4, 2024).
“Our brains and our bodies have an innate ... propensity toward healing,” explains Fee. She uses the metaphor of a cut on your finger: If you cut your finger, your body is able to heal that cut. But if a splinter or something else gets in there to interrupt the healing process, then the healing can’t happen, and pain remains.
“And so the adaptive information processing model pretty much says the same thing: We naturally process through a lot of distress in life, but then sometimes, with certain things, we don’t ... like trauma or other distressing events. They kind of get stuck in our system,” says Fee.
In alignment with the AIP theory, Fee explains, EMDR is able to remove the splinter, so to speak, and the body’s natural healing mechanism can kick in, allowing healthy function to resume.
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Title of Study: Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis
Year of Study: 2020
From Conclusion: “A recent increase in RCTs of psychological therapies for PTSD, results in a more confident recommendation of CBT-T and EMDR as the first-line treatments.”
Number of Times It Has Been Referenced by Other Studies (Google Scholar): 448
Citation: Lewis, C., Roberts, N. P., Andrew, M., Starling, E., & Bisson, J. I. (2020). Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis. European Journal of Psychotraumatology, 11(1), 1729633. https://doi.org/10.1080/20008198.2020.1729633
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Title of Study: Efficacy of eye-movement desensitization and reprocessing for patients with posttraumatic-stress disorder: A meta-analysis of randomized controlled trials
Year of Study: 2014
From Conclusion: “[A] quantitative meta-analysis on the findings of 26 randomized controlled trials of EMDR therapy for PTSD published between 1991 and 2013 . . . confirmed that EMDR therapy significantly reduces the symptoms of PTSD, depression, anxiety, and subjective distress in PTSD patients.”
Number of Times It Has Been Referenced by Other Studies (Google Scholar): 301
Citation: Chen, Y. R., Hung, K. W., Tsai, J. C., Chu, H., Chung, M. H., Chen, S. R., Liao, Y. M., Ou, K. L., Chang, Y. C., & Chou, K. R. (2014). Efficacy of eye-movement desensitization and reprocessing for patients with posttraumatic-stress disorder: A meta-analysis of randomized controlled trials. PloS one, 9(8), e103676. https://doi.org/10.1371/journal.pone.0103676
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Title of Study: The Effectiveness of EMDR in Reducing Psychological Distress in Survivors of Natural Disasters: A Review.
Year of Study: 2014
From Conclusion: “The results of this meta-analysis demonstrate that EMDR interventions yielded clinically significant reductions in PTSD symptoms. Furthermore, EMDR proves to be a cost-effective intervention and valuable resource.”
Number of Times It Has Been Referenced by Other Studies (Google Scholar): 41
Citation: Natha, F., & Daiches, A. (2014) The effectiveness of EMDR in reducing psychological distress in survivors of natural disasters: A review. Journal of EMDR Practice and Research, 8(3), 157-170.
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Title of Study: Treating PTSD in patients with psychosis: a within-group controlled feasibility study examining the efficacy and safety of evidence-based PE and EMDR protocols
Year of Study: 2013
From Conclusion: “An intention-to-treat analysis of the 10 patients starting treatment showed that the PTSD treatment protocols of prolonged exposure (PE) and EMDR significantly reduced PTSD symptom severity; PE and EMDR were equally effective and safe. Eight of the 10 patients completed the full intervention period. Seven of the 10 patients (70%) no longer met the diagnostic criteria for PTSD at follow-up. No serious adverse events occurred, nor did patients show any worsening of hallucinations, delusions, psychosis proneness, general psychopathology, or social functioning. The results of this feasibility trial suggest that PTSD patients with comorbid psychotic disorders benefit from trauma-focused treatment approaches such as PE and EMDR.”
Number of Times It Has Been Referenced by Other Studies (Google Scholar): 150
Citation: de Bont, P. A., van Minnen, A., & de Jongh, A. (2013). Treating PTSD in patients with psychosis: A within-group controlled feasibility study examining the efficacy and safety of evidence-based PE and EMDR protocols. Behavior Therapy, 44(4), 717–730. https://doi.org/10.1016/j.beth.2013.07.002
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The EMDR International Association certifies licensed therapists in EMDR after proper training. You can find a therapist offering EMDR using EMDRIA’s Find an EMDR Therapist search tool:
EMDR was discovered in the 1980s by Dr. Francine Shapiro, who noticed that, while walking through the park one day, thinking distressing thoughts, her eyes darted back and forth, and afterwards, she felt better. Shapiro (2017) took this one idea and developed it into her doctoral thesis, launching further studies and what came to be called EMDR.
Flyers:
EMDRIA. (2023). EMDR Therapy and Your Brain [Flyer]. https://www.emdria.org/wp-content/uploads/2023/09/EMDRTherapyAndYourBrainGraphic202309.pdf
EMDRIA. (2021). The Eight Phases of EMDR Therapy [Flyer.] https://www.emdria.org/wp-content/uploads/2022/10/2021_copyright-infographic-8-Phases-English.pdf
Videos:
EMDR International Association. (2019, September 5). Introduction to EMDR therapy [Video]. YouTube. https://www.youtube.com/watch?v=Pkfln-ZtWeY
Veterans Health Administration. (2021, September 21). Eye movement desensitization and reprocessing (EMDR) for PTSD [Video]. YouTube. https://www.youtube.com/watch?v=tLrmZXheY5c
Department of Veterans Affairs/Department of Defense. (2023). VA/DoD clinical practice guideline for the management of post-traumatic stress disorder and acute stress disorder. U.S. Government Printing Office. https://www.healthquality.va.gov/guidelines/MH/ptsd/VA-DoD-CPG-PTSD-Full-CPG-Edited-11162024.pdf
Duros, P. & Crowley, D. (2014). The body comes to therapy too. Clinical Social Work Journal, 42, 237–246. https://doi.org/10.1007/s10615-014-0486-1
EMDR International Association. (n.d.) Find an EMDR therapist. https://www.emdria.org/find-an-emdr-therapist
Harper, M. L., Rasolkhani-Kalhorn, T., & Drozd, J. F. (2009). On the neural basis of EMDR therapy: Insights from qEEG studies. Traumatology, 15(2), 81–95. https://doi.org/10.1177/1534765609338498
Mattera A., Cavallo A., Granato G., Baldassarre G., & Pagani M. (2022). A biologically inspired neural network model to gain insight into the mechanisms of post-traumatic stress disorder and eye movement desensitization and reprocessing therapy. Frontiers in Psychology, 13, 944838. httsp://doi.org/10.3389/fpsyg.2022.944838
Shapiro, F. (2017). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Publications.
The Psychology Webinar Group. (2014, Feb 6). Francine Shapiro Ph.D. EMDR Webinar "The Past is Present" [Video]. YouTube. https://www.youtube.com/watch?v=lsQbzfW9txc
U.S. Department of Veteran Affairs. (2024, February 13). Treatment. https://www.mentalhealth.va.gov/ptsd/treatment.asp
World Health Organization. (2023). Posttraumatic stress disorder (PTSD): Psychological interventions - Adults. https://www.who.int/teams/mental-health-and-substance-use/treatment-care/mental-health-gap-action-programme/evidence-centre/conditions-related-to-stress/posttraumatic-stress-disorder-(ptsd)--psychological-interventions---adults
By Ariana Ziminsky, Last Updated: 12/10/2024