Understanding EMDR

What is EMDR therapy?

Eye Movement Desensitization and Reprocessing (EMDR) therapy is a structured psychotherapy approach to help individuals process and recover from traumatic experiences. EMDR is based on the premise that traumatic memories can become “stuck” in the brain, leading to ongoing psychological distress such as post-traumatic stress disorder (PTSD). During EMDR sessions, a therapist guides the patient to recall distressing memories while engaging in bilateral stimulation, most commonly through guided eye movements but can also be done through tapping. This process is to help the brain reprocess the trauma in a way that reduces its emotional intensity and allows for adaptive resolution.

EMDR therapy is most widely known for treating PTSD and severe trauma, but it is also effective for addressing less obvious or “minor” traumatic experiences, which are often referred to as “small-t” trauma. These can include events such as childhood bullying, medical procedures, embarrassing social interactions, breakups, or chronic feelings of failure or neglect. While these experiences might not meet the clinical threshold for PTSD, they can still have a lasting negative impact on a person’s emotional well-being, self-esteem, or behavior patterns. EMDR can help individuals reprocess these memories and reduce their emotional charge, making it easier to move forward without being held back by past events. According to the EMDR International Association, therapists often use EMDR for a wide range of issues including anxiety, depression, performance anxiety, and grief, highlighting its adaptability beyond traditional trauma contexts. This makes EMDR a valuable therapeutic option for anyone experiencing distress tied to unresolved past experiences, no matter how “big” or “small” they may seem.

Numerous studies have validated EMDR’s effectiveness, especially for PTSD, with organizations such as the World Health Organization, the U.S. Department of Veterans Affairs, and the American Psychiatric Association endorsing it as a first-line treatment. EMDR differs from traditional talk therapy by focusing less on detailed discussions of the trauma and more on changing how the memory is stored in the brain. According to the EMDR International Association (EMDRIA), the therapy typically follows an eight-phase protocol that includes history-taking, preparation, assessment, desensitization, and re-evaluation, among others. Although more research is still needed to fully understand the neurobiological mechanisms behind EMDR, clinical evidence supports its efficacy for treating a range of trauma-related conditions.

What an EMDR session looks like?

An EMDR therapy session typically follows a structured eight phase protocol designed to help clients process distressing memories and integrate them adaptively.

The process begins with history-taking and treatment planning, where the therapist identifies target memories and assesses the client’s readiness. In the preparation phase, the therapist explains EMDR and teaches coping strategies to ensure emotional stability during the process and provide tools to be used later in processing. During the assessment phase, the client selects a specific memory to target, along with associated negative beliefs, emotions, and physical sensations.

The core of the treatment occurs during the desensitization phase, where the client focuses on the traumatic memory while simultaneously engaging in bilateral stimulation, such as guided eye movements, tapping, or auditory tones. This helps the brain reprocess the memory, therefore reducing its emotional intensity. The session continues with installation of positive beliefs. This is a key phase in EMDR therapy where the therapist helps the client replace negative, distressing beliefs associated with a traumatic memory with more adaptive and empowering ones. After the memory has been sufficiently desensitized, the client is guided to focus on a positive belief they would rather associate with the event. For example, a belief like “I am powerless” might be replaced with “I am strong and in control now.” The therapist then uses bilateral stimulation again while the client concentrates on this positive belief and the memory together, helping the brain form new, healthier associations. This phase strengthens the client’s sense of resolution and supports long-term emotional healing by reinforcing a sense of competence, safety, or self-worth.

Body scanning is also used to identify and clear any lingering physical tension, discomfort, or distress that may still be held in the body in relation to the memory. Even after a memory no longer feels emotionally distressing, the body may retain subconscious sensations or reactions linked to the trauma, such as tightness in the chest, a knot in the stomach, or tension in the shoulders. During body scanning, the therapist asks the client to think about the memory and the newly installed positive belief while mentally scanning their body from head to toe. If the client notices any residual discomfort or tension, bilateral stimulation is reintroduced to help release those sensations. This step helps ensure that the trauma is fully processed not just cognitively, but also physically, promoting deeper healing and a greater sense of emotional resolution and bodily calm.

The next stage is closure to ensure that the client leaves the session feeling stable, grounded, and emotionally safe, regardless of whether the traumatic memory was fully processed during that session. During closure, the therapist may guide the client through relaxation techniques, breathing exercises, or imagery, such as imagining a “safe place”, that were taught in preparation to help reduce any lingering distress. The therapist will also check in on the client’s emotional state, provide reassurance, and remind them of coping tools they can use between sessions if distress resurfaces. Finally, in the re-evaluation phase, the therapist reviews the progress and adjusts the treatment plan as needed. Sessions typically last 60–90 minutes and are repeated as necessary based on individual progress.

The Eight Phases of EMDR Therapy

The History of EMDR

EMDR therapy was first developed in the late 1980s by psychologist Francine Shapiro, who discovered its potential benefits somewhat accidentally. In 1987, while walking in a park and reflecting on distressing thoughts, Shapiro noticed that her negative emotions diminished when her eyes moved rapidly from side to side. She then began researching the phenomenon and later developed a standardized procedure that became the foundation of EMDR. Her first controlled study, published in 1989, demonstrated that EMDR significantly reduced symptoms of post-traumatic stress in Vietnam veterans and trauma survivors. Shapiro went on to formalize EMDR into an eight-phase treatment model, combining elements of cognitive behavioral therapy with bilateral stimulation to support the brain’s natural healing processes.

Since its introduction, EMDR has evolved from a controversial new method into a well-established, evidence-based treatment for trauma. In the 1990s and early 2000s, a multiple pieces of research validated its efficacy, especially for treating PTSD, leading to endorsements by major health organizations such as the American Psychological Association, World Health Organization, and the U.S. Department of Veterans Affairs. Over time, EMDR expanded beyond PTSD to address a range of conditions including anxiety, depression, and complex trauma. In 1995, the formation of the EMDR International Association (EMDRIA) helped establish training standards, ethics, and continued research into its mechanisms and applications. Today, EMDR is practiced globally by over 100,000 trained therapists and is recognized as one of the most effective psychotherapies for trauma recovery.

Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories (Journal of Traumatic Stress)

The Science behind EMDR

The science behind EMDR therapy is rooted in the brain’s natural information processing system, which can become disrupted by trauma. According to EMDR’s creator, Francine Shapiro, traumatic experiences can overwhelm the brain’s ability to process information, causing disturbing memories to become “frozen” in their original, distressing form. These unprocessed memories stay stored with the original emotions, thoughts, and physical sensations, and can be easily triggered by reminders, leading to symptoms of PTSD or emotional dysregulation. EMDR appears to stimulate the brain’s natural healing processes by facilitating the reprocessing of these memories so they can be stored in a more adaptive way. Bilateral stimulation, typically through eye movements, seems to help the brain “digest” the traumatic material and reintegrate it into a more neutral memory network.

Although the exact neurological mechanisms are still being researched, several theories help explain EMDR’s effects. One leading theory is that bilateral stimulation mimics processes that occur during rapid eye movement (REM) sleep, a phase associated with memory consolidation and emotional regulation. Research using neuroimaging has shown that EMDR can reduce activity in the amygdala, which is the brain’s fear center, while increasing connectivity between the prefrontal cortex and hippocampus, which are areas involved in rational thinking and memory processing. Another theory argues that bilateral stimulation helps reduce working memory load, which allows distressing images and sensations to be re-evaluated more calmly. Overall, clinical studies consistently support EMDR’s effectiveness for trauma and related conditions, but ongoing research is aimed at deepening our understanding of the precise brain mechanisms involved.

For more information:

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0045753