Therapy & Medication

EMDR Therapy for Trauma, PTSD, Anxiety, and Panic

Eye Movement Desensitization and Reprocessing (EMDR) can be an effective trauma therapy, a way to move past a stressful event. Here’s how to decide if it’s right for you.

What is EMDR?

Eye Movement Desensitization and Reprocessing (EMDR) is a trauma therapy developed by psychologist Dr. Francine Shapiro. She made the chance observation that eye movements can reduce the intensity of disturbing thoughts. While she walked through a park one day, she noted her own stress reactions diminished as her eyes swept back and forth.

EMDR therapy involves recalling a stressful past event and “reprogramming” the memory in the light of a new, positive belief, using rapid eye movements to facilitate the process. Theories as to why EMDR works are still evolving, but many people have found EMDR to be extremely beneficial.

EMDR incorporates elements of cognitive-behavioral therapy (CBT) with bilateral eye movements or other forms of rhythmic, left-right stimulation. One of the key elements of EMDR is “dual stimulation.” During EMDR treatment, you are asked to think or talk about memories, triggers, and painful emotions related to your trauma or other condition. At the same time, you focus on your therapist’s finger with your eyes as it moves back and forth across your field of vision.

Instead of the therapist’s finger, other forms of external stimuli may also be used in EMDR therapy. These can include tactile sensations, such as alternating hand taps, or sounds, such as a chime that moves back and forth from ear to ear.

How EMDR therapy works

At the time of a traumatic event, the strong emotions you experience can interfere with your ability to completely process the event, and this one unpleasant moment becomes “frozen in time.” Recalling the traumatic event may feel as though you are reliving it all over again because the images, smells, sounds, and feelings are still so close to the surface, they can easily be triggered in the present.

When triggered, these memories can interfere with your daily functioning, change the way you see yourself and the world around you, and impact how you relate to others. EMDR therapy appears to work by directly affecting the brain and “unfreezing” the traumatic memories, allowing you to resolve them.

Over time, you’re able to work through the disturbing memories and associated feelings, until you are able to think about the event without reliving it. The memory is still there, but it is less upsetting.

Treatment affects

Using rapid eye movements seems to relieve the anxiety associated with the trauma so that the original event can be viewed from a more detached perspective, like watching a movie of what happened. This enables you to access positive ways of reframing the original trauma (reprocessing), and to release the body’s stored negative emotional charges around it (desensitization).

[Read: Post-Traumatic Stress Disorder (PTSD)]

Others believe it reactivates parts of the brain that were “shut down” as a coping mechanism during the traumatic event. In this way, your brain reconsiders the experience, allowing the negative, painful emotions to give way to more resolved, empowered feelings.

Some experts have noted that the eye movements involved in EMDR might be similar to what occurs naturally during dreaming or REM (rapid eye movement) sleep. It allows you to see experiences in a new and less distressing way.

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Trapped by memories: How a single trauma can impact your life

Francine Shapiro, the creator of EMDR, uses the example of a rape survivor to illustrate how people can get “trapped” by memories of trauma.

While a woman who has been raped might intellectually know that she’s not to blame, she still may feel emotions of guilt and shame surrounding the attack. Her memory of the rape is then forever affected by these emotions, which she hasn’t fully explored or dealt with.

Shapiro believes that as time goes by, “when the individual thinks about the trauma, or when the memory is triggered by similar situations, the person may feel like she is reliving it, or may experience strong emotions and physical sensations.”

The 8 phases of EMDR therapy: Phases 1-3

EMDR often helps people feel better very quickly, but it is important to work through the entire 8-phase process with a qualified EMDR therapist to ensure the most beneficial, lasting results.

EMDR phase 1: History and treatment planning

If you choose to try EMDR therapy, your first session will likely involve the therapist taking your history. The therapist will probably ask you about the problems, behaviors, and fears that have brought you into therapy.

However, one difference between EMDR and many other therapies is that you won’t be asked to discuss the traumatic event in detail. The emotions and physical sensations surrounding the event are what’s important, not the details about the event itself.

Once the therapist has developed a treatment plan for you based on this initial assessment, the process of EMDR can begin.

EMDR phase 2: Preparation

The preparation stage involves the therapist teaching you some self-care techniques, so that you can handle strong emotions that may arise during or between sessions. EMDR places a strong emphasis on self-care.

This stage is also important for developing a sense of trust with the therapist. They will explain the theory of EMDR in more detail and talk about what you can expect in the following sessions.

EMDR phase 3: Assessment

Phase 3 lays the groundwork for your actual EMDR therapy sessions. In the assessment phase, the therapist will ask you to identify three things:

  1. A specific scene or picture that best represents the traumatic event you’re targeting with this treatment. You likely will have already discussed your target in the first session, but at this point you’ll clarify the visual image of the trauma you experienced, including the associated emotions and bodily sensations.
  2. A negative belief about yourself associated with the traumatic event. For example, your negative belief could be “I am helpless,” “I am worthless”, or “I’m a bad person.”
  3. A positive belief you would rather believe about yourself. This positive belief should reflect what is appropriate in the present. For example, perhaps you survived an assault, with the subsequent negative belief: “I’m in danger.” You might replace it with the positive belief: “I’m safe now.”

Once the visual image and negative and positive beliefs have been identified, you’ll be asked to rate how strongly you feel the positive thought to be true on the Validity of Cognition (VOC) scale of 1-7. Here, 1 equates to being “completely false” while 7 rates as “completely true”.

You’ll also be asked to describe the disturbing emotions you feel when you focus on the visual image of the traumatic event. You’ll then rate the intensity on the 11-point Subjective Units of Disturbance (SUD) scale. 0 means the emotion isn’t distressing at all and 10 means it’s the worst feeling you’ve ever had.

Finally, you’ll be asked to identify the locations in the body where you feel physical sensations when you think about the trauma.

Processing the trauma: EMDR therapy phases 4-6

Once you’ve completed the first three phases of EMDR therapy, the work of processing the trauma begins. In phases 4-6, your therapist will help you recall your target image while leading you through a series of rapid eye movements (or alternating sounds, tactile stimulation, or a combination thereof).

With your attention split between the internal image you’re concentrating on and the external stimuli of your therapist’s moving finger, you’re able to experience the distressing memory while remaining grounded in the present, enabling you to process and reframe the trauma.

Your EMDR therapist will also monitor the intensity of your symptoms between sessions to ensure that progress is being made and maintained. According to the EMDR Network, reprocessing a single trauma is generally accomplished within three sessions. If treatment takes longer, you should still see some improvement within that amount of time.

EMDR phase 4: Desensitization

During the desensitization phase, you’ll pay attention to all the negative beliefs and disturbing emotions and bodily sensations that arise. As you focus on your target image while following your therapist’s finger with your eyes, you’ll be asked to take note of all your reactions to the processing—good, bad, or neutral. You’ll also be asked about any new insights, associations, or emotions you experience.

After each set of rapid eye movements, the therapist will check in with you and assess your level of disturbance regarding the target image. During this process, you will continue to “digest” or process the feelings, images, and beliefs that occur in relation to the trauma.

The desensitization phase continues until your distress level, as measured by the SUD scale, is reduced to 0 or 1.

EMDR phase 5: Installation

In the installation phase, you’ll be asked to focus on the positive belief you’ve identified to replace your old negative belief about the trauma.

As in phase 4, you’ll concentrate on this mental image while simultaneously tracking your therapist’s finger with your eyes. The goal is to strengthen the positive belief until you accept it as fully true.

After each set of rapid eye movements, the therapist will ask you to rate the positive belief on the 7-point VOC Scale, which gives the therapist concrete measures of how you are progressing. The installation phase is complete once you are able to accept the positive belief at a level of 7 (“completely true”).

What is unique about EMDR therapy is how rapidly new beliefs about yourself and your interpretations of the trauma can replace old beliefs. New possibilities often emerge that you have never before considered. These new insights can be used as the starting points for the next set of eye movements, continually helping you to process the trauma in healthier, more manageable ways.

EMDR phase 6: Body scan

After replacing negative beliefs surrounding the trauma with healthier, positive beliefs, the next phase is to focus on any lingering physical sensations. Your therapist will ask you to think about your original target while scanning your body from head to toe, looking for residual tension.

Any bodily tension or uncomfortable physical sensations are then targeted until they are resolved. According to the EMDR Network, “positive self-beliefs are important, but they have to be believed on more than just an intellectual level.” Phase 6 is considered successful when you are able to think or talk about the original target without feeling any body tension or any other unpleasant physical sensations.

EMDR therapy phases 7-8

EMDR phase 7: Closure

One of the goals of an EMDR therapy session is for you to leave feeling better than you did when you got there. If you haven’t been able to finish working through the target trauma in a particular session, your therapist will lead you through a variety of relaxation techniques. These draw from what you were taught in phase 2 and are designed to bring you back into emotional balance.

Your therapist will also prepare you for what you may experience between sessions. For example, disturbing images, thoughts, and emotions may arise during the week as you continue to process the trauma. The EMDR therapist may suggest you keep a journal of these negative memories and thoughts. This can help you distance yourself from the unpleasant thoughts and provide you with new targets for future therapy sessions.

Your therapist may also review the visualization techniques and relaxation exercises you can use to maintain emotional balance between sessions.

EMDR phase 8: Reevaluation

Each new session begins with a reevaluation of your progress. First, you will be asked to focus on any targets you’ve already reprocessed. Your therapist will review your responses, checking if you’ve maintained the positive results.

Your therapist may also ask how you feel about the previously-treated targets and review any negative emotions that came up between sessions. Based on this reevaluation, your therapist will decide whether to move on to new targets or to revisit old targets for additional reprocessing and integration.

Benefits and drawbacks of EMDR

EMDR therapy is relatively new, developed in 1987, and the scientific community continues to examine its long-term results. While there are differing opinions on how effective this treatment really is, the main benefit of EMDR is the speed at which deep-seated problems can be resolved.

Single sessions of EMDR have been shown to produce results, and Dr. Francine Shapiro reports an average treatment time of five sessions to comprehensively treat people with post-traumatic stress disorder (PTSD). To help decide if EMDR therapy is right for you, consider the following:

Benefits of EMDR

  • EMDR does not require you to go into detail about the traumatic events of the past. Unlike many “talk” therapies, the trauma isn’t analyzed for long periods of time.
  • EMDR simultaneously works on your mind, body, and emotions. This may account for its success in taking intellectual understanding of the origins of a problem (e.g. “I know I have guilt over killing in the war”) to a resolution where post-traumatic symptoms clear up.
  • The trauma that must be re-experienced during treatment is relatively short-lived. The reprocessing occurs at the same time as the memory recall.

EMDR may not be right for everyone

  • EMDR was created for use as a trauma therapy and as such focuses on intensely stressful subjects.
  • Pregnant women, or those with heart conditions, eye problems, or other health issues should consult their doctor before beginning EMDR therapy.

Research on EMDR

Despite its increasing use, there remains some debate within the psychological community regarding the efficacy of EMDR, especially when compared with other types of therapy.

Critics question the scientific validity of the method and the lack of data explaining how EMDR works. On the other hand, numerous people have reported significant benefits from EMDR treatment, as have many studies published in peer-reviewed journals. Research also shows it can improve PTSD in children and teens, and it seems to be about as effective as trauma-focused cognitive behavioral therapy (CBT).

Based on the encouraging results of these studies, the American Psychological Association and the International Society of Traumatic Stress Studies have approved EMDR as a valid therapy for post-traumatic stress disorder.

EMDR has also been reported to have a positive effect on other conditions, including eating disorders, severe stress, unipolar depression, and anxiety disorders such as Obsessive-Compulsive Disorder (OCD), panic disorder, and phobias. However, recent systemic reviews of EMDR research stress the need for higher quality studies to gain a better understanding of its effectiveness.

Finding an EMDR therapist

EMDR is a highly specialized therapy that should be conducted by a licensed mental health professional who has specific training in this complex approach. Some therapists are EMDR trained, meaning they have completed EMDR basic training. Others are EMDR certified, meaning they have conducted at least 50 EMDR sessions with patients and continue to further their education.

EMDR therapy can also be done online, so if finding an in-person therapist is difficult, consider using an online therapy service.

[Read: Finding a Therapist Who Can Help You Heal]

In addition to ensuring a therapist is certified to provide EMDR therapy, there are specific questions you may want to ask a potential therapist.

Questions to ask a potential EMDR therapist

  • What is your training and experience with EMDR?
  • Have you kept up to date about the latest protocols and developments?
  • How many people with my particular problem have you successfully treated?
  • Are there other therapies that you use besides EMDR for times when EMDR is not the best fit for a client?
  • What will we do if I become overwhelmed and don’t want to keep going in a session?

As well as having the right experience to help you, look for an EMDR therapist you feel you can trust and who makes you feel understood and cared for.

Author: Carol Corcoran, LCMFT, LMFT, and EMDR Certified Therapist

Last updated or reviewed on June 4, 2024