Eye Movement Desensitization and Reprocessing (EMDR)
Eye Movement Desensitization and Reprocessing (EMDR) is a revolutionary treatment, originally created to combat Post Traumatic Stress Disorder (PTSD). It uses a unique methodology to reduce symptoms in a brief period of time. Let’s learn more about EMDR.
Summary
- EMDR is an evidence-based therapy for trauma that helps clients process distressing memories with less emotional overwhelm.
- Bilateral stimulation (eye movements, sounds, or tapping) is central to EMDR, helping reduce the emotional charge of traumatic memories.
- EMDR is a structured, short-term approach—often delivering meaningful results in as few as 6–15 sessions. By leveraging an EHR like TheraPlatform for efficient documentation, therapists can organize sessions with ease.
- While best supported for PTSD, EMDR also shows promise for anxiety, depression, and OCD, making it a versatile tool for therapists. Download my free anxiety worksheets.
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What is EMDR?
Francine Shapiro discovered the underlying premise of EMDR in the mid 1980’s and further developed it through clinical trials into the treatment used today. It was based on a novel theory and techniques that had never been used before.
Here are the basic principles of the treatment:
- It is theorized that symptoms result from past distressing experiences that were not processed successfully. EMDR enables the adaptive processing of that information.
- Bilateral sensory stimulation is the core mechanism used to assist in the processing of traumatic memories. It is believed that this technique removes the emotional charge of difficult recollections.
- EMDR also utilizes aspects of both cognitive behavioral therapy (CBT) and exposure therapy.
- It typically occurs in 6–15 sessions, usually 60–90 minutes each.
How EMDR Works
The Adaptive Information Processing Model (AIP)
EMDR operates according to the Adaptive Information Processing (AIP) model. This model posits that maladaptively stored memories create obstacles to the processing of information, which in turn, produce unhealthy functioning. The goal of EMDR is to decrease the distress associated with a memory so it no longer triggers an intense anxiety response and can be processed effectively.
What is bilateral stimulation?
Bilateral sensory stimulation refers to the activation of senses on both sides of the brain. Although eye movements to either side are most common, auditory (e.g., relaxation sounds presented to both ears) and tactile stimulation (e.g., tapping on both sides of the body) can also be used.
How does bilateral stimulation help reduce negative symptoms?
Bilateral stimulation removes the barriers that prevent the complete processing of memories, resulting in a reduction in symptoms. For example, a soldier who witnesses his friend die in combat may be unable to process that memory due to trauma, leading to symptoms of anxiety, arousal, and avoidance. However, bilateral sensory stimulation acts as an emotional buffer and allows the person to fully recall the painful memories in order to more successfully process them.
How EMDR differs from traditional talk therapy
EMDR is different from other therapies in theory and technique. Unlike other treatments that focus on altering the emotions, thoughts, and behavior associated with traumatic experiences, EMDR focuses directly on the memory; it attempts to change the way that the memory was stored in the brain, thus reducing problematic symptoms.
Additionally, the use of bilateral sensory stimulation as an agent of change has been controversial because it is esoteric and far removed from the widely held beliefs underpinning most of talk therapy.
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The eight phases of EMDR
EMDR phase | Description |
|---|---|
History | The client provides background information and establishes treatment goals. |
Preparation | Therapist sets treatment expectations and helps develop appropriate coping tools |
Assessment | Specific memories are identified as the target of reprocessing. |
Desensitization | The negative memory is recalled and bilateral stimulation occurs. The client also reports corresponding thoughts and feelings |
Installation | More positive and realistic thoughts are reinforced, replacing negative beliefs. |
Body scan | The client is asked to report on how they feel physically as a result of re-experiencing the negative event and corresponding thoughts. |
Closure | Examines how the client feels as a result of experiencing desensitization and installation and provides them with tools to cope until the next session |
Re-evaluation | Evaluates the client’s current emotional state and reviewing progress |
The Eight Phases of EMDR explained
History: The client provides background information and establishes treatment goals.
Preparation: The therapist sets treatment expectations and helps develop appropriate coping tools, including the frequently used safe/calm place exercise.
Assessment: Specific memories are identified as the target of reprocessing. The therapist will help the client identify negative thoughts and emotions about how the trauma has made them feel, as well as positive thoughts that they would like to believe about the event moving forward. The therapist wants to try to instill some positive thinking to combat the negative thoughts and emotions involving the traumatic event.
Two measures are used to evaluate the changes in emotion and cognition: the subjective units of distress scale (SUD) and the validity of cognition scale (VOC). Clients are given these assessment tools at each session to evaluate how the treatment is working.
SUD is used to measure the client’s level of distress in regard to the traumatic memory. The clinician may ask, "On a scale of 0-100, where 0 is no distress or neutral, and 100 is the highest disturbance you can imagine, how distressing does it feel now?"
The VOC is used to measure the client’s belief in positive thoughts regarding the memory, which the therapist hopes to facilitate. An example of a positive thought could be, “I am strong” or “I am lovable”. Therefore, the clinician may ask, "When you think of the incident, how true does the (positive thought) feel to you now on a scale of 1-7, where 1 feels completely false, and 7 feels totally true?"
Ideally, as EMDR progresses, the SUD score will become lower, and the VOC score will increase.
Desensitization: This is the crux of the treatment. The negative memory is recalled and bilateral stimulation occurs. The client also reports corresponding thoughts and feelings. The goal is to decrease SUD.
Installation: More positive and realistic thoughts are reinforced, replacing negative beliefs. While desensitization focuses on reducing SUD, installation aims to increase VOC.
Body scan: The client is asked to report on how they feel physically as a result of re-experiencing the negative event and corresponding thoughts.
Closure: This occurs at the end of every session. It examines how the client feels as a result of experiencing desensitization and installation and provides them with tools to cope until the next session. The goal is to provide feelings of confidence and safety in the process.
Re-evaluation: Starts the next session by evaluating the client’s current emotional state and reviewing progress, ensuring previously processed memories remain neutral.
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Benefits and effectiveness
EMDR has been studied extensively in the treatment of trauma. It has consistently been found to be an effective treatment for PTSD and is recommended by the American Psychological Association and the World Health Organization as a viable treatment.
While EMDR has been found to be effective for treating trauma, the evidence for other disorders is not as vast or conclusive. More research is needed for a more definitive recommendation. Still, EMDR has shown some success in the treatment of anxiety, depression, and obsessive-compulsive disorder.
Other benefits of EMDR include:
- EMDR is a brief therapy, producing significant results in as few as six sessions.
- The use of bilateral stimulation leads to less emotional distress for clients when recalling painful memories as compared to exposure therapy.
- Homework is not usually given as part of EMDR.
- EMDR is more suitable for clients who struggle with verbal processing because bilateral stimulation does not require as much verbal expression as other talk therapies.
Documentation and treatment planning
EMDR is a brief and structured therapy that repeats the same phases of treatment, making it relatively simple to plan treatment and evaluate progress.
Therapists need to keep in mind the following considerations when documenting EMDR therapy:
- EMDR lends itself very easily to various progress notes formats, particularly SOAP notes. Measures of VOC and SUD fit neatly under the “objective” part of the note, and progress from session to session can be easily tracked through AI notes software and its integration with EHR platforms.
- Progress notes should document the type of bilateral stimulation utilized each session and the rationale for its use.
- EMDR is covered by most insurance payers for the treatment of PTSD but may not be authorized for other disorders. Therefore, the matching of ICD-10 and CPT codes becomes paramount. Many EHR platforms, such as TheraPlatform, have integrated clearinghouses that can check for authorization and coding errors before treatment begins, preventing claim denials.
- Progress notes must reflect specific trauma-informed goals in the treatment plan. Not only can AI note programs use completed progress notes to update treatment plans, but they also take into account treatment plan goals when creating notes, therefore ensuring continuity of care.
How EHRs can help with documentation
Modern EHR/practice management platforms (such as TheraPlatform) assist greatly with documentation by providing HIPAA‑compliant, integrated systems for note entry, storage, scheduling, and billing.
They allow therapists to:
- Use and customize templates (e.g., SOAP, DAP, and others) or build their own to streamline note writing and ensure consistency.
- Link notes to treatment plans, goals, and session history so client progress is easily tracked over time.
- Utilize e-fax and secure document sharing via client portal to safely exchange information with clients or other providers while maintaining confidentiality.
- Leverage dictation and telehealth transcription, which can automatically convert sessions into therapy or assessment notes, saving time and reducing manual entry.
- Take advantage of AI features that streamline documentation by automatically populating intake form data into assessment templates and generating complete therapy and assessment notes from the information you provide, all with a single click.
Watch this video to learn how to save time on therapy notes
Meanwhile, AI‑assisted note tools are emerging which can further help clinicians by:
- Automatically transcribing session audio (if permitted) and highlighting key moments (e.g. emotional shifts, major themes).
- Suggesting draft notes or filling in objective or assessment sections based on observed data, freeing up clinicians’ time.
- Supporting consistency and reducing missing components in notes, which helps from both clinical, legal, and insurance perspectives.
Together, structured SOAP‑type notes, good EHR platforms, and smart AI tools support better therapeutic outcomes, more efficient workflows, and stronger accountability.
Streamline your practice with One EHR
- Scheduling
- Flexible notes
- Template library
- Billing & payments
- Insurance claims
- Client portal
- Telehealth
- E-fax
Resources for mental health therapists
Theraplatform is an all-in-one EHR, practice management and teletherapy solution with AI-powered notes and Wiley Treatment Planners that allow you to focus more on patient care. With a 30-day free trial, you have the opportunity to experience Theraplatform for yourself with no credit card required. Cancel anytime. They also support different industries including mental and behavioral health therapists in group practices and solo practices.
More resources
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- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Therapy Practice
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- Free mini video lessons to enhance your private practice
- 9 Admin tasks to automate in your private practice
References
Balanced Minds. Calm place imagery script. https://balancedminds.com/calm-place-imagery-script/
Miller, P. (2023). What is AIP? The Adaptive Information Processing model and how to use it in a therapy setting [Video]. Mirabilis Health Institute. https://www.youtube.com/watch?v=h1GEtmPGbsw
Scelles, C., & Bulnes, L. C. (2021). EMDR as Treatment Option for Conditions Other Than PTSD: A Systematic Review. Frontiers in psychology, 12, 644369. https://doi.org/10.3389/fpsyg.2021.644369
Wilson, G., Farrell, D., Barron, I., Hutchins, J., Whybrow, D., & Kiernan, M. D. (2018). The use of eye-movement desensitization reprocessing (EMDR) therapy in treating post-traumatic stress disorder-A systematic narrative review. Frontiers in Psychology, 9, 923. https://doi.org/10.3389/fpsyg.2018.0092
FAQs about EMDR
What is EMDR therapy?
EMDR (Eye Movement Desensitization and Reprocessing) is a structured therapy that helps clients process distressing memories using bilateral stimulation to reduce emotional intensity and shift negative beliefs.
How long does EMDR treatment typically take?
EMDR is considered a brief therapy, usually completed in 6–15 sessions lasting 60–90 minutes each.
What conditions can EMDR treat?
EMDR is most effective for PTSD but has also shown promising results for anxiety, depression, and OCD, though more research is needed for these conditions.
