Eye Movement Desensitization and Reprocessing (EMDR)

Eye movement desensitization and reprocessing or EMDR therapy sounds almost too good to be true. It reportedly allows individuals to reduce the symptoms of trauma without the accompanying emotional anguish experienced in exposure therapy.

But how does moving your eyes help heal trauma—and what does the research actually say?

Summary

• EMDR is evidence-based for PTSD: Supported by the APA, WHO, and VA as an effective trauma treatment.

• Bilateral stimulation is central: Eye movements, sounds, or taps help clients process distressing memories with less emotional overwhelm.

• Beyond trauma: EMDR shows promise for anxiety, depression, and OCD, though research is strongest for PTSD. Download my free anxiety worksheets.

• Brief, structured therapy: EMDR typically produces significant results in 6–15 sessions without extensive homework. By leveraging an EHR like TheraPlatform for efficient documentation, therapists can organize sessions with ease.

Streamline your practice with One EHR

• Scheduling
• Flexible notes
• Template library
• Billing & payments

• Insurance claims
• Client portal
• Telehealth
• E-fax

Learn More

Although EMDR is thought of as a preeminent therapy for post-traumatic stress disorder (PTSD), it has expanded to address other mental health conditions, including anxiety and depression. Let’s unpack the elements of EMDR to take a closer look.

What is EMDR?

Psychologist Francine Shapiro conceived the idea for EMDR while walking through a park. It occurred to her that eye movements decreased her sensitivity to distressing memories and that it might do the same thing for people experiencing trauma.

After lengthy trials and experimentation, EMDR was founded.

EMDR has evolved since Shapiro’s initial musings in 1987, but its basic principles remain the same:

• EMDR is a structured therapy that uses bilateral sensory stimulation as a core mechanism to assist in processing information.

• Symptoms result from past distressing experiences that were not processed adaptively.

• In addition to bilateral stimulation, EMDR utilizes aspects of both cognitive behavioral therapy (CBT) and exposure therapy.

• It typically occurs in 6–15 sessions, usually 60–90 minutes each.

Practice Management + EHR + Telehealth

Mange more in less time in your practice with TheraPlatform

Start Free Trial

How does EMDR work?

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.

Bilateral stimulation is hypothesized to remove these barriers and facilitate the complete processing of memories, resulting in a reduction in symptoms. For example, a soldier who witnesses his friend die in combat will be unable to adaptively process that memory due to trauma, leading to symptoms of anxiety, arousal, and avoidance.

However, bilateral sensory stimulation acts as a buffer and allows the person to fully recall the painful memories in order to more successfully process them.

What is Bilateral Sensory 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.

The role of CBT and exposure therapy

CBT and exposure are used in tandem with bilateral stimulation. The therapist first helps the client identify thoughts and behaviors associated with the traumatic memory. They then expose the individual to those memories and use bilateral stimulation to make them manageable, which allows the person to fully process them and replace them with more adaptive thoughts and behaviors.

In short, you can think of EMDR as exposure with a sensory buffer that allows CBT to take place.

The eight phases of EMDR

Here is a more detailed look at the steps that take place in EMDR:

• History: The client provides background information and establishes treatment goals.

• Preparation: The therapist sets treatment expectations and helps develop appropriate coping tools.

• Assessment: Specific memories are identified as the target of reprocessing. The therapist will help the client identify both negative thoughts about how the trauma has made them feel, as well as positive thoughts that they would like to believe moving forward.

• 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.

• Installation: More positive and realistic thoughts are reinforced, which replace 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: 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. It provides feelings of confidence and safety in the process.

• Reevaluation: During the final phase, the therapist and client will review progress and adjust goals for future sessions.

Free Resources for Therapists

Click below and help yourself to peer-created resources:

• Ready-to-use worksheets, checklists, assessments & more!
• Master insurance billing with our expert-led course
• Telehealth 101: On-demand videos
• Curious how TheraPlatform solves private practice pain points?

Is EMDR effective?

Since its founding, EMDR has been a controversial therapy, mainly because bilateral stimulation seems like a strange way to treat psychiatric disorders.

While it is definitely an unusual procedure, you can’t argue with the results, especially regarding trauma:

• Across studies, EMDR consistently reduces PTSD and other trauma-related symptoms.

• The American Psychological Association, the World Health Organization, and the Department of Veterans Affairs all approve EMDR as an evidence-based treatment for post-traumatic stress disorder (PTSD).

• Founder Francine Shapiro best sums up the productivity of EMDR for trauma in her book, EMDR: The breakthrough therapy for overcoming anxiety, stress, and trauma: “Research has shown that about five hours of EMDR treatment eliminates PTSD in 84 to 100 percent of civilians with a single trauma experience, including rape, accident, or disaster.”

Is it better than CBT and exposure for trauma?

It is difficult to say definitively if EMDR is better than CBT and exposure in treating traumatic conditions. This is because EMDR incorporates elements of both. Additionally, EMDR is not as well studied as either of those therapies, which have been around since the mid-20th century.

• Still, in several well-designed studies, EMDR has been found to be more effective in treating PTSD than CBT.

• Additionally, a systematic review of several studies indicates that EMDR may be better tolerated than prolonged exposure.

Is EMDR effective for mental health conditions besides trauma?

While EMDR has been found to be effective for treating trauma, the evidence for other disorders is not as conclusive. For many years, EMDR was not used to treat other conditions, so it does not have the same research support as it does for PTSD. Still, several studies point to its potential efficacy in treating other disorders:

• EMDR has significantly reduced depressive symptoms to non-clinical levels.

• Several mental health conditions, including anxiety, mood disorders, and OCD have been successfully treated with EMDR.

Overall, it seems fair to conclude that EMDR works well for conditions related to trauma, but it is only considered a “promising” intervention for other mental health problems until stronger research is conducted.

Benefits and limitations of EMDR

Besides efficacy, here are some of the other advantages and limitations of utilizing EMDR:

Benefits

• 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.

• Homework is not usually given as part of EMDR.

• EMDR is more suitable for clients who struggle with verbal processing because bilateral stimulation is a nonverbal process, and it does not require as much verbal expression as other talk therapies.

Limitations

• Despite the buffer provided by sensory bilateral stimulation, EMDR still involves confronting painful traumatic memories, which can be difficult for those with insufficient coping skills.

• EMDR requires formal training to deliver.

• Because of a lack of reliable evidence regarding its effectiveness with other disorders, it may not be covered by insurance if not used to treat PTSD.

• EMDR is not recommended for clients with active substance abuse, severe psychosis or dissociation, or those in acute crisis situations.

• EMDR continues to be controversial. Certain critics believe the efficacy of EMDR is only due to exposure and CBT and has little to do with bilateral sensory stimulation.

Practical considerations for conducting EMDR

Therapists need to keep the following considerations in mind when conducting EMDR:

Training and certification

Performing EMDR is not something you should do without some specialized training. You can find in-person or virtual training at the official EMDR website. You can take their basic two-day training or more advanced offerings. You can find additional training and resources on the internet, including at EMDRIA, the EMDR International Association.

Insurance reimbursement

Because EMDR typically takes place in 60-90 minute sessions, it can’t be billed with the usual 90834 CPT code. Instead, it can be billed for reimbursement using CPT code 90837 for an hour session. For 90-minute sessions, two consecutive 90834 codes can be used.

Note: Add-on code 99354 was discontinued two years ago and is no longer a viable billing strategy for lengthy sessions.

Teletherapy

• EMDR can be conducted online using a HIPAA-approved video conferencing platform, such as TheraPlatform. For example, therapists can instruct clients to perform the butterfly hug for bilateral tactile stimulation. Additionally, bilateral sound stimulation can be produced through headphones using specialized software.

• Although evidence for online EMDR is currently scarce, preliminary research indicates that virtual EMDR is effective for treating trauma.

Even though the underpinnings of how EMDR works are a bit mysterious, it has proven to be an effective trauma treatment and has shown initial promise for addressing other mental health disorders.

It is best utilized for people who may not be able to tolerate traditional talk therapy or the emotional distress of prolonged exposure. Although its use as an online therapy is relatively new, it is believed to be no less effective than in-person treatment. Therefore, if you desire a brief, less distressing, and effective intervention to address trauma, EMDR seems a positive and reliable option.

Documenting EMDR therapy

An essential component of EMDR therapy (and indeed nearly all therapeutic work) is accurate, timely documentation.

One common structure is the SOAP format:

• S (Subjective): What the clients report — emotional state, concerns, events since last session.
• O (Objective): What the therapist observes — interaction patterns, tone, nonverbal cues.
• A (Assessment): Therapist’s clinical interpretation — what the subjective and objective data suggest in terms of attachment needs, emotional blocks, and relational dynamics.
• P (Plan): What will be done going forward — interventions, new homework, focus for next session.

Watch this video to learn 6 ways to save time on therapy notes

→ Start My Free Trial Now

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 templates (e.g. SOAP, DAP, others) to speed note writing and ensure completeness.

• Link notes to treatment plans, goals, and session history so that therapeutic progress is more easily tracked.

• Securely access and share documents (with clients or other providers, where appropriate) and maintain confidentiality.

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 plus 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

Learn More

Resources

Theraplatform is an all-in-one EHR, practice management and teletherapy solution with AI-powered note taking features that allows 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

• Therapy resources and worksheets
• Therapy private practice courses
• Ultimate teletherapy ebook
• The Ultimate Insurance Billing Guide for Therapists
• The Ultimate Guide to Starting a Private Therapy Practice
• Mental health credentialing
• Insurance billing 101
• Practice management tools
• Behavioral Health tools

Free video classes

• Free on-demand insurance billing for therapist course
• Free mini video lessons to enhance your private practice
• 9 Admin tasks to automate in your private practice

References

Ala'ilima, K. (2023, July 21). Choosing Therapy. Bilateral stimulation: What it is, effects, and use in EMDR. https://www.choosingtherapy.com/bilateral-stimulation

American Psychological Association. (2025, June 10). What is EMDR therapy and why is it used to treat PTSD? https://www.apa.org/topics/psychotherapy/emdr-therapy-ptsd

Altmeyer, S., Wollersheim, L., Kilian-Hütten, N., Behnke, A., Hofmann, A., & Tumani, V. (2022). Effectiveness of treating depression with eye movement desensitization and reprocessing among inpatients-A follow-up study over 12 months. Frontiers in Psychology, 13, 937204. https://doi.org/10.3389/fpsyg.2022.937204

Khan, A. M., Dar, S., Ahmed, R., Bachu, R., Adnan, M., & Kotapati, V. P. (2018). Cognitive behavioral therapy versus eye movement desensitization and reprocessing in patients with post-traumatic stress disorder: Systematic review and meta-analysis of randomized clinical trials. Cureus, 10(9), e3250. https://doi.org/10.7759/cureus.3250

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

Shapiro F. (2014). The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences. The Permanente Journal, 18(1), 71–77. https://doi.org/10.7812/TPP/13-098

Shapiro, F. & Forrest, M.S. (2016). EMDR: The breakthrough therapy for overcoming anxiety, stress, and trauma. Basic Books. https://www.hachettebookgroup.com/titles/francine-shapiro/emdr/9780465096749/

Strelchuk, D., Turner, K., Smith, S., Bisson, J., Wiles, N., & Zammit, S. (2023). Provision of online eye movement and desensitisation therapy (EMDR) for people with post-traumatic stress disorder (PTSD): a multi-method service evaluation. European Journal of Psychotraumatology, 14(2), 2281182. https://doi.org/10.1080/20008066.2023.2281182

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.2018.00923