Eye Movement Desensitization and Reprocessing (EMDR)

Eye Movement Desensitization and Reprocessing (EMDR) was formulated by Francine Shapiro, Ph.D., in 1987 while walking through a park. She found that her own eye movements decreased her sensitivity to distressing memories and decided to test how therapist-guided eye movements might help better address painful recollections. It was originally conceived as a treatment for post-traumatic stress disorder (PTSD) but has since been expanded to address other disorders.

What is Eye Movement Desensitization and Reprocessing?

Eye Movement Desensitization and Reprocessing (EMDR) is a structured therapy that is usually completed in 6-15 sessions of 60-90 minutes. Think of it as a mix of traditional CBT exposure techniques combined with bilateral sensory stimulation.

EMDR has the following eight phases of treatment:

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

• 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 that will 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 going through 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.

How does Eye Movement Desensitization and Reprocessing work?

Shapiro hypothesized that Eye Movement Desensitization and Reprocessing works through an adaptive information processing (AIP) model. She believes that traumatic experiences disrupt the normal ways that information is processed in the brain. As a result, the memory is dysfunctionally stored and more adaptive processing is halted, leaving the memory in its most raw and negative form. For example, a man in a combat situation may have a friend die in front of him after he is shot by an enemy. 

Although he didn’t kill him, the man may blame himself for his death, questioning if there was anything he could have done to save him. While this is not a very rational thought, the trauma may prevent him from accessing the reasonable part of his brain, causing the memory to be stuck in his head in its most distressing form. Therefore, instead of allowing for the possibility that he is not responsible, he always feels tremendous guilt, shame, and horror whenever he is reminded of his friend’s death.

Eye Movement Desensitization and Reprocessing allows the “reprocessing” of these memories so that they can be subject to more adaptive information. It uses two main techniques: exposure to traumatic events and guided bilateral stimulation (stimuli presented to both sides of the body) while recalling the painful memory. Guided eye movement is the most traditional form of bilateral stimulation but other forms of stimulation have been used, including sounds and tapping.

The reasons why bilateral stimulation help people recover from trauma is a bit mysterious, but it appears to allow the person to recall negative events without an aversive amount of arousal, therefore better helping them to process painful memories. Also, working memory appears to be occupied by sensory stimulation and makes the recall of traumatic events more indirect. Overall, it allows the brain to process memories more adaptively, transforming purely negative thoughts into more manageable memories. You can look at it like performing exposure with a sensory buffer.

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Is Eye Movement Desensitization and Reprocessing effective?

Although this may seem like an unusual treatment approach, it has yielded overwhelmingly positive results, even when compared to other types of treatment. Almost all research has acknowledged the efficacy of Eye Movement Desensitization and Reprocessing in the treatment of trauma. Further, it has been recommended as a treatment for PTSD by the American Psychological Association (APA) and many other professional organizations. It is generally covered by insurance, but some sessions of Eye Movement Desensitization and Reprocessing may go over 60 minutes and need special approval.

There is some evidence to suggest that Eye Movement Desensitization and Reprocessing works for other problems as well, namely those involving pain, anxiety, depression, and stress. But the quality of some of the research is questionable and the number of studies is currently lacking to make definitive conclusions. As a result, insurance may hesitate in covering EMDR for problems other than trauma.

Advantages and disadvantages

The main advantage of Eye Movement Desensitization and Reprocessing is that you don’t have to endure the full impact of the negative emotions associated with a traumatic event. In contrast, exposure therapy asks the client to confront the trauma in its raw form. Although effective, exposure can be a painful and unpleasant process. Because bilateral sensory stimulation appears to act as a buffer, the client undertaking Eye Movement Desensitization and Reprocessing may see the same benefits without experiencing as much negative emotional arousal.

Clients who use EMDR are not asked to do homework, something that is often prescribed in CBT. Why wouldn’t you try EMDR if you can get the same results without the added work?

It is a very brief therapy. You will likely start to see positive results when receiving EMDR within the first few months. This means that there is less time spent on processing traumatic experiences and you will save time and money on therapy.

The only downside to EMDR is that processing trauma can be a painful process. However, it is designed to decrease sensitivity to trauma and is more easily tolerated than a prolonged exposure approach.