What Is EMDR Therapy?
A comprehensive guide to Eye Movement Desensitization and Reprocessing
Eye Movement Desensitization and Reprocessing, known as EMDR, is a psychotherapy approach that has transformed the treatment of trauma and post-traumatic stress disorder over the past three decades. Originally developed in 1987 by psychologist Francine Shapiro, EMDR has since become one of the most extensively researched and widely practiced trauma treatments in the world, recommended by organizations ranging from the World Health Organization to the American Psychological Association.
If you are considering EMDR therapy, have been recommended for EMDR by a healthcare provider, or are simply curious about how this unique treatment works, this guide will provide you with a thorough understanding of the approach, its scientific foundations, and what you can expect from the therapeutic process.
The Origins of EMDR
The discovery of EMDR began with an observation that Francine Shapiro made during a walk in 1987. She noticed that certain disturbing thoughts she had been experiencing seemed to lose their emotional charge when her eyes moved rapidly from side to side. Intrigued, she began experimenting with this phenomenon, first with herself and then with volunteers, eventually developing a structured therapeutic protocol.
Shapiro's initial findings were published in 1989 in the Journal of Traumatic Stress, and they generated both excitement and skepticism in the clinical community. In the decades since, over thirty randomized controlled trials and hundreds of other studies have been conducted, establishing EMDR as an evidence-based treatment with a robust scientific foundation. What began as an observation during a walk has become one of the most important advances in trauma psychotherapy.
The Adaptive Information Processing Model
EMDR is built on the Adaptive Information Processing (AIP) model, which provides the theoretical framework for understanding both how trauma affects the brain and how EMDR produces therapeutic change.
According to the AIP model, the human brain has an innate information processing system that naturally moves experiences toward adaptive resolution. When you have a disturbing experience, your brain typically processes it during sleep and waking reflection, filing it away with appropriate connections to existing memories and knowledge. After processing, you can recall the experience without being overwhelmed by the emotions you felt at the time.
Traumatic experiences, however, can overwhelm this natural processing system. When the brain cannot adequately process an experience, the memory becomes stored in its original, unprocessed form, retaining the vivid sensory impressions, intense emotions, and physical sensations that were present during the event. These unprocessed memories are essentially frozen in time, and when they are triggered by current experiences, the individual can feel as though the traumatic event is happening again in the present moment.
EMDR therapy activates the brain's stalled processing system and allows it to complete the work that was interrupted by the original trauma. The bilateral stimulation used in EMDR, whether through eye movements, tactile tapping, or auditory tones, appears to facilitate the same type of processing that occurs naturally during REM sleep, during which the eyes move rapidly back and forth as the brain consolidates and integrates experiences from the day.
The Eight Phases of EMDR
EMDR follows a structured eight-phase protocol that guides both therapist and client through the treatment process. Understanding these phases can help demystify what happens during EMDR and reduce anxiety about beginning treatment.
Phase 1: History and Treatment Planning
The therapist takes a comprehensive history, exploring the client's background, current symptoms, and the specific traumatic experiences or adverse life events that may be contributing to their difficulties. Together, they develop a treatment plan that identifies the memories to be targeted during processing, beginning with the experiences that are most closely linked to current distress. This phase typically spans one to two sessions.
Phase 2: Preparation
Before beginning active processing, the therapist ensures that the client has adequate coping resources. This phase involves explaining the EMDR process in detail, answering questions, addressing concerns, and teaching the client self-regulation techniques such as guided imagery, deep breathing, or the "safe place" exercise. These skills provide tools the client can use during and between sessions if they become overwhelmed. The preparation phase is essential for establishing the trust and safety that allow effective processing to occur.
Phase 3: Assessment
For each target memory, the therapist guides the client through a structured assessment. The client identifies the most vivid visual image associated with the memory, the negative belief about themselves that is connected to it (for example, "I am helpless" or "I am not safe"), and the positive belief they would prefer to hold. They rate how true the positive belief feels on a scale from one to seven, identify the emotions the memory evokes, rate the level of distress from zero to ten, and note where they feel the disturbance in their body. This assessment provides a baseline against which progress can be measured.
Phase 4: Desensitization
This is the active processing phase. The client holds the target memory in mind, including the image, the negative belief, and the associated emotions and body sensations, while the therapist initiates bilateral stimulation. After each set of stimulation, which typically lasts twenty to thirty seconds, the therapist asks the client to take a breath and report what they notice. The client may report changes in the image, new memories, shifts in emotion, or changes in physical sensation. The therapist follows the client's processing, providing guidance when necessary, until the level of distress associated with the target memory drops to zero or near zero.
Phase 5: Installation
Once the distress has been reduced, the therapist helps the client strengthen the positive belief identified during assessment. The client holds the target memory together with the positive belief while engaging in additional bilateral stimulation. This phase installs the adaptive, healthy belief in place of the negative one, so that when the memory is recalled in the future, it is associated with the positive cognition rather than the negative one.
Phase 6: Body Scan
Trauma is stored not only in thoughts and emotions but also in the body. After installation of the positive belief, the therapist asks the client to think about the target memory and scan their body for any remaining tension, discomfort, or unusual sensation. If residual physical disturbance is found, additional bilateral stimulation is used to process it. Complete processing of a memory includes resolution of associated body sensations.
Phase 7: Closure
Each session ends with a closure procedure that ensures the client leaves feeling stable and grounded, regardless of whether processing of the target memory is complete. The therapist may guide the client through relaxation exercises and explains what to expect between sessions, including the possibility that processing may continue after the session ends, sometimes bringing up new memories, insights, or emotions.
Phase 8: Reevaluation
At the beginning of subsequent sessions, the therapist checks whether the gains from previous sessions have been maintained. The client revisits the target memory to assess whether the reduction in distress has held, whether the positive belief remains strong, and whether any new material has emerged that needs attention. This phase ensures that treatment is thorough and that previously processed material has been fully resolved.
What Does an EMDR Session Feel Like?
Many people are understandably curious, and sometimes anxious, about what they will actually experience during an EMDR session. While every person's experience is unique, there are some common elements.
During the bilateral stimulation sets, clients often report a stream-of-consciousness flow of thoughts, images, emotions, and physical sensations. It is common for the mind to move rapidly through associated memories and feelings, sometimes making connections that the client had not previously recognized. Some clients describe it as watching a train pass by, observing the carriages of memory and emotion without being fully immersed in them.
Sessions can be emotionally intense, particularly when processing highly distressing material. It is normal to experience strong emotions, including sadness, anger, fear, or grief, during processing. However, these emotions are typically transient, peaking briefly before subsiding as the brain completes its processing work. Most clients report feeling a sense of relief or lightness after a memory has been fully processed.
Between sessions, clients may notice that their dreams are more vivid, that they are having new insights about past experiences, or that situations that previously triggered strong reactions are bothering them less. These are all signs that the processing initiated during the session is continuing naturally.
Conditions Treated by EMDR
While EMDR was originally developed for PTSD, its applications have expanded significantly as research has demonstrated its effectiveness across a range of conditions:
- Post-traumatic stress disorder remains the primary and most extensively researched application
- Anxiety disorders, including generalized anxiety, social anxiety, and specific phobias
- Depression, particularly when it has roots in traumatic or adverse life experiences
- Panic disorder and agoraphobia
- Grief and complicated bereavement
- Relationship difficulties stemming from attachment trauma
- Chronic pain syndromes with a trauma component
- Performance anxiety and mental blocks
- Addiction and substance use disorders with underlying trauma
Is EMDR Right for You?
EMDR may be a good fit if you have experienced traumatic events that continue to affect your daily life, if you have tried talk therapy without achieving the relief you hoped for, or if you prefer a treatment approach that does not require extensive verbal processing of traumatic details. It is also worth considering if your symptoms include vivid intrusive memories, strong physical reactions to reminders of past events, or persistent negative beliefs about yourself that you recognize as connected to specific experiences.
The best way to determine whether EMDR is appropriate for your situation is to consult with a certified EMDR therapist who can assess your needs and recommend the most suitable treatment approach. Our therapist directory can help you find a qualified practitioner in your San Diego neighborhood.