What Is EMDR? How This Therapy Is Used for PTSD
Mental health experts explain how EMDR therapy works and how it might help you deal with trauma.
Living with PTSD
Post-traumatic stress disorder (PTSD) can strike when someone least expects it. Maybe an aggressive driver makes a person feel endangered, or a sound or smell triggers a traumatic memory and leads to an outsized reaction that’s hard to control.
Trauma changes your brain—but there are treatments to help. One intriguing option is EMDR, an evidence-based therapy that helps you reprocess traumatic memories and learn to cope in healthy ways.
What is PTSD?
PTSD affects nearly 7 percent of the U.S. population, according to the National Institute of Mental Health. From flashbacks and hypervigilance to trouble concentrating and sleeping, symptoms of this surprisingly common disorder can dramatically alter your daily life.
And though the condition itself is not always permanent, researchers suggest it can forever alter the way your brain functions.
PTSD is “a type of anxiety disorder that develops after a person experiences or witnesses an event that is intense and causes fear,” explains Janet Civitelli, PhD, a licensed psychologist and certified career coach in Austin, Texas.
Though PTSD is commonly linked to combat, Civitelli explains that many experiences can trigger this “fight or flight” response to trauma, including bullying, abuse, medical treatments, and natural disasters.
People can also develop PTSD from recurrent small traumas. “We now have evidence that repeated exposure to smaller traumas can cause more emotional harm than exposure to a single big trauma,” says clinical social worker Annie Miller, who specializes in therapy for trauma and sleep disorders.
Whether you experience an accumulation of non-life-threatening incidents or a single tragic event, you experience trauma and develop the potential for PTSD when your stress exceeds your brain’s processing limits, says board-certified and EMDR-trained therapist Kevin Faust, who practices at Akahai Emotional Wellness in Hawaii.
What is EMDR?
Eye movement desensitization and reprocessing (EMDR) is a highly complex, structured form of therapy offered by trained mental health professionals.
EMDR utilizes rhythmic bilateral actions (using both sides of the body) to help people reprocess trapped memories, according to Indiana-based licensed counselor Brittany A. Johnson, who is certified in EMDR and is currently training to become an EMDR educator.
Research on the therapy is promising, and it’s one of the approaches the American Psychological Association (APA) suggests for treating PTSD. (Here’s the full list of PTSD therapies from the APA.)
EMDR therapy sessions involve focusing on a past traumatic event while performing back-and-forth actions designed to activate both sides of the brain and keep you “safe and grounded in the present,” according to Miller. For instance, you might track your therapist’s hands back and forth across your vision, all while thinking of a traumatic event.
Though side-to-side eye movements are a hallmark of EMDR, she says, the bilateral stimulations can be visual, auditory, or tactile. The idea is that focusing on the stimulation while reliving an event can help you reprocess the memory without getting lost in a flood of negative emotions.
How EMDR works
The therapy is attributed to research first begun by psychologist Francine Shapiro in the late 1980s; remarkably, she got the idea while on a walk in the woods in which she found that flicking her eyes back and forth in the trees helped ease the anxiety she was feeling at the time. After trying it successfully with patients, she developed the theory behind EMDR. The approach took time to gain acceptance, but a 2018 extensive review of research on EMDR—published in the journal Frontiers in Psychology—found that EMDR could not only help diagnose PTSD but reduce symptoms such as anxiety and distress.
The foundation of EMDR is a theory called adaptive information processing (AIP), which theorizes that mental disorders can occur when a traumatizing experience is inadequately or incorrectly processed by the brain, according to another report published in Frontiers in Psychology.
“Dr. Shapiro’s research led her to work with ‘bilateral stimulation,’ or rhythmic stimulation of both sides of the body,” says Faust. “It is thought that stimulating both sides of the body stimulates both sides of the brain, helping that stuck psychological trauma move from the emotional part of the brain to the logical part, thus processing it and storing it properly.”
Miller says stress and trauma can overwhelm your brain’s ability to heal. EMDR could help by allowing you to reprocess those events and gain closure at a later date.
Rewinding the clock and releasing “trapped memories,” as Johnson describes it, through rapid eye movements and hand tapping might sound a little fantastical. But the research seems to back up practitioners’ claims.
Numerous studies have found that EMDR therapy is particularly useful in reducing PTSD symptoms. Research published in the International Journal of Stress Management also suggested that the effects of EMDR remain several months after people stop going to therapy.
The 8 phases of EMDR therapy
If you’re interested in pursuing EMDR therapy, it’s important to have clear expectations. A single session will not be enough to alleviate PTSD symptoms or teach you all the regulation methods you need.
“EMDR is done in eight phases, and while some clients and clinicians can complete the phases quickly, there are some things that take several sessions for each phase,” explains Johnson. She says an EMDR-trained therapist will explain how many sessions you need toward the beginning of the process.
Johnson says the basic focus of each EMDR therapy phase is split the following ways:
- Phases 1 and 2: Reviewing your mental health history and creating a target treatment plan.
- Phases 3 and 4: Identifying, reprocessing, and desensitizing specific memories using bilateral stimulation.
- Phases 5 and 6: “Installation” (inserting or strengthening positive thoughts) and “body scan” (observing your thoughts, feelings, and actions, then identifying remaining negatives responses).
- Phases 7 and 8: Gaining closure, evaluating progress, and identifying future targets.
What it’s like to go to an EMDR therapy session
An EMDR session typically lasts between 60 and 90 minutes. Your session will vary depending on how far you have progressed through the EMDR phases.
Once you’ve reviewed your mental health history and created a treatment goal and plan with your therapist, “expect your therapist to only allow you to talk for a few seconds in between each set [of bilateral stimulation],” Johnson says. The goal is to keep a continuous flow through the recall and processing.
EMDR-trained therapists emphasize that you can expect warm-up activities and careful handling of your traumatic memories and negative emotions.
Traumatic experiences are relived in 20- to 30-second bursts while you simultaneously perform bilateral stimulation. You might be asked to follow your therapist’s hand with your eyes quickly back and forth or listen to tapping, vibrating buzzers, or auditory tones. Your therapist will guide you throughout the process.
“The goal with an EMDR therapy session is to allow you to think about the memory or event but not feel stuck in it,” Miller says. “You can learn how to let go of painful emotions more easily.”
How to find an EMDR-trained therapist
To find a therapist trained in EMDR, visit the EMDR International Association or ask for a referral from your doctor or a local clinic.
“If you are planning to use health insurance to pay for EMDR therapy, I recommend calling the phone number on the back of your insurance card and asking what mental health therapists in your area are ‘in-network,'” Faust says. Once you have a list, you can visit their websites to check for EMDR certification.
Can EMDR treat other issues?
Although the research isn’t as clear on the success of EMDR in treating other mental health conditions, researchers are looking into EMDR’s potential in managing:
- Janet Civitelli, PhD, a psychologist and certified career coach in Austin, Texas
- Brittany A. Johnson, LMHC, an Indiana-based licensed mental health counselor certified in EMDR and training to be an EMDR educator
- Annie Miller, LCSW-C, LICSW, a clinical social worker and trained EMDR therapist in Washington, D.C.
- Kevin Faust, MS, LPC, NCC, a licensed counselor and trained EMDR therapist in Hawaii
- National Institute of Mental Health: "Post-Traumatic Stress Disorder (PTSD)"
- American Psychological Association: "Eye Movement Desensitization and Reprocessing (EMDR) Therapy"
- Frontiers in Psychology: "The Use of Eye-Movement Desensitization Reprocessing (EMDR) Therapy in Treating Post-traumatic Stress Disorder—A Systematic Narrative Review"
- Frontiers in Psychology: "The AIP Model of EMDR Therapy and Pathogenic Memories"
- Innovations in Clinical Neuroscience: "A Flash of Hope: Eye Movement Desensitization and Reprocessing (EMDR) Therapy"
- International Journal of Stress Management: "Three- and 6-Month Follow-Up of EMDR Treatment of PTSD in an HMO Setting"
- Department of Veterans Affairs: "VA/DoD Clinical Practice Guideline for Management of Post-Traumatic Stress"
- The EMDR International Association: "Find an EMDR Therapist"
- Frontiers in Psychology: "EMDR beyond PTSD: A Systematic Literature Review"