What is EMDR Therapy?
Eye movement desensitization and reprocessing (EMDR) is a fairly new, nontraditional type of psychotherapy. It's getting more popular, particularly for treating posttraumatic stress disorder (PTSD). PTSD often happens after experiences such as military combat, physical assault, rape, or car accidents.
Although research has shown it's effective, EMDR remains controversial among some health care professionals.
At first glance, EMDR appears to approach psychological issues in an unusual way. It does not rely on talk therapy or medications. Instead, EMDR uses a patient's own rapid, rhythmic eye movements. With the help of an EMDR therapist, these eye movements can decrease the power of emotionally charged memories of past traumatic events.
What Can You Expect From EMDR?
An EMDR treatment session can be as long as 90 minutes. Your therapist will move their fingers back and forth in front of your face and ask you to follow these hand motions with your eyes. At the same time, the EMDR therapist will have you recall a disturbing event. This will include the emotions and body sensations that go along with it.
Gradually, the therapist will guide you to shift your thoughts to more pleasant ones. Some therapists use alternatives to finger movements, such as tapping sounds or musical tones.
People who use the technique say EMDR can weaken the effect of negative emotions. Before and after each EMDR treatment, your therapist will ask you to rate your level of distress. The hope is that your disturbing memories will become less disabling.
Although most research into EMDR has examined its use in people with PTSD, EMDR is sometimes used to treat other psychological challenges. They include:
- Panic attacks
- Eating disorders
- Anxiety, such as discomfort with public speaking or dental procedures
Phases of EMDR
EMDR can be separated into eight phases. The first three basically help identify the issues to be addressed during therapy and explain how the process works.
The next three phases are grouped as “EMDR bilateral stimulation.” They are the active part of therapy. These phases connect the emotional trauma and troubling memories with your current state of mind and the ways your body is responding to therapy. Bilateral stimulation activates both sides of the brain – often with a therapist directing side-to-side eye movement – to deal with traumatic memories or difficult emotions in a different way. Your therapist will call this “reprocessing.”
The seventh and eighth phases are meant to return you to a calmer state and find out how the therapy sessions are going. All phases are important, but not all phases are included in every session with a therapist.
Briefly, the phases are:
Phase 1: Information gathering and sharing: This includes a conversation about why you’ve come to therapy and some information about your personal history. Your therapist will also come up with a treatment plan in phase 1.
Phase 2: Preparation: The main purpose of phase 2 is for the therapist to explain how EMDR works and how to manage hard or upsetting emotions that may come up during sessions.
Phase 3: Assessment: During phase 3, you and your therapist identify the traumatic events or circumstances you want to address during therapy. This includes talking about details of the events and the emotions around them, as well as ideas about how you would like to think and feel about them in the future.
Phase 4: Desensitization: During phase 4, you focus on the target memory while your therapist leads you through eye movements. You also share any new thoughts or feelings about the source of your trauma.
Phase 5: Installation: This is a key part of therapy. It’s when you start to attach positive feelings and thoughts to a memory that has previously been tied to traumatic or unpleasant emotions.
Phase 6: Body scan: As you think about a memory that is the target of your therapy, you pay close attention to any physical responses you have. The goal is that as therapy goes on, you will have fewer and fewer negative physical symptoms until you have none at all.
Phase 7: Closure: This is how many sessions will end. Your EMDR therapist helps you keep a state of calm and a sense of security. You and your therapist talk about how the target memories have been processed and how you feel about them now. Your therapist also gives you ways to manage any emotional challenges that may come up between sessions.
Phase 8: Reevaluation: Though this is phase 8, it’s also how most sessions begin once the active part of therapy has started. It’s a time for you and your therapist to figure out how therapy is going and talk about any new memories, feelings, or thoughts that have come out since the previous session. Phase 8 is also used to make any changes to your treatment plan.
If you're getting EMDR treatment to deal with one traumatic event or memory, you might have between three and six sessions. If the disturbing event is more complicated or happened over a long period of time, you might need eight to 12 sessions, or even more.
Does EMDR Work?
Psychologist Francine Shapiro came up with EMDR in 1989. While walking through the woods one day, she happened to notice that her own negative emotions lessened as her eyes darted from side to side. Then, she found the same positive effect in patients.
Since then, many studies in recent years suggest that EMDR can help diagnose PTSD and reduce the symptoms of PTSD and other trauma-related complications. The EMDR International Association reports that more than 110,000 therapists across 130 countries have helped more than 7 million people with EMDR therapy.
The U.S. Department of Veterans Affairs considers EMDR an especially effective treatment for people struggling with PTSD.
What Do the Guidelines Recommend?
Guidelines issued by more than one professional organization have recently boosted the credibility of EMDR. These guidelines define who may benefit from the treatment. For example:
- The American Psychiatric Association (APA) has noted that EMDR is effective for treating symptoms of acute and chronic PTSD. According to the APA, EMDR may be particularly useful for people who have trouble talking about the traumatic events they've had. The APA guidelines note that other research is needed to tell whether improvements from EMDR can be sustained over time.
- The Department of Veterans Affairs and the Department of Defense have jointly issued clinical practice guidelines. These guidelines "strongly recommended" EMDR for the treatment of PTSD in both military and non-military people. They also note that this method has been as effective as other psychological treatments in some studies, and less effective in others.
The World Health Organization (WHO) has given EMDR its official approval. So have government agencies and organizations around the world, including ones in Australia, Germany, and the U.K.
What other disorders can EMDR help with?
While EMDR is usually associated with PTSD treatment, studies have found that this type of therapy may also help treat anxiety, sexual dysfunction, addiction, obsessive compulsive disorder, and other mental health conditions. Specifically, research shows that EMDR may be good at treating general anxiety disorder, social anxiety disorder, and certain phobias. Other conditions, including depression and gender dysphoria, may also be treated effectively with EMDR.
How Does EMDR Work?
Even the most enthusiastic supporters of EMDR have not agreed on how the therapy works. At this point, only theories exist, and that has made EMDR controversial sometimes. By inducing the recall of distressing events and diverting attention from their emotional consequences, EMDR in some respects borrows basic principles used in prolonged exposure therapy, the gold standard behavioral psychotherapeutic treatment of PTSD. Some therapists believe that EMDR reduces anxiety. This allows patients to better take control of their upsetting thoughts. Others simply say that we don't yet understand how EMDR works. According to the APA guidelines, EMDR needs further study to more fully understand it.
Pros and Cons of EMDR
This therapy has some advantages, including:
- EMDR has been proven effective in many studies.
- It requires less “homework” (such as journaling or practicing certain behaviors) between sessions.
- It can produce positive results faster than some other types of mental health therapy.
- It’s generally considered safe.
There are some disadvantages, too, including:
- Finding a therapist trained in EMDR may be difficult in some areas.
- It is still a relatively new type of therapy, so it’s not yet clear exactly why or how it works, or whether it can be a long-term solution for everybody.
There are no real dangers of EMDR therapy, but you do have to discuss traumatic memories or other troubling feelings. That can be difficult for many people (though after the first sessions, these conversations should become easier).
Who is EMDR not suitable for?
EMDR works by helping people move past trauma, anxiety, or certain other mental health disorders. But if you have a condition you were born with or was passed down through your family, or you’re dealing with complications from a brain injury, EMDR may not be appropriate or helpful.
Also, some people who have only recently survived trauma may not yet be ready to process their experiences through EMDR. For this reason, EMDR is not recommended for children who have recently gone through abuse or neglect. Children may not be able to view their trauma as something they can put behind them or deal with in a way that promotes healing.
EMDR is a different type of therapy that a psychologist came up with by accident in 1989. Studies have shown eye movement desensitization and reprocessing can help replace negative emotions tied to traumatic events or situations with more positive ones.
- If you have PTSD and have faced serious negative emotions related to it, EMDR may help you. It has been shown to be safe and effective in treating it, so much so that the U.S. Department of Veterans Affairs recommends it for military vets who have PTSD.
- Therapists also are using EMDR for anxiety disorders, depression, eating disorders, and other mental health conditions.
- What are the eight phases of EMDR?
The eight phases of EMDR, not all of which are included in every session, are: information gathering and sharing, preparation, assessment, desensitization, installation, body scan, closure, and reevaluation. Breaking down the parts of EMDR into phases creates a map for you and your therapist to follow throughout your therapy.
- Is EMDR for anxiety?
Research suggests that EMDR may help some people with anxiety disorders, including obsessive compulsive disorder (OCD) and other related conditions. You may find it useful if you have panic attacks and serious stress, too. Keep in mind that other treatments, including cognitive behavior therapy (CBT), as well as acceptance and commitment therapy (ACT), are also known options for treating anxiety.
- What does EMDR feel like?
EMDR sessions usually last 60 to 90 minutes. During a session, your therapist moves their fingers side to side in front of your face for about 30 seconds at a time as you follow the fingers with your eyes. Sometimes, lights or sounds are used instead to trigger your eye movement. After each series of eye movements, your therapist will ask about your thoughts and feelings about a traumatic memory or other source of distress. You are in control the entire time, and you may find it empowering.