Understanding EMDR Therapy

What is EMDR?

Eye Movement Desensitization and Reprocessing (EMDR) is a structured, trauma-focused psychotherapy that was developed in the late 1980s by psychologist Francine Shapiro. The primary goal of EMDR is to help individuals reprocess disturbing memories so that these memories become less vivid, less emotionally disturbing, and more seamlessly integrated with their current understanding of themselves and their present lives.

How EMDR Works

During EMDR sessions, the client is guided to briefly recall aspects of a troubling memory. At the same time, they engage in “bilateral stimulation” (commonly referred to as “BLS”). The most frequent method of BLS involves following the therapist’s fingers or a light bar from side to side with their eyes. Other alternatives for bilateral stimulation include taps or alternating tones. This approach requires the client to maintain a dual focus: one part of their attention remains on the memory, while another part stays anchored in the present moment. This process appears to assist the brain in completing the “digesting work” that was interrupted during the trauma.

Why EMDR Helps with Trauma

Trauma can disrupt the way memories are stored, leaving them in an unprocessed state that is rich in sensory detail and continues to activate the nervous system. When a person encounters reminders (or “triggers”) of the trauma—such as certain smells, sounds, or anniversaries—the nervous system may respond as though the original danger is happening all over again. These triggers can lead to intense emotional and physical reactions.

EMDR therapy is designed to address this issue by helping individuals restart the brain’s adaptive processing mechanisms. Through EMDR, traumatic memories are reprocessed so that their emotional intensity fades and they become integrated with other memories. As a result, these memories no longer set off the body’s alarm system. Instead, they are stored more like regular memories: the events remain real, but they do not control the person's present emotional or physical responses.

How EMDR Produces Change

Two complementary theories help explain the effectiveness of EMDR therapy. The first, Adaptive Information Processing (AIP), is the foundational model proposed by Francine Shapiro. According to AIP, psychological symptoms develop when overwhelming or traumatic experiences are stored in a dysfunctional way. EMDR therapy seeks to reprocess these memories, allowing the brain to connect them with more adaptive and realistic information. For instance, through this process, a person might move from believing “I’m powerless” to “I can cope,” or from feeling ongoing threat to recognizing “I survived; I’m safe now.” This linking of distressing memories with healthier beliefs and emotions leads to a reduction in distress and negative self-perceptions.

The second explanation is known as the working memory account. This theory suggests that holding a vivid, disturbing image in mind while simultaneously performing a demanding task—such as tracking the therapist’s moving fingers or a moving light—slightly taxes the brain’s working memory. Because working memory has limited capacity, this dual task reduces how vivid and emotionally charged the memory feels.

Both laboratory and clinical research have shown that, as a result, the distressing “charge” associated with the memory tends to fade over the course of an EMDR session and remains lower when the memory is recalled later.

For clients, the practical outcome of these mechanisms is significant. They often experience fewer intrusive thoughts and flashbacks, calmer physiological responses, better sleep, and the ability to hold more flexible, positive beliefs and make healthier choices in daily life.

Research Evidence Supporting EMDR

EMDR has been extensively studied as a trauma therapy. Both systematic reviews and narrative summaries identify numerous randomized controlled trials that demonstrate EMDR’s effectiveness in treating post-traumatic stress disorder (PTSD) for adults and children.

Clinical Guidelines Endorsing EMDR

 The U.S. Department of Veterans Affairs and Department of Defense (VA/DoD) Clinical Practice Guideline from 2023 recommends individual trauma-focused psychotherapies—including Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and EMDR—as first-line treatment options for PTSD, placing them above medication-based interventions. (VA PTSD Resources)

 The World Health Organization also advises considering EMDR for individuals experiencing PTSD, along with trauma-focused cognitive behavioral therapy (CBT). (World Health Organization)

 In the United Kingdom, the National Institute for Health and Care Excellence (NICE) lists EMDR as a recommended intervention for treating PTSD.

Since Francine Shapiro’s initial 1989 trial establishing the foundation for EMDR’s evidence base, many randomized controlled trials and meta-analyses have expanded support for EMDR across a wide range of populations, such as survivors of assault, accidents, disasters, and war-related trauma. Collectively, high-quality evidence shows that EMDR can lead to substantial reductions in PTSD symptoms. These positive effects are often maintained during follow-up periods and, for many clients, EMDR also helps improve related concerns such as depression and anxiety. (PubMed)

The Eight Phases of EMDR Therapy

EMDR therapy unfolds in a structured sequence of eight distinct phases. Although the pace and details are customized to each client, the protocol provides a framework that ensures sessions remain safe and focused on clear therapeutic objectives:

1. History-Taking & Treatment Planning

In this initial phase, you and your therapist work together to map out your personal history, identify strengths, assess current stability, and select specific targets such as memories, triggers, or beliefs to address during therapy. Safety and readiness for EMDR remain central throughout this process.

2. Preparation

During preparation, you learn about the EMDR approach and collaborate with your therapist to establish signals that allow you to pause if needed. You also practice regulation techniques—like grounding exercises and safe-place imagery—to help you maintain emotional steadiness throughout the processing phases.

3. Assessment

This phase focuses on a specific target memory. Together, you identify the most distressing image, the negative belief you hold about yourself (such as “I’m not safe”), the desired positive belief (for example, “I am safe now”), associated emotions, and any physical sensations. You also rate the level of distress (using the Subjective Units of Disturbance scale, SUD) and the strength of your positive belief (using the Validity of Cognition scale, VOC).

4. Desensitization

In desensitization, you focus on the chosen memory while engaging in bilateral stimulation, such as guided eye movements, taps, or tones. These are typically delivered in brief “sets” allowing related thoughts and feelings to surface. After each set, your therapist checks in with you, monitoring changes as distress decreases and your perspective on the memory begins to shift.

5. Installation

The installation phase centers on reinforcing the preferred, adaptive belief. Bilateral stimulation continues to help this new, healthier perspective become established and integrated.

6. Body Scan

With your eyes closed, you conduct a mental scan from head to toe, noticing any lingering physical tension or discomfort connected to the target memory. The therapist helps you process any residual sensations until you experience a sense of neutrality and relaxation.

7. Closure

Every session concludes with a return to emotional balance. You use regulation skills as needed and receive simple guidelines to support you between sessions, ensuring you maintain stability and comfort after processing.

8. Re-evaluation

At the start of the next session, you and your therapist revisit the previously targeted material and assess your current well-being. This helps guide the direction of future sessions and ensures that progress is maintained and further needs are addressed.

It is important to note that the structure of EMDR therapy is not strictly linear. Phases 3 through 7—desensitization, installation, body scan, closure, and re-evaluation—are frequently revisited and may be repeated for different memories as therapy progresses.

The therapist adjusts the focus and pace of sessions according to your individual needs and level of stability, ensuring that the process remains tailored and responsive throughout treatment.

What a Typical Session Feels Like

After careful preparation, processing looks like this: you call up the target memory and notice whatever comes—images, thoughts, emotions, body sensations—while following left-right cues with your eyes (or taps/tones). Sets last approximately 50 – 120 seconds; then you briefly report what you noticed. Your mind often hops to related moments (“the day after,” “what my boss said,” “how my chest clamps down”), and the therapist invites you to “go with that.” Over minutes to sessions, distress tends to drop, the narrative clarifies, and new meanings emerge (e.g., “I did the best I could,” “It’s over,” “I have choices now”).

Bilateral stimulation is utilized as one component within the broader context of the therapy. It is important to understand that this technique is not a form of hypnosis.

Throughout the process, you remain in control at all times. The therapist’s role is to guide and support you, but you maintain agency and awareness during every step of the session.

Treatment Length and Suitability

The duration of EMDR therapy varies, depending on your personal history, current stress levels, and individual goals. For those with single-incident trauma, effective processing may occur in fewer than twelve sessions. In contrast, individuals who have experienced complex or prolonged trauma usually require a more comprehensive approach, involving additional groundwork and a phased, integrative process.

EMDR is recognized as a first-line treatment for PTSD for a broad range of adults, including veterans and those who have survived interpersonal violence, accidents, sexual trauma, and childhood trauma. Additionally, children and adolescents can benefit from EMDR when the therapy is modified to suit their developmental needs.

The Takeaway

EMDR therapy is not a magical fix, but instead a well-developed therapeutic method. Its effectiveness relies on the combination of a solid therapeutic relationship, thorough preparation, and a structured approach to reprocessing traumatic memories using bilateral stimulation. This process allows the brain to fully process and integrate distressing experiences, leading to meaningful changes.

Many individuals who undergo EMDR report a decrease in emotional reactivity, a greater sense of personal agency, and a narrative about themselves that feels authentic and sustainable. The approach is supported by decades of research and is recommended by international guidelines as a leading treatment for PTSD, alongside other trauma-focused therapies.

If you are considering EMDR, speaking with a licensed therapist who is trained in this method can help you evaluate whether it aligns with your current goals and is a suitable fit for your nervous system at this time.

By Katya Dow, LMHC