EMDR Therapy

In-Depth Explanation

Eye Movement Desensitization and Reprocessing (EMDR)

Eye Movement Desensitization and Reprocessing (EMDR) is a structured psychotherapy developed by Dr. Francine Shapiro in the late 1980s. Originally developed for treating Post-Traumatic Stress Disorder (PTSD), EMDR has since been recognized by the World Health Organization, the American Psychological Association, and the Department of Veterans Affairs as an effective treatment for trauma and many other psychological conditions. EMDR is based on the understanding that every person has a natural ability to heal from psychological distress, just as the body heals from physical wounds. Sometimes, however, traumatic experiences overwhelm this natural processing system, leaving memories "stuck" in a disturbing, unprocessed form. EMDR therapy helps "reprocess" these memories so they no longer cause distress.

The Adaptive Information Processing (AIP) Model

The theoretical foundation of EMDR is the Adaptive Information Processing (AIP) model. This model proposes that our brains have an innate information processing system that naturally moves toward health and integration—similar to how the body heals a wound.

How Normal Processing Works:

When we experience an event, our brain processes the information—images, sounds, feelings, thoughts, sensations.
Through natural processing, we integrate the experience, learn from it, and store it in a way that no longer disturbs us.
We can recall the memory without re-experiencing the original distress.
The memory becomes linked to adaptive information: lessons learned, sense of strength, positive self-beliefs.

What Happens with Trauma:

When an experience is overwhelming, the natural processing system becomes disrupted.
The memory gets "frozen" or stored in its raw, unprocessed form—with all the original images, sounds, thoughts, emotions, and body sensations.
When triggered, the person re-experiences the disturbance as if it's happening now.
Negative beliefs from the event ("I'm not safe," "I'm worthless," "It's my fault") remain attached to the memory.

How EMDR Helps: EMDR therapy uses bilateral stimulation (eye movements, taps, or sounds) while the person focuses on the disturbing memory. This activates the brain's natural processing system, allowing the stuck memory to finally be processed and integrated. After successful processing, the memory can be recalled without distress, and adaptive beliefs replace the negative ones.

Bilateral Stimulation: The Core Mechanism

(BLS) is a key component of EMDR therapy. It involves alternating stimulation of the left and right sides of the body or sensory fields. The most common forms include:

Eye movements: Following an object moving back and forth
Tactile taps: Alternating taps on the hands, knees, or shoulders
Auditory tones: Sounds alternating between left and right ears

Why Bilateral Stimulation Works: While the exact mechanism is still being researched, several theories explain its effectiveness:

Working memory taxation: The dual attention required (focusing on memory while tracking movement) reduces the vividness and emotionality of the memory.
REM sleep connection: Eye movements may mimic the rapid eye movement during REM sleep, when the brain naturally processes emotional memories.
Interhemispheric communication: Bilateral stimulation may enhance communication between brain hemispheres, facilitating integration.
Orienting response: The repetitive stimulation activates a relaxation response that counters the stress response attached to the memory.

The Eight Phases of EMDR Therapy

EMDR therapy follows a structured eight-phase protocol. Each phase serves a specific purpose, and together they provide a comprehensive framework for treatment. Not all phases occur in every session—the phases act as a map for the overall treatment process.

Phase 1: History Taking and Treatment Planning

The first phase establishes the foundation for treatment. This involves understanding your history, identifying targets for processing, and developing a treatment plan.

What Happens:

Discussion of presenting problems and symptoms
Review of relevant history and past traumas
Identification of target memories for processing
Assessment of client's readiness and resources
Development of a treatment plan with appropriate pacing

The Three-Pronged Approach: EMDR addresses issues across three time dimensions:

Past: Memories that laid the foundation for current problems
Present: Current triggers that activate distress
Future: Desired skills and behaviors for future situations

Phase 2: Preparation

The preparation phase ensures you are ready for reprocessing by establishing safety, building coping resources, and understanding the EMDR process.

Key Elements:

Creating safety: Establishing a safe, trusting environment for yourself
Education: Explaining how EMDR works, what to expect, and addressing questions
Resource development: Teaching coping strategies and self-soothing techniques
Safe/Calm Place: Creating a mental "" the client can access if overwhelmed
Container exercise: Teaching a technique to temporarily "" disturbing material

Phase 3: Assessment

In the assessment phase, you identify and activate the specific target memory for processing, along with all its components. For help identifying your beliefs, see and .

Components Identified:

Target image: The most disturbing image from the memory
Negative cognition (NC): The irrational, negative belief about self connected to the memory (e.g., "I am powerless," "I am not safe," "I am worthless")
Positive cognition (PC): The desired, adaptive belief the client would rather believe (e.g., "I have choices," "I am safe now," "I am worthy")
Validity of Cognition (VOC): Rating from 1-7 of how true the positive belief feels right now (1 = completely false, 7 = completely true)
Emotions: What emotions come up when focusing on the image and negative belief
Subjective Units of Disturbance (SUD): Rating from 0-10 of current distress level (0 = no disturbance, 10 = worst possible)
Body location: Where in the body the disturbance is felt

Common Negative Cognitions:

Responsibility/Defectiveness: "I am not good enough," "I am a bad person," "I am worthless"
Safety/Vulnerability: "I am not safe," "I am in danger," "I cannot protect myself"
Power/Control: "I am powerless," "I have no control," "I am helpless"

Phases 4-6: Desensitization, Installation, and Body Scan

These three phases form the core "reprocessing" work of EMDR, all involving bilateral stimulation.

Phase 4: Desensitization

Focus on the target memory while applying bilateral stimulation (typically 24-36 eye movements or taps)
After each set, notice what comes up—new thoughts, images, feelings, or sensations
Acknowledge what arose and continue with another set from where you left off
This continues until the SUD rating reaches 0 (no disturbance)
During processing, the memory often changes—becoming less vivid, more distant, or taking on new meaning

Phase 5: Installation

Once desensitization is complete (SUD = 0), the positive cognition is "installed"
Hold the original memory together with the positive belief while applying bilateral stimulation
This continues until the VOC reaches 7 (completely true)
The positive belief becomes associated with the memory, replacing the old negative belief

Phase 6: Body Scan

Hold the target memory and positive belief while scanning your body from head to toe
Any remaining tension, discomfort, or unusual sensations are processed with additional bilateral stimulation
Processing is complete when your body is clear of disturbance

What Processing Looks Like: During reprocessing, you may experience rapid shifts—new memories may emerge, perspectives may change, emotions may intensify briefly and then release. Follow wherever your processing leads, trusting your brain's natural healing capacity.

Phases 7-8: Closure and Reevaluation

Phase 7: Closure

Every session ends with closure, ensuring you finish in a stable, grounded state—whether or not processing is complete.

If processing is incomplete, use containment techniques to store the material and return to equilibrium
Safe Place or other calming techniques may be used
Expect that processing may continue between sessions and dreams may occur
Journaling between sessions is encouraged to track any new insights, memories, or disturbances

Phase 8: Reevaluation

Each new session begins with reevaluation:

Checking the SUD of previously processed memories (they should remain at 0)
Ensuring positive beliefs remain strong
Identifying any new material that has emerged
Determining whether to continue with the current target or move to a new one

Complete Processing: A memory is considered fully processed when:

SUD = 0 (no disturbance when recalling the memory)
VOC = 7 (positive belief feels completely true)
Body is clear of any disturbance
These results maintain over time (verified in reevaluation)

What EMDR Can Treat

While EMDR was originally developed for PTSD, research has demonstrated its effectiveness for many conditions:

PTSD and trauma: Single-incident trauma, complex trauma, childhood abuse
Anxiety disorders: Panic, phobias, generalized anxiety
Depression: Especially when linked to past experiences
Grief and loss: Complicated grief, traumatic loss
Performance anxiety: Test anxiety, public speaking, sports performance
Disturbing memories: Any memory that continues to cause distress
Negative self-beliefs: Core beliefs of worthlessness, powerlessness, being defective
Addictions: When underlying trauma contributes to addictive behaviors

Applying EMDR Principles in Daily Life

These EMDR principles and techniques can be applied on your own to support daily wellbeing:

Resource Development:

Practice the Safe Place visualization regularly to strengthen it as a resource
Use the Container technique to mentally "put away" distressing thoughts until you can address them properly
Build a library of positive memories and resources you can access when stressed

Butterfly Hug (Self-Administered BLS):

Cross your arms over your chest, with fingertips resting below your collarbones
Alternately tap your hands gently (like a butterfly's wings)
While tapping, think of your Safe Place or a calming image
Use this for self-soothing during mild stress—not for processing trauma

Notice and Name:

When triggered, notice the image, the negative belief, the emotion, and where you feel it in your body
This awareness helps separate past from present
Ask yourself: "Is this about now, or is this an old memory getting activated?"

The Container Technique:

Visualize a sturdy container (vault, box, safe) with a secure lid
Mentally place disturbing thoughts, images, or feelings into the container
Close and lock the lid—you can open it later when you're ready to process
This helps manage overwhelming material between sessions or when triggered

What to Expect During EMDR

During Processing:

Emotions may intensify briefly before releasing
New memories or connections may surface
Perspectives may shift suddenly ("I realize now it wasn't my fault")
Physical sensations may arise and clear
The memory may become more distant or the image may change

Between Sessions:

Processing may continue after the session
Vivid dreams are common and often part of processing
New memories or insights may emerge
Journaling helps track what comes up
Use self-soothing techniques if distressed

Signs of Successful Processing:

The memory feels more distant, like "ancient history"
Emotional charge is gone—you can think about it without distress
Negative beliefs are replaced by adaptive ones
Triggers that once caused reactions no longer do
Sleep improves, physical symptoms reduce

Important Considerations

EMDR can be rapid and powerful—many people experience significant relief in fewer sessions than traditional talk therapy. However, results vary based on the complexity of the trauma and individual factors.

For complex trauma or severe symptoms, adequate preparation time is essential before processing begins. Some clients need extensive Phase 2 work to build stability and resources.

EMDR is not about talking in detail about the trauma. You don't need to describe everything that happened—you simply follow your internal processing. This can make it easier if you find it difficult to discuss your experiences verbally.

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