EMDR (Eye movement desensitization and reprocessing)

The core idea

1. Stuck memories2

   Shapiro proposed that a traumatic event can be stored unprocessed, with its original emotions, sensations and beliefs, so present cues set it off again.

2. Process it, don't just talk about it3

   The aim is to link the memory with more adaptive information so distress fades and negative beliefs change.

3. The theory behind it1

   This model is called Adaptive information processing; Wikipedia notes the proposed mechanism has no known scientific basis.

4. How it differs from trauma-focused CBT1

   WHO (2013): unlike trauma-focused CBT, EMDR uses no detailed account of the event, no direct challenging of beliefs, no extended exposure and no homework.

The eight phases

1. 1. History taking2

   Gather background, check suitability, and pick targets: past events, current triggers and future needs.

2. 2. Preparation2

   Explain symptoms and teach stabilising and self-calming skills, so the client can handle distress during and between sessions.

3. 3. Assessment2

   Activate the target: the image, a negative belief about self, the desired positive belief, emotions, body sensations and baseline ratings.

4. 4–6. Desensitization, installation, body scan2

   Reprocess with sets of eye movements, taps or tones until the memory stops hurting; strengthen the positive belief; clear leftover body sensations.

5. 7–8. Closure and reevaluation3

   End each session stable, keep a log during the week, and check next time that the gains hold.

One memory through the phases

1. History taking: choosing the memory8

   In a published case, a woman afraid of vomiting could not say when the fear began; asked for early memories, she recalled a classmate throwing up over a table in kindergarten, at about four. That memory was chosen to reprocess first.

2. Assessment: target image and negative cognition8

   Her most disturbing picture was "the moment that my class mate vomits all over the table". The feeling it evoked was one of powerlessness, so the negative cognition was "I am powerless".

3. Assessment: the SUD rating8

   Disturbance is rated on the Subjective Units of Disturbance scale, 0 (none) to 10 (worst possible). Holding the kindergarten image, she rated it 8.

4. Assessment: positive cognition and VOC9

   The client also names a preferred positive belief and rates how true it feels on the Validity of Cognition scale, 1 (not true) to 7 (completely true).

5. A set of eye movements8

   The therapist moves the fingers back and forth in front of the client, who tracks them while holding the memory in mind. After each set, the client reports what came up, emotions, thoughts, body sensations or images.

6. Desensitization: what comes up between sets8

   During her second set she burst into tears, realising how much fun she had missed as a fearful child; in the next she saw jars of paste in her old classroom. Back at the target she said the picture "seems to be simply disappearing".

7. Desensitization: SUD falls to 08

   Sets continue until the SUD is at or near zero. A linked memory, her father cleaning up her brother's vomit, was also brought down to a SUD of 0.

8. Installation: VOC rises to 78

   The positive belief is paired with the memory in new sets until the VOC reaches 7. For a feared future bus trip she held the image while saying "I can handle it", and her confidence grew a little after each set until VOC 7.

9. Body scan9

   For example, a client who still notices tightness in the stomach when holding the memory would keep processing that sensation in further sets, until they report the body clear of any disturbance.

10. Closure and reevaluation8

    She ended her first session saying "I will keep a journal and look forward to the next time". The next session began from that journal and returned to a memory that was "not yet really neutral".

Bilateral stimulation

1. What it is3

   The therapist's hand moves back and forth and the client follows it with the eyes; taps, or tones alternating left and right, are alternatives.

2. Between sets3

   After each set the client notices whatever comes up, and the therapist chooses the next focus from that report.

3. Proposed explanations2

   Three hypotheses: eye movements tax working memory, trigger an orienting response, or engage REM-sleep-like processes.

4. Working memory, in plain words1

   Doing a second task while recalling makes the memory less vivid and intense, a "distancing effect" that lets it be re-evaluated.

What the research says

1. It works about as well as the best alternatives1

   Reviews since 2013 find EMDR equivalent to prolonged exposure and cognitive processing therapy for adult PTSD; a 2023 Cochrane review calls it first-line.

2. Guidelines1

   WHO (2023) recommends it for adults and children with PTSD; NICE (2018) says offer it for non-combat trauma after 3 months; APA (2017) only conditionally recommends it.

3. NICE's version4

   NICE wants a validated manual, phased delivery, psychoeducation, repeated bilateral stimulation on target memories, and self-calming skills.

4. Do the eye movements add anything?1

   Most meta-analyses find adding eye movements makes little or no difference, and describe a high risk of allegiance bias in EMDR studies.

5. The dissenting meta-analysis5

   Lee and Cuijpers (2013) found a moderate added effect of eye movements in 15 trials (Cohen's d = 0.41) and a large one in 11 lab studies (d = 0.74).

6. Criticism1

   Critics call it pseudoscience or a "power therapy": its theory is untestable and its effect comes from exposure and cognitive work.

Where to start reading

The line under a date fills as it gets older: empty when new, full at 2 years.

1. 2017 · 9 years ago

   Eye Movement Desensitization and Reprocessing (EMDR) Therapy, 3rd edition6

   Shapiro's primary text on the principles, protocols and procedures (Guilford).

2. 2014 · 12 years ago

   The Role of EMDR Therapy in Medicine2

   Shapiro's free overview of the model, the eight phases and the research, from the founder's side.

3. 2013 · 13 years ago

   Getting Past Your Past6

   Shapiro's self-help book built on EMDR ideas, for readers rather than clinicians.