Ultimate Guide to How EMDR Works
Although EMDR has been around since the late 1980’s, it has really taken off in recent years, owing to some great publicity created when celebrities like Miley Cyrus, Sandra Bullock, and especially, Prince Harry shared how it helped them heal from past trauma. As a result, many people have heard about EMDR and wondered if it can help them, but most people do not understand what exactly it is. Even I, a trauma specialist, was initially skeptical of EMDR, however after getting extensively trained in it, learning about the research supporting it, and now practicing it, I have become a big fan of it and think it is a helpful tool for many, many clients.
What is EMDR?
EMDR stands for Eye Movement Desensitization and Reprocessing. It is a treatment created in the late 80’s when therapist Dr. Francine Shapiro noticed a connection between eye movement and memories that persistently created distress.
It is based on the Adaptive Information Processing model, which considers distress related to past experiences as upsetting because the memory was not adequately processed at the time. According to this model, these unprocessed memories still contain the feelings, thoughts, beliefs, and physical sensations that happened at the time of the event and are experienced in the present anytime the memory is triggered.
EMDR was originally created to treat post-traumatic stress disorder (PTSD). While the treatment was initially viewed with skepticism, it has since been shown to be effective for many problems in numerous clinical research studies.
It is a structured therapy that pairs rhythmic left-right bilateral stimulation (BLS) with briefly focusing on a traumatic or painful memory in order to help the brain reprocess the memory so that it is less emotionally and physically distressing. The BLS is traditionally eye movement, but can also be tones or taps. So to unpack the name, left-right (bilateral) eye movement is used to desensitize people to painful memories and reprocess them so they are less distressing.
How does EMDR work?
The short answer is that bilateral stimulation (BLS) activates the parts of our brains that are responsible for naturally processing painful emotions and trauma. Normally, when we sleep, our eyes dart back and forth (bilateral stimulation) during the REM stage of sleep. REM sleep is a very active stage of sleep during which the brain is organizing and storing memories and processing emotions. EMDR mimics this natural processing of emotions and memories, basically kickstarting the brain’s built in ability to process painful memories and heal from painful or traumatic events.
EMDR is normally done in 50-90 minute sessions once a week, but can be done more or less frequently or for extended sessions (EMDR intensives). It consists of 8 phases: Phases 1-3 are focused on preparing for bilateral stimulation (BLS) reprocessing and phases 4-7 are the actual reprocessing phases where BLS is used.
It is important to note that this is a general framework. It is possible to go through multiple phases in one session or focus mostly on one phase and stay there for several sessions. These phases can also be repeated for new goals and memories. Additionally, if you are starting EMDR with a therapist you have already been working with for sometime, phases 1 and 2 may be much briefer.
Treatment planning and history taking
Preparation: the process is explained and the client is taught coping skills to manage any distress that may arise.
Assessing the target memory: the client and therapist decide together on which memory they will target and identify the thoughts, feelings, images, and physical sensations associated with the memory.
Desensitization: BLS is used while briefly connecting to the target memory to reduce distress until it can be reduced no further or is eliminated.
Installation: BLS is used to help a positive, more adaptive belief become associated with the target memory (instead of the negative, unhelpful belief it was previously associated with) and strengthens it so that it feels true.
Body scan: the client holds together both the target memory and the positive belief and scans the body to see if there is any lingering discomfort. If so, it is addressed.
Closure: returning to a sense of being grounded and calm after the reprocessing. This is done after every EMDR session regardless of what other phases were addressed.
Revaluation: each new session after reprocessing has started, the therapist and client discuss recently processed memories to ensure that the distress is still low and the positive belief is still strong. If not, they address it with more of phase 4 or 5 as needed. New goals and targets are also explored.
What is EMDR reprocessing like?
During the processing, BLS (tapping, eye movement, etc.) is done for brief intervals and in between intervals the therapist asks the client quick, brief questions to guide the reprocessing. There are three levels of EMDR the therapist and client can choose from, and the therapist asks different questions in each: unrestricted (traditional), contained, and restricted.
Unrestricted is focused on opening up insight and exploration in addition to desensitization. In unrestricted EMDR, the therapist asks “what do you notice?” It is very open ended and trusts the client’s brain to find the path where it needs to go. It is the “choose your own adventure” version of EMDR for your brain.
When the therapist and client want to focus on their target and not go wherever the brain decides to go, they can use contained processing, in which the therapist asks the client “what is different about the incident now?” The “incident” refers to whatever the target memory is about and asking what is different can lead the client to new insights about their memory and experience, while still desensitizing the client to the distress around the memory.
If the therapist and the client want to focus only on desensitizing the target memory and/or want to contain the emotion that the client might feel, they can use restricted EMDR in which the therapist asks the client to quickly rate how disturbing the incident is from 1-10. In restricted EMDR the client is not asked open ended questions and following where their brain takes them.
How is EMDR different from other therapies?
While other therapies try to change feelings, thoughts, and behaviors, EMDR works to change the way the memory is stored, processing it adequately so that the resulting symptoms can be reduced and/or eliminated. EMDR and other somatic (body focused) therapies are thought of as a bottom up approach, starting with emotions and bodily sensations connected to the memory with a resulting change in beliefs and behaviors, rather than a top down approach that focuses on changing beliefs in order to change emotions and behaviors (like cognitive-behavioral therapy).
EMDR does not require clients to expose themselves to the distressing memory over an extended period of time, talk about their distressing memories in great detail, complete homework, or try to challenge their beliefs.
Both the therapist and the client talk less than in other therapies during the active processing phase of EMDR. This is to help the client not be “in their head” and stay connected to their body instead. We don’t want to turn on the active thinking part of the brain. Instead, the therapist and client want to get out of the brain’s way and just let it do its thing.
What are the different ways EMDR can be done in person and online?
EMDR can easily be adapted to be online or in person and both are equally effective. In person, traditionally the therapist sits close to the client without touching, and moves their fingers back and forth while the client follows the movement with their eyes. If done virtually, the therapist simply moves their fingers back and forth across the screen and the client follows along.
However, there are many ways to do bilateral stimulation (BLS) that clients may prefer regardless of format. The one I prefer is when the client crosses their arms and taps their own shoulders left and right, also called the butterfly hug. I find it is a soothing gesture for clients to use as it is similar to a self-hug and therefore feels very containing for clients to use. The other reason I prefer it is that for many people, the eye movement can feel a bit dizzying, too distracting, or too vulnerable.
Other therapists and clients may use a light bar with a light that travels left-right for clients to follow with their eyes, buzzers to hold in the hands that buzz left-right, or headphones that play left-right tones. These may be done virtually for clients who wish to purchase these options or who can borrow them from their therapists. Self-tapping may also be done tapping the tops of the thighs or with tapping the feet on the floor.
Who and what is EMDR for?
Initially EMDR was developed as a treatment for trauma and post traumatic stress disorder (PTSD), but has since been shown to be effective for a wide range of problems including:
Anxiety
Depression and bipolar disorder
Distress related to chronic illness and medical issues
Pain
Panic attacks
Performance anxiety
Phobias
Poor sleep (due to emotional distress)
Substance abuse
While no treatment works 100% of the time with 100% of people, EMDR is well suited for most any problem someone wants to address in therapy because painful experiences (i.e. memories) underlie most emotional difficulties. Additionally, it can be easily adapted for virtual or in person, or for a person with a visual impairment of some kind.
Who is EMDR best suited for?
In my experience, EMDR is a great fit for clients who:
Feel stuck in painful past experiences with distressing physical and emotional reactions when the memory is triggered
Have maxed out on how much benefit they have gotten from top down therapies like cognitive behavioral therapy
Have an internal conflict between what they know to be true intellectually vs what feels true internally (for example, a client knows logically they have worth and value but still struggles with feelings of worthlessness or a client who knows their current partner is safe but their body is still reacting as if they are in an abusive previous relationship)
Overly rely on logic and thinking to solve problems and have a harder time connecting to their bodies and emotions and turning their thinking brain off.
Who should not do EMDR?
I’m hard pressed to think of people for whom EMDR isn’t a good fit but there are a few groups. EMDR is not indicated for people experiencing psychosis, although this is currently being studied so this may change in the future. It also requires the ability to access a safe place for the therapy sessions, free from interruptions and distractions. It also should not be done with clients who are intoxicated. And of course, EMDR shouldn’t be done with anyone who doesn’t want to do it!
It is sometimes said that EMDR should not be done with clients who have traumatic brain injuries (TBIs) or who are pregnant, but the research does not support this. EMDR is safe for pregnancy and can be easily modified to accommodate a brain injury history.
Start EMDR Therapy in Manhattan Beach:
Are you interested in trying EMDR to help you get unstuck? Meeting with an EMDR therapist can help you properly process painful memories to reduce distress and help you reach your goals. If you’d like to try EMDR to see if it can help you too, follow these steps.
Reach out for a consultation at Well Woman Psychology, or if you aren’t located in a state Dr. Baggett is licensed in, you can search for providers on the EMDRIA (EMDR International Association) directory.
Meet with your EMDR therapist.
Support your brain as it connects with its own innate ability to heal.
About the Author:
Dr. Linda Baggett is a Licensed Psychologist and the owner of Well Woman Psychology, a woman-focused practice serving clients online in California, Illinois, New York, and Washington. She earned her PhD in Counseling Psychology from the University of Memphis and has training in a variety of evidence-based therapies. As an EMDR therapist and trauma and PTSD psychologist, she specializes in helping people heal from trauma, so that they can live their best lives. She also helps clients where trauma overlaps with relationship issues, sexuality, pregnancy loss and miscarriage, birth trauma and postpartum issues, infertility, and body image and size-based oppression.
Disclaimer:
Disclaimer: This blog is for educational and informational purposes only, is not a substitute for individual medical or mental health advice, and does not constitute a client-therapist relationship.