EMDR Therapy: How it Works, Benefits, Uses, and Side Effects - PsychCentral.com

Developed by trauma therapists, EMDR helps your brain process and release traumatic memories in an unusual way — through your eye movements.

If you've experienced trauma, you'll know just how much hold it can have over you. Intense dreams, flashbacks, and anxiety-induced isolation can bring your daily life to a halt. Sometimes, it can be a challenge to leave your home at all.

While traditional talk therapy and medications are the main treatments for post-traumatic stress, you might be wondering what other options are out there.

Eye movement desensitization and reprocessing (EMDR) therapy was developed by Dr. Francine Shapiro in 1987 to treat post-traumatic stress disorder (PTSD). This therapy uses eye movements (or sometimes rhythmic tapping) to change the way a memory is stored in the brain, allowing you to process it.

This therapy aims to help you work through painful memories with your body's natural functions to recover from the effects of trauma.

EMDR therapy is considered a new, nontraditional form of psychotherapy. Therapists mostly use it to treat PTSD or trauma responses.

This therapy is based on the theory that traumatic events aren't properly processed in the brain when they happen. This is why they continue to affect us — with nightmares, flashbacks, and feelings of the trauma happening again — long after the actual trauma is over.

When something reminds you of the trauma, your brain and body react as though it's happening again. The brain isn't able to tell the difference between the past and the present.

This is where EMDR comes in. The idea, known as the adaptive information processing model, is that you can "reprocess" a disturbing memory to help you move past it.

This therapy aims to change the way that the traumatic memories are stored in your brain. Once your brain properly processes the memory, you should be able to remember the traumatic events without experiencing the intense, emotional reactions that characterize post-traumatic stress.

During an EMDR therapy session, your therapist will ask you to briefly focus on a trauma memory. Then, they'll instruct you to perform side-to-side eye movements while thinking of the memory. This engages both sides of your brain and is termed bilateral stimulation.

If you have visual processing issues, your therapist may use rhythmic tapping on both of your hands or play audio tones directed towards both ears.

One theory behind how EMDR works is that it helps the two sides of the brain to communicate with one another — the left side, which specializes in logic and reason, and the right side, which specializes in emotion.

Experts don't know exactly how EMDR works. Ongoing investigations point out that it's a complex form of therapy and likely has many mechanisms of action.

A review of 87 studies on EMDR found that two theories held the most promise: the working memory theory and the physiological changes theory.

Working memory theory

According to this theory, EMDR works through competition between where the brain stores information on sight and sound and where it processes working memory.

In this theory, recalling a memory at the same time your eyes are moving back and forth forces your brain to split its resources. You can't dedicate all of your focus to memory recall because you're also focusing on visual stimulation.

This split-focus can make any disturbing images you recall less vivid, and you may feel comfortably distanced from them. In this way, you might feel the emotional impact of the memories less strongly.

The bilateral brain stimulation might also help you feel more relaxed. As the memories grow less and less vivid, your brain might start to associate the memory recall with relaxation rather than emotional shock, which results in desensitization.

Physiological changes theory

Some researchers have found that performing eye movements in EMDR can invoke physiological changes in your body — a lowered heart rate, slower breathing, and decreased skin conductance — all of which are markers of relaxation.

This suggests that something about bilateral eye movements can alter how your nervous system is responding, allowing you to move away from an anxious fight, flight, or freeze response and toward nervous system regulation.

Other theories

Other theories about the way EMDR therapy works include:

• Rapid eye movement (REM) sleep phase replication. Back-and-forth eye movements may help the brain consolidate memories in the same way it does during REM sleep.
• Thalmo-cortical binding. Eye movements may directly impact a brain region called the thalamus, which may cause a cascade of cognitive processes that allow greater control over emotional distress.
• Structural brain differences. Structural and functional brain differences may exist in people who respond well to EMDR therapy.

Much of the research involving EMDR therapy is on its use in working with trauma and treating PTSD.

A mental health professional may also recommend this therapy for:

With EMDR, you'll usually have one or two sessions per week, about 6 to 12 sessions in total. You may require more or fewer sessions depending on your individual response to therapy.

There are eight phases to EMDR therapy. Here's what to expect:

Phase 1: History taking

First, you'll work with your therapist to develop a treatment plan and treatment goals. This might include talking about your history, what emotional triggers and symptoms you experience, and what you'd like to achieve from therapy.

Your therapist might also determine whether you'd benefit from therapies or treatments alongside EMDR.

Phase 2: Preparation

Your therapist will then walk you through the therapeutic process, explain how EMDR works, and answer any questions.

EMDR therapy often takes multiple sessions to see progress. Your therapist can help you develop coping methods to help you manage your emotions both during and between sessions. This can include stress reduction techniques, such as breathing exercises and resourcing techniques.

Phase 3: Assessing the target memory

The goal of phase 3 is to identify and evaluate the memory causing your emotional distress.

Imagery, cognition, affect, and body sensation related to the memory are all assessed on diagnostic scales. Your therapist will use this as a starting point to track your progression through the EMDR treatments.

Phase 4–7: Treatment (desensitization, reaction, installation, closure)

Phase 4 marks the beginning of the memory desensitization process.

During your session, you'll be asked to recall parts of a distressing memory. As you do this, your therapist will cue you to perform specific eye movements.

Once you've finished recalling the memory or feeling, you may be asked about the thoughts, feelings, and reactions you experienced during the recall.

Noting these responses is another means of helping track the progress of your EMDR therapy. The goal is to "install" improved emotional responses and positive beliefs within each session.

Remember, your mental health team has your best interests in mind at all times during your therapy session. If you experience distress, your therapist can help you work through those feelings and come back to the present.

At the end of your session, your therapist will determine whether the memory was fully reprocessed based on your responses. If the reprocessing is incomplete, they'll do a resource or stress-reduction exercise with you in order to ensure that you feel OK before ending the session.

They'll also review which coping strategies you can use to manage your emotions and keep yourself safe until the next session. Not all memories can be processed in one session.

Phase 8: Re-evaluation

At the end of each therapy session, both you and your therapist will evaluate the effects of the treatments, what memories have been uncovered, and which memories to target next time.

At the end of your therapy program, after you've targeted all the memories you've wished to, your therapist will complete a Future Template. In this exercise, they'll use the bilateral stimulation again as you walk through an imagined future scenario of handling any previously triggering situations.

While the exact mechanisms behind EMDR remain up for debate, this therapy is recognized as an effective treatment by a number of national and international organizations, including the World Health Organization (WHO) and the American Psychiatric Association (APA).

A 2018 review provides supportive evidence for the mechanisms behind EMDR, and other research continues to support this therapy's effectiveness.

In 2019, a narrative review looked into the results of seven randomized controlled trials that involved early EMDR interventions. The researchers concluded that EMDR early interventions significantly reduced symptoms of traumatic stress and prevented symptoms from becoming worse.

Other review studies have also found positive results from EMDR therapy:

• A 2018 review, conducted using eight databases of current studies, found that EMDR improved PTSD symptoms and was more effective compared to some traditional trauma therapies. However, they noted that much of the current evidence relies on small sample sizes.
• A 2018 review focused on 15 studies involving the use of EMDR therapy for children with PTSD. Researchers found that all studies in the review showed reduced PTSD symptoms, as well as other trauma-related symptoms, in children.
• A 2017 review looked at how EMDR therapy could impact conditions outside of PTSD. The results showed that EMDR therapy was a promising option for trauma-related symptoms in psychotic, affective, and chronic pain conditions.
• A 2017 review suggested that, though the research is currently limited, EMDR could have potential as a treatment for depression.

Most forms of therapy can have side effects. These secondary reactions can range from mild to severe, even with EMDR therapy.

Before you start an EMDR program, a mental health professional may warn you about potential side effects, such as:

• strong emotional fluctuations
• increased recall of traumatic or distressing memories
• vivid, intense dreams
• feelings of vulnerability
• lightheadedness
• physical stress responses (nausea, headache)

Part of your EMDR therapy plan will may include developing ways to manage these challenges if they arise.

Your healthcare team can recommend focus and relaxation methods or prescribe medications to help manage symptoms during treatment.

Past memories can do far more than just create feelings of sadness. If you've experienced trauma, these memories can impair your daily functioning.

Sometimes memories are so painful that they "freeze" you in that moment. You're unable to get out, and it may feel easier to avoid those thoughts completely.

When this happens, people, places, and events, continue to bring out the emotions of trauma long after it's passed.

EMDR therapy can help you break the freeze cycle by allowing your brain to process memories in a less painful way.

EMDR can be an emotional process, but you're never alone. If you're considering self-harm or suicide, help is available right now:

To learn more about EMDR or to access online support networks, publications, therapist finders, and other resources, visit The EMDR International Association (EMDRIA).

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