Updated: Oct 22
EMDR stands for Eye Movement Desensitisation and Reprocessing. This is a structured, eight-phase therapy that can improve the psychological effects of trauma. EMDR has a strong evidence-base for Post Traumatic Stress Disorder (PTSD), but can also be used to improve distress in other health presentations like panic, pain and anxiety.
How does it work?
Unprocessed traumatic memories come back in the form of intrusive thoughts, flashbacks, unexplained pain, or repetitive behaviours, all of which can cause intense negative emotions such as anxiety, anger or shame. In EMDR you work with the therapist first to trace these difficulties back to the trauma-wounds from which they stem. Then, to 'file' these unprocessed memories into the right parts of your brain (and body) so that they no longer feel so real or intense, this phase of therapy is called trauma-processing.
When you get to this phase, the left and right hemispheres of your brain are stimulated in quick succession: known as bilateral stimulation. This is done through rapid eye movements (by following the therapist's finger or watching a lightbar), tapping or beeps in your ears through a headset. This is not a painful process and the therapist will help you choose the method that suits you best.
The path to recovery is considered to be similar to the Rapid Eye Movement (REM) stage of sleep: when our eyes move back and forth very quickly under our eyelids and we dream. During this stage of sleep our brain makes sense of day's events and as such the memories become less emotionally charged.
Following a traumatic event the body's natural ability to process the traumatic memory can get interrupted due to the strong physical and emotional intensity of bringing it to mind. In EMDR therapy we start by creating a safe space, alongside soothing skills, so that we can then revisit the trauma-wound; here we then use the bilateral stimulation to release the stuck trauma and move through it so you feel better.
What actually happens in an EMDR session?
The processing of memories only happens once you and the therapist have a clear idea of the trauma memories that are holding you back (the assessment phase) and have covered techniques for calming your nervous system (preparation phase). So early sessions involve discussing your background, developing an understanding of why these traumas have contributed to your difficulty, and learning coping skills like visualisations, grounding and soothing breathing.
Then, in the trauma processing sessions, your therapist asks questions that will activate the neural networks linked to the traumatic memory (the image, the emotion, any body sensations and beliefs about yourself). Once these neural networks are lit up you start the taps, eye movements or beeps and this enables you to start moving through the traumatic material. Most people don't talk at the point so it can feel quite different to any talking therapies you've tried. This part is free associative, meaning that your brain is following associations in a freeform way, it can feel a bit like dreaming does; you don't know what to expect next, so for some people it can take a few moments to get into this (which the therapist will support you with).
A metaphor we often give at this stage is to imagine you are on a train watching out the window at the scenery passing by. Sometimes scenery passes slowly, at other times it speeds up. Scenery can include images, emotions, thoughts and physical sensations. You are always in charge of what happens in the session and can ask to pause whenever you need. The therapist supports you to stay anchored in the present, so you are aware that you are watching scenery from the safety of the train, and that it is not happening again.
The therapist will pause the bilateral stimulation at certain points to check in with you, asking you what you noticed (what the last bit of scenery was from your window), and guide you if the material is very intense or you don't feel that there is any movement happening.
In some sessions you may be able to process one whole traumatic memory, or even two, meaning it's come to a point where you no longer feel distressed by it. At other times we will need to come back to the same traumatic incident to resume work the following week. When this happens we close the session down using the soothing practices and visualisations that you learnt in phase two of the EMDR. We advise client to keep notes between the processing sessions of any fresh insights or dreams, which can become more vivid afterwards.
After we have processed the trauma we strengthen the more positive beliefs about yourself that have come up in this time, then we discuss the new, adaptive understandings and meanings of the event, considering how to weave these into your every day life.
Most people will notice the memory becomes less emotionally charged. So whilst the memory is still there it is now held differently in your brain and nervous system. It might not become a positive memory but will be held more lightly now, for example you may not blame yourself anymore or feel that you were a failure, you may not feel panicky or get overwhelmed by it. Most importantly, the belief about yourself becomes more adaptive and healthy, for example you may stop believing "it's all my fault", or "I'm not good enough". As a result your emotions become more balanced, your self-esteem should improve and unhealthy coping behaviours can reduce.
How effective is EMDR?
EMDR is an evidence-based therapy for Post-Traumatic Stress Disorder (PTSD). In the UK the choice of therapies offered to NHS patients is informed by the recommendations from the National Institute of Clinical Excellence (NICE) who currently recommend EMDR as one of the trauma-therapies that should be available for PTSD.
In particular you may be considering whether to choose EMDR over other evidence-based trauma-therapies such as Trauma-Focused Cognitive Behaviour Therapy (TF-CBT) and Cognitive Processing Therapy (CPT). This large meta-analysis (an analysis of multiple studies) in 2019, found EMDR to be more effective than Cognitive Behavioural Therapy in alleviating specific symptoms of distressing intrusive thoughts (like flashbacks or nightmares), and heightened anxiety. Additionally, this study showed that it had a bigger impact on PTSD symptoms in both the short and long term when compared with other trauma-therapies.
However, many therapists offer EMDR for difficulties beyond PTSD, such as social anxiety, health anxiety, depression, or pain; particularly where trauma has been identified as being a causal factor in these difficulties. Evidence for the effectiveness in applying EMDR to these other mental health issues is still considered to be in the 'emerging' stage. Researchers conducting a review of the literature in 2021 found a trend towards positive reports of EMDR but, concluded that more studies are still required to build a fuller picture.
Some of the most recent publications into EMDR therapy shows it can be effective in supporting people with:
How to choose an EMDR therapist
EMDR therapy should be carried out by a therapist with pre-existing core mental health training, for example as a psychologist, psychotherapist or counselling. EMDR therapists who are accredited practitioners have done the pre-requisite number of hours of EMDR therapy, supervision and reflective practice to demonstrate their skills. You can find an accredited EMDR therapist on the EMDR Association website.
EMDR can be offered in the traditional way of once-a-week sessions but there is also a strong evidence base for offering it in an intensive format which includes longer sessions in a condensed timeframe. Read more about my offering of this here.
We have several EMDR trained therapists as part of this online therapy service. If you are considering EMDR therapy please get in touch here to discuss with us.
You may also find it helpful to read my blog post How many sessions of therapy will I need?