Bilateral Stimulation: What It Is, Effects, & Use in EMDR

What Is Bilateral Stimulation?

Bilateral stimulation is the process of using sounds, tapping, or eye movements on one side of the body before crossing over to the next side, therefore activating both hemispheres of the brain. Bilateral stimulation is actually what people often think EMDR therapy is; however, bilateral stimulation is only one powerful aspect of Dr. Francine Shapiro’s eight phases of EMDR therapy.¹

What Does Bilateral Mean?

The word bilateral means, “affecting both sides.” In EMDR, bilateral stimulation targets both the left and right hemispheres of the brain in order to help the person properly reprocess traumatic memories.

Some examples of bilateral stimulation techniques include:^2,3

• Following a ball during a tennis match
• Alternating stepping on your left and right feet
• Patting your shoulders or knees with your hands, alternating between your left and right sides
• Rocking back and forth from left to right sides
• Listening to music, sounds, or tones with headphones that allow you to alternate between ears

How Does Bilateral Stimulation Work?

We all naturally engage in bilateral stimulation daily, whether we walk, swim, ride a bike, or dance. EMDR uses this natural phenomenon to calm the nervous system and engage the reasoning part of the brain in reprocessing sensory memories.

Some examples of bilateral stimulation techniques used in therapy include:^2,3

• Eye movements: In a therapy session, the clinician may instruct the client to use their eyes to follow the clinician’s fingers, a lightbar, or virtual technology on the client’s computer screen. In play therapy with children, the clinician may use a cute finger puppet or fluffy wand to make it more fun for the child to follow the clinician’s fingers with their eyes.
• Walking/running: This typically involves walking or running while stepping on the ground with alternating left and right feet. The clinician can teach clients these alternating foot motions in a session.
• Tapping/patting: The client may be instructed to pat their own shoulders or knees with their hands, alternating between their left and right sides while following the clinician’s pace. Some clinicians have “buzzers” that vibrate in the client’s hands, going between left and right sides.
• Drumming: Playing the drums involves rhythmic, alternating hand movements, which, in addition to the sound it creates, can be a powerful experience of bilateral stimulation.
• Rocking/swaying: Many parents instinctively know to rock their baby back and forth to soothe them, but may not be aware that swaying is an effective self soothing activity for many adults as well.
• Audio Tones: Some clinicians may play calming music or audio tones using special headphones that alternate sound from the left to right ear, crossing the midline of the body and activating both hemispheres of the brain.

Bilateral Stimulation in EMDR Therapy

There are two types of bilateral stimulation used in EMDR therapy: slow and fast bilateral stimulation. During the preparation phase of EMDR therapy, slow and short sets of bilateral stimulation are used to reduce anxiety and slow their thinking and breathing. On the other hand, fast bilateral stimulation will make connections to additional traumatic material the client may not have identified within their mind and body.

Slow bilateral stimulation teaches clients to maintain dual attention by focusing on the stimuli as well as a positive thought, image, or experience. It also helps the client contain negative material, alter their relationship to the negative trigger, or shift their focus to more positive material. This is typically used during the preparation phases of EMDR therapy, to help clients feel ready for the more challenging phases of the process.

Fast bilateral stimulation can facilitate reprocessing and integration of negative traumatic material that is “stuck,” or dysfunctionally stored, in the client’s neural networks.⁶ Fast bilateral stimulation brings up negative material for the client, which can be very distressing.⁷ It is here that the client’s ability to pay “dual attention” to both their trauma and their existing coping skills is so important. Fast bilateral stimulation links, blends, and consolidates the negative memories, emotions, and physical sensations with positive beliefs, qualities, memories, and skills.⁸

The desensitization, installation, and the body scan phases of EMDR can be thought of as “updating the file” of negative past experiences with current information, perspective, emotions, and wellbeing.

Does the Type of Bilateral Stimulation Matter During EMDR Therapy?

There are several ways that therapists work with clients to implement bilateral stimulation during EMDR therapy. The most common is through the use of left-to-right eye movements. Other methods might include alternating bilateral sounds using headphones, alternating tactile stimulation using a vibrating handheld device, or taps to the back of the person’s hands. It is notable that the majority of the research that has been done on EMDR utilized eye movements specifically as the method of bilateral stimulation.⁷

Conditions That Might Benefit From Bilateral Stimulation

Bilateral stimulation through EMDR can be helpful for a variety of mental health concerns, including trauma, ADHD, anxiety, and more.

Bilateral Stimulation for Integrating Trauma

Bilateral stimulation is a key component of EMDR, an evidence-based treatment proven to decrease symptoms related to PTSD and other trauma-related mental health concerns. By engaging the brain in bilateral stimulation, distressing memories are reprocessed properly using both the left and right hemispheres of the brain.⁷

Bilateral Stimulation for Anxiety

Studies have shown bilateral stimulation used in EMDR to be an effective treatment for anxiety disorders including panic disorder, OCD, phobias, and performance anxiety.⁹ By addressing the anxiety-inducing memory using bilateral stimulation, the person is better able to remain calm in similar situations in the future.

Bilateral Stimulation for ADHD

While one study showed promise for EMDR as a treatment for children with ADHD who have experienced Adverse Childhood Experiences (ACEs), not much evidence exists for bilateral stimulation as a stand-alone treatment for ADHD.⁸

The Potential Benefits of Bilateral Stimulation

Bilateral stimulation can provide a new tool for people to process and recover from traumatic events. The client practices how to regulate their own body, get distance from negative aspects, and changes their perspective on the trauma. People should become familiar with what to expect after an EMDR session, depending on the EMDR phase they are currently exploring in therapy. Bilateral stimulation in EMDR therapy can help alleviate distressing emotional and physiological symptoms of many conditions, including childhood trauma and complex PTSD.

Some common positive effects of bilateral stimulation include:

• Decreased instances of emotional and physiological disturbances
• Increased relaxation
• Can help mitigate effects of trauma brain
• Improved executive functioning
• Allows clients access to some positive aspects of their recovery experience
• Increased awareness of social support systems
• Alleviates symptoms of PTSD, anxiety, stress, and trauma
• Greater sense of resilience
• Improved, healthier coping mechanisms to deal with trauma
• Provides emotional distance between the client and their trauma

Is Bilateral Stimulation Safe?

Bilateral stimulation is safe for most people. In rare cases, such as in a person with a previous brain injury, hypersensitivity to sensory stimuli can occur. People with Dissociative Identity Disorder (DID) may be advised against bilateral stimulation, as various ego states might be activated by sensory changes. People with PTSD who engage in EMDR therapy may experience the emergence of new traumatic memories. If this occurs, the therapist can work with the client to address these new memories.

Overall, EMDR has been found to be more rapid and effective than trauma-focused cognitive behavioral therapy in 7 out of 10 studies.¹⁰ The clinical efficacy of bilateral stimulation in EMDR therapy for PTSD has been proven in many research studies, leading the World Health Organization (WHO) to recommend it as a first-line treatment for PTSD.¹¹

How to Find an EMDR Specialist

When looking for an EMDR therapist, it is important to find a clinician who is certified in EMDR by the EMDR International Association (EMDRIA). These clinicians must undergo additional education and practical training to meet the certification requirements. You can find the right therapist using an online therapist directory and filter by gender, additional specialties, insurance, in-person vs. online EMDR therapy, and more. It is always recommended that clients visit the EMDRIA website to confirm whether a specific therapist you’re interested in has met EMDRIA certification requirements.

Can You Practice Bilateral Stimulation on Your Own?

EMDR should only be practiced by a trained, licensed therapist. However, integrating bilateral practices into daily life can be beneficial for anyone. Even going for a walk outside is an easy way to practice bilateral stimulation on your own. EFT tapping, also known as the Emotional Freedom Technique, is one kind of bilateral stimulation that targets acupressure points to provide relief from mental health symptoms, and is a technique that some people practice regularly on their own.

Dancing, drumming, and horseback riding are activities that you can incorporate into your life that naturally utilize bilateral stimulation. These simple activities can encourage better communication between the two sides of the brain, calming the nervous system.

Final Thoughts

Bilateral stimulation can be a powerful tool in EMDR therapy from the early stages of the preparation process, so it is important that clients and clinicians interested in EMDR therapy become familiar with the technique. Bilateral stimulation provides a number of benefits for people dealing with stress, anxiety, depression, and other concerns; if this sounds like you, finding an EMDR-certified therapist can help you manage your symptoms and improve your daily functioning.