EMDR for PTSD: How It Works, Examples, & Effectiveness

What Is EMDR?

EMDR has a unique approach to treating PTSD by utilizing the mechanisms of the brain and facilitating the brain’s natural process of healing. It also uses techniques from modalities like cognitive behavioral therapy, person centered therapy, psychodynamic therapy, somatic therapy, and behavioral therapy.

How Does EMDR Trauma Therapy Help With PTSD?

EMDR for PTSD works because it specifically focuses on the memory centers of the brain, particular events or triggers, and any neurological associations. The primary difference between EMDR and other therapy approaches is that EMDR works by specifically using dual attention stimuli (DAS) which facilitates the desensitization of traumatic content. This lessens the impact of common PTSD symptoms like flashbacks, triggers of sound or smell, and hypervigilance.

EMDR does not require the person to talk or share events in detail like other therapies, and treatment is often short-term. Clients struggling with PTSD can experience positive treatment effects after a few sessions.

EMDR for PTSD facilitates the nervous system’s existing mechanisms of healing by:

• Desensitizing past traumatic memories so that they no longer trigger a fight, flight, freeze, or fawn emergency response in the body
• Teaching the brain to orient more accurately to time and place, so the mind can recognize that the traumatic event is over and in the past
• Engaging with the upper cortex of the brain that holds rational reasoning and thought; this allows the brain to think more accurately about the events and unlink the mind to irrational, cognitive distortions, ie. “It’s my fault,” “I am unlovable,” etc.
• Reducing vividness and intensity of visual or other stimuli related to specific traumatic memory content
• Activating the parasympathetic nervous system, also known as “rest and digest,” so the body can return to a homeostatic state that promotes a greater sense of ease, a neutral to positive outlook, as well as, smooth digestion and physical healing

Phases of EMDR Therapy for PTSD

The therapist will collaborate with the client to determine the specific goals for therapy and treatment. This includes frequency of sessions, length of sessions, prioritization of memories to focus on, and any preparation work needed. It is most common to meet at least once a week for 60 to 90 minutes. Recent research demonstrates that meeting twice a week for six weeks can bring swift results.³

EMDR therapy for PTSD utilizes an eight-phase protocol:

Phase 1

The first phase takes place where the therapist helps the client map out specific disturbing content including etiological (origin) memories, current triggers, and future potential events.

During this process there is no need for the client to go into any detail about the memories, unless they want to. The list of specific, activating content is called a “target sequence.” The experience of identifying “targets” can be triggering for many clients; therefore, the counselor may choose to start with the second phase of EMDR, called the preparation phase.

Phase 2

During the preparation phase, clients practice specific coping strategies, mindfulness exercises, and stabilization techniques that the client can use during session, at the close of sessions, or in-between sessions.

Phases 3-7

Once the past, present and future targets have been identified (with or without detail), the counselor and client will decide together which memory to focus on first. This is where phases 3 through 7 take place.

The client will activate the content of the specific target selected, including identifying the worst part of the memory, emotions, body sensations, and associated negative beliefs, while the therapist assigns dual attention stimuli (DAS), like eye movements, self-tapping, or auditory sounds.

Activating this memory or triggering content while participating in DAS begins to desensitize the disturbance and allows the mind to make new, healthier, and more accurate connections with the past memory or trigger.

When the traumatic past memory is no longer disturbing and feels neutral, the client will be instructed to conduct a body scan, meaning to mentally “scan” over the body while holding the original memory or trigger. Since traumatic content becomes associated in the body, the protocol is comprehensive enough to also address any physical disturbances like abdominal cramping, muscle tension, irritable bowel syndrome, headaches, etc.

If the body scan is clear, then the target is considered complete. If the client experiences a disturbance, they focus on that particular part of the body while participating in dual attention stimuli (DAS) until that physical sensation dissipates.

Each target will be systematically worked through one by one until it is neutralized, including any origin memories and any current triggers. The client may then choose to participate in future template work, which means imagining future scenarios where content could become activated again. A similar process is applied.

Phase 8

The eighth and final phase includes an overall assessment of the treatment success to make sure that the symptoms have resolved and no disturbances remain.

Common Concerns of EMDR Treatment for PTSD

There are several questions and concerns about EMDR therapy that arise when people initially think about the process of it for treating PTSD.

Here are some of the most commonly asked questions people have before starting EMDR for PTSD:

Will I lose Control of Myself or My Emotions?

The nature of EMDR can be very activating. An appropriately trained EMDR provider will walk you through every specific concern including experiencing strong emotions. The protocol has safety measures in place to prevent anyone from losing control, and the client is in charge of the entire process from beginning to end. Therefore you can stop or take a break at any time.

Will This Cause Me to Forget?

Using EMDR to desensitize memories can cause them to become altered. If you have any legal issues that require you to recall certain information or details, such as giving a testimony, it is best to wait to undergo EMDR treatment until after the legal proceedings.

The memories do not disappear, but become less vivid, and less triggering. They become a part of your story as a “normal memory” that no longer hijak the emergency system in your brain when the danger is over, or when no actual danger is present.

What If I Need to Keep the Memory in Order to Protect Myself?

It is a common concern that by desensitizing memory content, one might be disarmed or feel they are without protection since the memory triggers us to be cautious and possibly take certain actions or safety measures. It is important to remember that the body is supposed to return to homeostasis, or “rest and digest” once a traumatic or dangerous event has passed.

Desensitizing this content does not put us in danger, in fact, it equips us to respond more effectively because the body and brain is free to respond to the current situation or danger right in front of us without these past traumatic events interfering.

How Do I Still Honor Those who I Lost During These Events or am I Betraying Those who Lost Their Lives?

When traumatic memories become “normal memories” we are better able to serve those who we wish to remember well. Healing from these events provides the space and ability to celebrate them.

When the memories are stuck in the emergency center of the brain, it is much harder to honor them because it is too triggering. Again, traumatic memories are not erased, just changed into healthier more adaptive memories.

What if I Can’t Remember What Happened or Only Have Fragmented Parts of the Event?

It is not uncommon for traumatic or dangerous events to overwhelm the memory centers of the brain causing only somatic (body) memory or fragmented parts of a memory in the mind. EMDR is very successful in working with fragmented memories or even body based memories where there are no words or visuals.

What if I Don’t Know What Started My Symptoms of PTSD?

During phase 1 of EMDR, the counselor will help you work through the process of identifying etiological events.

Is EMDR Effective for Treating PTSD?

The treatment of PTSD is the most commonly researched topic among EMDR studies. There are over 2400 listings in the Francine Shapiro Library and more than 30 randomized controlled trials demonstrating the effectiveness of EMDR with patients with debilitating mental health conditions, including PTSD.² Studies have shown a 36-95% reduction in PTSD symptoms by the end of treatment.^1,2 Other studies found that 45-93% of participants no longer fulfilled the diagnostic criteria for a PTSD diagnosis after EMDR treatment.²

EMDR is recommended for the treatment of PTSD by over a dozen associations and guideline authorities both nationally and internationally. This includes the American Psychological Association,⁴ the American Psychiatric Association,⁵ The Department of Veterans Affairs and Department of Defense,^6,7 the International Society for Traumatic Stress Studies,⁸ and the National Institute for Health and Clinical Excellence.⁹

How to Find an EMDR Therapist

One of the most common ways of finding an EMDR therapist is word of mouth. Some primary care physicians, or even talk based therapists will be able to refer you to a reputable EMDR provider. In addition, most online therapist directories have the option to select EMDR as a treatment modality when conducting a search in your area. Please also remember that EMDR can be conducted both in-person and online when treating PTSD.

Final Thoughts on EMDR Treatment for PTSD

Anyone struggling with PTSD can benefit from looking into EMDR treatment. It is a proven, effective intervention for addressing symptoms of PTSD with short-term and significant results. EMDR clients are often able to find relief without ever having to disclose the memory.