Eye movement desensitization and reprocessing (EMDR) is a protocol-based, neuro-biological mental health treatment. It works by targeting specific events, memories, negative beliefs, intense emotions, and strong body sensations for desensitization. The mind and body become less disturbed and are able to make new, more accurate connections about the self, past events, and current stressors.
How Does EMDR Therapy Work?
Throughout EMDR treatment, a therapist guides their client through the process of identifying specific problem areas or “targets” find the client’s life. The client and counselor work through the activation, desensitization, and reprocessing stages one target at a time. As targets find resolution, the client experiences relief from the mental health symptoms of post-traumatic stress disorder (PTSD), anxiety, depression, and more.
EMDR treatment for single incident issues, like a car accident, can find resolution between six and eight visits. In general, each session is 60 or 90 minutes in length, and it is recommended to attend EMDR sessions one to two times per week. EMDR can be done online or in person.
8 Phases of EMDR
The eight phases of EMDR structure the treatment process; they each involve a different part of the therapy.
Here are the eight phases of EMDR:
1. History & Treatment Planning
The first phase of EMDR focuses on target identification; it often takes one session to complete. Target selection begins with an assessment of past, present, and predicted future associations of the client’s symptoms. The most common targets are memories and current triggers. Targets discovered during this phase create the outline for the remaining phases.
Phase one also includes an assessment of the client’s ability to manage and cope with stressors and symptoms. This guides the amount of time spent in the next phase.
2. Preparation
Since EMDR works by activating difficult content, side effects include strong emotions, dreams, and temporary discomfort. During phase two, the client learns EMDR coping skills, or “resources,” to ease potential and temporary side effects during or between sessions. The client also practices the mechanics of the dual-attention stimuli, like eye movements, while focusing on positive content. This phase is typically one to two sessions.
3. Assessment
Phases three through seven are done together in one session, assessing and desensitizing targets one by one until all identified targets have been resolved. The assessment phase involves accessing and activating difficult content within the identified targets. The client will focus on one target at a time and elicit associated disturbing mental images, negative beliefs, feelings, and physical sensations.
The intensity is ranked by the Subjective Units of Disturbance (SUD) scale from 0 to 10. The client will also identify adaptive, alternative, or positive beliefs to replace the negative beliefs as the target finds resolve.
4. Desensitization
Once the target content has been accessed and activated, the client will participate in the desensitization phase by using dual-attention stimuli. This mechanic is referred to as bi-lateral stimulation (BLS) when alternating between each side of the body. The most common are eye movements, self-tapping, or alternating sounds through headphones. Modern methods include non-bilateral mechanics like general body movements or mental math.
The therapist guides the client in focusing on both the activated target content and simultaneous dual-attention stimuli activities. This causes the brain to begin desensitizing negative and disturbing content, which improves symptoms, facilitates resolution, and promotes an overall sense of wellbeing for the client. Phases three and four will remain focused on a single target until the SUD scale reaches 0 or 1.
5. Installation
The installation phase increases the brain’s connections to positive cognitive networks. The client focuses on the neutralized target and previously identified alternative or positive belief while simultaneously engaging in dual-attention stimulation activities. The belief is ranked on a Validity of Cognition (VOC) scale running from 1 to 7. Installation continues until the client reports that the belief feels “the most true it could possibly feel,” (a VOC of 7).
6. Body Scan
This phase occurs after the client reports a SUD of 0 and a VOC of 7, meaning the target no longer activates disturbance, negative feelings, or intrusive images and the alternative or positive belief feels very true. The client mindfully scans their body while thinking about the neutralized target to determine if disturbances remain (e.g., a knot in the stomach or tension in the shoulders).
If a disturbance is detected, the client focuses on the identified body sensation while simultaneously participating in dual-attention stimuli activities until the sensation dissipates or becomes positive. When a client reports no remarkable negative body sensations while thinking about the target, it’s considered a “clear body scan”.
Once a target is resolved, it is called a “0-7 Clear,” and the target is considered “complete.” Sessions that end before the target is resolved are considered “incomplete” and reprocessing continues into the next session. Each target will be desensitised and reprocessed in this way until treatment goals are met and symptoms subside.
7. Closure
The closure phase occurs at the end of each session, regardless of if the session is considered complete or incomplete. The counselor will provide time for debrief, grounding exercises, and any stabilization exercises that may be necessary. The counselor will prepare the client for any needs between sessions, including any potential side effects from the session content.
8. Evaluation
The evaluation phase occurs at the beginning of each reprocessing session. The client reports anything they experienced between sessions including side effects, improvements, and reductions in symptoms. If the last target was considered complete, the counselor will begin the phase three assessment of the next target in the treatment plan (phase one).
If the target was considered incomplete, the counselor will facilitate the activation of the target’s negative associated content, evaluate the SUD scale, and move onto phase four for continued desensitization.
What to Expect After EMDR Therapy
Results from participating in EMDR treatment vary per individual. As treatment progresses, clients report both significant, overt improvements and subtle realizations. This frequently includes overall increased resilience to life stressors.
After a Session
The client experience immediately following an EMDR session depends on the session content. Certain incomplete sessions may result in the client feeling temporarily worse. Other times, clients end sessions feeling significantly better. As a target resolves, clients report that the negative content feels far away with faded imagery. The associated negative beliefs that drive intense feelings are often reported as no longer holding significance.
After Treatment Is Complete
Goals with any mental health treatment include reducing the intensity of symptoms and increasing resilience. EMDR specifically targets past experiences that inform current responses to events, as well as potential future events that may instigate current anxiety. As a result, the client is able to face challenges with increased confidence, improved ability to remain in the present, and enhanced skills to understand oneself.
Depending on the client’s specific needs and number of goals, EMDR treatment may be short-term or longer-term. The treatment may be combined with general psychotherapy or traditional talk therapy prolonging the treatment time. It is common for clients who have experienced significant results from EMDR to re-engage in treatment to work on additional goals.
Side Effects of EMDR Therapy
An effective EMDR therapist will review potential side effects, concerns, and fears about EMDR treatment before beginning the protocol. In general, EMDR is considered an expedited therapy process, which may result in an increased intensity of common counseling side effects.
Side effects of EMDR can include:
- Fatigue
- Feeling emotional
- Vivid dreaming or nightmares
- Feelings of relief
- Increased relaxation
- Feeling energized
Is EMDR Effective?
Dozens of studies confirm EMDR as an effective and evidence-based practice for treating PTSD, anxiety, and depression. Participants reported a 36% to 95% reduction in symptoms of PTSD, with similar drops in symptoms of anxiety, depression, and co-morbid psychosis.1,2 Studies found that 45% to 93% of participants no longer fulfilled the diagnostic criteria for PTSD following EMDR treatment.2
At follow-ups that took place 6 to 18 months after treatment, clients reported continued relief of symptoms and an overall improved quality of life.2,3,4,5,6,7 EMDR is also considered one of the most cost-effective mental health treatments for trauma recovery.1
Finding an EMDR Therapist
Anyone interested in participating in EMDR treatment should look for a qualified counselor who is trained in EMDR by an EMDRIA approved training course. Advanced EMDR providers have achieved certification or approved consultant status. The primary source for finding an EMDR therapist is through an online therapist directory.
Final Thoughts
EMDR is an effective treatment that is quite different from other traditional mental health treatment models. Understanding how EMDR works can help you feel empowered about the process and get the most out of the experience.
