How Does EMDR Work?

What Is EMDR Therapy & How Does It Work?

Throughout EMDR treatment, a therapist guides their client through the process of identifying specific problem areas or “targets” found in 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 can experience relief from the mental health symptoms of PTSD, anxiety, depression, and more.

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.

Who Needs EMDR Therapy?

EMDR therapy has proven to be efficient for a wide range of populations and conditions. EMDR is increasingly gaining recognition as a primary intervention not only for trauma-related issues (like EMDR for PTSD) but also for helping adults and children better cope with a variety of problems, including psychological concerns like anxiety, depression, phobias, and significant life altering events such as grief and loss, as well as for medical conditions like chronic pain.¹

EMDR requires a level of readiness and commitment to address and work through unprocessed trauma. Thus, this intervention is best suited for people who have developed a degree of coping resilience, are in a balanced mindset, and live in a stable and safe environment. Moreover, since EMDR often elicits disturbing memories and strong feelings, this therapy is most appropriate for someone who isn’t dealing with an immediate crisis and is able to tolerate and handle distressing emotions.¹

The 8 Phases of EMDR

EMDR always follows an eight-phase protocol. The eight phases allow for the therapist to properly prepare and educate the client before jumping into the actual process, and also leaves time for the therapist to help the client develop appropriate coping strategies before confronting difficult memories and feelings. The final phase offers time to evaluate the efficacy of the treatment and whether more needs to be done.

Here are the eight phases of EMDR:

1. History & Treatment Planning

The first phase of EMDR focuses on target identification, often taking one full 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, EMDR 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 bilateral 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 desensitized 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 debriefing, 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.

Why Does EMDR Work? The Science Behind EMDR

To better understand why EMDR works, it’s important to look at the scientific theories behind it.

Here are a few theories that explain why EMDR works to improve mental health:

The Working Memory Theory

According to this theory, recalling a memory while simultaneously moving the eyes back and forth compels the brain to divide its attention. This split focus can make any distressing image feel less intense when recalled and, in some cases, harder to remember—allowing the person to more easily detach from them. In this way, an individual might become less emotionally reactive when remembering the disturbing memory.²

The Physiological Changes Theory

It has been found that eye movements in EMDR can produce physiological changes in the body, including slower breathing and lowered heart rate, which are signs of the relaxation response. This means that the process of the bilateral eye activity can impact the nervous system, allowing the person to disengage from the stress-related arousal and shift toward a more centered state in their body.³

The Sleep Phase Replication Theory

This theory postulates that the eye movements that occur during EMDR therapy may help the brain organize recollections in a similar way that it does during REM sleep. Vast studies have demonstrated that REM sleep provides several healthy functions including memory consolidation, which can help neutralize emotionally charged memories. This means that EMDR can promote the reconfigurations of the traumatic memories which in turn will likely reduce the intense discomfort associated with the memories.⁴

What to Know Before Starting EMDR

If you are considering EMDR, it’s important that you’re fully aware of what to expect from the treatment and the possible effects it may have on you.

Here are some things to consider before you start EMDR therapy:¹

• “Revisiting” your trauma is not usually prolonged: Many people often worry that with EMDR they’ll have to relive a traumatic memory for an extended period. However, that’s not usually the case. And, if the intensity increases, the therapist helps the person pace themself and cope before feeling too distressed. That’s why many clients often find it easier or more comfortable than they imagined.
• You might have more vivid dreams: After an EMDR session, it’s not uncommon for sleep to be affected as a person begins to reprocess traumatic events. Some people experience vivid or unpleasant dreams, and may feel more susceptible to interactions with other people or things in their environment.
• You might have a temporary spike in emotional distress: As other therapies, a temporary surge in distress can be expected throughout the course of EMDR treatment. Some may experience sudden emotionally charged reactions or uncomfortable bodily sensations during and in between sessions, but a skilled professional will provide the tools and strategies to support the client when they feel distressed.

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.

Potential side effects of EMDR can include:

• Fatigue
• Feeling emotional
• Vivid dreaming or nightmares
• Feelings of relief
• Increased relaxation
• Feeling energized

What to Expect After EMDR Therapy

Results after EMDR treatment vary from person to person. As treatment progresses, clients report both significant, overt improvements as well as subtle realizations. This frequently includes overall increased resilience to life stressors.

What to Expect After an EMDR 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.

What to Expect After EMDR 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 later on.

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.^5,6 Studies found that 45% to 93% of participants no longer fulfilled the diagnostic criteria for PTSD following EMDR treatment.⁶

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.^{6,7,8,9,10,11} EMDR is also considered one of the most cost-effective mental health treatments for trauma recovery.⁵

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 a 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.