EMDR was born of serendipity. As a survivor in the human condition, there is a frequent dance with stress or anxiety. Some individuals can overcome it more easily than others. As neuroscience instructs us, we can emerge from cyclical thought patterns. The search for ways we can improve coping strategies and address mental health has led to the development of modern therapies. Any effective tool that helps us deal with issues stemming from our mental health can impact the quality of our lives.
New types of psychotherapy are emerging, sometimes in advance of a theory showing their effectiveness. Sometimes they undergo scientific studies after they are launched. One therapy, in particular, has garnered attention over the years due to its effectiveness in treating people suffering from anxiety, Post-traumatic Stress Disorder (PTSD), or trauma: Eye Movement Desensitization and Reprocessing or EMDR.
History of EMDR
EMDR is a byproduct of chance observation. In 1987, while psychologist Francine Shapiro was walking in the park, she realized that eye movements seemed to reduce the intensity of disturbing thoughts when her own stress reactions diminished after moving her eyes back and forth while observing her surroundings. She experimented with this procedure with her clients and found that they, too, had a similar response to eye movements.
However, it appears that eye movements by themselves may not create comprehensive therapeutic effects. This observation led Shapiro to add other treatment elements, including a cognitive component and developed a standard procedure she called Eye Movement Desensitization (EMD).
After an initial published study investigating the treatment of PTSD using the EMD method in 1989, Shapiro continued to develop this treatment approach, incorporating the feedback from clients and other clinicians using EMD. A couple of years later, in 1991, Shapiro changed EMD to Eye Movement Desensitization and Reprocessing (EMDR) to reflect the insights and cognitive changes occurring with the treatment.
She also developed the information processing theory to explain the treatment effects, which have since been clinically validated by more than thirty randomized, controlled studies — the gold standard of clinical research.
What is EMDR?
EMDR is an interactive psychotherapy technique that involves recalling a stressful past event in a safe and measured way while using rapid eye movements to facilitate the process. Typically, symptoms occur when trauma and other challenging experiences cause your brain to remain hypervigilant, suppressing your memory and impulse control and overwhelming your brain’s natural ability to heal.
Based on that premise, EMDR incorporates elements of cognitive-behavioral therapy (CBT) with bilateral eye movements while consciously re-experiencing your trauma in an environment where you feel safe (therapist’s office) until those memories no longer cause distress.
Who May be a Candidate?
EMDR therapy, with its extensively researched and proven effectiveness, has invited therapists to incorporate this treatment to other conditions, including sexual dysfunction, eating disorders, schizophrenia, depression, and even dementia. This treatment approach can help relieve psychological trauma for millions of people of all ages. In addition, some healthcare providers specialize in EMDR to treat children with mental health issues.
Which Conditions can EMDR Treat?
Therapists initially use EMDR to help clients overcome the anxiety associated with PTSD, but some mental health professionals have since been recommending it to treat:
- Panic attacks
- Eating disorders
- Substance use disorders
- Obsessive-compulsive disorders (OCD)
- Personality disorders
According to a 2017 systemic review, EMDR therapy could be potentially beneficial for trauma patients with comorbid psychiatric disorders, including:
- Bipolar disorder
- Unipolar depression
- Chronic back pain
Ultimately, EMDR appears to be a safe intervention for various mental health symptoms, with evidence coming from several randomized controlled trials (RCT).
How Effective is EMDR?
While experts can’t explain with certainty why EMDR works, several studies have found support for its effectiveness since its introduction in 1987. Here are some articles that suggest EMDR is an ideal treatment option for people with mental health issues:
- For children: A Journal of EMDR Practice and Research summarizes all the studies that investigated the effectiveness of EMDR as a treatment option for traumatized children and adolescents. According to the article, the application of EMDR results in significant remission of symptoms and appears to be more efficient than CBT.
- For depression: In a 2015 study, two groups of 16 patients with depressive episodes received different inpatient care, with one group treated with EMDR in addition to treatment as usual (TAU). EMDR therapy showed promising results as 68% of patients exhibited complete remission after treatment.
- Panic disorder: In a 2017 study involving 84 patients, researchers proved that EMDR therapy is as effective as CBT for treating people with panic disorder.
- Traumatized patients requiring ER treatment: A 2018 pilot RCT found that a 60-min EMDR intervention can effectively prevent post-concussion-like symptoms (PCLS) in patients receiving emergency room care after a stressful event.
- Psychosis: EMDR may be a feasible treatment option for psychosis without the risk of any adverse effects, according to a 2020 review of six studies. With EMDR, participants appeared to have decreased delusions and negative symptoms and reported less use of medications and mental health services across six studies. EMDR was also associated with reductions in paranoia and hallucinations.
How EMDR Works
There are eight phases in EMDR therapy, which would require you to attend multiple sessions. EMDR typically takes anywhere from 6-12 sessions, but some people may benefit from fewer sessions while others may need more.
Phase 1: History and treatment planning
In the first phase, your therapist will review your symptoms and health history and start planning for your treatment. Unlike other therapies, you won’t need to discuss the traumatic event in detail — just the emotions and physical sensations surrounding the event.
Phase 2: Preparation
During this phase, your therapist will teach you a few different techniques to help manage and cope with strong emotions that may arise during or between sessions. Since the therapy emphasizes self-care, you might learn stress management techniques such as deep breathing or guided meditation.
Phase 3: Assessment
The assessment phase will lay the foundation of what your sessions are going to be. In this phase, your therapists will ask you to select a specific memory to target, such as:
- Painful emotions or physical sensations
- Distressing or unwanted self-beliefs
- Intrusive thoughts or images
Phase 4-7: Treatment
Once you’ve identified your targeted memories, your therapist will begin using EMDR therapy techniques to address them. The process has four stages:
- Desensitization. During this phase, you’ll focus on your target memory while following your therapist’s fingers back and forth with your eyes. Then, you’ll have to note any thoughts and feelings that come up spontaneously. After each set of bilateral stimulation (BLS), your therapist will assess your level of disturbance regarding a specific memory. They will ask you to move on to another if that memory no longer triggers unwanted emotions.
- Installation. In this phase, you’ll focus on the positive self-belief or image you’ve identified to replace the unwanted thoughts or beliefs about your trauma as you undergo another set of rapid eye movements.
- Body scan. Once you’ve replaced the negative beliefs surrounding your trauma with healthier, more positive thoughts, your therapist will ask you if the targeted memory prompts any bodily tension or uncomfortable physical sensations. If it does, they’ll lead you to another set of BLS until you resolve those tensions.
- Closure. After each session, your therapist will evaluate your progress. They will also review the visualization techniques and relaxation exercises that can help you maintain balance.
Phase 8: Re-evaluation
Before starting a new session, your therapist will evaluate your progress. They’ll ask about the memories you’ve addressed in the previous session and see if they still cause distress. Your response will determine whether to continue or move on to another target.
What are the Pros and Cons of EMDR?
Like any other psychotherapies, EMDR has its fair share of advantages and disadvantages. Here’s a closer look at some of them:
- It works. EMDR is proven to be effective, as evidenced by several studies.
- It’s more efficient than other therapies. Results are seen much sooner in people receiving EMDR therapy when compared to other therapies.
- It involves less homework. With EMDR, you’ll only need to write down any thoughts and ideas you want to bring up at your next session.
- It’s usually less stressful. In other methods, they require you to describe or relive traumatic events. But with EMDR, it only focuses on processing and moving past your trauma.
There are very few negative aspects to using EMDR therapy, but it does have its drawbacks, including:
- Why it works is still theoretical. Despite the evidence that EMDR works, experts still can’t fully explain why it works. Additional research may be necessary because all they have right now are theories.
- It’s a new method. There are many other forms of therapies that clinicians have been using for much longer than EMDR. While being a new method does not automatically make it a disadvantage, EMDR does need further research to determine if it’s a long-term solution.
Ultimately, experts consider EMDR therapy one of the better treatment options for trauma and PTSD symptoms. When treatments like talk therapy or medication are less effective or lead to unwanted side effects, EMDR becomes the treatment of choice, especially for anxiety and depression.
However, since EMDR is still a relatively new approach in psychotherapy, it’s not without controversy. Some critics would label EMDR a “pseudoscience” despite its demonstrated effectiveness. The EMDR Institute posted several answers to this and other questions on their website. At present, it is a “phenomenon in search of an explanation.”
Nevertheless, it should not diminish or invalidate the people who felt better after receiving EMDR therapy; not with all the studies and RCTs supporting that it works.
With additional research and more trials, the theory behind EMDR can be enhanced and the method further developed. It holds potential as a long-term solution to various mental health issues, or at least another modality in a therapist’s toolkit. But in the meantime, most of the available data says that EMDR is safe and effective to use as treatment.