A woman in her forties sits in a quiet consulting room, following her therapist’s slow hand movements with her eyes. Twenty minutes earlier, she began describing a car accident that happened nine years ago, one she has told herself she has “dealt with.” As she speaks, her chest tightens, her hands grow cold, and the memory arrives with the same intensity as if it were happening again: the screech of brakes, the flash of headlights, the certainty that she was about to die. The therapist asks her to hold the worst moment in mind while her eyes track from side to side. After a minute, they pause, and she is asked what she notices. She says that the image seems farther away, as though it were a photograph that had faded. Her heart is still beating faster than usual, but the sense of immediate threat has loosened. By the end of the session, she says something she has not said in nine years: “It happened, and it’s over.”
This is the kind of experience that people describe in eye movement desensitization and reprocessing, known universally as EMDR. It is a structured psychotherapy for the effects of traumatic and distressing memories, and it is one of the best-known and most debated treatments in modern mental health. To many who have received it, EMDR feels almost surprising: a therapy in which the person does not have to describe the trauma in detail, does not do long homework assignments, and yet reports that the memory loses its charge. To skeptics, the eye movements look like an odd ornament on what is essentially exposure therapy. The truth, as research has gradually shown, lies somewhere between the enthusiasm and the doubt.
EMDR is recommended by the World Health Organization and by clinical guidelines in many countries as a first-line treatment for post-traumatic stress disorder in adults, alongside trauma-focused cognitive behavioral therapy. More than thirty randomized controlled trials support its use for trauma, and it has been applied to a widening range of conditions, including anxiety, phobias, grief, chronic pain, and distress linked to adverse childhood experiences. At the same time, the question of how it works, and in particular whether the eye movements matter, remains one of the liveliest controversies in psychotherapy research.
This article offers a detailed, evidence-based account of EMDR. It explains how the therapy was discovered and what its theory proposes, describes the eight phases of treatment in plain language, and reviews the competing explanations for why eye movements might help, including working memory theory, orienting responses, and memory reconsolidation. It examines the strength of the evidence, the criticisms, the groups for whom it is and is not suitable, and what a person can realistically expect. It also offers guidance on finding a qualified therapist, supporting someone in treatment, and answering common questions. It is an educational overview and not a substitute for professional care. The central message is that EMDR is a well-supported treatment for trauma, that the details of how it works are still being worked out, and that people can recover from traumatic memories that once seemed permanent.
What Trauma Does to Memory
To understand why a therapy such as EMDR exists, it helps to understand what happens to memory in the aftermath of overwhelming experience. Most memories are processed in a way that integrates them into a person’s life story: they are placed in time, linked to other memories, and tagged as over. Traumatic memories often behave differently.
Post-Traumatic Stress Disorder
Post-traumatic stress disorder, or PTSD, can develop after exposure to actual or threatened death, serious injury, or sexual violence, whether directly, by witnessing it, or by learning of it happening to a loved one. Its symptoms fall into four groups: intrusive symptoms, such as unwanted memories, nightmares, and flashbacks, in which the person feels as though the event is recurring; avoidance of reminders, including thoughts, places, and people; negative changes in mood and thinking, such as persistent guilt, shame, detachment, or a loss of interest; and heightened arousal, such as irritability, hypervigilance, exaggerated startle, and poor sleep. Symptoms must persist for more than a month and cause significant distress or impairment. Lifetime prevalence in many countries is around six to eight percent, and it is considerably higher in survivors of combat, sexual assault, and disasters, and in people exposed to repeated childhood abuse.
Why the Memory Stays Raw
Research suggests that during overwhelming stress, the brain encodes experience differently. Stress hormones and heightened amygdala activity can strengthen the emotional and sensory elements of a memory, such as sights, sounds, smells, and bodily sensations, while the hippocampus, which places memories in context and time, may be less effective. The result may be a memory that is vivid, fragmentary, and tied to the body, and that lacks the label of being in the past. When a cue triggers it, the person may re-experience the fear and physical response as though the danger were present. This is the basis of the model of dual representation proposed by Chris Brewin and others: a vivid, sensory, context-free memory that is easily triggered, and a more verbal, contextualized memory that is less accessible.
Beyond Single Events
Not all trauma is a single catastrophic event. Repeated experiences, such as childhood neglect, emotional abuse, bullying, and domestic violence, can leave memories that shape beliefs about the self, such as I am worthless, I am unsafe, or It is my fault. Such memories may not meet the dramatic threshold of an accident or an assault but can contribute to anxiety, depression, shame, and difficulties in relationships. EMDR was developed originally for the former but is now used for the latter as well, with attention to the longer-term patterns that they produce.
The Aim of Trauma Treatment
The goal of trauma-focused therapy is not to erase the memory but to change how it is stored and experienced, so that it becomes an ordinary memory: something that happened in the past, which can be recalled without being re-lived. In the words often used by clinicians, the memory remains, but the charge goes. EMDR pursues this aim by a particular route, which is discussed below.
How EMDR Began
The history of EMDR is unusual, since it began with a personal observation and became a formal therapy, a path that has shaped both its popularity and the skepticism surrounding it.
Francine Shapiro’s Walk in the Park
In 1987, the American psychologist Francine Shapiro was walking in a park in California, troubled by some distressing thoughts, when she noticed that the thoughts seemed to lose their emotional force as her eyes moved rapidly from side to side. Intrigued, she began to experiment, first on herself and then on others, and found that when people held a disturbing memory in mind while moving their eyes in a certain way, the distress often decreased. She developed a procedure, tested it in a study of Vietnam veterans and survivors of sexual assault, and published the results in 1989 in the Journal of Traumatic Stress. The treatment was first named eye movement desensitization, and the word reprocessing was added in 1990 to reflect her view that more than desensitization was occurring. She went on to found the EMDR Institute and to train thousands of clinicians, and published the standard text in 1995.
Early Reception and Controversy
The therapy was received with a mixture of enthusiasm and suspicion. Many clinicians reported striking results, and a large number of therapists were trained quickly. Researchers, however, noted that the initial study had methodological limitations, and some criticized the theoretical language, the commercial training structure, and the early claims of dramatic effectiveness. A decade of debate followed, in which critics argued that EMDR was effective only because it contained elements of exposure therapy, and that the eye movements were superfluous. These critiques led to better research and, ultimately, to an acceptance of EMDR as an effective treatment, even as the question of mechanism remained open.
Recognition
Over time, trials accumulated, and clinical guideline bodies took notice. The World Health Organization, in its 2013 guidelines for stress-related conditions, recommended both trauma-focused cognitive behavioral therapy and EMDR for children, adolescents, and adults with PTSD. The International Society for Traumatic Stress Studies, the American Psychological Association, the United Kingdom’s National Institute for Health and Care Excellence, and the Department of Veterans Affairs in the United States have recognized it to varying degrees, with some placing it at the same level as trauma-focused cognitive behavioral therapy and others giving it a more conditional recommendation. It is now among the most widely practiced trauma therapies in the world.
The Adaptive Information Processing Model
Shapiro explained EMDR through a theory that she called the adaptive information processing model. It is a framework for how the mind handles experience and why trauma disrupts it. Though not all researchers accept its details, it provides the logic behind the treatment.
The Brain’s Natural Healing System
The model starts from the idea that the brain, like the body, has a built-in system for healing. When a person is injured, the body repairs the wound unless something blocks it. Likewise, the mind normally processes experience, integrating it with existing knowledge, drawing lessons, and storing it as a memory that no longer upsets. Most unpleasant experiences are processed in this way, and over time lose their emotional charge. According to the model, a traumatic experience can overwhelm this system, so that the memory is stored in its raw form, together with the emotions, images, beliefs, and body sensations of the time, in an isolated network that is not linked to adaptive information.
Unprocessed Memories as the Root
The model proposes that many current symptoms stem from such unprocessed memories. A present situation that resembles the original event can activate the stored memory network, so that the person reacts with the feelings, beliefs, and bodily states of the past. A person who was humiliated as a child may feel intense shame when criticized as an adult, not because of the present remark but because it triggers the old memory. Treatment, in this view, involves identifying the memories that underlie current problems, and processing them so that they connect with more adaptive information.
What Processing Means
Reprocessing is the term for the shift that occurs during a successful session. The person is asked to bring up the memory while engaging in bilateral stimulation, and as they do so, associations arise, such as other memories, insights, and new thoughts. The memory often changes: the image becomes less vivid, the emotional intensity decreases, the bodily sensations ease, and the belief shifts from a negative one such as I am in danger to a positive one such as I survived and it is over. Shapiro described this as the brain moving the memory along a natural path toward resolution.
The Three-Pronged Approach
EMDR therapy is designed to address the past, present, and future. The past prong targets the memories that have set the groundwork for the problem. The present prong targets current triggers, the situations and cues that still evoke distress. The future prong prepares the person for upcoming situations by rehearsing how they will respond with new skills and a new perspective. This three-pronged plan means that the therapy is not simply about reliving a single event but about changing the network of memories, triggers, and expectations that sustain the problem.
A Note on the Model’s Status
Many researchers regard the adaptive information processing model as a useful clinical framework but note that its core claims, such as the existence of a specific information processing system and the notion of dysfunctionally stored memories, are not easily testable and have not been directly demonstrated. It sits alongside other theories of trauma, such as emotional processing theory and dual representation theory, which share some of the same ideas in different language. The effectiveness of the treatment does not depend on the model being correct.
The Eight Phases of EMDR Therapy
EMDR is delivered in a structured sequence of eight phases. Not every session includes eye movements, and a large part of the therapy is preparation. Understanding the phases helps to dispel the misconception that EMDR consists simply of moving the eyes.
Phase One: History Taking and Treatment Planning
In the first phase, the therapist gathers a history of the person’s difficulties, current symptoms, past experiences, and strengths, and assesses suitability. Together they identify target memories, which may include a disturbing event, the earliest memory linked to the problem, current triggers, and future challenges, and create a plan. The therapist also screens for conditions that need attention first, such as dissociation, suicidal thoughts, substance misuse, or medical issues. This stage may take one or more sessions.
Phase Two: Preparation
The second phase builds trust and teaches the person coping skills for managing distress, because processing trauma can bring strong feelings. The therapist explains how EMDR works and what to expect, and introduces techniques such as the safe or calm place, in which the person imagines a place that gives a feeling of peace and security, and learns to evoke it using bilateral stimulation or breathing. Containment exercises, such as imagining placing disturbing material in a box, and grounding techniques are taught. The person is told that they are in control and can stop at any time, and that the aim is to notice what happens without judgment. For people with complex trauma or dissociation, this phase may be prolonged.
Phase Three: Assessment
In the assessment phase, the therapist and client choose a target memory and identify its components. The person selects the image that represents the worst part of the memory, the negative belief about themselves linked to it, such as I am helpless or I am to blame, and a positive belief that they would prefer, such as I did the best I could. They rate how true the positive belief feels on a scale from one to seven, called the validity of cognition scale, name the emotions that come up, rate the level of disturbance on a scale from zero to ten, called the subjective units of distress scale, and locate where they feel the disturbance in the body. These baseline measures allow progress to be tracked.
Phase Four: Desensitization
This is the phase most associated with EMDR. The person brings the image, negative belief, and body sensation to mind while following a form of bilateral stimulation, most often the therapist’s moving fingers, but also tapping or sounds that alternate between ears. After a set of about twenty to forty passes, which usually lasts under a minute, the therapist asks the person to take a breath and to report what they noticed, with the instruction to simply “go with that.” The person’s thoughts, images, feelings, or sensations are noted, and another set begins, following the person’s own associations. The process continues until the disturbance falls to zero or near zero. The person is not required to describe the memory in detail, and the therapist stays in a supportive, non-directive role, acting as a facilitator. Sets are repeated, and the memory often shifts from distressing, to less intense, to neutral.
Phase Five: Installation
When the memory is no longer disturbing, the focus moves to strengthening the positive belief. The person holds the memory together with the chosen positive belief, such as I am safe now, while engaging in further bilateral stimulation, until the belief feels completely true, a seven on the scale. This is intended to link the memory with adaptive information and to install a new, healthier view of the self.
Phase Six: Body Scan
The person holds the memory and the positive belief in mind and scans the body from head to toe, noticing any residual tension or unusual sensation. If any is found, it is targeted with further bilateral stimulation. The aim is to ensure that the body is no longer holding on to the trauma, since many people experience trauma in physical ways, and a clear body scan is regarded as a sign of complete processing.
Phase Seven: Closure
At the end of each session, whether or not the processing is complete, the therapist helps the person to return to a calm and stable state, using grounding, the safe place, or relaxation exercises. If processing is incomplete, the person is reassured that the work will continue in the next session. They are advised that further thoughts, images, dreams, or feelings may arise between sessions, which is part of the processing, and are invited to note them in a log and to use the coping skills as needed.
Phase Eight: Reevaluation
At the beginning of the next session, the therapist checks whether the earlier target is still resolved and whether new material has emerged. If gains have held, treatment can move on to the next target, including current triggers and future challenges. In the future template, the person imagines a situation that was once difficult, such as meeting a reminder of the trauma, and rehearses coping with it while using bilateral stimulation, building confidence.
Length and Format
A course of EMDR is often between six and twelve sessions of sixty to ninety minutes for a single-incident trauma, though longer for complex or multiple trauma. Studies have found that a substantial proportion of people with a single traumatic event no longer meet the criteria for PTSD after three to six sessions, though results vary. People with complex histories may require months or years, with more emphasis on preparation and stabilization. EMDR can also be delivered in intensive formats, with several sessions over a few days, and in group and online forms, which have shown promise.
What Do the Eye Movements Do? The Mechanisms
The most intriguing and contentious question is why eye movements, or other forms of bilateral stimulation, should have any effect. Research over three decades has produced several hypotheses, and none has been fully proven, though some are better supported than others.
Working Memory Theory
The best-supported explanation is the working memory theory, developed by Marcel van den Hout, Iris Engelhard, and colleagues in the Netherlands. Working memory is the mental workspace in which a person holds and manipulates information, and its capacity is limited. The theory proposes that when a person recalls a distressing memory while performing a demanding secondary task, such as following moving fingers with the eyes, the two tasks compete for working memory resources. As a result, the memory becomes less vivid and less emotional, and each time it is brought to mind in this way, it is stored in a degraded form. In laboratory experiments with healthy volunteers, recalling a memory while making eye movements reduces its vividness and emotional intensity more than recalling it without a task, and the effect is larger when the task is more demanding. Other taxing tasks, such as counting or playing a visual game, show similar effects, which suggests that the eye movements are not unique.
The theory fits with research by Andrade, Holmes, and others showing that visuospatial tasks, such as playing the computer game Tetris, can reduce the vividness of intrusive images, including in the hours after a traumatic film or event. It also offers an account of why the therapy does not require the person to describe the memory in detail: the benefit comes from the dual attention, with the memory held in mind while the working memory is taxed. A prediction of the theory, that more demanding tasks should work better, has been supported, though findings are not entirely consistent, and the effect sizes in experiments are modest.
The Orienting Response
Another account, put forward by Stephen Porges, Robert Stickgold, and others, centers on the orienting response, an automatic reaction to novel stimuli in which the animal stops, attends, and evaluates. The theory proposes that the rhythmic bilateral stimulation evokes an orienting response, which in turn produces a state of relaxation and reduced arousal. Studies have found that EMDR is associated with changes in heart rate, skin conductance, and respiration consistent with a decrease in arousal, and with a rise in parasympathetic activity. A related idea is that the repetitive movement mimics the investigatory reflex, which signals safety and facilitates the processing of threatening memory. The evidence for this theory is limited and mixed.
REM Sleep Theory
Robert Stickgold proposed in 2002 that the eye movements of EMDR resemble the rapid eye movements of REM sleep, a phase of sleep that is thought to be important for emotional memory processing. According to this hypothesis, bilateral stimulation may induce a state of the brain similar to REM, in which memories are integrated into broader networks of knowledge and their emotional components are reduced. Evidence includes studies showing that REM sleep helps to depotentiate emotional memories, and a few experiments showing that eye movements can shift memory retrieval patterns toward those seen in REM. The idea is intriguing but speculative, and the equivalence between EMDR eye movements and REM has not been demonstrated.
Memory Reconsolidation
A more recent perspective relates EMDR to memory reconsolidation, the finding that a memory, when it is retrieved, becomes briefly malleable and must be stored again, a process during which it can be modified. The therapy repeatedly retrieves the memory, and the accompanying task, together with the person’s new, safer experience of recalling it, may update the memory trace. This is consistent with research by Karim Nader, Daniela Schiller, and others, though direct demonstration in EMDR is limited. It forms part of a convergence of ideas suggesting that exposure-based therapies work through new learning that competes with, or modifies, the original fear memory.
Exposure, Attention, and Distance
Critics, including Gerald Rosen, Richard McNally, and others, have argued that EMDR is a form of exposure therapy in which the person recalls the trauma briefly and repeatedly, and that any benefit comes from the exposure, not the eye movements. Exposure indeed forms part of the therapy: the person confronts the memory, in small doses, while remaining in a safe setting. Some argue that the eye movements work by making the exposure more tolerable, or by creating a mental distance from the memory. It is also possible that the combination of dual attention, the therapeutic relationship, and the structure of the sessions all contribute.
What the Studies of Eye Movements Show
Dismantling studies, which compare EMDR with and without eye movements, have produced mixed results. Early reviews, including one by Davidson and Parker in 2001, concluded that the eye movements added nothing. Later meta-analyses, such as that by Lee and Cuijpers in 2013, concluded that in laboratory studies, eye movements had a significant additional effect on memory vividness and emotionality, while in clinical studies, the evidence for an added effect was weaker and less consistent. A review in 2020 by Landin-Romero and colleagues suggested that the additional benefit of eye movements may be modest, but real, and probably related to the taxing of working memory. Overall, the weight of evidence suggests that eye movements are probably not sufficient or magical, but may add something, at least in reducing the vividness and distress of memories.
Other Forms of Bilateral Stimulation
Many therapists use tapping on the hands or knees, or alternating tones in headphones, as an alternative to eye movements. These are useful for people who find eye movements uncomfortable, and for remote sessions. Research suggests that they may be about as effective, which is consistent with the working memory account that any demanding task could serve. Some therapists also use a lightbar or a pair of hand-held pulsers.
The Brain Imaging Evidence
Brain imaging studies have found changes after EMDR in regions involved in emotion and memory. Several studies report reduced activity in the amygdala and increased activity in the prefrontal cortex and hippocampus following treatment, along with an increase in hippocampal volume in some patients, which parallels the findings with other effective trauma treatments. Studies of single sessions suggest changes in the way the brain responds to trauma reminders. These findings are preliminary, and many samples are small, but they are consistent with the view that the therapy helps the brain to integrate the memory and to regulate the emotional response.
An Honest Summary
The mechanism of EMDR remains incompletely understood. The most plausible account is that holding a distressing memory in mind while performing a demanding task reduces its vividness and emotional power, which, combined with a safe, structured therapeutic context and the exposure to the memory, helps to update how the memory is stored. The therapy works, but the explanation continues to evolve. Importantly, the practical value of the therapy does not depend on resolving this debate.
The Evidence: Does EMDR Work?
The evidence for EMDR is considerable, though it is not without qualification. Summaries of the research depend on which trials are included and how they are judged.
Trials in Adults With PTSD
Dozens of randomized controlled trials have compared EMDR with waiting list conditions, with usual care, with supportive therapy, and with other active treatments, in adults with PTSD. Meta-analyses, including those by Bisson and colleagues for the Cochrane Collaboration in 2013 and by Chen and colleagues in 2014, found that EMDR was significantly more effective than waiting list and non-trauma-focused therapies in reducing PTSD symptoms, anxiety, and depression, and that it produced results broadly similar to those of trauma-focused cognitive behavioral therapy. A large randomized trial of veterans and others, such as the work of Carlson and colleagues in 1998, found that EMDR substantially reduced PTSD symptoms in combat veterans, and a study by Rothbaum and colleagues in 2005 compared EMDR with prolonged exposure and a waiting list in female assault survivors and found that both treatments were effective. A trial by Nijdam and colleagues in the Netherlands in 2012 found that EMDR worked faster than brief eclectic psychotherapy, with a faster reduction in symptoms, though both were effective at follow-up.
Comparison With Trauma-Focused Cognitive Behavioral Therapy
When EMDR is compared head to head with trauma-focused cognitive behavioral therapy, including prolonged exposure and cognitive processing therapy, most trials and meta-analyses find that the two are about equally effective, with some finding small differences in either direction, and some indicating that EMDR may be completed in fewer sessions and with less homework. A potential advantage is that people who find it very hard to talk about the trauma in detail may find EMDR more tolerable, and dropout rates in some trials have been lower. However, the quality of trials varies, and the research base for prolonged exposure is larger.
Children and Adolescents
Studies in children and adolescents, including trials after natural disasters, accidents, and abuse, find that EMDR reduces PTSD symptoms, and the World Health Organization has recommended it for young people. The evidence base is smaller than for adults, but meta-analyses suggest efficacy comparable to that of trauma-focused cognitive behavioral therapy. Trials of EMDR in refugee children and in children exposed to violence are particularly relevant to wider public health.
Veterans and First Responders
Combat-related PTSD is often complex, with moral injury, multiple traumas, and associated depression, and results for veterans are more variable. Some trials show good results, while others show that treatment effects are smaller than in civilian samples, as is true for other trauma therapies. EMDR is used in military and first-responder settings, sometimes in intensive formats, and studies of police officers and firefighters suggest benefit.
Survivors of Sexual Violence and Childhood Abuse
For survivors of sexual assault, trials show benefit, and EMDR is a recommended option. For adults with a history of childhood abuse, the evidence is more limited and the treatment requires a longer course with extensive preparation. A trial by van der Kolk and colleagues in 2007 found that EMDR was more effective than fluoxetine and placebo for adults with PTSD, with improvements maintained at follow-up, and was particularly effective in people with adult-onset trauma, with a smaller effect in those with childhood-onset trauma, which suggests the need for adaptations in complex trauma.
Other Conditions
EMDR has been studied for depression, anxiety, panic disorder, phobias, obsessive-compulsive disorder, complicated grief, chronic pain, phantom limb pain, somatic symptom disorders, and performance anxiety, with promising but less conclusive results. Trials of EMDR for depression, for example, have found that targeting adverse memories can reduce depressive symptoms, and a number of trials in psychosis, such as the work of van der Gaag and colleagues, suggest that trauma-focused work including EMDR is feasible and may reduce symptoms such as paranoia and voices in people with trauma histories. For these conditions, EMDR is considered a promising adjunct, and the quality of evidence is lower than for PTSD.
Long-Term Outcomes
Follow-up studies indicate that improvements from EMDR are generally maintained over months and years. Some studies report maintenance at fifteen months, and some longer, with most people who lose their PTSD diagnosis keeping the gains. Relapse can occur, particularly after new stress, but booster sessions are often effective.
Limitations and Criticisms of the Evidence
Several limitations should be acknowledged. Many trials are small, vary in quality, and use waiting lists as controls. Some have been carried out by researchers with a close association to the therapy. The additional contribution of the eye movements is uncertain. Dropout is not negligible, and not everyone responds. Some critics, such as Richard McNally, have argued that the research on EMDR demonstrates its equivalence to exposure, not its superiority, and that the therapy’s novel elements are unproven. Recent, higher-quality trials have been more consistent with a conclusion that EMDR is effective, but the debate over its unique ingredients continues. Another limitation is that the evidence is largely drawn from Western settings, and more research is needed across cultures.
Recommendations in Guidelines
Guideline recommendations differ. The World Health Organization, the International Society for Traumatic Stress Studies, and the United Kingdom’s National Institute for Health and Care Excellence recommend EMDR for PTSD, the latter specifying that it should be offered to those who have a diagnosis of PTSD and who prefer it. The American Psychological Association’s 2017 guideline gave a conditional recommendation, reflecting the strength of evidence at the time, while the Veterans Affairs and Department of Defense guideline recommended it alongside other trauma-focused therapies. These differences reflect differences in evidence standards, not a consensus that the therapy is ineffective.
Who Is EMDR For?
EMDR can be useful for many people, but it is not suitable for everyone in every circumstance. Matching the treatment to the person is part of good practice.
Good Candidates
EMDR is commonly used for adults and young people with PTSD after single or multiple traumatic events, such as accidents, assaults, disasters, medical trauma, military experience, and witnessing violence. It is also used for people with distressing memories that contribute to anxiety, phobias, depression, grief, low self-esteem, or relationship problems. It may suit people who find it hard to talk about the details of their trauma, who prefer a less verbal approach, or who have not benefited from other therapies. Those with a good level of stability and support are well placed.
Complex Trauma and Dissociation
People with complex trauma, such as a history of prolonged childhood abuse, or with dissociative disorders, can be helped, but the therapy requires much longer preparation and stabilization, and a therapist experienced in treating dissociation. Processing too quickly can overwhelm a person and increase symptoms. Guidelines, such as those from the International Society for the Study of Trauma and Dissociation, advise a phased approach: first safety and stabilization, then trauma processing, then integration. A modified version of EMDR for dissociation exists, but it should be used by specialists.
Cautions and Contraindications
Care is needed in several situations. People with active suicidal thoughts, severe self-harm, or ongoing crises should be stabilized first. Those with active substance dependence may need to address it before or alongside trauma processing. Those who are in an unsafe situation, such as ongoing abuse, need safety first. Some medical conditions, including certain eye disorders, epilepsy, and pregnancy complications, call for medical advice, and bilateral stimulation can be adapted, for example by using tapping instead of eye movements. People with severe mental illness, such as psychosis, may be treated by specialists with adaptations. Therapists should assess these factors in the first phase.
Possible Side Effects
EMDR can bring strong emotions, including fear, sadness, and anger, during and after sessions, and some people experience temporary increases in distressing symptoms, vivid dreams, new memories, or fatigue between sessions. These reactions are usually short-lived and are part of processing, but they can be uncomfortable, and they are why the preparation phase and coping skills are important. Some people report headaches or dizziness. Serious adverse effects are uncommon when treatment is delivered by a qualified therapist, but people should tell their therapist if they feel overwhelmed.
Medication and EMDR
Many people undergoing EMDR also take medication, such as antidepressants, and this is generally acceptable. Some medications, particularly sedatives such as benzodiazepines, may dampen emotional processing, and some therapists prefer to discuss their use. Decisions should be made with a doctor, and medication should not be stopped abruptly.
What an EMDR Session Is Like
For people who are considering EMDR, a picture of what a session feels like can reduce anxiety. Experiences vary, but common themes emerge.
The Atmosphere
Sessions take place in a quiet, private room, with the person and the therapist seated facing each other, often at an angle. The therapist is warm and calm, and gives clear explanations. The person remains awake and aware throughout, in contrast to hypnosis, and can speak or stop at any time. The process is often described as being like watching a film of one’s own mind, noticing what comes, without the pressure to explain.
During Bilateral Stimulation
While following the therapist’s fingers, or feeling the tapping or hearing the tones, the person notices what arises: images, emotions, sensations, or thoughts. These may seem unrelated to the original memory, as the mind jumps through associations. People may feel waves of emotion, sometimes tears, and then a release, and the sense of distance from the memory. After each short set, they briefly report what they noticed. Some people describe the sets as though the mind is being tidied, while others find them tiring.
After a Session
People often feel tired or emotionally raw after a session, and some feel relieved or lighter. Over the following days, they may notice thoughts, memories, or dreams linked to the material, and are encouraged to note them. It is advisable to plan something calming after a session, and to avoid demanding commitments. Self-care, sleep, and gentle activity are important.
Progress Over Time
Many people notice that the memory feels different: it seems more distant, less vivid, and less painful, and they can think about it without being overwhelmed. Triggers may lose their power, and symptoms such as nightmares and flashbacks may decrease. Beliefs about the self often shift, such as from I am to blame to I did what I could. Progress is not always smooth, and some sessions are harder than others. The therapist monitors the person’s responses and adapts the pace.
A Composite Example
The following account is a composite and does not describe a real person. A man in his mid-thirties, whom we shall call Marcus, developed nightmares, irritability, and avoidance of driving after a motorway collision in which a passenger was seriously injured. He felt guilty and could not bear to talk about the crash in detail. His therapist spent two sessions teaching him a calm-place exercise and grounding skills, then began processing. Marcus held the image of the moment before impact, with the belief that it was his fault, and followed the therapist’s tapping. During the sets, other memories arose, including how he had braked and swerved, and an image of the other driver’s car coming from the lane beside him. By the fourth session, his distress about the memory had fallen from nine out of ten to one, and the belief had changed to I did everything I could. Later sessions addressed driving cues and rehearsed a future journey. After eight sessions, his nightmares had stopped, and he drove his own car on the motorway without panic. He said that the accident remained part of his story, but no longer controlled it.
EMDR Compared With Other Trauma Therapies
People seeking treatment often wonder how EMDR compares with other approaches. Understanding the similarities and differences supports informed choice.
Prolonged Exposure
Prolonged exposure, developed by Edna Foa, involves repeatedly recounting the trauma aloud in detail, and confronting avoided situations, with extensive homework. It is among the best-supported therapies for PTSD. EMDR differs in that it does not require lengthy retelling or exposure homework, and the memory is accessed briefly with alternating attention. Both aim for emotional processing, and both are effective.
Cognitive Processing Therapy
Cognitive processing therapy focuses on identifying and challenging unhelpful beliefs about the trauma, such as self-blame, through written accounts and structured worksheets. It is more explicitly cognitive, while EMDR addresses beliefs through the processing of memory and the installation of positive beliefs, without detailed debate. Evidence supports both.
Trauma-Focused Cognitive Behavioral Therapy
This umbrella term covers prolonged exposure, cognitive processing therapy, and similar therapies, including a form for children developed by Judith Cohen and Esther Deblinger. Reviews generally find that it and EMDR have comparable effectiveness, with a larger body of evidence for the former.
Medication
Selective serotonin reuptake inhibitors such as sertraline and paroxetine are approved for PTSD in some countries and reduce symptoms in many people, though effects are generally smaller than those of trauma-focused psychotherapy, and relapse after stopping is common. Guidelines favor trauma-focused therapy as first-line treatment, with medication used when therapy is not available or acceptable, or for coexisting depression. Some people use both.
Other Approaches
Other therapies used for trauma include narrative exposure therapy, designed for survivors of multiple traumas and refugees, somatic approaches, internal family systems therapy, and stabilization-focused work. Some evidence supports narrative exposure therapy, while evidence for others is more limited. The best therapy is the one that a person will engage in and that is delivered by a trained clinician.
Choosing Between Therapies
Preferences matter. Some people want to talk through the story in detail and find exposure empowering. Others do not wish to retell their experiences and prefer EMDR. Practical factors, such as availability, cost, and the skills of local therapists, also influence choice. Guidelines suggest that people should be offered a choice among trauma-focused therapies.
Finding a Qualified EMDR Therapist
The quality of therapy depends greatly on the therapist. EMDR is a clinical method and not a technique to be applied mechanically, and training and experience matter.
Training and Credentials
Qualified therapists are licensed mental health professionals, such as psychologists, psychiatrists, counselors, and social workers, who have completed an approved EMDR training program, usually including lectures, supervised practice, and consultation hours. In many countries, national EMDR associations, such as EMDRIA in the United States and EMDR Europe, accredit trainers and offer certification for practitioners who have completed additional supervision. The term EMDR is sometimes used loosely, so it is reasonable to ask about a therapist’s training.
Questions to Ask
People can ask how long the therapist has been using EMDR, what kind of training they have, whether they work with the type of problem that the person has, how they handle the preparation phase, how they handle distress during sessions, and what a course of treatment would look like. A good therapist will give clear answers, will emphasize safety and the person’s control, and will not promise a cure or a quick fix. Be cautious of anyone who uses the technique without a thorough assessment and preparation.
Online and Intensive Formats
EMDR is increasingly delivered by video, with the therapist guiding the person to use self-tapping or on-screen bilateral stimulation. Studies during and after the pandemic suggest that this is feasible and similarly effective for many people, though suitability should be assessed, particularly for those with dissociation or in unsafe home environments. Intensive formats, with several sessions in a short period, are offered by some clinics and have shown benefit.
Cost and Access
Access varies. In some health systems, EMDR is available through public services, particularly for PTSD, while in others it is offered privately. Some charities and training programs offer low-cost sessions. A general practitioner or mental health service can advise on local options.
Self-Help and Safety Cautions
People sometimes wish to try EMDR techniques on their own, and many online videos and apps invite them to do so. A few cautions are important.
Why Self-Administered EMDR Is Not Advised for Trauma
Processing traumatic memory without a trained therapist can be overwhelming, may trigger flashbacks or dissociation, and can leave a person more distressed. The structure of the therapy, including assessment, preparation, and the therapist’s skill in guiding the process and closing the session, is designed to protect the person. Self-administered bilateral stimulation is not a replacement for therapy for significant trauma.
Safe Techniques for Calming
Some elements may be used safely for relaxation and grounding. Butterfly hug, in which the person crosses their arms over the chest and taps alternately on the shoulders while breathing slowly, is a calming technique developed for use after a disaster, and can be used to soothe. Gentle alternating tapping on the knees while thinking about a safe place can be calming. These are not a way of processing trauma but a way of lowering arousal. Other grounding techniques, such as slow breathing, naming things that one can see, hear, and touch, and pressing the feet into the floor, are also helpful.
When to Seek Help
It is time to seek professional help when memories of a distressing event continue to intrude weeks or months after it happened, when you avoid reminders, when sleep, mood, or relationships suffer, when you feel numb or constantly on edge, or when you use alcohol or drugs to cope. A good first step is to see a general practitioner or a mental health professional, and to ask about trauma-focused therapies, including EMDR. If you are having thoughts of suicide or feel unable to keep yourself safe, contact local emergency services or a crisis line immediately. Early treatment generally leads to better outcomes, though people can recover even decades after trauma.
Supporting Someone Who Is Having EMDR
Family and friends can play a valuable role in a person’s recovery, and a few principles can help.
What Helps
Offer patience, reliability, and a calm presence. Understand that the person may feel tired, tearful, or irritable after sessions, and that new memories or dreams may emerge. Ask how you can help, such as arranging transport, a quiet evening, or a meal. Do not press for details of what was discussed, since the person may not wish to share, and respect their privacy. Encourage self-care and attendance at sessions. Learn about trauma and its effects, which makes it easier to avoid misunderstanding.
What to Avoid
Avoid telling the person to get over it, to move on, or to think positively, which can feel dismissive. Do not pressure them to describe the trauma, and do not criticize the therapy. Avoid taking their irritability or withdrawal personally. Do not make plans that expect rapid improvement. If you see signs of crisis, such as talk of suicide, contact the therapist, a crisis line, or emergency services.
Supporting Children
Parents of children having EMDR can help by providing reassurance, a stable routine, and a safe, predictable home. They can listen without questioning, validate feelings, and let the therapist guide the process. They should tell the therapist about changes in behavior, sleep, or mood. Parents may also need support, since a child’s trauma can affect the whole family, and some programs involve parents directly.
Looking After Yourself
Supporting a loved one with trauma can be draining, and secondary stress is real. Keep your own routines, friendships, and health, and seek support if you need it. You are not responsible for the person’s recovery, but your steady presence matters.
Common Myths About EMDR
Several misconceptions surround the therapy. The first is that EMDR is hypnosis. The person is awake and in control throughout, and can stop at any time. The second is that the eye movements alone are the treatment. EMDR is an eight-phase therapy with assessment, preparation, and structured processing, and the eye movements are one element. The third is that EMDR erases memories. The memory remains, but its emotional charge decreases, and the person can recall it without re-living it.
A fourth myth is that it is a quick fix that works in one session for everyone. Single-incident trauma may respond in a few sessions, but complex trauma takes longer. A fifth is that it is pseudoscience. EMDR is supported by many randomized trials and recommended by major health bodies, even though its mechanism is debated. A sixth is that it is only for veterans or for severe PTSD. It is used for a range of distressing memories. A seventh is that you must relive the trauma in detail. A person does not need to describe the memory fully. An eighth is that it is risk-free. Strong emotions can arise, which is why a trained therapist is important. A ninth is that you can do it yourself from a video. Safe self-calming techniques exist, but trauma processing should be done with a professional.
A Realistic and Hopeful Outlook
The outlook for people with trauma-related problems who receive effective treatment is encouraging. Studies show that a majority of people treated with EMDR or other trauma-focused therapies experience substantial reductions in symptoms, and a considerable proportion no longer meet the criteria for PTSD. Improvements tend to last. Many people describe the change not only as fewer symptoms but as a different relationship with the past: it is something that happened, and not something that is still happening. Sleep returns, relationships improve, and the capacity for enjoyment and for planning ahead is restored.
Recovery does not mean forgetting or never being affected by reminders. People may still feel sadness, anger, or grief when they think about what happened, and anniversaries or new stresses may stir old feelings. The difference is that these feelings are proportionate and manageable, and no longer take over life. For complex trauma, the path is longer and involves rebuilding trust, a sense of self, and relationships, but many people make significant progress. Research on post-traumatic growth also shows that some people find new strength, meaning, and appreciation of life after working through trauma, though this should never be demanded of anyone.
The Future of EMDR Research
Research continues to refine the therapy. Studies are examining how best to adapt it for complex trauma, for children, for refugees, and for use in low-resource settings, including brief and group protocols. Researchers are testing whether adding or changing specific elements, such as the type of task and the intensity of the working memory load, can improve outcomes, and are using brain imaging to understand its effects. The relationship between EMDR and memory reconsolidation, and the potential of combining it with medication or with other techniques, is the subject of active investigation. These developments suggest that the therapy will continue to evolve.
Conclusion
EMDR is a structured psychotherapy in which a person holds a distressing memory in mind while attending to a bilateral stimulus, most often side-to-side eye movements, within an eight-phase framework that includes history taking, preparation, assessment, desensitization, installation of positive beliefs, a body scan, closure, and reevaluation. It was discovered by Francine Shapiro in 1987 and has grown from a controversial novelty to a treatment recommended for post-traumatic stress disorder by the World Health Organization and by guideline bodies in many countries, with a substantial body of randomized trials showing that it reduces symptoms to a degree comparable with trauma-focused cognitive behavioral therapy.
How it works remains debated. The best-supported explanation is that dual attention taxes working memory, making the recalled memory less vivid and emotional, and that this, combined with safe, repeated, controlled contact with the memory, helps the brain to store it in a less disturbing form, possibly through reconsolidation. The eye movements may add a modest benefit, and the structure, the therapeutic relationship, and the exposure to the memory all contribute. Anyone who recognizes themselves in this description is encouraged to seek a qualified, trained therapist, to be wary of self-administered trauma processing, and to contact emergency services or a crisis line in a crisis. Traumatic memories can feel as if they will never fade, but for most people, with the right help, they can become what memories are meant to be: part of the past, remembered, and no longer in command of the present.
FAQ About EMDR
What is EMDR therapy, and how does it work?
EMDR, or eye movement desensitization and reprocessing, is a structured psychotherapy for traumatic and distressing memories. The person recalls aspects of a memory in brief intervals while paying attention to a back-and-forth stimulus, usually the therapist’s moving fingers, or alternating taps or sounds. Between sets, they report what comes to mind, and the process continues until the memory becomes less distressing and a more positive belief takes its place. The leading explanation is that doing a demanding task while recalling the memory reduces its vividness and emotional power, which, together with safe exposure and the therapy’s structure, helps the memory to be stored differently. The exact mechanism is still debated.
Is EMDR scientifically proven to work?
EMDR has been tested in more than thirty randomized controlled trials, and meta-analyses show that it is effective for PTSD, producing results broadly similar to those of trauma-focused cognitive behavioral therapy. The World Health Organization and several national guidelines recommend it. Evidence for other conditions, such as depression and anxiety, is promising but less conclusive. Questions remain about whether the eye movements add anything beyond the exposure and structure of the therapy, and some trials are small or of moderate quality. Overall, the evidence supports its use for trauma, even though the mechanism is not fully understood.
Do the eye movements really matter?
This is still debated. Laboratory experiments show that recalling a memory while making eye movements reduces its vividness and emotional intensity, probably by taxing working memory, and other demanding tasks may do the same. Clinical studies comparing EMDR with and without eye movements have produced mixed results, with some finding no additional benefit and some a small one. Most researchers think the eye movements are not magical and are not the only active ingredient, but they may contribute. Many therapists use tapping or sounds instead, and these appear to work about as well.
How many sessions of EMDR do I need?
It depends on the nature of the trauma. For a single traumatic event in adulthood, many people benefit after about six to twelve sessions of sixty to ninety minutes, and some trials report that a majority no longer meet criteria for PTSD within three to six sessions. For complex trauma, such as repeated childhood abuse, treatment is longer, often many months or more, with a substantial period of preparation and stabilization. The therapist will agree a plan and review progress regularly. Intensive formats with several sessions over a few days are also available.
Do I have to talk about the trauma in detail?
No. A distinctive feature of EMDR is that you do not need to describe the memory in detail. You identify the memory, the worst image, the negative belief, and the feelings and sensations, and during processing you briefly report what you notice. For people who find it distressing or shameful to retell their story, this can be a welcome difference from approaches that involve long verbal accounts. You do share enough for the therapist to understand and guide the work, and you stay in control of what you say.
Is EMDR safe, and are there side effects?
When delivered by a trained therapist after proper assessment and preparation, EMDR is generally safe. It can bring up strong emotions during and after sessions, and some people experience vivid dreams, new memories, tiredness, or a temporary increase in distress between sessions. These effects are usually short-lived and are part of processing. People with severe dissociation, active suicidal thoughts, ongoing abuse, active substance dependence, or certain medical conditions need extra care, stabilization, or adaptation. Tell your therapist if you feel overwhelmed, and seek urgent help if you feel unsafe.
How is EMDR different from hypnosis or ordinary talk therapy?
In EMDR, you are fully awake and in control, unlike hypnosis, in which suggestion is used to induce a trance-like state. Unlike traditional talk therapy, EMDR does not rely mainly on analyzing the story or discussing the past at length, but on briefly accessing the memory while using bilateral stimulation and noticing what arises. It also differs from exposure therapy, which requires prolonged retelling and homework, though it shares the element of safe contact with the memory. It follows a structured eight-phase protocol, with emphasis on preparation and on both negative and positive beliefs.
Can EMDR help with anxiety, depression, or childhood trauma?
Yes, there is evidence and clinical experience supporting its use for conditions linked to distressing memories. Trials suggest benefit in anxiety disorders, phobias, complicated grief, and some forms of depression, and it is used for the effects of childhood adversity, though the evidence is less extensive than for PTSD. For childhood trauma, particularly prolonged abuse or neglect, treatment generally requires a longer course with careful preparation and a therapist experienced in complex trauma. A clinician can assess whether EMDR is suitable alongside other approaches.
Can I do EMDR on my own or online?
EMDR delivered by a qualified therapist over video has been shown to be feasible and often effective, using self-tapping or on-screen stimulation. Processing significant trauma on your own with videos or apps is not recommended, since it can be overwhelming without a therapist’s guidance, assessment, and support. Gentle techniques such as the butterfly hug, alternating tapping, slow breathing, and grounding can be used safely for calming, but they are not a substitute for therapy. If you have trauma symptoms, seek a qualified professional.
How do I find a good EMDR therapist?
Look for a licensed mental health professional, such as a psychologist, psychiatrist, counselor, or social worker, who has completed an approved EMDR training and, ideally, certification through a national association such as EMDRIA or EMDR Europe. Ask about their experience with your type of problem, how they prepare clients, how they handle distress during sessions, and what a course of treatment involves. A good therapist emphasizes safety and your control, conducts a thorough assessment, and does not promise a quick cure. A general practitioner or mental health service can also provide referrals.
How can I support a loved one who is doing EMDR?
Offer patience and practical help, such as transport or a quiet evening after sessions, and understand that tiredness, tearfulness, and vivid dreams can be part of processing. Do not press for details, and respect their privacy. Avoid telling them to move on or think positively, and do not criticize the therapy. Encourage self-care, sleep, and attendance. If they speak of suicide or seem unsafe, contact their therapist, a crisis line, or emergency services. Look after your own wellbeing, since supporting someone through trauma recovery can be demanding.
Recommended Books on EMDR and Trauma Recovery
- Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy by Francine Shapiro
- Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures by Francine Shapiro
- EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma by Francine Shapiro and Margot Silk Forrest
- The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk
- Trauma and Recovery: The Aftermath of Violence by Judith Herman
- Waking the Tiger: Healing Trauma by Peter A. Levine
- Self-Help for Trauma Recovery: Practical Techniques Based on EMDR by Katie Mottershead and colleagues
- Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation by Janina Fisher
- The EMDR Handbook of Research: Evidence for the Efficacy of EMDR by Mark Brown and colleagues
- The Post-Traumatic Stress Disorder Sourcebook: A Guide to Healing, Recovery, and Growth by Glenn Schiraldi
