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EMDR Therapy: How Does It Work?

What is EMDR?

EMDR (eye movement desensitization and reprocessing by its technical name) is a relatively new form of therapy being used in treating many kinds of anxiety and stress disorders. It's showing great promise for all age groups.

It's also being used to treat things like depression, anger management and posttraumatic stress disorder. But more on that in a bit.

To describe this therapy technique briefly, it involves stimulating the right brain and the left brain simultaneously through eye movement. This in effect helps to restore harmony in the central nervous system, which is where anxiety and stress feelings can become trapped. 

The concept of EMDR is that by recalling the events that have become trapped in our nervous system that make us anxious, cause us to have phobias, or to react badly to certain things, we will be able to process them in a positive way and finally resolve the negative feelings. This results in loss of the anxiety that we have experienced and teaches us a new way to handle the stressor.

It should be pointed out that this is a therapy that has eight different phases. Even though that seems like an enormous amount of time to put into curing for instance one problem, it really isn't. Even if a therapist trained in EMDR focuses on only one painful or stress producing memory, it's worth the effort to go through the process. Why? Because it teaches your mind and thus your body to handle stresses differently in the future. The concepts are easily applied to other incidents in life that perhaps might be similar, whether they are past, present or future.

In order to receive the full benefit of EMDR, it's necessary to go through the preliminary stages before getting to the real meat and potatoes of the therapy itself.

EMDR is being used to treat many disorders like PTSD successfully. You can even learn to self-administer EMDR therapy in any situation.

Phases of Treatment in EMDR

Treatment with EMDR actually consists of 2 different elements--a preparatory phase and then an actual physical part where the stimulation and reprocessing begin.

You must complete step 1 to be ready to go on to the more involved 6-part therapy of step 2.

Step 1: Before therapy begins

  • Obtaining a history and creating a treatment plan
  • Preparation and relaxation techniques

Step 2: Therapy begins

  • Assessment - selecting image and describing feeling associated with it
  • Desensitization - tapping/buzzing/left and right brain stimulation begins
  • Reprogramming - replacing negative thought/feelings with positive
  • Body check on how anxiety level is
  • Closing the door to feel better at the end than at the beginning
  • Reevaluating what was processed

Each step in the process of the treatment plays a vital role in the overall plan of therapy.

-History and Treatment Outline

In order for EMDR to be effective, no matter what the type of anxiety it is being used to treat, there must be an outline complete with images that the therapist will target. This takes some time to develop, as the client must be forthcoming in the disturbing events that he or she wishes to eradicate.

-Relaxation Training and Readiness

To participate in an EMDR session, it's necessary to have certain relaxation techniques in place and to have a "safety valve." For some people, revisiting unpleasant scenes and recalling horrific images could potentially overload their system and their psyche. In anticipation of the possible anxiety that can be evoked during a session of actual EMDR stimulation, it's important to know ways of "coming back."

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These can include deep breathing exercises, visualizing a pleasant place, a safe place, or mentally opening a drawer and putting the image into it, closing it temporarily.

Another technique that's helpful in promoting self confidence for someone during an EMDR session is to have a visual circle of support. The therapist may ask the client to name people in his or her life who have always been there for them and to visually construct a welcoming circle should they need to enlist someone's help during stressful moments.

These two phases are necessary before moving ahead with the actual visualization of the images causing the stress or anxiety. At any time during the next four phases, should the client experience difficulty, he or she has only to hold up a hand or say "stop." There is no pass or fail with EMDR therapy.

-Looking at the Image

When this part of the treatment begins, it is not a discussion of it that occurs. The client is asked to mentally "go back there" and revisit the painful moment. This is the only way to pry the unwanted feelings loose.

The therapist will ask the client to also vocalize the feeling associated with the image. If it is sexual abuse for instance, the client might say "I'm dirty" or "I'm helpless." Over the course of the next few minutes, the client is asked to stay with the feeling while the tapping or alternating stimulation begins.

Physical reactions are not uncommon; for instance, fast breathing, sweaty palms, tears, fright. The client is in fact "in the moment" again. The therapist will ask the client to validate what the level of the stress is on a scale of 1-7 (Validity of Cognition or VOC scale). This means how deeply is the image being perceived.

-Desensitization - Right/Left Brain Stimulation

This is where the actual release begins. The negative feelings that are trapped inside the nervous system are felt by the client but through a series of repetitions of sounds, movements, or physical taps, the client is led gradually from a bad image to a better image.

For instance, stepping outside the image and watching it, as if on a moving train, or perhaps looking in a window at it as an observer rather than as a participant. This is when the circle of support can be very helpful as they can mentally offer advice or encouragement to the sufferer.

-Reprogramming - Installing a New Cognition

A positive cognition (thought) is also used to replace the bad feeling or thought. The "I am dirty" or "I am helpless" is replaced with "I am fine just how I am, I am good" or "I am strong and no one can hurt me anymore." The therapist keeps repeating the above steps until the SUD (Subjective Units of Disturbance) scale is close to 0.

Note: For some people, it might stay at a 1 or 2 even after trying multiple times. That is not unusual and is a marked improvement from the high level of anxiety at the beginning. With time and more work, it can be reduced to 0 but in some cases, might remain at a 1 or 2. The goal of the therapist is to get to a 0 every time, however.

The therapist will suggest that the client look at things in a different light or ask him or her to disengage from how they previously felt during the episode. This image can oftentimes effectively "change" the old image into a newer improved image during the stimulation.

The important thing to remember is that honesty is the only policy here. The client should be forthcoming about any reaction that he or she is having and about the resolution of those feelings on an accurate scale.

-Comfort Level - Body Scan

An EMDR session cannot end with the client still trapped in the bad feelings or tied up with the negative cognition.

This means that peace has to replace the anxious or stressful feeling. By working through the exercise, when the client recalls the image now, it is not with anxiety or distress. Instead, they may have a rather detached feeling about it.

Their body will also feel subjectively normal again, meaning it is free of tension. If there was a burning sensation in the stomach, it is replaced by a warm feeling. If there was stress in the chest at the beginning of the treatment, it has now eased. Breathing is back to normal and pulse rate has returned to normal.

-Closure of the Session and the Image

Someone who has worked with EMDR cannot just turn on and off like a light switch. There has to be some processing and decompression time after the actual therapy to get one's bearings. The therapist will ask how the client is feeling and even ask some cognitive questions to make sure the person is back in the "now" and not trapped somehow in the past.

He or she may ask what your plans are for the rest of the day or evening or what you plan on doing. He or she may even toss you a ball to make sure your coordination is alright before leaving the office.

-Evaluation or Reevaluation

Talking over the exercise and what insights the client gained is also common or thinking forward to applying it to other situations might come up. The therapist will probably advise the client that the work is sometimes not completed during the session. This means that the client can experience dreams or thoughts about the image after the session is over, but the rules during the session still will apply.

For instance, if there is a resurgence of the image or bad feelings, the breathing techiques or relaxation exercises can be recalled by the client. The circle of support is still there for the person going through EMDR and they can be called upon at any time to mentally step in.

Does EMDR Work?

This treatment is showing much promise and in a relatively short period of time.

Here are just some of the targets for EMDR therapy:

  • Loss of an arm or leg
  • Drug addiction/alcoholism
  • Anger management
  • Violent behavior
  • PTSD
  • Fears and phobias such as fear of flying and agoraphobia
  • Violent crimes such as rape/assault/robbery
  • Accidents
  • Traumatic childhood events
  • Serious accidents
  • Child abuse
  • Sexual abuse
  • Low self esteem
  • Panic attacks
  • Rumination/brooding

Certain problems can be cured by relatively few sessions while other, more severe traumas may take longer to heal. However, it is a psychotherapy technique that seems to be working in many avenues to rid people of unwanted baggage.


Karen Lanser on October 27, 2015:

I have taken the basic training and believe deeply in the efficacy of EMDR. I, however, take exception to some of your description. For example, you state:

"The therapist will ask the client to validate what the level of the stress is on a scale of 1-7 (Validity of Cognition or VOC scale). This means how deeply is the image being perceived.

This is not accurate. The SUDS ( rated ftom 0 to 10 calibrate the level of disturbance in the system NOT the VOC. The VOC rates the validity of cognition regarding the belief they would rather feel. I was going to pass on your blog to potential clients but can not do so unless and until your representation is accurate.

Audrey Kirchner (author) from Washington on July 26, 2012:

Thanks for the visit, Pamela~

Pamela Oglesby from Sunny Florida on July 26, 2012:

This therapy is new to me and very interesting, Thanks for a very thorough explanation of this therapy. Excellent hub.

Audrey Kirchner (author) from Washington on July 26, 2012:

Thanks drpjl for adding that information to the hub!

drpjl on July 26, 2012:

Just FYI, EMDR therapy is recommended as effective by organizations like the American Psychiatric Association and the Department of Defense. A study by Kaiser Permanente reported that after an average of six sessions 100% of single trauma victims and 77% of multiple trauma victims no longer have PTSD. A terrific self-help book written by the creator of EMDR, Dr. Francine Shapiro (all proceeds go to EMDR charities that help suffering world-wide) is Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy.

Audrey Kirchner (author) from Washington on July 26, 2012:

Cloverleaf, Shara and SexyLady - thanks for stopping in and it is a truly amazing therapy. I didn't mention in this article my own personal experience with it but I suffer from PTSD myself. I wrote an article about that a few days ago. The upshot is, after having symptoms crop up at the most inopportune times, I gave this therapy a try with a therapist I met a few months ago. It really does work! I can see how it would work for so many things, too. Again, thanks for taking the time to read and hope it helps someone~

Crewman - You are a wise man and a kind one as well. Don't doubt that your wife is very blessed to have you care so much for her. I do understand what you are saying's not that someone doesn't "want" to be helped - it's just that as you say, they've learned to cope with it in their own way. I suppose on many levels I am the same way with my "checkered" past. My husband becomes very frustrated with me because he sees it pull me backwards or he sees how much it can come around again and still hurt me. That's the hardest part...when you have a problem and it becomes someone else's problem.

I did see a video on YouTube about self-administering EMDR and think I may do an article on that - all part of my apprenticeship don't ya know - running out of things to write about - ha ha - 6 months is a long time...hopefully I won't crash and burn though.

I also was thinking about doing one on agoraphobia because my aunt had that as well - I never quite understood how it came upon her but since I have a horrific fear of flying myself, I now completely understand.

All I can say though on the coping front is that we all do the best we can. Lucky are we that do have supportive people in our lives that love us no matter what. Personally, I'm happy about the EMDR treatments simply because by MY coping with my past better, I'm a better person all the time and not having those lapses where I let the past become my present is a gift. In my case, it's hard to deal with my mother and stepfather a lot in the present and that triggers things for me. But with my new and improved nonreactionary mode (most of the time), it's helped - and made my husband not want to strangle my aged mother or my stepfather with his bare hands...that's improvement! At my age, I'll take anything that works~

See you next time and thanks as always for dropping in and being so honest. I'm always "too" honest me thinks but I can't seem to think there is any other way to be~

Healing Herbalist from The Hamlet of Effingham on July 26, 2012:

Very interesting. I shall have to read more about this. Thanks for sharing the great information. Voted up.

Farhat from Delhi on July 25, 2012:

I'd never heard or read about EMDR earlier , it sounds really good...i wish this wonderful information relieves too many!

Thankyou akirchner for sharing this knowledge!

SEXYLADYDEE from Upstate NY on July 25, 2012:

Another answer choice should be yes I've heard of it. Because I have and I keep reading about it to educate myself. It doesn't sound weird and I haven't made my mind up yet. I voted up! Dee

Crewman6 on July 25, 2012:

I'd like to see this therapy reach it's full promise. Unfortunately, in my personal experience, if a less-optimal coping mechanism evolves and becomes fixed in place, it's nearly impossible to substitute a better mechanism. The person being treated has to want the treatment, and want to change. If they've already developed a coping technique they like, it's incredibly hard to see value in deliberately voiding that technique.

Not sure if I'm saying this well. But in my life, someone I love is agorophobic, content with her coping mechanisms, and nothing I say or do will convince her to explore alternatives. All I can do is love her, and encourage her in whatever way I can.

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