What Is EMDR Therapy and How Does It Work?
What to Expect From an EMDR Therapy Session
Talk therapy is popular for good reason. Cognitive behavioural therapy (CBT) is one of the most popular forms of talk therapy and it focuses on breaking down your thoughts, feelings, and behaviours "to find new perspectives and change [your] thought patterns," says therapist Kandace Ledergerber, LMHC. But the therapeutic style doesn't work for everyone. If you've exhausted the talk therapy route, there's another method you should be aware of: EMDR therapy, or Eye Movement Desensitization and Reprocessing.
EMDR therapy is very different from CBT, primarily because it doesn't actually involve much talking. Ledergerber, who is also EMDR-trained, LMHC, describes it as a "is a bottom-up approach that helps clients build upon resources they already have within them and process trauma by using bilateral stimulation." Get used to that term, "bilateral stimulation" — we'll explain more on that ahead. EMDR, in other words, is a unique therapeutic approach that actively utilises the biology of your brain to help you process trauma. Keep reading to find out how it works, why it's useful, and whether you should consider trying EMDR therapy yourself.
What Is EMDR Therapy?
EMDR therapy is "a form of trauma therapy that takes place by activating bilateral stimulations of the brain," says EMDR-trained psychotherapist Elizabeth Fedrick, PhD, LPC. Bilateral stimulation is the activation of one side of your brain, then the other, in a repetitive, continuous pattern. This can be done by following your clinician's finger horizontally from side to side while thinking about the traumatic event you're trying to reprocess, for example — the original format of EMDR. The approach has since evolved, Dr. Fedrick explains, "and now can be facilitated through visual, auditory, or tactile stimulations," like tapping or blinking lights.
A bit of background: the idea behind EMDR actually comes from REM (rapid eye movement) sleep. "This is the stage of sleep in which you are dreaming, processing life events, and storing memories into long-term memory," Dr. Fedrick says. All throughout REM sleep, your eyes naturally move back and forth to create bilateral stimulation. EMDR taps into the same physical strategy, but applies it to specific, traumatic events. "With EMDR, you choose which event you want to target," Dr. Fedrick says, "and then intentionally focus on this event to work to desensitize the distressing emotions and reprocess the negative beliefs associated with it."
What Does EMDR Therapy Do?
Essentially, EMDR therapy "can help rewire the brain and process unresolved trauma," Ledergerber explains. It can actually help "accelerate the therapeutic process," adds Dr. Fedrick, noting that in some cases, improvement can be noticed after just one session. Another benefit: in EMDR therapy, it's not necessary for clients to speak openly about their traumatic experiences with their therapist. This can be helpful to trauma survivors, Ledergerber explains, because trauma can feel shame-inducing and difficult (or even impossible) to verbalize.
How Effective is EMDR Therapy?
Studies have found EMDR therapy to be effective for a number of different mental health issues. It's primarily used for and recommended to treat PTSD, and a 2014 review found that 24 studies supported EMDR's effectiveness for treating "emotional trauma and other adverse life experiences," with some of the studies finding EMDR to be "rapid and/or more effective than trauma-focussed cognitive behavioural therapy."
Other research shows that EMDR is effective in treating depression. A small 2015 study found that, out of a group of 16 patients receiving inpatient care for depression, 68 percent showed "full remission" after receiving EMDR therapy (an average of between four and five EMDR sessions over an average of nearly 46 days in treatment). A year later, they also reported fewer depression-related problems and relapses. EMDR may also be effective for treating issues like panic disorder, with a 2017 study showing that it was equally as effective as cognitive behavioural therapy.
What Happens During EMDR Therapy?
We've already established that EMDR therapy is pretty different than some of our previous conceptions of therapy, so what exactly can you expect from an EMDR session? EMDR therapy is actually an eight-phase process. You'll go through some of the phases just once, while others will be repeated each session.
- Obtaining your history and planning treatment: Your therapist will ask you questions and give you questionnaires to fill out to learn more about your background and why you're seeking treatment. You'll determine treatment goals and explore the ways EMDR could be beneficial. "[T]reatment planning is completed jointly between the client and therapist, to ensure they both have an understanding and are in agreement with treatment goals," Dr. Fedrick notes.
- Preparation: In the preparation phase, your therapist will help you understand the EMDR process, develop coping mechanisms in case of adverse side effects (more on that below), and give you the opportunity to talk through any questions or concerns. "The preparation phase is important in order for the client and therapist to start to build rapport and trust within the therapeutic alliance," Dr. Fedrick says.
- Assessment: This is when you'll talk about the "target memory" you want to reprocess. This is usually usually your first traumatic memory or the worst traumatic memory you have, though it's sometimes more appropriate for clients "to process lesser charged events first," Ledergerber notes. You and your clinician will talk through key aspects of the event, like images, core beliefs, feelings, and sensations, and your clinician will take a "baseline measurement of the distress of this event," Dr. Fedrick says. You'll also identify a positive belief you'd rather associate with the memory.
- Desensitization: This is when your therapist will start bilateral stimulations with you as you start to reprocess and desensitize your target memory. You can ask your clinician what EMDR technique(s) they usually use (such as visual, auditory, or tactile) and discuss which feels most comfortable for you. Once you start reprocessing, "the target memory will be active in your mind," Dr. Fedrick says. Your clinician should stay aware of your emotional state to guide you and help you regulate any overwhelming emotions, she adds, but expect them to intervene very little during this time.
- Installation: Once you've lowered your emotional distress around the traumatic event, you and your therapist will work to strengthen the positive belief (the one you identified during the assessment phase) via bilateral stimulation until it feels true to you.
- Body scan: Your therapist will ask you to hold the target memory and your positive belief in your mind while mentally scanning your body "to determine if any disturbance remains regarding the target memory," Dr. Fedrick explains. If you do find some negative feelings or disturbances, your therapist will use bilateral stimulation to help you continue to process it.
- Closure: "The closure phase is imperative because it is when the client returns to a state of emotional regulation and calmness," Dr. Fedrick says. This phase takes place before the close of every session, even if you haven't completely reprocessed the target memory. Your therapist will help you "contain" the events you processed through grounding techniques, such as recalling a safe space that you and your therapist may have discussed and installed prior to the reprocessing. (Your safe space is a place — either real or imaginary — that helps you feel peaceful and calm. You'll identify sensory aspects of the place, like what you see, hear, and feel, and your therapist will install this resource using gentle bilateral stimulations. The idea is that this is a place you can go to when you're feeling anxious, overwhelmed, or triggered during or between sessions.)
- Re-evaluation: The last phase takes place at the beginning of your next EMDR session, Dr. Fedrick says. This is a time for your therapist to check in with you, ask you how you feel about your last session and assess the level of disturbance around your target memory and how true the new positive beliefs feel to you.
EMDR Therapy Tips
Even if you have an idea of what EMDR therapy will be like, it might still be nerve-wracking to try it for the first time. Here are some important things to remember:
- It's normal to be nervous. "Many clients feel anxious about the thoughts or feelings that might arise during this time," Dr. Fedrick says. Be open with your clinician about your worries so they can give you resources and help you develop coping mechanisms to manage any emotions that may come up.
- You're completely awake, alert, and in control during EMDR. EMDR is not hypnosis, and you'll be aware of everything going on during your reprocessing. You absolutely can and should let your clinician know if you want to stop during the reprocessing, Dr. Fedrick says.
- There's no right or wrong way to respond to EMDR. "I often encourage my clients to stay open-minded throughout this process and to try not to control . . . where their mind goes during the reprocessing," Dr. Fedrick says. "There isn't anything they have to do 'correctly' during this time."
EMDR Therapy Dangers and Risks
While EMDR therapy can be very beneficial for your mental health, there are some possible side effects worth pointing out. According to Dr. Fedrick, these include:
- Increase in disturbing memories or emotions
- Increase in disturbing dreams
- Heightened emotional sensitivity
- Fatigue after EMDR therapy, which can last for several days
- Feeling overwhelmed with emotions during the EMDR process
"All clients have different experiences when it comes to their reactions during and following the EMDR process," Dr. Fedrick says. Before starting EMDR, your therapist should make sure you have support and resources outside of therapy to help you cope with these potential side effects.
What Conditions Would Benefit From EMDR Therapy?
EMDR therapy is a form of trauma therapy, and Ledergerber notes that it can be helpful "for people who have experienced a wide range of trauma" — including both "big T trauma" (events like abuse, combat, or natural disasters) and "little t trauma" (the accumulated effect of "smaller," less pronounced events).
EMDR therapy isn't only used for dealing with trauma, though. While this approach was originally created to treat post-traumatic stress disorder (PTSD), it's now also used to treat issues like "anxiety and panic attacks, depression, phobias, sleep issues, complicated grief, addictions, and more," Dr. Fedrick says. It can be used for all age groups as well.
Like any type of therapy, though, EMDR isn't for everyone. "Individuals who have a history of dissociation, are pregnant, have pre-existing medical conditions, are in the process of legal proceedings, or lack a positive support system at home should inform their clinician (and medical provider if needed) prior to starting this process to ensure this is the right approach for their current needs," Dr. Fedrick says.
For context, some research suggests that EMDR might "influence or undermine" the accuracy of your memory around the event you're reprocessing, Dr. Fedrick says. So if you're part of a legal proceeding that has to do with the target memory, you may not be able to recall the memory clearly for possible testimony. Be sure to talk to your therapist and attorney, if you have one, about whether or not to move forward with EMDR while undergoing legal proceedings.
If you do decide to try EMDR therapy, know that it may bring up some "charged and disturbing emotions, triggers and thoughts," Ledergerber says. "It's paramount to build a trusting relationship with the therapist and feel secure before processing that trauma." Take your time and find the right therapist for your needs before starting your EMDR journey.
