How Eye Movement Desensitization and Reprocessing Therapy (EMDR) Works

This post was developed via a partnership with BetterHelp.

Have you seen an image or scene in a movie that you kept replaying in your mind? Even if it’s an unpleasant image from a show, some images can be hard to get out of our heads. But when someone is experiencing PTSD, the effects can be more dramatic. A person with PTSD can be replaying an unpleasant image in their head from a traumatic past event and experiencing difficult emotions.

Sometimes, the disturbing feelings and images from the trauma can interrupt a person’s life and interfere with their ability to function in their job and relationships. But that’s no reason to give up. People experiencing the effects of trauma have treatment options like eye movement desensitization and reprocessing therapy (EMDR), which have been shown to be effective. To learn more about EMDR, check out these informative BetterHelp resources on EMDR therapy and reprocessing trauma.

In this article, we’ll delve into how eye movement desensitization and reprocessing therapy works and what to expect during EMDR therapy.

What An EMDR Therapy Session Looks Like

Let’s go back to the movie analogy discussed earlier to explore what an eye movement desensitization and reprocessing therapy session may look like. During an EMDR session, a therapist guides the patient to a traumatic event, the memory of which runs through their mind like a movie. The therapist may ask the person to push pause on the worst image from that memory, almost like you would push pause on a movie you’re watching.

What makes an EMDR session different from some kinds of therapy is that the process involves some form of bilateral stimulation. Bilateral stimulation is designed to stimulate activity between the left and right sides of the brain. Bilateral stimulation has been shown in studies to help with replacing disturbing memories with more positive thoughts and feelings, a process known in EMDR as installation.

Although EMDR treatment specifically refers to “eye movement” in the EMDR abbreviation, bilateral stimulation can be accomplished through many different methods. Tapping is a form of bilateral stimulation. Music can also be used as a form of sound-based bilateral stimulation.

Why It Works

EMDR can take several different forms in practice, but the course of EMDR treatment can generally be expected to follow eight steps.

The Eight Steps of EMDR Therapy

There tend to be eight steps that are part of the EMDR process. Let’s look at these EMDR therapy steps in more detail to understand more about what one may be able to expect during EMDR treatment.

EMDR Phase 1: Getting History

The first step in EMDR is getting the person’s history. This process involves the therapist leading a discussion of what disturbing memories led them to seek EMDR treatment. The therapist also asks about a person’s current symptoms and triggers and their future goals.

Working together, the therapist and the person being treated will identify goals to reach and what completing EMDR treatment looks like. Once the past factors and future goals are agreed upon, a person receiving EMDR treatment can move into phase two.

EMDR Phase 2: Preparing For Treatment

The second phase of EMDR focuses on preparing a person for treatment. This can be described as the educational phase. During this time, the therapist provides educational resources to help the person being treated understand the bilateral stimulation mechanism involved in EMDR. Often a patient is encouraged to read scientific studies detailing the effectiveness of EMDR.

This educational phase also often extends to learning about complementary therapies and strategies for dealing with stress. Mindfulness training, breathing techniques, and meditation are often considered helpful exercises that support successful EMDR outcomes. After the education phase is completed, the next treatment phase involves selecting a memory to focus on.

EMDR Phase 3: Selecting A Memory To Target During Treatment

Unfortunately, some people may have a series of traumatic events to work on reprocessing. While EMDR can be used to treat more than one disturbing event, only one event can be processed at a time.

This phase focuses on singling out one event to reprocess and establishing a baseline for how disturbing the event is to the person, which is measured in the Subjective Units of Distress (SUD) and the Validity of Cognition scale (VOC).

EMDR Phase 4: Desensitization

The desensitization process is the primary mechanism in EMDR, and where this form of therapy takes its name. During this phase, the therapist guides a person to a form of bilateral stimulation. Bilateral stimulation is the process of engaging the communication between the right and left hemispheres of the brain.

In the case of EMDR, this often involves a person moving their eyes in a left-and-right motion. In that way, the two sides of the brain are both stimulated. Although bilateral stimulation may involve tapping the left and right sides of the body to get the same effect going on between the two sides of the brain.

Once eye movement or tapping has begun, the person is encouraged to engage with the memory in a process called desensitization. To go back to our movie analogy, the therapist may encourage the person to replay the most painful part of the traumatic event.

The therapist may then ask the person an open-ended question, like “What came up for you?” The person is then encouraged to let the feelings and images associated with a memory play in their mind. This kind of free association is thought to help dislodge a painful life event they may have buried in their mind. The thinking here is that the traumatic memory has a hold on the person because of their unprocessed feelings surrounding the event.

Everything that comes up that may be tied to the trauma is discussed, such as tightness of breath and other physical manifestations. Additional symptoms, such as body sensations, can often be tied to the trauma.

In this sense, EMDR is a form of exposure therapy. Some studies show that continued exposure to a traumatizing event may dull a person’s sensitivity to the trauma. In addition to the mechanism of bilateral stimulation, some of the effectiveness of EMDR is believed to be due in part to elements of exposure therapy that take place.

A desensitization session generally continues until the person has reached a lower level of disturbance, as measured in Subjective Units of Distress (SUD) or the Validity of Cognition scale (VOC).

EMDR Phase 5: Installation

During the Installation phase, new thoughts are associated with the traumatic event to replace the disturbing thoughts and “install” new, positive thoughts. Like the desensitization phase, the installation phase involves using some form of the bilateral stimulation mechanism. In this phase, the therapist helps guide the person to a positive belief surrounding the event.

For example, if someone was the victim of a violent crime that left them feeling powerless, a therapist may encourage a new positive affirmation surrounding the event that involves taking back their power. The new belief may be something like: “I am in control of my life” or “I am in a safe place now.” The therapist encourages the person to hold the new belief to be true and rate how much they believe in their new thought.

Bilateral stimulation is used throughout the process until the person embraces the new belief and rates it acceptable. The process is measured as successful once the person fully accepts their new belief, which means the “installation” phase is complete.

EMDR Phase 6: Body Scan

The next phase of EMDR involves the body scan. As in the previous phases of EMDR where specific measurements of Subjective Units of Distress (SUD) are taken, this phase is designed to measure levels of possible distress and to uncover remaining feelings of disturbance. During the body scan phase, the therapist guides the person seeking treatment to scan their entire body from their head to their toes. If any signs of disturbance are reported, the therapist will continue with bilateral stimulation.

EMDR Phase 7: Closure

The closure phase is designed to help move the patient safely out of the treatment and back into the world. Generally, a therapist is looking at the person’s sense of calm.

This may also be a point where the therapist encourages a person to engage in complementary techniques once they head back out into the world, like mindfulness and grounding exercises. 

EMDR Phase 8: Evaluation Of Treatment

Measurement is an important part of EMDR therapy sessions. In the final phase of treatment, the therapist works with the patient to evaluate whether a previous memory has been successfully reprocessed.

If the person’s distress level is still high surrounding a traumatic memory, they may decide to repeat the desensitization and reprocessing steps. Conversely, the therapist and their patient may decide to move on if the memory has been deemed as having become less distressing. Since EMDR therapy is designed to work on one specific memory, the process may continue for patients who wish to reprocess more than one traumatizing event.

In Conclusion

Eye movement desensitization and reprocessing therapy is one form of treatment for those experiencing trauma, but it’s not the only way. If you or someone you know is experiencing feelings of overwhelm, know that there is help out there. Almost all of us can relate to feelings of needing help, please don’t hesitate to seek support. Taking steps to care for your mental health is one of the most positive things a person can do for themself.