EMDR: How it works and what to expect
Reviewed by Brooks Baer, LCPC, CMHP
Written bytherapist.com team
Last updated: 05/30/2023
What is EMDR?
Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that allows you to work through heightened emotions or traumatic experiences. EMDR helps survivors of trauma reprocess memories and make new connections, ultimately reducing the distress associated with the trauma.
What is EMDR used for?
EMDR is most strongly recommended for trauma survivors and people struggling with posttraumatic stress disorder (PTSD), which EMDR was originally developed to treat. It has also proven effective for other conditions, including:
How does EMDR work?
EMDR uses eye movements and other types of bilateral stimulation (BLS) to help the brain access and process traumatic memories and beliefs.
The eye movements used in EMDR, such as tracking your therapist’s finger as it moves from left to right, are one kind of BLS. EMDR’s eye movements are meant to mimic the rapid eye movement (REM) you experience during the final stage of a sleep cycle, when you dream and your brain works through experiences and makes connections.
What is bilateral stimulation (BLS)?
BLS is a process that engages both the left and right sides of your brain and body in an alternating, consistent rhythm or pattern. Common BLS types used in EMDR include:
- Slow, rhythmic tapping on the knees or shoulders
- Following your therapist’s finger from left to right with your eyes
- Visually tracking dots on a screen as they move from left to right
- Listening to soft tones through headphones, alternating from left to right audio channels
- Squeezing a ball in one hand and then the other
- Holding buzzers in each hand that vibrate back and forth
How does BLS work?
BLS engages both sides of the brain. You may have heard certain people are left-brained (logical) or right-brained (creative). That’s false. However, it’s true that certain skills or abilities tend to be dominated by one side of the brain over the other.
Generally speaking, the left side of your brain dominates language processing, memory association, and positive emotions, while the right side of your brain dominates visual interpretation, spatial reasoning, and negative emotions. In addition, each side of your brain controls the opposite side of your body: Your brain’s right side controls movements on your body’s left side, and vice versa.
BLS and trauma processing
BLS helps stimulate both sides of your brain so you can make new connections and process traumatic memories that may have gotten “stuck.” Processing trauma often requires making associations, interpreting visual information, putting words to your feelings, and working through both positive and negative feelings. BLS helps your brain accomplish these tasks so you can make meaning from what happened and move forward.
Is EMDR hypnosis?
EMDR isn’t hypnosis. EMDR uses bilateral stimulation to allow your brain to make new neural connections. Hypnotherapy, meanwhile, uses guided relaxation to place you in a focused state for therapeutic purposes.
Is EMDR effective?
EMDR has proven to be very effective. In particular, the Department of Veterans Affairs strongly recommends it for veterans struggling with PTSD.1
Why EMDR is so effective is still unclear. Some theories suggest it’s because it mimics REM sleep, allowing memory consolidation to occur. Others theorize it works because it includes principles of prolonged exposure therapy, a first-line treatment for PTSD. Despite its effectiveness, EMDR has historically been controversial, and critics argue that the BLS component of EMDR isn’t relevant to treatment. For now, more research is required.
Phases of EMDR
BLS is an important technique in EMDR, but it isn’t the only part of the process. EMDR consists of eight distinct stages:
In the first part of EMDR, you’ll establish a relationship with your therapist, share your mental health history, and determine your reason for seeking treatment.
You may want to try EMDR because of a specific traumatic memory that’s negatively affecting your life. You may have had a traumatic experience but have no memory of it, or you may be seeking treatment for distressing thoughts, feelings, or behaviors that may or may not be rooted in a specific trauma.
In history-taking, your therapist will learn more about you and decide whether they think EMDR can help. If so, they’ll work with you to identify a distressing memory or belief to target with treatment.
2. Preparation and resourcing
Revisiting the upsetting memory or belief you target can cause you intense distress and overwhelming emotion. Before proceeding, your therapist will prepare you by explaining how EMDR works and helping you practice various forms of BLS. You’ll also learn a variety of methods (or “resources”) for managing your emotions, including:
- Containment: Using your imagination and sensory language, you’ll create a specific container (such as a box) in which to keep memories, thoughts, feelings, or beliefs you aren’t yet ready to address.
- Safe place: Using your imagination and sensory language, you’ll place yourself in a natural environment that feels completely safe and peaceful (like an autumn forest, quiet beach, or mountaintop).
- Sensory memories: You’ll make a list of sensory experiences that bring you joy or make you feel safe (like petting a dog, eating homemade cookies, or swimming in the ocean).
3. Activation and assessment
Once you’re prepared and have resources at your disposal, your therapist will help you “activate” your distressing target memory. They’ll help you use your resources to regulate your emotions. You’ll identify what’s happening in the memory and what you’re thinking and feeling.
During “assessment,” you’ll evaluate your levels of distress as well as the validity of certain beliefs you have. You’ll be asked to rate your distress on a scale of one to 10 (known as the “subjective units of disturbance” or “SUD” scale). And you’ll rate how true a belief feels to you on a scale of one to seven (known as the “validity of cognition” or “VOC” scale).
Rating your distress with the SUD scale helps you and your therapist understand which specific parts of the target memory upset you most. Your therapist can then help you develop better resources to manage those emotions. Eventually your traumatic memory will become less distressing, and you’ll rate that memory lower and lower until it’s no longer upsetting at all (zero on the SUD scale).
The VOC scale helps you measure how true a belief feels, not how true you think or know it is. This helps you and your therapist learn what beliefs you have about your traumatic memory and identify healthier beliefs you’d like to adopt regarding what happened. When you struggle with trauma, you may know a belief (such as “I’m still in danger right now”) isn’t logical, but it feels real all the same. As EMDR treatment progresses, your unhelpful beliefs will feel less trustworthy, while more helpful beliefs (like “I’m safe now”) will start to ring true.
At the desensitization stage, your therapist will ask you to focus on the target memory during bilateral stimulation. You’ll measure your distress with the SUD scale and share any insights, connections, or new memories that emerge. This will help your therapist determine new targets for further desensitization. This work continues until your distress associated with the target memory disappears or reaches a reasonable low point (typically in the zero to two range).
Once you’ve been desensitized to your target memory, your therapist will use eye movements and other forms of BLS to help you adopt and strengthen the positive belief you identified during the assessment stage. As you work to adopt this positive belief, you’ll use the VOC scale to communicate how true the belief feels. The goal is for your positive belief to ring completely true—a seven out of seven.
6. Body scan
After desensitization and adoption, you should feel low distress levels regarding the traumatic memory, and your positive belief should feel strongly true.
In the next step, the body scan, you’ll assess what’s happening in your body as you revisit your traumatic memory and your new positive belief. This helps you identify any lingering tension in your body that may need to be addressed.
Even if you’ve intellectually adopted your positive belief, your body may feel otherwise. Trauma’s residual effects can be felt in the body, and they can’t be addressed through logic alone. The body scan allows you to strengthen the connection between what your brain knows and what your body feels.
EMDR often brings up distressing, overwhelming emotions. During closure, the final stage of every session, you’ll use some of the resources you learned during the preparation stage as your therapist helps you return to a state of emotional balance and calm.
While closure ends every session, reevaluation is added each time after the initial session’s history-taking and preparation stages. Here, your therapist checks in on your stress levels, beliefs, and body tension. This allows your therapist to see if treatment has helped, if more work is required, or if new targets need to be addressed.
What to expect after EMDR
Side effects are minimal after EMDR. Some people experience lightheadedness. Your brain may try to continue reprocessing your traumatic memory in the form of nightmares while you sleep. But a good session should end with the closure stage, resetting your body to a peaceful state so you can leave your session without lingering distress.
Get help now
EMDR is a promising, effective treatment method for people struggling with trauma. Browse our directory to find a specialist near you. EMDR can also be conducted remotely: Many therapists use specific software to allow for bilateral stimulation during online therapy sessions.
If you’re currently in crisis, help is available immediately:
- 988 Suicide & Crisis Lifeline: 988 or 1-800-273-TALK (8255)
- Crisis Text Line: Text HOME to 741741
- Veterans Crisis Line: 1-800-273-8255, press 1, or send a text to 838255
Can you do EMDR at home by yourself?
No. EMDR is a structured therapeutic process that requires the expertise and guidance of a mental health professional trained in EMDR. Don’t try to perform EMDR on yourself or others. However, you can and should use the skills and resources you acquire during EMDR, such as your safe place or container, in your daily life.
Other types of trauma therapy
Trauma is complicated, and not everyone is a good candidate for EMDR. If you’re interested in other types of trauma therapy, consider learning more about:
- Cognitive behavioral therapy
- Dialectical behavior therapy
- Prolonged exposure therapy
- Somatic therapy
- Mindfulness-based stress reduction (MBSR)
- Animal-assisted therapy
- Group therapy
About the author
The editorial team at therapist.com works with the world’s leading clinical experts to bring you accessible, insightful information about mental health topics and trends.
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