EMDR stands for Eye Movement Desensitization and Reprocessing. It is a research-tested and highly effective treatment for trauma, PTSD (Post-Traumatic Stress Disorder), anxiety, panic, OCD, and is rapidly gaining support as an effective treatment for other conditions, such as depression, addictions, and pain control. Before addressing what EMDR involves and how it works, it is first important to explain how trauma is not only stored mentally or in our mind’s memory, but also etched deeply into our physical fiber in a body memory. A body memory can be defined as a physical reexperiencing of the actual traumatic event. In other words, your mind and body “replay” the emotions and sensations you felt during the original experience, at the same intensity. The body memory can be explicit (the same feelings and sensations that were actually experienced) or implicit (not connected to any story line). Implicit body memories are common if during the trauma, the victim was a child, under the influence of alcohol or drugs, or if the trauma occurred over a long period of time.

The prospect of working through trauma in therapy can be intimidating or frightening, as clients sense (or more likely, have experienced) the buried power and explosiveness of traumatic body memories, i.e., when something has triggered such a memory. For this reason, the therapist’s first task, before approaching the traumatic material, is to establish a “safe place” for the client, usually some type of “containment” image/visualization, such as a locked box or vault, into which the traumatic memories can be placed in between sessions, or even during sessions, if material is becoming too intense or disturbing. The therapist can also help by establishing “grounding” techniques, which are methods of bringing the client’s focus back to the present moment (and hence remind them that the trauma is over/in the past). One grounding technique is to have the client direct their focus and awareness to their feet by wiggling them, feeling them against the floor, and repeating something out loud like, “My feet are touching the floor. I’m here in this moment, today. Regardless of what I’m feeling in my body, the trauma is over. It’s not happening now.” This may sound simplistic or silly but feeling one’s feet and speaking such phrases aloud go a long way to keep the client in the present moment and prevent them from flashing back to the past. Clients can also be taught other strategies for self-care and emotional regulation between sessions.

Once the safe place, grounding, and other strategies are established, the client is prepared to move into the EMDR procedure. The client first describes the visual image of the traumatic event. If doing so is too intense for the client, the therapist might direct them to do so as if from a safe distance away, or perhaps from behind a protective glass wall. The client is asked to come up with the negative belief about themselves that the trauma created, such as “I am powerless” or “I am unlovable.” They are also directed to come up with the positive self-belief into which they want to transform the latter, i.e., “I am in control” or “I am lovable and deserve to be treated with respect.” To enable later measurement of the effectiveness of the EMDR, the client rates on a numerical scale how false or true the positive self-belief feels to them. Then they are directed back to the negative self-belief and guided to note the emotions and bodily sensations it brings up and rate their level of distress.

Focusing on the visual image of the trauma and the negative self-belief, the essential component of EMDR begins, which is bilateral stimulation of the brain (stimulation alternating between each side). This can be accomplished in several different modes, (1) visual stimulation, causing eye movements from side to side, either (a) with the therapist moving their fingers back and forth from one side of the client’s visual field to the other, or (b) using a light bar, with a row of LED lights that flash back and forth, (2) auditory stimulation, using a device and headphones in which a beep is heard back and forth between each ear, (3) tactile stimulation, where the same device causes pulsers held in each hand to vibrate back and forth, or any combination of these different types of stimulation (i.e., auditory + tactile, where the beep in the headphones and vibration in the pulser are synchronized—alternating between both on the left, both on the right, and so on).

EMDR typically involves 10 sets of bilateral stimulation per one-hour session, each one lasting 2-3 minutes long. After each set, the client is simply asked what they noticed, i.e., what were their thoughts/emotions/bodily sensations. Usually, with each set of bilateral stimulation, the intensity of the visualized trauma and negative self-belief start to fade, as measured by the client’s numerical rating of their distress. Once the distress has mostly or completely abated, the therapist switches to stating the memory paired with the positive self-belief, and again, bilateral stimulation is employed. In combination with the positive self-belief, the bilateral stimulation usually functions in an opposite manner, i.e., instead of causing the positive self-belief to fade (as with the negative self-belief), it usually strengthens and “locks in” the positive self-belief. Once the client rates the positive self-belief as feeling maximally true, the bilateral stimulation is complete. Thus, initially the bilateral stimulation serves to “desensitize” when paired with the negative self-belief, and “reprocess” when paired with the positive self-belief.

The final aspect of EMDR is called a body scan. As trauma is so physical by nature, even after the client’s visualization of the trauma has faded, and their self-belief has been transformed from negative to positive, essentially, the “body has to agree” that the process is complete. As such, the therapist directs the client to close their eyes, and gradually scanning from the top of their head to the bottom of their feet and tips of their fingers, note if they feel any tightness, tension, or unusual sensation.  If any of the latter is noted, bilateral stimulation is again employed, until the discomfort fades.

As opposed to trauma, when EMDR is used for other conditions, such as OCD or panic attacks, the process is similar: The client visualizes the situation in which they experience the obsession/compulsion or panic attack, then proceed to formulate the negative self-belief (i.e., “I am not in control” or “I cannot tolerate this compulsion/fear”), then the positive self-belief. After gathering the ratings and other information as above, the therapist proceeds to administer the bilateral stimulation until the desensitization and reprocessing are complete.