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Understanding EMDR: How it works and what to expect

Writer's picture: Anita JadeAnita Jade

Updated: Feb 3



Eye Movement Desensitisation and Reprocessing (EMDR) is a psychotherapy method that has gained significant recognition for its efficacy in treating post-traumatic stress disorder (PTSD). The World Health Organisation (WHO) and American Psychiatric Association (APA) both recommend EMDR as a frontline treatment for trauma. Developed by Francine Shapiro in the late 1980s, EMDR is particularly unique because it does not rely heavily on traditional talk therapy. Instead, it incorporates bilateral stimulation (such as guided eye movements, tapping, or auditory tones) to help the brain process and integrate traumatic memories in a healthier way.

What is bilateral stimulation and why is it used?

Bilateral stimulation is a core component of EMDR therapy. It involves alternating stimuli, typically in the form of eye movements, to engage both sides of the brain. The purpose of this stimulation is to facilitate the reprocessing of traumatic memories by mimicking the brain's natural memory processing during REM sleep.


The idea is that the rhythmic left-right movement encourages both hemispheres of the brain to work together, helping to integrate the traumatic experience in a way that reduces its emotional intensity. This process is believed to help the brain process the trauma more naturally, similar to how it processes memories during REM sleep.

This dual activation helps to "rework" traumatic memories, allowing the brain to integrate them in a healthier way. Rather than being stuck in a high-emotion state, the memories are reprocessed, reducing their emotional charge and allowing the person to reframe the memory with a more balanced perspective.


The stimulation also helps the brain access different cognitive resources, allowing the individual to associate new, more adaptive beliefs and emotions with the traumatic event, instead of being overwhelmed by it.


When a traumatic event occurs, the brain may become overwhelmed, causing the memory to remain “stuck” in an unprocessed state. This can lead to distressing symptoms like flashbacks, nightmares, and heightened anxiety. EMDR works by helping the brain reprocess these traumatic memories and store it in long-term memory rather than having it feel recurrent. Fun fact: EMDR is not recommended for those involved in court cases, as it can blur details and affect memory accuracy (Otgar et al, 2021).


The 8 stages of EMDR:

  1. History Taking: The therapist gathers information about the client’s history, including significant life events and symptoms.


  1. Preparation: The client is educated about EMDR, and the therapist ensures they have tools for emotional regulation.


  1. Assessment: Specific memories or experiences are targeted, including the thoughts, emotions, and body sensations linked to them.


  1. Desensitisation: Using bilateral stimulation, the client focuses on the traumatic memory while allowing thoughts, feelings, and sensations to arise naturally. Over time, the emotional intensity decreases.


  1. Installation: Positive beliefs are integrated into the memory to replace negative, distressing ones.


  1. Body Scan: Any lingering physical sensations tied to the memory are addressed.


  1. Closure: The therapist ensures the client leaves the session feeling stable and grounded.


  1. Reevaluation: Progress is reviewed in subsequent sessions, and additional memories may be targeted.


How many sessions is needed?

The number of sessions required for EMDR can vary depending on the individual's specific needs, the complexity of the trauma, and the goals of therapy. For more straightforward or specific trauma, some individuals may experience relief or resolution in just a few sessions. However, if the trauma is deep-rooted, involves multiple issues, or has been affecting a person for a long time, more sessions may be needed, i.e. anywhere from 6 to 12 sessions, with follow up and sessions when a client feels it is needed. A therapist will typically assess and adjust the treatment plan based on your progress and needs as you go along.


How often do I need treatment?

The frequency of EMDR sessions can vary based on a client’s needs, but typically, clients begin with one session per week. This allows enough time for processing and integration of the material between sessions. Some clients prefer bi-weekly sessions, especially if the trauma is not as intense or if they need more time to process emotions between sessions.


If the trauma is more complex or emotionally charged, weekly sessions may be beneficial to maintain momentum and provide enough time for the brain to reprocess traumatic memories and leave less of a window for a client to feel raw and prickly.


Benefits of EMDR as a therapeutic approach:

  • Faster Results: For some people, EMDR can provide faster relief compared to traditional talk therapy because it works directly with the brain’s natural healing processes, bypassing some of the usual cognitive defenses.

  • Versatility: While EMDR is primarily known for treating trauma and PTSD, it’s also effective for issues like phobias, anxiety, depression, grief, and even performance enhancement.

  • No need for detailed recounting: Unlike some therapies, EMDR doesn’t require you to relive the trauma in depth, which can make the process feel less retraumatising. However, sharing your story can be healing, especially for those carrying guilt or shame, as it helps release repressed emotions and gain clarity. Verbalising these feelings in a safe space can validate experiences and support the healing process.


Reported benefits from EMDR:

  • Improved emotional regulation: It helps individuals process distressing emotions more effectively, leading to better emotional stability and a greater sense of control.

  • Lessening of negative beliefs: EMDR can help identify and reprocess limiting beliefs (e.g., "I am unworthy," "I am unsafe") that have developed as a result of trauma, replacing them with more adaptive, positive beliefs.

  • Reduction in physical symptoms: Many people notice a decrease in stress-related physical symptoms (like headaches, tension, gut and sleep issues) as their emotional and mental states improve.

  • Enhanced coping skills: After processing trauma, clients often report feeling more equipped to handle stress and adversity, with stronger coping strategies.

  • Greater sense of peace and integration: The reprocessing of traumatic memories helps integrate past experiences into a more balanced view, leading to a greater sense of peace and acceptance.


Risks of EMDR:

  • Emotional distress: Processing trauma can bring up intense emotions, memories, or physical sensations that may feel overwhelming.

  • Temporary worsening of symptoms: In the short term, some people might experience an increase in symptoms like anxiety, distress, flashbacks, and a general sense of feeling sensitive and on edge.

  • Re-traumatisation: If not handled carefully, deep trauma can resurface in a way that feels re-traumatising, particularly if the individual is not fully prepared. This is why it is important to establish strong foundations in the earlier stages of EMDR, such as identifying allies (supportive people or resources), safe memories and places, containers (mental or emotional spaces for storing difficult feelings) and grounding practices, as healing work can feel scary to face the things that we may have tried to avoid for so long.

  • Dissociation: Some individuals might experience feelings of detachment or a sense of losing touch with reality during or after a session. This is part of nervous system's survival response known as the freeze state, when intense emotions or memories become overwhelming, and the brain shuts down to disconnect from the emotional overload.


With the right preparation and support, EMDR has the potential to create lasting positive change for those struggling with trauma, anxiety, and other emotional difficulties. As with any therapeutic approach, it’s important to work with a skilled practitioner who can tailor the treatment to your unique needs, ensuring a safe and effective healing journey. Although this article was about EMDR, other therapies like Cognitive Behavioural Therapy (CBT), somatic therapies, or traditional talk therapy can also be very effective.

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anitajade88@gmail.com

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