What is EMDR therapy and why is it used to treat PTSD?

Originally developed in the late 1980s by psychologist Francine Shapiro, PhD, eye movement desensitization and reprocessing, or EMDR, has grabbed headlines in recent years with celebrities such as Miley Cyrus and Prince Harry touting the therapy as helping them heal from trauma. Although there is debate about how EMDR works and whether eye movements are necessary, it may be effective, and its use has been suggested as a possible second-line treatment in APA’s guidelines for the treatment of posttraumatic stress disorder (PTSD).

EMDR therapy is a structured psychotherapy that primarily focuses on treating individuals who have experienced distressing, traumatic events. The idea behind EMDR is those traumatic memories, when unprocessed, can become “stuck” in the brain, leading to a wide array of emotional and psychological difficulties, said clinical psychologist Steven Silver, PhD, who coauthored the book Light in the Heart of Darkness: EMDR and the Treatment of War and Terrorism Survivorsopens in new window.

Patients who have experienced trauma often find themselves going back to thoughts of past events and experiencing disturbances, Silver said. These unresolved memories can manifest in the form of anxiety, depression, PTSD, and other trauma-related conditions.

“The brain, among other things, is always trying to solve problems,” he said. For someone experiencing PTSD, these could be questions such as ‘All my friends are dead; why am I still alive?’ “This is the kind of question that the mind will insist be answered. So, it keeps going back to the event, whatever it was. But if it can’t find the answer, or can’t accept the answer, it doesn’t abandon the search if the question is considered important enough. It keeps going back. This effort to return to the event can result in recurrent dreams, intrusive memories, and flashbacks.”

EMDR addresses the ongoing PTSD patients experience by relying on the brain’s natural capacity to heal and process traumatic experiences, Silver said.

During an EMDR session, the therapist guides the patient through a series of standardized procedures designed to stimulate bilateral brain activity. This bilateral stimulation can be achieved through various methods, with the most common being the side-to-side movement of the eyes. Other techniques include alternating sounds or taps, but eye movements are the most widely used, said Marianne Silva, LCSW, an EMDR-certified therapist and clinical social worker with the Department of Veterans Affairs.

“Sometimes clients know very clearly what their triggering event is, for example, they were in a car accident or experienced a sexual assault,” Silva said. “But sometimes clients show up saying they can’t sleep, they’re snapping at everyone, and crying all the time, and they have no idea why. Our job as therapists in this phase is to help them figure that out.”

EMDR therapy focuses directly on the memory and is intended to facilitate the reprocessing of memories, thus reducing and eliminating the problematic symptoms.

EMDR therapy is also time-limited, Silva added.

“The goal is to help people heal from trauma in a relatively short amount of time,” she said.

This treatment uses a structured eight-phase approach over a series of sessions until their symptoms have been fully resolved. These phases are:

1. taking history and treatment planning
2. preparing and explaining the treatment
3. activating the memory to be reprocessed
4. memory desensitization
5. using bilateral stimulation to install the patient’s desired way of thinking about the traumatic experience
6. identifying and processing residual physical disturbances related to the target memory
7. bringing each session to an orderly close
8. re-assessing the patient and their memories to ensure they are progressing throughout the treatment and staying on track to meet their goals.

“What we’re doing with EMDR is bringing back the trauma of the memory and applying techniques to allow the brain to bring in additional information that the client knows now because the trauma is over,” Silva said. “These could be things like the fact that they’re safe now, that they survived, that they’re not in a state of danger anymore, and even that they realize the event wasn’t their fault and they are not to blame for the rape or assault or whatever it is that they experienced.”

During the therapy, Silva noted, many patients experience strong emotions, including grief, anger, anxiety, and fear as they face the memory, but as additional information gets added to their memory, the emotionality and distress start to come down.

“We know this because we check in with patients and they report that back to us, but we can also see it in their bodies,” Silva said. “That’s how we know that things are moving in the right direction without having to talk about it in detail.”

Silva also noted EMDR’s potential side effects are similar to what people experience through other psychotherapies.

“I tell clients they may experience an increase in distressing emotions or uncomfortable physical sensations; however, these experiences are transient, and we expect they decrease or resolve as treatment progresses,” she said, adding that some patients also report feeling tired or experiencing more vivid dreams following reprocessing sessions. “I remind clients that it’s normal to experience these things as they decrease avoidance and begin approaching their trauma and that we’ll be checking in each session about what they’re experiencing and adjust as needed to ensure they’re able to engage with the therapy as effectively as possible.”

Some research studies support the effectiveness of EMDR therapy in treating trauma-related conditions. APA, the World Health Organization, and the Department of Veterans Affairs all recognize EMDR as a possible treatment for PTSD.

APA has a clinical practice guideline for the treatment of PTSD and includes a conditional recommendation suggesting the use of EMDR as a second-line treatment. This means that while there are other PTSD treatments that received a stronger recommendation from the panel of PTSD experts, the panel determined that potential benefits of EMDR outweigh potential harms and burdens sufficiently to suggest its use versus receiving no treatment or treatment as usual. However, there was not enough quality evidence for the panel to be able to recommend for or against EMDR when compared with other psychological treatments.

Please refer to APA’s Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults for additional discussion and background.

EMDR therapy is well-suited for individuals who have experienced various forms of trauma, whether from a single distressing event or a series of accumulated negative experiences. Trauma can take many forms, including physical or emotional abuse, bullying, accidents, combat experiences, natural disasters, or the sudden loss of a loved one. In addition, even those who have experienced long-standing emotional neglect or witnessed traumatic events may benefit from EMDR therapy.

Of course, not everyone who experiences trauma will go on to develop PTSD. However, patients and clinicians can discuss whether EMDR is an appropriate treatment choice for them based on the patients’ values, preferences, and individual characteristics, and the clinician’s expertise.

EMDR is not just for those who have experienced a recent trauma—it can benefit those who have carried the weight of traumatic memories for years or even decades, Silver said.

In fact, one of the first veterans Silver used EMDR with was a Vietnam War veteran seeking help for a long-standing combat-related trauma that had budged very little despite the use of traditional CBT.

“After about three repetitions of the bilateral stimulation, he started telling me that the picture no longer seemed as intense as it had been, and after the fifth set, he’d lost the picture entirely and said to me, ‘You know, it’s too bad my friend died; he was a good man,’” Silver recalled. “In 20 minutes, we saw a combat trauma that occurred nearly 30 years ago get resolved.”