EMDR (Eye Movement Desensitization and Reprocessing)
Trauma processing therapy using bilateral stimulation (eye movements, tapping, or sounds) while recalling distressing memories to reduce their emotional charge
Bottom Line
EMDR is one of the most well-researched trauma therapies, recognized by the WHO, APA, and VA as a first-line treatment for PTSD. Developed by psychologist Francine Shapiro in 1987, it involves recalling traumatic memories while following bilateral stimulation (typically eye movements following a therapist's fingers).
The evidence is strong - comparable to trauma-focused CBT, often with faster results. The mechanism is debated (working memory interference, memory reconsolidation, REM-like processing), but the outcomes are well-documented. EMDR requires a trained therapist; self-administered versions exist but lack the same evidence base.
If you have PTSD, trauma-related anxiety, or distressing memories that haven't resolved, EMDR is worth serious consideration. It's not a DIY intervention - find a certified EMDR therapist.
Science
How EMDR works (proposed mechanisms):
The mechanism is still debated. Leading theories:
1. Working Memory Hypothesis:
- Recalling trauma while doing eye movements taxes working memory
- Memory can't be held as vividly while attention is divided
- Reconsolidation stores a less distressing version
- Lee & Cuijpers (2013): Eye movements reduce memory vividness and emotionality
2. Memory Reconsolidation:
- Reactivated memories become temporarily unstable
- Bilateral stimulation during this window alters storage
- Memory reconsolidates with reduced emotional charge
3. REM Sleep Analogy:
- Eye movements mimic REM sleep patterns
- REM sleep processes emotional memories
- EMDR may activate similar processing mechanisms
4. Orienting Response:
- Eye movements trigger orienting reflex
- This activates parasympathetic system
- Reduces arousal while processing trauma
Key research:
- Shapiro (1989): Original controlled study showing PTSD reduction
- Bisson et al. (2013): Cochrane review - EMDR effective for PTSD
- Chen et al. (2014): Meta-analysis confirming EMDR efficacy
What the evidence shows:
- PTSD treatment: Strong evidence (WHO, APA, VA endorsed)
- Trauma-related anxiety: Strong evidence
- Phobias: Moderate evidence
- Depression (trauma-related): Moderate evidence
- Chronic pain: Preliminary evidence
- Performance anxiety: Some evidence
Comparison to other treatments:
- Comparable efficacy to trauma-focused CBT
- Often faster (fewer sessions needed)
- May be easier for those who struggle to talk about trauma
- Less homework than CBT approaches
Supporting Studies
8 peer-reviewed studies
View all studies & compare research →Practical Protocol
Important: EMDR should be done with a trained therapist
The following is educational - not a self-treatment guide.
8 Phases of EMDR:
Phase 1: History & Treatment Planning
- Therapist gathers trauma history
- Identifies target memories for processing
- Assesses readiness and resources
Phase 2: Preparation
- Explains the EMDR process
- Teaches self-calming techniques
- Establishes "safe place" visualization
- Builds therapeutic alliance
Phase 3: Assessment
- Selects specific memory to target
- Identifies negative belief about self (e.g., "I'm not safe")
- Identifies desired positive belief
- Rates disturbance level (SUD scale 0-10)
- Rates validity of positive belief (VOC scale 1-7)
Phase 4: Desensitization (core processing)
- Hold target memory in mind
- Follow therapist's fingers (or other bilateral stimulation)
- Sets typically 24-36 back-and-forth movements
- Brief check-in: "What do you notice now?"
- Continue until disturbance level drops
Phase 5: Installation
- Strengthen positive belief
- Pair positive cognition with original memory
- Continue bilateral stimulation
- Goal: positive belief feels true (VOC 7)
Phase 6: Body Scan
- Hold memory and positive belief
- Scan body for residual tension
- Process any remaining physical sensations
Phase 7: Closure
- Return to calm state
- Use safe place or calming techniques
- Debrief the session
- Prepare for between-session experiences
Phase 8: Reevaluation
- Next session: check if gains maintained
- Address any new material that emerged
- Identify next target if needed
Types of bilateral stimulation:
- Eye movements (most researched)
- Tapping (alternating knees or shoulders)
- Auditory (tones alternating left/right ears)
- Tactile buzzers (held in hands)
Typical treatment course:
- Single trauma: 3-6 sessions
- Complex trauma: 12+ sessions
- Sessions: 60-90 minutes
- Frequency: Weekly or bi-weekly
Risks & Side Effects
Known risks:
- Temporary increase in distress during processing
- Vivid dreams or new memories between sessions
- Emotional intensity during sessions
- Incomplete processing if stopped prematurely
Contraindications:
- Active suicidality (stabilize first)
- Severe dissociation (requires specialized protocol)
- Psychosis (not appropriate)
- Lack of affect tolerance (preparation needed first)
- Medical conditions affecting eye movement
Precautions:
- Must be done with trained, certified therapist
- Requires adequate preparation and stabilization
- Not appropriate for everyone immediately
- May need to address dissociation first
- Pregnant individuals: consult with therapist
Self-EMDR concerns:
- Apps and self-help versions exist but lack evidence
- Risk of retraumatization without proper support
- May miss important preparation phases
- Cannot provide same containment as therapist
- Bilateral stimulation alone is not EMDR
Risk level: Low when done with trained therapist. Higher risk with self-administration or untrained practitioners.
Who It's For
Strong evidence for:
- Post-Traumatic Stress Disorder (PTSD)
- Single-incident trauma (accidents, assaults, disasters)
- Combat trauma (VA-endorsed treatment)
- Childhood trauma and abuse
- Complex PTSD (requires extended treatment)
Moderate evidence for:
- Phobias
- Anxiety disorders
- Depression (especially trauma-related)
- Grief and loss
- Performance anxiety
May be helpful for:
- Chronic pain with trauma component
- Addiction (trauma-related)
- Disturbing life experiences (not meeting PTSD criteria)
- Negative self-beliefs stemming from experiences
Good candidate signs:
- Specific traumatic memories causing distress
- Intrusive thoughts, flashbacks, nightmares
- Avoidance of trauma reminders
- Negative beliefs about self linked to experiences
- Previous talk therapy hasn't resolved trauma
May need other approaches first:
- Currently in crisis (stabilize first)
- Severe dissociation (specialized treatment needed)
- Active substance abuse (address first or concurrently)
- No specific trauma memories (may need different approach)
How to Track Results
What therapists measure:
- SUD (Subjective Units of Disturbance): 0-10 scale for memory distress
- VOC (Validity of Cognition): 1-7 scale for positive belief
- PCL-5 or IES-R: PTSD symptom questionnaires
- PHQ-9 or GAD-7: Depression/anxiety screens
What you might track:
- Frequency of intrusive thoughts/flashbacks
- Nightmare frequency and intensity
- Avoidance behaviors
- Overall anxiety/depression levels
- Sleep quality
- Trigger reactivity
Timeline:
- Session 1-2: Assessment, preparation, possibly begin processing
- Sessions 3-6: Core processing of target memories
- Often significant relief within 3-6 sessions for single trauma
- Complex trauma: 12-20+ sessions
Signs it's working:
- Memory becomes less distressing to recall
- Fewer intrusive thoughts
- Reduced avoidance behaviors
- Nightmares decrease
- Negative self-beliefs shift
- Can think about event without emotional flooding
Top Products
Finding a therapist:
EMDR International Association (EMDRIA):
- emdria.org - Find certified EMDR therapists
- Look for "EMDRIA Certified" credential
- Ensures adequate training and supervision
What to look for:
- Licensed mental health professional (psychologist, LCSW, LPC)
- Completed EMDRIA-approved training
- Experience with your type of trauma
- Consultation/supervision (especially for complex cases)
Cost factors:
- Individual session: $100-250 typically
- May be covered by insurance (check coverage)
- Some therapists offer sliding scale
- Intensive formats available (multiple hours/day)
Self-help tools (limited evidence):
- EMDR apps - Light bars for bilateral stimulation
- Bilateral music - Audio with alternating tones
- Tapping tappers - Vibrating devices
Note: Self-help tools are not a substitute for therapist-guided EMDR. Use only as adjunct or for general calming, not trauma processing.
Cost Breakdown
Cost: $100-250/session
Typical treatment costs:
- Single trauma (6 sessions): $600-1,500
- Complex trauma (12-20 sessions): $1,200-5,000
- Intensive format (weekend): $1,500-3,000
Insurance:
- Often covered as psychotherapy
- Check mental health benefits
- May require preauthorization
- Some plans limit sessions
Reducing costs:
- Training clinics (supervised students): Lower rates
- Sliding scale therapists
- Community mental health centers
- VA (for veterans): Free
- Some nonprofits offer low-cost trauma therapy
Cost-per-benefit assessment:
High upfront cost but potentially excellent ROI for trauma. Fewer sessions typically needed than traditional talk therapy. Consider: cost of untreated PTSD (lost work, health issues, relationships) vs. treatment cost.
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History of EMDR from Francine Shapiro's 1987 discovery
Dr. Honda traces EMDR's origin to Francine Shapiro noticing that eye movements reduced her own trauma distress around 1987. She developed it from a personal observation into a comprehensive therapy integrating psychodynamic, interpersonal, and CBT techniques, now used by over 100,000 clinicians worldwide.
"Around nineteen eighty seven, she noticed that when she thought about her own traumas I believe she was sexually assaulted, her eyes moved in a rapid diagonal direction side to side, so she would look up and look, you know, she'd look up into the right or I think, and then down into the left, up and to the right and left, and her eyes moved back and forth. And she noticed that this eye movement back and forth while she thought about these traumas that she had been through, she noticed that it seemed to help her recover from those terrible experiences."
Eye movements are actually a small part of overall EMDR therapy
Dr. Honda argues that the eye movement component is a relatively small part of the overall EMDR protocol, which includes extensive assessment, relationship building, distress regulation training, and cognitive restructuring. He suspects EMDR might be effective even without the eye movements.
"Is actually a kind of a small part of it. And in my estimation, if you did this, if you did EMDR and never actually did the eye movements, I would suspect that it would be at least somewhat effective, if not just as effective."
Why nobody knows the mechanism behind bilateral stimulation
Dr. Honda explains that despite various hypotheses involving REM sleep and brain lateralization, the scientific community genuinely does not understand why bilateral stimulation works. He notes that we do not even fully understand basic brain mechanics, making claims about EMDR's mechanism premature.
"To the lay person, I can imagine it being very convincing. But to people who understand the brain, I imagine they roll their eyes pretty hard. You'll hear people say that it has to do with ram sleep or something rapid eye movement sleep. And anyone who knows anything about the brain knows that these hypotheses are just initial speculations. I mean, we we don't really even understand how the brain works, and we definitely don't understand why we have rapid eye movements during sleep, So how in the world would we understand how EMDR works. And that that's the there's this big myth that is I think upheld by society and the media and maybe even biologists in their attempt to come across as as relevant. There's this big myth that we understand the brain, and we understand we've we learned new things about the brain every day, but the basic mechanics of the brain is a complete mystery to us."
EMDR endorsement and final word on its real-world impact
Despite his criticisms, Dr. Honda firmly endorses EMDR as a therapy that has saved hundreds of thousands of lives by helping people recover from trauma, reduce PTSD symptoms, anxiety, depression, anger, and suicidality. He recommends it for both clinicians and clients.
"The point is is that EMDR has helped people recover from their traumas, which can in a very real way, improve people's lives in a very real way, reduce their PTSD symptoms, their anxiety symptoms, their depression symptoms, their anger reactions, their suicidality, their homicidality. It's without a doubt clear to me that people around."
The body knows how to heal but trauma prevents it
Dr. Freitas explains that while the body is naturally geared toward healing, trauma keeps accumulating because we cannot pause the brain the way we cast a broken arm. The brain gets overwhelmed and cannot process and store memories functionally.
"The body knows how to heal. It's geared towards healing. So when we break an arm, basically, the doctor is like, We're going to put this cast on it so you just don't move it. So the body can do what it needs to do. But when it comes to trauma, when it comes to these experiences, we keep having more experiences. Like we can't put the brain in a cast and be like, wait, just hold still for a second."
EMDR as evidence-based trauma therapy supported by RCTs
Dr. Freitas describes EMDR as an evidence-based approach recognized by the National Registry for treating trauma, effective for phobias, anxiety, mood disorders, eating disorders, and panic disorder. She addresses common misconceptions about it being woo-woo or similar to hypnosis.
"And I knew that there have been randomized controlled trial studies. I knew that it was really effective for things like phobias and anxiety and mood disorders. And that I also was beginning to understand how it could support eating disorders and panic disorder and how effective it was."
Personal EMDR experience connecting birth trauma to childhood memory
Dr. Freitas shares how EMDR processing of her traumatic birth experience led to a childhood touchstone memory involving body shame. The therapy revealed how the brain connects seemingly unrelated experiences through shared emotional themes like shame and loss of control.
"And then it brought me to these memories and these other childhood experiences where I was like, whoa, this is impacting so many different areas of my life. And so while we started with, okay, the recent events that were coming up related to the traumatic birth experience, when we floated back to other times that I had felt emotionally some of the same things."
EMDR as a game changer for therapists who hit walls with clients
Kathy Dan describes how adding EMDR to her practice was a game changer, comparing pre-EMDR therapy to working with one hand tied behind her back. She initially was slow to believe but kept seeing clients referred to EMDR come back transformed.
"introducing EMDR into my therapeutic bag of tricks has really been a game changer. Some people describe their work pre-EMDR like providing therapy with one hand tied behind their back, and I now really see what they mean by that."
Research showing rapid PTSD resolution with EMDR
The hosts cite multiple studies showing EMDR's remarkable effectiveness: 84-90% of single-trauma victims lost PTSD after three sessions, 100% of single-trauma victims after six sessions (Kaiser Permanente), and 77% of combat veterans were free of PTSD after 12 sessions.
"some of the studies showed that 84 to 90% of single trauma victims no longer had post-traumatic stress disorder after only three 90 minute sessions."
The eight phases of EMDR therapy explained
Kathy Dan walks through all eight phases of EMDR: history taking, client preparation with safe place and breathing tools, assessment to determine the target, desensitization with bilateral stimulation, installation of positive cognitions, body scan for somatic holding, closure, and reevaluation.
"it sounds so structured with the eight phases, but we could be really, really flexible."
EMDR accesses trauma at a cellular level that talk therapy cannot reach
Kelly explains that while CBT keeps processing intellectual, EMDR reaches clients at a physiological level because trauma is trapped in the body. She notes that some research suggests even conditions like MS could involve trapped trauma.
"EMDR encourages becoming unstuck. And sometimes CBT just cannot reach a client at that level because EMDR can be very physiological. It encourages trauma. It's trapped in the body."
One EMDR session can equal five to twelve talk therapy sessions
Kelly describes how research shows one EMDR session can be equivalent to about five talk therapy sessions, and up to twelve sessions for veterans with PTSD. She uses an envelope system where clients write trauma titles on index cards, seal them, and only open them in session to maintain a sense of control.
"I'm not asking you to deal with it at home or talk to your spouse or your kids about it. We got it on paper. It's sealed. And all of the EMDR, you know, that I do outpatient takes place in my office unless I'm seeing patients in a hospital. But often in my office, if I'm working on one thing and I assess that there are several others, and that is the case, Joy, with a lot of African-Americans, several others, meaning a theme of traumatic experiences that stand out, they really do favor and like the whole envelope system. Yeah, I can imagine that does feel a little comforting, like they can kind of contain it, so to speak. Absolutely. Yeah. So you mentioned, you know, that you found that particularly with African-Americans, they find that comforting."
Who to Follow
Founder:
- Francine Shapiro, PhD (1948-2019) - Developed EMDR in 1987, founded EMDR Institute
Key researchers:
- Bessel van der Kolk, MD - Trauma researcher, author of "The Body Keeps the Score," EMDR advocate
- Roger Solomon, PhD - EMDR trainer, law enforcement trauma specialist
- Robin Shapiro, LICSW - EMDR author and trainer (no relation to Francine)
Organizations:
- EMDR International Association (EMDRIA) - Professional organization
- EMDR Institute - Training organization founded by Francine Shapiro
- EMDR Europe - European association
Related trauma researchers:
- Peter Levine, PhD - Somatic Experiencing founder
- Pat Ogden, PhD - Sensorimotor Psychotherapy
- Stephen Porges, PhD - Polyvagal Theory
Synergies & Conflicts
Pairs well with:
- TRE - Somatic complement to EMDR's cognitive approach
- Mindfulness Meditation - Helps with between-session regulation
- Progressive Muscle Relaxation - Self-calming skill for preparation
- NSDR - Recovery after intense sessions
Treatment sequencing:
- Stabilization first (grounding skills, nervous system regulation)
- EMDR for trauma processing
- Integration and maintenance after
Supporting practices:
- Daily: Grounding exercises, self-care
- After sessions: Rest, gentle activity, journaling optional
- Between sessions: Notice what comes up, use coping skills
- Avoid: Major decisions, intense activities right after sessions
Complementary modalities:
- Somatic therapies (Somatic Experiencing, sensorimotor)
- Yoga or gentle movement
- Vagus nerve practices
- HRV training for regulation
Not recommended to combine:
- Multiple trauma therapies simultaneously (too activating)
- Intensive EMDR with major life stressors
- Processing while in crisis
What People Say
Clinical recognition:
Common positive reports:
Common concerns:
Why it's controversial to some: