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See Also

See Also:

Eye movement;

Francine Shapiro;

Post traumatic stress disorder. Psychotherapy;

Therapy;

Trauma;

Treatment.

Psychology & Behavioral Health

Eye movement desensitization and reprocessing (EMDR)

by Adam Lynn

Type of psychology: Biological bases of human behavior; Clinical; Counseling; Family; Health; Psychopathology; Psychotherapy

Eye movement desensitization and reprocessing (EMDR) is an exposure therapy discovered in 1987 by Dr. Francine Shapiro. It was discovered “by accident” while walking in the park, according to her own account. Since that time, the technique has been heavily researched with veterans suffering from combat related posttraumatic stress disorder (PTSD) as well as other clinical populations. In addition, EMDR is utilized to help clients struggling with non-PTSD conditions including phobias, performance anxiety, social anxiety, and coping skills for medical and terminal illness and bereavement

Key Concepts:

  • Desensitization

  • Exposure

  • Posttraumatic stress disorder

  • Psychosomatic

  • SUDS score

EMDR has become a first-line treatment for many clinicians to help clients overcome the devastating symptoms of PTSD. This is due to the rapid results often achieved in eliminating symptoms common to PTSD, such as nightmares, flashbacks, blackouts, rage, dissociation, exaggerated startled response, anxiety, depression, and avoidance of details reminiscent of the traumatic event. Sometimes use of EMDR is able to erase the image or memory completely. Considered an intervention with rapid results, EMDR reprocessing is often achieved in fewer than 30 minutes. In fact, session preparation often takes longer than the amount of time required for EMDR to reprocess the trauma.

Application

Because EMDR is an exposure-oriented therapy, the client must be willing and able to conjure and confront images and memories of the trauma. Images and memories are usually self-generated, but external cues may also be used to trigger memories. If the client is not able to tolerate a discussion about or unable to conjure an image of traumatic material, EMDR is contraindicated. In other words, EMDR is not an effective treatment for vague or repressed memories. Two main criteria determine whether the client is likely to benefit from EMDR: 1) the level of clarity and 2) the level of emotional disturbance the memory causes. If the traumatic memory is disturbing but not clear, EMDR's effectiveness is drastically reduced. The client must remember at least some important details of the trauma so that the memories can be reprocessed.

The second criterion is that the internal or external images are disturbing enough to the client that intense psychosomatic reactions are elicited. Common psychosomatic reactions include muscle tension, tightness in one's chest, butterflies in the stomach, clenching of fists and/or jaw, palpitations, sweating, dizziness, nausea, and crying. These psychosomatic reactions are often accompanied by feelings of intense fear, anger, helplessness, and horror. In other words, EMDR is most effective when traumatic memories are very clear and very disturbing. At the beginning of a treatment, clients will often say something like, “This happened twenty-five years ago, but I remember it like it was yesterday.”

How EMDR works

Although there is some controversy about why EMDR works, most agree that it involves bilateral brain stimulation which catalyzes emotional healing. This can be achieved through eye movements back and forth, alternating auditory pulsations, or tapping on the client's knees in a pitter-patter fashion. The left side of the brain is responsible for rational thinking and language, while the right side of the brain is thought to be associated with images, creativity, and feelings. A hallmark feature of PTSD is that the person experiences a disconnected reality between what they know to be true intellectually versus how they feel about themselves or the world emotionally. For example, a woman who was raped may understand intellectually that it was not her fault yet she may experience feelings of guilt or shame as though she were responsible for the incident. This is an example of a disconnection between the left brain and right brain. The left-right brain disconnection often results in a distorted, negative sense of self, and EMDR helps desensitize and reprocess trauma so that the right brain (feeling) defers to the left brain (rational).Thus the person experiences the memory according to rational reality as opposed to irrational feelings. During the course of a single session, the client may start the session sobbing uncontrollably about a traumatic event and after the session may say something like, “What happened to me was unfortunate, but it doesn't mean I have to walk around in fear anymore.” When EMDR is successful, the shift in perspective is rapid and dramatic.

Procedure

Use of EMDR is straightforward. The first step is to obtain a detailed description of the traumatic event with special emphasis on the image or snapshot that best represents the most painful part. It is usually easy for the client to identify the worst part, because it is often the subject of nightmares, flashbacks, or details that they most want to avoid. Once the targeted snapshot is identified, the client is asked to rate the snapshot on a scale of 0–10. The client's ability to rate their experience is vitally important because the clinician is dependent on the client's self reporting to verify the effectiveness of the treatment. This is known as the Subjective Unit of Disturbance Scale (SUDS); 0 represents no disturbance while 10 represents the most disturbing thing the client can imagine. At the beginning of the treatment session, a baseline SUDS score is taken. Periodically, the SUDS scores are recorded to determine whether EMDR is decreasing the client's level of disturbance associated with the trauma. Each set of eye movements lasts approximately one to two minutes. This process is repeated until the SUDS score decreases to 1 or 0.

In addition to the SUDS level, prior to starting desensitization, a detailed description of the incident is obtained. Then the client is asked what negative self concept is associated with the memory. This elicits the distortion which will be reprocessed by EMDR. For example, if we use EMDR for an incident where a person was robbed at gunpoint, the client is asked, “What negative self idea is associated with seeing the robber pointing a gun in your face?” The client will usually say something like “I'm dead!” As EMDR treatment progresses, the clinician checks between sets of eye movements to see whether anything has shifted in terms of the disturbing image (e.g., a gun pointed at the client's face) or the client's feelings associated with the image. Usually, the image becomes increasingly unclear, and the client reports that the incident feels more like a movie than his or her own life experience (desensitization).

In addition to a baseline SUDS score, a detailed description of the traumatic event, and negative, distorted self statements, EMDR preparation includes asking clients about their emotions and body sensations elicited by the trauma. The most common emotions reported are fear, anger, sadness, and helplessness. The most common bodily sensations are tight chest and/or jaw, heart palpitations, difficulty breathing, crying, butterflies in the stomach, and dizziness. After each set of eye movements, emotional and somatic symptoms are assessed. Typically, there is a direct relationship between the clarity of the image and the level of emotional and bodily discomfort.

The final part of the EMDR preparation is the creation of a “safe place.” This is a happy scene or memory where the client can retreat if the disturbing images become too intense to tolerate. Even though it is useful for clients to know they can stop EMDR at any time, the safe place is rarely utilized. As noted above, EMDR preparation often takes longer than the actual treatment.

In summary, the client gives a detailed account of the trauma. A baseline SUDS score is recorded as well as the negative self statement and the related bodily sensations and emotions. The client is asked to focus on the disturbing image and then asked to open his or her eyes. A clinician then waves fingers in front of the client's field of vision, and he or she follows back and forth while keeping the head still. Each set of eye movements lasts about one to two minutes. Between sets, the client takes a deep breath and is asked to assess the clarity and level of disturbance of the traumatic image, as well as any changes to emotional and somatic status. This process is repeated until the SUDS score decreases to 1 or 0.

Conclusion

EMDR is an extremely useful image oriented exposure treatment that rapidly desensitizes and reprocesses traumatic memories and other anxiety-based irrational thoughts. EMDR requires that the traumatic memory is clear and disturbing and that the client can tolerate a discussion about it. Often, by the end of the brief treatment, the client feels relaxed and is unable to visualize the disturbing image any longer.

It should be noted that although EMDR is simple to understand conceptually, the client should pursue treatment only from licensed behavioral health professionals who are properly trained by groups like the EMDR Institute.

Bibliography

1 

Shapiro, F. (1995). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures. New York, NY: Guilford.This book is geared towards clinicians, giving a historical and theoretical background of the technique and providing the standard protocol in detail.

2 

Shapiro, F., & Silk Forrest, M. (1997). EMDR: The Breakthrough Therapy For Overcoming Anxiety, Stress and Trauma. New York, NY: Harper Collins. This book is written for laypeople to give a taste of EMDR treatment and what disorders it may be useful in treating.

3 

Grand, D. (2001). Emotional Healing At Warp Speed: The Power of EMDR. New York, NY: Crown Publishing Group. This book is written by an experienced EMDR practitioner and trainer. It is easy reading for the general population interested in an expert therapist's inspiring anecdotes.

4 

www.emdr.com This is the homepage for the EMDR Institute. It includes a wealth of information about EMDR research and development as well as a description of the numerous humanitarian projects that practitioners are involved with. There are also pages that provide products, answers to frequently asked questions, and a list of EMDR certified clinicians by zip code.

Citation Types

Type
Format
MLA 9th
Lynn, Adam. "Eye Movement Desensitization And Reprocessing (EMDR)." Psychology & Behavioral Health, edited by Paul Moglia, Salem Press, 2015. Salem Online, online.salempress.com/articleDetails.do?articleName=PBH_0236.
APA 7th
Lynn, A. (2015). Eye movement desensitization and reprocessing (EMDR). In P. Moglia (Ed.), Psychology & Behavioral Health. Salem Press. online.salempress.com.
CMOS 17th
Lynn, Adam. "Eye Movement Desensitization And Reprocessing (EMDR)." Edited by Paul Moglia. Psychology & Behavioral Health. Hackensack: Salem Press, 2015. Accessed September 17, 2025. online.salempress.com.