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EMDR Therapy: A Comprehensive Overview of Theory, Mechanisms, and Applications

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Eye Movement Desensitization & Reprocessing, known as EMDR, was developed by Francine Shapiro in 1987. This method, which has been approved by institutions such as the American Psychiatric Association (APA), the World Health Organization (WHO), and the National Institute for Health and Care Excellence (NICE), offers a scientifically based, holistic treatment approach for many mental disorders, especially trauma. EMDR, broadly defined, is a psychotherapy approach that helps individuals heal from symptoms and emotional distress that are the result of distressing or traumatic life experiences. EMDR therapy proves that the mind can heal from psychological trauma just as it can from physical trauma. To illustrate with an example, in its natural course, the water of a river flows in the same way as the brain processes information. But if a giant boulder falls into the riverbed, for example, a traumatic memory, the flow of the river is interrupted, the water pools, overflows, and damages the environment. EMDR therapy allows the water to return to its natural flow by changing the path of the giant boulder or eroding its edges. In this way, the brain can digest the traumatic memory that it could not process in the past and leave it behind. In the present therapy sketch, the theoretical foundations of the EMDR approach, its areas of work, and its clinical effectiveness in treating mental disorders will be presented.

What is EMDR Therapy?

Originally designed to alleviate distress associated with traumatic memories, EMDR was later developed based on the Adaptive Information Processing (AIP) model to define and expand its application areas (Shapiro, 2001). The AIP model assumes that if information about a distressing or traumatic experience is not fully processed, initial perceptions, emotions, and distorted thoughts will be stored as they were experienced at the time of the event. According to Shapiro, such unprocessed experiences form the basis for current dysfunctional responses, leading to a variety of mental disorders. Shapiro (2001) suggests that the Adaptive Information Processing Model facilitates EMDR therapy’s access to traumatic memories and other adverse life experiences and their processing for resolution. Through EMDR therapy, emotional distress is relieved, negative beliefs are reorganized, and physiological arousal is reduced. According to Shapiro (1995), since EMDR therapy facilitates access to traumatic memory, information processing is improved by establishing new relationships between traumatic memory and more compatible memories. It is suggested that these new relationships result in complete information processing, new learning, eliminating emotional distress, and developing cognitive insights. In addition, experiences are stored with appropriate emotions that can guide the individual in the future. Several studies demonstrating the effectiveness of EMDR therapy have found that 84-90% of trauma survivors no longer suffer from post-traumatic stress disorder (PTSD) after only three sessions lasting 90 minutes (Rothbaum, 1997; Wilson et. al., 1997). Moreover, it is known that EMDR therapists in 130 different countries have successfully treated millions of people with EMDR (Shapiro and Forrest, 2016). EMDR is not only recognized worldwide as an effective psychotherapy method for many mental disorders, especially PTSD, but its use is also becoming widespread for any other daily challenges, such as self-esteem issues, and negative beliefs that cause individuals to seek therapy. 

How Does EMDR Therapy Work? 

Even though “Eye movement” sounds unfamiliar in therapy, it is a biological method we use daily while we sleep. EMDR applies bilateral stimulation based on the left-right activation of the eye during sleep. This activation is called rapid eye movement (REM). REM is a phase of the sleep cycle, also known as the dreaming phase of sleep. Compared to other sleep phases, REM is associated with increased eye movement activation. During this phase, the eyeballs move rhythmically left and right. These bilateral eye movements allow the brain to process information we receive or experience daily, such as emotions, thoughts, sensations, images, sounds, and smells, and integrate them into associated memory networks, especially long-term memory networks. This system seems to break down when traumatic or disturbing events occur. New information is not processed and integrated into the existing memory network. There is no connection with functional information in the memory network to make sense of the experience. Emotions, thoughts, images, sounds, and body sensations are stored as they are experienced. Therefore, if some situations experienced today trigger these isolated memories, the person is affected as if reliving part or all of that memory (Shapiro, 2001).

During EMDR psychotherapy, eye movements are used to create an effect similar to that of REM sleep. The bidirectional stimulation (moving the eyes left and right) in EMDR facilitates the cortical integration of traumatic memories, as we are in the REM sleep phase. The goal of bidirectional stimulation is to activate adaptive information processing disrupted by traumatic experiences. Thus, it affects the limbic system and amygdala, which are known to be associated with traumatic experiences. In addition to the eyes, tactile or auditory bidirectional stimulation can also be used in EMDR therapy (Shapiro, 2001). But how is this process put into practice during the therapy? Let’s take a closer look at how these methods are utilized in the therapy room.

How is EMDR Implemented in Therapy?

According to EMDR, negative emotions, thoughts, behaviors, and personality traits are associated memories that are maladaptive, dysfunctional, unprocessed, and stored in isolation. Negative beliefs about oneself (e.g., I am worthless if I fail the exam), adverse emotional reactions (fear of failure), and adverse somatic reactions (abdominal pain the night before the exam) are not the problem itself, but its symptoms and present as manifestations (Ivanova, 2018). Events in the present trigger the unprocessed memories that lead to these negative beliefs and emotions. To address this, EMDR therapy uses a 3-way protocol:

  1. First, past events that form the basis of the dysfunction are processed, and new relational connections are established with adaptive information.
  2. Current situations causing distress are targeted, and internal and external triggers are desensitized.
  3. Imaginary sketches of future events are incorporated into the process to help the client acquire the skills needed for adaptive functioning.

EMDR therapy involves an 8-phase, structured process that guides the therapist and the client to process traumatic memories and resolve related distress. The 8 phases of EMDR serve the purpose of EMDR therapy: ‘’facilitate accelerated information processing.’’ The eight phases are (Kaufman, 2021): 

  1. History Taking and Treatment Planning: In the first stage, the factors that lead the client to therapy and how EMDR therapy can be used in the most appropriate way for the client are evaluated. The client’s current triggers, past experiences, and future goals are discussed. The therapist and client develop a safe working relationship and create an appropriate treatment plan.
  2. Preparation: In this phase, the therapist explains the EMDR process, terms, and expectations to the client. The therapist and client collaborate on coping mechanisms for any emotional disturbance that may arise. 
  3. Assessment: This phase, which can last only 30 seconds, involves asking questions to activate the client’s memory of the trauma and bring it to the client’s awareness.
  4. Desensitization: Desensitization is initiated while side-to-side eye movements, sounds, or touch focus on the traumatic event and continues until the client’s SUDS (Subjective Units of Distress Scale) drops to zero (or one if appropriate). During this time, new thoughts, images, and feelings may emerge.
  5. Installation: When desensitization ends, installation begins. In this phase, the client associates a positive belief with the target event and reinforces it until it feels entirely true. These beliefs can be beliefs such as ‘’I am worthy’’ or ‘’I am safe now.’’
  6. Body Scan: At this stage, the client is asked to keep the target event and positive belief in mind while scanning the body from head to toe. If there is any discomfort left in the body, it is reprocessed.
  7. Closure: The aim is to end the session, and the focus is on helping the client return to a calm state in the present moment.
  8. Reevaluation: Each new session begins with the therapist and client jointly reviewing the current level of distress and change in symptoms around the traumatic memory. If the client reports a decrease in distress, we move on to the next target memory. This reevaluation process is the starting point of each session and guides the future goals and objectives of the treatment.

What are the Working Areas of EMDR Therapy?

In EMDR therapy, the insights that the client gains come from the client’s accelerated intellectual and emotional processes. Significant changes occur because clients complete EMDR therapy feeling empowered by experiences that once humiliated them. A natural outcome of the structured EMDR therapeutic process is that clients’ thoughts, feelings, and behaviors are robust representations of emotional health and resolution. Although this approach was developed primarily for post-traumatic stress disorder, a wide range of scientific research has shown it to be effective for a broader range of psychological disorders. As a holistic and flexible method, EMDR therapy is used in the following areas:

  • Trauma and Post-Traumatic Stress Disorder (PTSD): Korn’s study (2009) suggests that EMDR therapy is a significant source of impact in resolving complex trauma. In addition, Bisson et al. (2007) found that EMDR was as effective as cognitive behavioral therapy (CBT) in reducing PTSD symptoms. On the other hand, in studies conducted with children, it has been observed that EMDR treatment relieves symptoms in a short time (Ahmad et. al., 2007; Adler-Tapia & Settle, 2008).
  • Depression: In a study conducted by Hoffman et. al. in 2014, EMDR treatment was found to be beneficial in reducing symptoms of major depression.
  • Anxiety Disorders: EMDR is known to be a practical approach to reduce symptoms of social phobia, specific phobias, and panic disorder (Faretta, 2013).
  • Grief: EMDR treatment has been shown to soften complicated grief reactions in individuals going through the grief process and struggling with the complex nature of the process (Solomon & Rando, 2007).
  • Eating Disorders: EMDR, which is a powerful method in the treatment of eating disorders, is beneficial in processing past traumas that cause eating disorders (Côté & Bouchard, 2009).
  • Psychosomatic Disorders: EMDR provides relief by targeting the emotional components that cause pain, especially in trauma-induced pain disorders, and helps relieve chronic pain (Grant & Threlfo, 2002).
  • Addictions: EMDR treatment, which provides a significant benefit in dealing with addictions, aims to improve, especially by focusing on triggering events and self-beliefs (Markus & Hornsveld, 2017).

Although EMDR is used in many areas mentioned above, it is most commonly applied in trauma treatment, as this is where it shows the strongest and most consistent effects supported by numerous studies. That brings the question, “How does EMDR therapy work with trauma”?

How Does EMDR Therapy Work with Trauma?

EMDR is a therapy modality that primarily emphasizes the role of trauma because it recognizes that many present-day symptoms stem from unprocessed and unresolved past experiences. It works with the traumatic memory and the negative beliefs, emotions, and bodily sensations created by the memory, using bidirectional eye movements or other bidirectional stimulation (sound, touch). It is stated that individuals with symptoms of PTSD cannot evaluate the traumatic event they have experienced as an event that happened in the past and perceive this event as an event that is threatening at any moment and affects future time. When a traumatic event occurs, the person records the memory in an unprocessed form, with the emotions and body sensations at the time of the event. Since the brain does not digest these memories like normal memories, the event’s negative feelings and thoughts reappear repeatedly when the slightest trigger is encountered. EMDR helps to assimilate the negative effects of the traumatic memory by processing the traumatic memory stored in the form of a false memory in a non-functional way in the memory. Traumatic experiences in childhood are especially stored without being processed adaptively. The basis of the challenges experienced by the person in the present lies in the traumatic experiences experienced in the past and stored without being processed in a harmonious way. Through this process, EMDR helps people feel that the traumatic event is truly in the past.

Takeaways:

  • EMDR is an evidence-based, holistic psychotherapy approach that supports healing from the psychological impact of traumatic life experiences.
  • EMDR therapy enables deep and lasting healing by reprocessing traumatic memories, reducing emotional distress, and fostering new, adaptive insights, backed by strong global evidence and high success rates.
  • By engaging the brain’s natural REM sleep processes through bilateral stimulation, EMDR therapy helps reprocess unintegrated traumatic memories, allowing individuals to heal and respond adaptively to past experiences.
  • EMDR therapy works by reprocessing traumatic memories, along with their associated negative beliefs, emotions, and bodily sensations, using bilateral stimulation to help individuals integrate these memories in a way that allows them to perceive the trauma as a past event, rather than a constant, threatening presence affecting their future.

References

  1. Shapiro, D., & Shapiro, D. A. (1987). Change processes in psychotherapy. British Journal of Addiction, 82(4), 431–444. https://doi.org/10.1111/j.1360-0443.1987.tb01498.x 
  2. Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures (2nd ed.). Guilford Press. https://psycnet.apa.org/record/2001-05049-000 
  3. Shapiro, F. (1995). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures. Guilford Press.
  4. Rothbaum, B. O. (1997). A controlled study of eye movement desensitization and reprocessing in the treatment of posttraumatic stress disorder in sexual assault victims. Bulletin of the Menninger Clinic, 61(3), 317. 
  5. Wilson, S. A., Becker, L. A., & Tinker, R. H. (1997). Fifteen-month follow-up of eye movement desensitization and reprocessing (EMDR) treatment for posttraumatic stress disorder and psychological trauma. Journal of consulting and clinical psychology, 65(6), 1047.
  6. Shapiro, F., & Forrest, M. S. (2016). EMDR: The breakthrough therapy for overcoming anxiety, stress, and trauma. Hachette UK
  7. Kaufman, S. (2021, August 13). The eight phases of EMDR therapy. EMDR International Association. https://www.emdria.org/blog/the-eight-phases-of-emdr-therapy/ 
  8. (2024, December 3). What is EMDR? – EMDR Institute – EYE MOVEMENT DESENSITIZATION AND REPROCESSING THERAPY. EMDR Institute – EYE MOVEMENT DESENSITIZATION AND REPROCESSING THERAPY. https://www.emdr.com/what-is-emdr/ 
  9. Eye Movement Desensitization and Reprocessing (EMDR). (n.d.). Texas Tech University Health Sciences Center. https://www.ttuhsc.edu/medicine/psychiatry/counseling/emdr.aspx  
  10. Korn, D. L. (2009). EMDR and the treatment of complex PTSD: A review. Journal of EMDR Practice and Research, 3(4), 264-278.
  11. Bisson, J. I., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner, S. (2007). Psychological treatments for chronic post-traumatic stress disorder: Systematic review and meta-analysis. The British journal of psychiatry, 190(2), 97-104.
  12. Ahmad, A., Larsson, B., & Sundelin-Wahlsten, V. (2007). EMDR treatment for children with PTSD: Results of a randomized controlled trial. Nordic journal of psychiatry, 61(5), 349-354.
  13. Adler-Tapia, R., & Settle, C. (2008). EMDR and the art of psychotherapy with children: treatment manual. Springer Publishing Company.
  14. Hofmann, A., Hilgers, A., Lehnung, M., Liebermann, P., Ostacoli, L., Schneider, W., & Hase, M. (2014). Eye movement Desensitization and Reprocessing as an Adjunctive treatment of unipolar Depression: a controlled study. Journal of EMDR Practice and Research, 8(3), 103–112. https://doi.org/10.1891/1933-3196.8.3.103 
  15. Faretta, E. (2013). EMDR and cognitive behavioral therapy in the treatment of panic disorder: A comparison. Journal of EMDR Practice and Research, 7(3), 121-133.
  16. Solomon, R. M., & Rando, T. A. (2007). Utilization of EMDR in the treatment of grief and mourning. Journal of EMDR Practice & Research, 1(2).
  17. Côté, G., & Bouchard, S. (2009). Documenting the efficacy of EMDR on phantom limb pain. Journal of EMDR Practice and Research, 3(2), 98–104. 
  18. Grant, M., & Threlfo, C. (2002). EMDR in the treatment of chronic pain. Journal of Clinical Psychology, 58(12), 1505-1520.
  19. Markus, W., & Hornsveld, H. K. (2017). EMDR interventions in addiction.
  20. Ivanova, D. (2018). EYE MOVEMENT DESENSITIZATION AND REPROCESSING AS A PSYCHOTHERAPEUTIC APPROACH. Problems of Psychology in the 21st Century.

While our physical offices are located in South Loop and Lakeview neighborhoods in Chicago, Illinois for in-person sessions, we also welcome and serve clients for online therapy from anywhere in Illinois and Washington, D.C. Clients from the Chicagoland area may choose in-office or online therapy and usually commute from surrounding areas such as River North, West Loop, Gold Coast, Old Town, Lincoln Park, Lake View, Rogers Park, Logan Square, Pilsen, Bridgeport, Little Village, Bronzeville, South Shore, Hyde Park, Back of the Yards, Wicker Park, Bucktown and many more.  

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At Roamers Therapy, our psychotherapists are here to support you through anxiety, depression, trauma and relationship issues, race-ethnicity issues, LGBTQIA+ issues, ADHD, Autism, or any challenges you encounter. Our psychotherapists are trained in Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Psychodynamic Therapy, Acceptance, and Commitment Therapy, Person-Centered Therapy, and Gottman Therapy. 

Whether you’re seeking guidance on a specific issue or need help navigating difficult emotions, we’re ready to assist you every step of the way.

Contact us today to learn more about our services and schedule a session with our mental health professionals to begin your healing journey. To get started with therapy, visit our booking page.

First, decide if you’ll be paying out-of-pocket or using insurance. If you’re a self-pay client, you can book directly through the “Book Now” page or fill out the “Self-Pay/Out-of-network Inquiry Form.” If you’re using insurance, fill out the “Insurance Verification Form” to receive details about your costs and availability. Please let us know your preferred therapist. If your preferred therapist isn’t available, you can join the waitlist by emailing us. Once your appointment is confirmed, you’ll receive intake documents to complete before your first session.

This page is also part of the Roamers Therapy Glossary; a collection of mental-health related definitions that are written by our therapists.

While our offices are currently located at the South Loop neighborhood of Downtown Chicago, Illinois, we also welcome and serve clients for online therapy from anywhere in Illinois and Washington, D.C. Clients from the Chicagoland area may choose in-office or online therapy and usually commute from surrounding areas such as River North, West Loop, Gold Coast, Old Town, Lincoln Park, Lake View, Rogers Park, Logan Square, Pilsen, Bridgeport, Little Village, Bronzeville, South Shore, Hyde Park, Back of the Yards, Wicker Park, Bucktown and many more. You can visit our contact page to access detailed information on our office location.