EMDR Therapy
Definition
Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based therapy developed by Francine Shapiro in 1987 for trauma and PTSD. EDRR uses bilateral stimulation (eye movements, taps, or sounds) while the client processes traumatic memories, facilitating adaptive resolution through the brain’s natural information processing system.
How It Works
Adaptive Information Processing (AIP) Model
Traumatic memories become “stuck” in the brain’s neural networks, preventing adaptive resolution. EMDR uses bilateral stimulation to:
- Activate the brain’s innate healing mechanisms
- Help the brain reprocess traumatic memories
- Transform distressing memories into adaptive narratives
- Reduce emotional intensity while preserving factual content
The 8 Phases of EMDR
| Phase | Name | Duration | Purpose |
|---|---|---|---|
| 1 | History Taking | 1-2 sessions | Assessment and treatment planning |
| 2 | Preparation | 1-3 sessions | Stabilization, resource development, psychoeducation |
| 3 | Assessment | Minutes per target | Activate memory network (image, belief, emotion, body) |
| 4 | Desensitization | Variable | Bilateral stimulation until distress reduced (SUDS = 0-1) |
| 5 | Installation | Minutes | Strengthen adaptive belief (VOCC = 6-7) |
| 6 | Body Scan | Minutes | Check for residual somatic disturbance |
| 7 | Closure | Minutes | Ensure client is stabilized between sessions |
| 8 | Reevaluation | Each session | Review progress and select next target |
Evidence Base
PTSD — First-Line Recommendation
EMDR is recommended as first-line treatment for PTSD by WHO, APA, NICE, and ISSTD:
| Organization | Recommendation |
|---|---|
| World Health Organization | First-line for adults with PTSD |
| APA Division 12 | Well-Established Empirically Supported Treatment |
| NICE (UK) | Recommended first-line for PTSD |
| VA/DoD | Recommended (conditional recommendation) |
| ISSTD | First-line for complex trauma |
Comparative Evidence
- vs. TF-CBT: Similar efficacy for single-incident trauma; EMDR may be faster
- vs. Trauma-Focused CBT: Equivalent outcomes for adult PTSD
- Response rate: ~50-80% of single-trauma PTSD patients achieve remission
- Speed: Often requires fewer sessions than CBT-based trauma therapies
Strengths
- Minimal homework required (appeals to clients who resist CBT homework)
- Often produces rapid symptom reduction
- Less reliance on detailed verbal narrative than CPT
- Effective for visual and somatic trauma memories
- Growing evidence for complex trauma and non-trauma conditions
Limitations
- May trigger dissociation without proper preparation
- Less effective for severe dissociation without stabilization
- Mechanism debate: is it eye movements specifically, or bilateral stimulation generally?
- Training and certification requirements vary by organization
Key Parameters
- Duration: 6-12 sessions for single-incident PTSD; longer for complex trauma
- Format: Individual (standard); group adaptations emerging
- Assessment: SUDS (Subjective Units of Distress), VOC (Validity of Cognition)
- Primary conditions: PTSD, complex trauma, phobias, grief, performance anxiety
Relevant Concepts
Source Metadata
- Type: Concept
- Primary sources: Shapiro (1989); EMDRIA evidence database; WHO PTSD guidelines 2024
- Updated: 2025 research synthesis