Inside the Science of EMDR

Local mental health experts explore the growing interest in this newer psychotherapy

By Anna Faller | Nov. 9, 2024

When you think about therapy, what comes to mind? Is it a chaise lounge in a quiet room? A stoic professional taking notes? Sigmund Freud?

Whatever visual the term conjures, we bet it doesn’t include using bilateral stimulation to help process traumatic experiences—but that’s exactly what the psychotherapy known as Eye Movement Desensitization and Reprocessing (EMDR), does.

EMDR was developed in 1987 by Dr. Francine Shapiro, Ph.D., a psychologist and mental health research fellow, and hinges on the connection between rapid eye movement and how the brain handles trauma.

Because it’s a newer therapy—especially in comparison to practices like psychoanalysis, which date back to the 19th century—EMDR wasn’t formally recognized by health organizations until the late 1990s. Since then, it’s been proven to achieve results quickly for many patients, with more than 30 control studies published, some with a nearly 90 percent success rate.

“It’s such a wild and fun therapy to watch in session,” says Alyssa Withun, outpatient supervisor at Northern Lakes Community Mental Health (NLCMH). “It’s amazing how quickly EMDR patients can get past something that’s been affecting them for years.”

Reframing Memory

So, how does EMDR work? Though formal research is still emerging—in fact, scientists have yet to reach a consensus as to exactly how EMDR functions—the basic gist pairs traumatic memory with a form of bilateral stimulation (engaging alternate sides of the brain) to help work through and ultimately re-file those memories in a less detrimental way.

EMDR is not the removal of memory, nor is it a form of hypnosis—a common misconception, per NLCMH Operations Manager Kendall Sidnam. Instead, she explains, it’s “targeting different parts of the brain to reframe how we remember trauma.”

Take the ubiquitous (and usually positive) memory of visiting the zoo as a kid. Because we’ve fully dealt with those memories, a process which largely occurs in the brain’s cortical regions, they tend to fade and feel less vivid once we grow into adulthood.

Traumatic memories, by contrast, can sometimes get stuck in the limbic system—that’s where your fight, flight, or freeze response lives—and as a result, can be set off by daily sensations, like sounds or smells, that make those memories feel just as vivid and horrific as when they first happened.

The goal of EMDR therapy is to un-stick those negative experiences and weave them back into the main memory line. “The idea,” adds Withun, “is to remember those traumas [in the same way we remember] that trip to the zoo. Though the experience is [no less] terrible, it no longer feels like you’re reliving it.”

A Trauma Inventory

This psychotherapeutic process, which, per the EMDR Institute, comprises eight “phases,” starts by compiling patient history, wherein the client and therapist build a “trauma inventory.”

The specifics here differ based on provider—Sidnam, for instance, who works mostly with kids, helps conceptualize the weight of each memory with capital and lowercase T’s for “trauma”—but the framework often includes creating a timeline of the patient’s memories, highlights and lowlights, and the emotional impact of each event.

Then there’s the question of determining whether a patient is a good fit for EMDR, or phase two.
Per Sidnam, there are no known age or demographic contingencies to the therapy’s efficacy. EMDR works for both kids and adults, she says, and though this type of psychotherapy is most often used to treat PTSD, it’s also “all-encompassing,” meaning it can successfully mitigate the effects of various traumas, both mental and physical.

EMDR is, however, very intense, and essentially asks patients to revisit some of their most deeply-repressed and painful experiences. It’s for this reason that a strong set of coping skills is non-negotiable for EMDR patients. These could include self-calming techniques developed from other therapies as well as external supports like financial security, physical safety, and a robust familial and social network.

There’s also an element of consent at play here, as the patient should feel comfortable enough with their provider to tell them when they need a break, as well as ensuring that patients understand what EMDR entails. As Sidnam reiterates, the goal of this therapy is to fully heal and process old traumas, but that can only happen if the patient is prepared enough to address them.

“It’s a day-by-day and sometimes moment-by-moment process,” Withun says. “The last thing we want to do is retraumatize someone by doing something they’re not ready to do.”

Down to Zero

Once the patient gets the green light, the next three EMDR phases take place mid-session.

This starts with the patient and provider talking through a target memory, with a focus on the negative beliefs it has produced (I’m worthless, I’m unlovable, I’m at fault, etc.), as well as a positive replacement emotion. It’s also here that the patient establishes a baseline for how distressing that memory feels by rating it on a scale from zero (no disturbance) all the way up to a 10 (worst possible).

From there, the patient again queues up the memory and associated emotions, this time using bilateral stimulation and analyzing their experience as they process. Per Withun, standard stimuli here range from REM-adjacent visuals, wherein patients follow a finger or light, as well as tactile sensations, like alternated tapping, touches, and even auditory tones.

All of these methods achieve the same goal, she adds, and can be catered to meet the needs of each patient.

Once the trauma’s been processed down to a zero (though a rating as high as a two could suffice), EMDR phases seven and eight involve a debrief and full body scan to close the memory, before recording the patient’s progress in preparation for future therapy sessions.

Faster Processing

All told, unpacking each memory could take anywhere from 20 minutes to weeks to process, depending on that patient’s capacity and the severity of the experience.

In comparison to other therapies, like cognitive behavioral therapy, EMDR has been clinically proven to deliver patient results in less time, on average, sometimes even within one session. This, says Withun, is because the EMDR process provides the framework for the brain to self-heal, in contrast to the extra processing time conversation-based therapies often require. It’s a definite draw for patients, she adds, as is the reduced verbal component, which applies both to the patient and the provider.

“EMDR is very client-led, so they get to come to their own understanding that maybe they’re not all these horrible things that they’ve thought about themselves for so long. That brings a lot of confidence and pride, and I think that’s a very big thing,” Sidnam notes.

Still, it wasn’t until the early 2000s that EMDR was recommended for trauma treatment. Since then, it’s gained ground for its efficacy, which is not only reflected in formal research representing a range of disturbances from PTSD to addiction, assault, and beyond, but also in patients’ firsthand accounts.

Sidnam, for instance, remembers a teen who was deeply affected by the violent death of two family members and was struggling with psychological disturbances like nightmares and flashbacks. Three weeks of EMDR later, she says, he was able to reprocess those memories and manage his symptoms.

“Now he’s a sophomore in college and can speak fondly on [those relatives] without the memories of their deaths overshadowing their lives,” she adds.

With the global mental health crisis in mind—not to mention healthcare field advances, like the rise of telehealth and Medicaid’s extended coverage—and both Sidnam and Withun expect that the recent uptick in demand for EMDR is just the beginning.

As Sidnam underscores, the number of patients interested in pursuing EMDR currently outweighs providers. EMDR is seen as an expedient service, and therefore, a better bang for agencies’ and clients’ buck. Further, people are seeing results and sharing their experiences.

“I think there’s a word-of-mouth component to it, which isn’t necessarily a bad thing,” adds Sidnam. “EMDR can be very effective, and the more people are talking about it, the more it [can help] people.”