By Diana Schaefer, LCSW-S and William Schroeder, LPC and clinically reviewed by Teri Schroeder, LCSW
Table of Contents
Introduction
How EMDR works is a question that comes up commonly and there is a lot that goes into this answer. Eye Movement Desensitization and Reprocessing (EMDR) is an innovative therapeutic technique that has captured attention within the psychological community. Back in 2013, when Diana Schaefer, LCSW became a certified EMDR therapist, she observed that while traditional talk therapies yielded positive results, there were cases where patients recognized their patterns yet struggled to change them. Interestingly, the interplay between the emotional right-side and the logical left-side of our brains plays a pivotal role in this.
The Brain’s Hemispheric Divide and EMDR
Research has illuminated the distinct roles played by the brain’s two hemispheres in how EMDR works. The right hemisphere is proficient in decoding symbols, images, and sensory stimuli, but it often operates without the linguistic understanding of the left hemisphere. This dichotomy is evident in everyday experiences. For instance, even when someone understands the importance of a balanced diet (left brain’s logical understanding), they might still crave sugary treats or fried foods driven by the pleasure-seeking right brain. EMDR acts as a bridge, facilitating communication between these two brain hemispheres.
What Exactly is EMDR?
EMDR stands for Eye Movement Desensitization and Reprocessing. It’s a specialized therapy aiming to process and integrate distressing memories from past traumas in a way that they no longer trigger disproportionate emotional reactions. Bilateral stimulation while following a specific protocol and treatment plan is part of the process of treatment.
The Underpinning Theory of EMDR
Memory storage in our brain influences our perceptions, attitudes, and behaviors. When distressing memories become entrenched in our neural pathways, they can induce persistent distress. While many traumas naturally fade with time, some linger and continue to distress an individual. How EMDR words is that it assists in the adaptive resolution of these lingering memories, encompassing experiences from the past, their current implications, and prospective effects.
The EMDR Process
During an EMDR session, the therapist commences with information collection, pinpoints the distressing issues, and then introduces bilateral stimulation, followed by feedback.
Bilateral stimulation, the cornerstone of EMDR, involves activating both brain hemispheres through synchronized left-right patterns. This can be achieved through eye movements (following the therapist’s fingers), tactile stimuli (vibrating tappers alternating between hands), and sometimes auditory cues (beeps alternating between ears). Research underscores that all these bilateral stimulation techniques are comparably effective. The choice often rests on individual preferences and the therapist’s assessment.
During the process, patients might experience a flurry of memories, emotions, or sensations. They’re encouraged to passively observe these, akin to watching landscapes from a moving train, without clinging to or overly analyzing them.
Efficacy and Duration of EMDR
EMDR’s efficacy, particularly in trauma resolution, is well-documented. Many find it expedited compared to other therapeutic methods. The timeline, however, is inherently subjective, given the unique experiences and resilience of each individual. Cases with more complexity can take longer to work through. Yet, the consensus in both research and personal experience points towards EMDR being a faster approach to trauma resolution.
- Research has shown that EMDR therapy is highly effective in the treatment of trauma, with 100% of single-trauma survivors and 77% of multiple-trauma survivors no longer meeting diagnostic criteria for PTSD after just six 50-minute EMDR sessions.
- EMDR is not only clinically effective but the most cost-effective in the treatment of adults with PTSD.
- EMDR is found to be much more effective to help adults and children lessen (or lose) PTSD entirely after 6 months compared to other medications.
Diana Schaefer – Client Example of How EMDR works:
“I assisted a woman who experienced a traumatic car accident during daylight when a truck veered into her lane, causing her to crash into a guardrail at 65 mph. The accident’s vivid memories, including the impact sound and the ambulance ride, haunted her, leading to nightmares and high anxiety around driving. This significantly disrupted her daily life. In our sessions, besides understanding her trauma history, she was equipped with coping tools for distressing memories. Using EMDR, we focused on the accident’s memory over three months, assessing her distress level each week. By the end of our sessions, her distress level dropped to zero. While the accident’s memory remained, its emotional intensity had diminished completely.”
EMDR for PTSD: From Skeptic to Believer
William Schroeder, LPC: I have to admit, the first time I heard about EMDR therapy, I was skeptical. So you are telling me that wagging your finger back and forth causes trauma to go away?
Then I was in a dog bite incident, and that took me from skeptic to believer. I can honestly say that personally, I made more progress with EMDR in a year than I did in 20 years of therapy.
The part that surprises most people, and the part that surprised me: you are not asked to describe the memory in detail, and there is no homework. That is often why people who have stalled everywhere else are willing to try it.
Some memories never get filed properly. A memory stored while your nervous system was overwhelmed stays raw, and anything that resembles it pulls the whole thing back into the present with its original charge. That was my experience after the dog bite. My body reacted to dogs I had never met as though the incident were happening again. EMDR, which Francine Shapiro developed in 1987, aims to get that memory processed and filed, so it becomes something that happened rather than something happening.
The Eight Phases of EMDR
Standard EMDR runs eight phases: history taking, preparation and resourcing, assessment of the target memory, desensitization, installation of a more useful belief, a body scan, closure at the end of each session, and re-evaluation at the start of the next. The reprocessing everyone associates with EMDR is phase four. The preparation before it is what makes phase four survivable.
Sessions usually run longer than a standard hour, and most people need several before reprocessing begins. Feeling stirred up for a day or two afterward is common. So is being unusually tired.
What the Research Says About EMDR for PTSD
EMDR is a first-line treatment for PTSD, and it sits alongside two others rather than above them. The VA and Department of Defense clinical practice guideline recommends three trauma-focused psychotherapies as most effective: Prolonged Exposure, Cognitive Processing Therapy, and EMDR. It deliberately declines to rank them and directs clinicians to choose with the patient. When three treatments perform comparably, fit becomes the deciding factor.
Where the field disagrees is on how strongly EMDR should be recommended relative to exposure-based therapy. Head-to-head trials have produced mixed results. The Journal of EMDR Practice and Research published a critique of the American Psychological Association’s most recent PTSD guideline arguing it underrates EMDR.
My honest summary: EMDR works for PTSD, the evidence for that is strong, and whether it beats Prolonged Exposure for any particular person is not something the research can tell you in advance. It worked for me. That is one case, not a study.
How EMDR Compares to Other Trauma Therapies
- Prolonged Exposure asks you to approach the memory and the situations you avoid, repeatedly, including between sessions. Demanding, and well evidenced.
- Cognitive Processing Therapy works on the conclusions the trauma left behind, the beliefs about fault, safety, and trust, largely through writing and structured discussion.
- EMDR requires the least narration. You do not have to tell the story out loud in detail, which is the barrier that stops some people from starting at all.
Who Should Be Cautious
If you are in active crisis, currently unsafe, in heavy substance use, or dealing with dissociation, the preparation phase comes first and it may need to take a while. A therapist who moves to reprocessing before you can stay present for it is going too fast.
Complex trauma, meaning repeated harm over years rather than a single event, generally takes longer than the trial protocols suggest. That is not a failure of the method or of you.
Finding an EMDR Therapist
Look for someone trained through an EMDRIA-approved program, and ask how many phases of preparation they typically do before reprocessing. The answer tells you a lot. It is also fair to ask how they work with culture and identity, since those shape what feels safe to disclose. Cleveland Clinic’s overview is a solid plain-language primer.
Several of our clinicians are EMDR trained. If you are weighing EMDR therapy in Austin against another form of trauma therapy, that is worth working out in a first conversation rather than deciding alone.
How EMDR works in the brain
- Bilateral Stimulation and Brain Hemispheres: One of the main features of EMDR is bilateral stimulation, often achieved through guided eye movements. Some researchers believe that this rapid back-and-forth eye movement might help in the integration and communication of the right and left hemispheres of the brain. The right hemisphere is more associated with emotional processing, and the left with cognitive functions and language. EMDR may help link emotional and cognitive aspects of the traumatic memory.
- Working Memory and Cognitive Load: Another theory suggests that recalling a traumatic event while simultaneously engaging in the distraction of bilateral eye movements imposes a certain cognitive load on working memory. This might cause the traumatic memory to become less vivid and emotional when recalled in the future.
- Accelerating the Adaptive Information Processing System: EMDR practitioners believe in an innate human ability to move towards psychological health. Traumatic memories can block or skew this adaptive information processing. EMDR might work by unblocking the system, allowing the traumatic memory to be integrated and stored adaptively in the brain.
- Activation of the Default Mode Network: Some neuroimaging studies have shown that EMDR activates the default mode network (DMN) in the brain, a network associated with self-referential processing and autobiographical memory. Activation of the DMN might help in integrating and reprocessing the traumatic memory.
- Mimicking REM Sleep: The eye movements in EMDR are thought by some to be similar to the rapid eye movements observed in REM (Rapid Eye Movement) sleep. REM sleep is believed to play a role in memory consolidation. EMDR might simulate this process, allowing for traumatic memories to be reprocessed and integrated in a manner similar to how our brains process information during sleep.
- Neurobiological Changes: Some studies have indicated that EMDR can lead to changes in the amygdala, hippocampus, and anterior cingulate cortex, brain areas involved in fear response and memory. Post-treatment, these areas might show altered activation patterns, indicating that the traumatic memory has been reprocessed.
Who is it best for?
In my training when I experienced EMDR, I found that it helped my thoughts and the connections of those thoughts happen much faster. It also surprised me how well it works to improve processing of memories and experiences. EMDR works in treating anxiety, depression, trauma, and PTSD. If you suffer from any of these, EMDR therapy might be a helpful for you. EMDR therapy is something that we offer, so do not hesitate to contact us to make a counseling appointment.
Bonus: How EMDR Heals Trauma
Photo by Norman Toth on Unsplash
