What is EMDR Therapy and How Does it Work?
EMDR Therapy may help heal trauma, anxiety, depression, burnout, and more.
As an EMDR therapist in Indianapolis, Fort Wayne and Bloomington, I work with a variety of clients who are struggling with anxiety, depression, burnout, and more. Many of these folks are looking for ways to feel better and stop experiencing so many difficult, troublesome symptoms.
If that feels close to how you’d describe your situation, you're not alone. Millions of people experience these challenges, and finding the right therapy can be a critical step in the healing process. One type of therapy that has gained (some much deserved) attention in recent years is Eye Movement Desensitization and Reprocessing (EMDR). In this blog post, I’ll talk about what EMDR therapy is, the research behind it, and how it may be beneficial for those facing anxiety, depression, or burnout.
What is EMDR Therapy?
As an EMDR therapist, I always tell my clients that while it’s a powerful healing tool, EMDR is a “funky” therapy intervention, because it’s so different from traditional talk therapy.
EMDR therapy is a psychotherapy approach developed by Dr. Francine Shapiro in the late 1980s. It focuses on helping individuals process and resolve traumatic memories and other distressing life experiences. The primary technique used in EMDR involves bilateral stimulation (often through eye movements) while the individual recalls a distressing memory. This process is believed to help the brain reprocess memory, reducing its emotional impact and allowing the individual to develop more adaptive coping mechanisms.
The Research Behind EMDR:
There are about 30 years’ worth of research that have demonstrated the effectiveness of EMDR therapy for things like post-traumatic stress disorder (PTSD), anxiety, depression, and even burnout. The American Psychiatric Association, the World Health Organization, and the Department of Veterans Affairs have all recognized EMDR as an effective treatment for PTSD.
While most research has focused on PTSD, there is also evidence supporting EMDR's effectiveness in treating anxiety, depression, and burnout. As a burnout therapist in Indianapolis, I use EMDR with many of my clients to help alleviate the stress, overwhelm, and anxiety that can come along with clinical burnout. Many find that the coping skills alone (called “resourcing” in EMDR) are hugely helpful in their healing from burnout process.
EMDR: What to Expect
When you work with an EMDR therapist, you’ll go through eight distinct phases that act as a guide for both you, the client, and for the EMDR therapist as you process your painful emotions, memories, and physical sensations. The EMDR phases include:
History and Treatment Planning: Your EMDR therapist will gather information about your personal history, and will work with you to identify “target memories” for processing. This will also involve developing an EMDR treatment plan.
Preparation: Your therapist will work to build trust and rapport with you, ideally by explaining the EMDR process and teaching you the EMDR resourcing skills you can use to self-soothe before, during, and after EMDR therapy sessions.
Assessment: Your EMDR therapist will help you find the “target” for your reprocessing, usually a specific memory, along with any emotions, physical sensations, and negative beliefs that come up alongside those memories.
Desensitization: Your therapist will ask you to focus on the stressful or painful memory while either you or your therapist applies what is called “bilateral stimulation.” This phase continues until your level of distress around the memory is significantly reduced or even gone, and can sometimes take several EMDR therapy sessions to resolve.
Installation: This phase typically happens when your emotional distress is resolved, and your therapist will help you effectively “replace” your old negative belief with a positive one, while using bilateral stimulation once again to strengthen the new belief and help it feel more “real” or “true” to you.
Body Scan: After installation, your EMDR therapist will have you scan your body for any lingering tension or discomfort. If any is found, your therapist will likely use additional bilateral stimulation to help you resolve it, until no discomfort remains.
Closure: Each EMDR session should ideally end with resourcing or self-soothing techniques, whether you were able to resolve your past memories or not. This is done to help you regain a sense of calm and stability once you leave the session. Your therapist should also discuss what to expect between sessions and how to manage any lingering emotions, side effects, or memories that come up.
Reevaluation: At the beginning of subsequent sessions, you and your therapist will review your progress and talk about whether more reprocessing is needed for the targeted memories, or if new memories need to be addressed. You might also decide that you want to return to more traditional talk therapy.
How does EMDR Work in the Brain?
Although the exact mechanism is still up for debate, there is around 30 years’ worth of research that points to the efficacy and powerful healing properties of EMDR. There are several theories that might be able to answer the question, “How does EMDR Work in the Brain?”
One theory is that EMDR therapy stimulates what is known as the brain's “information processing system” through intervals of bilateral stimulation. The theory is that during EMDR therapy, bilateral stimulation—things like eye movements, hand tapping, or auditory stimulation—stimulates the information processing system in a way that promotes the integration of fragmented memories and emotions, while also “desensitizing” the client to the painful emotions and sensations that occur when those memories are called up and integrated.
The following brain structures are considered to be part of the information processing system:
Prefrontal cortex: located at the front of the brain and is involved in higher-level cognitive functions, such as decision-making, planning, working memory, regulating emotions, and integrating sensory inputs.
Amygdala: small and almond-shaped, located deep within the temporal lobes of the brain. The amygdala plays a role in how we process emotions, particularly fear and anxiety. It’s theorized that during a traumatic event, the amygdala becomes overactive and struggles to process information, leading to the formation of fragmented and disorganized memories.
Hippocampus: located in the temporal lobes of the brain and involved in how memories are formed and consolidated. We think it plays a role in taking sensory inputs and emotions and converting them into coherent memories.
Thalamus: located in the center of the brain, the thalamus serves as the “relay station” for sensory information. It helps our brains process and filter sensory inputs and sends that information to the appropriate brain regions for further processing.
Basal ganglia: The basal ganglia are a group of structures located deep within the brain that help with regulating movement and motor coordination. They are also believed to play a role in learning, motivation, and emotion.
EMDR therapy is also theorized to lead to positive changes in the brain structures themselves that help promote healing and emotional regulation.
Other Theories about EMDR
Other theories about EMDR are that EMDR therapy may help to “desensitize” (literally, make us less sensitive and reactive to) the intensity of emotions and bodily sensations that we feel when we think about or are reminded of traumatic memories. During EMDR therapy, focusing on the traumatic memory while engaging in bilateral stimulation may actually desensitize you to the intensity of the memory, which gives you the space to process the memory in a less distressing
EMDR therapy is based on the idea that traumatic experiences can cause negative beliefs and feelings that can become deeply ingrained in the brain. By stimulating the brain with alternating bilateral sensory input, such as eye movements or hand tapping, EMDR therapy aims to help the brain reprocess traumatic memories and release negative emotions and beliefs.
What is Bilateral Stimulation and How Do You Do it In EMDR?
Okay, so I’ve mentioned bilateral stimulation (BLS) a few times now but haven’t actually explained what we EMDR therapists mean when we talk about BLS. This funky sounding technique is a key component of EMDR therapy, and can be done in several ways, including eye movements, hand tapping, or audio stimulation. Here are the basic steps for doing BLS in EMDR:
Eye movements: This is the traditional method of BLS and is done in-person with the therapist and client in the same room. If you’re doing eye movement BLS with an in-person therapist, the therapist will ask you to follow their fingers or a moving object with your eyes while holding the target memory in your mind. The eye movements typically last for 20-30 seconds before the therapist pauses and asks you to report briefly on what you felt, noticed, or thought of. They will typically repeat this multiple times throughout a session.
Hand tapping, or “self-administered” BLS: If you can’t or don’t want to watch something with your eyes, or if you are doing virtual EMDR your therapist may show you how to use hand tapping as a form of BLS. With hand tapping, you will hold the target memory in mind while tapping quickly and rhythmically on your shoulders or knees. The tapping typically lasts for 20-30 seconds before the therapist asks you to pause and report briefly on what you felt, noticed, or thought of. They will typically repeat this multiple times throughout a session.
Audio stimulation: This is another form of BLS that you can do in-person or virtually. With audio BLS, your therapist may give you headphones to use, or will ask you to bring your own headphones. They will play a tone that alternates between the left and right ear. Similar to eye movements and hand tapping, you’ll hold the target memory in your mind as the audio plays, and the therapist will pause every 20-30 seconds to check in about what you noticed during the BLS. When I use audio BLS in my sessions, I have my clients use their own headphones and we use a website called bilateralstimulation.io
Is EMDR Right For Me?
EMDR is one of many types of therapy that can be used to treat depression, anxiety, trauma, burnout, and more. Whether you have been to therapy before or not, this style of therapy can help a wide variety of people from all walks of life—regardless of whether they’ve experienced trauma or not.
Here are some situations where EMDR therapy might prove incredibly helpful:
PTSD: EMDR therapy has tons of research behind it, and is considered one of the most effective treatments for PTSD—and not just for military members or those who have been in traumatic accidents. EMDR can be helpful in reducing symptoms like flashbacks, nightmares, and hypervigilance.
Other trauma-related disorders: EMDR therapy can be very effective in treating other disorders that have traumatic origins, like complex PTSD (C-PTSD), acute stress disorder, and some dissociative disorders.
Anxiety and depression: EMDR therapy can be helpful for individuals with anxiety and depression who have negative beliefs or memories that are contributing to their symptoms—whether they’ve experienced trauma or not.
Addiction: EMDR therapy can be used to help individuals with addiction who have experienced trauma or who have negative beliefs or memories that are contributing to their addiction.
That being said, there are some situations where EMDR should be avoided until the more acute (serious or persistent) symptoms are addressed and well-managed. These situations include:
Active substance abuse: doing EMDR therapy while intoxicated isn’t recommended and may render the treatment ineffective, or may worsen symptoms.
Active psychosis: isn’t appropriate for folks who are actively psychotic, as they may have difficulty distinguishing reality from their traumatic memories.
Severe dissociation: EMDR is contraindicated for people with severe and unmanaged dissociative symptoms.
Severe depression or suicidal ideation: Folks with severe depression or suicidal ideation may require more intensive treatment before beginning EMDR therapy.
Downsides and Side Effects of EMDR
While EMDR is an effective treatment option for many individuals, there are potential downsides to consider before pursuing this type of therapy. Your EMDR therapist should discuss these with you prior to starting any form of EMDR.
Emotional distress: EMDR therapy involves thinking about traumatic memories and emotions, which can be incredibly difficult. It is important to have a strong therapeutic relationship with a trained EMDR therapist as well as a toolbelt full of resourcing skills and techniques, to help you manage any emotional distress that comes up when you go through EMDR treatment.
Overwhelming sensations: Some people report overwhelming or upsetting physical sensations during EMDR therapy, such as dizziness or nausea. Make sure to talk about any physical sensations with your therapist to ensure that the treatment is adjusted as necessary.
Side effects after EMDR: While many people don’t experience any side effects after EMDR therapy, some people report an increase in dreams, memories, or physical sensations. Immediately following EMDR, some people can feel fatigued, exhausted, or even thirsty. Some people report taking long naps after an EMDR session.
Learning More about EMDR
If you are interested in learning more about EMDR therapy, there are several resources where I will direct your attention:
Journal of EMDR Practice and Research
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk
EMDR Therapy and Somatic Psychology: Interventions to Enhance Embodiment in Trauma Treatment by Arielle Schwartz
EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma by Francine Shapiro
Note: while these resources are highly reputable and full of good information, it is still a good idea to consult with a trained EMDR therapist for personalized information and treatment recommendations.
Whew! We made it. I hope this blog post answers some of your questions about EMDR. As an online EMDR therapist in Fort Wayne, Indianapolis, and across the state of Indiana, I love using EMDR to help my clients accelerate their healing. If you’re looking for an EMDR therapist in Fort Wayne or an EMDR therapist in Indianapolis, reach out to me today for a free consultation.