I was skeptical about EMDR before my first session and didn’t bother doing any research. After the third session, when I started processing past traumas, I was blown away by how efficacious EMDR could be. I started diving into the literature to understand what was happening.
EMDR was discovered in 1987 by Dr. Francine Shapiro. Dr. Shapiro was walking in a park one day thinking about a distressing experience when she observed the distress was suddenly gone. Wondering what had happened, she noticed she’d been moving her eyes left and right.
Dr. Shapiro started experimenting with people, asking them to talk about distressing experiences while following her fingers moving laterally and confirmed they observed the same reduction in distress. Dr. Shapiro refined the process into an eight-step therapy she called Eye Movement Desensitization and Reprocessing.
During the first two EMDR sessions, the EMDR therapist collects the client’s history and helps the client set up a Safe Place where the client can return during a session if feeling overwhelmed.
In session three, the processing starts. The therapist asks the client to think about the traumatic experience, associated emotion, body sensation, negative belief, and positive belief that he or she would prefer to associate with the event. Then the client follows with his or her eyes the moving fingers of the therapist for about a minute and then notices what shows up, often an earlier memory related to the distress. The client thinks about this memory, and the therapist starts another cycle of lateral movement. Some clients prefer to tap their shoulders or thighs left and right instead of moving their eyes.
In my case, a lot of memories surfaced during each cycle. The memories didn’t always seem rationally connected, but often logically connected, like in a dream. A lot of emotion, anger, and sadness were also released during my sessions. EMDR doesn’t require a detailed description of the distressing experience, homework that is often required with Cognitive Behavioral Therapy (CBT), or exposure, which I found helpful when dealing with past traumatic experiences.
The therapist tracks the distress level or sometimes the alignment with the intended belief during the session and occasionally adjusts the speed or duration of the lateral movements. At the end of the session, remaining tensions are released, and the session always ends with the Safe Place, even for a few seconds, to ground the client.
Pre-COVID, most of the EMDR sessions were conducted face-to-face. Post-COVID, a lot of EMDR therapists have shifted to teletherapy. I had all my EMDR sessions via Zoom. I can’t compare with face-to-face sessions, but I never felt I was missing out. I liked that I was at home and didn’t have to drive back home after sessions when I was left spent and drained.
Part of the scientific community was skeptical about EMDR at first. Not surprising, I guess, I was very skeptical and wondered why following moving fingers would help me heal from PTSD. 25 Randomized Control Trials have been conducted to evaluate the efficacy of EMDR for the treatment of trauma.¹ A Kaiser Permanente study showed that 100% of single-trauma victims and 77% of multiple-trauma victims no longer had PTSD symptoms after a mean of six 50-min EMDR sessions.², ³ Two other RCTs showed that 84% to 90% of single-trauma victims no longer had PTSD after three 90-min EMDR sessions.⁴ ,⁵
Since then, EMDR has been used to treat long-term depression,⁶ reduce suicidal ideation,⁷ improve sleep parameters,⁸ and for other mental health conditions such as bipolar disorder and anxiety disorder.⁹
The American Psychiatric Association,¹⁰ the US Department of Defense,¹¹ and the World Health Organization¹² started recommending EMDR as an effective treatment for victims of trauma. Still, EMDR is not as well-known as CBT. I don’t fully understand why. Maybe because the scientific community remained skeptical for some time. Maybe because of the limited number of EMDR-trained therapists.
When the flashbacks of childhood traumas started eight years ago, a social worker friend of mine moved her fingers in front of my eyes to try to calm me down. I had no clue what she was doing, was not open to new forms of therapies, and dismissed her. It would take six more years for me to rediscover EMDR, this time in a New York Times piece on PTSD and fear. Few of my friends had heard about it. None of my relatives or friends had suggested it to me. Maybe because I was not fully aware I suffered from PTSD symptoms and never mentioned the symptoms.
When I started raving about EMDR and researching Akesa Health with connections in Europe, I was surprised to see that EMDR is quite well-known, especially in the UK, where the NHS recommends it.
For years, scientists have hypothesized various mechanisms of action. Because the lateral eye movement of EMDR resembles the eye movement of REM sleep, where a lot of emotional and mental distress is also processed, it was believed at first that the same mechanism was at play.
In 2018, a scientist working under Prof Huberman, a Stanford professor of ophthalmology and neuroscience, showed in a Nature paper¹³ that the lateral eye movement decreases the activation of the amygdala, the organ at the center of the brain responsible for emotional response, especially fear. This paper was key for me to understand and accept why I was able to think about traumatic experiences while following the moving fingers of my therapist that I couldn’t even journal about. The results were confirmed by another scientific team in the Netherlands.¹⁴
A lot of information on EMDR is available online, and I’ve found the following resources helpful:
- EMDR Association (Link)
- EMDR International Association (Link)
- Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy, Francine Shapiro (Link)
- Eye Movement Desensitization and Reprocessing (EMDR) Therapy, Third Edition: Basic Principles, Protocols, and Procedures 3rd Edition, Francine Shapiro (Link)
- Prof Huberman’s short video on eye movement, EMDR, and its mechanism (Link)
1. Shapiro F. The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences. Perm J. 2014;18(1):71–77 (Link)
2. Marcus, S. V., Marquis, P., & Sakai, C. Controlled study of treatment of PTSD using EMDR in an HMO setting. Psychotherapy: Theory, Research, Practice, Training, 1997; 34(3), 307–315
3. Marcus S, Marquis P, Sakai C. Three- and 6-month follow-up of EMDR treatment of PTSD in an HMO setting. Int J Stress Manag. 2004;11(3):195–208
4. Rothbaum BO. A controlled study of eye movement desensitization and reprocessing in the treatment of posttraumatic stress disordered sexual assault victims. Bull Menninger Clin. 1997 Summer;61(3):317–34
5. Wilson SA, Becker LA, Tinker RH. Eye movement desensitization and reprocessing (EMDR) treatment for psychologically traumatized individuals. J Consult Clin Psychol. 1995 Dec;63(6):928–37
6. Wood E, Ricketts T, Parry G. EMDR as a treatment for long-term depression: A feasibility study. Psychol Psychother. 2018;91(1):63–78
7. Proudlock S, Peris J. Using EMDR therapy with patients in an acute mental health crisis. BMC Psychiatry. 2020;20(1):14
8. Rousseau PF, Vallat R, Coste O, et al. Sleep parameters improvement in PTSD soldiers after symptoms remission. Nature Sci Rep. 2021;11(1):8873
9. Valiente-Gómez A, Moreno-Alcázar A, Treen D, et al. EMDR beyond PTSD: A Systematic Literature Review. Front Psychol. 2017;8:1668
10. Practice guideline for the treatment of patients with acute stress disorder and post traumatic stress disorder. Arlington, VA: American Psychiatric Association; 2004 (Link)
11. Department of Veterans Affairs, Department of Defense. VA/DoD clinical practice guideline for management of post-traumatic stress. Washington, DC: Veterans Health Administration; 2010 Oct (Link)
12. Guidelines for the management of conditions specifically related to stress. Geneva, Switzerland: World Health Organization; 2013 (Link)
13. Salay LD, Ishiko N, Huberman AD. A midline thalamic circuit determines reactions to visual threat. Nature. 2018;557(7704):183–189 (Link)
14. de Voogd LD, Kanen JW, Neville DA, Roelofs K, Fernández G, Hermans EJ. Eye-Movement Intervention Enhances Extinction via Amygdala Deactivation. J Neurosci. 2018;38(40):8694–8706