EMDR: Eye Movement Desensitization Reprocessing Therapy
- Social Work Graduate
- 21 hours ago
- 15 min read
Adaptive information processing, EMDR process, treatments, research, advantages, disadvantage, suggestions for practice, case study.
Four sections follow:
Background Material that provides the context for the topic
Suggestions for Practice
A list of Supporting Material / References
Appendix: EMDR Case Study
Feedback welcome!
Background Material
Introduction
EMDR is based on a chance discovery of Francine Shapiro in 1987. Shapiro discovered that forms of bilateral stimulation, such as eye movement (following the therapist’s fingers back and forth), hand tapping and audio stimulation, can be used to diminish the disturbance associated with painful experiences. Talk therapy accompanies the bilateral stimulation and this accelerates the brain’s processing of unconscious material. Shapiro hypothesized that EMDR therapy facilitates access to the traumatic memory network, so that information processing is enhanced, with new associations forged between the traumatic memory and more adaptive memories. These new associations are thought to result in complete information processing, new learning, elimination of emotional distress, and development of cognitive insights. This therapy usually includes eight phases where the discomfort caused by traumatic memories is processed so the memories are remembered rather than re-experienced in a traumatic way. Overly stimulating, revolting, frightening or even shaming unconscious memories, which are shaping current behavior, are reprocessed into a more adaptive state (Dwyer,, 2021; EMDR Institute Inc., 2025; Franklin, 2015; Valiente-Gomez et al., 2017).
EMDR is best known for its role in treating post-traumatic stress disorder (PTSD), but its use is expanding to include treatment of many other conditions. Dozens of clinical trials since EMDR’s development show this technique is effective and can help children, adolescents, teenagers and adults of all ages with a wide range of mental health conditions faster than many other methods (Cleveland Clinic, 2022).
EMDR is now practised right around the world with clients of many different cultures. EMDR has been endorsed by a range of organisation, e.g. WHO, International Society for Traumatic Stress Studies, American Psychiatric Association, US Department of Veterans Affairs and Department of Defence, Phoenix Australia – Centre for Post-traumatic Mental Health and Medicare Australia, as a focused psychological strategy (Cleveland Clinic, 2022; Dwyer, 2021).
Theoretical Background
The adaptive information processing (AIP) model is the conceptual foundation of EMDR. It falls directly into the parameters of psychodynamic theory (Franklin, 2015). AIP suggests that the brain stores normal and traumatic memories differently. The brain has an information processing system that usually categorises and integrates new experiences with existing memory networks. Like other physiological systems, it is geared toward health – to process information in an adaptive way. During traumatic events, the brain stores memories in an incomplete and unprocessed manner. Rather than memories being understood, categorized, made sense of and decisions made about what to keep and what to be discarded, the memory becomes stored in the form it was initially experienced, in its own neural network, isolated from adaptive information, i.e. from thoughts, smells, tastes, other sensory information, emotions that help process and store memories. Memories are stored improperly (Cleveland Clinic, 2022; Dwyer, 2021).
Because of lack of proper processing, sights, sounds and smells with a connection or similarity to a trauma event can “trigger” those improperly stored memories. Unlike other memories, these can cause overwhelming feelings of fear, anxiety, anger or panic. An example of this is a post-traumatic stress disorder (PTSD) flashback, where improper storage and networking cause the mind to access those memories in a way that is uncontrolled, distorted and overpowering. That is why people with a history of flashbacks describe feeling as if they were reliving a disturbing event. The past becomes the present (Cleveland Clinic, 2022). The response of people to COVID is an example. People have different memories, possibly traumatic, of COVID depending on their location, job, family experience, etc. For example, a front-line worker in a COVID ward will have a different memory of COVID and different experiences to a person in a relatively isolated rural area, who will differ from a person in a city under lock down. AIP suggests traumatic memories are stored in an incomplete and unprocessed way (Dwyer, 2021).
Treatments
The most widespread use of EMDR is for treating post-traumatic stress disorder (PTSD). Mental healthcare providers also use it in the treatment of the following conditions:
Anxiety disorders: Generalized anxiety disorder, panic disorder, phobias and social anxiety/phobia.
Depression disorders: Major depressive disorder, persistent depressive disorder and illness-related depression.
Dissociative disorders: Dissociative identity disorder or amnesia and depersonalization or derealization disorder.
Eating disorders: Anorexia nervosa, bulimia nervosa and binge-eating disorder.
Obsessive-compulsive disorders: Obsessive-compulsive disorder (OCD), body dysmorphic disorder and hoarding disorder.
Personality disorders: Borderline personality disorder, avoidant personality disorder and antisocial personality disorder.
Trauma disorders: Acute stress disorder, PTSD and adjustment disorder (Cleveland Clinic, 2022).
The EMDR Approach
The procedural steps of EMDR activate the information processing system. They:
Identify the memory that will be worked on
Ask the person to bring up the memory – this is the activation, so the person is encouraged to think about the images, thoughts, sensations, feelings, emotion that go with the memory
Stimulate the information processing system by using bilateral stimulation. This is when processing occurs. The brain forges new connections between the information that is held in the brain in fragmented form.
Processing forges new connections to adaptive information
The memory is reconsolidated in an adaptive form
The adaptive shift occurs in all components of the memory at all of the different levels that memories are held in the body – thoughts, emotions, sensations.
As processing occurs it is believed there is a shift from implicit to explicit memory and from episodic memory to semantic memory systems.
EMDR reprocesses the memory and allows it to be remembered, rather than really experienced again. EMDR processing replicates REM sleep to some extent by initiating processes in the brain that normally occur when people are asleep (Dwyer, 2021).
There are 8 phases in EMDR; EMDR does not just involve eye movement or other forms of bilateral stimulation. It has the adaptive information processing (AIP) model at is basis.
Patient history and information gathering. Information about the person and his/her past is gathered to determine if EMDR is likely to help the person. The person is asked about upsetting or disturbing events and memories that he/she wants therapy to focus on, as well as goals for the therapy.
Preparation and education. The client learns coping mechanisms, and the therapist builds a relationship with the client and establishes safety. Resourcing, which strengthens positive memories and coping skills, is also part of this phase.
Assessment. Identifying themes and specific memories for working on during reprocessing, both negative beliefs about the trauma, as well as positive beliefs that the person would like to believe about her/himself going forward.
In phases 4, 5 and 6 the therapist engages in bilateral stimulation to assist the person to process and digest the experience so that it can be remembered, rather than re-experienced in the everyday. The session is closed and re-evaluated in an ongoing manner (Dwyer, 2021).
Desensitization and reprocessing. Activating the memory by helping the person identify one or more specific negative images, thoughts, feelings and body sensations. Throughout the reprocessing, any new thoughts or insight about what is being experienced will be noted.
Installation. The positive belief identified in Phase 3 is installed and strengthened by associating it with the desensitized memory.
Body scan. The client scans their body for any residual tension or physical sensations related to the memory and processes them until a feeling of calm and neutrality is achieved. This phase helps identify progress through EMDR therapy overall. As the person goes through sessions, symptoms should decrease. Once the symptoms are gone, reprocessing is complete.
Closure and stabilization. What the person should expect between sessions including how to stabilize, especially if negative thoughts or feelings occur during the time between sessions.
Re-evaluation and continuing care. Review of progress and how the person is now. This can help determine the need for additional sessions or how to adjust goals and expectations for therapy. Future experiences and how to handle them might be explored (Cleveland Clinic. 2022; Dwyer, 2021; EMDR Institute, 2025).
Research
The effectiveness of EMDR therapy in treating Post-traumatic Stress Disorder (PTSD) has undergone the scrutiny of several meta-analyses; this led to the final recognition by the World Health Organization (in 2013) as a psychotherapy of choice in the treatment of PTSD in children, teenagers, and adults. Investigation in EMDR therapy has increased beyond PTSD and several studies have analyzed the effect of this therapy in other mental health conditions such as psychosis, bipolar disorder, unipolar depression, anxiety disorders, substance use disorders, and chronic back pain.
An important finding about EMDR therapy is that it seems a safe intervention. This allows clinicians to consider EMDR therapy as an appropriate treatment in various psychiatric comorbid conditions without causing side effects (Valiente-Gomez et al., 2017). A 2017 review by Valiente-Gomez et al. of the available randomized controlled trials at that time found the following.
EMDR in Affective Disorders
EMDR has positive effects in the treatment of depression
EMDR might be a useful approach for treating addiction memory and craving of alcohol.
PTSD symptoms can be successfully treated with EMDR in substance abuse patients.
Pain-focused EMDR might be useful for non-specific chronic back pain patients.
EMDR Therapy in Anxiety Disorders
EMDR therapy demonstrated a positive effect on anxious and OCD symptoms.
EMDR Therapy in Substance Use Disorders
EMDR therapy could be a useful therapy to use in substance use disorders with a history of traumatic life events in order to improve the prognosis of these patients. EMDR therapy could also help as an adjuvant psychotherapy to standard treatment of alcohol dependence directly decreasing craving.
EMDR Therapy and Chronic Pain
EMDR therapy is a safe and effective therapeutic strategy to reduce pain intensity and disability in patients with chronic back pain.
Other research reviews have considered qualitative research studies. Marich et al. (2020) examined 12 major, non-case, qualitative studies in the EMDR literature. The 12 studies reviewed covered the following areas:
Adult male sex offenders with history of childhood sexual abuse (N = 10)
Adults with OCD (N = 24)
Adult females with primary substance use disorders and history of trauma (N = 10) (2 studies)
Adults with PTSD and self-identified addiction issues (N = 9)
Adults having difficulty coping with grief (N = 18
Children impacted by trauma due to refugee experience (N = 8)
Adult females with history of childhood sexual abuse (N = 38)
Trained EMDR therapists (N = 56) (4 studies)
These qualitative studies produced positive findings for the effectiveness of EMDR. Other themes emerging from the studies included:
The therapeutic relationship was viewed as paramount in the delivery of EMDR therapy. Attunement—best represented by a willingness to adapt in order to meet clients at their level of readiness—was also seen as important. Qualities like flexibility, intuition, ease in working with trauma, and attending to small measure of caring were also identified.
A recurring theme in several studies was the importance of safety, preparation, and orientation for the participants.
The key factors for change brought about by the EMDR, as perceived by the participants, included recognition of distorted beliefs and clarification of thoughts.
Standard trainings in EMDR therapy must include more of a cross-cultural component, specifically on the nuance of language, if EMDR trainings are going to serve a more diverse world.
The EMDR community is advised to develop better and simpler rationales for EMDR’s implementation that can be easily understood by the general public as it appears many therapists have difficulty explaining EMDR to their clients.
EMDR Institute (2025) includes much of the above in its summary of research findings noting positive positive therapeutic results with EMDR have been reported with a wide range of populations. Leeds (2018) found EMDR therapy to be effective in the following areas:
Eating Disorders, 2017. EMDR appears to be a promising approach, but further scientific evidence in support of its efficacy is required.
Depression, 2017. Current evidence suggests that EMDR could be a promising therapy to treat depression.
Grief, 2017. Participants who completed EMDR reported that distressing memories were less clear and felt more distant from such memories following treatment.
Low self-esteem, 2017. EMDR has the potential to be effective treatments for patients with low self-esteem and a wide range of comorbid psychiatric conditions.
PTSD and depression, 2017. EMDR therapy is an effective treatment to reduce symptoms of PTSD and depression.
PTSD in adolescents and children, 2017. EMDR significantly reduced PTSD symptoms in the majority of the subjects.
Advantages and Disadvantages
Advantages
It works. Dozens of studies have found that EMDR is effective.
It tends to work faster than other forms of therapy. People receiving EMDR typically start seeing results much sooner than with other forms of therapy.
It involves less homework. Other forms of therapy typically involve journaling or other types of homework outside of the sessions. EMDR usually involves only writing down any thoughts or ideas to bring up at the next session (if and when those thoughts happen).
It’s usually less stressful. EMDR focuses on processing and moving past the trauma. Other methods involve having the person describe and even relive negative events (Cleveland Clinic, 2022).
Disadvantages
It only works with conditions related to traumatic experiences. If the person has a mental health condition because of an inherited condition, an injury or other physical effect on the brain, EMDR is unlikely to help.
Why it works is still theoretical. EMDR was an accidental discovery. Experts still can't fully explain why it works, despite the evidence that it works.
It’s a new method. EMDR’s creation happened in 1989, while other forms of therapy have been in use for much longer. More research is necessary before experts know if EMDR is a long-term solution or if people need additional therapy years or decades later (Cleveland Clinic, 2022).
As with any form of psychotherapy, there may be a temporary increase in distress.
Distressing and unresolved memories may emerge.
Some clients may experience reactions during a treatment session that neither they nor the administering clinician may have anticipated, including a high level of emotion or physical sensations.
Subsequent to the treatment session, the processing of incidents/material may continue, and other dreams, memories feelings, etc., may emerge (EMDR Institute, 2025).
Other issues to be aware of:
EMDR can cause harm if administered incorrectly and without training. Some people will have a strong defence against accessing traumatic memories and if EMDR breaches that defence before the person is ready to engage with them, it can cause more trauma. EMDR operates in the person’s window of tolerance, and it is important not to breach that. If it is breached, there are strategies to bring the person back to the tolerance level they can manage. The first thing that is assessed is whether the person can stay with dual awareness, stay in the room and visit a memory, not have the memory happen now.
If the problem is not to do with memory (e.g. autism and ADHD), EMDR may not be suitable. The initial interview is important in determining whether EMDR will be suitable. It looks at the history of the person, how the presenting problem is related earlier experiences and memories that may be maladaptive. Some clients may need much more preparation to commence EMDR therapy. Building up support around the client may be necessary so they can stay within the window of tolerance (Dwyer 2021).
Suggestions for Practice
EMDR is now proven to be effective in treating trauma. Dwyer (2021) suggests it is an approach very relevant for social workers to master as the problems people often present to social workers with can be due to underlying trauma. EMDR treats this underlying problem, to alleviate the presenting problem. People who have experienced trauma are:
15 times more likely to commit suicide
4 times more likely to become an alcoholic
4 times more likely to inject drugs
4 times more likely to develop a sexually transmitted disease
3 times more likely to use antidepressant medications
3 times more likely to be absent from work
3 times more likely to experience depression
3 times more likely to have serious job problems
2.5 times more likely to smoke tobacco (Dwyer, 2021)
Training
EMDR should not be practised without appropriate training. Participants are allowed to practise EMDR after completing the first 20 hours (level1) of two levels of training but require level 2 training to support clients with more complex needs.
Training is available through the EMDR Institute (2025) and, for social workers in Australia, via the Australian Association of Social Workers or at https://www.jennydwyer.com.au/training.
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Supporting Material / References
Further resources (Vakakis, 2023)
EMDRAA website: www.emdraa.org
Mindful Living website: www.mindfulliving.com.au
Free resources for the public: www.mindfulliving.com.au/resources/
The book discussed: www.everymemorydeservesrespect.com/
Australian Psychological Society. (2019). Demystifying EMDR. InPsych, 41(3). https://psychology.org.au/for-members/publications/inpsych/2019/june/demystifying-emdr
Cleveland clinic. (2022). EMDR Therapy. https://my.clevelandclinic.org/health/treatments/22641-emdr-therapy
Dwyer, J. (2021). Introduction to eye movement desensitisation reprocessing (EMDR) therapy for social workers. AASW Webinar Recording. https://my.aasw.asn.au/s/event-information?EventID=a2Y9g0000002KDUEA2
EMDR Institute Inc. (2025). What is EMDR therapy? https://www.emdr.com/what-is-emdr/
Franklin, J. L. (2015). The effectiveness of EMDR therapy on clients with addictions. Masters Thesis, Smith College, Northampton, MA. https://scholarworks.smith.edu/theses/921
Leeds, A. M. (2018). Recent articles on EMDR. https://www.emdria.org/wp-content/uploads/2020/03/Research-Corner-March-2018.pdf
Marich, J., Dekker, D., Riley, M., O’Brien, A. (2020). Qualitative research in EMDR therapy: Exploring the individual experience of the how and why. Journal of EMDR Practice and Research, 14(3), 118-134. http://dx.doi.org/10.1891/EMDR-D-20-00001
Vakakis, M. (Host). (2023, August 3). Understanding EMDR therapy with Caroline Burrows [Audio podcast]. This Complex Life (Episode 4). https://my.aasw.asn.au/s/article/Podcasts-relating-to-mental-health
Valiente-Gómez, A,, Moreno-Alcázar, A., Treen D., Cedrón, C., Colom, F., Pérez, V. & Amann, B. L. (2017) EMDR beyond PTSD: A systematic literature review. Frontiers in Psychology, 8 (1668). doi: 10.3389/fpsyg.2017.01668
Appendix
EMDR: A Case Study
From Australian Psychological Society (2019).
EMDR therapy follows standardised procedures. Treatments begin with psychoeducation and mapping out the client’s symptoms, support systems, resources and self-regulation skills. After making an overview of the client’s traumatic memories, for example on a timeline, one of the network of memories is selected.
Mary, a 23-year-old woman, presents for treatment describing a difficult, traumatic history.
Mary: “domestic violence between mum and dad when I was three to seventeen, sexual abuse by my uncle at the age of 11, sexual abuse by my grandfather from the age of six to nine, bullying in year nine, domestic violence with first partner and a car crash”.
The domestic violence is selected to process first. Mary is asked to provide a brief summary of what happened and then select what has become the worst image in her mind. The psychologist then asks what makes this memory still so disturbing. Clients may report feeling powerless, or they feel it was their fault or that they are worthless. The aim is to change these negative ideas and help the client to understand that it was not their fault, and that despite what happened to them, they are not worthless. Clients then rate how true this positive belief feels now on a 1–7 point scale, with 1 being completely false and 7 being completely true. They usually say it does not feel true at all.
Mary: “I am five and I see myself standing beside mum who is bleeding, and I do nothing. Dad is drunk and is yelling and screaming. This was my fault because I should have helped mum and distracted dad. I know it was not my fault, but I still feel so guilty”.
The client is then asked which emotions they feel, to rate their distress on a scale of 0–10, and the location where they feel this distress in their body. The purpose of this whole process is to activate the memory, the associated images, thoughts, feelings and bodily sensations.
Mary: “I feel sad and scared, very scared, about a 9 or a 10 in my stomach”, and she starts to cry and shake.
The clinician then instructs the client to concentrate on the image, think about their negative belief and feel the distress in their body while simultaneously applying a form of bilateral stimulation, most commonly in the form of repeated eye movements. Clients are asked to follow the clinician’s fingers moving left to right in front of their eyes. Every 30–45 seconds the clinician asks the client to briefly describe what they notice and instructs them to continue tracking. Clients report all sorts of associations such as, it is like a movie playing in their head, they think about other memories, they feel afraid, angry, sick or pain in their body. Some report being distracted by the eye movements or they think about other things.
After the first set of eye movements, Mary notices the scared feeling in her stomach getting stronger and she is asked to concentrate on that. After the next set she feels like she wants to vomit, and she is asked to concentrate on that. She then remembers the smell of alcohol on her dad’s breath.
Mary: “I see flashes of many other situations. That little girl was only five, she could not do anything”.
The client regularly rates the level of disturbance, and the same process is continued until the memory is rated zero and the memory does not affect them anymore. Clients usually say the memory is vague and distant or they cannot really remember it clearly anymore. The client is then asked to rate the believability of the positive belief again. They concentrate on the memory and this belief, while focusing on the bilateral stimulation again. The process is repeated until clients rate the believability as a 6 or 7.
Mary: ”I know it happened, and it was terrible growing up like that, but it really feels like it does not affect me anymore. I no longer feel afraid, but strong. My mum and dad’s fighting were not my fault, I know it and it feels very true.”
Generally, it takes one or two sessions of 60 minutes to process one memory, and the effect generalises to most or all other similar situations. Then the next category can be addressed.
Mary said all the other memories of domestic violence between her parents were also processed in this single session. In the next session she addressed the sexual abuse by her grandfather.
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EMDR therapy may seem like an easy job, waving a finger and letting the client do all the work. Obviously it does not work like that. During the 30 to 45 seconds when the client is concentrating on the memory and bilateral stimulation, the EMDR clinician is tuned into the client, notices change in the client’s body or expression and co-regulates. When clients become too overwhelmed, are not concentrating, get stuck in repetitive thoughts or feelings, the EMDR clinician intervenes to get the client back on track by for example asking brief questions such as “How old were you then?”, “Did you really die?”, “Who was responsible, you or him?” or changing the speed, intensity or length of the bilateral stimulation.