What Is EMDR Therapy: Frequently Asked Questions About EMDR
EMDR... You may have heard about it. A lot has been written about it. Because it’s somewhat different from conventional talk therapy, you may be skeptical. I was too, before I participated in a rigorous and extensive training in EMDR through the Parnell Institute. As part of the training, I was required to be an EMDR client, and I saw that it worked. Since then, I’ve been using it in my practice for a few years. Several clients who were naturally skeptical have since said “Wow, something feels different,” when they returned after an EMDR session. This is why I continue to weave it into my work, as necessary and when clients ask for it. Because EMDR may be new to you, I’ve put together a list of 24 common questions about EMDR, along with answers.
1. What is EMDR therapy?
EMDR is a form of psychotherapy that fosters healing from emotional distress, and other symptoms resulting from traumatic or disturbing experiences.
2. What does EMDR stand for?
Eye Movement Desensitization and Reprocessing.
3. What sort of traumatic experiences can EMDR help with?
EMDR is effective at treating:
PTSD
Motor vehicle accidents
Panic attacks
Natural disasters
Critical illness
Traumatic labor and delivery
Humiliation at work or school
...But it’s also effective in healing the long-lasting effects of subtle “relational wounds” that most of us experienced while growing up:
Harsh criticism from a parent
Being raised by a depressed parent
Feeling rejected by a crush
Feeling different from everyone
Being shamed by a teacher
Feeling overlooked in our emotional experience
Feeling unlovable
Feeling overshadowed by someone else’s emotions
Abandonment by a parent
Feeling recognized only for our achievements
Feeling excluded
Feeling unrecognized as an individual
Family conflict
These relational wounds occur in adulthood as well. When you argue with your romantic partner, endure emotional or other abuse by a significant other, undergo a breakup of a romantic relationship, or experience humiliation or shame at work, this can be stored as trauma and affect you.
4. How do I know if these things are affecting me?
Even if you feel okay most of the time, you might notice pronounced surges of emotion. You may notice a pattern of instability or anxiety in your romantic relationship, your interactions at work, or with family or friends. Some people wind up numbing themselves from feeling those emotions, whether that be through alcohol, videogames, working longer hours than they need to, etc.
It may show up in the form of:
Insomnia
Anxiety
Depression
Phobias
Excessive guilt
Addictions
Excessive anger
Unexplained bodily tension
Sexual dysfunction
Social anxiety
Difficulty trusting others
Difficulty concentrating
Night terrors
Difficulty with life decisions
Flashbacks
Low self-esteem
Unexplained body aches
Changes in mood
5. What’s the neuroscience behind these things affecting me?
Things that are unpleasant or frightening happen to all of us. We’re all capable of taking a raw experience and putting it into a personal narrative. When this happens, the ideal outcome is for us to make sense of the experience without it impacting our sense of self, how we view others, or how we view the world. But sometimes, when a traumatic or disturbing event happens, the brain can't process the experience as it normally would. Whatever we feel or notice (images, sounds, physical sensations, emotions) and whatever we think or believe (such as “I have no control,” “I’m not good enough”) can get stuck. Stuck in the right side of your brain (where there’s no sense of time), in undigested, fragmented form, as if frozen in time. Years later, when exposed to something similar (e.g. how your boss looks at you, the tone of your partner’s voice), or when remembering what happened, any aspect of those fragments can get triggered, and you can feel exactly the same as you did back then.
6. What else can EMDR help with?
Although there is extensive research on EMDR Therapy as an effective treatment for trauma and adverse life experiences, I’ve also used it to work with clients on alleviating social anxiety, enhancing self-esteem, overcoming negative thought patterns, improving relationship dynamics, identifying barriers to intimacy, overcoming phobias, etc.
EMDR can also be used as a performance enhancement tool, to reduce anxiety and fear in high-stress situations such as working or performing in front of others, public speaking, flying, taking a standardized test, undergoing a job interview, etc.
7. How does EMDR work?
EMDR in effect unfreezes the integrative capacity of your brain to process memories effectively. We do this by engaging both the left brain and the right brain (bilateral stimulation), which activates the brain’s information processing system to “digest” unresolved stuff, in a different way than you did back then.
According to Robert Stickgold, Ph.D. at Harvard Medical School, “We believe that EMDR induces a fundamental change in brain circuitry similar to what happens in REM sleep — that allows the person undergoing treatment to more effectively process and incorporate traumatic memories into general association networks in the brain. This helps the individual integrate and understand the memories within the larger context of his or her life experience.” Think of it as combining your raw experience with wisdom that was unavailable at the time.
As a result, EMDR clients have reported, you’ll still remember what happened, but it’ll have less of an effect on you than it once did. You’re in effect re-integrating your past experience into your psyche so that it’s less distressing, with less of a “charge” around it. Along with this shift in your emotional and physiological experience, you may notice new insights and understandings emerging as well; the old beliefs about the things you’ve experienced may feel like they no longer fit.
8. Why does EMDR Therapy work?
EMDR consists of eight phases, as part of a standardized protocol. First we’ll gather information to understand your relevant history. We’ll assess whether EMDR would be appropriate to use in our work together. In the preparation phase, you’ll be resourced with new ways to cope with stress, new ways to stay grounded and present when strong emotions happen, allowing you to live more comfortably. We’ll then together determine the most appropriate event or memory to start with (the “target”), and its components (emotions, bodily sensations, negative thoughts associated with it, etc.).
To begin the actual processing, I’ll ask you to hold the target memory in mind, while we run an alternating bilateral stimulus (more of that below). I’ll ask you to notice whatever comes to mind without directing it or censoring it. You’ll report in what’s coming to mind, whether that be internal associations, related memories, how you’re feeling, or anything else. Depending on what you report, I may focus your attention on one aspect, as a starting point. We’ll then repeat the process, and re-assess your symptoms to see if you need to process other targets. Over time, clients routinely report a shift in how they feel, and new cognitive insights emerge. We’ll then work on reinforcing the new insights.
9. What do you mean by “alternating bilateral stimulus”?
As EMDR was originally developed, the client would track the therapist’s fingers as they moved back and forth across the client’s field of vision. But I’ve found that many clients prefer to close their eyes as they’re processing. So I use equipment that stimulates both sides of the body in a rhythmic fashion, which activates both sides of the brain (it’s been discovered that you get the same effect with this equipment). The equipment is surprisingly analog… it actually looks like a small walkie-talkie.
It’s got little devices called “tappers” that you hold in your hands as they buzz gently; facilitated tapping is also an option. For auditory stimulation, it produces gentle beeps that you’ll hear through headphones. Many clients opt for a combination of the tactile and auditory stimulation. Before we do any processing, you’ll already have tried it out and gotten familiar with it.
10. How long does it take for EMDR Therapy to work?
Together we’ll discuss the possibility of using EMDR. We can discuss whether it’s appropriate, and how it can be part of our work together. The length of treatment will vary, depending on what you’re looking to resolve, your life circumstances, the extent of past trauma, your current psychological resources, etc. While EMDR is designed to speed up your ability to heal, it’s not a one-time treatment. But results may be somewhat more rapid than in conventional talk therapy. My clients and I continue to be amazed at how quickly change can occur with this technique.
11. Can we do both EMDR and talk therapy?
Yes. EMDR can serve as separate, stand-alone therapy. Or, it can be woven into an ongoing course of talk therapy, when appropriate. I also provide EMDR as adjunctive therapy, for clients who are already in individual or couples therapy with another therapist but want to use EMDR to target a specific issue or symptom. In these situations, coordination between your primary therapist and your EMDR therapist is important, so that your primary therapist has input and so that all parties feel comfortable with the arrangement.
12. Is EMDR hypnosis?
No. You’re fully awake, alert and in control throughout every stage of EMDR. You can stop it at any time and return the session to regular talk therapy. While we’re on the subject, EMDR does not produce any sort of “altered state.” It doesn’t place anything in your brain that wasn’t already there. It just facilitates your brain in a natural healing process, dumping what you don’t want or need, and strengthening what you do want and need.
13. With EMDR Therapy, do I have to talk about my trauma?
Ironically, during the actual processing, you don’t have to really share details of disturbing or traumatic events. And you don’t have to relive the trauma over and over. Instead, you’re just quietly holding a memory in mind, mentally visiting it in small doses, and then letting your mind wander wherever it naturally wanders to. The bilateral stimulation allows your brain to do all of the work of self-healing, just as your body heals after a physical injury. Ironically, after several EMDR sessions, clients usually find themselves wanting to discuss whatever happened because they’re relieved that it’s no longer as emotionally charged.
14. Is EMDR evidence based?
EMDR has more published reports than any treatment for trauma. An overview of the research can be found through the EMDR International Association’s website.
Some relevant highlights:
EMDR has been designated as an “effective treatment of trauma” by the American Psychiatric Association (2004). It was placed in the “A” category (“strongly recommended”) by the Department of Veterans Affairs and the Department of Defense (2004), for the treatment of trauma.
The California Evidence-Based Clearinghouse for Child Welfare determined that EMDR and Trauma-Focused CBT were “well-supported by clinical evidence” (2010).
In the Practice Guidelines of the International Society for Traumatic Stress Studies, EMDR was designated as an effective and empirically-supported treatment for PTSD. Foa, E.B., Keane, T.M., Friedman, M.J., & Cohen, J.A. (2009). Effective treatments for PTSD: Practice Guidelines of the International Society for Traumatic Stress Studies. New York: Guilford Press.
Finally, check out this study. EMDR clients were equipped with EEG devices. Following EMDR therapy, there was a noticeable shift in activation from the amygdala (the part of your brain where emotions are stored and felt) to the prefrontal cortex, which is involved in higher cognitive functioning such as emotion regulation, decision making, and impulse control. Pretty cool, right?
15. Can you do EMDR yourself?
Oy… please don’t. Why not? Because EMDR has shown to be effective when a specific protocol is followed, which involves distinct phases. If you were to access a traumatic memory and pair it with bilateral stimulation, the associated elements are “lit up” in the brain, including emotions and bodily sensations. A therapist who is trained in EMDR (especially a “certified” EMDR therapist) will closely monitor the progression of these elements, and will use specific interventions to clear any obstacles to your brain’s natural capacity to heal. Together you’re in effect changing the neural circuitry around memories that are upsetting or disturbing. Trying this on your own is most definitely not recommended.
On the other hand, Resource Tapping, which draws upon the same mechanisms as EMDR, is safe and effective to do on your own. For more how this works, click here.
16. How do you feel after an EMDR session?
Following an EMDR session, clients will often say “I feel lighter.” Or “I don’t know why, but I feel kinda relieved.” It makes total sense. Why? Because the same memory that used to cause distress has usually lost most of its sting. Also, a negative belief about oneself (e.g. “I’m not good enough,” “I’m not safe”) usually flips to the opposite. This means that clients wind up leaving an EMDR session feeling empowered.
Sometimes clients may feel “impacted”, as if they’ve just had a very deep conversation or watched a serious movie. This could be because the brain has just processed a memory that was upsetting or scary. The EMDR therapist will usually save at least 10 minutes at the end of the session to reorient you to the present moment, so that you feel grounded and ready to go on with your day.
Following the session, some clients wind up thinking about the same material that they processed during the session, whether they consciously realize it or not. This can lead to new insights, thoughts or emotions. It’s helpful to write this stuff down, to make use of it in the next session.
17. Is EMDR psychotherapy?
EMDR is a form of psychotherapy, a specialized, brain-based method for healing trauma. But unlike conventional therapy, you’re not talking back-and-forth with the therapist for the entire session.
Instead, during the reprocessing stage of EMDR, with buzzers in your hands or headphones in your ears (both of which provide bilateral stimulation), you’re holding a traumatic memory in mind while allowing your brain to wander wherever it wanders. Your brain makes associations, and after you process the memory, it winds up affecting you way less.
So with EMDR, unlike regular talk therapy where you develop insights from just talking, progress derives from allowing your brain to just do its thing.
18. What is EMDR Therapy for PTSD?
PTSD (post-traumatic stress disorder) can occur when we experience or witness a traumatic event, an event that’s outside the range of normal human experience. Common symptoms include re-experiencing the event (i.e. upsetting memories), feeling on edge, insomnia, hypervigilance and more.
EMDR is a form of psychotherapy that can significantly reduce these symptoms, by taking the original memory and “rewriting” how it’s stored in your brain, giving you a newfound sense of power and control over it.
19. Why does EMDR Therapy work?
Despite massive advances in the field of neuroscience, no one knows why any form of therapy truly works in the brain. Researchers studying EMDR have hypothesized as to its effectiveness. The following are four such hypotheses:
Our brains have a healthy information processing system, which combines our raw experience with an adult narrative (e.g. “I’m safe now”). Trauma disrupts that integrative process, meaning that images, emotions, bodily sensations, and negative beliefs are frozen in timeless form, in the right side of our brain. By engaging our left brain and right brain alternatingly, EMDR is said to reconstruct that integrative process, in effect “rewriting” neural pathways associated with traumatic memories. This is the Accelerated Information Processing Model (Shapiro, 1995, 2001, 2006).
As your brain attends to the bilateral stimulus, it links the left brain with the right brain, similar to REM sleep (Stickgold, 2002),
As your attention is divided between focusing on the memory and attending to a bilateral simulus, this taxes working memory, such that you’re less able to focus on the disturbing effect of the memory. (van den Hout et al., 2013).
The same dual attention activates the anterior cingulate cortex, which connects the upper brain to the lower brain, and is involved in processing both positive and negative memories (Kaye, 2008).
20. What is a Certified EMDR Therapist?
A Certified EMDR Therapist has reached a higher level of expertise and mastery of EMDR.
EMDRIA, the EMDR International Association, provides this certification to EMDR therapists who apply for such designation and have met certain criteria. For instance, the therapist must be fully licensed in their field, with at least two years experience in their field. The therapist must have completed an EMDRIA-approved training program in EMDR Therapy, at least 50 hours of EMDR therapy with at least 25 clients, at least 20 hours of consultation in EMDR by an Approved Consultant, at least 12 hours of continuing education related to EMDR Therapy, and other requirements.
21. Why does EMDR make you tired?
Many clients report that the bilateral stimulation (“BLS”) is relaxing. After a session in which they’re successfully reprocessed a memory that brings up significant emotion, some clients have reported better sleep. But what’s the connection? No one really knows. Two theories about why EMDR works may help explain. They include:
BLS facilitates neurobiological mechanisms that are similar to REM sleep (Stickgold, 2002).
BLS simulates the fetus hearing the mother’s soothing heartbeat (Dr. Bruce Perry).
If your EMDR session is in the middle of your work day, it’s a good idea to budget 10-15 minutes afterwards to get back in the swing of things.
22. Can EMDR make things worse? Is it safe?
When conducted with a trained EMDR therapist, EMDR is safe.
You’ll be asked to briefly hold a specific memory in mind, including the image that comes to mind, and how you feel now when quickly thinking of it. When you add the bilateral stimulation, the images, emotions and bodily sensations will likely change. This is your brain naturally moving towards healing. The therapist monitors these changes, and can help if you feel stuck. As you’re noticing these changing emotions and body sensations, it may momentarily seem like you’re “feeling worse.” But this is normal… a necessary step along the path towards healing, and a sign that it’s working. It’ll be paced in a manner that ensures that you feel safe throughout the process. You’re in control, and can stop or take breaks at any time.
As the brain does its thing during EMDR, the same memory that used to make you feel badly starts to lose its effect. Negative messages that may have once seemed so convincing are replaced by a new sense of empowerment or freedom. And this lasts well beyond the EMDR session. The neural pathways in your brain have now been rewritten, so you won’t be triggered by the same thing that used to trigger you.
So on the off chance that you feel a little “worse” before feeling much better, you’ll find that it’s very worth it.
23. How do you know if EMDR is working?
When you’re in the reprocessing phase of EMDR, between sets of bilateral stimulation, you’ll be very briefly checking in to describe your experience.
Over the course of an EMDR session, clients invariably find that the memory that they initially began the session with gradually fades, losing its power. They begin to think about what happened in a new way, letting go of negative beliefs or patterns of thinking.
You’ll likely notice this not just during an EMDR session, but as you go about your life. You might not be able to describe the difference in words. But the old beliefs around what happened, even if out of your awareness, may feel like they no longer fit. Emotions like shame and anger may be replaced by a new sense of empowerment or even peace. You might find yourself less reactive to things that used to trigger you. Coping strategies that you once used (avoiding emotions, drinking to feel better, zoning out, etc.) won’t feel as necessary.
After a number of EMDR sessions, when asked about the same memory (e.g. harsh criticism from parents, a bad breakup, a setback at work), clients will say something like “I can sort of remember it, but it’s weird… it doesn’t feel like a big deal now.”
24. How often should you do EMDR?
Therapy in general is usually most effective with weekly sessions. EMDR sessions can be done as often as finances and scheduling permit. Weekly or even twice-per-week EMDR sessions are acceptable.
However, between sessions in which you reprocess traumatic memories, client and therapist should debrief, to optimize the experience. It’s also helpful to work on resourcing between EDMR sessions. This means that you’re building / reinforcing neural pathways in the brain that are associated with positive feelings or qualities. These considerations may make every-other-week EMDR sessions a wise choice.
Let’s get you feeling better, like soon!
If lately you’ve felt numb or disconnected from your emotions… If you’ve been pushing people away, or had problems in your relationships… If you’ve had lots of trouble sleeping… If you’ve felt super-anxious or jumpy, with difficulty trusting people... Or depressed, lonely or alienated… EMDR can be a powerful part of individual therapy, helping to relieve any or all of that stuff. Together we can get you feeling more like your old self again.
I know, all of this may sound kinda weird. I’m right there with ya.
May I humbly suggest that you suspend your disbelief. There’s a reason so many people are asking for EMDR.
So feel free to reach out with any questions, or to schedule a complimentary 15-minute phone consultation. Let’s do this!
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Andrew Kushnick is a Certified EMDR therapist in downtown San Francisco. As a former practicing attorney, Andrew’s approach is practical and concrete, using science-based and evidence-based methods. Video appointments are available during afternoons and evenings. To schedule a complimentary 15-minute phone consultation, email andrew@andrewkushnick.com.