EMDR Therapy
What is EMDR Therapy?
Eye Movement Desensitization and Reprocessing (EMDR) is a specialized type of psychotherapy developed by Dr. Francine Shapiro in 1987. It has proven to be highly effective for treating trauma, anxiety, stress-related conditions, and other symptoms related to negative and adverse experiences.
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EMDR is backed by extensive research and is widely recognized as the preferred treatment for Post-Traumatic Stress Disorder (PTSD) and Complex PTSD (C-PTSD). EMDR demonstrates effectiveness with symptom reduction for anxiety, panic, OCD, emotional regulation, performance improvement in sports and business, and mood stabilization.
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For most clients, EMDR can provide significant permanent relief from the emotional distress caused by trauma, often more quickly than traditional therapy approaches.
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A key feature of EMDR is that it doesn’t require clients to relive or talk in detail about their traumatic memories. This allows many individuals to heal and regain control over their thoughts and feelings without having to revisit the pain of past experiences.
A Beginner’s Guide to EMDR Therapy: How It Works and What to Expect
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EMDR is a psychotherapy that relies upon the mind’s ability to naturally heal from negative experiences that are stored in memory incorrectly.
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When these negative experiences are stored incorrectly in our brain they block our ability to grow, move forward, and heal.
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As a result of these blocks we feel emotional distress, re-experience negative events, and become emotionally paralyzed or unable to cope causing impairments with our ability to function in daily life, and prevent us from healing.
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EMDR is a completely drug-free and holistic healing process that utilizes the mind’s innate desire to heal and achieve optimal functioning.
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For most people, EMDR provides relief of distress faster, more effectively, and with longer lasting positive results than other types of counseling and psychotherapy.​
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EMDR utilizes a specific structured 8 step protocol designed to help the brain process and release trauma. The EMDR 8 Step Protocol is the framework used to conduct EMDR sessions.​​
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Clients proceed at their own pace based on their feelings of comfort, safety, and stability. For some clients, it may take several sessions to proceed through one step of the protocol while others may move through steps more quickly. EMDR is an individualized process based on the client’s needs so there is no expectation to move through the steps at a specific pace.
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Though the protocol itself is highly structured client care is adaptable and flexible to ensure the client feels comfortable and achieves their goals. Clients can adjust and use the skills developed and used in the protocol based on how their thoughts, emotions, and physical symptoms arise in a session.
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EMDR core concepts are taught in session and the client is guided through the process by the therapist who assists and encourages the client to begin processing their traumatic memories so they are stored correctly in the brain to remove the emotional blocks causing distress.
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Unlike traditional talk therapy, EMDR doesn’t involve extensive discussion, processing, or analysis of traumatic experiences. Instead, EMDR uses bilateral stimulation, such as, guided eye movements, sounds, or taps, to help the brain naturally heal itself. This approach allows clients to process difficult emotions without needing to repeatedly revisit or verbally explore painful memories, making the experience less emotionally taxing while still highly effective.
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Bilateral stimulation activates the Adaptive Information Processing (AIP) network in the brain. With this activation of neuro-networks the client’s blocked memories are reprocessed and stored correctly providing symptom relief and healing.
The Science of EMDR Therapy:
How It Helps You Heal
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Trauma changes the brain in profound ways. It affects various regions of the brain, particularly those involved in emotional regulation, memory processing, and stress response.
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The primary areas negatively impacted by trauma include the amygdala, hippocampus, and prefrontal cortex.
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Neuroimaging studies provide evidence of the positive healing effects of EMDR.
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The changes in the brain documented with neuroimaging, in conjunction with the symptom reduction reported by clients, provides an evidence-based informed treatment for trauma and adverse negative experiences.​​
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Research on the effectiveness of EMDR therapy demonstrates a positive effect on brain functioning, activity, connectivity and structure. These positive effects are observed in the same regions impacted by trauma including the amygdala, hippocampus, and prefrontal cortex.​
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​EMDR has been associated with reduced activation of the amygdala during the processing of traumatic memories. This reduction is linked to decreased anxiety and fear responses, allowing individuals to process traumatic memories more adaptively.​
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Research indicates that EMDR may promote neurogenesis and increase hippocampal volume, which can enhance memory processing and contextualization of experiences. This improvement helps individuals differentiate between past traumas and present situations, reducing the likelihood of re-experiencing symptoms.
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Studies have indicated that EMDR can enhance connectivity between the amygdala and prefrontal cortex, improving emotional regulation and reducing fear responses. This increased connectivity is crucial for integrating traumatic memories into a coherent narrative.
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EMDR appears to enhance the functioning of the prefrontal cortex, leading to improved emotional regulation and cognitive control. This enhancement allows individuals to better manage their emotional responses and reduces the impact of trauma on their daily lives.
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Neuroimaging studies provide evidence of the positive healing effects of EMDR.​​​
The Neuro-Biology of EMDR
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​​​​The mechanisms through which EMDR operates have been the subject of extensive research, leading to several proposed hypotheses that elucidate its therapeutic effects. Neurobiological research supports these mechanisms, indicating that EMDR can lead to changes in brain activity associated with fear processing and emotional regulation. For instance, studies using functional magnetic resonance imaging (fMRI) have shown decreased activation in the prefrontal cortex and amygdala following EMDR treatment, suggesting a normalization of brain function related to trauma processing. Additionally, the modulation of the default mode network (DMN) during EMDR sessions indicates that the therapy may help reestablish healthy patterns of self-referential thought and memory processing.
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Working Memory Hypothesis: One of the primary mechanisms of action is the working memory hypothesis, which posits that the dual-task nature of EMDR—where clients recall traumatic memories while simultaneously engaging in bilateral stimulation (such as eye movements)—reduces the emotional intensity and vividness of these memories. This hypothesis is supported by various studies indicating that the cognitive load imposed by the dual task facilitates the processing of traumatic memories, leading to desensitization. However, this hypothesis does not fully account for all observed effects of EMDR, such as spontaneous positive insights and relaxation states experienced by clients during therapy.
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Neurobiological Changes: Another significant mechanism involves neurobiological changes, particularly in brain regions associated with fear processing. EMDR has been shown to reduce hyperactivation in the prefrontal cortex, which is often associated with emotional dysregulation in PTSD patients. Studies using functional magnetic resonance imaging (fMRI) have demonstrated that successful EMDR therapy correlates with changes in the connectivity of the amygdala and other emotional processing regions, suggesting a reorganization of neural pathways related to fear and trauma. The adaptive information processing (AIP) model further supports this by proposing that EMDR helps integrate traumatic memories into a more adaptive framework, thereby reducing their psychological impact.​
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The REM Sleep Hypothesis: This theory suggests that the bilateral stimulation used in EMDR mimics the brain's processing during rapid eye movement (REM) sleep, facilitating memory reconsolidation and emotional processing. This hypothesis aligns with findings that EMDR can enhance the brain's natural mechanisms for processing distressing memories, similar to the functions of sleep.
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Default Mode Network (DMN): EMDR is thought to influence the default mode network, which is involved in self-referential thought and memory processing. Changes in DMN activity post-EMDR suggest a normalization of brain function, which may contribute to the alleviation of PTSD symptoms. This is particularly relevant as the DMN is often dysregulated in individuals with trauma histories.​
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Bilateral Stimulation (BLS): This is a core component of EMDR, which typically involves alternating eye movements, though it can also include auditory or tactile stimuli. The purpose of BLS is to facilitate the processing of traumatic memories by engaging both hemispheres of the brain. Research indicates that BLS can enhance the retrieval of episodic memories and reduce the emotional distress associated with traumatic recollections. The neurobiological effects of BLS have been documented, showing that it activates specific brain regions involved in emotional regulation, such as the amygdala and prefrontal cortex, thereby aiding in the desensitization process. Furthermore, studies suggest that BLS may induce a brain state similar to that of rapid eye movement (REM) sleep, which is known to be crucial for memory processing and emotional regulation.
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Adaptive Information Processing (AIP): This model underpins the theoretical framework of EMDR. This model posits that psychological distress arises when traumatic experiences are inadequately processed and stored in the brain, leading to maladaptive beliefs and emotional responses. The AIP model suggests that EMDR therapy facilitates the integration of these unprocessed memories into more adaptive networks, allowing individuals to reframe their experiences and reduce the associated psychological distress. Shapiro, the originator of EMDR, emphasizes that the AIP model explains how the brain's natural information processing system can be restored through therapy, leading to improved emotional and cognitive functioning.
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Working Memory Hypothesis: This hypothesis suggests that the dual-task nature of EMDR—where clients recall distressing memories while simultaneously engaging in BLS—taxes the working memory, thereby reducing the vividness and emotional intensity of the traumatic memories. This cognitive load may help clients process their traumatic experiences more adaptively, leading to symptom relief.​
EMDR Explained: Core Concepts for Emotional Recovery
Eye Movement Desensitization and Reprocessing (EMDR) therapy employs several key concepts that play critical roles in the therapeutic process. Core concepts include: Positive Cognition, Negative Cognition, Subjective Units of Disturbance (SUD), and Validity of Cognition.
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Positive Cognition:
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Definition and Explanation: Positive cognition refers to the adaptive beliefs or thoughts that individuals wish to associate with their traumatic memories. These beliefs are often the opposite of the negative cognitions that arise from the trauma. For example, a client may aim to replace the belief "I am powerless" with "I am in control".
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Phases of EMDR: Positive cognition is primarily addressed during the Installation phase (Phase 5) of EMDR. In this phase, after the traumatic memory has been desensitized, the therapist helps the client to focus on and strengthen positive beliefs related to the memory.
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Purpose: The purpose of integrating positive cognition is to facilitate the formation of a healthier self-concept and to promote adaptive emotional responses. By reinforcing positive beliefs, clients can develop resilience and improve their overall emotional well-being.
Negative Cognition:
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Definition and Explanation: Negative cognition refers to the maladaptive beliefs or thoughts that individuals associate with their traumatic experiences. These beliefs often stem from the trauma and can lead to ongoing psychological distress. For instance, a client might believe "I am to blame" or "I am unlovable" as a result of their traumatic experiences.
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Phases of EMDR: Negative cognition is primarily addressed during the Assessment phase (Phase 3) and the Desensitization phase (Phase 4). In the Assessment phase, clients identify the negative beliefs associated with their traumatic memories, while in the Desensitization phase, they work to process these memories and reduce the emotional charge associated with them.
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Purpose: The purpose of addressing negative cognition is to help clients recognize and challenge these maladaptive beliefs, ultimately leading to their reprocessing and integration into a more adaptive framework.
Subjective Units of Disturbance (SUD):
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Definition and Explanation: Subjective Units of Disturbance (SUD) is a self-reported scale that clients use to rate their level of distress related to a specific memory or thought, typically on a scale from 0 (no distress) to 10 (maximum distress).
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Phases of EMDR: SUD ratings are utilized throughout the Desensitization phase (Phase 4) and are also revisited during the Reevaluation phase (Phase 8). Clients provide SUD ratings before and after processing the traumatic memory to assess changes in their emotional response.
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Purpose: The purpose of using SUD ratings is to monitor the effectiveness of the therapy and to gauge the client's progress in reducing distress associated with traumatic memories. This feedback allows therapists to adjust the therapeutic approach as needed.
Validity of Cognition:​​
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Definition and Explanation: Validity of cognition refers to the degree to which the positive beliefs that clients wish to adopt are believed to be true. Clients are asked to rate the validity of these positive cognitions on a scale from 1 (not true at all) to 7 (completely true).
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Phases of EMDR: Validity of cognition is primarily assessed during the Installation phase (Phase 5) after the negative cognition has been processed. Clients evaluate how true they feel the positive cognition is after working through the traumatic memory.
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Purpose: The purpose of assessing the validity of cognition is to determine the strength of the client's belief in the positive cognition and to identify any remaining barriers to fully adopting this belief. This assessment helps guide further processing if necessary.
Bilateral Stimulation (BLS):​​
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Definition and Explanation: Bilateral Stimulation (BLS) is a core component of EMDR, which typically involves alternating eye movements, though it can also include auditory or tactile stimuli.
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Phases of EMDR: Bilateral Stimulation is used in steps 4, 5, and 6 of the 8 step EMDR protocol.
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Purpose: The purpose of BLS is to facilitate the processing of traumatic memories by engaging both hemispheres of the brain. Research indicates that BLS can enhance the retrieval of episodic memories and reduce the emotional distress associated with traumatic recollections. The neurobiological effects of BLS have been documented, showing that it activates specific brain regions involved in emotional regulation, such as the amygdala and prefrontal cortex, thereby aiding in the desensitization process. Furthermore, studies suggest that BLS may induce a brain state similar to that of rapid eye movement (REM) sleep, which is known to be crucial for memory processing and emotional regulation.
Adaptive Information Processing (AIP):​​
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Definition and Explanation: The Adaptive Information Processing (AIP) model underpins the theoretical framework of EMDR. This model posits that psychological distress arises when traumatic experiences are inadequately processed and stored in the brain, leading to maladaptive beliefs and emotional responses. The AIP model suggests that EMDR therapy facilitates the integration of these unprocessed memories into more adaptive networks, allowing individuals to reframe their experiences and reduce the associated psychological distress. Shapiro, the originator of EMDR, emphasizes that the AIP model explains how the brain's natural information processing system can be restored through therapy, leading to improved emotional and cognitive functioning.
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Phases of EMDR: The Adaptive Information Process (AIP) is the foundational principle of EMDR and provides the framework for the 8 step EMDR protocol.
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Purpose: In addition to BLS and the AIP model, the working memory hypothesis also plays a significant role in understanding EMDR's effectiveness. This hypothesis suggests that the dual-task nature of EMDR—where clients recall distressing memories while simultaneously engaging in BLS—taxes the working memory, thereby reducing the vividness and emotional intensity of the traumatic memories. This cognitive load may help clients process their traumatic experiences more adaptively, leading to symptom relief.
The EMDR Telehealth Experience
The Wellness Solutions EMDR Telehealth platform provides a client and therapist with flexibility and options to individualize the client's experience. This provides for a better, more effective session, with faster results.
The client and therapist can adjust the speed of the stimulus, to change the direction of the stimulus, and to change the color of the stimulus. These changes are based on the individual needs and preferences of the client.
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In specific steps of The 8 Step EMDR Protocol the client is asked to “keep their eyes on the ball” to reprocess traumatic memory, remove blocked memories, and then install new beliefs about their experiences. In the images below the "ball" aka the stimulus is white and travels throughout the client's screen.
EMDR Resourcing
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In Eye Movement Desensitization and Reprocessing (EMDR) therapy, the concept of "resourcing" refers to techniques employed to enhance a client's emotional stability and coping abilities before delving into the processing of traumatic memories.
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Resourcing is primarily integrated into the Preparation phase, which is the second phase of the eight-phase EMDR protocol. This phase is essential for establishing a safe therapeutic environment and equipping clients with tools to manage distressing emotions that may arise during later phases of therapy.
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The goal of resourcing is to activate positive memories and experiences that can serve as emotional anchors, providing clients with a sense of safety and strength as they confront their trauma.
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This process helps to build resilience and can significantly improve the effectiveness of the subsequent desensitization and reprocessing phases.
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EMDR therapy incorporates various resourcing techniques designed to enhance the therapeutic process and support clients in managing distressing memories.
Below is a list of EMDR resourcing techniques, along with brief explanations of each:
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1. Float Back: The Float Back technique involves guiding the client to mentally "float back" to a time in their past when they felt safe, strong, or happy. This technique helps clients access positive memories and feelings that can serve as resources during the processing of traumatic memories. By recalling these positive experiences, clients can enhance their emotional resilience and create a sense of safety that supports their therapeutic journey.
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2. Float Forward: The Float Forward technique encourages clients to visualize a future scenario where they successfully cope with challenges or distressing situations. This technique allows clients to imagine themselves handling future stressors with confidence and ease, reinforcing their belief in their ability to manage difficulties. This forward-looking approach can foster hope and motivation, which are crucial for healing.
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3. Resource Development and Installation (RDI): This technique focuses on identifying and strengthening positive memories or resources that can help the client cope with distressing experiences. Clients visualize these resources and integrate them into their therapeutic process.
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4. Safe Place Visualization: Clients create a mental image of a safe and calming place, which serves as a grounding technique to return to when feeling overwhelmed during therapy.
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5. Positive Memory Recall: Clients recall a positive memory that evokes happiness or safety, counterbalancing the negative emotions associated with traumatic memories.
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6. Strengths Identification: Clients identify personal strengths and qualities that have helped them cope with challenges, fostering a sense of self-efficacy.
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7. Imagery Rescripting: Clients reimagine a distressing memory by altering its narrative or outcome, allowing them to gain control over their memories.
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8. Body Scan: Clients perform a body scan to identify areas of tension or discomfort, promoting awareness of physical sensations and helping them learn to release tension.
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9. Future Template: Clients visualize a future situation where they successfully cope with potential stressors, helping build confidence in their ability to handle future challenges.
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10. Guided Imagery: Clients are led through a guided imagery exercise that promotes relaxation and positive feelings, reducing anxiety and preparing them for processing traumatic memories.
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11. Breathwork: Clients practice controlled breathing techniques to promote relaxation and reduce physiological arousal, particularly useful during moments of distress.
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12. Emotional Regulation Skills: Clients learn specific skills to manage their emotions, such as mindfulness techniques or grounding exercises, maintaining emotional stability during therapy.
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13. Symbolic Objects: Clients may use physical objects that symbolize strength or safety, enhancing feelings of security during therapy.
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14. Nature Connection: Clients visualize or recall experiences in nature that evoke peace and tranquility, serving as a grounding technique.
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15. Support Network Mapping: Clients identify supportive individuals in their lives and visualize their presence during therapy, reinforcing the idea that they are not alone in their healing journey.
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16. Mindfulness Practices: Clients practice mindfulness techniques to enhance present-moment awareness and reduce anxiety, including meditation or focused attention exercises.
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PRO-TIP: This is a general list of EMDR resourcing skills. Most clients will develop approximately 3-5 of these types of skills when starting EMDR. Some clients may need more skill development than others depending on their individual circumstances. Clients are not expected to learn all of these skills to progress through the 8 step EMDR protocol.​​​​​​​​​
What to Expect from an EMDR Session:
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Telehealth Privacy & Focus - EMDR is equally as effective utilizing telehealth for care delivery as in person care. It is important to ensure that your sessions are private, secure, focused, and allow for uninterrupted concentration throughout the duration of the appointment. Wellness Solution will provide client education information via email to provide suggestions to help.
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Establishing Rapport, Obtaining Client History, & Starting Your Care Journey - In the beginning of EMDR the first few sessions are very similar to regular counseling sessions. The client and therapist begin to establish rapport, review the client’s history and symptoms, and the client receives education and information regarding EMDR.
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Starting with Comfort and Safety - Each session begins with a check-in to ensure you feel comfortable and secure in your environment. Your therapist will work with you to create a calming space, whether it's at home or a quiet place where you feel safe and can focus.
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Setting Goals Together - Before starting EMDR, you and your therapist will talk about the thoughts, feelings, or memories you'd like to address. This guides and helps inform the process, identify objectives and goals, and set up a path for your healing journey. This includes identifying the target memories that you want to work on and process are key to the desensitization and reprocessing of blocked memories.
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EMDR Sessions - As clients progress through the 8 Step EMDR Protocol and begin to engage in processing their experiences sessions are focused on the client identifying their Negative Cognitions (NC), Positive Cognitions (PC), Validity of Cognitions (VOC), Subjective Units of Disturbance (SUD), and using Bilateral Stimulation (BLS) to process blocked memories. These sessions are unlike traditional counseling sessions where there is a lot of conversation, discussion, and information sharing. EMDR is unique for counseling and psychotherapy as the emphasis is not on talk therapy. Clients are not required to provide extensive details of their traumas and relive their experiences which can be triggering and destabilizing. Instead EMDR emphasizes the importance of processing these blocked memories using bilateral stimulation rather than talk therapy. In most EMDR sessions there is very little discussion as the objective is to utilize bilateral stimulation to process blocked memory.
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Using Bilateral Stimulation (BLS) - BLS is a key part of EMDR therapy, involving gentle back-and-forth movements or sounds to help the brain process difficult memories. In telehealth, BLS may involve following your therapist’s hand movements on the screen, watching a ball move across the computer monitor, or listening to alternating sounds with earbuds. You’ll be guided through each step so it feels manageable and supportive.
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Processing Memories and Emotions - During the session, your therapist will guide you in revisiting specific memories in a gentle way, allowing difficult feelings to come up safely. With BLS, your brain works to release these old memories, helping you find peace and relief. You can pause at any time if you need a break or extra support.
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Reflecting and Wrapping Up - As we close the session, you and your therapist will talk about how you feel and any shifts you noticed. This reflection helps solidify the healing that took place and offers insight into your progress. You’ll also receive tips to stay grounded after the session.
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Post-Session Care - Healing takes time, so be gentle with yourself. Your therapist will provide ways to help you manage emotions that may come up and encourage you to reach out if you have questions or need extra support between sessions. The processing in an EMDR session does not end in the session. Research demonstrates that most clients continue to process the blocked memories for at least 24 hours after an EMDR session. The benefits of EMDR are lasting and do not “wear off” the same way that medication benefits decrease over time once someone stops taking their medication. EMDR provides a natural, holistic, mechanism for healing by unblocking memories stored incorrectly in the brain due to trauma. Once EMDR helps clients access and reprocess these blocked memories they will continue to receive symptom relief and benefits.
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PRO-TIP: The Wellness Solutions website has links to video examples of EMDR sessions to help provide clients with helpful information and context to understand EMDR and what to expect in EMDR sessions
Eye Movement Desensitization and Reprocessing (EMDR) therapy employs several key concepts that play critical roles in the therapeutic process. Core concepts include: Positive Cognition, Negative Cognition, Subjective Units of Disturbance (SUD), and Validity of Cognition.
The EMDR 8 Step Protocol
Step 1: History Taking & Treatment Planning
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The client and therapist explore the EMDR process and the client receives education and information regarding EMDR.
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The client and therapist establish rapport, review the client’s personal history, symptoms, goals, and develop a treatment plan.
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The client’s readiness for EMDR is assessed and evaluated.
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The client’s specific targets for reprocessing are identified and prioritized.​​
Step 2: Preparation
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The preparation step includes client education and skills development.
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Building Trust and Safety: The therapist helps establish a trusting therapeutic relationship and ensures the client feels comfortable discussing difficult memories.
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Explaining EMDR and Its Process: The therapist provides an overview of how EMDR works, including the use of bilateral stimulation and the goal of reprocessing traumatic memories.
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Teaching Coping Skills: The client is taught coping techniques, like grounding, deep breathing, or visualization, to manage any distress that may arise during or between sessions. This may include creating a “safe place” visualization for emotional support.
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Setting Expectations: The therapist prepares the client for potential after effects, such as vivid dreams or emotional responses, and reassures them of support throughout the process.
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Resourcing: The client begins to learn specific coping skills, mindfulness skills, and grounding techniques. This process is called resourcing.
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The client’s ability to develop resourcing skills is paramount to EMDR success. These skills will help the client tolerate and cope with distress (inside of session and outside of session) when triggered.
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Resourcing helps the client maintain stability while reprocessing target memories in later steps of the protocol.​
Step 3: Assessment
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The Assessment phase is the third step in EMDR therapy, where the therapist and client focus on activating the target memory to begin reprocessing.
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Identifying the Target Memory: The client brings a specific traumatic memory to mind, including the most distressing image or moment of that memory.
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Connecting to Negative and Positive Beliefs: The client identifies a negative belief they hold about themselves related to the memory (e.g., "I am powerless") and selects a positive belief they would prefer to hold instead (e.g., "I am in control").
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Rating Distress and Desired Belief: The client rates the intensity of their distress associated with the memory using the Subjective Units of Disturbance (SUD) scale and how true the positive belief feels on the Validity of Cognition (VOC) scale.
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Tuning into Emotions and Body Sensations: The client notices and describes any emotions and physical sensations connected to the memory, as this helps bring the experience fully into awareness for processing.
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The client and therapist review the primary target memory the client identified as causing distress.
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Image Identification: Then the client is encouraged to identify a specific memory or mental image the client associates with the target memory or “What picture represents the worst part of the experience as you think about it now?” (if no picture, “when you think of the experience, what do you get?”)
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The client and therapist collaborate together to assign a Negative Cognition (NC) and a Positive Cognition (PC) to the primary target.
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A Negative Cognition is a negative core belief about one’s self that develops as a result of a traumatic experience.
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A Positive Cognition is a positive adaptive and resilient belief about one’s self that the client uses to replace the negative cognition.
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The client is then asked to rate the Validity of Cognition (VOC) on a scale of 1-7.
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The Validity of Cognition (VOC) is degree to which the client’s target mental image matches or is congruent with the positive cognition or “When you think of the picture/memory, how true do those words {positive cognition} feel to you now on a scale of 1 to 7, where 1 feels completely false and 7 feels completely true?”
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Emotion Identification: The client will then be asked to identify the specific emotions they experience when they think of the target’s mental image or “When you bring up the picture/memory, and the words {negative cognition}, what emotions do you feel now?”
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The client is then asked to rate the Subjective Units of Disturbance (SUD) on a scale of 1-10.
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The Subjective Units of Disturbance (SUD) is the degree to which the client’s target mental image matches or is congruent with the negative cognition or “When you bring up the picture/memory, and the words {negative cognition}, what emotions do you feel now?”
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Body Sensation: The client is asked to identify the specific body sensations they experience when the think of the target’s mental image or “Where do you feel it in your body?”​
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Step 4: Desensitization
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In this step the client will maintain dual attention by focusing on the identified target while engaging in bilateral stimulation and begin to process traumatic memory.
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Dual Attention Stimulation (DAS): Involves engaging the client's attention in two different areas simultaneously. In EMDR, this typically means that while the client focuses on a distressing memory or negative belief (one area of attention), they are also attending to an external stimulus, such as eye movements, tapping, or sounds (second area of attention).
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The dual focus helps the brain process and integrate the traumatic memory in a more adaptive way, reducing its emotional impact and leading to desensitization. It serves to keep the client grounded in the present while accessing distressing past memories, allowing for a safer and more effective therapeutic process.
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Bilateral Stimulation (BLS): A core component of EMDR. BLS refers specifically to the type of external stimulus used to create the "dual attention" effect. Common forms of BLS include guided eye movements, alternating tapping on the knees or shoulders, or listening to alternating auditory tones. The therapist may prompt the client stating, “Now, bring up the picture and the words {repeat the NC} and notice where you feel it in your body, and follow my fingers (ball on the screen, the buzzing/tones, this depends on the type of stimulation being used) and notice whatever happens.”
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The alternating stimulation across the left and right hemispheres of the brain is believed to enhance the brain's information processing capabilities. This helps to integrate the memory and reduce its distressing impact, leading to more adaptive thoughts and emotional responses.
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The primary purpose of BLS is to promote interhemispheric communication within the brain, which is believed to enhance emotional processing and memory integration during therapy sessions.
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It is normal and expected that the client’s mind may wander and other memories will “pop up” while desensitization occurs. The client is encouraged to allow this to develop. This provides support that the client is beginning to get “unblocked” and the memories are starting to “move” through the neuro-network.
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Identifying the Target and Engaging in Bilateral Stimulation: The client focuses on a specific target memory. Then Bilateral stimulation (BLS) such as eye movements, tapping, or auditory tones is used to help process the memory.
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Brief Periods of Stimulation with Breaks Between Sets: In EMDR, BLS is typically conducted in short sets. Sets of bilateral stimulation are approximately 1-2 minutes at a time depending on the client’s comfort level. The client may select new targets as a result of memories that come to mind while engaging in BLS. The new targets are provided at a different time after the primary target is processed all the way through the protocol.
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Use of Resourcing Techniques if Distress Occurs: If the client experiences significant distress during this phase, resourcing techniques may be utilized to help the client regain emotional stability. Once the client returns to baseline, they can continue with the next set of BLS.
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At various intervals the therapist will request the client to “revisit” the original target and rathe their Subjective Units of Disturbance (SUD) on a scale of 1-10. The desensitization step will continue until the client reports a zero.
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In some limited circumstances a client may proceed to the next step in the protocol with a SUD of 1. However, the goal is to engage in BLS until the target has a SUD of 0. The therapist may state something similar to, “When you bring up the original target/memory now, what do you notice? — and on a scale of 0 to 10, where 0 is no disturbance or neutral, and 10 is the highest disturbance you can imagine, how disturbing does it feel now?”
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It is important that the client take their time in this step and not feel rushed or pushed to report a zero. For some targets this step may take several sessions especially if the client needs to engage in resourcing to stay centered and grounded while coping with distressing symptoms.​​
Step 5: Installation
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This step aims to strengthen a positive replacement belief that they wish to associate with the traumatic memory. This phase aims to replace negative beliefs with more adaptive ones, fostering a healthier self-concept and emotional response. It includes “installing” a new belief about the situation that provides a new perspective and insight that the client was not able to see because the trauma memory blocked the processing and understanding of the target event.
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The client is asked to check in with the positive cognition and ensure that is still the same PC they want to install. The therapist may say something like, “Do the words {repeat the PC} still fit or is there another positive statement that fits better?”
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The client will also be asked to check in with the Validity of Cognition (VOC), such as “When you bring up the original target/memory, how true do those words {repeat selected PC} feel now on a scale from 1 to 7, where 1 is completely false and 7 completely true?”
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The client will then be asked to Install the Positive Cognition by engaging in bilateral stimulation. The therapist may prompt the client by saying, “Now think of the original event/memory and hold it along with the positive belief {repeat PC} and notice your experience.
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The client and therapist will participate in multiple bilateral stimulation sets while periodically taking small breaks and checking in to rate the client’s Validity of Cognition (VOC).
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The goal is to continue in this step with the same target until the client achieves a VOC of 7. Achieving a VOC of 7 in the installation step may take multiple sets and should not be rushed or pushed. For some clients achieving a VOC of 7 may take multiple appointments with the same target. This is a personal process and depends on the client and the disturbance of the target.
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For some targets this step may take several sessions especially if the client needs to engage in resourcing to stay centered and grounded while coping with distressing symptoms.
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Most clients report feeling relief and positive feelings associated with this step and may opt to engage in some extra BLS sets as a result.​​
Step 6: Body Scan
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Checking for Residual Tension: After the memory has been processed and a positive belief has been installed, the therapist asks the client to bring the memory to mind while mentally scanning their body from head to toe. Skills developed in the resourcing step will be utilized to assist the client with the body scan step.
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Identifying Physical Sensations: The client notices any physical sensations that may arise, such as tension, tightness, or discomfort. Sometimes trauma can leave lingering sensations in the body even after emotional distress is reduced.
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Processing Sensations: If any tension or discomfort is present, the client may engage in additional sets of bilateral stimulation (e.g., eye movements, tapping) to process these sensations until they feel calm and relaxed in their body.
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Achieving Physical Calm: The body scan is considered complete once the client can think about the memory without experiencing any negative physical sensations, indicating that the memory has been fully processed both emotionally and physically.
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The therapist may prompt the client by stating, “Close your eyes and keep in mind the original target/memory and the positive cognition. {repeat PC}. Then bring your attention to the different parts of your body, starting with your head and working downward. Any place you find any tension, tightness, or unusual sensation, tell me.”
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If disturbance continues then the client will be encouraged to engage in sets of BLS with body sensations only and then repeat the body scan and BLS until the body is cleared of disturbance.​
Step 7: Closure
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The closure phase involves returning the client to a state of equilibrium after the intense processing of traumatic memories. The therapist helps the client to ground themselves and may use relaxation.
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Grounding and Calming Techniques: The therapist may guide the client through calming exercises (e.g., deep breathing, visualization) to ensure they leave the session feeling safe and calm.
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Self-Soothing Tools: The client is provided with tools for self-care between sessions, such as relaxation techniques or positive imagery, to help them manage any residual distress.
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Checking In: The therapist assesses how the client is feeling and provides reassurance or resources if needed.
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Setting Expectations for Between Sessions: The therapist may remind the client of any normal after effects of processing, like unusual dreams or heightened awareness, and encourages them to note any reactions or insights for the next session.
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The client may provide the following prompt to the client, “Remember that following an EMDR session, you may experience continued processing in the next few days, including dreams, insights, new memories, emotional vulnerability, and body sensations. This is normal. You can keep a log of things that arise as that offers good feedback about your processing, and things we might need to target in future sessions. If something disturbing arises, take a snapshot of it and then use your Container and Calm Place to help soothe the disturbance. And you can call me if you need to.”​
We care about you, your safety, and your peace of mind. If you or someone you care about is having a mental health emergency and needs immediate care to ensure the safety and security of themselves or others please call 911 or go to the nearest emergency room. If you are in need of mental health crisis resources please visit the Wellness Solutions "Safety Resources" page for helpful information and supports.
