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Eye Movement Desensitization and Reprocessing (EMDR)

Written By
Chris Elkins, M.A.
This page features
20 Cited Research Articles

Traumatic events cause stress, unease and worry that can lead to post-traumatic stress disorder. PTSD can cause flashbacks, bad dreams and paranoia, and it’s a major risk factor for addiction. Eye movement desensitization and reprocessing therapy helps individuals with PTSD recover from trauma by reshaping how they associate feelings with distressing memories.

All of us will experience some form of trauma during our lives. We’ll know someone who dies too soon, or we may experience a car accident, natural disaster or violence. Millions of people work jobs where they are regularly exposed to traumatic situations.

Trauma causes natural feelings of unease, worry and stress. As time passes, most people overcome these feelings on their own or by talking with friends and family. However, people often have difficulty overcoming exposure to severe trauma without professional help.

Post-traumatic stress disorder causes prolonged side effects such as flashbacks, nightmares and fear. People with PTSD intentionally avoid places and things that remind them of the traumatic experience. They often lose interest in normal activities, feel unnecessary blame or guilt and turn to substances of abuse to self-medicate.

Therapists treat PTSD with eye movement sensitization and reprocessing therapy. Psychologist Francine Shapiro developed EMDR in 1987 to teach the brain to properly cope with upsetting memories. The basis of EMDR is that the brain’s coping mechanisms are overwhelmed by trauma, so associated memories are improperly stored in the brain.

When people with PTSD have a co-occurring addiction to alcohol or other drugs, therapists use EMDR to treat the trauma that is contributing to the alcohol or drug abuse. Addiction specialists will also use a combination of behavioral therapies and medications to help people in recovery.

EMDR allows patients to reprocess traumatic memories, learn how to cope with them and disassociate unnecessary emotions. EMDR is one of two therapies recommended by the World Health Organization to treat PTSD. Numerous studies have proved it to be effective in treating minor and severe symptoms of PTSD.

What Is EMDR?

EMDR is a psychotherapy used to treat PTSD. Psychotherapies emphasize counseling techniques that explore mental health issues through personal interaction. EMDR allows patients to access memories of traumatic events and process them in a way that resolves distress.


Nanci Stockwell of Advanced Recovery Systems discusses how eye movement desensitization and reprocessing therapy helps individuals overcome trauma.

After EMDR therapy, some patients report feeling relieved. They may stop experiencing flashbacks from triggers and recall memories with less stress or unease. Eye movements are the most distinguishing aspect of EMDR, but the therapy involves several other therapeutic techniques.

During EMDR therapy, the therapist asks the client to think of a specific distressing memory and then to focus on the therapist’s moving hand. The eye movement focuses a patient’s attention on external stimuli while he or she internally focuses on the distressing memory. Therapists usually direct eye movements, but some incorporate auditory stimuli.

Researchers believe eye movement allows the brain to access internal associations connected to the memory. Clients may be asked to think of empowering phrases, so they can develop healthy associations with the memory when it’s accessed.

EMDR therapy occurs in eight phases. During treatment sessions, the therapist helps the patient overcome negative memories associated with the traumatic event, cope with everyday triggers and develop lifelong stress-management skills. Thus, EMDR therapy helps patients overcome past trauma, learn to handle daily life and prepare for the future.

Phase 1

The initial phase of EMDR treatment involves creating a client history. The therapist tries to find targets for reprocessing, such as traumatic events, related occasions or troubling childhood memories. The client then gets a preview of future skills and behaviors that he or she will learn.

Initial EMDR therapy might focus on events leading up to the traumatic event. The patient learns about the emotional distress associated with the memory and how to change behavior.

Phase 2

In the second phase, the therapist teaches the client numerous stress-relief techniques and reviews how the patient used the skills during the time between sessions.

Phases 3 – 6

In the third, fourth, fifth and sixth phases, EMDR therapy focuses on specific traumatic events called targets. During therapy, the patient is challenged to identify:

The patient then identifies a positive belief and begins EMDR therapy — thinking of the memory while focusing on the therapist’s external stimuli. Next, the patient clears his or her mind and becomes aware of the thought, feeling or memory that appears. The steps are repeated until the patient feels no stress. Then the patient thinks of a positive feeling.

Phase 7

Phase seven emphasizes closure. The patient keeps a log of feelings or memories that arise, and he or she practices stress-relief techniques.

Phase 8

In phase eight, the therapist and patient examine progress and discuss potential future events that might require different coping techniques, skills or responses.

How Does EMDR Work?

Shapiro developed EMDR based on the Accelerated Information Processing model. The model theorizes that the brain processes the multiple components of an event in an adaptive state associated with learning. Memory is stored in a network containing thoughts, images, emotions and feelings.

When a person experiences a traumatic event, he or she only stores initial thoughts, images, emotions and feelings before the process is disrupted. The unprocessed information causes dysfunctional reactions in the brain that lead to mental health problems.

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EMDR allows the brain to process the thoughts, images, emotions and feelings that were not properly processed during the traumatic event. The traumatic memory is targeted and connected to new skills and positive emotions, allowing the brain to learn and properly store the information.

How Long Does EMDR Take?

The severity of PTSD symptoms and each person’s history of trauma affects how long it takes EMDR to be effective. A study published in the Journal of Clinical Psychology indicated that 80 percent to 90 percent of civilians recovered from PTSD after four to seven sessions.

Numerous studies from the late ’90s and early 2000s found patients experienced relief from minor symptoms of PTSD after three or four sessions, but combat veterans required up to 12 sessions to treat severe symptoms. Patients who possessed multiple traumatic memories, such as a history of child abuse or repeated exposure to violence, required extensive therapy.

People with co-occurring substance use disorders and PTSD might require additional therapeutic sessions to overcome trauma and to learn to live without alcohol or other drugs that they had previously used to self-medicate.

How Effective Is EMDR?

EMDR and cognitive-behavioral therapy are the only therapies recommended by the World Health Organization for the treatment of PTSD in children, adolescents and adults. The recommendations are backed by numerous studies that indicate CBT and EMDR are the most effective therapies for treating PTSD.

Researchers have published an abundance of studies investigating the effectiveness of EMDR, and scholars have performed meta-analyses — extensive reviews of research in the field — of those studies to summarize aggregate findings.

The findings of the studies include:

  • A 1998 meta-analysis of 61 clinical trials involving PTSD treatment published in Clinical Psychology and Psychotherapy found EMDR and CBT were equally the most effective treatments for PTSD.
  • A 2012 analysis of five clinical trials involving children and adolescents undergoing EMDR therapy revealed that preliminary studies have had promising results but that research involving adolescents with PTSD is limited.
  • A 2013 meta-analysis of 70 studies published in the Cochrane Database of Systematic Reviews found EMDR was more effective at treating PTSD than standard forms of care such as support therapy, nondirective counseling and nontrauma-focused variations of cognitive behavioral therapy.
  • A 2013 meta-analysis of 112 studies published in the Journal of Clinical Psychiatry concluded that CBT, EMDR and exposure therapy can effectively treat PTSD, and therapists can use a variety of medications to aid treatment.

Almost 30 years after introducing the therapy, Shapiro reviewed the support for EMDR in an article published in The Permanente Journal. She concluded that 24 randomized clinical trials supported using EMDR therapy for emotional trauma and seven out of 10 studies found EMDR was more effective than trauma-focused CBT.

She also wrote that 12 studies on eye movement found patients reported prompt decreases in negative emotions and vividness of troubling images after EMDR.

Treating Addiction and PTSD with EMDR

The research on the effectiveness of using EMDR to treat PTSD and addiction is limited. In a 1994 article published in the Journal of Psychoactive Drugs, researchers argued EMDR could resolve problematic memories contributing to substance abuse and reduce the effects of relapse triggers.

A 2014 study of 12 patients with co-occurring PTSD and drug or alcohol addiction found that EMDR therapy in combination with “treatment as usual” effectively reduced symptoms of PTSD but did not treat addiction. However, the study was significant in finding it could treat PTSD in patients with substance abuse issues.

The findings indicate that EMDR can be an effective complement to a comprehensive treatment plan for patients affected by trauma and addiction, but it should not be the sole treatment for addiction.

Dangers and Downsides of EMDR Therapy

Numerous studies have found that EMDR is a safe and effective therapy. However, some patients may experience distressing side effects.

For example, a 2016 study exploring the effectiveness of EMDR among people with PTSD found that two participants panicked and experienced intense emotions and increased emotional instability. The study authors said these reactions could have been caused by the combination of EMDR and a technique the researchers used to measure the patients’ responsiveness to the traumatic memory.

Research published in the Encyclopedia of Social Work stated that the intense levels of emotion associated with the technique could be harmful for some patients, including certain people with substance abuse issues and those with dissociative disorders. The author explained that the severity of medical conditions such as seizures and neurological disorders may be worsened by EMDR.

In addition, some scientists have criticized the effectiveness of EMDR. Several experts in the field of psychology have said that reprocessing clinicians rely on anecdotal reports of its effectiveness rather than on scientific evidence. Other experts have questioned the usefulness of eye movements in alleviating traumatic thoughts.

While research has shown that EMDR can be an effective treatment for PTSD, a meta-analysis of EMDR research found overwhelming evidence suggesting that eye movements are not a necessary or useful element of trauma therapy. And traumatic feelings, some critics contend, could persist after completing a therapy session.

In the 1990s, several studies examined EMDR’s effectiveness in treating combat veterans experiencing trauma and reported mixed or negligible results. However, the Department of Veterans Affairs and the International Society of Traumatic Stress Studies criticized these studies for providing an insufficient amount of treatment for this demographic.

Where Can I Find Treatment for Addiction and PTSD?

Trauma is one of the most common contributors to alcohol or drug use disorders in the United States. However, many treatment facilities do not provide any trauma-specific counseling.

The 2014 National Survey of Substance Abuse Treatment Services found that 32 percent of all facilities (4,483 out of 14,152) in the United States and its territories offered programs tailored to persons who had experienced trauma. An additional 40 percent of facilities reported “sometimes” using trauma-related counseling during addiction treatment.

However, the survey does not specify which types of trauma-related counseling those rehab facilities used. The number of facilities that offered EMDR was likely lower than the total number of facilities that offered some type of trauma-related counseling.

When choosing a rehab facility, patients with a history of trauma and their caregivers should ensure that the treatment facility offers trauma-specific counseling such as EMDR therapy or trauma-specific CBT.

Some facilities have a specialized trauma track. At The Recovery Village at Palmer Lake, therapists trained to treat co-occurring PTSD and substance use disorders offer EMDR therapy in combination with comprehensive behavioral therapy and medication-assisted treatment to help patients recover from addiction.

EMDR therapy is an effective approach to treating symptoms of PTSD. It allows patients to reprocess memories, overcome negative emotions and return to life without fear or anxiety.

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