Everyone’s talking about: EMDR – but what is it and how does it work?

Published in British Vogue (May 2023), with modifications

Emerging as a popular alternative to talk therapy, EMDR involves the use of guided eye movements, tapping and auditory tones to help patients process traumatic events and memories.

Vogue asked the world-renowned psychotherapist Sanja Oakley, who was recently featured in the Oprah Winfrey and Prince Harry-produced Apple TV documentary The Me You Can’t See, to explain how this relatively new, but fast-growing form of therapy works.

What is EMDR and how does it work?

Eye Movement Desensitisation and Reprocessing (EMDR) is a “powerful, scientifically proven psychotherapy to help people recover from disturbing events in their lives”, Oakley explains. Sometimes, she says, the brain gets overwhelmed by such incidents, and becomes stuck and unable to process the experience, so the emotions around the memory remain intense.

EMDR’s bilateral stimulation (through eye movements or tapping while recounting the experiences in question) sparks the information processing system, which can “help the brain reprocess – or digest – the memory so that it is not as intense”, she explains. Removing the emotional charge means “people are no longer as easily triggered by current life situations”.

It can speed up the healing process, she says. “There’s less talking involved [than with more traditional forms of therapy]. In fact, if you don’t want to talk about something, there is a way of processing it with EMDR.” However, it is not a form of hypnosis, as the client is fully present in the session at all times.

The science of EMDR

Brain scans have clearly demonstrated changes after EMDR therapy, returning the brain to more ‘normal’ functioning. The bottom line of EMDR outcome research is that clinical change can be both profound and efficient.

Research has also found that during EMDR sessions the brain is more active. The specific areas of the brain that are in this active state include the prefrontal cortex, orbitofrontal cortex, and anterior cingulate cortex.

This is important because:

• The prefrontal cortex is responsible for planning, organising, focusing, personality, and impulse control.
• The orbitofrontal cortex controls your emotions and how you interact with other people.
• The anterior cingulate cortex also works to regulate impulse control, as well as empathy and judgment

Therefore, your brain isn’t just sitting idly by during an EMDR session. Instead, it is actively working to process and resolve the trauma and its connected emotions.

The EMDR Process

EMDR therapy is structured into eight distinct phases, each playing a vital role in the therapeutic process.

• History Taking: The therapist gathers comprehensive information about the client’s history and identifies target memories for reprocessing.
• Preparation: The therapist explains the EMDR process and helps the client develop coping strategies for emotional disturbances.
• Assessment: Target memories are identified, and the client describes related images, beliefs, and emotions.
• Desensitisation: Bilateral stimulation is used to reprocess the target memory, reducing its emotional impact.
• Installation: Positive beliefs are strengthened to replace the negative beliefs associated with the traumatic memory.
• Body Scan: The client focuses on any physical sensations to identify and process residual distress.
• Closure: The therapist ensures the client feels stable and provides techniques for self-soothing if needed.
• Reevaluation: The therapist assesses the progress and determines if further processing is required.

The therapist plays a crucial role in guiding the client through these phases, ensuring a safe and supportive environment.

Who is EMDR suitable, or unsuitable, for?

According to Oakley, it’s unsuitable for people experiencing florid psychosis, although there are currently EMDR trials underway for people with a psychosis diagnosis. “There’s growing evidence it’s working,” she says. On the other hand, it can be especially helpful for “people with head injuries and people who are neurodiverse. It is very helpful for people with dissociation – but it’s a much slower process.”

Does EMDR help with anxiety?

The short answer is yes. Anxiety is a symptom of many conditions successfully treated by EMDR, like phobias, panic disorder, social anxiety, PTSD, complex PTSD and attachment trauma. By targeting the memories they are linked to, EMDR can “neutralise these events and reduce the anxiety”, says Oakley.

What is considered trauma in the context of EMDR?

“We talk about ‘big T’ traumas and ‘small t’ traumas,” says Oakley. The former are universally considered to be traumatic – “natural disaster, rape, seeing a loved one murdered” – while “small t” traumas might include “being reprimanded at work, chronic low level invalidating experience, living with a depressed parent… Anything that overwhelms us and gets stuck in the memory system.”

Why is there a controversy with EMDR?

According to Oakley, some mental health professionals do not yet fully understand what makes it work. But, she adds: “Its efficacy in treating trauma has been proven in more than 40 clinical randomised trials and it is recommended by leading organisations like the World Health Organisation and the NHS.”

How do I practise EMDR myself?

While there is limited research to suggest self-administered EMDR can be beneficial in some cases, because it is a “power tool”, the majority of experienced clinicians do not recommend it. “EMDR can take you to places you don’t expect,” Oakley says. While you might start at something you consider relatively insignificant, you might end up at an overwhelming or distressing event. “The role of the therapist is to ensure a safe space for processing whatever arises.”

How effective is EMDR?

Research has shown that EMDR can be very effective, very quickly in treating PTSD and C-PTSD and the symptoms they bring.

Several studies have looked at the effectiveness of EMDR for both PTSD and C-PTSD:

• One study showed up to 90% of single-trauma victims no longer have PTSD after only 3 90-minute sessions.
• Another study, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six 50-minute sessions.
• In another study, 77% of combat veterans were free of PTSD in 12 sessions.

As with all treatments and therapies, there has been a huge amount of research placed upon looking into the efficacy of EMDR just like the studies mentioned above – and although there still seems to be some debate (some health practitioners’ debate EMDR’s effectiveness), it has been, and is continually, clinically validated by a number of randomised, controlled studies from all over the world.

Things to know before starting EMDR therapy

Over 100,000 medical professionals throughout the world use EMDR therapy.  Millions of people have been treated successfully over the past 25 years. It’s an incredibly effective treatment for PTSD and C-PTSD.

Despite that, individuals with PTSD or past trauma experiences need to go into EMDR therapy with a full understanding of what the treatment requires and entails.

‘Revisiting’ your trauma’

You might be concerned that EMDR therapy will make you “confront” your worst moments in life. But, your therapist will guide the pace of your work together so it is as comfortable for you as possible. One therapist said ‘The process of EMDR psychotherapy is often very comfortable for many patients.  Clients regularly comment to me that they are surprised at how this work is easier than they thought it would be.’

Unlike some other therapies, ‘EMDR therapy clients are not asked to relive the trauma intensely and for prolonged periods of time. In EMDR therapy, when there is a high level of intensity it only lasts for a few moments and then decreases rapidly. If it does not decrease rapidly on its own, the clinician has been trained in techniques to assist it to dissipate. The client has also been trained in techniques to immediately relieve the distress.

Patients will be instructed to revisit their trauma multiple times during treatment – but that doesn’t always mean talking about it, something which many people find very appealing when looking at therapy options.

Still, the process can be mentally and emotionally stressful on patients and can trigger negative responses in the early stages of treatment. The intense mental focus that occurs during therapy may linger for a while after a session has ended. This may cause the patient to feel faint or experience lucid dreams. While these side effects may be challenging at times, they are typically more favourable than those caused by medicinal treatment. Also, EMDR therapy typically results in a better outcome with longer-lasting relief.

Sleep and dreams

Following an EMDR session, it’s not unusual for sleep to be impacted. Vivid dreams are common as well as feeling more sensitive to interactions with others and to external stimuli.

Temporary increase in emotional distress

As with any form of psychotherapy, there may be a temporary increase in distress, but your therapist will provide you tools and techniques to help with these. For some people, distressing and unresolved memories may emerge in between sessions, some may experience reactions during a treatment session that neither they nor their therapist may have anticipated, including a high level of emotion or physical sensations (again, setting your ‘safe place’ can really help with these) and in between treatment sessions, the processing of incidents may continue, and therefore other dreams, memories and feelings, may emerge. Your therapist will ensure you are equipped to deal with all of these events if they occur.

Conclusion

EMDR is a highly effective therapy that offers hope and healing to individuals suffering from various psychological issues. Its structured approach, combined with the powerful mechanism of bilateral stimulation, allows for the reprocessing of traumatic memories and the alleviation of distressing symptoms. If you or someone you know could benefit from EMDR, consider seeking professional help.