Eye movement desensitization and reprocessing (also
known as EMDR) is a technique used in psychotherapy
that is most often used to decrease anxiety, often in
people who suffered from a previous trauma (such as
sexual abuse, physical abuse, or war combat). EMDR
has also been used to treat depression, anger,
addictions, self-esteem problems, and personality
HOW DOES EMDR WORK?
about an event that produces anxiety, such as a traumatic memory. Saccadic eye
movements are extremely fast, small, jerky movements of the eye that redirect the line of
sight, allowing them to fix on a still object as the head turns or the person moves.
Saccadic eye movements are common during reading and when a person tracks an
object that is moved back in forth in front of the eyes. EMDR does not require the patient
to discuss the past in detail. Rather, the focus of EMDR is on the here and now and
the number of sessions in each phase differing, depending on the patient. These eight
phases are described below:
PHASE ONE: A history is taken to determine if the patient is
appropriate for treatment. Information such as medical conditions,
stressors, and the ability to cope with stress are all determined. A
plan for treatment is then designed.
PHASE TWO: This is called the preparation phase. In this phase
the patient is introduced to the EMDR procedures, theories, and
expectations for treatment. Audiotapes of relaxation exercises are
often given to the patient that he/she can use before and between
EMDR sessions. Relaxation techniques are also used during the
therapy sessions to help the patient deal with the traumatic
memories that are recalled.
PHASE THREE: This is the assessment phase. In this phase, the patient chooses an image that best
represents a particular traumatic memory. Then the patient chooses a negative thought associated with
the traumatic event, such as "I am a bad person." The patient then chooses a positive thought to replace
the bad thought, such as "I am a good person," and rates how much he/she believes in the statement. The
patient then combines the image with the negative thought and rates his/her level of disturbance.
PHASE FOUR: This is the desensitization phase. The patient focuses on his/her negative feelings and
follows therapist's rapidly moving fingers, which move back and forth about 12 to 14 inches. This
technique is repeated over and over until the patient rates their level of distress to be very low. The sets
can range from one minute in length to longer than one minute. It is not necessary for eye movements to
be used, however. The rhythm is what is believed to be the important factor, whether that rhythm is the
therapist moving their fingers quickly in front of the patient's eyes or playing tones in both ears at separate
PHASE FIVE: This is the installation phase. In this phase, the person is taught to think differently so as to
replace the negative belief. The patient is told to think of a positive thought while thinking of the image
associated with the memory. The patient is exposed to the rapid eye movement technique while doing
this. This continues until the patient rates the positive thought highly. The end result is to pair the positive
thought with the image of the traumatic memory. Thus, when the patient remembers the traumatic event,
he/she has a positive image instead of a negative one.
PHASE SIX: The patient holds the positive thought and the image in his/her mind while trying to detect any
tension in the body. Any tension is targeted by using the eye movement techniques in an attempt to
PHASE SEVEN: This is the closure phase. In this phase, the client is reminded that he/she may still
experience disturbing thoughts, feelings, or memories between sessions. The patient is told that this is a
good thing and is asked to write down any negative thoughts, dreams, memories, or situations that may
PHASE EIGHT: This is the reevaluation phase. In this phase, the client's use of the techniques learned in
therapy are assessed again to see if he/she has effectively learned how to use them. New memories can
be treated after the eight phases are completed.
The hope is that when treatment ends, the patient will be less disturbed by the traumatic memories and
anxiety, or not disturbed at all.
DOES EMDR WORK?
EMDR is still a relatively new technique (created in 1987) that is still being researched to determine its
effectiveness. Most of the research (including research using independent examiners) on EMDR has
found the technique to be useful. However, other studies have not found the technique to be useful. At this
time, research suggests that EMDR works best with adults who are healthy and who have suffered a
single trauma or fear. The technique has been found to be more helpful in treating anxiety than depression
or personality disorders.
Some of the reported positive studies on EMDR have been criticized for being biased since the therapists
were the people collecting the data and rating the patients' changed behaviors. One of the arguments of
the critics is that the EMDR therapists are presumably motivated to report the results as being helpful to
the patient, thus biasing their interpretation of what they see. Having independent examiners and
independent raters helps avoid this problem. Another criticism is that the patients may have felt pressured
by the therapists to report that they were getting better because they were being verbally praised by the
therapists to say such things.
Another factor to consider is that EMDR is not the only technique used during the eight phases described
above. Critics say that the other techniques, such as the relaxation techniques, may have been what was
the most successful aspect of the treatment, as opposed to the EMDR. Many professionals in the field of
psychology and psychiatry are waiting for additional research studies to be done before making a final
judgment about its usefulness.
WHAT IS THE CONTROVERSY OVER EMDR ABOUT?
EMDR is controversial because many clinicians and researchers argue over whether the treatment really
works (see previous section). In addition, the founder of EMDR, Dr. Francine Shapiro has been
controversial because she has controlled the teaching of the technique. That is, any person that she
teaches the technique to must sign a contract that they will not teach it to anybody else. This is
controversial because most people who develop a type of psychotherapy do not impose such restrictions.
There are variations of the EMDR technique that are taught by others, but if you want to learn the original
technique, this has to be done through Dr. Shapiro.
There is also controversy about how the technique actually leads to good results. Some have suggested
that the positive findings are due to the fact that the EMDR is new and that new techniques tend to be
responded to more favorable than others because both the client and therapist are more excited about it.
Even the founder of the technique, Dr. Shapiro, has had different explanations over the years for how
EMDR works. She originally believed that traumatic memories cause an imbalance in the brain and that
EMDR helps to correct this imbalance. She later reported that she believed the rapid eye movements
worked by distracting the patient from the traumatic memory. This is why eye movements are not
considered by all to be an essential part of the treatment, just as long as there is something to distract the
Some clinicians have thought that the rapid eye movements are similar to the rapid eye movements in
sleep and that this would help people process information and learn new information better. Other
mechanisms have been proposed for how EMDR works, but none have gained clear acceptance at this
point in time. Shapiro has even stated that it is likely the combination of all the elements of EMDR and not
just the eye movements that make it effective.
WHO CREATED EMDR?
EMDR was created by Dr. Francine Shapiro, a psychologist at the Mental Research Institute in Palo Alto,
California. She created the technique when she was a graduate student. During a walk in a California park
one day, while she was preoccupied by traumatic memories, she had noticed that her eyes moved back
and forth quickly, causing her traumatic memories to go away. Dr. Shapiro experimented with the
technique on 70 volunteers, was pleased with the results, and began to conduct formal research on it. Dr.
Shapiro runs the EMDR Institute and a website, where you can read more about the technique from her