EMDR therapy: what it is, how it works and how it treats trauma
It sounds odd when someone first explains it: recalling something painful while following a movement with your eyes. What EMDR therapy really is, how it is structured and how far the evidence goes.
When someone first explains what EMDR therapy involves, the usual reaction is polite scepticism: you recall something painful while following the therapist's fingers with your eyes. It sounds like a trick. And yet it is one of the two treatments the World Health Organization recommends for post-traumatic stress, alongside trauma-focused cognitive behavioural therapy. This guide explains what it is, how it is structured, what the evidence says and when it is worth preparing the ground before starting.
What EMDR therapy is
EMDR stands for Eye Movement Desensitization and Reprocessing. It is a structured psychotherapy method, with eight phases and a defined protocol, aimed at treating memories that still hurt years later.
It was developed by the American psychologist Francine Shapiro in the late 1980s, from a chance observation: walking through a park, she noticed that certain distressing thoughts lost intensity when she moved her eyes from side to side. That intuition led to a line of research that now runs to hundreds of trials.
It is worth placing it properly: EMDR is not a loose technique added to a session, but a complete treatment with prior assessment, preparation, reprocessing work and closure. Nor is it hypnosis, although the two are often confused: throughout the process the person is awake, aware and able to stop whenever they want.
How it works: the memory that was never filed properly
The model behind EMDR is called Adaptive Information Processing. The underlying idea is that the brain naturally processes what happens to us, integrates the experience and stores it as learning. When something overwhelms that capacity, the memory stays stored raw: with the images, bodily sensations and emotions of the moment intact.
That is why, years later, a smell or a tone of voice can return someone to a scene with the same intensity as the first day. The memory was not filed, it was frozen.
The aim of EMDR is to resume that interrupted processing. It is not about erasing the memory or making it stop mattering, but about it being stored as what it is: something that happened and ended.
Why the eye movements
During reprocessing, the person briefly brings the memory to mind while performing bilateral stimulation: following the movement of a hand with their eyes, listening to alternating sounds in each ear, or receiving light taps on both hands. It is done in short sets, with pauses to check what has shifted.
The most widely accepted hypothesis today is the working memory one: holding the memory and an attention-consuming task at the same time makes the image lose sharpness and emotional charge, which makes it easier to reintegrate.
What is well established and what is still debated
Here it is worth being honest, because this is where claims get stretched. That EMDR works for post-traumatic stress is solidly demonstrated: it is recognised by the World Health Organization and by the UK NICE guidelines on post-traumatic stress disorder. What is still debated is why it works, and specifically how much the bilateral stimulation adds compared with the exposure component it shares with other therapies. Several meta-analyses have reached different conclusions on that point.
Put another way: the effectiveness is not in question for its main indication; the mechanism is not fully settled.
The eight phases of EMDR treatment
An EMDR process does not begin on day one with the difficult memory. It follows a sequence:
- History and treatment plan. The life history is gathered, the memories underpinning the current problem are identified and the order is decided.
- Preparation. The method is explained and regulation resources are trained: breathing, a safe place, techniques to lower activation. This phase can take several sessions and is what separates safe work from rushed work.
- Assessment. A specific memory is chosen and the most disturbing image, the associated negative belief ("I'm worthless", "I'm not safe"), the desired positive belief and the bodily sensations are identified.
- Desensitisation. Sets of bilateral stimulation while holding the memory in mind, checking between sets what comes up.
- Installation. The positive belief is strengthened until it feels true, not merely reasonable.
- Body scan. Any remaining tension in the body when thinking about the memory is checked; if it is there, work continues.
- Closure. Every session ends with the person stabilised, even if reprocessing is unfinished.
- Re-evaluation. At the start of the next session, what has changed during the week is reviewed.
What it treats and what the evidence says
The main indication, and where the evidence is strongest, is post-traumatic stress disorder. The World Health Organization's fact sheet on post-traumatic stress lists EMDR among the recommended treatments, and that is where most clinical guidelines place it in the first line.
Beyond that, it is used with varying amounts of support in:
- Complex trauma, where there are repeated childhood experiences rather than a single event.
- Complicated grief, when a loss has become stuck.
- Specific phobias and fears tied to a particular episode.
- Anxiety and depression with adverse experiences underneath. If that is your case, the Anxiety Test and the Depression Test give you a first measure of where you are now.
- Sleep problems and nightmares linked to trauma, which you can assess with the Insomnia Test.
In these secondary indications the research is thinner than in post-traumatic stress, and whoever proposes it should say so just as plainly. All the questionnaires are in the psychological tests catalogue: free and scored in your own browser.
What a session feels like and what EMDR does not do
During reprocessing, images, physical sensations, intense emotions or memories that had not surfaced for years can appear. It is common to leave a session somewhat tired, and for processing to continue over the following days, sometimes through dreams. That is why the closure and re-evaluation phases are not paperwork.
Three things EMDR does not do, worth clearing up because the claims circulate:
- It does not erase memories. What changes is the emotional charge, not the content. You will still remember what happened; it will stop hurting the way it did on day one.
- It is not hypnosis. You are awake, aware and in control of the process. It can be stopped at any moment with a signal agreed in advance.
- It is not fast by definition. A single trauma can resolve in a few reprocessing sessions; complex trauma takes months, like any other serious approach.
When it is better to prepare first
EMDR is not indicated for everyone at any moment. There are situations where stabilising comes first:
- Acute crisis or immediate risk. If there is active suicidal ideation or ongoing danger, safety is the priority. In Spain the 024 line is available around the clock and 112 is the emergency number; elsewhere, use your local emergency service.
- Significant dissociative symptoms. These require specific assessment and a considerably longer preparation phase.
- Active substance use or a lack of support network, both of which make it harder to hold the process between sessions.
- Ongoing violence. Processing trauma while it is still happening does not work; getting out comes first.
A trained professional will assess this before proposing anything. If someone offers to start reprocessing in the first session, with no history-taking or preparation, be wary. MedlinePlus has general information about post-traumatic stress and its treatments.
How to start: what to look for in an EMDR professional
Three basic checks: that she is registered and licensed to practise, that she has specific accredited EMDR training (a single short course is not enough) and that she works the method within a wider therapeutic framework, because trauma rarely comes alone.
At MyPsicoTest we recommend Xènia Capel Salcedo, a licensed clinical psychologist (COPC 14982) with a master's degree in Clinical Psychology and Psychotherapy. She works on trauma treatment with EMDR within an integrative approach built on a cognitive behavioural base, and sees clients through online therapy with a free first information call to assess whether the method fits your case.
If you first want to see how it compares with other approaches, the guides on Cognitive behavioural therapy: what it is, how it works and what it treats and Online psychologist: how to choose well and what to expect from video-call therapy cover that, along with the checks worth doing before choosing a professional.
If your result worries you or you want a professional assessment, you can talk to Xènia Capel Salcedo, a licensed psychologist (COPC reg. 14982), who offers a free first consultation call and online therapy from anywhere.
MyPsicoTest team · Updated:
FAQ
Frequently asked questions
What exactly is EMDR therapy?
It is a psychological treatment structured in eight phases that aims to reprocess memories that were poorly integrated. It combines recalling the memory with bilateral stimulation (eye movements, sounds or alternating taps) to reduce its emotional charge.
How many sessions does EMDR therapy need?
It depends on the type of trauma. A single event can resolve in a few reprocessing sessions, plus those for history-taking and preparation. Complex trauma, with repeated childhood experiences, requires months of work.
Is EMDR scientifically recognised?
Yes for its main indication. The World Health Organization and international clinical guidelines recommend it for post-traumatic stress disorder. What researchers still debate is the exact mechanism by which it works, not its effectiveness in that condition.
Can EMDR be done online?
Yes. Bilateral stimulation can be delivered through visual or auditory cues on screen, and adapted protocols exist. It requires the person to be stable, in a private place and with a good connection, because being cut off mid-reprocessing is uncomfortable.
Is it painful to recall things during sessions?
It can be intense, especially in the first sets, which is why the preparation phase with regulation techniques exists. The person stays in control and can stop the process at any time. The discomfort usually drops quickly as the memory is reprocessed.
Does EMDR work for anxiety or only for trauma?
Its best-supported indication is post-traumatic stress. It is also used for anxiety, phobias and grief where adverse experiences lie underneath, although the evidence there is weaker. For an anxiety problem with no associated trauma, cognitive behavioural therapy is usually the first option.
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