What is EMDR therapy? Origins, how it works and what the evidence says

EMDR — short for Eye Movement Desensitization and Reprocessing — is a structured form of psychotherapy designed to help people process distressing memories so that they stop feeling as raw and present as the day they happened. It is best known as a treatment for post-traumatic stress, and it is recommended by the World Health Organization. Here is where it came from, how a session works, and what the evidence actually says.

Where EMDR came from

EMDR began with a walk. In 1987, the American psychologist Francine Shapiro noticed that some disturbing thoughts seemed to lose their intensity while her eyes moved rapidly from side to side. She began to study the effect systematically, combining it with elements of existing therapies, and in 1989 published the first controlled study of the method in the Journal of Traumatic Stress.

The procedure was originally called EMD (Eye Movement Desensitization). Shapiro added the “R” for Reprocessing shortly afterwards, to reflect her view that the method does more than reduce anxiety: it helps the brain integrate the memory in a new, more adaptive way. Shapiro continued developing and teaching EMDR until her death in 2019.

That makes EMDR almost four decades old. Since then it has been the subject of dozens of randomised controlled trials, has spread to practitioners in well over a hundred countries, and has professional associations of its own — such as the EMDR International Association, EMDR Europe and EMDR Iberoamérica — which set training and certification standards.

How EMDR works

EMDR is grounded in what Shapiro called the Adaptive Information Processing (AIP) model. The idea is that most experiences are processed and stored in a way that lets us learn from them and move on. A very distressing experience, however, can be stored “unprocessed”: together with the images, emotions, body sensations and beliefs of the moment. When something later triggers that memory, it can feel as though it is happening again.

In EMDR, the person briefly brings a specific memory to mind while following a bilateral stimulation — most often the therapist’s hand moving from side to side, but also alternating taps or tones. This is done in short sets, with a quick check-in after each one (“What do you notice now?”). Over the session, many people find that the memory becomes less vivid and less distressing, and that a more balanced belief about themselves becomes easier to hold.

EMDR is not hypnosis. The person stays awake, aware and in control throughout, and can stop the process at any moment.

Why does the bilateral stimulation help? Researchers are still debating it. One well-supported explanation is the working-memory hypothesis: holding a memory in mind while doing a demanding task such as tracking eye movements taxes limited working memory, so the memory is re-stored as less vivid and less emotional. A 2013 meta-analysis by Lee and Cuijpers found that eye movements do add an effect beyond simply recalling the memory.

The eight phases of EMDR

EMDR follows a structured protocol of eight phases. A single session usually covers only some of them, and the early phases can take several sessions on their own.

1. History taking. The therapist learns about the person’s history and current difficulties, and together they identify target memories and goals.
2. Preparation. The therapist explains the process and teaches stabilisation skills — such as a “calm place” or a “container” exercise — so the person has ways to settle strong emotions.
3. Assessment. For a chosen target, the person identifies the image, a negative belief about themselves (“I am in danger”), the positive belief they would prefer (“I am safe now”), the emotion, and where they feel it in the body.
4. Desensitisation. Sets of bilateral stimulation while focusing on the target, until the distress comes down.
5. Installation. Strengthening the positive belief while holding the original memory in mind.
6. Body scan. Checking the body for any remaining tension or discomfort linked to the memory.
7. Closure. Returning to a state of calm at the end of every session, whether or not processing is complete, and preparing for what may come up between sessions.
8. Re-evaluation. At the start of the next session, reviewing what has changed and deciding what to work on next.

Measuring progress: SUD and VOC

Two simple ratings run through an EMDR session and make progress visible:

• SUD (Subjective Units of Disturbance): “How disturbing does it feel now, from 0 to 10?” The aim of desensitisation is to bring this as close to 0 as possible.
• VOC (Validity of Cognition): “How true does the positive belief feel now, from 1 to 7?” The aim of installation is to bring this close to 7.

Tracking how SUD falls and VOC rises — within a session and across sessions — is one of the clearest signals an EMDR therapist has that processing is moving.

What the evidence says

EMDR is one of the most studied psychological treatments for post-traumatic stress:

• The World Health Organization (2013) recommends EMDR, alongside trauma-focused cognitive behavioural therapy, for children, adolescents and adults with post-traumatic stress disorder (PTSD).
• The International Society for Traumatic Stress Studies (ISTSS, 2018) gives EMDR a strong recommendation for adults with PTSD.
• The UK’s National Institute for Health and Care Excellence (NICE, 2018) recommends EMDR for adults with PTSD after non-combat-related trauma.

Researchers are also studying EMDR for other difficulties, such as anxiety, phobias, depression and chronic pain. The evidence there is promising but still more limited than for PTSD, so it is best seen as an area of active research.

Why people and therapists choose EMDR

• It works with memories, beliefs and the body together, not with thoughts alone.
• It does not require describing the trauma in detail. The person keeps the memory in mind, but does not have to narrate everything aloud — something many people find easier.
• It has no homework of reliving the event between sessions; the work happens in session, with stabilisation skills to use in between.
• It is structured and measurable. The protocol and the SUD/VOC ratings give both people a shared, concrete sense of progress.

Is EMDR right for me?

Only a qualified professional can answer that, after getting to know you. A few things are worth knowing:

• Look for a licensed mental-health professional with recognised EMDR training, ideally certified by a national or regional EMDR association.
• The preparation phase matters. If you have experienced repeated or early trauma, or experience dissociation, a good therapist will spend more time on stabilisation before processing memories.
• It is normal for memories, dreams or emotions to keep surfacing between sessions. Your therapist will help you prepare for this.
• EMDR is not a self-help technique. Please do not try bilateral stimulation on painful memories on your own.

How Kalmo supports EMDR work

Kalmo does not deliver EMDR therapy — that happens with your therapist. What it can do is support the work around the sessions:

• For people in EMDR therapy: keep your stabilisation exercises, like a calm place or container, close at hand in the app; practise them during the week; and note what comes up after processing so you can share it with your therapist if you choose.
• For EMDR therapists: we are building an EMDR toolkit for the professional portal — an EMDR session type, a SUD/VOC score card that lines up with the session recording, and session analysis that understands the eight phases. You can follow its progress on our public roadmap.

This article is for general information only and is not a substitute for professional advice, diagnosis or treatment. If you are in crisis, contact your local emergency number right away.

References

1. Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2(2), 199–223.
2. Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures (3rd ed.). Guilford Press.
3. World Health Organization (2013). Guidelines for the management of conditions specifically related to stress. Geneva: WHO.
4. International Society for Traumatic Stress Studies (2018). Posttraumatic Stress Disorder Prevention and Treatment Guidelines.
5. National Institute for Health and Care Excellence (2018). Post-traumatic stress disorder (NICE guideline NG116).
6. Lee, C. W., & Cuijpers, P. (2013). A meta-analysis of the contribution of eye movements in processing emotional memories. Journal of Behavior Therapy and Experimental Psychiatry, 44(2), 231–239.
7. van den Hout, M. A., & Engelhard, I. M. (2012). How does EMDR work? Journal of Experimental Psychopathology, 3(5), 724–738.