The EMDR Method
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EMDR in brief
EMDR has recently become exceptionally popular for what it can do in therapy, particularly for the vivid, rapid and effective way it allows us to reprocess, through direct experience, the troubling memories and past learning that underlie our current difficulties. Like the other approaches I practise, EMDR is evidence-based. Its claims to efficacy and effectiveness are backed by solid statistical evidence and research.
EMDR is best known for its effectiveness in treating post-traumatic stress disorder (PTSD). A landmark review by de Jongh and colleagues in 2024 summarised the results of more than 30 randomised controlled trials and concluded that EMDR is effective and safe for this disorder. At the same time, EMDR has shown no significant advantage over several other evidence-based approaches, such as trauma-focused cognitive behavioural therapy. A 2025 review by Simpson and colleagues likewise concluded that EMDR and trauma-focused CBT produce comparable results, while noting limitations in the available research (de Jongh et al., 2024; Simpson et al., 2025).
The reprocessing protocol itself is deceptively simple and may look strange to an outside observer. Imagine a session focused on a specific traumatic memory. It begins with a short interview exploring different aspects of the experience, with particular attention to each of the so-called ‘channels’ of experience, namely the sensory, emotional, cognitive and bodily channels. Then come sets of bilateral stimulation, preferably visual. The therapist moves a hand from left to right and the client follows it with their eyes. A brief discussion follows, and the process is repeated several times.
Given how simple the protocol looks, the emotional experience during a session is often striking. As the client moves their eyes, memories come up, images, emotions and sensations shift, and associations emerge with other memories, facts, people in their life and much else besides. The end result can be even more striking. For example, the client might initially rate the emotional intensity of a memory at 8 out of 10 and rate it at 0 or 1 by the end.
How it began
EMDR was discovered by chance by the clinical psychologist Francine Shapiro in the late 1980s. The story goes that she had been traumatised by a long and difficult course of cancer treatment. While walking in a park during her recovery, she was overcome by memories. She happened to move her eyes rapidly and systematically from left to right and back again, and noticed that the memory she was thinking about gradually faded and became less emotionally charged. She tried it with other memories and found that the effect could be reproduced. Soon afterwards, in 1989, Shapiro tested the first EMD protocol, which at that point involved desensitisation alone, with the ‘R’ still to come. She published a controlled study involving 22 participants who had experienced a range of traumatic events, including sexual trauma, assaults and war. One group received EMD, while the other received a control procedure in which participants pictured and described the traumatic memory without making eye movements. The control group then received EMD as well. The results showed a significant reduction in symptoms associated with traumatic memories after a single EMD session. This improvement was maintained at the one- and three-month follow-ups.
The protocol has evolved since then. The ‘R’, which stands for ‘reprocessing’, was added as early as 1991. Shapiro herself later emphasised that reprocessing was the most important part of the therapy. In an interview with Careers in Psychology, she said, ‘If I could go back, I would call it Reprocessing Therapy. But it is now too well known as EMDR therapy for me to do that.’
The Adaptive Information Processing model
The conceptual model underlying EMDR is the Adaptive Information Processing model.
How did we learn the dysfunctional patterns that bring us to a clinician’s office?
The model proposes that the brain has a natural system for healthy learning. Information from an event is processed adaptively and integrated into our life story, the resources we draw on and so on. The result is adaptive learning and the development of adaptive patterns and templates for how we think, feel and behave.
According to the model, however, traumatic events sometimes exceed our capacity to process them. When this happens, the information is processed maladaptively, leading to maladaptive learning and the formation of maladaptive patterns and templates.
The aim of EMDR is to bring the memories underlying our problematic learning back into processing and to activate the natural process of adaptive learning and the capacity of the brain, and of the body more generally, to heal. Once the ‘problematic’ memories have been reprocessed, the work moves on to present-day triggers and to developing a future template for an adaptive response.
A traditional treatment plan moves from the past to the present and then to the future. In practice, this sequence is often adapted to the needs of the therapy, the person or the particular problem. The work is also often done in cycles, moving from past to present to future, then back to the past, and so on.
Why bilateral stimulation? Why would I move my eyes?
The short answer is that it works. We are less sure why it works, which is true of many things about the brain.
From the outside, EMDR looks like magic. The sets of bilateral stimulation begin. The emotions are often intense, and there may be tears. The person talks about what they are experiencing. There is no specific instruction beyond noticing whatever happens. They describe the associated memories, images, emotions and bodily sensations that come up. Gradually, the negative emotions subside, positive ones emerge, and the person learns some things anew. Somehow, all of this happens naturally, simply by moving the eyes and noticing what comes up. The therapist sometimes needs to intervene more actively, but I will leave that for another time. How does this happen?
There are several main groups of hypotheses, and some of these explanations are likely to operate in tandem. I will sketch out the ones most widely discussed in the research literature.
Some of these hypotheses fall under psychological models. These models explain what happens to the experience and the memory during EMDR without necessarily invoking specific brain mechanisms.
The working memory taxation hypothesis is a widely discussed account of one way the therapy might work. It draws attention to the limited capacity of working memory, a system that coordinates the small number of things we can hold in mind and work with at any given moment. When working memory is occupied with both the eye movements and the traumatic memory, the memory becomes less vivid, creating some psychological distance from the experience.
The orienting reflex hypothesis is based on the nervous system’s natural response to a new stimulus. Bilateral stimulation is thought to activate this reflex. If the stimulus is safe, the overall effect is an initial rise in arousal followed by a settling response, which may reduce the emotional charge of the memory.
Other related psychological hypotheses see recalling the memory while in a calm state as the basis for new learning, through classical conditioning and fear extinction.
Psychophysiological models shift the focus to measurable bodily responses associated with relaxation or arousal, such as heart rate, skin conductance, breathing and finger temperature. Broadly speaking, the findings are consistent with the orienting reflex hypothesis, with initial arousal followed by relaxation during a long set of eye movements. This pattern leaves open whether the reflex itself explains why EMDR works.
The REM sleep hypothesis was one of the earliest hypotheses proposed by Shapiro herself. REM sleep is characterised by vivid dreams. According to this hypothesis, the eye movements used in EMDR induce a brain state similar to that of REM sleep. Years of sleep research have shown that REM sleep serves several adaptive functions. One is memory consolidation, in which emotionally charged autobiographical memories are integrated into the wider context of a person’s life experience and knowledge. More recent hypotheses draw closer parallels between the rhythmic eye movements used in EMDR and the processes that take place during slow-wave sleep. These processes also play a key role in consolidating memories and linking them with other knowledge and experiences, even when there is no obvious connection between them.
Neurobiological models seek to establish how EMDR relates to the way brain structures and networks function and interact. Researchers use methods such as functional magnetic resonance imaging, SPECT, EEG and other imaging or physiological measures. One hypothesis suggests that eye movements may alter how the left and right hemispheres interact, helping people retrieve and connect memories and associations. Other hypotheses start from the central role of thalamic structures in integrating bodily sensations, memories, thoughts and emotions, as well as in coordinating the two hemispheres. These processes are disrupted in post-traumatic stress disorder (PTSD). Still others focus on patterns of brain activity that may strengthen cognitive control over excessively intense emotional responses and thereby reduce overall distress. Broadly speaking, studies have identified changes in the brain associated with successful treatment, while a single, definitive explanation of how EMDR works remains elusive.
In conclusion
EMDR is an effective and clinically proven method that, paradoxically, came about by chance. It initially focused on PTSD, but its use and protocols have since expanded to cover a range of other mental health difficulties, life challenges and psychiatric disorders. EMDR uses experiential techniques to process the past, present and future, drawing on the brain’s natural capacity for adaptive information processing and learning. It is deservedly gaining wider recognition and becoming an increasingly sought-after clinical intervention.
References
Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures. The Guilford Press. E-book edition. ISBN: 9781462535514.
de Jongh, A., de Roos, C., & El-Leithy, S. (2024). State of the science: Eye movement desensitization and reprocessing (EMDR) therapy. Journal of Traumatic Stress, 37, 205–216. https://doi.org/10.1002/jts.23012
Careers in Psychology. (n.d.). Interview with Dr. Francine Shapiro. https://careersinpsychology.org/interview/dr-francine-shapiro/
Landin-Romero, R., Moreno-Alcazar, A., Pagani, M., & Amann, B. L. (2018). How does eye movement desensitization and reprocessing therapy work? A systematic review on suggested mechanisms of action. Frontiers in Psychology, 9, Article 1395. https://doi.org/10.3389/fpsyg.2018.01395
Simpson, E., Carroll, C., Sutton, A., Forsyth, J., Rayner, A., Ren, S., Franklin, M., & Wood, E. (2025). Clinical and cost-effectiveness of eye movement desensitization and reprocessing for treatment and prevention of post-traumatic stress disorder in adults: A systematic review and meta-analysis. British Journal of Psychology, 116, 1128–1149. https://doi.org/10.1111/bjop.70005
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