What is EMDR – and Why is it So Effective?

Francine ShapiroDuring REM sleep, the brain is attempting to process survival information until it’s resolved.

Eye Motion Desensitization and Reprocessing (EMDR) is a potent trauma treatment developed by Dr. Francine Shapiro (left), a literature professor who was diagnosed with cancer.  The shock of suddenly finding her survival was under threat, affected her so strongly that Dr. Shapiro mindfully paid attention to how her body was reacting.

She discovered by accident that when the survival fear got intense, her eyes would sometimes move back and forth diagonally or from side to side, as if in dreaming – following which she felt less upset, much to her surprise.

So Dr. Shapiro began to study mind-body programs for trauma and PTSD – and went back to school for a PhD in trauma psychology.  EMDR, the treatment she developed,  is now used by the Departments of Defense and Veteran’s Affairs, the World Health Organization, and many others.  Dr. Vincent Felitti, co-director of the Adverse Childhood Experiences (ACE) Study, recommends EMDR as “highly effective” for the healing of trauma.

In EMDR a therapist moves a finger or two from side to side (or diagonally) before the patient’s eyes.  This guides the eyes to move as they do during the Rapid Eye Movement (REM) phase of sleep in which we do most active dreaming. Dreaming can “process” a lot of trauma, move it from short-term memory banks where it feels like a terrifying flash happening “right now,” to long-term memory banks where we feel it’s past and we’re “over it.”

I use EMDR to calm myself at home, sitting with eyes closed and moving my eyes back and forth while focusing on the upsetting thought until it dissipates.  This works with upsetting incidents in the present, such as arguments.  I also use EMDR to heal grief over specific past incidents such as hurtful acts by others. But long-term healing needs a therapist.

It had been thought that EMDR is best for “incident trauma” due to one or any finite number of incidents, such as battlefield traumas, car accidents, rape, threats such as Dr. Shapiro’s cancer, or incidents like mine above.

EMDR  had been considered iffy for developmental trauma which starts with fetal stress and continues while the infant brain is developing. As Dr. Bessel van der Kolk notes, it’s a continuum of panic until we become a “frightened organism.” Drs. Shapiro and van der Kolk have said that in developmental trauma, EMDR may bring up infant feelings so overwhelming as to be re-traumatizing. [FN1]

More recently, however, Dr. Sandra Paulsen and colleague Katie O’Shea  have had success using new EMDR methods they’ve created specifically to address developmental trauma, documented in  “Neurobiology and Treatment of Traumatic Dissociation.” [FN2] Here’s a summary: http://attachmentdisorderhealing.com/emdr-sandra-paulsen-developmental-trauma/

“EMDR is effective and well-supported by research evidence for treating children with symptoms accompanying post-traumatic stress (PTSD), attachment issues, dissociation, and self-regulation,” GoodTherapy.org also recently reported: http://www.goodtherapy.org/blog/emdr-for-children-how-safe-and-effective-is-it-0430155

Dr. Paulsen’s collaborator Dr. D. Michael Coy details how he keeps patients safe while going deep into infancy with EMDR on his website:  https://www.dmcoy.com/main/my_practice/emdr-therapy/emdr-pre-verbal-trauma/.  See also Dr. Coy’s comments below, including a link to the EMDR International Association’s EMDR therapist finder directory: http://www.emdria.org/search/custom.asp?id=2337

I still say, as in my book title, “Don’t Try This at Home.”  Please do not “do it yourself.”  Get a highly-trained attachment-based psychotherapist and/or EMDR specialist with a lot of specific training in your type of trauma.

When Nightmares are Real

Until you’ve been beside a man/ You don’t know what he wants
You don’t know if he cries at night/ You don’t know if he don’t
When nothin’ comes easy/ Old nightmares are real
Until you’ve been beside a man/ You don’t know how he feels
Bob Seeger

Francine Shapiro Getting_Past_Your_Past_smallDr. Shapiro gave a terrific webinar on EMDR which even explained what nightmares are, how they work in trauma, and how we can leverage this to heal traumatic feelings.  It was Dr. Ruth Buczynski’s April 17, 2013 interview for the National Institute for the Clinical Application of Behavioral Medicine (NICABM) “Trauma 2013” series.  [FN3]  Her book is seen above (please click on the graphic to see it best; my software’s not behaving well…)

“Disrupted REM (Rapid Eye Movement ) sleep is often a marker of PTSD,” Shapiro said. “The earlier memory in PTSD, the trauma, is being held unprocessed with the emotions as physical sensations.  The brain continues to try to process it; sleep researchers say that during REM sleep, the brain is attempting to process survival information until it’s resolved.  That’s why we’ve all had the experience of being disturbed at something, going to sleep, and feeling better about it, with a better understanding of what to do next.

“The brain has done what it’s supposed to do: it’s processed the information, and now it’s guiding us appropriately into the future.  But if a trauma has disrupted that process, although the brain may be again trying to process this (survival information) in dreams, the person continues to wake up in the middle of a nightmare (ie., stop the processing prematurely), because it’s too disturbing.”

“When people are jarred from sleep because of a nightmare, the disturbing images can be difficult to shake,” Dr. Buczynski said on her blog April 12, 2013.  “Even though they’re ‘just dreams,’ nightmares can be very upsetting and can sometimes haunt us long after we’ve awoken. But believe it or not, there may be a good reason for them. Nightmares are part of the brain’s attempt to help us resolve traumatic experiences. But when they wake us up too soon, a key process for healing gets interrupted. So how can we finish what the brain is trying to start?”

“In EMDR,” Dr. Shapiro then explained, “we look for what are the nightmare images that a person can recall. One person would continually wake up from a nightmare of being chased by a monster through a cave.  So (in the EMDR session) we target that dream image, so she’s holding in mind being chased through a cave by the monster.  Then we start the EMDR processing – and it’s like a veil gets peeled back, and the individual sees what the actual experience was, and she reports, ‘OMG, that’s the person who molested me, chasing me through my childhood home!’

“The EMDR processing moves the past memory to resolution, and now the person no longer has that dream, because once it’s processed, it’s integrated with larger memory networks and arrives at adaptive resolution, so that dream image does not come back. So with EMDR you don’t have to try to change their mind about it or talk about it. It’s simply identifying the image and their thoughts that go with it, and then processing it (by EMDR) to complete resolution.”  Check out her video: http://www.nicabm.com/nicabmblog/the-brains-attempt-to-help-us-heal-from-trauma/

Dr. Shapiro reports fantastic results especially with rape victims and war veterans.  “These past traumatic experiences get locked into the brain until they can get processed… We try to process how the earlier traumatic memories created the problem, then we process their current situations that are disturbing, and then what might disturb them in time in future.  If they can’t identify the past memories, we talk about what is currently disturbing them.  That often automatically takes them back to the past experience — and in those instances where it (the past traumatic experience) hasn’t fully be stored (in  long-term memory,) we can see that it shifts (from short-term to long-term memory) and ultimately they’re no longer disturbed…

“My PhD dissertation on rape victims was published in the Journal of Traumatic Stress back when PTSD was viewed as intractable, but I was getting results in a single session,” Shapiro said. “So the controversy was: ‘how could anything be that rapid, and how could eye movements have any effect?’  There were 20 randomized controlled trials introducing EMDR. One done with rape victims was by a very experienced cognitive behavioral researcher viewed as extremely credible; she reported that 90% of the rape victims no longer had PTSD after three EMDR sessions.

“That corresponded to another study at the time published in the Journal of Clinical Psychology which showed the same with a mixed trauma group, that after three EMDR sessions, 84% no longer had PTSD.  We’ve continued to see that… a rule of thumb is, a single trauma can be processed by three 90-minute EMDR sessions.  A study by Kaiser Permanente that used 50-minute sessions found… that an average of 6 EMDR sessions, found 100% of single-trauma victims no longer had PTSD and 76% of multiple trauma victims no longer had PTSD.”

Here’s an ABC News clip by the CalSouthern School of Behavioral Sciences featuring Dr. Shapiro. Again it notes that EMDR is best done with a therapist, which is why they don’t post “How To” on the internet.  It also notes that in Shapiro’s original discovery, her eyes “flickered,” and therapists continue to have patients move eyes fast, “like watching tennis,” as one rape victim (who got huge relief) reports: https://www.youtube.com/watch?v=GTLLfdcJE0Q


Kathy’s blogs expand on her book “DON’T TRY THIS AT HOME: The Silent Epidemic of Attachment Disorder—How I accidentally regressed myself back to infancy and healed it all.” Watch for the continuing series each Friday, as she explores her journey of recovery by learning the hard way about Attachment Disorder in adults, adult Attachment Theory, and the Adult Attachment Interview.


FN1  Francine Shapiro, PhD, “The Power of EMDR to Treat Trauma,” April 17, 2013 and Bessel van der Kolk, MD, “Expanding the Perspective on Trauma,” April 24, 2013, webinars by the National Institute for Clinical Application of Behavioral Medicine (NICABM): http://www.nicabm.com/trauma2013/trauma2013-post/

FN2  “Neurobiology and Treatment of Traumatic Dissociation: Toward an Embodied Self,” by Lanius, Paulsen, and Corrigan, 2014, http://www.amazon.com/Neurobiology-Treatment-Traumatic-Dissociation-Embodied/dp/0826106315

FN3  Transcripts and recordings of this and five related webinars again at  http://www.nicabm.com/trauma2013/trauma2013-post/

More reading:

Shapiro, Francine, PhD, “Getting Past Your Past: Take Control of Your Life with EMDR Therapy.”

Shapiro, Francine, PhD, “The Role of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in Medicine: Addressing the Psychological and Physical Symptoms Stemming from Adverse Life Experiences,” Permanente Journal, Perm J. 2014 Winter; 18(1): 71–77   A substantial body of research shows that adverse life experiences contribute to both psychological and biomedical pathology. Eye movement desensitization and reprocessing (EMDR) therapy is an empirically validated treatment for trauma, including such negative life experiences as commonly present in medical practice. The positive therapeutic outcomes rapidly achieved without homework or detailed description of the disturbing event offer the medical community an efficient treatment approach with a wide range of applications. Methods: All randomized studies and significant clinical reports related to EMDR therapy for treating the experiential basis of both psychological and somatic disorders are reviewed. Also reviewed are the recent studies evaluating the eye movement component of the therapy, which has been posited to contribute to the rapid improvement attributable to EMDR treatment.  Results:  Twenty-four randomized controlled trials support the positive effects of EMDR therapy in the treatment of emotional trauma and other adverse life experiences relevant to clinical practice. Seven of 10 studies reported EMDR therapy to be more rapid and/or more effective than trauma-focused cognitive behavioral therapy. Twelve randomized studies of the eye movement component noted rapid decreases in negative emotions and/or vividness of disturbing images, with an additional 8 reporting a variety of other memory effects. Numerous other evaluations document that EMDR therapy provides relief from a variety of somatic complaints: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951033/

van der Kolk, Bessel A, MD, “Restoring the Body: Yoga, EMDR, and Treating Trauma , July 11, 2013 interview by  Krista Tippett of OnBeing.Org.  Human memory is a sensory experience says psychiatrist Bessel van der Kolk. Through long research and innovation in trauma treatment, he’s learning how bodywork like yoga or eye movement therapy can restore a sense of goodness and safety: http://www.onbeing.org/program/restoring-the-body-bessel-van-der-kolk-on-yoga-emdr-and-treating-trauma/5801

van der Kolk Bessel A, MD, Spinazzola J, Blaustein ME, Hopper JW, Hopper EK, Korn DL, Simpson WB,  “A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: treatment effects and long-term maintenance, J Clin Psychiatry. 2007 Jan; 68(1):37-46. Abstract: The relative short-term efficacy and long-term benefits of pharmacologic versus psychotherapeutic interventions have not been studied for posttraumatic stress disorder (PTSD). This study compared the efficacy of a selective serotonin reup-take inhibitor (SSRI), fluoxetine, with a psychotherapeutic treatment, eye movement desensitization and reprocessing (EMDR), and pill placebo and measured maintenance of treatment gains at 6-month follow-up. METHOD: Eighty-eight PTSD subjects diagnosed according to DSM-IV criteria were randomly assigned to EMDR, fluoxetine, or pill placebo. They received 8 weeks of treatment and were assessed by blind raters posttreatment and at 6-month follow-up. The primary outcome measure was the Clinician-Administered PTSD Scale, DSM-IV version, and the secondary outcome measure was the Beck Depression Inventory-II. The study ran from July 2000 through July 2003.RESULTS: The psychotherapy intervention was more successful than pharmacotherapy in achieving sustained reductions in PTSD and depression symptoms, but this benefit accrued primarily for adult-onset trauma survivors. At 6-month follow-up, 75.0% of adult-onset versus 33.3% of child-onset trauma subjects receiving EMDR achieved asymptomatic end-state functioning compared with none in the fluoxetine group. For most childhood-onset trauma patients, neither treatment produced complete symptom remission. CONCLUSIONS: This study supports the efficacy of brief EMDR treatment to produce substantial and sustained reduction of PTSD and depression in most victims of adult-onset trauma. It suggests a role for SSRIs as a reliable first-line intervention to achieve moderate symptom relief for adult victims of childhood-onset trauma. Future research should assess the impact of lengthier intervention, combination treatments, and treatment sequencing on the resolution of PTSD in adults with childhood-onset trauma: http://www.ncbi.nlm.nih.gov/pubmed/17284128

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12 responses to “What is EMDR – and Why is it So Effective?

  1. Wow, I had no idea that you could use EMDR therapy in so many different situations. I would love to find a way to help myself calm down, and I think having someone teach me some skills on how to help relieve some of my anxiety. I’m going to start looking for a therapist that I could work with.

  2. I am getting EMDR through a registered therapist for trauma. My question is this: When I am remembering a specific trauma I have my full concentration on that specific incident. Then she stops and asks me what I am noticing? Well of course I am noticing the incident! When she keeps asking over and over what do you notice now? I do not know how to answer because all I notice is the incident she told me to concentrate on. What is it that I am supposed to see or notice other than the incident I am concentrating on? When you are concentrating on a memory is it supposed to morph into something else — or am I doing something wrong?

    • When I am able to remember a trauma, of course I have my full concentration on that specific incident. In fact, the only way to heal a trauma is to be able to do that, while also being conscious that another human being is there to support us while we do that. Of course, it’s not good to go it alone and bring up those traumatic incidents; that only re-traumatizes us. That’s why my book’s called “Don’t Try this at Home.” But you’re not doing it at home; you’re there doing what your EMDR therapist asked of you. I don’t think you’re doing anything wrong. Please sit down with the therapist before you get into the memories,and discuss your question here thoroughly with them until you reach mutual understanding of the full procedure.

  3. For anyone whose interest in EMDR in general has been stoked by this thread, I recommend the EMDR International Association’s therapist finder. Best to work with a Certified EMDR therapist. They have extra training and consultation beyond basic training.
    The link to EMDRIA website therapist finder page is: http://www.emdria.org/search/custom.asp?id=2337
    Many EMDRIA members, though not all, are trained specifically in EMDR Early Trauma (ET) approach. Although it can be employed in a week-to-week therapy, early trauma EMDR healing is best experienced in an intensive format. Dr. Sandra Paulsen has taken early trauma EMDR to a new level with intensive format–this is her primary practice focus these days.
    Dr. Paulsen discusses early trauma EMDR here: http://www.bainbridgepsychology.com/EarlyTraumaOShea.html
    I have trained with Dr. Paulsen for the past year and treated people referred by her, including for early trauma. I am happy to answer questions about this early trauma EMDR approach.

    • Thank you! I rewrote my EMDR blog above after studying “Neurobiology and Treatment of Traumatic Dissociation” by Dr. Sandra Paulsen and collaborators, at your suggestion, as well as studying your website. I include links to both.
      I’ve just run a “client testimony” guest blog on Neurofeedback by Dr. Tina Hahn, MD (also a patient): http://attachmentdisorderhealing.com/hahn-journey/
      I’d also love to have two guest blogs on EMDR for developmental trauma: one by you, and another by one of your clients. I can’t thank you enough for all that you do. – Kathy

  4. I did this early childhood EMDR protocol for developmental trauma and now am going through the regular protocol. EMDR is absolutely amazing. I feel like I have a completely different brain already and I’m not even finished. I can think so much more clearly now. I’m much less numb. I’m much more able to speak up about how I’m feeling and ask for what I need. The constant panic attacks I’ve lived with for the last 3 years since being forced to face my childhood and adult trauma are subsiding. I no longer feel like I’m drowning. I no longer feel crazy. My family and friends are very aware of the change. It has been dramatic. I’m changing the dance of my relationships now, which has led some of my family into EMDR as well! I wish I could tell everyone about this treatment. Thank you for your blog.

  5. D. Michael Coy, LCSW

    Dr. Paulsen is a clinical ‘heavy hitter’ and Fellow of the International Society for the Study of Trauma & Dissociation, among other things. She also wrote (and illustrated) a really helpful book called ‘Looking Through The Eyes of Trauma and Dissociation: An Illustrated Guide for EMDR therapists and clients’ that discusses in a readable way the extra work that goes into making EMDR therapy safe for clients who need additional preparation and support throughout reprocessing. I’m certain she knows Dr. van der Kolk and Early Trauma EMDR has been around for almost ten years now, so he may be aware of it. But I’ll pass on the suggestion.
    Dr. Paulsen is the lead on writing a book about the Early Trauma approach to EMDR that’s appropriate for clients and therapists; it’s now in editing. I use her approach because, after study of a number of approaches, hers makes the most sense to me and my clients. Plus what she does actually works, for both straightforward and more difficult issues.
    I will do my best to visit your blog often. If you’d like a bit more info on the EMDR approach to treating early trauma, see: https://www.dmcoy.com/main/my_practice/emdr-therapy/emdr-pre-verbal-trauma/. Warmest regards, Michael

  6. Your blog is a pleasure to read. I’ve just discovered it.
    There is actually a specific Early Trauma approach within EMDR therapy, developed by a therapist named Katie O’Shea. O’Shea later brought it to the attention of EMDR therapist and complex trauma and dissociation expert Sandra Paulsen, who collaborated with O’Shea to hew with current neurobiology research (Panksepp, Schore, Siegel, and others) so the approach could be extended for people struggling with more acute complex emotional wounding and dissociative disorders. I am trained in the approach, and it’s very powerful–and gentle.
    Because there may not be any first-hand, conscious awareness at all of explicit traumas (as you’ve reported elsewhere, there usually isn’t), the approach moves chronologically from pre-conception through to age 3, listening and looking for what would have been there back that far: body sensation, emotion, and relational enactment. The results I and others have seen have been quite impressive. Think of it as ‘somatic’ EMDR.
    The approach has most recently been discussed in Chapters 16 and 20 of the book “Neurobiology and Treatment of Traumatic Dissociation: Toward an Embodied Self,” by Lanius, Paulsen, and Corrigan published in 2014. Thanks again for all of your efforts to educate and share. The information you offer up here is so very vital and important.
    D. Michael Coy, LCSW, EMDR Certified Therapist; Regional Coordinator, EMDR International Association Chicago Network

    • Thank you, this is wonderful news. I added a link to your comment here to my blog above. It was Dr. Bessel van der Kolk, MD, whose National Center for Child Traumatic Stress Complex Trauma Network (NCTSN) has seen over 40,000 traumatized children, who mentioned that EMDR often doesn’t work for developmental trauma — so I would urge you to get with him on the points that you’ve made.

  7. Thank You Kathy. Until reading this article, I never knew why my first EMDR therapist said I had been “over-utilizing my short-term memory”…..I must say it is a very well-written piece, and I am most grateful for the cautionary note about its use in trying to process childhood trauma, as well as the PubMed link.

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