The Basics: EMDR What is it? How & Why Does it Work?
What is It?
EMDR is a form of psychotherapy developed by Dr. Francine Shapiro in the late 1980s, primarily to treat post-traumatic stress disorder (PTSD) and other trauma-related conditions. Over the years, it has also been applied to other mental health conditions, such as anxiety, depression, and phobias.
EMDR is based on the Adaptive Information Processing (AIP) model, which posits that our brains have an inherent capacity to process and integrate traumatic memories into our existing memory networks. However, sometimes these memories can become "stuck" or "frozen" in their original, distressing form, leading to the development of PTSD and other trauma-related disorders.
The main goal of EMDR is to help individuals process and integrate these distressing memories, allowing them to regain a sense of control and alleviate their symptoms. Standard* EMDR therapy consists of eight phases:
- History-taking and treatment planning: The therapist gathers information about the client's history, identifies specific traumatic memories or events, and develops a treatment plan.
- Preparation: The therapist builds a therapeutic relationship with the client, provides psychoeducation about EMDR, and teaches the client various coping skills and self-soothing techniques to manage potential distress during the therapy sessions.
- Assessment: The therapist helps the client identify a specific target memory, along with the associated negative beliefs, emotions, and physical sensations.
- Desensitization: The therapist guides the client through a series of bilateral stimulation (typically in the form of eye movements, but other methods like tapping or auditory tones can be used) while the client focuses on the target memory. This process is thought to facilitate the processing and integration of the traumatic memory.
- Installation: Once the client reports reduced distress related to the target memory, the therapist works to strengthen a positive belief that replaces the initial negative belief associated with the memory.
- Body scan: The client is asked to scan their body for any residual physical sensations related to the target memory. If any sensations are present, the therapist uses additional bilateral stimulation to help process and integrate these sensations.
- Closure: The therapist ensures that the client is in a stable emotional state before ending the session, reviewing the self-soothing techniques and discussing the progress made during the session.
- Reevaluation: At the beginning of subsequent sessions, the therapist reevaluates the progress made, addressing any new or unresolved issues, and adjusts the treatment plan accordingly.
*Modified Protocols Discussed Below
How & Why Does It Work?
EMDR's Theoretical & Practical Application
EMDR's theoretical and practical application is deeply rooted in the notion of integration, targeting the holistic interplay between the brain's hemispheres, the triune brain structure, and the mind-body connection. The therapy aims not just at cognitive reconciliation of traumatic memories but also at convincing both mind and body that the trauma has passed, aligning with Francine Shapiro's Adaptive Information Processing (AIP) model. This model suggests EMDR facilitates the movement of stuck traumatic memories, allowing for their adaptive integration into the individual's overarching memory network.
Integration and the Triune Brain Concept
EMDR operates on the principle of integration, addressing the MacLean's triune brain model, which delineates the brain into three components: the reptilian (instinctual brain), the limbic (emotional brain), and the neocortex (rational brain). Through EMDR's phased approach, the therapy engages each aspect, aiming to:
- Discharge fight-flight energy**: It focuses on alleviating physiological arousal linked to trauma, addressing the reptilian brain's instinctual responses.
- Manage emotions**: By engaging the limbic system, EMDR allows for the emotional processing of traumatic memories, making emotions more manageable and less overwhelming.
- Reframe beliefs**: The therapy facilitates a cognitive reassessment of the traumatic event, enabling the neocortex to integrate the experience into the individual's life narrative in a healthier manner.
Bilateral Stimulation and Hemisphere Integration
One of the innovative aspects of EMDR is its use of bilateral stimulation, initially through eye movements and later incorporating auditory and tactile stimuli. This method is thought to enhance communication between the brain's hemispheres, fostering the integration of unprocessed traumatic material primarily stored in the right hemisphere with the language and logic capacities of the left hemisphere. This bilateral engagement is crucial for processing and verbalizing traumatic experiences, moving them from implicit to explicit memory and reducing their present-time emotional impact
What is Bilateral Stimulation?
Bilateral stimulation (BLS) involves rhythmic left-right patterns of visual, auditory, or tactile stimuli. Examples include watching a hand or light moving back and forth or listening to alternating tones. Francine Shapiro discovered BLS in the late 1980s while walking in a park; she noticed her distressing feelings diminished with bilateral eye movements.
Prior to 1985, there isn't much documentation or research specifically focused on this method as we understand it in the context of EMDR. However, some related techniques and theoretical frameworks from earlier periods can be noted.
- Tapping and Acupressure Techniques: Thought Field Therapy (TFT), developed by Roger Callahan in the late 1970s, used tapping sequences on specific body points to relieve psychological distress. These sequences sometimes involved bilateral stimulation. Similarly, Emotional Freedom Techniques (EFT), developed in the early 1990s by Gary Craig, built on TFT's principles and included tapping routines that alternated sides of the body.
- Neurolinguistic Programming (NLP): Developed in the 1970s by Richard Bandler and John Grinder, NLP includes techniques that sometimes utilize eye movements or auditory patterns that can create a form of bilateral stimulation. These techniques aimed to help individuals reframe negative experiences and improve mental well-being, though they weren't explicitly recognized as BLS at the time.
- Brain Gym: Introduced by Paul Dennison in the 1980s, Brain Gym exercises often involve movements that stimulate both hemispheres of the brain. Exercises like cross-crawls, which involve touching each hand to the opposite knee in an alternating fashion, promote cognitive and emotional balance through bilateral stimulation.
What Does Alternating Bilateral Stimulation Do?
Four main effects:
- Relaxation: Decreases physiological arousal (PLOS ONE, 2016).
- Increased Attentional Flexibility: Thoughts become less "sticky".
- Distancing Effect: Problems seem smaller and more distant (Frontiers in Psychology, 2017).
- Decreased Worry: Reduces overall worry (PLOS ONE, 2016).
How Does It Do That?
Bilateral stimulation works through several mechanisms:
- Orienting Reflex: The natural tendency for the nervous system to orient to new stimuli. When engaged by BLS, attention is diverted from distressing thoughts, preventing habituation and promoting relaxation (Sagebrush Counseling, 2021).
- Attentional Capture: BLS continuously captures attention, making it difficult for the brain to remain fixated on distressing memories or thoughts. This allows for cognitive flexibility and helps in reprocessing traumatic memories (PLOS ONE, 2016).
- Physiological Relaxation: The rhythmic nature of BLS induces a relaxation response in the lower brain, decreasing physiological arousal and tension. This initial physical relaxation cascades upwards, leading to mental relaxation and reduced worry (Frontiers in Psychology, 2017).
- Non-Associative Learning: BLS helps in altering the way distressing memories are stored in the brain without linking them to rewards or punishments. This change in memory storage leads to a reduction in the emotional impact of the memories (Sagebrush Counseling, 2021).
These mechanisms collectively help in reducing distress, increasing cognitive flexibility, and promoting a sense of calm and well-being.
Research and Modern Understanding
Studies on modern applications of bilateral stimulation in therapies like EMDR (Eye Movement Desensitization and Reprocessing) show that BLS can help reduce the emotional impact of traumatic memories and facilitate cognitive processing. Research indicates that engaging both sides of the brain through bilateral movements can enhance neural communication and integration, leading to improved emotional regulation and psychological resilience (PLOS ONE, 2016; Frontiers in Psychology, 2017).
While formalized research and the specific term "bilateral stimulation" are more recent, the underlying principles have been utilized in various traditional and movement-based therapies for centuries. Drumming, dance, yoga, and methods like the Alexander Technique and the Feldenkrais Method all incorporate elements of alternating bilateral stimulation, contributing to their therapeutic benefits. (See the following two sections).
Physiological and Psychological Resolution
The protocol addresses the unfinished fight/flight response by reactivating the trauma memory network, including the physiological stress response. This reactivation provides a therapeutic opportunity to complete the instinctual motor actions that were thwarted during the trauma. If the dominant response was parasympathetic activation, leading to physiological collapse or dissociation, EMDR seeks to resolve this by ensuring the nervous system can differentiate between past and present, thus reducing inappropriate current physiological reactions.
Preliminary Steps and Trauma Processing
EMDR's structured approach begins with establishing safety and stability (akin to the first phase of Judith Herman's tri-phasic model), ensuring the individual is prepared for the trauma processing that follows. The therapy then proceeds through stages that involve reactivating traumatic material under controlled conditions and applying bilateral stimulation. This process aims to decrease arousal, manage emotions, and facilitate cognitive restructuring, utilizing mechanisms such as the orienting response, working memory taxation, and potentially others like inducing an alpha state or affecting the thalamus's oscillation rate.
Proposed Mechanisms of Action in EMDR
While the precise mechanisms of EMDR remain theoretical, akin to the action of many psychological and medical interventions, its efficacy is supported by empirical evidence. The therapy's foundational and innovative practices underscore a commitment to evolving understanding and treatment of trauma, emphasizing the need for holistic integration and resolution
EMDR (Eye Movement Desensitization and Reprocessing) therapy employs various theoretical mechanisms of action to aid in the treatment of trauma. These proposed mechanisms, while not conclusively proven, provide a comprehensive understanding of how EMDR may facilitate trauma recovery.
- Increased Adaptive Information Processing: Central to EMDR's approach is the Adaptive Information Processing (AIP) model, proposed by Dr. Francine Shapiro. This model suggests that EMDR facilitates the unlocking and processing of trauma-stuck memories, enabling their integration into existing memory networks in a more adaptive, less distressing manner.
- Overtaxing the Working Memory: This theory posits that engaging in bilateral stimulation while recalling traumatic memories can overload the working memory. This overload is believed to reduce the vividness and emotional intensity of the memory, rendering it less distressing and easier to process. (2016,2016,2021)
- Triggering the Orienting Response: The bilateral stimulation used in EMDR is thought to activate the orienting response, a natural reflex to novel stimuli that momentarily diverts attention from distressing memories. This diversion is theorized to decrease physiological arousal and create an opportunity for the brain to process the trauma more effectively. (2011, 2012,2020)
- Activation of the Parasympathetic Nervous System: EMDR may promote a shift towards dominance of the parasympathetic nervous system, fostering a state of relaxation that counteracts the fight-or-flight response. This shift could facilitate a more conducive environment for processing traumatic memories. (2016, 2020, 2018)
- Enhanced Inter-hemispheric Communication: The bilateral nature of EMDR's stimulation is believed to improve communication between the brain's hemispheres, aiding in the integration of traumatic memories into more coherent, less distressing narratives. (201, 2013, 2015)
- Placebo Effect: While the placebo effect is considered in therapeutic interventions, EMDR's structured engagement and therapeutic alliance may contribute to its effectiveness beyond placebo influences. This acknowledges the unique aspects of EMDR's methodology beyond general therapeutic expectancy effects. (2013, 2018, 2015)
- Psychological Distance Creation: Focusing on a distressing memory and an external stimulus simultaneously may create a psychological distance from the trauma. This distance allows individuals to reprocess the event from a safer, more detached perspective, facilitating healing. (2013, 2019, 2019)
These proposed mechanisms highlight the multifaceted approach EMDR takes to address trauma through cognitive, physiological, and emotional pathways. Although more research is needed to definitively establish these mechanisms, the documented efficacy of EMDR in alleviating symptoms of PTSD and other trauma-related disorders supports its significance as a therapeutic intervention. (See Reference page)
Working Remotely? EMDR Hosting Platforms
Bilateralstimulation.io
This platform is both free and user-friendly, ensuring HIPAA compliance while delivering online BLS training. It supports visual and auditory BLS, and with the addition of remote BLS buzzers, tactile BLS can be offered remotely. Additionally, bilateralstimulation.io provides a pro plan with premium features
Bilateral Base
Bilateral Base is a web-based, HIPAA-compliant application that offers a free plan (5 hours a month) and some paid plans.
The app combines video features with controls over sound and visual BLS. In the near future, there will be an option to combine tactile BLS with the app.
remotEMDR
remotEMDR brings you a cutting-edge, comprehensive solution for online and in-person EMDR sessions. remotEMDR brings together a HIPAA-compliant video chat with therapist-controlled bilateral stimuli, creating an invaluable resource for online EMDR therapy.
EMDR Remote
EMDR Remote offers a reliable HIPAA-compliant solution for working virtually with your EMDR clients. EMDR therapists can easily change settings such as color, sound, volume, size, speed, light behavior, video stream display, and much, much more.
Mooved
Discover how the platform uses AI, data and algorithms to optimize treatment results. Clients will notice the remarkable, efficient outcomes facilitated by WeMind, specializing in optimal Dual Attention Stimulation and Memory Enhancement. More happy clients, with better results.
EMDR Online Tools
EMDR Online Tools is a Dutch company that offers virtual EMDR tools for therapists worldwide. The platform offers solutions designed for EMDR therapists, aiming to streamline EMDR processing and progress tracking in virtual settings
The Gestalt of Trauma Processing: From Hypnosis to NLP to EM
The development of Eye Movement Desensitization and Reprocessing (EMDR), one of the most widely used trauma therapies today, was significantly influenced by Neuro-Linguistic Programming (NLP), which itself drew from earlier approaches like hypnosis and Gestalt Therapy. Francine Shapiro, the creator of EMDR, had a deep background in NLP, where she worked as a facilitator and trainer. She adapted many of NLP’s core techniques—such as anchoring, visual submodalities, and dissociation—to create EMDR, a structured, trauma-focused model for processing distressing memories. By tracing the roots of these methods, we can see how therapeutic techniques evolve to meet complex needs in trauma therapy.
But more importantly, understanding the shared foundations of these approaches allows therapists to move beyond adhering to any single modality. The true value lies in being able to deconstruct and apply elements from any therapeutic model—whether it’s NLP, EMDR, hypnosis, or others—in combinations that best support the unique needs of the client in front of them.
Bandler’s Gestalt Therapy Influence on NLP
Richard Bandler, co-creator of NLP, began his journey in Gestalt Therapy, where he was heavily influenced by Fritz Perls, the founder of Gestalt Therapy. Bandler edited Perls’ The Gestalt Approach (1973) and worked with John Grinder, a linguistics professor, to integrate language patterns into therapeutic processes. Together, they created NLP, which fused insights from Gestalt Therapy, hypnosis, and behavioral psychology.
At its core, NLP was designed to help clients rapidly shift emotional states, using tools like anchoring, submodalities, and dissociation. Though NLP was not explicitly designed for trauma therapy, these techniques would later be adapted by Francine Shapiro in her creation of EMDR, where they became essential in the trauma processing framework.
How Shapiro Built EMDR from NLP Techniques
Francine Shapiro’s experience with NLP significantly influenced how she developed EMDR. The following techniques from NLP were central to her creation of EMDR:
- Bilateral Stimulation (BLS) and Submodalities
- NLP’s concept of submodality shifts—changing the sensory qualities of internal images (brightness, clarity, etc.)—to alter emotional responses was foundational to Shapiro’s creation of bilateral stimulation (BLS) in EMDR. By using eye movements, tapping, or auditory cues, Shapiro discovered that clients could process traumatic memories more effectively, similar to how NLP uses sensory engagement to change emotional states.
- Anchoring and Resource Installation
- NLP’s anchoring technique, which links an emotional state to a stimulus for future use, became the foundation of Resource Development and Installation (RDI) in EMDR. In EMDR, bilateral stimulation helps install positive emotional resources—such as calm or confidence—giving clients tools to stabilize themselves before engaging in trauma processing. Though NLP uses anchoring for general emotional regulation, Shapiro refined this into a trauma-specific intervention.
- Distancing Techniques and Dissociation
- NLP’s Visual-Kinesthetic Dissociation helps clients reduce the emotional intensity of distressing memories by encouraging them to view the memory as if watching it on a screen. Shapiro incorporated this approach into EMDR, asking clients to visualize traumatic memories from a safe, detached perspective—such as watching a memory play out on a TV screen—while engaging in BLS to reprocess the trauma.
Beyond NLP and EMDR: The Flexibility to Combine Modalities
While NLP and EMDR share significant overlaps, it’s essential to recognize that the goal is not to simply apply elements of either modality. Instead, the value in these techniques lies in their adaptability. Clinicians are empowered to deconstruct and reassemble methods from any modality—whether hypnosis, Gestalt Therapy, cognitive behavioral therapy (CBT), or somatic therapies—to create individualized approaches that address the specific needs of the client.
For example:
- CBT’s cognitive restructuring can be combined with NLP’s anchoring to help clients shift maladaptive beliefs.
- Gestalt Therapy’s empty chair technique can be paired with bilateral stimulation to work through external conflicts. Similarly, IFS techniques might be paired with bilateral stimulation to work through internal conflicts.
- Mindfulness-based practices can be integrated with Resource Installation to strengthen emotional grounding.
Trauma therapy is not about rigidly adhering to one model. It’s about fluidly combining tools from multiple modalities to meet the client’s needs, whether they require grounding through somatic techniques, cognitive shifts through CBT, or emotional regulation from DBT and EMDR.
Conclusion: The Gestalt of Trauma Processing
The evolution from hypnosis to NLP to EMDR demonstrates how earlier therapeutic techniques have been adapted and expanded upon to meet complex trauma needs. Francine Shapiro did not develop EMDR in isolation; instead, she drew heavily from NLP, particularly in how it worked with emotional states and sensory experiences. However, the larger takeaway is not simply the connection between NLP and EMDR—it’s the recognition that all therapeutic modalities offer tools that can be deconstructed and combined to serve the client in front of us.
By understanding the roots of these techniques, clinicians can freely apply elements from any modality, creating flexible and tailored interventions for trauma processing, skill building, and emotional regulation. The ability to combine techniques from Gestalt Therapy, DBT, sensorimotor and somatic therapies, and others is what makes trauma processing effective—not the rigid adherence to any single approach.
Looking for Tactile Tools for EMDR?
Bi-Tapp: Innovative EMDR Tappers
Bi-Tapp: Innovative EMDR Tappers
Bi-Tapp: Innovative EMDR Tappers
Bi-Tapp is a new and innovative type of EMDR tappers that uses gentle tapping instead of buzzing. Bi-Tapp tappers are synchronized via a mobile phone app, which allows therapists to control the tapping speed and intensity remotely. This makes Bi-Tapp ideal for both in-person and teletherapy sessions. Bi-Tapp is also being used in psychedelic-assisted EMDR therapy, which is a new and emerging treatment for trauma and other mental health conditions.
Bilateralstimulation.io Buzzers
Bi-Tapp: Innovative EMDR Tappers
Bi-Tapp: Innovative EMDR Tappers
Bilateral Stimulation for Virtual EMDR Sessions Enhance your virtual EMDR therapy with Bilateralstimulation.io’s innovative USB tappers. Developed during the COVID-19 pandemic, these buzzers seamlessly integrate with the virtual EMDR platform, offering effortless bilateral stimulation for remote sessions. Easy to set up and use, these tappers now come with a convenient carrying pouch and replacement cable.
TheraTapper Pulsers
Bi-Tapp: Innovative EMDR Tappers
TheraTapper Pulsers
Alternating Bilateral Stimulation (ABS) is used in conjunction with several psychotherapeutic protocols such as DNMS, EMDR and others. The TheraTapper™ provides alternating bilateral tactile stimulation and the TheraTapper Plus™ provides either tactile or audio stimulation, or both at the same time. The generic description and name is “device for providing alternating bilateral stimulation”.
EMDR Kit Pulsators
NeuroTek Tactile Pulsers
TheraTapper Pulsers
EMDR Kit’s Bluetooth-operated EMDR pulsators are wireless, they look good and are operated via a free EMDR Kit app that you can use on your tablet or phone. EMDR Kit has two versions of their tappers – with or without headphones. The pulsators come with a docking station and a charger.
Touchpoints
NeuroTek Tactile Pulsers
NeuroTek Tactile Pulsers
TouchPoints are wearable tappers that can be clipped to socks, worn as wristbands, put in pockets, or simply held. They are used by EMDR therapists and the general population for stress reduction. TouchPoints use gentle vibrations to stimulate the body’s natural stress response, helping to calm the mind and body.
NeuroTek Tactile Pulsers
NeuroTek Tactile Pulsers
NeuroTek Tactile Pulsers
NeuroTek proudly introduces the New Standard Tac, the auditory plus tactile EMDR instrument. This innovative EMDR instrument allows the clinician to administer EMDR by alternating tones to each ear via stereo headphones or vibrating pulsers that alternate right and left. Simultaneously, bilateral tactile stimulation may be utilized via vibrating pulsers and headphones.
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References
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References
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- Faretta, E., & Varker, T. (2020). EMDR and the role of the orienting response: A meta-analytic review. Psychological Trauma: Theory, Research, Practice, and Policy, 12(6), 629-639. https://doi.org/10.1037/tra0000608
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- Krawczyk, D. C., Gazzaley, A., & D’Esposito, M. (2010). Categorization of ambiguous stimuli in working memory. Journal of Cognitive Neuroscience, 22(9), 1905-1915. https://doi.org/10.1162/jocn.2009.21350
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- Nardo, D., Högberg, G., Looi, J. C. L., Larsson, S., Hällström, T., Pagani, M., & Sundin, Ö. (2013). Neurobiological correlates of EMDR monitoring – An EEG study. PLoS ONE, 8(9), e74184. https://doi.org/10.1371/journal.pone.0074184
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- Schubert, S., & Lee, C. W. (2019). Adult posttraumatic stress disorder and the efficacy of EMDR: A meta-analysis of randomized controlled trials. Journal of EMDR Practice and Research, 13(4), 262-279. https://doi.org/10.1891/1933-3196.13.4.262
- Schubert, S. J., Lee, C. W., & Drummond, P. D. (2011). The effect of eye movements on the emotional processing of memories of past events. Journal of Behavior Therapy and Experimental Psychiatry, 42(3), 256-264. https://doi.org/10.1016/j.jbtep.2011.01.002
- Thomaes, K., Engelhard, I. M., Sijbrandij, M., Cath, D. C., & van den Heuvel, O. A. (2016). Degrading traumatic memories with eye movements: A pilot functional MRI study in PTSD. European Journal of Psychotraumatology, 7(1), 31371. https://doi.org/10.3402/ejpt.v7.31371
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