Eye Movement Desensitization and Reprocessing (EMDR) Therapy Exercise

What is EMDR?

EMDR therapy is a clinical process that helps people with trauma replace negative neural patterns. EMDR therapy does this through alternating visual or auditory stimulation, known as BLS (bilateral stimulation). The modern 8-step process was formulated by Francine Shapiro, PhD, in 2001, and is based on Adaptive Information Processing (AIP) theory that she also formulated. AIP states that unresolved trauma is isolated and unconsolidated, resulting in repeated patterns of the original perceptions. These unconsolidated patterns can be replaced or “processed” through EMDR, with the BLS helping neuroplasticity to enable encoding new patterns.

EMDR is commonly used to treat PTSD, but is also shown to be effective for depression, phobias, and anxiety.

How do I do EMDR?

EMDR is an 8-step clinical process that is commonly administered by a certified practitioner usually in hour to hour and a half sessions. The number of sessions required varies based on patient response and is anywhere from 3 to 12 usually. The 8-step process can be found in detail here, but is as follows

1. Patient history and information gathering
2. Preparation and education
3. Assessment
4. Desensitization and reprocessing
5. Installation
6. Body scan
7. Closure and stabilization

Jopro does not offer a full EMDR protocol including all steps such as clinical assessment, rather we offer a writing protocol inspired by EMDR that leverages BLS to achieve maladaptive thought reprocessing. BLS here refers to Bilateral stimulation, usually achieved through a bouncing focal point (such as a circular ball on the screen) or a tone shifting between left and right stereo headphones.

You should be cautious when attempting to perform EMDR on yourself, especially if you have diagnosed PTSD, think you may have PTSD. EMDR can be dangerous if you are prone to dissociating, decompensating, or otherwise have poor emotional regulation in the face of the trauma you are attempting to process.

What are the benefits of EMDR?

• Improvements to OCD
  • Meta-analysis showed that “EMDR is a promising candidate for treating OCD, with all studies showing EMDR therapy resulted in reduced symptoms from baseline. Results also indicated that EMDR may be as effective as ERP, and more effective than selective serotonin reuptake inhibitors (SSRIs) in treating OCD” - from Examination of Initial Evidence for EMDR as a Treatment for Obsessive-Compulsive Disorder
  • At posttreatment, 2 of the 3 cases showed more than a 50% reduction on validated psychometric measures, with symptoms below diagnostic cutoff. - EMDR Treatment of Obsessive-Compulsive Disorder: Three Cases
• Improves relationship satisfaction, depression, and anxiety in couples with large effect sizes. - Effects of the EMDR Couple Protocol on Relationship Satisfaction, Depression, and Anxiety Symptoms
• While many studies show EMDR as effective for improving the symptoms of PTSD, it can also significantly improve the impact (as measured by the Impact of Event Scale, and the State-Trait Anxiety Inventory after memory recall) of non-PTSD traumatic events. - from EMDR Treatment of Distressful Experiences That Fail to Meet the Criteria for PTSD
• Usage as a self-administered tool to children during the covid pandemic showed “a statistically significant decrease in the posttest PTSS (posttraumatic stress symptoms) scores for the intervention group compared to waitlist. The intervention group had significant pre–post improvement on all but one subscale, while the waitlist group showed significant increase in state anxiety on the STAIC” - from Use of EMDR-Derived Self-Help Intervention in Children in the Period of COVID-19: A Randomized-Controlled Study
• Reduction in “Athletic” traumas in golfers as measured by Competetive-State anxiety inventory as well as subjective levels of distress. - from EMDR-Based Interventions for Athletic Traumas: A Case Study of Two Female Golfers
• PTSD
  • Effective at reducing PTSD symptoms in war-affected Iraqi children - from The Use of EMDR in Treatment of Traumatized Iraqi Children
  • A 2007 study from the Department of Defense and Department of Veterans Affairs (called Responding to an Identified Need: A Joint Department of Defense/Department of Veterans Affairs Training Program in Eye Movement Desensitization and Reprocessing (EMDR) for Clinicians Providing Trauma Services) found EMDR as highly effective for treating chronic PTSD, with significant changes across 4 scales measuring the impact of the trauma and depression.
  • Improvements in PTSD, depression, and anxiety from trauma related to sexual violence and intimate partner violence (IPV) - from EMDR for Survivors of Sexual and Intimate Partner Violence at a Nonprofit Counseling Agency
  • Significant reduction of symptoms, both immediately after, and as measured 3 months later from disaster-related trauma after 1 session of EMDR in Argentinian children. - from Helping child flood victims using group EMDR intervention in Argentina: Treatment outcome and gender differences.
  • Reduction in alcohol dependence of a PTSD victim - from EMDR Treatment of Comorbid PTSD and Alcohol Dependence: A Case Example
  • Effective at treating workplace post-traumatic stress syndrome and depression - from EMDR Treatment of Workplace Trauma A Case Series
  • Treatment of disaster related PTSD from a Tsunami, claiming “symptoms were eradicated” - from Combating Tsunami Disaster Through EMDR
  • Treatment of PTSD from human massacre, with results showing that “[...] one session of EMDR-PRECI produced significant improvement on self-report measures of posttraumatic stress and PTSD symptoms for both the immediate treatment and waitlist/delayed treatment groups” - from The EMDR Protocol for Recent Critical Incidents: Brief Report of an Application in a Human Massacre Situation
  • Treatment of PTSD in survivors of life-threatening cardiac events, EMDR saw improvements when measured 6 months after when compared to Imaginal Exposure (IE), a form of exposure therapy. - from EMDR for Survivors of Life-Threatening Cardiac Events: Results of a Pilot Study
• Significant improvements in tinnitus symptoms in 64.3% of participants, with no adverse effects. - from EMDR in the Treatment of Chronic Subjective Tinnitus: A Systematic Review
• Treating cognitive distortions in sex offenders - Treating Cognitive Distortions with EMDR: A Case Study of a Sex Offender
• A meta-analysis of 39 studies found a large and significant effect of EMDR on depression - from EMDR for Depression: A Meta-Analysis and Systematic Review
• Potential improvement in Bulimia when combined with CBT, as shown in the case study Integrating EMDR With Enhanced Cognitive Behavioral Therapy in the Treatment of Bulimia Nervosa: A Single Case Study
• Preliminary evidence that EMDR is effective at treating panic disorder as well as specific phobias. - from Efficacy of EMDR Therapy for Anxiety Disorders
  • Further evidence for it treating phobias through the case study EMDR With Choking Phobia: Reflections on the 2008 Study by de Roos and de Jongh
  • Use of EMDR in the treatment of water phobia at Navy boot camp: A case study.
• Reduction in frequency and duration for those with chronic migraines, maintained at the 3-month follow-up. - from EMDR Treatment of Migraine
• Reducing presentation anxiety in a student, from the 98th to 55th percentile as measured by State-Trait Anxiety Inventory (STAI). - from The Use of EMDR in Reducing Presentation Anxiety: A Case Study
• More effective than CBT at improving self-esteem and behavior issues in children - from EMDR Versus CBT for Children With Self-Esteem and Behavioral Problems: A Randomized Controlled Trial
• Shown in an individual to reduce unexplained chronic pain from EMDR and the Treatment of Medically Unexplained Symptoms
• Treatment of Capgras Syndrome in a survivor of sexual abuse - from EMDR Intervention in the Treatment of Capgras Syndrome Case Report
• Effective at treating Generalized Anxiety Disorder in 4 subjects, “At both posttreatment and at 2 months follow-up, all four participants no longer presented with GAD diagnosis” - from Preliminary Evidence for the Efficacy of EMDR in Treating Generalized Anxiety Disorder

How does EMDR work?

EMDR relies on the underlying theory of Adaptive Information Processing or AIP. EMDR is subject to a lot of controversy, and most of it is not around its efficacy, which has been proven over the last few decades since it’s seen widespread use, but more around how it works and under what conditions does it work (refer to EMDR: Why the Controversy?).

AIP theorizes that traumatic memories are encoded in the brain in an unprocessed way. These memories are not well integrated into the rest of the brain and can trigger in unexpected contexts, and in a way that is quite similar to the initial perceptions of the traumatic event. AIP itself receives most of its support from the efficacy of EMDR, though it’s quite possible expressive writing and other writing protocols that rely on structuring narrative around a traumatic event support AIP in theory.

AIP is only half of EMDR, the other half being the mechanism by which BLS helps enable trauma reprocessing. It was tested when compared to Imaginal Exposure (a form of exposure therapy where you imagine the traumatic event), and was found to be significantly more effective. It’s theorized that BLS helps neuroplasticity, in particular of the parietal lobe.

It’s been found that playing Tetris can also help reduce flashbacks of PTSD sufferers (Can Playing the Computer Game “Tetris” Reduce the Build-Up of Flashbacks for Trauma? A Proposal from Cognitive Science), though the authors propose that the mechanism is through the brains limited resource ability, another paper titled Frontal activation patterns during Tetris game play and differences between high and low performers: a preliminary functional near-infrared spectroscopy study indicates that playing tetris does result in bilateral stimulation of the prefrontal cortex.

What are the alternatives to EMDR?

EMDR is quite similar in how it works compared to Expressive Writing, which involves using writing to structure the narrative around a traumatic event, essentially consolidating the neural networks around it. Expressive Writing achieves neuroplasticity through emotional response, rather than Bilateral Stimulation.

CBT or Cognitive Behavioral Therapy is another popular form of treatment that is often paired or contrasted with EMDR, see EMDR Versus CBT for Children With Self-Esteem and Behavioral Problems: A Randomized Controlled Trial or Integrating EMDR With Enhanced Cognitive Behavioral Therapy in the Treatment of Bulimia Nervosa: A Single Case Study.

What are the risks of EMDR?

EMDR can be risky, especially for those prone to dissociate, decompensate, or otherwise have poor emotional regulation skills. This is one of the top issues called out by A Review of Mobile Applications for Facilitating EMDR Treatment of Complex Trauma and Its Comorbidities. In particular the paper argues against unregulated and unsupervised use of EMDR as a protocol for complex cases without a trained clinician supervising. If you have PTSD or think you may have PTSD, reach out for professional help.

Beyond risks of complications, there are risks that EMDR may not work for you. Part of the controversy around EMDR is the uncertainty around under what conditions and for what people it works for. BLS tooling may be insufficient to induce neuroplasticity for you, especially if you attempt to do it on a mobile device where the visual marker (usually a ball traveling between two sides of the screen) doesn’t have a lot of travel space.

Another consideration is for people with Autism, or issues visualizing, such as those with Aphantasia. Parts of the process may need to be adapted as per Using eye movement desensitisation and reprocessing (EMDR) with autistic individuals: A qualitative interview study with EMDR therapists.

Finally, it is known that the therapist / patient relationship plays a role in the mechanism of therapeutic healing. It’s theorized that removing that aspect from the process may result in poorer results. However it’s also been shown that self-administered EMDR-based therapy can work, as in Use of EMDR-Derived Self-Help Intervention in Children in the Period of COVID-19: A Randomized-Controlled Study.

References and Other Resources

The definitive source of information on the 8-step full EMDR process is the book Eye Movement Desensitization and Reprocessing (EMDR) Therapy, Third Edition: Basic Principles, Protocols, and Procedures by Francine Shapiro.

The book Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy is also worth reading, as it contains a self-help guided approach to AIP.