Approaches / Trauma-focused
Eye movement desensitisation and reprocessing (EMDR)
A structured therapy for trauma that combines recall of a distressing memory with alternating bilateral stimulation, such as eye movements.
Overview
Eye movement desensitisation and reprocessing is a structured therapy used mainly for post-traumatic stress. The client recalls a distressing memory briefly while following alternating bilateral stimulation, most often side-to-side eye movements.
Core ideas
Shapiro's model proposes that distressing memories can be stored in ways that keep them unprocessed and that the procedure helps them to be reprocessed. Researchers disagree about the mechanism, including how much the eye movements themselves contribute.
What a session can involve
Treatment follows eight phases, from history-taking and preparation through reprocessing to review. During reprocessing, the person holds a memory in mind with an image, belief and bodily sensation, while the therapist guides sets of eye movements or other stimulation and checks in between sets.
Formats and settings
EMDR is mainly individual and is offered in mental health services and private practice by trained clinicians. It has been used with adults and with children.
How it relates to other approaches
EMDR includes elements found in exposure-based and cognitive therapies, and these are sometimes cited as overlapping with them. It is usually grouped with trauma-focused therapies alongside trauma-focused CBT and prolonged exposure.
Limits and open questions
The contribution of eye movements remains debated. The procedure can bring up strong feelings, and preparation matters.
NICE says to offer EMDR to adults with PTSD in some circumstances and to consider it for children and young people in others (England and Wales). In the US, the 2023 VA/DoD guideline recommends EMDR among specific trauma-focused psychotherapies for PTSD; its recommendations apply to its stated clinical scope.
History
Francine Shapiro described the procedure in a controlled study in 1989, then published a foundational text in 1995.
Key people
Francine Shapiro developed EMDR.
Sources and inspection notes
Supports: An introductory description of the approach from a UK professional body.
NHS, Treatment for post-traumatic stress disorder (PTSD)
Supports: That EMDR is listed among the treatments for PTSD in NHS information (UK).
NICE, Post-traumatic stress disorder (NG116)
Supports: That the guideline contains recommendations on EMDR for adults, children and young people with PTSD, with conditions on timing and engagement (England and Wales).
Supports: The first controlled study of the procedure, by its developer.
US Department of Veterans Affairs, National Center for PTSD. Overview of psychotherapy for PTSD.
Supports: US VA/DoD 2023 guideline summary recommends EMDR, cognitive processing therapy and prolonged exposure as individual trauma-focused psychotherapies for PTSD.