EMDR: Desensitization and Reprocessing

What Is EMDR?

EMDR (Eye Movement Desensitization and Reprocessing) is an integrative psychotherapeutic approach developed in 1987 by American psychologist Francine Shapiro. She accidentally discovered that rapid eye movements reduced the intensity of disturbing thoughts, then formalized this observation into a structured therapeutic protocol.

The underlying theoretical model, Adaptive Information Processing (AIP), posits that the brain has a natural information processing system that allows adaptive integration of life experiences. A traumatic event overwhelms this system, leaving the memory dysfunctionally stored — with its emotional charge, bodily sensations, and negative cognitions intact. EMDR aims to restart this blocked processing.

The 8-Phase Protocol

Phase 1 — History and Planning

Patient history, target traumatic memory identification, resource assessment, and treatment planning (1-3 sessions).

Phase 2 — Preparation

Therapeutic alliance, psychoeducation, stabilization techniques (safe place, breathing, grounding).

Phase 3 — Assessment

For each target memory: most disturbing image, associated negative cognition, desired positive cognition, emotion, disturbance level (SUD 0-10), and body sensations.

Phase 4 — Desensitization

The central phase. Patient simultaneously focuses on the traumatic memory and alternating bilateral stimulation (typically following therapist's moving fingers). 20-30 second sets are followed by pauses. Process continues until SUD reaches 0-1.

Phase 5 — Installation

Positive cognition is strengthened and associated with the reprocessed memory (VOC scale 1-7).

Phase 6 — Body Scan

Patient thinks of memory and positive cognition while scanning body for residual tension.

Phase 7 — Closure

Patient stabilization, self-soothing reminders, between-session guidance.

Phase 8 — Reevaluation

Verifying gains maintenance at next session start.

Mechanisms of Action

• Taxing working memory: dual task reduces memory vividness and emotional charge
• Memory reconsolidation: reactivated memory is reconsolidated with new emotional associations
• REM sleep connection: eye movements mirror REM sleep, when emotional memories are naturally processed
• Interhemispheric synchronization: bilateral stimulation promotes brain hemisphere communication
• Orienting response: eye movements activate a reflex signaling environmental safety

Efficacy and Recognition

• Recognized by WHO (2013) as recommended PTSD treatment
• Recommended by HAS (France) and APA
• Over 30 randomized controlled trials demonstrating PTSD efficacy
• Comparable to trauma-focused CBT, sometimes with faster results

Beyond PTSD

Also studied for anxiety, phobias, complicated grief, chronic pain, depression, addictions, and attachment disorders.

In Practice

Typically 6-12 sessions for simple trauma, longer for complex trauma. Sessions last 60-90 minutes. EMDR doesn't require detailed trauma narration.

Precautions

• Must be practiced by trained, certified EMDR therapist
• Not recommended during acute psychosis or severe dissociation
• Patient needs minimum emotional stabilization capacity
• Intense emotional reactions may occur between sessions

EMDR doesn't erase trauma. It allows remembering the event without triggering an emotional storm. The past remains the past, but it stops contaminating the present.