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While many find EMDR beneficial, potential dangers include experiencing intense emotional or physical reactions during or after sessions, a resurgence of repressed traumatic memories, and incomplete processing, which might leave the individual in a heightened state of distress. Like all therapies, working with a trained and experienced therapist is essential.
What is EDMR
Eye movement desensitization and reprocessing (EMDR) therapy is a treatment for mental health that uses eye movements and bilateral stimulation to help people who have experienced trauma.
EMDR is a therapy introduced by Francine Shapiro in 1989 for treating traumatic memories. It has since been proposed for various anxiety disorders like PTSD, panic disorder, and specific phobias.
EMDR helps people recall their traumatic events and process them in a new way to normalize them and make them less triggering and painful.
This therapy involves reconnecting the client to their memories safely and structured, following eight stages from preparation to reprocessing.
EMDR helps people to process any negative images, emotions, beliefs, and body sensations associated with the traumatic memories which seem to be unprocessed and causing harm.
EMDR is an individual therapy typically delivered once or twice a week for around 6-12 weeks. However, depending on their progress, some people may benefit from more or fewer sessions.
EMDR is now considered to meet criteria for evidence-based practice in the United Kingdom by the National Institute for Clinical Excellence (2005), in America by the American Psychiatric Association (2004), in Australia by the Australian Centre for Posttraumatic Mental Health (2007), and in the Netherlands by the Dutch National Steering Committee for Guidelines for Mental Health Care (2003).
Why is EMDR so Controversial?
EMDR is controversial because, while studies show its effectiveness for treating PTSD and trauma, the exact mechanism behind its success remains unclear.
A significant point of contention is the role of eye movements in EMDR, with some researchers believing they are essential and others seeing them as unnecessary. The effectiveness and mechanisms of EMDR have been widely debated.
Skeptics question whether eye movements, a core component of the therapy, are essential or just a placebo effect.
Some suggest EMDR may simply be an exposure technique without the need for eye movements, while others argue for its efficacy in treating trauma and PTSD.
A 2001 meta-analysis has concluded that EMDR therapy is proven effective, especially when compared to no treatment. However, its efficacy is comparable to other treatments like exposure treatments for anxiety and cognitive-behavioral therapy.
The hallmark eye movements of EMDR may not be crucial for its success. While initially promoted as a one-session solution, multiple sessions are often required for best results. As EMDR research continues, there’s a need for rigorous study design and consistent outcome measurements to ensure reliable findings.
Are There Any Dangers of EMDR Therapy?
Since EMDR therapy is used with people who have experienced trauma, it is essential that the practices are safe to use on these individuals.
EMDR therapy has been used for a long time, and there have not been any reports of any dangerous side effects. As such, there appear to be no dangers in using EMDR for a victim of trauma.
Overall, EMDR is considered to be a safe therapy. It is recommended by professionals and organizations such as the American Psychological Association (APA) and the World Health Organisation (WHO).
EMDR is a structured therapy with eight stages that must be followed since these are designed so that the pace of therapy is not too quick or too distressing for the client. Evoking traumatic memories too early in the treatment can be detrimental and emotionally affect the client.
Likewise, the bilateral stimulation stage of the treatment requires careful analysis by the therapist to determine whether the client is ready for this step.
Though parts of EMDR may sound dangerous, a skilled therapist will help the client prepare for the reprocessing before treatment and will not progress onto this stage until they believe the client is ready.
The therapist will also take the client’s history and teach them coping skills that will assist them in managing EMDR and any potential side effects.
As with any mental health therapy that tackles difficult topics or emotions, side effects may occur, and the therapist will keep this in mind during the sessions. A skilled therapist will develop a treatment plan that helps to minimize these risks.
EMDR Side Effects
It is important to recognize that any effective therapy can have potential side effects, so EMDR is no exception. Understanding the possible risks and challenges of EMDR can better equip both the therapist and the client to ensure the success of the therapy.
Below are some possible side effects:
Feeling uncomfortable
Any therapy can feel uncomfortable, especially at the beginning. Meeting and talking to someone you may not know very well can feel awkward, and it may not be easy to share your private thoughts and feelings, which can hinder your treatment.
For those with trauma, therapy is likely to be more challenging. Trauma survivors may have a hard time trusting others, and their survival response may become activated during treatment.
Surfacing of new memories
As you focus on a past memory, other memories may arise, which can be unsettling.
The therapist should work with you to determine how to contain and/or work on these additional memories to minimize your distress.
Intense emotions
Strong and intense emotions may come out during the therapy sessions, lasting from hours to days after the session.
After the sessions, you may become upset, agitated, or on edge. These feelings are not long-lasting; typically, as therapy carries on, the client improves their processing of emotions.
Physical sensations
You may find that during the sessions, you experience some physical sensations such as muscle tension and crying.
If this happens, remember you are always in control and can ask for a break if needed. These sensations are also not likely to continue for very long.
Vivid dreams
It is not unusual to notice new or intense dreams after attending an EMDR session. This may also present as shifts in recurring dreams.
If this happens, this is likely to show that your brain is reprocessing.
Feeling emotionally sensitive
You may feel more vulnerable to emotions during the EMDR sessions. Staying with a traumatic memory can be tiring and lead to feeling more sensitive to your emotions, so make sure to rest and care for yourself as needed.
Myths & Misconceptions
There are many myths and misconceptions about EMDR therapy, which can confuse anyone considering this type of treatment. Some of these include the following:
EMDR is only for those with PTSD
Many people may believe that EMDR is unsuitable as they are not diagnosed with PTSD.
However, while this therapy was originally developed for those with PTSD, it has also proved beneficial for other conditions, including anxiety, depression, panic, and dissociation.
EMDR is a type of hypnosis
The bilateral stimulation, such as the eye movements, understandably reminds people of hypnosis. However, this is not the case, and EMDR is not hypnosis.
Others may be skeptical about the bilateral stimulation working at all, but plenty of evidence supports that EMDR with bilateral stimulation is an effective treatment.
I will start reprocessing my traumatic memories straight away
While some people may feel ready to start reprocessing their traumatic memories straight away, other steps must be taken first.
EMDR requires a thorough preparation stage which includes taking the client’s history, ensuring they can engage in the bilateral stimulation, and having coping strategies in place.
Only when the therapist believes the client is ready will they progress onto reprocessing, which often starts after a few sessions.
I will have to discuss my trauma in detail
Some people may be put off by some therapies, which can require delving into traumatic memories and recounting loads of details.
With EMDR, however, clients are not required to share all the details of their trauma. The therapist will only need a few details to help the memories reprocess.
This way, the client controls how much they wish to share, and they are still likely to experience positive outcomes.
It plants false memories
Since EMDR deals with the reprocessing of memories, some may question whether this therapy can create false memories in people.
However, EMDR cannot create a memory that was not already there – it only works with memories that exist within the person.
It will cause me to lose control
People may think that engaging in EMDR therapy can cause someone to get so emotional that they lose control.
Any therapy has the potential to make someone feel emotional, but becoming so emotional that a client cannot return from it is highly unlikely and has not been reported for EMDR.
The therapist will ensure the client is thoroughly prepared for the reprocessing stage and that they are equipped with the tools and coping skills to manage any discomfort.
The client is also in control of the therapy, so if their feelings become too strong, they can ask for a break to recover.
Can EMDR Cause Dissociation?
Dissociation is characterized by a disconnection between a person’s thoughts, sensory experience, memory, and/or sense of identity.
Since dissociation can occur as a result of experiencing trauma, EMDR therapists will likely treat clients who are experiencing dissociation.
Although EMDR may not be the main therapy for dissociative individuals, it has the potential to improve their condition. The risks for people with dissociative disorders are inherently the same as with people with PTSD, and EMDR is not known to cause dissociation.
However, breaching the dissociative boundaries too early in treatment can be risky and result in an increase in suicidal ideation or destabilization.
Therefore, it is important that a skilled therapist goes through each stage of EMDR thoroughly and does not progress to the reprocessing stage until the client is ready.
Can EMDR Make Things Worse?
If your main coping method is to avoid and minimize your distress, it may feel easier to ignore your distress to make you feel better.
It can, therefore, be very uncomfortable to reflect on your trauma in EMDR.
To begin with, it can seem that EMDR makes things more painful, especially if you are working on something that has not been thought about for a long time.
What is important to remember is that these feelings are all a part of the healing process. Even if things get worse for a moment, that moment will not last, and eventually, you should feel better than you did before.
What are the benefits of EMDR?
There are many reasons why someone may consider EMDR therapy. There are many benefits to the treatment, including:
It is not solely for PTSD
While EMDR was devised to help those with PTSD, it is now proven beneficial for other disorders such as dissociative disorder, depression, and anxiety, especially when there are links with childhood trauma.
Often, EMDR can be used alongside other therapies to increase its results, especially for treating disorders other than PTSD.
Reduces unhelpful thoughts
EMDR is useful to help identify and challenge unhelpful thoughts associated with the traumatic memory. For example, many people may blame themselves for what happened to them in the past.
EMDR can help people to see that; realistically, they were probably not at fault. EMDR helps to declutter the mind of these negative thoughts and helps to replace them with more helpful and realistic ones.
Yields fast results
The main selling point of EMDR therapy is that it tends to have rapid results compared to other types of therapy.
EMDR focuses directly on the traumatic memory, which is causing distress, which may be why EMDR can be quicker than other treatments.
While you shouldn’t expect to complete the therapy as quickly as possible, many people who undergo EMDR report positive results, sometimes within as little as three sessions.
Minimal talking required
In EMDR, there is no pressure to disclose all the details of a traumatic experience. The therapy is likely to be as successful with the therapist only being aware of the basic details of the trauma.
For this reason, EMDR can be favorable for many people who have difficulty discussing their trauma.
Increases self-esteem
Since EMDR targets distressing memories and negative thoughts someone may have about themselves, these thoughts can be changed.
A client may believe they are weak, powerless, or useless because of their trauma, but processing the trauma can help them see that these negative self-statements are false.
Adjusting these negative thoughts about the self into something more positive can greatly impact the client’s self-worth.
Supported by research
EMDR has high rates of effectiveness, with as many as 30 clinical studies showing that EMDR is effective for people with PTSD, especially those dealing with a single trauma.
Studies have shown that EMDR can be just as effective as cognitive behavioral therapy (CBT) for treating trauma (Lewey et al., 2018) and panic disorder (Horst et al., 2017).
A 2014 study looked at 24 randomized controlled trials that support the effectiveness of EMDR for the treatment of trauma. The results of some of these studies suggested that EMDR therapy is more effective than CBT for trauma (Shapiro, 2014).
A 2021 study surveyed data from 33 EMDR therapists who gave therapy online. The results showed that EMDR provided over the Internet was still shown to help relieve mental health symptoms as it does in person (McGowan et al., 2021).
Further Information
Shapiro, F. (1995). Eye movement desensitization and reprocessing.
References
Davidson, P. R., & Parker, K. C. (2001). Eye movement desensitization and reprocessing (EMDR): a meta-analysis. Journal of consulting and clinical psychology, 69(2), 305.
de Jongh, A., Amann, B. L., Hofmann, A., Farrell, D., & Lee, C. W. (2019). The status of EMDR therapy in the treatment of posttraumatic stress disorder 30 years after its introduction. Journal of EMDR Practice and Research, 13(4), 261-269.
Hase, M., Balmaceda, U. M., Hase, A., Lehnung, M., Tumani, V., Huchzermeier, C., & Hofmann, A. (2015). Eye movement desensitization and reprocessing (EMDR) therapy in the treatment of depression: a matched pairs study in an inpatient setting. Brain and Behavior, 5 (6), e00342.
Horst, F., Den Oudsten, B., Zijlstra, W., de Jongh, A., Lobbestael, J., & De Vries, J. (2017). Cognitive behavioral therapy vs. eye movement desensitization and reprocessing for treating panic disorder: a randomized controlled trial. Frontiers in Psychology, 8, 1409.
Lee, C. W., & Cuijpers, P. (2013). A meta-analysis of the contribution of eye movements in processing emotional memories. Journal of behavior therapy and experimental psychiatry, 44(2), 231-239.
Lewey, J. H., Smith, C. L., Burcham, B., Saunders, N. L., Elfallal, D., & O’Toole, S. K. (2018). Comparing the effectiveness of EMDR and TF-CBT for children and adolescents: A meta-analysis. Journal of Child & Adolescent Trauma, 11( 4), 457-472.
Lewey, J. H., Smith, C. L., Burcham, B., Saunders, N. L., Elfallal, D., & O’Toole, S. K. (2018). Comparing the effectiveness of EMDR and TF-CBT for children and adolescents: A meta-analysis. Journal of Child & Adolescent Trauma, 11 (4), 457-472.
Mazzei, R. (2021, January 27). What is Resourcing in EMDR Therapy? Evolutions Behavioral Health Services. https://www.evolutionsbh.com/articles/what-is-resourcing-in-emdr-therapy/
McGowan, I. W., Fisher, N., Havens, J., & Proudlock, S. (2021). An evaluation of eye movement desensitization and reprocessing therapy delivered remotely during the Covid–19 pandemic. BMC psychiatry, 21 (1), 1-8.
Rogers, S., & Silver, S. M. (2002). Is EMDR an exposure therapy? A review of trauma protocols. Journal of clinical psychology, 58(1), 43-59.
Shapiro, F. (1989). Eye movement desensitization: A new treatment for post-traumatic stress disorder. Journal of behavior therapy and experimental psychiatry, 20(3), 211-217.
Shapiro, F. (2014). The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences. The Permanente Journal, 18 (1), 71.
Shapiro, F. (2017). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures. Guilford Publications.
Shapiro, F., & Maxfield, L. (2002). Eye movement desensitization and reprocessing (EMDR): Information processing in the treatment of trauma. Journal of clinical psychology, 58 (8), 933-946.
Valiente-Gómez, A., Moreno-Alcázar, A., Treen, D., Cedrón, C., Colom, F., Perez, V., & Amann, B. L. (2017). EMDR beyond PTSD: A systematic literature review. Frontiers in psychology, 8, 1668.
van den Berg, D. P., & van der Gaag, M. (2012). Treating trauma in psychosis with EMDR: a pilot study. Journal of behavior therapy and experimental psychiatry, 43 (1), 664-671.
Wanders, F., Serra, M., & De Jongh, A. D. (2008). EMDR versus CBT for children with self-esteem and behavioral problems: A randomized controlled trial. Journal of EMDR Practice and Research, 2 (3), 180-189.
