WTF is EMDR, Anyway?

I actually suck at explaining EMDR to patients. At least, succinctly. If you’ve got 10 minutes, I can muscle my way through it, but I’m never sure if I’ve raised more questions than I’ve answered by the time I’m done. 

Today I’m going to take a stab at explaining it in writing. 

EMDR (eye movement desensitization reprocessing) is a highly researched, evidence-based psychotherapy that was originally developed to treat trauma, complex trauma and PTSD.

In the old-school version, the therapist reprocessed traumatic events by moving two fingers in front of the client’s face and instructing the client to follow their fingers with their eyes — hence the first two letters in EMDR’s acronym, eye movement. The process looked and probably felt a lot like the hypnosis we’ve seen in black and white movies, which didn’t thrill patients and which I’m told gave all the OG’s tendonitis from the endless hand motions.

What it should be called is BLSDR (bilateral stimulation desensitization reprocessing), even though BLSDR sounds like a sex fettish, because what makes it work is the bi-lateral stimulation (BLS) that’s provoked by following the therapist’s fingers with your eyes. And we facilitate BLS a bunch of ways these days.

Bilateral stimulation means stimulating both sides of the brain, and we can facilitate BLS through the use of alternate tones in the ears (sound), alternate vibrations on the hands or legs (tactile), alternate tapping (also tactile), by following the shrink’s fingers (visual), and by following digital dots on a computer screen (also visual). 

Here’s why BLS and EMDR work: 

Traumatic memory gets stored in the amygdala which is the part of the brain that does 1 thing: It keeps us alive by choosing one of three options in a crisis: fight, flight or freeze. You’ve probably heard this.

When you’re out of danger or no longer in the stressful situation and you find your brain continuously replaying the unpleasant memory on loop, that’s your brain trying to process it. But because it’s an upsetting, highly emotional memory, it’s stored in your amygdala and your amygdala can’t reprocess it because, once again, the amygdala’s only job is to keep us alive by choosing fight, flight or freeze. Or by replaying an unpleasant memory on loop so you don’t do the scary thing that your brain linked with the traumatic event again. 

Today, if you’re lucky enough to live in a place where you’re not in danger, your amygdala will latch on to emotionally stressful memories as though remembering them is vital to your survival, because its purpose is to hunt for threats.

Which brings us back to EMDR. 

What started out as a treatment for trauma has proven effective for all kinds of stuff. 

I use it for anxiety, depression, phobias, and especially when someone says something like, “My brain knows this is OK but my feelings aren’t in agreement.”

To be honest, we don’t exactly know why EMDR works other than this: 

Stuck feelings and traumatic memories get lodged in our amygdala, which, as we’ve discussed, cannot process information beyond choosing the fight flight or freeze response in a crisis. 

Bilateral stimulation activates the prefrontal cortex (PFC) of the brain which is the part of the brain that can organize, synthesize, and reprocess information. 

So, the therapist “develops a target” which is a complicated process that would put you to sleep if I tried to explain it, but suffice to say, they identify a very narrow, specific entry point of the memory, they ask the client to imagine themselves in that very specific entry point, and once they’re sure the client’s amygdala is activated (which makes me feel sadistic for a few seconds every time I do it), they employ the BLS which then lights up the PFC and when both parts of the brain are lit up — and you’re with a very well-trained shrink who is certified in EMDR — they take you on an emotional rollercoaster which can feel like a lite version of ayahuasca (sans puking), ending with the issue being reprocessed and desensitized — hence the last two letters in EMDR’s acronym, desensitization reprocessing.

EMDR is to talk therapy what a power screwdriver is to a manual screwdriver. 

That said, it’s most effective when the client can really lean into the process, and most people aren’t able to lean into something like that with a stranger. Which usually means I’m doing talk therapy for a few months until my clients tells me they’re ready. 

When they’re ready, I try to sketch out the memory that we’re going to reprocess in the session before EMDR, and then for the EMDR session, I carve out a minimum of an hour and a half to ensure that my client is emotionally stitched up by the end of the session. 

I will not hesitate to postpone or cancel my next appointment if my client isn’t grounded and regulated (ie, she’s still fucked up) by the end. To do less feels to me like a surgeon who didn’t book the operating room for enough time. I always tell my clients: You should walk out of my office (virtual or irl) feeling at least as good as you felt walking in. Otherwise, my job’s not done. 

That night, there’s no drinking or using recreational drugs, otherwise we run the risk of having to do the whole thing again. <- I’m talking about my client here. 

In the 24-48 hours post-EMDR, your nervous system will continue to reprocess the memory whether you try to or not. There’s nothing you have to do. It all happens organically. Most of my clients report feeling like they just finished final exams after EMDR. They’re tired that night and energized in the days that follow. 

For the next 3 weeks, I test the work we did to ensure that the target is properly reprocessed. 

What I mean by “properly reprocessed” is that the client can recall the memory and reports that it no longer causes them distress. They know a bad or unpleasant thing happened, but they’re able to recall it with a level of objectivity that no longer makes them feel as though they’re back in that moment. They often walk away with a new positive narrative about how they handled themselves in the original memory. 

So that’s the story of EMDR. And now you know why it takes me so long to explain it irl. 

Hit me up on the socials with any questions you have about it 😉