What is EMDR and the 8 phases of the protocol

In brief

EMDR stands for Eye Movement Desensitization and Reprocessing.
The person recalls a difficult event while receiving bilateral stimulation: following movement with their eyes, hearing sound alternating left and right, or feeling taps.
The method was developed by Francine Shapiro: her first observation was in 1987 and the first controlled study in 1989.
The protocol has 8 phases, from history taking to reevaluation at the next session.
Progress is tracked with the SUD scale (0–10, level of distress) and the VoC scale (1–7, how true a positive belief feels).
The WHO (2013) and NICE (2018) include EMDR among recommended treatments for PTSD in adults.
For PTSD, dissociation and other severe conditions, EMDR should be delivered by a trained professional.

Definition

EMDR is a structured psychotherapy method aimed at reprocessing memories that still cause strong emotions, physical tension and negative beliefs about oneself. The client keeps a fragment of the memory in focus while the therapist delivers short series — sets — of bilateral stimulation. Between sets the client reports what they noticed: images, thoughts, sensations.

The aim is not to erase the memory but to change its charge: the event stays in memory but is recalled more calmly, and a negative belief (“I am helpless”, “it was my fault”) gives way to an adaptive one (“I got through it”, “I did what I could”).

Where the method came from

1987 — the American psychologist Francine Shapiro notices that disturbing thoughts lose their edge when her eyes move rapidly from side to side.
1989 — the Journal of Traumatic Stress publishes her study of the method, then called EMD, with 22 participants who had traumatic memories.
1990 — the method is renamed EMDR: “reprocessing” is added to desensitization. Shapiro founds the EMDR Institute to train therapists.
2013 — the WHO includes EMDR in its guidance on stress-related conditions.
2018 — the 3rd edition of Shapiro's core textbook appears; NICE updates its PTSD guideline.

How it works: the adaptive information processing model

The theoretical basis of EMDR is the adaptive information processing (AIP) model. It holds that the mind normally “digests” difficult experience on its own, but an overwhelming experience can stay in memory unprocessed — with the same images, emotions and sensations as at the moment of the event. According to this model, bilateral stimulation helps start the processing.

The mechanism has not been fully established. The main explanations are:

Working memory load. It is hard to hold a memory in mind and follow a dot at the same time, so the image becomes less vivid and less emotional.
The orienting response. Movement produces a relaxed alertness that lowers physiological arousal.
Similarity to REM sleep, when the brain processes the day's experience — a hypothesis that is discussed but not considered proven.

Bilateral stimulation

Bilateral stimulation (BLS) is alternating input to the left and right sides of the body or visual field. Three kinds are used:

Visual — the eyes follow the therapist's finger or a dot on a screen that moves horizontally. This is the classic and best-studied form.
Auditory — a sound in headphones alternating between left and right.
Tactile — taps on the knees or palms, or vibration.

A set usually lasts from 20 seconds to a minute. The speed is chosen so that it is comfortable for the eyes to follow, and a short pause between sets leaves room for feedback. Online, visual and auditory stimulation move to the client's screen and headphones.

The 8 phases of the EMDR protocol

Shapiro's standard protocol has eight phases. Not all of them are completed in one session: preparation may take several appointments, and desensitizing a single target takes one or two sessions.

The phases of the protocol and their outcomes
#	Phase	What happens	Sign it is complete
1	History taking and planning	The presenting problem, resources, contraindications, choosing targets	A plan exists
2	Preparation	Explaining the method, a resource, the “safe place”, stabilization skills	The client can calm themselves
3	Target assessment	Image, negative belief (NB), positive belief (PB), VoC, emotion, SUD, location in the body	The target is described, scales are rated
4	Desensitization	Sets of BLS, with brief feedback in between	SUD 0–1
5	Installation	The positive belief is linked to the memory with sets	VoC 6–7
6	Body scan	The client holds the target and the PB in mind and notes any tension in the body	The body feels calm
7	Closure	A container for unfinished material, stabilization, instructions until the next appointment	The client is resourced
8	Reevaluation	At the next session: whether the result holds, what has come up, the next target	A decision on what comes next

What a target includes

In phase three the memory is broken into components that are then tracked:

Image — the worst picture from the event.
Negative belief — what the event says about the person now: “I am in danger”, “there is something wrong with me”.
Positive belief — what they would like to believe about themselves instead.
Emotion and the place in the body where it is felt.

The SUD and VoC scales

SUD (Subjective Units of Disturbance) is a rating from 0 to 10 of how disturbing the memory is right now, where 0 is not at all and 10 is the worst imaginable. The scale was proposed by the psychiatrist Joseph Wolpe.

VoC (Validity of Cognition) is a rating from 1 to 7 of how true the positive belief feels, where 1 is completely false and 7 is completely true. The scale was introduced by Shapiro.

Typical progress on a successful target: SUD from 7–8 down to 0–1 in phase 4, VoC from 2–3 up to 6–7 in phase 5.

What clinical guidelines say

WHO, 2013. Guidelines for the management of stress-related conditions: trauma-focused cognitive behavioral therapy and EMDR are recommended for adults, children and adolescents with PTSD.
NICE, 2018 (NG116). The UK's National Institute for Health and Care Excellence recommends EMDR for adults with PTSD after a non-combat trauma more than 3 months old; a course is typically 8–12 sessions.
American Psychological Association, 2017. A conditional recommendation for EMDR in adults with PTSD.

The guidelines cover therapy with a professional. They do not evaluate self-guided use of the protocol — which is why the self-guided format is suitable only for non-severe distress.

When you need a professional

EMDR should not be done on your own if you have:

PTSD or severe or complex trauma;
dissociative symptoms — gaps in memory, a feeling that things are not real;
epilepsy, because of a possible reaction to rhythmic visual stimulation;
a psychotic disorder;
pregnancy, without your doctor's approval;
suicidal thoughts.

If you are in crisis right now, call your local emergency number (112 in Europe, 911 in the US).

EMDR online

Since 2020, EMDR has been widely delivered by video, and professional EMDR associations have published guidance on remote work. What it takes:

a stable video connection and a screen on which the client can follow the stimulation;
stimulation controlled by the therapist — speed, color, sound;
a safety plan: what to do if the connection drops in the middle of a set;
a quiet place on the client's side where they will not be interrupted.

This is how the session for therapists in TetaLink is built. For milder concerns there is a self-guided mode with an autopilot.

Frequently asked questions about EMDR

Is EMDR different from the Russian term DPDG?

No. DPDG is simply the Russian translation of EMDR (Eye Movement Desensitization and Reprocessing). It is one and the same method and one 8-phase protocol.

How many EMDR sessions are needed?

It depends on the presenting problem. Preparation takes from one to several appointments, and desensitizing one target usually takes one or two sessions. For PTSD in adults, NICE (2018) describes a course of typically 8–12 sessions, more if needed. How many are right in a particular case is for a professional to decide.

Can EMDR be done online?

Yes. Since 2020 EMDR has been widely delivered by video. It needs a stable connection, a screen on which the client can follow the stimulation, stimulation controlled by the therapist, and a plan in case the connection drops in the middle of a set.

Can I do EMDR on my own?

Only for mild to moderate distress, with one clear target per session, the ability to stop at any moment and stabilization exercises. The WHO and NICE guidelines evaluate EMDR with a professional, not self-guided use. With PTSD, dissociation, epilepsy, psychosis, suicidal thoughts, or pregnancy without your doctor's approval, EMDR should only be done with a professional.

How much does online EMDR cost on TetaLink?

TetaLink is software, not therapy sessions. A therapist pays ₽2,000 per month and can run as many sessions with clients as they like; clients join the room for free. Self-guided practice with the autopilot costs ₽1,000 per month, with the first day free. Details are on the pricing page.

Sources

Shapiro F. Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress. 1989;2(2):199–223.
Shapiro F. Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures. 3rd ed. New York: Guilford Press; 2018.
EMDR Institute — emdr.com.
World Health Organization. Guidelines for the management of conditions specifically related to stress. Geneva: WHO; 2013. who.int.
NICE. Post-traumatic stress disorder. NICE guideline NG116; 2018. nice.org.uk/guidance/ng116.
American Psychological Association. Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder. 2017. apa.org/ptsd-guideline.
Wolpe J. The Practice of Behavior Therapy. New York: Pergamon Press; 1969.

This article is for information only and does not replace consultation with a professional.