What Is EMDR Therapy and How Can It Help After a Traumatic Event?

EMDR (Eye Movement Desensitisation and Reprocessing) is a form of trauma therapy used to help people recover after frightening or traumatic experiences, such as a car accident, an assault or a medical emergency. It has been researched for decades and there is good evidence that EMDR can reduce symptoms of PTSD. It is recommended in UK clinical guidelines and is used internationally in the treatment of trauma.

But before explaining how EMDR works and what actually happens during an EMDR session, it helps to understand why something that happened in the past can continue to affect you long after the danger itself has gone.

When something frightening is over, but it doesn’t feel over

When something happens that seriously threatens us, frightens us or leaves us feeling powerless, our whole system responds. We don’t have to consciously decide what to do. Our attention changes, our body prepares to act and we become very good at noticing anything that might signal danger. In the moment, that is exactly what we need. Our brains also learn from experience, and we are particularly good at learning from danger. If you’ve been in a serious car accident, for example, it makes sense that your brain takes notice of what was happening around you at the time. A screech of brakes, the feeling of a car getting too close, a particular stretch of road or even a smell might become associated with what happened.

Usually, once danger has passed, we gradually learn that we are safe again. After a traumatic experience, however, reminders of what happened can sometimes continue to set off the same alarm. This can happen remarkably quickly, before you’ve had much chance to think, hang on, I’m actually safe here. So you can know that you are safe and still feel unsafe.

You might find that memories of what happened come into your mind when you don’t want them to, or that you have nightmares or flashbacks which make the experience feel frighteningly present again. You may avoid a place, a person, a conversation or anything else that reminds you of what happened because you don’t want to feel that way. You might also feel much more on edge than you did before. Perhaps you’re easily startled, constantly looking out for danger, finding it difficult to relax or becoming anxious when something reminds you of what happened. Sleep and concentration can be affected, and some people become more irritable or find themselves feeling detached or emotionally numb.

Sometimes the connection with the traumatic experience is obvious. You know why a particular sound, place or situation makes you anxious. At other times, you may notice the reaction first, such as your heart racing, a sudden feeling of fear, and an urge to get away, before you realise what has reminded you of what happened.

What happened to you is over. The fact that your brain still reacts to reminders of it doesn’t mean you haven’t tried hard enough to move on. There are understandable reasons why frightening experiences can continue to affect us after the danger has passed, and those reactions aren’t necessarily fixed. Our brains continue to learn from experience. EMDR is one way we can work with the memory of what happened, so that it can become something that belongs more firmly in the past.

How EMDR can help

During EMDR, we deliberately bring the traumatic memory to mind while also keeping some of your attention in the present. We use bilateral stimulation while doing this, which simply means alternating stimulation from one side to the other. This might involve eye movements, tapping or another method. As the memory is processed, people often notice that it begins to feel different. You don’t forget what happened and EMDR doesn’t erase the memory. Instead, it may become less vivid, less distressing or feel further away. The thoughts, emotions and physical reactions connected with it can change too.

This is where the difference between knowing and feeling can be important. As the memory is processed, something you already know intellectually — it’s over; I’m safe now — can begin to feel true in a way that it didn’t before.

We don’t yet fully understand the role that bilateral stimulation plays in this process, but there are several theories and research is continuing. What we do know is that EMDR has a substantial evidence base for PTSD and is included in UK and international clinical guidelines for its treatment.

What EMDR is like in practice

Before working directly with a traumatic memory, it is important to spend some time understanding what has brought you to therapy. I would want to know what happened, but also what life has been like for you since then. What is troubling you now? What are you avoiding? What happens when something reminds you of the experience? And, importantly, what would you like to be different?

We would also spend some time preparing for the memory work itself. EMDR can bring up difficult feelings, so I wouldn’t simply ask you to think about one of the worst experiences of your life and then hope for the best. We would talk about what to expect, what might help you if things feel difficult, and how you can let me know if you need to pause. When we do begin working with the memory, you don’t have to sit there and tell me every detail of what happened. I’ll ask you to bring the experience to mind and notice what comes up for you. We then use short sets of bilateral stimulation, with pauses in between so that I can ask what you’re noticing.

There isn’t a correct response you’re supposed to have. You might notice a thought, another memory, an emotion, an image or a physical sensation. Something may change in a way neither of us expected. My job isn’t to decide where your mind ought to go or to give you the “right” interpretation of what happened. We pay attention to what is coming up for you and work from there.

Although you’re connecting with a difficult memory, you are still here with me in the present. EMDR isn’t hypnosis and you don’t lose control of what is happening. If you need to slow down, pause or stop, we do.

Over the course of the processing, you may begin to notice that the memory doesn’t affect you in quite the same way. Perhaps an image that felt horribly vivid seems more distant, or something that immediately brought up fear no longer has quite the same emotional charge. Sometimes the change is in what you believe or feel about yourself when you think about what happened. You may also continue to notice things after an EMDR session. A memory, thought, feeling or dream might come up, or you might become aware of a connection you hadn’t noticed before. We can talk about this beforehand so that you know what to expect, and we come back to what you’ve noticed when we meet again.

Timing EMDR therapy

There isn’t a set number of EMDR sessions that everybody needs. When you are coming to therapy because of one particular traumatic experience, such as an accident or assault, the work can sometimes be quite focused and some people notice significant changes relatively quickly. For others, it takes longer. There are all sorts of reasons for that, because two people can go through apparently similar experiences and be affected very differently by them. Rather than deciding in advance how quickly you should process something, we would keep looking at how the memory is affecting you and what is changing as we work.

How often we meet matters too. EMDR is usually offered weekly, and sometimes more frequently. Once we have started actively processing a traumatic memory, I would generally recommend meeting at least once a week rather than leaving long gaps between sessions. This gives us continuity and allows us to build on the work from one session to the next. For some people, meeting more than once a week may also be appropriate and can allow the work to take place over a shorter period. How often we meet needs to take account of you, what we are working with and what is realistically manageable in your life.

EMDR is a structured therapy, but that doesn’t mean your response to it has to follow a predetermined timetable.

If you’ve just been through something frightening, perhaps a car accident, an assault, a traumatic medical experience or another sudden event, you may be having quite strong reactions to what happened. In the first few days and weeks, that doesn’t necessarily mean you need trauma therapy straight away. Our brains have a natural capacity to process difficult experiences, and for many people the initial reactions to a traumatic event gradually settle. Not everyone who experiences a traumatic event will develop PTSD. People who have been through the same accident can respond very differently afterwards. Some people recover naturally, while for others symptoms such as flashbacks, nightmares, avoidance or feeling constantly on alert continue.

So if you had a car accident yesterday, for example, I wouldn’t assume that feeling frightened, shaky, having trouble sleeping or thinking repeatedly about what happened means that you now need EMDR. Those reactions can make sense when something frightening has only just happened, and it is important to allow some time for your natural recovery process to take place.

If some time has passed and those reactions aren’t settling, perhaps you’re still having flashbacks or nightmares, you’re avoiding reminders of what happened, or part of you still seems to be responding as though the danger is present, then we can look at whether EMDR might be helpful.

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Further reading and references

National Institute for Health and Care Excellence (NICE) — Post-traumatic stress disorder (NG116)
UK clinical guidance on the recognition and treatment of PTSD, including recommendations for EMDR.

NHS — PTSD (post-traumatic stress disorder)
Information about PTSD, including common symptoms and treatments such as EMDR.

EMDR Association UK — The basics
An accessible introduction to EMDR, including what it is, how it is used and what EMDR therapy involves.