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TIRCIA · EMDR

EMDR in brief

How it works, and what science really says about it

Marie-Agnès Thulliez

By · Author · Publishing Director12-minute read

EMDR session: the therapist raises two fingers at the eye level of the patient, seen from behind

Following the therapist's fingers with your eyes to soothe a traumatic memory: EMDR therapy intrigues people, and arouses as much hope as suspicion. Yet it is one of the most extensively studied psychotherapies for post-traumatic stress in the world. How does it work in practice, who is it suitable for, and what do we really know about its effectiveness and its mechanisms? Here are the essentials, without exaggeration or shortcuts.

At a glance

  • EMDR helps memories lose their charge of distress: you remember, without reliving.
  • Its effectiveness in post-traumatic stress disorder (PTSD) is well established, at a level comparable to trauma-focused cognitive behavioural therapies.
  • It is delivered through a structured eight-phase protocol, by a trained professional; bilateral stimulation is only one part of it.
  • Exactly how it works is still partly a matter for research. Working memory is currently the best-supported explanation.

1. Where does EMDR come from?

EMDR (Eye Movement Desensitization and Reprocessing) was developed by the American psychologist Francine Shapiro in the late 1980s. She noticed that disturbing thoughts lost some of their intensity when her eyes moved rapidly back and forth, turned this into a procedure and published a first study in 1989 (Shapiro, 1989). The method was then structured into a complete protocol and has been the subject of dozens of clinical trials.

In France, EMDR spread in the early 2000s, championed in particular by David Servan-Schreiber, whose book Guérir (2003) [published in English as "The Instinct to Heal"] introduced it to the general public, and by Jacques Roques, one of its French pioneers, author of the volume on EMDR in the French "Que sais-je ?" series.

2. What EMDR aims to do

EMDR aims to change the effect of the traumatic memory while leaving the memory itself in place: it remains part of the person's story, but it no longer triggers the same distress. This change can be compared to the shift from an open wound, painful at the slightest touch, to a scar: it can still be seen, but it no longer hurts.

In concrete terms, this means fewer flashbacks and nightmares, less avoidance, vigilance that settles, and often a change in the way people see themselves: "it's my fault" becomes "I did what I could".

3. How EMDR therapy unfolds

EMDR follows a standardised eight-phase protocol. Working on memories is only one part of it:

PhaseIn a few words
1. History takingThe person's history, symptoms, choice of the memories to be processed.
2. PreparationExplaining the method, building the therapeutic alliance, tools for regulating emotions.
3. AssessmentImage of the memory, negative belief, desired positive belief, emotions, intensity from 0 to 10, bodily sensations.
4. DesensitisationThe person briefly holds the memory in mind during short sets of bilateral stimulation, then simply says what comes up.
5. InstallationThe positive belief is strengthened.
6. Body scanChecking that no tension linked to the memory remains.
7. ClosureEnding the session in a stable state.
8. Re-evaluationAt the next session, reviewing what has changed.

Bilateral stimulation can take the form of eye movements, alternating tones through headphones or alternating taps. The number of sessions varies a great deal: a few sessions may be enough for a single trauma, whereas repeated trauma, particularly in childhood, calls for longer work. It is common for memories, emotions or dreams to arise between sessions: this is expected, and is discussed at the next session.

For details of the theoretical model and the phases, see our article The AIP model.

4. Who recommends it, and how strongly?

EMDR is recognised for the treatment of PTSD, but the level of recommendation varies from one institution to another:

  • WHO (2013, updated 2023): EMDR is one of the recommended psychotherapies for adults, children and adolescents. The 2023 update places it among five options for adults, with a conditional recommendation based on moderate-quality evidence.
  • HAS, the French National Authority for Health (2007): EMDR is listed alongside CBT among the psychotherapies for PTSD.
  • NICE (2018): recommended for adults with PTSD related to non-combat trauma.
  • ISTSS (2019): among the recommended treatments for adults, children and adolescents.
  • APA (2025): in its updated guideline, EMDR is "suggested" (second tier), as are cognitive therapy and narrative exposure therapy. The first tier goes to cognitive processing therapy, prolonged exposure and trauma-focused CBT.

Saying that "all the major institutions make it a first-choice treatment" would therefore be an overstatement: EMDR is recommended everywhere, though not always in first place. Situation as of October 2026.

5. What the studies show

In PTSD, the results are solid and consistent. In a trial directly comparing EMDR and prolonged exposure in women who had been raped, both treatments did clearly better than the waiting list, with no difference between them, including six months later (Rothbaum et al., 2005). A Cochrane review found similar effects for EMDR and trauma-focused CBT immediately after treatment, while highlighting the still insufficient quality of many studies (Bisson et al., 2013). The idea that EMDR is "faster" rests on data too limited to be asserted.

Beyond PTSD, caution is called for. A meta-analysis of 76 trials concludes that the evidence remains insufficient to recommend EMDR for depression, anxiety disorders, chronic pain or addictions, and that, even in PTSD, few trials are of good methodological quality (Cuijpers et al., 2020).

Contraindications: what has changed

  • In 2007, the HAS (France) stated that EMDR was contraindicated in psychotic disorders. Since then, a randomised trial has shown that, in patients with both a psychotic disorder and PTSD, EMDR was effective and did not worsen symptoms, without a prior stabilisation phase (van den Berg et al., 2015).
  • Caution remains appropriate for people who are very unstable or in current danger: safety comes before work on memories. The initial assessment serves precisely to judge this.

6. How does it work?

The AIP model: a clinical framework

According to the adaptive information processing (AIP) model proposed by Francine Shapiro, an overly intense event is thought not to be "digested" normally: the memory remains stored with its original emotions and sensations. EMDR is thought to help the brain resume this processing. It is a useful model for guiding practice, and remains a framework rather than a demonstrated mechanism.

Working memory: the best-supported explanation

Our working memory, which holds what we are thinking about at any given moment, has a limited capacity. Recalling a distressing memory while following an eye movement places a double demand on it: the memory then becomes less vivid and less emotionally charged. This hypothesis is supported by numerous laboratory experiments (van den Hout and Engelhard, 2012).

And in the brain?

A few imaging studies observe, after successful EMDR, reduced reactivity of the amygdala and increased activity in certain prefrontal regions, which is consistent with better emotional regulation. But a review of 87 studies concludes that research on the neurobiological mechanisms of EMDR is still in its infancy, with small samples and preliminary results (Landin-Romero et al., 2018).

7. EMDR 2.0: a promising development, yet to be confirmed

Building on the working memory hypothesis, Ad de Jongh and Suzy Matthijssen proposed EMDR 2.0: the protocol stays the same, but additional tasks make the stimulation more demanding, in order to reduce the emotional charge of the memory more quickly. One question remains open: does it do better than standard EMDR?

  • Direct comparison: the only published trial, to our knowledge, comparing the two versions, conducted with 62 non-patient volunteers, found no superior effect for EMDR 2.0; it simply required fewer sets of stimulation (Matthijssen et al., 2021).
  • Intensive treatment: in the Netherlands, programmes lasting a few days that combine prolonged exposure and EMDR 2.0 achieve large reductions in symptoms, in adults as well as in adolescents and young adults (Matthijssen et al., 2024; Rentinck et al., 2025). But these studies have no control group, and EMDR 2.0 is combined with another therapy.
  • In groups and online: a small randomised trial, conducted with non-clinical volunteers who had experienced a road traffic accident, found better results for anxiety, stress and some trauma symptoms than with a WHO stress management module (Yaşar et al., 2025).

The ENHANCE trial, which compares standard EMDR, EMDR 2.0 and the Flash technique (in French) in patients, should provide the answer (Alting van Geusau et al., 2023): at the date of this article, its results have not yet been published.

Clinical vignette

Fictional case, composed from common clinical situations.

Hélène, 34, was assaulted in a car park a year earlier. She no longer drives in the evening, sleeps badly and sees the scene again several times a day. In the first sessions, the therapist goes over her history, explains the method and teaches her a breathing exercise. The target memory: the figure emerging from between two cars. Associated belief: "I am in danger". Intensity: 9 out of 10.

Over the sets of eye movements, other images emerge: her escape, the arrival of the emergency services, her sister's face at the hospital. Within three sessions, the intensity falls to 0 and the belief "it's over, I got through it" takes hold. The following sessions target the car park itself, then an imagined journey in the evening. Two months later, she is driving again.

What is established, and what is not yet

  • Established: the effectiveness of EMDR in PTSD, comparable to that of trauma-focused CBT.
  • Well supported in the laboratory: the role of working memory.
  • Not established: its effectiveness in most other disorders.
  • Yet to be confirmed: the precise brain mechanisms, and any superiority of EMDR 2.0 over standard EMDR.

Frequently asked questions

Is EMDR a form of hypnosis?

They are different: in EMDR, the person remains fully conscious and in control throughout the session, and can stop at any time.

Do I have to describe my trauma in detail?

Briefly bringing the memory to mind is enough; there is no need to give a full account of it.

Does EMDR work for everything?

Its strongest evidence concerns post-traumatic stress. For other difficulties, it can be considered, but the data are still insufficient.

Can EMDR be done online?

Yes, with particular precautions. See our article Online EMDR: what research says.

In a nutshell

EMDR is a recognised treatment for post-traumatic stress, whose workings are increasingly well understood, even if all its mechanisms are not yet known.

It should be delivered by a trained professional, within a complete protocol, and used for the indications where it has proven its worth.

References

  1. Alting van Geusau, V. V. P., et al. (2023). The effectiveness, efficiency, and acceptability of EMDR vs. EMDR 2.0 vs. the Flash technique in the treatment of patients with PTSD: Study protocol for the ENHANCE randomized controlled trial. Frontiers in Psychiatry, 14, 1278052. Link
  2. American Psychological Association (2025). New guidelines for treating PTSD and trauma. Monitor on Psychology, July-August 2025. Link
  3. Bisson, J. I., et al. (2013). Psychological therapies for chronic post-traumatic stress disorder in adults. Cochrane Database of Systematic Reviews. Link
  4. Bisson, J. I., et al. (2019). The International Society for Traumatic Stress Studies new guidelines for the prevention and treatment of PTSD. Journal of Traumatic Stress, 32(4), 475-483. Link
  5. Cuijpers, P., van Veen, S. C., Sijbrandij, M., Yoder, W., & Cristea, I. A. (2020). Eye movement desensitization and reprocessing for mental health problems: A systematic review and meta-analysis. Cognitive Behaviour Therapy, 49(3), 165-180. Link
  6. Haute Autorité de santé (2007). Affections psychiatriques de longue durée : troubles anxieux graves [Long-term psychiatric conditions: severe anxiety disorders] (guide ALD 23). Link
  7. Landin-Romero, R., Moreno-Alcazar, A., Pagani, M., & Amann, B. L. (2018). How does eye movement desensitization and reprocessing therapy work? A systematic review on suggested mechanisms of action. Frontiers in Psychology, 9, 1395. Link
  8. Matthijssen, S. J. M. A., et al. (2021). The effect of EMDR versus EMDR 2.0 on emotionality and vividness of aversive memories in a non-clinical sample. European Journal of Psychotraumatology. Link
  9. Matthijssen, S. J. M. A., et al. (2024). The effects of an intensive outpatient treatment for PTSD. European Journal of Psychotraumatology, 15(1). Link
  10. National Institute for Health and Care Excellence (2018). Post-traumatic stress disorder (NG116). Link
  11. World Health Organization (2013). Guidelines for the management of conditions specifically related to stress. Link
  12. World Health Organization (2023). mhGAP Evidence Centre: PTSD, psychological interventions (adults). Link
  13. Rentinck, E. M., van Mourik, R., de Jongh, A., & Matthijssen, S. J. M. A. (2025). Effectiveness of an intensive outpatient treatment programme combining prolonged exposure and EMDR therapy for adolescents and young adults with PTSD in a naturalistic setting. European Journal of Psychotraumatology, 16(1). Link
  14. Rothbaum, B. O., Astin, M. C., & Marsteller, F. (2005). Prolonged exposure versus eye movement desensitization and reprocessing (EMDR) for PTSD rape victims. Journal of Traumatic Stress, 18(6), 607-616. Link
  15. Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2(2), 199-223.
  16. van den Berg, D. P. G., de Bont, P. A. J. M., van der Vleugel, B. M., et al. (2015). Prolonged exposure vs eye movement desensitization and reprocessing vs waiting list for posttraumatic stress disorder in patients with a psychotic disorder: A randomized clinical trial. JAMA Psychiatry, 72(3), 259-267. Link
  17. van den Hout, M. A., & Engelhard, I. M. (2012). How does EMDR work? Journal of Experimental Psychopathology, 3(5), 724-738. Link
  18. Yaşar, A. B., et al. (2025). The effectiveness of online EMDR 2.0 group protocol in individuals who have experienced a traffic accident: A randomized-controlled study. Frontiers in Psychiatry. Link

This article offers general guidance, up to date at the date of publication. It is no substitute for the advice of a doctor, who alone can make a diagnosis, or for support from a psychologist or psychotherapist.

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