EMDR (Eye Movement Desensitization and Reprocessing) is one of the most misunderstood therapies among the general public, and one of the most effective for trauma. Developed in 1989 by the American psychologist Francine Shapiro after an almost accidental discovery, it is today the subject of more than 44 randomized controlled studies and is recommended as a first-line treatment for PTSD by the WHO (2013), the HAS (2007), the INSERM (2004) and the American Psychiatric Association. While the image of someone following a therapist's fingers with their gaze may seem strange, the underlying mechanisms are robust and the results documented. Here's everything I need to know about this remarkable therapy.
1. How does EMDR work? The AIP model
EMDR is based on the AIP (Adaptive Information Processing) model developed by Shapiro. Its central hypothesis: psychological disorders result from traumatic or disturbing memories that have not been properly processed and integrated by the brain.
Normally, when we experience a difficult event, the brain processes it gradually, particularly during paradoxical sleep, and integrates it into autobiographical memory as a past event. In trauma, this processing is blocked: the memory remains stored in its raw state (fragmented, sensory, emotionally charged) and is activated as a present danger in the face of stimuli recalling the event.
The bilateral stimulation used in EMDR (eye movements from left to right, alternating taps on the knees, or alternating sounds in the ears) would activate mechanisms similar to those of paradoxical sleep, facilitating the reprocessing and integration of the traumatic memory. The result: the memory loses its intense emotional charge and takes on the dimension of a past memory, painful but bearable.
| Indication | Level of evidence | Details |
|---|---|---|
| PTSD (post-traumatic stress) | Very high, WHO recommendation, HAS, APA | First-line treatment, effective on recent and old trauma |
| Complex trauma (PTSC) | High | Requires longer preparation and stabilization before reprocessing |
| Specific Phobias | Good | Particularly useful when the phobia is linked to an identifiable triggering event |
| Anxiety and attacks of panic | Moderate to good | Effective when a traumatic experience is causing the symptoms |
| Complicated grief | Moderate | Helps reprocess intrusive images and memories related to loss |
| Depression with underlying trauma | Moderate | Adjuvant treatment useful when trauma maintains the depression |
2. For whom and for what is EMDR recommended?
3. How does an EMDR session take place?
The standard EMDR protocol (Shapiro protocol) takes place in 8 phases:
- ●Phase 1, Anamnesis: collection of life history, identification of treatment targets (disturbing memories), assessment of psychological stability.
- ●Phase 2, Preparation: setting up an imaginary safe place, learning emotional stabilization techniques to manage discomfort between sessions.
- ●Phases 3-6, Processing the memory: identification of the negative belief linked to the memory and the desired positive belief, measurement of the intensity (SUDS and VoC), then series of bilateral stimulations while I access the memory.
- ●Phase 7, Closure: stabilization at the end of the session, regardless of the progress of the treatment.
- ●Phase 8, Reassessment: at the start of the next session, evaluation of what has happened since and adjustment of the treatment.
The number of sessions varies considerably depending on the nature of the trauma: from 3 to 5 sessions for a recent single trauma, to several months for complex traumas or busy life stories.## 4. What I may feel during and after a session
EMDR is an intense therapy. During the sessions, it is normal to:
- ●Feeling intense emotions (crying, anger, fear) is a sign that reprocessing is in progress.
- ●Having unexpected images, thoughts or bodily sensations related or not directly related to the targeted memory.
- ●Feeling tired or emotionally drained after the session, the following days may bring dreams or awareness.
My therapist will warn me of these effects and give me resources to manage them. EMDR is practiced only by psychologists or psychiatrists trained specifically in this protocol.
EMDR is not suitable for all profiles and requires rigorous prior evaluation. It is not recommended without a sufficient stabilization phase for complex trauma or in cases of severe dissociation.
5. Find an EMDR therapist and the practical aspects
In France, EMDR training is certified by EMDR France, the national association which publishes a directory of certified practitioners. All certified EMDR therapists are mental health professionals (psychologists, psychiatrists) who have followed specific recognized training.
Reimbursement depends on the professional consulted: consultations with a psychiatrist are reimbursed like any medical procedure. Sessions with a psychologist can be partially reimbursed via the MonPsy system (8 sessions on prescription). EMDR is generally practiced in weekly sessions of one hour to one and a half hours.
💡 tips to remember
- EMDR reprocesses traumatic memories by activating mechanisms similar to REM sleep: the memory loses its intense emotional charge and becomes a memory of the past, painful but bearable.
- EMDR is recommended as a first-line treatment for PTSD by the WHO, HAS and INSERM. It is effective on old traumas, even those that occurred decades earlier.
- The number of sessions varies: 3 to 5 for a recent single trauma, several months for complex traumas. Duration does not prejudge effectiveness, some changes are rapid and profound.
- Feeling intense emotions during sessions is normal and part of the retreatment. My therapist provides me with stabilization tools to get through these moments safely.
- I am looking for an EMDR France certified therapist (directory on emdr-france.org): certification guarantees rigorous training in the protocol and management of intense reactions.
