EMDR for trauma: how does it work and who is it for?

As a healthcare psychologist I have been treating people with trauma for more than fifteen years, and EMDR is one of the methods that impresses me again and again. Yet it raises many questions among clients: what exactly happens when I have to follow those fingers, and why would that help? Understandable, because at first sight it seems almost too simple to be true. In this article I explain calmly what trauma does to your memory, how EMDR works, and who it is suitable for.

What is a trauma, really?

We use the word 'trauma' nowadays for all sorts of things, but in mental health care we mean something specific by it: the psychological after-effects of one or more drastic events, such as an accident, violence, loss or prolonged unsafety. The trauma is not the event itself, but what it does to you, sometimes years later.

What is characteristic of a traumatic memory is that it has not been 'tidily stored away'. An ordinary unpleasant memory fades and feels like the past. A traumatic memory can overcome you as if it is happening now: with images, smells, a pounding heart, fright. You know it is over, but your body and your brain have not yet received that message.

Do you recognise that a particular memory can still overcome you with full force, as if no time has passed? That 'not being processed' is exactly what EMDR targets.

What is EMDR?

EMDR stands for Eye Movement Desensitization and Reprocessing. It is a form of psychotherapy that was developed in the 1980s by the American psychologist Francine Shapiro, and which has since been further researched and refined worldwide. The core: reducing the emotional charge of a drastic memory, so that it no longer dominates your daily life.

Important to emphasise: the memory does not disappear, and that is not the intention either. What changes is how the memory feels. After a successful treatment you can think back to what happened without it still overwhelming you. The facts remain, the overwhelming tension around them melts away.

Many people find that a reassuring thought: you do not have to erase or forget your past to suffer less from it.

How does a session go?

An EMDR session looks unusual from the outside. Together with your clinician you bring the unpleasant memory to the fore, with the worst image and the feeling that goes with it. At the same time we ask you to do a distracting task, classically following a hand that moves back and forth, but it can also be done with sound (alternating in your left and right ear) or gentle taps.

You do that distracting task in short sets, with a moment of rest each time to share what came up. You do not have to tell your story in detail or relive it; you mainly allow what comes up by itself, and we follow where your brain goes. Step by step the tension around the memory diminishes.

The idea behind it is that recalling the memory and performing that task both draw on your working memory, which has only a limited capacity. Through that 'double work' the memory becomes less sharp and vivid, and your brain gets the chance to store it anew, more calmly.

Why does something so simple work?

That is exactly the question clients ask me most often, often with some scepticism. Honest answer: scientists do not yet fully agree on the exact mechanism. The most common explanation is the working-memory theory I just described: you cannot simultaneously hold a memory vividly and perform an attention-demanding task, and so the memory 'fades'.

What we do know for sure is that it works, and that is ultimately what counts. You do not have to fully understand the engine to notice that the car drives. In fact, many people find it pleasant precisely that they do not have to talk or analyse endlessly. EMDR does a large part of the work on a layer that sits beneath the words.

Doubt or scepticism, by the way, is entirely normal and no obstacle at all to the effect. You do not have to 'believe' in it to benefit from it.

Who is EMDR suitable for, and how well does it work?

EMDR is first and foremost proven effective for post-traumatic stress disorder (PTSD). It is recommended by the World Health Organization (WHO) and in the Dutch care standard for psychotrauma as one of the first-choice treatments. More than thirty controlled studies and a large meta-analysis with almost 6,000 participants show that it works, both directly after treatment and half a year later.

But it is not only for 'full' PTSD. Even with distressing memories that affect your daily life without all the criteria for PTSD being met, EMDR can help. Think of an unpleasant medical experience, loss, bullying, or a shocking event that you cannot let go of. Increasingly EMDR is also used for complaints with trauma underlying them, such as certain forms of anxiety.

Whether EMDR suits you we never determine on paper, but together during the intake, with an eye for your story, your resilience and your background. Sometimes stabilisation is needed first before we get to work with the memories. That is not a delay, but care.

What can you expect after a session?

EMDR can be intense. During and just after a session emotions can run high, and in the hours or days afterwards the processing sometimes continues: you may be more tired, dream more vividly or get new thoughts and images. That is, however uncomfortable, usually a sign that something is in motion.

We always prepare you for that and give you something to hold on to between sessions. Good trauma treatment also means that you know what you can do if things stir at home for a while. You are not on your own; we build it up carefully, at a pace you can manage.

And the beautiful thing? Many people notice a difference after just a few sessions. A memory that lay on your chest like a stone for years can then finally start to feel like what it is: something from the past. Imagine: which memory would you like to be able to give back to the past, where it belongs?

EMDR and your background

Trauma and the way you experience it are not separate from your language, culture and life history. What is experienced as threatening or shameful, and how you are allowed to talk about difficult events, differs from one world to another. A memory can be loaded with meanings that only make sense within your context.

That is why at AndersGGZ we carry out EMDR within a culturally sensitive approach and, where possible, in your own language. Precisely with trauma, where words often fall short, it makes a difference that your clinician understands your world.

Do you have the feeling that a drastic event still tugs at you? Then that is worth discussing, in a first conversation, at your own pace. You do not have to have solved it yourself first to apply.

EMDR, CBT or exposure — what is the difference?

EMDR is not the only proven treatment for trauma. Trauma-focused cognitive behavioural therapy (CBT) and exposure treatments are also recommended in the guidelines. With exposure you do, step by step and in a safe setting, expose yourself for longer to the memory or to situations you avoid, so that your body learns that the danger is over.

The biggest practical difference lies in the experience. Exposure asks you to allow the memory more extensively and for longer, whereas EMDR is often shorter and less 'verbal': you do not have to tell your whole story in detail or relive it again and again. For some people that feels lighter, for others the approach of exposure works better.

Which method suits best depends on your complaints, your preferences and what you can manage. Sometimes we combine techniques. The good news is that there is not one 'right' road, but several proven routes to the same goal. Which approach appeals to you most at first hearing?

Common misunderstandings about EMDR

Misunderstanding one: 'EMDR is a kind of hypnosis.' It is not. During a session you are fully awake, clear and present; you always keep control yourself and can stop at any moment. Nothing happens to you without your knowledge.

Misunderstanding two: 'I will lose my memories.' Also not. EMDR erases nothing; it takes the sharp, overwhelming charge off a memory. You will still know exactly what happened, it just hurts much less to think back to it.

Misunderstanding three: 'It works for everyone immediately and always.' That would be nice, but it is not that simple. With a single trauma it sometimes goes surprisingly fast, with more complex or long-term problems more time and build-up are needed. And as with any treatment, it does not work equally well for everyone. Setting honest expectations is, for me, simply part of it.

How many sessions do you need?

A question almost everyone asks, and rightly so. An honest answer is: that varies greatly. With a one-off, clearly delineated event (think of a single accident or a single shocking experience) a few sessions can already make a lot of difference. With trauma that has built up over years, or that is interwoven with other complaints, a longer road is needed.

We often work in phases. First we make sure you stand firmly enough to get to work with the heaviest memories: that is called stabilisation. Only after that do we process in a targeted way. That build-up is not a waste of time, but exactly what makes a treatment safe and sustainable.

What we do from the start is sketch a realistic picture together and adjust it along the way. So you do not have to begin with an open ending; we regularly evaluate whether you are on course and what you still need.

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This article is informative and does not replace personal advice from a care provider. In doubt, or do you have questions about your own situation? Feel free to contact us.