EMDR Therapy: The Eight Phases and What It Treats
EMDR therapy is a structured, eight-phase treatment for distressing memories in which you attend to one piece of a memory while following a repeated left and right stimulus, usually the therapist's moving hand. This guide walks through all eight phases, what a session actually feels like, what the major guidelines recommend, and which parts of the research are still argued over.
Reviewed byMichael Callans, MSWThe eight phases of EMDR
- History and treatment planning. Your therapist takes a full history, identifies the memories, triggers and beliefs that could become targets, and puts them in an order.
- Preparation. You learn what EMDR involves, agree a stop signal, and practice calming and grounding skills, including a safe or calm place image you can return to.
- Assessment. One target is set up: the worst image, the negative belief it carries, the preferred belief, the emotion, where it sits in the body, a disturbance rating from 0 to 10 and a belief rating from 1 to 7.
- Desensitization. Short sets of bilateral stimulation while you notice whatever arises, repeated until the disturbance rating drops to 0 or as low as it realistically goes.
- Installation. The preferred belief about yourself is paired with the memory and strengthened with further sets until it feels as true as it can.
- Body scan. You hold the memory and the new belief together and scan your body for remaining tension or sensation, which is then processed.
- Closure. Every session ends with you stable and oriented, whether or not the target is finished, using the containment and grounding skills from phase two.
- Re-evaluation. The next session opens by checking what held, what changed in the week, and what to target now.
Terms you will hear
What the major guidelines say
World Health Organization, 2013
Individual trauma-focused cognitive behavioral therapy or EMDR should be considered for adults with PTSD. Quality of evidence rated moderate for both. The recommendation carries WHO's standard rather than strong rating.
NICE, NG116, United Kingdom
EMDR is recommended for adults with a diagnosis of PTSD or clinically important symptoms after a non-combat-related trauma, typically delivered over 8 to 12 sessions, alongside individual trauma-focused cognitive behavioral therapy. The committee did not extend the recommendation to combat-related trauma.
American Psychological Association, 2025
EMDR is a conditional recommendation: the panel suggests it. Cognitive processing therapy, prolonged exposure and trauma-focused cognitive behavioral therapy hold the strong recommendations. The 2017 edition rated EMDR the same way, and the 2025 update did not raise it.
Preparation sheet: fill this in before your first session
- My calm or safe place image, in enough detail to return to it: where it is, what I see, hear and feel there, and the word I will use to call it up.
- Three grounding moves that work for me when I am distressed, ranked by how reliable they are.
- My stop signal: the word or hand gesture I will use to pause a set, agreed out loud with my therapist.
- Two people I can contact after a hard session, and what I will actually say to them.
- The twenty-four hours after a session: what I have scheduled, what I can move, and how I will get home.
- My own early warning signs that I am outside my limit: what my body does, what my thinking does, what I start wanting to do.
What to tell your therapist, and what to ask
- Tell them: any history of dissociation, blanking out, or feeling detached from your body, including how often and what brings it on.
- Tell them: current substance use, current danger at home or work, pregnancy, eye conditions, epilepsy or seizures, and any recent head injury.
- Tell them: medications that blunt or amplify emotion, and anything that makes it hard to feel your body.
- Ask: are you EMDR trained or EMDRIA certified, and how many clients have you taken through all eight phases?
- Ask: how long will we spend on preparation before any reprocessing, and what decides when we start?
- Ask: what happens if I get overwhelmed mid-set, and what is the plan for the hours after a session?
- Ask: what will we target first, why that one, and how will we know whether this is working?
Tracking the week between sessions
Reprocessing can keep going after you leave, so therapists usually ask for a simple log rather than analysis. Note the date, what surfaced (a memory, a dream, an image, a body sensation), how strong it was out of ten, what you did, and whether it settled. Keep it to a few lines; this is information for the next session, not homework to be graded.
Two things are worth flagging early rather than at the next appointment: distress that does not come down within a day or two, and any new numbness, blanking out or sense of being outside your body. Both change the plan, and both are easier to handle before the following session than during it.
What EMDR is not
It is not hypnosis. You remain awake and aware, you can speak at any point, and you can stop a set with the signal you agreed.
It is not memory removal. The aim is that the memory stops arriving with the full force of the original moment, not that it disappears or that you stop caring about what happened.
It is not a one-session cure. Guideline estimates sit in the range of eight to twelve sessions for a single trauma, and more where there were many events over years.
It is not a self-help exercise. Moving your own eyes while thinking about the worst thing that happened to you misses the entire point of the protocol, which is that a trained person is watching your state, holding the structure and able to stop. Preparation you can do alone. Reprocessing you should not.
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About this tool
EMDR therapy, short for eye movement desensitization and reprocessing, is a structured psychotherapy for distressing memories. In a session you hold one piece of a memory in mind, the image, the body sensation, the belief about yourself that arrived with it, while you follow a repeated left and right stimulus: the therapist's hand moving across your field of vision, alternating taps on your knees or hands, or alternating tones through headphones. The psychologist Francine Shapiro noticed in 1987 that her own intrusive thoughts lost some of their charge while her eyes moved back and forth during a walk, turned the observation into a procedure, and published the first controlled study of it in 1989.
Read the diagram as text
A brand lens shape runs between two quiet posts at the left and right edges of a field, with an accent dot at each turn and a chevron on each pass: the repeated left and right stimulus. Below it the same memory is drawn twice across a dashed divider, each time as one box holding the same three pieces, a picture, a line of writing and a body with a sensation mark. On the left the box carries a heavy brand ring and radiating brand spikes, the charge the memory arrives with, and its sensation mark is accented. On the right the identical box has only a quiet dashed ring and a soft sensation mark. The accent marks what the method works on, the charge, not the memory itself. On the phone canvas the two scenes stack with the lens between them.
One target memory, before and after the sets
Conceptual contrast, not ratings
The same memory and the same pieces of it: the image, the belief about yourself, the body sensation. Nothing is erased.
The target is set up and held in mind: The image, the belief and the place it sits in the body arrive together, and the memory carries its full charge.
Short sets of left and right stimulus, repeated: The same memory is still there, with the same pieces, and the charge it carries is lower.
The theory behind the method is called adaptive information processing. Shapiro proposed that most experience gets filed in memory in a usable form, connected to everything else you know, but that a sufficiently overwhelming event can be stored in a raw state instead: the pictures, sounds, body sensations and conclusions of the worst moment, locked together and unintegrated. On that account a trigger in the present reaches the raw file, which is why a smell or a tone of voice can produce a reaction that belongs to another decade. EMDR is meant to reopen the file under conditions where it can finish processing. The model is a working theory, not a settled account of what the brain does.
EMDR runs through eight phases, and the first two are not reprocessing at all. History taking maps your life, your symptoms and the memories that may become targets. Preparation teaches you how to stop, how to settle your body, and how to reach a calm internal image before anything distressing is touched. Assessment picks one target and measures it. Desensitization is the back-and-forth phase people picture when they hear the word EMDR. Installation strengthens a new belief about yourself. The body scan checks for leftover physical residue. Closure returns you to a stable state before you leave. Re-evaluation opens the next session by checking what held.
A session feels less dramatic than people expect. You sit facing the therapist, agree on a target memory, and rate how disturbing it feels right now on a zero to ten scale. Then you track their fingers, or hold buzzers, for twenty to forty seconds, stop, and say whatever came up: a different scene, a sentence, a tightness in your chest, sometimes nothing. The therapist usually says little beyond asking you to notice that, and the sets continue. Most people stay fully aware and in control throughout. Emotion can rise sharply and then drop, which is why the preparation phase comes first.
EMDR appears in the main national and international guidelines for post-traumatic stress disorder. The World Health Organization's 2013 stress guidelines say individual trauma-focused cognitive behavioral therapy or EMDR should be considered for adults with PTSD, rating the evidence for both as moderate. The UK National Institute for Health and Care Excellence recommends EMDR in guideline NG116 for adults with PTSD after a non-combat-related trauma, typically over eight to twelve sessions, and the committee limited that recommendation to non-combat trauma on the evidence it had. The American Psychological Association's guideline, updated in 2025, is more reserved: it suggests EMDR rather than recommending it, with cognitive processing therapy, prolonged exposure and trauma-focused cognitive behavioral therapy carrying the strong recommendations instead. The 2017 edition rated EMDR the same way, so eight more years of trials did not move it.
The honest reading of the trials is that EMDR works about as well as the best-tested trauma-focused talking therapies, and that the eye movements themselves are the contested part. Davidson and Parker's 2001 meta-analysis of thirty-four studies found EMDR no more effective than other exposure treatments and found no added benefit from the eye movements. Lee and Cuijpers reached the opposite conclusion in 2013, reporting a moderate additive effect for eye movements across fifteen therapy trials (d = 0.41) and a larger one in laboratory studies. Two decades of argument have not resolved it. What that debate does not undermine is the finding that the whole package helps people with PTSD.
People search for EMDR therapy for anxiety, panic, phobias, grief and chronic pain, and the evidence outside PTSD is thinner than the evidence inside it. Where anxiety follows an identifiable frightening event, a car accident, an assault, a medical emergency, a humiliation, clinicians often use the standard protocol on that memory and many report good results. For generalized anxiety with no clear origin, the research base is small and cognitive behavioral therapy has far more behind it. A reasonable approach is to ask a therapist what they would target and why, and to treat the absence of guideline support outside PTSD as a real limitation rather than a formality.
Side effects are usually short-lived but they are real. Distress can continue after a session, dreams can get vivid, and new memories can surface between appointments, which is the reason therapists teach grounding before they start reprocessing. EMDR is normally delayed, not refused, when a person is in current danger, is drinking or using heavily, is severely dissociative, or has a medical condition such as unstable epilepsy or a recent eye injury. In those cases the preparation phase gets longer and the stabilizing work comes first. A therapist who wants to begin reprocessing in the first session without that groundwork is not following the protocol.
Training matters more than the label on a website. In the United States, EMDRIA, the EMDR International Association, approves basic trainings that combine around twenty hours of instruction, twenty hours of supervised practice and ten hours of consultation. Finishing one makes a clinician EMDR trained. The separate EMDRIA Certified Therapist credential requires a license, more consultation hours, at least fifty EMDR sessions with twenty-five or more clients, advanced course work and renewal every two years. Either can be appropriate; it is reasonable to ask which one you are being offered, how many trauma cases the clinician has taken through all eight phases, and what their plan is if you become overwhelmed.
A few things EMDR is not. It is not hypnosis: you stay awake, oriented and able to stop. It is not memory erasure, and it is not a way of recovering memories that were never there, so a therapist should never tell you what your symptoms must mean about your past. It is not something to attempt alone from a video, because the point of the protocol is that someone else is tracking your state while you look at the worst thing. The printable below prepares you for that work: a resource and grounding plan modeled on the preparation phase, a glossary of the terms you will hear, and prompts for what to tell your therapist. For the calm-image resource itself, our Safe Place Imagery Script script is a longer version, and Grounding Techniques collects the orienting skills a therapist will want you to have ready.
References
- 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. Guilford Press; 2018.
- World Health Organization. Guidelines for the Management of Conditions Specifically Related to Stress. Geneva: WHO; 2013. https://www.who.int/publications/i/item/9789241505406
- National Institute for Health and Care Excellence. Post-traumatic stress disorder. NICE guideline NG116; 2018. https://www.nice.org.uk/guidance/ng116
- American Psychological Association. Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. 2025. https://www.apa.org/ptsd-guideline
- Lee CW, Cuijpers P. A meta-analysis of the contribution of eye movements in processing emotional memories. Journal of Behavior Therapy and Experimental Psychiatry. 2013;44(2):231-239. doi:10.1016/j.jbtep.2012.11.001
- Davidson PR, Parker KCH. Eye movement desensitization and reprocessing (EMDR): a meta-analysis. Journal of Consulting and Clinical Psychology. 2001;69(2):305-316. doi:10.1037/0022-006X.69.2.305
Cite this source
Psychology.com. (2026, November 6). EMDR Therapy. Psychology.com. https://psychology.com/tools/emdr-therapy
EMDR Therapy FAQ
What is EMDR therapy?
EMDR therapy is a structured treatment for distressing memories, developed by Francine Shapiro in the late 1980s. The name stands for eye movement desensitization and reprocessing. Across eight phases, a therapist takes a history, teaches you grounding and calming skills, then has you hold a specific memory in mind while following a repeated left and right stimulus, usually their moving hand, in short sets. Between sets you report whatever came up. The goal is that the memory stops carrying the charge of the original moment. It is used mainly for post-traumatic stress disorder and appears in the WHO, NICE and American Psychological Association guidelines for it.
How does EMDR work?
Nobody can answer that with certainty, and it is fair to be told so. The working theory, adaptive information processing, holds that an overwhelming event can be stored in a raw, unintegrated form, and that attending to it in short bursts while your attention is partly taken by something else lets it finish being filed. Competing explanations point to working memory: doing a demanding task while recalling a memory appears to make the image less vivid and less emotional. Others argue it is structured exposure with extra steps. The mechanism is unsettled; the outcome evidence for PTSD is stronger than the explanation for it.
Does EMDR therapy work for anxiety?
EMDR therapy has far more evidence for post-traumatic stress disorder than for anxiety on its own, and no major guideline recommends it as a first choice for anxiety disorders. Where the anxiety traces back to identifiable frightening events, many clinicians target those memories with the standard protocol and report good results, and small trials have looked at panic and specific phobias. For generalized anxiety with no clear origin, cognitive behavioral therapy has a much larger evidence base. If a therapist proposes EMDR for anxiety, it is reasonable to ask what memory they would target and what the alternative would be.
How many EMDR sessions will I need?
For a single traumatic event, guideline estimates commonly sit between eight and twelve sessions, and NICE uses that range for adults with PTSD. That count includes the history and preparation phases, which can take two or three sessions on their own before any reprocessing starts. Where there were many events over years, or where dissociation is part of the picture, the preparation phase is deliberately longer and the whole course runs longer with it. Sessions are often ninety minutes rather than fifty, so that a target can be opened and closed properly. Anyone promising resolution in one session is overselling it.
What are the side effects of EMDR?
The common ones are temporary: feeling tired or raw after a session, distress that lingers for a day or two, vivid dreams, and new memories or images surfacing between appointments. These are expected enough that the protocol builds in a closure phase and asks you to keep a brief log. Less commonly, people feel more detached, blank out, or find emotion harder to manage, and that is a reason to tell your therapist straight away rather than wait. Treatment is normally postponed when someone is in current danger, drinking or using heavily, or severely dissociative, with stabilizing work coming first.
Can I do EMDR on myself at home?
No, and the videos offering it are not EMDR. Reprocessing is the fourth of eight phases, and the three before it exist so that someone trained can assess whether you are ready, teach you how to stop, and build the resources you will need. During a set, the therapist is watching your breathing, your face and your language for signs you are outside your limit, which is exactly what you cannot do for yourself while looking at the worst thing that happened to you. What you can do alone is the preparation on this page: the calm place image, grounding, and the notes you take to your therapist.
Is EMDR better than trauma-focused CBT?
The comparisons do not show a clear winner. Head-to-head trials and meta-analyses generally find EMDR and trauma-focused cognitive behavioral therapies produce similar reductions in PTSD symptoms, which is why guidelines tend to list both. Davidson and Parker's 2001 meta-analysis concluded EMDR was no more effective than other exposure treatments. The practical differences are in the experience: EMDR involves less talking through the detail of the event and no written homework, while cognitive behavioral approaches ask you to describe or write the account and practice between sessions. Availability, cost and which one you can see yourself doing often matter more than the averages.