WTF is EMDR?

You've heard of EMDR. Maybe your therapist mentioned it, maybe you're on a waitlist for it, maybe you keep seeing it online and wondering if it's actually legit or another wellness trend with good branding.

This episode is the honest, no-shortcuts explanation you've been looking for.

Helen Billows — registered psychologist, EMDR therapist, and EMDR consultant — breaks down what EMDR actually is, how it works neurologically, and what happens in the room during a session. She covers the Adaptive Information Processing model, why trauma memories get stuck in the first place, and what a processed memory actually feels like from the inside.

No finger-waggling mysticism. A clear, evidence-based explanation from someone who does this for a full-time job.

If you're considering EMDR, currently in it, or tired of not understanding what people mean when they talk about trauma processing — start here.

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Follow Helen: @helenbillows | @thetraumanerd

Transcript

SPEAKER_00 0:05

Hello, I'm Helen Villows, and this is the Trauma Nerd Podcast. I'm a registered psychologist, EMDR therapist, and I work exclusively with trauma. This podcast is for people who want psychologically sound explanations without pop psych shortcuts, toxic positivity, or excuses dressed up as empathy. We'll talk about trauma, responsibility, relationships, and recovery, backed by nuance, honesty, and of course, actual evidence. Let's get into it. Hello and welcome to the Trauma Nerd Podcast. This is the very first episode. So thank you just so much for being here. I'm really glad you're listening. So I talk about EMDR all the time. Let's break down what it actually is. This episode is going to be what the F is EMDR? You wave your fingers around and my trauma just goes away. Sounds fake? Okay. It is weird, and you've probably heard EMDR described as the eye movement thing. But first, let me introduce myself properly. I'm Helen Billows. I am a registered psychologist, a fully trained EMDR therapist, an EMDR supervisor, which means I also help train other therapists in how to do this work. And I also run a trauma-focused private practice in Adelaide, South Australia. So yes, a big chunk of what I do with clients is EMDR. Not exclusively, but heavily, because it's a fabulous tool that I really love and that can really get to the root and what's keeping you stuck. So I am going to be up front. If you've done other therapy, like CBT, talk therapy counseling, if you're used to other styles, EMDR is going to be very different. And when I say different, I mean like aliens visited the planet kind of different. So today we're going to break down what exactly EMDR is, how it works, what trauma processing actually means, because it's kind of an abstract concept, isn't it? What does it mean to process my trauma? What's going to happen? Um, and how to tell if it's actually working. So let's start with a clear definition. EMDR stands for eye movement desensitization and reprocessing. It was developed in the late 1980s by Dr. Francine Shapiro, my idol, by the way. Uh, she basically she noticed, I think the story is she was walking to a park one day and she noticed that as she moved her eyes, uh, the intensity linked to a distressing experience seemed to reduce. I love that for her. What a vibe. Um, today EMDR is a structured eight-phase psychotherapy. It is a full psychotherapeutic product uh approach used to heal, treat trauma, and other disturbing or distressing experiences. It's not, so it's not just a strategy, it's a full therapy. And EMDR is now recognized as an evidence-based treatment for PTSD and trauma by well, international organizations. So the World Health Organization, the UK NICE Guidelines, the American Psychological Association, the Australian Psychological Association uh Association, um, all of the all the big dogs really worldwide. There's a very large body of research uh supporting EMDR. It's got a significant evidence base. So uh that's not to say that it didn't attract skepticism in the early days. And just to get an idea of the skepticism around EMDR, all you need to do is look at the Wikipedia page. It is savage. It's also biased and has a lot of inaccuracies, and it's very outdated. So I'm pretty up to date on the literature uh around EMDR, and quite frankly, whoever did that Wikipedia entry has beef. That's not to say I don't understand the skepticism. Because EMDR is so weird, I was skeptical before I personally trained in it and also did the therapy myself. I've done a lot of EMDR. But like I said, worldwide, it is considered a first-line trauma therapy. So take that, Wikipedia author. So to understand why EMDR works, we need to address the foundations beneath it. And that is the adaptive information processing model, or for short, AIP. The core idea is that your brain is naturally wired to process and integrate your experiences. So when life events happen, your system usually files them away as memories you can think about without reliving them. So think about your normal healthy memory storage system as a nice tidy uh filing cabinet that's all alphabetized and color coordinated, and it's all working just fine and dandy. But then something overwhelming, shocking, or traumatic happens that causes the processing system to break down. So the memory is unable to be filed appropriately, color coordinated, and alphabetized. As such, the memory gets stuck, it's not in the filing cabinet, and it's locked in what we call its state-specific form, with all of the vivid sensory, emotional content that you experienced when it occurred. That includes the images, the body sensations, any smells, any emotional responses, and any beliefs uh associated with those. So, or any beliefs associated with the event, I should say. So these unprocessed trauma contents, these un sorry, these unprocessed memory contents can continue to trigger reactions in your life because your brain hasn't integrated the experience into your memory properly. In EMDR, we intentionally and safely reactivate those unprocessed memories in a controlled context so your brain and nervous system can properly finish that process. Updating the memory, putting it in the filing cabinet, alphabetizing, color coordinating, it no longer bothers you anymore. So, what actually happens in EMDR? The actual eye movements or whatever you do, it's not necessarily eye movements, but we'll get to that later. Um, the eye movements are actually from so there's eight phases. Eye movements start at phase four. So you're not gonna walk into your first EMDR session and start eye waggling, okay? The early stages of EMDR are necessary to basically, well, first we need to figure out what's going on. We need to pick our memories, we need to figure out why you're in therapy, what your goals are, and how EMDR is going to help you. Uh, and if EMDR could help you, whether you're a good candidate for the EMDR. And then we're gonna collaborate and figure out what memories we need to target and what memories we need to prioritize because we have certain ways of doing that, and we have certain uh characteristics of memories that we prioritize to give you the best results too. So the first two phases of EMDR are history taking and preparation, and basically that's all that stuff. Sorting out what we're doing and getting you ready for it. Phases three to seven are actually the processing. So phase three, we are activating the memory. Phase four, we are doing eye movements, and phase five, six, and seven is kind of like the closing phases of the processing. So technically, if you are doing a memory processing session and you completely process your memory in that session, you will do phases three to seven in one session. The eighth phase of EMDR is re-evaluation, and that occurs the session after you do your memory processing, and that's really us checking how that memory is now and going from there. Maybe you need more work on it, maybe it's finished. So just to clarify, we've got the phase before EMDR starts, assessment and history taking and preparation. Then we've got the phases that involve active memory processing work, and then we've got the stage afterwards where we're checking in around how we've gone and going from there. So, in an actual EMDR processing session, where you're sitting down, you're like, okay, we're actually doing the memory work now. This is phase four. We will know what memory we're working on. We will have agreed on that uh beforehand. We're gonna activate the memory. We've got a process for that that will bring you through. You're gonna hold that memory in your brain while you also engage in a challenging task, which is usually eye movements, like I said, but sometimes, because actually the research, we know now that eye movements are not actually necessary for EMDR to work. It's more about doing a challenging task. So that is often the eye movements, but sometimes it can be tapping or other things. People in the Netherlands will have you walking in a square or spelling words backwards. Maybe those things simultaneously. And after about 40 seconds of doing that challenging task while you think of the memory, we'll pause and you'll stop doing the task and we'll say, What are you noticing now? And you'll just tell me whatever you're noticing in that very moment. Maybe you're having a certain feeling, maybe you're noticing something happening in your body, or maybe something visually is happening in your mind. So maybe there's a different, maybe you're like, oh, my perspective has changed before I was in the memory, now I'm looking at it from a third-person perspective. That is a very real change that people report, by the way. So you're gonna let me know it's going, and then I'm gonna say, notice that, and we're gonna keep going. Back into the task, back to thinking about the memory. Okay. So during EMDR, you can pause or stop at any point. You have full control. The only point you might get pushed a little bit is if you're wanting to stop because you don't want to face or experience the memory contents, um, or you're getting upset or you don't like it. Uh, so those are actually avoidance symptoms. And avoidance is a very common thing with trauma because it doesn't it doesn't feel good. So our body does often sort of automatically want to pull away from it sometimes. Um, not all the time, but that can happen. So your therapist would be doing a really good job if they gently challenged you because you're actually going to feel better if you keep going, because it's going to enable the memory to process. If we help you stop when it gets uncomfortable, we're actually enabling your avoidance. And I don't think you want to pay your therapist to do that for you. So ultimately, we want to activate the memory enough so that EMDR will work. And we do require it the memory to be activated in order for EMDR to work. Um, I do use this analogy. I use an analogy. I don't know how helpful this is, but you can't cook spaghetti if there's no spaghetti in the water. So we can have our pot here, we can have the water in there, we can have it boiling. But if your spaghetti is not in the water, it's not going to cook. So if you're you can be sitting in front of me and doing the eye movements and everything can look as it should be. But if that memory is not in your brain activated, nothing's going to happen because the past is not in the water. Okay. So I just want to note EMDR, yeah, we we can only do one memory at a time. And if you're somebody with a complex trauma history, you're probably going to be thinking, that's going to take forever because I've got a lot of memories that need to be worked on. So what we're always aiming for in EMDR is called generalization effects. And I want you to think of that like a Jenga stack. Your memory network might be stacked up to the rafters, but after we remove a few blocks, suddenly it's looking a little more precarious. Once we've removed enough of those blocks, the whole thing will tumble down. So this is the idea. We want to target the right memories, which we do strategically, in order to make the blocks full. This means efficient work, uh, where basically we can do as much work as possible while working on as few memories as possible. Don't get me wrong, I don't want to set you unrealistic expectations to think you're going to do a few memories and have your complex trauma healed. That is not the case. Um, unless you're one of those unicorn people that can do that can do that. Um, no, but it's more likely that you might need probably around 20-ish sessions, maybe even more. But I think um that's still not that bad when you're progressively feeling better and we're actually working towards an outcome that's helping. Um there's also no point plucking memories off the top. Um, and what I mean by that is we don't just want to target things that have happened recently. That's not gonna do you much good if you have a history of some of some kind of theme in your life that we're looking at, some memory network that goes all the way back to childhood. Plucking the memories off the top of the Jenga stack is not going to be enough. This is why we need to start in childhood, because we're gonna get those blocks from the bottom of the Jenga stack, and that's when we're gonna really see things topple over, and you're really gonna notice some change. So, what is actually happening in our brain that makes EMDR work? One an older idea was relating to EMDR integrating brain hemispheres through bilateral stimulation, that's the left, right, left, right movement of your eyes. Um, but as you know, because you're an expert now, the eye movements are not necessarily required. So we know that's not true anymore. Uh, the prevailing explanation we have per the current literature is what we call the working memory taxation theory. And it basically means that when you're holding an a traumatic experience in your working memory, aka you're thinking of it right now in front of me. If you do that while you do another task that requires your working memory, like a challenging task such as uh eye movements or tapping or spelling words backwards or walking in a square, it's difficult and your working memory system gets taxed. So it's working hard. And it seems to be that while that is happening, that taxation reduces the emotional vividness and intensity of the memory. So that seems to cause the memory to restore into your long-term memory a process known as memory reconsolidation, um, and it will carry less emotional charge. It will have all of the changes that we see in a processed memory. So this really aligns with the cognitive science and memory theory. Memories are not fixed files, they're dynamic and they can be act uh they can be updated if reactivated in the right conditions. I will just note this is the prevailing theory. It's not the only mechanism, probably, of how EMDR works. There are other ideas uh such as orienting responses, procedural learning. I think there's probably numerous mechanisms occurring simultaneously, but still pretty interesting. So, what does a processed memory look like? What on earth does it mean to process a memory? What does that look like? So, first of all, the memory no longer lives in the present. When a memory, when a trauma memory is stark, it can feel like it's happening right now. You think it, you feel it, you see through the eyes of that memory. Uh, and when it's processed, it stays in the past. It no longer hijacks your system. No more overreactions, no more disproportionate reactions, no more losing control of your thoughts and feelings. It just won't happen anymore. Or it will happen to a much reduced magnitude. The second is that it's not upsetting in the same way. So you'll be able to recall this memory and you might feel neutral, you might feel a bit sad or annoyed that it happened, but you're not going to be distressed by it anymore. So that's the real distinction. Before EMDR, you will find that memory disturbing or distressing to think about. It will probably be more than a six out of 10 on our the scale that we use. So a zero is neutral, 10 is the worst distress you can imagine. And before EMDR, you'll likely be able to recall that experience and feel more than a six out of 10. After EMDR, you're gonna feel a zero or a one out of ten. So a one or a zero is an indicator that a memory has effectively processed. Three, the negative beliefs will no longer feel true. So trauma memories will hold with them emotional beliefs about you, about the self. These can because some common ones include I'm not good enough, I did something wrong, I am powerless. I like to think about these beliefs as a verbalization of the emotion that's stuck in the memory. So usually these beliefs will be pretty consistent with how you feel. So if you feel ashamed or guilty, it's probably going to be I did something wrong. Um, if you feel worthless when you think about the memory, your self-belief is probably going to be something along the lines of I'm not good enough or I'm worthless. So get this right, this is pretty amazing. Post-processing, when you have completed the EMDR process, that belief will not feel true. So, and I want to really distinguish here the difference between intellectual understanding and emotional understanding. So before EMDR, you're likely, well, you may, not necessarily, but you may notice a contradiction between what feels true and what you know logically and intellectually is true. So, for example, some people will think back to a memory and say, I feel so worthless when I think about that experience, but I know logically that doesn't mean that I'm worthless. Like the fact that that happened to me, I shouldn't feel worthless. It doesn't make sense that I feel this way about myself. It's irrational. So CBT therapists are going to say, they're going to challenge your emotional belief. They're going to say, What's another way to think about that? What are some alternative perspectives? Uh, you're going to be engaged in a sort of um challenging your thoughts procedure in relation to that. But in EMDR, we know that that belief that feels true, that emotional belief, an emotional experience is just a symptom of the memory being stuck. So we don't worry about it too much. We just go, yep, of course that's there. Let's move on. We're gonna do processing. Uh so that belief is not going to live in your body anymore. EMDR will bring the body in alignment with the mind around your beliefs. And often, interestingly, this is a nice nugget to a healthy belief throughout the process of your processing will likely arise spontaneously. It often emerges organically, and we also uh, as part of the protocol, will strengthen that. So if your initial belief was um, I did something wrong or I'm to blame, you might come to a point in your processing processing where you go, oh my god, it wasn't my fault. I've just realized it wasn't my fault. Or perhaps you'll suddenly go, oh my gosh, that doesn't mean I was worthless. I can't believe I believed that about myself. So a healthy belief will actually replace the negative belief. Some common things, now these are not actual client reports, don't come at me opera, um, but some common things that clients can say, it feels really far away now. That's being that being the memory. It's not so close in my head. When I think of it, I can still see it, but it's not it's not upsetting. It's like the volume of the memory's been turned down. Uh I know it happened, but I really know it's over now. But before it felt like it was still happening. Uh, I feel calm, like my body finally believes I'm safe. And I'm noticing I can think about it without going into that spiral I usually do. So there's this shift from it's happening to it happened. And you'll be able to recall the experience whilst remaining regulated, even when your triggers are tested. So, best case scenario, a traumatic memory can be fully processed in a single session, 60 to 90 minutes. Now, do remember the content from earlier regarding the phases of EMDR. This doesn't mean you're only doing one session of therapy overall. It just means that when you do get to the actual EMDR active memory processing phase, that's phase four, it is fully uh sorry, it is possible to fully process that memory in a single session. I've done it many times. It doesn't always happen like that, you know. Uh it's probably off the top of my head one to three sessions for most people to process a memory could take even longer, depends on a number of variables, and also depends on that person. But all of the outcomes that we've just gone over that can happen after one session. And you can just imagine clients walk out. That session and go, what did you just do to me? It is it can feel quite miraculous. Um, it's not again, don't come at me, Abra. Uh, but it can feel like it. I should mention too that obviously that's pretty quick. Um, and within that quickness, the distress can shift quickly. It's quick and quick. So, for example, if you cut if you start your memory processing and you have rated your trauma a 10 out of 10 on the distress scale, it is entirely possible during an EMDR session for that memory that started at a 10 to get to a 5 out of 10 in 10 to 15 minutes. I've seen that happen again many times. And not only is that quick, but the durability of that change, research shows that EMDR outcomes, the improvements do tend to stick. So at six and 12 month or whatever amount of time follow-ups, the gains do tend to hold. So there is a strong likelihood that if you're that change that you're experiencing so quickly is gonna stick and maintain. How amazing is that? That's pretty cool. So does it work for everyone? No. Because nothing does, right? That would not be realistic. Anybody who promises you a hundred percent success rate for anything, any surgery, therapy, medication, is selling you snake oil because that doesn't exist. Nothing has a hundred percent effectiveness. The research on EMDR suggests approximately a 70% effectiveness rate. So that means that 70% of people who do EMDR will experience a clinically significant benefit. That doesn't mean total resolution. It means clinically significant, they got better to a point that was significant. So they probably walked away going, great, I feel heaps better. It might not be 100% problem-solved, there might be some little residual things, but overall I'm feeling much, much better than I started. That means that 30% of people will either not benefit from EMDR or not benefit to a point of clinical significance. So that in reality means that their school might improve a bit, they might they might notice some changes, um, but not enough for us to call it clinically significant. Um, so they're walking away going, that shit didn't work for me. Um but overall, you know, I think in therapy standards, 70% is a pretty strong effectiveness rate. So if your difficulties are rooted in trauma or trauma-related issues, EMDR is likely to be a really good option for you. I have a lot of thoughts on when EMDR doesn't work. Um, I might do a podcast on that in future. So that's it for today. The take-home message: trauma's healable. It is not a life sentence. Not only can you feel better, but the odds are ever in your favor. It is likely that you will. Thank you so much for listening. I have lots of ideas for upcoming episodes, and I can't wait to share them with you. I also want to know what you want to hear. As a clinician, you get very disconnected from what people want to know. So please head to my website and send in your questions. I would absolutely love to answer them. Um, send your ideas, send me anything you would like to know more about. I'll see you next time. That's it for today's episode of the Trauma Nerd Podcast. If you felt validated, yay! If you felt challenged, double yay! If you found this useful, you can follow or subscribe wherever you listen to podcasts. If you're interested in trauma focused therapy or resources, you can find more information at my website. Thanks for listening and bye for now.