EMDR: the research
foundation.
Eye Movement Desensitization and Reprocessing (EMDR) was developed by Francine Shapiro, Ph.D., following her initial observations in 1987 and formalised in a landmark randomised controlled trial published in 1989. In the decades since, EMDR has accumulated one of the most robust evidence bases of any trauma-focused psychological intervention.
Foundational Research
Shapiro's original 1989 study demonstrated significant reductions in subjective distress in trauma survivors following eye movement desensitisation. Her subsequent development of the Adaptive Information Processing (AIP) model proposed a theoretical mechanism: traumatic memories become "frozen" in the nervous system in a form that cannot be fully integrated, and bilateral stimulation supports the brain's natural information-processing capacity to assimilate those memories adaptively.
"Subjects receiving EMD showed a significant decrease in disturbance related to traumatic memories and a significant positive change in beliefs about those memories."
Shapiro, F. (1989). Eye movement desensitization: A new treatment for post-traumatic stress disorder. Journal of Behavior Therapy and Experimental Psychiatry, 20(3), 211–217.
Shapiro's full formalisation of the eight-phase protocol, including the Adaptive Information Processing model, established the clinical framework that remains standard practice today.
Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures (2nd ed.). Guilford Press.
International Clinical Endorsement
EMDR is now endorsed as an evidence-based treatment for PTSD and trauma-related conditions by the following bodies:
- World Health Organization (WHO) — Guidelines for the Management of Conditions Specifically Related to Stress (2013). Recommends EMDR and trauma-focused CBT as the two first-line psychological treatments for PTSD in adults.
- American Psychological Association (APA) — Clinical Practice Guideline for the Treatment of PTSD in Adults (2017). Conditionally recommends EMDR as an evidence-based treatment for PTSD.
- National Institute for Health and Care Excellence (NICE), UK — Post-Traumatic Stress Disorder (NG116) (2018). Recommends EMDR as one of two first-line treatments for PTSD in adults.
- International Society for Traumatic Stress Studies (ISTSS) — Designates EMDR as a "strong recommendation" for adults with PTSD.
Meta-Analytic Evidence
Multiple high-quality meta-analyses have confirmed the efficacy of EMDR across populations and trauma types:
- Bisson, J.I., et al. (2013). Psychological therapies for chronic post-traumatic stress disorder in adults. Cochrane Database of Systematic Reviews, Issue 12. Found trauma-focused psychological therapies including EMDR were more effective than non-trauma-focused treatments and waitlist controls.
- Lee, C.W., & Cuijpers, P. (2013). A meta-analysis of the contribution of eye movements in processing emotional memories. Journal of Behavior Therapy and Experimental Psychiatry, 44(2), 231–239. Found significant effect of eye movements on emotionality and vividness of trauma memories in analogue studies.
- van Etten, M.L., & Taylor, S. (1998). Comparative efficacy of treatments for post-traumatic stress disorder. Clinical Psychology & Psychotherapy, 5(3), 126–144. Meta-analysis of 61 treatment outcome studies; EMDR and behaviour therapies showed superior outcomes compared to pharmacotherapy.
- Chen, Y.R., et al. (2014). Effectiveness of EMDR for trauma among children and adolescents: A meta-analysis. Journal of Traumatic Stress. Confirmed efficacy of EMDR across paediatric populations.
The Bilateral Stimulation Mechanism
The active ingredient most associated with EMDR's unique effect — bilateral stimulation (BLS) via eye movements, taps, or bilateral audio — is the subject of ongoing research. Leading hypotheses include:
- Working memory hypothesis: Dual-task processing during BLS taxes working memory, reducing the vividness and emotionality of traumatic imagery (Maxfield et al., 2008; van den Hout & Engelhard, 2012).
- Orienting response: BLS elicits a reflexive orienting/relaxation response, reducing physiological arousal during trauma memory activation (Armstrong & Vaughan, 1996).
- REM sleep analogy: BLS may mimic the information-consolidation processes of REM sleep, facilitating adaptive memory processing (Stickgold, 2002).
While the precise mechanism remains under investigation, the therapeutic effect of BLS-supported trauma processing is well-established across multiple independent research groups and populations.
The rationale for
between-session support.
A consistent finding across psychotherapy research is that between-session engagement — practice, self-monitoring, and skill generalisation — predicts better treatment outcomes. In trauma-focused therapies, between-session work serves the additional function of consolidating and extending the regulatory gains made within sessions.
Between-Session Engagement in Trauma Treatment
Research consistently demonstrates that between-session practice and homework completion is positively associated with PTSD symptom reduction and treatment outcomes across modalities (Kazantzis et al., 2016). In EMDR specifically, therapists routinely assign grounding exercises, container techniques, safe/calm place visualisations, and resourcing practices for clients to use between sessions. These exercises serve to:
- Maintain affect regulation capacity outside the therapeutic frame
- Prevent avoidance of the therapeutic material between appointments
- Extend the therapeutic window beyond the 50-minute session
- Build self-efficacy and internal resources prior to more intensive processing
How Rewire Supports This Practice
Rewire provides a structured, clinician-assigned digital environment for clients to engage with between-session exercises. The platform is designed to:
- Deliver practitioner-assigned bilateral stimulation exercises (visual, tactile, and auditory) in a format appropriate for unsupervised use
- Provide structured grounding, resourcing, and containment sequences consistent with EMDR standard-of-care between-session practices
- Track nervous system state (pre/post) and completion data, surfacing this to the assigning clinician prior to sessions
- Provide structured journaling prompts that invite reflection without encouraging unsupervised processing of target memories
All exercises available within Rewire are containment-focused and have been designed to be appropriate for independent use by clients within an active therapeutic relationship. They do not constitute trauma reprocessing and are not a substitute for EMDR therapy.
What Rewire is —
and what it is not.
Between-session grounding
Structured, containment-focused exercises assigned by a clinician for independent use between appointments.
Trauma reprocessing
Active processing of target memories. Rewire does not facilitate or guide trauma reprocessing work. This must only occur within a supervised therapeutic session.
Resourcing & stabilisation
Safe place, calm place, container exercises, and positive resource installation for nervous system regulation.
Clinical assessment
Rewire does not provide or assist with clinical assessment, diagnosis, risk formulation, or treatment planning.
Session progress tracking
Pre/post nervous system state ratings and completion data for review by the assigning clinician.
Crisis intervention
Rewire is not designed for, and must not be used in, acute crisis situations. Users in crisis should contact their therapist or emergency services immediately.
Practitioner Considerations: Appropriate Use
Practitioners assigning Rewire to clients should consider the following contraindications and precautions, consistent with standard EMDR best-practice guidelines for between-session work:
- Clients in the active destabilisation phase of treatment who do not yet have sufficient affect regulation capacity for independent practice
- Clients with active psychosis, active substance use disorder, or severe dissociative disorders (DID, complex OSDD) where unsupervised BLS exercises may be contraindicated
- Clients currently in acute crisis, experiencing suicidal ideation, or presenting with significant self-harm risk
- Clients for whom the clinician has not yet completed a thorough trauma history and stabilisation assessment
- Children and adolescents, unless the clinician has made a specific, documented clinical decision that use is appropriate and has obtained appropriate consent from a parent or guardian
Practitioner
responsibility.
Rewire is a tool for use by qualified practitioners. By assigning Rewire to clients, clinicians accept that:
- They hold sole clinical responsibility for assessing client suitability for between-session exercises
- They have obtained appropriate informed consent from the client for the use of the platform, including data collection and storage
- They will monitor client engagement with the platform as part of their ongoing clinical management and review it at sessions
- They will advise clients on appropriate use, including what to do if they become distressed during an exercise (stop, ground, contact their therapist)
- They are operating in accordance with the ethical code and professional standards of their registering or licensing body
Rewire is not responsible for, and cannot substitute for, the clinical judgment of the treating practitioner. If in doubt about whether between-session exercises are appropriate for a given client, err on the side of clinical caution.
Full reference
list.
- American Psychological Association. (2017). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. APA.
- Armstrong, M.S., & Vaughan, K. (1996). An orienting response model of eye movement desensitization. Journal of Behavior Therapy and Experimental Psychiatry, 27(1), 21–32.
- Bisson, J.I., Roberts, N.P., Andrew, M., Cooper, R., & Lewis, C. (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD003388.
- Chen, Y.R., Hung, K.W., Tsai, J.C., Chu, H., Chung, M.H., Chen, S.R., … Chou, K.R. (2014). Efficacy of eye-movement desensitization and reprocessing for patients with posttraumatic-stress disorder: A meta-analysis of randomized controlled trials. PLOS ONE, 9(8), e103676.
- Kazantzis, N., Whittington, C., Zelencich, L., Kyrios, M., Norton, P.J., & Hofmann, S.G. (2016). Quantity and quality of homework compliance: A meta-analysis of relations with outcome in cognitive behavior therapy. Behavior Therapy, 47(5), 755–772.
- Lee, C.W., & Cuijpers, P. (2013). A meta-analysis of the contribution of eye movements in processing emotional memories. Journal of Behavior Therapy and Experimental Psychiatry, 44(2), 231–239.
- Maxfield, L., Melnyk, W.T., & Hayman, C.A.G. (2008). A working memory explanation for the effects of eye movements in EMDR. Journal of EMDR Practice and Research, 2(4), 247–261.
- National Institute for Health and Care Excellence. (2018). Post-Traumatic Stress Disorder (NG116). NICE.
- Shapiro, F. (1989). Eye movement desensitization: A new treatment for post-traumatic stress disorder. Journal of Behavior Therapy and Experimental Psychiatry, 20(3), 211–217.
- Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures (2nd ed.). Guilford Press.
- Stickgold, R. (2002). EMDR: A putative neurobiological mechanism of action. Journal of Clinical Psychology, 58(1), 61–75.
- van den Hout, M.A., & Engelhard, I.M. (2012). How does EMDR work? Journal of Experimental Psychopathology, 3(5), 724–738.
- van Etten, M.L., & Taylor, S. (1998). Comparative efficacy of treatments for post-traumatic stress disorder: A meta-analysis. Clinical Psychology & Psychotherapy, 5(3), 126–144.
- World Health Organization. (2013). Guidelines for the Management of Conditions Specifically Related to Stress. WHO Press.