What Is EMDR Therapy? Uses in Addiction and Trauma

Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based psychotherapy that helps people process traumatic memories and reduce their emotional intensity. Developed by psychologist Francine Shapiro in 1987, EMDR uses bilateral stimulation, typically guided eye movements, while the patient focuses on distressing memories. The therapy allows the brain to reprocess traumatic experiences so they no longer trigger the intense emotional and physical reactions that often drive substance use. Both the World Health Organization (WHO) and the American Psychological Association (APA) recognize EMDR as an effective treatment for PTSD, and its application in addiction treatment is supported by a growing body of research.

Key Takeaways

• EMDR uses bilateral stimulation (eye movements, tapping, or auditory tones) to help the brain reprocess traumatic memories
• WHO and APA endorse EMDR as an effective treatment for PTSD
• Research increasingly supports EMDR for treating the trauma underlying many substance use disorders
• EMDR follows an eight-phase protocol: history-taking, preparation, assessment, desensitization, installation, body scan, closure, and reevaluation
• A typical EMDR course involves 6-12 sessions, though complex trauma may require more
• EMDR does not require patients to describe traumatic events in detail, making it accessible for people who find talk therapy about trauma overwhelming

What Is EMDR Therapy?

How EMDR Was Developed

Francine Shapiro, a psychologist at the Mental Research Institute in Palo Alto, observed that certain eye movements appeared to reduce the distress associated with negative thoughts. She developed this observation into a structured therapeutic protocol and published the first controlled study on EMDR in 1989.

EMDR (Eye Movement Desensitization and Reprocessing): A psychotherapy that uses bilateral stimulation (rhythmic left-right eye movements, tapping, or auditory tones) to help the brain reprocess traumatic memories. The Adaptive Information Processing (AIP) model, EMDR’s theoretical framework, proposes that trauma becomes “stuck” in the brain’s memory networks, and bilateral stimulation facilitates the brain’s natural processing mechanism.

Since its development, EMDR has been studied in over 30 randomized controlled trials for PTSD. It has moved from a controversial newcomer to a mainstream, guideline-recommended treatment endorsed by major international health organizations.

The Eight Phases of EMDR

EMDR follows a structured protocol comprising eight phases:

1. History-taking and treatment planning: The therapist gathers history, identifies target memories, and develops a treatment plan. No detailed narration of traumatic events is required.

2. Preparation: The therapist teaches coping and stabilization techniques, explains the EMDR process, and establishes trust. This phase ensures the patient has emotional regulation skills to manage any distress that arises.

3. Assessment: A specific target memory is identified along with associated negative beliefs (e.g., “I am powerless”), desired positive beliefs (e.g., “I can handle this”), associated emotions, and body sensations.

4. Desensitization: The core processing phase. The patient holds the target memory in mind while following the therapist’s bilateral stimulation (typically finger movements tracked by the eyes). This continues until the memory’s emotional charge is significantly reduced.

5. Installation: The desired positive belief is strengthened and associated with the target memory, replacing the negative cognition.

6. Body scan: The patient checks for any residual physical tension or distress associated with the memory. Any remaining somatic responses are processed.

7. Closure: The therapist ensures the patient is stable before ending the session, using grounding techniques if needed. Patients are oriented to what may occur between sessions.

8. Reevaluation: At the next session, the therapist assesses whether the previous target memory has been fully processed and determines next targets.

How EMDR Helps with Addiction

The Trauma-Addiction Connection

Trauma and substance use disorders frequently co-occur. SAMHSA estimates that up to two-thirds of people in addiction treatment report histories of childhood abuse or neglect. PTSD and substance use disorders co-occur at rates far exceeding chance.

The connection operates through several mechanisms:

• Self-medication: Substances provide temporary relief from trauma symptoms: hyperarousal, flashbacks, emotional numbness, and chronic anxiety
• Neurobiological overlap: Trauma and addiction both involve dysregulation of the brain’s stress response systems, reward circuits, and prefrontal cortex functioning
• Avoidance patterns: Both trauma and addiction involve avoidance of painful emotional states, creating reinforcing cycles

When treatment addresses only the substance use without resolving the underlying trauma, the emotional distress that drove substance use in the first place remains. This is why trauma-informed approaches are increasingly recognized as essential in addiction treatment.

Processing Traumatic Memories

EMDR’s value in addiction treatment lies in its ability to reduce the emotional charge of traumatic memories that trigger substance use:

• Specific traumatic events (assault, combat, accidents) that produce PTSD symptoms managed through substance use
• Developmental trauma (childhood neglect, abuse, attachment disruption) that creates pervasive emotional dysregulation
• Addiction-related trauma (overdose experiences, violence associated with drug culture, shame and stigma)
• Relapse triggers connected to traumatic memories that standard addiction treatment does not resolve

By processing these memories, EMDR can reduce the emotional distress that drives substance use while building resilience and self-efficacy, a combination that supports sustained recovery.

Is EMDR Therapy Legitimate?

Research Evidence

EMDR’s evidence base is substantial for PTSD and growing for addiction-related applications:

• WHO endorsement: The World Health Organization recommends EMDR as one of two psychotherapies for PTSD (alongside CBT-based trauma therapies)
• APA recommendation: The American Psychological Association conditionally recommends EMDR for PTSD treatment
• VA/DoD guidelines: The Department of Veterans Affairs and Department of Defense clinical practice guidelines include EMDR as a recommended treatment for PTSD
• Addiction-specific research: Studies have demonstrated that EMDR can reduce PTSD symptoms in patients with co-occurring substance use disorders, and some research suggests it may also reduce craving intensity and substance use

Clinical Guidelines

Professional organizations that endorse EMDR for PTSD treatment include:

• World Health Organization (WHO)
• American Psychological Association (APA)
• International Society for Traumatic Stress Studies (ISTSS)
• National Institute for Health and Care Excellence (NICE, UK)
• Department of Veterans Affairs/Department of Defense (VA/DoD)

For addiction specifically, EMDR is increasingly used within integrated dual diagnosis treatment programs where trauma and substance use are treated concurrently. The evidence is strongest when EMDR targets the traumatic memories underlying substance use rather than the addiction behavior itself.

What to Expect in an EMDR Session

A typical EMDR session lasts 60-90 minutes. The experience during the desensitization phase varies among individuals:

• The therapist directs the patient to follow bilateral stimulation (finger movements, a light bar, tapping, or auditory tones) while holding a target memory in mind
• Sets of bilateral stimulation last 20-30 seconds, followed by brief check-ins about what the patient is experiencing
• Patients may experience emotional intensity as memories are processed: sadness, anger, fear, or relief
• Between sets, patients often report that the memory feels more distant, less emotionally charged, or that new associations and perspectives emerge
• Sessions end with a stabilization period to ensure the patient leaves in a grounded state

A typical EMDR course for a single traumatic event involves 6-12 sessions. Complex trauma histories, which are common in addiction populations, may require more sessions and should be conducted by therapists experienced in both EMDR and addiction treatment.

Important practical considerations:

• EMDR should generally not be initiated during active withdrawal or acute psychiatric crisis
• Patients should have basic emotional regulation skills (the preparation phase addresses this)
• EMDR can be conducted alongside other therapies such as DBT or CBT
• Not every addiction treatment program that claims to offer EMDR has staff with comprehensive EMDR training; look for therapists certified by EMDRIA (EMDR International Association)

EMDR and Inner Child Work

Some EMDR therapists integrate inner child work into the standard protocol, particularly when treating developmental or childhood trauma. This involves:

• Identifying younger emotional states or “parts” that hold traumatic memories
• Using EMDR’s bilateral stimulation to process memories from the perspective of the child who experienced them
• Installing positive cognitions related to safety, worth, and belonging that the individual did not internalize as a child
• Addressing attachment wounds that contribute to adult patterns of emotional dysregulation and substance use

This application is particularly relevant for addiction patients whose substance use began as a response to childhood adversity. Adverse Childhood Experiences (ACE) research has established a strong dose-response relationship between childhood trauma and adult substance use disorders.

EMDR is one of several therapeutic approaches used to treat trauma in addiction settings. For a comparison of trauma-focused therapies, see our guide on EMDR vs. somatic therapy vs. art therapy. For information on therapy approaches focused on emotional regulation, see our DBT therapy guide. For insurance coverage of therapy, see our insurance resources.

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This is part of our complete guide to Types of Addiction Treatment.