Online EMDR therapy

What is EMDR?

Eye movement desensitisation and reprocessing (EMDR) is a structured psychological therapy that helps the brain process traumatic or distressing memories so they stop intruding on the present. It is recommended by NICE for post-traumatic stress disorder in adults and is delivered over secure video by our HCPC-registered clinical psychologists to people across the UK.

EMDR was developed by the American psychologist Francine Shapiro in the late 1980s. It has since become one of the most extensively researched trauma treatments in the world, with recommendations from NICE, the World Health Organization and the International Society for Traumatic Stress Studies. In the NHS it sits alongside trauma-focused CBT as one of the two first-line psychological treatments for PTSD.

The approach differs from most talking therapies in one important way. You do not have to describe what happened to you in detail, and there is no homework between sessions. The work is done in the session, by holding a memory in mind while following a form of left-right stimulation, usually eye movements. That combination allows the brain to do something it has not managed on its own: file the memory away as something that happened in the past, rather than something still happening now.

How does EMDR work?

EMDR is built on a model called adaptive information processing. The idea is straightforward. Most of the time, the brain processes experiences overnight and files them away as ordinary memories. You can recall them, but they do not hijack you. When an experience is overwhelming enough, that processing fails. The memory gets stored in a raw state, with the original images, sounds, body sensations, emotions and beliefs still attached and still live. A smell, a phrase, a particular tone of voice can trigger the whole package, and it feels as if the event is happening again.

This is why people with unprocessed trauma are so often told to ‘move on’ and cannot. It is a problem of memory storage, not willpower.

During EMDR, you bring the memory to mind briefly while engaging in sets of bilateral stimulation. That usually means following a point that moves left to right across your screen, but it can also be tapping alternately on your knees or shoulders, or alternating tones through headphones. Between sets, your psychologist asks what you noticed. Over the course of a session, the memory typically becomes less vivid and less distressing, and the belief attached to it (‘I am in danger’, ‘it was my fault’, ‘I am powerless’) gives way to something more accurate and more compassionate.

Exactly why bilateral stimulation helps is still being studied. The best-supported explanation is that holding a memory in mind while doing a second task loads the working memory, which makes the memory less vivid and less emotional each time it is recalled and re-stored. A second theory links the eye movements to the rapid eye movement phase of sleep, when the brain consolidates the day’s experiences. What is not in doubt is the outcome. Across many randomised controlled trials, EMDR reliably reduces PTSD symptoms, and the gains hold up at follow-up.

What does EMDR look like over video?

Most people’s picture of EMDR involves a therapist moving two fingers back and forth in front of a client’s face. Online, the same thing is done differently, and it works well.

The setup. You need a laptop, desktop or tablet with a camera, a stable internet connection and a private room where you will not be interrupted for the length of the session. Headphones help. Phones work in a pinch but a larger screen makes the visual stimulation easier to follow. Your psychologist will run through the setup with you in the early sessions, well before any reprocessing.

The stimulation. For eye movements, your psychologist shares a screen showing a point that moves from side to side at a speed they control. You follow it with your eyes while holding the target memory in mind. If eye movements do not suit you, or your connection is not reliable enough, you can use tapping instead. The ‘butterfly hug’, crossing your arms and tapping alternate shoulders, is widely used and well supported in research. Your psychologist will test both with you during preparation and choose what works.

The safety net. Before any reprocessing, you and your psychologist agree what happens if you become very distressed or the connection drops. Typically that means a phone number to call, a grounding exercise you have already practised, and a rule that you do not end the session while activated. You will also identify a trusted person and a local support option in case you need them. This planning is standard practice for online trauma work and your psychologist will not begin reprocessing without it.

The session itself. Reprocessing sessions follow the same structure as in-person work. You choose the memory, identify the image, the negative belief, the emotion and where you feel it in your body, rate the distress, then begin sets of stimulation with short check-ins between. The session ends with a closure phase so you are calm and oriented before you log off. Your psychologist keeps a close eye on you throughout, and because you are in your own space, you have your own grounding aids to hand.

Many clients tell us that processing difficult material at home, in a familiar room with a cup of tea and no journey back afterwards, is easier than doing it in a consulting room. That is one reason the outcomes for online EMDR hold up so well.

The eight phases of EMDR

EMDR follows a structured eight-phase protocol. The phases give the therapy a clear shape while leaving room to adapt to what you need.

Phase 1: History taking. Your psychologist builds a thorough understanding of your history, current difficulties and goals. Together you identify the memories and experiences driving your symptoms and agree the order in which to work on them. For a single event this is quick. For a longer history it may take several sessions and often starts with the earliest or most influential memory rather than the most recent.

Phase 2: Preparation. Before any processing, your psychologist teaches you stabilisation and grounding techniques, such as the ‘safe place’ exercise and a container image for putting material away between sessions. They explain exactly how EMDR works, test the bilateral stimulation with you, and make sure you feel resourced and in control. Some people need only one preparation session; others, particularly with complex trauma, spend considerably longer here, and that time is well spent.

Phase 3: Assessment. You bring the target memory to mind and identify the picture that represents it, the negative belief you hold about yourself in relation to it, the positive belief you would prefer to hold, the emotions and the body sensations. You rate how distressing the memory feels now and how true the positive belief feels.

Phase 4: Desensitisation. This is the core of the work. You hold the memory in mind while doing sets of bilateral stimulation. Between sets, your psychologist asks what you are noticing. The images may shift, new memories may connect, emotions may rise and fall. You do not need to say much. The process continues until the memory no longer carries significant distress.

Phase 5: Installation. The positive belief is paired with the memory and strengthened with further sets of stimulation until it feels true.

Phase 6: Body scan. You check your body for any residual tension connected to the memory and process anything left.

Phase 7: Closure. Every session, whether processing is complete or not, ends with a closure phase. Your psychologist makes sure you are grounded and stable, and anything unfinished is contained until next time.

Phase 8: Re-evaluation. At the start of the next session, you check how the memory sits now and whether anything new has come up, then decide together what to work on next.

How many sessions will I need?

This is the question we are asked most and the honest answer is that it depends on what you are processing.

A single distressing event in an otherwise settled life, such as a road accident, an assault or a difficult medical procedure, often resolves in six to 12 sessions, including history taking and preparation. Early trials of single-incident trauma found that most participants no longer met the criteria for PTSD after three to six reprocessing sessions.

Complex trauma takes longer. If your difficulties stem from repeated or prolonged experiences, particularly in childhood, more time goes into preparation and stabilisation, there are more memories to work through, and the pace has to respect your capacity to stay within a tolerable window. Courses of 20 sessions or more are common and appropriate. Your psychologist will give you a realistic estimate after the assessment phase and revisit it with you as you go.

Sessions are 50 minutes as standard. Where a longer reprocessing session would help, some of our psychologists offer this by arrangement, and will discuss it with you, including the fee, before you commit. Sessions are usually weekly, especially during active reprocessing, to keep momentum.

The evidence for EMDR

EMDR is one of two psychological therapies recommended by NICE for the treatment of PTSD in adults, alongside trauma-focused CBT (NICE guideline NG116, 2018). The World Health Organization made the same recommendation in its 2013 guidelines on conditions related to stress. These recommendations rest on dozens of randomised controlled trials showing that EMDR produces large and lasting reductions in PTSD symptoms, with treatment effects comparable to trauma-focused CBT and, in several trials, achieved in fewer sessions.

The evidence has broadened beyond PTSD. Trials and clinical series support EMDR for phobias, panic disorder, complicated grief, chronic pain and depression where past events play a part. The research in some of these areas is younger than the PTSD literature, and we say so, but the pattern is consistent with the model: when a symptom is being fed by an unprocessed memory, processing the memory helps.

Online delivery has its own evidence base now. When the pandemic forced trauma services onto video in 2020, several teams evaluated the results. An NHS evaluation published in BMC Psychiatry in 2021 (McGowan and colleagues) found that EMDR delivered remotely produced reductions in PTSD symptoms in line with those expected from in-person treatment, with no increase in adverse events. A Dutch study of fully remote intensive trauma treatment reported similar findings, including for complex PTSD. The EMDR Association UK and Ireland, which accredits EMDR practitioners in this country, publishes guidance on remote delivery and recognises it as a standard way to offer the therapy.

Does EMDR work online?

Yes. The evidence above is the short answer. The longer answer is that the parts of EMDR that matter, a thorough assessment, careful preparation, dual attention during reprocessing and a proper closure, all transfer to video without loss. The only thing that changes is the mechanism for bilateral stimulation, and both on-screen eye movements and self-tapping are supported by research.

There are some practical advantages too. You process difficult material in a place where you already feel safe, you do not have to travel home afterwards feeling raw, and you can work with a psychologist who specialises in your kind of difficulty rather than whoever happens to be nearby. For people in rural areas, people with health or mobility difficulties, and people whose work or caring responsibilities make a weekly trip to a clinic impossible, online EMDR is often the difference between getting treatment and not.

Is online EMDR safe?

It is, when it is done properly, and ‘properly’ has a specific meaning. EMDR of any kind is only as safe as the preparation that precedes it. Online, that preparation includes a few extra steps, and our psychologists follow them as a matter of course:

• A full assessment of your history, current risk and any dissociation before reprocessing is offered
• Grounding and containment techniques taught and practised until you can use them on your own
• A written plan covering what happens if you become distressed or lose connection, including who to contact and where you are
• Confirmation that you have a private, uninterrupted space for every session
• Sessions that always end with closure, and a psychologist who will not finish while you are activated

If any of that cannot be put in place, or if the assessment suggests you need stabilisation work first, your psychologist will tell you and suggest what to do instead. That might be a period of preparation before EMDR, a different therapy for now, or in some cases a referral to a service better placed to help. Saying ’not yet’ is part of doing this safely.

EMDR is not a crisis intervention. If you are in immediate danger or thinking about harming yourself, please use the crisis services listed at the bottom of this page.

Who is EMDR for?

EMDR has the strongest evidence for trauma and is increasingly used wherever a distressing experience is driving current symptoms. We use it for adults with:

• Post-traumatic stress disorder (PTSD) after single events
• Complex PTSD and childhood adversity
• Accidents, assaults and medical trauma
• Birth trauma and traumatic pregnancy loss (see our perinatal mental health page)
• Phobias and specific fears, including flying, needles, vomiting and driving
• Complicated grief and traumatic bereavement
• Panic disorder and anxiety with a clear origin
• Performance anxiety in exams, sport, music and public speaking
• Low self-esteem rooted in bullying, criticism or humiliation
• Intrusive memories, nightmares and flashbacks

EMDR is particularly well suited when you can point to specific experiences behind your difficulties, when you have tried talking therapy and found it hard to put things into words, or when your reactions to present-day situations feel out of proportion and you suspect the past is being triggered. Because EMDR works with memory networks directly, it can help even when the events themselves are hard to articulate.

Who is EMDR not right for, or not right for yet?

We would rather be straight about this than promise EMDR to everyone. There are situations where reprocessing is not the first step:

• Significant dissociation. If you regularly lose time, feel detached from your body or have gaps in memory, reprocessing can be destabilising until you have built the skills to stay present. Preparation work comes first, sometimes for a while.
• Active dependence on alcohol or drugs. Substances used to manage distress tend to escalate when memories are stirred up. Stabilising this first makes the trauma work safer and more effective.
• Ongoing danger. If the trauma is still happening, whether abuse in a current relationship or an unsafe living situation, the priority is safety, and EMDR waits.
• Acute crisis or high risk. Active suicidal intent, severe self-harm or a recent hospital admission mean stabilisation and, often, a more intensive service should come first.
• A major life event in the next few weeks. A court date, a house move or an exam is not the moment to open up old material. Timing matters.

Some medical conditions, including certain eye problems and epilepsy, mean eye movements are unsuitable, but tapping or tones can usually be used instead. None of these situations rules EMDR out for good. They are reasons to sequence the work properly, and your psychologist will explain what that would look like for you.

EMDR vs CBT for trauma

Both EMDR and trauma-focused CBT are NICE-recommended for PTSD, and both work. The difference is mostly in method. Trauma-focused CBT involves talking through the trauma in detail, writing or recording an account of it, and updating the meaning of the worst moments, often with tasks between sessions. EMDR involves holding the memory in mind with minimal verbal description and letting the processing happen through bilateral stimulation, with no homework.

People who find it very hard to talk about what happened, or who have tried talking therapy and felt stuck, often prefer EMDR. People who like a clear cognitive framework and want to understand and challenge their thinking sometimes prefer CBT. Many of our psychologists are trained in both and will help you choose. Our post on EMDR vs CBT for trauma goes into more detail.

EMDR at The Online Psychologists

EMDR here is delivered by HCPC-registered clinical psychologists who have completed specialist EMDR training accredited by the EMDR Association UK and Ireland or an equivalent professional body, and who have experience adapting the protocol for secure online delivery. Every one of our clinicians holds a doctorate in clinical psychology, which means EMDR is one of several approaches they can draw on rather than the only tool they have. If assessment suggests that something else would serve you better, they will say so.

When you get in touch, Dr Rachel Whatmough, our Clinical Director, reads what you tell us and matches you with a psychologist whose expertise fits your situation. If you are seeking help for birth trauma, for instance, you will be matched with someone experienced in perinatal presentations as well as EMDR. If your history is complex, you will be matched with someone used to phased work.

Sessions are £130 for 50 minutes. We are registered with Bupa, AXA, Aviva, Cigna, Vitality, WPA and Healix, and we invoice insurers directly so there is no paperwork for you. There is no waiting list and no GP referral needed. Most people have their first session within a week of getting in touch.

Frequently asked questions

Does EMDR work online? Yes. Studies published since 2020, including an NHS evaluation of EMDR delivered remotely during the pandemic, found reductions in trauma symptoms comparable to in-person treatment. The eye movements are guided by a moving point on your screen, or replaced by self-tapping, and both methods are well supported. Your psychologist will check the setup with you before any reprocessing begins.

Is online EMDR safe? It is, provided it is done properly. Before any memory work, your psychologist will assess your history and current risk, teach you grounding and containment techniques, agree a plan for what happens if you become distressed or the connection drops, and confirm you have a private space. Reprocessing does not start until both of you are confident you are ready. If EMDR is not the right approach for you at the moment, we will say so.

Is online EMDR as effective as face-to-face EMDR? Research consistently shows that online EMDR produces outcomes comparable to in-person delivery. The key adaptations, using on-screen visual stimulation or self-tapping instead of the therapist’s finger movements, have been validated in clinical studies. Our psychologists are trained in online EMDR delivery and will make sure the process feels natural.

Do I need to talk about my trauma in detail? No. Your psychologist needs a general understanding of what happened, but you do not need to give a detailed verbal account. During reprocessing you hold the memory in mind internally. Your psychologist guides the process by checking in with you, and the detailed content stays private unless you choose to share it.

What does bilateral stimulation feel like? Most people describe it as a gentle, rhythmic experience. With eye movements, you follow a moving dot across your screen. With tapping, you alternate tapping your knees, or cross your arms and tap your shoulders. Neither is uncomfortable. Your psychologist will try different methods with you during the preparation phase to find what works best.

How many EMDR sessions will I need? It depends on what you are processing. A single distressing event with no wider history often resolves in six to 12 sessions, including the preparation phases. Complex or repeated trauma, particularly from childhood, usually takes longer, because more time is spent on stabilisation and there are more memories to work through. Your psychologist will give you an honest estimate after the assessment sessions and review it with you as you go.

Will I feel worse after a session? Some people feel tired, emotional or a little unsettled for a day or two after reprocessing, and processing can continue between sessions in the form of dreams or new memories surfacing. This is normal and usually short-lived. Every session ends with a closure phase so you leave feeling grounded, and you will have the techniques from the preparation phase to use if anything comes up. Your psychologist will explain what to expect and how to get in touch if needed.

Do I need a diagnosis of PTSD to have EMDR? No. EMDR was developed for post-traumatic stress and has the strongest evidence there, but it is used for any difficulty where a distressing memory or experience keeps driving present-day symptoms. That includes phobias, grief, panic, performance anxiety and low self-esteem rooted in past experiences. We do not diagnose through the website; your psychologist will assess whether EMDR fits your situation in the first sessions.

Can EMDR help with things other than trauma? Yes. While EMDR was originally developed for PTSD, it is now used for a range of difficulties where distressing memories or experiences are contributing to current symptoms. This includes phobias, anxiety, grief, low self-esteem and performance difficulties. Your psychologist will assess whether EMDR is appropriate for your specific situation.

Is EMDR covered by health insurance? Usually, yes. We are registered with Bupa, AXA, Aviva, Cigna, Vitality, WPA and Healix, and EMDR delivered by a clinical psychologist falls within the psychological therapy most policies cover. You will normally need a pre-authorisation from your insurer. We invoice the insurer directly, so there is no paperwork for you to submit. Self-funded sessions are £130.

Is EMDR a form of hypnosis? No. You remain fully awake, alert and in control throughout. You can pause or stop at any point, and you will remember everything that happens in the session. EMDR does not erase memories either. The aim is for the memory to stay as part of your history without the distress it currently carries.