EMDR online: how it works and what the evidence says

Eye Movement Desensitisation and Reprocessing (EMDR) was developed for in-person delivery, so the question of whether it translates to a video call is a fair one. The short answer is that it does, with some adjustments to how bilateral stimulation is delivered, and early research on online EMDR is encouraging, though there is less of it than for in-person EMDR. Here is what actually changes when EMDR moves online, and what stays the same.

What stays the same

EMDR follows an eight-phase structure regardless of setting: history-taking, preparation, assessment of the target memory, desensitisation, installation of a more adaptive belief, a body scan, closure, and re-evaluation at the start of the next session. None of that changes for a remote session. The clinical psychologist still works from a detailed history, still agrees a target memory with you before starting reprocessing, and still checks in throughout using the same standard measures of distress and belief.

The eight phases come from Francine Shapiro, who developed EMDR. NICE has recommended EMDR for post-traumatic stress disorder since 2005, and its current guideline recommends it for adults with PTSD after non-combat trauma, alongside trauma-focused CBT. So it is one of the main recommended treatments, not something to try once other approaches have failed.

What changes: bilateral stimulation over video

The part of EMDR most people picture, side-to-side eye movements following a therapist’s fingers, is one of three ways of delivering bilateral stimulation, and it is the one that needs the most adaptation for video. Over a screen, this is usually done with an on-screen moving target you follow with your eyes, either a simple ball or bar that moves left to right at a pace the psychologist controls, or a small light bar connected to your computer.

The other two methods carry across more directly. Tapping, alternating taps on your own knees or shoulders, either self-administered following instruction or guided by audio cues, works in much the same way online as it does in person. Alternating audio tones through headphones work the same way too, and headphones are worth having ready for an online session regardless of which method ends up being used, since audio quality affects this more than it affects a normal conversation.

What a typical online session looks like

A session starts the way any online therapy session does: video connects, you confirm you are in a private space where you will not be interrupted, and there is a brief check-in on how the week has gone and how you are feeling coming into the session. If you are at the reprocessing stage, the psychologist will confirm the target memory and the bilateral stimulation method for that session, then guide short sets of stimulation interspersed with brief check-ins on what came up. Sessions typically run 50 to 90 minutes, with the longer end more common once reprocessing is underway rather than in the early history-taking sessions.

Closure at the end of a session matters more online than it might seem. Because you are moving straight from a piece of active reprocessing work into the rest of your day, without the transition of leaving a clinic building, the last part of the session is spent deliberately bringing your state back down, sometimes using a grounding technique, before the call ends.

What the evidence says about remote delivery specifically

The shift to remote mental health care that followed 2020 produced a substantial expansion of research into whether therapies designed for a shared room hold up over video. For EMDR, the picture that has emerged is broadly reassuring: early studies comparing online and in-person delivery have found similar reductions in trauma symptoms, though the evidence base for online EMDR specifically is younger and smaller than the decades of in-person trials behind the original NICE recommendation. Some clinicians note that certain bilateral stimulation methods, tapping and audio tones in particular, translate more smoothly to video than eye-movement tracking does, which is one reason a psychologist may suggest a particular method rather than leaving it entirely open.

Practical factors affect outcomes more for EMDR than for some other therapies, given how much of the work depends on staying regulated during reprocessing. A stable internet connection, a private room, and headphones for audio-based stimulation all help a session run smoothly.

Is it right for you

EMDR online is not right for every trauma presentation, particularly where dissociation is significant or where a private, uninterrupted space at home is not reliably available. An assessment session is where that gets worked out properly, alongside your history and what you are hoping to address. For more on how EMDR compares with other trauma-focused approaches, see our EMDR page and our page on PTSD and trauma.

If you are considering EMDR and want to talk through whether it fits your situation, you can get started online from Islington or anywhere else in the UK.