Is Virtual EMDR as Effective as In-person EMDR?

Virtual therapy has risen in popularity since the COVID-19 pandemic. Now more than ever, folks are utilizing telehealth services through secure video conferencing to find support for their mental health needs. Even though this is a convenient and accessible  way to get therapy, some folks might still have concerns about whether online therapy is as effective as in-person therapy. This is especially significant when it comes to more specialized approaches, like EMDR. Is virtual EMDR as effective as in-person? Let’s find out!

A Quick Review of EMDR: 

Eye Movement Desensitization and Reprocessing (EMDR) is a framework of  psychotherapy that is most often used to treat trauma, phobias, anxiety, and depression. This is an eight-phase protocol that involves history taking, skill building, and reprocessing – focusing on a specific memory, negative conclusion, or physical sensation while following a set of eye movements, sounds, or taps, to reduce the associated discomfort in the body. This creates a platform for the brain to reorganize information in a more helpful way and reduce the intensity of any uncomfortable emotions associated with the target experience. Sounds like hocus pocus, but I swear it works on a brain-science level! In-person EMDR therapy may not be available or accessible for everyone because of location, physical limitations, or work schedules. This is where virtual EMDR therapy comes in as an alternative option, AND you can do it from the comfort of your home!

How Does Virtual EMDR Work?

Virtual EMDR follows the same basic methodology as in-person EMDR. Remember how I mentioned that it’s an 8-phase protocol? Well, typically, when folks think of EMDR, they think of phase 4, which is when we focus on a specific thing and apply Bilateral Stimulation (BLS), the back-and-forth eye movements or taps, to reduce the intensity of the target experience. This is usually the most concerning part about online EMDR therapy, and folks often wonder how it would work.

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Allow me to shed some light on the process: when getting ready to enter phase 4, your therapist might provide you with several options for BLS. This can include sending you a link to a moving dot that you will follow with your eyes, a common option used for virtual BLS. In this case, your therapist will be able to control the dot’s movement from their end while you just focus on following it back-and-forth with your eyes. An option that works really well for my folks is to tap back-and-forth on the knees. This is often a more preferred option, even when I’m doing EMDR in person. It has a way of involving the body and giving agency to the client as they reprocess.

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I’ve also had folks utilize the “butterfly hug” (hands crossed over chest with fingers underneath the collar bones), as well as tapping feet or swaying from one foot to the other while standing as alternative forms of BLS. A good therapist will help you find something that feels good for you and will collaborate with you on cues, pauses, and stopping signals before jumping into the actual reprocessing. Just as they would do in person, your therapist will guide you on what to focus on during reprocessing and keep the structure so that you can focus on the healing part of things.

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Effectiveness of Virtual EMDR:

When it comes to reducing emotional discomfort and processing through painful experiences, several studies have found that virtual EMDR is just as effective as in-person EMDR (Sbarra & Wheaton, 2020; McGowen et al., 2021; Dyer, de Young, & Porges, 2021). These studies have found that virtual EMDR significantly reduces  symptoms of PTSD, anxiety, and depression, even more so than virtual Cognitive Behavioral Therapy (McGowen et al., 2021). As it turns out, virtual EMDR does the job just as well as face-to-face EMDR therapy does. This is really good news for those of us who worry about spending resources on something that “might not work,” or “might not work as well.” As far as neutralizing charged experiences, virtual EMDR is just as good of an option as in-person services are.

Benefits of Virtual EMDR Therapy:

1. Accessibility: Virtual EMDR therapy removes the barrier of travel, making therapy more accessible. This can be especially helpful for folks who live in remote areas or have limited mobility.
2. Convenience: Virtual sessions eliminate the need for travel, which can save time and reduce logistical challenges in your schedule.
3. Flexibility: Virtual therapy is more flexible in scheduling appointments. If your schedule is busy, it may be easier to fit an appointment in over your lunch hour, for example. Many virtual therapists also offer hours of operation that in-person therapists may not. It might be easier to find evening or weekend appointments with a virtual provider than with an on-site provider.
4. Comfort and Privacy: For some folks, participating in therapy from a familiar environment can feel more comfortable and secure than from an office. Some people may feel more secure discussing sensitive or traumatic experiences from their own space, which may encourage openness and vulnerability. You also have the option of choosing your location for virtual therapy, as long as it’s private and safe.
5. Reduced Stigma: Some people may feel more comfortable seeking therapy when it can be done discreetly from their own homes. Virtual EMDR therapy may help reduce the perceived stigma associated with mental health treatment, thereby encouraging more people to seek the support they need.
6. Cost-Effectiveness: Virtual EMDR therapy can be more cost-effective for both therapists and clients. Without the need for physical office space, therapists can reduce overhead costs, which may lead to more affordable therapy options. Clients also save on transportation expenses and potential childcare costs associated with attending in-person sessions.
7. Continuity of Care: Virtual EMDR therapy provides a solution for maintaining continuity of care in situations where in-person therapy is not feasible or accessible. This includes circumstances such as travel, relocation, or unexpected disruptions, such as a pandemic or natural disasters. Clients can continue their therapy without significant interruptions, ensuring ongoing support and progress in their healing journey.

A Few Considerations…

Even though research shows that virtual EMDR is just as effective as in-person EMDR, there are a few sensitivities that are worth addressing. The first is that many folks may choose in-person services because it offers the felt presence of another human being. For those of us whose trauma includes being left alone, abandoned, forgotten, or left behind somehow, in-person services may offer a unique healing element of being witnessed by another human where we have been left alone before. In other words, sometimes the worst part about a hard situation is that no one was there to help us through it or to offer support. Processing through this with another person physically in the room may offer a different kind of healing than processing through it with someone who is present virtually but not physically.

On the other hand, another consideration is that virtual EMDR offers the privacy of one’s home to be as expressive, casual, and comfortable as possible. Some folks really appreciate that they can process in complete privacy without having to worry about being heard by anyone else. Others really appreciate having their pets nearby for comfort, being able to pace in between sets, and reorienting towards their home as their safe space. Sometimes, having access to the comforts of home, as well as taking up as much space as needed, is what makes the difference in shifting the charge that’s being reprocessed.

Yet another thing to keep in mind is that not every home is a safe space for vulnerable processing. Maybe you don’t have complete privacy where you live; maybe part of what needs to be processed happened within your home, making it a space of uncomfortable association; maybe the physical therapy room acts as a container that you can leave some of these experiences in to be kept safely between sessions. There are plenty of reasons that folks might prefer to utilize in-person services, even if they would be willing to engage in virtual therapy.

The bottom line is that you are allowed to prefer what you prefer. You may have a reason, or you may not. Sometimes, effectiveness of virtual therapy isn’t the determining factor in whether someone chooses it or not.

A Few Things to Remember::

If you decide that virtual EMDR is a good fit for you, here are a few things that can help you have the best virtual therapy experience:

1. Privacy and confidentiality are essential components of any therapy, including virtual EMDR therapy. Therapists are legally required to protect client information, so it’s okay to ask your therapist about how they are staying within the measures of confidentiality. This may include asking about their video conferencing platform and how and where your data is being stored.
2. Virtual EMDR therapy does come with some limitations and challenges, particularly when it comes to technological difficulties. Poor internet connections or technical glitches can sometimes interrupt session. If you prefer eye movement for BLS, depending on what software your therapist uses, setting that up can take time out of the session itself. Your therapist should have a protocol for handling any technological difficulties. To minimize any sort of technological interruptions and to know what to do if one occurs, be sure to ask your therapist how they handle these situations before you enter the reprocessing phase of EMDR.
3. Observing body language and non-verbal cues can be a bit tricky in a virtual setting. Some of these cues might be missed, making it essential for your therapist to ask more clarifying questions throughout the process. Make sure that your camera is on and that you can see your therapist, and that they can see you as well.
4. If you anticipate that what you want to reprocess may cause significant emotional distress, talk to your therapist about creating a strategy for grounding, safety, and support. This may include strategies for the moment itself, as well as a plan for how to cope after the session is over. It’s important to resource these things in earlier EMDR phases. If you feel overwhelmed or under-resourced as you approach reprocessing, it would be beneficial for your therapist to be aware of this so that they can support you better.
5. In the event of an emergency, such as a fire or thoughts of harming yourself or another person, your therapist is required to follow the same emergency guidelines that they would if you were in person. This may involve contacting emergency services or emergency contacts, or providing referrals to local resources for stabilization. As always, safety and security take priority in virtual therapy, as well as in-person therapy.

How Effective is Online EMDR Therapy?

So many folks have reported positive experiences and successful outcomes with virtual EMDR therapy. The convenience, flexibility, and sense of safety that virtual sessions offer help to establish a strong therapeutic relationship, even without physical presence. This may be part of the reason why research has found that online EMDR therapy results in significant reductions in distressing symptoms, increased emotional regulation, and improved overall well-being. Virtual sessions have provided a platform for clients to engage in deep processing and healing, leading to positive changes in their thoughts, emotions, and behaviors.

Virtual EMDR therapy offers a promising and accessible option for folks seeking effective trauma treatment and emotional healing. With advances in technology and the growing need for remote mental health services, virtual EMDR has become a prominent and valuable therapeutic option, leveraging technology in overcoming barriers to provide effective therapy in the digital age.

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References:

Dyer, A. S., de Young, K. P., & Porges, S. W. (2021). Efficacy of Eye Movement Desensitization and Reprocessing Delivered via Telehealth in Adults with PTSD: A Systematic Review. Journal of EMDR Practice and Research, 15(3), 146-158.

McGowan, I. W., Fisher, N., Havens, J., & Proudlock, S. (2021). An evaluation of eye movement desensitization and reprocessing therapy delivered remotely during the Covid–19 pandemic. BMC psychiatry, 21(1), 1-8.

Sbarra, D. A., & Wheaton, M. G. (2020). No Place Like Home: EMDR for PTSD via Telehealth. Journal of EMDR Practice and Research, 14(3), 181-193.