Does EMDR Always Use Eye Movements?

Does EMDR Always Use Eye Movements?

Short Answer: No. Eye Movement Desensitization and Reprocessing (EMDR) does not always use eye movements. Side-to-side eye movements are the best-known form of bilateral stimulation used in EMDR, but alternating sounds or tactile stimulation, such as tapping, may also be used. Eye movements have been studied more extensively than some alternatives, so the different forms of bilateral stimulation should not automatically be considered interchangeable or equally supported by research.

Key Takeaways

• EMDR does not always require eye movements.
• Side-to-side eye movements are one form of bilateral stimulation.
• Alternating sounds and alternating tactile stimulation may also be used.
• Tactile stimulation can include left-right tapping or alternating pulses.
• Different forms of bilateral stimulation should not automatically be assumed to work equally well.
• Eye movements have been studied more extensively than some alternatives.
• The bilateral stimulation is only one part of the larger EMDR process.

Why Are Eye Movements So Strongly Associated With EMDR?

The connection is understandable: eye movement is right there in the name Eye Movement Desensitization and Reprocessing.

In a common EMDR setup, a person brings a distressing memory or another target to mind while following movement from side to side with their eyes.

Traditionally, this might involve following a therapist's fingers.

Visual bilateral stimulation can also be presented in other ways, including a moving object or a visual stimulus on a screen.

But eye movements are not the only recognized way to provide bilateral stimulation in EMDR.

What Is Bilateral Stimulation?

Bilateral stimulation involves alternating sensory stimulation from one side to the other while attention remains connected to the material being processed.

EMDR commonly uses three broad forms:

• Visual: following something moving from side to side with the eyes
• Auditory: hearing sounds that alternate between the left and right sides
• Tactile: feeling taps, pulses, or other stimulation that alternates left and right

The EMDR International Association describes dual-attention bilateral stimulation as including eye movements, tactile stimulation, and auditory stimulation while the person simultaneously focuses on a targeted memory and related associations.

What Is Visual Bilateral Stimulation?

Visual bilateral stimulation usually involves tracking a stimulus from side to side.

For example, you might follow:

• A person's fingers
• A moving light
• A dot traveling across a screen
• Another visual target moving horizontally

Your eyes repeatedly move back and forth while you remain connected to the memory, thought, emotion, image, or sensation being processed.

This is probably the form of EMDR most people recognize.

What Is Auditory Bilateral Stimulation?

Auditory bilateral stimulation uses sounds that alternate from one side to the other.

For example, if you are wearing headphones, you might hear:

left — right — left — right

The sounds may be tones, clicks, or another simple auditory cue.

The purpose is not to listen to music or become distracted from the target. You continue paying attention to the material being processed while the alternating sounds provide the additional task.

Auditory stimulation is recognized as one of the forms of bilateral stimulation used in EMDR.

What Is Tactile Bilateral Stimulation?

Tactile bilateral stimulation uses physical sensations that alternate between the two sides of the body.

Examples can include:

• Alternating taps on the knees
• Alternating taps on the hands
• Left-right shoulder tapping
• Handheld devices that pulse alternately
• Other alternating physical sensations

EMDR guidance also describes self-tapping patterns such as alternating left-right taps as possible forms of stimulation.

Is Tapping Still EMDR?

It can be.

If alternating tapping is being used as bilateral stimulation within an EMDR process, eye movements are not required for that part of the session.

But tapping alone does not automatically make something EMDR.

EMDR is a larger structured process that includes selecting a target, identifying associated thoughts, emotions and body sensations, reprocessing, checking what changes, and moving through other treatment phases.

Bilateral stimulation is one part of that process.

Are Alternating Sounds Still EMDR?

Yes, alternating auditory stimulation can be used within EMDR.

EMDR references specifically include auditory stimulation along with eye movements and tactile stimulation as forms of bilateral stimulation.

However, saying that multiple methods are used in clinical practice does not mean research has proven that every method produces exactly the same effects.

That distinction is important.

Are Eye Movements, Sounds, and Tapping Equally Effective?

We do not have enough evidence to make that broad claim.

All three are used as forms of bilateral stimulation in EMDR, but the research supporting them is not identical.

Eye movements have been studied extensively in experimental research.

One study comparing eye movements with alternating beeps found that eye movements placed greater demands on working memory and produced larger reductions in memory vividness under the experimental conditions studied.

Other research has also found differences between visual, tactile, and auditory stimulation depending on what outcome was being measured.

So it is more accurate to say:

EMDR can use several types of bilateral stimulation, but they should not automatically be assumed to have identical effects.

Why Might Eye Movements Have Different Effects?

One leading explanation for part of EMDR's effect is the working-memory account.

When you bring a vivid memory to mind, that uses limited working-memory resources.

Following moving visual stimuli also requires attention and working-memory resources.

Doing both at the same time may make the memory harder to hold with the same vividness and emotional intensity.

Experimental studies have found that eye movements can place measurable demands on working memory.

This is one leading explanation for EMDR's effects, not a final or complete explanation of exactly how EMDR works.

Does That Mean Eye Movements Are Always Better?

No.

Evidence that eye movements produce stronger effects in certain experiments does not mean they will always be the best choice for every person or every situation.

EMDR practice includes other forms of stimulation for a reason.

For example, a person may find it easier to follow:

• Alternating sounds
• Tactile stimulation
• Another available bilateral method

The appropriate method can also depend on practical considerations and the way EMDR is being delivered.

What the research does not support is assuming that every method is automatically equivalent simply because all of them can be used within EMDR.

If you experience anxiety about following a moving visual target, you can discuss that concern when choosing a stimulation method.

Why Might Someone Use Tapping Instead of Eye Movements?

There can be several practical reasons.

Someone may:

• Find tapping easier to follow
• Prefer keeping their eyes still
• Have difficulty comfortably tracking a visual stimulus
• Be doing EMDR in a setting where visual stimulation is less convenient
• Simply respond better to another available method

Preference can influence how comfortable and workable a method feels.

That is different from proving that the preferred method has exactly the same therapeutic effect as another one.

Why Might Someone Use Sounds Instead?

Alternating sounds can be easy to deliver through headphones and may be convenient in some online settings.

They also allow a person to keep their eyes wherever feels natural rather than continuously following a moving visual target.

Again, convenience or personal preference should not be confused with evidence that auditory stimulation and eye movements are identical.

Research has found meaningful differences between them in some laboratory studies.

Do Eye Movements Have to Be Perfect?

No.

EMDR does not depend on making perfectly timed or perfectly symmetrical eye movements.

The person typically follows a moving stimulus from side to side at a workable pace.

The exact speed, distance, and form of stimulation may vary.

During reprocessing, what matters is not performing the movement like a test. The eye movements are part of a larger process in which attention remains connected to the memory and whatever thoughts, emotions, images, or body sensations emerge.

Is Bilateral Stimulation the Whole Treatment?

No.

This is an important distinction.

Watching something move back and forth or listening to alternating tones by itself is not the same as completing an EMDR process.

EMDR is a structured therapy that includes several phases and works with specific target material.

A target can include:

• A memory
• An image
• A negative belief
• An emotion
• A body sensation
• A present trigger
• A future situation

During active reprocessing, bilateral stimulation is paired with focused attention to the target and the associations that emerge.

So the bilateral stimulation supports the process rather than replacing it. For someone working with experiences connected to childhood trauma, identifying the target is a separate step from choosing the stimulation method.

What Happens Between Sets of Bilateral Stimulation?

After a brief set, the stimulation usually stops.

You then notice what is present.

You might become aware of:

• Another thought
• A different memory
• A change in emotion
• A new image
• A body sensation
• A different perspective
• Very little change at all

Processing then continues from whatever is there.

This repeated pattern of focused attention, stimulation, noticing, and continuing is part of what distinguishes EMDR from simply watching a moving object or listening to alternating sounds.

Can the Type of Bilateral Stimulation Change During EMDR?

Yes.

The stimulation method used for one person or one session does not necessarily have to remain the same forever.

EMDR practitioners may use different forms of bilateral stimulation depending on the situation and how the person is responding.

Eye movements are familiar because of the treatment's name, but tapping and auditory stimulation are also used in EMDR practice.

Does Online EMDR Always Use Eye Movements?

No.

Online therapist-guided EMDR can use different forms of bilateral stimulation.

Visual stimulation may be provided on a screen.

Other options can include tactile self-tapping or alternating auditory stimulation.

EMDRIA guidance for online EMDR specifically describes screen-based eye movements, tactile methods, and alternating auditory tones as possible methods.

So moving EMDR online does not mean eye movements disappear, but it can change how bilateral stimulation is delivered.

What About Self-Guided EMDR?

The same general principle applies to structured self-guided EMDR: eye movements are not the only possible type of stimulation.

With Virtual EMDR, the program uses a structured self-guided online format, and users can select and adjust the available visual or audio bilateral stimulation settings themselves.

That means someone using Virtual EMDR does not necessarily have to use visual eye movements every time.

This is also an important example of why EMDR should not be described as something that only happens in a therapist's office while watching a therapist's fingers. EMDR may be therapist-guided in person or online, and structured self-guided formats also exist.

Why Is It Still Called “Eye Movement Desensitization and Reprocessing”?

The name reflects how the treatment originally developed and the strong association between EMDR and eye movements.

Eye movements remain an important and extensively studied part of EMDR.

But the clinical method has long included other forms of bilateral stimulation, including tactile and auditory stimulation. An overview coauthored by EMDR founder Francine Shapiro describes bilateral physical stimulation as including side-to-side eye movements, alternating hand taps, and alternating auditory tones.

So the name should not be interpreted to mean:

“No eye movements = no EMDR.”

Conclusion

EMDR does not always use eye movements.

Side-to-side eye movements are the best-known form of bilateral stimulation and have been studied extensively, but EMDR practice also includes alternating auditory and tactile stimulation.

Those methods should not automatically be treated as scientifically identical. Some experimental research has found stronger working-memory effects for eye movements than for alternating sounds, and researchers continue to study how different forms of stimulation contribute to the process.

The most useful distinction is:

Eye movements are one important form of bilateral stimulation used in EMDR—but they are not the only one.