Side Effects of EMDR Therapy: A Complete Guide

Eye Movement Desensitization and Reprocessing (EMDR) therapy is a powerful treatment for trauma, but like any therapeutic intervention, it can produce side effects and healing responses. Understanding these potential reactions is crucial for anyone considering or undergoing EMDR treatment.

This comprehensive guide will help you understand what side effects to expect, how long they typically last, and how to manage them effectively. We'll also cover which side effects are normal, which require attention, and when to seek professional support.

Image credit: Taylor Grote on Unsplash

Understanding EMDR Side Effects: The Foundation

What Are "Side Effects" in EMDR Context?

In EMDR therapy, "side effects" typically refer to:

• Processing responses: Emotional, cognitive, and physical reactions during and between sessions
• Healing symptoms: Temporary intensification of symptoms as trauma processes
• Integration effects: Changes in perception, emotional regulation, and physical sensations
• Treatment reactions: Your nervous system's response to activating and reprocessing trauma material

Important distinction: Most EMDR side effects are actually healing responses—your brain and nervous system's natural reaction to processing difficult material. Rather than being complications, these are often signs that therapy is working.

The Science Behind EMDR Reactions

EMDR works by stimulating the brain's information processing system. When you activate traumatic memories with bilateral stimulation:

• Neural pathways temporarily intensify before reorganization occurs
• Memory networks activate related emotions, sensations, and associated memories
• Nervous system reorganizes how it stores and processes trauma
• Body-mind connection processes trauma stored somatically

This temporary disruption explains why you might feel worse before feeling better—the healing process is active and working.

Common Side Effects: What Most People Experience

Emotional Side Effects

Intensified Emotions:

• Increased anxiety: Heightened worry or fear, especially around triggers
• Emotional volatility: Rapid mood swings or unexpected emotional responses
• Sadness or depression: Feeling hopeless or deeply sad between sessions
• Anger or irritability: Short temper or frustration with everyday situations
• Emotional numbness: Feeling disconnected from your emotions temporarily

Memory-Related Effects:

• Vivid dreams or nightmares: Processing continues during sleep
• Increased intrusive thoughts: Memories popping up more frequently
• Flashback intensification: Temporary increase in memory vividness
• Memory networks activating: Related memories surfacing unexpectedly
• Confusion about timeline: Difficulty distinguishing past from present

Cognitive Side Effects

Concentration and Focus:

• Brain fog: Difficulty thinking clearly or making decisions
• Memory problems: Short-term memory difficulties or forgetfulness
• Reduced attention span: Trouble focusing on tasks or conversations
• Mental fatigue: Feeling mentally exhausted after processing

Thought Pattern Changes:

• Negative self-talk: Increase in critical or judgmental thoughts
• Overthinking or rumination: Getting stuck in thought loops
• Catastrophic thinking: Expecting worst-case scenarios
• Doubt about therapy: Questioning if EMDR is working or right for you

Image credit: Taylor Grote on Unsplash

Physical Side Effects

Somatic Manifestations:

• Headaches or migraines: Tension headaches, often one-sided
• Muscle tension or pain: Jaw clenching, shoulder tightness, back pain
• Fatigue or exhaustion: Deep physical tiredness, like you've run a marathon
• Sleep disturbances: Difficulty falling asleep, staying asleep, or restless sleep
• Digestive issues: Stomach pain, nausea, or appetite changes
• Dizziness or lightheadedness: Feeling off-balance or spacey

Autonomic Nervous System Responses:

• Heart rate changes: Palpitations, racing heart, or irregular heartbeat
• Breathing changes: Shortness of breath or hyperventilation
• Temperature changes: Feeling hot or cold, sweating, or chills
• Tremors or shaking: Internal trembling or visible shaking
• Blood pressure changes: Temporary increases or decreases in blood pressure

Behavioral Side Effects

Social and Interpersonal Effects:

• Social withdrawal: Wanting to avoid people or social situations
• Relationship conflicts: Increased arguments or misunderstanding with loved ones
• Work difficulties: Trouble concentrating, decreased productivity, or conflicts with coworkers
• Isolation behaviors: Spending more time alone, avoiding contact
• Communication problems: Difficulty expressing needs or understanding others

Daily Functioning Impacts:

• Self-care challenges: Difficulty with basic hygiene, eating, or sleep routines
• Decision-making impairment: Poor judgment or impulsive decisions
• Responsibility neglect: Forgetting important tasks or appointments
• Risk behaviors: Increased substance use or unsafe choices

Timeline of EMDR Side Effects

Immediate Effects (First 24 Hours)

What to Expect:

• Emotional intensity: Heightened emotional sensitivity and reactivity
• Physical exhaustion: Deep fatigue and muscle tension
• Dream activation: Vivid dreams or nightmares about processed material
• Disorientation: Feeling confused or spaced out
• Increased startle response: Jumpiness or hyper-vigilance

Management Strategies:

• Rest and recovery: Plan quiet time after sessions
• Grounding techniques: Use skills learned in therapy to stay present
• Hydration and nutrition: Support your nervous system with water and balanced meals
• Comfort measures: Warm baths, comfortable clothing, gentle movement

Short-Term Effects (First 3-7 Days)

Typical Experience:

• Emotional waves: Periods of intense processing alternating with relative calm
• Memory surfacing: New memories or insights appearing spontaneously
• Physical symptoms: Fluctuating energy levels, tension patterns, sleep changes
• Cognitive processing: Making new connections or understanding about experiences
• Emotional regulation: Difficulty managing emotions, periods of overwhelm

Support Approaches:

• Journaling: Write down dreams, memories, emotions, and insights
• Regular self-care: Consistent sleep, nutrition, and gentle exercise
• Therapist communication: Check in between sessions if needed
• Patience and compassion: Allow healing at your own pace

Medium-Term Effects (First 2-4 Weeks)

Stabilization Phase:

• Gradual reduction in symptom intensity
• Increased clarity: Better understanding of processed material
• Improved regulation: Enhanced ability to manage emotions and stress
• Physical improvements: Reduced tension, better sleep, more energy
• Integration progress: New responses to old triggers and situations

Positive Indicators:

• Memories feeling neutral: Less emotional charge when recalled
• Improved daily functioning: Better work performance and relationships
• New coping skills: Effective use of therapy techniques
• Hope and optimism: Positive outlook about continued healing

Image credit: Robina Weermeijer on Unsplash

Normal vs. Concerning Side Effects

Completely Normal Side Effects

These healing responses are expected and generally resolve without intervention:

Expected Reactions:

• Emotional processing: Increased feelings, dreams, or emotional sensitivity
• Physical tension: Headaches, muscle tightness, fatigue
• Cognitive changes: Temporary brain fog or concentration difficulties
• Sleep changes: Vivid dreams, restless sleep, or temporary insomnia
• Memory activation: Related memories surfacing or increased vividness

Duration Guidelines:

• Mild effects: 1-3 days
• Moderate effects: 3-7 days
• Intense effects: Up to 2 weeks
• Complex trauma: Effects may last longer as more material processes

Monitor Closely: Keep in Touch with Your Therapist

These effects warrant contact with your therapist:

Physical Concerns:

• Severe headaches: Migraines lasting more than 24-48 hours
• Chest pain or pressure: Especially with breathing difficulties
• Loss of consciousness: Fainting, severe dizziness, or confusion
• Physical symptoms: Any new or worsening physical concerns

Emotional/Mental Concerns:

• Suicidal thoughts: Any thoughts of self-harm or suicide
• Psychotic symptoms: Hearing voices, severe paranoia, or break with reality
• Severe dissociation: Feeling completely disconnected from reality or body
• Inability to function: Can't care for basic needs (eating, sleeping, hygiene)

Behavioral Concerns:

• Self-harm behaviors: Any intentional injury to yourself
• Risk behaviors: Dangerous activities, reckless decisions, or aggression
• Substance abuse: Significant increase in alcohol or drug use
• Complete withdrawal: Inability to leave home, work, or communicate

Managing EMDR Side Effects Effectively

Immediate Self-Care Strategies

Emotional Regulation Techniques:

• Box breathing: Slow, deep breathing to activate parasympathetic nervous system
• Progressive muscle relaxation: Systematically tensing and relaxing muscle groups
• Safe place visualization: Return to your EMDR safe/calm place mentally
• Resource tapping: Alternating taps while focusing on positive memories or resources
• Mindful awareness: Observe emotions without judgment or needing to change them

Physical Comfort Measures:

• Temperature regulation: Warm baths, cool compresses, or comfortable clothing
• Gentle movement: Stretching, walking, or restorative yoga
• Sensory grounding: Hold ice cubes, smell strong scents, or feel different textures
• Body positioning: Use pillows, blankets, or comfortable seating for support

Environmental Support:

• Reduce stimulation: Dim lights, quiet environment, limited technology use
• Create safety: Make your physical space feel secure and comfortable
• Supportive contacts: Let trusted people know you're processing and might need support
• Emergency plan: Know who to call and what to do if symptoms escalate

Communication and Support

With Your Therapist:

• Regular check-ins: Schedule calls or messages between sessions
• Honest reporting: Share all symptoms, concerns, or questions
• Track progress: Keep simple notes about symptom changes and improvements
• Request modifications: Ask for changes in technique or pacing if needed

With Support Systems:

• Educate key supporters: Help trusted friends/family understand EMDR process
• Set up support team: Identify who you can call for different types of support
• Plan for help: Arrange practical assistance (meals, childcare, transportation)
• Use your resources: Don't hesitate to access your support network

Lifestyle Adjustments

During Intensive Processing:

• Reduce obligations: Cancel or postpone non-essential activities
• Modify work responsibilities: Ask for reduced hours or lighter duties
• Simplify daily tasks: Focus on essential needs only
• Limit decision-making: Postpone major life decisions until processing stabilizes

Long-Term Self-Care:

• Establish routines: Consistent sleep, meals, and activity schedules
• Practice therapy skills: Regular use of grounding, calming, and resource techniques
• Monitor your energy: Pace activities according to your current capacity
• Celebrate small wins: Acknowledge and appreciate healing progress

Special Considerations

For Different Populations

Children and Adolescents:

• More intense processing: May express through behavior rather than words
• Parental involvement: Often needs family support for integration
• School accommodations: May need temporary modifications to academic demands
• Shorter sessions: May need briefer, more frequent processing periods

Complex Trauma Survivors:

• Prolonged processing: Effects may last longer with more intense periods
• Fragmented memories: Multiple memory networks may activate simultaneously
• Dissociation patterns: May experience disconnection or reality confusion
• Systemic involvement: Family or relationship system may be affected

Professionals and Helpers:

• Vicarious trauma: Processing others' trauma stories can affect you
• Burnout risk: Need additional self-care and boundary maintenance
• Countertransference: Personal reactions to client material
• Secondary trauma: Workplace exposure to many trauma stories

With Co-Occurring Conditions

Anxiety Disorders:

• Increased panic symptoms: Heightened anxiety or panic attacks
• OCD intensification: More compulsions or obsessive thoughts
• Phobia activation: Increased fear responses to specific triggers
• Generalized anxiety: More constant worry or tension

Depression:

• Lowered mood: Increased sadness or hopelessness
• Energy changes: More fatigue or motivation problems
• Cognitive effects: More negative thought patterns
• Physical symptoms: Increased aches, sleep changes, or appetite changes

Medical Conditions:

• Chronic pain: May experience temporary pain increases
• Autoimmune conditions: Possible symptom flares during processing
• Neurological issues: May affect seizure threshold or coordination
• Medication interactions: May need temporary adjustments during intensive processing

Long-Term Effects and Benefits

Positive Outcomes After Processing Completes

Emotional Benefits:

• Reduced trigger responses: Old situations don't cause the same distress
• Improved emotional regulation: Better ability to manage and express emotions appropriately
• Increased resilience: Greater capacity to handle stress and challenges
• Enhanced self-compassion: kinder, more understanding relationship with yourself
• Emotional freedom: Less controlled by past trauma responses

Cognitive Improvements:

• Clearer thinking: Better concentration, memory, and decision-making
• Realistic perspectives: More balanced understanding of past experiences
• Problem-solving skills: Enhanced ability to address current challenges
• Reduced negative self-talk: More positive internal dialogue
• Improved learning: Better capacity for new information and skills

Physical Health Gains:

• Reduced tension: Less muscle pain, headaches, or body armor
• Better sleep: Improved sleep quality and more restful rest
• Increased energy: More stamina and vitality for daily activities
• Reduced somatic symptoms: Fewer trauma-related physical complaints
• Improved immune function: Often better physical health overall

Relational and Social Benefits:

• Healthier boundaries: Better ability to set and maintain appropriate limits
• Improved communication: More authentic and effective expression of needs
• Deeper connections: More intimate and meaningful relationships
• Increased trust: Greater ability to rely on others and form secure attachments
• Better social functioning: More confidence and comfort in social situations

Life Quality Enhancements

Professional and Personal Growth:

• Career advancement: Improved work performance and satisfaction
• Educational achievements: Better ability to learn and apply new skills
• Creative expression: More artistic or self-expressive activities
• Spiritual connection: Deeper sense of meaning or purpose
• Future orientation: Greater ability to plan and work toward goals

When to Seek Additional Support

Crisis Intervention

Immediate Emergency Services:

• Suicidal thoughts: Call 988 (US/Canada) or local crisis line
• Psychotic symptoms: Contact emergency services or psychiatric evaluation
• Harm to self or others: Call emergency services immediately
• Severe dissociation: Seek medical evaluation for safety
• Inability to function: Contact emergency services or go to emergency room

Safety Resources:

• Crisis hotlines: 24/7 support for emotional crises
• Emergency departments: Medical evaluation and stabilization services
• Psychiatric urgent care: Emergency mental health services
• Safety planning: Remove means of harm and ensure immediate support

Professional Support

Therapist Consultation:

• Additional sessions: Extra appointments for stabilization or support
• Referral for medication: If symptoms are severe or prolonged
• Specialist consultation: Psychiatrist or medical doctor evaluation
• Treatment modification: Changes in approach, pacing, or technique

Complementary Services:

• Psychiatric care: Medication management and evaluation
• Medical evaluation: Rule out physical causes for concerning symptoms
• Group therapy: Additional support during intensive processing periods
• Case management: Coordination of multiple services and supports

Image credit: Taylor Grote on Unsplash

Maximizing Benefits While Minimizing Side Effects

Preparation Strategies

Before Beginning EMDR:

• Comprehensive assessment: Full evaluation of your history and current symptoms
• Resource development: Strong skills before intensive processing begins
• Stabilization work: Ensure you can regulate emotions and stay present
• Safety planning: Clear protocols for managing difficult reactions
• Pacing discussion: Agreement about treatment speed and intensity

Optimal Conditions:

• Therapeutic alliance: Strong, trusting relationship with your therapist
• Support system: Reliable people to help between and after sessions
• Life stability: Minimal external stress during intensive processing
• Physical readiness: Good nutrition, sleep, and health before treatment

During Treatment Best Practices

Session Management:

• Regular check-ins: Ongoing assessment of your responses and needs
• Technique adjustment: Modify approach based on your feedback
• Appropriate pacing: Neither too fast nor too slow for your processing
• Immediate debriefing: Clear understanding and integration of each session

Between-Session Care:

• Consistent communication: Regular contact with your therapist
• Symptom tracking: Monitor changes, patterns, and improvements
• Self-care commitment: Dedicated attention to healing activities
• Boundary maintenance: Protect your energy and focus on recovery

Long-Term Success Factors

After Completion:

• Integration period: Time for continued stabilization and adjustment
• Follow-up support: Periodic check-ins and booster sessions if needed
• Skills maintenance: Regular practice of learned techniques and strategies
• Relapse prevention: Plan for handling future stressors effectively
• Community connection: Ongoing support for maintaining gains

Conclusion: Understanding the Healing Journey

EMDR side effects, while sometimes challenging, are typically normal signs that your brain and nervous system are actively processing and healing from trauma. Understanding these potential reactions helps you:

• Prepare appropriately with resources and support systems
• Recognize healing responses as progress rather than complications
• Manage symptoms effectively with self-care and professional support
• Trust the process while advocating for your specific needs
• Celebrate progress as your nervous system reorganizes and heals

Most EMDR side effects are temporary and resolve as integration completes. The immediate discomfort often leads to profound, lasting benefits in emotional regulation, physical health, relationships, and overall quality of life.

If you're experiencing severe symptoms or crisis, please reach out to your therapist, crisis services, or emergency medical care immediately. Your healing journey doesn't have to be walked alone—support is available and essential for optimal outcomes.

Image Credits:

• Person experiencing emotional processing: Taylor Grote on Unsplash
• Person journaling emotions after therapy: Taylor Grote on Unsplash
• Person practicing grounding techniques: Robina Weermeijer on Unsplash
• Therapist providing support during session: Taylor Grote on Unsplash

This article is for informational purposes only and does not constitute medical advice. If you're experiencing severe symptoms or crisis, please contact your therapist, crisis services, or emergency medical care immediately.