EMDR (standard, group and recent-event protocols)

1. Introduction

Version followed: the standard eight-phase, three-pronged EMDR protocol as organised in Francine Shapiro's 3rd edition textbook (2018; only its table of contents is drawn on, so procedure is taken from Shapiro 2014 and Shapiro-derived scripted and primer texts), the Recent Traumatic Episode Protocol (R-TEP) as first published by Elan Shapiro and Brurit Laub (2008), the Group Traumatic Episode Protocol (G-TEP) by Elan Shapiro (adapted from R-TEP in 2013; described here from secondary trial reports), and the EMDR Integrative Group Treatment Protocol (EMDR-IGTP) by Ignacio Jarero and Lucina Artigas, including its adaptation for ongoing traumatic stress (IGTP-OTS; Jarero et al. 2016). EMDRIA and EMDR Europe practice standards are not drawn on [uncertain].

Eye Movement Desensitization and Reprocessing (EMDR) is a structured psychotherapy for symptoms that arise from disturbing life experiences. The client briefly holds a disturbing memory in mind while attending to a bilateral stimulus (eye movements, alternating taps or tones). The therapist then steps back and lets associations unfold. Its theory, the Adaptive Information Processing (AIP) model, holds that symptoms come from memories stored unprocessed, still carrying the emotions, body sensations and beliefs of the original event. Present-day triggers link to those stored memories, so reactions are coloured by the past. In AIP terms, processing links the memory to adaptive information so it is stored as ordinary, explicit memory, and the disturbance, the negative self-belief and the body charge resolve [source: Shapiro 2014; Primer ch. 1]. Shapiro contrasts this associative process with prolonged focus on the event as in exposure-based CBT. She also notes that EMDR sets no between-session homework, so sessions can run on consecutive days [source: Shapiro 2014].

The recent-event and group protocols keep the same AIP logic but change the target. They process a trauma episode, running from the event to the present, and they build in extra containment. The group protocols let many people reprocess at once using self-administered bilateral stimulation and private drawings or worksheets [source: Shapiro & Laub 2008; Jarero et al. 2016; Yurtsever et al. 2018].

2. Framework

2.1 Standard protocol: eight phases [source: Shapiro 2014 table of phases; Shapiro 2018 table of contents; Primer ch. 1; Springer scripted appendix]

• Three-pronged order: past events that set up the problem (touchstones first), then present triggers, then future templates. The Primer notes the order is important but not always practical, and the client's goals guide it. Skipping the future template may give only part of the treatment effect [source: Primer ch. 1; Logie & de Jongh 2014].
• Ending criteria per target: SUD 0, VoC 7 and a clear body scan [source: Springer scripted appendix; Logie & de Jongh 2014]. A SUD stuck at 1 or above, a VoC stuck below 7, or a body that will not clear suggests a blocking belief or a feeder memory [source: Primer ch. 1]. Logie and de Jongh accept a SUD of 1 for some catastrophic future fears [source: Logie & de Jongh 2014]. R-TEP uses "ecological" SUD, meaning a residual level that fits current reality [source: Shapiro & Laub 2008].
• Session count and format: individual sessions, typically 50–90 minutes. Shapiro reports 3–6 sessions for single-incident trauma (for example, three 90-minute sessions or about six 50-minute sessions) and 8 sessions in several RCTs. She notes that repeated childhood abuse generally needs longer [source: Shapiro 2014]. Phases 1–2 may take one session or many, depending on stability [synthesis].
• Special-situation protocols: the 2018 textbook has a chapter on "Standardized Protocols and Procedures for Special Situations" and one on the cognitive interweave. Their contents (for example, Shapiro's Recent Event Protocol) are not drawn on [uncertain].

2.2 R-TEP (recent trauma, individual) [source: Shapiro & Laub 2008]

• Model: recent memories are not yet consolidated, so no single image represents the whole event. The target is the episode, running from the event to today, including its aftermath and changing meaning. Processing can widen in focus from a sensory image, to the event, to the episode, to a theme.
• Phases: (I) History, gathered as far as circumstances allow, including from others; screen for complex PTSD; IES-R if possible; discourage detailed retelling. (II) Preparation and stabilisation (safe/calm place, resource connection and/or the 4 Elements exercise) plus a distancing metaphor. (III–IV) Episode processing with multiple targets: Episode Narrative with dual attention stimuli (DAS), then a silent Google Search for points of disturbance, processing each with returns to target; repeat the Google Search; episode SUD (E-SUD) check. (V) Install an Episode PC (E-PC). (VI) Episode body scan. (VII) Strong closure every session. (VIII) Follow-up: recheck E-SUD and use Google Search for residual targets.
• Timing: no fixed cutoff for "recent". The authors give a rough continuum (acute stress reaction about 2 days, acute stress disorder about 2 weeks, acute PTSD about 1 month, chronic PTSD about 3 months). They report use beyond 3 months, with a case at 18 months. No fixed session count; the protocol "may take several sessions".

2.3 G-TEP (group adaptation of R-TEP) [source: Yurtsever et al. 2018; JNZCCP 2024 article; NCT07246356 protocol; Shapiro 2026 abstract]

• Model: a group version of R-TEP (Elan Shapiro, 2013) built on the same trauma-episode logic. Members work privately on a worksheet; they process one point of disturbance (PoD) at a time with self-administered BLS. Members do not share trauma content aloud. Shapiro (2026) calls this "microprocessing" and stresses that it does not replace screening, risk assessment and suitability decisions.
• Worksheet sequence (as reported): stabilisation/containment (safe or calm place) → a positive past resource → a future statement of how the person wants to think back on the event → drawing or writing one PoD → BLS rounds guided by the facilitators, with SUD ratings → closing stabilisation [source: JNZCCP 2024 article]. The original worksheet layout is [uncertain].
• Reported formats (they vary): two sessions of about 4 hours over 3 days with refugees, run by two therapists per group (time doubled by translation) [Yurtsever 2018]; 2 hours weekly for 5 weeks, 6–10 clients, two clinicians, as an adjunct to individual therapy [JNZCCP 2024]; six 1.5-hour online sessions for about 5 participants, with the first three for stabilisation and the last three for PoD processing, plus individual intake and a follow-up 2–6 weeks later [NCT07246356].

2.4 EMDR-IGTP and IGTP-OTS (group) [source: Jarero et al. 2016; NCT07027930]

• Structure: the eight phases run inside each group session. An individual Phase 1 intake comes first. The leader instructs; an Emotional Protection Team (EPT) of about one member per 8–10 participants (1:10 adults in NCT07027930) monitors the room. Each participant draws in four quadrants (A–D) of a page and uses the Butterfly Hug (BH) as self-administered BLS. Phases 3 and 5 leave out cognitions; Phase 5 is replaced by a future-vision drawing.
• OTS dosing: one individual intake, then six group sessions over three consecutive days, morning and afternoon. Participants who remain distressed get individual or small-group (about 3–8) follow-up [source: Jarero et al. 2016].
• Origins: the claim that EMDR-IGTP began in Mexico in the late 1990s is not confirmed [uncertain].

3. Guiding principles

• AIP as the case formulation: present symptoms are treated as driven by unprocessed memories. Practical meaning: for every symptom, ask which memories feed it and target those, not just the symptom [source: Shapiro 2014; Primer ch. 1].
• Touchstone first: the earliest memory at the core of a network is processed earlier where possible, so later processing runs more freely. Practical meaning: use the history to find the node that similar events attach to [source: Primer ch. 1].
• Past, present, future: all three prongs are needed for a full effect. Practical meaning: do not stop when the memory is neutral; clear triggers and install future templates [source: Shapiro 2014; Primer ch. 1].
• Generalisation: processing one memory spreads to similar ones, so not every event needs targeting. Practical meaning: pick representative memories from each cluster [source: Shapiro 2014].
• The client's own system does the processing: the therapist sets up and then keeps out of the way. Practical meaning: between sets, take a brief report and say "go with that" rather than interpreting [source: Springer scripted appendix; Shapiro & Laub 2008].
• The client is in control: a stop signal is agreed before processing. Practical meaning: always honour it, then re-establish safety before going on [source: Springer scripted appendix].
• Dual attention: the client keeps one foot in the present while touching the memory. Practical meaning: eyes open during eye movements; stimulus types and directions are agreed in advance; tell the client before switching [source: Primer ch. 1; Shapiro & Laub 2008].
• Feeders before current targets; progressions noted for later: Practical meaning: if an earlier memory blocks the current one, process it first; note later memories that arise and come back to them [source: Primer ch. 1].
• Stability before processing; every session closed safely: Practical meaning: no client leaves a session dysregulated; an incomplete session gets a containment closure [source: Shapiro 2014; Shapiro & Laub 2008].
• Containment proportionate to recency and fragility (R-TEP, G-TEP): Practical meaning: start with a narrow focus (point of disturbance, event), and widen to episode or theme only if processing stalls; return to target when associations drift [source: Shapiro & Laub 2008; Shapiro 2026].
• Ecological endpoints: Practical meaning: residual disturbance that fits current reality (an ongoing threat, a fresh bereavement) is accepted, not pushed to zero [source: Shapiro & Laub 2008; Logie & de Jongh 2014].
• Group privacy and self-pacing: no trauma narratives are spoken in group; participants self-administer BLS; staff support silently. Practical meaning: arrange the room and staffing so a distressed person is helped without disturbing others [source: Jarero et al. 2016; JNZCCP 2024].
• Social support matters for group suitability: Jarero et al. added a complete lack of social and family support as an exclusion criterion. Practical meaning: ask about support at intake [source: Jarero et al. 2016].
• Memories as experience, not evidence: Practical meaning: work with what the client reports as their experience; never use EMDR to "recover" or verify memories; warn clients in legal proceedings that processing may change how a memory feels and how they tell it [synthesis].

4. Intervention inventory

All example language is illustrative wording written for this guide, except short phrases in quotation marks with a citation. Procedures in 4A–4B follow the standard protocol (Shapiro 2018 structure); 4C covers the recent-event and group protocols.

4A. Standard protocol: history, preparation and assessment

4.1 History taking, readiness screening and target sequencing (Phase 1)

• Purpose / when: at the start of treatment, to decide whether EMDR fits now and to build the treatment plan [source: Shapiro 2014; Primer ch. 1].
• Steps:
  1. Take a full psychiatric and psychometric history and agree goals [source: Shapiro 2014].
  2. Screen readiness: current safety (ongoing abuse, suicidality), affect tolerance, dissociation (a structured screen such as the Dissociative Experiences Scale, followed by clinical interview where positive), substance use, psychosis, physical health issues that strong arousal could worsen (for example, cardiac conditions, epilepsy, pregnancy), pending legal proceedings, and social support [synthesis; the textbook has an appendix on "Client Safety" that is not drawn on: uncertain]. In group protocols, published exclusions include psychosis, bipolar disorder, intellectual disability, severe head injury, high dissociation, self-harm "red flags" and complete lack of support [source: Yurtsever 2018; NCT07246356; NCT07027930; Jarero et al. 2016].
  3. List the targets for each prong. Past: the worst memory, the first memory and other key memories in each cluster, looking for a touchstone. Present: current triggers. Future: the situations where the client wants to respond differently [source: Shapiro 2014; Primer ch. 1].
  4. Order the targets: touchstone or earliest relevant memory first where the client can tolerate it, then other past memories, then triggers, then future templates [source: Primer ch. 1].
• Example language (illustrative): "When you think of this pattern, what is the earliest time you remember feeling this way about yourself?" "Which situations set it off now?" "How would you like to handle that situation in future?"
• Watch for: a story that gets more vivid as it is told (slow down; Phase 1 is not processing); a dissociative presentation hidden behind high function [synthesis].

4.2 Explanation of EMDR and the AIP model (Phase 2)

• Purpose / when: before any processing, to obtain informed consent and set expectations [source: Shapiro 2014; NCT07027930 (simple AIP analogy for groups)].
• Steps: explain in plain terms that upsetting memories can stay "stuck" in their original form; that BLS plus brief attention to the memory lets the brain process them; that the client stays in control; and what may happen during and after sessions (emotions, new memories, dreams). Agree a stop signal (4.4). Obtain consent, including to the possibility of intense emotion [source: Springer scripted appendix; synthesis for the consent wording].
• Example language (illustrative): "Some memories get filed with the original fear still attached. In EMDR you touch the memory briefly while your eyes follow my hand, and your mind does the sorting. You stay in charge the whole time."
• Watch for: expectations of a quick fix or of uncovering hidden memories. Correct both: EMDR works with what the client already remembers [synthesis].

4.3 Setting up and testing bilateral stimulation (Phase 2)

• Purpose / when: before resource work and processing, to find a comfortable form of dual-attention stimulus [source: Primer ch. 1; Shapiro 2014].
• Steps:
  1. Offer eye movements first (the preferred form); taps or tones are alternatives when eye movements are uncomfortable or impossible [source: Primer ch. 1].
  2. Agree seating, distance and speed. Test horizontal movement, and agree in advance two directions or two modalities in case one stops working. Tell the client before you switch [source: Primer ch. 1].
  3. Keep the client's eyes open during eye movements. The Primer notes there is no research support for processing with eyes closed [source: Primer ch. 1].
  4. Slower, shorter sets for resource installation; faster, longer sets for processing [synthesis; the Primer's speed guidance: uncertain].
• Example language (illustrative): "Tell me if that is too fast, too close or uncomfortable. Is this distance okay for your eyes?"
• Watch for: eye strain, nausea or dizziness (switch to taps or tones); stimuli the client finds threatening, such as a hand moving toward the face in someone assaulted [synthesis].

4.4 Stop signal

• Purpose / when: set before any processing, so the client controls exposure [source: Springer scripted appendix (raised hand)].
• Steps: agree a non-verbal signal, usually a raised hand. Rehearse it once. During processing, stop BLS immediately when it is used, check in, and offer grounding or a calm place before deciding together whether to continue [source: Springer scripted appendix; synthesis for the follow-up steps].
• Example language (illustrative): "If at any point you want to stop, just raise your hand and I will stop straight away."
• Watch for: clients who never use it while visibly overwhelmed (frozen, glazed). Check in yourself, and treat this as dissociation risk [synthesis].

4.5 Distancing metaphors (train, screen, remote control)

• Purpose / when: in preparation, for clients who fear being swamped; built into R-TEP's Episode Narrative [source: Shapiro & Laub 2008; Shapiro 2014 (metaphors in Phase 2)].
• Steps: offer an image in which the memory is observed from a distance, such as watching it on a TV screen. Give the client a "remote control" to shrink, move or pause the screen. Use the metaphor during processing if distress spikes [source: Shapiro & Laub 2008].
• Example language (illustrative): "Imagine the memory playing on a screen across the room. You hold the remote; you can make it smaller or pause it whenever you like."
• Watch for: distance that becomes avoidance, with no affect at all. Processing needs some activation [synthesis].

4.6 Calm/safe place

• Purpose / when: in Phase 2, to build a self-calming resource; also used in closure and when processing must be paused [source: Primer ch. 1; Springer scripted appendix; Shapiro & Laub 2008].
• Steps (structure given in your own sequence; the textbook's procedure is not drawn on) [synthesis]:
  1. Ask the client for a real or imagined place linked with calm or safety.
  2. Elicit sensory detail, the emotion and where it is felt in the body.
  3. Add short, slow BLS sets only while the experience stays positive; stop if it turns negative.
  4. Agree a cue word, and have the client practise moving from mild disturbance back to the place.
• Example language (illustrative): "Notice what you see there, the sounds, the temperature. Where do you feel the calm in your body?"
• Watch for: the place becoming contaminated by trauma material (choose another resource, or use a calm state rather than a place); clients for whom "safe" is a triggering word (use "calm") [synthesis].

4.7 Resource connection / positive past resource

• Purpose / when: stabilisation before episode processing in R-TEP; a worksheet step in G-TEP [source: Shapiro & Laub 2008; JNZCCP 2024].
• Steps: ask for a time the person felt good about themselves or coped well. Elicit its image and body feeling. Strengthen it briefly with slow BLS (in groups, self-administered) and return to it at closure [source: JNZCCP 2024; synthesis for the BLS detail].
• Example language (illustrative): "Bring to mind a moment when you felt capable, even a small one. Notice how that feels in your body."
• Watch for: the resource memory linking to loss or trauma (switch resource) [synthesis].

4.8 The "4 Elements" exercise

• Purpose / when: listed by Shapiro & Laub (2008) among R-TEP stabilisation and closure tools [source: Shapiro & Laub 2008].
• Steps: not described in the sources [uncertain]. Use it only as taught in an EMDR-approved training; otherwise substitute the calm place or resource connection.

4.9 Phase 3 assessment of a target

• Purpose / when: at the start of processing each target, to activate the memory network and take baselines [source: Shapiro 2014; Springer scripted appendix].
• Steps (order as in the Shapiro-derived script) [source: Springer scripted appendix]:
  1. Image: the picture that represents the worst part of the memory. If the client is confused, narrow to the most traumatic part.
  2. Negative cognition (NC): the irrational negative self-belief that goes with the image, in the first person and present tense (for example, "I am powerless").
  3. Positive cognition (PC): what the client would prefer to believe about themselves now.
  4. Validity of Cognition (VoC): how true the PC feels while the client holds the image, on a 1 (completely false) to 7 (completely true) scale.
  5. Emotion: what the client feels now, holding the image and the NC.
  6. SUD: disturbance now, 0 (none or neutral) to 10 (the worst imaginable).
  7. Body location: where the disturbance is felt.
• Example language (illustrative): "When you bring up that picture, what words go with it that describe what you believe about yourself now?" "When you think of the picture, how true do the words '[PC]' feel from 1, completely false, to 7, completely true?"
• Watch for: NCs that are descriptions of the event or of feelings ("I was scared") rather than self-beliefs; PCs that are wishes about others or impossible. Help the client reword them. Cognitive "channels" (responsibility/defectiveness, responsibility/action, safety/vulnerability, power/control or choice) help locate the NC [source: Primer ch. 1].

4B. Standard protocol: reprocessing, closure and the three prongs

4.10 Desensitization sets (Phase 4)

• Purpose / when: immediately after Phase 3, to process the target to resolution [source: Shapiro 2014; Springer scripted appendix].
• Steps:
  1. Brief reminder: the client's own brain does the work, they are in control, and they can raise a hand to stop. Ask them to just notice whatever comes up, without judging it [source: Springer scripted appendix].
  2. Ask the client to bring up the image and the NC and notice where they feel it in the body. Start BLS [source: Springer scripted appendix].
  3. After a set, stop, invite a breath, and ask a neutral open question such as "What do you get now?" [source: Shapiro & Laub 2008]. Take the brief report without discussion.
  4. If material is changing, continue with "Go with that" [source: Shapiro & Laub 2008] and another set on what was just reported.
  5. Treat whatever arises (images, thoughts, emotions, sensations, other memories) as connected to the target [source: Springer scripted appendix].
  6. Set length and speed are adjusted to the client's response; a longer set while emotion is building, shorter sets if the client is close to overwhelm [synthesis; the textbook's default set lengths are not drawn on: uncertain].
• Example language (illustrative): "Just notice. ... Take a breath. What's there now?" "Okay, stay with that."
• Watch for / working: change from set to set in images, emotion, sensation or meaning; the content moving toward adaptive themes ("it's over", "it wasn't my fault"). Lack of change over two or more sets suggests looping (see 4.12–4.14) [synthesis].

4.11 Returning to target and checking SUD

• Purpose / when: when a channel of association seems finished (reports are neutral or positive), or when associations have drifted far from the target [source: Primer ch. 1; Shapiro & Laub 2008].
• Steps: ask the client to go back to the original memory and notice what they get now. Run BLS on that. When returns to target yield no new material, take a SUD. If SUD is above 0, continue processing; if 0, run one more set to confirm, then move to installation [source: Springer scripted appendix; Primer ch. 1; synthesis for the confirm set].
• Example language (illustrative): "When you go back to the original incident, what do you notice now?" "On 0 to 10, how disturbing does it feel now?"
• Watch for: feeder memories (earlier memories that block progress; process these first) and progressions (later memories; note these for future targets) [source: Primer ch. 1].

4.12 Blocking-belief questions

• Purpose / when: when SUD will not drop below 1, VoC stays below 7, or the body scan will not clear [source: Primer ch. 1].
• Steps: ask what keeps the rating where it is, or what prevents it from reaching 0. Take the answer (often a belief such as "if I let go I'll be careless") as the next focus for BLS, or find the memory that holds that belief and target it [source: Primer ch. 1; synthesis for next steps].
• Example language: "What keeps it a 2?" and "What prevents it from being a 0?" [source: Primer ch. 1 (paraphrasing Shapiro)].
• Watch for: ecologically valid residues (for example, an ongoing real threat). Accept these rather than pushing [source: Shapiro & Laub 2008; Logie & de Jongh 2014].

4.13 Floatback and affect scan

• Purpose / when: to find feeder or touchstone memories when a present trigger or block has an older root [source: Primer ch. 1; Logie & de Jongh 2014].
• Steps: the sources name these techniques but do not give their steps [uncertain]. General structure [synthesis]: have the client hold the current image and NC (floatback) or the current emotion and body sensation (affect scan), then let their mind drift back to the earliest time they felt this way, without searching hard. Take whatever comes as a candidate target, then do a Phase 3 assessment on it.
• Example language (illustrative): "Hold that feeling and the words 'I'm not safe', and just let your mind drift back. What's the earliest time you notice?"
• Watch for: demand for a "true" origin. Accept what arises as experience, not as historical proof, and never suggest content [synthesis].

4.14 Cognitive interweave

• Purpose / when: a proactive strategy for when processing stalls (looping, high distress without change, insufficient information), where the therapist briefly supplies or prompts the missing perspective so the client's own processing can restart [source: Shapiro 2018 table of contents (chapter on cognitive interweave); Primer ch. 1 (channels)]. Detailed procedures are not drawn on [uncertain].
• Steps [synthesis organised by the Primer's channels]:
  1. Notice the stall: same content and SUD across several sets, despite changing the BLS direction or modality.
  2. Identify which channel is stuck: responsibility ("it was my fault"), safety ("I'm still in danger") or choice/control ("I had no options").
  3. Offer one short question or piece of information that targets that channel, ideally a question the client answers themselves.
  4. Then, with the client's answer in mind, run BLS: "think of that", followed by a set. Return to normal processing as soon as material moves.
• Example language (illustrative): Responsibility: "Whose responsibility is it when an adult hurts a child?" Safety: "Where are you now, and is it over?" Choice: "What choices do you have now that you didn't have then?"
• Watch for: turning the session into talk therapy; long interweaves pull the client out of processing. Use the minimum needed [synthesis].

4.15 Managing abreaction during processing

• Purpose / when: intense emotional release while processing. The textbook has a chapter on abreaction and blocks [uncertain]. Guidance below is [synthesis].
• Steps: keep BLS going steadily through a peak if the client remains present (abreactions often pass during the set); speak in a calm, brief voice; remind the client that it is an old memory and they are safe here now; lengthen the set until the emotion begins to fall. If the client loses dual attention (no longer present, unresponsive), stop, ground (feet, room, naming objects, temperature), and contain before deciding whether to resume.
• Example language (illustrative): "It's old stuff; you're here with me. Just keep noticing, it's passing through."
• Watch for: signs of dissociation (glazed stare, flat voice, no response to questions, lost sense of time) versus emotion with presence (crying while tracking).

4.16 Installation of the positive cognition (Phase 5)

• Purpose / when: after SUD reaches 0 (or an ecological level), to strengthen the positive belief and link it to the memory [source: Shapiro 2014; Springer scripted appendix].
• Steps: check whether the original PC still fits or a better one has emerged. Ask the client to hold the memory together with the PC and rate the VoC. Run BLS sets, re-rating each time, until the VoC reaches 7 or stops rising. Probe if it stalls (4.12) [source: Springer scripted appendix; Primer ch. 1].
• Example language (illustrative): "Do the words '[PC]' still fit, or is there a better statement now?" "Think of the incident and those words. How true do they feel, 1 to 7?"
• Watch for: a VoC stuck at 5–6 (look for a blocking belief) [source: Primer ch. 1].

4.17 Body scan (Phase 6)

• Purpose / when: after installation, to clear residual somatic disturbance [source: Shapiro 2014; Springer scripted appendix].
• Steps: have the client hold the memory and the PC and scan the body from head to toe, reporting any tension or unusual sensation. Process any sensation with BLS until it clears; strengthen positive sensations with BLS [source: Springer scripted appendix].
• Example language (illustrative): "Hold the memory and the words '[PC]'. Scan your body slowly from top to bottom. Tell me if you notice anything."
• Watch for: new sensations that open a related memory (a sign more processing is needed) [synthesis].

4.18 Closure, complete or incomplete (Phase 7)

• Purpose / when: at the end of every reprocessing session [source: Shapiro 2014; Springer scripted appendix].
• Steps:
  1. Leave enough time (about 10–15 minutes) [synthesis].
  2. Incomplete session (SUD above 0, or VoC below 7): stop processing, acknowledge the work done, and use a containment and calming procedure (calm place, resource connection, container imagery). Do not install the PC or do the body scan [synthesis; the scripted appendix does not cover incomplete-session handling].
  3. Complete session: acknowledge the work done.
  4. Brief the client: processing may continue after the session (new memories, dreams, emotions or nothing at all). Ask them to keep a brief log of disturbing images, thoughts, emotions and sensations with 0–10 ratings, including positive experiences, as brief "snapshots" for the next session. Remind them to use the calm place and to call if needed [source: Springer scripted appendix; Shapiro 2014].
  5. Check the client is oriented and stable before they leave [synthesis].
• Example language (illustrative): "Processing may continue on its own this week. If something comes up, jot down a quick snapshot, the picture, the thought and a number, and use your calm place. We'll pick it up next time."
• Watch for: clients who leave activated. Do not let time pressure skip closure [synthesis].

4.19 Reevaluation (Phase 8)

• Purpose / when: at the start of each subsequent session and at key points [source: Springer scripted appendix; Shapiro 2014].
• Steps (four types) [source: Springer scripted appendix]:
  1. Changes since the last session (review the log, symptoms, new material).
  2. The previous target: re-access it, take SUD (and VoC). If SUD is above 0, continue processing; if 0, confirm and move on.
  3. Periodic review at critical points of treatment.
  4. Before ending treatment: review past targets, NCs, a chronological scan of life, clusters, significant people, present and recent triggers and future goals.
• Example language (illustrative): "When you bring up last week's memory, what do you notice now? How disturbing is it 0 to 10?"
• Watch for: gains that were not integrated into daily functioning or relationships [source: Shapiro 2014].

4.20 Processing present triggers

• Purpose / when: after the relevant past memories are processed, for situations that still set off disturbance [source: Springer scripted appendix; Primer ch. 1].
• Steps: identify each trigger and run a full Phase 3 assessment on it. Process through Phases 4–6 to SUD 0, VoC 7 and a clear body scan. Then install a future template for that situation [source: Springer scripted appendix].
• Example language (illustrative): "When you think of the next time you hear sirens, what picture comes up? What do you believe about yourself in that moment?"
• Watch for: a trigger that stays highly charged, which may show an unprocessed past memory. Floatback (4.13) [synthesis].

4.21 Future template (image and movie versions)

• Purpose / when: the third prong. Rehearse adaptive responses to future situations, once past and present targets are processed [source: Springer scripted appendix; Logie & de Jongh 2014; Primer ch. 1].
• Steps [source: Springer scripted appendix]:
  1. Check significant people and situations for remaining distress, testing whether the feeling fits current reality.
  2. Anticipatory anxiety: do a full assessment on the future scene. Go ahead with brief desensitization only if SUD is about 3–4 or lower. Otherwise target a present trigger first.
  3. Image template: the client imagines coping well in a specific future scene, paired with the PC. Process any blocks with BLS. Add skills or information if they are missing. Finish with a body scan.
  4. Movie template: the client runs a movie with a beginning, middle and end of handling the situation, including challenges. Resolve blocks, then replay the movie with BLS to install it.
  5. For skills-building or imaginal rehearsal, start directly with the movie; no full assessment is needed.
• Example language (illustrative): "Run a movie of next Monday's meeting from start to finish, seeing yourself handling it the way you'd like. Stop wherever it gets hard."
• Watch for: blocks showing a skills deficit rather than unprocessed material. Teach or model the skill, then repeat the template [source: Logie & de Jongh 2014; Primer ch. 1].

4.22 Flashforward procedure (Logie & de Jongh)

• Purpose / when: a variant for fear of a future catastrophe. Use it when the fear blocks work on the past, when a sceptical client needs to see EMDR work on a current issue, or when no past trauma can be found [source: Logie & de Jongh 2014].
• Steps: identify the worst imagined future outcome (the "flashforward" image). Elicit the NC, PC, VoC, emotion, SUD and body location "in the usual way". Process with the remaining phases until SUD 0 and VoC 7; a SUD of 1 may be acceptable in some cases. Typical PCs concern capacity to cope, such as "I can deal with it" [source: Logie & de Jongh 2014].
• Example language (illustrative): "What's the very worst picture of what could happen, the scene you avoid letting yourself imagine?"
• Watch for: realistic danger, which needs problem-solving, not desensitization [synthesis].

4C. Recent-event and group protocols

4.23 Shapiro's Recent Event Protocol and the EMD option

• Purpose / when: Shapiro's textbook includes protocols for recent events in its special-situations chapter. The procedure is [uncertain]. Shapiro & Laub (2008) state that, unlike the Recent Event protocol, R-TEP includes a body scan.
• EMD option inside R-TEP: if the target found is an intrusive sensory image, R-TEP allows the more contained EMD procedure, usually brief, instead of full assessment [source: Shapiro & Laub 2008]. Its steps are not described in the source [uncertain]. Restricting processing to the image with frequent returns to target is the general idea [synthesis].

4.24 R-TEP Episode Narrative with dual attention stimuli

• Purpose / when: the first R-TEP processing step, after history and stabilisation, to activate the whole episode in a contained way [source: Shapiro & Laub 2008].
• Steps: ask the client to "run the movie" of the episode from just before the event up to today, telling it aloud. Give continuous DAS (for example, taps) throughout to ground the client and keep distance. Offer the screen and remote-control metaphor, so the client can shrink, move or pause the image. Do not process yet; this is activation with containment [source: Shapiro & Laub 2008].
• Example language (illustrative): "While I tap, tell me the story from just before it happened until now, as if watching it on a screen you control."
• Watch for: arousal rising beyond tolerance. Slow down, shrink the screen, or pause and stabilise [source: Shapiro & Laub 2008; synthesis].

4.25 Episode "Google Search" for points of disturbance

• Purpose / when: to locate targets inside the episode, and later to check for residual disturbance [source: Shapiro & Laub 2008].
• Steps: with DAS running, the client silently scans the whole episode in any order and stops at the first point of excessive disturbance. That point becomes the target for 4.26. After it is processed, repeat the search for the next one. Variants include a resource Google Search and searching forward or back in time [source: Shapiro & Laub 2008].
• Example language (illustrative): "Without telling me, scan the whole period from the event until now, and stop at the first moment that still feels strongly disturbing. Just tell me when you've found one."
• Watch for: a client who finds everything disturbing. Narrow the search to a smaller time frame [synthesis].

4.26 Processing a point of disturbance, with regulated associations (R-TEP)

• Purpose / when: for each target found by the Google Search [source: Shapiro & Laub 2008].
• Steps: assess as appropriate (image, NC, PC, VoC, emotion, SUD, body sensation). Run a set of DAS and ask "What do you get now?" If the association relates to the episode, follow it ("Go with that"). If it moves outside the episode (into older memories), bring the client back to the target. Continue until SUD reaches an ecological level [source: Shapiro & Laub 2008]. Start with a narrow focus and widen (to the episode, then to themes or earlier memories) only if processing stalls [source: Shapiro & Laub 2008].
• Example language (illustrative): "Let's stay with what happened in the hospital for now. Go back to that moment. What do you notice?"
• Watch for: links to older trauma in recent-trauma work. Note them for later standard-protocol work rather than opening them now [source: Shapiro & Laub 2008; synthesis].

4.27 Episode SUD check, Episode PC installation, episode body scan, closure and follow-up (R-TEP)

• Steps [source: Shapiro & Laub 2008]:
  1. E-SUD: when the Google Search finds no new targets, rate the whole episode 0–10. If it is not ecological, search again for remaining pockets of disturbance. Persistent disturbance may point to meaning-level themes such as a shattered sense of safety.
  2. E-PC: ask how the client would like to think about the whole episode now and what they have learned. Rate the VoC 1–7. Install with DAS while the client runs the episode movie again from start to present.
  3. Episode body scan: with the E-PC in mind, check the body and process sensations with DAS.
  4. Closure: strong closure each session (calm place, resource connection, 4 Elements), because the protocol may span several sessions.
  5. Follow-up: get feedback, recheck the E-SUD, use the Google Search for residual targets, and repeat the IES-R if possible.
• Example language (illustrative): "Looking at the whole time since the accident, what would you like to believe about yourself now?"

4.28 G-TEP group session (worksheet procedure)

• Purpose / when: group early intervention or group trauma treatment where individual therapy cannot reach everyone, or as an adjunct to individual therapy [source: Yurtsever 2018; JNZCCP 2024; NCT07246356].
• Steps (as reported in secondary sources; the developer's script is not drawn on) [source: JNZCCP 2024; NCT07246356; Shapiro 2026]:
  1. Screen each member individually beforehand, including whether they can contain and regulate their own distress. Yurtsever et al. excluded people who could not manage self-containment during screening.
  2. Opening: group ground rules (no sharing of trauma content), then stabilisation and containment (safe or calm place) entered on the worksheet.
  3. Positive past resource: each person recalls a time they felt good about themselves and records it.
  4. Future statement: each person writes how they would like to be able to think back on the event (for example, "I survived"); this is reviewed at the end.
  5. Point of disturbance: each person draws or writes one part of the memory to work on, privately.
  6. Reprocessing: facilitators lead several rounds of self-administered BLS (4.29), with participants rating SUD between rounds (online: SUD sent privately via chat [NCT07246356]).
  7. Closing: stabilisation and containment again; review the future statement.
• Example language (illustrative): "Without telling anyone, choose one small part of what happened that still bothers you, and draw a symbol for it in this box."
• Watch for: members who cannot contain distress (a second facilitator or a breakout room for one-to-one support); offering individual EMDR afterwards when needed [source: Yurtsever 2018; JNZCCP 2024].

4.29 G-TEP self-administered BLS: eyes following the hand across the page

• Purpose / when: BLS during G-TEP reprocessing [source: JNZCCP 2024].
• Steps: participants mark two points on the worksheet, one for today's date and one for the symbol of the memory, and follow their own finger with their eyes as it moves back and forth between them [source: JNZCCP 2024].
• Watch for: participants who speed up or stop to avoid distress. Facilitators pace the rounds [synthesis].

4.30 Butterfly Hug

• Purpose / when: self-administered bilateral stimulation in EMDR-IGTP (and an option for self-soothing). Jarero et al. state it helps keep participants within their window of tolerance and gives them control over the stimulation [source: Jarero et al. 2016].
• Steps: taught in the first group session (Preparation) together with the SUD scale. Participants cross their arms over the chest and tap alternately with their hands, at their own pace, while observing what comes up; in IGTP each round lasts about 2–3 minutes [source: Jarero et al. 2016 for timing; the physical description: uncertain].
• Example language (illustrative): "Cross your arms and tap gently, left, right, at your own pace. Just notice what happens inside, like watching clouds go by."
• Watch for: participants who tap hard or very fast while agitated (prompt slower, gentler tapping) [synthesis].

4.31 EMDR-IGTP four-quadrant drawing sequence (with IGTP-OTS mental movie)

• Purpose / when: group reprocessing after a shared critical incident, or for ongoing traumatic stress in the OTS adaptation [source: Jarero et al. 2016; NCT07027930].
• Steps [source: Jarero et al. 2016; NCT07027930]:
  1. Preparation: a self-soothing exercise (for example, abdominal breathing or a pleasant memory) starts every session. The page is divided into four quadrants: A, B, C and D.
  2. Assessment: standard IGTP has participants identify their most distressing memory. In IGTP-OTS they run a mental movie from just before the original incident until now and pick the most distressing moment, noticing emotions and body sensations; in later sessions they pick any memory that is disturbing now.
  3. Picture A: draw the experience; rate SUD; Butterfly Hug for about 2–3 minutes.
  4. Picture B: draw how they feel now; rate SUD; Butterfly Hug. Repeat for C and D.
  5. End-of-session SUD: look at all four drawings, choose the most disturbing one, turn the page over and write a new SUD.
  6. Future vision (replaces cognitive installation): draw how they see themselves in the future, give it a title, Butterfly Hug. Staff should avoid pushing positivity here [NCT07027930].
  7. Body scan: recall the most disturbing drawing, notice pleasant or unpleasant body sensations, Butterfly Hug.
  8. Closure: favourite self-soothing exercise for 1–2 minutes; optional voluntary sharing of the experience (not trauma content); staff normalise reprocessing effects and answer questions.
• Example language (illustrative): "In box B, draw how you feel right now, any way you like. Then write a number from 0 to 10 and do the Butterfly Hug."
• Watch for: SUD that does not fall across A–D, or a future drawing that is bleak. Flag for EPT follow-up [source: Jarero et al. 2016].

4.32 Emotional Protection Team monitoring and team reevaluation (IGTP)

• Purpose / when: throughout each IGTP session and after it [source: Jarero et al. 2016].
• Steps: about one EPT member per 8–10 participants. Members move quietly around the room before, during and after the procedure. A distressed participant is approached silently and offered presence or tissues, without conversation, so that others are not disturbed. After each session the team reviews every participant's drawings, SUDs and future-vision titles and identifies who needs extra help: individual sessions or small groups of about 3–8 [source: Jarero et al. 2016]. Participants needing more support stay after closure for individual attention [source: NCT07027930].
• Watch for: participants who go still and stop drawing (possible dissociation). Approach quietly and help them ground [synthesis].

5. Handling problems

Sourced items are tagged; the rest is [synthesis] drawn from general trauma-therapy practice, not from the EMDR sources.

• Looping (same content, same SUD across sets): first change the mechanics: direction, speed, length or modality of BLS (agreed in advance) [source: Primer ch. 1 for agreeing alternatives; the sequence is synthesis]. Then ask the blocking-belief questions (4.12), look for a feeder memory by floatback or affect scan (4.13), and if needed use a cognitive interweave on the stuck channel: responsibility, safety or choice (4.14) [source: Primer ch. 1].
• SUD stuck at 1–2 / VoC stuck at 5–6: ask what keeps it from reaching 0 or 7 [source: Primer ch. 1]. Decide whether the residue is ecological, for example a current threat or a recent loss. If it is, accept it and record it [source: Shapiro & Laub 2008; Logie & de Jongh 2014].
• Overwhelm during processing: if the client remains present, continue steady BLS through the peak with brief reassurance. If the client loses dual attention, stop and ground them, then apply the distancing metaphor (screen/remote) or narrow the focus to a smaller piece. Close the session as incomplete if needed (4.18) [synthesis; distancing and narrowing source: Shapiro & Laub 2008].
• Dissociation (blank stare, numbness, losing time, "floating"): stop BLS; orient the client to the present (name the date and place, feel the feet, notice room temperature, hold a cold object); slow down. Reconsider readiness: more Phase 2 stabilisation, smaller targets, shorter sets, or specialist dissociation-informed EMDR. Screen for a dissociative disorder if this was not done [synthesis]. In groups, high dissociation is an exclusion criterion or a reason for one-to-one care [source: NCT07246356; NCT07027930].
• Too little activation (flat, "nothing"): check that the image, NC and body sensation were truly accessed. Ask for the worst moment again, or use the movie or Google Search to find the hot spot [synthesis; Google Search source: Shapiro & Laub 2008].
• Avoidance and missed sessions after a hard session: normalise between-session processing; review the log; make the next session start with resource work; agree smaller steps. Respect the client's control over pace, but name the pattern [synthesis].
• Non-adherence to logs or self-calming practice: EMDR sets no homework [source: Shapiro 2014]. Keep the log optional and brief, and rehearse the calm place in session so it works when needed [synthesis].
• Ruptures (client feels pushed, or that the therapist is "just waving a hand"): stop processing; ask directly what happened; acknowledge your part; give more choice over targets, BLS type and pace; re-explain the rationale. Return to processing only after the alliance is restored [synthesis].
• New disturbing material between sessions (nightmares, new memories): expected and covered in closure. Review it in reevaluation, then target it or note it as a progression [source: Springer scripted appendix; Primer ch. 1].
• Memories that emerge as images or fragments the client is unsure about: treat them as the client's present experience. Do not confirm, deny or elaborate content. Do not use EMDR to test or recover memories. If the client is involved in legal proceedings, discuss with them, before processing, that processing may change the vividness and the way they recount a memory, and liaise with legal advisers where relevant [synthesis].
• Recent trauma with ongoing threat: process only what is over. Use R-TEP's episode focus, narrow containment and ecological endpoints, and work on practical safety first [source: Shapiro & Laub 2008; synthesis for the safety priority].
• Older trauma surfacing during recent-event work: bring the client back to the episode target; note older material for later standard-protocol treatment; widen the focus only if processing stalls [source: Shapiro & Laub 2008].
• Group participant overwhelmed (G-TEP, IGTP): a silent EPT member approaches with presence or tissues [source: Jarero et al. 2016]; a second facilitator or a breakout room for one-to-one stabilisation [source: Yurtsever 2018; JNZCCP 2024]; participants are free to leave [source: Yurtsever 2018]; individual follow-up is offered [source: Jarero et al. 2016; Yurtsever 2018]. Jarero et al. report that in 18 years no patient had left the group room due to overwhelming distress [source: Jarero et al. 2016].
• Group members who share trauma details aloud: gently interrupt, remind the group of the no-sharing rule, and invite the person to put it on the worksheet [synthesis; no-sharing rule source: JNZCCP 2024].
• Remaining distress after a group course: individual EMDR or small-group sessions [source: Jarero et al. 2016; Yurtsever 2018]; online G-TEP used a scheduled 1:1 follow-up and a referral route to the service [source: NCT07246356].
• Literacy or language barriers in group protocols: drawings instead of writing, and allow extra time for translation [source: Yurtsever 2018].
• Suicide risk or self-harm emerging: pause processing; do a standard structured risk assessment; make a safety plan, including lethal-means counselling (safe storage or removal); resume processing only once the client is stable. In groups, self-harm "red flags" mean individual therapy instead of group [source: NCT07027930 for the group criterion; the rest synthesis].
• Physical reactions (dizziness, eye strain, headache, nausea): switch to taps or tones; check medical conditions; consult the client's physician where arousal could be risky (cardiac conditions, epilepsy, pregnancy) [synthesis; the textbook's client-safety appendix is not drawn on: uncertain].

Sources

Sources:

• Eye Movement Desensitization and Reprocessing (EMDR) Therapy, Third Edition — table of contents (Guilford Press) (chapter titles only)
• Shapiro, F. (2014). The role of EMDR therapy in medicine — Spanish translation hosted by the Asociación EMDR España (original: The Permanente Journal, 18(1), 71–77)
• An EMDR Therapy Primer, Chapter 1 (Springer Publishing) (author [uncertain])
• Appendix A: Worksheets, in Treating Anxiety, Obsessive-Compulsive, and Mood-Related Conditions (Springer Publishing; scripts credited to Shapiro 2001, 2006) (editor not shown [uncertain])
• Shapiro, E., & Laub, B. (2008). Early EMDR intervention (EEI): A summary, a theoretical model, and the recent traumatic episode protocol (R-TEP). Journal of EMDR Practice and Research, 2(2), 79–96
• Logie, R. D. J., & de Jongh, A. (2014). The "Flashforward Procedure": Confronting the catastrophe. Journal of EMDR Practice and Research, 8(1), 25–32
• Jarero, I., Artigas, L., Uribe, S., & García, L. E. (2016). The EMDR Integrative Group Treatment Protocol for patients with cancer. Journal of EMDR Practice and Research, 10(3), 199–207
• ClinicalTrials.gov NCT07027930 — EMDR-IGTP for ongoing traumatic stress in road traffic accident survivors: protocol
• Shapiro, E. (2026). The EMDR group traumatic episode protocol: A theoretical framework (EMDRIA abstract page)
• Yurtsever, A., et al. (2018). An EMDR group intervention for Syrian refugees with post-traumatic stress symptoms: results of a randomized controlled trial. Frontiers in Psychology, 9, 493 (PDF); abstract page
• How does EMDR work in a group context? Journal of the New Zealand College of Clinical Psychologists (G-TEP practice report)
• ClinicalTrials.gov NCT07246356 — Feasibility and efficacy of GTEP for birth trauma: protocol

Further reading (not drawn on beyond the pages above):

• Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures (3rd ed.). Guilford Press.
• Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures (2nd ed.). Guilford Press.

Not drawn on [uncertain]: EMDRIA and EMDR Europe practice standards; Shapiro's Recent Event Protocol and EMD procedure; the 4 Elements exercise; the original EMDR-IGTP papers (Artigas, Jarero and colleagues) and its origin story; Elan Shapiro's G-TEP manual and worksheet; the textbook chapters on abreaction, cognitive interweave and client safety.