The Future of Psychological Therapy?

Intensive EMDR

Authors: Dr Jonathan Hutchins and Dr Deborah Kingston

Introduction

Intensive EMDR (I-EMDR) is a condensed format of EMDR offering multiple sessions over a shorter time frame, often within days or weeks, rather than the traditional model of most psychological therapies of weekly one-hour to 90-minute sessions. Many practitioners and some services are offering I-EMDR as an alternative way of working with clients in order to achieve symptom relief from traumatic memories and to improve their life functioning due to increased adaptive information processing (AIP). This article seeks to summarise some of the literature related to I-EMDR and to emphasise how this approach may be more unique to EMDR and what this can offer NHS services and the wider public.

Summary of the literature

I-EMDR has been used effectively with clients who experience Post Traumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD) when combined with prolonged exposure (PE) and exercise in an inpatient setting in the Netherlands (Voorendonk et al., 2020), as well as for borderline personality disorder (Kolthof et al., 2022; De Jongh et al., 2020). This setting included doing twice-daily EMDR sessions, of up to two-hours in length, over a period of between four days and two weeks. Further research within this inpatient setting highlighted how I-EMDR can improve sexual functioning (van Woudenberg et al., 2023), and it can also have a positive impact on depression (Paridaen et al., 2023). The challenge relating to these studies is that the results are based on a combination of PE, physical exercise and I-EMDR, and that there was no control group to compare the results to. Therefore, it is difficult to attribute the benefits the clients gained in these settings purely to I-EMDR.

In terms of outpatient I-EMDR, one study highlighted the effectiveness of a six-day outpatient intervention, which included daily 90-minute sessions of I-EMDR and PE. After one month, 52% of the 146 study participants no longer met the diagnostic criteria for PTSD (Matthijssen et al., 2024). A further study of active-duty personnel compared twice-daily EMDR sessions for 10 days to weekly EMDR sessions and demonstrated equivalent effectiveness that was maintained at one-year follow-up (Hurley, 2018). A recent cohort study, which combined I-EMDR, exposure in vivo and trauma-sensitive yoga components over a five-day period, showed significant gains in symptom reduction for clients with probable CPTSD and dissociation (Zepeda Méndez et al., 2025).

Further studies have examined the effectiveness of a fully remote, online, four-day intervention, including daily 90-minute sessions of PE and EMDR for PTSD and CPTSD. Demonstrating significant efficacy at reducing symptoms to a subclinical level (Bongaerts et al., 2022). Whilst these studies have similar difficulties of mixed treatment approaches, such as PE with EMDR, as well as a lack of a comparator control group, the results are very encouraging and highlight how an intensive approach can be just as, and arguably, in some cases, more effective than traditional weekly psychological therapy.

Group I-EMDR interventions

Further I-EMDR research has been carried out in the form of group EMDR interventions, such as the Group Traumatic Episode Protocol (G-TEP) (Yurtsever et al., 2018). A recent study by Farrell et al. (2023) used the G-TEP protocol in the form of an early intervention video therapy approach to support frontline workers in the COVID-19 pandemic. The intervention involved two-hour sessions delivered four times within one week to 95 participants, 45 in a control group and 50 who received the intervention. The results demonstrated a significant reduction in trauma symptoms in the treatment group compared to the control group. However, for participants who experienced a moral injury as a result of their experiences, the intervention did not resolve this (Farrell et al., 2023). Despite this limitation, the results from this randomised controlled trial demonstrated that a two-hour intervention over four days delivered via video call remotely was effective at reducing trauma symptoms and distress.

Further I-EMDR group research has used the Integrated Group Treatment Protocol (IGTP). One study used the IGTP, which was adapted to Ongoing Traumatic Stress (EMDR-IGTP-OTS) to treat trauma with young refugees (Josefa Molero et al., 2019). The study recruited 184 refugee minors, with 91 in the control group and 93 in the treatment group. The treatment involved two-hour sessions, three times per day over three days. The results showed that the IGTP-OTS intervention was feasible, well tolerated, culturally sensitive and efficient (Josefa Molero et al., 2019).

An additional study that utilised the EMDR-IGTP-OTS protocol remotely with health workers during the COVID-19 pandemic who were exposed to deaths was conducted by Pérez et al. (2020). The study was a randomised controlled trial of 80 participants, with 40 in the control group and 40 in the treatment group. Participants in the treatment group showed a significant reduction in symptoms of PTSD and depression compared to the wait-list control group.

In summary, whilst there are limitations in the research done to date, I-EMDR has been demonstrated to deliver efficient and effective outcomes on trauma, PTSD and depression symptoms. The I-EMDR interventions can be delivered online to good effect and also in group formats, such as the G-TEP or EMDR-IGTP-OTS protocol.

The client’s experience

Several studies have investigated clients’ experiences of having I-EMDR using qualitative methodologies. This article focuses on one recent study. Butler and Ramsey-Wade (2024) conducted interviews with 10 participants who had taken part in I-EMDR and completed an interpretative phenomenological analysis (Smith et al., 2022) of the data from the interviews. The core themes that arose from the interviews included the importance of psychological safety and the changing self. The core theme of psychological safety related to having a protected physical and psychological space for the intensive work, as well as a continued connection and ongoing link with the process, which acted as a container for distress. The core theme of a changing self was related to how I-EMDR facilitated changes in perspective and altered their view of themselves, their lives and their relationships with others. A sub-theme highlighted as part of the changing self was the WOW! moment when participants described the shift from I-EMDR in relation to their trauma memories (Butler & Ramsey-Wade, 2024). An aspect that many EMDR practitioners will likely relate to.

How to do it

The evidence base varies in its guidance on I-EMDR, where the terms ‘intensive,’ ‘massed’ and ‘condensed’ EMDR have been used to describe the same procedure (Butler & Ramsey-Wade, 2024; Ragsdale et al., 2020). There is also a lot of variability in how much the different I-EMDR programmes focus on the assessment and preparation phases versus reprocessing sessions, and how much follow-up clients receive following the intervention. However, the following principles may act as a guide when considering offering I-EMDR in clinical practice:

Preparation: Ensure a thorough history has been taken and the client is resourced in preparation for intensive work. If the client is travelling to attend sessions, Phases 1 and 2 can be done in advance.

Session length: For reprocessing sessions, aim for two-hour appointments or up to a maximum of four hours, depending on the client’s energy levels, attention span and capacity for concentration.

Session frequency: While the research varies, aim for at least twice-weekly sessions where possible. However, if possible and time allows, try doing daily sessions, both morning and afternoon, over a four-day period.

Van der Kolk (2014), Fetzner and Asmundson (2015) and Porges (2011) highlight the importance of movement. Therefore, when undertaking intensive work, you might want to consider adding moderate aerobic activity, e.g., walking, cycling or yoga, pre- and post-each session. This can help regulate the autonomic nervous system, preparing the brain and body for EMDR reprocessing and help ground the client after the session.  This is also supported by a recent randomised controlled trial that found adding physical activity to I-EMDR and PE resulted in better outcomes (Voorendonk et al., 2023).

This guide is dependent on the client’s needs and abilities, as well as what is feasible for the clinical practitioner and their service. In terms of the approach to use, the evidence supports the use of the eight-phase standard EMDR protocol (Shapiro, 2018) and using the additional time within the I-EMDR approach for the desensitisation phase to reprocess trauma memory targets.

Based on clinical experience, the first author has completed a three-hour I-EMDR session in which three trauma memories where processed. Once the target was completed, both the client and clinician took a short break and then returned to continue further reprocessing to good effect. The second author has done multiple 4-hour I-EMDR sessions with veterans over a three-day period and was able to completely reprocess combat trauma from multiple conflicts. These clients initially scored high on PCL-5 at the start of the week, but during the review sessions, which are completed two weeks after the I-EMDR, PCL-5 scores were in the non-clinical range.

Cost-effectiveness and impact on waiting list times

It could be argued that I-EMDR may provide an answer to long wait times for trauma-focused psychological therapies or, indeed, for any client who seeks psychological therapy. Some of the research evidence highlights how I-EMDR had similar outcomes to longer-term, weekly EMDR (Hurley, 2018). Therefore, if a client were to be offered up to 20 weekly sessions of psychological therapy, including EMDR, and if this were to be compared to I-EMDR (which could be over a period of four days with twice-daily sessions), then the impact on patient throughput and reduction in waiting list times is clear. This may provide organisations, such as the NHS, a method to provide highly efficient, effective and swift care to more patients in a quicker time frame. Furthermore, there may be fewer patients dropping out from I-EMDR in comparison to standard, weekly, trauma-focused psychological therapies, where dropout rates can be as high as 65% (Lewis et al., 2020).

Summary and recommendations

I-EMDR may offer a cost-effective, efficient and more accepted intervention for clients. Within services, such as the NHS, I-EMDR may provide an answer to long waiting list times for people to receive evidence-based, trauma-focused therapies, as the evidence to date suggests that it may be just as effective as standard weekly therapy. Further larger-scale randomised controlled trials are needed to grow the evidence base in this area.

References

Bongaerts, H., Voorendonk, E. M., Van Minnen, A., Rozendaal, L., Telkamp, B. S. D., de Jongh, A. (2022) Fully remote intensive trauma-focused treatment for PTSD and complex PTSD. European Journal of Psychotraumatology, 13(2), 2103287. https://doi.org/10.1080/20008066.2022.2103287

Butler, S. J., & Ramsey-Wade, C. (2024). How do clients experience intensive EMDR for post-traumatic stress? An interpretative phenomenological analysis. European Journal of Trauma & Dissociation 8(4),100479. https://doi.org/10.1016/j.ejtd.2024.100479

De Jongh, A., Groenland, G. N., Sanches, S., Bongaerts, H., Voorendonk, E. M., & Van Minnen, A. (2020). The impact of brief intensive trauma-focused treatment for PTSD on symptoms of borderline personality disorder. European Journal of Psychotraumatology, 11(1), 1721142. https://doi.org/10.1080/20008198.2020.1721142

Farrell, D., Moran, J., Zat, Z., Miller, P., Knibbs, L., Papanikolopoulos, P. et al. (2023). Group early intervention eye movement desensitization and reprocessing therapy as a video-conference psychotherapy with frontline/emergency workers in response to the COVID-19 pandemic in the treatment of post-traumatic stress disorder and moral injury–An RCT study. Frontiers in psychology, 14, 1129912. https://doi.org/10.3389/fpsyg.2023.1129912

Fetzner, M. G., & Asmundson, G. J. (2015). Aerobic exercise reduces symptoms of posttraumatic stress disorder: A randomized controlled trial. Cognitive Behaviour Therapy, 44(4), 301–313. https://doi.org/10.1080/16506073.2014.916745

Hurley, E. C. (2018). Effective treatment of veterans with PTSD: Comparison between intensive daily and weekly EMDR approaches. Frontiers in Psychology, 9, 1458. https://doi.org/10.3389/fpsyg.2018.01458

Josefa Molero, R., Jarero, I., & Givaudan, M (2019). Longitudinal multisite randomized controlled trial on the provision of the EMDR-IGTP-OTS to refugee minors in Valencia, Spain. American Journal of Applied Psychology, 8(4), 77–88. https://doi.org/10.11648/j.ajap.20190804.12

Kolthof, K., Voorendonk, E., van Minnen, A., & de Jongh, A. (2022). Effects of intensive trauma-focused treatment of individuals with both post-traumatic stress disorder and borderline personality disorder. European Journal of Psychotraumatology, 13(2). 2143076. https://doi.org/10.1080/20008066.2022.2143076

Lewis, C., Roberts, N. P., Gibson, S., & Bisson, J. I. (2020). Dropout from psychological therapies for post-traumatic stress disorder (PTSD) in adults: Systematic review and meta-analysis. European Journal of Psychotraumatology, 11(1). 1709709. https://doi.org/10.1080/20008198.2019.1709709

Matthijssen, S., Menses, S., & Huisman-van Dijk, H. (2024). The effects of an intensive outpatient treatment for PTSD. European Journal of Psychotraumatology, 15(1). 2341548. https://doi.org/10.1080/20008066.2024.2341548

Paridaen, P., Voorendonk, E. M., Gomon, G., Hoogendoorn, E. A., van Minnen, A., & de Jongh, A. (2023). Changes in comorbid depression following intensive trauma focused treatment for PTSD and complex PTSD. European Journal of Psychotraumatology, 14(2). 2258313. https://doi.org/10.1080/20008066.2023.2258313

Pérez María, C., Estévez María, E., Becker, Y., Osorio, A., & Jarero, I. (2020). Multisite randomized controlled trial on the provision of the EMDR Integrative Group Treatment Protocol for ongoing traumatic stress remote to healthcare professionals working in hospitals during the Covid-19 pandemic. Psychology and Behavioural Science International Journal, 15(4). https://doi.org/10.19080/PBSIJ.2020.15.555920

Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W. W. Norton & Company.

Ragsdale, K. A., Watkins, L. E., Sherrill, A. M., Zwiebach, L., & Rothbaum, B. O. (2020). Advances in PTSD treatment delivery: Evidence base and future directions for intensive outpatient programs. Current Treatment Options in Psychiatry, 7(3), 291–300. https://doi.org/10.1007/s40501-020-00219-7

Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.) New York: Guilford Press.

Smith, J., Flowers, P., & Larkin, M. (2022). Interpretative phenomenological analysis:

Theory method and research (2nd ed.). Sage.

Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.

van Woudenberg, C., Voorendonk, E. M., Tunissen, B., van Beek, V. H. F., Rozendael, L., van Minnen, A., & De Jongh, A. (2023). The impact of intensive trauma-focused treatment on sexual functioning in individuals with PTSD. Frontiers in Psychology, 14. 1191916. https://doi.org/10.3389/fpsyg.2023.1191916

Voorendonk, E. M., Sanches, S. A., Tollenaar, M. S., Hoogendoorn, E. A., de Jongh, A., & van Minnen, A. (2023). Adding physical activity to intensive trauma-focused treatment for post-traumatic stress disorder: Results of a randomized controlled trial. Frontiers in Psychology, 14. 1215250. https://doi.org/10.3389/fpsyg.2023.1215250

Voorendonk E.M., De Jongh, A., Rozendaal. L., & van Minnen, A. (2020) Trauma-focused treatment outcome for complex PTSD patients: results of an intensive treatment programme. European Journal of Psychotraumatology, 11(1), 1783955. https://doi.org/10.1080/20008198.2020.1783955

Yurtsever, A., Konuk, E., Akyüz, T., Zat, Z., Tükel, F., Cetinkaya, M., Savran, C., & Shapiro, E. (2018). An Eye Movement Desensitization and Reprocessing (EMDR) group intervention for Syrian refugees with post-traumatic stress symptoms: Results of a randomized controlled trial. Frontiers in Psychology, 9, 493. https://doi.org/10.3389/fpsyg.2018.00493

Zepeda Méndez, M., Nijdam, M.J., Ter Heide, F.J.J., van der Aa, N., & Olff, M. (2025). Response of patients with complex forms of PTSD to highly intensive trauma treatment: A clinical cohort study. Psychological Trauma: theory, research, practice and policy, 17(3), 676–684. https://doi.org/10.1037/tra0001747