Same same but different: Variations in the therapists´ application of the EMDR standard 3 protocol and the usage of minimal nonverbal changes

Following the Eye Movement Desensitization and Reprocessing (EMDR) standard 17 protocol, counting down a fixed number of bilateral stimuli (BLS) is the guideline-18 conforming strategy for determining the optimal length of each set within processing the 19 pathogenic memories. A surprisingly high proportion of EMDR therapists, however, 20 deviates from this recommendation, making the time-point for interruption dependent on 21 the occurrence of Minimal Nonverbal Changes (MNCs) in gestures, facial mimics, muscle 22 tension or breathing, which are supposed to indicate a change in emotional valence. This 23 survey-based pilot study attempts to scientifically examine this important phenomenon 24 within EMDR. Eighty-eight certified EMDR therapists reported on their individual 25 application of the standard protocol. In addition, the frequency, indicator value, and 26 emotional valence of a broad range of MNCs were assessed. Significant individual 27 differences and a high degree of deviation from the standard guidelines were found, with 28 age, gender, therapeutic orientation, and patient clientele as moderating factors. Whereas 29 three-quarters of the therapists determined the optimal length of each set of BLS dependent 30 on MNC, only about a quarter used counting down as the preferred interruption strategy. 31 98.2% of the therapists estimated that MNCs are highly important. Visible forehead 32 relaxation, smiling, and deepened inhalation and exhalation were considered particularly 33 valuable as indicators for a valence change. The results can serve as a basis for an further 34 experimental design that enables the observation of nonverbal changes and their 35 physiological correlates during an ongoing session.

Other

English

Valeska Reichel Pape
Carolin von Klitzing
Olaf Wolkenhauer
Eva Schäflein
Markus Stingl

Pape, V. R., von Klitzing, C., Wolkenhauer, O., Schäflein, E., & Stingl, M. (2026). Same same but different: Variations in the therapists’ application of the EMDR standard protocol and the usage of minimal nonverbal changes [Preprint]. medRxiv. https://doi.org/10.64898/2026.01.06.26343513