Same same but different: Variations in Therapists’ Application of the EMDR Standard Procedure and the Use of Minimal Nonverbal Changes

Abstract Following the standard Eye Movement Desensitization and Reprocessing (EMDR) procedure, counting a fixed number of bilateral stimuli (BLS) is the guideline-congruent strategy for determining the length of the first stimulation set during the processing of pathogenic memories. For the subsequent sets, an individually adapted stimulation length depending on minimal nonverbal changes (MNCs) is recommended, such as changes in facial expression, muscle tone, posture, or breathing, which are assumed to reflect shifts in emotional valence. This exploratory survey study is the first work to investigate the relevance of these MNCs in clinical practice. This exploratory survey study examined how certified EMDR therapists apply the BLS procedure in practice and how they evaluate the relevance of MNCs. Eighty-eight certified EMDR therapists reported on their individual application of BLS. In addition, the perceived frequency, indicator value, and emotional valence of a broad range of MNCs were assessed. The results revealed substantial variability in therapists’ application of the BLS procedure. Whereas one quarter of therapists reported using counting as their preferred interruption strategy, approximately three quarters relied on MNCs. Nearly all therapists (98.2%) considered MNCs clinically important. Forehead relaxation, smiling, and respiratory changes were rated as particularly relevant indicators of valence change. Exploratory analyses suggested that therapist gender, therapeutic orientation, and patient clientele may be associated with variation in interruption strategies. These findings provide initial descriptive evidence of substantial heterogeneity in how EMDR therapists determine the length of BLS sets in clinical practice. They also identify specific MNCs that may be relevant targets for future observational and experimental research.