Comprehensive training guide for mental health clinicians
Evidence-based EMDR protocols for treating phobias, panic disorder, and OCD
Francine Shapiro's comprehensive approach targeting first events, worst experiences, and future scenarios.
Structured approach addressing panic attacks from first episode to flashforward scenarios.
Marsden Protocol focusing on obsessions, compulsions, and feared consequences.
A comprehensive approach that systematically addresses all aspects of phobic responses.
Note: This approach can be time-consuming but is highly comprehensive.
Identify the sensitizing incident
Target the most distressing episode
Process current activation
Events that primed the system
Target body-based fear responses
Address future fear scenarios
Real-world application
Events that occurred before the onset of the phobia and may have set the stage emotionally or psychologically for it to develop. They don't directly cause the phobia but often prime the nervous system or shape core beliefs.
Identification technique: Use floatback technique
Use this strategy only if the client cannot recall specific past events associated with the fear.
"I'm powerless"
25-year-old woman with phobic response to not sleeping—panic at bedtime, racing thoughts, compulsive sleep rituals, avoidance of evening plans, and intense fear of sleep deprivation consequences.
Originated during college finals week; couldn't sleep and failed a test.
Target memory: "I lay in bed until sunrise thinking, 'If I don't sleep, I'll fail everything.'"
Panic attack in hotel room before a business presentation; fainted the next day.
Target memory: "Room spinning, heart racing, thought I might die from exhaustion."
Couldn't sleep despite self-care efforts; spiraled, overdosed on melatonin, googled symptoms obsessively.
Target memory: "Watching the clock, thinking, 'I won't survive tomorrow.'"
Anxious, perfectionistic mother emphasized performance.
Target memory: "Mom woke me to double-check my alarm for school."
Core belief: "If I don't control everything, I'll fail."
Tight chest, racing heart, stomach knots, obsessive fatigue scanning, hypervigilance
Scenario: Lying awake before a client meeting, having a panic attack at the meeting.
When flashforward is cleared, Mental Video check is applied until the client can imagine navigating the next day while sleep-deprived but composed.
Significant reduction in bedtime anxiety, reclaimed evenings, belief shift: "Even if I don't sleep well, I can still take care of myself."
Systematic approach to treating panic disorder through targeted reprocessing and exposure.
Identify the first panic episode (often the sensitizing event)
Target the most distressing panic experience
Process the last panic attack
Any other significant experiences that intensified fear
Fear of physical sensations is common with panic disorder and must be targeted on their own.
Target catastrophic 'what if' scenarios
Test for SUD reduction and adaptive integration
When you use EMDR to desensitize the fear exposure becomes much easier for the client to initiate and increases real world confidence.
30 Year old Male - Presenting with Panic Disorder and avoidance of exercise, driving along on the highway and planes. He also fears when his heart rate increases, feeling dizzy, and when his chest is tight.
Research Note: Recent studies by Ad de Jongh indicate that EMDR may be just as effective as CBT in treating OCD, with no significant difference in outcomes reported.
While CBT with ERP and medication remains the gold standard, EMDR offers a promising alternative approach.
Address intrusive thoughts, images, or urges that trigger significant distress
Process the urge to ritualize or act to neutralize the obsession
Desensitize imagined catastrophic outcomes if compulsion not performed
Test whether distressing scenario has been effectively resolved
While not a core component of the Marsden Protocol, therapists may integrate real-world (in vivo) exposure tasks after EMDR processing has reduced internal distress—particularly if behavioral avoidance persists.
If symptoms persist or past traumas emerge, process early experiences, attachment themes, or core beliefs (e.g., excessive responsibility, fear of harm, need for control).
32-year-old female with persistent intrusive thoughts about having a terminal illness despite medical reassurance. Engages in compulsive body scanning, internet research, and repeated doctor visits.
• Recurrent intrusive thought after noticing a mole on her leg
• Negative Cognition: "I'm not safe" / "Something is wrong with my body"
• Positive Cognition: "I'm healthy and okay"
• Emotion: Fear
• SUD: 9/10
• Body Sensation: Tightness in chest
Outcome: The target is cleared after several sessions. During processing, the client connects the fear to a childhood memory of her mother being hospitalized suddenly.
• Urge to Act: Belief that researching will protect her or help her "catch something early"
• Negative Cognition: "If I don't check, I'll miss something and die"
• Positive Cognition: "I can handle uncertainty"
• Emotion: Anxiety
• SUD: 8/10
• Body Sensation: Tension in chest and shoulders
"I can trust my body."
"I am safe now."
"I can handle uncertainty."
"My body can take care of itself."
"I don't need to be in control to be okay."
"I have strength" / "I can face it"
The compulsion becomes less urgent. The client states, "It's exhausting, and I never feel reassured anyway."
• Scenario: She imagines being told she has Stage 4 cancer and hearing, "It's too late."
• Negative Cognition: "I'm powerless"
• Positive Cognition: "I can handle whatever comes" (alternatives: "I have strength" or "I can face it")
• Emotion: Terror, helplessness
• SUD: 10/10
• Body Sensation: Heavy chest, pit in stomach, tight throat
The client reports, "I can accept that I can't control everything, but I trust myself to handle whatever comes. I don't need to live in fear of what might happen."
The therapist guides the client to imagine noticing a new bodily symptom and choosing not to engage in her usual compulsion of checking Google. The client narrates the day of seeing the new symptom and said,
"I see the spot, I feel anxious, but I remind myself I've been here before. I take a breath and move on with my day."
When she reports a mild spike in anxiety, the therapist applies one set of fast bilateral stimulation (BLS). The client then resumes narrating her day until she is able to complete the narration without further distress. Although aware of the sympmtom, her lack of distress indicates increased tolerance and adaptive coping.
Therapist role-plays patient receiving minor health information without giving reassurance
"I'm not safe"
"I can't handle this"
"I'm powerless"
With a clear, step-by-step protocol, EMDR can dismantle the fear structures behind phobias, panic, and OCD. By targeting root events, key triggers, and physical sensations—and using the Flashforward Technique for future fears—clients move beyond symptom relief to reclaim confidence, resilience, and choice.
"When we target the roots of fear, we don't just reduce symptoms—we give clients their lives back."