Bilateral stimulation (BLS) is one of the hallmarks of EMDR therapy. The term bilateral stimulation (BLS) is often referred to alongside the term dual attention stimulus (DAS).
Bilateral stimulation (BLS): the back-and-forth (often left to right, sometimes diagonal) movement across the body’s midline that promotes neural activity
(Laliotis et al., 2021).
Dual attention (DAS): engaging in two or more different tasks at once, like moving one’s eyes AND focusing on a memory, which is also believed to generate information processing (Laliotis et al., 2021).
Both together (DAS/BLS) “involve the client in bilateral eye movements, tactile, and/or auditory stimulation while simultaneously focusing on aspects of the targeted memory and other associations that are accessed. This stimulation is posited to activate and facilitate the innate information processing system” (Laliotis et al., 2021). There is research being done on why and how BLS and/or DAS help to make EMDR therapy effective. In everyday use, bilateral stimulation (BLS) is commonly used alone to describe how EMDR therapy helps bring about change.
BLS movements can take multiple forms, the most familiar being eye movements. Eye movements are well known mainly because they comprise part of EMDR therapy’s name (eye movement desensitization and reprocessing). However, other forms of bilateral stimulation are also commonly used: auditory tones, tapping back and forth, or physical sensations like alternating pulses in each palm. Research has shown that lateral eye movements have decreased activity in the amygdala, a part of the brain that detects danger and is involved in emotional reactivity.
The EMDR with Children & Adolescents EMDRIA Online Community recently posted some questions about what types of BLS members in that community use to highlight unique best practices:
“What types of creative bilateral stimulation (BLS) have you incorporated in your work with children and adolescents (for example magic wand, hand tapping, drumming)?”
***NOTE: For closed captioning on videos, play the video and click on the ‘CC’ icon in the lower right-hand corner.
*** Ann Beckley-Forest: “I use EMDR with young children and have my tappers in the doctor kit for spontaneous first encounters to “use these to find our big feelings.” My other favorite BLS is being very physical with pool noodle ‘swords’—it really helps kids stay present!”
*** Megan Bigwood
*** Anna Blum: “My favorite is bubbles! Asking kiddos to bat with both hands. This is a favorite as it helps keep them engaged with the fun of punching bubbles and is thus regulated as they listen to a story that highlights their experiences and negative cognitions. I also have kiddos use thumbs up and thumbs down around confirming or disconfirming negative and positive cognitions. This is especially helpful when they don’t want to talk and when working with resistant parts, as they may not like to be tapped because they know it is supposed to exact some change, and often, these parts are not interested in change. These interventions help lighten the mood and give them control. At the same time, they can be exposed to work that is titrated. I love working with children and adolescents – so easy to reprocess and so in touch with their truth, especially when it is safe to tell it.”
*** Chelsea Cameron: “I have used non-traditional BLS with a few of my teenage clients. These styles include bouncing a basketball between their hands (they tried dribbling, standing still, between their legs, and while moving towards the hoop), tossing a baseball back and forth, kicking a soccer ball between their legs, and walking in a safe and confidential location. I have done this using standard protocol and performance enhancement protocol. In each case, when trying more traditional methods of BLS, the client appeared to shut down by zoning out, becoming focused on something else, or being overly concerned about “doing it right.” When we moved to non-traditional BLS, the client became more engaged and aware of their body and emotions by using an activity they found meaningful. When we discussed using a different type of BLS, we discussed the activities that are important to them or times they felt like they could feel calmer and think more clearly in their everyday lives. The counselor suggested walking and being in nature with movement appeared to assist the client in staying within their window of tolerance for an increased amount of time. When resourcing, we walk more slowly and pay attention to the world around us (sounds, smells, temperature). When processing, we would walk more quickly and then stop and breathe between sets.”
*** Karli Coverdale
*** Jessica Crane
*** Paisley Cummings
*** Shayla Sima Dube: “As a culturally affirming child and adolescent therapist, I ensure that the therapeutic interventions I invite my therapy participants to engage in are often culturally responsive and identity affirming; that’s why I have djembe drums in the playroom. I often invite the children and youth that I serve to use drumming for bilateral stimulation. The integration of drumming in play therapy and psychotherapy often plays the dual role of cultural affirmation, rhythmic nurturing, and bilateral stimulation. I also incorporate Ana Gomez’s three storytellers, inviting them to mindfully notice their minds, hearts ( feelings and emotions), and bodies as they play the drums, which most children and youth often actively participate in. Drumming often promotes self-expression and creativity while activating the brain. Depending on the age of the youth, I explain the left and right sides of the brain and the connection that happens when they play the drums. With Ubuntu rooted solidarity.”
*** Amy Earl
*** Kim Feeney: “In my work with children, I incorporate bilateral stimulation through musical instruments like xylophones, bongo drums, and keyboards to engage them in rhythmic activities that encourage coordination between both hands. I focus more on physical activities such as basketball, dance, and walking for adolescents to promote bilateral integration through coordinated movements. These activities make therapy sessions more engaging and support cognitive and emotional development by simultaneously stimulating both hemispheres of the brain. By tailoring the activities to each child or adolescent’s interests and needs, I aim to create a therapeutic environment that fosters growth and well-being.”
*** Ashley Hamby
*** Renata Huewitt
*** Cyndi Jordan: “I love how you can incorporate BLS with children! One of the things that I have had kiddos enjoy is doing the Tooty Ta song by Jack Hartmann. After they’ve learned the song (many of them already know it), we change the words to their positive cognition. Of course, there are all the other fun things like sword fights, bongos, thumb drums, ribbon streamers, and the list goes on!”
*** Kara Kushnir
*** Lisa LaRosa
*** Roei Levi: “I’ve used “foam swords,” and we did the BLS by alternating between right and left “strikes.” It was a playful and active way (so it benefited those who had a hard time sitting or standing still). We could incorporate resource development and installation by adding PCs (I’m strong, I’m capable, I can do this, etc.). I used the child’s ability to do this to acknowledge or develop it, like pointing out how strong he is. We would even sometimes do this thing where we tried to capture the other one’s sword, and I could comment on his ability to do so and his creative thinking. We could work out frustration if he weren’t able to succeed. Sometimes, I’d ask him to pull my foam sword as hard as he could, and he would succeed in taking it from me or not. That also brought up the thing with effort and then release, which was also important to him. There’s much more to be done with it, and it was great and fun for him (and others). Another thing I did was an imaginary obstacle course – I would tell them when to duck or just move to the side. It was good for someone who had a problem with not moving.”
*** Amanda Martin: “One of my favorite methods involves utilizing animals, whether it’s an emotional support dog in the office or incorporating horses at an equine site. Clients can interact with these animals, tapping on them during processing, which has a remarkable effect on their ability to regulate emotions and stay present. For instance, during a session with an emotional support dog, a client began experiencing an abreaction. The dog instinctively leaned in, placing its head on the client’s leg, providing comfort as the client wrapped them in a hug and tapped. This simple act helped the client stay grounded throughout the intense experience, and they later expressed gratitude for the animal’s presence during their healing journey.”
*** Mary McInerney
*** Frances Mican: “One of my adolescent clients was NOT a fan of eye movements, tapping, auditory, or any other creative strategies… but they would often toss a tennis ball back and forth during sessions. We started using that for BLS, and it worked well!”
*** Ann T Magee Mulroy: “Hand tapping knees.”
*** Bambi Parks: “A neat way to use BLS is with two scarves. Imagine this: one scarf is held by the client, and you hold the other end, making sure both left hands are connected. At the same time, another scarf links both right hands. Then, as you start the BLS, you and the client move back and forth in sync, almost like dancing, using both your hands and your feet. What’s cool about this is how it mixes creativity and flexibility. Adding the feeling of the scarves to the BLS movements makes therapy more engaging. The gentle pulling and swaying aren’t just therapeutic actions; they’re a fun way for you and the client to connect. Using scarves with BLS brings energy and excitement to the session, making it more enjoyable for both of you. It is a journey you take together, where the scarf dance (BLS) reflects the journey of healing and growth.”
*** Mor Regev: “I have been having an 11-year-old client throw a ball back and forth between her hands like a mini juggling act. She’s enjoyed it, and it’s helping!”
*** Ezgi Seda Yayla: “I am a therapist who works primarily with couples and adolescents. I was generally working with CBT until I was introduced to EMDR techniques. Now, I use EMDR techniques and CBT techniques together. If I am in my clinic, I prefer to use an EMDR device because I can take notes more easily and observe the client’s reactions better. The bilateral stimulation method I use varies depending on the person’s experience. For example, I do not prefer bilateral stimulation with light or finger tracking to someone with bad eyesight or migraine. In cases of violence or abuse, I avoid contact such as tapping and use a bilateral stimulation method such as sound or light.”
*** Jennifer Spell: “I love working with children using EMDR, and they often come up with interesting comparisons for the BLS. I have a colorful rug in my office that I will sit on with them to help make the experience more comfortable. I find out what their interests are, such as planes, cars, unicorns, rainbows, etc, and use their interest to engage them with the BLS. If they are shy or not as involved in talking about their interests, then I compare EMDR to magic and use the magic wand or a bright marker—I let them choose.”
*** Joanne Thomas: “As a Registered Play Therapist Supervisor™ and EMDRIA Certified Therapist, I had already explored the idea of alternatives to achieve Bilateral Stimulation while in session. When I was completing EMDR consultations, my consultant was very helpful in discussing items such as a wand to incorporate into sessions. We also discussed interweaving EMDR into a regular play therapy session and conceptualizing what that might look like. My two alternatives to using two fingers or Theratappers are a fuzzy wand with a unicorn head and a pinwheel with an elongated pen. The pinwheel I also utilize for emotional regulation while providing play therapy intervention. These two alternatives allow my clients help them to better manage their Subjective Units of Distress (SUDS), in such a way that their trauma does not seem as daunting a task to navigate.”
*** Cindy Vang: “In my work with children and teens, I have incorporated patty cake, hand clapping, hand/knee/shoulder taps, dance, drumming, EMs with puppets and magic wands, butterfly hugs, body sways and movements, auditory tones, scribbling, walking, and stomping as creative BLS. If a parent is also present, I have the parent do back-and-forth backrubs or hug the client and alternate tapping the child’s back. I utilized these because my children and teen clients find traditional EMs more distracting than helpful. Some have also disliked the look of traditional pulsers, feeling like the pulsers look more like electric shock devices but are receptive to the pulsers being tucked in their pockets or socks. Specifically, I have found that the younger the client is, the more I need to cycle through multiple types of BLS in one session. My child and teen clients also find it challenging to focus on the image in their mind with their eyes open, so closing their eyes is more helpful. Also, sometimes, my clients play out the target memory or image in the sand tray or in the dollhouse or draw out the target image.”
*** Danyale Weems
*** Michael Zuch: “I have put the bilateral tactile tappers in sweatbands with small zippable pouches around their wrists so they can freely move around and use the sand tray, expressive methods, or toys. Many of my young people love this option. ”
Resources
de Voogd, L. D., Kanen, J. W., Neville, D. A., Roelofs, K., Fernandez, G., & Hermans, E. J. (2018). Eye-movement intervention enhances extinction via amygdala deactivation. The Journal of Neuroscience, 38(40), 8694-8706. Open access: https://doi.org/10.1523%2FJNEUROSCI.0703-18.2018
EMDRIA. (n.d.) EMDR therapy toolkit for children. https://www.emdria.org/publications-resources/practice-resources/emdr-childrens-toolkit/ (Members Only)
EMDRIA. (2019). EMDR therapy with children & adolescents. Go With That Magazine Issue. https://www.emdria.org/magazine/emdr-therapy-with-children-and-adolescents/ (Members Only)
EMDRIA. (2021). 12 bilateral options with children. Infographic. https://www.emdria.org/resource/12-das-bls-options-for-children/ (Members Only)
EMDRIA. (2023). Counselor’s Corner on BLS alternatives. Go With That MagazineTM. https://www.emdria.org/magazine/counselors-corner-on-bls-alternatives/ (Members Only)
EMDRIA. (2023). EMDR therapy and children with Ann Beckley-Forest, LCSW, RPT-S. Let’s Talk EMDR Podcast. https://www.emdria.org/podcast/emdr-therapy-and-children/
Laliotis, D., Luber, M., Oren, U., Shapiro, E., Ichii, M., Hase, M., La Rosa, L., Alter-Reid, K., St. Jammes, J. T. (2021). What Is EMDR Therapy? Past, Present, and Future Directions. Journal of EMDR Practice and Research, 15(4), 186–201. Open access: https://doi.org/10.1891/EMDR-D-21-00029
Miller, P. (2023). How does Bilateral Stimulation (BLS) work in EMDR therapy? [Video]. Mirabilis Health Institute. https://www.youtube.com/watch?v=bRHeQCdhAtk
Zahrai, S. (2020). Three neuroscience insights to help you perform during uncertainty. Forbes. https://www.forbes.com/sites/forbescoachescouncil/2020/11/18/three-neuroscience-insights-to-help-you-perform-during-uncertainty/?sh=1c8a4ac133d9
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