Summary

This manual describes how to perform Brief Bilateral Stimulation-Imagery Rescripting (BiRes) as a self-help trauma therapy for dealing with troubling memories. It consists of briefly thinking of a traumatic event followed by mental rehearsal of a positive, fictional version of the event. Lateral eye movements are performed in each step. Within one and a half hours of BiRes, your negative memory may not bother you as much going forward. One or two sessions are often all that is needed for long-term relief of trauma.

Reduces the occurrence and emotional pain of negative memories.

A traumatic memory can often be treated in a single one-hour session.

Practical to perform on oneself because the benefits are not related to the client-counselor relationship.

Developing a new script for your memory can be personally empowering. You are in full control and you get to utilize your creativity.

Potential for strongly re-experiencing the trauma.

As a targeted, brief treatment, it is not expected to fully treat broad or complex PTSD.

BILATERAL STIMULATION

Bilateral stimulation (BLS) has become a mainstay of trauma treatment. The practice is based upon making lateral eye movements or tapping alternative sides of the body. The underlying theory is that reliving traumatic memories while making bilateral movements helps the subconscious mind to process negative memories so that recall will no longer be accompanied by negative emotions or negative thoughts about yourself.

In this modality, a client attempts to relive a traumatic memory, along with it’s associated negative thoughts and feelings, as vividly and painfully as possible while moving their eyes side to side continuously. If and when the negative reactions associated with the memory subside considerably, the client continues to think of the traumatic event while making the eye movements. At this point, the client tries to make herself experience happy thoughts and beliefs while imagining the event.

That is the basics of bilateral therapy (aka eye movement desensitization and reprocessing, or EMDR). It seems easy and straightforward, but it has powerful downsides. The clients are forced to repeatedly re-experience the most terrible experiences and emotions of their lives. Not only is this painful during a session but it tends to result in the clients reliving the targeted traumas more often and more intensely than before they began therapy.

Another major drawback of BLS is that other related (and unrelated) traumas arise during treatment, both in-session and between sessions. This modality’s philosophy suspiciously considers this a good thing. Clients are actually instructed to think about, for instance, the ten most traumatic memories of their lives and do eye movements on each of them. That is in addition to doing eye movements on earlier bad memories related to the original targeted memory.

BLS practitioners claim that unless bilateral stimulation is done on all related (and often many unrelated traumatic memories), the client will receive no benefit for doing BLS on the original targeted bad memory. The result of this practice and philosophy is that clients undergo BLS treatment for many months (2-5 years for complex PTSD) reliving many traumatic memories far more intensely and frequently than they did prior to therapy.

As an exposure therapy, BLS frequently causes more trauma-related suffering during the long course of treatment than the already beleaguered clients experienced prior to beginning therapy. Adherents claim that the trade-off is worth it because after the treatment is finally complete, one’s mental health should be better. However, the increase in symptoms during this long-term treatment is so considerable that even ‘successful’ BLS treatment is a net increase in suffering for many.

A small portion of BLS counselors perform the practice differently. They target a limited number of bad memories, typically one per session. A small number of related memories may also be targeted. These counselors don’t intentionally lead their clients to bring up unrelated memories. Importantly, they do not incite their clients to acutely experience the emotional pain of their memories.

In fact, these brief bilateral stimulation-imagery rescripting (BiRes) counselors try to keep their clients in a peaceful state throughout the entire process. In this form of BLS, there is no homework and only one to five sessions are needed to treat severe trauma.

EFFECTIVENESS

Most of the evidence base for BiRes is based on case studies and the personal experience of counselors. However, there have been a few clinical trials, some of which have used control groups. In a 2020 4-session trial of seniors, complex grief was reduced an average 23 points on a 76-point scale. Scores for control group participants decreased 4 points.¹

In 2012, BiRes was administered to 80 people with PTSD in a pre-post clinical trial. Participant scores on the PTSD Checklist went from an average of 54 prior to the intervention to 30 afterwards. Depression scores also decreased dramatically, from an average of 29 before the trial to an average of 12. For both trauma and depression, the improvements still held at the 2-month follow-up.² The participants received an average of 3 BiRes sessions each.

The following year, the same research team performed another pre-post trial on people with trauma. PTSD Checklist scores went down an average of 29 on the 85-point scale. This study had a 4-month follow-up. Again, symptom relief was maintained for the follow-up period.³ In another study, 5 female veterans with sexual trauma recorded a 28-point reduction in scores on the military version of the PTSD Checklist.⁴

Improvement in trauma symptoms seem to hold well over time in BiRes studies. A trial of 20 survivors of cancer reported that BiRes significantly reduced trauma symptoms and cancer distress at the one-month follow-up.⁵ One paper consisting of 8 case studies on deployed military personnel found that results from a single BiRes session were still strong one year after the intervention.⁶ This is especially significant considering that the soldiers had months of combat remaining immediately following the BiRes session.

While empirical support for BiRes is currently small, there is much greater support for EMDR and imagery rescripting, the two major components of the intervention. A systematic analysis of EMDR published in 2019 determined that it is highly effective in treating trauma with an NNT (number needed to treat) of 2.04.⁷ That means that statistically, for every ~2 people who undergo EMDR, one will receive significant improvement in their trauma. An NNT of 2 is excellent considering that counseling in general has an NNT of 4 to 5.⁸ Of course, EMDR efficacy studies don’t factor in the high drop out rate nor the long-term exasperation of symptoms that often occurs during and after treatment.

Imagery rescripting also has a much larger evidence base than BiRes. A systematic review of rescripting from 2023 found the practice to have high efficacy for both trauma and anxiety.⁹ The paper assessed 23 clinical trials that utilized a maximum of 6 sessions each.

To date, there have been no clinical trials on self-BiRes. However, adult self-BiRes is expected to work as well as counselor-led BiRes because the modality is entirely based upon actions taken by the individual. The client-counselor relationship is not relevant to the treatment outcome. Even when directed by a psychotherapist, BiRes is essentially a type of meditation.

Children are an exception. For kids, a counselor or parent is essential for guidance, support, and assistance with the rescripting phase.

ELIGIBILITY

To perform BiRes on yourself, you should have the ability and willingness to think about your traumatic incident. Although the practice has safeguards to minimize distress, there remains the potential to become overwhelmed with emotion.

You may spend 1 to 1.5 hours at a time thinking about the traumatic event in some form. If you think that could be too much for you at this point in time, you should not practice BiRes either alone or with a counselor. Self-Interrupted Memory Reconsolidation (self-IMR) would be a better option.

INSTRUCTIONS

Step 1

Practice relaxation techniques

1-10 minutes

Step 2

Scan body for tension

5-15 minutes

Step 3

Recall the targeted traumatic event

15-25 minutes

Step 4

Re-shoot a new, positive version of the event

15-25 minutes

Step 5

Rehearse future triggers

10-15 minutes

HOW TO PERFORM EYE MOVEMENTS

Face straight ahead with your eyes open. Without moving your head, look all the way to one side of your field of vision, then look all the way to the other side. Move your eyes back and forth continuously at a rate of approximately one second for one ‘back and forth’ round. If you can’t do them that fast, that is fine. Don’t look so far to the side that you feel strain.

Ideal speed of eye movements is specific to the individual. While one round per second is the default speed, you are encouraged to try going faster or slower to see what helps you the most. You may use a stopwatch or clock to keep track of the time. If you feel that you are good at estimating the time, that also works.

It is preferable to visually track an object rather than simply looking from side to side. You can use your own finger about a foot from your face. Resting your elbow on a table will reduce strain on your shoulder. Even easier is to use a light stick-like object, like an extended back-scratcher. Holding the bottom of the stick on your lap and tilting it side to side will allow you to keep both your arms still.

One good self-BiRes option is to track a dot on a computer or television screen. Bilateralstimulation.io is one website that lets you do this. It is free, requires no sign-in, and lets you adjust the speed. Other “self-EMDR” websites exist but may require payment. Make sure the dot window is full-screen and your face is very close to the screen so that your eyes get an adequate range of motion. Doing self-BiRes this way may seem cringy and unnatural, but it is very practical.   

You may also perform self-BiRes without using eye movements. Bilateral tapping theoretically should work as well as eye movements and is commonly used in conventional BLS. A butterfly hug is one option. Cross your arms over your chest and tap your shoulders, one at a time, with the opposing hand.

A further option is to pat your thighs alternately with your same-side hands. This option may be the easiest physically. With the butterfly hug or moving your hand in front of your face, your shoulders get tired easily. Alternately clasping your hands while resting on your lap is equally acceptable.

Step 1

Practice relaxation techniques

The first step in performing BiRes on yourself is to learn how to deal with excessive distress during the procedure. You always want to be relaxed and centered during this self-therapy. Don’t do it if you are feeling particularly stressed. Sit down someplace comfortable and quiet so there will be no distractions.

Emotional distress is primarily managed using the process itself–altering the eye movements, scanning your body for tension, and modifying the memory to make it a happier one. However, if intense emotions arise and the process doesn’t adequately deal with them, the following techniques are recommended to quickly induce calmness. At the beginning of each self-session, practice or at least remind yourself of these methods. If you have existing relaxation methods that work for you, you may use those as well.

Safe Place

Imagine that you are in a place where you feel completely happy and content. It may be imaginary, such as lounging on a beach in Hawaii, or from real-life, like playing with your dog or fishing. Close your eyes and imagine yourself there. Experience the sights, sensations, smells, and sounds. Focus on how peaceful you feel.

The safe place may not even be visual. For example, you can imagine yourself cuddling with your life partner with your eyes closed or sitting eyes-closed in a whirlpool after a hard workout.

Bridge

One way of dealing with distress is to imagine yourself walking on a sturdy, wide concrete pedestrian bridge over a river. The river represents your negative memory. The shore that you are walking away from represents where you have been living since the traumatic event. The shore that you are walking towards represents the happier, peaceful life ahead of you once the session is over and your trauma has been sufficiently processed.

As you walk on the bridge, looking at the new shore, you may imagine it as a fictional paradise or as something more realistic, like the decent life you had before your traumas began. Besides instilling security, as you see that your memory is flowing a few meters below you while you are safe on the bridge, this analogy can also increase your motivation to continue with the session.

Return to senses

If your emotions start to get out of hand, you may need to take a quick break from the practice. Using the physical senses is a great way to quickly get out of your head. Wiggle your toes. Feel your feet against the floor and your butt and back against your chair. Look around the room intently like you’re a detective looking for clues for something. Stroke the back of your hands upwards on your cheeks and scrunch your face. Squeeze a random muscle for a few seconds then release.

By using your physical senses, you can snap yourself out of an emotional slide. There is no shame in doing it. Once your emotions have subsided, you may continue BiRes where you left off.

Step 1 may take around 10 minutes the first time you try BiRes. If you do this self-therapy regularly, you may only need to take a minute or so to go over these three grounding exercises. Again, you may never have to use any of these 3 methods because controlling emotions are built-in to the BiRes process itself.

Step 2

Scan body for tension

Trauma often manifests as physical (somatic) sensations in the body. Remembering a disturbing event can bring abdominal cramps, headaches, or other random negative sensations in various parts of the body.

Close your eyes and think about your traumatic event for a few moments. You may want to take some slow, deep breaths. Now go into your body. Do you feel any stress anywhere? Do you have pain, tension, heaviness, heat/chills, tingling, or other abnormal sensations? One at a time, identify these somatic symptoms.

For each symptom, identify it in detail. What does it feel like? Where is it? How strong is it? Take it a step further and give it a size, shape, color, etc., if possible. By describing each one in detail, you are objectifying it and distancing yourself from it.

Pick the strongest sensation. Open your eyes and begin eye movements while imaging the sensation is weakening, melting, fading, crumbling, etc. Imagine that air, magical gas, or a beam of spiritual love is entering the spot and dissipating it. Slowly chanting “om” in silence while imagining the om energy entering your problem spot and healing it can make this step even more effective.

Each problem area in your body should have at least two minutes of eye movements performed on it. Once the problem is resolved, it is good to continue the movements to lock in the improved feeling. If the problem spot is slow to improve, spend up to seven minutes on it then move to another somatic issue if one exists. Experiment with different speeds of eye movements to see which works best for you. Continue to think of your troubling memory while doing the eye movements.

The goal of Step 2 is to lower the sensations so that you are calm enough to continue with the process. You may not be able to get rid of every sensation entirely. If your somatic sensations are not too intense, proceed to the next step. If strong sensations in your body remain after 15 minutes of performing eye movements on them, end the session and try again another day. If you become highly distressed, perform one of the relaxation exercises from Step 1.

Step 3

Recall the targeted traumatic event 

Once your somatic sensations, if any, are neutralized, you can start the desensitization phase. Think of the distressing event that you want to target. It is up to you if your eyes are open or closed. Rate the psychological and somatic distress it causes you on a scale of 0 to 10. Do not intentionally make yourself feel as much emotional distress over it as possible, as is done in conventional EMDR. Just think of the event and honestly rate the level of distress. This provides you with a baseline so you can measure the effectiveness of the session.

You can imagine yourself in the first person reliving the scene or you can imagine that you are watching the scene on a television. The latter is recommended if your stress level becomes very high, as it provides some emotional distance from the event. Perform eye movements while thinking about the traumatic event as you remember it. After every two minutes, re-check your distress level.

Performing lateral eye movements while thinking of the event is intended to allow your brain to process the distressing memory and reduce the negative emotions and somatic sensations that accompany it. If your distress level isn’t gradually going down while doing the movements, experiment with different speeds of eye movement or tapping.

If your distress gets worse despite doing a few minutes of bilateral movements on it, stop thinking about the incident and continue looking side to side while focusing directly on your emotions (and bodily sensations, if present). Alternatively, you can imagine that you are watching the scene on a television and the television is sliding further away. A third way of dealing with climbing distress is to make the video you are watching on the TV fuzzier and/or in black and white. These television-related hacks are meant to emotionally distance yourself from the memory. Return to the memory once the stress is back under control.

Ideally, you will reach a distress level of 0 or 1 and continue to the next step. If your distress does not fall to around at least a 2 after 10-15 minutes, start performing eye movements on an earlier related memory that could be contributing to the trauma from this event. For example, if the event is a physical assault, perhaps you have older memories of being assaulted that still affect you subconsciously.

Step 4

Re-shoot a new, positive version of the event

Once you have done several minutes of eye movement on the original memory and the related emotional and somatic distress is at a much lower level, it is time for the rescripting phase. Think about how your unhappy memory can be altered or ‘re-shot’ to make it into a happy memory.

For instance, if the incident involved verbal bullying, you may want to imagine the bully saying something nice to you, rather than something mean, or you may imagine that you shouted down the bully and ‘won’ the confrontation. If the negative memory was a car crash, you could imagine yourself swerving to avoid the crash or large balloons popping up around your vehicle and the other car bouncing off of them. The new script may be realistic or fantastical, assertive or funny.

If you have trouble coming up with a new, happy version the event, try making the memory into a TV show. You can make it a television show that you are watching, and at the end of the scene the theme song and credits come on. You can also imagine that everyone in the incident are actors being filmed in a television studio. The director yells “Cut!” at the end and everyone looks at each other triumphantly and congratulates each other on nailing the scene. You can always rescript the entire bad memory at a later time.

Rescripting puts you in charge of your memory and lets you use your creative right brain to address your emotional challenges. You can experiment with different re-shoots and see which one brings you the most peace. Once you decide upon a new script, resume doing lateral eye movements.

Keep doing eye movements until the new script feels real and your distress level is low (preferably at zero). Once that happens, do another two minutes to consolidate (lock-in) the new positive ‘memory.’ Try to imagine yourself inside the new scene and make it as vivid as possible before proceeding to the next step.

Step 5

Rehearse future triggers

You’re almost done! Now that you have replaced your negative memory with a more positive one, the next step is to do a little preparation for future flashbacks and triggers. If you skip this step, your bilaterally reprocessed memory may more easily revert back to the original memory and accompanying trauma.

Think of 1 to 3 situations that are most likely to trigger you to relive your disturbing memory. It could be a place that you visit, a person you bump into, or something as simple as sitting at home alone with your mind wandering. For each situation, perform around 3 minutes of eye movement in which you imagine yourself in the potentially triggering situation without being affected by it.

For example, if someone mentioning football is a trigger for you, imagine that you overhear people near you talking about football. Rather than having an emotional episode like you used to, you remain calm and happy and even listen to the football talk without thinking about the disturbing memory. In the simulation, you may remember the new, happy memory or not give much thought to the original negative memory.

Monitor your emotions and somatic sensations during the trigger rehearsal. Clean out the dirt with eye movements in the first three minutes, then do another two minutes to consolidate your smooth rehearsal in which you are not bothered by the ‘trigger.’ If after 10-15 minutes, you still feel significant distress, consider returning to the rescripting phase and doing a few minutes of lateral movements with a different rescript. Retake your level of distress. Hopefully, it is at a 0 or 1 on 10.

If the 45 to 90-minute self-BiRes session didn’t do much to improve your symptoms of trauma, or you think you can improve further, try it again another day. Doing BiRes on earlier disturbing memories that could be related to the original targeted memory may help. Often, these earlier memories block the reprocessing of your targeted memory. Self-IMR is another good option for treating trauma.

Don’t let your mind free-associate and don’t intentionally dive deeply into the negative emotions. That could unleash a cascade of traumas or cause strong emotions, as is common in EMDR therapy. Neither should you try to intellectually analyze your targeted memories during a BiRes session. You can do that at other times. When you are doing BiRes, you want to keep your mind focused on how you feel. Intellectual activity can interfere with the reprocessing effect.

Most BiRes counselors consider five sessions the upper limit for a single trauma or cluster of related traumas. Like all forms of psychological treatment, BiRes may not work for everyone. Nonetheless, the potential to resolve mild to severe trauma in an hour at no cost makes self-BiRes a viable option for many suffering from bad memories.