Liz Frings

EMDR Side Effects, Hangovers and Shift Work: A Guide for Emergency Services Staff

When your job depends on staying sharp, it makes sense to ask what trauma therapy will do to you before you agree to it. Staff in the police, ambulance and fire services, and in 999 control rooms, tend to ask the same few questions. Will it make things worse first? Can I still work a night shift after a session? Will I lose the edge I rely on, or the humour that gets the crew through? And if a job stops haunting me, does that mean I've stopped caring about the person in it?

This guide answers those questions as honestly as the evidence allows. It covers the after-effects that are common, the ones that are rarer and worth reporting, what the research does and doesn't show, and how to fit EMDR (eye movement desensitisation and reprocessing) around a rota. For an overview of how the therapy is adapted for these roles, see EMDR for emergency services staff.

What is the EMDR hangover?

"EMDR hangover" is an informal name, used by clients and therapists, for feeling drained, foggy or emotionally raw for a while after a processing session. It isn't a medical term, and not everyone gets it. Processing traumatic memories is real mental work, and the brain often carries on with it after you leave the room. Plenty of people feel nothing unusual at all.

Common after-effects

In the hours or days after a processing session, some notice:

  • tiredness, sometimes a heavy need to sleep that evening
  • more vivid dreams, or dreams that replay parts of a job
  • older incidents surfacing, sometimes ones you hadn't thought about for years
  • emotional ups and downs, such as tearfulness, irritability or low mood
  • poor concentration or a foggy head
  • headaches, or tension in the body
  • feeling lighter or calmer, which can be just as unfamiliar

These usually settle within a day or two. Your therapist should tell you about them before treatment starts, and will often ask you to jot down anything that comes up so it can be picked up at the next appointment. For many who get these after-effects, they ease as the work goes on.

Will I feel worse before I feel better?

Some do, for a while. Processing one memory can stir up others, and a run of shifts can add new material at the same time. That is one reason EMDR doesn't start with the hardest traumatic memories. The early appointments are about history and preparation, including ways to steady yourself, and processing only begins once those are in place.

Feeling worse for a few days after processing is common. Feeling steadily worse over several weeks is not something to push through quietly. Tell your therapist, because the pace or the target may need to change.

What the research says about side effects

Less than you might expect. A 2025 review by van Schie and van Veen looked at 51 randomised trials of EMDR for PTSD. Only nine mentioned adverse effects at all, and only one measured them in a structured way. Where clients did report them, they were typically mild and temporary. The authors call this a neglected area and argue that trials should monitor harms as carefully as benefits.

In other words, the evidence that EMDR works for PTSD is strong, and NICE recommends it as a treatment, but the evidence about how often it causes unpleasant after-effects is thin. The common experience reported by clinicians is the list above. The honest position is that nobody yet knows exactly how common each one is.

The same review looked at a worry some have about memory. Holding a memory in mind during eye movements can make it feel less vivid, and some have asked whether that could blur details or create false memories. The review concluded that recent evidence suggests these effects don't hold up reliably and aren't a clinical concern. If you may give evidence about an incident, tell your therapist at the start anyway, so the work can be planned with that in mind. Is counselling confidential? covers notes, courts and inquests.

Less common effects to report

Tell your therapist promptly if you notice:

  • feeling detached, spaced out or unreal for long stretches after a session
  • flashbacks or nightmares that are getting stronger week on week
  • drinking more, or using anything else, to get through the days after an appointment
  • thoughts of harming yourself

None of these means the therapy has failed. They are signs the pace, the preparation or the target needs to change. If you have thoughts of harming yourself, don't wait for the next appointment. Ring 999 in an emergency, ring NHS 111 and choose the mental health option, or ring Samaritans free on 116 123.

How each appointment is closed

Every EMDR appointment ends with a closing stage, whether or not the memory being worked on is finished. The aim is for you to leave steady enough to get on with your day.

One tool from the preparation phase is particularly useful for shift workers. Robbie Adler-Tapia, a former firefighter and emergency medical technician, writes in EMDR with First Responders (Luber, ed., 2015) about teaching responders to use containers. A container is an imagined place where you put thoughts, feelings or images that would get in the way at work, so you can deal with them later. She is clear that a container is meant to be emptied, ideally as a daily routine of clearing the jobs from that shift. Most in the job are already good at shutting things away. What many never learn is the second half, taking them out again somewhere safe.

Containers pair well with the Flash technique, developed by Dr Philip Manfield, which I've used with clients. It takes some of the intensity out of a memory while your attention stays on something positive. Working without describing the trauma explains it in more detail.

Having EMDR while working shifts

Many staff have EMDR while still working. It takes a little planning, and it helps to talk through with your therapist at the start how sessions might affect your work. Some things worth thinking about:

  • avoid processing sessions straight before a night shift or a long run of shifts, if you can
  • leave a little time after sessions before you drive, go back on shift or pick the children up
  • agree what you'll do if something surfaces on shift, such as using a container exercise
  • know who to contact if you're struggling between appointments
  • check your service's policy if your role involves firearms, response driving or other safety-critical duties

Control room staff can find that a call similar to the one being worked on hits harder for a while. It is worth naming that in advance, and planning what you'll do if it happens.

If travelling to sessions is hard, can EMDR therapy online be effective? looks at how online sessions work.

Will I lose my edge?

Your edge is your training, your experience and your ability to act fast under pressure. EMDR works on memories that have stayed stuck, with the images, sensations and sense of threat still attached. It doesn't remove skills or experience. The aim is that you can still respond at full speed when the job needs it, and stand down when it doesn't, instead of staying on high alert in the supermarket or lying awake listening for the next call.

It also doesn't erase what happened. In my experience, if someone feels an error was made, EMDR can help them process their feelings about it.

Will I lose my sense of humour?

Dark humour is part of the culture in every emergency service, and it's one of the ways people cope with the job. I don't see it as something therapy should take away. Some find their humour shifts a little once it no longer has to cover something heavy. That can happen as things ease, and it isn't a goal anyone sets for you.

Will I stop caring, or forget the people involved?

This worry runs deep. For some, being haunted by a job feels like the last way they can honour the person in it, and they're afraid that letting go of the distress means letting go of them.

EMDR doesn't erase memories. You will still remember what happened and who was there. What tends to change is how the memory feels, so that it stops forcing its way in and becomes something you can think about when you choose to. For recent events, or the loss of someone close, distress may not drop all the way to zero, and in my experience that's normal. Some sadness about a tragedy is a fitting response, not a sign the therapy has failed.

Something I find helpful is the idea of "finishing the call", meaning some kind of closure on jobs that stay with you. That might be attending a funeral, a personal ritual, or finding out what happened to a patient afterwards. Adler-Tapia describes a responder who kept seeing the injured face of a child he had rescued. Seeing a school photograph of her later helped him close that job.

Who should wait, or go more slowly?

EMDR may need adapting, or delaying, if you are:

  • in crisis, or at risk of harming yourself
  • dissociating heavily, losing time or feeling unreal much of the day
  • drinking heavily or using drugs to cope
  • facing a major upheaval at home or at work

None of these rules you out. They mean more time on preparation and a slower course of treatment, which a good therapist will discuss with you at the start.

Being a witness, or involved in an investigation, is not on this list. Tell your therapist at the start if you could be asked to give evidence about an incident. It usually means planning the work, not delaying it.

Frequently asked questions

How long do the after-effects last?

Usually a day or two, sometimes a little longer. If they last weeks or keep building, tell your therapist.

Is it normal to have vivid dreams after EMDR?

Yes. Dreams often become more vivid for a few nights, and sometimes replay parts of the memory being worked on.

Can EMDR make PTSD worse?

Some feel worse for a short while. The research on lasting harm is limited, and that is a gap worth knowing about. Careful preparation and a therapist who paces the work reduce the risk.

Can I go to work the day after a session?

Most can. It helps to agree with your therapist what you'll do if something surfaces on shift.

Should I drink water or rest afterwards?

There is no evidence that drinking water does anything specific, but rest, food and a quiet evening are sensible after a heavy session.

Will the jobs ever go away completely?

They won't be wiped. The realistic aim is that they become memories you can live with, rather than ones that turn up uninvited at 3am or in the middle of the next job.

If now isn't the right time for EMDR

Not everyone is ready to work on specific incidents, and that's a reasonable place to be. Person centred therapy for trauma describes a slower approach that follows your lead. If your main worry is having to describe what you saw, EMDR without talking about the trauma may help.

I offer EMDR therapy and person centred counselling in Nottingham and online. You can get in touch to talk it through before committing to anything.

Sources

More about EMDR therapy