EMDR Therapy Quarterly

Abstract

The On-the-Spot EMDR method, developed by Tamaki Amano and Motomi Toichi (2014), is a simplified EMDR protocol for immediate, in-the-moment use with individuals unable to tolerate or engage in standard EMDR therapy. Originally applied to reduce the behavioural and psychological symptoms of dementia (BPSD), the approach combines bilateral tactile stimulation and grounding statements to down-regulate distress in real time. This article explores extending the method beyond dementia care – to contexts of acute emotional dysregulation, decision-related conflict and focused desensitisation of internal sensations or dilemmas – highlighting its potential as a brief, stabilising intervention within and beyond EMDR therapy.

The On-the-Spot EMDR method: Origins and core steps

Developed in a Japanese long-term care facility over fifteen years ago, the On-the-Spot method emerged from clinical observations that agitation and distress in dementia may reflect flashback-like re-experiencing of trauma (Amano & Toichi, 2014). Because conventional EMDR requires sustained attention and recall, Amano & Toichi adapted the procedure for use by carers during episodes of distress. Key steps include:

1. Assessment: Identify patterned distress behaviours that may reflect trauma re-enactment, informed by carer observation.
2. EMD phase: Engage the client calmly with bilateral tactile stimulation (tapping) while repeating grounding phrases, such as “You are safe now” or “It’s over.”
3. Resource installation: Once settled, pair slow bilateral stimulation with sensory or memory cues that evoke comfort and safety.

Outcomes from Amano and Toichi’s (2014) case series demonstrated substantial and sustained reductions in agitation, suggesting that even brief, non-verbal bilateral stimulation can modulate trauma-related arousal and restore behavioural equilibrium.

It is important to rule out other factors that may be causing agitation or distress-related behaviours before considering the On-the-Spot method. These factors can include the individual being hungry/thirsty, experiencing pain, having a urinary tract infection (UTI), low sodium levels or communication difficulties. Accurately identifying these factors can be challenging; however, those considering using the On-the-Spot method could be provided with psychoeducation on potential underlying causes and what they may need to look out for. For example, if there are any concerns about a UTI, then a urine sample should be taken and sent for analysis before using the method. Where this occurs outside an institutional setting, appropriate healthcare pathways should be followed, such as consultation with a GP or rapid response team.

Mechanisms of change

Amano & Toichi (2014) conceptualised BPSD as procedural re-experiencing loops – implicit trauma responses encoded somatically. The On-the-Spot method likely exerts its effect through bilateral sensorimotor input, reducing limbic hyperactivation, rapid access to parasympathetic regulation and facilitation of implicit emotional integration when cognitive processing is limited. These mechanisms align with neurophysiological theories of EMDR (Shapiro, 2018), in which alternating bilateral stimulation promotes dual attention and adaptive memory reconsolidation.

Extension: Desensitisation-only and conflict-focused use

Beyond dementia, the On-the-Spot method could function as a desensitisation-only intervention. Here, the goal is not full reprocessing but containment and reduction of distress around a singular difficulty, such as an intrusive bodily sensation, an emotional charge, an inner conflict about a decision or an imminent future worry.

Clinical application:
• The client identifies one focus, such as “the tightness in my chest when I think about telling my partner” or “the feeling of being pulled in two directions.”
• The therapist instructs the client to notice the sensation or conflict while engaging in gentle bilateral stimulation (e.g., self-tapping or alternating tones).
• The client is encouraged to simply observe changes in intensity, location or imagery without analysing content.
• When the arousal subsides, resource tapping or grounding can consolidate calm.

This desensitisation-only adaptation serves as an affect regulation bridge – supporting clients who may not yet be ready for full EMDR memory processing, such as those with high dissociative thresholds or those facing moral or decisional distress. It can also be self-administered between sessions as a stabilisation tool.

Applications with carers of people with dementia

In EMDR practice, full reprocessing of trauma memories should always be carried out by a clinician who has received training in the EMDR Standard Protocol from an EMDR Europe-accredited trainer. The On-the-Spot method differs from the full Standard Protocol and its aim is not to facilitate the full reprocessing of traumatic memories. We believe it has a place during moments of distress and high dysregulation, where it can act as a tool to process the immediate distress or physical reaction by focusing solely on the present experience, without directing attention towards traumatic material. Therefore, we would advocate that this tool be taught to carers of people with dementia, along with the psychoeducation referred to earlier, to reduce distress in the moment related to the person’s BPSD. This approach is arguably being delivered in a person-centred context, in that it meets the person living with dementia where they are, in the moment.

The advantage of teaching carers this approach in the community is that they can utilise the relationship they already have with the person they care for (e.g., understanding the subtle changes in that person), while taking into account the neuroscience of relationships and non-verbal communication, such as eye contact, touch, vocal tone and singing, which could be intuitively incorporated into the interaction to enhance it. (Bender et al., 2022; Liu et al., 2025).

Applications beyond dementia

Potential clinical extensions include:
• Crisis and acute distress regulation in PTSD, bereavement or medical trauma.
• Decision conflict or moral injury work, where the goal is emotional equilibrium rather than cognitive resolution.
• Somatic distress desensitisation for clients with trauma-linked pain, anxiety or neurogenic tension.
• Online healthcare services and self-help contexts, using self-tapping (this may also be known as the butterfly hug) or bilateral audio to restore emotional balance rapidly.

Conclusion

The On-the-Spot EMDR method represents a pragmatic, neurobiologically grounded intervention for rapid distress modulation. By emphasising focused attention, bilateral stimulation and simple verbal reassurance, it could be applied flexibly across clinical populations to facilitate desensitisation of bodily or emotional distress and promote adaptive stability. Further empirical study should examine physiological outcomes, its feasibility in community and telehealth contexts and its integration as a preparatory or adjunctive EMDR tool.