EMDR for Single Incident Trauma: A Case Study
This case study is a fictional composite drawing on common themes from clinical practice. It does not represent any single individual. All names and specific details are fictional. Published for educational purposes to illustrate how EMDR therapy can help people recover from single incident trauma.
When Sarah* came to therapy, she had quietly reorganised her entire life around fear.
She planned every journey with meticulous care—avoiding shortcuts, poorly lit streets, and anywhere that felt exposed. She no longer took the underground. She got Ubers home rather than walk, even short distances. She stayed in large groups, in well-lit places, never out late. When news stories about violent incidents appeared on television, she would map the locations—adding them to her mental geography of places to avoid.
At home alone, she used smart home technology to switch on all the lights before she arrived. She kept a meditation app playing through the night—just to have a voice in the room. When her partner was away, she locked herself in her bedroom. Every unfamiliar sound made her jump.
Before all of this, Sarah described herself as a trusting person. Someone who had never assumed the worst. That person felt very far away.
What Brought Sarah to Therapy
Several months earlier, Sarah had been involved in a frightening encounter—a threatening incident in a public place in which she felt her safety was seriously at risk. In that moment, she froze. She felt shocked, confused, and unable to move. Frightened, weak, helpless, and completely powerless.
What followed the incident was complex guilt. Sarah thought of herself as someone who did the right thing. A good person. But in that frozen moment, she had done nothing—and that silence had taken on a meaning that haunted her: I can't trust myself. I won't do the right thing when it matters.
What Sarah didn't know when she first came to therapy was that this incident hadn't happened in isolation. Some years earlier, she had been involved in a frightening incident whilst travelling. That experience had never been fully processed—it had simply been buried and carried forward. When the more recent incident happened, it landed on already-disturbed ground, amplifying everything.
Assessment
At the start of therapy, Sarah's clinical scores reflected the severity of her distress:
PHQ-9 (measuring depression and low mood): 18 — in the moderately severe range
GAD-7 (measuring anxiety): 16 — in the severe range
Her goals were clear:
To feel less frightened going out
To feel less frightened being at home alone
To manage the physical feelings of anxiety
How We Worked Together
Sarah and I worked together for 20 sessions using an integrated EMDR and CBT approach.
Building Safety First
Before any trauma processing began, we spent time building Sarah's internal resources. We worked on safe place visualisation and soothing breathing techniques—giving her tools to regulate her nervous system when it felt overwhelmed. In EMDR, this preparation phase is essential. Trauma processing should never begin until a person feels sufficiently grounded and safe within the therapeutic relationship and within themselves.
Understanding What Was Happening
We also spent time on psychoeducation—helping Sarah understand what happens in the brain following a traumatic experience, and crucially, why it happens. Understanding that her hypervigilance, her startle response, her need to control her environment were not signs of weakness—but of a nervous system doing exactly what it was wired to do after a frightening experience—was itself an important shift for Sarah. It moved her relationship with her own reactions from self-criticism to compassion.
EMDR Processing
Using bilateral stimulation, a technique of EMDR, we worked through the threatening incident—the image, the physical sensations, the emotions, and the beliefs it had created about herself and the world: I am vulnerable. I am not safe. I cannot trust myself or others.
During processing, the earlier incident—long buried—began to surface. This is common in EMDR. Traumatic memories are networked in the brain. Processing one memory often unlocks others that are connected by theme, emotion, or belief. We worked through both.
Throughout our sessions, we used standardised outcome measures to track progress, regularly reviewing Sarah's goals so she could see—concretely—how far she had come.
What Changed
By the end of therapy, Sarah was living differently.
She was going out again—taking routes she had avoided for months, socialising with friends, staying out in the evenings. She was no longer planning every journey around the possibility of threat, or mapping news stories onto a mental grid of danger. She had stopped locking herself in her bedroom when her partner was away. She no longer needed the lights pre-set or a voice playing through the night.
The hypervigilance that had quietly taken over her life had softened. She still took sensible precautions—as any of us do—but she was no longer organising her entire existence around fear.
The clinical scores reflected this transformation:
PHQ-9: 18 → 4 (moderately severe → minimal)
GAD-7: 16 → 3 (severe → minimal)
In Sarah's own words:
"It doesn't feel like that traumatic memory is happening now—it feels like the past. Once upon a time."
"Every time we processed it, it felt a little easier."
"Therapy was surprising. I hadn't realised there were things I had locked away that were affecting me now."
And most powerfully:
"What surprised me was discovering the strength I used to have as a child to get through difficult things. And being able to tap into that again."
What This Case Illustrates About EMDR
You don't have to relive the trauma in detail: EMDR doesn't require you to describe everything that happened. Sarah processed the memories internally, guided by bilateral stimulation, at her own pace. She remained in control throughout.
There is often more than one layer: Sarah came to therapy for one incident. What emerged was that an earlier experience—one she believed she had moved past—was also contributing to her distress. EMDR works by following the thread of trauma wherever it leads, not just the most recent event.
Hypervigilance is not weakness—it's protection: Sarah's need to control her environment, to plan every journey, to assess every person—these weren't irrational responses. They were her nervous system's attempt to keep her safe after it had been shaken. EMDR helped her nervous system update: the danger is over. You are safe now.
Significant outcomes are possible in a relatively short time: Twenty sessions. PHQ-9 from 18 to 4. GAD-7 from 16 to 3. This is what well-matched, evidence-based trauma therapy can achieve.
Could EMDR Help You?
If you've experienced a frightening or threatening incident—or any event that has left you feeling unsafe, anxious, or unlike yourself—EMDR may be able to help.
You don't need a formal PTSD diagnosis to benefit. Many people experience what is sometimes called "small-t trauma"—events that weren't life-threatening but have nonetheless left a significant mark on how you feel and move through the world.
If Sarah's story resonates with you, I'd be glad to have a conversation about whether EMDR might be the right approach.
Book a free 15-minute consultation. There is no obligation—just a quiet, confidential space to talk about how you're feeling and how I might be able to help.
*Sarah is a fictional composite character. This case study does not represent any single individual.
Thulasi is a BABCP Accredited CBT Therapist and EMDR UK Accredited Practitioner based in Epsom, Surrey, with over 16,000 clinical hours of experience. She offers EMDR therapy in-person in Epsom and online across the UK.
