How this may present
“I know what to do until someone is watching” can describe several different problems. A student may freeze during timed examinations despite adequate knowledge. A musician may become preoccupied with shaking hands. An employee may avoid presenting because the manager publicly ridicules mistakes. An athlete may struggle after an injury, while another needs technical coaching rather than psychotherapy. Similar words do not establish the same formulation.
Some activation before a demanding task is expected and need not be eliminated. The clinical question concerns distress, avoidance, impairment, and the processes restricting performance. Aiming for zero anxiety can itself become an obstacle if the person concludes they must feel completely calm before participating. The objective should be agreed in terms of what the person wants to do, with realistic acknowledgment of preparation, ability, opportunity, and uncertainty.
What to assess before choosing a target
Ask for a detailed account of one recent performance, including the period before and afterward. Establish when attention shifted, what the person predicted, what they did to manage the fear, and what happened. Compare rehearsal and performance conditions without assuming that good practice performance proves adequate preparation for every task demand.
Distinguish a skills gap from anxiety interfering with an existing skill. Review workload, sleep, physical health, pain, stimulant or substance use, medication effects, and accessibility needs. A student may need assessment for learning or attention difficulties; a performer with a new movement problem may need medical evaluation. Avoid psychological explanations that bypass these possibilities.
Assess whether the central concern is negative evaluation, panic sensations, recurrence of a traumatic event, failure with practical consequences, or a genuinely hostile environment. These can overlap. An employer's unreasonable demands or a coach's abusive conduct should not be reformulated solely as the client's lack of confidence.
Evidence and treatment context
Where a performance problem meets criteria for social anxiety disorder, condition-specific CBT has guideline support. That does not mean every examination, sport, or workplace difficulty is social anxiety. [18]
A small study of advanced pianists compared cognitive hypnotherapy, EMDR, and a control condition in 46 participants across two concerts. Its reported findings are relevant to a narrow research question, not a general demonstration that EMDR improves occupational performance, examination scores, or athletic results. Broader claims would require appropriate replication and condition-specific evidence. [19]
EMDR can be selected to address identified experiences and triggers that interfere with performance. Explain the particular treatment rationale, match the strength of the claim to the research, and combine memory processing with skills practice or environmental changes when these address different parts of the problem.
Possible candidate target categories
A remembered adverse performance experience. The client may identify a specific episode of public ridicule, frightening loss of control, or a serious mistake that remains active in present situations. Its relevance must be established rather than presumed.
A known injury or traumatic event. A traumatic sports injury, workplace incident, or other event may require a PTSD assessment. Recovery planning also needs physical and occupational expertise; processing a memory does not establish medical readiness to return.
A current trigger or feared prediction. These help identify what performance work should address. A mental image of failing next week is a prediction, not a past memory. No childhood target is required if the relevant problem is current preparation, avoidance, or a learned performance habit.
Assessment Script
- “Walk me through the most recent situation where this happened.”
- “At what point did the task become harder, and what did you notice then?”
- “What were you trying to prevent or control?”
- “How does this compare with doing the same task when no one is evaluating you?”
- “Does a particular experience you remember seem connected, or is the concern mainly about what might happen next?”
- “What preparation, coaching, adjustment, or support has helped?”
- “What would a useful performance look like if it were not perfect?”
Keep the questions open enough to reveal a non-trauma explanation. Do not ask what earlier humiliation “must be underneath” a current difficulty.
Past Present Future Map
Fictional formulation example. Owen, a laboratory scientist, avoids giving updates at team meetings. He can explain his work clearly in individual conversations. In a previous job, a senior colleague interrupted a presentation, mocked an error, and encouraged others to laugh. Owen remembers this incident when his current manager asks questions. He reports no similar conduct from the current manager, but worries that any hesitation will end his career.
Past: The clearly remembered interruption and laughter. Owen identifies the meaning as “One mistake gives people a reason to dismiss everything I do.” The clinician does not turn this statement into a universal belief without checking its scope.
Present: Overpreparing every sentence, monitoring his voice, rushing, and declining presentations. His current role also includes unfamiliar presentation software, which needs ordinary practice rather than memory processing.
Future: Delivering a short update, referring to notes when helpful, pausing after a question, and acknowledging an answer he does not yet know. Success is defined by participation and recovery from an interruption, not universal approval.
Why this candidate target might fit
The humiliation memory offers a concrete EMDR target because Owen identifies a specific link to current evaluative situations and gives it a meaning relevant to his difficulty. An agreed treatment plan can proceed from that target to present meeting cues and future participation, while addressing the software skill gap in parallel.
A useful plan records both a memory-related hypothesis and alternatives. For example, self-monitoring and avoidance may continue even if the remembered incident feels less distressing. The clinician therefore needs functional measures: accepting a presentation, time spent preparing, ability to answer questions, and the cost of post-event review. Performance quality and anxiety intensity are related questions, not interchangeable outcomes.
Putting EMDR to work: anxiety, workplace stress, and performance
EMDR's clinical use is not confined to PTSD. A meta-analysis of 17 randomized trials involving 647 participants reported benefits for anxiety, panic, and phobic symptoms, with larger effects against passive controls. This supports an active, formulation-led approach to anxiety targets, while recognizing that evidence strength differs between problems. Yunitri and colleagues, 2020 In performance research, Brooker's small study of 46 advanced pianists found reduced state anxiety following EMDR and cognitive hypnotherapy. It offers encouragement for performance-anxiety work, not a guarantee of professional or examination results. Brooker, 2018
The practical question is: What experience or cue is pulling this person away from the ability they already have? A presentation can activate a humiliation memory; an unread message can reactivate an abrupt dismissal; a supervisor's silence can evoke an earlier experience of being punished without explanation. These are concrete starting points for EMDR formulation. Public speaking coaching, workload changes, and EMDR may address different parts of the same problem.
A useful workplace target inventory
Ask for episodes, not just themes. “My job is stressful” is a presenting problem; “the moment my supervisor read my mistake aloud” is a possible target.
- Public failure or humiliation: a presentation interrupted by ridicule, an examination blank-out, a missed shot followed by criticism, or a creative audition in which the person felt exposed.
- Authority and evaluation: a damaging appraisal, an unexpected disciplinary meeting, discriminatory feedback, or a message associated with losing a previous job.
- Responsibility and mistakes: discovering an error, being blamed for a team's failure, or witnessing consequences that now make ordinary decisions feel intolerable.
- Injury and return to performance: the moment of an accident, the first failed return, or a coach's response to the injury, alongside appropriate physical rehabilitation.
- Present triggers: a calendar invitation, camera activation, a notification tone, a question from the audience, the countdown before starting, or the sensation of a dry mouth.
- Anticipated catastrophe: imagining going blank, being dismissed, or being laughed at. Record this as a feared future image, not an event that occurred.
For each candidate ask, “What happens inside when you bring up that moment now, and what does it interfere with this week?” Select a manageable, relevant starting point together; there is no requirement to uncover a childhood cause. If the workplace is currently unsafe or exploitative, treatment can reduce past-event activation while practical action addresses the actual conditions.
From Owen's target to reprocessing
Fictional worked example, extending Owen's earlier formulation. Owen chooses the moment his former colleague displayed his error and others laughed. Before Phase 3, the clinician has established the treatment plan, consent, preparation, a stop signal, and Owen's ability to remain connected with the present. The following is clinician-oriented application, not a substitute for EMDR training.
Phase 3: make the target specific. Ask, “Which image represents the hardest part now?” Owen selects the colleague pointing at the slide. “When you hold that image, what negative words about yourself fit?” Owen chooses “I am incompetent.” His preferred cognition is “I can be capable and make a mistake.” Establish its present validity on the 1–7 VOC scale, then identify emotion, current disturbance on the 0–10 SUD scale, and body location. These are starting observations, not scores Owen must improve to please the therapist. The image, cognition, emotion, and bodily response form the assessment of this target. APA's description of EMDR phases
Phase 4: process, rather than coach the answer. With the agreed dual-attention stimulation, begin from the assessed target. Between sets, use a brief invitation such as “What do you notice now?” Follow emerging material according to the trained protocol. Owen might notice anger, another incident, a changed image, or the recognition that one error did not represent his whole ability; these are possibilities, not outcomes to suggest. Keep explanatory discussion brief while processing is moving. If it stalls, clarify what is stuck and use an indicated intervention rather than repeatedly asking him to think positively.
Phases 5–7: consolidate and close. When the target's disturbance is appropriately resolved, check whether the preferred cognition still fits, strengthen it through installation, and assess residual disturbance in the body scan. End with closure whether the target is complete or incomplete, accurately recording where work stopped. EMDRIA's eight-phase overview
Present triggers, future performance, and reevaluation
At the next appointment, revisit the original target and ask what happened in actual meetings. If the old incident is less charged but a new manager's “Any questions?” still triggers a freeze, assess that cue specifically rather than declaring the work finished. Where an imagined catastrophe remains central, a clinician trained in the flashforward procedure can assess it separately; processing a frightening prediction and installing an adaptive future template are different tasks. Logie and de Jongh, 2014
For the future template, Owen imagines opening his slides, giving the update, hearing a difficult question, pausing, and answering what he knows. “I can respond without knowing everything” may fit better than “I will be brilliant.” Identify any remaining block, address its source, and rehearse flexible participation. A software lesson remains a software lesson; bilateral stimulation does not supply missing technical knowledge.
Reevaluate both memory change and function: Did Owen accept the presentation? How long did preparation take? Could he recover after a pause? Did he spend the evening replaying it? The desired result is greater access to his skills and choices, not an obligation to perform without normal activation.
What would make us reconsider
Reconsider if Owen describes current harassment, if his actual task knowledge is insufficient, or if the main difficulty appears only under fatigue or a medication change. These findings shift the plan. If repeated rehearsal becomes more rigid and consumes increasing time, ask whether preparation is serving a compulsive or safety-seeking function.
A calmer in-session image does not demonstrate readiness for a high-stakes event. Conversely, experiencing anxiety during a presentation does not mean treatment has failed. Compare agreed functional goals and the person's capacity to respond flexibly, rather than treating bodily activation as the sole scorecard.
Preparation and readiness considerations
Clarify the distinction between therapy, coaching, and certification of competence. A clinician should not promise promotion, selection, a passing grade, or a winning result. Discuss performance deadlines so treatment does not become an unexamined last-minute attempt to guarantee success.
Agree on manageable opportunities to apply learning, within the appropriate treatment plan. Preserve legitimate preparation and accommodations. Eliminating all notes, breaks, or aids is not inherently therapeutic; their function and the person's needs matter. Where trauma-focused work is considered, assess ordinary readiness and consent rather than assuming that a seemingly “small” event cannot be destabilizing.
Future Planning Script
“Picture a realistic version of your upcoming task. You are prepared, but you might pause, make an error, or receive a question you cannot answer. What would you want to do next? Where would you put your attention? What preparation is useful, and when would more preparation stop helping? How will we evaluate the attempt without requiring perfection?”
This script defines behavior and response options. It is not a promise that visualization improves performance or a substitute for the formal procedures of the treatment being used.
Common target selection errors
Avoid assuming that anxiety proves trauma, that the earliest embarrassing experience is the correct target, or that confidence can replace skill. Do not pathologize all anticipatory activation. Do not use a future scene to guarantee a result outside the client's control. Another error is responding only to the client's self-criticism while ignoring an environment where mistakes are actually punished unfairly.
When to coordinate consult or refer
Consider appropriately qualified educators, coaches, occupational services, medical clinicians, or condition-specific therapists. With consent, clarify roles and prevent performance stakeholders from treating therapy as surveillance. A coach or employer does not automatically need access to memory content. Medical assessment is important when new physical symptoms, injury concerns, or movement difficulties warrant it.
Companion connection
A relevant metaphor from Metaphors That Open Doors might help with a specific block involving perfection, judgment, or recovery after error. Use it to open options, not to advertise a hidden power to succeed. A client who needs more rehearsal or a safer workplace should not receive a metaphor in place of those needs.