All of us experience stress, anger, pain and anxiety from time to time. Normally, we feel heightened and then return to baseline or back to our normal level of functioning. However, when stressors are persistent or spike to acute levels, even for a short period of time, we are often left exhausted, discouraged and are unable to perform our best. Having access to a resource that can reduce sympathetic activation in real time will help you return to baseline more quickly.
The numeric pain scale (Rating of 0-10 with 10 being the most severe level of pain you can experience) can be used to measure not only your level of pain, but also your level of stress, anxiety, activation or intensity of a trigger, and even anger levels. We are typically able to manage our level of distress from 0-3. If you are continually at a 4-5 on that scale, it becomes much harder to not only remember coping skills you have been taught, but to utilize them. Once you get to a 6 or higher, coping skills often do not work fast enough or do not work at all for certain people. (Artigas & Jarero, 2014. p.4)
In heightened moments of distress, especially if it is persistently in the moderate to severe range, receiving the benefit of ongoing regulation working in the background without any conscious effort on your part is optimal. Research shows that bilateral stimulation calms the amygdala, the part of the brain that activates the fight/flight response.
A walk in the park
Francine Shapiro, the founder of EMDR therapy, shared that in the spring of 1987, she made a chance observation. “While walking one day, I noticed some disturbing thoughts I was having suddenly disappeared…what caught my attention that day was that my disturbing thoughts were disappearing and changing without any conscious effort. Fascinated, I started paying very close attention to what was going on. I noticed that when disturbing thoughts came into my mind, my eyes spontaneously started moving very rapidly back and forth in an upward diagonal. Again, the thoughts disappeared, and when I brought them back to mind, their negative charge was greatly reduced. At that point I started making the eye movements deliberately while concentrating on a variety of disturbing thoughts and memories, and I found that these thoughts also disappeared and lost their charge. My interest grew as I began to see the potential benefits of this effect.” (Shapiro, 2018, p.7)
From that walk in the park, EMD (Eye Movement Desensitization), an anxiety reducing technique was developed. EMD went on to become EMDR therapy, which “is a complex methodology that includes many components. In addition to directed eye movements, “alternating bilateral hand taps and auditory tones have also proven clinically effective.” (Shapiro, 2018, p.29) Because other forms of bilateral stimulation (BLS) have been proven to be clinically effective, Dr. Shapiro stated that if she had to do it over again, “I would name it simply Reprocessing Therapy”. (Shapiro, 2018, preface) However, due to the worldwide recognition of EMDR, she kept the original name.
Bilateral stimulation has been studied for decades
Dr. Shapiro was not the first person to research the effects of eye movement. She states that “the role of eye movement had been well documented in connection with higher cognitive processes and cortical function”(Shapiro, 2018, p.7). She provides references going back as far as 1963. Why is this important? Because bilateral stimulation (BLS) has been studied for several decades. Bilateral stimulation is regularly used in therapeutic settings not only for reprocessing but for regulation. Bilateral stimulation is also regularly used for self regulation.
Our goal is to share some of the research that has been done on each form of bilateral stimulation so you can choose which form of BLS is best for you to use as a self regulation resource. That decision may vary depending on the situation you are in. If you struggle with flight anxiety, you could potentially use any of the forms of bilateral stimulation as a regulation resource. If you are giving a presentation and you are anxious, your choice of which bilateral stimulation to use in the moment, narrows dramatically. This is also true if you experience stress and anxiety while driving. Research shows that high levels of stress or sitting in our stress for prolonged periods of time, negatively impacts our physical and mental health as well as our performance. Using bilateral stimulation as a self regulation resource in real-time helps us stay regulated or return to a regulated state throughout the day.
Why is bilateral stimulation calming?
Robert Scaer, MD, stated “With the use of fMRIs, we now can view what regions of the brain are in play at any given moment, as well as identify their function based on the experience we are testing…we can actually use techniques that stimulate each cerebral hemisphere in an alternating pattern to inhibit the amygdala. This includes “alternating left and right visual, auditory, or tactile stimuli.” (Scaer, 2012, p.144)
Eye Movement BLS: In a study in 2008, Physiological correlates of eye movement desensitization and reprocessing,it was found that eye movements during the EMDR-procedure are accompanied by a number of physiological changes. “At the start of eye movements, the sympathetic drive is decreased as indicated by a fall in skin conductance and an increase in skin temperature, while the parasympathetic/vagal influence is increased, shown by heart rate deceleration and a changed balance between high frequency and low frequency heart rate variability”… (Elofsson et al., 2008, p.626)
In 2018, a study entitled: Eye-Movement Intervention Enhances Extinction via Amygdala Deactivation, stated “in two independent studies we found that goal-directed eye movements suppress amygdala activity.” (De Voogd, et al., 2018)
Butterfly Hug: This is a technique was developed in 1998 by Lucina Artigas. It that allows you to provide tactile bilateral stimulation to yourself by “crossing your arms over your chest, so that the tip of the middle finger from each hand is placed below the clavicle…Hands and fingers must be as vertical as possible so that the fingers point toward the neck and not toward the arms. If you wish, you can interlock your thumbs to form the butterfly’s body and the extension of your other fingers outward will form the Butterfly’s wings.” (Artigas & Jarero, 2014, p.1)
In 2012, Dr. Francine Shapiro states in her book, Getting Past your Past, take control of your life with self-help techniques from EMDR therapy, “While EMDR therapy needs to be conducted with the help of a trained and licensed therapist, you can use one its components for self-care. You cannot do memory processing, which needs all of the EMDR therapy procedures. But you can try a form of the bilateral stimulation component -tapping – that might be useful to reduce minor anxiety.”(Shapiro, 2012, p.148) You can do the Butterfly Hug, tap back and forth on your thighs, move your feet back and forth or wiggle your toes back and forth.
There have been many studies focused on the use of the Butterfly Hug, sometimes called the Butterfly Technique or Butterfly Hug Therapy, although the founder of this technique, Lucina Artigas named it the “Butterfly Hug”. Exploring the Effectiveness of Self-Healing Butterfly Technique for Anxiety Management: A Systematic Review did a thorough summary of the studies that have been done during the time period 2020-2024. “Several studies have shown that the butterfly hug can reduce anxiety, provide a sense of safety and comfort, and improve concentration, thereby helping individuals feel more at ease…the butterfly hug therapy is a simple intervention that has proven effective in reducing anxiety in various populations, ranging from patients with medical stress to individuals with academic stress.” (Mahyuvi & Ramadhan,p. 241, 248)
Auditory BLS: Francine Shapiro states “bilateral taps and tones, have been used clinically to good effect since 1990.” (Shapiro, 2018, p.357)
Mark Grant, a psychologist practicing in Australia has conducted research in using bilateral stimulation as a relaxation technique for both anxiety and pain. (Grant, 2009, 2012) Bilateral stimulation is a calming resource for people who experience pain because when we are in pain, the amygdala is one of the regions of the brain that is activated. (Louw, et al., 2024) Mark states “people cannot maintain their attention on their pain whilst simultaneously focusing on bilateral audio tones.” He has developed apps for people to listen bilateral tones or bilateral tones with built in music. You can also search “bilateral music” and explore the different options available.
If you don’t like the bilateral tones or music that has been created, you can always choose your favorite song and hold or wear tappers to receive the benefit of bilateral stimulation while you listen to your music.
Tactile BLS provided to someone: During an EMDR therapy session, the therapist can provide bilateral tapping to the client either by tapping on the side of the clients knees or by handing them a device that does the tapping instead of the provider doing the bilateral tapping.
Formal research into having someone hold a device that provides the bilateral tapping for them found that “bilateral tactile stimulation is effective in reducing distress and affect-modulated startle reflex reactivity while imagining negative scenes, and that it is also capable of reducing general startle reactivity.” (Reichel, et al., 2021, p.11)
It has also been observed that when your distress or pain levels are at debilitating levels, you will most likely be unable to tap on your own. Gary Quinn, MD has witnessed “silent terror” when working with highly traumatized individuals. (Quinn, 2018). In situations where someone feels disabled due to trauma, high pain levels, etc, having someone or a device provide the tactile BLS for you is optimal. Additionally, if someone is struggling with certain physical and/or mental disabilities, providing the tappers to someone to receive bilateral stimulation is necessary.
Which form of BLS is best when using it for self regulation?
The research that has been done on bilateral stimulation in all it’s forms has been shown to inhibit, calm or down-regulate the amygdala. “A key advantage of amygdala deactivation through behavioral manipulations, rather than via pharmacological treatments, is that they are noninvasive, precise in time and duration and shown to be clinically effective.” (De Voogd et al., 2018) Which option you choose will be the one that works best for you in the moment you need extra help with regulation.
Eye Movement BLS: While this option can be difficult to perform on your own in many instances when you feel your anxiety levels increasing, you could choose to go for go for a walk or a bicycle ride, your eyes are naturally going to scan the space ahead and you will receive the benefit of settling down the amygdala.
Butterfly Hug: If you type the term “butterfly hug” into any search engine, you will have many videos come up that show how to do the butterfly hug and share the benefits of this technique. Adults and children can easily perform the butterfly hug. While this technique is proven to work, just as eye movement bilateral stimulation, it is not always convenient to do. For example, if you have anxiety while driving or when giving a presentation, it is difficult, if not impossible to do the butterfly hug in those moments. Also, certain disabilities make it difficult, if not impossible, to perform the butterfly hug.
Auditory BLS: There are different types of bilateral tones and music that you can choose to listen to. The limitation of this modality is you can’t always leave a situation to listen to the bilateral music or tones. Examples of this would be interviewing for a job or providing customer service to an upset customer and you need to stay regulated so you can respond in effective ways.
For some people who have experienced trauma, getting quality sleep is difficult. Some people may not want to wear headphones as they go to sleep for a variety of reasons, including an increased sense of hypervigilance at not being able to hear clearly.
Tactile BLS provided through a device: The advantage of Bi-Tapp over other products is that the tappers feel like manual tapping, as if someone was providing the bilateral tapping for you. With the tappers, you are able to customize the settings, you choose how fast or how slow you like the tapping. You choose how strong or how soft you like the tapping. You can place them on your wrists if that’s where you like the tapping best. Or, you can place them in your pockets or your socks. Because the tapping is quiet, people won’t even know you are using the tappers as a regulation resource. You receive the benefit of ongoing regulation, working in the background without any conscious effort on your part.
Because of their versatility, tappers are being used in a variety of ways by all ages, for example; during medical appointments, to take tests, to give presentations, to use when driving or flying, during difficult conversations to help someone stay more grounded. Tappers are being handed to someone as part of immediate stabilization, for ongoing stress/anxiety and for situational stress/anxiety and as part of pain relief.
If someone you know is upset, anxious or stressed, simply hand them the tappers and you will see them physically begin to settle down. Another advantage of using tappers for self regulation versus the other methods of bilateral stimulation is you are able to stay in connection with other people. Co-regulation is often beneficial to us when we are upset or overwhelmed.
You can also combine bilateral stimulation with other coping skills such as, holding or wearing the tappers while engaging in focused breathing or listening to calming music. Children often place the tappers on the arms of their favorite stuffed animal to receive the benefit of both the comfort of the stuffed animal and the calming effect of the bilateral tapping.
Conclusion:
While there are countless coping skills being taught, what is most effective is what works in the moment we need it to work. Bilateral stimulation helps down-regulate or calm the amygdala which is responsible for activating the fight/flight response. We do not need to white knuckle through situations. Advances in our understanding of how the brain works in real time lets us match interventions that provide the most beneficial help to us at any given moment. Everybody deserves to feel calm and confident and in control. Self regulation through bilateral stimulation is the resource you can count on when it matters most.
References:
Amadeo, M, & Shagass, CM. (1963) Eye movements, attention and hypnosis. Journal of Nervous and Mental Disease, 136, 139-145.
Artigas, L & Jarero, I. (September, 2014) The Butterfly Hug Method for Bilateral Stimulation.
De Voogd LD, Kanen, JW, Neville DA, Roelofs K, Fernandez G, Hermans EJ. (2018) Eye-Movement Intervention Enhances Extinction via Amygdala Deactivation. The Journal of Neuroscience, 2018 Oct 3; 38 (40)
Elofsson, U, Scheele, B, Theorell, T, Sondergaard, H. (2008) Physiological correlates of eye movement desensitization and reprocessing.Journal of Anxiety Disorders, Vol 22, Issue 4, pages 622-634.
Grant M. (2009, 2012) Pain Control with EMDR
Grant M. OvercomingPain.com (website)
Hagan M. (February 25, 2025) What is Co-Regulation? Website: Child Mind Institute.
Louw, A, Schuemann, T, Zimney, K, Puentedura, EJ. (2024) Pain Neuroscience Education for Acute Pain. IJSPT. 2024; 19(6): 758-767.
Scaer R.(2012) 8 Keys to Brain-Body Balance. New York: W.W. Norton & Company.
Shapiro F. (2012) Getting Past Your Past: take control of your life with self-help techniques from EMDR therapy. New York: Rodale.
Shapiro F. (2018) Eye Movement Desensitization and Reprocessing (EMDR) Therapy. 3rd edition. New York: Guilford Press.
Quinn G, Zucker D, Thomas R.;Rieman J, Pynch,T. (March 29, 2018) Immediate Stabilization Procedure (ISP) Field Manual.
Valeska R, Sammer G, Gruppe, H, Hanewald B, Garder R, Blob, C, Stingl, M. (2021) Good vibrations: Bilateral tactile stim1ulation decreases startle magnitude during negative imagination and increases skin conductance response for positive imagination in an affective startle reflex paradigm. European Journal of trauma & Dissociation 5 (2021) 100197.
Zahrai S. (2020) Three Neuroscience Insights to Help You Perform During Uncertainty. Forbes, November 18.