What is eye movement desensitization and reprocessing (EMDR)?

Introduction

Eye movement desensitization and reprocessing (EMDR) is a widely implemented and controversial psychological treatment for anxiety disorders and other conditions. EMDR was originally developed for post-traumatic stress disorder (PTSD). In PTSD, a patient who has been exposed to a traumatic event experiences a set of symptoms such as intrusive memories of the event, avoidance of situations reminiscent of the event, and excessive physiological arousal. Some therapists have extended EMDR to a host of other conditions, including phobias (intense, irrational fears), obsessive-compulsive disorder, clinical depression, eating disorders, schizophrenia, sexual dysfunction, discomfort concerning sexual orientation, and psychological distress resulting from cancer.

Description of the Procedure and Rationale

Although EMDR is a complex treatment that contains multiple components, its most distinctive feature is the induction of lateral eye movements. EMDR requires clients to track the back-and-forth movements of the therapist’s fingers with their eyes as they recall disturbing memories, such as those of a traumatic event. As Harvard University psychologist Richard McNally observed, this element of EMDR is reminiscent of the classic portrayal of hypnosis, in which the subject follows the lateral movements of the hypnotist’s dangling pocket watch. EMDR also includes cognitive restructuring, a technique that encourages clients to learn to think about life problems in new and more constructive ways and to make positive self-statements (such as “I can get over my fears”).

EMDR advocates have proposed a number of explanations for the technique’s apparent success, none of which has been universally accepted. Some have maintained that the eye movements of EMDR simulate those of rapid eye movement (REM) sleep, the stage of sleep often associated with vivid dreaming. Because some research suggests that REM sleep plays a role in the processing of memories, including painful ones, these advocates have conjectured that EMDR may similarly facilitate such processing. Others have speculated that EMDR may accelerate memory processing by synchronizing the brain’s two hemispheres. Still others have suggested that the lateral eye movements of EMDR may serve as a distraction while people visualize unpleasant memories and that this distraction may reduce the anxiety associated with these memories. All these explanations assume that eye movements contribute to EMDR’s clinical effects.

History of the Procedure

EMDR was developed in 1989 by California psychologist Francine Shapiro. According to Shapiro, while walking in a forest, she found that her anxieties dissipated after visually scanning her surroundings. This informal observation led her to attempt a similar eye scanning procedure with her anxiety-disordered clients, which she claimed to be successful. Following an initial publication by Shapiro in 1989 suggesting that EMDR may be effective for individuals with traumatic memories, research on the technique expanded at a remarkably rapid rate, with more than two hundred publications on the technique appearing in the following decade.

EMDR has been widely disseminated in workshops aimed at psychotherapists. The Substance Abuse and Mental Health Services Administration (SAMHSA), a branch of the US Department of Health and Human Services, estimated in 2014 that since its introduction in 1989, approximately 100,000 therapists have participated in EMDA training, and that EMDR had been implemented in over seventy countries worldwide. The EMDR International Association (EMDRIA) began certifying practitioners in EMDA in 1999, and over the next fifteen years, approximately 2,500 clinicians were certified, with certified clinicians and approved consultants located in over forty countries worldwide. Many practitioners routinely administer the technique as part of their daily practice. EMDR has been administered to clients in the aftermath of several traumatic events, including witnesses of the September 11, 2001, terrorist attacks in New York City as well as victims of Hurricane Katrina in New Orleans and Mississippi in 2005.

Controversy and Scientific Status

EMDR has been embroiled in scientific controversy virtually since its inception. Many of its proponents claim that it is a major innovation and others call it a breakthrough in the treatment of PTSD and other anxiety disorders. They hold that EMDR is more effective and efficient than extant treatments and operates by means of distinctly different mechanisms than these treatments. Lending credibility to these assertions was the 1998 decision by a committee within the American Psychological Association’s Society for Clinical Psychology to list EMDR as a “probably efficacious” treatment for civilian PTSD (such as PTSD induced by rape). EMDR is also endorsed under the Veterans Administration and the US Department of Defense practice guidelines for the management of PTSD and is described by these groups as a treatment of significant benefit.

Some skeptics, including University of Arkansas psychologist Jeffrey Lohr and Drexel University psychologist James Herbert, have argued that EMDR is no more effective than a host of longstanding treatments that rely on exposure to anxiety-provoking imagery. Psychotherapy researchers have known for decades that prolonged exposure to stimuli that trigger anxiety, a technique called flooding, is an effective treatment for anxiety disorders. For example, in a flooding session for a client with severe acrophobia, or fear of heights, a therapist might accompany this client to the top floor of a skyscraper and instruct the person to look at the ground below until the fear dissipates.

Buttressing the assertions of these critics are meta-analyses indicating that although EMDR is more effective for PTSD than no treatment, it is no more effective than other exposure-based treatments. These analyses have led some scholars to conclude that EMDR is merely a variant of standard exposure therapies and that EMDR is effective only because it asks clients to focus repeatedly on their anxiety-provoking memories.

Further fueling the criticisms of skeptics are controlled studies demonstrating that the eye movements of EMDR do not contribute to its clinical effectiveness. For example, investigations comparing EMDR with a fixed eye movement condition—which is identical to standard EMDR except that clients keep their eyes stationary—typically reveal that both procedures yield identical effects on anxiety and other psychological symptoms. These studies raise questions concerning theoretical explanations of EMDR that involve a special role for eye movements.

To resolve these controversies, researchers will need to better understand EMDR’s underlying mechanisms of action. The question of whether EMDR is a novel treatment or merely a repackaging of standard exposure-based treatments remains unresolved. Moreover, although EMDR is more effective than no treatment for individuals with PTSD, it remains to be seen whether it contributes to clinical improvement over and above extant treatments. Finally, because controlled studies of EMDR for conditions other than PTSD are lacking, further work will be needed to ascertain the boundaries of its effectiveness.

Bibliography

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Davidson, Paul R., and Kevin C. H. Parker. “Eye Movement Desensitization and Reprocessing (EMDR): A Meta-analysis.” Journal of Consulting and Clinical Psychology 69 (2001): 305–16. Print.

De Roos, Carlijn, et al. "A Randomised Comparison of Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitisation and Reprocessing (EMDR) in Disaster-Exposed Children." European Journal of Psychotraumatology 2 (2011): n. pag. Web. 12 May 2014.

"Eye Movement Desensitization and Reprocessing." NREPP. US Department of Health and Human Services, 28 Jan. 2014. Web. 12 May 2014.

Herbert, James D., et al. “Science and Pseudoscience in the Development of Eye Movement Desensitization and Reprocessing: Implications for Clinical Psychology.” Clinical Psychology Review 20 (2000): 945–71. Print.

Lee, C. W., and P. Cuijpers. "A Meta-Analysis of the Contribution of Eye Movements in Processing Emotional Memories. Journal of Behavior Therapy and Experimental Psychiatry 44 (2013): 231–39. Print.

McNally, Richard J. “EMDR and Mesmerism: A Comparative Historical Analysis.” Journal of Anxiety Disorders 13 (1999): 225–36. Print.

Shapiro, Francine. Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures. New York: Guilford, 1995. Print.

Shapiro, Francine. Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy. New York: Rodale, 2012. Print.

Stickgold, Robert. “EMDR: A Putative Neurobiological Mechanism of Action.” Journal of Clinical Psychology 58 (2002): 61–75. Print.