Eye Movement Desensitization and Reprocessing (EMDR): A Controversial Treatment for Trauma Survivors
Proponents of eye movement desensitization and reprocessing (EMDR) claim it is a breakthrough treatment for those plagued with traumatic memories and other psychological problems. But does it actually work?
Eye movement desensitization and reprocessing (EMDR) is a relatively new therapeutic technique that increasing numbers of mental health professionals are using in the treatment of post-traumatic stress disorder (PTSD), phobias, and a wide variety of psychological disorders. According to the American Psychiatric Association, this fairly complicated treatment includes elements of behavioral, cognitive, psychodynamic, body-based, and systems therapies.
A Brief History of EMDR
EMDR was developed by psychologist Francine Shapiro, PhD, in 1987 when she discovered, by chance, that she could ease her own disturbing thoughts by moving her eyes rapidly from left to right. From there, Dr. Shapiro studied the effectiveness of EMDR on people with PTSD. Her research showed that EMDR held promise in reducing flashbacks, nightmares, negative thoughts and avoidant behaviors in study participants. Since then, thousands of mental health professionals have received training in EMDR and use it regularly with patients suffering from traumatic memories.
According to the EMDR International Association in Austin Texas, EMDR is often used to treat patients with trauma resulting from:
- Sexual assaults
- Other violent crimes
- Airline and train crashes
- Automobile and industrial accidents
In adults, these events often lead to symptoms such as nightmares, panic attacks, phobias, insomnia, and substance abuse. In children, symptoms such as oppositional behavior, sleep disturbances, and bed wetting may be present.
What You Can Expect
If you are seeking EMDR treatment, the EMDR International Association recommends that you find an EMDR-trained mental health professional who will guide you through eight phases of treatment. The number of sessions and phases within each session varies from patient to patient, however, the eight phases of treatment are essential. They include:
Phase one: patient history
The therapist will ask questions about your mental health history to evaluate your suitability for treatment. You will be asked about the level of your distress, current life stressors, and medical conditions. The therapist will then set up a treatment plan.
Phase two: preparation phase
The therapist will introduce you to EMDR, explain how it works, and let you know what you can expect. He or she will discuss with you the possibility of increased symptoms between sessions. You may be given an audiotape of relaxation exercises to use before and between EMDR sessions.
Phase three: assessment
You will be asked to identify the traumatic memory or an image from that memory. Then you will be asked to think about a negative thought you have about yourself in relation to the traumatic event, such as “I am a bad person.” Next, the therapist will ask you to come up with a positive thought about yourself, such as “I am a lovable person” and to rate how much you believe that thought, using a rating scale called Validity of Positive Cognition (VOC). Lastly, you will focus on the traumatic image and the negative thought you have about yourself and rate your level of emotional upset on a rating scale called the Subjective Units of Disturbance Scale (SUDS).
Phase four: desensitization
You will be asked to focus on your disturbing feelings while letting your eyes follow the therapist’s fingers as they move rapidly back and forth across a span of about 12 inches. This procedure is repeated in sets, each of which last from 10 seconds to more than 1 minute. This will continue until your emotional distress is greatly reduced (which you will indicate on the SUDS).
In some cases, instead of eye movement, the therapist may ask you to tap alternate hands on a chair rest, or may use alternating sounds in your ears. Other more advanced strategies may also be used.
Phase five: cognitive restructuring
In this phase, the positive belief will be strengthened in an effort to replace the negative belief associated with the traumatic memory. You will be asked to concentrate on the positive belief during the eye movement sets. This will continue until you reach a specific rate on the VOC scale. When evoking the traumatic memory, this should help you believe the positive thought about yourself.
Phase six: awareness of bodily sensation
As you hold the traumatic image and positive belief in your mind, you will focus on any tension that arises in your body. During the following sets of eye movements, or other desensitization techniques, the therapist will help you reduce bodily tension.
Phase seven: closure
Your therapist will talk to you about disturbing thoughts, images, or emotions that may occur between sessions and may ask you to keep a log or journal. Though these symptoms may be uncomfortable, they are interpreted as a positive sign.
Phase eight: reevaluation
Before each new session, you will be reevaluated to see if the treatment effects have been maintained. The therapist will continue to work with you on additional traumatic memories and images, following the same eight-phase procedure.
Does EMDR Work, and If So, How?
Much of the literature available on EMDR is positive. A number of studies on EMDR have been highlighted online in the paper “Eye Movement Desensitization and Reprocessing: A Controversial Treatment Technique” by Suzanne Hurst and Natasha Milkewicz of the Virginia Consortium for Professional Psychology. These studies, involving participants suffering from a variety of trauma (abuse, sexual assault, sexual molestation, combat trauma, health crisis, relationship crisis, death of a significant person), have suggested that EMDR may be effective in reducing many symptoms, including anxiety, depression, and intrusive thoughts, while increasing positive thoughts.
EMDR, however, does not work in every case of trauma and continues to be a controversial treatment. Critics question the scientific validity of the method. Among their concerns are the following:
- Reports of decreased distress after EMDR may be influenced by positive reinforcement and the patient’s desire to meet the therapist’s expectations.
- EMDR is frequently supplemented with other interventions such as relaxation techniques and cognitive restructuring. Therefore, the effectiveness of EMDR itself (“pure” EMDR) is uncertain.
- According to at least one study on Vietnam veterans with PTSD, the benefits of EMDR were lost at a five-year follow-up.
- There isn’t enough data to support the use of EMDR for the treatment of other psychiatric and behavioral disorders such as phobias, anxiety and panic disorders, and eating disorders.
Critics also question the fact that there is no data to explain how EMDR works. Dr. Shapiro theorizes that EMDR works through an accelerated information processing system. A theory by Nathan Denny, PhD, proposes that the eye movements of EMDR cause a reflex that somehow inhibits the “fight or flight” stress response. EMDR was previously thought to work by distraction or by mimicking REM sleep (which is believed to facilitate information processing and learning).
However, a 2001 meta-analysis of 34 studies found that while EMDR treatment did appear to have a significant effect on various populations being treated for various conditions, in actuality, no effect was found from eye movements themselves, when EMDR was compared to the same procedure without them. So exactly which aspects of EMDR are helpful remain unclear.
Further Research Needed
While there are many questions surrounding the mechanism and scientific validity of EMDR, a number of individuals have reported significant benefits after receiving the treatment. In 1998, EMDR made it onto the American Psychological Association’s list of probable treatments for civilian PTSD. The demand for EMDR continues to grow. At the same time, new studies continue to validate the benefits of this procedure. While there have been relatively few comparisons with other treatments, at least one study showed no difference in effectiveness between EMDR and cognitive behavioral therapy—a well-studied treatment for a variety of affective disorders. At least one study has shown objective changes following EMDR in PTSD victims who were followed with SPECT scans (a CT-like scan that assesses where certain mental processes are localized in the brain).
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Last reviewed June 2009 by ]]>Rosalyn Carson-DeWitt, MD ]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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