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eye movement desensitization and reprocessing (EMDR)
....what is new in EMDR does not appear to be helpful, and what is helpful is what we already know about relaxation, education, and psychotherapy.*
Although the research regarding the necessity of the eye movement component is currently inconclusive, EMDR is a psychological treatment for PTSD which has received considerable empirical validation (Carlson et al., 1998; Marcus et al., 1997; Rothbaum, 1997; Scheck et al., 1998; Wilson et al., 1995). However, in spite of the empirical validation, confusion still exists in the literature regarding EMDR. Some of the confusion is theoretical and due to the current lack of empirical validation of Shapiro’s (1991b, 1995) information processing model and the continued inability of other models (e.g., exposure) to convincingly explain EMDR methods and effects.*
EMDR is a therapeutic technique in which the patient moves his or her eyes back and forth, hither and thither, while concentrating on "the problem." The therapist waves a stick or light in front of the patient and the patient is supposed to follow the moving stick or light with his or her eyes. The therapy was discovered by therapist Dr. Francine Shapiro while on a walk in the park. At least, that's her version. John Grinder, one of the founders of NLP, claims he taught the eye movement part to her when she worked for his office as an administrator in the 1980s. (Shapiro's doctorate was earned at the now defunct and never accredited Professional School of Psychological Studies. Her bachelor's degree is in English literature.*) It is claimed that EMDR can "help" with “phobias, generalized anxiety, paranoid schizophrenia, learning disabilities, eating disorders, substance abuse, and even pathological jealousy” (Lilienfeld 1996), but its main application has been in the treatment of post traumatic stress disorder (PTSD). No one has been able to adequately explain how EMDR is supposed to work. Some think it works something like acupuncture (which allegedly unblocks chi): rapid eye movements allegedly unblock "the information-processing system." Some think it works by a sort of ping-pong effect between the right and left sides of the brain, which somehow restructures memory. Or perhaps it works, as one therapist suggested, by the rapid eye movements sending signals to the brain which somehow tame and control the naughty part of the brain which had been causing the psychological problems. I heard the latter explanation on a television news report (December 2, 1994). The television station provided a nice visual of a cut-away head with sparks flying in the brain. The anchorman warned us not to try this at home, that only licensed mental health professionals were qualified to give this kind of therapy. One such professional is Dr. Ann T. Viviano, who thinks EMDR works this way: "The client, by following a moving light with their eyes, activates the healing process of the brain, much as what occurs in sleep. As a result, the painful memories are re-processed and the original beliefs which sprang up from them are eliminated. New, healthy beliefs replace these." The healing occurs by activating the healing process.
Evidence for the effectiveness of EMDR's eye movement component is not much stronger than the theoretical explanations for how EMDR allegedly "works." The evidence has the virtue of being consistent, unlike the theoretical explanations, but it is mainly anecdotal and very vague. It has not been established beyond a reasonable doubt by any controlled studies that any positive effects achieved by an EMDR therapist's eye movement techniques are not likely due to chance, the placebo effect, patient expectancy, posthypnotic suggestion, other aspects of the treatments besides the eye movement aspect, etc. This is not to say that there have not been controlled studies of EMDR. Dr. Shapiro cites quite a few, including her own. The reader is invited to look at her summaries of the research and determine for him or herself just how adequate the evidence is in support of EMDR's eye movement component as the main causal agent in recovery from PTSD. One study by Wilson, Becker and Tinker, to be published in The Journal of Consulting and Clinical Psychology, reports a "significant improvement" in PTSD subjects treated with EMDR. The study also provides significant evidence that spontaneous healing cannot account for this improvement. Nevertheless, the study is unlikely to convince critics that EMDR's eye movement component is the main causal agent in measured improvement of PTSD subjects. I suspect that until a study is done which isolates the eye movement part from other aspects of the treatment, critics will not be satisfied. It may well be that those using EMDR are effecting the cures they claim and thereby benefiting many victims of horrible experiences such as rape, war, terrorism, murder or suicide of a loved one, etc. It may well be that those using EMDR are directing their patients to restructure their memories, so that the horrible emotive aspect of an experience is no longer associated with the memory of the experience. But, for now, the question still remains, whether the rapid eye movement part of the treatment is essential. In fact, one of the control studies cited by Shapiro seems counter-indicative:
In a controlled component analysis study of 17 chronic outpatient veterans, using a crossover design, subjects were randomly divided into two EMDR groups, one using eye movement and a control group that used a combination of forced eye fixation, hand taps, and hand waving. Six sessions were administered for a single memory in each condition. Both groups showed significant decreases in self-reported distress, intrusion, and avoidance symptoms (Pitman et al. 1996).
Maybe hand taps will work just as well as eye movements. According to one EMDR practitioner, Dr. Edward Hume,
...taps to hands, right and left, sounds alternating ear-to-ear, and even alternating movements by the patient can work instead. The key seems to be the alternating stimulation of the two sides of the brain.*
According to Dr. Hume, Shapiro now calls the treatment Reprocessing Therapy and says that eye movements aren't necessary for the treatment! Maybe none of these movements are needed to restructure memory. In short, EMDR is a scientifically controversial technique at present.* This has not prevented thousands of practitioners from being certificated to practice EMDR by Shapiro and disciples.
EMDR is controversial and although it is not an approved practice of the American Psychological Association (APA), it is not disapproved either. According to Pamela Willenz of the APA Public Affairs Office, the "APA rarely approves or disapproves of therapies. We don't approve or disapprove of EMDR as a therapy. APA does recognize therapies and does recognize EMDR as a type of therapy. We offer CE credits for psychologists wanting to learn EMDR." This practice of the APA to neither approve nor disapprove of therapies tells us more about the APA than it does about EMDR. It might be useful to consumers if the APA would at least distinguish between therapies proven to be effective and those that are controversial. One does not need to be an expert in anything to recognize that EMDR is a type of therapy.
Advocates of EMDR claim that it is "a widely validated treatment for Post Traumatic Stress Disorder" and other ailments such as "traumatic memories of war, natural disaster, industrial accidents, highway carnage, crime, terrorism, sexual abuse, rape and domestic violence." [David Drehmer, Ph.D., Licensed Clinical Psychologist & Director, Performance Enhancement Laboratory, Associate Professor of Management, DePaul University, personal correspondence.] What is needed is not proof that PTSD subjects are being helped by the treatment, but that it is the eye movement part of the treatment that is essential. Once that is established, a theory as to how it works would be most gratifying. At present, we are being given theories to explain something that we can't yet be sure is even occurring: that eye movements are restructuring memory. If it turns out that that claim is true, I suggest it will have significance far beyond the treatment of PTSD subjects.
Finally, when evidence came in that therapists were getting similar results to standard EMDR with blind patients whose therapists used tones and hand-snapping instead of finger-wagging, Shapiro softened her stance a bit. She admits that eye movement is not essential to eye movement desensitization processing, and claims attacks on her are ad hominem and without merit.
update (Dec 20,2000): Ranae Johnson has founded the Rapid Eye Institute on a blueberry farm in Oregon where she teaches Rapid Eye Technology. This amazing new therapy is used "to facilitate releasing and clearing of old programming, opening the way to awareness of our joy and happiness." It helps us "find light and spirituality within us that has always been there." Apparently, people are paying some $2,000 for the training and all the blueberries you can eat.
books and articles (critical of EMDR)
(thanks to psychologist Dr. Terry Sandbeck)
Acierno, R., Hersen, M., Van Hasselt, V., Tremont, G., & Meuser, K. (1994). Review of the validation and dissemination of eye-movement desensitization and reprocessing: A scientific and ethical dilemma. Clinical Psychology Review, 14, 297-298.
Bates, L., McGlynn, F., Montgomery, R., & Mattke, T. (1996). Effects of eye-movement desensitization versus no treatment on repeated measures of fear of spiders. Journal of Anxiety Disorders.
Butler, K. (1993, November/December, 19-31). Too good to be true? Networker, November/December, 19-31.
Davidson, P., & Parker, K. (2001, Apr). Eye movement desensitization and reprocessing (EMDR): A meta-analysis. Journal of Consulting & Clinical Psychology, 69(2), 305-316.
DeBell, C., & Jones, R. (1997). As good as it seems? A review of EMDR experimental research. Professional Psychology: Research and Practice, 28, 153-163.
Foa, E., & Meadows, E. (1997). Psychosocial treatments for posttraumatic disorder: A critical review. Annual Review of Psychology, 48, 449-480.
Goldstein, A., de Beurs, E., Chambless, D., & Wilson, K. (2000, Ded). EMDR for panic disorder with agoraphobia: Comparison with waiting list and credible attention-placebo control conditions. Journal of Consulting & Clinical Psychology, 68(6), 947-956.
Greenwald, R. (1994). Eye movement desensitization and reprocessing (EMDR): An overview. Journal of Contemporary Psychotherapy, 24, 15-33.
Herbert, J., Lilienfeld, S., Lohr, J., Montgomery, R. W., O'Donohue, W., Rosen, G., et al. (2000). Science and pseudoscience in the development of Eye Movement Desensitization and Reprocessing: Implications for clinical psychology. Clinical Psychology Review, 20, 945-971.
Herbert, J., & Meuser, K. (1995). What is EMDR? Harvard Mental Health Newsletter, 11(8).
Joseph, S. (2002, May). Counterpoint: Emperor's new clothes? Psychologist, 15(5), 242-243.
Lipke, H. (1997). Commentary on the Bates et al. report on eye-movement desensitization and reprocessing (EMDR). Journal of Anxiety Disorders, 11, 599-602.
Lohr, J., Kleinknecht, R., Tolin, D., & Barrett, R. (1995). The empirical status of the clinical application of eye movement desensitization and reprocessing. Journal of Behavior Therapy and Experimental Psychiatry, 26, 285-302.
Lohr, J., Tolin, D., & Lilienfeld, S. (1998). Efficacy of eye movement desensitization and reprocessing: Implications for behavior therapy. Behavior Therapy, 29, 123-156.
Marquis, J. (1991). A report on seventy-eight cases treated by eye movement desensitization. Journal of Behavior Therapy and Experimental Psychiatry, 22, 187-192.
McNally, R. (1996). Review of F. Shapiro's "Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures. Anxiety, 2, 153-155.
McNally R. J. "Research on Eye Movement Densensitization and Reprocessing (EMDR) as a Treatment for PTSD," PTSD Research Quarterly 10(1):1-7, 1999.
McNally, R. (1999). EMDR and Mesmerism: A comparative historical analysis. Journal of Anxiety Disorders, 13, 225-236.
McNally, R. (2001). How to end the EMDR controversy. Psicoterapia Cognitiva e Comportamentale, 7(2), 153-154. Montgomery, R. W., & Ayllon, T. (1994). Eye movement desensitization across subjects: Subjective and physiological measures of treatment efficacy. Journal of Behavior Therapy and Experimental Psychiatry, 25, 217-230.
NCAHF. (1997). Newsletter, January-February 1997.Can Eye Movements Cure Mental Ailments?
Osby, L. (1997, August 21). Treating mental trauma with unusual therapy. Daily Record, sec. A1, p. A14.
Perkins, B., & Rouanzoin, C. (2002, Jan). A critical evaluation of current views regarding eye movement desensitization and reprocessing (EMDR): Clarifying points of confusion. Journal of Clinical Psychology, 58(1), 77-97.
Pitman, R., Orr, S., Altman, B., Longpre, R., Poire, R., & Macklin, M. (1996, Nov-Dec). Emotional processing during eye movement desensitization and reprocessing therapy of Vietnam veterans with chronic posttraumatic stress disorder. Comprehensive Psychiatry, 37(6), 419-429.
Renfrey, G., & Spates, R. C. (1994). Eye movement desensitization: A partial dismantling study. Journal of Behavior Therapy and Experimental Psychiatry, 25, 231-239.
Rosen, G. (1992). A note to EMDR critics: What you didn't see is only part of what you don't get. The Behavior Therapist, 19, 76-77.
Rosen, G. (1995). On the origin of eye movement desensitization. Journal of Behavior Therapy and Experimental Psychiatry, 26, 121-122.
Rosen, G. (1996). Level II training for EMDR: One commentator's view. The Behavior Therapist, 19, 76-77.
Rosen, G. (1997). Dr. Welch's comments on Shapiro's walk in the woods and the origin of eye movement desensitization and reprocessing. Journal of Behavior Therapy and Experimental Psychiatry, 28, 247-249.
Rosen, G. (1999). Treatment fidelity and research on Eye Movement Desensitization and Reprocessing (EMDR). Journal of Anxiety Disorders, 13, 173-184.
Rosen, G., & Lohr, J. (1997). Can eye movements cure mental ailments? Newsletter of the National Council Against Health Fraud, 20, 1.
Rosen, G., Lohr, J., McNally, R., & Herbert, J. (1998). Power therapies, miraculous claims, and the cures that fail. Behavioural and Cognitive Psychotherapy, 26, 97-99.
Senior, J. (2001, Jul). Eye movement desensitization and reprocessing: A matter for serious consideration? Psychologist, 14(7), 361-363.
Simon, M. (2000, Sept). A comparison between EMDR and exposure for treating PTSD: A single-subject analysis. Behavior Therapist, 23(8), 172-175.
Taylor, S., Thordarson, D., Maxfield, L., Fedoroff, I., Lovell, K., & Ogrodniczuk, J. (2003, Apr). Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training. Journal of Consulting & Clinical Psychology, 71(2), 330-338.
Thorp, S. (2004, Mar). Book review: Science and Pseudoscience in Clinical Psychology. Journal of Psychosomatic Research, 56(3), 381-381.
Tucker P, Pfefferbaum B, Nixon SJ, et al. "Trauma and recovery among adults highly exposed to a community disaster," Psychiatric Annals 29(2):78-83, 1999.
Vaughan, K., Armstrong, M., Gold, R., O'Connor N., Jenneke, W., & Tarrier, N. (1994). A trial of eye movement desensitization compared to image habituation training and applied muscle relaxation in post-traumatic stress disorder. Journal of Behavior Therapy and Experimental Psychiatry, 25, 283-291.
Zeiss, A. (1998). EMDR 1997 update. The Behavior Therapist, 21, 28.
books and articles (in support of EMDR)
Chambless, D.L. et al. (1998). Update of empirically validated therapies, II. The Clinical Psychologist, 51, 3-16. (They list EMDR as "probably efficacious," i.e., at least two experiments show the treatment to be superior to a waiting-list control group.)
Foa, E.B., Keane, T.M., & Friedman, M.J. (2000). Effective treatments for PTSD: Practice Guidelines of the International Society for Traumatic Stress Studies New York: Guilford Press.
United Kingdom Department of Health. (2001). Treatment choice in psychological therapies and counseling evidence based clinical practice guideline. London, England.
Davidson, P.R., & Parker, K.C.H. (2001). Eye movement desensitization and reprocessing (EMDR): A meta-analysis. Journal of Consulting and Clinical Psychology, 69, 305-316.
Maxfield, L., & Hyer, L.A. (2002). The relationship between efficacy and methodology in studies investigating EMDR treatment of PTSD. Journal of Clinical Psychology, 58, 23-41
Van Etten, M., & Taylor, S. (1998). Comparative efficacy of treatments for post-traumatic stress disorder: A meta-analysis. Clinical Psychology and Psychotherapy, 5, 126-144.
Eye Movement Desensitization Reprocessing (EMDR): Science or Pseudoscience? by Bunmi O. Olatunji, University of Arkansas The New England Journal of Skepticism Vol. 4 Issue 1 (Winter 2001)
EMDR and Fad Therapies by Stuart Losen, PhD The New England Journal of Skepticism Vol. 4 Issue 1 (Winter 2001)
"Can Eye Movements Cure Mental Ailments?" by Gerald M. Rosen, PhD and Jeffrey Lohr, PhD (National Council Against Health Fraud)
"New Therapy for Trauma Doubted" by Judy Foreman
Mental Help: Procedures to Avoid by Stephen Barrett, M.D.
Questionable Treatments for Learning Disabilities and Autism by Stephen Barrett, M.D.
"Can We Really Tap Our Problems Away? A Critical Analysis of Thought Field Therapy" by Brandon A. Gaudiano and James D. Herbert, Skeptical Inquirer July/Aug 2000
About EMDR by Edward S. Hume, M.D., J.D.
New PTSD Therapy: Innovative or Smoke and Mirrors? from Psychiatric News, a publication of the American Psychiatric Association
A Critical Evaluation of Current Views Regarding Eye Movement Desensitization and Reprocessing (EMDR): Clarifying Points of Confusion by Byron R. Perkins, Psy.D. Private Practice and Curtis C. Rouanzoin, Ph.D. Hope International University
EMDR and Acupuncture – Selling Non-specific Effects by Stephen Novella "A common error to make when interpreting clinical studies is to confuse non-specific effects – those that result from the therapeutic interaction or the process of observation – with a specific effect from the treatment being studied. While this is broadly understood within the scientific medical community, it seems that within certain fields proponents are going out of their way to sell non-specific effects as if they were specific effects of the favored treatment. This is perhaps most true for acupuncture....Perhaps another example is Eye Movement Desensitization and Reprocessing (EMDR), a practice that is increasingly popular among psychiatrists."
Expert Answers on E.M.D.R. By THE NEW YORK TIMES Shapiro answers questions and claims EMDR is good for PTSD, autism, relationship problems, and a host of other issues. She wraps her technique in intricate webbing, making it difficult to extricate what is unique and essential about her form of cogntive behavioral therapy.