Does EMDR Therapy Work?
The truth about a very popular, and very controversial therapy.
Davidson, P.R., & Parker, K.C.H. (2001). Journal of Consulting and Clinical Psychology
Post-Traumatic Stress Disorder (PTSD), a condition that can profoundly affect individuals who have experienced trauma, is a critical concern in the field of mental health. Its prevalence is alarming, with millions of people worldwide grappling with its debilitating symptoms. The importance of providing effective and evidence-based treatments for PTSD cannot be overstated. Several treatment modalities have emerged as popular choices, including Prolonged Exposure, Cognitive Processing Therapy, and Eye Movement Desensitization and Reprocessing (EMDR). Recently, EMDR, short for Eye Movement Desensitization and Reprocessing, has been getting a lot of attention in the popular media. Its claims are quite extraordinary, its popularity is increasing exponentially, and its coverage in the scientific literature is… mixed at best. This article will discuss the differences between these treatments, their effectiveness, as well as the quality of the evidence supporting them.
What is EMDR Therapy?
EMDR therapy is a form of therapy that emerged in the late 90’s, developed specifically to treat post-traumatic stress disorder. When it was created, it was strikingly similar to an existing cognitive behavioral treatment for PTSD called Prolonged Exposure. Prolonged Exposure was, and still is, considered to be the gold standard treatment of PTSD. However, EMDR contained one very striking variant distinguishing it from Prolonged Exposure: The creator claimed that by shifting one’s eyes back and forth rhythmically, a neural reprocessing occurred that increased the efficacy of this treatment over existing PTSD treatments.
EMDR therapy mainly consisted of the patient repeatedly describing in detail the trauma or disturbing event responsible for their PTSD while moving their eyes side to side, following a metronome, a moving LED light, or some other object of focus. After eight phases of EMDR sessions, the patient was supposed to have less distress in response to the trauma and reduced symptoms of PTSD.
The creator of the treatment, Francine Shapiro, was not a neuroscientist, nor did she have any formal training in neuropsychology. However, she believed that the side-to-side eye movement increased insight regarding the original traumatic event by differentially stimulating both sides of the brain. Her claims about using EMDR and its effectiveness as a reprocessing therapy were very seductive to therapists looking for a more effective treatment. Treating PTSD had been notoriously hard for clinicians without training in cognitive behavioral therapy, and the claim that it could be cured, eliminating the impact of troubling memories in as little as 12 sessions, seemed too good to be true. EMDR caught on very quickly among therapists and garnered the attention of researchers excited by the anecdotal claims of its effectiveness. However, the conclusions of numerous large-scale trials of EMDR became the subject of a great deal of controversy.
Does EMDR Work?
So, does EMDR really work? The short answer is yes… kind of. The researchers did find that EMDR was significantly more effective than placebo in reducing symptoms of PTSD, and that it was effective in reducing symptoms of most patients who completed an entire course of the therapy (Carlson et al., 1998). As a result, EMDR caught on like wildfire and was even quickly adopted by the Department of Veterans Affairs due to the promising effectiveness studies. It looked like another evidence-based treatment had been discovered, giving clinicians more options for treating people suffering from PTSD.
Eye Movement Desensitization and Reprocessing?
But there was a catch. Psychologists who had experience with the cognitive-behavioral treatment, Prolonged Exposure, recognized many of the components of the new therapy. The only difference they saw was the addition of the eye movement feature, EMDR’s defining characteristic. Following the flood of positive research, another wave of EMDR studies was published, but this time, the studies were dismantling analyses, experiments that study which parts of the treatment are most effective. Despite the fact that EMDR had been found to be a very effective treatment for PTSD when the eye movement portion was omitted from the treatment, the outcomes were exactly the same. Several important studies (i.e., Davidson and Parker, 2001) that were conducted found the same thing: the eye movement added nothing (apart from the additional expense for the therapist) to the treatment. It was merely cognitive behavioral therapy with a dash of sci-fi pseudoscience. Furthermore, subsequent studies compared patient outcomes in EMDR with those of Prolonged Exposure and found no differences.
Should I Try EMDR?
The good news is that because the research shows that EMDR likely works no differently than Prolonged Exposure, it is still effective for the patients who receive it. The problematic piece of this is the perpetuation of this treatment despite the identification of the extra, needless components.
The idea that the core component of bilateral stimulation or bilateral movement (via rapid eye movements) can desensitize traumatic memories lacks a robust scientific foundation. Numerous studies have led to serious psychology researchers abandoning it as an evidence-based treatment approach. The lack of a clear and well-established theoretical framework and a consistent body of evidence has led many in the scientific and clinical communities to view EMDR with skepticism, questioning its scientific validity as compared to other evidence-based treatments for conditions like post-traumatic stress disorder (PTSD). While some individuals may find relief through EMDR, the concerns raised by critics underscore the need for more rigorous research and evidence to support its use in the treatment of trauma-related disorders.
EMDR clearly does not incorporate the most up-to-date treatment methods, nor does it make use of the best psychological science has to offer. With the increased focus on evidence-based practice, the popularity of this outmoded therapy highlights the number of clinicians who are basing a large portion of their practice on interventions lacking strong research support. A staggering 83% of clinicians do not use exposure therapy (Zayfert et al., 2005), which is the treatment of choice for all anxiety disorders due to its high success rates. This frightening statistic underscores the importance of patients becoming informed consumers of science, asking about their therapist’s methods and training before being seen as a patient.
More troubling yet, in recent years, therapists have claimed EMDR effectively treats everything from major depression to schizophrenia. These claims are not at all supported by the research. The only treatment in which EMDR has been proven to be more effective than traditional talk therapy is PTSD. Any other claim made by EMDR practitioners is not grounded in any research or any cogent psychological science, for that matter.
So EMDR works, but not the way that it’s supposed to. This begs the question: Would you want to receive a treatment from someone who does not understand how it works?
Evidence-Based Treatments for PTSD
Prolonged Exposure Therapy: Prolonged Exposure (PE) therapy has emerged as a highly effective evidence-based treatment for post-traumatic stress disorder (PTSD), and its success is rooted in its empirical support and therapeutic approach. PE operates on well-established psychological principles, exposing individuals to their traumatic memories in a structured and controlled manner. This exposure helps individuals confront and process their distressing thoughts and emotions, ultimately reducing the emotional charge associated with traumatic memories. The effectiveness of PE has been substantiated through numerous clinical trials and research studies, consistently demonstrating significant reductions in PTSD symptoms and improvements in overall psychological well-being. Furthermore, PE's adaptability to various trauma types and its structured nature make it a versatile and reliable choice for individuals who have experienced diverse traumatic events. The scientific community's overwhelming endorsement of Prolonged Exposure therapy underscores its position as a robust and evidence-based treatment for PTSD, offering hope and healing to those who have experienced trauma.
Cognitive Processing Therapy: Cognitive Processing Therapy (CPT) stands as a highly effective evidence-based treatment for post-traumatic stress disorder (PTSD) as well as for complex trauma due to its well-established theoretical framework and empirical support. CPT is grounded in cognitive-behavioral principles and targets the modification of negative thought patterns associated with traumatic experiences. Through structured cognitive restructuring, individuals learn to identify and challenge their maladaptive beliefs, ultimately reshaping their perspectives on their traumatic memories. The extensive body of research underpinning CPT highlights its efficacy in reducing PTSD symptoms and improving overall psychological well-being. Clinical studies consistently reveal the positive impact of CPT, making it a reliable and scientifically sound choice for individuals seeking relief from the distressing effects of trauma. Its adaptability to various trauma types and the endorsement it receives from the mental health community further solidify CPT's position as a leading evidence-based treatment for PTSD, offering hope for recovery and healing to those who have experienced traumatic events.
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Carlson, J., Chemtob, C.M., Rusnak, K., Hedlund, N.L, & Muraoka, M.Y. (1998). Eye movement desensitization and reprocessing (EMDR): Treatment for combat-related post-traumatic stress disorder. Journal of Traumatic Stress, 11, 3-24.
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.
Zayfert, C et al. (2005). Exposure utilization and completion of cognitive behavioral therapy for PTSD in a "real world" clinical practice. Journal of Traumatic Stress, 18, 6, 637-645.