There are polarizing beliefs when it comes to eye movement desensitization and reprocessing (EMDR) therapy. On the one hand, it is considered as a curative treatment for all mental health symptoms. On the other hand, critics see it as a treatment similar to today's snake oil. The protocol for EMDR therapy is complete and detailed.
Since its appearance on the therapeutic scene, EMDR has received some criticism and its share of controversy. It was a radical approach to dealing with traumatic memories and it was not well understood at the time. When scientists compared EMDR to imaginary exposure, they found little or no difference. Nor have they found that EMDR works faster than imaginary exposure.
Most researchers have taken these findings to mean that EMDR results are derived from exposure, as this treatment requires clients to view traumatic images repeatedly. Finally, researchers have found scant evidence that EMDR's eye movements are contributing anything to its effectiveness. When researchers compared EMDR to a “fixed eye movement” condition, in which clients keep their eyes fixed forward, they have found no difference between the conditions. In light of these findings, the panoply of hypotheses invoked for EMDR eye movements seems to be “explanations in search of a phenomenon”.
The effectiveness of EMDR for PTSD is an extremely controversial topic among researchers, since the available evidence can be interpreted in several ways. On the one hand, studies have shown that EMDR results in a greater reduction in PTSD symptoms compared to untreated control groups. On the other hand, existing methodologically sound research comparing EMDR with non-eye movement exposure therapy has found no difference in results. Therefore, it seems that while EMDR is effective, the mechanism of change may be exposure, and eye movements may be an unnecessary addition.
If EMDR is simply an exposure therapy with a superfluous addition, the question arises as to whether the dissemination of EMDR is beneficial to patients and the field. However, EMDR advocates insist that it has empirical support and is more efficient than traditional treatments for PTSD. In any case, more concrete scientific evidence supporting the proposed mechanisms is needed before the EMDR controversy arises. Twenty-nine RCTs have evaluated EMDR therapy as a treatment for trauma.
Excluding 4 RCTs that, according to the International Traumatic Stress Society's Practice Guidelines Working Group, provided insufficient treatment doses, fidelity, or both, the remaining 25 studies have created a strong knowledge base. Twenty-four RCTs support the use of EMDR therapy with a wide range of trauma populations (see meta-analyses cited above for a complete list of most studies and critiques). Seven out of 10 RCTs have indicated that EMDR therapy is faster or superior to CBT12, 12-19 and only 1 has reported superior effects for CBT in some measures, 20 The latter is also the only RCT (out of 2) that reports a control condition superior to EMDR. While EMDR therapy involved only 8 standard sessions and no tasks, CBT treatment was much more complex and involved 4 sessions of imaginary exposure (describing trauma) and 4 sessions of therapist-assisted in vivo exposure (physically going to a disturbing place) plus approximately 50 hours of exposure combined imaginary and in vivo exposure.
The condition of EMDR therapy involved only 8 standard sessions and there was no task. Of particular interest with regard to general clinical practice is a study conducted at Kaiser Permanente21,22 which reported that 100% of single trauma victims and 77% of multiple trauma victims no longer had PTSD after an average of six sessions of 50-minute EMDR therapy, demonstrating a pretreatment broad and significant versus the size of the post-treatment effect (% 3D 1.7.de Cohen). This is consistent with 2 other RCTs that found that 84 to 90% of single trauma victims no longer had PTSD after three 90-minute sessions of EMDR, 23-25 More recently, a study funded by the National Institute of Mental Health evaluated the effects of 8 sessions of EMDR therapy compared to 8 weeks of treatment with fluoxetine, 26 EMDR was superior for improvement of symptoms of PTSD and depression. After completion of treatment, the EMDR group continued to improve, while participants on fluoxetine who had reported being asymptomatic at the time after the test returned to symptoms.
At follow-up, 91% of the EMDR group no longer had PTSD, compared to 72% of the fluoxetine group. The good news is that, because research shows that EMDR probably doesn't work differently from Prolonged Exposure, it's still effective for patients who receive it. The problematic part of this is the perpetuation of this treatment despite the identification of additional and unnecessary components. Evidently, EMDR does not incorporate the most up-to-date treatment methods, nor does it make use of the best that psychological science has to offer.
With the increased focus on evidence-based practice, the popularity of this antiquated therapy highlights the number of physicians who base a large part of their practice on interventions that lack strong research support. A staggering 83% of physicians do not use exposure therapy (Zayfert et al. This alarming statistic highlights the importance of the need for patients to become informed consumers of science, asking about the methods and training of their therapist before being seen as patients. EMDR appears to be a safe therapy with no negative side effects.
Even so, despite its increasing use, mental health professionals are debating the effectiveness of. Critics point out that most EMDR studies have involved only a small number. However, other researchers have demonstrated the effectiveness of the treatment in published reports that consolidate data from several studies. The widespread and continuous use of EMDR for therapeutic purposes in the absence of adequate evidence can be considered just one more example of the willingness of the human mind to sacrifice critical thinking for illusory thinking.