Eye movement desensitization and reprocessing: Difference between revisions

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EMDR involves talking about traumatic memories while engaging in side-to-side eye movements or other forms of bilateral stimulation. It is also used for some other psychological conditions.

EMDR is recommended for the treatment of PTSD by various government and medical bodies citing varying levels of evidence, including the [[World Health Organization]], the UK [[National Institute for Health and Care Excellence]], the Australian [[National Health and Medical Research Council]], and the US Departments of Veteran[[United States Department of Veterans Affairs|Veterans Affairs]] and [[United States Department of Defense|Defense]]. The [[American Psychological Association]] does not endorse EMDR as a first-line treatment, but indicates that it is probably effective for treating adult PTSD.

Systematic analyses published since 20202013 suggestgenerally indicate that EMDR treatment efficacy for adults with PTSD is equivalent to trauma-focused cognitive and behavioral therapies (TF-CBT), such as [[Prolongedprolonged exposure therapy]] (PE) and [[Cognitivecognitive Processingprocessing Therapytherapy]] (CPT). However, bilateral stimulation does not contribute substantially, if at all, to treatment effectiveness. The predominant therapeutic factors in EMDR and TF-CBT are [[Exposure therapy|exposure]] and various components of [[cognitive-behavioral therapy]].

Because eye movements and other bilateral stimulation techniques do not uniquely contribute to EMDR treatment efficacy, EMDR has been characterized as a [[purple hat therapy]], i.e., its effectiveness is due to the same therapeutic methods found in other evidence-based psychotherapies for PTSD, namely exposure therapy and CBT techniques, without any contribution from its distinctive add-ons.

== History ==

EMDR was invented by [[Francine Shapiro]] in 1987. In a workshop, Shapiro related how the idea of the therapy came to her while she was taking a walk in the woods, and discerned she had been able to cope better with disturbing thoughts when also experiencing [[saccadic]] eye movements.<ref name=walk>{{cite journal |vauthors=Rosen GM |title=On the origin of eye movement desensitization |journal=J Behav Ther Exp Psychiatry |volume=26 |issue=2 |pages=121–2 |date=June 1995 |pmid=7593684 |doi=10.1016/0005-7916(95)00014-q |url=}}</ref> Psychologist Gerald Rosen has expressed doubt about this description, saying that people are normally not aware of this type of eye movement.<ref name=walk/>

EMDR was invented by [[Francine Shapiro]] in 1987.

{{excerpt|Francine Shapiro|Eye movement desensitization and reprocessing|paragraph=2|inline=yes}}

==Technique==

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===Other mechanisms===

Several other possible mechanisms have been proposed:

* EMDR may impactaffect working memory.<ref>{{cite journal | vauthors = van den Hout MA, Engelhard IM, Beetsma D, Slofstra C, Hornsveld H, Houtveen J, Leer A | title = EMDR and mindfulness. Eye movements and attentional breathing tax working memory and reduce vividness and emotionality of aversive ideation | journal = Journal of Behavior Therapy and Experimental Psychiatry | volume = 42 | issue = 4 | pages = 423–431 | date = December 2011 | pmid = 21570931 | doi = 10.1016/j.jbtep.2011.03.004 }}</ref> If a patient performs bilateral stimulation task while remembering the trauma, the amount of information they can recall is thought to be reduced, making the resulting [[negative emotion]]s less intense and more bearable.<ref name="Chen2015">{{cite journal | vauthors = Chen L, Zhang G, Hu M, Liang X | title = Eye movement desensitization and reprocessing versus cognitive-behavioral therapy for adult posttraumatic stress disorder: systematic review and meta-analysis | journal = The Journal of Nervous and Mental Disease | volume = 203 | issue = 6 | pages = 443–451 | date = June 2015 | pmid = 25974059 | doi = 10.1097/NMD.0000000000000306 | s2cid = 34850645 }}</ref> This is seen by Robin Logie of the EMDR Association UK and Ireland as a "distancing effect". The client is then believed to re-evaluate the trauma and process it in a less-harmful environment.<ref name=Logie2014>{{cite journal | vauthors = Logie R |title=EMDR - more than just a therapy for PTSD? |journal=The Psychologist |date=July 2014 |volume=27 |issue=7 |pages=512–517 |url=https://thepsychologist.bps.org.uk/volume-27/edition-7/emdr-more-just-therapy-ptsd }}</ref> This explanation is plausible, given research showing that memories are more modifiable once recalled.<ref name=epid/>

* Horizontal eye movement is thought to trigger an "[[orienting response]]" in the brain, used in scanning the environment for threats and opportunities.<ref name="Jeffries & Davis 2012">{{cite journal | vauthors = Jeffries FW, Davis P | title = What is the role of eye movements in eye movement desensitization and reprocessing (EMDR) for post-traumatic stress disorder (PTSD)? a review | journal = Behavioural and Cognitive Psychotherapy | volume = 41 | issue = 3 | pages = 290–300 | date = May 2013 | pmid = 23102050 | doi = 10.1017/S1352465812000793 | s2cid = 33309479 }}</ref>

* The idea that eye movement prompts communication between the two sides of the brain. This idea is not grounded in accepted [[neuroscience]].<ref name=epid>{{cite book |veditors=Zeigler-Hill V, Shackelford TR |entry= Eye Movement Desensitization and Reprocessing (EMDR) |title= Encyclopedia of Personality and Individual Differences |year= 2020 |vauthors= Patihis L, Cruz CS, McNally R |publisher=Springer |doi=10.1007/978-3-319-24612-3_895 }}</ref>

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Bilateral stimulation is a generalization of the left and right repetitive eye movement technique first used by Shapiro. Alternative stimuli include auditory stimuli that alternate between left and right speakers or headphones and physical stimuli such as tapping of the therapist's hands or tapping devices.<ref name="Rodenburg2009">{{cite journal | vauthors = Rodenburg R, Benjamin A, de Roos C, Meijer AM, Stams GJ | title = Efficacy of EMDR in children: a meta-analysis | journal = Clinical Psychology Review | volume = 29 | issue = 7 | pages = 599–606 | date = November 2009 | pmid = 19616353 | doi = 10.1016/j.cpr.2009.06.008 }}</ref>

Most [[Meta-analysis|meta-analyses]] have found that the inclusion of bilateral eye-movements within EMDR makes little or no difference to its effect.<ref name=ps-in>{{cite book |chapter=Chapter 4: Pseudoscience in Treating Adults Who Experienced Trauma |title=Science and Pseudoscience in Social Work Practice |vauthors=Thyer BA, Pignotti MG |year=2015 |publisher=Springer |pages=106, 146 |doi=10.1891/9780826177698.0004 |isbn=9780826177681}}</ref><ref>{{cite journal | vauthors = Cuijpers P, Veen SC, Sijbrandij M, Yoder W, Cristea IA | title = Eye movement desensitization and reprocessing for mental health problems: a systematic review and meta-analysis | journal = Cognitive Behaviour Therapy | volume = 49 | issue = 3 | pages = 165–180 | date = May 2020 | pmid = 32043428 | doi = 10.1080/16506073.2019.1703801 | s2cid = 202289231 | doi-access = free | hdl = 11577/3461344 | hdl-access = free }}</ref><ref name="RodenburgBenjaminde Roos2009">{{cite journal | vauthors = Rodenburg R, Benjamin A, de Roos C, Meijer AM, Stams GJ | title = Efficacy of EMDR in children: a meta-analysis | journal = Clinical Psychology Review | volume = 29 | issue = 7 | pages = 599–606 | date = November 2009 | pmid = 19616353 | doi = 10.1016/j.cpr.2009.06.008 | quote-page = {{page needed|date=May 2024}} | quote = "Results indicate efficacy of EMDR when effect sizes are based on comparisons between the EMDR and the non-established trauma treatment or the no-treatment control groups, and the incremental efficacy when effect sizes are based on comparisons between the EMDR and the established (CBT) trauma treatment." }}</ref> Meta-analyses have also described a high risk of [[allegiance bias]] in EMDR studies.<ref name="CuijpersVeenSijbrandij2020">{{cite journal | vauthors = Cuijpers P, Veen SC, Sijbrandij M, Yoder W, Cristea IA | title = Eye movement desensitization and reprocessing for mental health problems: a systematic review and meta-analysis | journal = Cognitive Behaviour Therapy | volume = 49 | issue = 3 | pages = 165–180 | date = May 2020 | pmid = 32043428 | doi = 10.1080/16506073.2019.1703801 | quote = "EMDR was found to be significantly more effective than other therapies in the treatment of PTSD. However, these results are not convincing for a number of reasons. First, there were few studies with low risk of bias. Furthermore, studies with low risk of bias did not point at a significant difference between EMDR and other therapies. The difference between studies with low risk of bias and those with at least some risk of bias was significant and we found considerable indications for researcher allegiance. Because studies with low risk of bias found no difference between EMDR and other therapies, we conclude that there is not enough evidence to decide about the comparative effects of EMDR." | quote-page = {{page needed|date=May 2024}} | s2cid = 202289231 | eissn = 1651-2316 | doi-access = free | hdl = 11577/3461344 | hdl-access = free }}</ref> One 2013 meta-analysis with fewer exclusion criteria found a moderate effect.<ref name=pmid23266601>{{cite journal | vauthors = Lee CW, Cuijpers P | title = A meta-analysis of the contribution of eye movements in processing emotional memories | journal = Journal of Behavior Therapy and Experimental Psychiatry | volume = 44 | issue = 2 | pages = 231–239 | date = June 2013 | pmid = 23266601 | doi = 10.1016/j.jbtep.2012.11.001 | url = http://researchrepository.murdoch.edu.au/id/eprint/13100/ | url-access = subscription }}</ref>

== Research ==

===Effectiveness===

[[Systematic review|Systematic reviews]] in 2013, including a [[Cochrane (organisation)|Cochrane]] study comparing EMDR with other psychotherapies in the treatment of chronic PTSD found EMDR to be as effective as TF-CBT (trauma-focused cognitive behavioral therapies).<ref name="Watt2013">{{cite journal | vauthors = Watts BV, Schnurr PP, Mayo L, Young-Xu Y, Weeks WB, Friedman MJ | title = Meta-analysis of the efficacy of treatments for posttraumatic stress disorder | journal = The Journal of Clinical Psychiatry | volume = 74 | issue = 6 | pages = e541–e550 | date = June 2013 | pmid = 23842024 | doi = 10.4088/JCP.12r08225 | s2cid = 23087402 }}</ref><ref name="Bisson2013">{{cite journal | vauthors = Bisson JI, Roberts NP, Andrew M, Cooper R, Lewis C | title = Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2013 | issue = 12 | page = CD003388 | date = December 2013 | pmid = 24338345 | pmc = 6991463 | doi = 10.1002/14651858.CD003388.pub4 }}</ref> A 2018 systematic review found moderate strength of evidence supporting the effectiveness of EMDR in reducing symptoms of PTSD and depression, as well as increasing the likelihood of patients losing their PTSD diagnosis.<ref>{{Cite report |url= https://effectivehealthcare.ahrq.gov/topicsproducts/ptsd-adult-treatment-update/research-2018 |title=Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder: A Systematic Review Update |last1=Forman-Hoffman |first1=Valerie |last2=Cook Middleton |first2=Jennifer |date=2018-05-17 |publisher=Agency for Healthcare Research and Quality (AHRQ) |doi=10.23970/ahrqepccer207 |last3=Feltner |first3=Cynthia |last4=Gaynes |first4=Bradley N. |last5=Palmieri Weber |first5=Rachel |last6=Bann |first6=Carla |last7=Viswanathan |first7=Meera |last8=Lohr |first8=Kathleen N. |last9=Baker |first9=Claire}}</ref> A 2020 systematic review concluded: "A recent increase in RCTs [randomized controlled trials] of psychological therapies for PTSD, results in a more confident recommendation of CBT-T and EMDR as the first-line treatments."<ref>{{Cite journal |lastlast1=Lewis |firstfirst1=Catrin |last2=Roberts |first2=Neil P. |last3=Andrew |first3=Martin |last4=Starling |first4=Elise |last5=Bisson |first5=Jonathan I. |date=2020-12-31 |title=Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis |url=https://www.tandfonline.com/doi/full/10.1080/20008198.2020.1729633 |journal=European Journal of Psychotraumatology |language=en |volume=11 |issue=1 |doi=10.1080/20008198.2020.1729633 |issn=2000-8066 |pmc=PMC71441877144187 |pmid=32284821}}</ref> A 2023 Cochrane systematic review analyzed psychosocial interventions for survivors of rape and sexual assault experienced during adulthood and concluded that EMDR is a "first-line treatment" for PTSD along with other trauma-focused psychotherapies, such as Cognitive Processing Therapy and Prolonged Exposure.<ref>{{Cite journal |lastlast1=O'Doherty |firstfirst1=Lorna |last2=Whelan |first2=Maxine |last3=Carter |first3=Grace J. |last4=Brown |first4=Katherine |last5=Tarzia |first5=Laura |last6=Hegarty |first6=Kelsey |last7=Feder |first7=Gene |last8=Brown |first8=Sarah J. |date=2023-10-05 |title=Psychosocial interventions for survivors of rape and sexual assault experienced during adulthood |url=https://pubmed.ncbi.nlm.nih.gov/37795783 |journal=The Cochrane Database of Systematic Reviews |volume=102023 |issue=10 |pages=CD013456 |doi=10.1002/14651858.CD013456.pub2 |issn=1469-493X |pmc=PMC1055207110552071 |pmid=37795783}}</ref>

===Client experience===

In aA 2021 systematic review of 13 studies, found that clients had mixed perceptions of the effectiveness of EMDR therapy.<ref>{{cite journal | vauthors = Shipley G, Wilde S, Hudson M |title=What do clients say about their experiences of Eye Movement Desensitisation and Reprocessing therapy? A systematic review of the literature. |journal=European Journal of Trauma & Dissociation |date=April 2021 |volume=6 |issue=2 |pagearticle-number=100226 |doi=10.1016/j.ejtd.2021.100226| issn=2468-7499 |s2cid=235544895 }}</ref>

=== Treating conditions other than PTSD ===

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EMDR has been characterised as a modern-day [[mesmerism]], as the therapies have striking resemblances, from the sole inventor who devises the system while out walking, to the large business empire built on exaggerated claims. In the case of EMDR, these have included the suggestions that EMDR could drain violence from society and be useful in treating [[cancer]] and [[HIV/AIDS]].<ref name="tsep">{{cite book |title=[[The Skeptic Encyclopedia of Pseudoscience]] |vauthors=Rosen GM, McNally RJ, Lilienfield SO |publisher=Bloomsbury |year=2002 |isbn=978-1-57607-653-8 |veditors=Shermer M, Linse P |volume=1 |pages=321–326 |chapter=EMDR: Eye Movement Desensitization and Reprocessing}}</ref> Psychology historian Luis Cordón has compared the popularity of EMDR to that of other cult-like pseudosciences, [[facilitated communication]] and [[thought field therapy]].<ref name=cordon>{{cite book |veditors=Cordón LA |year=2005 |title=Popular psychology: An encyclopedia |publisher=Greenwood Press |chapter=Eye movement desensitization and reprocessing |pages=81–82}}</ref>

A parody website advertising "{{Not a typo|sudotherapy}}" created by a fictional "Fatima Shekel" appeared on the internet in the 1990s.<ref name="The Psychologist_2007">{{cite journal | vauthors = de Jongh A, ten Broeke E |title=A course in pseudoscience |journal=De Psycholoog |date=February 2007 |pages=87–91 |url=https://www.dousa.nl/DePsycholoogFebr2007letters.pdf |access-date=15 April 2023}}</ref><ref name="McNally_Dutch">{{cite journal | vauthors = McNally RJ |title=emdr en mesmerisme |journal=DTH Magazine |date=2001 |volume=3 |issue=21 |url=https://www.directievetherapie.nl/artikelen/jaargang21/emdr-en-mesmerisme-21-3-270/ |access-date=15 April 2023 |language=Dutch}}</ref><ref name=ps-in_sudotherapy/> Proponents of EMDR described the website as libelous, since the website contained an image of a pair of shifting eyes following a cat named "Sudo", and "Fatima Shekel" has the same initials as EMDR's founder, Francine Shapiro.<ref name=ps-in_sudotherapy/> However, no legal action took place against the website or its founders.<ref name=ps-in_sudotherapy>{{cite book |chapter=Chapter 1: Characteristics of Science and Pseudoscience in Social Work Practice |title=Science and Pseudoscience in Social Work Practice |vauthors=Thyer BA, Pignotti MG |year=2015 |publisher=Springer |doi=10.1891/9780826177698.0004 |isbn=9780826177681}}</ref>

== Society and culture ==

* [[Sandra Bullock]] used EMDR following a home invasion by a stalker in 2014.<ref name="Blum_2022" />

*In 2019, [[Jameela Jamil]] said she partook in EMDR therapy to treat her [[PTSD|post traumatic stress disorder]].<ref>{{cite web |last1=Luu |first1=Christopher |title=Jameela Jamil Reveals She Attempted Suicide |url=https://www.instyle.com/news/jameela-jamil-suicide-attempt |website=InStyle |language=EN |date=10 October 2019 |access-date=11 November 2020 |archive-date=15 October 2021 |archive-url=https://web.archive.org/web/20211015064549/https://www.instyle.com/news/jameela-jamil-suicide-attempt |url-status=dead}}</ref><ref>{{Cite AV media |url=https://www.youtube.com/watch?v=F2c1_QiQSsc |title="EMDR therapy removed emotion linked to the traumatic memory." Jameela Jamil |date=2024-03-15 |last=Creative Mind Videos |access-date=2024-07-27 |via=YouTube}}</ref>

* In 2021, [[Prince Harry]] took a course of EMDR and filmed a session for [[Oprah Winfrey]] during a mental health television documentary.<ref name="hw">{{cite news | vauthors = Sample I |date=21 May 2021 |title=EMDR: what is the trauma therapy used by Prince Harry? |newspaper=The Guardian |url=https://www.theguardian.com/science/2021/may/21/emdr-what-is-the-trauma-therapy-used-by-prince-harry}}</ref><ref name="Blum_2022">{{Cite news | vauthors = Blum D, Park S |date=2022-09-19 |title='One Foot in the Present, One Foot in the Past:' Understanding E.M.D.R. |language=en-US |work=The New York Times |url=https://www.nytimes.com/2022/09/19/well/emdr-therapy.html |access-date=2023-04-09 |issn=0362-4331}}</ref>

* In 2022, [[BBC]] war correspondent [[Fergal Keane]], who suffered from PTSD, credited his EMDR therapist with helping save his life.<ref>{{Cite web|url=https://emdrassociation.org.uk/media/bbc2-ptsd-fergal-keane/|title=BBC2 PTSD Fergal Keane|website=EMDR UK Association}} Starting 34:38 into the programme.</ref>

== See also ==

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== External links ==

* [https://www.emdr.com/ EMDR Institute (US)]

* {{Skeptoid|id=4928|number=928|title=EMDR: Looking Past the Pain.|date=March 19, 2024}}

{{psychotherapy}}