Eye movement desensitization and reprocessing: Difference between revisions

Revision as of 14:57, 21 February 2025

Revision as of 06:27, 19 March 2025

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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 2013 generally indicate that EMDR treatment efficacy for adults with PTSD is equivalent to trauma-focused cognitive and behavioral therapies (TF-CBT), such as [[Prolonged exposure therapy]] (PE) and [[Cognitive Processing Therapy]] (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]].

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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/> Gerald Rosen and Bruce Grimley suggest that it is more likely that she developed EMDR out of her experience with [[neuro-linguistic programming]].<ref name=":1" /><ref>{{Cite journal |last=Grimley |first=Bruce |date=2014 |title=Origins of EMDR- a question of integrity? |url=https://www.bps.org.uk/psychologist/letters-men-and-mental-health-minefield |journal=The Psychologist}}</ref><ref>{{Cite web |last=Grimley |first=Bruce |title=What is Neurolinguistic Programming, (NLP) |url=https://www.academia.edu/39222352 }}</ref>

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

==Technique==

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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/ }}</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/topics/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 |last=Lewis |first=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=7144187 |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 |last=O'Doherty |first=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=10 |issue=10 |pages=CD013456 |doi=10.1002/14651858.CD013456.pub2 |issn=1469-493X |pmc=10552071 |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 |page=100226 |doi=10.1016/j.ejtd.2021.100226| issn=2468-7499 |s2cid=235544895 }}</ref>

=== Treating conditions other than PTSD ===