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Eye Movement Desensitization and Reprocessing (EMDR)

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 psychologist Francine Shapiro while on a walk in the park. It is claimed that EMDR can "help" with nearly any kind of mental or physical illness, including schizophrenia and cancer, 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. Another trained professional, Tom Denham, offers this scientific explanation: "EMDR appears to access some kind of brain mechanism that allows traumatic memories to be reprocessed more fully than conventional forms of therapy."

Evidence for the effectiveness of EMDR 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 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 as the main causal agent in recovery from PTSD. The latest study by Wilson, Becker and Tinker is to be published in The Journal of Consulting and Clinical Psychology. It 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 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:

Pitman et al. (1996). 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.

Maybe hand taps will work just as well as eye movements. According to one EMDR practitioner,

...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 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 not accepted practice by the American Psychological Association. Advocates disagree, of course, and claim that EMDR 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.] So far, the validation referred to by Dr. Drehmer is mainly in the form of unconvincing research studies and testimonials by practitioners relating anecdotes and their interpretations of those anecdotes. 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 which 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 softend 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.

further reading

reader comments

• "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
• PRO and CON -- Eye Movement Desensitization and Reprocessing
• Mental Help: Procedures to Avoid according to Stephen Barrett, M.D.
• The American Psychological Association view on EMDR
• "Eye Movement Desensitization and Reprocessing: A Controversial Treatment Technique" by Suzanne Hurst and Natasha Milkewicz
• "Therapists eye new treatment for trauma," a rather uncritical review of Shapiro's latest book
• Dr. Hume's Theory
• Review of Laurel Parnell's Transforming Trauma: EMDR The Revolutionary New Therapy for Freeing the Mind, Clearing the Body, and Opening the Heart by Bryan M. Knight
• Post-Traumatic Stress Disorder
• The American Academy of Experts in Traumatic Stress
• The EMDR Institute

"EMDR Treatment: Less Than Meets the Eye?" by Scott O. Lilienfeld, Skeptical Inquirer, Jan/Feb 1996.

 Lohr JM, Tolin DF, Lilienfeld SO. "Efficacy of Eye Movement Desensitization and Reprocessing: Implications for behavior
therapy," Behavior Therapy 29:126-153, 1998.

Singer, Margaret Thaler and Janja Lalich. Crazy Therapies (San Francisco: Jossey-Bass, Inc., 1996). review 

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