As she walked in a park in 1988, Francine Shapiro noticed that the anxious thoughts that were troubling her became less of a burden when her eyes spontaneously shifted back and forth. Based on this experience, she developed an unusual treatment for anxiety. Eye movement desensitization and reprocessing (EMDR), the technique she developed, has been heavily promoted as an unusually effective treatment for anxiety and stress produced by traumatic memories, especially as seen in posttraumatic stress disorder (PTSD).
EMDR involves recalling the particular traumatic memory, along with negative thoughts associated with it, then maintaining awareness of the thoughts while following the therapist’s ﬁnger back and forth in front of the patient’s eyes. In addition to PTSD, EMDR advocates also have proposed its use for other disorders, including but not limited to depression, panic disorder, phobias, alcoholism, sexual dysfunction, learning disabilities, and eating disorders.
Though the ﬁrst publication concerning the treatment only dates back to 1989, published reports now indicate that as many as 25,000 to 40,000 therapists have been trained in its use. This is a remarkably rapid spread for a new and largely untested therapy, but then the claims supporting it are also quite remarkable. Shapiro (and Forrest, 1997) reported that the aversive impact of persistent and traumatic memories could be eliminated for between 84 and 100 percent of clients, often in as few as three therapy sessions. This is a much higher cure rate, with much faster results, than proponents of any other technique claim for PTSD, or for any other psychological disorder for that matter. The treatment has accordingly been greeted with great enthusiasm by the therapeutic community, but the scientiﬁc literature has been quite critical.
Criticism of the technique has focused on several issues, but probably the greatest of these is that there is no known physiological process by which eye movements could, or should, have any effect on the anxiety produced by a traumatic memory. Various possibilities have been proposed, most noteworthy among them the idea that by moving the eyes back and forth, the client duplicates the brain state of rapid eye movement sleep (REM), thus entering a sort of waking dream state, during which it is easier to experience the traumatic memory without stress. It should be noted that no empirical support whatsoever exists for this explanation.
The second major criticism is the absence of empirical support for the effectiveness of EMDR in the form of controlled experiments showing it to work better than other treatments. Though some studies show that EMDR works better than doing nothing, this is true for virtually all treatments due to nonspeciﬁc effects such as the placebo effect and the simple fact of receiving therapeutic attention. Furthermore, much of the published evidence for EMDR takes the form of case studies and single-subject trials with few experimental controls in place. Many of the studies that have compared EMDR to other treatments have found EMDR equally effective as, but no better than, other treatments.
It is now acknowledged by Shapiro that the actual eye movements are not even a necessary part of the treatment. This is the source of the third major criticism of EMDR: apart from the eye movements, it offers nothing new. Indeed, the process of focusing attention on the traumatic memory for a prolonged period of time is already a central part of ﬂooding and exposure, two therapies that EMDR’s proponents claim that it outperforms. Other elements of EMDR seem to be borrowed from cognitive-behavioral therapy, which is already well established as a treatment for anxiety.
The many studies which have failed to show a difference in outcomes between EMDR and control conditions are interpreted by EMDR advocates, however, as actually supportive of EMDR. In one study that compared EMDR to a control condition in which subjects simply tapped their ﬁngers rather than moving their eyes, a null result (no difference) was reported. Rather than the usual interpretation, which would be that EMDR was no more effective than the placebo treatment, the authors saw this as evidence that both EMDR and ﬁnger tapping are useful treatments.
Given that its only unique element appears to be unnecessary for its therapeutic efﬁcacy, its extremely rapid spread seems to be in part due to the same sort of successful marketing and almost cult-like atmosphere that have accompanied other highly successful psychological pseudosciences such as facilitated communication and thought ﬁeld therapy (Herbert et al., 2000). Furthermore, despite the therapy’s relative newness, it already possesses a central governing body, the EMDR Institute, Inc., which is the sole provider of training in this therapy, following which therapists are invited to join the EMDR Network and the EMDR International Association. Despite these scientiﬁc-o9sounding trappings, however, the evidence for EMDR remains very inconclusive, while its claims continue to grow.
- Herbert, J. D., Lilienfeld, S. O., Lohr, J. M., Montgomery, R. W., O’Donohue, W. T., Rosen, G. M., and Tolin, D. F. “Science and Pseudoscience in the Development of Eye Movement Desensitization and Reprocessing: Implications for Clinical Psychology.” Clinical Psychology Review, 20(8) (2000): 945–971;
- Shapiro, F. “Efﬁcacy of the Eye Movement Desensitization Procedure in the Treatment of Traumatic Memories.” Journal of Traumatic Stress, 2 (1989): 199–223;
- Shapiro, F., and Forrest, M. S. EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma. New York: Basic Books, 1997.