Psychotherapy has been a staple of mental healthcare for centuries, if not longer, under different names but with the same intent. Which, is to utilize effective treatments to help clients with psychological disorders, or what was understood as a psychological disorder at the time.
However, while psychotherapy has remained the same in its spirit, its methods have drastically changed over the years. Talk therapy remains a staple in the treatment of most conditions. However, years of rigorous research and qualitative, empirical evidence gathering has led to the development, scrutiny, and implementation of countless effective psychotherapies, from exposure therapy to online counseling.
One such therapy is eye-movement desensitization and reprocessing (EMDR) – yet how effective is EMDR truly?
What Is EMDR?
Eye-movement desensitization and reprocessing revolves around the idea that trauma-based disorders, particularly post-traumatic stress disorder (PTSD), are caused by “feelings and behaviors [that] are the result of unprocessed memories.” The treatment involves gradually helping a client open up about traumatic events and memories while engaging in a side-to-side motion with the eyes or hands, either through eye-movement or hand tapping.
EMDR was first developed by Francine Shapiro, PhD, a senior research fellow at the Palo Alto Mental Research Institute. Since its introduction, the therapy was widely accepted and propagated in several different guidelines produced for dealing with PTSD, including guidelines published and promoted by the WHO, the NICE, and the US Dept. of Veterans Affairs. However, it has also drawn the attention of critics.
EMDR Principles & Procedure
During EMDR, clients are asked to recall distressing images of their trauma while engaging in a repetitive side-to-side motion. The general idea behind EMDR in this sense is similar to the idea behind utilizing cognitive-behavioral therapy (CBT) for trauma disorders – to help clients overcome stress and adapt to the aftermath of their trauma.
EMDR treatment is broken up into several different phases. The first phase involves taking an accurate history of the client’s readiness and memories. Phase 2 involves preparing different ways of handling emotional distress to reduce stress during and between EMDR sessions. From there, EMDR sessions begin from phases 3-6, tackling negative thoughts, emotive and distressing imagery, and bodily sensations while maintaining the side-to-side eye movement or hand-tapping. The final two phases involve maintaining a log to record any relevant information post-treatment and reflecting on progress made.
Some evidence suggests that despite differences, CBT for trauma and EMDR exhibit the same level of effectiveness in the treatment of PTSD.
Comparative Efficacy of EMDR vs. Exposure Therapy & Relaxation
In the treatment of PTSD, other forms of psychotherapy that are often recommended include exposure therapy and relaxation methods. Exposure therapy is utilized in the treatment of other anxiety disorders, such as certain phobias. Exposure therapy involves very gradually exposing a client to a source of their fear, without any negative intention. The idea being that in a non-threatening and welcoming context, a client may learn to gradually accept and work towards eliminating their fears towards an event, memory, visual, or object.
In the treatment of phobias, the progression may begin with an image held at a distance, eventually moving up to a client’s immediate proximity, and then moving on as per a therapist’s recommendations. In the treatment of PTSD, exposure therapy is meant to help clients tackle avoidance. Avoidance is a natural reflex after a traumatic experience to keep from opening old wounds. However, avoidance must be overcome for a client to learn to cope with, and better adapt to the trauma, without it continuing to affect their everyday life.
Exposure therapy for PTSD may involve the aforementioned image or bringing a client closer to the site of their trauma. When compared to EMDR, exposure therapy produced larger reductions in re-experiencing symptoms in one study – however, relaxation methods meant to help a client reduce the anxiety effects of PTSD were found to be just as effective as EMDR. Another study points out that prolonged exposure therapy and EMDR were just as effective at reducing symptoms of PTSD, showing no significant difference.
In both cases – EMDR vs. CBT and EMDR vs. exposure therapy – it’s important to know that single studies are not a good basis to help form an opinion for individual efficacy. EMDR has been proven across different studies to be more effective than doing nothing, but its exact efficacy is not adequately explored to make a definitive recommendation without being face-to-face with a client.
Clients should heed the advice of their healthcare professionals, and if possible, should try out several different forms of psychotherapy and possibly integrate several treatment methods for the best effect.
EMDR as Part of Integrative Psychotherapy
EMDR as an Integrative Psychotherapy Approach by Francine Shapiro suggests that EMDR has shown efficacy not only in the treatment of PTSD, but in the treatment of a wide range of other disorders including:
- Major Depressive Disorder (MDD)
- Attachment Disorder
- Social Phobia
- Generalized Anxiety Disorder (GAD)
- And more.
Outside of her book, several other articles have explored the efficacy of EMDR in the treatment of depression and various anxiety disorders. However, very little literature exists to indicate anything other than EMDR being potentially more effective than no treatment at all in various anxiety disorders. Some evidence suggests efficacy in the treatment of major depression, but most studies and guidelines involving EMDR are strictly to do with post-traumatic stress disorder.
Risks, if Any
The only known risk is that it might not work for you. EMDR is a safe form of psychotherapy that does not involve the use of invasive measures, electrotherapy, or any possible procedure that might lead to adverse symptoms. However, due to a lack of concrete evidence regarding its use in disorders other than PTSD, it may be that while it could be recommended for the treatment of various anxiety disorders and depression, it may also not work. As with anything, your mileage may vary, and it’s important to keep that in mind when exploring any treatment option.
EMDR was first developed in the late 80s and is still recommended by organizations and professionals today for the treatment of post-traumatic stress disorder.