The March 2, 2012 edition of the New York Times featured a Q&A session with Dr. Francine Shapiro, the originator of EMDR, on the evidence on EMDR, one of the most highly researched therapies out there. She stated that the American Psychiatric Association (2004), Department of Veterans Affairs and Department of Defense (2010), and other worldwide organizations recommend EMDR as an effective treatment of Post Traumatic Stress Disorder. There have been 20 randomized controlled studies supporting the efficacy of EMDR.
Shapiro noted that the therapeutic relationship is important in therapy, but that EMDR really relies on the client’s own ability to heal which impacts the effectiveness of the treatment. There were questions raised on the efficacy of EMDR, and whether the placebo effect – of just being with a supportive therapist – could be the reason EMDR has been effective. Shapiro presented a study that was specifically designed to test the placebo effect, and demonstrated that the protocol is effective, and not because of the placebo effect. She also stated that client’s expectations of positive results did not impact the study either.
There were questions about the effectiveness of the bilateral stimulation and whether it is the exposure to the fear that allows the person to heal. This brought up an interesting discussion on the difference between exposure therapy and EMDR.
During reprocessing in EMDR, the client brings up something disturbing, and bilateral stimulation is added to a brief process. New material will keep emerging and the therapist guides the client through this process until all the material is no longer disturbing. Some exposure therapists believe that this brief exposure should make the client feel worse.
Unlike exposure therapy, an EMDR client does not have to tell the details of the event, and does not have “homework” of reviewing the traumatic event. In prolonged exposure therapy the client describes in detail the event as if reliving it. The story is repeated several times, and sometimes the client listens to the recording of the session at home as homework. This allows for habituation over time
A study (Ironson et al, 2002) found that 70% of the EMDR had good outcomes after 3 sessions compared to Exposure therapy where 17% of those in prolonged exposure group had good outcomes. Both have been found to be effective, but EMDR allowed the client to have less exposure to the traumatic event and no homework of listening to the event over and over.
The big question that always comes up when talking about EMDR, are the eye movements really are as effective as EMDR reports. This is still a controversial area. Some say that the eye movements interfere with the working memory processes (van den Hout et el, 2011) and another study links the same processes that occur during REM sleep (Stickgold, 2002). These reports show that the eye movements lessen the emotion and vividness of memories and help the client relax more. They also found the clients felt they had a better understanding of the truth of the event once they finished processing.
EMDR has been around for 20 years now, and there is some good research to support its use with the healing of trauma. The importance of more research being done will help answer the unknowns, and help more people to accept EMDR as a researched based therapy.
As I teach more around the country, I still here stories of therapists believing that there is no research to back up the efficacy of EMDR. I hope Dr. Shapiro will have more press time to spread the word to help solidify EMDR as solid trauma therapy. I am lucky to live in a city that embraces EMDR, and that therapists and clients ask for more all the time.
For those of you who have never heard Dr. Shapiro speak, she will be presenting at the 2012 EMDRIA Conference in Washington DC this year. It is a wonderful chance to hear from the originator of what she thinks is important in the development of this work.