Jump to content

Eye movement desensitization and reprocessing: Difference between revisions

Extended-protected article
From Wikipedia, the free encyclopedia
Browse history interactively
← Previous edit
Content deleted Content added
VisualWikitext
return previous structure of article - walling everything off under criticisms is generally not done on Wikipedia
→top: this is cited with multiple sources in the body, so why was only one 1999 one used in the lead - it's bound to cause issues like this
 
(22 intermediate revisions by 13 users not shown)
Line 3: Line 3:
{{pp-extended|small=yes}}
{{pp-extended|small=yes}}


'''Eye movement desensitization and reprocessing''' ('''EMDR''') is a form of [[psychotherapy]] that is a recommended treatment for [[post-traumatic stress disorder]], but remains controversial within the psychological community.<ref name="McNally1999"/> It was devised by [[Francine Shapiro]] in 1987 and originally designed to alleviate the distress associated with [[traumatic memories]] such as [[Post-traumatic stress disorder|post-traumatic stress disorder (PTSD)]].
'''Eye movement desensitization and reprocessing''' ('''EMDR''') is a form of [[psychotherapy]] that is a recommended treatment for [[post-traumatic stress disorder]] (PTSD), but remains controversial within the psychological community. It was devised by [[Francine Shapiro]] in 1987 and originally designed to alleviate the distress associated with [[traumatic memories]] such as PTSD.


EMDR involves focusing on traumatic memories in a manner similar to [[exposure therapy]] while engaging in side-to-side eye movements or other forms of bilateral stimulation.<ref name="Blum_2022" /><ref name="Rodenburg2009" /> It is also used for some other psychological conditions.<ref name="Carletto_2021" /><ref name="Cuijpers 2020" />
EMDR involves focusing on traumatic memories in a manner similar to [[exposure therapy]] while engaging in side-to-side eye movements or other forms of bilateral stimulation.<ref name="Blum_2022" /><ref name="Rodenburg2009" /> It is also used for some other psychological conditions.<ref name="Carletto_2021" /><ref name="Cuijpers 2020" />


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 [[Department of Veterans Affairs|Veteran Affairs]] and [[Department of Defense|Defense]]. The US [[National Institute of Medicine]] found insufficient evidence to recommend EMDR.<ref name=NAS_IOM_2008/> The American Psychological Association suggests EMDR may be useful for treating adult PTSD.<ref name=apa2017/> Treatment guidelines note EMDR effectiveness is statistically the same as trauma-focused behavioral therapy, and the Australian National Health and Medical Research Council notes that this may be due to including most of the core elements of [[cognitive behavioral therapy]] (CBT).{{Citation needed|reason=Please in include reference with page number or link for verifiability.|date=May 2024}}
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 [[Department of Veterans Affairs|Veteran Affairs]] and [[Department of Defense|Defense]]. The US [[National Institute of Medicine]] found insufficient evidence to recommend EMDR.<ref name=NAS_IOM_2008/> The American Psychological Association suggests EMDR may be useful for treating adult PTSD.<ref name=apa2017/> Treatment guidelines note EMDR effectiveness is statistically the same as trauma-focused behavioral therapy, and the Australian National Health and Medical Research Council notes that this may be due to including most of the core elements of [[cognitive behavioral therapy]] (CBT).


There is debate about how the therapy works and whether it is more effective than other established treatments.<ref name="Blum_2022" /><ref name="Sikes_2003" /> The eye movements have been criticized as having no scientific basis.<ref name="non"/> The founder promoted the therapy for the treatment of PTSD, and proponents employed [[Pseudoscience#Falsifiability|untestable hypotheses]] to explain negative results in controlled studies.<ref name=ps-in_promotion>{{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 |page=221 |doi=10.1891/9780826177698.0004 |isbn=9780826177681|quote=Nevertheless, to date, given that there is no evidence that anything unique to EMDR is responsible for the positive outcomes in comparing it to no treatment and the florid manner in which it has been marketed, we are including it in this book... Another way in which EMDR qualifies as a pseudoscience is the manner in which it was developed and marketed... EMDR proponents have come up with ad hoc hypotheses to explain away unfavorable results that do not support its theory, which is one of the hallmark indicators of a pseudoscience... This type of post hoc explanation renders her theory unfalsifiable and thus places it outside the realm of science, because to qualify as scientific, a theory must be falsifiable.}}</ref> EMDR has been characterized as a pseudoscientific [[purple hat therapy]] (i.e., only as effective as its underlying therapeutic methods without any contribution from its distinctive add-ons).<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>
There is debate about how the therapy works and whether it is more effective than other established treatments.<ref name="Blum_2022" /><ref name="Sikes_2003" /> The eye movements have been criticized as having no scientific basis.<ref name="non"/> The founder promoted the therapy for the treatment of PTSD, and proponents employed [[Pseudoscience#Falsifiability|untestable hypotheses]] to explain negative results in controlled studies.<ref name=ps-in_promotion>{{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 |page=221 |doi=10.1891/9780826177698.0004 |isbn=9780826177681|quote=Nevertheless, to date, given that there is no evidence that anything unique to EMDR is responsible for the positive outcomes in comparing it to no treatment and the florid manner in which it has been marketed, we are including it in this book... Another way in which EMDR qualifies as a pseudoscience is the manner in which it was developed and marketed... EMDR proponents have come up with ad hoc hypotheses to explain away unfavorable results that do not support its theory, which is one of the hallmark indicators of a pseudoscience... This type of post hoc explanation renders her theory unfalsifiable and thus places it outside the realm of science, because to qualify as scientific, a theory must be falsifiable.}}</ref> EMDR has been characterized as a pseudoscientific [[purple hat therapy]] (i.e., only as effective as its underlying therapeutic methods without any contribution from its distinctive add-ons).<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 name="Fasce2017">{{cite journal | last=Fasce | first=Angelo | title=What do we mean when we speak of pseudoscience? The development of a demarcation criterion based on the analysis of twenty-one previous attempts [¿Qué queremos decir cuando hablamos de pseudociencia? El desarrollo de un criterio de demarcación basado en el análisis de veintiún intentos anteriores] | journal=Disputatio: Philosophical Research Bulletin | volume=6 | issue=7 | pages=459–488 | date=22 December 2017 | issn=2254-0601 | doi=10.5281/ZENODO.1433737 | quote=a technique that avoids [criteria] 1 and 3 but not 2 [and is therefore a pseudoscience based on the classification method described on the previous page]}}</ref>


==Classification and technique==
==Classification and technique==
Line 17: Line 17:


=== Trauma and PTSD ===
=== Trauma and PTSD ===
The person being treated is asked to recall an image, phrase, and emotion that represent a level of distress related to a trigger while generating one of several types of bilateral sensory input, such as side-to-side [[eye]] movements or hand tapping.<ref name=feske>{{cite journal | vauthors = Feske U |title=Eye Movement Desensitization and Reprocessing Treatment for Posttraumatic Stress Disorder |journal=Clinical Psychology: Science and Practice |date=June 1998 |volume=5 |issue=2 |pages=171–181 |doi=10.1111/j.1468-2850.1998.tb00142.x }}</ref> The 2013 World Health Organization practice guideline says that "Like [[cognitive behavioral therapy]] (CBT) with a trauma focus, EMDR aims to reduce subjective distress and strengthen adaptive beliefs related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure or (d) homework."<ref name="WHO 2013">{{cite report |publisher=World Health Organization |year=2013 |title=Guidelines for the Management of Conditions that are Specifically Related to Stress |location=Geneva |url=https://www.who.int/mental_health/emergencies/stress_guidelines/en/ |archive-url=https://web.archive.org/web/20131129075320/http://www.who.int/mental_health/emergencies/stress_guidelines/en/ |url-status=dead |archive-date=November 29, 2013 |page=Glossary page 1 |pmid=24049868}}</ref>
The person being treated is asked to recall an image, phrase, and emotion that represent a level of distress related to a trigger while generating one of several types of bilateral sensory input, such as side-to-side [[eye]] movements or hand tapping.<ref name=feske>{{cite journal | vauthors = Feske U |title=Eye Movement Desensitization and Reprocessing Treatment for Posttraumatic Stress Disorder |journal=Clinical Psychology: Science and Practice |date=June 1998 |volume=5 |issue=2 |pages=171–181 |doi=10.1111/j.1468-2850.1998.tb00142.x | issn = 0969-5893}}</ref> The 2013 World Health Organization practice guideline says that "Like [[cognitive behavioral therapy]] (CBT) with a trauma focus, EMDR aims to reduce subjective distress and strengthen adaptive beliefs related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure or (d) homework."<ref name="WHO 2013">{{cite report |publisher=World Health Organization |year=2013 |title=Guidelines for the Management of Conditions that are Specifically Related to Stress |location=Geneva |url=https://www.who.int/mental_health/emergencies/stress_guidelines/en/ |archive-url=https://web.archive.org/web/20131129075320/http://www.who.int/mental_health/emergencies/stress_guidelines/en/ |url-status=dead |archive-date=November 29, 2013 |page=Glossary page 1 |pmid=24049868}}</ref>


===Training===
===Training===
Line 28: Line 28:
===Acute stress disorder and PTSD===
===Acute stress disorder and PTSD===
==== Effectiveness ====
==== Effectiveness ====
A [[Cochrane (organisation)|Cochrane]] systematic review comparing EMDR with other psychotherapies in the treatment of Chronic PTSD found EMDR to be just as effective as TF-CBT and more effective than the other non-TF-CBT psychotherapies.<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><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> Caution was urged interpreting the results due to low numbers in included studies, risk of [[Experimenter's bias|researcher bias]], high drop-out rates, and overall "very low" quality of evidence for the comparisons with other psychotherapies.<ref name="Bisson2013" /> A 2016 systematic review and meta-analysis found that the effect size of EMDR for PTSD is comparable to other evidence-based treatments, but that the strength of evidence was of a low quality,<ref>{{cite journal | vauthors = Cusack K, Jonas DE, Forneris CA, Wines C, Sonis J, Middleton JC, Feltner C, Brownley KA, Olmsted KR, Greenblatt A, Weil A, Gaynes BN | display-authors = 6 | title = Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis | journal = Clinical Psychology Review | volume = 43 | pages = 128–141 | date = February 2016 | pmid = 26574151 | doi = 10.1016/j.cpr.2015.10.003 | doi-access = free }}</ref> indicating that the effect sizes achieved are associated with substantial uncertainty. 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|doi-broken-date=2024-05-25 }}</ref>
A [[Cochrane (organisation)|Cochrane]] systematic review comparing EMDR with other psychotherapies in the treatment of Chronic PTSD found EMDR to be just as effective as TF-CBT and more effective than the other non-TF-CBT psychotherapies.<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><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> Caution was urged interpreting the results due to low numbers in included studies, risk of [[Experimenter's bias|researcher bias]], high drop-out rates, and overall "very low" quality of evidence for the comparisons with other psychotherapies.<ref name="Bisson2013" /> A 2016 systematic review and meta-analysis found that the effect size of EMDR for PTSD is comparable to other evidence-based treatments, but that the strength of evidence was of a low quality,<ref>{{cite journal | vauthors = Cusack K, Jonas DE, Forneris CA, Wines C, Sonis J, Middleton JC, Feltner C, Brownley KA, Olmsted KR, Greenblatt A, Weil A, Gaynes BN | display-authors = 6 | title = Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis | journal = Clinical Psychology Review | volume = 43 | pages = 128–141 | date = February 2016 | pmid = 26574151 | doi = 10.1016/j.cpr.2015.10.003 | doi-access = free }}</ref> indicating that the effect sizes achieved are associated with substantial uncertainty. 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>


Many randomized trials of EMDR have been criticized for poor control groups,<ref name ="SBM"/> small sample sizes,<ref name="SAB_Psychotherapy">{{cite journal |title=Expert opinion on the scientific recognition of the EMDR method (Eye Movement Desensitization and Reprocessing) for the treatment of post-traumatic stress disorder |journal=German Medical Association Scientific Advisory Board for Psychotherapy |date=September 2006 |volume=37 |issue=103 |url=https://www.wbpsychotherapie.de/fileadmin/user_upload/_old-files/downloads/pdf-Ordner/WBP/EMDR_Dtsch_Arztebl.pdf |access-date=15 April 2023}}</ref><ref name = "Cuijpers 2020"/> and other methodological flaws.<ref name = "Cuijpers 2020">{{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 | doi-access = free }}</ref><ref name=Bisson2013/><ref name="KaptanDursunKnowles2021">{{cite journal | vauthors = Kaptan SK, Dursun BO, Knowles M, Husain N, Varese F | title = Group eye movement desensitization and reprocessing interventions in adults and children: A systematic review of randomized and nonrandomized trials | journal = Clinical Psychology & Psychotherapy | volume = 28 | issue = 4 | pages = 784–806 | date = July 2021 | pmid = 33415797 | doi = 10.1002/cpp.2549 | s2cid = 231194631 | eissn = 1099-0879 | doi-access = free }}</ref> It has been called a [[purple hat therapy]] because any effectiveness is provided by the underlying therapy (or the standard treatment), not from EMDR's distinctive features.<ref name="SciAm_2012">{{cite news | vauthors = Arkowitz H, Lilienfeld SO |title=EMDR: Taking a Closer Look |url=https://www.scientificamerican.com/article/emdr-taking-a-closer-look/ |access-date=21 March 2023 |work=Scientific American |date=1 August 2012 |language=en}}</ref><ref>{{cite book |title=Exposure Treatments for Anxiety Disorders: A Practitioner's Guide to Concepts, Methods, and Evidence-Based Practice |vauthors=Rosquist |year=2005 |publisher=Routledge |isbn=9781136915772 |page=94}}</ref>
Many randomized trials of EMDR have been criticized for poor control groups,<ref name ="SBM"/> small sample sizes,<ref name="SAB_Psychotherapy">{{cite journal |title=Expert opinion on the scientific recognition of the EMDR method (Eye Movement Desensitization and Reprocessing) for the treatment of post-traumatic stress disorder |journal=German Medical Association Scientific Advisory Board for Psychotherapy |date=September 2006 |volume=37 |issue=103 |url=https://www.wbpsychotherapie.de/fileadmin/user_upload/_old-files/downloads/pdf-Ordner/WBP/EMDR_Dtsch_Arztebl.pdf |access-date=15 April 2023}}</ref><ref name = "Cuijpers 2020"/> and other methodological flaws.<ref name = "Cuijpers 2020">{{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 | doi-access = free }}</ref><ref name=Bisson2013/><ref name="KaptanDursunKnowles2021">{{cite journal | vauthors = Kaptan SK, Dursun BO, Knowles M, Husain N, Varese F | title = Group eye movement desensitization and reprocessing interventions in adults and children: A systematic review of randomized and nonrandomized trials | journal = Clinical Psychology & Psychotherapy | volume = 28 | issue = 4 | pages = 784–806 | date = July 2021 | pmid = 33415797 | doi = 10.1002/cpp.2549 | s2cid = 231194631 | eissn = 1099-0879 | doi-access = free }}</ref> It has been called a [[purple hat therapy]] because any effectiveness is provided by the underlying therapy (or the standard treatment), not from EMDR's distinctive features.<ref name="SciAm_2012">{{cite news | vauthors = Arkowitz H, Lilienfeld SO |title=EMDR: Taking a Closer Look |url=https://www.scientificamerican.com/article/emdr-taking-a-closer-look/ |access-date=21 March 2023 |work=Scientific American |date=1 August 2012 |language=en}}</ref><ref>{{cite book |title=Exposure Treatments for Anxiety Disorders: A Practitioner's Guide to Concepts, Methods, and Evidence-Based Practice |vauthors=Rosquist |year=2005 |publisher=Routledge |isbn=9781136915772 |page=94}}</ref>
Line 58: Line 58:
===Other mechanisms===
===Other mechanisms===
Several other possible mechanisms have been proposed:
Several other possible mechanisms have been proposed:
* EMDR may impact working memory.<ref>{{cite journal | vauthors = van den Hout MA, Engelhard IM, Beetsma D, Slofstra C, Hornsveld H, Houtveen J, Leer A | title = EMDR and mindfulness. Eye movements and attentional breathing tax working memory and reduce vividness and emotionality of aversive ideation | journal = Journal of Behavior Therapy and Experimental Psychiatry | volume = 42 | issue = 4 | pages = 423–431 | date = December 2011 | pmid = 21570931 | doi = 10.1016/j.jbtep.2011.03.004 }}</ref> If a patient performs bilateral stimulation task while remembering the trauma, the amount of information they can recall is thought to be reduced, making the resulting [[negative emotion]]s less intense and more bearable.<ref name="Chen2015">{{cite journal | vauthors = Chen L, Zhang G, Hu M, Liang X | title = Eye movement desensitization and reprocessing versus cognitive-behavioral therapy for adult posttraumatic stress disorder: systematic review and meta-analysis | journal = The Journal of Nervous and Mental Disease | volume = 203 | issue = 6 | pages = 443–451 | date = June 2015 | pmid = 25974059 | doi = 10.1097/NMD.0000000000000306 | s2cid = 34850645 }}</ref> This is seen by some{{By whom|section=Seen by whom specifically?|date=May 2024}} as a "distancing effect". The client is then believed to re-evaluate the trauma and process it in a less-harmful environment.<ref name=Logie2014>{{cite journal | vauthors = Logie R |title=EMDR - more than just a therapy for PTSD? |journal=The Psychologist |date=July 2014 |volume=27 |issue=7 |pages=512–517 |url=https://thepsychologist.bps.org.uk/volume-27/edition-7/emdr-more-just-therapy-ptsd }}</ref> This explanation is plausible, given research showing that memories are more modifiable once recalled.<ref name=epid/>
* EMDR may impact working memory.<ref>{{cite journal | vauthors = van den Hout MA, Engelhard IM, Beetsma D, Slofstra C, Hornsveld H, Houtveen J, Leer A | title = EMDR and mindfulness. Eye movements and attentional breathing tax working memory and reduce vividness and emotionality of aversive ideation | journal = Journal of Behavior Therapy and Experimental Psychiatry | volume = 42 | issue = 4 | pages = 423–431 | date = December 2011 | pmid = 21570931 | doi = 10.1016/j.jbtep.2011.03.004 }}</ref> If a patient performs bilateral stimulation task while remembering the trauma, the amount of information they can recall is thought to be reduced, making the resulting [[negative emotion]]s less intense and more bearable.<ref name="Chen2015">{{cite journal | vauthors = Chen L, Zhang G, Hu M, Liang X | title = Eye movement desensitization and reprocessing versus cognitive-behavioral therapy for adult posttraumatic stress disorder: systematic review and meta-analysis | journal = The Journal of Nervous and Mental Disease | volume = 203 | issue = 6 | pages = 443–451 | date = June 2015 | pmid = 25974059 | doi = 10.1097/NMD.0000000000000306 | s2cid = 34850645 }}</ref> This is seen by Robin Logie of the EMDR Association UK and Ireland as a "distancing effect". The client is then believed to re-evaluate the trauma and process it in a less-harmful environment.<ref name=Logie2014>{{cite journal | vauthors = Logie R |title=EMDR - more than just a therapy for PTSD? |journal=The Psychologist |date=July 2014 |volume=27 |issue=7 |pages=512–517 |url=https://thepsychologist.bps.org.uk/volume-27/edition-7/emdr-more-just-therapy-ptsd }}</ref> This explanation is plausible, given research showing that memories are more modifiable once recalled.<ref name=epid/>
* Horizontal eye movement is thought to trigger an "[[orienting response]]" in the brain, used in scanning the environment for threats and opportunities.<ref name="Jeffries & Davis 2012">{{cite journal | vauthors = Jeffries FW, Davis P | title = What is the role of eye movements in eye movement desensitization and reprocessing (EMDR) for post-traumatic stress disorder (PTSD)? a review | journal = Behavioural and Cognitive Psychotherapy | volume = 41 | issue = 3 | pages = 290–300 | date = May 2013 | pmid = 23102050 | doi = 10.1017/S1352465812000793 | s2cid = 33309479 }}</ref>
* Horizontal eye movement is thought to trigger an "[[orienting response]]" in the brain, used in scanning the environment for threats and opportunities.<ref name="Jeffries & Davis 2012">{{cite journal | vauthors = Jeffries FW, Davis P | title = What is the role of eye movements in eye movement desensitization and reprocessing (EMDR) for post-traumatic stress disorder (PTSD)? a review | journal = Behavioural and Cognitive Psychotherapy | volume = 41 | issue = 3 | pages = 290–300 | date = May 2013 | pmid = 23102050 | doi = 10.1017/S1352465812000793 | s2cid = 33309479 }}</ref>
* The idea that eye movement prompts communication between the two sides of the brain. This idea is not grounded in accepted [[neuroscience]].<ref name=epid>{{cite book |veditors=Zeigler-Hill V, Shackelford TR |entry= Eye Movement Desensitization and Reprocessing (EMDR) |title= Encyclopedia of Personality and Individual Differences |year= 2020 |vauthors= Patihis L, Cruz CS, McNally R |publisher=Springer |doi=10.1007/978-3-319-24612-3_895 }}</ref>
* The idea that eye movement prompts communication between the two sides of the brain. This idea is not grounded in accepted [[neuroscience]].<ref name=epid>{{cite book |veditors=Zeigler-Hill V, Shackelford TR |entry= Eye Movement Desensitization and Reprocessing (EMDR) |title= Encyclopedia of Personality and Individual Differences |year= 2020 |vauthors= Patihis L, Cruz CS, McNally R |publisher=Springer |doi=10.1007/978-3-319-24612-3_895 }}</ref>
Line 66: Line 66:
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>
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-analyses have found that the inclusion of bilateral eye-movements within EMDR makes little or no difference to its effect.<ref name="ps-in"/><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 }}</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 = {{pn|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 = {{pn|date=May 2024}} | s2cid = 202289231 | eissn = 1651-2316 | doi-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>
Most 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"/><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 }}</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 }}</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>


==Pseudoscience==
==Pseudoscience==
Line 72: Line 72:


{{blockquote|[T]he false specificity of these treatments is a massive clinical distraction. Time and effort are wasted clinically in studying, perfecting, and using these methods, rather than focusing on the components of the interaction that actually work.<ref name = "SBM" >{{cite web | vauthors = Novella S | author-link = Steven Novella |title=EMDR and Acupuncture – Selling Non-specific Effects |url=https://sciencebasedmedicine.org/emdr-and-acupuncture-selling-non-specific-effects/ |department=Science Based Medicine |publisher=Society for SBM |date=March 30, 2011 |access-date=12 July 2020}}</ref>}}
{{blockquote|[T]he false specificity of these treatments is a massive clinical distraction. Time and effort are wasted clinically in studying, perfecting, and using these methods, rather than focusing on the components of the interaction that actually work.<ref name = "SBM" >{{cite web | vauthors = Novella S | author-link = Steven Novella |title=EMDR and Acupuncture – Selling Non-specific Effects |url=https://sciencebasedmedicine.org/emdr-and-acupuncture-selling-non-specific-effects/ |department=Science Based Medicine |publisher=Society for SBM |date=March 30, 2011 |access-date=12 July 2020}}</ref>}}

Investigation into EMDR has been characterised by poor-quality studies, rather than tightly-controlled trials that could justify or falsify the mechanisms that have been proposed to support it. Novella writes that the research quantity nevertheless means that EMDR has claimed a place among accepted treatments and is "not likely going away anytime soon, even though it is a house of card built on nothing".<ref name="f445">{{cite web | title=EMDR Is Still Dubious | publisher=Science-Based Medicine | date=23 October 2024 | url=https://sciencebasedmedicine.org/emdr-is-still-dubious/ | vauthors=Novella S}}</ref>


EMDR has been characterised as a modern-day [[mesmerism]], as the therapies have striking resemblances, from the sole inventor who devises the system while out walking, to the large business empire built on exaggerated claims. In the case of EMDR, these have included the suggestions that EMDR could drain violence from society and be useful in treating [[cancer]] and [[HIV/AIDS]].<ref name="tsep">{{cite book |title=[[The Skeptic Encyclopedia of Pseudoscience]] |vauthors=Rosen GM, McNally RJ, Lilienfield SO |publisher=Bloomsbury |year=2002 |isbn=978-1-57607-653-8 |veditors=Shermer M, Linse P |volume=1 |pages=321–326 |chapter=EMDR: Eye Movement Desensitization and Reprocessing}}</ref> Psychology historian Luis Cordón has compared the popularity of EMDR to that of other cult-like pseudosciences, [[facilitated communication]] and [[thought field therapy]].<ref name=cordon/>
EMDR has been characterised as a modern-day [[mesmerism]], as the therapies have striking resemblances, from the sole inventor who devises the system while out walking, to the large business empire built on exaggerated claims. In the case of EMDR, these have included the suggestions that EMDR could drain violence from society and be useful in treating [[cancer]] and [[HIV/AIDS]].<ref name="tsep">{{cite book |title=[[The Skeptic Encyclopedia of Pseudoscience]] |vauthors=Rosen GM, McNally RJ, Lilienfield SO |publisher=Bloomsbury |year=2002 |isbn=978-1-57607-653-8 |veditors=Shermer M, Linse P |volume=1 |pages=321–326 |chapter=EMDR: Eye Movement Desensitization and Reprocessing}}</ref> Psychology historian Luis Cordón has compared the popularity of EMDR to that of other cult-like pseudosciences, [[facilitated communication]] and [[thought field therapy]].<ref name=cordon/>
Line 85: Line 87:


== Society and culture ==
== Society and culture ==
* [[Sandra Bullock]] used EMDR following a home invasion by a stalker in 2014.<ref name="Blum_2022" />
⚫
[[Prince Harry]] took a course of EMDR and filmed a session for [[Oprah Winfrey]] during a mental health television documentary in 2021.<ref name="hw">{{cite news | vauthors = Sample I |date=21 May 2021 |title=EMDR: what is the trauma therapy used by Prince Harry? |newspaper=The Guardian |url=https://www.theguardian.com/science/2021/may/21/emdr-what-is-the-trauma-therapy-used-by-prince-harry}}</ref><ref name="Blum_2022">{{Cite news | vauthors = Blum D, Park S |date=2022-09-19 |title='One Foot in the Present, One Foot in the Past:' Understanding E.M.D.R. |language=en-US |work=The New York Times |url=https://www.nytimes.com/2022/09/19/well/emdr-therapy.html |access-date=2023-04-09 |issn=0362-4331}}</ref> Producer and actress [[Sandra Bullock]] used EMDR following a home invasion by a stalker in 2014.<ref name="Blum_2022" />
*In 2019 [[Jameela Jamil]] said she partook in EMDR therapy to treat her [[PTSD|post traumatic stress disorder]].<ref>{{cite web |last1=Luu |first1=Christopher |title=Jameela Jamil Reveals She Attempted Suicide |url=https://www.instyle.com/news/jameela-jamil-suicide-attempt |website=InStyle |language=EN |date=10 October 2019 |access-date=11 November 2020 |archive-date=15 October 2021 |archive-url=https://web.archive.org/web/20211015064549/https://www.instyle.com/news/jameela-jamil-suicide-attempt |url-status=dead}}</ref><ref>{{Cite AV media |url=https://www.youtube.com/watch?v=F2c1_QiQSsc |title="EMDR therapy removed emotion linked to the traumatic memory." Jameela Jamil |date=2024-03-15 |last=Creative Mind Videos |access-date=2024-07-27 |via=YouTube}}</ref>
⚫
* In 2021 [[Prince Harry]] took a course of EMDR and filmed a session for [[Oprah Winfrey]] during a mental health television documentary.<ref name="hw">{{cite news | vauthors = Sample I |date=21 May 2021 |title=EMDR: what is the trauma therapy used by Prince Harry? |newspaper=The Guardian |url=https://www.theguardian.com/science/2021/may/21/emdr-what-is-the-trauma-therapy-used-by-prince-harry}}</ref><ref name="Blum_2022">{{Cite news | vauthors = Blum D, Park S |date=2022-09-19 |title='One Foot in the Present, One Foot in the Past:' Understanding E.M.D.R. |language=en-US |work=The New York Times |url=https://www.nytimes.com/2022/09/19/well/emdr-therapy.html |access-date=2023-04-09 |issn=0362-4331}}</ref>
* In 2022 [[BBC]] war correspondent [[Fergal Keane]], who suffered from PTSD, credited his EMDR therapist with helping save his life.<ref>{{Cite web|url=https://emdrassociation.org.uk/media/bbc2-ptsd-fergal-keane/|title=BBC2 PTSD Fergal Keane|website=EMDR UK Association}} Starting 34:38 into the programme.</ref>


== See also ==
== See also ==
* [[Abreaction]]
* [[Abreaction]]
⚫
* [[Treatments for PTSD]]
* [[List of topics characterized as pseudoscience]]
* [[List of topics characterized as pseudoscience]]
⚫
* [[Treatments for PTSD]]


== References ==
== References ==

Latest revision as of 15:04, 16 December 2024

"EMDR" redirects here. For the materials characterisation technique, see Electrically detected magnetic resonance.

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that is a recommended treatment for post-traumatic stress disorder (PTSD), but remains controversial within the psychological community. It was devised by Francine Shapiro in 1987 and originally designed to alleviate the distress associated with traumatic memories such as PTSD.

EMDR involves focusing on traumatic memories in a manner similar to exposure therapy while engaging in side-to-side eye movements or other forms of bilateral stimulation.[1][2] It is also used for some other psychological conditions.[3][4]

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 Affairs and Defense. The US National Institute of Medicine found insufficient evidence to recommend EMDR.[5] The American Psychological Association suggests EMDR may be useful for treating adult PTSD.[6] Treatment guidelines note EMDR effectiveness is statistically the same as trauma-focused behavioral therapy, and the Australian National Health and Medical Research Council notes that this may be due to including most of the core elements of cognitive behavioral therapy (CBT).

There is debate about how the therapy works and whether it is more effective than other established treatments.[1][7] The eye movements have been criticized as having no scientific basis.[8] The founder promoted the therapy for the treatment of PTSD, and proponents employed untestable hypotheses to explain negative results in controlled studies.[9] EMDR has been characterized as a pseudoscientific purple hat therapy (i.e., only as effective as its underlying therapeutic methods without any contribution from its distinctive add-ons).[10][11]

Classification and technique

EMDR adds a number of non-scientific practices to exposure therapy.[8] EMDR is classified as one of the "power therapies" alongside thought field therapy, Emotional Freedom Techniques and others – so called because these therapies are marketed as being superior to established therapies which preceded them.[12]

EMDR is typically undertaken in a series of sessions with a trained therapist.[13] The number of sessions can vary depending on the progress made. A typical EMDR therapy session lasts from 60 to 90 minutes.[14]

Trauma and PTSD

The person being treated is asked to recall an image, phrase, and emotion that represent a level of distress related to a trigger while generating one of several types of bilateral sensory input, such as side-to-side eye movements or hand tapping.[15] The 2013 World Health Organization practice guideline says that "Like cognitive behavioral therapy (CBT) with a trauma focus, EMDR aims to reduce subjective distress and strengthen adaptive beliefs related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure or (d) homework."[16]

Training

Shapiro was criticized for repeatedly increasing the length and expense of training and certification, allegedly in response to the results of controlled trials that cast doubt on EMDR's efficacy.[17][18] This included requiring the completion of an EMDR training program in order to be qualified to administer EMDR properly after researchers using the initial written instructions found no difference between no-eye-movement control groups and EMDR-as-written experimental groups. Further changes in training requirements and/or the definition of EMDR included requiring level II training when researchers with level I training still found no difference between eye-movement experimental groups and no-eye-movement controls and deeming "alternate forms of bilateral stimulation" (such as finger-tapping) as variants of EMDR by the time a study found no difference between EMDR and a finger-tapping control group.[17] Such changes in definition and training for EMDR have been described as "ad hoc moves [made] when confronted by embarrassing data".[19]

Medical uses

EMDR is controversial within the psychological community.[20][7][21] It is used by some practitioners for trauma therapy and in the treatment of complex post-traumatic stress disorder.[22][23]

Acute stress disorder and PTSD

Effectiveness

A Cochrane systematic review comparing EMDR with other psychotherapies in the treatment of Chronic PTSD found EMDR to be just as effective as TF-CBT and more effective than the other non-TF-CBT psychotherapies.[24][25] Caution was urged interpreting the results due to low numbers in included studies, risk of researcher bias, high drop-out rates, and overall "very low" quality of evidence for the comparisons with other psychotherapies.[24] A 2016 systematic review and meta-analysis found that the effect size of EMDR for PTSD is comparable to other evidence-based treatments, but that the strength of evidence was of a low quality,[26] indicating that the effect sizes achieved are associated with substantial uncertainty. 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.[27]

Many randomized trials of EMDR have been criticized for poor control groups,[28] small sample sizes,[29][4] and other methodological flaws.[4][24][30] It has been called a purple hat therapy because any effectiveness is provided by the underlying therapy (or the standard treatment), not from EMDR's distinctive features.[31][32]

There is some evidence that EMDR can be as effective as trauma focused cognitive behavioral therapy (TF-CBT) for treating PTSD, though concerns have been raised about the poor quality of the underlying studies.[4][24] In a 2021 systematic review of 13 studies, clients had mixed perceptions of the effectiveness of EMDR therapy.[33]

Medical guidelines

  • The World Health Organization's 2013 report on stress-related conditions found insufficient evidence to support EMDR for acute symptoms of traumatic stress.[34] Its 2023 guideline for mental, neurological and substance use disorders recommended EMDR with moderate evidence for adults and children in treating PTSD.[35]
  • The 2018 International Society for Traumatic Stress Studies practice guidelines "strongly recommend" EMDR as an effective treatment for post-traumatic stress symptoms.[36]
  • As of 2017, the American Psychological Association "conditionally recommends" EMDR for the treatment of PTSD in adults, meaning its use is suggested rather than recommended.[6]
  • The UK National Institute for Health and Care Excellence's 2018 PTSD guidelines found low-to-very-low evidence of efficacy for EMDR in treating PTSD, but what was available justified recommending it for non combat-related trauma.[37][38]
  • A 2017 joint report from the US Departments of Veterans Affairs and Defense describes the evidence for EMDR in the treatment of PTSD as "strong."[39]
  • The Australian 2013 National Health and Medical Research Council guidelines recommends EMDR for the treatment of PTSD in adults with its highest grade of evidence, noting that "EMDR now includes most of the core elements of standard trauma-focussed CBT (TF-CBT)" and "the two variants of trauma-focussed therapy are not statistically different."[40]
  • The Institute of Medicine's 2008 report on the treatment of PTSD found insufficient evidence to recommend EMDR, and criticized many of the available studies for methodological flaws including allegiance bias and insufficient controls.[5]
  • The Dutch National Steering Committee on Mental Health Care has released multidisciplinary guidelines which describe "insufficient scientific evidence" to support EMDR in the acute period following a stressful event (2008),[41] but recommend EMDR's use in chronic PTSD (2003).[42][page needed]

Other conditions

EMDR has been tested on a variety of other mental health conditions with mixed results.[4]

  • A 2021 systematic review and meta-analysis found EMDR to have a moderate benefit in treating depression, but the number and quality of the studies were low.[3]
  • Positive effects have also been shown for certain anxiety disorders, but the number of studies was low and the risk of bias high.[4] The American Psychological Association describes EMDR as "ineffective" for the treatment of panic disorder.[43]
  • EMDR has been found to cause strong effects on dissociative identity disorder patients, leading to recommendations for adjusted use.[44][45]
  • A 2023 systematic review of evidence found EMDR's effectiveness in treating mental health conditions of children and adolescents who have been sexually abused is limited.[46]

Possible mechanisms

Incomplete processing of experiences in trauma

Many proposals of EMDR efficacy share an assumption that, as Shapiro posited, when a traumatic or very negative event occurs, information processing of the experience in memory may be incomplete. The trauma causes a disruption of normal adaptive information processing, which results in unprocessed information being dysfunctionally held in memory networks.[47] According to the 2013 World Health Organization practice guideline: "This therapy [EMDR] is based on the idea that negative thoughts, feelings and behaviours are the result of unprocessed memories."[16] This proposed mechanism has no known scientific basis.[8]

Other mechanisms

Several other possible mechanisms have been proposed:

  • EMDR may impact working memory.[48] If a patient performs bilateral stimulation task while remembering the trauma, the amount of information they can recall is thought to be reduced, making the resulting negative emotions less intense and more bearable.[49] This is seen by Robin Logie of the EMDR Association UK and Ireland as a "distancing effect". The client is then believed to re-evaluate the trauma and process it in a less-harmful environment.[50] This explanation is plausible, given research showing that memories are more modifiable once recalled.[51]
  • Horizontal eye movement is thought to trigger an "orienting response" in the brain, used in scanning the environment for threats and opportunities.[52]
  • The idea that eye movement prompts communication between the two sides of the brain. This idea is not grounded in accepted neuroscience.[51]

Bilateral stimulation, including eye movement

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.[2]

Most meta-analyses have found that the inclusion of bilateral eye-movements within EMDR makes little or no difference to its effect.[10][53][54] Meta-analyses have also described a high risk of allegiance bias in EMDR studies.[55] One 2013 meta-analysis with fewer exclusion criteria found a moderate effect.[56]

Pseudoscience

EMDR has been characterized as pseudoscience, because the underlying theory and primary therapeutic mechanism are unfalsifiable and non-scientific. EMDR's founder and other practitioners have used untestable hypotheses to explain studies which show no effect.[9] The results of the therapy are non-specific, especially if directed eye movements are irrelevant to the results. When these movements are removed, what remains is a broadly therapeutic interaction and deceptive marketing.[18][57] According to Yale neurologist Steven Novella:

[T]he false specificity of these treatments is a massive clinical distraction. Time and effort are wasted clinically in studying, perfecting, and using these methods, rather than focusing on the components of the interaction that actually work.[28]

Investigation into EMDR has been characterised by poor-quality studies, rather than tightly-controlled trials that could justify or falsify the mechanisms that have been proposed to support it. Novella writes that the research quantity nevertheless means that EMDR has claimed a place among accepted treatments and is "not likely going away anytime soon, even though it is a house of card built on nothing".[58]

EMDR has been characterised as a modern-day mesmerism, as the therapies have striking resemblances, from the sole inventor who devises the system while out walking, to the large business empire built on exaggerated claims. In the case of EMDR, these have included the suggestions that EMDR could drain violence from society and be useful in treating cancer and HIV/AIDS.[59] Psychology historian Luis Cordón has compared the popularity of EMDR to that of other cult-like pseudosciences, facilitated communication and thought field therapy.[60]

A parody website advertising "sudotherapy" created by a fictional "Fatima Shekel" appeared on the internet in the 1990s.[61][62][63] Proponents of EMDR described the website as libelous, since the website contained an image of a pair of shifting eyes following a cat named "Sudo", and "Fatima Shekel" has the same initials as EMDR's founder, Francine Shapiro.[63] However, no legal action took place against the website or its founders, who are likely protected by American First Amendment protections.[63]

History

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.[64] Psychologist Gerald Rosen has expressed doubt about this description, saying that people are normally not aware of this type of eye movement.[64] Gerald Rosen and Bruce Grimley suggest that it is more likely that she developed EMDR out of her experience with neuro-linguistic programming.[65][66][67]

Fuelled by marketing hype, EMDR was taken up enthusiastically by therapists even while scientists remained skeptical.[60] By 2012 more than 60,000 therapists had been trained in its use.[31]

Society and culture

See also

References

  1. ^ a b c d Blum D, Park S (2022-09-19). "'One Foot in the Present, One Foot in the Past:' Understanding E.M.D.R." The New York Times. ISSN 0362-4331. Retrieved 2023-04-09.
  2. ^ a b Rodenburg R, Benjamin A, de Roos C, Meijer AM, Stams GJ (November 2009). "Efficacy of EMDR in children: a meta-analysis". Clinical Psychology Review. 29 (7): 599–606. doi:10.1016/j.cpr.2009.06.008. PMID 19616353.
  3. ^ a b Carletto S, Malandrone F, Berchialla P, Oliva F, Colombi N, Hase M, et al. (April 2021). "Eye movement desensitization and reprocessing for depression: a systematic review and meta-analysis". European Journal of Psychotraumatology. 12 (1): 1894736. doi:10.1080/20008198.2021.1894736. PMC 8043524. PMID 33889310.
  4. ^ a b c d e f Cuijpers P, Veen SC, Sijbrandij M, Yoder W, Cristea IA (May 2020). "Eye movement desensitization and reprocessing for mental health problems: a systematic review and meta-analysis". Cognitive Behaviour Therapy. 49 (3): 165–180. doi:10.1080/16506073.2019.1703801. PMID 32043428.
  5. ^ a b Treatment of Posttraumatic Stress Disorder. National Academies Press. 2008. doi:10.17226/11955. ISBN 978-0-309-10926-0.
  6. ^ a b "Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults" (PDF). American Psychological Association. 2017. Retrieved 2023-06-10.
  7. ^ a b Sikes C, Sikes V (2003). "EMDR: Why the controversy?". Traumatology. 9 (3): 169–182. doi:10.1177/153476560300900304.
  8. ^ a b c Lohr JM, Gist R, Deacon B, Devilly GJ, Varker T (2015). "Chapter 10: Science- and Non-Science-Based Treatments for Trauma-Related Stress Disorders". In Lilienfeld SO, Lynn SJ, Lohr JM (eds.). Science and Pseudoscience in Clinical Psychology (2nd ed.). Routledge. p. 292. ISBN 9781462517893. ...eye movements and other bilateral stimulation techniques appear to be unnecessary and do not uniquely contribute to clinical outcomes. The characteristic procedural feature of EMDR appears therapeutically inert, and the other aspects of this treatment (e.g., imaginal exposure, cognitive reappraisal, in vivo exposure) overlap substantially with those of exposure-based treatments for PTSD...EMDR offers few, if any, demonstrable advantages over competing evidence-based psychological treatments. Moreover, its theoretical model and purported primary active therapeutic ingredient are not scientifically supported.
  9. ^ a b Thyer BA, Pignotti MG (2015). "Chapter 4: Pseudoscience in Treating Adults Who Experienced Trauma". Science and Pseudoscience in Social Work Practice. Springer. p. 221. doi:10.1891/9780826177698.0004. ISBN 9780826177681. Nevertheless, to date, given that there is no evidence that anything unique to EMDR is responsible for the positive outcomes in comparing it to no treatment and the florid manner in which it has been marketed, we are including it in this book... Another way in which EMDR qualifies as a pseudoscience is the manner in which it was developed and marketed... EMDR proponents have come up with ad hoc hypotheses to explain away unfavorable results that do not support its theory, which is one of the hallmark indicators of a pseudoscience... This type of post hoc explanation renders her theory unfalsifiable and thus places it outside the realm of science, because to qualify as scientific, a theory must be falsifiable.
  10. ^ a b Thyer BA, Pignotti MG (2015). "Chapter 4: Pseudoscience in Treating Adults Who Experienced Trauma". Science and Pseudoscience in Social Work Practice. Springer. pp. 106, 146. doi:10.1891/9780826177698.0004. ISBN 9780826177681.
  11. ^ Fasce, Angelo (22 December 2017). "What do we mean when we speak of pseudoscience? The development of a demarcation criterion based on the analysis of twenty-one previous attempts [¿Qué queremos decir cuando hablamos de pseudociencia? El desarrollo de un criterio de demarcación basado en el análisis de veintiún intentos anteriores]". Disputatio: Philosophical Research Bulletin. 6 (7): 459–488. doi:10.5281/ZENODO.1433737. ISSN 2254-0601. a technique that avoids [criteria] 1 and 3 but not 2 [and is therefore a pseudoscience based on the classification method described on the previous page]
  12. ^ Rosquist J (2012). Exposure Treatments for Anxiety Disorders: A Practitioner's Guide to Concepts, Methods, and Evidence-Based Practice. Routledge. p. 92. ISBN 9781136915772.
  13. ^ "Post-Traumatic Stress Disorder". National Institute for Health and Care Excellence. 2018-12-05. Retrieved 2021-12-03. 1.6.20 EMDR for adults should: be based on a validated manual; typically be provided over 8 to 12 sessions, but more if clinically indicated, for example if they have experienced multiple traumas; be delivered by trained practitioners with ongoing supervision; be delivered in a phased manner and include psychoeducation about reactions to trauma, managing distressing memories and situations, identifying and treating target memories (often visual images), and promoting alternative positive beliefs about the self; use repeated in-session bilateral stimulation (normally with eye movements) for specific target memories until the memories are no longer distressing; include the teaching of self-calming techniques and techniques for managing flashbacks, for use within and between sessions.
  14. ^ "Experiencing EMDR Therapy".
  15. ^ Feske U (June 1998). "Eye Movement Desensitization and Reprocessing Treatment for Posttraumatic Stress Disorder". Clinical Psychology: Science and Practice. 5 (2): 171–181. doi:10.1111/j.1468-2850.1998.tb00142.x. ISSN 0969-5893.
  16. ^ a b Guidelines for the Management of Conditions that are Specifically Related to Stress (Report). Geneva: World Health Organization. 2013. p. Glossary page 1. PMID 24049868. Archived from the original on November 29, 2013.
  17. ^ a b Rosen GM, Mcnally RJ, Lilienfeld SO (1999). "Eye Movement Magic: Eye Movement Desensitization and Reprocessing". Skeptic. 7 (4).
  18. ^ a b Herbert JD, Lilienfeld SO, Lohr JM, Montgomery RW, O'Donohue WT, Rosen GM, Tolin DF (November 2000). "Science and pseudoscience in the development of eye movement desensitization and reprocessing: implications for clinical psychology". Clinical Psychology Review. 20 (8): 945–971. doi:10.1016/s0272-7358(99)00017-3. PMID 11098395. S2CID 14519988.
  19. ^ McNally RJ (2003). "The demise of pseudoscience". The Scientific Review of Mental Health Practice. 2 (2): 97–101. Archived from the original on 2005-02-11.
  20. ^ McNally RJ (1999). "Research on eye movement desensitization and reprocessing (EMDR) as a treatment for PTSD". PTSD Research Quarterly. 10 (1): 1–7.
  21. ^ Hasandedić-Đapo L (February 2021). "How Psychologists Experience and Perceive EMDR?". Psychiatria Danubina. 33 (Suppl 1): 18–23. PMID 33638952.
  22. ^ Adler-Tapia R, Settle C (2008). EMDR and The Art of Psychotherapy With Children. New York: Springer Publishing Co. p. 228. ISBN 978-0-8261-1117-3.
  23. ^ Scott CV, Briere J (2006). Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment. Thousand Oaks, CA: Sage Publications. p. 312. ISBN 978-0-7619-2921-5.
  24. ^ a b c d Bisson JI, Roberts NP, Andrew M, Cooper R, Lewis C (December 2013). "Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults". The Cochrane Database of Systematic Reviews. 2013 (12): CD003388. doi:10.1002/14651858.CD003388.pub4. PMC 6991463. PMID 24338345.
  25. ^ Watts BV, Schnurr PP, Mayo L, Young-Xu Y, Weeks WB, Friedman MJ (June 2013). "Meta-analysis of the efficacy of treatments for posttraumatic stress disorder". The Journal of Clinical Psychiatry. 74 (6): e541–e550. doi:10.4088/JCP.12r08225. PMID 23842024. S2CID 23087402.
  26. ^ Cusack K, Jonas DE, Forneris CA, Wines C, Sonis J, Middleton JC, et al. (February 2016). "Psychological treatments for adults with posttraumatic stress disorder: A systematic review and meta-analysis". Clinical Psychology Review. 43: 128–141. doi:10.1016/j.cpr.2015.10.003. PMID 26574151.
  27. ^ Forman-Hoffman, Valerie; Cook Middleton, Jennifer; Feltner, Cynthia; Gaynes, Bradley N.; Palmieri Weber, Rachel; Bann, Carla; Viswanathan, Meera; Lohr, Kathleen N.; Baker, Claire (2018-05-17). Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder: A Systematic Review Update (Report). Agency for Healthcare Research and Quality (AHRQ). doi:10.23970/ahrqepccer207.
  28. ^ a b Novella S (March 30, 2011). "EMDR and Acupuncture – Selling Non-specific Effects". Science Based Medicine. Society for SBM. Retrieved 12 July 2020.
  29. ^ "Expert opinion on the scientific recognition of the EMDR method (Eye Movement Desensitization and Reprocessing) for the treatment of post-traumatic stress disorder" (PDF). German Medical Association Scientific Advisory Board for Psychotherapy. 37 (103). September 2006. Retrieved 15 April 2023.
  30. ^ Kaptan SK, Dursun BO, Knowles M, Husain N, Varese F (July 2021). "Group eye movement desensitization and reprocessing interventions in adults and children: A systematic review of randomized and nonrandomized trials". Clinical Psychology & Psychotherapy. 28 (4): 784–806. doi:10.1002/cpp.2549. eISSN 1099-0879. PMID 33415797. S2CID 231194631.
  31. ^ a b Arkowitz H, Lilienfeld SO (1 August 2012). "EMDR: Taking a Closer Look". Scientific American. Retrieved 21 March 2023.
  32. ^ Rosquist (2005). Exposure Treatments for Anxiety Disorders: A Practitioner's Guide to Concepts, Methods, and Evidence-Based Practice. Routledge. p. 94. ISBN 9781136915772.
  33. ^ Shipley G, Wilde S, Hudson M (April 2021). "What do clients say about their experiences of Eye Movement Desensitisation and Reprocessing therapy? A systematic review of the literature". European Journal of Trauma & Dissociation. 6 (2): 100226. doi:10.1016/j.ejtd.2021.100226. ISSN 2468-7499. S2CID 235544895.
  34. ^ Guidelines for the Management of Conditions Specifically Related to Stress (PDF). Geneva, Switzerland: World Health Organization (WHO). 2013. pp. 8–9. ISBN 978-92-4-150540-6. Retrieved 21 March 2023.
  35. ^ Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders. World Health Organization. 2023. ISBN 9789240084278.
  36. ^ Posttraumatic Stress Disorder Prevention and Treatment Guidelines: Methodology and Recommendations. International Society for Traumatic Stress Studies. pp. 13–16. Retrieved 21 March 2023.
  37. ^ "Post-traumatic stress disorder". p. 54.
  38. ^ National Guideline Alliance hosted by the Royal College of Obstetricians and Gynaecologists (2018). NICE guideline NG116: Post-traumatic stress disorder: B- Evidence reviews for psychological, psychosocial and other non-pharmacological interventions for the treatment of PTSD in children and young people. United Kingdom: National Institute for Health and Care Excellence. pp. 69–72. Retrieved 21 March 2023.
  39. ^ Clinical Practice Guideline For The Management Of Posttraumatic Stress Disorder And Acute Stress Disorder (PDF). Washington, D.C.: United States Departments of Veteran Affairs and Defense. 2017. p. 6. Retrieved 21 March 2023.
  40. ^ National Health and Medical Research Council (2013). Australian Guidelines for the Treatment of Acute Stress Disorder & Posttraumatic Stress Disorder (PDF) (Report).
  41. ^ Impact, the Dutch knowledge & advice centre for post-disaster psychosocial care (2008). European Multidisciplinary Guideline: Early psychosocial interventions after disasters, terrorism and other shocking events (PDF). Amsterdam-Zuidoost, Netherlands. pp. 40–41. Retrieved 21 March 2023.{{cite book}}: CS1 maint: location missing publisher (link)
  42. ^ Dutch National Steering Committee Guidelines Mental Health and Care (2003). Guidelines for the diagnosis treatment and management of adult clients with an anxiety disorder (Report). Utrecht, Netherlands: The Dutch Institute for Healthcare Improvement.
  43. ^ APA Work Group On Panic Disorder (2010). Practice Guideline For The Treatment of Patients With Panic Disorder (PDF). American Psychological Association. p. 13. Retrieved 21 March 2023.
  44. ^ Recommended Guidelines: A General Guide to EMDR's Use in the Dissociative Disorders (authored by the EMDR Dissociative Disorders Task Force and published in Shapiro, 1995, 2001)
  45. ^ p. 159, Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision, International Society for the Study of Trauma and Dissociation. 3 Mar 2011
  46. ^ Caro, Paola; Turner, William; Caldwell, Deborah M; Macdonald, Geraldine (2023-06-05). "Comparative effectiveness of psychological interventions for treating the psychological consequences of sexual abuse in children and adolescents: a network meta-analysis". Cochrane Database of Systematic Reviews. 2023 (6): CD013361. doi:10.1002/14651858.CD013361.pub2. PMC 10243720. PMID 37279309.
  47. ^ Solomon RM, Shapiro F (November 2008). "EMDR and the Adaptive Information Processing ModelPotential Mechanisms of Change". Journal of EMDR Practice and Research. 2 (4): 315–325. doi:10.1891/1933-3196.2.4.315. S2CID 7109228.
  48. ^ van den Hout MA, Engelhard IM, Beetsma D, Slofstra C, Hornsveld H, Houtveen J, Leer A (December 2011). "EMDR and mindfulness. Eye movements and attentional breathing tax working memory and reduce vividness and emotionality of aversive ideation". Journal of Behavior Therapy and Experimental Psychiatry. 42 (4): 423–431. doi:10.1016/j.jbtep.2011.03.004. PMID 21570931.
  49. ^ Chen L, Zhang G, Hu M, Liang X (June 2015). "Eye movement desensitization and reprocessing versus cognitive-behavioral therapy for adult posttraumatic stress disorder: systematic review and meta-analysis". The Journal of Nervous and Mental Disease. 203 (6): 443–451. doi:10.1097/NMD.0000000000000306. PMID 25974059. S2CID 34850645.
  50. ^ Logie R (July 2014). "EMDR - more than just a therapy for PTSD?". The Psychologist. 27 (7): 512–517.
  51. ^ a b Patihis L, Cruz CS, McNally R (2020). "Eye Movement Desensitization and Reprocessing (EMDR)". In Zeigler-Hill V, Shackelford TR (eds.). Encyclopedia of Personality and Individual Differences. Springer. doi:10.1007/978-3-319-24612-3_895.
  52. ^ Jeffries FW, Davis P (May 2013). "What is the role of eye movements in eye movement desensitization and reprocessing (EMDR) for post-traumatic stress disorder (PTSD)? a review". Behavioural and Cognitive Psychotherapy. 41 (3): 290–300. doi:10.1017/S1352465812000793. PMID 23102050. S2CID 33309479.
  53. ^ Cuijpers P, Veen SC, Sijbrandij M, Yoder W, Cristea IA (May 2020). "Eye movement desensitization and reprocessing for mental health problems: a systematic review and meta-analysis". Cognitive Behaviour Therapy. 49 (3): 165–180. doi:10.1080/16506073.2019.1703801. PMID 32043428. S2CID 202289231.
  54. ^ Rodenburg R, Benjamin A, de Roos C, Meijer AM, Stams GJ (November 2009). "Efficacy of EMDR in children: a meta-analysis". Clinical Psychology Review. 29 (7): 599–606. doi:10.1016/j.cpr.2009.06.008. PMID 19616353. p. [page needed]: 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.
  55. ^ Cuijpers P, Veen SC, Sijbrandij M, Yoder W, Cristea IA (May 2020). "Eye movement desensitization and reprocessing for mental health problems: a systematic review and meta-analysis". Cognitive Behaviour Therapy. 49 (3): 165–180. doi:10.1080/16506073.2019.1703801. eISSN 1651-2316. PMID 32043428. S2CID 202289231. p. [page needed]: 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.
  56. ^ Lee CW, Cuijpers P (June 2013). "A meta-analysis of the contribution of eye movements in processing emotional memories". Journal of Behavior Therapy and Experimental Psychiatry. 44 (2): 231–239. doi:10.1016/j.jbtep.2012.11.001. PMID 23266601.
  57. ^ Devilly G (2002). "Eye movement desensitization and reprocessing: a chronology of its development and scientific standing" (PDF). The Scientific Review of Mental Health Practice. 1 (2): 132.
  58. ^ Novella S (23 October 2024). "EMDR Is Still Dubious". Science-Based Medicine.
  59. ^ Rosen GM, McNally RJ, Lilienfield SO (2002). "EMDR: Eye Movement Desensitization and Reprocessing". In Shermer M, Linse P (eds.). The Skeptic Encyclopedia of Pseudoscience. Vol. 1. Bloomsbury. pp. 321–326. ISBN 978-1-57607-653-8.
  60. ^ a b Cordón LA, ed. (2005). "Eye movement desensitization and reprocessing". Popular psychology: An encyclopedia. Greenwood Press. pp. 81–82.
  61. ^ de Jongh A, ten Broeke E (February 2007). "A course in pseudoscience" (PDF). De Psycholoog: 87–91. Retrieved 15 April 2023.
  62. ^ McNally RJ (2001). "emdr en mesmerisme". DTH Magazine (in Dutch). 3 (21). Retrieved 15 April 2023.
  63. ^ a b c Thyer BA, Pignotti MG (2015). "Chapter 1: Characteristics of Science and Pseudoscience in Social Work Practice". Science and Pseudoscience in Social Work Practice. Springer. doi:10.1891/9780826177698.0004. ISBN 9780826177681.
  64. ^ a b Rosen GM (June 1995). "On the origin of eye movement desensitization". J Behav Ther Exp Psychiatry. 26 (2): 121–2. doi:10.1016/0005-7916(95)00014-q. PMID 7593684.
  65. ^ M. Rosen, Gerald (2023-05-23). "Revisiting the Origins of EMDR". Journal of Contemporary Psychotherapy. doi:10.1007/s10879-023-09582-x. ISSN 1573-3564.
  66. ^ Grimley, Bruce (2014). "Origins of EMDR- a question of integrity?". The Psychologist.
  67. ^ Grimley, Bruce. "What is Neurolinguistic Programming, (NLP)".
  68. ^ Luu, Christopher (10 October 2019). "Jameela Jamil Reveals She Attempted Suicide". InStyle. Archived from the original on 15 October 2021. Retrieved 11 November 2020.
  69. ^ Creative Mind Videos (2024-03-15). "EMDR therapy removed emotion linked to the traumatic memory." Jameela Jamil. Retrieved 2024-07-27 – via YouTube.
  70. ^ Sample I (21 May 2021). "EMDR: what is the trauma therapy used by Prince Harry?". The Guardian.
  71. ^ "BBC2 PTSD Fergal Keane". EMDR UK Association. Starting 34:38 into the programme.
Retrieved from "https://en.wikipedia.org/enwiki/w/index.php?title=Eye_movement_desensitization_and_reprocessing&oldid=1263416374"