EMDR

Definition

EMDR is an eight-phase protocol for traumatic memory. The distinctive procedure is bilateral stimulation — typically horizontal eye movements, sometimes alternating taps or tones — carried out while the client attends to a traumatic memory, the associated bodily sensation, and a negative belief about themselves.

The protocol also includes history taking, preparation, assessment of the target memory, installation of a positive belief, a body scan, and closure.

History

Francine Shapiro described the effect in 1989, reportedly after noticing that her own distressing thoughts weakened while her eyes moved during a walk.

The treatment spread quickly and controversially. It was for many years dismissed by parts of the field and simultaneously adopted enthusiastically elsewhere, a split that has only partly closed.

Theory

The official account is Adaptive Information Processing: traumatic memories are stored in an unprocessed, state-specific form, and bilateral stimulation allows them to be integrated with existing adaptive networks.

The more parsimonious account is working memory taxation. Holding a vivid memory in mind while performing a demanding secondary task loads working memory, which reduces the vividness and emotionality of the image. On this account the eye movements are doing something real but not what the theory says, and any sufficiently demanding task would work.

The working memory account has more direct experimental support than the AIP account.

Research

EMDR is recommended for PTSD in NICE and WHO guidance and performs comparably to trauma-focused CBT in meta-analyses.

The contested question is not whether the package works but whether the eye movements contribute. Dismantling studies have gone both ways. Laboratory studies of the vividness effect fairly consistently find eye movements do something; clinical dismantling trials are more mixed and often underpowered for the comparison.

A reasonable summary: the treatment works, and the mechanism is not what the founding theory claims.

Applications

Primarily PTSD and single-incident trauma. Increasingly used for complex trauma, though with less evidence and more debate about sequencing.

It requires less verbal disclosure than prolonged exposure, which some clients strongly prefer and which is a genuine practical advantage.

Criticism

• The theory is weak. Adaptive Information Processing is difficult to falsify and does not predict much beyond what it was built to explain.
• Training and certification are tightly controlled by organisations with a commercial interest in the treatment, which has slowed independent scrutiny.
• Early enthusiasm outran the evidence and left a durable credibility problem that better recent trials have only partly repaired.
• Dismantling remains unresolved, and papers on both sides tend to be written by people with a prior position.

References

• Shapiro, F. (2017). Eye Movement Desensitization and Reprocessing (3rd ed.). Guilford Press.
• Bisson, J. I., et al. (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews, CD003388.
• van den Hout, M. A., & Engelhard, I. M. (2012). How does EMDR work? Journal of Experimental Psychopathology, 3(5), 724-738.
• Cuijpers, P., et al. (2020). Eye movement desensitization and reprocessing for mental health problems: A meta-analysis. Cognitive Behaviour Therapy, 49(3), 165-180.