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Eye Movement Desensitization and Reprocessing Therapy (abbreviated as EMDR) is a form of psychotherapy that combines both behavioral therapy techniques and cognitive behavioral techniques with the utilization of lateral eye movements.
EMDR was developed by Dr. Francine Shapiro, a psychotherapist, in the 1980s. She had observed that her clients who were in psychotherapy for issues related to trauma reported relief from their stress as they discussed their recollections of stressful events while engaging in lateral eye movements. Lateral eye movements consist of horizontal movements of the eyes from right to left and then left to right as the individual follows the therapist’s fingers, which the therapist waives horizontally across the client’s visual plane.
Shapiro’s technique gained popularity with therapists. As she refined the technique, she applied it to the treatment of other issues, such as depression, anxiety, and even substance abuse. EMDR has achieved a sort of cult status within the field of clinical psychology. There are journals that specialize in research for EMDR as well as an international organization devoted to the technique. Nonetheless, the technique has generated moderate controversy in the field of clinical psychology.
The first basic principle of EMDR is that the client reflects on their emotionally charged or upsetting experiences while they follow the therapist’s hands back and forth across their visual field. This is the lateral eye movement component of EMDR. Dr. Shapiro has been asked in numerous contexts how this lateral eye movement is supposed to work, and she has explained that use of saccadic eye movements helps to reprocess emotionally laden experiences.
Saccadic eye movements consist of jerky and fast movements of the eyes that occur whenever an individual attempts to focus on an object. Dr. Schapiro and her group have posited numerous neuroanatomical exhalations of why these movements help individuals to process emotionally laden memories or experiences; however, many of these explanations are questionable at best. Essentially, the use of the lateral eye movements is the only original application used in EMDR.
EMDR borrows heavily from other forms of psychotherapy and from overall general principles derived from research that have been found to increase the effectiveness of therapy. These specific techniques and principles include:
This technique has been used in numerous contexts by professional therapists who are trained in applying the technique safely. In addition, cognitive therapists have used exposure techniques extensively by having individuals imagine or recollect past traumatic events, anxiety-provoking situations, feared outcomes, etc. Cognitive-behavioral therapists often use exposure techniques in conjunction with relaxation training. When individuals are trained in muscle relaxation and diaphragmatic breathing, they can tolerate any anticipated stress or discomfort associated with exposure more effectively.
EMDR uses exposure techniques and stress management techniques, such as relaxation training, heavily. Exposure is a technique that is a component of numerous cognitive-behavioral therapeutic interventions, and it has been around far longer than EMDR.
EMDR uses an approach that immediately gets both the therapist and the client involved in the treatment. Variations in the treatment process will occur from therapist the therapist, but there is an overall recommended approach that involves eight phases or steps in the treatment.
EMDR is a recognized form of psychotherapy. In order to practice EMDR professionally, an individual must have a license to perform psychotherapy within the state, and complete specific and intensive training that leads to certification in EMDR interventions.
Competent practice of EMDR cannot be learned through reading articles or books. It requires that an individual be formally trained by an individual certified in EMDR who is qualified to train others.
As mentioned above, EMDR practitioners are fully convinced that the technique is a valid and unique approach to the treatment of stress, trauma, anxiety, and numerous other issues. The therapists are often devoted to the technique and to the principles originally developed by Dr. Shapiro. However, there have been numerous concerns associated with this technique.
The first issue that is often considered to be a “red flag” by many professional psychologists is that the eye movement component of EMDR is not necessary.
Some of the therapists who practice EMDR do not even use the eye movement component but instead use other types of attention-grabbing techniques, such as finger taps, sounds, or other attention-focusing techniques with equivalent success to therapists who use the eye movement component. Thus, it is unclear if the eye movement component of the technique offers any incremental clinical utility to other already empirically validated techniques from the cognitive and behavioral schools of psychotherapy.
The text Science and Pseudoscience in Clinical Psychology, a book that attempts to differentiate empirically validated techniques in clinical psychology from techniques that are not empirically validated, reviewed the research regarding the effectiveness of EMDR and concluded that the eye movement component is not necessary, and the success of the EMDR therapy technique is primarily due to the use of cognitive and behavioral components. Numerous other sources, including meta-analytic research and the journal Scientific American, have come to the same conclusion.
A 2013 study in the prestigious Cochrane Review found that EMDR is superior to no treatment at all for trauma- and stressor-related disorders, and overall, its treatment success is comparable and equivalent in its effectiveness to other cognitive-behavioral forms of treatment used to address these issues. These findings suggest that the EMDR technique offers no incremental validity over the other already established interventions that it incorporates and that the eye movement component adds very little, if anything at all, to the therapy; incremental validity refers to the notion that a new type of technique increases the effectiveness of already established techniques. Thus, it appears that the effectiveness of EMDR is primarily due to its use of established cognitive and behavioral principles.
These types of findings suggest that EMDR is certainly no worse than already established treatments, but it also adds little that is unique to techniques that have been used and developed by other paradigms. This could be an important consideration when an individual is choosing a therapist who uses EMDR compared to one who uses more standard cognitive-behavioral techniques because EMDR interventions are often more expensive than standard cognitive-behavioral treatments. However, some individuals may become more involved in therapies that use different or unique approaches, and may experience more satisfaction as a result of the overall approach used by EMDR therapists and its concentration on the relationship between the client and therapist.