In Brief

EMDR is an acronym for Eye Movement Desensitization and Reprocessing. It is an innovative clinical treatment that has successfully helped over a million individuals who have survived trauma, including sexual abuse, domestic violence, combat, crime, and those suffering from a number of other complaints including depressions, addictions, phobias and a variety of self-esteem issues.

EMDR is a complex method of psychotherapy that integrates many of the successful elements of a range of therapeutic approaches in combination with eye movements or other forms of rhythmical stimulation in ways that stimulate the brain's information processing system. With EMDR therapy it is unnecessary to delve into decades-old psychological material, but rather, by activating the information-processing system of the brain, people can achieve their therapeutic goals at a rapid rate, with recognizable changes that don't disappear over time.

Fourteen controlled studies support the efficacy of EMDR, making it the most thoroughly researched method ever used in the treatment of trauma. The most recent 5 studies with individuals suffering from events such as rape, combat, loss of a loved one, accidents, natural disasters, etc. have found that 84-90% no longer had post-traumatic stress disorder after only three treatment sessions. A recent study financed by Kaiser Permanente revealed that EMDR was twice as effective in half the amount of time compared to the standard traditional care. However, clients and clinicians should note that EMDR is not a race. While many people show dramatic responses in a short amount of time, there are also those who will progress more slowly and that the slower progresssion is not abnormal. Just as in any therapy, we all progress at the rate appropriate to the individual and the clinical situation.

The major significance of EMDR is that it allows the brain to heal its psychological problems at the same rate as the rest of the body is healing its physical ailments. Because EMDR allows minds and body to heal at the same rate, it is effectively making time irrelevant in therapy. Given its wide application, EMDR promises to be the therapy of the future.

Dr. Francine Shapiro is the creator of EMDR. She is a licensed psychologist and a senior research fellow at the Mental Research Institute in Palo Alto. She is the Executive Director of the EMDR Institute, which trains clinicians in the EMDR method. She is the recipient of the 1994 Distinguished Scientific Achievement Award presented by the California Psychological Association.

What EMDR is NOT

• Hypnosis (not that we at VPG have anything against hypnosis!).
• A miracle cure.
• A quick fix.
• A "technique."
• "Mind control."
• A "simple treatment" that anyone can learn.

EMDR In More Detail

Eye Movement Desensitization and Reprocessing (EMDR) is an interactional, standardized approach and method that integrates into, and augments, a treatment plan. EMDR accelerates the treatment of a wide range of pathologies and self esteem issues related to both upsetting past events and present life conditions. Controlled studies of victims of Vietnam combat, rape, molestation, accident, catastrophic loss and natural disaster indicate that the method is capable of a rapid desensitization of traumatic memories, including a cognitive restructuring and a significant reduction of client symptoms (e.g., emotional distress, intrusive thoughts, flashbacks and nightmares. There are more controlled studies to date on EMDR than on any other method used in the treatment of trauma. A literature review indicated only six other controlled clinical outcome studies (excluding drugs) in the entire field of PTSD (Solomon, Gerrity, and Muff, 1992).

EMDR was developed by Francine Shapiro, Ph.D. in 1987, and to date over 22,000 licensed mental health therapists in 52 countries have been trained. Because a clinical background is necessary for the effective application of EMDR, workshops are limited to mental health professionals who are licensed or certified to provide treatment. Training is considered mandatory for appropriate use (Shapiro,1991b). EMDR is a specialized approach and method that requires supervised training for full therapeutic effectiveness and client safety.

EMDR is a complex methodology which combines salient elements of the major modalities (e.g., psychodynamic, behavioral, cognitive, physiological, and interactional). Although the eye movement, or other forms of dual stimulation, has garnered the most attention, the method actually consists of eight phases and numerous procedural elements that all contribute to its efficacy (see Shapiro, 1995a). Far from being viewed as a panacea, EMDR should be used only within a comprehensive treatment plan by a licensed and trained clinician who is experienced in working with the targeted population. To date, thirteen controlled studies of EMDR have been completed, making it the most intensively researched of any method for the treatment of trauma. Two of these studies reported mixed results (Boudewyns et al., 1993; Pitman, et al., 1996) and one obtained null results (Jensen, 1994). Five demonstrated superiority of EMDR over one or more alternative treatments (Boudewyns & Hyer, 1996; Carlson et al., in press; Marcus et al. ,1996; Scheck et al., in press; Vaughan, Armstrong et al., 1994) and two found EMDR to be more effective than a wait-list control (Rothbaum, 1997; Wilson, Becker & Tinker, 1995 and in press). In addition, substantial alleviation of PTSD symptomatology was reported in two controlled component analyses (Renfrey & Spates, 1994; Wilson, Silver, Covi, & Foster, 1996), as well as in numerous case studies. The most recent and rigorously controlled studies with single trauma victims indicate that after three sessions, 84 - 90% of the subjects no longer meet the criteria for PTSD.

Regardless of the primary psychological orientation, clinicians would generally agree that most psychological complaints stem from the impact of earlier life experiences. The EMDR protocols guide clinicians to utilize specific history-taking procedures to ascertain (a) what earlier life experiences have contributed to the symptomatology, (b) what present triggers elicit the disturbance, and (c) what behaviors and skills are necessary to prepare the client for appropriate future action. For instance, the clinician identifies the specific events which taught the client such negative self-assessments as: I'm not good enough; I'm not lovable; I can't succeed; I'm worthless; I can't trust, etc. The assumption is that these earlier life experiences are stored in a dysfunctional fashion, contributing to the client's inappropriate reactions in the present. Consistent with recent conjectures regarding memory (van der Kolk, 1994), it is believed that experiences which provide the underpinnings of pathology have been stored without sufficient processing. When these earlier experiences are brought to mind, they retain a significant level of disturbance, manifested by both emotions and physical sensations. Reprocessing these experiences with EMDR allows the client to gain insight, shift cognitive assessment, incorporate ecological emotions and body reactions, as well as adopt more adaptive behaviors.

What some well-know psychotherapists and researchers say

"The speed at which change occurs during EMDR contradicts the traditional notion of time as essential for psychological healing. Shapiro has integrated elements from many different schools of psychotherapy into her protocols, making EMDR applicable to a variety of clinical populations and accessible to clinicians from different orientations."

- Bessel A. van der Kolk, MD, Professor of Psychiatry, Boston University School of Medicine

"EMDR assists survivors in the immediate aftermath of violent trauma by breaking through the walls of denial, shock, grief and anger..Ideal for those who have been unable to forget past traumatic life events, as it allow for a rapid processing of even deeply rooted memories, giving individuals back control of their lives and their emotions."

- -Dusty Bowencamp, RN CTR, Disaster Mental Health, American Red Cross

"EMDR is a significant component of treatment in the Trauma Recovery Program at the Menninger Clinic."

- Bulletin of the Menninger Clinic

"EMDR is a powerful new tool for relieving human suffering; its study opens new doors to our understanding of the mind. It is one of the most significant advances since the introduction of psychopharmacologic drugs."

- Steven Lazrove, M.D., Yale University

"EMDR is one of the newest and most promising methods that has arisen in the last 10-20 years. EMDR attends to the client as a complex and multifaceted person."

-Arnold A. Lazarus, Ph.D., A.B.P.P., Rutgers University

"Francine Shapiro has made an enduring contribution to the field of psychotherapy."

-Jeffrey K. Zeig, Ph.D., Director, The Milton H. Erickson Foundation

"Dr. Shapiro's work has proven invaluable to clinicians around the world in helping people following trauma."

-Atle Dyregrov, Ph.D., Consultant to UNICEF

"A lifesaving process for battered women...everyone who has experienced the psychological pain from abuse or knows someone who has should know about EMDR!"

-Lenore Walker, Ed.D. ABPP, Domestic Violence Institute

"EMDR provides a proven approach to address the trauma that can interfere with healthy grief and mourning following the loss of a loved one."

-Therese A. Rando, Ph.D., Founder and Executive Director, The Institute for the Study and Treatment of Loss

"EMDR is proving to be the silicon chip of psychotherapy; it allows people to process incredible amounts of material in a shockingly short time."

-Michael Elkin,Ph.D., Director, Center for Collaborative Solutions

"EMDR quickly opens new windows on reality, allowing people to see solutions within themselves that they never knew were there. And it's a therapy where the client is very much in charge, which can be particularly meaningful when people are recovering from having their power taken away by abuse and violation."

-Laura S. Brown, Ph.D., University of Washington

"EMDR is the most revolutionary, important method to emerge in psychotherapy in decades."

-Herbert Fensterheim, Ph.D., Cornell University

"EMDR is the most powerful and integrative intervention I have learned in the past five years."

-John C. Norcross, Ph.D., University of Scranton

What the studies show

There are more controlled studies on EMDR than on any other method used in the treatment of PTSD (Shapiro, 1995a,b, 1996). A literature review indicated only 6 other controlled clinical outcome studies (excluding drugs) in the entire field of PTSD (Solomon, Gerrity, and Muff, 1992).

The following controlled EMDR studies have been completed:

• Boudewyns, Stwertka, Hyer, Albrecht, and Sperr (1993). A pilot study randomly assigned 20 chronic inpatient veterans to EMDR, exposure, and group therapy conditions and found significant positive results from EMDR for self-reported distress levels and therapist assessment. No changes were found in standardized and physiological measures, a result attributed by the authors to insufficient treatment time considering the secondary gains of the subjects who were receiving compensation. Results were considered positive enough to warrant further extensive study, which has been funded by the VA. Preliminary reports of the data (Boudewyns & Hyer, 1996) indicate that EMDR is superior to a group therapy control on both standard psychometrics and physiological measures.
• Carlson, et al. (in press) tested the effect of EMDR on chronic combat veterans suffering from PTSD since the Vietnam War. Within 12 session subjects showed substantial clinical improvement, with a number becoming symptom-free. EMDR proved superior to a biofeedback relaxation control group and to a group receiving routine VA clinical care. Results were independently evaluated on CAPS-1, Mississippi Scale for PTSD, IES, ISQ, PTSD Symptom Scale, Beck Depression Inventory, and STAI.
• Jensen (1994). A controlled study of the EMDR treatment of 25 Vietnam combat veterans suffering from PTSD, as compared to a non-treatment control group, found small but statistically significant differences after two sessions for in-session distress levels, as measured on the SUD Scale, but no differences on the Structured Interview for Post-traumatic Stress Disorder (SI-PTSD), VOC, GAS, and Mississippi Scale for Combat-Related PTSD (M-PTSD; Jensen, 1994). This study was done by two psychology interns who had not completed formal EMDR training. Furthermore, the interns reported low fidelity checks of adherence to the EMDR protocol and skill of application, which indicated their inability to make effective use of the method to resolve the therapeutic issues of their subjects.
• Marcus et al. (1996) evaluated sixty seven individuals diagnosed with PTSD in a controlled study funded by Kaiser Permanente Hospital. EMDR was found superior to standard Kaiser Care which consisted of combinations of individual, and group therapy, as well as medication. An independent evaluator assessed participants on the basis of the Symptom Checklist-90, Beck Depression Inventory, Impact of Event Scale, Modified PTSD Scale, Spielberger State-Trait Anxiety Inventory, and SUD.
• Pitman et al. (1996). In a controlled component analysis study of 17 chronic outpatient veterans, using a crossover design, subjects were randomly divided into two EMDR groups, one using eye movement and a control group that used a combination of forced eye fixation, hand taps, and hand waving. Six sessions were administered for a single memory in each condition. Both groups showed significant decreases in self-reported distress, intrusion, and avoidance symptoms.
• Renfrey and Spates (1994). A controlled component study of 23 PTSD subjects compared EMDR with eye movements initiated by tracking a clinician's finger, EMDR with eye movements engendered by tracking a light bar, and EMDR using fixed visual attention. All three conditions produced positive changes on the CAPS, SCL-90-R, Impact of Event Scale, and SUD and VOC scales. However, the eye movement conditions were termed "more efficient."
• Rothbaum (1997) the controlled study of rape victims found that, after three EMDR treatment sessions, 90% of the participants no longer met full criteria for PTSD. Results were evaluated on the PTSD Symptom Scale, Impact of Event Scale, Beck Depression Inventory, and Dissociative Experience Scale by an independent assessor.
• Scheck et al. (in press) Sixty females ages 16-25 screened for high-risk behavior and traumatic history were randomly assigned to two session of either EMDR or active listening. There was substantially greater improvement for EMDR as independently assessed on the Beck Depression Inventory, State-Trait Anxiety Inventory, Penn Inventory for Post-Traumatic Stress Disorder, Impact of Event Scale, and Tennessee Self-Concept Scale. Although the treatment was comparatively brief, the EMDR treated participants came within the first standard deviation compared to non-patient norm groups for all five measures.
• Shapiro (1989a). The initial controlled study of 22 rape, molestation, and combat victims compared EMDR and a modified flooding procedure that was used as a placebo to control for exposure to the memory and to the attention of the researcher. Positive treatment effects were obtained for the treatment and delayed treatment conditions on SUDs and behavioral indicators, which were independently corroborated at 1- and 3-month follow-up sessions.
• Vaughan, Armstrong, et al. (1994). In a controlled comparative study, 36 subjects with PTSD were randomly assigned to treatments of (1) imaginal exposure, (2) applied muscle relaxation, and (3) EMDR. Treatment consisted of four sessions, with 60 and 40 minutes of additional daily homework over a 2- to 3-week period for the image exposure and muscle relaxation groups, respectively, and no additional homework for the EMDR group. All treatments led to significant decreases in PTSD symptoms for subjects in the treatment groups as compared to those on a waiting list, with a greater reduction in the EMDR group, particularly with respect to intrusive symptoms.
• D. Wilson, Covi, Foster, and Silver (1996). In a controlled study, 18 subjects suffering from PTSD were randomly assigned to eye movement, hand tap, and exposure-only groups. Significant differences were found using physiological measures (including galvanic skin response, skin temperature, and heart rate) and the SUD Scale. The results revealed, with the eye movement condition only, a one-session desensitization of subject distress and an automatically elicited and seemingly compelled relaxation response, which arose during the eye movement sets.
• S. Wilson, Becker, and Tinker (1995). A controlled study randomly assigned 80 trauma subjects (37 diagnosed with PTSD) to treatment or delayed-treatment EMDR conditions and to one of five trained clinicians. Substantial results were found at 30 and 90 days and 12 months post treatment on the State-Trait Anxiety Inventory, PTSD-Interview, Impact of Event Scale, SCL-90-R, and the SUD and VOC scales. Effects were equally large whether or not the subject was diagnosed with PTSD.

Non-randomized studies involving PTSD symptomatology include:

• An analysis of an inpatient veterans' PTSD program (n = 100) compared EMDR, biofeedback, and relaxation training and found EMDR to be vastly superior to the other methods on seven of eight measures (Silver, Brooks, & Obenchain, 1995).
• Astudy of Hurricane Andrew survivors found significant differences on the Impact of Event Scale and SUD scales in a comparison of EMDR and non-treatment conditions (Grainger, Levin, Allen-Byrd, Doctor & Lee, in press).
• A study of 60 railroad personnel, suffering from high-impact critical incidents, compared a peer counseling debriefing session alone to a debriefing session that included approximately 20 minutes of EMDR (Solomon & Kaufman, 1994). The addition of EMDR produced substantially better scores on the Impact of Event Scale at 2- and 10-month follow-ups.
• Research at Yale Psychiatric Clinic conducted by Lazrove et al. (1995) indicated that all symptoms of PTSD were relieved within three sessions for single-trauma victims as independently assessed on standard psychometrics.
• Of 445 respondents to a survey of trained clinicians who had treated over 10,000 clients, 76% reported greater positive effects with EMDR than with other methods they had used. Only 4% found fewer positive effects with EMDR (Lipke, 1994).

Recent EMDR Studies

Studies with single trauma victims indicate that after three sessions 84 - 90% of the subjects not longer meet the criteria for PTSD.

• The Rothbaum (1997) study found that, after three EMDR sessions 90% of the participants no longer met full criteria for PTSD. In a test of subjects whose responses to EMDR were reported by Wilson, Becker & Tinker (1995a), it was found that 84% (n=25) of the participants initially diagnosed with PTSD still failed to meet criteria at 15 month follow-up (Wilson, Becker & Tinker, in press). Similar data were reported by Lazrove et al. (1995, November) in a recent systematically evaluated case series. While one subject dropped out very early in the study, of the seven subjects who completed treatment (including mothers who had lost their children to drunken drivers), none met PTSD criteria at follow-up.