Does EMDR work better than supportive listening?
Probably. Although the research evidence on this front is less extensive, most studies indicate that EMDR produces more improvement than control conditions in which therapists merely listen attentively to a client’s problems but do not attempt to intervene directly. (Studies generally show, however, that such supportive listening conditions produce positive effects in their own right.) So the therapeutic effects of EMDR probably cannot be attributed entirely to the beneficial consequences of interacting with a warm and empathetic therapist. Something more seems to be going on.
Does EMDR work better than standard behavior and cognitive-behavior therapies?
No. Most behavior and cognitive-behavior therapies for anxiety rely on a core principle of change: exposure. That is, these treatments work by exposing clients repeatedly to anxiety-provoking stimuli, either in their imagination (“imaginal exposure”) or in real life (“in vivo exposure”). When exposure to either type is sufficiently prolonged, clients’ anxiety dissipates within and across sessions, generating improvement.
When scientists have compared EMDR with imaginal exposure, they have found few or no differences. Nor have they found that EMDR works any more rapidly than imaginal exposure. Most researchers have taken these findings to mean that EMDR’s results derive from the exposure, because this treatment requires clients to visualize traumatic imagery repeatedly. Last, researchers have found scant evidence that the eye movements of EMDR are contributing anything to its effectiveness. When investigators have compared EMDR with a “fixed eye movement condition”—one in which clients keep their eyes fixed straight ahead—they have found no differences between conditions. In light of those findings, the panoply of hypotheses invoked for EMDR’s eye movements appears to be “explanations in search of a phenomenon.”
So, now to the bottom line: EMDR ameliorates symptoms of traumatic anxiety better than doing nothing and probably better than talking to a supportive listener. Yet not a shred of good evidence exists that EMDR is superior to exposure-based treatments that behavior and cognitive-behavior therapists have been administering routinely for decades. Paraphrasing British writer and critic Samuel Johnson, Harvard University psychologist Richard McNally nicely summed up the case for EMDR: “What is effective in EMDR is not new, and what is new is not effective.”
This article was originally published with the title EMDR: Taking a Closer Look.
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19 Comments
Add CommentBoth McNally and Lilienfeld have seemingly taken upon themselves the mission of discrediting EMDR. Ask any therapist who has been trained in EMDR and you will get a completely different opinion. Research psychologists know very little about what works outside of university studies. Clinicians know that EMDR works faster and better than traditional exposure therapies (for PTSD) and that there are much fewer drop-outs.
Reply | Report Abuse | Link to thisDan Opdyke, Ph.D.
I've received both EMDR and Experiential therapies for anxiety related conditions. Both were effective, each slightly differently than another. As I saw what each did for me, I felt empowered to ask for what I wanted, sometimes EMDR, sometimes Experiential, sometimes both. Why should it be one or the other? Seems like someone was getting defensive - have an issue you'd like to explore? :-)
Reply | Report Abuse | Link to thisI am concerned that the same old articles regarding EMDR and its efficacy are being retread as if they were pertaining to new material. There is a failure to look at any relevant data regarding the efficacy of EMDR. There are over 16 controlled studies supporting demonstrating the effectiveness of the 8 phase treatment protocol. In contrast to the claim that there is no difference between EMDR and Exposure Based treatments, the data have indicated that although there was no significant differences in outcome, the EMDR treatment did not require an hour of homework. If one really wants to know whether EMDR works or doesn't work, is different or the same as other treatments, one should be looking at the data and not at reworked statements of the data. Please look at www.emdr.com; www.emdria.org and www.emdr-hap.org for a full depiction of the studies and their results.
Reply | Report Abuse | Link to thisZona Scheiner, Ph.D.
Lilienfeld and McNally attack EMDR as not effective in spite of resounding endorsements of EMDR'S effectiveness in the treatment of trauma. They seem not to notice the world of trauma treatment is moving past them.
Reply | Report Abuse | Link to thisThe point is somewhat moot - we don't really know much about what works in psychotherapy - there has been a lot of research on exposure and other cbt therapies - much of it not well done, so to criticize another modalilty onthe basis of old research, seems irrelevant. Comments such as " scientists have,,," are not helpfulor useful and simply contribute to misinformation. This comment seems to be more like pseudo science than anything else, and since the authors are promoting science, perhaps closer attention is in order.
Reply | Report Abuse | Link to thisLiz Massiah
Drs. Lillienfeld and Arkowitz perform an interesting slight-of-hand when they state no to their question, does EMDR work better than standard behavior [i.e. exposure] and cognitive behavior therapies? They do NOT say that EMDR has been found to be of equivalent benefit, leaving the reader possibly assuming that EMDR is a less effective treatment. In fact, several studies have found EMDR equal to or superior in efficiency to CBT (see Van Etten, 1998; Ironson, 2002; Jaberghaderri et al. 2004).
Reply | Report Abuse | Link to thisExposure theorists require specific doses, i.e. continuous stimulation with response prevention, to effect habituation. Thus, EMDR should not make clients better but rather worse, since the intermittent exposure that can occur in EMDR theoretically should tend to increase symptom reactivity rather than dampen it. Accepted habituation/extinction mechanisms of conventional exposure do not seem to explain how EMDR dampens responses without continuous stimulation. Therefore, while exposure and CBT theorists continuously attempt to subsume EMDR as a kind of exposure therapy, EMDR is far more multi-dimensional.
EMDR is more efficient than CBT or exposure since it does not require homework in between sessions. In fact, when homework was equalized in the Ironson et al. (2002) study, the effectiveness of EMDR was comparable to exposure therapy but more efficient. In three sessions, 70% of the EMDR subjects had significant symptom reduction vs. only 29% of subjects in the exposure cohort. This same efficiency rate was previously noted (three-session remission of 84-90% of PTSD symptoms: Rothbaum, 1997; Wilson et al., 1995, 1997; and 77-100% remission with 5.4 treatment hours Marcus et al., 1997, 2004). Rothbaum et al. (2005) noted: An interesting potential clinical implication is that EMDR seemed to do equally well in the main despite less exposure and no homework. It will be important for future research to explore these issues.
Drs. Lillienfeld and Arkowitz state scant evidence that eye movements contribute anything to its effectiveness. However, in seven randomized studies, researchers investigated the eye movements used in EMDR to evaluate several hypotheses, including working memory and the orienting response (see Barrowcliff et. al 2004; Barrowcliff et. al 2003; Christman et. al 2003; Kavanagh et. al 2001; Kuiken et. al 2001-2002; Lee & Drummond in press; and Van den Hout et. al 2001). All seven studies independently corroborate that eye movements have a direct effect upon memory, including distress reduction and diminution of vivid imagery. Psychophysiological research also documents that eye movements create a pronounced parasympathetic activation (e.g., Elofsson et al., in press; Barrowcliff et al., 2003). The ISTSS treatment guidelines published in 2000 for PTSD indicated that the extant clinical component analyses were flawed and could not be used to determine the role of the eye movement.
While the authors note the large number of EMDR-trained therapists, they do not mention the significant number of randomized clinical trials (over 18) or non-randomized clinical trials (over 8). One might wonder why the authors consistently and energetically publish similar articles attempting to discredit EMDR using misinformation as well as omission of evidence-based research.
Patti Levin, LICSW, PsyD
Boston, MA
When my 5 year old child and I almost burned to death in a middle-of-the night house fire I know EMDR helped both of us.
Reply | Report Abuse | Link to thisI did the research, I know of all of the studies that say it does work more importantly, I know that my child and I (along with others involved in the fire)can live life without fearing the sound of a siren, the smell of burning wood and the sight of a fireplace.
In fact, last week we had the fire dept in our house because of a bad outlet. My daughter didn't even bat an eye, we were both just fine and all of that credit goes to 6 (between the two of us) EMDR sessions.
An unfortunate example of substandard journalism this time in the Scientific American ignoring the evidence that EMDR is clearly a superior treatment to CBT/Exposure.
Reply | Report Abuse | Link to thisIn addition to what Patti Levin cited in her earlier post, I would add what I consider some very relevant research information for prospective consumers of PTSD treatment. Dr. Tonya Edmond has brought to this issue qualitative published research data on how adult females with histories of significant Child Sexual Abuse (CSA) were impacted by their therapy experience. In her study, EMDR and eclectic groups each had significant positive effects compared to the control group as measured by four standardized quantitative measures, but there were no significant outcome differences between them on those measures a fairly typical outcome in research reported by other respondents. However, the EMDR group did report significantly greater problem resolution than the eclectic therapy group on the subjective quantitative measures.
Reply | Report Abuse | Link to thisThe most interesting differences, however, were in the qualitative individual assessments of the therapy experience data from individual standard interviews asking clients what the experience was like for them and what differences it made for them. The eclectic group typically stated that the relational quality of their experience was the most helpful component, and their benefits from treatment were described in terms of increased resources and ability to deal with their distress, improved perceptions of themselves, and increased power and potential for going on with life in spite of the issues with past problems. However none of the 20 respondents from this group stated that the problem they chose to address in the six treatment sessions had been resolved -- these targets would benefit from further treatment.
In the EMDR group, clients identified the EMDR procedures and process as the major component contributing to the effectiveness of their treatment. None of them commented about the relational aspects of treatment unless prompted to do so. However, half of this group stated that the targets chosen to be addressed in treatment were resolved -- concluded, done, finished -- and they did not contemplate any further need of treatment for them. About half of the others in the EMDR group were less certain that the selected issues were fully resolved and stated that additional therapy might be needed. The remaining quarter stated it was probable that they would seek additional treatment for the issues they had worked on.
To me, Dr. Edmonds work suggests strongly that treatments that appear equally effective by widely accepted quantitative measures may be seen to provide qualitatively very different outcomes when client-focused questions are asked. Her studies also seem to me to suggest that if you want help to live more effectively with past trauma, several treatment options can be considered. But if you want to really be done with the negative and disagreeable ongoing residuals of past trauma, then the options are more limited and EMDR emerges as the major contender.
Much more of this qualitative type of research needs to be done with a focus not only on clients, but also on family members, employers, etc., if we are to have anything like a complete picture of what is going on.
This comment is based on actual experience using current methods to help me with anxiety and trauma.
Reply | Report Abuse | Link to thisThe article states:
So, now to the bottom line: EMDR ameliorates symptoms of traumatic anxiety better than doing nothing and probably better than talking to a supportive listener.
I am fearless and not affected by my traumatic experience anymore after using EMDR. I did not experience this with other methods of twenty years of therapy, combined with only two prescriptions for ativan lasting only a few months during the deaths of close family members. My life is no longer fear based after EMDR. I feel like I can be a contributing member to society now, and hope this comment helps many doctors and therapists take a close look at this type of therapy. My trauma occurred at three years of age, and was extreme, lasting for many days. I had a wonderful support system throughout my life, a healthy family upbringing. This can help isolate the effects of the trauma I experienced and the effects of the therapies that were offered to me.
The article also states:
Yet not a shred of good evidence exists that EMDR is superior to exposure-based treatments that behavior and cognitive-behavior therapists have been administering routinely for decades.
This is true. A person afraid of elevators can be desensitized with great benefits with current behavior therapies. Anxieties resulting from traumatic experiences that cannot be practically treated with immersion therapy or exposure based therapy due to the natures of the trauma need another modality. For instance, if the trauma is due to criminal or insane behaviors by another, due to mass deaths and exposure to bombings or war, EMDR can intervene and help the brain process the event(s), and the patient can recover. EMDR does not have to compete with previous proven methods. EMDR only fills in where other methods are not working.
The article also states:
Paraphrasing British writer and critic Samuel Johnson, Harvard University psychologist Richard McNally nicely summed up the case for EMDR: What is effective in EMDR is not new, and what is new is not effective.
I would have to disagree if this implies that EMDR is not effective. This statement is unclear.
This comment is based on actual experience using current methods to help me with anxiety and trauma.
Reply | Report Abuse | Link to thisThe article states:
So, now to the bottom line: EMDR ameliorates symptoms of traumatic anxiety better than doing nothing and probably better than talking to a supportive listener.
I am fearless and not affected by my traumatic experience anymore after using EMDR. I did not experience this with other methods of twenty years of therapy, combined with only two prescriptions for ativan lasting only a few months during the deaths of close family members. My life is no longer fear based after EMDR. I feel like I can be a contributing member to society now, and hope this comment helps many doctors and therapists take a close look at this type of therapy. My trauma occurred at three years of age, and was extreme, lasting for many days. I had a wonderful support system throughout my life, a healthy family upbringing. This can help isolate the effects of the trauma I experienced and the effects of the therapies that were offered to me.
The article also states:
Yet not a shred of good evidence exists that EMDR is superior to exposure-based treatments that behavior and cognitive-behavior therapists have been administering routinely for decades.
This is true. A person afraid of elevators can be desensitized with great benefits with current behavior therapies. Anxieties resulting from traumatic experiences that cannot be practically treated with immersion therapy or exposure based therapy due to the natures of the trauma need another modality. For instance, if the trauma is due to criminal or insane behaviors by another, due to mass deaths and exposure to bombings or war, EMDR can intervene and help the brain process the event(s), and the patient can recover. EMDR does not have to compete with previous proven methods. EMDR only fills in where other methods are not working.
The article also states:
Paraphrasing British writer and critic Samuel Johnson, Harvard University psychologist Richard McNally nicely summed up the case for EMDR: “What is effective in EMDR is not new, and what is new is not effective.”
I would have to disagree if this implies that EMDR is not effective. This statement is unclear.
I am a patient of a therapist who incorporates EMDR as the primary treatment for PTSD. It works for me. However, he and I both believe that we will be having weekly sessions for a while.
Reply | Report Abuse | Link to thisyes yes yes i lost two children from suicide. in counseling for 5 years and then emdr. works. i feel so different now and i am still processing
Reply | Report Abuse | Link to thisTake a look at recent neuro-imagingstudies of persons with PTSD. These studies challenge a pure cognitive approach for the treatment of PTSD due to the effects on cognitive fx during high affective states. Also, see article comparing Fluoxetine, Controls and EMDR, Van De Kolk, 2006, EMDR was superior. Also, during a rece nt workshop by this Author, challenged CBT as not superior to EMDR.
Reply | Report Abuse | Link to thisThe authors seem to be out of touch with much of the research in recent years (go to www.emdria.org) and the fact that numerous organizations, the American Psychological Association and the American Psychiatric Association among them, have endorsed EMDR as empirically validated. I would strongly suggest that the authors review the findings of Tonya Edmond, Ph.D. (Washington University) that indicated that although immediate results from EMDR and an eclectic therapy group were similar, followup after three months revealed that EMDR results held, as opposed to the other group. Furthermore, the changes found from a qualitative study indicated core changes in EMDR participants, rather than the symptomatic changes in the second group. A final point of correction: EMDR treatment does not ask the client to focus repeatedly on the traumatic image. It begins with it, as well as with negative cognitions, feelings and body sensations, and then allows the free association of the brain's innate processing system to heal the heart of the trauma, rather than simply providing symptomatic relief.
Reply | Report Abuse | Link to thisAndrew Seubert, LPC, NCC
What is resounding in my head is Bill Mahr's anti-pharma rant: There is no money in the healthy people, there is no money in the dead people. The money is in the middle-people that are alive-sort of.
Reply | Report Abuse | Link to thisBy the way, is there mal-practice in psychotherapy?
I have been in EMDR therapy since January 2012. Before EMDR therapy I was in much distress in dealing with my androgen insensitivity syndrome (AIS) experience, and past memories of school bullying related to my AIS status. Family secrecy and shame is all a part of this too. I'm in full acceptance of AIS, and am very proud of who I am. As a result I had many problems dealing with the lack of family support and past memories of bullying. EMDR has helped me immensely in working through these issues. I feel better equipped to deal with whatever my family may throw my way, and the trauma of the bullying has lessened a great deal. What I think this article misses is the REAL LIFE stories of how EMDR therapy can be helpful. Perhaps the authors could have touched on this and showed how many have benefited from EMDR therapy.
Reply | Report Abuse | Link to thisWhat I don't understand about this article, is that it seems to use anxiety and ptsd due to a traumatic event interchangeably. I feel there would be a huge difference between someone who has anxiety due to a phobia and a rape victim who suffers from ptsd. They may share similar symptoms, but to combine the two is sloppy journalism.
Reply | Report Abuse | Link to thisThis article also smacks of journalistic sensationalism to be different for the sake of sales.
First, EMDR, the legend of its inception in this article seems a bit different. Dr. Shapiro was supposed to be watching leaves falling down, one side and another; this way I was told. Anyway sounds legends -with all my respect-. Richard Schwartz, Internal Family System or IFS says personally in his book, IFS Therapy, that it was a client in therapy that talked to him about her parts in the mind; Dr. Schwartz says he was about to drop off therapy because he felt he could harm patients because of being not prepared for -the multiplicity of human mind- thanks to whatever, he did not.
Reply | Report Abuse | Link to thisSecondly, EMDR was born as EMD that is Eye Movement Desensitization and later became EMDR. Many scholars have tried to give us explanations on how it works; we should say today now "how brain bi-lateral stimulation works", because bi-lateral tapping,sounds,vibrations, only bi-laterally applied have same effect. So it seems that it is not the eyes, but the effect on the brain produced by bi-lateral stimulation the reason of its effect, but the how still remains in hypothesis field. Prof. Bessel van der Kolk lead a study on EMDR vs. fluoxetine in PTSD and according to him in the sense of long term effects EMDR was more effective. Nothing so broad and rigorous has been done since then -more than 10 years-. Now EMDR has been admited as therapeutic fro PTSD and child PTSD too by WHO.
EMDR tried to explain itself through AIP or accelerated information processing and in 2001 it became AIP, but this time it was Adaptive Information Processing. EMDR Institute, its theorists apparently meant by "AIP" that all origin of pathology is in the alteration of the innate capacity of the brain to eliminate emotions, sensations, beliefs derived from incidents that can cause Trauma and ´trauma`. The meaning, not thoroughly explained of ´t` could be what other clinicians/researchers name as highly stressing incidents -that do not constitute Trauma per se-, but can be recalled and are felt more or less disturbing in present.
I don´t agree with AIP model; to afirm that the basis of all kind of emotional schemas, constructs, symptoms that we create or give as an answer are pathological in essence is kind of peyorative.We know that memory reconsolidation(Frame of Emotional Coherence of Symptoms) explains that it is coherent to develop symptoms that need to be created as part of Schemas in front of emotional wounds for example. There are approaches that do not conceptualize, pathologizing, the symptom production, Coherence Therapy is one example, and IFS is another.