Eye Movement Desensitization and Reprocessing

The development of eye movement desensitization and reprocessing (EMDR) has been hotly debated, with rhetoric often being posited as evidence either for or against the technique. This paper aims to provide a brief overview of the procedure, a critical review of the studies completed to date, a meta-analytic review of the available data, and a chronology of the evolution of EMDR over the past 10 years. Treatment-outcome studies were of such disparate quality-even studies meeting similar broad criteria-that combining their results in a meta-analysis was of very questionable value. Overall, an appraisal of the published research supported the following conclusions: (1) There is overwhelming evidence that eye movements are neither a necessary nor a useful addition to the procedure; (2) there is strong and consistent evidence that EMDR is better than no treatment, yet only as good as any other treatment that utilizes some aspect of exposure therapy; and (3) there is strong evidence that a full-exposure-based intervention package is superior to EMDR. There is also some evidence that "reprocessing" is likewise superfluous to EMDR and that the effects of EMDR dissipate over time. It is also concluded that the current debate cannot be entirely settled through scientific investigation due to the rapid and constant reshaping of what constitutes EMDR, the similarity to extant alternative methods, and the lack of a falsifiable theory underpinning the procedure. A treatment for posttraumatic stress disorder (PTSD) has been proposed by Shapiro (1989b) involving ocular tracking, by the client, of a bilaterally moving stimulus while holding in mind a mental representation of the traumatic event. Shapiro claimed to have happened upon this procedure, eye movement desensitization (EMD), through serendipity. During a now famous walk in the woods (Rosen, 1995, 1997; Shapiro, 1995; Welch, 1996), while thinking of an anxiety-provoking situation, she noticed that her eyes were involuntarily moving in a multisaccadic manner, followed by the disappearance of these anxiety-provoking thoughts. Shapiro also noted that following this procedure she, and later her clients, found it very difficult to retrieve the memory of the anxiety provoking material, and that even when the thoughts were deliberately retrieved, she found that their anxiety valence had dissipated. This treatment procedure was first investigated by Shapiro in 1989(a) and the method of treatment quickly developed to the point of workshop training (Shapiro, 1992). During the development phase of the process, the acronym "EMD" grew into EMDR (eye movement desensitization and reprocessing), to keep in line with the descriptive rationale for its effects. It has now been promoted as an unique, fast-acting, and effective intervention method for treating a plethora of problems including, but not limited to, substance abuse (Shapiro, Vogelmann-Sine, & Sine, 1994), personality disorders (Fensterheim, 1996), PTSD (Shapiro, 1989b), sexual dysfunction (Wernik, 1993), dissociative disorders (Paulsen, 1995), body dysmorphic disorder (Brown, McGoldrick, & Buchanan, 1997), and morbid jealousy (Blore, 1997). EMDR has even been advocated for enhancing performance in athletes (Foster & Lendl, 1995). Such claims have been partly responsible for the development of a growing rift within clinical psychology. Critics claim that the level and method of marketing EMDR has outstripped its evidence, and proponents claim that EMDR is being treated unfairly by the academic "fraternity" who expect a higher standard of evidence than would be accepted for other, more conventional treatments. Whatever the truth, widespread and vigorous application of any therapeutic technique requires evidence that the procedure is not just more effective than a wait list condition, but that there are incremental effects over placebo treatments. It is also desirable that the mechanism responsible for improvement in patient functioning is isolated. Furthermore, evidence is needed that the intervention is at least effective as standard clinical care. It is the purpose of this article to address these issues. In order to accomplish this goal, the treatmentoutcome literature was critically reviewed, effect size estimates for completed studies were derived, and the results were integrated into an overall "state of affairs. " In addition, a chronological review of EMDR research and of EMDR protocol development was conducted in order to provide the reader with an appreciation of why this area of research is so controversial. Past reviews of the EMDR literature have focused on methodological critiques of the EMDR research (Lohr et al., 1993), efficacy of EMDR for The Scientific Review of Mental Health Practice Objective Investigations of Controversial and Unorthodox Claims in Clinical Psychology, Psychiatry, and Social Work