Eye Movement Desensitization and Reprocessing: Theory and Research

Eye movement desensitization and reprocessing (EMDR) is a method of psychotherapy developed by psychologist Francine Shapiro as a treatment for psychological distress associated with trauma, discovered when she chanced to notice a connection between a decrease in her own emotional distress over a personal concern after having spontaneously moved her eyes back and forth. Integrating her eye movement (EM) observation with aspects of, at least, imaginal exposure, cognitive therapy, psycho-dynamic therapy, and mindfulness teachings, and adding an early positive-psychology idea, Shapiro developed a treatment, which she informally tested. Shapiro first systematically tested her work in a wait-list control study of 21 subjects recruited from local mental health centers, including a Department of Veterans Affairs veteran readjustment center. Remarkably, all of her first 21 subjects showed profound single-session desensitization effects. In addition, Shapiro published a case study in a journal edited by Joseph Wolpe, an originator of behavior therapy, in which Wolpe, in an editorial footnote, endorsed Shapiro's rapid effects from his own informal replication.

In response to Shapiro's unique findings of effectiveness, her attempts to ensure that the method would be taught competently, and the odd nature of the eye movement component, considerable controversy erupted in which academic psychologists in particular publicly criticized many aspects of EMDR. Despite this controversial beginning, EMDR has been validated by numerous well-designed outcome studies, which have appeared in peer-reviewed scientific journals. As a result of these, EMDR has been endorsed as an effective treatment for posttraumatic stress disorder (PTSD) by many major U.S. and international evaluating scientific and professional mental health organizations, including the International [Page 249]Society for Traumatic Stress Studies (ISTSS), the U.S. Veterans Administration/Department of Defense, and the American Psychiatric Association.

Analogue studies have unequivocally supported the value of the most controversial aspect, the eye movement activity. Numerous studies have demonstrated the role of the eye movement in reducing emotional responsivity and vividness of imagery for personal emotionally evocative memories. In clinical dismantling studies, the role of EM is supported but less conclusively. A leading candidate to explain the role of EM is the idea that if it is elicited while the traumatic memory is brought to “working memory” it affects the way that memory is subsequently stored.

Aspects of EMDR that, added to the positive outcome research, make it a candidate for treatment of choice for the psychological effects of trauma are the high frequency of rapid therapeutic effects, the absence of requirement for disclosing the details of traumatic event or dwelling on the painful memories, and the absence of a requirement for client homework.