1. What is the theoretical basis for EMDR?
2. Is EMDR a one-session cure?
3. Is EMDR an efficacious treatment for PTSD?
4. Are treatment effects maintained over time?
5. Can EMDR's effects be attributed to placebo or non-specific effects?
6. Is EMDR effective in the treatment of phobias, panic disorder, or agoraphobia?
7. What can I expect with EMDR? What should/could happen?
8. What questions should be asked to find out if clincians are qualified and if they have expertise using EMDR with my problem/disorder?
9. How do I know EMDR would work for me/work for my anxiety/problems, etc.? Am I a candidate for EMDR?
10. How many sessions with the therapist BEFORE (s)he begins EMDR?
11. How many sessions will it take?
12. Will I live the trauma as intensely as before?
13. What are the side effects of EMDR?

1.  What is the theoretical basis for EMDR?

Shapiro (1995) developed the Accelerated Information Processing model to describe and predict EMDR’s effect. More recently, Shapiro (2001) expanded this into the Adaptive Information Processing (AIP) model to broaden its applicability. She hypothesizes that humans have an inherent information processing system that generally processes the multiple elements of experiences to an adaptive state where learning takes place. She conceptualizes memory as being stored in linked networks that are organized around the earliest related event and its associated affect. Memory networks are understood to contain related thoughts, images, emotions, and sensations. The AIP model hypothesizes that if the information related to a distressing or traumatic experience is not fully processed, the initial perceptions, emotions, and distorted thoughts will be stored as they were experienced at the time of the event. Shapiro argues that such unprocessed experiences become the basis of current dysfunctional reactions and are the cause of many mental disorders. She proposes that EMDR successfully alleviates mental disorders by processing the components of the distressing memory. These effects are thought to occur when the targeted memory is linked with other more adaptive information. When this occurs, learning takes place, and the experience is stored with appropriate emotions able to guide the person in the future.

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2.  Is EMDR a one-session cure?

No. When Shapiro (1989a) first introduced EMDR into the professional literature, she included the following caveat: “It must be emphasized that the EMD procedure, as presented here, serves to desensitize the anxiety related to traumatic memories, not to eliminate all PTSD-symptomology and complications, nor to provide coping strategies to victims” (p 221). In this first study, the focus was on one memory, with effects measured by changes in the Subjective Units of Disturbance (SUD) scale. The literature consistently reports similar effects for EMDR with SUD measures of in-session anxiety. Since that time, EMDR has evolved into an integrative approach that addresses the full clinical picture. Two studies (Lee, Gavriel, Drummond, Richards, & Greenwald, 2002; Rothbaum, 1997) have indicated an elimination of diagnosis of posttraumatic stress disorder (PTSD) in 83-90% of civilian participants after four to seven sessions. Other studies using participants with PTSD (e.g. Ironson, Freund, Strauss, & Williams, 2002; Scheck, Schaeffer, & Gillette, 1998; S. A. Wilson, Becker, & Tinker, 1995) have found significant decreases in a wide range of symptoms after three-four sessions. The only study (Carlson, Chemtob, Rusnak, Hedlund, & Muraoka, 1998) of combat veterans to address the multiple traumas of this population reported that 12 sessions of treatment resulted in a 77% elimination of PTSD. Clients with multiple traumas and/or complex histories of childhood abuse, neglect, and poor attachment may require more extensive therapy, including substantial preparatory work in phase two of EMDR (Korn & Leeds, 2002; Maxfield & Hyer, 2002; Shapiro, 2001).

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3.  Is EMDR an efficacious treatment for PTSD?

Yes. EMDR is the most researched psychotherapeutic treatment for PTSD. Twenty controlled outcome studies have investigated the efficacy of EMDR in PTSD treatment. Sixteen of these have been published, and the preliminary findings of four have been presented at conferences. Studies using waitlist controls found EMDR superior; six studies compared EMDR to treatments such as biofeedback relaxation (Carlson et al., 1998), active listening (Scheck et al., 1998), standard care (group therapy) in a VA hospital (Boudewyns & Hyer, 1996), and standard care (various forms of individual therapy) in a Kaiser HMO facility (Marcus, Marquis, & Sakai, 1997). These studies all found EMDR superior to the control condition on measures of posttraumatic stress.

Seven randomized clinical trials have compared EMDR to exposure therapies (Ironson et al., 2002; McFarlane, 2000; Rothbaum, 2001; Thordarson et al., 2001; Vaughan et al., 1994) and to cognitive therapies plus exposure (Lee et al., 2002; Power et al., 2002). These studies have found EMDR and the cognitive/behavioral (CBT) control to be relatively equivalent, with a superiority in two studies for EMDR on measures of PTSD intrusive symptoms, and for CBT in the study by Taylor and colleagues Taylor, Thordarson, and Maxfield (2002) on PTSD symptoms of intrusion and avoidance. There were two controlled studies without randomization; one (Devilly & Spence, 1999) found the CBT condition superior to EMDR and the other (Sprang, 2001) found EMDR superior to the CBT control on multiple measures.

Two studies found EMDR to be more efficient than the CBT control condition, with EMDR using fewer treatment sessions to achieve effects (Ironson et al., 2002; Power et al., 2002). Two studies that compared treatment response on a session-by-session basis (Thordarson et al., 2001) and at mid-point (Rothbaum, 2001), reported that EMDR did not result in more rapid treatment effects than exposure. However, in both these studies the exposure treatment sessions were supplemented with one hour of daily homework, while the EMDR condition was implemented without homework. The only study to control for the ancillary effects of homework (Ironson et al., 2002) supplemented both exposure and EMDR treatments with the same number of hours of exposure homework (see above). Most studies noted that because EMDR has minimal homework requirements the overall treatment time was much shorter for EMDR (e.g., Lee et al., 2002; Vaughan et al., 1994). Treatment effects have generally been well maintained (see below).

The efficacy of EMDR in the treatment of PTSD is now well recognized. In 1998, independent reviewers (Chambless et al., 1998) for the APA Division of Clinical Psychology placed EMDR, exposure therapy, and stress inoculation therapy on a list of empirically supported treatments, as “probably efficacious” ; no other therapies for any form of PTSD were judged to be empirically supported by controlled research. In 2000, after the examination of additional published controlled studies, the treatment guidelines of the International Society for Traumatic Stress Studies gave EMDR an A/B rating (Chemtob, Tolin, van der Kolk, & Pitman, 2000) and EMDR was found efficacious for PTSD. The United Kingdom Department of Health (2001) has also listed EMDR as an efficacious treatment for PTSD.

Foa, Riggs, Massie, and Yarczower (1995) suggested that exposure therapy may not be very effective with clients whose prominent affect is anger, guilt, or shame. Reports by clinicians treating combat veterans (e.g., Lipke,1999; Silver & Rogers, 2002) indicate that EMDR may be effective with such PTSD presentations. A preliminary study found that EMDR reduced symptoms of guilt in combat-related PTSD (Cerone, 2000). Taylor et al. (2002) reported equivalent and significant effects for exposure therapy and EMDR on reducing symptoms of anger and guilt.

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4.  Are treatment effects maintained over time?

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5. Can EMDR's effects be attributed to placebo or non-specific effects?

No. A number of studies have found EMDR superior in outcome to placebo treatments, and to treatments not specifically validated for PTSD. EMDR has outperformed active listening (Scheck et al., 1998), standard outpatient care consisting of individual cognitive, psychodynamic, or behavioural therapy in a Kaiser Permanente Hospital (Marcus et al., 1997), relaxation training with biofeedback (Carlson et al., 1998). EMDR has been found to be relatively equivalent to CBT therapies in seven randomized clinical trials that compared the two approaches. Because the treatment effects are large and clinically meaningful, it can be concluded that EMDR is not a placebo treatment. For example, in a meta-analysis of PTSD treatments, Van Etten and Taylor (1998), calculated the mean effect sizes on self-report measures for placebo and control conditions as 0. 43, for EMDR as 1.24, and for CBT as 1.27 (p. 135). Several studies (e.g., Thordarson et al., 2001) have measured the credibility of the treatments being provided, as a way to determine if EMDR elicited more confidence from clients, thereby producing larger effects; no study found EMDR more or less credible. Because EMDR is not more credible than these other therapies, it appears that the effects cannot be attributed to suggestion or a heightened placebo effect.

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6. Is EMDR effective in the treatment of phobias, panic disorder, or agoraphobia?

There is much anecdotal information that EMDR is effective in the treatment of specific phobias. Unfortunately, the research that has investigated EMDR treatment of phobias, panic disorder, and agoraphobia has failed to find strong empirical support for such applications. Although these results are due in part to methodological limitations in the various studies, it is also possible that EMDR may not be consistently effective with these disorders. De Jongh, Ten Broeke, and Renssen (1999) suggest that since EMDR is a treatment for distressing memories and related pathologies, it may be most effective in treating anxiety disorders which follow a traumatic experience (e.g., dog phobia after a dog bite), and less effective for those of unknown onset (e.g., snake phobia).

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7. What can I expect with EMDR? What should/could happen?

Each case is unique, but there is a standard eight phase approach that each clinician should follow. This includes taking a complete history, preparing the client, identifying targets and their components, actively processing the past, present and future aspects, and on-going evaluation. The processing of a target includes the use of dual stimulation (eye movements, taps, tones) while the client concentrates on various aspects. After each set of movements the client briefly describes to the clinician what s/he experienced. At the end of each session, the client should use the techniques s/he has been taught by the clinician in order to leave the session feeling in control and empowered. At the end of EMDR therapy, previously disturbing memories and present situations should no longer be problematic, and new healthy responses should be the norm. A full description of multiple cases is available in the book EMDR: The Breakthrough "Eye Movement" Therapy for Overcoming Anxiety, Stress, and Trauma by Shapiro & Forrest.

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8. What questions should be asked to find out if clinicians are qualified and if they have expertise using EMDR with my problem/disorder?

Ask:

• Have they received both levels of training;
• Was the training approved by EMDRIA;
• Have they kept informed of the latest protocols and developments;
• How many cases have they treated with your particular problem/disorder;
• What is their success rate.

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9. How do I know EMDR would work for me/work for my anxiety/problems, etc.? Am I a candidate for EMDR?

EMDR has been extensively researched as effective for problems based on earlier traumas. In addition, reports from clinicians over the past ten years have indicated that EMDR can be extremely effective when there are experiential contributors that need to be addressed. Read the book EMDR: The Breakthrough "Eye Movement" Therapy for Overcoming Anxiety, Stress, and Trauma by Shapiro & Forrest and see if any of your problems are covered in the cases. Interview at least 3 clinicians to ask them what experience they have using EMDR with your particular problem.

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10. How many sessions with the therapist BEFORE (s)he begins EMDR?

This depends upon the client's ability to "self-soothe" and use a variety of self-control techniques to decrease potential disturbance. The clinician should teach the client these techniques during the preparation phase. The amount of preparation needed will vary from client to client. In the majority of instances the active processing of memories should begin after one or two sessions.

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11. How many sessions will it take?

The number of sessions depends upon the specific problem and client history. However, repeated controlled studies have shown that a single trauma can be processed within 3 sessions in 80-90% of the participants. While every disturbing event need not be processed, the amount of therapy will depend upon the complexity of the history. In a controlled study, 80% of multiple civilian trauma victims no longer had PTSD after approximately 6 hours of treatment. A study of combat veterans reported that after 12 sessions 77% no longer had post traumatic stress disorder.

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12. Will I live the trauma as intensely as before?

Many people are conscious of only a shadow of the experience, while others feel it to a greater degree. Unlike some other therapies, EMDR clients are not asked to relive the trauma intensely and for prolonged periods of time. In EMDR, when there is a high level of intensity it only lasts for a few moments and then decreases rapidly. If it does not decrease rapidly on its own, the clinician has been trained in techniques to assist it to dissipate. The client has also been trained in techniques to immediately relieve the distress.

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13. What are the side effects of EMDR?

As with any form of psychotherapy, there may be a temporary increase in distress.

• distressing and unresolved memories may emerge
• some clients may experience reactions during a treatment session that neither they nor the administering clinician may have anticipated, including a high level of emotion or physical sensations
• subsequent to the treatment session, the processing of incidents/material may continue, and other dreams, memories feelings, etc., may emerge

Answers are provided by the EMDR Institute. Click here, to find an certified EMDR therapist.

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Reviewed: 02/2006