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Eye Movement Desensitization and Reprocessing:

A Controversial Treatment Technique

Suzanne Hurstand Natasha Milkewicz

Virginia Consortium for Professional Psychology

Abstract:

ye mo!ement desensitization and re"rocessing is a contro!ersial# new thera"eutic techni$ue

re"orted to relie!e traumatic memories# "hobias# and a wide !ariety of "sychological "roblems% &his

"a"er e'"lains the M() "rocedure# and discuses research that su""orts and refutes its efficacy%

Contro!ersy regarding M() training "ractices are addressed% Various hy"otheses of how M()

works are also e'"lored%

Eye movement desensitization and reprocessing (EMDR) is a relatively ne therapeutic

technique! "ounded in #$%&! that has 'een said to help relieve traumatic memories t is primarily used to

access! neutralize! and 'ring to adaptive resolution the upsetting memories at the root o" currentpsychological distur'ances (*reenald! #$$+) t is a controversial topic ith empirical evidence 'oth

supporting and negating the claims that have 'een made regarding this treatment

The "olloing paper ill e,plain the 'asic procedure o" EMDR and discuss research that supports

and re"utes the signi"icance o" the therapeutic technique Controversy over EMDR training practices ill

also 'e addressed -inally! various hypotheses "or ho EMDR or.s ill 'e e,plored

/hapiro! an un.non clinical psychology graduate student! discovered EMDR hile al.ing

through a par. in Cali"ornia! preoccupied ith old memories and distur'ing thoughts /he discovered that

as her eyes moved rapidly 'ac. and "orth! her memories seemed to dissolve spontaneously Amazed! she

e,perimented ith &0 volunteers! o'tained similar results! and then organized a "ormal research study one

year later (1utler! #$$2)

n this study! hich 'ecame her doctoral thesis! 33 survivors o" rape! childhood a'use! and arere given one 405minute EMDR session All o" these participants reported that their memories had lost

most o" their devastating charge and that their irrational! negative sel"5attri'utions and presenting

complaints had greatly improved This e""ect as maintained at a three5month and a three5year "ollo5up

A control group that simply called up a memory ithout using the eye movement shoed no relie" at all

(/hapiro! #$%$a6 as cited in *reenald! #$$+)

Although her research as encouraging! there ere limitations to this study All o" the treatmentand assessment as done 'y /hapiro! hence demand or other non5speci"ic e""ects could account "or part o"

the treatment e""ect 7eart rate as only monitored "or the treatment group! hich may have created a

di""erence in e,pectations -urthermore! the diagnostic criteria ere unclear and the only standardized

measures ere sel"5reports (*reenald! #$$+) 8onetheless! most participants ere diagnosed ith 9T/D!

and in most cases signi"icant others corro'orated the changes o" symptoms in the participants9erhaps at this point! the reader is ondering hat e,actly occurs in this hour5long treatment

session and ho it or.s /ince the time this technique has 'een developed! the sessions have 'ecome

more intricate and no incorporate many aspects o" treatment not original to EMDR The currenttechnique discussed in /hapiros (#$$;) 'oo. is the procedure that ill 'e presented 7oever! one should

'e aare that this technique is more comprehensive than the one used in her original study

M() treatment consists of eight essential "hases%The num'er o" sessions devoted to each

phase and the num'er o" phases included in each session vary "rom client to client The first "hase

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involves ta.ing a client history to evaluate the suita'ility "or treatment The clients a'ility to deal ithhigh levels o" distur'ance! the amount o" e,ternal stress in his or her li"e! and medical conditions are all

considered The treatment plan is then designed

Phase two is the preparation phase! in hich the clinician introduces the client to EMDR

procedures! e,plains EMDR theory! esta'lishes e,pectations a'out treatment e""ects! and prepares the

client "or possi'le 'eteen5session distur'ance At this point! clinicians o"ten give the client an audiotape

o" rela,ation e,ercises so that he or she can use it 'e"ore 'eginning the EMDR sessions and 'eteen

sessions *uided imagery and rela,ation are occasionally used during the sessions to "acilitate the clients

a'ility to deal ith the recalled memories

Phase three is assessment! hich includes identi"ying the memory and an image that 'est

represents that memory Then the client chooses a negative cognition that he or she has in relation to the

event! such as ?C) scale Then! the image and the

negative cognition are com'ined! and the client rates his or her level o" distur'ance on the #05point

/u'@ective nits o" Distur'ance /cale (/D/)

&he fourth "haseinvolves desensitization The client "ocuses on the negative a""ect and "ollos

the clinicians rapidly moving "ingers! seeping 'ac. and "orth appro,imately #3 to #+ inches The

procedure is repeated in sets ranging "rom #0 seconds to longer than a minute! until the /D/ level is

reduced to 0 or # Recently! it has 'een noted that eye movement is not necessarily needed! 'ecause

similar results have 'een "ound 'y tapping alternate hands on a chair rest or 'roadcasting alternating tonesin a clients ear Any o" these strategies can 'e implemented at this point t is also emphasized that these

initial sets are o"ten not su""icient "or complete processing and that other strategies and advanced EMDR

procedures may 'e needed to restimulate processing

Phase fi!eis the installation phase! hich "ocuses on cognitive restructuring 7ere! the positive

cognition is strengthened in order to replace the negative 'elie" The client holds the positive 'elie" ith

the image in his or her mind and the eye movement sets are continued until the client rates the positive

cognition at a 4 or & on the >?C scale A"ter lin.ing the positive cognition ith the target memory! an

associative 'ond is created Thus! the client 'elieves the positive cognition hen remem'ering thepreviously distur'ing image

*n "hase si'! the client holds the image and the positive cognition in his or her mind and scans the

'ody in order to identi"y any tension These 'ody sensations are then targeted during the "olloing sets o"

eye movements or alternative desensitization techniques

Phase se!en is closure! hich includes a de'rie"ing reminding the client that he or she may

e,perience distur'ing images! thoughts! or emotions 'eteen sessions The client is told that this is a

positive sign and is o"ten as.ed to .eep a log or @ournal a'out negative thoughts! situations! dreams! and

memories that may occur " the client is not de'rie"ed! there is a danger o" decompensation or! in an

e,treme case! suicide

Phase eight is reevaluation! hich is implemented at the 'eginning o" each ne session

9reviously accessed targets are 'rought 'ac. and the clients responses are revieed to assess i" thetreatment e""ects have 'een maintained 8e images or memories are then targeted "olloing the eight5

step procedure

A"ter the client has gone through these steps! the "re!iously disturbing memories should be

altered The image may change in content or appearance! the sounds or voices recalled o"ten 'ecome

quieter or disappear! the clients cognitions may 'ecome more therapeutically adaptive! and emotions and

physical sensations o"ten lessen in intensity A"ter treatment! many people "eel as though a slate has 'een

iped clean and a space created here ne learning can ta.e place (1utler! #$$2) They "eel as i" the

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memory is no a part o" the past ?ther positive e""ects are also common! such as improved competence!mood! attitude! or sel"5appraisal 9rocessing may continue on a sporadic 'asis "or days or ee.s "olloing

the sessions! including increased dream activity! mood changes! additional memory recall and ne

insights (*reenald! #$$+)

9erhaps this treatment sounds too easy to 'e e""ective 1ut! much o" the literature availa'le on this

topic is positive n #$$;! a comprehensive study as completed 'y Bilson! 1ec.er and Tin.er Eighty

participants su""ering "rom a variety o" trauma (physical5mental a'use! death o" a signi"icant other! rape

and se,ual molestation! relationship crisis! health crisis! pho'ic memory and com'at trauma) ere

randomly assigned to treatment or delayed5treatment conditions All outcome measures ere administered'y a s.eptical! independent assessor! hich ere /D/! mpact o" Event /cale! /tate5Trait An,iety

nventory and /ymptom Chec. ist The participants that received three $05minute EMDR sessions

shoed decreases in their presenting complaints and in an,iety and increases in positive cognition

9articipants in the delayed5treatment condition shoed no improvement on any o" these measures during

the 205day aiting period! 'ut they shoed similar improvement on all measures a"ter treatment EMDR

as equally e""ective on all the types o" trauma studied! and outcomes did not vary 'eteen those +4

diagnosed ith 9T/D and those that did not meet "ull 9T/D criteria Also! the severity or time period in

hich the trauma had occurred did not ma.e a di""erence in EMDR e""ectiveness The e""ect sizes ere

too large "or a place'o e""ect to account "or the changes! and the e""ects ere maintained at a $05day

"ollo5up

A study done 'y /ilver (#$$;) also supported positive e""ects o" EMDR >eterans on an inpatient

unit completed a pre5 and post5treatment sel"5report measure (9ro'lem Rating -orm) Thirty5"ive

participants ere treated ith EMDR! hile %2 ere not The EMDR group shoed signi"icantly greater

improvement on hal" o" the su'scales! ith a similar trend on the other su'scales This study is

strengthened 'y the "act that participants served as their on controls! the use o" a standardized measure!

and minimal e,pectancy e""ects Additionally! this study may 'e underestimating the e""ects o" EMDR

since participants ere included regardless o" the quantity o" EMDR treatment they ere given! as some

only received one session 7oever! it should 'e noted that the EMDR5trained therapists e,citement may

have in"luenced the participants improvement to a degree (*reenald! #$$+)

n comparison to more traditional techniques o" treating 9T/D! some reported EMDR results are

impressive An unpu'lished study "ound that "ive sessions o" EMDR ere tice as e""ective in reducing

9T/D symptoms compared to ad@unctive 'io"eed'ac. or rela,ation training ?ther research "ound EMDR

to 'e a'out equal to "looding! an e,posure technique o"ten used "or 9T/D! 'ut EMDR had "eer negative

side e""ects (1utler! #$$2) 1uttressing these "indings! ip.es (#$$2! as cited in *reenald! #$$+)

preliminary survey "ound that only % o" therapists trained in EMDR reported negative side e""ects ere

more "requent ith EMDR than ith other interventions6 the rest o" the respondents ere a'out equally

divided in reporting that negative side e""ects ere a'out the same! or less "requent! ith EMDR

7oever! several studies attempting to replicate earlier "indings o" EMDRs apparent e""icacy

"ailed to do so ?salt! Anderson! 7agstrom and 1er.oitz (#$$2) reported that the technique as

success"ul ith only 2 o" % people volunteering "or treatment to relieve traumatic memories or an,iety

related to traumatic memories -urthermore! the most seriously distur'ed participants! hose intrusive

memories included scenes o" chronic child a'use and 'eing raped at .ni"epoint! shoed the least 'ene"itn "act! + o" the ; hospitalized participants "ailed to complete the single5session treatment 'ecause their

memories ere too distressing and the EMDR as having no ameliorative e""ect The 2 college student

participants ho reported signi"icant decreases in their /D/ ratings had much milder memories o"

'rea.ing up ith a 'oy"riend! itnessing a con"rontation 'eteen "amily mem'ers! and "ainting during an

operation on an animal

Montgomery and Ayllon (#$$+) "ound that EMDR provided su'@ective relie" "rom 9T/D

symptomatology! 'ut not as immediately and pro"oundly as previously reported The sel"5reported

decreases in /D/! intrusive thoughts or dreams! and 1ec. Depression nventory scores ere achieved

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over the course o" 4 sessions! in contrast to /hapiros early claims o" success in only # or 3 sessionsMontgomery and Ayllon also "ound that su'@ective reports o" relie" ere not corro'orated 'y psycho5

physiological measures o" an,iety The participants systolic 'lood pressure and heart rate hen recalling

the treated image did consistently decrease! 'ut not to the level o" statistical signi"icance in any o" the 4

participants The authors called "or "urther research using more re"ined psycho5physiological measures o"

situational distress

>aughan et als (#$$+) study divided 24 9T/D patients into treatment groups o" imaginal

e,posure! applied muscle rela,ation! and EMDR 9articipants underent 25; individual sessions over a 35

2 ee. period All therapists "or the EMDR treatment group ere trained 'y /hapiro The participantsere assessed "or 9T/D diagnosis and symptom severity 'y 'lind! independent raters! and these ratings

@oined sel"5report symptom measures as outcome varia'les All three treatments resulted in signi"icant

improvements compared to the ait list control group! 'ut "urther analyses "ailed to demonstrate

consistent superiority o" any one treatment type over any others The authors speculated that this "ailure

might 'e attri'uted to the small sample sizes o" each condition 7oever! EMDR as the only technique

to sho immediate! signi"icant decreases in posttreatment reports o" intrusive symptoms! li.e "lash'ac.s

and nightmares >aughan et al noted that despite EMDRs previously reported single5session successes! it

is 'etter carried out in a longer5range therapeutic conte,t! 'y clinicians 'roadly trained in cognitive

therapy

Many o" the early case studies claiming stunning success rates "or EMDR have also 'een

criticized "or their lac. o" o'@ective diagnostic criteria and outcome measures Eight such uncontrolled

case studies (/hapiro! #$%$a6 9u.! #$$#6 Bolpe A'rams! #$$#6 Marquis! #$$#6 ip.e 1ot.in! #$$36

Flein.necht Morgan! #$$36 McCann! #$$36 9ellicer! #$$2! as cited in Acierno! 7ersen! >an 7asselt!

Tremont! Meuser! #$$+) "ailed to e""ectively veri"y the presence o" diagnostically signi"icant

psychopathology in their participants All o" those case studies ere also su'@ect to unintentional

e,perimenter 'ias! as all data as collected 'y the authors=therapists themselves The highly su'@ective

dependent varia'le o" o'served 'ehavior change used in some o" these studies (ip.e 1ot.in! #$$36

Marquis! #$$#! as cited in Acierno et al! #$$+) "urther demonstrated the potential "or e,perimenter 'ias to

cloud results

n addition to an overreliance on therapists ratings! clients /D/ ratings ere quite possi'ly

compromised 'y demand e""ects Clients su'@ective reports o" decreased distress could have resulted "rom

su'tle positive rein"orcement they received "rom therapists! and "rom the negative rein"orcement o" 'eing

alloed to stop thin.ing a'out their aversive images Most o" these case studies also lac.ed treatment

purity! as EMDR as "requently supplemented ith other interventions li.e rela,ation training! cognitive

restructuring and in vivo e,posure (Acierno et al! #$$+)

/ome later controlled studies including standardized assessments "or diagnostic criteria and

physiological data as dependent varia'les "ailed to sho that EMDR reduced physiological arousal related

to the traumatic memories or pho'ias A study o" 30 hospitalized >ietnam veterans (1oudeyns! /ter.a!

7yer! Al'rect! /terr! #$$2! as cited in Acierno et al! #$$+) compared EMDR ith imaginal e,posure

and milieu therapy! ith all treatments delivered in to $05minute sessions 8one o" the interventions

success"ully reduced physiological responsiveness! as measured 'y heart5rate! electomyographic response!

electrodermal response! or s.in temperature! to audiotaped trauma descriptions Also! there ere nodi""erences 'eteen the treatment groups on standardized clinician and sel"5report ratings o"

symptomatology 7oever! during treatment! participants in the EMDR group reported signi"icantly

greater reductions in their /D/! and clinicians rated signi"icantly more o" the EMDR group participants

as treatment responders A"ter treatment! though! the EMDR participants /D/ ratings ere not

signi"icantly loer than those o" participants in the other treatment groups Acierno et al (#$$+) contend

that place'o and demand e""ects in"luenced the participants decreased in5session /D/ ratings! and thatclinicians ratings o" improvement ere a""ected 'y e,citement over EMDRs novelty

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Another ma@or point o" contention has 'een /hapiros EMDR training practices /oon a"terEMDRs discovery! /hapiro 'egan holding or.shops at hotel con"erence centers around the country

These or.shops included the eye5movement technique! a pac.age o" clinical s.ills! and & hands5on

practice sessions /ince #$$#! the training has 'een revised to include


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*reenald! #$$+) /ome studies supported the idea that repeated saccadic eye movements ere anecessary component to EMDRs e""ectiveness Montgomery and Ayllon (#$$2) "ound that hen

participants "ocused on the therapists still "inger instead o" seeping their eyes 'ac. and "orth! they

reported signi"icantly less improvement in their /D/ 7oever! other research re"uted the necessity o"

including eye movement in EMDR /tudies comparing the original EMDR procedure to "i,ed visual

attention during the technique (Ren"rey /pates! #$$+) and to image con"rontation! hich is per"ormed

ith eyes closed and still! (/anderson Carpenter! #$$3! as cited in Ren"rey /pates! #$$+) "ound nosigni"icant di""erences in the treatment outcomes Thus! it as suggested that the distraction /hapiro

credited to the eye movement tas. might also 'e achieved through other procedures! such as "i,ed visual

attention (#$$#! as cited in Ren"rey /pates! #$$+) or listening to alternating tones (1utler! #$$2)

?thers have hypothesized that o'@ects or sounds attended to during EMDR serve as sa"ety signals!

since the therapist .eeps the e,posure period accompanied 'y these signals ithin the clients limits "or

an,iety arousal (Ren"rey /pates! #$$+) This


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)eferences

Acierno! R! 7ersen! M! >an 7asselt! > 1! Tremont! *! Meuser! F T (#$$+) Revie o" the

validation and dissemination o" eye5movement desensitization and reprocessing: A scienti"ic and

ethical dilemma Clinical 9sychology Revie! #+! 3%&53$%

1utler! F (#$$2) Too good to 'e trueH 8etor.er! 8ovem'er=Decem'er! #$52#

*reenald! R (#$$+) Eye movement desensitization and reprocessing (EMDR): An overvie Iournal o"

Contemporary 9sychotherapy! 3+! #;522

Marquis! I 8 (#$$#) A report on seventy5eight cases treated 'y eye movement desensitization Iournal o"

1ehavior Therapy and E,perimental 9sychiatry! 33! #%&5#$3

Montgomery! R B! Ayllon! T (#$$+) Eye movement desensitization across su'@ects: /u'@ective and

physiological measures o" treatment e""icacy Iournal o" 1ehavior Therapy and E,perimental

9sychiatry! 3;! 3#&5320

?salt! R! Anderson! M! 7agstrom! F! 1er.oitz! 1 (#$$2) Evaluation o" the one5session eye5

movement desensitization reprocessing procedure "or eliminating traumatic memories9sychological Reports! &2! $$5#0+

Ren"rey! *! /pates! R C (#$$+) Eye movement desensitization: A partial dismantling study Iournal

o" 1ehavior Therapy and E,perimental 9sychiatry! 3;! 32#532$

/hapiro! - (#$%$) Eye movement desensitization: A ne treatment "or post5traumatic stress disorder

Iournal o" 1ehavior Therapy and E,perimental 9sychiatry! 30! 3##53#&

/hapiro! - (#$$;) Eye movement desensitization and reprocessing: 1asic principles! protocols! and

procedure 8e Gor.: *uil"ord

>aughan! F! Armstrong! M /! *old! R! ?Connor 8! Ienne.e! B! Tarrier! 8 (#$$+) A trial o" eye

movement desensitization compared to image ha'ituation training and applied muscle rela,ation

in post5traumatic stress disorder Iournal o" 1ehavior Therapy and E,perimental 9sychology! 3;!

3%253$#

Bilson! /! 1ec.er! ! Tin.er! R (#$$;) Eye movement desensitization and reprocessing (EMDR)

treatment "or psychologically traumatized individuals Iournal o" Consulting and Clinical

9sychology! 42! $3%5$2&

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