Estimates suggest that 70% of the world’s population experiences at least one traumatic event in their lifetimes, and we know how trauma can affect mental health and well-being. As rates of mental illness continue to grow, access to effective, quality mental health care is a priority. Traditionally, most mental health conditions are treated with medication and talk therapy, however, one emerging approach attempts to heal traumatic memories without either.
Eye movement desensitization and reprocessing (EMDR) is an eight-phase treatment during which negative thoughts, images, and/or bodily sensations associated with trauma are reprocessed through bilateral stimulation such as eye movements, physical taps on the body, or by listening to audio. While EMDR has recently gained more popularity, debate remains on how excited we should be about it considering its controversial history, mixed research, and lack of understanding the mechanisms behind its success.
Francine Shapiro developed EMDR in 1987 when she noticed how certain eye movements decreased her own negative emotions. It seems to work faster than other psychotherapies, typically completed in six to 12 sessions. It also doesn’t require any verbal discussion of the trauma itself, which can be one of the most exhausting aspects of traditional therapy.
Today, EMDR is officially recognized as an effective treatment for posttraumatic stress disorder (PTSD) across several organizations including the United States Department of Veterans Affairs, American Psychiatric Association, and the World Health Organization. However, it’s also often used in therapeutic settings where traumatic events are associated with other mental health concerns (depression, anxiety, etc.).
“The bravest thing I’ve done so far in my life.”
It’s not uncommon to hear testimony that EMDR was the only treatment to help some heal from their trauma. Several public figures have shared these kinds of experiences, such as Prince Harry who filmed an EMDR session for his new mental health docuseries, and Sandra Bullock who shared her story on Red Table Talk.
One patient I spoke with emphasized that, after years of living at war with herself, EMDR provided the final piece to healing. Daniella said that it is strikingly clear to her how much EMDR changed her on a neurological level, greatly impacting her present and future self. The cognitive stability, perspective, peace, and control she now has, along with the seamless connection between her body and brain, continues to stay strong.
A History of Controversy
EMDR may be a promising therapy for those who have found little remedy with other treatments, but it has been controversial from the beginning.
Since its conception, Shapiro has been widely scrutinized for how she disseminated EMDR. Early on, she claimed that EMDR was a breakthrough therapy and trained clinicians to use it for PTSD while it was still labeled “experimental.”
EMDR then gained popularity in 1998 when the American Psychiatric Association listed it as a “probable efficacious treatment” for PTSD. This stirred more controversy, with some arguing that the Association’s decision was unjustified and better research was still needed. Early efficacy studies showed mixed results, although these publications were mostly case studies and researcher narratives.
The rocky start complicated EMDR’s reception by the field. It’s still a newer intervention, and we don’t fully understand how it works. Current understanding relies on Shapiro’s information processing theory as its methodological rationale, which hasn’t been substantiated in explaining how EMDR works on a neurological level.
Gaps in knowledge are common across most mental health therapies, however Shapiro had originally made claims explaining how EMDR worked that cannot be fully justified today. Bilateral eye movements were foundational to Shapiro’s original practice and served as a physiological explanation for how EMDR worked in the brain. However, some early studies found that they weren’t actually necessary. While more recent research has shown benefits, today most believe eye movements can be substituted for other forms of stimulation.
Advocates have also prematurely claimed that EMDR can treat a range of mental health conditions beyond PTSD such as anxiety and personality and substance use disorders. There isn’t substantial evidence to support this yet, as research remains in its early stages.
What To Make of EMDR Today
The current state of EMDR research and its clinical use remains mixed. For example, a commonly referenced meta-analysis observed that, while EMDR has positive effects, the quality of existing research is still poor. Plus, when EMDR is compared to other treatments like cognitive behavioral therapy, it’s effective but not better.
Some skepticism towards EMDR is fair: it has rapidly gained recognition while still having some unanswered questions. Resistance to new treatments is common, as are discrepancies early on between personal experience and research. Nonetheless, EMDR’s trajectory is hopeful, and it has helped those who felt like they had nowhere else to turn.
