A Meta-Analysis of Research on Eye Movement Desensitization and Reprocessing (EMDR)

Eye Movement Desensitization and Reprocessing (EMDR) has been a controversial CBT treatment approach for over a decade. Originally developed by Francine Shapiro as a treatment for PTSD, it combines "standard" CBT interventions such as cognitive restructuring and imaginal exposure with therapist-guided eye movements. Many have questioned the relevance of eye movements, however proponents of EMDR have claimed that EMDR is an effective treatment for a wide range of problems and that it is much more effective than other treatment approaches. This assertion has been disputed by a number of critics and the controversy has been quite heated at times.

A recent article presents a meta-analysis of the available empirical research on EMDR. Davidson and Parker (2001) analysed the results of 28 published outcome studies and conclude that EMDR appears to be an effective treatment when compared to no-treatment control groups or non-specific treatments. However, when compared to treatments which include in-vivo exposure or which include "standard" CBT interventions, EMDR was no more effective. In fact, there was a non-significant trend for EMDR to be less effective than exposure/CBT.

The use of alternating eye movements (or other alternating stimuli) is emphasized by Shapiro's rationale for the treatment approach. However, the available evidence does not provide support for the idea that EMDR is more effective than cognitive restructuring and imaginal exposure without eye movements.

Early reports by EMDR proponents portrayed the approach as producing dramatic results, often in a single session. These claims are not supported by the available evidence and Shapiro and her colleagues have backed off from making such claims.

Davidson, P.R. & Parker, K. C. H. (2001). Eye movement desensitization and reprocessing (EMDR): A meta analysis. Journal of Consulting and Clinical Psychology, 305-316.

NOTE: Some critics have suggested that EMDR is more effective at producing verbal reports of improvement than it is at producing behavior change. While Davidson and Parker (2001) do not address this issue, it would be wise of any clinician using EMDR to assess the extent to which the treatment eliminates behavioral avoidance and to supplement EMDR with in-vivo exposure as needed. (Since EMDR is no more effective than in-vivo exposure and the available evidence suggests that the eye movements are unnecessary, one might question the need for doing EMDR rather than exposure-based CBT).

Replies:

Comparative Efficacy of Exposure Therapy, EMDR, and Relaxation Therapy for PTSD, by Jim Pretzer, 06/08/03

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