What is EMDR?

Next, what is EMDR? I agree here with most of what you said, about the range of possible impacts of adding interventions. From a research design perspective, you are correct. However, I don't think that's the whole truth.

EMDR is a trauma resolution method. Trauma resolution is a late-phase component of trauma treatment, which might be considered to consist of the following steps: Evaluation, psychoeducation, case formulation, motivation enhancement, treatment planning/contracting, safety/stabilization, skill-building, development of affect tolerance, trauma resolution, consolidation of gains, and relapse prevention. (There are many ways to delineate this, this is of course just one version/example.) So you can't just "do EMDR." It's not a stand-alone, it can only follow the prior steps.

Of course, that assertion is open to debate, and can be challenged by research showing that you can skip certain steps and still get to your goal. But for now, I think that this is a fair reflection of the state of the field.

There is a lot of confusion about this, among those not trained in EMDR as well as those who are. In fact, the EMDR training does address these various steps, and does emphasize that EMDR is to be used within a comprehensive treatment approach. However, the training typically focuses so much on the trauma resolution component that the other stuff is not in the limelight and can be easily forgotten. It can be even more easily forgotten when the preliminaries occur so quickly and in-stride that the therapist may not even consciously realize that these things are occurring. (I think that this is a problem with the way EMDR training has been conducted, and I have taken a number of steps to address this within the EMDR community, but that's not my main point just now.)

This is also true for PE, CPT, and any other CBT flavor of trauma resolution. The advantage that the CBT treatments have is clarity: everyone knows that the preparatory phases are officially part of the treatment, so they're not considered "additional" to the treatment.

So I don't think it's realistic to expect a "pure" EMDR treatment, because that would be clinically inappropriate and not reflective of the way that EMDR is actually practiced. There will always be some preparatory phases. These are, technically, "additional interventions." I would not run a study including a group without the preparatory stuff, it would be clinically inappropriate, unethical, and have no chance for external validity (it would not apply to the real world of clinical practice).

So what we're left with is clearly defining what these preparatory phases are. This is already somewhat defined within the standard EMDR protocol. However, it may vary by problem/population, for example, children have different needs than adults, and multiple-trauma samples will likely need more preparation than single-trauma samples. I think that the best we can do is have good treatment manuals and good controlled comparison studies, making as much the same as possible across groups, so that differences in outcome are likely to reflect differences in the intervention of interest.

That being said, in-vivo exposure is not typically considered part of the EMDR protocol, and would have to be considered an "additional" intervention. On the other hand, given the Muris et al data, I would not do an EMDR study of phobia without including an in-vivo exposure component (unless the phobias were clearly trauma-onset).

Replies:

Re:What is EMDR?, by Cahill, 05/01/03

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