I have tried to do some research but the explanations are not very satisfying to me. On the other hand, if it really works, take it if you can get it right?
There is a bunch of recent work from the group of Marcel van den Hout at Utrecht University that has looked into possible mechanisms of action of EMDR. Forget about the pseudo-neurobiological theory proposed by Helen Shapiro for why it works. In fact, the eye movements are likely not to be of major importance. Basic research suggests that the crucial aspect is the fact that working memory is taxed during exposure. See for instance [Hout, M.A. van den, Bartelski, N., & Engelhard, I.M. (2012). On EMDR: eye movements during retrieval reduce subjective vividness and objective memory accessibility during future recall. Cognition and Emotion, 27, 177-184] and [Hout, M.A. van den & Engelhard, I.M. (2012). How does EMDR work? Journal of Experimental Psychopathology, 5, 724-738]. So yes, it probably works, but not for the reasons that many in the EMDR field proclaim.
Here's a review that tells the story, in agreement with Rakhshan and Fresco.
1999 The Power of Placebos; review of Transforming Trauma EMDR: The Revolutionary New Therapy, for Freeing the Mind, Clearing the Body, and Opening the Heart by L. Parnell. American Journal of Psychology 112, 465-469.
It may work primarily - or entirely - due to the fact that it incorporates exposure to unwanted images, thoughts, etc. There is not a lot of evidence that the eye movement component adds to the effectiveness of exposure therapy. I think C. Richard Spates at Central Michigan has looked at this.
Thanks! Intuitively I would guess that the eye movement is a good placebo but also serves as a distraction to the unpleasant thoughts and images. I wonder if other motor activities wouldn't do the trick just as well.
"pseudoscience propaganda"
theoretician speaking? I use EMDR and see it working - and it is accepted even in narrow-minded german medical scheme.
In my opinion it is allowed to be called "placebo", because placebo is obviously one of the most powerful strategies to influence our mind and body. Why not? Somewhere along the way even the theoretical psychologists will have to look after this.
And therefore i queue up:
who has a logical explanation for these strange influence of EMDR?
thanks :o)
Not a prejudice, but experience: EMDR works without suggestion, works without paying and works without waiting long. Yes, i belief in the result of "doing something important" (there are enough significant references in medicine), but in case of EMDR there is a effect beyond this, because many other "doing-something-important"s (hypnotic suggestions included) have no effect, where EMDR works.
I am fascinated by the fact that it seems to work so well, at least based on anecdotal accounts. It would seem that the jury is still out regarding the mechanism of action, whether it is a placebo, an unusually effective placebo, or has some actual effect on the central nervous system related to its action. This is why I stated in the beginning "take it if you can get it." This is particularly good advice that my neuroscientist friend gave me regarding the power of prayer. As neuroscientists we can speculate about limic system influences, or whatever other brain region, neurotransmitter system and circuitry we devise to explain the effect of something spiritual or curative. At the end of the day, there may be a client in your office who is in pain. Will they be one of the 80% who experienced relief from a specific treatment versus placebo in a clinical trial? There is a point when you do what you need to to help that person. If EMDR is an unusually strong placebo, that works for me, although as a scientist I may not BELIEVE, and then, what do I convey to my client? I am going to treat you with this thing that is likely not based in science but is probably a placebo? I need to believe in my treatment, so this is a quandry. I need at least some type of explanation that is satisfying to the the client and to myself. For me, it would help to actually see the technique in action, which I have not been able to do so far. Perhaps then, in combination with the literature, I could devise a satisfying explanation of why it works.
By satisfying explanation, I also do not mean the typical neurobabble that seems to have permeated into society in general and also into some psychotherapists' vocabulary. Such as "this will act on the fear centers of your brain to re-balance the neural circuitry" or some similar phrase that essentially has no meaning.
Here is the link to an article I wrote on the topic for Scientific American Mind: http://www.scientificamerican.com/article/can-eye-movements-treat-trauma/
So are you proposing David that the eye movements might make the anxiety worse? I wonder if there is clinical experience to this effect.
I read your article Tori and I think it is what I have been looking for in terms of an explanation (provided in your quote given by the psychologist Chris Lee). Actually, the article would make a good handout for clients, and I like that it acknowledges the possible effectiveness of the technique, provides hypotheses for mechanism of action, but also admits that it is incompletely understood. That is very nice work and accessible to the general public.
Very many thanks to you, Alisa! I'm so glad you find it helpful. It was certainly a fascinating topic to dig into.
Not to worry - if the patient can't manage eye movements, the terapist can tap their knees - passive, not active, ttally different brain process, but who cares? So no neurological explanation will work, except placebo expectation.
See mindspaces.org for the scientific basis for the success of EMDR and similar exposure therapies.
I have not had any scientifically verifiable success with EMDR, although I use what I know about the neuropsychology of eye movements as a diagnostic procedure. Left looking, particularly down, indicates right hemispheric emotional activation regarding past memories which is accompanied by beta/gamma EEG registrations, while looking up and to the right is more cognitive-data focused and accompanied by theta/delta EEG registrations. In psychotherapy, this approach allows for moment to moment evaluation of the patient's reactions.
You skimmed 3 articles in the now defunct journal. Very clever. Do you think the fact that because Sage discontinued publication in December 2013 means that the hundreds of peer reviewed articles published in the years while it was extant are not valid because the publication has ended? Sage discontinued the publication because the editor and founder of Traumatology changed jobs. Moreover, our paper was based not only on the 6 clinical studies but also on over 50 EEG lab studies to confirm and explain the astounding results we found in the clinical studies. We have several hours of EEG data from these studies. The authors of this article challenge you to disprove the scientific results of this study. We will be glad to provide you with the raw data and let you disprove, if you can, the major scientific result of the study: low frequency sensory input such as eye movements vastly increases the power of the EEG in the delta range, particularly around 1.5 Hz. This particular wave form reverses the potentiation of receptors mediating memories by a complex series of events set out in the paper which you are unlikely to have found through skimming the articles. In addition, the EEGs from these studies show that the sensory input causes the EEG to mimic that of slow wave sleep during which the day's memories are edited, below consciousness. In addition, this period of sleep insures that the brain's neurons are reset to the lowest possible homeostatic level consonant with ongoing mental activity. The principal tool used in restoring homeostasis is the same as that used during EMDR to depotentiate receptors on synapses in the lateral amygdala mediating fear memories. We await your comments on the scientific basis of the papers.
Our website, mindspaces.org, has had over 30,000 visitors from all over the world during the past 3 years. Dr. Shapiro, the originator of EMDR, was very complementary of our research.:
I appreciate all of the sources given by the respondents to this initial question and I do plan to follow up on them. It is interesting to me that this controversy continues and I am further interested to dig into the sources provided. I'm eager to follow further research into this topic as well. I'm also aware that research is important, but clinical experience is also important and can sometimes provide insights that extend beyond formal research. Ideally, we should be able to test hypotheses derived from clinical experience in a controlled and rigorous manner. In practice, this is easier said than done, in a world with limited funding and human beings as test subjects, who do not always comply with the parameters of the designed experiment, or have ideal controls that we can test them against.
There is a bunch of recent work from the group of Marcel van den Hout at Utrecht University that has looked into possible mechanisms of action of EMDR. Forget about the pseudo-neurobiological theory proposed by Helen Shapiro for why it works. In fact, the eye movements are likely not to be of major importance. Basic research suggests that the crucial aspect is the fact that working memory is taxed during exposure. See for instance [Hout, M.A. van den, Bartelski, N., & Engelhard, I.M. (2012). On EMDR: eye movements during retrieval reduce subjective vividness and objective memory accessibility during future recall. Cognition and Emotion, 27, 177-184] and [Hout, M.A. van den & Engelhard, I.M. (2012). How does EMDR work? Journal of Experimental Psychopathology, 5, 724-738]. So yes, it probably works, but not for the reasons that many in the EMDR field proclaim.
David Grand developed "Brainspotting" out of a background of EMDR and I'm wondering if a similar mechanism is at play here with simple eye gaze in a particular direction and depth of focus - if indeed the visual aspect has anything to do with it.
The first thing, of course, is that it works. Then, we need to try to look directly at the way it works. If we design experiment just to verify our hypothesis about how it works, then we will likely see what we want to see. We human beings are very good at making stories. How about look at the work without a story? That may bring around better knowledge.
Vahid, thank you for the discussion. You see, language is insufficient to express the meaning. By saying 'The first thing, of course, is that it works', I mean that is the baseline for further discussion. If practitioners found that it did not work, then it is over. The reason we are talking is because they found it works.
Of course, just by anyone saying it works, or even everyone else saying it works, it does not mean that it will work if we do it ourselves. So, if we ever want to be serious, we have to try it and see it work on ourselves, or our consultees. That is really a practical way.
When talking about a story, I mean if one really want to understand it, we should have an open mind when thinking. Do not limit ourselves to a hypothesis or two. We may test many hypothesis if possible. Test one and get approved, does not mean that it will be the only answer. I guess you will agree with me on that.
Of course, when talk, we will need a story. But people usually insist on their own story, that is where things go ashtray. If we can test our own story while still open to more other stories, then it will be better. Unfortunately, in the history of science, it is very often not the case. That is why I say better have no story, which means do not try to keep an only story.
Hope that makes sense.
Dear Alisa,
next months there will be an international conference in Heidelberg, Germany "Reden reicht night", where some of the most experienced therapists and scientist will discuss the subject, like Fred Gallo, Daniele Baulieu or Michael Bohne. This is the link to the conference
Most of the contributions are in German, but some of the most interesting are in English ;-)
www.redenreichtnicht.de
I wish you enlightening insights
hildegard
Memory formation and quenching
1. Memories, including fear memories, are formed by an increase in the number of potentiated receptors on the synapses mediating the memory.
2. Emotional memories are mediated in the lateral amygdala, cognitive memories are mediated in the hippocampus.
3. The amygdalar memory system comes without a volume control; this is the cause of many pathologically recorded memories.
4. There are about 84 receptor locations in the amygdalar synapses; if extreme emotional signals are recorded from the environment, almost all of these locations are filled.
5. This filling of most of the receptor locations in amygdalar synapses makes it impossible for the signals to be merged in the ACC with the cognitive signals from the hippocampus.
6. Persons with extreme fear memories then can only bring to consciousness the terrifying signals from the amygdala.
7. The receptors of the amygdala can be quenched through, for example, providing sensory input such as tapping the palms of the hands or by lateral or vertical movement of the eyes.
8. Such input causes enormous increases in the power (amplitude) of the delta waves.
9. Under such conditions synapses involved in mediating the memory open to calcium ion inflows a second time, on the minimum shown on Figure 3 of “Taming the Amygdala”.
10. These ions contact calcineurin molecules sequestered in vesicles, releasing them to the interior of the synapse. The calcineurin moves to specific places on the receptors, changing their configuration so they can no longer open.
11. Such receptors are then removed from the surface of the synapse.
12. If a sufficient number of the receptors are so removed, the synapse can no longer carry the memory message and the memory is disrupted.
13. These facts are known from animal and human studies, and they form the basic argument for the success of EMDR as explained in our clinical and laboratory studies. Any theory concerning the origin of the EMDR effect must take them into account.
14. If you do not like the venue for our papers, perhaps you should consult the book “When the Past is Always Present” written by Ruden (MD, PhD), and published in 2011 by Routledge. The book is based in large part on our studies. .
Can the fear memory be removed in less than one hour by your suggested therapies? It can.be removed in one hour or less by EMDR. All points quoted are well known in the literature. We added only #8.
David Fresco -- try this paper by Shapiro:
J Behav Ther Exp Psychiatry. 1989 Sep;20(3):211-7.
Eye movement desensitization: a new treatment for post-traumatic stress disorder.
Shapiro F.
"The procedure can be extremely effective in only one session, as indicated by a previous controlled study and a case history presented here."
Also please note my paper "Taming the Amygdala" in which I generalize the findings re EMDR to all exposure therapies. If you choose not to read my articles, do you think you should criticize them?
Obviously you have not read my article on exposure theories. Also, you have not read the article by F. Shapiro in which she gives the evidence you seek. She backs up her quote with research. Why do use your postdoc - you should look at the articles yourself and then criticize them.
Well this is certainly a lively debate and more than I ever expected when I posted the question. I see that the controversy regarding this technique rages on! I have been contemplating writing an article about EMDR and this discussion certainly gives me plenty to work with!
Hi Vahid, if I do go ahead with an article I will of course thoroughly investigate several sources, including those mentioned here and cite and attribute appropriately. :0)
Yes, we learned that the amygdala is a center for negative emotion, however, current views extend beyond that and define it as a center that processes salience, in other words, what is important in the environment. So again, the over-simplification. Oh well, you work with what you have and keep moving forward.
There is a lot of information to be found at www.childtrauma.com in the publication list. The clinicians and researchers involved there can provide data and information on controlled trials and so on.
EMDR, as a package, is an empirically supported treatment for PTSD. However, the currently available evidence suggests that eye movements (or any other "lateralizations") aren't necessary for EMDR to work. So, it is the rest of the package, in other words, good old CBT, that works.
Mechanism of Action
EMDR contains many procedures and elements that contribute to treatment effects. While the methodology used in EMDR has been extensively validated (see above), questions still remain regarding mechanism of action. However, since EMDR achieves clinical effects without the need for homework, or the prolonged focus used in exposure therapies, attention has been paid to the possible neurobiological processes that might be evoked. Although the eye movements (and other dual attention stimulation) comprise only one procedural element, this element has come under greatest scrutiny. Randomized controlled studies evaluating mechanism of action of the eye movement component follow this section.
El Khoury-Malhame, M. et al. (2011). Attentional bias in post-traumatic stress disorder diminishes after symptom amelioration. Behaviour Research and Therapy 49, 796-801.
Attentional bias toward aversive cues in PTSD has been hypothesized as being part of the dysfunction causing etiology and maintenance of PTSD. The aim of the present study was to investigate the cognitive strategy underlying attentional bias in PTSD and whether normal cognitive processing is restored after a treatment suppressing core PTSD symptoms.” An average of 4.1 EMDR sessions resulted in remission of PTSD. Post treatment “similarly to controls, EMDR treated patients who were symptom free had null e-Stroop and disengagement indices.
Elofsson, U.O.E., von Scheele, B., Theorell, T., & Sondergaard, H.P. (2008). Physiological correlates of eye movement desensitization and reprocessing. Journal of Anxiety Disorders, 22, 622-634.
Changes in heart rate, skin conductance and LF/HF-ratio, finger temperature, breathing frequency, carbon dioxide and oxygen levels were documented during the eye movement condition. It was concluded the “eye movements during EMDR activate cholinergic and inhibit sympathetic systems. The reactivity has similarities with the pattern during REM sleep.”
Hornsveld, H. K., Landwehr, F., Stein, W., Stomp, M., Smeets, S., & van den Hout, M. A. (2010). Emotionality of loss-related memories is reduced after recall plus eye movements but not after recall plus music or recall only. Journal of EMDR Practice and Research, 4, 106-112.
Recall-plus-music was added to investigate whether reductions in emotionality are associated with relaxation. . . Participants reported a greater decline in emotionality and concentration after eye movements in comparison to recall-only and recall-with-music. It is concluded that eye movements are effective when negative memories pertain to loss and grief.
Kapoula Z, Yang Q, Bonnet A, Bourtoire P, & Sandretto J (2010). EMDR Effects on Pursuit Eye Movements. PLoS ONE 5(5): e10762. doi:10.1371/journal.pone.0010762
EMDR treatment of autobiographic worries causing moderate distress resulted in an “increase in the smoothness of pursuit [which] presumably reflects an improvement in the use of visual attention needed to follow the target accurately. Perhaps EMDR reduces distress thereby activating a cholinergic effect known to improve ocular pursuit.”
Kristjánsdóttir, K. & Lee, C. M. (2011). A comparison of visual versus auditory concurrent tasks on reducing the distress and vividness of aversive autobiographical memories. Journal of EMDR Practice and Research, 5, 34-41.
Results showed that vividness and emotionality ratings of the memory decreased significantly after eye movement and counting, and that eye movement produced the greatest benefit. Furthermore, eye movement facilitated greater decrease in vividness irrespective of the modality of the memory. Although this is not consistent with the hypothesis from a working memory model of mode-specific effects, it is consistent with a central executive explanation.
Lee, C.W., Taylor, G., & Drummond, P.D. (2006). The active ingredient in EMDR: Is it traditional exposure or dual focus of attention? Clinical Psychology and Psychotherapy, 13, 97-107.
This study tested whether the content of participants’ responses during EMDR is similar to that thought to be effective for traditional exposure treatments (reliving), or is more consistent with distancing which would be expected given Shapiro’s proposal of dual focus of attention. Greatest improvement on a measure of PTSD symptoms occurred when the participant processed the trauma in a more detached manner, which indicates the underlying mechanisms of EMDR and exposure therapy are different.
Lilley, S.A., Andrade, J., Graham Turpin, G.,Sabin-Farrell, R., & Holmes, E.A. (2009). Visuospatial working memory interference with recollections of trauma. British Journal of Clinical Psychology, 48, 309–321.
Tested patients awaiting PTSD treatment and demonstrated that the eye movement condition had a significant effect on vividness of trauma memory and emotionality compared to counting and exposure only. In addition, “the counting task had no effect on vividness compared to exposure only, suggesting that the eye-movement task had a specific effect rather than serving as a general distractor” (p. 317)
MacCulloch, M. J., & Feldman, P. (1996). Eye movement desensitization treatment utilizes the positive visceral element of the investigatory reflex to inhibit the memories of post-traumatic stress disorder: A theoretical analysis. British Journal of Psychiatry, 169, 571–579.
One of a variety of articles positing an orienting response as a contributing element (see Shapiro, 2001 for comprehensive examination of theories and suggested research parameters). This theory has received controlled research support (Barrowcliff et al., 2003, 2004).
Propper, R., Pierce, J.P., Geisler, M.W., Christman, S.D., & Bellorado, N. (2007). Effect of bilateral eye movements on frontal interhemispheric gamma EEG coherence: Implications for EMDR therapy. Journal of Nervous and Mental Disease, 195, 785-788.
Specifically, the EM manipulation used in the present study, reported previously to facilitate episodic memory, resulted in decreased interhemispheric EEG coherence in anterior prefrontal cortex. Because the gamma band includes the 40 Hz wave that may indicate the active binding of information during the consolidation of long-term memory storage (e.g., Cahn and Polich, 2006), it is particularly notable that the changes in coherence we found are in this band. With regard to PTSD symptoms, it may be that by changing interhemispheric coherence in frontal areas, the EMs used in EMDR foster consolidation of traumatic memories, thereby decreasing the memory intrusions found in this disorder.
Rogers, S., & Silver, S. M. (2002). Is EMDR an exposure therapy? A review of trauma protocols. Journal of Clinical Psychology, 58, 43-59.
Theoretical, clinical, and procedural differences referencing two decades of CBT and EMDR research.
Rogers, S., Silver, S., Goss, J., Obenchain, J., Willis, A., & Whitney, R. (1999). A single session, controlled group study of flooding and eye movement desensitization and reprocessing in treating posttraumatic stress disorder among Vietnam war veterans: Preliminary data. Journal of Anxiety Disorders, 13, 119–130.
This study was designed as primarily a process report to compare EMDR and exposure therapy. A different recovery pattern was observed with the EMDR group demonstrating a more rapid decline in self-reported distress.
Sack, M., Hofmann, A., Wizelman, L., & Lempa, W. (2008). Psychophysiological changes during EMDR and treatment outcome. Journal of EMDR Practice and Research, 2, 239-246
During-session changes in autonomic tone were investigated in 10 patients suffering from single-trauma PTSD. Results indicate that information processing during EMDR is followed by during-session decrease in psychophysiological activity, reduced subjective disturbance and reduced stress reactivity to traumatic memory.
Sack, M., Lempa, W. Steinmetz, A., Lamprecht, F. & Hofmann, A. (2008). Alterations in autonomic tone during trauma exposure using eye movement desensitization and reprocessing (EMDR) - results of a preliminary investigation. Journal of Anxiety Disorders, 22, 1264-1271.
The psycho-physiological correlates of EMDR were investigated during treatment sessions of trauma patients. The initiation of the eye movements sets resulted in immediate changes that indicated a pronounced de-arousal.
Servan-Schreiber, D., Schooler, J., Dew, M.A., Carter, C., & Bartone, P. (2006). EMDR for PTSD: A pilot blinded, randomized study of stimulation type. Psychotherapy and Psychosomatics. 75, 290-297.
Twenty-one patients with single-event PTSD (average IES: 49.5) received three consecutive sessions of EMDR with three different types of auditory and kinesthetic stimulation. All were clinically useful. However, alternating stimulation appeared to confer an additional benefit to the EMDR procedure.
Stickgold, R. (2002). EMDR: A putative neurobiological mechanism of action. Journal of Clinical Psychology, 58, 61-75.
Stickgold, R. (2008). Sleep-dependent memory processing and EMDR action. Journal of EMDR Practice and Research, 2, 289-299.
Comprehensive explanations of mechanisms and the potential links to the processes that occur in REM sleep. Controlled studies have evaluated these theories (see next section; Christman et al., 2003; Kuiken et al. 2001-2002).
Suzuki, A., et al. (2004). Memory reconsolidation and extinction have distinct temporal and biochemical signatures. Journal of Neuroscience, 24, 4787– 4795.
The article explores the differences between memory reconsolidation and extinction. This new area of investigation is worthy of additional attention. Reconsolidation may prove to be the underlying mechanism of EMDR, as opposed to extinction caused by prolonged exposure therapies. “Memory reconsolidation after retrieval may be used to update or integrate new information into long-term memories . . . Brief exposure … seems to trigger a second wave of memory consolidation (reconsolidation), whereas prolonged exposure . . leads to the formation of a new memory that competes with the original memory (extinction).”
van den Hout, M., et al. (2011). EMDR: Tones inferior to eye movements in the EMDR treatment of PTSD. Behaviour Research and Therapy, 50, 275-79.
EMs outperformed tones while it remained unclear if tones add to recall only. . . EMs were superior to tones in reducing the emotionality and vividness of trauma memories. [I]n contrast to EMs, tones hardly tax working memory and induce a smaller reduction in emotionality and vividness of aversive memories. Interestingly, patients’ preferences did not follow this pattern: the perceived effectiveness was higher for tones than for EMs. . . . Clearly, the superior effects of EMs on emotionality and vividness of trauma memories were not due to demand characteristics.
Wilson, D., Silver, S. M., Covi, W., & Foster, S. (1996). Eye movement desensitization and reprocessing: Effectiveness and autonomic correlates. Journal of Behaviour Therapy and Experimental Psychiatry, 27, 219–229.
Study involving biofeedback equipment has supported the hypothesis that the parasympathetic system is activated by finding that eye movements appeared to cause a compelled relaxation response. More rigorous research with trauma populations is needed.
Randomized Studies of Hypotheses Regarding Eye Movements
Numerous memory researchers have evaluated the eye movements used in EMDR therapy. A recent meta-analysis of the eye movement research has reported positive effects (Lee & Cuijpers, 2013) in both clinical and laboratory trials (see above). It is hypothesized that a number of mechanisms interact synergistically. The following studies have tested specific hypotheses regarding mechanism of action and found a direct effect on emotional arousal, imagery vividness, attentional flexibility, retrieval, distancing and memory association.
Andrade, J., Kavanagh, D., & Baddeley, A. (1997). Eye-movements and visual imagery: a working memory approach to the treatment of post-traumatic stress disorder. British Journal of Clinical Psychology, 36, 209-223.
Tested the working memory theory. Eye movements were superior to control conditions in reducing image vividness and emotionality.
Barrowcliff, A.L., Gray, N.S., Freeman, T.C.A., MacCulloch, M.J. (2004). Eye-movements reduce the vividness, emotional valence and electrodermal arousal associated with negative autobiographical memories. Journal of Forensic Psychiatry and Psychology, 15, 325-345.
Tested the reassurance reflex model. Eye movements were superior to control conditions in reducing image vividness and emotionality.
Barrowcliff, A.L., Gray, N.S., MacCulloch, S., Freeman, T. C.A., & MacCulloch, M.J. (2003). Horizontal rhythmical eye-movements consistently diminish the arousal provoked by auditory stimuli. British Journal of Clinical Psychology, 42, 289-302.
Tested the reassurance reflex model. Eye movements were superior to control conditions in reducing arousal provoked by auditory stimuli.
Christman, S. D., Garvey, K. J., Propper, R. E., & Phaneuf, K. A. (2003). Bilateral eye movements enhance the retrieval of episodic memories. Neuropsychology. 17, 221-229.
Tested cortical activation theories. Results provide indirect support for the orienting response/REM theories suggested by Stickgold (2002, 2008). Saccadic eye movements, but not tracking eye movements were superior to control conditions in episodic retrieval.
Christman, S. D., Propper, R. E., & Brown, T. J. (2006). Increased interhemispheric interaction is associated with earlier offset of childhood amnesia. Neuropsychology, 20, 336.
The results of the current Experiment 2 suggest that the eye movements employed in EMDR may induce a neurobiological change in interhemispheric interaction and an attendant psychological change in episodic retrieval.
Engelhard, I.M., van den Hout, M.A., Janssen, W.C., & van der Beek, J. (2010). Eye movements reduce vividness and emotionality of ‘‘flashforwards.’’ Behaviour Research and Therapy, 48, 442–447.
This study examined whether eye movements reduce vividness and emotionality of visual distressing images about feared future events. . . Relative to the no-dual task condition, eye movements while thinking of future-oriented images resulted in decreased ratings of image vividness and emotional intensity.
Engelhard, I.M., van Uijen, S.L. & van den Hout, M.A. (2010). The impact of taxing working memory on negative and positive memories. European Journal of Psychotraumatology, 1: 5623 - DOI: 10.3402/ejpt.v1i0.5623
Additional investigation of eye movements compared to Tetris from a working memory perspective.
Engelhard, I.M., et al. (2011). Reducing vividness and emotional intensity of recurrent “flashforwards” by taxing working memory: An analogue study. Journal of Anxiety Disorders 25, 599–603.
Results showed that vividness of intrusive images was lower after recall with eye movement, relative to recall only, and there was a similar trend for emotionality.
Gunter, R.W. & Bodner, G.E. (2008). How eye movements affect unpleasant memories: Support for a working-memory account. Behaviour Research and Therapy 46, 913– 931.
Three studies were done that cumulatively support a working-memory account of the eye movement benefits in which the central executive is taxed when a person performs a distractor task while attempting to hold a memory in mind.
Kavanagh, D. J., Freese, S., Andrade, J., & May, J. (2001). Effects of visuospatial tasks on desensitization to emotive memories. British Journal of Clinical Psychology, 40, 267-280.
Tested the working memory theory. Eye movements were superior to control conditions in reducing within-session image vividness and emotionality. There was no difference one-week post.
Kuiken, D., Bears, M., Miall, D., & Smith, L. (2002). Eye movement desensitization reprocessing facilitates attentional orienting. Imagination, Cognition and Personality, 21, 3-20.
Tested the orienting response theory related to REM-type mechanisms. Indicated that the eye movement condition was correlated with increased attentional flexibility. Eye movements were superior to control conditions.
Kuiken, D., Chudleigh, M. & Racher, D. (2010). Bilateral eye movements, attentional flexibility and metaphor comprehension: The substrate of REM dreaming? Dreaming, 20, 227–247.
This study adds additional support to the orienting response theory related to REM-type mechanisms. Evaluations of participants experiencing significant loss or trauma demonstrate differential effects in a comparison of eye movement and non-eye movement conditions.
Lee, C.W., & Drummond, P.D. (2008). Effects of eye movement versus therapist instructions on the processing of distressing memories. Journal of Anxiety Disorders, 22, 801-808.
There was no significant effect of therapist’s instruction on the outcome measures. There was a significant reduction in distress for eye movement at post-treatment and at follow-up.. . . The results were consistent with other evidence that the mechanism of change in EMDR is not the same as traditional exposure.
Maxfield, L., Melnyk, W.T. & Hayman, C.A. G. (2008). A working memory explanation for the effects of eye movements in EMDR. Journal of EMDR Practice and Research, 2, 247-261.
In two experiments participants focused on negative memories while engaging in three dual-attention eye movement tasks of increasing complexity. Results support a working memory explanation for the effects of eye movement dual-attention tasks on autobiographical memory.
Nieuwenhuis, S., Elzinga, B. M., Ras, P. H., Berends, F., Duijs, P., Samara, Z., & Slagter, H. A. (2013). Bilateral saccadic eye movements and tactile stimulation, but not auditory stimulation, enhance memory retrieval. Brain and Cognition, 81, 52-56.
Increased memory retrieval in two experiments support “the possibility that alternating bilateral activation of the left and right hemispheres exerts its effects on memory by increasing the functional connectivity between the two hemispheres.
Parker, A., Buckley, S. & Dagnall, N. (2009). Reduced misinformation effects following saccadic bilateral eye movements. Brain and Cognition, 69, 89-97.
Bilateral saccadic eye movements were compared to vertical and no eye movements. “It was found that bilateral eye movements increased true memory for the event, increased recollection, and decreased the magnitude of the misinformation effect.” This study supports hypotheses regarding effects of interhemispheric activation and episodic memory.
Parker, A. & Dagnall, N. (2007). Effects of bilateral eye movements on gist based false recognition in the DRM paradigm. Brain and Cognition, 63, 221-225.
Bilateral saccadic eye movements were compared to vertical and no eye movements. Those in the bilateral eye movement condition “were more likely to recognise previously presented words and less likely to falsely recognize critical non-studies associates.”
Parker, A., Relph, S. & Dagnall, N. (2008). Effects of bilateral eye movement on retrieval of item, associative and contextual information. Neuropsychology, 22, 136-145.
The effects of saccadic bilateral eye movement were compared to vertical eye movements and no eye movements on the retrieval of item, associative and contextual information. Saccadic eye movements were superior on all parameters in all conditions.
Samara, Z., Bernet M., Elzinga, B.M., Heleen A., Slagter, H.A., & Nieuwenhuis, S. (2011). Do horizontal saccadic eye movements increase interhemispheric coherence? Investigation of a hypothesized neural mechanism underlying EMDR. Frontiers in Psychiatry, 2, 4. doi: 10.3389/fpsyt.2011.00004.
The study demonstrated that 30 seconds of bilateral saccadic EMs enhanced the episodic retrieval of non-traumatic emotional stimuli in healthy adults. There was no evidence for an increase in interhemispheric coherence. However, a number of caveats regarding interpretation are noted
Schubert, S.J., Lee, C.W. & Drummond, P.D. (2011). The efficacy and psychophysiological correlates of dual-attention tasks in eye movement desensitization and reprocessing (EMDR). Journal of Anxiety Disorders, 25, 1-11.
EMDR-with eye movements led to greater reduction in distress than EMDR-without eye movements. Heart rate decreased significantly when eye movements began; skin conductance decreased during eye movement sets; heart rate variability and respiration rate increased significantly as eye movements continued; and orienting responses were more frequent in the eye movement than no-eye movement condition at the start of exposure.
Sharpley, C. F. Montgomery, I. M., & Scalzo, L. A. (1996). Comparative efficacy of EMDR and alternative procedures in reducing the vividness of mental images. Scandinavian Journal of Behaviour Therapy, 25, 37-42.
Eye movements were superior to control conditions in reducing image vividness.
Smeets, M. A., Dijs, M. W., Pervan, I., Engelhard, I. M., & Van den Hout, M. A. (2012). Time-course of eye movement-related decrease in vividness and emotionality of unpleasant autobiographical memories. Memory, 20, 346-357.
Results revealed a significant drop [in eyes moving condition] compared to the [eyes stationary] group in emotionality after 74 seconds compared to a significant drop in vividness at only 2 seconds into the intervention. These results support that emotionality becomes reduced only after vividness has dropped.
van den Hout, M., Muris, P., Salemink, E., & Kindt, M. (2001). Autobiographical memories become less vivid and emotional after eye movements. British Journal of Clinical Psychology, 40, 121-130.
Tested their theory that eye movements change the somatic perceptions accompanying retrieval, leading to decreased affect, and therefore decreasing vividness. Eye movements were superior to control conditions in reducing image vividness. Unlike control conditions, eye movements also decreased emotionality.
van den Hout, M., et al. (2011). EMDR: Eye movements superior to beeps in taxing working memory and reducing vividness of recollections. Behaviour Research and Therapy, 49, 92-98.
Vividness of negative memories was reduced after both beeps and eye movements, but effects were larger for eye movements. Findings support a working memory account of EMDR and suggest that effects of beeps on negative memories are inferior to those of eye movements.
Additional Psychophysiological and Neurobiological Evaluations of EMDR Treatment
All psychophysiological studies have indicated significant de-arousal. Neurobiological studies have indicated significant effects, including changes in cortical, and limbic activation patterns, and increase in hippocampal volume.
Aubert-Khalfa, S., Roques, J. & Blin, O. (2008). Evidence of a decrease in heart rate and skin conductance responses in PTSD patients after a single EMDR session. Journal of EMDR Practice and Research, 2, 51-56.
Bossini L. Fagiolini, A. & Castrogiovanni, P. (2007). Neuroanatomical changes after EMDR in posttraumatic stress disorder. Journal of Neuropsychiatry and Clinical Neuroscience, 19, 457-458.
Bossini, L., Tavanti, M., Calossi, S., Polizzotto, N. R., Vatti, G., Marino, D., & Castrogiovanni, P. (2011). EMDR treatment for posttraumatic stress disorder, with focus on hippocampal volumes: A pilot study. The Journal of Neuropsychiatry and Clinical Neurosciences, 23, E1-2. doi:10.1176/appi. neuropsych.23.2.E1.
Frustaci, A., Lanza, G.A., Fernandez, I., di Giannantonio, M. & Pozzi, G. (2010). Changes in psychological symptoms and heart rate variability during EMDR treatment: A case series of subthreshold PTSD. Journal of EMDR Practice and Research, 4, 3-11.
Grbesa et al.: (2010). Electrophysiological changes during EMDR treatment in patients with combat-related PTSD. Annals of General Psychiatry 9 (Suppl 1) :S209.
Harper, M. L., Rasolkhani-Kalhorn, T., & Drozd, J. F. (2009). On the neural basis of EMDR therapy: Insights from qeeg studies. Traumatology, 15, 81-95.
Kowal, J. A. (2005). QEEG analysis of treating PTSD and bulimia nervosa using EMDR. Journal of Neurotherapy, 9(Part 4), 114-115.
Lamprecht, F., Kohnke, C., Lempa, W., Sack, M., Matzke, M., & Munte, T. (2004). Event-related potentials and EMDR treatment of post-traumatic stress disorder. Neuroscience Research, 49, 267-272.
Landin-Romero, R., et al. (2013). EMDR therapy modulates the default mode network in a subsyndromal, traumatized bipolar patient. Neuropsychobiology, 67, 181-184.
Lansing, K., Amen, D.G., Hanks, C. & Rudy, L. (2005). High resolution brain SPECT imaging and EMDR in police officers with PTSD. Journal of Neuropsychiatry and Clinical Neurosciences, 17, 526-532.
Levin, P., Lazrove, S., & van der Kolk, B. A. (1999). What psychological testing and neuroimaging tell us about the treatment of posttraumatic stress disorder (PTSD) by eye movement desensitization and reprocessing (EMDR). Journal of Anxiety Disorders, 13, 159-172.
Nardo D et al. (2009, in press). Gray matter density in limbic and paralimbic cortices is associated with trauma load and EMDR outcome in PTSD patients. Journal of Psychiatric Research. doi:10.1016/j.jpsychires.2009.10.014
Oh, D.-H., & Choi, J. (2004). Changes in the regional cerebral perfusion after Eye Movement Desensitization and Reprocessing: A SPECT study of two cases. Journal of EMDR Practice and Research, 1, 24-30.
Ohta ni, T., Matsuo, K., Kasai, K., Kato, T., & Kato, N. (2009). Hemodynamic responses of eye movement desensitization and reprocessing in posttraumatic stress disorder. Neuroscience Research, 65, 375–383.
Pagani, M. et al. (2007). Effects of EMDR psychotherapy on 99mTc-HMPAO distribution in occupation-related post-traumatic stress disorder. Nuclear Medicine Communications, 28, 757–765.
Pagani, M. et al. (2011). Pretreatment, intratreatment, and posttreatment EEG imaging of EMDR: Methodology and preliminary results from a single case. Journal of EMDR Practice and Research, 5, 42-56.
Propper, R., Pierce, J.P., Geisler, M.W., Christman, S.D., & Bellorado, N. (2007). Effect of bilateral eye movements on frontal interhemispheric gamma EEG coherence: Implications for EMDR therapy. Journal of Nervous and Mental Disease, 195, 785-788.
Richardson, R., Williams, S.R., Hepenstall, S., Sgregory, L., McKie, & Corrigan, F. (2009). A single-case fMRI study EMDR treatment of a patient with posttraumatic stress disorder. Journal of EMDR Practice and Research, 3, 10-23.
Sack, M., Lempa, W., & Lemprecht, W. (2007). Assessment of psychophysiological stress reactions during a traumatic reminder in patients treated with EMDR. Journal of EMDR Practice and Research, 1, 15-23.
Sack, M., Nickel, L., Lempa, W., & Lamprecht, F. (2003) Psychophysiological regulation in patients suffering from PTSD: Changes after EMDR treatment. Journal of Psychotraumatology and Psychological Medicine, 1, 47 -57. (German)
van der Kolk, B., Burbridge, J., & Suzuki, J. (1997). The psychobiology of traumatic memory: Clinical implications of neuroimaging studies. Annals of the New York Academy of Sciences, 821, 99-113.
Dear Patti,
Thank you for this extensive literature review. I guess people have different view on the nature of EMDR simply because they use it differently. Some grasped the core and found effects better than simple exposure, while others didn't.
Your citation also give me an enlightment. Is it that the stressed individuals do not have an eye-movement as smooth as un-stressed ones? If so, then to train eye-movement itself is definitely a treatment. Just like if someone have trouble walking due to some CNS deficit, then training to walk along will correct both the behavior and the underlying brain processing. Even before doing any double-blind experiment we will accept it as a fact.
I just wonder why we can not accept EMDR like that? Probably because we have a hidden thought that stress is somehow more mysterious than CNS deficit? That is interesting, really, really interesting.
Dr. Shapiro has a blog in the NY Times with info that should be relevant to this discussion. Therefore I am cutting and pasting some of her posts:
From: http://consults.blogs.nytimes.com/2012/03/16/expert-answers-on-e-m-d-r/?_php=true&_type=blogs&_r=0
"In prolonged exposure therapy, clients must describe the memory as if it were happening to them in the present. They repeat this two to three times during the session while an audio recording is made. The rationale for this form of treatment is that the reason clients’ problems persist is that they are avoiding reminders of the instigating events. Therefore, it is considered important for them to learn firsthand that they can experience the distress without being overwhelmed. Likewise, they are required to do daily homework between sessions that consists of listening to the recordings of their description of the event and visiting locations associated with it, to cause the disturbance to dissipate.
In cognitive processing therapy, clients are asked to provide details about the traumatic event so that their negative beliefs can be identified and then challenged and changed. This occurs during sessions and by doing daily homework assignments.
In contrast to the preceding treatments, the emphasis in E.M.D.R. is to help the information processing system make the automatic connections required to resolve the disturbance. Specific procedures are used to help clients maintain a sense of control during memory work as the therapist guides their focus of attention. They need only focus briefly on the disturbing memory during the processing while engaged in the bilateral stimulation (eye movements, taps or tones) as the internal associations are made. The client’s brain makes the needed links as new emotions, sensations, beliefs and memories emerge. All the work is done during the therapy sessions. It is not necessary for the client to describe the memory in detail, and no homework is used."
IMO the best articles on this subject:
Rothbaum, B.O., Astin, M.C., & Marsteller, F. (2005). Prolonged exposure versus eye movement desensitization (EMDR) for PTSD rape victims. Journal of Traumatic Stress, 18, 607-616.
In this NIMH funded study both treatments were effective: “An interesting potential clinical implication is that EMDR seemed to do equally well in the main despite less exposure and no homework. It will be important for future research to explore these issues.”
Lee, C.W., Taylor, G., & Drummond, P.D. (2006). The active ingredient in EMDR: Is it traditional exposure or dual focus of attention? Clinical Psychology and Psychotherapy, 13, 97-107.
This study tested whether the content of participants’ responses during EMDR is similar to that thought to be effective for traditional exposure treatments (reliving), or is more consistent with distancing which would be expected given Shapiro’s proposal of dual focus of attention. Greatest improvement on a measure of PTSD symptoms occurred when the participant processed the trauma in a more detached manner, which indicates the underlying mechanisms of EMDR and exposure therapy are different.
Rogers, S., & Silver, S. M. (2002). Is EMDR an exposure therapy? A review of trauma protocols. Journal of Clinical Psychology, 58, 43-59.
Theoretical, clinical, and procedural differences referencing two decades of CBT and EMDR research.
All these bifocal multi-sensory interventions BFMSi use stephen PORGES Polyvagal Theory for justification. The basic assumption is that the theory of sympathicus & parasympathicus is not sufficient to explain physiological reactions, but there are 2 branches of the parasympathicus.
Furthermore I would like to mention from my own work on evaluating TRE it seems that symptoms become a little bit worse in the beginning of therapy, but then decrease significantly after some months. - Irritating in this result is that normally patients experience immediate strong relief of the most disturbing symptoms within minutes or hours after using these BFMS interventions they take as miracles.
Pain research explains it as re-calibration of their psychophysical perception.
What I would also like to mention is that eye movement doesn't seem to be a crucial part in this intervention, but it probably facilitates the healing; other variables seem to be much more important like activation of the original pattern of experience.
Good luck in chosing the most sensitive variables :-)
If you have further questions on your research design don't hesitate to contact me after May 5th, 2014.
For those genuinely interested in a theory concerning the biological (neural) basis of the EMDR effect, please consider the three scientifically based papers published in Traumatology by Harper, Kalhorn, and Drozd and repeated on our web page mindspaces.org. The first paper by Kalhorn and Harper presents the theory of depotentiation of synapses based on animal studies; the second paper gives EEG wave data supporting the theory of depotentiation; the third paper generalizes the concept from EMDR to all exposure therapies.
We carefully recorded the EEGs of patients undergoing EMDR. We found that merely thinking of the fear memory increases delta wave power by 150 to 200 percent. This explains the reason for the success of exposure therapy without sensory input, although it takes many sessions. With sensory input, the wave power is increased by 15 to 300 times, and the fear memory is rapidly erased by depotentiation of the synapses mediating the memory, usually in a single session. We conducted over 50 experiments in our EEG lab to corroborate the clinical findings.
All successful exposure therapy relies on the same effect: depotentiation of the synapses in the lateral amygdala mediating the fear memory. This depotentiation requires that the NMDA receptor opens on the minimum phase of the delta wave, allowing into the synapse calcium ions. These contact vesicles containing molecules of calcineurin. This releases the calcineurin molecules, which travel to the surface of the synapse and cause the reorientation of a critical area of the receptors, and thereby preventing them from opening. The depotentiated receptors are then removed from the surface of the synapse. Repeated action such as this causes the synapses to drop out of the memory chain, and the fear memory itself is extinquished.
The main difficulty is that, up to now the Mind research is not based on the neuroscience or biology.
With all due respect, there is no convincing scientific evidence to explain how exposure therapy (once called flooding) works.
To say that EMDR is CBT says very little about either CBT or EMDR. It only exposes a lack of critical thinking. CBT is such a broad rubric that it fundamentally covers anything involving a targeted focus on cognition and behavior. One might as well say psychoanalysis is long term CBT.
The issue about mechanisms underlying the efficacy of treatment is important. With respect to flooding/exposure, it is as likely that the effective behavioral mechanism is the supportive impact of the treatment alliance in reducing distress as the patient recalls the trauma that leads to symptom relief as it is that avoidance reduction accounts for positive treatment outcomes.
Recent research involving neurobiology and behavioral studies suggests that the overarching mechanism likely involves reduction of amygdala responsiveness and increased prefrontal activity. There is little specificity to this with respect to CBT (which kind) or EMDR. It is likely both treatments impact similar mechanisms through different pathways. Of interest in possibly distinguishing pathways differentially involved in EMDR and PE is evidence that suggests that attentional allocation changes after treatment. I suspect that in a decade or so we will discover that all roads (treatments) meet at the same intersection (mechanisms) with respect to the endpoints associated with efficacious outcomes.
http://scholar.google.co.uk/scholar?hl=en&q=Pagani+et+al.+2012+EMDR+NEURO&btnG=&as_sdt=1%2C5&as_sdtp=
Neurobiological correlates of EMDR monitoring–An EEG study..
Paul, you have missed the point entirely. There has never been such a successful therapy for any psychological trauma such as PTSD. You are doing your commercial interprise a vast injury by attacking in ignorance a therapy known to be so benign and helpful as EMDR and other exposure therapies. Please do your homework before you spout such ignorant hogwash. You must particularly study scientific articles supporting the therapy.
Dr. rakshan: What science did you find in dessauer's arguments? Also please advise us of pseudoscientific jargon. Have you read yhe relevant articles? I doubt if you can judge scientific presentations, from your statements.
In what kind of science do you speak? My colleages and I started the process by studying the undeniably scientific work on animals with implanted electrodes that depotentiated synapses in the relevant areas. These researchers were even able to determine the area of each receptor that turned off the receptor. Perhaps your review of this basic work would be enlightening.
Thank you Vahid. This is the first sign of scientific inquiry. You can read in our paper "On the Neural Basis of EMDR Therapy", page 7 and following, the main points made in the bibliography extracts below. However, if you want to consult the original sources, I suggest Lin, et al, 2003 first.. The titles themselves give a good idea of what each article is about. Also, if you look at the entire bibliography, all scientific articles for the most part, how could our paper, which is based on these prior studies not also be a scientific paper?
We made an important discovery on our first patient whose EEG we recorded during an EMDR session. We recorded these phases: Relaxed, fear memory only, and finally, fear memory plus sensory input (vibrating pads in palms of hands). This discovery was made because we did not use the usual EEG processing, but instead went to the raw data to use an interpretation technique I learned in my other profession, earth sciences (geophysics). The vast increase in power had not been remarked upon as far as we could see from extensive searches. This is the basic secret of the success of exposure therapies (those in which the patient is exposed to a fear memory). For the full argument of depotentiation of fear memories by powerful delta waves, please refer to the full text of the paper. I wish we could have another kind of communication, by phone, for example. A conversation about scientific discovery and scientific writing in general would be most welcome. Or simply by email. My email address is [email protected].
Earnshaw, B. A. & Bressloff, P. C. (2006). Biophysical model of AMPA receptor trafficking and its regulation during long-term potentiation/long-term depression. Journal of Neuroscience, 26(47), 12362-12373.
Hölscher, C., Anwyl, R., & Rowan, M.J. (1997). Stimulation on the positive phase of
hippocampal theta rhythm induces long-term potentiation that can be depotentiated by stimulation on the negative phase in area CA1 in vivo. Journal of Neuroscience, 17(16), 6470-6477.
Lin, C.H., Yeh, S.H., Lu, H.Y., & Gean, P.W. (2003). The similarities and diversities of
signal pathways leading to consolidation of conditioning and consolidation of extinction of fear memory. Journal of Neuroscience, 23(23), 8310-8317.
Lisman, J. E. (2001). Three Ca2+ levels affect plasticity differently: the LTP zone, the LTD zone and no man's land. Journal of Physiology, 532(2), 285-285.
Rubin, J. E., Gerkin, R. C., Bi, G-Q., & Chow, C. C. (2005). Calcium time course as a signal for spike-timing-dependent plasticity. Journal of Neurophysiology, 93(5), 2600-2613.
G'day Melvin,
You wrote;
>
Can you provide some independent scientific evaluation to support this assertion of fact?
You also wrote;
>
I have no commercial interprise(sic). I work for a not-for-profit NGO that delivers public health services free of charge.
And actually, I did not "attack" exposure therapies.
Nor did I personally attack EMDR. I just quoted an article that critiques EMDR's more outlandish claims.
The article from which I have quoted states that EMDR's effects are probably a result of the factors EMDR has in common with other exposure therapies, and are not a result of the eye-movement element of the therapeutic model. In other words EMDR works, but the eye movements are not a clinically significant part of the therapy.
Finally, you wrote;
>
I have often had people correct me when I am factually wrong, and I have had people suggest alternative interpretations of evidence, but I don't think I have ever been accused of ignorance for simply posting a link to someone else's writing before.
So, I do apologize if my post has caused you some form of personal insult. This was not intended.
Melvin, if you look at my two posts (above) again, you should realise that I did not write any of that text at all.
I am merely quoting an article from the Skeptic's society that critiques Shapiro's theory and practice. That is why the text is inside > and why I have provided links to the original article.
>
The article also relates how Shapiro's therapeutic method has evolved over time, so that any independent attempts at verification of her claims are difficult. When a researcher fails to replicate any advantage of EMDR over other exposure therapies, Shapiro's response has been that they didn't carry out the process correctly. But she keeps changing her requirements for proper training in the technique. She appears to be constantly moving the goal posts.
>
You finished with;
>
I would respectfully suggest that scientific method involves studying all of the available evidence, and then forming a hypothesis to explain it, and then testing that hypothesis.
Pseudo-science involves cherry-picking the data and research that conforms to your preconceptions and preexisting theories, ignoring or discounting contrary evidence, and then asserting that you have proved something to be true.
So, when you write of EMDR that > you really need to provide some solid evidence to support this assertion. This means peer-reviewed controlled trials, or credible meta-studies, that allow us to see beyond our own selection biases, prejudices, and preconceptions.
Regards,
Paul.
I agree with Paul. You must not select the evidence that fits the theory and not review evidence that does not. This is a problem involved when researching any therapeutic process. Pseudo-science certainly does cherry pick in order to find the ripest evidence while disregarding any evidence that DOES NOT support a particular theory.
You are correct Paul in your comment that all relevant articles must be consulted, not just those that support a particular theory. We did consult all relevant articles. There are very few such articles. We included those, such as one by Dr. stickgold, and noted in our publication that his theory disagreed with ours. We suggested that his study be consulted for an alternate view. We listed all previous attempts to explain the biological basis of the EMDR effect without critical comments. None supported our theory because none of them went to the basic data, the EEG recordings of actual EMDR sessions. In short, there were NO relevant studies to support or deny our findings.
Regarding my statement that there has never been such a successful therapy for extreme trauma, we challenge you to give evidence for a more successful one. We studied every known trauma therapy and concluded that none even comes close to the effectiveness of exposure therapies. The only one that could be considered is dialectical behavior therapy, which is more useful than EMDR for chronic PTSD; luckily a rare condition.
Paul seems to be citing research from the 90s. There are far better and more recent studies available now. I am giving folks a much larger list of articles, both recent and not-so-recent, from which to read.
On the mechanism of action, EMDR contains many procedures and elements that contribute to treatment effects. While the methodology used in EMDR has been extensively validated (see below), questions still remain regarding mechanism of action. However, since EMDR achieves clinical effects without the need for homework, or the prolonged focus used in exposure therapies, attention has been paid to the possible neurobiological processes that might be evoked. Although the eye movements (and other dual attention stimulation) comprise only one procedural element, this element has come under greatest scrutiny. Randomized controlled studies evaluating mechanism of action of the eye movement component follow this section.
It's important to note the number of highly respected organizations and associations that endorse EMDR therapy as a front-line treatment for PTSD including departments of health of many countries, the US Dept. of Defense, and the VA, all which have given their "stamp of approval" to EMDR therapy. There are over 24 randomized studies (plus over a dozen non-randomized) of trauma victims, and an additional 24 studies have demonstrated positive effects for the eye movement component used in EMDR therapy.
American Psychiatric Association (2004). Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Post-traumatic Stress Disorder. Arlington, VA: American Psychiatric Association Practice Guidelines. EMDR therapy was determined to be an effective treatment of trauma.
Department of Veterans Affairs and Department of Defense (2004, 2010). VA/DoD Clinical Practice Guideline for the Management of Post-Traumatic Stress. Washington, DC. EMDR therapy was placed in the "A" category as “strongly recommended” for the treatment of trauma.
And significantly: the World Health Organization has published Guidelines for the management of conditions that are specifically related to stress. Trauma-focused CBT and EMDR are the only psychotherapies recommended for children, adolescents and adults with PTSD. “Like CBT with a trauma focus, EMDR therapy aims to reduce subjective distress and strengthen adaptive cognitions related to the traumatic event. Eye movement desensitization and reprocessing (EMDR): This therapy is based on the idea that negative thoughts, feelings and behaviours are the result of unprocessed memories. The treatment involves standardized procedures that include focusing simultaneously on (a) spontaneous associations of traumatic images, thoughts, emotions and bodily sensations and (b) bilateral stimulation that is most commonly in the form of repeated eye movements. Like CBT with a trauma focus, EMDR aims to reduce subjective distress and strengthen adaptive beliefs related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure, or (d) homework.” (p.1) (Geneva, WHO, 2013)
Here's an extensive list of research on mechanism of action, etc.
Note: if you want to read just one, I recommend this one:
Lee, C.W. & Cuijpers, P. (2013). A meta-analysis of the contribution
of eye movements in processing emotional memories. Journal of Behavior
Therapy & Experimental Psychiatry, 44, 231-239.
“The effect size for the additive effect of eye movements in EMDR treatment
studies was moderate and significant (Cohen’s d = 0.41). For the second
group of laboratory studies the effect size was large and significant (d =
0.74).”
El Khoury-Malhame, M. et al. (2011). Attentional bias in post-traumatic stress disorder diminishes after symptom amelioration. Behaviour Research and Therapy 49, 796-801.
Attentional bias toward aversive cues in PTSD has been hypothesized as being part of the dysfunction causing etiology and maintenance of PTSD. The aim of the present study was to investigate the cognitive strategy underlying attentional bias in PTSD and whether normal cognitive processing is restored after a treatment suppressing core PTSD symptoms.” An average of 4.1 EMDR sessions resulted in remission of PTSD. Post treatment “similarly to controls, EMDR treated patients who were symptom free had null e-Stroop and disengagement indices.
Elofsson, U.O.E., von Scheele, B., Theorell, T., & Sondergaard, H.P. (2008). Physiological correlates of eye movement desensitization and reprocessing. Journal of Anxiety Disorders, 22, 622-634.
Changes in heart rate, skin conductance and LF/HF-ratio, finger temperature, breathing frequency, carbon dioxide and oxygen levels were documented during the eye movement condition. It was concluded the “eye movements during EMDR activate cholinergic and inhibit sympathetic systems. The reactivity has similarities with the pattern during REM sleep.”
Hornsveld, H. K., Landwehr, F., Stein, W., Stomp, M., Smeets, S., & van den Hout, M. A. (2010). Emotionality of loss-related memories is reduced after recall plus eye movements but not after recall plus music or recall only. Journal of EMDR Practice and Research, 4, 106-112.
Recall-plus-music was added to investigate whether reductions in emotionality are associated with relaxation. . . Participants reported a greater decline in emotionality and concentration after eye movements in comparison to recall-only and recall-with-music. It is concluded that eye movements are effective when negative memories pertain to loss and grief.
Kapoula Z, Yang Q, Bonnet A, Bourtoire P, & Sandretto J (2010). EMDR Effects on Pursuit Eye Movements. PLoS ONE 5(5): e10762. doi:10.1371/journal.pone.0010762
EMDR treatment of autobiographic worries causing moderate distress resulted in an “increase in the smoothness of pursuit [which] presumably reflects an improvement in the use of visual attention needed to follow the target accurately. Perhaps EMDR reduces distress thereby activating a cholinergic effect known to improve ocular pursuit.”
Kristjánsdóttir, K. & Lee, C. M. (2011). A comparison of visual versus auditory concurrent tasks on reducing the distress and vividness of aversive autobiographical memories. Journal of EMDR Practice and Research, 5, 34-41.
Results showed that vividness and emotionality ratings of the memory decreased significantly after eye movement and counting, and that eye movement produced the greatest benefit. Furthermore, eye movement facilitated greater decrease in vividness irrespective of the modality of the memory. Although this is not consistent with the hypothesis from a working memory model of mode-specific effects, it is consistent with a central executive explanation.
Lee, C.W., Taylor, G., & Drummond, P.D. (2006). The active ingredient in EMDR: Is it traditional exposure or dual focus of attention? Clinical Psychology and Psychotherapy, 13, 97-107.
This study tested whether the content of participants’ responses during EMDR is similar to that thought to be effective for traditional exposure treatments (reliving), or is more consistent with distancing which would be expected given Shapiro’s proposal of dual focus of attention. Greatest improvement on a measure of PTSD symptoms occurred when the participant processed the trauma in a more detached manner, which indicates the underlying mechanisms of EMDR and exposure therapy are different.
Lilley, S.A., Andrade, J., Graham Turpin, G.,Sabin-Farrell, R., & Holmes, E.A. (2009). Visuospatial working memory interference with recollections of trauma. British Journal of Clinical Psychology, 48, 309–321.
Tested patients awaiting PTSD treatment and demonstrated that the eye movement condition had a significant effect on vividness of trauma memory and emotionality compared to counting and exposure only. In addition, “the counting task had no effect on vividness compared to exposure only, suggesting that the eye-movement task had a specific effect rather than serving as a general distractor” (p. 317)
MacCulloch, M. J., & Feldman, P. (1996). Eye movement desensitization treatment utilizes the positive visceral element of the investigatory reflex to inhibit the memories of post-traumatic stress disorder: A theoretical analysis. British Journal of Psychiatry, 169, 571–579.
One of a variety of articles positing an orienting response as a contributing element (see Shapiro, 2001 for comprehensive examination of theories and suggested research parameters). This theory has received controlled research support (Barrowcliff et al., 2003, 2004).
Propper, R., Pierce, J.P., Geisler, M.W., Christman, S.D., & Bellorado, N. (2007). Effect of bilateral eye movements on frontal interhemispheric gamma EEG coherence: Implications for EMDR therapy. Journal of Nervous and Mental Disease, 195, 785-788.
Specifically, the EM manipulation used in the present study, reported previously to facilitate episodic memory, resulted in decreased interhemispheric EEG coherence in anterior prefrontal cortex. Because the gamma band includes the 40 Hz wave that may indicate the active binding of information during the consolidation of long-term memory storage (e.g., Cahn and Polich, 2006), it is particularly notable that the changes in coherence we found are in this band. With regard to PTSD symptoms, it may be that by changing interhemispheric coherence in frontal areas, the EMs used in EMDR foster consolidation of traumatic memories, thereby decreasing the memory intrusions found in this disorder.
Sack, M., Hofmann, A., Wizelman, L., & Lempa, W. (2008). Psychophysiological changes during EMDR and treatment outcome. Journal of EMDR Practice and Research, 2, 239-246
During-session changes in autonomic tone were investigated in 10 patients suffering from single-trauma PTSD. Results indicate that information processing during EMDR is followed by during-session decrease in psychophysiological activity, reduced subjective disturbance and reduced stress reactivity to traumatic memory.
Sack, M., Lempa, W. Steinmetz, A., Lamprecht, F. & Hofmann, A. (2008). Alterations in autonomic tone during trauma exposure using eye movement desensitization and reprocessing (EMDR) - results of a preliminary investigation. Journal of Anxiety Disorders, 22, 1264-1271.
The psycho-physiological correlates of EMDR were investigated during treatment sessions of trauma patients. The initiation of the eye movements sets resulted in immediate changes that indicated a pronounced de-arousal.
Stickgold, R. (2002). EMDR: A putative neurobiological mechanism of action. Journal of Clinical Psychology, 58, 61-75.
Stickgold, R. (2008). Sleep-dependent memory processing and EMDR action. Journal of EMDR Practice and Research, 2, 289-299.
Comprehensive explanations of mechanisms and the potential links to the processes that occur in REM sleep. Controlled studies have evaluated these theories (see next section; Christman et al., 2003; Kuiken et al. 2001-2002).
Suzuki, A., et al. (2004). Memory reconsolidation and extinction have distinct temporal and biochemical signatures. Journal of Neuroscience, 24, 4787– 4795.
The article explores the differences between memory reconsolidation and extinction. This new area of investigation is worthy of additional attention. Reconsolidation may prove to be the underlying mechanism of EMDR, as opposed to extinction caused by prolonged exposure therapies. “Memory reconsolidation after retrieval may be used to update or integrate new information into long-term memories . . . Brief exposure … seems to trigger a second wave of memory consolidation (reconsolidation), whereas prolonged exposure . . leads to the formation of a new memory that competes with the original memory (extinction).”.
Wilson, D., Silver, S. M., Covi, W., & Foster, S. (1996). Eye movement desensitization and reprocessing: Effectiveness and autonomic correlates. Journal of Behaviour Therapy and Experimental Psychiatry, 27, 219–229.
Study involving biofeedback equipment has supported the hypothesis that the parasympathetic system is activated by finding that eye movements appeared to cause a compelled relaxation response. More rigorous research with trauma populations is needed.
Randomized Studies of Hypotheses Regarding Eye Movements:
Numerous memory researchers have evaluated the eye movements used in EMDR therapy. A recent meta-analysis of the eye movement research has reported positive effects (Lee & Cuijpers, 2013) in both clinical and laboratory trials (see above). It is hypothesized that a number of mechanisms interact synergistically. The following studies have tested specific hypotheses regarding mechanism of action and found a direct effect on emotional arousal, imagery vividness, attentional flexibility, retrieval, distancing and memory association.
Andrade, J., Kavanagh, D., & Baddeley, A. (1997). Eye-movements and visual imagery: a working memory approach to the treatment of post-traumatic stress disorder. British Journal of Clinical Psychology, 36, 209-223.
Tested the working memory theory. Eye movements were superior to control conditions in reducing image vividness and emotionality.
Barrowcliff, A.L., Gray, N.S., Freeman, T.C.A., MacCulloch, M.J. (2004). Eye-movements reduce the vividness, emotional valence and electrodermal arousal associated with negative autobiographical memories. Journal of Forensic Psychiatry and Psychology, 15, 325-345.
Tested the reassurance reflex model. Eye movements were superior to control conditions in reducing image vividness and emotionality.
Barrowcliff, A.L., Gray, N.S., MacCulloch, S., Freeman, T. C.A., & MacCulloch, M.J. (2003). Horizontal rhythmical eye-movements consistently diminish the arousal provoked by auditory stimuli. British Journal of Clinical Psychology, 42, 289-302.
Tested the reassurance reflex model. Eye movements were superior to control conditions in reducing arousal provoked by auditory stimuli.
Christman, S. D., Garvey, K. J., Propper, R. E., & Phaneuf, K. A. (2003). Bilateral eye movements enhance the retrieval of episodic memories. Neuropsychology. 17, 221-229.
Tested cortical activation theories. Results provide indirect support for the orienting response/REM theories suggested by Stickgold (2002, 2008). Saccadic eye movements, but not tracking eye movements were superior to control conditions in episodic retrieval.
Christman, S. D., Propper, R. E., & Brown, T. J. (2006). Increased interhemispheric interaction is associated with earlier offset of childhood amnesia. Neuropsychology, 20, 336.
The results of the current Experiment 2 suggest that the eye movements employed in EMDR may induce a neurobiological change in interhemispheric interaction and an attendant psychological change in episodic retrieval.
Engelhard, I.M., van den Hout, M.A., Janssen, W.C., & van der Beek, J. (2010). Eye movements reduce vividness and emotionality of ‘‘flashforwards.’’ Behaviour Research and Therapy, 48, 442–447.
This study examined whether eye movements reduce vividness and emotionality of visual distressing images about feared future events. . . Relative to the no-dual task condition, eye movements while thinking of future-oriented images resulted in decreased ratings of image vividness and emotional intensity.
Engelhard, I.M., van Uijen, S.L. & van den Hout, M.A. (2010). The impact of taxing working memory on negative and positive memories. European Journal of Psychotraumatology, 1: 5623 - DOI: 10.3402/ejpt.v1i0.5623
Additional investigation of eye movements compared to Tetris from a working memory perspective.
Engelhard, I.M., et al. (2011). Reducing vividness and emotional intensity of recurrent “flashforwards” by taxing working memory: An analogue study. Journal of Anxiety Disorders 25, 599–603.
Results showed that vividness of intrusive images was lower after recall with eye movement, relative to recall only, and there was a similar trend for emotionality.
Gunter, R.W. & Bodner, G.E. (2008). How eye movements affect unpleasant memories: Support for a working-memory account. Behaviour Research and Therapy 46, 913– 931.
Three studies were done that cumulatively support a working-memory account of the eye movement benefits in which the central executive is taxed when a person performs a distractor task while attempting to hold a memory in mind.
Kavanagh, D. J., Freese, S., Andrade, J., & May, J. (2001). Effects of visuospatial tasks on desensitization to emotive memories. British Journal of Clinical Psychology, 40, 267-280.
Tested the working memory theory. Eye movements were superior to control conditions in reducing within-session image vividness and emotionality. There was no difference one-week post.
Kuiken, D., Bears, M., Miall, D., & Smith, L. (2002). Eye movement desensitization reprocessing facilitates attentional orienting. Imagination, Cognition and Personality, 21, 3-20.
Tested the orienting response theory related to REM-type mechanisms. Indicated that the eye movement condition was correlated with increased attentional flexibility. Eye movements were superior to control conditions.
Kuiken, D., Chudleigh, M. & Racher, D. (2010). Bilateral eye movements, attentional flexibility and metaphor comprehension: The substrate of REM dreaming? Dreaming, 20, 227–247.
This study adds additional support to the orienting response theory related to REM-type mechanisms. Evaluations of participants experiencing significant loss or trauma demonstrate differential effects in a comparison of eye movement and non-eye movement conditions.
Maxfield, L., Melnyk, W.T. & Hayman, C.A. G. (2008). A working memory explanation for the effects of eye movements in EMDR. Journal of EMDR Practice and Research, 2, 247-261.
In two experiments participants focused on negative memories while engaging in three dual-attention eye movement tasks of increasing complexity. Results support a working memory explanation for the effects of eye movement dual-attention tasks on autobiographical memory.
Nieuwenhuis, S., Elzinga, B. M., Ras, P. H., Berends, F., Duijs, P., Samara, Z., & Slagter, H. A. (2013). Bilateral saccadic eye movements and tactile stimulation, but not auditory stimulation, enhance memory retrieval. Brain and Cognition, 81, 52-56.
Increased memory retrieval in two experiments support “the possibility that alternating bilateral activation of the left and right hemispheres exerts its effects on memory by increasing the functional connectivity between the two hemispheres.
Parker, A., Buckley, S. & Dagnall, N. (2009). Reduced misinformation effects following saccadic bilateral eye movements. Brain and Cognition, 69, 89-97.
Bilateral saccadic eye movements were compared to vertical and no eye movements. “It was found that bilateral eye movements increased true memory for the event, increased recollection, and decreased the magnitude of the misinformation effect.” This study supports hypotheses regarding effects of interhemispheric activation and episodic memory.
Parker, A. & Dagnall, N. (2007). Effects of bilateral eye movements on gist based false recognition in the DRM paradigm. Brain and Cognition, 63, 221-225.
Bilateral saccadic eye movements were compared to vertical and no eye movements. Those in the bilateral eye movement condition “were more likely to recognise previously presented words and less likely to falsely recognize critical non-studies associates.”
Parker, A., Relph, S. & Dagnall, N. (2008). Effects of bilateral eye movement on retrieval of item, associative and contextual information. Neuropsychology, 22, 136-145.
The effects of saccadic bilateral eye movement were compared to vertical eye movements and no eye movements on the retrieval of item, associative and contextual information. Saccadic eye movements were superior on all parameters in all conditions.
Samara, Z., Bernet M., Elzinga, B.M., Heleen A., Slagter, H.A., & Nieuwenhuis, S. (2011). Do horizontal saccadic eye movements increase interhemispheric coherence? Investigation of a hypothesized neural mechanism underlying EMDR. Frontiers in Psychiatry, 2, 4. doi: 10.3389/fpsyt.2011.00004.
The study demonstrated that 30 seconds of bilateral saccadic EMs enhanced the episodic retrieval of non-traumatic emotional stimuli in healthy adults. There was no evidence for an increase in interhemispheric coherence. However, a number of caveats regarding interpretation are noted
Schubert, S.J., Lee, C.W. & Drummond, P.D. (2011). The efficacy and psychophysiological correlates of dual-attention tasks in eye movement desensitization and reprocessing (EMDR). Journal of Anxiety Disorders, 25, 1-11.
EMDR-with eye movements led to greater reduction in distress than EMDR-without eye movements. Heart rate decreased significantly when eye movements began; skin conductance decreased during eye movement sets; heart rate variability and respiration rate increased significantly as eye movements continued; and orienting responses were more frequent in the eye movement than no-eye movement condition at the start of exposure.
Sharpley, C. F. Montgomery, I. M., & Scalzo, L. A. (1996). Comparative efficacy of EMDR and alternative procedures in reducing the vividness of mental images. Scandinavian Journal of Behaviour Therapy, 25, 37-42.
Eye movements were superior to control conditions in reducing image vividness.
Smeets, M. A., Dijs, M. W., Pervan, I., Engelhard, I. M., & Van den Hout, M. A. (2012). Time-course of eye movement-related decrease in vividness and emotionality of unpleasant autobiographical memories. Memory, 20, 346-357.
Results revealed a significant drop [in eyes moving condition] compared to the [eyes stationary] group in emotionality after 74 seconds compared to a significant drop in vividness at only 2 seconds into the intervention. These results support that emotionality becomes reduced only after vividness has dropped.
van den Hout, M., Muris, P., Salemink, E., & Kindt, M. (2001). Autobiographical memories become less vivid and emotional after eye movements. British Journal of Clinical Psychology, 40, 121-130.
Tested their theory that eye movements change the somatic perceptions accompanying retrieval, leading to decreased affect, and therefore decreasing vividness. Eye movements were superior to control conditions in reducing image vividness. Unlike control conditions, eye movements also decreased emotionality.
van den Hout, M., et al. (2011). EMDR: Eye movements superior to beeps in taxing working memory and reducing vividness of recollections. Behaviour Research and Therapy, 49, 92-98.
Vividness of negative memories was reduced after both beeps and eye movements, but effects were larger for eye movements. Findings support a working memory account of EMDR and suggest that effects of beeps on negative memories are inferior to those of eye movements.
Additional Psychophysiological and Neurobiological Evaluations of EMDR Treatment:
All psychophysiological studies have indicated significant de-arousal. Neurobiological studies have indicated significant effects, including changes in cortical, and limbic activation patterns, and increase in hippocampal volume.
Aubert-Khalfa, S., Roques, J. & Blin, O. (2008). Evidence of a decrease in heart rate and skin conductance responses in PTSD patients after a single EMDR session. Journal of EMDR Practice and Research, 2, 51-56.
Bossini L. Fagiolini, A. & Castrogiovanni, P. (2007). Neuroanatomical changes after EMDR in posttraumatic stress disorder. Journal of Neuropsychiatry and Clinical Neuroscience, 19, 457-458.
Bossini, L., Tavanti, M., Calossi, S., Polizzotto, N. R., Vatti, G., Marino, D., & Castrogiovanni, P. (2011). EMDR treatment for posttraumatic stress disorder, with focus on hippocampal volumes: A pilot study. The Journal of Neuropsychiatry and Clinical Neurosciences, 23, E1-2. doi:10.1176/appi. neuropsych.23.2.E1.
Frustaci, A., Lanza, G.A., Fernandez, I., di Giannantonio, M. & Pozzi, G. (2010). Changes in psychological symptoms and heart rate variability during EMDR treatment: A case series of subthreshold PTSD. Journal of EMDR Practice and Research, 4, 3-11.
Grbesa et al.: (2010). Electrophysiological changes during EMDR treatment in patients with combat-related PTSD. Annals of General Psychiatry 9 (Suppl 1) :S209.
Harper, M. L., Rasolkhani-Kalhorn, T., & Drozd, J. F. (2009). On the neural basis of EMDR therapy: Insights from qeeg studies. Traumatology, 15, 81-95.
Kowal, J. A. (2005). QEEG analysis of treating PTSD and bulimia nervosa using EMDR. Journal of Neurotherapy, 9(Part 4), 114-115.
Lamprecht, F., Kohnke, C., Lempa, W., Sack, M., Matzke, M., & Munte, T. (2004). Event-related potentials and EMDR treatment of post-traumatic stress disorder. Neuroscience Research, 49, 267-272.
Landin-Romero, R., et al. (2013). EMDR therapy modulates the default mode network in a subsyndromal, traumatized bipolar patient. Neuropsychobiology, 67, 181-184.
Lansing, K., Amen, D.G., Hanks, C. & Rudy, L. (2005). High resolution brain SPECT imaging and EMDR in police officers with PTSD. Journal of Neuropsychiatry and Clinical Neurosciences, 17, 526-532.
Levin, P., Lazrove, S., & van der Kolk, B. A. (1999). What psychological testing and neuroimaging tell us about the treatment of posttraumatic stress disorder (PTSD) by eye movement desensitization and reprocessing (EMDR). Journal of Anxiety Disorders, 13, 159-172.
Nardo D et al. (2009, in press). Gray matter density in limbic and paralimbic cortices is associated with trauma load and EMDR outcome in PTSD patients. Journal of Psychiatric Research. doi:10.1016/j.jpsychires.2009.10.014
Oh, D.-H., & Choi, J. (2004). Changes in the regional cerebral perfusion after Eye Movement Desensitization and Reprocessing: A SPECT study of two cases. Journal of EMDR Practice and Research, 1, 24-30.
Ohta ni, T., Matsuo, K., Kasai, K., Kato, T., & Kato, N. (2009). Hemodynamic responses of eye movement desensitization and reprocessing in posttraumatic stress disorder. Neuroscience Research, 65, 375–383.
Pagani, M. et al. (2007). Effects of EMDR psychotherapy on 99mTc-HMPAO distribution in occupation-related post-traumatic stress disorder. Nuclear Medicine Communications, 28, 757–765.
Pagani, M. et al. (2011). Pretreatment, intratreatment, and posttreatment EEG imaging of EMDR: Methodology and preliminary results from a single case. Journal of EMDR Practice and Research, 5, 42-56.
Propper, R., Pierce, J.P., Geisler, M.W., Christman, S.D., & Bellorado, N. (2007). Effect of bilateral eye movements on frontal interhemispheric gamma EEG coherence: Implications for EMDR therapy. Journal of Nervous and Mental Disease, 195, 785-788.
Richardson, R., Williams, S.R., Hepenstall, S., Sgregory, L., McKie, & Corrigan, F. (2009). A single-case fMRI study EMDR treatment of a patient with posttraumatic stress disorder. Journal of EMDR Practice and Research, 3, 10-23.
Sack, M., Lempa, W., & Lemprecht, W. (2007). Assessment of psychophysiological stress reactions during a traumatic reminder in patients treated with EMDR. Journal of EMDR Practice and Research, 1, 15-23.
Sack, M., Nickel, L., Lempa, W., & Lamprecht, F. (2003) Psychophysiological regulation in patients suffering from PTSD: Changes after EMDR treatment. Journal of Psychotraumatology and Psychological Medicine, 1, 47 -57. (German)
van der Kolk, B., Burbridge, J., & Suzuki, J. (1997). The psychobiology of traumatic memory: Clinical implications of neuroimaging studies. Annals of the New York Academy of Sciences, 821, 99-113.
Thanks Melvin.
I'll have to do some reading!
re >
It's not my responsibility to disprove your claim, it is your responsibility to provide credible evidence supporting the claim. Can you cite some of the studies you are talking about? Cheers.
Paul.
International Treatment Guidelines (14 of them) that cite EMDR as an effective treatment for trauma. These guidelines also state that EMDR and CBT are treatments of choice. There have been 7 meta-analyses between 2001 and 2013. The studies included in these meta-analyses compared various psychological therapies. Without exception these studies report that EMDR , Exposure, and other CBT based therapies were all effective in trauma treatment.
41 Randomised Clinical Trials report on the effectiveness of psychological therapies. The majority of these suggested that EMDR is an effective therapy, some suggest that both CBT and EMDR produce similar results. 21 Non-randomised studies report some supportive evidence for EMDR. One of these compared CBT and EMDR and reported the superiority of CBT. Many of the RCT and Non-RCT studies had relatively small samples.
In order to test the superiority of effectiveness of EMDR we should design comparative studies using larger samples. It may that multisite collaboration may indeed yield more robust results
Paul, it was not our objective to determine the effectiveness of EMDR, but to determine how it works so well.. We knew this from our own practice and those of others. Every day, hundreds of people successfully undergo the therapy. However, here are a few of the hundreds of relevant articles on that support our contention. If you would like to have more, please refer to EMDR Research & Reading on the EMDR website.
American Psychiatric Association (2004). Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder. Arlington, VA: American Psychiatric Association Practice Guidelines.
EMDR is recommended as an effective treatment for trauma.
Bleich, A., Kotler, M., Kutz, I., & Shalev, A. (2002). A position paper of the (Israeli) National Council for Mental Health: Guidelines for the assessment and professional intervention with terror victims in the hospital and in the community. Jerusalem, Israel.
EMDR is one of three methods recommended for treatment of terror victims.
CREST (2003). The management of post traumatic stress disorder in adults. A publication of the Clinical Resource Efficiency Support Team of the Northern Ireland Department of Health, Social Services and Public Safety, Belfast.
EMDR and CBT were stated to be the treatments of choice.
Department of Veterans Affairs & Department of Defense (2010). VA/DoD Clinical Practice Guideline for the Management of Post-Traumatic Stress. Washington, DC: Veterans Health Administration, Department of Veterans Affairs and Health Affairs, Department of Defense.
EMDR was placed in the category of the most effective PTSD psychotherapies. This “A” category is described as “A strong recommendation that clinicians provide the intervention to eligible patients. Good evidence was found that the intervention improves important health outcomes and concludes that benefits substantially outweigh harm.”
Dutch National Steering Committee Guidelines Mental Health Care (2003). Multidisciplinary Guideline Anxiety Disorders. Quality Institute Heath Care CBO/Trimbos Intitute. Utrecht, Netherlands.
EMDR and CBT both designated as treatments of choice for PTSD
Foa, E.B., Keane, T.M., Friedman, M.J., & Cohen, J.A. (2009). Effective treatments for PTSD: Practice Guidelines of the International Society for Traumatic Stress Studies New York: Guilford Press.
EMDR was listed as an effective and empirically supported treatment for PTSD, and was given an AHCPR “A” rating for adult PTSD. This guideline specifically rejected the findings of the previous Institute of Medicine report, which stated that more research was needed to judge EMDR effective for adult PTSD. With regard to the application of EMDR to children, an AHCPR rating of Level B was assigned.
INSERM (2004). Psychotherapy: An evaluation of three approaches. French National Institute of Health and Medical Research, Paris, France.
EMDR and CBT were stated to be the treatments of choice for trauma victims.
ational Collaborating Centre for Mental Health (2005). Post traumatic stress disorder (PTSD): The management of adults and children in primary and secondary care. London: National Institute for Clinical Excellence.
Trauma-focused CBT and EMDR were stated to be empirically supported treatments for choice for adult PTSD.
SAMHSA’s National Registry of Evidence-based Programs and Practices (2011) http://nrepp.samhsa.gov/ViewIntervention.aspx?id=199
The Substance Abuse and Mental Health Services Administration (SAMHSA) is an agency of the U.S. Department of Health and Human Services (HHS). This national registry (NREPP) cites EMDR as evidence based practice for treatment of PTSD, anxiety, and depression symptoms. Their review of the evidence also indicated that EMDR leads to an improvement in mental health functioning.
United Kingdom Department of Health (2001). Treatment choice in psychological therapies and counselling evidence based clinical practice guideline. London, England.
Best evidence of efficacy was reported for EMDR, exposure, and stress inoculation
World Health Organization (2013). Guidelines for the management of conditions that are specifically related to stress. Geneva, WHO.
Trauma-focused CBT and EMDR are the only psychotherapies recommended for children, adolescents and adults with PTSD. “Like CBT with a trauma focus, EMDR therapy aims to reduce subjective distress and strengthen adaptive cognitions related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure, or (d) homework.” (p.1)
Examples of Meta-analyses
EMDR has been compared to numerous exposure therapy protocols, with and without CT techniques. It should be noted that exposure therapy uses one to two hours of daily homework and EMDR uses none. The most recent meta-analyses are listed here.
Bisson, J., Roberts, N.P., Andrew, M., Cooper, R. & Lewis, C. (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews 2013, DOI: 10.1002/14651858.CD003388.pub4
Research indicates that CBT and EMDR therapy are superior to all other treatments.
Lee, C.W. & Cuijpers, P. (2013). A meta-analysis of the contribution of eye movements in processing emotional memories. Journal of Behavior Therapy & Experimental Psychiatry, 44, 231-239.
“The effect size for the additive effect of eye movements in EMDR treatment studies was moderate and significant (Cohen’s d = 0.41). For the second group of laboratory studies the effect size was large and significant (d = 0.74).”
Examples of Randomized Clinical Trials
Abbasnejad, M., Mahani, K. N., & Zamyad, A. (2007). Efficacy of "eye movement desensitization and reprocessing" in reducing anxiety and unpleasant feelings due to earthquake experience. Psychological Research, 9, 104-117.
“EMDR is effective in reducing earthquake anxiety and negative emotions (e.g. PTSD, grief, fear, intrusive thoughts, depression, etc) resulting from earthquake experience. Furthermore, results show that, improvement due to EMDR was maintained at a one month follow up.”
Capezzani et al. (2013). EMDR and CBT for cancer patients: Comparative study of effects on PTSD, anxiety, and depression. Journal of EMDR Practice and Research, 5, 2-13.
This randomized pilot study reported that after eight sessions of treatment, EMDR therapy was superior to a variety of CBT techniques. “Almost all the patients (20 out of 21, 95.2%) did not have PTSD after the EMDR treatment.”
Cvetek, R. (2008). EMDR treatment of distressful experiences that fail to meet the criteria for PTSD. Journal of EMDR Practice and Research, 2, 2-14.
EMDR treatment of disturbing life events (small “t” trauma) was compared to active listening, and wait list. EMDR produced significantly lower scores on the Impact of Event Scale (mean reduced from “moderate” to “subclinical”) and a significantly smaller increase on the STAI after memory recall.
Hogberg, G. et al., (2007). On treatment with eye movement desensitization and reprocessing of chronic post-traumatic stress disorder in public transportation workers: A randomized controlled study. Nordic Journal of Psychiatry, 61, 54-61.
Employees who had experienced “person-under-train accident or had been assaulted at work were recruited.” Six sessions of EMDR resulted in remission of PTSD in 67% compared to 11% in the wait list control. Significant effects were documented in Global Assessment of Function (GAF) and Hamilton Depression (HAM-D) score. Follow-up: Högberg, G. et al. (2008). Treatment of post-traumatic stress disorder with eye movement desensitization and reprocessing: Outcome is stable in 35-month follow-up. Psychiatry Research. 159, 101-108.
Nijdam, Gersons, B.P.R, Reitsma, J.B., de Jongh, A. & Olff, M. (2012). Brief eclectic psychotherapy v. eye movement desensitisation and reprocessing therapy in the treatment of post-traumatic stress disorder: Randomised controlled trial. British Journal of Psychiatry, 200, 224-231.
A comparison of “the efficacy and response pattern of a trauma-focused CBT modality, brief eclectic psychotherapy for PTSD, with EMDR . . . Although both treatments are effective, EMDR results in a faster recovery compared with the more gradual improvement with brief eclectic psychotherapy.”
Van der Kolk, B., Spinazzola, J. Blaustein, M., Hopper, J. Hopper, E., Korn, D., & Simpson, W. (2007). A randomized clinical trial of EMDR, fluoxetine and pill placebo in the treatment of PTSD: Treatment effects and long-term maintenance. Journal of Clinical Psychiatry, 68, 37-46.
EMDR was superior to both control conditions in the amelioration of both PTSD symptoms and depression. Upon termination of therapy, the EMDR group continued to improve while Fluoxetine participants again became symptomatic.
Thank you Melvin for adding the references and guideline that I was writing about in my last answer. There are more but I suggest multisite collaboration comparing the therapies offered for trauma would be useful and instructive. Another important piece of work would be studies investigating the effect of dissociation on therapy particularly trauma therapy.
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