Clinical Interventions Therapeutic Approaches

EMDR: What the Research Shows

Current research and recommendations supporting the application of EMDR (Eye Movement Desensitization and Reprocessing) for treating PTSD, trauma, and more.

By Mental Health Academy 2023-05-02 03:44:10

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EMDR (Eye Movement Desensitization and Reprocessing) reduces impairment from PTSD/trauma and more. Treatment offers long-term benefits, and sometimes uncomfortable short-term symptoms. Certification is possible in the U.S., U.K., and Australia/New Zealand.

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Introduction

Here’s a question: What therapy is fairly new to the scene, works in non-traditional ways, and is showing itself to be as effective as some gold standard therapies, but in less time? If you answered “EMDR” – Eye Movement Desensitisation and Reprocessing Therapy – you are right – and you might have read our previous article on it. In that piece, we introduced EMDR as a somewhat new kid on the therapy block, having been “discovered” serendipitously by Francine Shapiro in the late 1980s.

We underscored that it is not a traditional therapy in that, rather than asking clients to verbally process distressing memories, thoughts, emotions, and even bodily actions remaining with them after trauma, EMDR therapists involve the client in eye movements and other bilateral stimulation to “unfreeze” the brain from traumatic memories, allowing it to resume its natural healing capacity. In that article, we listed the eight phases of standard EMDR treatment and many conditions to which EMDR has come to be applied (APA, 2017; Arkowitz & Lilienfeld, 2012; EMDR Institute, 2020; EMDRIA, 2021; Leonard, 2019; Shapiro, 2014; Tejcek, 2020; WebMD, n.d.)

We noted, though, that, while clinicians have been applying EMDR therapy to ever-more diverse client conditions, not all of the applications have been empirically validated. Hence the focus of this article is to offer a snapshot of what research has been conducted and describe some of the effects that clients have experienced. First, though, let’s see who else – what other significant agencies and institutions – recognise it as an effective treatment.

Which agencies are recommending EMDR?

If you want to go out to eat, say, Thai food, what’s the best restaurant to go to? One strand of traditional wisdom says, “Well, of course, you go to the restaurant where all the Thai people are eating!” To some extent, we now have a parallel situation with regard to the development of EMDR in that we have numerous proponent agencies whose therapists or clientele have had good experiences with it.

Hal Arkowitz and Scott Lilienfeld, in a 2012 article, noted that “few psychological treatments have been as widely heralded as EMDR. Some EMDR proponents have called it a ‘miracle cure’ and ‘paradigm shift’ and ABC’s 20/20 proclaimed it an ‘exciting breakthrough’ in the treatment of anxiety” More than 60,000 clinicians, they said, have undergone formal training in EMDR (Arkowitz & Lilienfeld, 2012). That number has, just a few years later, surpassed 100,000, and “millions of people have been treated successfully over the past 25 years” (EMDR Institute, 2020). So, who’s “eating” at the EMDR “restaurant”? The following organisations and agencies are EMDR proponents, among many national and international ones:

  • The American Psychiatric Association practice guidelines give EMDR the same status as CBT as an effective treatment for both acute and chronic PTSD.
  • The International Society for Traumatic Stress Studies gives the therapy a “strong recommendation” as an effective and empirically supported treatment for PTSD.
  • The Substance Abuse and Mental Health Services Administration recognises the therapy as effective to help people recover from trauma/PTSD, especially with co-occurring substance misuse issues.
  • The U.S. Department of Veterans Affairs and the Department of Defense report that EMDR was one of three therapies given the highest level of evidence.
  • The Cochrane Database of Systematic Reviews recognises EMDR and CBT as superior to all other treatments.
  • The California Evidence-based Clearinghouse for Child Welfare lists EMDR and trauma-focused CBT as “well-supported by research evidence”.
  • The World Health Organization notes that trauma-focused CBT and EMDR are the only psychotherapies recommended for children, adolescents, and adults with PTSD (Bisson et al, 2013; EMDRIA, 2021).

What does the research say?

Snapshot of research on EMDR

There is both bad news and good news here. The bad news is that not all of the conditions we listed in the previous article have had the “gold standard” evaluation of a randomised controlled trial. The studies which have been completed, however, have consistently shown EMDR to be effective. Here we report on a small subset of the studies which are emerging.

Meta-analysis of controlled outcome studies of PTSD/trauma

A meta-analysis of 36 controlled outcome studies on EMDR therapy has shown some of the following results on studies of PTSD/trauma:

  • 84% – 90% of single trauma victims no longer had PTSD after only three 90-minute sessions.
  • 100% of single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six 50-minute sessions.
  • 77% of combat veterans were free of PTSD in 12 sessions (Leonard, 2019; EMDR Institute, 2020).

British study of EMDR for acute mental health crisis

In a British study of 72 patients in an acute mental health crisis, results showed that of the 57 who completed treatment, significant improvements were made across all metrics, including a reduction in suicidal ideation. The majority needed fewer than 10 sessions and no onward referral for further psychological therapy. The study authors noted that significant cost savings were realised by virtue of retracted referrals for further therapy and early discharge from acute wards (Proudlock & Peris, 2020).

Psychosis with PTSD: 2012 study of EMDR

A 2012 study of 22 people found that EMDR therapy helped 77% of the individuals with psychotic disorder and PTSD, finding that their hallucinations, delusions, anxiety, depression symptoms, and self-esteem were significantly improved after treatment, and not exacerbated during treatment. This showed that EMDR can be applied to this group of patients without adapting the treatment protocol or delaying treatment by applying stabilising interventions beforehand (Van den Berg & van der Gaag, 2012).

Inpatient study of EMDR and depression

A study of 32 people conducted in an inpatient setting found that 68% of those receiving EMDR therapy showed full remission after treatment, and also had a stronger decrease in depressive symptoms (Leonard, 2019).

EMDR beats prolonged exposure, thought both reduce PTSD

An older study comparing EMDR and PE (prolonged exposure) showed that both approaches resulted in significant reduction in PTSD and depression symptoms, maintained at three-month follow-up, for the 22 subjects (who had been mostly crime and rape victims). Successful treatment was faster with EMDR and it appeared to be better tolerated, as the dropout rate was significantly lower in those randomised to EMDR as opposed to PE. Post-session ratings on the Subjective Units of Distress (SUDS) ratings were significantly lower for EMDR than for PE (Ironson, Freund, Strauss, & Williams, 2002).

Benefits last

Finally, research also suggests that the benefits of EMDR persist over time. Authors of a 2015 study reported that those receiving EMDR for depression were less likely than those in the control group to experience relapse or problems relating to depression in the year following treatment (Leonard, 2019).

What results can clients of EMDR expect?

Those writers on EMDR who have addressed the question all insist that EMDR is not only effective, but also safe. Some do point out, however, that there can be uncomfortable effects in the short term as the process works through, on route to blessing the client with a much less troubled life in the long-term. Here are some of the effects that have been reported (we start with the negative ones). Note that not every client will feel all of these effects.

“Buzzing”, “energised”, “pulverised”

Some clients have commented that their brain or their head – or even their whole body – feels like it is vibrating or buzzing after a session. Apparently, it is a result of the brain stimulation and goes away in a few minutes. Jeffrey Tejcek, founder of Virtual EMDR and a person with lived experience of EMDR therapy, states that “your mind will feel energized, even if at first [it] feels a bit pulverized” (Tejcek, 2016).

Intense, even flooding, emotions – and a few bad dreams

Not surprisingly, if EMDR – like exposure therapies – is to be effective as a trauma treatment, it is likely to bring to the surface many of the troubling emotions which may have been squashed down after the traumatic incident if some part of us decided that they were too scary to deal with. Yet they fester there, driving things from underground. With EMDR, such emotions may bubble up, presenting themselves for healing and release (a good sign). Before that happens, though, the client may experience the emotions as intense, or feel flooded by them; this may apply to matters the client really thought were not bothersome anymore! The processing may continue on to the subconscious, as clients work out some of the emotions in bad dreams. This phase is only temporary.

Dealing with “real-life” problems and facing “broken” places and things that feel like they should have stayed hidden inside

As with festering emotions, some of the memories and images from the past that we may have hidden away present themselves for re-evaluation now during treatment. Yes, it’s painful, but EMDR helps clients get a perspective on such things, so that they are not as major and troublesome anymore. With trauma (for more on working with trauma, read Assessing and Treating Trauma), the intrusive thoughts/memories/nightmares from the past are repetitive and unwanted. EMDR helps people work through their childhood issues so that such phenomena just become plain old memories: not traumatic ones – and the past stays in the past.

Grieving a past that might have been different

With the bilateral stimulation targeting the past, clients may start thinking: about lots of things, including what might have been different in their careers, their lives, or with lost loves. This can elicit a sense of grief, which now will need to be worked through. For tools and guidelines on how to effectively support clients going through loss and grief, head to this page.

Shrinking problems, different perspective

One aspect frequently noted is that, after EMDR, people tend to feel differently about the things that they once feared. Encountering a memory or image from the past that used to be traumatic is now just a thought/image/memory: not bothersome as before. The problem for which the person entered EMDR therapy may still be there, but has shrunken in size, and seems now less significant. Once feared things (for example: a plane crash for people with a flying phobia) don’t seem like threats anymore. Clients may be able to see the perspective of problematic others in their lives, such as difficult parents or former abusers.

Lighter, healthier, less obsessed, more masterful

People report that all the overwhelming stuff that was rolling around in their heads is, if not gone, at least not problematic, so not being drawn to think about the issue all the time is a relief that lends a lightness of being. People tend to feel healthier, with more of a sense of dealing with life, changes, and relationships in a less intimidated, more masterful way. Having the courage to face one’s issues and work through them yields a sense of empowerment.

Relationships change; boundaries improve

Especially for those overcoming addiction, but true in general, energy that had to be directed to overwhelming problems/trauma before is now freed up to pay attention to maintaining and enhancing relationships. The new-found sense of energy and wellness gives more confidence and emotional reserve to deal with the people in one’s life. The greater sense of living in wholeness also translates to better boundaries in relationships. For those who had substance issues, “friends” may have been merely the people one smoked/drank/used with: not really “there” as friends. But now the door is open for the making of genuine, healthy friendships.

Memories improve

EMDR clinicians and commentators are not sure why, but something in the EMDR process stirs up many memories: not only ones of trauma, but also random ones seemingly unrelated to the trauma, such as vivid recollections of where the person grew up, or childhood friends, or places travelled to. People from the past are recalled, often in intense detail.

Addicts get over addiction; eating disorder clients lose weight

In other words, those who came into EMDR for a specific condition such as addiction or bulimia may find the way cleared after EMDR treatment to move toward the goal of overcoming the disorder. It just becomes easier to say “no” to the substance or the binge food (Tejcek, 2016).

What about certification?

If this article and our companion one on the background, structure, and applications of EMDR have piqued your curiosity to know more about EMDR and/or you are considering getting certification in order to work as an EMDR therapist, here are the certifying organisations in the United States, the United Kingdom, and Australia/New Zealand:

In the United States

The main certifying organisation in the United States is the EMDR International Association. Their website says about becoming an EMDR International Association-certified therapist:

“Clinicians are eligible to become EMDR International Association Certified Therapists if they are fully licensed in their mental health professional field for independent practice and have two years of experience (minimum) in that field. Specific EMDR requirements include completion of an EMDR International Association approved training program in EMDR therapy, a minimum of fifty clinical sessions in which EMDR was utilized, and twenty hours of consultation in EMDR by an Approved Consultant. To maintain the credential, EMDR International Association Certified Therapists must complete twelve hours of continuing education in EMDR every two years” (EMDRIA, 2021).

In the United Kingdom

Standard Accredited Training is the first step to becoming an accredited EMDR therapist, says the EMDR Association UK.

The training is described as Parts 1-4, and used to be called Level 1 and 2. After completing Part 1 of basic training, the therapist is expected to be using EMDR in their clinical practice with straightforward cases. The EMDR Association UK website lists all of the EMDR Accredited Trainers and basic training courses in the UK; at this writing there are 10 (click here to see the list). If the trainer or training company chosen is NOT listed on the website, then the course is NOT accredited by EMDR Europe.

The reason to choose an accredited training course is that EMDR Europe, in cooperation with the EMDR Association UK, regularly accredits and monitors the standards of all EMDR Trainers and training courses. Only EMDR Europe Accredited Trainers are allowed to teach the 7-day basic Accredited EMDR course.

Individuals claiming to be EMDR trainers running EMDR courses in the UK but not listed on the site are NOT accredited by EMDR Europe and are teaching a non-accredited course.  The content and quality of such courses will not meet the requirements of the EMDR Europe Association, the EMDR Association UK, or the worldwide EMDR international community. Therapists attending non-accredited courses will not be eligible to become an EMDR Europe practitioner (EMDR Association UK, 2020).

In Australia and New Zealand

At the time of this publication, the EMDR Training Australia & New Zealand website stated the following about their training:

“Welcome to “EMDR Training Australia and New Zealand, a training provider that presents an EMDR training program authorised by Dr Francine Shapiro and her training institute, the EMDR Institute.”

The EMDR Institute Weekend 1 & 2 training is the only EMDR Basic training authorised by Dr Shapiro that is available in Australia. It is truly an international training, being the only EMDR training offered in many countries throughout the world that is accredited by each country’s EMDR Association and the EMDR International Association (EMDRIA).

EMDR Training Australia and New Zealand offers EMDR basic training, training in structural dissociation, and advanced trainings such as Structural Dissociation, Master Class, Master Class Intensive and Anger Management Trainings. Please feel free to visit the EMDR Institute website (emdr.com) (EMDR Training Australia & New Zealand, n.d.).

Summary

Eye Movement Desensitisation and Reprocessing Therapy has splashed into the therapy pool in the last three decades or so – and it has been proving it can swim. Many heavyweight agencies and government departments are attesting to its effectiveness for trauma, PTSD, and more. There are numerous controlled trials showing its effectiveness for an ever-widening array of conditions, and its generally briefer duration tends to be cost effective. It has been shown to be safe as well as effective, and the list of positive effects is already long, while there are few short-term negative effects. We listed information about certification in this burgeoning therapy field. We leave you with the question: might it be an appropriate therapy for you to use in your helping efforts?

Key takeaways

  • The brief, non-traditional therapy of EMDR involves the client in eye movements and other bilateral stimulation to “unfreeze” the brain from traumatic memories, allowing it to resume its natural healing capacity.
  • It has gained endorsement as an efficacious therapy from organisations such as the American Psychiatric Association, SAMHSA, and the U.S. Department of Veterans’ Affairs, as multiple studies have shown it to be effective in reducing symptoms of PTSD, trauma, and more.
  • Though its multiple benefits persist long-term, EMDR treatment sometimes results in uncomfortable short-term symptoms as the healing takes hold.
  • Certification programs in the United States, the United Kingdom, and New Zealand and Australia offer therapists a safe and ethical means of using EMDR to help clients.

References:

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