The National Center for Post-Traumatic Stress Disorder RESEARCH ON EYE MOVEMENT DESENSITIZATON AND REPROCESSING (EMDR) AS A TREATMENT FOR PTSD

Ten years ago Shapiro (1989) modified Wolpe’s (1958) systematic desensitization therapy by re­ placing progressive muscle relaxation with induced eye movements as the “reciprocal inhibitor” of distress. Designed originally as a treatment for traumatic memories, it was called Eye Movement Desensitization (EMD). Its essence was as follows. After identifying a traumatic target memory, the therapist would have the client articulate a selfreferent “negative cognition” associated with the memory (e.g., “I am shameful”) and a “positive cognition” (e.g., “I am honorable”) to replace the negative one. The therapist would then move her fingers back and forth in front of the client’s eyes, instructing the client to track her fingers visually while concentrating on the distressing memory. After each set of 10-12 eye movements, the thera­ pist would ask the client to provide ratings of distress and strength of belief in the positive cogni­ tion. The therapist would repeat this procedure until distress subsided and belief in the positive cognition increased. According to Shapiro (1989), a single 50-minute session of EMD was 100% successful in abolishing distress associated with a traumatic memory in survivors of combat, rape, and childhood sexual or emotional abuse. To explain these impressive re­ sults, she hypothesized that “the crucial compo­ nent of the EMD procedure is the repeated eyemovements while the memory is maintained in awareness” (Shapiro, 1989, p. 220). Shortly thereafter, Shapiro reconceptualized EMD in terms of “accelerated information processing” and renamed it Eye Movement Desensitization and Reprocessing (EMDR). The shift from EMD to EMDR appears more conceptual than procedural. The treatment, as described in a recent text (Shapiro, 1995), is very similar to the original description (Shapiro, 1989), and Shapiro (1996) herself refers to her clinical trial as a “controlled study of EMDR” (p. 211). Following Shapiro (1995, pp. 324-336), I use the term “EMDR” in this article to denote both EMD and EMDR studies. Interest sparked by Shapiro’s (1989) report has resulted in many studies testing the efficacy of EMDR for trauma-exposed people. There have been three kinds of randomized, controlled trials: com­ parisons against a wait-list, comparisons against other treatments, and dismantling studies that test the active ingredients of EMDR. EMDR versus Wait-list Control Conditions. Wilson et al. (1995, 1997) reported significantly better re­ sults for trauma-exposed patients treated with EMDR than for those randomized to a wait-list. Although sufficiently distressed to seek therapy, nearly two-thirds of Wilson et al.’s patients fell short of qualifying for a diagnosis of PTSD when they entered the study. Rothbaum (1997), however, reported similarly favorable results for rape survi­ vors, all of whom met criteria for PTSD. She found EMDR markedly more effective than a wait-list. Comparing an intervention against no treatment is common in psychotherapy research, especially for new approaches. This design controls for cer­ tain threats to internal validity (e.g., “spontaneous” remission associated with the mere passage of time). However, studies testing a treatment versus a waitlist cannot exclude the possibility that whatever benefits achieved are merely the consequence of nonspecific (“placebo”) factors common to all psy­ chotherapies. Consistent with this possibility, re­ sponse to EMDR is strongly related to suggestibil­ ity in patients with PTSD (r = .86; Forbes et al., 1994). EMDR versus Other Treatments. Some random­ ized trials have involved comparisons between EMDR and other treatments. An advantage to this approach is that two (or more) treatments are di­ rectly compared on patients drawn from the same pool. Inferences about relative efficacy of different treatments are stronger than if comparisons are (Continued on Page 2)