Eye Movement Desensitization and Reprocessing Therapy
Eye Movement Desensitization and Reprocessing (EMDR) therapy is a non-traditional form of psychotherapy that aims to alleviate symptoms of distress that are borne from post-traumatic stress disorders (PTSD), depression, chronic pain, and other debilitating conditions (Shapiro, 1989). EMDR bases its principal tenets on Shapiro’s (2002) Adaptive Information Processing model as an underlying theoretical framework. Essentially, the model states that symptoms of PTSD and disorders such as depression stem from the brain’s inability to integrate and process disturbing experiences adequately. When this occurs, the unprocessed experiences generate memories associated with distressing emotions, thoughts, beliefs and physical sensations.
Opposed to traditional psychotherapies that attempt to reformulate the thoughts and responses from distressing experiences, EMDR focuses on the memory itself and changes how it is stored in the brain (Stickgold, 2002). Effectively, EMDR therapy facilitates the accessing and subsequent processing of a distressing memory to provide the brain with an opportunity to integrate it within its memory store adaptively. During treatment, patients undergoing EMDR will elicit disturbing memories whilst simultaneously focusing on an external stimulus that can be administered in either visual, auditory or sensual format. By doing this, the previously conditioned distress is paired with novel associations brought from the external stimuli and subsequently enhances information processing, reduces affective and physiological distress, and provides space for the individual to develop cognitive insights. Repeated studies have shown that EMDR therapy successfully treated various disorders in a brief amount of time that would have taken traditional psychotherapy months, if not years, to resolve (Shapiro, 2014). Moreover, its principles go directly against the previous assumptions that severe emotional pain requires a prolonged period to be processed and successfully managed with therapy. EMDR demonstrates that the path towards recovery necessitates a clear pathway for the brain to process information for a rapid healing process. Throughout this article, we will outline the current state of research surrounding EMDR therapy and its effectiveness in treating a wide range of mental disorders. We will begin by discussing the effectiveness of EMDR therapy and show the various benefits that stem from it. Following this, we will demonstrate how EMDR is highly flexible as a form of psychotherapy and show the various applications that it can have on mental illness.
Effectiveness of EMDR Therapy
The efficacy of EMDR is supported by a strong base of evidence that shows its applicability to a wide range of clinical domains (Hoogsteder et al., 2022; Sepehry et al., 2021). A major study conducted by American psychologist Francine Shapiro reviewed the cumulative effects of 24 studies on EMDR therapy (Shapiro, 2014). The study revealed multiple clinical outcomes that express robust levels of efficacy in favour of EMDR in comparison to traditional forms of psychotherapy. Most patients who had undergone EMDR therapy reported an extremely rapid reduction of clinical symptoms over 5 to 10 sessions (Shapiro, 2014). Unlike traditional cognitive behavioural therapies (CBT), EMDR does not possess challenging exposure sessions and homework assignments to complete as part of the treatment process. Concerning its effectiveness, multiple studies assessing the effects of EMDR have shown that multiple patient cohorts no longer possessed a diagnosis of mental illness following their treatment (Marcus, Marquis & Sakai, 2004; Johng et al., 2019). Accessibility wise, in a comparative study analyzing the cost-effectiveness of psychological therapies for PTSD, EMDR was shown to be the most cost-effective among all available therapies whilst maintaining consistent robust clinical effectiveness (Mavranezouli et al., 2020). In essence, the majority of scientific evidence strongly supports EMDR as an effective and robust treatment intervention for various disorders (Jongh et al., 2019). In a 2019 study assessing the current status of EMDR therapy, researchers Jongh et al. (2019) found that EMDR expressed similar success rates to pharmacotherapy and CBT interventions but attained its results in significantly less time. Moreover, due to its cost-effective protocols, the average cost of EMDR therapy was significantly cheaper than its other psychotherapeutic counterparts.
Application of EMDR in Clinical Settings
The underlying theoretical framework of EMDR (i.e., Adaptive Information Processing Model) supplies it with high levels of flexibility with regard to the different disorders it can be applied to. Effectively, EMDR therapy can be used to treat many conditions that stem from maladaptive memory processing and storage (Stickgold, 2002). Due to this, it has been supported to effectively treat a wide range of clinical disorders such as PTSD (e.g., Johng et al., 2019), depression (e.g., Sepehry et al., 2021), addiction (e.g., Markus & Hornsveld, 2017), bipolar (e.g., Valiente Gomez, 2019), chronic pain disorders (e.g., Tesarz et al., 2019) and eating disorders (e.g., Balbo et al. 2017) among others. Many of these disorders stem from the dysfunctional integration of past traumatic experiences, which have led to debilitating psychological symptoms manifesting in the form of various disorders. Research has shown solid evidence showing that traumatic events can contribute to and exacerbate the onset of severe mental disorders and, when left untreated, can significantly impact mental health (Houston, 2011). Through EMDR, patients are given a neural pathway for the brain to elicit distressing root memories and establish a space for natural healing processes to occur. As such, EMDR can be generalized to a wide range of trauma-based disorders. It does not need to target each symptom of a respective disorder specifically. However, it promotes adaptive memory processing, allowing the brain to form a new healthy association with distressing experiences.
Application of EMDR: Anxiety and Depression
As mentioned above, EMDR therapy has also shown strong success rates in treating patients with long-term depression and anxiety (Wood, Parry & Ricketts, 2018). Although initially developed to treat trauma-based disorders, researchers found that its therapeutic effects were not limited to them and could be expanded to other diagnoses, namely depression and anxiety. Depression and anxiety are debilitating conditions with a wide range of etymological factors (i.e., root causes). However, the development and maintenance of these disorders are significantly associated with negative life events that precipitate their onset, rendering them amenable to EMDR therapy as demonstrated by the Adaptive Information Processing Model (Phillips, Carrol & Der, 2015).
Recent studies investigating the effectiveness of EMDR therapy for depression and anxiety express high success rates that are on par with traditional psychotherapies such as CBT or psychodynamic therapy (Malandrone et al., 2019; Ostacoli et al., 2018; Shapiro & Forrest, 2016). The majority of patients having undergone EMDR therapy report a significant reduction of clinical symptoms where depressive and anxious symptomology remained below clinical threshold levels (Malondrone et al., 2019). Moreover, multiple studies assessed the long-term effects of EMDR therapy through follow-up analyses and found that clinical outcomes for the treatment remained stable (Guahar, 2016; Yunitri et al., 2020). Accordingly, EMDR therapy shows robust promise for treating disorders such as depression and anxiety. When factors such as accessibility and cost-effectiveness are taken into account, EMDR can be considered an extremely effective form of treatment that can significantly impact depressive and anxious populations.
The Bottom Line
Taken together, a host of available evidence supports EMDR therapy as an effective intervention strategy. It is based on an Adaptive Information Processing Model (Shapiro, 2002) that provides the empirical grounds for treating clinical symptoms by creating positive associations with external stimuli. Using this theoretical framework, EMDR applies to a wide range of clinical disorders that stem from the dysfunctional integration of traumatic memories. Multiple studies have demonstrated favorable success rates for EMDR in treating PTSD, depression, anxiety, addiction disorders and many more (Johng et al., 2019; Sepehry et al., 2021; Markus & Hornsveld, 2017). Moreover, it is a highly cost-effective alternative to more expensive forms of treatment such as pharmacotherapy or CBT, and it has been shown to achieve successful symptom reduction through significantly shorter durations of time (Shapiro, 2014). Overall, the general consensus of EMDR therapy is that it is an efficient, accessible and promising form of treatment that is open to treating all demographics and several clinical disorders. Moreover, research into its therapeutic effects and applications are still reporting novel findings in support of its benefits.
Balbo, M., Zaccagnino, M., Cussino, M., & Civiiotti, C. (2017). Eye Movement Desensitization and Reprocessing (EMDR) and eating disorders: A systematic review. Clinical Neuropsychiatry: Journal of Treatment Evaluation.
Gauhar, Y. W. M. (2016). The efficacy of EMDR in the treatment of depression. Journal of EMDR Practice and Research, 10(2), 59-69.
Hoogsteder, L. M., Ten Thije, L., Schippers, E. E., & Stams, G. J. J. (2022). A meta-analysis of the effectiveness of EMDR and TF-CBT in reducing trauma symptoms and externalizing behavior problems in adolescents. International journal of offender therapy and comparative criminology, 66(6-7), 735-757.
de Jongh, A., Amann, B. L., Hofmann, A., Farrell, D., & Lee, C. W. (2019). The status of EMDR therapy in the treatment of posttraumatic stress disorder 30 years after its introduction. Journal of EMDR Practice and Research, 13(4), 261-269.
Malandrone, F., Carletto, S., Hase, M., Hofmann, A., & Ostacoli, L. (2019). A brief narrative summary of randomized controlled trials investigating EMDR treatment of patients with depression. Journal of EMDR Practice and Research, 13(4), 302-306.
Marcus, S., Marquis, P., & Sakai, C. (2004). Three-and 6-month follow-up of EMDR treatment of PTSD in an HMO setting. International Journal of Stress Management, 11(3), 195.
Markus, W., & Hornsveld, H. K. (2017). EMDR interventions in addiction. Journal of EMDR Practice and Research.
Mavranezouli, I., Megnin-Viggars, O., Grey, N., Bhutani, G., Leach, J., Daly, C., ... & Pilling, S. (2020). Cost-effectiveness of psychological treatments for post-traumatic stress disorder in adults. PloS one, 15(4), e0232245.
Ostacoli, L., Carletto, S., Cavallo, M., Baldomir-Gago, P., Di Lorenzo, G., Fernandez, I., ... & Hofmann, A. (2018). Comparison of eye movement desensitization reprocessing and cognitive behavioral therapy as adjunctive treatments for recurrent depression: The European Depression EMDR Network (EDEN) randomized controlled trial. Frontiers in psychology, 9, 74.
Phillips, A. C., Carroll, D., & Der, G. (2015). Negative life events and symptoms of depression and anxiety: stress causation and/or stress generation. Anxiety, Stress, & Coping, 28(4), 357-371.
Sepehry, A. A., Lam, K., Sheppard, M., Guirguis-Younger, M., & Maglio, A. S. (2021). EMDR for depression: A meta-analysis and systematic review. Journal of EMDR Practice and Research, 15(1), 2-17.
Shapiro, F. (1989). Eye movement desensitization: A new treatment for post-traumatic stress disorder. Journal of behavior therapy and experimental psychiatry, 20(3), 211-217.
Shapiro, F., & Maxfield, L. (2002). Eye movement desensitization and reprocessing (EMDR): Information processing in the treatment of trauma. Journal of clinical psychology, 58(8), 933-946.
Shapiro, F., & Forrest, M. S. (2016). EMDR: The breakthrough therapy for overcoming anxiety, stress, and trauma. Hachette UK.
Stickgold, R. (2002). EMDR: A putative neurobiological mechanism of action. Journal of clinical psychology, 58(1), 61-75.
Valiente-Gómez, A., Moreno-Alcázar, A., Gardoki-Souto, I., Masferrer, C., Porta, S., Royuela, O., ... & Amann, B. L. (2019). Theoretical background and clinical aspects of the use of EMDR in patients with bipolar disorder. Journal of EMDR Practice and Research, 13(4), 307-312.
Wood, E., Ricketts, T., & Parry, G. (2018). EMDR as a treatment for long‐term depression: A feasibility study. Psychology and Psychotherapy: Theory, Research and Practice, 91(1), 63-78.
Yunitri, N., Kao, C. C., Chu, H., Voss, J., Chiu, H. L., Liu, D., ... & Chou, K. R. (2020). The effectiveness of eye movement desensitization and reprocessing toward anxiety disorder: a meta-analysis of randomized controlled trials. Journal of psychiatric research, 123, 102-113.