EMDR vs Behavior Therapy
Eye Movement Desensitization and Reprocessing, or EMDR, is a popular PTSD treatment for patients and clinicians alike. While it has gained in popularity over the years, it has also been mired in controversy. Proponents of EMDR maintain that the treatment more effectively reprocesses trauma than exposure therapy, and does so at a faster rate. CBT and behavioral practitioners have questioned whether the mechanisms of action underlying EMDR are simply exposure-based and if bilateral stimulation (i.e. eye movements) is a superfluous addition.
State of the Evidence
Previous meta-analyses and dismantling studies appear to support this analysis, indicating that eye movements and other bilateral stimulation do not add anything beyond exposure elements. Division 12 of the American Psychological Association (APA), has therefore called into question whether EMDR works any differently than established protocols and if it is beneficial to disseminate to the field. APA Division 12 does not take issue with EMDRs efficacy as an evidence-based treatment for PTSD, it simply questions whether its mechanisms differ from established CBT and Behavioral interventions.
APA Concerns
“The efficacy of EMDR for PTSD is an extremely controversial subject among researchers, as the available evidence can be interpreted in several ways. On one hand, studies have shown that EMDR produces greater reduction in PTSD symptoms compared to control groups receiving no treatment. On the other hand, the existing methodologically sound research comparing EMDR to exposure therapy without eye movements has found no difference in outcomes. Thus, it appears that while EMDR is effective, the mechanism of change may be exposure – and the eye movements may be an unnecessary addition. If EMDR is indeed simply exposure therapy with a superfluous addition, it brings to question whether the dissemination of EMDR is beneficial for patients and the field. However, proponents of EMDR insist that it is empirically supported and more efficient than traditional treatments for PTSD. In any case, more concrete, scientific evidence supporting the proposed mechanisms is necessary before the controversy surrounding EMDR will lift.“
New EMDR Research
Clearly more research is needed or the controversy surrounding EMDR and its mechanisms of change will remain. A recent meta-analysis was conducted by Cuijpers et al. (2019) in order to take up this issue. Results showed that EMDR had a large effect size when compared to control conditions in the short-term. Two difficulties, however, confounded this finding. First, most studies used in the meta-analysis did not report follow-up data making long-term interpretation of benefits difficult if not impossible. Second, analyzed studies demonstrated a significantly “high risk of bias”, making results again difficult to interpret. The few studies presenting with low risk of bias found no difference between EMDR and other therapeutic interventions.
These new data add to the EMDR literature, but do not answer the most critical question. Is bilateral stimulation a necessary or superfluous addition to an already validated behavioral approach? The controversy continues.
Please click on the link below to read the latest EMDR meta-analysis.
