Editor’s note: ANDThis is the first of two articles about EMDR. The first article is a critique of EMDR and its controversial evidence. The second article is a response written by a group of experts on this therapy and will be published on September 21.
YesIt is estimated that there may be at least 400 with around a dozen theoretical models on which they are based. In the last two decades, one of these psychotherapies has received special attention from the media, health professionals and users. I’m talking about Eye Movement Desensitization and Reprocessing or EMDR (for its acronym in English).
What is Eye Movement Desensitization and Reprocessing or EMDR?
According to It is a psychotherapeutic approach that proposes to treat all types of emotional difficulties caused by difficult experiences in the subject’s life. Thus, they treat everything from phobias, panic attacks, anxiety and/or anguish, deaths or traumatic grief in adults and children, to accidents and natural disasters. EMDR is also used to improve performance at work, in sports, and in artistic performances. But its main application and what it is best known for is being an effective treatment for post-traumatic stress disorder (PTSD).
How does EMDR arise?
By. Any given day in 1987 A psychologist trained in Palo Alto who had a private practice went for a walk in the woods. She was worried about a series of problems, she felt anxious and restless and she realized that when she moved her eyes back and forth looking at her surroundings she managed her discomfort better. So Shapiro began testing variants of this “procedure” with his patients and found that they felt better too. That is the “official history” but there is another version of events: John Grinder, one of the founders of states that when she worked in the early 80s in her office as an administrator. In Grinder’s own words, Shapiro approached him one day and told him that a friend of his from New York had suffered a rape and he wanted to help her overcome this trauma. He gave her a series of instructions including that she would use eye movements while she recalled the event and it seems to have been a complete success. “Imagine my surprise when I later learned that she had turned those suggestions into presenting a training protocol without reference to the source, with a copyright, and with a fairly rigorous set of documentation that essentially does not allow who have been trained to teach it to the rest of the world.” Although the origin is controversial, EMDR was already born.
He Shapiro published it in 1989 and quickly aroused interest among mental health professionals. The author initially developed EMDR to help people suffering from anxiety associated with post-traumatic stress disorder (PTSD) and phobias. However, little by little the scope of intervention has been extended to another series of conditions such as eating disorders, erectile dysfunction, depression or schizophrenia.
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What is EMDR?
Of, an EMDR therapist asks the person to visualize the traumatic event as vividly as possible and hold it in their mind. While he does so, he is asked to follow the (much like a hypnotist’s pocket watch). There are variants where the person continueswhere they are used or even the (technique known as. the same: desensitize the patient to discomfort, generally anxiety, and integrate information processing. Shapiro explains that it works because it emulates the rapid eye movements that occur in the and this causes unpleasant emotional information to be processed properly. With the passage of time, later we will see why, the author herself has changed the explanation of why her technique works and other explanations have been postulated for its effectiveness such as the synchronization of the two cerebral hemispheres, distraction and relaxation.
EMDR is a treatment endorsed by the APA. Why and for what?
EMDR has been as a treatment that has “Strong Research Support / Controversial” for post-traumatic stress disorder (PTSD). The criteria used by the APA to grant this type of classification can be.
It should be noted that the APA itself describes EMDR therapy for PTSD as “controversial,” this is because the available evidence of the effectiveness of EMDR can be interpreted in several ways. As we will see later, the mechanism of change or improvement in EMDR may be exposure to unpleasant events and eye movements an unnecessary addition.: “If EMDR is simply exposure therapy with a superfluous addition, we should question whether the dissemination of EMDR is beneficial to patients and the field”. The fact that much more concrete scientific evidence is needed to support the mechanisms of action proposed by EMDR advocates is what maintains the status of “controversial” in the APA.
What do the efficacy studies tell us about EMDR?
There is a huge volume of research regarding the effectiveness of EMDR and the quality of this has been greatly improving over the last 15 years. I will try to summarize the data consulted as best as possible:
- It works better than doing nothing. Numerous controlled studies conclude that EMDR is superior to the no treatment condition, that is, better than no treatment. This has been proven to relieve symptoms related to PTSD and some anxiety disorders.
- Works better than supportive therapies. Most studies indicate that EMDR is better than control conditions in which therapists simply listen carefully to patients’ problems. They are also called support sessions and refer to those in which there is no direct intervention on the problem.
- It does not work better than cognitive behavioral therapy (CBT). Most studies tend to compare CBT with EMDR since the former is the one that has accumulated the most research and the one that has been shown to be more effective for most psychological problems. When EMDR has been compared with imagination exposure,that is, EMDR does not achieve objectives in fewer sessions or more quickly than exposure in imagination as they claim. In fact, many studies suggest that EMDR is less effective for PTSD than either.
- There is no evidence to recommend the use of EMDR for anxiety disorders other than PTSD, such as phobias (in fact), obsessive-compulsive disorder or generalized anxiety disorder. Just as there is not enough evidence for its use in other problems such as mood disorders, sexual disorders, eating disorders or psychotic disorders, no matter how much its defenders.
What conclusions can we draw from EMDR efficacy studies?
The APA’s warning cannot go unnoticed. EMDR is controversial because most researchers interpret the evidence of effectiveness that EMDR shows in studies as a result of the inclusion in its procedure of “exposure techniques” since the EMDR intervention requires people to deliberately and systematically view anxiety-provoking images, a form of exposure.
But what is the ? Cognitive Behavioral Therapy for anxiety-related problems is based on a basic principle of therapeutic change: exposure. In general terms, it consists of confronting, in a systematic and deliberate way, situations or internal stimuli that generate or other negative emotions and/or cause the impulse to perform a certain action. The goal is for the person to stay in the situation or face the internal stimulus until the emotion or impulse is significantly reduced and/or until he or she verifies that the negative consequences he anticipates do not occur. There are 2 main types of exposure: Live exposure (exposing yourself to real feared situations in daily life) and imaginative exposure (imagining that you are facing problematic situations and/or that you are experiencing internal stimuli that generate anxiety).
“If EMDR is simply exposure therapy with a superfluous addition, we should question whether the dissemination of EMDR is beneficial to patients and the field”
There are also such as interoceptive exposure (exposing oneself to feared bodily sensations); exposition through audiovisual aids (they are usually used to complement other exposition modalities); exposure using writing or games (writing about anxiety-producing events and reading it to oneself and/or in front of the therapist. For children, drawings or games can be used); exposure through or augmented reality and simulated exposure (behavioral test or role playingconsists of exposure to problematic social situations that are simulated or reproduced in the therapeutic session).
The procedure in EMDR is basically exposure in imagination to traumatic events while the person focuses their attention on an object, light or sound that moves from side to side. Curiously, advocates of EMDR do not attribute the effectiveness of the procedure to exposure but to eye movements..
Is there something about EMDR that works, or is there something beyond the exposure effect?
Apparently not. And if there is, EMDR therapists have not been able to demonstrate it. When I see these therapists advocate the use of EMDR in therapy I remember They made to Division 12 of the APA, warning of the need to give more importance to empirically validated mechanisms of action than to therapies in general. For this they told us about “Purple Hat Therapy” or TSM.
Imagine a psychologist asking his patients with a driving phobia to wear a purple hat with a band of magnets built into it while he applies relaxation and coping or exposure techniques. The psychologist specifically places the band of magnets on the hats, claiming that they have a certain position depending on particular aspects of each person such as the age, sex or personality of each subject. Patients improve with the procedure, and the psychologist affirms that it is the magnets that reorient the energy fields and that, thanks to this, they accelerate the processing of emotional information, improve interhemispheric coherence and clearly eliminate phobic avoidance. The enthusiastic psychologist begins to promote the use of Purple Hat Therapy (TSM) or as he has also called it “Electromagnetic Desensitization and Remobilization” or…