View source for Eye movement desensitization and reprocessing

{{Short description|Form of psychotherapy}}
{{redirect|EMDR|the materials characterisation technique|Electrically detected magnetic resonance}}
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'''Eye movement desensitization and reprocessing''' ('''EMDR''') is a form of [[psychotherapy]] designed to treat [[post-traumatic stress disorder]] (PTSD). It was devised by [[Francine Shapiro]] in 1987.

EMDR involves talking about traumatic memories while engaging in side-to-side eye movements or other forms of bilateral stimulation. It is also used for some other psychological conditions.

EMDR is recommended for the treatment of PTSD by various government and medical bodies citing varying levels of evidence, including the [[World Health Organization]], the UK [[National Institute for Health and Care Excellence]], the Australian [[National Health and Medical Research Council]], and the US Departments of [[United States Department of Veterans Affairs|Veterans Affairs]] and [[United States Department of Defense|Defense]]. The [[American Psychological Association]] does not endorse EMDR as a first-line treatment, but indicates that it is probably effective for treating adult PTSD. 

Systematic analyses published since 2013 generally indicate that EMDR treatment efficacy for adults with PTSD is equivalent to trauma-focused cognitive and behavioral therapies (TF-CBT), such as [[prolonged exposure therapy]] (PE) and [[cognitive processing therapy]] (CPT). However, bilateral stimulation does not contribute substantially, if at all, to treatment effectiveness. The predominant therapeutic factors in EMDR and TF-CBT are [[Exposure therapy|exposure]] and various components of [[cognitive-behavioral therapy]]. 

Because eye movements and other bilateral stimulation techniques do not uniquely contribute to EMDR treatment efficacy, EMDR has been characterized as a [[purple hat therapy]], i.e., its effectiveness is due to the same therapeutic methods found in other evidence-based psychotherapies for PTSD, namely exposure therapy and CBT techniques, without any contribution from its distinctive add-ons.

== History ==
EMDR was invented by [[Francine Shapiro]] in 1987.

In a workshop, Shapiro related how the idea of the therapy came to her while she was taking a walk in the woods, and discerned she had been able to cope better with disturbing thoughts when also experiencing [[saccadic]] eye movements.<ref name=walk>{{cite journal |vauthors=Rosen GM |title=On the origin of eye movement desensitization |journal=J Behav Ther Exp Psychiatry |volume=26 |issue=2 |pages=121–2 |date=June 1995 |pmid=7593684 |doi=10.1016/0005-7916(95)00014-q |url=}}</ref> Psychologist Gerald Rosen has expressed doubt about this description, saying that people are normally not aware of this type of eye movement.<ref name=walk/> Gerald Rosen and Bruce Grimley suggest that it is more likely that she developed EMDR out of her experience with [[neuro-linguistic programming]].<ref>{{Cite journal |last=Grimley |first=Bruce |date=2014 |title=Origins of EMDR- a question of integrity? |url=https://www.bps.org.uk/psychologist/letters-men-and-mental-health-minefield |journal=The Psychologist}}</ref><ref>{{Cite web |last=Grimley |first=Bruce |title=What is Neurolinguistic Programming, (NLP) |url=https://www.academia.edu/39222352 }}</ref>

==Technique==
EMDR is typically undertaken in a series of sessions with a trained therapist.<ref>{{cite web |title=Post-Traumatic Stress Disorder |url=https://www.nice.org.uk/guidance/ng116/chapter/Recommendations#assessment-and-coordination-of-care |publisher=[[National Institute for Health and Care Excellence]] |quote=1.6.20 EMDR for adults should: be based on a validated manual; typically be provided over 8 to 12 sessions, but more if clinically indicated, for example if they have experienced multiple traumas; be delivered by trained practitioners with ongoing supervision; be delivered in a phased manner and include psychoeducation about reactions to trauma, managing distressing memories and situations, identifying and treating target memories (often visual images), and promoting alternative positive beliefs about the self; use repeated in-session bilateral stimulation (normally with eye movements) for specific target memories until the memories are no longer distressing; include the teaching of self-calming techniques and techniques for managing flashbacks, for use within and between sessions. |date=2018-12-05 |access-date=2021-12-03 }}</ref> The number of sessions can vary depending on the progress made. A typical EMDR therapy session lasts from 60 to 90 minutes.<ref>{{Cite web|url=https://www.emdria.org/about-emdr-therapy/experiencing-emdr-therapy/|title = Experiencing EMDR Therapy}}</ref>

The person being treated is asked to recall an image, phrase, and emotion that represent a level of distress related to a trigger while generating one of several types of bilateral sensory input, such as side-to-side [[eye]] movements or hand tapping.<ref name=feske>{{cite journal | vauthors = Feske U |title=Eye Movement Desensitization and Reprocessing Treatment for Posttraumatic Stress Disorder |journal=Clinical Psychology: Science and Practice |date=June 1998 |volume=5 |issue=2 |pages=171–181 |doi=10.1111/j.1468-2850.1998.tb00142.x | issn = 0969-5893}}</ref> The 2013 World Health Organization practice guideline says that "Like [[cognitive behavioral therapy]] (CBT) with a trauma focus, EMDR aims to reduce subjective distress and strengthen adaptive beliefs related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure or (d) homework."<ref name="WHO 2013">{{cite report |publisher=World Health Organization |year=2013 |title=Guidelines for the Management of Conditions that are Specifically Related to Stress |location=Geneva |url=https://www.who.int/mental_health/emergencies/stress_guidelines/en/ |archive-url=https://web.archive.org/web/20131129075320/http://www.who.int/mental_health/emergencies/stress_guidelines/en/ |url-status=dead |archive-date=November 29, 2013 |page=Glossary page 1 |pmid=24049868}}</ref>

==Possible mechanisms==
===Incomplete processing of experiences in trauma===
Many proposals of EMDR efficacy share an assumption that, as Shapiro posited, when a traumatic or very negative event occurs, information processing of the experience in memory may be incomplete. The trauma causes a disruption of normal adaptive information processing, which results in unprocessed information being dysfunctionally held in memory networks.<ref>{{cite journal | vauthors = Solomon RM, Shapiro F | s2cid=7109228 |title=EMDR and the Adaptive Information Processing ModelPotential Mechanisms of Change |journal=Journal of EMDR Practice and Research |date=November 2008 |volume=2 |issue=4 |pages=315–325 |doi=10.1891/1933-3196.2.4.315 }}</ref> According to the 2013 World Health Organization practice guideline: "This therapy [EMDR] is based on the idea that negative thoughts, feelings and behaviours are the result of unprocessed memories."<ref name="WHO 2013" /> This proposed mechanism has no known scientific basis.<ref name=non/>

===Other mechanisms===
Several other possible mechanisms have been proposed:
* EMDR may affect working memory.<ref>{{cite journal | vauthors = van den Hout MA, Engelhard IM, Beetsma D, Slofstra C, Hornsveld H, Houtveen J, Leer A | title = EMDR and mindfulness. Eye movements and attentional breathing tax working memory and reduce vividness and emotionality of aversive ideation | journal = Journal of Behavior Therapy and Experimental Psychiatry | volume = 42 | issue = 4 | pages = 423–431 | date = December 2011 | pmid = 21570931 | doi = 10.1016/j.jbtep.2011.03.004 }}</ref> If a patient performs bilateral stimulation task while remembering the trauma, the amount of information they can recall is thought to be reduced, making the resulting [[negative emotion]]s less intense and more bearable.<ref name="Chen2015">{{cite journal | vauthors = Chen L, Zhang G, Hu M, Liang X | title = Eye movement desensitization and reprocessing versus cognitive-behavioral therapy for adult posttraumatic stress disorder: systematic review and meta-analysis | journal = The Journal of Nervous and Mental Disease | volume = 203 | issue = 6 | pages = 443–451 | date = June 2015 | pmid = 25974059 | doi = 10.1097/NMD.0000000000000306 | s2cid = 34850645 }}</ref> This is seen by Robin Logie of the EMDR Association UK and Ireland as a "distancing effect". The client is then believed to re-evaluate the trauma and process it in a less-harmful environment.<ref name=Logie2014>{{cite journal | vauthors = Logie R |title=EMDR - more than just a therapy for PTSD? |journal=The Psychologist |date=July 2014 |volume=27 |issue=7 |pages=512–517 |url=https://thepsychologist.bps.org.uk/volume-27/edition-7/emdr-more-just-therapy-ptsd }}</ref> This explanation is plausible, given  research showing that memories are more modifiable once recalled.<ref name=epid/>
* Horizontal eye movement is thought to trigger an "[[orienting response]]" in the brain, used in scanning the environment for threats and opportunities.<ref name="Jeffries & Davis 2012">{{cite journal | vauthors = Jeffries FW, Davis P | title = What is the role of eye movements in eye movement desensitization and reprocessing (EMDR) for post-traumatic stress disorder (PTSD)? a review | journal = Behavioural and Cognitive Psychotherapy | volume = 41 | issue = 3 | pages = 290–300 | date = May 2013 | pmid = 23102050 | doi = 10.1017/S1352465812000793 | s2cid = 33309479 }}</ref>
* The idea that eye movement prompts communication between the two sides of the brain. This idea is not grounded in accepted [[neuroscience]].<ref name=epid>{{cite book |veditors=Zeigler-Hill V, Shackelford TR |entry= Eye Movement Desensitization and Reprocessing (EMDR) |title= Encyclopedia of Personality and Individual Differences |year= 2020 |vauthors= Patihis L, Cruz CS, McNally R |publisher=Springer |doi=10.1007/978-3-319-24612-3_895 }}</ref>

===Bilateral stimulation, including eye movement===
Bilateral stimulation is a generalization of the left and right repetitive eye movement technique first used by Shapiro. Alternative stimuli include auditory stimuli that alternate between left and right speakers or headphones and physical stimuli such as tapping of the therapist's hands or tapping devices.<ref name="Rodenburg2009">{{cite journal | vauthors = Rodenburg R, Benjamin A, de Roos C, Meijer AM, Stams GJ | title = Efficacy of EMDR in children: a meta-analysis | journal = Clinical Psychology Review | volume = 29 | issue = 7 | pages = 599–606 | date = November 2009 | pmid = 19616353 | doi = 10.1016/j.cpr.2009.06.008 }}</ref>

Most [[Meta-analysis|meta-analyses]] have found that the inclusion of bilateral eye-movements within EMDR makes little or no difference to its effect.<ref name=ps-in>{{cite book |chapter=Chapter 4: Pseudoscience in Treating Adults Who Experienced Trauma |title=Science and Pseudoscience in Social Work Practice |vauthors=Thyer BA, Pignotti MG |year=2015 |publisher=Springer |pages=106, 146 |doi=10.1891/9780826177698.0004 |isbn=9780826177681}}</ref><ref>{{cite journal | vauthors = Cuijpers P, Veen SC, Sijbrandij M, Yoder W, Cristea IA | title = Eye movement desensitization and reprocessing for mental health problems: a systematic review and meta-analysis | journal = Cognitive Behaviour Therapy | volume = 49 | issue = 3 | pages = 165–180 | date = May 2020 | pmid = 32043428 | doi = 10.1080/16506073.2019.1703801 | s2cid = 202289231 | doi-access = free | hdl = 11577/3461344 | hdl-access = free }}</ref><ref name="RodenburgBenjaminde Roos2009">{{cite journal | vauthors = Rodenburg R, Benjamin A, de Roos C, Meijer AM, Stams GJ | title = Efficacy of EMDR in children: a meta-analysis | journal = Clinical Psychology Review | volume = 29 | issue = 7 | pages = 599–606 | date = November 2009 | pmid = 19616353 | doi = 10.1016/j.cpr.2009.06.008 | quote-page = {{page needed|date=May 2024}} |  quote = "Results indicate efficacy of EMDR when effect sizes are based on comparisons between the EMDR and the non-established trauma treatment or the no-treatment control groups, and the incremental efficacy when effect sizes are based on comparisons between the EMDR and the established (CBT) trauma treatment." }}</ref> Meta-analyses have also described a high risk of [[allegiance bias]] in EMDR studies.<ref name="CuijpersVeenSijbrandij2020">{{cite journal | vauthors = Cuijpers P, Veen SC, Sijbrandij M, Yoder W, Cristea IA | title = Eye movement desensitization and reprocessing for mental health problems: a systematic review and meta-analysis | journal = Cognitive Behaviour Therapy | volume = 49 | issue = 3 | pages = 165–180 | date = May 2020 | pmid = 32043428 | doi = 10.1080/16506073.2019.1703801 | quote = "EMDR was found to be significantly more effective than other therapies in the treatment of PTSD. However, these results are not convincing for a number of reasons. First, there were few studies with low risk of bias. Furthermore, studies with low risk of bias did not point at a significant difference between EMDR and other therapies. The difference between studies with low risk of bias and those with at least some risk of bias was significant and we found considerable indications for researcher allegiance. Because studies with low risk of bias found no difference between EMDR and other therapies, we conclude that there is not enough evidence to decide about the comparative effects of EMDR." | quote-page = {{page needed|date=May 2024}} | s2cid = 202289231 | eissn = 1651-2316 | doi-access = free | hdl = 11577/3461344 | hdl-access = free }}</ref> One 2013 meta-analysis with fewer exclusion criteria found a moderate effect.<ref name=pmid23266601>{{cite journal | vauthors = Lee CW, Cuijpers P | title = A meta-analysis of the contribution of eye movements in processing emotional memories | journal = Journal of Behavior Therapy and Experimental Psychiatry | volume = 44 | issue = 2 | pages = 231–239 | date = June 2013 | pmid = 23266601 | doi = 10.1016/j.jbtep.2012.11.001 | url = http://researchrepository.murdoch.edu.au/id/eprint/13100/ | url-access = subscription }}</ref>

== Research ==
===Effectiveness===
[[Systematic review|Systematic reviews]] in 2013, including a [[Cochrane (organisation)|Cochrane]] study comparing EMDR with other psychotherapies in the treatment of chronic PTSD found EMDR to be as effective as TF-CBT (trauma-focused cognitive behavioral therapies).<ref name="Watt2013">{{cite journal | vauthors = Watts BV, Schnurr PP, Mayo L, Young-Xu Y, Weeks WB, Friedman MJ | title = Meta-analysis of the efficacy of treatments for posttraumatic stress disorder | journal = The Journal of Clinical Psychiatry | volume = 74 | issue = 6 | pages = e541–e550 | date = June 2013 | pmid = 23842024 | doi = 10.4088/JCP.12r08225 | s2cid = 23087402 }}</ref><ref name="Bisson2013">{{cite journal | vauthors = Bisson JI, Roberts NP, Andrew M, Cooper R, Lewis C | title = Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2013 | issue = 12 | page = CD003388 | date = December 2013 | pmid = 24338345 | pmc = 6991463 | doi = 10.1002/14651858.CD003388.pub4 }}</ref> A 2018 systematic review found moderate strength of evidence supporting the effectiveness of EMDR in reducing symptoms of PTSD and depression, as well as increasing the likelihood of patients losing their PTSD diagnosis.<ref>{{Cite report |url=https://effectivehealthcare.ahrq.gov/topics/ptsd-adult-treatment-update/research-2018 |title=Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder: A Systematic Review Update |last1=Forman-Hoffman |first1=Valerie |last2=Cook Middleton |first2=Jennifer |date=2018-05-17 |publisher=Agency for Healthcare Research and Quality (AHRQ) |doi=10.23970/ahrqepccer207 |last3=Feltner |first3=Cynthia |last4=Gaynes |first4=Bradley N. |last5=Palmieri Weber |first5=Rachel |last6=Bann |first6=Carla |last7=Viswanathan |first7=Meera |last8=Lohr |first8=Kathleen N. |last9=Baker |first9=Claire}}</ref> A 2020 systematic review concluded: "A recent increase in RCTs [randomized controlled trials] of psychological therapies for PTSD, results in a more confident recommendation of CBT-T and EMDR as the first-line treatments."<ref>{{Cite journal |last=Lewis |first=Catrin |last2=Roberts |first2=Neil P. |last3=Andrew |first3=Martin |last4=Starling |first4=Elise |last5=Bisson |first5=Jonathan I. |date=2020-12-31 |title=Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis |url=https://www.tandfonline.com/doi/full/10.1080/20008198.2020.1729633 |journal=European Journal of Psychotraumatology |language=en |volume=11 |issue=1 |doi=10.1080/20008198.2020.1729633 |issn=2000-8066 |pmc=7144187 |pmid=32284821}}</ref> A 2023 Cochrane systematic review analyzed psychosocial interventions for survivors of rape and sexual assault experienced during adulthood and concluded that EMDR is a "first-line treatment" for PTSD along with other trauma-focused psychotherapies, such as Cognitive Processing Therapy and Prolonged Exposure.<ref>{{Cite journal |last=O'Doherty |first=Lorna |last2=Whelan |first2=Maxine |last3=Carter |first3=Grace J. |last4=Brown |first4=Katherine |last5=Tarzia |first5=Laura |last6=Hegarty |first6=Kelsey |last7=Feder |first7=Gene |last8=Brown |first8=Sarah J. |date=2023-10-05 |title=Psychosocial interventions for survivors of rape and sexual assault experienced during adulthood |url=https://pubmed.ncbi.nlm.nih.gov/37795783 |journal=The Cochrane Database of Systematic Reviews |volume=10 |issue=10 |pages=CD013456 |doi=10.1002/14651858.CD013456.pub2 |issn=1469-493X |pmc=10552071 |pmid=37795783}}</ref>

===Client experience===
A 2021 systematic review of 13 studies found that clients had mixed perceptions of the effectiveness of EMDR therapy.<ref>{{cite journal | vauthors = Shipley G, Wilde S, Hudson M |title=What do clients say about their experiences of Eye Movement Desensitisation and Reprocessing therapy? A systematic review of the literature. |journal=European Journal of Trauma & Dissociation |date=April 2021 |volume=6 |issue=2 |page=100226 |doi=10.1016/j.ejtd.2021.100226| issn=2468-7499 |s2cid=235544895 }}</ref>

=== Treating conditions other than PTSD ===
EMDR has been tested on a variety of other mental health conditions with mixed results.<ref name = "Cuijpers 2020">{{cite journal | vauthors = Cuijpers P, Veen SC, Sijbrandij M, Yoder W, Cristea IA | title = Eye movement desensitization and reprocessing for mental health problems: a systematic review and meta-analysis | journal = Cognitive Behaviour Therapy | volume = 49 | issue = 3 | pages = 165–180 | date = May 2020 | pmid = 32043428 | doi = 10.1080/16506073.2019.1703801 | doi-access = free | hdl = 11577/3461344 | hdl-access = free }}</ref>
* A 2021 systematic review and meta-analysis found EMDR to have a moderate benefit in treating [[Depression (mood)|depression]], but the number and quality of the studies were low.<ref name="Carletto_2021">{{cite journal | vauthors = Carletto S, Malandrone F, Berchialla P, Oliva F, Colombi N, Hase M, Hofmann A, Ostacoli L | display-authors = 6 | title = Eye movement desensitization and reprocessing for depression: a systematic review and meta-analysis | journal = European Journal of Psychotraumatology | volume = 12 | issue = 1 | pages = 1894736 | date = April 2021 | pmid = 33889310 | pmc = 8043524 | doi = 10.1080/20008198.2021.1894736 }}</ref>
* Positive effects have also been shown for certain anxiety disorders, but the number of studies was low and the risk of bias high.<ref name="Cuijpers 2020" /> The American Psychological Association describes EMDR as "ineffective" for the treatment of [[panic disorder]].<ref name="APA_Panic_2010">{{cite book |last1=APA Work Group On Panic Disorder |title=Practice Guideline For The Treatment of Patients With Panic Disorder |date=2010 |publisher=American Psychological Association |page=13 |url=https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/panicdisorder.pdf |access-date=21 March 2023}}</ref>
* EMDR has been found to cause strong effects on [[dissociative identity disorder]] patients, leading to recommendations for adjusted use.<ref>Recommended Guidelines: A General Guide to EMDR's Use in the Dissociative Disorders (authored by the EMDR Dissociative Disorders Task Force and published in Shapiro, 1995, 2001)</ref><ref>p. 159, Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision, International Society for the Study of Trauma and Dissociation. 3 Mar 2011</ref>
* A 2023 systematic review of evidence found EMDR's effectiveness in treating mental health conditions of children and adolescents who have been sexually abused is limited.<ref name="Caro-2023">{{cite journal | last1=Caro | first1=Paola | last2=Turner | first2=William | last3=Caldwell | first3=Deborah M | last4=Macdonald | first4=Geraldine | title=Comparative effectiveness of psychological interventions for treating the psychological consequences of sexual abuse in children and adolescents: a network meta-analysis | journal=Cochrane Database of Systematic Reviews | volume=2023 | issue=6 | date=2023-06-05 | pages=CD013361 | pmid=37279309 | pmc=10243720 | doi=10.1002/14651858.CD013361.pub2 }}</ref>

== Professional practice guidelines ==
* The [[World Health Organization]]'s 2013 report on stress-related conditions found insufficient evidence to support EMDR for acute symptoms of traumatic stress.<ref name="WHO_Guidelines_2013">{{cite book |title=Guidelines for the Management of Conditions Specifically Related to Stress |date=2013 |publisher=World Health Organization (WHO) |location=Geneva, Switzerland |isbn=978-92-4-150540-6 |pages=8–9 |url=https://apps.who.int/iris/bitstream/handle/10665/85119/9789241505406_eng.pdf |access-date=21 March 2023}}</ref> Its 2023 guideline for mental, neurological and substance use disorders recommended EMDR with moderate evidence for adults and children in treating PTSD.<ref>{{Cite book |title=Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders |publisher=World Health Organization |year=2023 |isbn=9789240084278}}</ref>
* The 2018 [[International Society for Traumatic Stress Studies]] practice guidelines "strongly recommend" EMDR as an effective treatment for post-traumatic stress symptoms.<ref name="ISTSS_2018">{{cite book |title=Posttraumatic Stress Disorder Prevention and Treatment Guidelines: Methodology and Recommendations |publisher=International Society for Traumatic Stress Studies |pages=13–16 |url=https://istss.org/getattachment/Treating-Trauma/New-ISTSS-Prevention-and-Treatment-Guidelines/ISTSS_PreventionTreatmentGuidelines_FNL-March-19-2019.pdf.aspx |access-date=21 March 2023}}</ref>
* As of 2017, the [[American Psychological Association]] "conditionally recommends" EMDR for the treatment of PTSD in adults, meaning its use is suggested rather than recommended.<ref name=apa2017>{{Cite web |title=Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults |url=https://www.apa.org/ptsd-guideline/ptsd.pdf |access-date=2023-06-10 |website=American Psychological Association |year=2017 }}</ref>
* The UK [[National Institute for Health and Care Excellence]]'s 2018 PTSD guidelines found low-to-very-low evidence of efficacy for EMDR in treating PTSD, but what was available justified recommending it for non combat-related trauma.<ref>{{Cite web|url=https://www.nice.org.uk/guidance/ng116/resources/posttraumatic-stress-disorder-pdf-66141601777861|title=Post-traumatic stress disorder| page=54}}</ref><ref name="NICE NG116">{{cite book |last1=National Guideline Alliance hosted by the Royal College of Obstetricians and Gynaecologists |url=https://www.nice.org.uk/guidance/ng116/evidence/evidence-review-b-psychological-psychosocial-and-other-nonpharmacological-interventions-for-the-treatment-of-ptsd-in-children-and-young-people-pdf-6602621006 |title=NICE guideline NG116: Post-traumatic stress disorder: B- Evidence reviews for psychological, psychosocial and other non-pharmacological interventions for the treatment of PTSD in children and young people |date=2018 |publisher=National Institute for Health and Care Excellence |location=United Kingdom |pages=69–72 |access-date=21 March 2023}}</ref>
* A 2017 joint report from the US Departments of [[United States Department of Veterans Affairs|Veterans Affairs]] and [[United States Department of Defense|Defense]] describes the evidence for EMDR in the treatment of PTSD as "strong."<ref name="VA_DoD_2017">{{cite book |title=Clinical Practice Guideline For The Management Of Posttraumatic Stress Disorder And Acute Stress Disorder |date=2017 |publisher=United States Departments of Veteran Affairs and Defense |location=Washington, D.C. |page=6 |url=https://www.healthquality.va.gov/guidelines/MH/ptsd/VADoDPTSDCPGClinicianSummaryFinal.pdf |access-date=21 March 2023}}</ref>
* The Australian 2013 [[National Health and Medical Research Council]] guidelines recommends EMDR for the treatment of PTSD in adults with its highest grade of evidence, noting that "EMDR now includes most of the core elements of standard trauma-focussed CBT (TF-CBT)" and "the two variants of trauma-focussed therapy are not statistically different."<ref name="NHMRC">{{cite report |author=National Health and Medical Research Council |title=Australian Guidelines for the Treatment of Acute Stress Disorder & Posttraumatic Stress Disorder |year=2013 |url=https://aci.health.nsw.gov.au/__data/assets/pdf_file/0004/212971/ACPMH_Full_ASD_PTSD_Guidelines.pdf}}</ref>
* The [[Institute of Medicine]]'s 2008 report on the treatment of PTSD found insufficient evidence to recommend EMDR, and criticized many of the available studies for methodological flaws including [[allegiance bias]] and insufficient controls.<ref name="NAS_IOM_2008">{{cite book | title = Treatment of Posttraumatic Stress Disorder | date = 2008 | publisher = National Academies Press | doi = 10.17226/11955 | isbn = 978-0-309-10926-0 | url = }}</ref>
* The Dutch National Steering Committee on Mental Health Care has released multidisciplinary guidelines which describe "insufficient scientific evidence" to support EMDR in the acute period following a stressful event (2008),<ref name="Impact2008">{{cite book |last1=Impact, the Dutch knowledge & advice centre for post-disaster psychosocial care |title=European Multidisciplinary Guideline: Early psychosocial interventions after disasters, terrorism and other shocking events |date=2008 |location=Amsterdam-Zuidoost, Netherlands |pages=40–41 |url=https://www.coe.int/t/dg4/majorhazards/ressources/virtuallibrary/materials/netherlands/guideline_English_incl.%20preamble%20_def_.pdf |access-date=21 March 2023}}</ref> but recommend EMDR's use in chronic PTSD (2003).<ref name="Dutch">{{Cite report |author=Dutch National Steering Committee Guidelines Mental Health and Care |year=2003 |title=Guidelines for the diagnosis treatment and management of adult clients with an anxiety disorder |location=Utrecht, Netherlands |publisher=The Dutch Institute for Healthcare Improvement }}</ref>{{page needed|date=July 2020}}

== Criticism ==
EMDR is controversial among some scholars in the psychological community.<ref name="McNally1999">{{cite journal | vauthors = McNally RJ |author-link1= Richard McNally |title=Research on eye movement desensitization and reprocessing (EMDR) as a treatment for PTSD |journal=PTSD Research Quarterly |volume=10 |issue=1 |year=1999 |pages=1–7 |url=https://www.hsdl.org/?view&did=13105 }}</ref><ref name="Sikes_2003">{{cite journal | vauthors = Sikes C, Sikes V |title=EMDR: Why the controversy? |journal=Traumatology |date=2003 |volume=9 |issue=3 |pages=169–182 |doi=10.1177/153476560300900304 }}</ref><ref>{{cite journal | vauthors = Hasandedić-Đapo L | title = How Psychologists Experience and Perceive EMDR? | journal = Psychiatria Danubina | volume = 33 | issue = Suppl 1 | pages = 18–23 | date = February 2021 | pmid = 33638952 | doi =  }}</ref> It is used by some practitioners for trauma therapy and in the treatment of [[complex post-traumatic stress disorder]].<ref name="Adler-Tapia">{{cite book | vauthors = Adler-Tapia R, Settle C |title=EMDR and The Art of Psychotherapy With Children |location=New York |publisher=Springer Publishing Co. |page=228 |year=2008 |isbn=978-0-8261-1117-3}}</ref><ref name="isbn0-7619-2921-5">{{cite book | vauthors = Scott CV, Briere J |title=Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment |publisher=Sage Publications |location=Thousand Oaks, CA |year=2006 |pages=312 |isbn=978-0-7619-2921-5}}</ref>

EMDR has been called a [[purple hat therapy]] because any effectiveness is provided by the underlying therapy (or the standard treatment), not from EMDR's distinctive features.<ref name="SciAm_2012">{{cite news | vauthors =  Arkowitz H, Lilienfeld SO |title=EMDR: Taking a Closer Look |url=https://www.scientificamerican.com/article/emdr-taking-a-closer-look/ |access-date=21 March 2023 |work=Scientific American |date=1 August 2012 |language=en}}</ref><ref>{{cite book |title=Exposure Treatments for Anxiety Disorders: A Practitioner's Guide to Concepts, Methods, and Evidence-Based Practice |vauthors=Rosquist |year=2005 |publisher=Routledge |isbn=9781136915772 |page=94}}</ref>

Some scholars have criticized Francine Shapiro for repeatedly increasing the length and expense of training and certification, allegedly in response to the results of controlled trials that cast doubt on EMDR's efficacy.<ref name="1999 Skeptic">{{cite journal|title=Eye Movement Magic: Eye Movement Desensitization and Reprocessing|journal=Skeptic|volume=7|issue=4|year=1999| vauthors = Rosen GM, Mcnally RJ, Lilienfeld SO | author-link3=Scott Lilienfeld | url=http://www.skeptic.com/eskeptic/14-05-21/#feature}}</ref><ref name="Herbert">{{cite journal | vauthors = Herbert JD, Lilienfeld SO, Lohr JM, Montgomery RW, O'Donohue WT, Rosen GM, Tolin DF | title = Science and pseudoscience in the development of eye movement desensitization and reprocessing: implications for clinical psychology | journal = Clinical Psychology Review | volume = 20 | issue = 8 | pages = 945–971 | date = November 2000 | pmid = 11098395 | doi = 10.1016/s0272-7358(99)00017-3 | s2cid = 14519988 }}</ref> This included requiring the completion of an EMDR training program in order to be qualified to administer EMDR properly after researchers using the initial written instructions found no difference between no-eye-movement control groups and EMDR-as-written experimental groups. Further changes in training requirements and/or the definition of EMDR included requiring level II training when researchers with level I training still found no difference between eye-movement experimental groups and no-eye-movement controls and deeming "alternate forms of bilateral stimulation" (such as finger-tapping) as variants of EMDR by the time a study found no difference between EMDR and a finger-tapping control group.<ref name="1999 Skeptic" /> Such changes in definition and training for EMDR have been described as "ad hoc moves [made] when confronted by embarrassing data".<ref name ="McNally2003">{{cite journal | vauthors = McNally RJ |title=The demise of pseudoscience |journal=The Scientific Review of Mental Health Practice |year=2003 |volume=2 |issue=2 |pages=97–101 |url=https://www.srmhp.org/0202/pseudoscience.html |archive-url=https://web.archive.org/web/20050211230751/https://www.srmhp.org/0202/pseudoscience.html |archive-date=2005-02-11 }}</ref>

EMDR adds a number of techniques that do not appear to contribute to therapeutic effectiveness, e.g., bilateral stimulation.<ref name="non">{{cite book |page=292 |vauthors= Lohr JM, Gist R, Deacon B, Devilly GJ, Varker T |chapter=Chapter 10: Science- and Non-Science-Based Treatments for Trauma-Related Stress Disorders |publisher=Routledge |veditors=Lilienfeld SO, Lynn SJ, Lohr JM |title=Science and Pseudoscience in Clinical Psychology |edition=2nd |year=2015 |isbn=9781462517893|quote="...eye movements and other bilateral stimulation techniques appear to be unnecessary and do not uniquely contribute to clinical outcomes. The characteristic procedural feature of EMDR appears therapeutically inert, and the other aspects of this treatment (e.g., imaginal exposure, cognitive reappraisal, in vivo exposure) overlap substantially with those of exposure-based treatments for PTSD...EMDR offers few, if any, demonstrable advantages over competing evidence-based psychological treatments. Moreover, its theoretical model and purported primary active therapeutic ingredient are not scientifically supported."}}</ref> EMDR is classified as one of the "power therapies" alongside [[thought field therapy]], [[Emotional Freedom Techniques]] and others{{snd}}so called because these therapies are marketed as being superior to established therapies which preceded them.<ref name=ros2012>{{cite book |vauthors=Rosquist J |isbn=9781136915772 |publisher=Routledge |year=2012 |title=Exposure Treatments for Anxiety Disorders: A Practitioner's Guide to Concepts, Methods, and Evidence-Based Practice |page=92}}</ref>

EMDR has been characterized as [[pseudoscience]], because the underlying theory and primary therapeutic mechanism are [[Falsifiability|unfalsifiable]] and non-scientific. EMDR's founder and other practitioners have used [[Pseudoscience#Falsifiability|untestable hypotheses]] to explain studies which show no effect.<ref name=ps-in_promotion>{{cite book |chapter=Chapter 4: Pseudoscience in Treating Adults Who Experienced Trauma |title=Science and Pseudoscience in Social Work Practice |vauthors=Thyer BA, Pignotti MG |year=2015 |publisher=Springer |page=221 |doi=10.1891/9780826177698.0004 |isbn=9780826177681|quote=Nevertheless, to date, given that there is no evidence that anything unique to EMDR is responsible for the positive outcomes in comparing it to no treatment and the florid manner in which it has been marketed, we are including it in this book... Another way in which EMDR qualifies as a pseudoscience is the manner in which it was developed and marketed... EMDR proponents have come up with ad hoc hypotheses to explain away unfavorable results that do not support its theory, which is one of the hallmark indicators of a pseudoscience... This type of post hoc explanation renders her theory unfalsifiable and thus places it outside the realm of science, because to qualify as scientific, a theory must be falsifiable.}}</ref> The results of the therapy are non-specific, especially if directed eye movements are irrelevant to the results. When these movements are removed, what remains is a broadly therapeutic interaction and deceptive marketing.<ref name="Herbert" /><ref name=Devilly2002>{{cite journal | vauthors = Devilly G |title=Eye movement desensitization and reprocessing: a chronology of its development and scientific standing |journal=The Scientific Review of Mental Health Practice |date=2002 |volume=1 |issue=2 |pages=132|url=http://devilly.org/Publications/EMDR-review.pdf}}</ref> According to neurologist [[Steven Novella]]:

{{blockquote|[T]he false specificity of these treatments is a massive clinical distraction. Time and effort are wasted clinically in studying, perfecting, and using these methods, rather than focusing on the components of the interaction that actually work.<ref name = "SBM" >{{cite web | vauthors = Novella S | author-link = Steven Novella |title=EMDR and Acupuncture – Selling Non-specific Effects |url=https://sciencebasedmedicine.org/emdr-and-acupuncture-selling-non-specific-effects/ |department=Science Based Medicine |publisher=Society for SBM |date=March 30, 2011 |access-date=12 July 2020}}</ref>}}

Furthermore, Novella argues that investigation into EMDR has been characterised by poor-quality studies, rather than tightly-controlled trials that could justify or falsify the mechanisms that have been proposed to support it. Novella writes that the research quantity nevertheless means that EMDR has claimed a place among accepted treatments and is "not likely going away anytime soon, even though it is a house of cards built on nothing".<ref name="f445">{{cite web | title=EMDR Is Still Dubious | publisher=Science-Based Medicine | date=23 October 2024 | url=https://sciencebasedmedicine.org/emdr-is-still-dubious/ | vauthors=Novella S}}</ref>

EMDR has been characterised as a modern-day [[mesmerism]], as the therapies have striking resemblances, from the sole inventor who devises the system while out walking, to the large business empire built on exaggerated claims. In the case of EMDR, these have included the suggestions that EMDR could drain violence from society and be  useful in treating [[cancer]] and [[HIV/AIDS]].<ref name="tsep">{{cite book |title=[[The Skeptic Encyclopedia of Pseudoscience]] |vauthors=Rosen GM, McNally RJ, Lilienfield SO |publisher=Bloomsbury |year=2002 |isbn=978-1-57607-653-8 |veditors=Shermer M, Linse P |volume=1 |pages=321–326 |chapter=EMDR: Eye Movement Desensitization and Reprocessing}}</ref> Psychology historian Luis Cordón has compared the popularity of EMDR to that of other cult-like pseudosciences, [[facilitated communication]] and [[thought field therapy]].<ref name=cordon>{{cite book |veditors=Cordón LA |year=2005 |title=Popular psychology: An encyclopedia |publisher=Greenwood Press |chapter=Eye movement desensitization and reprocessing |pages=81–82}}</ref>

A parody website advertising "{{Not a typo|sudotherapy}}" created by a fictional "Fatima Shekel" appeared on the internet in the 1990s.<ref name="The Psychologist_2007">{{cite journal | vauthors = de Jongh A, ten Broeke E |title=A course in pseudoscience |journal=De Psycholoog |date=February 2007 |pages=87–91 |url=https://www.dousa.nl/DePsycholoogFebr2007letters.pdf |access-date=15 April 2023}}</ref><ref name="McNally_Dutch">{{cite journal | vauthors = McNally RJ |title=emdr en mesmerisme |journal=DTH Magazine |date=2001 |volume=3 |issue=21 |url=https://www.directievetherapie.nl/artikelen/jaargang21/emdr-en-mesmerisme-21-3-270/ |access-date=15 April 2023 |language=Dutch}}</ref><ref name=ps-in_sudotherapy/> Proponents of EMDR described the website as libelous, since the website contained an image of a pair of shifting eyes following a cat named "Sudo", and "Fatima Shekel" has the same initials as EMDR's founder, Francine Shapiro.<ref name=ps-in_sudotherapy/> However, no legal action took place against the website or its founders.<ref name=ps-in_sudotherapy>{{cite book |chapter=Chapter 1: Characteristics of Science and Pseudoscience in Social Work Practice |title=Science and Pseudoscience in Social Work Practice |vauthors=Thyer BA, Pignotti MG |year=2015 |publisher=Springer |doi=10.1891/9780826177698.0004 |isbn=9780826177681}}</ref>

== Society and culture ==
* [[Sandra Bullock]] used EMDR following a home invasion by a stalker in 2014.<ref name="Blum_2022" />
*In 2019 [[Jameela Jamil]] said she partook in EMDR therapy to treat her [[PTSD|post traumatic stress disorder]].<ref>{{cite web |last1=Luu |first1=Christopher |title=Jameela Jamil Reveals She Attempted Suicide |url=https://www.instyle.com/news/jameela-jamil-suicide-attempt |website=InStyle |language=EN |date=10 October 2019 |access-date=11 November 2020 |archive-date=15 October 2021 |archive-url=https://web.archive.org/web/20211015064549/https://www.instyle.com/news/jameela-jamil-suicide-attempt |url-status=dead}}</ref><ref>{{Cite AV media |url=https://www.youtube.com/watch?v=F2c1_QiQSsc |title="EMDR therapy removed emotion linked to the traumatic memory." Jameela Jamil |date=2024-03-15 |last=Creative Mind Videos |access-date=2024-07-27 |via=YouTube}}</ref>
* In 2021 [[Prince Harry]] took a course of EMDR and filmed a session for [[Oprah Winfrey]] during a mental health television documentary.<ref name="hw">{{cite news | vauthors = Sample I |date=21 May 2021 |title=EMDR: what is the trauma therapy used by Prince Harry? |newspaper=The Guardian |url=https://www.theguardian.com/science/2021/may/21/emdr-what-is-the-trauma-therapy-used-by-prince-harry}}</ref><ref name="Blum_2022">{{Cite news | vauthors = Blum D, Park S |date=2022-09-19 |title='One Foot in the Present, One Foot in the Past:' Understanding E.M.D.R. |language=en-US |work=The New York Times |url=https://www.nytimes.com/2022/09/19/well/emdr-therapy.html |access-date=2023-04-09 |issn=0362-4331}}</ref>
* In 2022 [[BBC]] war correspondent [[Fergal Keane]], who suffered from PTSD, credited his EMDR therapist with helping save his life.<ref>{{Cite web|url=https://emdrassociation.org.uk/media/bbc2-ptsd-fergal-keane/|title=BBC2 PTSD Fergal Keane|website=EMDR UK Association}} Starting 34:38 into the programme.</ref>

== See also ==
* [[Abreaction]]
* [[List of topics characterized as pseudoscience]]
* [[Treatments for PTSD]]

== References ==
{{Reflist}}

== External links ==
* [https://www.emdr.com/ EMDR Institute (US)]

{{psychotherapy}}
{{pseudoscience}}

[[Category:Anxiety disorder treatment]]
[[Category:Counseling]]
[[Category:Psychotherapy by type]]
[[Category:Pseudoscience]]