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 Veterans Affairs and 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 substantially contribute to treatment effectiveness, if at all. The predominant therapeutic factors in EMDR and TF-CBT are 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.
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. Psychologist Gerald Rosen has expressed doubt about this description, saying that people are normally not aware of this type of eye movement.
EMDR is typically undertaken in a series of sessions with a trained therapist. The number of sessions can vary depending on the progress made. A typical EMDR therapy session lasts from 60 to 90 minutes.
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. 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."
Many proposals of EMDR efficacy assume, as Shapiro posited, that when a traumatic or very negative event occurs, the information processing of the experience in memory may be incomplete. The trauma disrupts normal adaptive information processing, leading to unprocessed information being dysfunctionally retained in memory networks. 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." This proposed mechanism has no known scientific basis.
Several other possible mechanisms have been proposed:
Bilateral stimulation is a generalization of the left- and right-repetitive eye movement technique first used by Shapiro. Alternative stimuli include auditory stimuli alternating between left- and right-sided speakers or headphones, and physical stimuli such as the therapist's hand tapping or tapping devices.
Most meta-analyses have found that including bilateral eye movements in EMDR makes little or no difference to its effect. Meta-analyses have also described a high risk of allegiance bias in EMDR studies. One 2013 meta-analysis with fewer exclusion criteria found a moderate effect.
EMDR has been found to be as effective as other psychological interventions for treating PTSD, with no evidence of added benefit derived from eye movement. Men are more likely to drop out of an EMDR program that women.
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.
A 2021 systematic review of 13 studies found that clients had mixed perceptions of the effectiveness of EMDR therapy.
EMDR has been tested on a variety of other mental health conditions with mixed results.
EMDR is controversial among scholars in the psychological community. It is used by some practitioners during trauma therapy and in the treatment of complex post-traumatic stress disorder.
EMDR has been called a purple hat therapy on the grounds that its effectiveness stems from its underlying mainstream therapy (or the standard treatment), not from its distinctive features.
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. 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. Such changes in definition and training for EMDR have been described as "ad hoc moves [made] when confronted by embarrassing data", argues Richard McNally.
EMDR adds a number of techniques that do not appear to contribute to therapeutic effectiveness (e.g., bilateral stimulation). EMDR is classified as one of the "power therapies" alongside thought field therapy, Emotional Freedom Techniques, and othersâÂÂso called because these therapies are marketed as being superior to established the therapies which preceded them.
EMDR has been characterized as pseudoscience because the underlying theory and primary therapeutic mechanism are non-falsifiable and non-scientific. EMDR's founder and other practitioners have used untestable hypotheses to explain studies that show no effect. 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. According to neurologist and skeptic Steven Novella:
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 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".
EMDR has been characterised as a modern-day mesmerism, with striking similarities, from the sole inventor who devised 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. Psychology historian Luis Cordón has compared the popularity of EMDR to that of other cult-like pseudosciences, facilitated communication and thought field therapy.
A parody website advertising "" created by a fictional "Fatima Shekel" appeared on the internet in the 1990s. 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. However, no legal action took place against the website or its founders.