As outlined in the History of EMDR section, when the first EMDR study1 was published in 1989, the first three cognitive behavioural therapy (CBT) studies on the treatment of posttraumatic stress disorder were also published. One2 used desensitization with civilian participants, and two3,4 tested flooding (exposure) with veteran participants. All achieved only moderate effects after 6-14 sessions. In contrast, the EMDR study showed significant desensitization of a traumatic memory in one session. A review in 1992 pointed out that all published studies suffered from methodological limitations and stated that, “further research was needed before any of the reviewed approaches could be pronounced effective as lasting treatments of PTSD.5”
Exposure therapy is often advocated as a treatment of choice for PTSD. In exposure therapy, the client relates his/her traumatic experience for an hour in the treatment session, and then typically listens to an audiotape of the session for an hour every day. Exposure therapy also requires in vivo exposure homework in which the client engages in an avoided activity related to the trauma (e.g., going into Manhattan), with an additional hour per day spent on such activities.
Although exposure therapy, as generally advocated for use in the USA, demands many client hours (e.g., 15-85 hours), controlled studies generally indicate that only a 60% remission of PTSD is typically achieved6,7. For instance, a researcher of exposure therapy, and her colleagues reported a decrease of 55% in PTSD diagnosis for female assault victims who received 10.5 hours of exposure therapy and who engaged in 24 hours of homework6. In contrast, a British controlled exposure study reached an 80% remission of PTSD diagnosis with a combination of imaginal exposure and therapist-accompanied in vivo therapy9. This treatment prescribed 15 hours of treatment and 70-100 hours of homework, and the researchers commented that completion of at least 50% of the homework was necessary for good outcome. The necessity of homework compliance may limit the generalizability of exposure therapy to community settings, where compliance is much less likely10, and may limit its effectiveness with clients whose function is impaired because of severe distress. The British researchers also reported that the clinicians administering exposure therapy became disturbed because of the detailed stories used in treatment.
In contrast, four EMDR studies11,12,13 have indicated an elimination of diagnosis of posttraumatic stress disorder (PTSD) in 77-90% of civilian participants after three to seven sessions (without homework). Studies using participants with PTSD14,15,16,17 have found significant decreases in a wide range of symptoms after two or three active treatment sessions. Treatment effects appear to be well maintained at follow-up assessments. For example, one study reported an 84% remission of PTSD diagnosis at 15 month follow-up18. Studies using waitlist controls found EMDR superior; studies comparing EMDR to commonly used treatments such as biofeedback relaxation19, active listening16, and various forms of individual therapy in a Kaiser Permanente HMO facility12 found EMDR superior to the control condition on measures of posttraumatic stress.
Five randomized clinical trials have compared EMDR to exposure therapies20,21,31 and to cognitive therapies plus exposure22,23. These studies found EMDR and the cognitive/behavioral control to be relatively equivalent on most measures. Two studies reported a superiority for EMDR on measures of PTSD intrusive symptoms8,9 and one study (which used imaginal plus therapist assisted in vivo exposure) reported a CBT superiority in 2 of 10 subscales. There were two controlled studies without randomization; one24 found the CBT condition superior to EMDR and the other25 found EMDR superior to the CBT control on multiple measures.
Two studies found EMDR to be more efficient than the CBT control condition, with EMDR using fewer treatment sessions to achieve effects23 and more EMDR participants achieving a good outcome in three sessions20. As noted above, CBT treatments generally require one to two hours of daily homework, while EMDR is implemented without homework. This makes the overall treatment time for EMDR substantially less and easier for many clients. [For more information on EMDR studies, see Studies Investigating EMDR Treatment of PTSD]
The equivalence of EMDR and CBT in PTSD treatment was confirmed in two meta-analyses26,27. One meta-analysis27 also examined efficiency and concluded that EMDR was more efficient than CBT as the research studies had used fewer sessions to achieve similar results. [For more information, see What have meta-analyses revealed about EMDR? in the Commonly Asked Questions section.]
Some reviewers28 have suggested that EMDR is very similar to exposure therapy in its process and mechanisms of action. Others27,29,30 argue that this conclusion overlooks core differences between the two treatment approaches. A randomized process analysis of one session each also found significant differences between the two.31 [For more information see: Is EMDR an exposure therapy? in the Commonly Asked Questions section.
1Shapiro, F. (1989). Efficacy of the Eye Movement Desensitiaation Procedure in the Treatment of Traumatic Memories. Journal of Traumatic Stress. 2 (2), 199-223
2Brom, D., Kleber, R.J. & Defares, P.B. (1989). Brief psychotherapy for posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 57, 607-612.
3Cooper, N.A. & Clum, G.A. (1989). Imaginal flooding as supplementary treatment for PTSD in combat veterans: a controlled study. Behavior Therapy, 20, 381-391.
4Keane, T.M., Fairbank, J.A., Cadell, J.M. & Zimering, R.T. (1989). Imploxive (flooding) therapy reduces symptoms of PTSD in Vietnam combat veterans. Behavior Therapy, 20, 245-260.
5Solomon, S.D., Gerrity, E.T., & Muff, A.M. (1992). Efficacy of treatments for posttraumatic stress disorder. JAMA, 268, 633-638
6Foa, E. B., Rothbaum, B.O., Riggs, D., & Murdock, T. (1991). Treatment of posttraumatic stress disorder in rape victims: A comparison between cognitive-behavioral procedure and counseling. Journal of Consulting and Clinical Psychology, 59, 715-723.
7Tarrier, N., Pilgrim, H., Sommerfiled, C., Faragher, M.R., Graham, E., Barrowclough, C. (1999). A randomized trial of cognitive therapy and imaginal exposure in the treatment of chronic posttraumatic stress disorder. Journal of Counseling and Clinical Psychology, 67, 13-18.
8Foa, E. B., Dancu, C V., Hembree, E. A., Jaycox, L. H., Meadows, E. A., & Street, G. P. (1999). A comparison of exposure therapy, stress inoculation training, and their combination for reducing posttraumatic stress disorder. Journal of Consulting and Clinical Psychology 67, 194-200.
9Marks, I.M., Lovell, K., Noshirvani, H., Livanou, M., & Thrasher, S. (1998). Treatment of posttraumatic stress disorder by exposure and/or cognitive restructuring: A controlled study. Archives of General Psychiatry, 55, 317-325.
10Scott, M. J. & Stradling, S. G. (1997). Client compliance with exposure treatments for posttraumatic stress disorder. Journal of Traumatic Stress, 10, 523-526.
11Lee, C. & Gavriel, H., Drummond, P., Richards, J. & Greenwald, R. (2002). Treatment of post-traumatic stress disorder: A comparison of stress inoculation training with prolonged exposure and eye movement desensitisation and reprocessing. Journal of Clinical Psychology, 58, 1071-1089.
12Marcus, S. , Marquis, P. & Sakai, C. (1997). Controlled study of treatment of PTSD using EMDR in an HMO setting. Psychotherapy, 34, 307-315.
13Rothbaum, B.O. (1997). A controlled study of eye movement desensitization and reprocessing for posttraumatic stress disordered sexual assault victims. Bulletin of the Menninger Clinic, 61, 317-334.
14Ironson, G.I., Freund, B., Strauss, J.L., & Williams, J. (2002). A comparison of two treatments for traumatic stress: A community based study of EMDR and prolonged exposure. Journal of Clinical Psychology, 58, 113-128
15Power, K. G., McGoldrick, T., Brown, K., Buchanan, R., Sharp, D., Swanson, V., & Karatzias, A. (2002). A controlled comparison of eye movement desensitisation and reprocessing versus exposure plus cognitive restructuring, versus waiting list in the treatment of posttraumatic stress disorder. Journal of Clinical Psychology and Psychotherapy, 9, 299-318.
16Scheck, M.M., Schaeffer, J..A. & Gillette, C.S. (1998). Brief psychological intervention with traumatized young women: The efficacy of eye movement desensitization and reprocessing. Journal of Traumatic Stress, 11, 25-44.
17Wilson, S.A., Becker, L.A., & Tinker, R.H. (1995). Eye movement desensitization and reprocessing (EMDR) treatment for psychologically traumatized individuals. Journal of Consulting and Clinical Psychology, 63, 928-937
18Wilson, S.A., Becker, L.A., & Tinker, R.H. (1997). Fifteen-month follow-up of eye movement desensitization and reprocessing (EMDR) treatment for PTSD and psychological trauma. Journal of Consulting and Clinical Psychology, 65, 1047-1056.
19Carlson, J.G., Chemtob, C.M., Rusnak, K., Hedlund, N.L., & Muraoka, M.Y. (1998). Eye movement desensitization and reprocessing for combat-related posttraumatic stress disorder. Journal of Traumatic Stress, 11, 3-24.
20Ironson, G.I., Freund, B., Strauss, J.L., & Williams, J. (2002). A comparison of two treatments for traumatic stress: A pilot study of EMDR and prolonged exposure. Journal of Clinical Psychology, 58, 113-128.
21Vaughan, K., Wiese, M., Gold, R., & Tarrier, N. (1994). Eye-movement desensitisation: Symptom change in post-traumatic stress disorder. British Journal of Psychiatry, 164, 533-541.
22Lee, C. & Gavriel, H., Drummond, P., Richards, J. & Greenwald, R. (2002). Treatment of post-traumatic stress disorder: A comparison of stress inoculation training with prolonged exposure and eye movement desensitisation and reprocessing. Journal of Clinical Psychology, 58, 1071-1089.
23Power, K. G., McGoldrick, T., Brown, K., Buchanan, R., Sharp, D., Swanson, V., & Karatzias, A. (2002). A controlled comparison of eye movement desensitisation and reprocessing versus exposure plus cognitive restructuring, versus waiting list in the treatment of posttraumatic stress disorder. Journal of Clinical Psychology and Psychotherapy, 9, 299-318.
24Devilly, G. J., & Spence, S. H. (1999). The relative efficacy and treatment distress of EMDR and a cognitive behavioral trauma treatment protocol in the amelioration of post traumatic stress disorder. Journal of Anxiety Disorders, 13, 131-157.
25Sprang, G. (2001). The use of eye movement desensitizatioin and reprocessing (EMDR) in the treatment of traumatic stress and complicated mourning: Psychological and behavioral outcomes. Research on Social Work Practice, 11, 300-320.
26Davidson, P. R., & Parker, K. C. H. (2001). Eye movement desensitization and reprocessing (EMDR): A meta-analysis. Journal of Consulting and Clinical Psychology, 69, 305-316.
27Van Etten, M.L. & Taylor, S. (1998). Comparative efficacy of treatments for posttraumatic stress disorder: A meta-analysis. Clinical Psychology & Psychotherapy, 5, 126-144.
28Lohr, J. M., Tolin, D. F., & Lilienfeld, S. O. (1998). Efficacy of eye movement desensitization and reprocessing: Implications for behavior therapy. Behavior Therapy, 29, 123-156.
29Rogers, S., & Silver, S. M. (2002). Is EMDR an exposure therapy?: A review of trauma protocols. Journal of Clinical Psychology, 58, 43-59.
30Chemtob, C.M., Tolin, D.F., van der Kolk, B.A., & Pitman, R.K. (2000). Eye movement desensitization and reprocessing. In E.B. Foa, T.M. Keane, & M.J. Friedman (Eds.), Effective treatments for PTSD Practice guidelines from the International Society for Traumatic Stress Studies, (pp. 139-155). New York: Guilford Press.
31Rogers, S., Silver, S., Goss, J., Obenchain, J., Willis, A., & Whitney, R. (1999). A single session, controlled group study of flooding and eye movement desensitization and reprocessing in treating posttraumatic stress disorder among Vietnam war veterans: Preliminary data. Journal of Anxiety Disorders, 13, 119-130.