In 1987, Francine Shapiro was walking in the park when she realized that eye movements appeared to decrease the negative emotion associated with her own distressing memories1,2. She assumed that eye movements had a desensitizing effect, and when she experimented with this she found that others also had the same response to eye movements. It became apparent however that eye movements by themselves did not create comprehensive therapeutic effects and so Shapiro added other treatment elements, including a cognitive component, and developed a standard procedure that she called Eye Movement Desensitization (EMD)1.
Shapiro then conducted a case study4 and a controlled study1 to test the effectiveness of EMD. In the controlled study, she randomly assigned 22 individuals with traumatic memories to two conditions: half received EMD, and half received the same therapeutic procedure with imagery and detailed description replacing the eye movements. She reported that EMD resulted in significant decreases in ratings of subjective distress and significant increases in ratings of confidence in a positive belief. Participants in the EMD condition reported significantly larger changes than those in the imagery condition.
Shapiro wrote “a single session of the procedure was sufficient to desensitize subjects’ traumatic memories, as well as dramatically alter their cognitive assessments6.” Unfortunately, Shapiro has often been erroneously cited as claiming that “EMDR can cure [posttraumatic stress disorder] PTSD in one session (F. Shapiro, 1989).”7 Shapiro never made this statement; what she actually wrote was that the EMD procedure “serves to desensitize the anxiety … not to eliminate all PTSD-related symptomatology and complications, nor to provide coping strategies for the victims8” and reported “an average treatment time of five sessions”8 to comprehensively treat PTSD.
1989 was the first year that controlled studies investigating the treatment of PTSD were published. Besides Shapiro’s article, three other studies9,10,11 were published. The Brom et al.9 study compared the results of psychodynamic therapy, hypnotherapy, and desensitization and provided an average of 16 sessions. It found clinically significant treatment effects for 60% of the civilian participants, with no differences between the conditions. The Cooper and Clum10 study compared flooding to standard care in a Veterans Administration Hospital. They reported moderate clinical effects after 6-14 sessions, with a 30% patient drop-out rate. The Keane et al.11 (1989) study compared flooding to a wait-list control for veteran participants and reported moderate clinical effects after 14-16 sessions. [See Comparison of EMDR and Cognitive Behavioral Therapies for more information.
Shapiro continued to develop this treatment approach, incorporating feedback from clients and other clinicians who were using EMD. In 1991 she changed the name to Eye Movement Desensitization and Reprocessing12 (EMDR) to reflect the insights and cognitive changes that occurred during treatment, and to identify the information processing theory that she developed to explain the treatment effects.
Because EMDR therapy was an effective treatment, achieving results very quickly for many clients, Shapiro felt an ethical obligation to teach other clinicians so that individuals suffering from PTSD could find relief. However, EMDR was still experimental since it had not received independent confirmation through other controlled studies. She attempted to resolve this ethical dilemma by teaching EMDR only to licensed clinicians, and by ensuring that everyone who learned the approach was trained by the EMDR Institute in the same model. That way safeguards would be in place, clinicians would be taught to inform clients of its status, and a feedback system would allow everyone that was trained to get the most up to date information. In 1995, after other controlled studies had been published, the label “experimental” and the training restrictions were removed and a textbook of procedures was published13 . Shapiro has been severely criticized by some for her method of dissemination, because she initially restricted training and because she taught an experimental procedure. However, these critics ignore the APA ethics code mandated responsibilities of an innovator to determine training practices and the fact that even as late as 1998, there were no treatments for PTSD that were designated as well-established and empirically validated15. At that time, independent reviewers for the Clinical Psychology Division of the American Psychological Association identified three treatments with “probable efficacy.” These were EMDR, exposure therapy, and stress inoculation therapy.
Since the initial studies were published in 1989, hundreds of case studies have been published, and there have been numerous controlled outcome studies16 . These studies have demonstrated EMDR’s effectiveness in PTSD treatment and EMDR is now recognized as efficacious in the treatment of PTSD [See Efficacy of EMDR and Summary of PTSD Studies].
A professional association, independent from Shapiro and the EMDR Institute was founded in 1995 to establish standards for training and practice. The EMDR International Association (EMDRIA) declares that its primary objective is “to establish, maintain and promote the highest standards of excellence and integrity in Eye Movement Desensitization and Reprocessing (EMDR) practice, research and education.” Information about EMDRIA is available at www.emdria.org
Despite its demonstrated effectiveness, similar to most new approaches in psychotherapy, EMDR has been surrounded by controversy. While some critics have labeled EMDR a “pseudoscience” others have commented that these conclusions are based on misinterpretations of the literature [see “Confusion, Misinformation, and Charges of “Pseudoscience”]. Another area of debate is the role of eye movements in EMDR [See Eye Movements and Alternate Dual Attention Stimuli and What has research determined about EMDR’s eye movement component? In the Commonly Asked Questions section.
1Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2, 199-223.
2Shapiro, F. & Forrest, M. (1997). EMDR The Breakthrough Therapy for Overcoming Anxiety, Stress and Trauma. New York: Basic Books
5Shapiro, F. (1989). Eye movement desensitization: A new treatment for post-traumatic stress disorder. Journal of Behavior Therapy and Experimental Psychiatry, 20, 211-217.
6Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2, 199-223
7Lohr, 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.
6Shapiro, F. (1989). Efficacy of the eye movement desensitizatioin procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2, 199-223.
9Brom, D., Kleber, R. J., & Defares, P. B. (1989). Brief psychotherapy for posttraumatic stress disorders. Journal of Consulting and Clinical Psychology, 57, 607-612
10Cooper, N.A., & Clum, G.A. (1989). Imaginal flooding as a supplementary treatment for PTSD in combat veterans: A controlled study. Behavior Therapy, 20, 381-391.
11Keane, T.M., Fairbank, J.A., Caddell, J.M., & Zimmering, R.T., (1989). Implosive (flooding) therapy reduces symptoms of PTSD in Vietnam combat veterans. Behavior Therapy, 20, 245-260.
12Shapiro, F., (1991). Eye movement desensitization & reprocessing procedure: From EMD to EMD/R-a new treatment model for anxiety and related traumata. Behavior Therapist, 14, 133-135.
13Shapiro, F. (1995). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures (1st edition). New York: Guilford Press
15Chambless, D.L., Baker, M.J., Baucom, D.H., Beutler, L.E., Calhoun, K.S., Crits-Christoph, P., Daiuto, A., DeRubeis, R., Detweiler, J., Haaga, D.A.F., Bennett Johnson, S., McCurry, S., Mueser, K.T., Pope, K.S., Sanderson, W.C., Shoham, V., Stickle, T., Williams, D.A., & Woody, S.R. (1998) . Update on empirically validated therapies, II., The Clinical Psychologist, 51, 3-16.
16For complete listing see See Shapiro, F., (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures (2nd edition). New York: Guilford Press