Research Overview

EMDR Therapy

EMDR therapy, grounded in extensive research, has emerged as a pivotal tool in psychological treatment. This page outlines the continually expanding body of scientific studies and clinical trials that validate and refine EMDR's methodologies. Explore the journey of EMDR from experimental therapy to a globally recognized and evidence-based practice.

International Treatment Guidelines

Meta-Analyses

EMDR has been compared to numerous exposure therapy protocols, with and without CT techniques. It should be noted that exposure therapy uses one to two hours of daily homework and EMDR uses none.  The most recent meta-analyses are listed here.

Randomized Clinical Trials

Non-Randomized Studies

Adaptive Information Processing
and EMDR Procedures

The Adaptive Information Processing model (Shapiro, 2001, 2002, 2007) is used to explain EMDR’s clinical effects and guide clinical practice. This model is not linked to any specific neurobiological mechanism since the field of neurobiology is as yet unable to determine this in any form of psychotherapy (nor of most medications).  This section includes literature to provide an overview of the model and procedures, as well as selected research and case reports that demonstrate the predictive value of the model in the treatment of life experiences that appear to underlie a variety of clinical complaints.

Mechanism of Action

EMDR contains many procedures and elements that contribute to treatment effects.  While the methodology used in EMDR has been extensively validated (see above), questions still remain regarding mechanism of action. However, since EMDR achieves clinical effects without the need for homework, or the prolonged focus used in exposure therapies, attention has been paid to the possible neurobiological processes that might be evoked. Although the eye movements (and other dual attention stimulation) comprise one only one procedural element, this element has come under greatest scrutiny.

Randomized controlled studies evaluating mechanism of action of the eye movement component follow this section.

Randomized Studies of Hypotheses
Regarding Eye Movements

Numerous memory researchers have evaluated the eye movements used in EMDR therapy. A recent meta-analysis of the eye movement research has reported positive effects (Lee & Cuijpers, 2013) in both clinical and laboratory trials (see above). It is hypothesized that a number of mechanisms interact synergistically. The following studies have tested specific hypotheses regarding mechanism of action and found a direct effect on emotional arousal, imagery vividness, attentional flexibility, retrieval, distancing and memory association.

Additional Psychophysiological and Neurobiological Evaluations of EMDR Treatment

All psychophysiological studies have indicated significant de-arousal. All neurobiological studies have indicated significant effects, including changes in cortical, and limbic activation patterns, and increase in hippocampal volume.

Treatment of Military Personnel

As noted in the WHO (2013) guidelines and the American Psychiatric Association Practice Guidelines (2004, p.18), in EMDR therapy “traumatic material need not be verbalized; instead, patients are directed to think about their traumatic experiences without having to discuss them.”  Given the reluctance of many combat veterans to divulge the details of their experience, this factor is relevant to willingness to initiate treatment, retention and therapeutic gains.  It may be one of the factors responsible for the lower remission and higher dropout rate noted in this population when CBT techniques are used.

As described previously, an RCT by Carlson et al. (1998) reported that after twelve EMDR treatment sessions, 77.7% of the combat veterans no longer met criteria for PTSD.  There were no dropouts and effects were maintained at 3- and 9-month follow-up.  In addition, the Silver et al., (1995) analysis of an inpatient veterans’ PTSD program (n = 100) found EMDR to be superior to biofeedback and relaxation training on seven of eight measures. Russell et al. (2007) evaluated 72 active-duty military personnel, 48 diagnosed with combat PTSD and reported that pre-post changes were significant on all measures. A recent program evaluation of active duty military by McLay et al. (2016) compared various forms of treatment and reported, “Results indicated that patients receiving EMDR had significantly fewer therapy sessions over 10 weeks but had significantly greater gains in their PCL–M scores than did individuals not receiving EMDR.”

All other RCT of veterans have used insufficient treatment doses to assess PTSD outcomes (e.g., two sessions; see ISTSS, 2000; DVA/DoD, 2004). Sufficient treatment time must be used for multiply traumatized veterans (e.g., see below: Russell et al., 2007). However, in a process analysis, Rogers et al. (1999) compared one session of EMDR and exposure therapy with inpatient veterans, and a different recovery pattern was observed. The EMDR group demonstrated a more rapid decline in self-reported distress (e.g., SUD levels decreased with EMDR and increased with exposure).

As stated in the American Psychiatric Practice Guidelines (2004, p. 36), if viewed as an exposure therapy, “EMDR employs techniques that may give the patient more control over the exposure experience (since EMDR is less reliant on a verbal account) and provides techniques to regulate anxiety in the apprehensive circumstance of exposure treatment. Consequently, it may prove advantageous for patients who cannot tolerate prolonged exposure as well as for patients who have difficulty verbalizing their traumatic experiences. Comparisons of EMDR with other treatments in larger samples are needed to clarify such differences.”

Such research is highly recommended.  In addition, since EMDR utilizes no homework to achieve its effects it may be particularly suited for front line alleviation of symptoms (see Russell, 2006; Wesson & Gould, 2009).  Further, the prevalent somatic and chronic pain problems experienced by combat veterans indicate the need for additional research based upon the reports of Russell (2008), Schneider et al., (2007, 2008) and Wilensky (2007), which demonstrate EMDR’s capacity to successfully treat phantom limb pain (see also Ray & Zbik, 2001).  The ability of EMDR to simultaneously address PTSD, depression, and pain can have distinct benefits for DVA/DoD treatment.

The following contain clinically relevant information for the treatment of veterans, including therapy parameters.