Does Moving Your Eyes Treat PTSD? Eye Movement Desensitization and Reprocessing
Eye Movement Desensitization and Reprocessing (EMDR) is a therapy designed to treat posttraumatic stress disorder (PTSD). It requires clients to retrieve a traumatic memory and to visually track the therapist’s finger as he or she moves it back and forth in front of the client’s eyes. The aim is to desensitize the client to traumatic memories such that their recollection ceases to provoke intense emotional distress. It resembles other cognitive-behavioral therapies for PTSD, such as prolonged imaginal exposure, except that EMDR involves repeated, brief exposures to the memory as well as induction of bilateral eye movements hypothesized to facilitate emotional processing and recovery. Controlled studies indicate that EMDR is more efficacious for PTSD than no treatment and similarly effective as some exposure and cognitive therapies (Bisson et al., 2007; Watts et al., 2013).
However, debate persists regarding its mechanism of action. In this entry, we describe EMDR in more detail, review critiques of the method, summarize the evidence from meta-analyses, and discuss the working memory hypothesis regarding its mechanism of action.
EMDR phases. EMDR has developed into a therapy with eight phases (Shapiro, 2001; see also Shapiro & Forrest, 2004). Typically, during the first phase the therapist evaluates the client’s history and develops a plan for treatment. Phase 2 typically involves the therapist teaching the client self-calming techniques for use at the end of and between therapy sessions. For example, one such technique involves visualizing an image or memory that brings about feelings of well-being and a positive view of self. Phase 3 involves identifying a distressing memory and an associated negative cognition, and also identifying an alternative positive cognition. For example, a negative cognition might be “I am helpless” and the alternative positive cognition might be “I survived, and I am strong.” In Phase 4, desensitization, the client focuses on a traumatic memory and negative cognition while his or her eyes follow the therapist’s finger (or another object) as it is moved back and forth in front of the client’s eyes. The therapist repeats these steps until the client’s self-reported distress associated with the memory has subsided. In Phase 5 the therapist asks the client to focus on the previous positive cognition in association with the traumatic memory. In Phase 6, the client is typically again asked to identify any remaining uncomfortable feelings within his or her body and these may be dealt with by returning to an earlier phase. In Phase 7, the therapist guides the client in applying the self-calming techniques to diminish any residual distress. In Phase 8, the therapist typically evaluates the progress of the client and considers whether the same or new target memories should be addressed in future sessions.
History. EMDR was an outgrowth of Francine Shapiro’s doctoral dissertation research. Shapiro (1989) reported that a single session produced lasting reduction in the distress associated with a target traumatic memory in all 22 clients who had undergone the procedure, as well as the elimination or improvement of primary presenting problems in most clients.
Criticisms. Shortly thereafter, Shapiro began to market EMDR in training workshops. Claims made on behalf of the power of bilateral eye movements for hastening the processing of traumatic memories struck many clinical scholars as premature. For example, Herbert et al. (2000) criticized EMDR proponents for their “pseudoscientific marketing practices” (p. 946). The controversy incited by EMDR motivated research into its comparative efficacy for treating PTSD. Its distinctive element—bilateral eye movement—did not appear to enhance the efficacy of EMDR’s exposure element, prompting McNally (1999) to conclude “Therefore, what is effective in EMDR is not new, and what is new is not effective” (p. 619). Indeed some meta-analyses have indicated that EMDR is beneficial for PTSD, but not more than are other exposure-based therapies and some cognitive behavioral therapies (Davidson & Parker, 2001; Bradley, Greene, Russ, Dutra, & Westen, 2005; Seidler & Wagner, 2006; Watts et al., 2013).
Do Eye Movements Make a Difference? However, a meta-analysis of randomized controlled trials and laboratory studies specifically tested the additive benefit of bilateral eye movements indicated that eye movements did produce statistically reliable clinical benefits (Lee & Cuijpers, 2013). In a critique of this meta-analysis, Devilly, Ono, and Lohr (2014) raised methodological objections to which Lee and Cuijpers (2014) replied. Several explanations have been put forward to explain why bilateral eye movements may confer therapeutic benefits when combined with brief retrieval of traumatic memories. For example, one hypothesis holds that eye movements foster communication between the left and right hemispheres, thereby hastening recovery from traumatic memories. However, the neuropsychological basis for this claim is dubious (e.g., see Samara, Elzinga, Slagter, & Nieuwenhuis, 2011). Devilly (2001) proposed that eye movements distract attention away from the traumatic mental images—essentially by splitting attention and lessening the impact of the exposure. Although distraction may result in lower immediate self-reported anxiety, Devilly (2001) warned that such initial gains may dissipate over time, compared to exposure without distraction (e.g., Macklin et al., 2000).
The Working Memory Hypothesis. An extension of the distraction hypothesis holds that effortful bilateral eye movements tax working memory as clients visualize their traumatic memory, thereby attenuating its vividness and consequently its capacity to provoke distress (van den Hout and Engelhard (2012; see also Gunter & Bodner, 2008; van den Hout et al., 2011; Andrade, Kavanagh, & Baddeley, 1997). Based on their studies, including findings that non-effortful bilateral auditory beeps were relatively ineffective, van den Hout and Engelhard suggest tasks that tax working memory are preferred (such as tracking an object with the eyes)—compared to passive tasks (such as listening to bilateral auditory beeps). They argue that a working memory explanation of EMDR offers a demystification that allows for better treatment decisions. For example, clients with high functioning working memory may require more demanding tasks compared to those with low working memory capabilities.
The working memory taxation hypothesis dovetails with work on memory reconsolidation (e.g., Kindt & Soeter, 2013; Nader, Schafe, & LeDoux, 2000). This research suggests that retrieval of memories renders them labile and subject to modification. Procedures, such as memory-taxing eye movements, may attenuate features of the memory (e.g., its vividness, emotionality) such that it is reconsolidated in a less distress-evocative form. Accordingly, when retrieved subsequently, it provokes less distress, although not invariably across all measures of memory (Liu & McNally, 2017).
Conclusion. In summary, EMDR is an empirically tested treatment for PTSD that has some positive reports in the research literature. Some researchers have provided evidence that effortful eye movements tax working memory during the recall of traumatic experiences, thus dividing attention and reducing vividness and distressing emotions. There is still some concern about the long-term efficacy of eye movements, but some meta-analyses have shown that EMDR is more effective than waitlist controls, and often comparable in efficacy to some exposure and cognitive behavioral therapies.
To cite this entry:
Patihis, L*., Cruz, C*., & McNally, R. J*. (in press). Eye Movement Desensitization and Reprocessing (EMDR). In V. Zeigler-Hill & T. K. Shackelford (Eds.) Encyclopedia of Personality and Individual Differences. New York, NY: Springer.
*Patihis L. is a research professor at The University of Southern Mississippi & where his graduate student Cruz C also conducts research. McNally R. J. is a research professor at Harvard University.
Cross-References. Post-Traumatic Stress Disorder, PTSD, Exposure Therapy, Cognitive Behavioral Therapy, CBT, Working Memory, Attention, Mental Imagery
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