EMDR — Eye Movement Desensitization and Reprocessing — is a structured therapy for traumatic memories, developed by the American psychologist Francine Shapiro. Her first study appeared in 1989, under the name „eye movement desensitization“; „reprocessing“ was added later. It is not a body psychotherapy, but it belongs on this site: it is the best-studied trauma treatment that works directly with what the body does while a memory is held in mind, and it is the honest yardstick for everything else.

How it is done

  • Eight phases: history taking and treatment planning; preparation; assessment; desensitization; installation; body scan; closure; re-evaluation.
  • In assessment the client chooses a target memory — an image, a negative belief about themselves, the emotion and where it is felt in the body — and a positive belief they would rather hold.
  • In desensitization the client holds the memory in mind while following the therapist’s hand with the eyes, in sets, and reports what comes up. Alternating taps or tones are also used.
  • The body scan is the phase closest to body work: the client goes through the body while holding the memory and the positive belief, and anything still felt there is processed.

Two scales, and why zero is not one

  • SUD — Subjective Units of Disturbance, 0 to 10. How disturbing the memory feels right now. The scale comes from the behaviour therapist Joseph Wolpe: originally 0 to 100, with 0 as „a state of absolute calmness“, later in a compact 0 to 10 form. Shapiro built it into the standard protocol and widened it from anxiety to any disturbance. It is checked in assessment and again during and at the end of desensitization.
  • VoC — Validity of Cognition, 1 to 7. How true the positive belief feels, from 1 (completely false) to 7 (completely true). It is raised during installation.
  • The two scales start differently, and that is not a detail. SUD has a zero: a named state in which nothing disturbs. VoC starts at one: a belief that feels completely false is still a belief being held up for checking. Where a scale puts its origin says what it takes as the baseline — and whether „no disturbance at all“ is assumed to be a reachable state. We will come back to this in a separate piece.

Indication, not measurement

  • In the session the SUD is an indication: it helps the client notice and say where they are, and it helps the therapist see where processing is stuck. Checking it, in the words of a validation study, „does more than just provide a quantitative index of progress“ — it gives the client a sense of achievement and the clinician a view of blocks and goals.
  • As an outcome measure in research it is weaker. It has been criticised as unreliable and as an inaccurate measure of outcome; a 2008 study of its properties inside EMDR, on 61 patients, found significant but modest correlations with questionnaires of distress, depression and state anxiety, and a modest prediction of the clinician’s rating at the end of therapy.
  • That difference is exactly the one this site keeps — see what „measurement“ means on this site. Reading the 0–10 scale as an imperfect instrument misses what it is for in the room.

What the guidelines say (PTSD)

  • WHO (2013): trauma-focused CBT, EMDR or stress management „should be considered“ for adults with PTSD — a standard recommendation, quality of evidence moderate for EMDR; for children and adolescents also standard, evidence low.
  • NICE (2018), UK: offer EMDR to adults with PTSD presenting more than 3 months after a non-combat trauma; consider it between 1 and 3 months if the person prefers it; for 7–17-year-olds only if trauma-focused CBT does not help (NICE NG116).
  • ISTSS (2018): strong recommendation for adults, and for children and adolescents.
  • American Psychological Association (2017): conditional recommendation — weaker than for cognitive-behavioural therapies, with the note that newer studies could raise it to strong.

What the trials say, and what is disputed

  • A meta-analysis of 76 trials: against control conditions EMDR has a large effect on PTSD (g = 0.93), but with high heterogeneity; only 4 of 27 studies had low risk of bias, and there were signs of publication bias. Against other therapies it looked better (g = 0.36), but not in the studies with low risk of bias. The authors‘ conclusion: probably effective for PTSD in the short term, the quality of studies too low for definite conclusions; not enough evidence for other problems.
  • Against trauma-focused CBT, direct comparisons show no clear winner.
  • The eye movements are disputed. An early meta-analysis found no added effect of eye movements over the same procedure without them; a later one found a moderate added effect in treatment studies (d = 0.41) and a larger one in laboratory studies (d = 0.74), and attributed the earlier null result to methodology. The question is open, and our evidence page has been corrected accordingly.

Sources

  • Shapiro, „Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories“, Journal of Traumatic Stress 2(2), 1989, 199–223 (doi:10.1002/jts.2490020207).
  • Shapiro, Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures, 3rd ed., Guilford Press, 2018.
  • Kim, Bae & Park, „Validity of the Subjective Units of Disturbance Scale in EMDR“, Journal of EMDR Practice and Research 2(1), 2008, 57–62 (doi:10.1891/1933-3196.2.1.57); Wolpe, The Practice of Behavior Therapy, 1969 and 4th ed. 1990.
  • World Health Organization, Guidelines for the management of conditions specifically related to stress, Geneva 2013, recommendations 14 and 15. NICE, Post-traumatic stress disorder, NG116, 2018, recommendations 1.6.13, 1.6.18, 1.6.19. ISTSS, PTSD Prevention and Treatment Guidelines, 2018.
  • APA Guideline Development Panel, „Summary of the clinical practice guideline for the treatment of PTSD in adults“, American Psychologist 74(5), 2019, 596–607 (doi:10.1037/amp0000473).
  • Cuijpers et al., „Eye movement desensitization and reprocessing for mental health problems: a systematic review and meta-analysis“, Cognitive Behaviour Therapy 49(3), 2020, 165–180 (doi:10.1080/16506073.2019.1703801).
  • Seidler & Wagner, „Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD“, Psychological Medicine 36(11), 2006, 1515–1522 (doi:10.1017/S0033291706007963).
  • Davidson & Parker, „Eye movement desensitization and reprocessing (EMDR): a meta-analysis“, Journal of Consulting and Clinical Psychology 69(2), 2001, 305–316 (doi:10.1037/0022-006X.69.2.305); Lee & Cuijpers, „A meta-analysis of the contribution of eye movements in processing emotional memories“, Journal of Behavior Therapy and Experimental Psychiatry 44(2), 2013, 231–239 (doi:10.1016/j.jbtep.2012.11.001).

Training and practitioner directories: EMDR International Association and the national associations of EMDR Europe.