It’s not that it’s not popular. EMDR has become an extremely popular treatment. And many clinicians advocate great gains in clients they have used EMDR with. But major research and trauma treatment organizations (e.g., VA, National Center for PTSD) more strongly recommend other established approaches. Why don’t experts strongly recommend EMDR for trauma?
Eye Movement Desensitization and Reprocessing (EMDR) uses bilateral stimulation through eye movements, sounds, or tapping. This stimulation activates different parts of the brain. The approach helps individuals process traumatic memories by recalling them, discussing them in therapy, and linking them with more adaptive information.
Research has found that EMDR can be effective for many forms of trauma. The VA even lists it as a “recommended” treatment. However, established treatments like Prolonged Exposure for PTSD, Cognitive Processing Therapy (CPT), and traditional CBT for trauma are more strongly recommended.
So why do top experts recommend other treatments over EMDR? First, in many ways we still do not know why EMDR works. That is, what does bilateral stimulation do in the brain for PTSD? Prolonged Exposure, CPT, and CBT effectiveness are very well known. And contrary to some assertions, these approaches (esp., prolonged exposure) do not retraumatize clients.
Understanding why a treatment works is important. It allows us to refine methods and strengthen the most effective elements for clients. For example, prolonged exposure improved effectiveness by helping clients develop new, adaptive ways of understanding trauma memories.
Understanding treatment mechanisms brings up the issue of not knowing how much an effect bilateral stimulation has. Do bilateral eye or auditory stimulations actually change anything? The reprocessing of memories by associating them with more adaptive information is part of exposure and cognitive therapies. So some researchers wonder whether EMDR is simply a form of exposure plus adding eye movements and other stimulation.
Lastly, EMDR has been exceedingly propriety. Other effective treatments are generally free to learn, aside from costs for continuing education courses. However, EMDR requires costly certificate programs and uses heavy marketing to promote a marketplace for approved stimulation items (e.g., wand eye trackers). Critics of the approach accuse of EMDR of profiting on the emotional needs of clinicians who only really want to help their clients.
Whether or not the intent of EMDR is highly profit driven is somewhat moot. The existence of other free and effective tools that we understand better is, admittedly, a compelling point. Further research might tell us exactly why EMDR works and may prove favorable for the approach. For now, prolonged exposure, CPT, and CBT sit in the coveted “strongly recommended” spot for trauma.
