The Evidence against EMDR

Not everything that sounds scientific is science

It’s 2021. The world is reeling from not just a viral pandemic turning much of our life it into a hobbled version of itself, but also the prevalence of sold-as-science unscientific methodologies and modalities.

This should not come as a surprise. The presence of OMM (osteopathic manual manipulation) in the DO curriculum, or homeopathy and “Traditional” Chinese Medicine in discussions of medical practice is as old as Quack.

But if there is one pre-pandemic modality I consider more than dangerous, founded on nothing but conjecture, and lacking any real scientific validation, it’s EMDR, the “Eye movement desensitization and reprocessing” therapeutic tool in Psychiatry and Psychology.

How EMDR was “developed”

It wasn’t. It was an “idea” by Francine Shapiro. Shapiro held a MA in English Literature and later, after the “release” of EMDR, completed a non-accredited certificate course in marketing and work psychology at the Professional School of Psychological Studies, San Diego.

During a walk in the park, she anecdotally observed, that her eye movements changed as she thought about traumatic parts of her past. This observation led her to open the “Human Development Institute” an ostensibly non-profit institute which charged steep fees to teach the trademarked and secretive practice of EMDR.

She later received a PhD from the Professional School of Psychological Studies, San Diego and published a number of small-n studies on EMDR.

Does EMDR work?

Origin story and “inventor” matter little to a new scientific discovery. What do matter are studies validating the process and outcome expectations.

In this context, it is important to understand, that EMDR is not like most medical and therapeutic interventions in psychiatry or somatic medicine. The Whipple procedure, for example, describes an approach to remove a cancerous pancreas and surrounding tissues, named after the procedure’s developer, Allen Whipple. Whipple would never have thought to patent and restrict the application of his improvements to Alessandro Codivilla’s pancreaticoduodenectomy.

EMDR isn’t like any of those things. It is not like Cognitive Behavioral Therapy, Psychotherapy, or other approaches in this field. Instead, it is a set of techniques that are gated behind a paid membership and governed by NDAs and secrecy. To practice EMDR one does not, as with any other therapeutic or medical intervention, read and practice from openly available data, but must purchase specific books and attend specific seminars which are controlled by the successor to Shapiro’s Human Development Institute.

Nevertheless, a number of studies have been published by members of this circle of insiders. While the studies seem to suggest some efficacy, they are widely criticised by psychologists who are not of the Human Development Institute’s circle of secrecy as being sloppy, often weak, and sometimes outright unscientific.

Overall, scientific consensus seems to be, that while some studies show efficacy, they are marred by extreme drop-out rates, small-n sample sizes, and researcher bias due to their required membership in the HDI and contractual obligation to secrecy about the technique.

Harvard Professor and one of the leading researchers in trauma and PTSD, Richard McNally, summed up the practice as “What is effective in EMDR is not new, and what is new is not effective.” He is referring to the stable and known effective components of trauma exposure and behavioral therapy that are usually come with EMDR and the unstable and ineffective component of eye movement respectively.

In other words, EMDR consists of two components: exposure to the traumatic event (the so-called “imaginary exposure”), and rapid eye movement. The former is proven to assist in the therapy of PTSD. The latter is not. Isolated experiments with eye movement showed no efficacy, while isolated experiments with exposure therapy showed efficacy equivalent to, well, isolated exposure therapy as it is practiced for decades.

To clarify this: if you have a headache and I give you a headache pill which is on the market for 20+ years and proven efficacious, your headache probably gets better. If I now go outside and kick a bunny as well, it would be wrong to claim that the practice of bunny-kicking cures headaches. To prove this, I’d have to kick the bunny and not give you a pill.

Worse, being a bunny-kicker makes me a terrible human being. Especially, since the kicking has no effect. I can claim, that I am a good person, because I relieved your headache, but the added step of cruelty is unnecessary and I should neither charge for it nor pay the Bunny Kicking Institute for the secret technique of kicking a bunny.

Read also: Herbert JD, Lilienfeld SO, Lohr JM, Montgomery RW, O’Donohue WT, Rosen GM, Tolin DF. Science and pseudoscience in the development of eye movement desensitization and reprocessing: implications for clinical psychology. Clin Psychol Rev. 2000 Nov;20(8):945-71. doi: 10.1016/s0272-7358(99)00017-3. PMID: 11098395.

Why is this a problem?

Health care is as complicated as the human body and mind are. Scientists and researchers work behind the scenes to decode and describe the mechanisms of illness and injury, both of the body and the mind. Much research leaves those ivory towers every day, now awaiting clinical research and the ultimate fate of those ideas.

In this climate it is understandable, that some notions of “more between heaven and earth” permeate the field. After all, there is still so much to discover and so much to learn.

But human beings are no lab animals. As those practices leave the ivory towers and become therapies, those who receive them deserve honest and clear communication about the efficacy and risks of everything thrown at them. “Informed consent,” as it is called.

EMDR leaves doubts as to its efficacy and isn’t a regular medical practice. It is, instead, a non-medical, commercial, tool, without strong evidence to back it up.

PTSD is a daunting problem at the best of times. Those suffering from it deserve the best, proven efficient, therapy with clear communication as to the risks and probabilities of success. Any exposure based therapy, which demands the patient relive and recall traumatic events, has risks. These risks are greatly offset by the benefits in approved and science-based therapies. They are not justified by commercial applications lacking the science to back them up.

Take Home

EMDR has low to no scientific validity behind it. Its origin story is suspect, its current development and application gated behind a paid membership in an almost cult-like organization, shrouded in practitioner secrecy.

It is not harmless, because the practice or recall exposure therapy never is. These risks are offset by strongly evidenced benefits when used in evidentiary stable therapies, they are not justified when taken with unproven and scientifically weak approaches.

Be wary of practitioners mentioning EMDR in their list of therapies. EMDR should, instead, serve as an indicator of sloppy provider adherence to science and the scientific method.