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Since Shapiro's initial paper in 1989, at least 27 studies have been conducted evaluating EMDR and the aspects that contribute to its effect. The studies asked the basic question, "Does EMDR work at all, and, if so, how does it compare to other accepted therapies?" The results were mixed: It does work, but at nowhere near the level its proponents have claimed, and apparently not for the reasons Shapiro has claimed.
Ten published studies compared Shapiro's method to a no-treatment control group. The results showed that receiving EMDR treatment was, indeed, better than getting no professional help at all. "But that's not an especially strong endorsement," says Scott Lilienfeld, assistant professor of psychology at Emory University in Atlanta. Davison echoes the thought, noting that almost any treatment given by a professional -- even a treatment with no real medical efficacy -- causes some study subjects to report improvement. "A lot of things are effective. Prayer is effective, eating raw eggs can be effective," he says. "It's the placebo effect."
Several studies also compared EMDR to other treatments, including a variant of exposure therapy called Image Habituation Training and biofeedback. All the studies showed EMDR to be somewhat more effective than the alternative treatments. "In general, it is somewhat effective," says Lilienfeld. "But the claims were not that it was somewhat effective, but that it was much more effective, novel, or breakthrough. That's what's wrong."
The Skeptics Dictionary
Entry for Eye Movement Desensitization and Reprocessing (EMDR)
Access official publications and studies, clinician referrals, and training information
Links to EMDR and trauma sites on the Web
Other research investigated the importance of the method's most defining element -- eye movements -- by comparing a group treated with EMDR to control groups treated either with no eye movement, or with an alternative form of bilateral stimulation, such as sounds or hand tapping. The results of the studies repeatedly showed no significant difference between treatment that used eye movements, and treatment that did not involve moving the eyes. In essence, the eye movements added nothing to the efficacy of the treatment.
Despite the studies showing that they are apparently irrelevant to treating post-traumatic stress sufferers, the eye movements continue to be taught as the major element of EMDR. If the method is so powerful and complex, critics argue, then why is the emphasis put on an element proven to be meaningless? "We spent hours learning how to induce eye movements in the right way," says USC's Davison of the workshop he attended. "We learned how to move the hand, how to hold the hand and raise the index finger -- it was important that it be the index finger -- and hold it 18 inches in front of the eyes, [and move it] not too slow, not too fast, just like Goldilocks." To Davison, this proved the method's inconsistency. It was a therapy, he says, "couched in mumbo jumbo and elaborate rituals."
As a result of these "dismantling" studies of EMDR, scientists concluded that whatever made the treatment work, to the relatively modest degree it worked, had to be in its other components -- components that mirrored existing psychotherapies. David Tolin, assistant professor of psychiatry at the University of Pennsylvania, likened using eye movements to treat post-traumatic stress disorder to adding red food dye to aspirin. "Yes, it will cure a headache, and no, it has nothing to do with the color," he says. "It would be silly to patent this as a 'new' medication."
Shapiro is unfazed by her critics. "It's ubiquitous in this field that what passes for scientific research is really not science," Shapiro says. "The dismantling studies are not scientifically rigorous. They [her critics] use them the way a drunk uses a lamppost -- more for support than illumination." Shapiro points out that the dismantling studies were conducted using a small number of participants; combat veteran populations who have encountered multiple traumas, and who are notoriously difficult to treat; and non-traumatized civilian populations, such as students with public speaking anxiety. "It's not science the way it's supposed to be done," she says. However, her first study was also conducted with veterans.
Exposure therapy, she explains, was never subjected to dismantling studies, and only offered a 50 percent remission of post-traumatic symptoms. Her method's success rate, she says, was much higher -- 80 percent -- and was achieved in fewer sessions. "EMDR is being held to this standard, but none of the other therapies have been subjected to that level of scrutiny," she says in exasperation.
In fact, she contends, EMDR is not just the addition of eye movement to existing types of therapy; her treatment, she says, actually goes against two decades of academic literature that describes how exposure therapy should be conducted, if it is to be successful. "They say exposure must be prolonged, and EMDR is not. They say you can't interrupt it. EMDR does. They say you can't use a distraction. If nothing else, the eye movements are a distraction," she says. "So we're doing something different here, even if it's a unique combination of what's been done before."
To date, Shapiro's defense of EMDR seems to have been extraordinarily successful. Despite the studies questioning its effectiveness, EMDR continues to grow. And it has been extended to a myriad of conditions: attention deficit disorder, self-esteem issues, personality problems, job performance anxiety, depression, phobias, panic attacks, and even writer's and artist's block. Freud's innovation of psychotherapy serves as a parallel example. Psychotherapy has never been proven to work, in a scientific sense, and yet people spend thousands of dollars each year seeking the cure it supposedly offers. They simply believe it works. And many believe in EMDR.