What Are the Dangers of EMDR Therapy?
When you think of trauma and therapy, you probably don’t immediately think of eye movements. But, if you’ve done any search for trauma treatment, you’ve probably seen “EMDR” and eye movement mentioned quite a bit. You’ve probably found lots of claims, lots of praise, plenty of practitioners and even some warnings.
In short, EMDR is typically a safe and effective treatment option. However, to fully understand potential dangers, let’s examine further.
Eye Movement Desensitization and Reprocessing (EMDR) therapy is a popular technique used in psychotherapy to relieve psychological stress. It is most often used to alleviate symptoms related to trauma and post-traumatic stress disorder (PTSD).
It is very popular among therapists with over 60,000 certified in EMDR.
It enjoys a great deal of support. In fact, EMDR is recommended by organizations such as the World Health Organization (WHO), the Department of Defense, and the American Psychiatric Association (APA) for persons dealing with PTSD.
Like any therapeutic technique, however, it is not appropriate for every situation. EMDR is not without its risks or its detractors. It is a technique that requires an advanced level of skill and training and understanding of the dynamics of the brain’s ability to process.
What is EMDR?
Before making decisions about EMDR, it’s important to understand just what it is. And what it is not.
EMDR was developed in the early 1980s by psychologist Francine Shapiro and her work with traumatic memory. She found that eye movements seemed to desensitize the anxiety associated with traumatic memories. Over time, the technique was studied and developed into the treatment approach that it is today.
EMDR, despite its name, is more than just eye movements healing traumatic memory. It has its foundations in the brain’s way of processing information. The theory behind EMDR is that trauma and the memories it creates make changes in the brain and the way information is processed. When the system is impacted by a traumatic experience, the emotional wounding can cause intense pain and suffering and block healing. Because the brain’s information processing system naturally moves toward mental health, removing the emotional block allows healing to occur. EMDR accomplishes unblocking and healing by employing very specific procedures to help clients access their brain’s natural healing processes.1
EMDR is not a single intervention but a structured process. The EMDR process consists of 8 distinct phases.2
Each phase addresses a specific dimension and allows the therapist to move the client through the process in a systematic way.
8 Phases of EMDR
Phase 1: History Taking and Treatment Planning
The therapist assesses the client’s readiness and develops a treatment plan. Current sources of distress are identified for processing. Emphasis is placed on the development of specific skills and behaviors that will be needed by the client in future situations.
Phase 2: Client Preparation
The therapist and client are building the therapeutic relationship and rapport. The therapist helps the client learn ways to handle emotional distress during and in between sessions.
Phase 3: Assessment
A therapeutic target is identified for processing. The client develops a vivid image related to the event, a related negative emotion and a positive emotion that contradicts the negative. This positive emotion will be crucial later in the process.
Phase 4: Desensitization
Desensitization reduces the client’s distressing reactions to the traumatic memory. This desensitization is accomplished by the therapist directing the client’s eye movements while they focus on the traumatic memory.
Phase 5: Installation
This stage “installs” the positive thoughts identified in phase 3. Additional sets of eye movements are used.
Phase 6: Body scan
A body scan is a meditative technique in which the person scans their body from head to toe noticing any physical sensations that may be occurring. The therapist may target these physical sensations for processing.
Phase 7: Closure
Each session ends with the therapist stabilizing the client using the self-control techniques identified in phase 2. The client will be asked to keep a record of any negative experiences that occur between sessions. These experiences can be targeted in subsequent sessions.
Phase 8: Reevaluation
The next session begins with an evaluation of the client’s progress. This evaluation provides information for the client and therapist going forward in treatment.
This protocol is very specific and requires a considerable level of training and skill for the therapist.
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Support for EMDR
When Dr. Shapiro first recognized the relationship between eye movements and traumatic memory, she initiated controlled studies to learn more. Her results demonstrated that EMDR (then known as EMD) significantly decreased the emotional distress related to traumatic memories and increases feelings of confidence in positive beliefs.3
Other research followed. As with any new technique, EMDR was quickly compared to other accepted therapies of the day including cognitive behavioral therapy (CBT) and exposure therapy which was the standard of care for PTSD. Meta-analyses have consistently shown EMDR to be at least as effective as CBT/exposure and, in many cases superior to CBT/exposure, in symptom reduction.
Unlike exposure therapy which can require many hours of treatment, EMDR was found to be more efficient, requiring fewer treatment hours.
EMDR has also been used applied successfully to treat other mental health issues including:4
EMDR has been mentioned as a possible treatment for mental health issues such as personality disorders, bipolar disorder, body dysmorphia and even psychosis and schizophrenia. However, the research is scant.
On the positive side, EMDR is generally considered a safe intervention when used appropriately. But not everyone agrees.
Since its emergence onto the therapeutic scene, EMDR has received considerable criticism and its share of controversy. It was a radical approach to treating traumatic memories and not well-understood at the time.
When Dr. Shapiro first described her findings, she was misquoted as stating that EMDR (then called EMD) could cure traumatic memory in a single session. That was not true, but it started a flurry of debate about whether eye movements could be that powerful.
For all of the research that has supported EMDR and its superiority to other approaches, other studies have not found the same results. Critics have argued that EMDR and CBT/exposure both rely on imaginal exposure. They have found little or no differences between EMDR and CBT.5 Others have found that techniques such as prolonged exposure (PE) yielded better chances for full remission than EMDR.6
Still, others argue that EMDR does not work based on eye movement but via other mechanisms such as the dual attention focus of EMDR and bilateral stimulation.7 There is still a great deal of controversy here. Neuro-imaging studies may yield more information about the exact mechanisms at work. For now, proponents and critics will have to agree to disagree on this one.
The biggest source of concern seems to be related to the use or rather, misuse, of EMDR that can result in adverse effects. EMDR is a powerful clinical tool that requires a therapist with a high level of expertise.
What Are the Risks of EMDR?
Like any other therapeutic intervention, EMDR is not without risks.
Therapy brings up memories and feelings that may have been buried deep for a long time. Bringing those up can be distressing. Anytime you engage in therapy, you may experience distressing thoughts, feelings or memories.
Sometimes recalling the past is intense and emotions can come flooding in especially in the beginning stages of therapy. It can feel scary and out of control. Therapy takes time so you may feel worse before you feel better.
Trauma work can heighten emotional awareness which can be quite intense and uncomfortable. You may even experience very vivid dreams.
Processing continues between sessions and you may have to deal with some very intense feelings outside of the therapy room.
Done incorrectly, EMDR, and other therapies can cause what is known as retraumatizing for the person. The situation becomes worse, not better. Most poor outcomes seem to result from inadequate or inappropriate treatment by poorly trained clinicians. Experience really does seem to matter.
There has recently been some research that suggests a connection between lateral eye movements used in EMDR and false memory creation.8 This is a topic that is often mentioned in popular discussions but little research has been done. Whether there is a true link is not clear, but it is important to be aware of this factor.
In working with trauma, safety has to be of utmost concern. When done correctly, EMDR has been found to be quite effective. While there is no 100% perfect approach, side effects are few and most significant adverse reactions seem to be related to therapist skill and safety practices.
If you are considering treatment that includes EMDR, there are things you can look for when choosing your therapist.
- Choose a clinically trained EMDR therapist. EMDR requires a highly specialized type of training that goes beyond general therapeutic training. Not every therapist is sufficiently trained in this type of intervention. Ask about the therapist’s specific EMDR training and experience.
- While not required to provide EMDR, consider choosing a certified EMDR therapist. Look for the EMDRIA certification. These therapists have undergone extensive, standardized training in this work. They utilize specific practices and protocols designed to facilitate your safety and healing.
- Ask questions. You want to feel comfortable with your therapist. How many cases like yours have they treated? What is their success rate?
- If something feels wrong or uncomfortable, tell your therapist. You won’t hurt their feelings and they can’t help you if you don’t tell what you’re experiencing.
- If something sounds too good to be true, keep looking. Nothing is 100%. Nothing is a guaranteed cure. And more expensive doesn’t mean better any more than less expensive means worse. Find a clinician that fits your needs, your budget and your level of comfort.
Starting something new can be scary. In sessions, your therapist will do some very specific things to maintain your safety and comfort as you work. Some things you might see them do include:
Establishing a Rapport
You’re getting to know each other and how to talk to each other. Being vulnerable to someone can be difficult. Remember, it is important that you allow yourself to be open and honest with your therapist.
It is important for your therapist to assess your readiness and appropriateness for EMDR. Not every person is a candidate. Not every person is ready for the process. There will probably be a lot of questions. You might be asked about thoughts of self-harm or how you cope with things. They might ask about major stressors or life events. It’s ok. There are no right or wrong answers. Honesty is most important so that your therapist can make sure you have the right fit at the right time and place.
Your therapist will also ask about your support system, your general health and more. The questions may seem odd, but they are necessary to be sure you have a healthy, productive experience.
So, is EMDR safe?
The answer seems to be yes, with a caveat.
EMDR is a safe and effective approach to treating trauma and PTSD – when that treatment is with an experienced, EMDR-trained therapist.
While some distress or discomfort may occur during the process, the safety measures that the therapist takes can minimize the risk of a more serious adverse experience.
Yes, there are inherent risks. Aside from the risks specific to clinician competency, most of these risks are similar to those you would find with any other therapeutic intervention. Dealing with past hurts is hard. Dealing with trauma is hard. Bringing it all back up can be uncomfortable and scary. But not dealing with something or avoiding it has risks too.
Remember, there will always be someone telling you that there is only one way. Or that something is dangerous or unnecessary. When that happens, do your homework. Get the facts. Not the hype.
At the end of the day, you have to decide if and when you are ready to take a step towards wellness. When you feel ready, take your time and choose the right therapist that’s right for you.F
or more information about EMDR and EMDRIA certified therapists, go here.
1. Shapiro, F. (1999). Eye movement desensitization and reprocessing (EMDR). (1999). Journal of Anxiety Disorders, 13(6), 35-67. https://www.ncbi.nlm.nih.gov/pubmed/10225500
2. EMDR Institute. Retrieved from https://www.emdr.com/what-is-emdr/
3. Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2, 199-223. https://onlinelibrary.wiley.com/doi/abs/10.1002/jts.2490020207
4. Valiente-Gómez, A., Moreno-Alcázar, A., Treen, D., Cedrón, C., Colom, F., Pérez, V., & Amann, B. L. (2017). EMDR beyond PTSD: A Systematic Literature Review. Frontiers in psychology, 8, 1668. https://doi.org/10.3389/fpsyg.2017.01668
5. Davidson, P. R., & Parker, K. C. H. (2001). Eye movement desensitization and reprocessing (EMDR): A meta-analysis. Journal of Consulting and Clinical Psychology, 69(2), 305–316. https://doi.org/10.1037/0022-006X.69.2.305
6. van den Berg DPG, de Bont PAJM, van der Vleugel BM, et al. (2015). Prolonged exposure vs eye movement desensitization and reprocessing vs waiting list for posttraumatic stress disorder in patients with a psychotic disorder: a randomized clinical trial. JAMA Psychiatry,72(3):259–267.
7. Landin-Romero, R., Moreno-Alcazar, A., Pagani, M., & Amann, B. L. (2018). How does eye movement desensitization and reprocessing therapy work? A systematic review on suggested mechanisms of action. Frontiers in psychology, 9, 1395.
8. Houben, S. T. L., Otgaar, H., Roelofs, J., & Merckelbach, H. (2018). Lateral eye movements increase false memory rates. Clinical psychological science, 6(4), 610–616.