Is EMDR an exposure therapy? A review of trauma protocols

Abstract

This article presents the well established theoretical base and clinical practice of exposure therapy for trauma. Necessary requirements for positive treatment results and contraindicated procedures are reviewed. EMDR is contrasted with these requirements and procedures. By the definitions and clinical practice of exposure therapy, the classification of EMDR poses some problems. As seen from the exposure therapy paradigm, its lack of physiological habituation and use of spontaneous association should result in negligible or negative effects rather than the well researched positive outcomes. Possible reasons for the effectiveness of EMDR are discussed, ranging from the fundamental nature of trauma reactions to the nonexposure mechanisms utilized in information processing models.

The efficacy of recommended treatments for veterans with PTSD: A metaregression analysis

“…Unlike exposure therapies, EMDR therapy uses free association techniques that often only briefly access details of traumatic memories, instead of repetitive exposure to traumatic memories. Experimental studies showed that the underlying mechanism of EMDR did not seem to be based on habituation (e.g., Leer, Engelhard, Altink, & Van den Hout, 2013), and would therefore be less suited for promoting habituation and symptom reduction compared exposure-based therapies (McGuire, Lee, & Drummond, 2014;Rogers & Silver, 2002). Alternatively, the inferior EMDR results might be attributed to study design characteristics.…”

Cognitive behaviour therapy versus eye movement desensitization and reprocessing for post-traumatic disorder – is it all in the homework then?

“…In contrast, although reliving often occurs during EMDR the dual attention processing eventually creates a sense of distance and mindfulness (Lee, Taylor & Drummond, 2006) . The occurrence of free association is thought to demonstrate successful consolidation between the event and the client's current knowledge networks (Lee, 2006;Lee et al, 2008;Rogers & Silver, 2002).…”

EMDR 12 years after its introduction: Past and future research

“…Whether its efficacy stems from the fact that it is yet another variant of exposure therapy (with some ingredients of cognitive therapy) or that it is based on new principles is unclear" (Shalev, Friedman, Foa, & Keane, 2000, p. 366). This question is of particular interest since EMDR calls for interrupted rather than prolonged exposure and elements of free association (Rogers et al, 1999;Rogers & Silver, 2002;Shapiro, 1995Shapiro, , 1999Shapiro, , 2001a, both of which are inconsistent with the principle and practice long espoused in the exposure literature (Boudewyns & Hyer, 1990Chaplin & Levine, 1981;Chemtob et al, 2000;Eysenck, 1979;Foa, Steketee, & Rothbaum, 1989;Keane & Kaloupek, 1982;Lyons & Scotti, 1995;Marks, 1972;Marks et al, 1998;Rachman, 1980). Any effective clinical method consists of a number of constituents whose relative weightings and mutual interactions are initially unknown.…”