The Amazingly Simple, Inexplicable Therapy That Just Might Work : Is EMDR Psychology’s Magic Wand or Just Some Hocus Pocus?

The videotape I’m watching is making me cry. The woman in it, in her 60s and neatly dressed, speaks in a self-possessed manner and without self-pity, despite the nasal-gastric tube that runs from her nose to her stomach. She’s talking with Colorado Springs psychologist Robert Tinker, a sympathetic off-screen presence. Found to have oral cancer two years ago, Mary Sarner is a nurse and has no illusions about her prognosis. That’s not what’s upsetting her at the moment, however.

Seven months ago, when her cancer flared up again, her husband, Charlie, left her, telling her, “I can’t watch you die anymore.” Sick and despairing, Sarner planned to kill herself. A friend intervened and talked Charlie into returning home. But now Sarner is facing the prospect of new surgery. Terrified that Charlie will leave again, she’s feeling desperately hurt and alone.

Tinker speaks up then, describing a new psychotherapeutic procedure--known by the bulky name of Eye Movement Desensitization and Reprocessing--he plans to try. It was developed, he says, as a treatment for trauma and may work because it “ties in with REM (rapid eye movement) sleep, a time when we process the day’s emotions.” Some events are so painful, “they overwhelm REM’s ability to process the emotions.” This therapy may be effective, he explains, because it’s an intensified form of REM.

He asks Sarner to visualize the moment when Charlie left and to recall the accompanying negative thoughts and feelings (“I’m nothing, I’m no good--pain, lonesomeness, terrible hurt”). Then, holding his fingers about 18 inches from her face, Tinker begins moving them back and forth in windshield-wiper fashion. Sarner’s eyes track the movement, as if observing a Ping-Pong game. On the first go-round, which lasts less than a minute, nothing much happens. The second time, Sarner begins to sob. “I don’t want to watch anymore,” she cries out, as if seeing a vision beyond the moving fingers. Yet she keeps her eyes moving, until Tinker has her close them briefly and breathe deeply.

“What do you get?” he asks.

“I hurt from head to toe,” she responds.

Again he has her think of Charlie’s desertion, while his hand zigzags back and forth. This time, as she watches, her face changes. “It’s gone,” she says when Tinker stops. “It’s just an old picture now. It’s amazing. I don’t have to hurt anymore. If Charlie wants to leave, it’s his choice.” She sits up straighter, more relaxed. “Oh gosh. I can do this, I’m going to be strong,” she says. “When I die, I’m going to die with dignity. If Charlie doesn’t want to see it, that’s OK.”

There are more rounds of hand movements. “I want to go deep-sea fishing, start calling my friends. Charlie, I can have fun without you.”

I’VE JUST SEEN A DEMONSTRATION, TAPED DURING THE COURSE OF A recent study, of what’s probably the most controversial psychotherapy in use today. In 1989, the first articles about an improbable-sounding technique for treating post-traumatic stress disorder (PTSD) appeared in the psychological literature. PTSD, an anxiety disorder with a multitude of mental and physical symptoms, strikes after an ordeal such as rape, combat, child abuse or natural disaster and can permanently scar a psyche. But with little more than a wave of the hand, it seemed, Eye Movement Desensitization and Reprocessing (EMDR) could undo trauma’s tormenting effects in a remarkably short time, sometimes in a single session.

The procedure, originated by psychologist Francine Shapiro, then a California graduate student, is fairly straightforward. A patient focuses on the traumatic memory, then follows the back-and-forth movement of a therapist’s fingers. That may lead to a new, related image, which the patient will focus on during another set of eye movements. Vivid memories often surface and many patients feel as if they’re reliving the original, devastating event. As thick and fast as images arise during the course of what’s usually a 90-minute session, they’re “processed” with the eye movements until a patient’s painful feelings are replaced by happier ones.

Word of EMDR rippled quickly through the psychological community. In some Veterans Administration clinics, the procedure reportedly helped turn things around for Vietnam vets who’d once been impossible to help. Psychologists use it to treat survivors of Florida’s Hurricane Andrew in 1992 and those who couldn’t function well after the Northridge earthquake this year. Proponents say thousands have benefited from EMDR.

“It’s like vacuuming, it sucks all the anxiety out and it’s done,” says a Hughes Aircraft staff engineer who left town after the January quake. Working on her doctoral dissertation at the time, she was afraid to return until, by chance, she hooked up with a therapist who practiced EMDR.

Although not widely known outside mental-health circles, EMDR is apparently headed for the mainstream. About 7,000 therapists in several countries, including nearly 2,500 in California, have been trained in the procedure, and many are testing EMDR to treat ills ranging from schizophrenia to eating disorders. “I’m committed to establishing this as a valid treatment,” says Yale psychiatrist Dr. Steve Lazrove. “I’ve seen it work with people who, well, I don’t know how I’d do it if we didn’t have EMDR. We’d probably spend years. This way, we just blow through and go on.”

Yet even as EMDR spreads so rapidly, there’s little hard evidence that it works any better than existing psychotherapies. “A long list of treatments come and go in psychology,” says Harvard psychiatrist Dr. Roger Pitman, who coordinates research and development at the VA Medical Center in Manchester, N.H. “Transactional analysis. Primal scream. I’m OK, you’re OK. There are a lot of fads and only time can tell which will hold up.”

Not surprisingly, EMDR is splitting the psychological community into warring camps. Some question the zeal with which it’s being promoted and marketed by Shapiro--in two-day training seminars around the country--before its efficacy is proved. “It’s kind of scary that EMDR is getting so much exposure when the people involved in marketing it don’t have the research to substantiate it,” says psychologist Susan Solomon, who heads the violence and traumatic stress research branch at the National Institute of Mental Health in Maryland. “Trying things is not uncommon, but talking about them as if it’s established that they work is different. This is a major business and it’s caught on in a big way.”

But most psychotherapies don’t come backed with proven track records. And EMDR advocates in the trenches are disinclined to wait until all the data is in. “This is the most helpful technique I’ve ever used for dealing with trauma,” says Tinker. “If therapists have used a variety of approaches and suddenly come on one which provides outcomes that go way beyond what they’ve obtained before, they’re not likely to take the stance ‘I won’t use this until hard evidence appears in the literature.’ Their experience is the hard evidence they need.”

FRANCINE SHAPIRO WAS 39 AND UNKNOWN TO THE PSYCHOLOGY world when she developed EMDR. At the time, she was about to start her doctoral dissertation at the Professional School for Psychological Studies, a non-accredited San Diego university that closed three years ago.

It was a spring day in 1987, and Shapiro was strolling in a park in Los Gatos, outside San Jose. She was musing about something troubling, though she no longer recalls what. Suddenly, she says, “I noticed those thoughts were disappearing. When I brought them back, they didn’t have the same charge. I thought, ‘What am I doing? What’s causing them to disappear?’ I had no idea. So I said, ‘Let me just pay attention.’ And I found that when that kind of thought went through my mind, my eyes started moving rapidly and the thought shifted from consciousness. So then I did it deliberately. I brought up something upsetting and did the eye movements. And the same thing happened.” The effect intrigued her, and she began to investigate further.

Shapiro is recounting this story at a natural-food stand not far from her home, about 30 minutes south of San Francisco. She’s taken a break from finishing an EMDR textbook she’s writing that’s to be published this year. An intense woman little given to small talk, Shapiro radiates a missionary zeal about spreading the news of her discovery and is impatient with debates over its merit. “What we’re doing is extremely important,” she says. “A lot of people are suffering. Unless we keep our eye on the suffering, it’s all politics.”

New York chutzpah, Shapiro has said, fuels her persistent campaign to bring EMDR to the world’s attention. She grew up in Brooklyn, the daughter of an auto mechanic and a housewife. At 30, she was married and teaching English in the New York City public schools while working on a literature doctorate. Then she was found to have cancer (she prefers not to discuss what kind). Though cured of the illness in 1978, she learned all she could about the mind’s role in promoting sickness or health. “The message coming through to me was that cancer was a stress disease,” she says. “I shifted my attention from literature to what would have an effect on stress and ended up in psychology.”

A year later, Shapiro left New York and her marriage for the New Age mecca of the West. In California, she began exploring meditation, hypnosis and other non-traditional therapies. “I took every alternative workshop I could find,” she says. “My question was, ‘What works, and how can I get it out to people?’ ”

She returned to school for her psychology degree--”and then I took a walk in the park.” Once she’d made the observation about eye movements, Shapiro began buttonholing acquaintances to test it. Results were successful enough that she started a study that became her dissertation. The 22 Mendocino County volunteers were Vietnam vets or victims of rape or sexual abuse who suffered symptoms of post-traumatic stress: nightmares, flashbacks or so-called intrusive thoughts. Shapiro found that after she gave them a single EMDR session, the volunteers’ anxiety levels dropped, their symptoms diminished and positive thoughts about themselves increased.

Shapiro termed her therapy “eye movement desensitization,” acknowledging her debt to the behavior therapy known as systematic desensitization. Behavior therapies work on the premise that self-defeating patterns of action are learned and can be unlearned. Systematic desensitization, developed in the 1950s by eminent behavorial therapist Dr. Joseph Wolpe, helps people overcome anxieties or phobias by teaching them deep-muscle relaxation techniques. Then they are incrementally exposed--through imagery and real-life confrontation--to the object or event that they fear. In essence, Shapiro was substituting eye movements for relaxation as she tried to desensitize subjects to past pain.

In 1988, Shapiro approached Wolpe with her findings. “She told me she had a remarkable new treatment,” says Wolpe, now a psychology and psychiatry professor at Pepperdine University. “I was skeptical, but decided to try it out. It was effective in some minor context and that encouraged me to continue.”

What he saw made him a believer. “There are certain cases where eye movement desensitization is dramatically rapid, cases that, as far as I know, are unparalleled,” he says. “I published one study of a woman who had been traumatized by a rape nine years ago. She had not improved at all with other therapy. With this, she was virtually cured after seven sessions. It was striking.”

Wolpe’s stamp of approval gave EMDR a certain psychotherapeutic cachet while Shapiro continued to present her findings to researchers at universities and VA centers across the country. In 1989, she accepted a position at the Mental Research Institute, a training and research facility for therapists in Palo Alto, where she’s now a senior research fellow. She refined EMDR, splicing in bits and pieces from other therapeutic traditions such as cognitive therapy or relaxation techniques. She changed her concept of the therapy from a behavioral model to one that was neurophysiologically based. The eye movements, she proposed, stimulated “an inherent information processing system that we all have that’s geared to take dysfunctional information and to work it through to an adaptive resolution.” What had started as EMD became EMDR, to reflect Shapiro’s feeling that the eye movements were helping patients “reprocess” old pain into something positive.

In 1990, Shapiro began offering training seminars for licensed mental-health clinicians. As a speaker, Shapiro is compelling: funny, personable, never at a loss for words. And the vision she presents is alluring. For those frustrated at the slow, backsliding process of helping an individual achieve change, she offers the possibility of rapid metamorphosis--as fast as one to four sessions of treatment. In place of the hit-or-miss style of talk therapy many therapists practice, she offers an eight-stage formulaic method that has the potential to help a therapist plunge straight to the depths of a patient’s pain and exorcise it.

Her message found eager listeners. “There’s a growing recognition among mental-health professionals that many patients who come into our offices have been subjected to violence or abuse,” says Terence M. Keane, director of the National Center for PTSD at the Boston VA Medical Center. “There’s a desperate need to help them, but few techniques exist in the literature. EMDR filled a terrible vacuum.”

Shapiro, now married to a virtual reality specialist at NASA, travels 25 to 30 weeks a year giving EMDR-related talks and trainings. But her enthusiastic marketing of the therapy has increasingly drawn unfriendly fire both in and outside the psychological community: A recent Newsweek article stopped just short of dubbing her a latter-day snake oil salesman. At $315 a session, the cost of the training is hardly astronomical, but Shapiro has been criticized because she has participants sign a statement saying they won’t teach EMDR to anyone else, in effect giving her proprietary interest in the treatment.

Shapiro has reported she pays herself no more than $125,000 a year, plowing the rest of the profits back into research or financial help for clinicians with ill or indigent populations. And she maintains that EMDR is too potent to be used by those without experience. “If EMDR went hog wild and was in the hands of every lay hypnotist and chiropractor. . . . I felt the responsible thing to do was keep it safe, until it is taught in universities.”

Shapiro also has been accused of adopting the role of guru ministering to a devoted flock. Such criticisms are largely based on the unquestioning acceptance with which some therapists practice EMDR. “It’s almost like a mass following that has perhaps a cultish nature to it,” says Dr. Barbara Rothbaum, a PTSD expert and assistant psychiatry professor at Emory Medical School in Georgia. “That aspect turns a lot of people off, me included.”

University of Arkansas psychology professor Jeffrey Lohr agrees: “A lot of undertrained, scientifically uncritical practitioners are viewing this as a kind of magic bullet, one size fits all. They’re making extravagant claims about the power and pervasiveness of the technique.”

In reporting this story, I did notice the therapy generated peculiar feelings of intensity. At one point, I walked into the office of an EMDR practitioner and found him waiting for me agitatedly. “I’ve been talking with some of the people you’ve talked to so far,” he told me, “and we’re not sure how well you understand EMDR”--leaving me with the uncomfortable sensation that my every move was being observed by a network of vigilant therapists.

“This is a gift from God,” one of them told me sincerely. “I feel honored to be part of this work.”

ELEVEN YEARS AGO, 33-YEAR-OLD ROGER THURSTON WAS WELDING IN the shaft of a silver mine on the Utah/Nevada border when the gaseous air below him ignited, engulfing him in flames. He lost both arms and his hearing, and after two years of hospitalization, needed 24-hour nursing care. During the next six years, he was plagued by flashbacks, nightmares and an inability to concentrate. By the time he consulted Salt Lake City psychiatrist Dr. David McCann, Thurston was desperate.

McCann asked whether he wanted to try a new PTSD treatment--one he had never used before and only read about. As they went through the EMDR procedure, Thurston clearly recalled the clang of his wrench hitting the rocks, shouts from his co-workers. He saw the fire around him. As he continued tracking McCann’s finger, the images gave way to a flooding sensation of peace. Free of nightmares or flashbacks, Thurston has weaned himself from nursing care, taught himself to drive and joined the board of a nonprofit group helping children who need prosthetic limbs.

Dramatic as such accounts are, and there are many, they count for relatively little in the scientific world. Hundreds of patients and clinicians may report miraculous changes because of a new therapy, but that doesn’t prove that the treatment is effective. Patients could be experiencing a placebo effect, particularly common with a novel therapy like EMDR.

“There’s something a little flashy about it,” says Harvard psychiatrist Pitman. “You tell a subject, ‘This is a hot new treatment, with a physiological component,’ and you create a set of expectancies.”

Most scientists, then, make their judgments based on research studies. For such a new technique, there’s been a surprising amount of research on EMDR. Unfortunately, much of it is composed of case studies, the scientific equivalent of anecdotal evidence. There are now, however, a number of controlled studies of EMDR, done by researchers around the country, in which one group of subjects receives the treatment while one or more other groups get no therapy and/or a different treatment. These studies, Shapiro asserts, have established EMDR’s efficacy beyond doubt. “Seven controlled studies of EMDR! What more do people want?” she fumes.

In fact, there are 10, some published and some not. But many researchers believe that most of them are preliminary or flawed. The best-designed had the least positive results, with a majority finding EMDR either ineffective or no more potent than therapy performed without eye movement. The study in which Mary Sarner participated has stirred much excitement in the EMDR community because results are so encouraging. Details, however, are embargoed until its presentation next week at the American Psychological Assn. meeting in Los Angeles.

Right now, it would be easy to conclude that, on balance, EMDR is more sound and fury than substance, yet even those whose studies have produced less-than-stellar results are reluctant to discount the therapy. Clinical psychologist Rick Lytle researched it as a Penn State University graduate student under the supervision of anxiety disorders expert Thomas Borkovec. Lytle found it essentially no better than two alternative therapies at alleviating anxiety symptoms. Even so, he says, “I’m unwilling to throw away EMDR, from the point of view of a researcher. I can’t account for the relatively dramatic results some people claim they’re getting, and I think it deserves further study.”

And other studies are continuing. Emory University’s Rothbaum is looking at EMDR as a therapy for rape victims. “I feel like when I present this research, I want to wear a big button that says, ‘I am not a cult member,’ ” she says. “But it definitely looks to me like there’s something there. Even several months after treatment, people are saying, ‘It changed my life.’ ”

SHOULD OUTCOMES BE MORE SALUTARY IN THE NEXT ROUND OF RESEARCH, one more question about EMDR will remain. Is this a technique that’s telling us something new about how the brain functions? Or is it a variation on an already familiar theme?

Several times a night, we enter a sleep stage when our head fills with dreams, and our eyes flick quickly back and forth. This, of course, is REM sleep. No one knows what the significance of REM is, though scientists increasingly suspect that it’s a time when the brain sifts through and stores learned material. The theory of the EMDR-REM connection thus makes a substantial leap in presuming that eye movements in sleep actively trigger a memory processing function, and further, that EMDR can activate that function as well.

Yet it’s not entirely implausible. Jonathan Winson, a neuroscientist at Rockefeller University in New York City, has conducted groundbreaking memory and sleep research. “I was skeptical, very skeptical,” he says about whether there might be something to the idea EMDR was related to REM. Nevertheless, he attended two trainings. “What I saw there and what I’ve seen since makes me believe there’s sufficient effect to warrant further investigation,” he says. “It’s provocative to think there might be a relationship between EMDR and REM sleep. But the bottom line is, there’s no definitive evidence.”

Shapiro also goes beyond the REM conjecture, offering a larger model of what happens when the brain is confronted with a disturbing experience. “When a trauma occurs, perceptions that are there at the time of the event are brought in, basically locked in the nervous system and held there, unable to process through,” she says. “We’re suggesting that perhaps the eye movement may be a body mechanism for catalyzing the inherent information-processing system that we all have, in an accelerated manner. The trauma is metabolized, digested, whatever, in a couple of 90-minute sessions.”

The issue of how traumatic memories are stored is, if anything, more inflammatory than EMDR itself, touching as it does on the question of whether shocking memories can be repressed from consciousness. In her professional talks, Shapiro is careful to tell audiences the theory is “written on rubber. There’s not enough known about brain physiology to actually know whether it’s true or not.” Nonetheless, because so much of her language is based on this model, listeners might be forgiven for ignoring the caveat.

Despite her REM hypothesis, Shapiro confusingly also proposes that eye movements aren’t the only means by which to do EMDR. Therapists, she says, also have success using alternate taps on the back of a patient’s hands or tones sounded alternately in each ear: “Eye movement is the first thing I discovered, but it’s not the only thing,” she says. “Something other than that may be able to stimulate the information processing system.”

Or another factor could be at work in successful EMDR cases. Some researchers feel EMDR is the latest comer in the group of behavior therapies known as exposure therapies, which traditionally have been used to treat anxiety disorders, including phobias and PTSD. Exposure therapy has patients confront, in a safe setting, the thing causing them pain or fear. A patient is asked to imagine a traumatic situation--a disturbing memory of combat, say--and stay with the feelings that arise until the anxiety diminishes.

“It can be traumatic,” says Dr. Patrick Boudewyns, chief of pyschology at the VA Medical Center in Augusta, Ga. “Patients don’t want to do it; they get very emotional.”

EMDR also starts by asking patients to conjure a painful recollection. But the eye movements might serve as a diversion of sorts, allowing patients to keep anxiety at a manageable level. “It’s something like desensitization, with a cute little device to distract a person from shifting his attention away,” suggests Penn State’s Borkovec. “It’s as if I was afraid of snakes, and you’re trying to get me to approach one. As I do that, you’re shooting off beautiful fireworks around me. So I keep my eyes open, and maybe some of the exposure to the snake is getting in.”

Adds Boudewyns: “I think EMDR is a better way to do what we’ve already been doing, and if that’s all it is--that’s enough, that’s good.” But studies have yet to prove that the movements add something to the overall procedure. Seven of the 10 controlled studies included a so-called component analysis: one group of subjects had EMDR, while another group went through the procedure, keeping their eyes fixed at the point where they’d normally move them. In four studies, those who got EMDR improved no more than those in the eyes-fixed group.

That, points out Lohr of the University of Arkansas, could be because most studies have been small, lacking statistical power. “The mean is a fiction,” he says. “Some people in the studies change not at all, others a great deal. I’ve seen this treatment work wonders for some people. We need to go back and identify those who did change and say, ‘What distinguishes them?’ ”

SPEND ENOUGH TIME HEARING about a new therapy with miraculous curative powers and you’ll inevitably grow curious. Twice, I tried EMDR. I had no horrendous traumas to work on, but since therapists at the trainings go through it, it seemed reasonable to expect I could get something out of it, too. In New York, I focused on the memory of an old school failure that I’ve thought might still have ramifications in my life, and in California, on something upsetting that had just happened in a personal relationship.

I’d been warned by EMDR folks to approach the therapy carefully, lest repressed material suddenly burst forth and traumatize me. Instead, the process remained a fairly intellectual one. No lurking memories or vivid images surfaced. I had no cathartic gush.

True, the conditions under which I tried EMDR would never pass muster in a clinical trial. I felt decidedly awkward at dropping my journalistic guard with people I’d just interviewed. In each case, I tried only a session of treatment, barely time enough for me to get the hang of EMDR.

I wouldn’t dismiss EMDR on the basis of my own experiences, but I can testify it’s not something that works automatically. Indeed, most therapists I spoke with, Shapiro included, assured me that they don’t regard EMDR as a panacea. But there seem to be few ills that proponents aren’t prepared to address. EMDR is currently being applied in child psychology, to multiple personality disorders, obsessive-compulsive disorders and even to stimulating “peak performance.”

“It’s being promoted as a breakthrough for virtually every form of psychopathology out there, when there are already established therapies to treat a lot of those conditions,” asserts Dr. Kim Mueser, associate psychiatry professor at Dartmouth Medical School. “Those should be the first choice, treatments with a track record.”

Yet many untested therapies are being used on patients today. For instance, Wolpe points out, “Psychoanalysis has been the thing for 70 years, but no one cares about the lack of demonstrated efficacy of that. People just go on doing it, even though it has not been shown to have any notable efficacy.”

Many therapists working in the area of post-traumatic stress believe Shapiro’s efforts will ultimately give the field a needed prod. “Francine gets criticized for taking this to the clinical level before the research is done, but I don’t think it’s all that bad,” says Boudewyns. “It gets people to thinking about it and kind of pushes the scientists along. God knows, we need better treatment for trauma and anxiety-related problems. This is a non-drug, it has virtually no side-effects. How much better could you get?”

Ideally, EMDR would be further tested in studies comparing it to the best therapies available for the specific condition being treated. Until then, there is only the testimony of those who’ve benefited from EMDR.

Months after she went through her first session, Mary Sarner has had additional cancer surgery that left her unable to speak. But she and her husband have drawn closer and are going through the ordeal together. Sarner continues to use the therapy and is urging other cancer patients she knows to try it, too. Without EMDR, Sarner says unequivocally, she would never have tried to keep going. With it, she knows she still has something to live for.