Are EMDR Effects Just Exposure Effects

The debate about whether EMDR is an effective procedure has now moved on, with its critics now suggesting that EMDR is simply a variant of exposure combined with inconsequential eye movements (Herbert et al., 2000; Lohr et al., 1999; McNally, 1999; Rosen et al., 1998). However, Boudewyns & Hyer (1996) point out: 'In strict exposure therapy, the use of many (EMDR treatment components) is considered contrary to (exposure) theory.' Shapiro (1999) points out that, beside eye movements, EMDR contains the additional elements of the creation and dismissal of traumatic imagery, cognitive restructuring, alignment of sensory input related to the targeted trauma, sequential targeting of information, and dosed short exposure. The unique element of free association that determines the route of the client's reprocessing is central to the procedure and very different from sustained exposure, which clearly calls for prolonged, uninterrupted, and undistracted stimulus exposure (Marks et al., 1998; Foa et al., 1999). In this regard, the EMDR procedures would be considered avoidant. According to a strict exposure definition, EMDR should sensitise rather than desensitise its recipients: 'Continuous stimulation in neurons and immune and endocrine cells tends to dampen responses, and intermittent stimulation tends to increase them' (Marks et al., 1998). The use of short bursts of exposure to the traumatic material in EMDR contrasts sharply with the expected minimum of 25 to 100 uninterrupted minutes recommended for exposure procedures (Foa et al., 1999).

An interesting study by Lee et al. (2006) investigated whether improvements in EMDR were more consistent with traditional exposure ('reliving effects') or dual focus of attention ('distancing effects'). The evidence was that the improvements were more consistent with dual focus of attention (distancing) effects, pointing up an essential difference between EMDR and cognitive behavioural therapies.

Critics of EMDR need to address the central question of how a procedure so apparently alien to traditional exposure can produce effective and efficient results.

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