Eleven years ago, Francine Shapiro, was strolling through a park in Los Gatos, Calif., thinking dark thoughts.
Suddenly, her eyes started darting back and forth, a spontaneous burst of what scientists call saccadic movement, much like the rapid eye movements that occur during dreams.
Weirder yet, Shapiro noticed that as her eyes moved, her thoughts lightened. She played with the phenomenon — calling up disturbing thoughts, then flicking her eyes back and forth. Soon, bad thoughts no longer “had the same charge,” she says.
She was intrigued and began waggling her fingers in front of friends to trigger rapid eye movements, and they, too, reported mood changes.
Perhaps, Shapiro reasoned, the eye movements were somehow mimicking dream sleep, allowing better processing of traumas that might otherwise cause nightmares. Or maybe the eye movements triggered some useful shift in brain processing.
To this day, neither Shapiro nor anyone else can explain what, if anything, happens inside the brain with the technique she has dubbed EMDR — eye movement desensitization disorder, which, as Shapiro initially conceived it, involves inducing rapid eye movements while reliving painful memories.
But since that day 11 years ago Shapiro has been ferociously studying — and promoting — EMDR. When she first began her studies, she was enrolled in a now-defunct, never-accredited school, the Professional School of Psychological Studies in San Diego. She eventually earned a PhD in psychology there and in 1989 published a study showing EMDR seemed to help people with post-traumatic stress disorder, which is characterized by nightmares, flashbacks and anxiety.
More recent EMDR studies in people with emotional trauma, Shapiro claims, show that “84-90 percent no longer have post-traumatic stress disorder after only three treatments.”
Surely one of the strangest therapies ever aimed at tortured psyches, EMDR has become increasingly popular — and controversial. Shapiro has now trained more than 25,000 practitioners through the EMDR Institute in Pacific Grove, Calif., and estimates 2 million people have been treated.
Indeed, EMDR is “among the fastest growing interventions in the annals of psychotherapy,” says Harvard psychologist Richard McNally. But he cautions: “What is effective in EMDR is not new, and what is new is not effective.” Many others agree.
Yet EMDR has obvious appeal, especially to health insurers.
This spring, the Kaiser Permanente medical center in northern California began offering EMDR, calculating it could save $2.8 million a year if it was used for all post-traumatic stress disorder patients, says Steven Marcus, a Kaiser psychologist whose 1997 study led to the decision.
Other insurers also offer it, says Shapiro. And Blue Cross Blue Shield in Massachusetts is informally looking into it.
But two huge questions loom: Does it work, and if so, how?
Last year, a task force of the American Psychological Association headed by Dianne Chambless, a University of North Carolina psychologist, proclaimed EMDR a “probably efficacious treatment for civilian PTSD.” That means it’s not a “well-established” treatment, she says, but that at least two “scientifically sound” studies — three, by her count — showed EMDR “was more effective than no treatment.”
The so-called Wilson study of 1995, the Rothbaum study of 1997 and the Scheck study of 1998 all found that EMDR patients improved more than patients on a waiting list to begin therapy or those receiving standard talk therapy. In the Rothbaum study of 21 rape victims, in fact, 91 percent of the group treated with EMDR was deemed to have recovered from the trauma disorder after three sessions, while there was no change in the control group.
But if EMDR worked, was it due just to “imaginal exposure,” that is, to reliving in the imagination the traumatic event until it loses its power — like watching a horror movie so often you become desensitized? Or was it some almost magical effect from the therapist waggling her fingers to trigger the eye movements?
Dr. Roger Pitman, a Harvard psychiatrist and coordinator of research at the Veterans Affairs Medical Center in Manchester, N.H., decided to find out. In research published in 1996, Pitman studied 17 Vietnam veterans with PTSD. (Vets with the disorder are considered harder to treat than rape victims dealing with one assault.)
Pitman gave half the group EMDR, complete with finger-wagging and eye movements, and the other half a similar treatment without eye movements. Each group then got the other treatment. “EMDR had some benefit,” Pitman says, but “whatever it was, it wasn’t the eye movements.”
Grant Devilly, a psychologist at the University of Queensland in Australia who has two studies about to be published in scientific journals, agrees.
Starting with a group of 51 war veterans, Devilly gave some vets two sessions of EMDR, others, no special treatment, and a third group, “sham” EMDR. This group relived traumatic memories, but their eyes remained fixed on a flashing light from an “opticator,” a phony machine designed to look scientific.
Both the real and sham EMDR groups showed some improvement, but it was not statistically signficant. And there was no difference between those whose eyes moved and those whose eyes didn’t, says Devilly. Conclusion: The eye movements are not essential.
In the other study, Devilly compared EMDR to cognitive behavior therapy, in which patients relive their trauma and learn ways to deal with it. Both helped, he says, but cognitive behavior therapy was better and longer lasting, though EMDR guru Shapiro claims other new studies still give EMDR the edge.
Other critics of EMDR, like Jeffrey Lohr, a psychology professor at the University of Arkansas, remain underwhelmed.
Writing in a 1997 newsletter of the National Council Against Health Fraud, Lohr and a co-author charged that Shapiro “took existing elements from cognitive-behavior therapies, added the unnecessary ingredient of finger waving, and then took the new techique on the road before science could catch up.”
But Dr. Bessel van der Kolk, a Boston University psychiatrist and head of the medical trauma center at Arbour Health Systems, a private organization in Brookline, disagrees.
Initially skeptical, van der Kolk, a specialist in post traumatic stress disorder, says he became convinced when his patients sought EMDR elsewhere and came back saying it helped more “than five years of talking therapy.” When that happens, he says, “you start sitting up.”
So far, he has studied 12 people with PTSD and is now analyzing brain scans before and after EMDR treatment. EMDR is “pretty bizarre,” he acknowledges, but it seems to have induced “remarkable changes” in some people.
For her part, Shapiro has softened her view that eye movements are essential. Part of what changed her mind was that anecdotal evidence from blind patients for whom therapists used tones and hand-snapping instead of finger-wagging and produced results similar to standard EMDR.
She bristles at charges that she has tried to keep data that conflict with her findings from being published, arguing her critics are waging “ad hominem” attacks on her.
But the critics aren’t backing off. As Lohr puts it: “EMDR is cognitive behavior therapy with bells and whistles that won’t do anything. It’s a dog that won’t hunt.”
SIDEBAR:
Troubles on the right
Eye movements may play a role in a new treatment for anxiety developed by Dr. Fredric Schiffer, a psychiatrist at Harvard’s McLean Hospital in Belmont.
Schiffer believes people may literally be of two minds: A person may feel anxious when one side of the brain is dominant, but calm and mature when the other side holds sway — almost as if the “inner child” lived on one side and the adult self on the other. By using special goggles that feed visual input to one side of the brain at a time, Schiffer thinks, it may be possible to shift back and forth between these states.
More than 30 years ago, researchers led by 1981 Nobel laureate Roger Sperry began studying “split brain” patients, people with severe epilepsy that doctors treated by cutting the nerves that connect the left brain hemisphere to the right.
The researchers found the two halves of the brain could process information independently. In the popular imagination, this helped fuel the (wildly oversimplified) notion that logic resides in the left brain and emotions on the right.
Two years ago, Schiffer studied a split-brain patient who’d been bullied as a child, and he found that the patient denied distress when his left brain was activated, but expressed it when the right side was.
Schiffer has devised goggles that control visual input to the brain and tested them in 70 patients. About 60 percent reported some difference in anxiety depending on which side of the brain was stimulated; 30 percent report clinically significant differences.
The goal, says Schiffer, whose book, “Of Two Minds,” hit stores this month, is “to teach the troubled side of the brain that the world is less threatening that it thought.”