Is EMDR Effective Treatment For Anxiety Disorder And Panic Attacks?
EMDR (Eye Movement Desensitization and Reprocessing) is a form of psychotherapy that was developed in 1987 by Francine Sapiro to help people who suffer with Post-Traumatic Stress Disorder.
EMDR is guided by the Adaptive Information Processing model (Shapiro 2007).
The Adaptive Information Processing model believes PTSD and other disorder symptoms (unless biologically caused) are the result of distress from past traumatic experiences where the memory was not adequately processed.
It’s believed these unresolved memories contain the thoughts, beliefs, emotions, and physical sensations that occurred during the event. When these memories replay or are triggered by a reminder, the event’s initial impact is re-experienced as symptoms of PTSD or other disorders.
Unlike other types of therapy that focus on the cognitive and behavioral aspects of trauma, such as identifying and successfully addressing the beliefs, thoughts, emotions, and overall behaviors that stem from traumatic events, EMDR focuses solely on the memory. It’s theorized that changing the way the memory is stored in the brain will reduce and eliminate the symptoms that are triggered by unprocessed memories.
EMDR seeks to resolve these unprocessed memories through an eight-phase process:
- Phase 1: History-taking
- Phase 2: Preparing the client
- Phase 3: Assessing the target memory
- Phases 4-7: Processing the memory to adaptive resolution
- Phase 8: Evaluating treatment results
This process is typically offered over eight to twelve sessions (more or less depending on results).
The EMDR Institute briefly describes the overall process as:
Eye movements (or other bilateral stimulation) are used during one part of the session. After the clinician has determined which memory to target first, he asks the client to hold different aspects of that event or thought in mind and to use his eyes to track the therapist’s hand as it moves back and forth across the client’s field of vision.
As this happens, for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and the clients begin to process the memory and disturbing feelings. In successful EMDR therapy, the meaning of painful events is transformed on an emotional level.
For instance, a rape victim shifts from feeling horror and self-disgust to holding the firm belief that, “I survived it and I am strong.” Unlike talk therapy, the insights clients gain in EMDR therapy result not so much from clinician interpretation, but from the client’s own accelerated intellectual and emotional processes.
The net effect is that clients conclude EMDR therapy feeling empowered by the very experiences that once debased them. Their wounds have not just closed, they have transformed. As a natural outcome of the EMDR therapeutic process, the clients’ thoughts, feelings and behavior are all robust indicators of emotional health and resolution—all without speaking in detail or doing homework used in other therapies.
EMDR does not include extended exposure to the distressing memory, delving into the details of the traumatic event, identifying and addressing the unhealthy beliefs and behaviors that stem from the event, or individual work on making behavioral change, which is different from other trauma-focused therapies, such as the many forms of Cognitive Behavioral Therapy (CBT).
Since its inception, therapists have been using EMDR for a host of other purposes, including depression, anxiety disorder, sexual dysfunction, schizophrenia, eating disorders, and even the psychological stress generated by other medical conditions.
There are both strong proponents for EMDR and those who say EMDR is ineffective over the long-term.
People who have received EMDR also report mixed results, from beneficial to making things worse.
Some of the latest research shows EMDR can provide positive clinical outcomes in treating trauma, but more research is required as previous research has shown limitations, including long-term efficacy.
Nevertheless, the general opinion is that EMDR is better than doing nothing, is better than just “listening” therapy (where the client talks and the therapist just listens), is somewhat better than exposure therapy alone, but not as effective as traditional cognitive behavioral therapy (CBT) for long-term results.
Jennifer Watts, a former anxietycentre.com client, then later therapist, shared this view, as well. She provided EMDR to clients who requested it but also found CBT to be more effective.
So, at this time, while EMDR might provide some benefits for some people, it might not for others since different therapeutic approaches work for different people (based on the specific underlying factors and client personality).
My first recommendation is enhanced CBT (there are many forms of CBT). EMDR might be appropriate with certain people, however.
EMDR focuses on feelings rather than the cause of those feelings (the ways we think and act).
Since anxiety disorder sufferers typically place heavy emphasis on their feelings, a feelings-only approach doesn’t address the cause of those feelings, which CBT addresses.
This could be one of the reasons why EMDR can be beneficial in the short-term but benefits might diminish over the long-term. CBT is effective over the long-term because it addresses the cause of our emotions.
Rational Emotive Behavioral Therapy (REBT) and CBT are based on the premise that thoughts drive emotions, and those emotions motivate actions.
CBT is the “Gold Standard” treatment for anxiety disorder (including panic attacks and depression) because of its consistent efficacy – CBT addresses the root of the problem rather than just the problem’s symptoms (physical symptoms, feelings, emotions, etc.).
This has been our experience, as well, which is why enhanced CBT (the many forms of CBT) is our preferred approach for addressing anxiety disorder, panic attacks, depression, trauma, and other behavioral wellness challenges.
Last, while EMDR can be helpful for trauma, it’s efficacy for anxiety disorder is mixed and requires more research.
Moreover, some research has called into question the theoretical mechanisms behind EMDR (eye movement as being a necessary part of EMDR) since similar outcomes can be achieved without eye movements.
Since many questions remain, and more research is required, EMDR wouldn’t be our first recommendation for anxiety disorder (which includes panic attacks) therapy. However, some people might find it helpful when trauma is a component of anxiety disorder and aspects of CBT are used in conjunction with EMDR.
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1. EMDR Institute, Inc. Retrieved 16 Dec 2019, https://www.emdr.com
2. P.G., David and van der Gaag, Mark. "Treating trauma in psychosis with EMDR: A pilot study." Journal of Behavior Therapy and Experimental Psychiatry, Mar 2012, https://www.sciencedirect.com/science/article/pii/S000579161100098X
3. Hase, Michael, et al. "Eye movement desensitization and reprocessing (EMDR) therapy in the treatment of depression: a matched pairs study in an inpatient setting." Brain and Behavior, Apr 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4467776/
4. Valienter-Gomez, Alicia, et al. "EMDR beyond PTSD: A Systematic Literature Review." Frontiers in Psychology, Sep 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623122/
5. Moreno-Alcazar, Ana, et al. "Efficacy of Eye Movement Desensitization and Reprocessing in Children and Adolescent with Post-traumatic Stress Disorder: A Meta-Analysis of Randomized Controlled Trials." Frontiers in Psychology, Oct 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641384/
6. Chen, Runsen, et al. "The Efficacy of Eye Movement Desensitization and Reprocessing in Children and Adults Who Have Experienced Complex Childhood Trauma: A Systematic Review of Randomized Controlled Trials." Frontier in Psychology, Apr 2018, https://www.frontiersin.org/articles/10.3389/fpsyg.2018.00534/full
7. David, Daniel, et al. “Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy.” US National Library of Medicine, 29, Jan. 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797481/
8. Hofmann, Stefan, et al. “The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses.” US National Library of Medicine, 1 Oct. 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584580/
9. Leahy, Robert L. “Cognitive-Behavioral Therapy: Proven Effectiveness.” Psychology Today, Sussex Publishers, Nov. 2011, www.psychologytoday.com/us/blog/anxiety-files/201111/cognitive-behavioral-therapy-proven-effectiveness.
10. "CBT can be recommended as a gold standard in the psychotherapeutic treatment of patients with anxiety disorders." - Otte, Christian. "Cognitive Behavioral Therapy in Anxiety Disorders: Current State of the Evidence." Dialogues in Clinical Neuroscience. Les Laboratoires Servier, Dec. 2011. Web. 14 Sept. 2016.
11. 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
12. de Voogd, Lycia D., et al. "Eye-Movement Intervention Enhances Extinction via Amygdala Deactivation." The Journal Of Neuroscience, Oct 2018, https://www.jneurosci.org/content/38/40/8694
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