The Future of EMDR

The articles in this special issue entitled “Breaking New Ground” represent noteworthy efforts to open up new fertile ground for the brain-based science of eye movement desensitization and reprocessing (EMDR). These articles offer preliminary findings and recommendations for further experimental studies to confirm (or disconfirm) results.

The idea for this special issue arose in a moment of abounding optimism at the annual meeting of the journal’s editorial board during the August 2011 EMDRIA Conference in Orange County, California. Jim Costello, Springer Publishing Company’s Vice President for Journal Publishing, was reviewing strategies to address the continuing challenge of obtaining sufficient quality articles to meet the journal’s publication schedule. The notion of special issues to be developed by guest editors was mentioned. In its fifth year of publication, the journal had already published four special issues—all edited by the Editor in Chief, Louise Maxfield. I volunteered to be the first guest editor and began to cultivate a vision for a special issue. Let me share with you some of the backstory related to the development of this vision.

In 2009, I was invited to deliver the closing plenary for the 2010 EMDR Europe Conference in Hamburg on “The Future of EMDR” (Leeds, 2010). The theme was the dramatic worldwide expansion of EMDR training and research from 1987 to 2010 fueled in large measure by the relentless encouragement for research by Francine Shapiro. The plenary’s prediction that for the next 10 years, EMDR’s scientific development would largely depend on research carried out in Europe, Asia, and South America. The explanation offered the desiccated state of major funding sources in the United States for research on EMDR—apparently related to the widely published view that EMDR was merely a variant of exposure-extinction therapy. I further opined that these claims had persisted, effectively unchallenged, because of a more than 10-year long delay to publish research addressing errors in analysis found in the two most oft cited meta-analyses (Davidson & Parker, 2001; Devilly, 2002) examining the role of eye movements in clinical and nonclinical studies.

Earlier this year, Chris Lee together with Pim Cuijpers finally published their long awaited meta-analysis—8 long years after their preliminary presentation (Lee, 2005)—addressing these earlier errors, in which they clarified the specific and effective role of bilateral eye movements in EMDR’s treatment effects and concluded “the processes involved in EMDR are different from other exposure based therapies” (Lee & Cuijpers, 2013, p. 231). Happily, the research-funding gap in the United States is now being partially addressed through the regular financial contributions of many clinicians and the dedication of the board of the EMDR Research Foundation; however, the 2010 plenary prediction was that the publication of the Lee and Cuijpers meta-analysis would not resolve the funding issue in the United States. I predicted it would require first, independent replication of the Lee and Cuijpers meta-analysis; second, further controlled studies; and finally, that not until 2020 would major funding opportunities in the United States resume their flow.

The theme for this special issue grew out of that prediction, and the fact that we find ourselves in a period (so in contrast to the early flood years of EMDR research in the United States in the 1990s) in which the future of EMDR, for now, rests in large part in the hands of our colleagues outside of the United States—in Europe, Asia, Mexico, and South America. Although funding may be one critical element, sheer determination and creativity in the pursuit of research findings are just as essential. The authors of the articles in this special issue possess these elements in abundant measure.

The articles in this special issue are the result of 18 invitations I sent to the authors of papers and posters from the 2012 EMDR Europe Conference in Madrid as well authors of Italian articles in the special 2012 EMDR issue of the Rivista Di Psichiatria. Eleven prospective authors agreed to prepare or to translate articles for this special issue. Some had never published before. None are native English writers or speakers. Some of these articles were completed in time to make this special issue. Others, still being revised, will appear in future issues.

These articles reflect the truly international scope of current EMDR research. All break new ground for EMDR. The first two are pilot studies. The reanalysis of Elisa Faretta’s data first published in the Rivista Di Psichiatria suggests that EMDR is at least equally effective as cognitive behavioral therapy (CBT) for the treatment of patients with panic or panic and agoraphobia. This is the first direct comparison treatment of panic disorder between EMDR and CBT. The second article, from Liuva Capezzani et al., is the first controlled study of the EMDR treatment of cancer patients. Given the historic role that cancer played in Francine Shapiro’s transition from English literature to the study of psychology and to the development of EMDR (Luber & Shapiro, 2009, p. 218), and the presence of sections on the treatment of cancer patients in both the 1995 and 2001 editions of her text (Shapiro, 1995, 2001), this article represents an important milestone. Capezzani et al. found that cancer patients in the follow-up stage of treatment, randomly assigned to EMDR or CBT treatment, were more likely to be free of posttraumatic stress disorder (PTSD) 1 month posttreatment if they received EMDR rather than CBT. They also found that EMDR showed the same efficacy when offered during the active period of medical treatment as after active medical treatment.

The next two articles are case studies with standardized measures. The first article from Tamaki Amano and Akitoshi Seiyama, Japanese graduate students, and their research advisor, Motomi Toichi, is the first article to offer a glimpse of real-time whole brain change during EMDR reprocessing using near-infrared spectroscopy in the treatment of a case of phantom limb pain. The second case study from Italian psychologists Maria Zaccagnino and Martina Cussino of a depressed mother who presented with a dismissing attachment style (with regard to both parents) shows adaptive changes in caregiving capabilities and attachment organization following treatment with EMDR as measured by the Parent Development Interview. Although an earlier case series from Wesselmann and Potter (2009) had shown positive changes in attachment status as measured by the Adult Attachment Interview (AAI), this is the first report of EMDR therapy for a mother with recurrent depression to show changes in both attachment organization and maternal caregiving capacities. Given the significant lifespan impact of maternal depression on infant attachment organization and emotional development (Schore, 2001; Siegel, 2002), this article suggests that EMDR therapy might play a significant role in improving maternal caregiving capacity.

The last article is a clinical practice article from Silvia Gauvry and her coauthors from Buenos Aires, Argentina, which describes a positive outcome from the application of EMDR treatment in a medical-surgical hospital setting for a young child with Complex Regional Pain Syndrome (CRPS). Formerly known as Sudeck’s dystrophy, CRPS is a disproportionate pain condition after a minor limb injury that can lead to sensory and motor dysfunction and muscular atrophy. As a clinician with some experience doing assessments and providing EMDR in a medical-surgical trauma recovery unit, I know how challenging it can be to deliver clinical hospital services because of interruptions for nursing care, physical therapy, family, or caregivers. This case, with 2-year follow up, is the first published report of the EMDR treatment of a chronic pain disorder in a child. In a helpful instance of synchronicity, my first patient with CRPS was just referred to me and because of this case report, I was able to let my patient know there was at least one other person with CRPS who had been helped by EMDR.

The publication of this issue would not have been possible without the many independent reviewers who provided essential constructive feedback to the authors and the editors. In addition to my heartfelt thanks to these anonymous reviewers, I particularly want to thank John “Jac” Carlson of Arizona who put in many hours to help with some of the challenges of English as a second language and statistical issues.

Before closing, I feel it is necessary to pay homage to the support and leadership of Louise Maxfield in the preparation of this special issue. Indeed, every issue that has appeared over the past 8 years is because of her generosity and talents. My editing skills, acquired in writing journal articles and a book manuscript, proved initially insufficient for the challenge of serving as associate editor. Louise was more than gracious with her time and energy, patient in her analyses—clarifying both strengths and weaknesses in manuscripts under consideration, and firm in her guidance. We in the international EMDR community are remarkably fortunate to have benefited from her dedicated service over these 8 years. No honorarium could possibly compensate for the countless hours and mental energies invested in the development of and service to the Journal of EMDR Practice and Research. The bountiful harvest of dozens of EMDR articles patiently culled from the fertile fields she has helped tend is a generative gift to the world of psychology.