EMDR and Mesmerism: a comparative historical analysis

The reasons for its effectiveness, however, remain in dispute—A tribute to Irving Kirsch

Irving Kirsch’s work spans over four decades and provided science and clinical practice with as much invaluable insights in the inner workings of treatments as it provided us and patients with their rights and our duties. Here, two early publications of Irving Kirsch on the topic of psychotherapy and its relation to placebo are revised and put into both a historical and contemporary context to pay tribute to the work of Irving Kirsch.

On EMDR: Measuring the working memory taxation of various types of eye (non-)movement conditions

BACKGROUND AND OBJECTIVE

A recent, large randomized controlled trial employing different forms of eye (non-)movements in eye movement desensitization and reprocessing (EMDR) showed that fixating the eyes either on a therapist's moving or non-moving hand led to equal reductions in symptoms of post-traumatic stress disorder (PTSD). However, numerous EMDR lab analogue studies found that eye movements produce larger memory effects than eyes stationary. These beneficial effects are typically explained by differences in working memory (WM) taxation. We tested the degree of WM taxation of several eye (non-)movement conditions used in the clinical trial.

METHODS

All participants (N = 40) performed: (1) eyes moving by following the experimenter's moving finger, (2) eyes fixed on the experimenter's stationary finger, (3) eyes closed, or (4) looking unfocused into the room. Simultaneously they performed a simple reaction time task. Reaction times are an objective index of the extent to which different dual attention tasks tax WM.

RESULTS

Eyes moving is more taxing than eyes fixed, while eyes fixed did not differ from eyes unfocused. All conditions were more taxing than eyes closed.

LIMITATIONS

We studied WM taxation in a laboratory setting; no clinical interventions were applied.

CONCLUSIONS

In line with previous lab studies, making eye movements was more taxing than eyes fixed. We discuss why this effect was not observed for reductions in PTSD symptoms in the clinical trial (e.g., differences in dependent variables, sample population, and intervention duration). For more comprehensive future insights, we recommend integration of mechanistically focused lab analogue studies and patient-oriented clinical studies.

The placebo and its effects: A psychoneuroendocrinological perspective

Placebos are usually employed deceptively in clinical trials in order to control for non-specific effects. However, since placebos themselves have been found to cause clinically relevant changes and in some cases are indistinguishable from the verum they are tested against, this theoretically inert, but practically effective intervention has become a scientific discipline in its own right. In this review, it is argued that placebos are generic and genuine biopsychosocial interventions and as such are highly interesting candidates for a psychoneuroendocrinological perspective. Yet, despite a considerable conceptual proximity between explanatory models of placebos and their effects with psychoneuroendocrine models and findings, placebos have thus far not been subject to systematic psychoneuroendocrine examination. Consequently, it would be highly interesting and informative to make placebos the target of psychoneuroendocrine scrutiny.

Placebo and Psychotherapy: Differences, Similarities, and Implications

The placebo and psychotherapy are both effective psychological interventions. Next to being characterized by their own and specific controversies and debates, there is a persistent-and least for psychotherapy-looming notion that these two interventions share more than just the first letter. Based on Grünbaum's influential conceptualization of placebo, this chapter critically reviews both the time-honored claim that psychotherapy is a placebo as well as the argument that the placebo concept does not translate to psychotherapy. We conclude that there is an unwanted proximity between these two interventions and that empirical attempts to separate the "wheat from the chaff" in psychotherapy research face several distinctive challenges and thus are often methodologically comprised by the integrity of the placebo. However, drawing on recent, innovative research, we conclude that psychotherapy can be saved, i.e., shown to be distinct from the placebo, by employing study designs derived from the placebo research. We conclude that the placebo concept has profound implications for psychotherapy, psychotherapy research, and last but not least its ethical practice.

Replication Requires Psychological Rather than Statistical Hypotheses: The Case of Eye Movements Enhancing Word Recollection

Can an experiment be replicated in a mechanical fashion without considering the processes underlying the initial results? Here I will consider a non-replication of Saccade Induced Retrieval Enhancement (SIRE) and argue that it results from focusing on statistical instead of on substantive process hypotheses. Particularly the theoretical integration of SIRE with Eye-Movement Desensitization and Reprocessing (EMDR) therapy, provides clues about when the memory enhancement should occur. A relatively large memory enhancement effect in participants with a consistent (i.e., extreme right or left) handedness should be observed, (a) when explicitly instructed to retrieve and imagine the memories during the eye manipulation, and (b) for emotionally negative material. A finer theoretical analysis may thus well explain the contrast between the original SIRE studies and the non-replication. Also the findings from preregistered confirmatory research (i.e., focusing solely on statistical hypotheses) should be considered preliminary, representing shifts on a gradual scale of evidence, and awaiting interpretation in terms of theoretical hypotheses. Stronger, but still not definitive, conclusions can better be postponed until after multi-study meta-analyses with theoretically motivated moderator variables have been performed.

Clinician Experiences With EMDR: Factors Influencing Continued Use

This study investigated factors contributing to clinicians’ use or discontinued use of eye movement desensitization and reprocessing (EMDR) as well as obtaining information pertaining to training experiences. Patterns emerged from a survey completed by 239 respondents highlighting some issues associated with discontinued use, specifically loyalty to other treatment modalities and discomfort with using EMDR. Factors investigated were not statistically significant; however, frequency analysis of the survey identified patterns in use and experience. Clinicians who continued to use EMDR reported that they did so because of both its effectiveness and the ongoing consultation they received. Practice setting surfaced as a statistically significant factor, with operating in private practice associated with greater participation in EMDR support activities. A discussion of the adequacy of the training format is presented as well as how prepared the participants felt after completion of EMDR training. Some findings were consistent with earlier studies, and the converging results of loyalty to previous modalities and discomfort using EMDR give rise to recommendations for future training and support of newly trained clinicians.

Tranceformations: hypnosis in brain and body

In this review, the role of hypnosis and related psychotherapeutic techniques are discussed in relation to the anxiety disorders. In particular, anxiety is addressed as a special form of mind/body problem involving reverberating interaction between mental and physical distress. The history of hypnosis as a therapeutic discipline is reviewed, after which neurobiological evidence of the effect of hypnosis on modulation of perception in the brain. Specific brain regions involved in hypnosis are reviewed, notably the dorsal anterior cingulate gyrus and the dorsolateral prefrontal cortex. The importance of hypnotizability as a trait, stable variability in hypnotic responsiveness, is discussed. Analogies between the hypnotic state and dissociative reactions to trauma are presented, and the uses of hypnosis in treating posttraumatic stress disorder, stressful situations, and phobias as well as outcome data are reviewed. Effects of hypnosis on control of somatic processes are discussed, and then effects of psychosocial support involving Supportive-Expressive Group Therapy and hypnosis on survival time for cancer patients are evaluated. The evidence indicates an important role for hypnosis in managing anxiety disorders and anxiety related to medical illness.

Anxiety and its treatment: promoting science-based practice

In this article we analyze ways that psychological science can inform the treatment of anxiety disorders. We focus on experimental psychopathology research to describe the structure of anxiety and the functions of danger, safety, predictability and controllability in contributing to disorder. We then address science-based practice in terms of principles of change and the benefits from the self-corrective nature of science, contrasting this form of practice with treatments that are not grounded in basic learning theory. Models for dissemination and implementation of science-based practices are described and related to practitioner attitudes regarding scientific evidence. Finally, we consider practice implications when treatments are, and are not, based on the informative role of clinical psychological science.

Making science work in mental health care

There is increasing attention for embedding research in mental healthcare. This involves a linkage between scientific research and routine practice, where research is fed by questions from practice and scientific insights are implemented better and faster in clinical practice. This paper illustrates bridging the gap, by focusing on eye movement desensitisation and reprocessing (EMDR), and provides arguments why it is relevant to connect research and practice. It also discusses why experimental psychopathology may have a substantial contribution.

Treating nightmares and insomnia in posttraumatic stress disorder: a review of current evidence

Emerging evidence supports the notion of disrupted sleep as a core component of Posttraumatic Stress Disorder (PTSD). Effective treatments for nighttime PTSD symptoms are critical because sleep disruption may be mechanistically linked to development and maintenance of PTSD and is associated with significant distress, functional impairment, and poor health. This review aimed to describe the state of science with respect to the impact of the latest behavioral and pharmacological interventions on posttraumatic nightmares and insomnia. Published studies that examined evidence for therapeutic effects upon sleep were included. Some behavioral and pharmacological interventions show promise, especially for nightmares, but there is a need for controlled trials that include valid sleep measures and are designed to identify treatment mechanisms. Our ability to treat PTSD-related sleep disturbances may be improved by moving away from considering sleep symptoms in isolation and instead conducting integrative studies that examine sequential or combined behavioral and/or pharmacological treatments targeting both the daytime and nighttime aspects of PTSD. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.

The Trauma of Torture and the Rehabilitation of Torture Survivors

The aim of torture is to cause severe pain and suffering in order to destroy the structure of the personality and the identity of the victim. Torture is applied in over a 100 countries worldwide, and its consequences affect millions of survivors. The rehabilitation of those who have experienced torture is a lengthy and complex process; treatment centers all over the world are constantly developing their methods to assist the mental and physical healing of torture survivors. The present article offers insights into the nature of torture, applied torture techniques, the psychological sequelae of torture, and diagnostic developments. Furthermore, current issues of rehabilitation and reparation are discussed, including the debate on evidence-based practice in treatment. The aim of the authors is to offer a brief but comprehensive review on torture and rehabilitation for professionals of mental health care and other relevant fields.

Efficacy of cognitive behavioral therapy for anxiety disorders: a review of meta-analytic findings

Numerous clinical trials have supported the efficacy of cognitive behavioral therapy (CBT) for the treatment of anxiety disorders. Accordingly, CBT has been formally recognized as an empirically supported treatment for anxiety-related conditions. This article reviews the evidence supporting the efficacy of CBT for anxiety disorders. Specifically, contemporary meta-analytic studies on the treatment of anxiety disorders are reviewed and the efficacy of CBT is examined. Although the specific components of CBT differ depending on the study design and the anxiety disorder treated, meta-analyses suggest that CBT procedures (particularly exposure-based approaches) are highly efficacious. CBT generally outperforms wait-list and placebo controls. Thus, CBT provides incremental efficacy above and beyond nonspecific factors. For some anxiety disorders, CBT also tends to outperform other psychosocial treatment modalities. The implications of available meta-analytic findings in further delineating the efficacy and dissemination of CBT for anxiety disorders are discussed.

Diversity of effective treatments of panic attacks: what do they have in common?

By comparing efficacious psychological therapies of different kinds, inferences about common effective treatment mechanisms can be made. We selected six therapies for review on the basis of the diversity of their theoretical rationales and evidence for superior efficacy: psychoanalytic psychotherapy, hypercapnic breathing training, hypocapnic breathing training, reprocessing with and without eye-movement desensitization, muscle relaxation, and cognitive behavior therapy. The likely common element of all these therapies is that they reduce the immediate expectancy of a panic attack, disrupting the vicious circle of fearing fear. Modifying expectation is usually regarded as a placebo mechanism in psychotherapy, but may be a specific treatment mechanism for panic. The fact that this is seldom the rationale communicated to the patient creates a moral dilemma: Is it ethical for therapists to mislead patients to help them? Pragmatic justification of a successful practice is a way out of this dilemma. Therapies should be evaluated that deal with expectations directly by promoting positive thinking or by fostering non-expectancy.

Comparative Case Study of Diffusion of Eye Movement Desensitization and Reprocessing in Two Clinical Settings: Empirically Supported Treatment Status Is Not Enough

An in-depth comparative case study was conducted of two attempts at diffusion of an empirically supported, but controversial, psychotherapy: eye movement desensitization and reprocessing (EMDR). One Department of Veterans Affairs (VA) treatment setting in which there was substantial uptake was compared with a second VA setting in which it was not adopted. Qualitative interviews were conducted with 10 mental health clinicians at the first site, and 19 at the second. Critical selling points for EMDR were a highly regarded champion, the observability of effects with patients, and personally experiencing its effects during a role training session. Compatibility with existing psychotherapist practices and values further allowed the therapy to become embedded in the organizational culture. At the second site, a sense that EMDR was not theoretically coherent or compelling overwhelmed other considerations, including its empirical status. Comparative studies contrasting settings in which innovative therapies are implemented versus those in which they were rejected may aid in refining theories of and strategies for dissemination.

Scientific resistance to research, training and utilization of eye movement desensitization and reprocessing (EMDR) therapy in treating post-war disorders

In this study, Barber's [(1961). Resistance by scientists to scientific discovery. Science, 134, 596-602] analysis of scientists' resistance to discoveries is examined in relation to an 18-year controversy between the dominant cognitive-behavioral paradigm or zeitgeist and its chief rival - eye movement desensitization and reprocessing (EMDR) in treating trauma-related disorders. Reasons for persistent opposition to training, utilization and research into an identified 'evidence-based treatment for post-traumatic stress disorder' (EBT-PTSD) within US military and veterans' agencies closely parallels Barber's description of resistance based upon socio-cultural factors and scientific bias versus genuine scientific skepticism. The implications of sustained resistance to EMDR for combat veterans and other trauma sufferers are discussed. A unified or super-ordinate goal is offered to reverse negative trends impacting current and future mental healthcare of military personnel, veterans and other trauma survivors, and to bridge the scientific impasse.

Posttraumatic stress disorder: etiology, epidemiology, and treatment outcome

Posttraumatic stress disorder (PTSD) results from exposure to a traumatic event that poses actual or threatened death or injury and produces intense fear, helplessness, or horror. U.S. population surveys reveal lifetime PTSD prevalence rates of 7% to 8%. Potential reasons for varying prevalence rates across gender, cultures, and samples exposed to different traumas are discussed. Drawing upon a conditioning model of PTSD, we review risk factors for PTSD, including pre-existing individual-based factors, features of the traumatic event, and posttrauma social support. Characteristics of the trauma, particularly peritraumatic response and related cognitions, and posttrauma social support appear to confer the greatest risk for PTSD. Further work is needed to disentangle the interrelationships among these factors and elucidate the underlying mechanisms. Based upon existing treatment outcome studies, we recommend use of exposure therapies and anxiety management training as first-line treatment for PTSD. Among psychopharmacological treatments, selective serotonin reuptake inhibitors evidence the strongest treatment effects, yet these effects are modest compared with psychological treatments.

EMDR treatment for children with PTSD: results of a randomized controlled trial

The objective of the study was to examine the efficacy of EMDR treatment for children with post-traumatic stress disorder (PTSD) compared with untreated children in a waiting list control group (WLC) participating in a randomized controlled superiority trial (RCT). Thirty-three 6-16-year-old children with a DSM-IV diagnosis of PTSD were randomly assigned to eight weekly EMDR sessions or the WLC group. The Posttraumatic Stress Symptom Scale for Children (PTSS-C scale) was used in interviews with children to evaluate their symptoms and outcome. Post-treatment scores of the EMDR group were significantly lower than the WLC indicating improvement in total PTSS-C scores, PTSD-related symptom scale, and the subscales re-experiencing and avoidance among subjects in the EMDR group, while untreated children improved in PTSD-non-related symptom scale. The improvement in re-experiencing symptoms proved to be the most significant between-group difference over time. The results of the present exploratory study including a limited number of children with PTSD are encouraging and warrant further controlled studies of larger samples of children suffering from PTSD.

Power Therapies and possible threats to the science of psychology and psychiatry

OBJECTIVE

Advocates of new therapies frequently make bold claims regarding therapeutic effectiveness, particularly in response to disorders which have been traditionally treatment-refractory. This paper reviews a collection of new therapies collectively self-termed "The Power Therapies", outlining their proposed procedures and the evidence for and against their use. These therapies are then put to the test for pseudoscientific practice.

METHOD

Therapies were included which self-describe themselves as "Power Therapies". Published work searches were conducted on each therapy using Medline and PsychInfo databases for randomized controlled trials assessing their efficacy, except for the case of Eye Movement Desensitization and Reprocessing (EMDR). Eye Movement Desensitization and Reprocessing has more randomized controlled studies conducted on its efficacy than any other treatment for trauma and thus, previous meta-analyses were evaluated.

RESULTS AND CONCLUSIONS

It is concluded that these new therapies have offered no new scientifically valid theories of action, show only non-specific efficacy, show no evidence that they offer substantive improvements to extant psychiatric care, yet display many characteristics consistent with pseudoscience.

The placebo is powerful: Estimating placebo effects in medicine and psychotherapy from randomized clinical trials

The logic of the randomized double-blind placebo control group design is presented, and problems with using the design in psychotherapy are discussed. Placebo effects are estimated by examining clinical trials in medicine and psychotherapy. In medicine, a recent meta-analysis of clinical trials with treatment, placebo, and no treatment arms was conducted (Hróbjartsson & Gøtzsche, 2001), and it was concluded that placebos have small or no effects. A re-analysis of those studies, presented here, shows that when disorders are amenable to placebos and the design is adequate to detect the effects, the placebo effect is robust and approaches the treatment effect. For psychological disorders, particularly depression, it has been shown that pill placebos are nearly as effective as active medications whereas psychotherapies are more effective than psychological placebos. However, it is shown that when properly designed, psychological placebos are as effective as accepted psychotherapies.

Special issue on the cognitive revolution in clinical psychology: beyond the behavioral approach-conclusions: toward an evidence-based psychology and psychotherapy

Integrating the criticisms of the cognitive psychology approach offered by behavioral oriented professionals, as well as the information offered in this special issue of the Journal of Clinical Psychology, the article presents an overview of the theoretical and practical implications of the cognitive revolution on the clinical field and discusses the unique contribution of this approach beyond the contribution of the behavioral approach.

EMDR: implications of the use of reprocessing therapy in nursing practice

TOPIC

Eye movement desensitization and reprocessing (EMDR).

PURPOSE

To examine the available evidence base for EMDR treatment in psychiatric nursing practice.

SOURCES

Evidenced-based research findings, published case and anecdotal reports, and primary source documents on the development of the treatment method.

CONCLUSIONS

EMDR use remains controversial. Although it is safe, little is known regarding the mechanism of action of any therapeutic effect; more rigorous empirical establishment of efficacy is needed.

Psychology should list empirically supported principles of change (ESPs) and not credential trademarked therapies or other treatment packages

Current systems for listing empirically supported therapies (ESTs) provide recognition to treatment packages, many of them proprietary and trademarked, without regard to the principles of change believed to account for their effectiveness. Our position is that any authoritative body representing the science and profession of psychology should work solely toward the identification of empirically supported principles of change (ESPs). As challenging as it is to take this approach, a system that lists ESPs will keep a focus on issues central to the science and practice of psychology while also insulating the profession from undue entrepreneurial influences.

Specific and nonspecific treatment factors in the experimental analysis of behavioral treatment efficacy

Interest in the empirical demonstration of the clinical efficacy of psychosocial treatments has been rekindled by societal concerns over accountability and cost-effectiveness in the delivery of mental health services. Behavior therapy has had a long history of experimental research on treatment efficacy and enjoys a visible presence in contemporary mental health practice. The demonstration of behavioral treatment efficacy, however, requires experimental evidence that shows the efficacy of prescriptive structured procedures beyond nonspecific factors in delivery of such procedures. The authors provide an analysis of the nature of nonspecific treatment factors and nonspecific effects and suggest experimental procedures testing the incremental validity of specific treatments. They examine two widely promoted, prescriptive structured treatments to analyze the specificity of their clinical efficacy: eye movement desensitization and reprocessing for anxiety disorders and cognitive-behavioral treatment of generalized anxiety disorder. They conclude that the treatments show different levels of efficacy and different degrees of specificity.

Mesmer, the Franklin Commission, and hypnosis: a counterfactual essay

The author reviews the social and scientific context for both Mesmer's theory of animal magnetism and the evaluation of that theory by the Franklin Commission. If Mesmer had never lived, someone else would have introduced magnets into medicine; and if the Franklin Commission had never met, someone else would have found the theory of animal magnetism invalid. Mesmer's theory was an imperfect analogy conditioned by the scientific vocabulary of his time, and the Franklin Commission's debunking of his theory left Mesmer's effects both unchallenged and unexplained. Both Mesmer and the Franklin Commission suffered from the fact that in their time scientific psychology was not merely unavailable but considered impossible.

A critical evaluation of current views regarding eye movement desensitization and reprocessing (EMDR): clarifying points of confusion

EMDR is an active psychological treatment for PTSD that has received widely divergent reactions from the scientific and professional community. This article examines points of confusion in the published literature on EMDR, including the theoretical, empirical, and historical issues around EMDR and placebo effects, exposure procedures, the eye movement component, treatment fidelity issues, and outcome studies. It also examines historical information relevant to the scientific process and charges of "pseudoscience" regarding EMDR. We conclude that the confusion in the literature is due to (a) the lack of an empirically validated model capable of convincingly explaining the effects of the EMDR method, (b) inaccurate and selective reporting of research, (c) some poorly designed empirical studies, (d) inadequate treatment fidelity in some outcome research, and (e) multiple biased or inaccurate reviews by a relatively small group of authors. Reading the original research articles frequently helps to reduce the confusion arising from the research review literature.

EMDR: a putative neurobiological mechanism of action

Numerous studies have provided evidence for the efficacy of eye movement desensitization and reprocessing therapy (EMDR) in the treatment of posttraumatic stress disorder (PTSD), including recent studies showing it to be more efficient than therapist-directed flooding. But few theoretical explanations of how EMDR might work have been offered. Shapiro, in her original description of EMDR, proposed that its directed eye movements mimic the saccades of rapid eye movement sleep (REM), but provided no clear explanation of how such mimicry might lead to clinical improvement. We now revisit her original proposal and present a complete model for how EMDR could lead to specific improvement in PTSD and related conditions. We propose that the repetitive redirecting of attention in EMDR induces a neurobiological state, similar to that of REM sleep, which is optimally configured to support the cortical integration of traumatic memories into general semantic networks. We suggest that this integration can then lead to a reduction in the strength of hippocampally mediated episodic memories of the traumatic event as well as the memories' associated, amygdala-dependent, negative affect. Experimental data in support of this model are reviewed and possible tests of the model are suggested.

Tertullian's motto and Callahan's method

The purposes of this commentary are to provide a critique of Callahan's (this issue) article on Thought Field Therapy (TFT) and to discuss when our commitment to intellectual open-mindedness requires that we attend to nontraditional treatment interventions in clinical psychology.

"Echo attributions" and other risks when publishing on novel therapies without peer review

A special series on Thought Field Therapy in the Journal of Clinical Psychology provides an opportunity for psychologists to learn about techniques and theories outside the mainstream of our field. Unfortunately, by publishing this series of manuscripts without meeting the standards of peer review, the Journal also provides an avenue for the misuse of its good reputation and the improper promotion of untested methods. "Echo attributions" can be made whereby an author attributes the source of his own words to the professional journal in which the text appears. Historical examples illustrate that such misuse of scientific journals and institutions occurs. A formal statement of guidelines is needed to instruct authors on appropriate versus unethical representations of their publications.

Eye movement desensitization and reprocessing (EMDR): a meta-analysis

Eye movement desensitization and reprocessing (EMDR), a controversial treatment suggested for posttraumatic stress disorder (PTSD) and other conditions, was evaluated in a meta-analysis of 34 studies that examined EMDR with a variety of populations and measures. Process and outcome measures were examined separately. and EMDR showed an effect on both when compared with no treatment and with therapies not using exposure to anxiety-provoking stimuli and in pre post EMDR comparisons. However, no significant effect was found when EMDR was compared with other exposure techniques. No incremental effect of eye movements was noted when EMDR was compared with the same procedure without them. R. J. DeRubeis and P. Crits-Christoph (1998) noted that EMDR is a potentially effective treatment for noncombat PTSD. but studies that examined such patient groups did not give clear support to this. In sum, EMDR appears to be no more effective than other exposure techniques, and evidence suggests that the eye movements integral to the treatment, and to its name, are unnecessary.

The power of suggestion: comment on EMDR and mesmerism: a comparative historical analysis

This response to McNally challenges the notion that scientific controversy should be waged with smear tactics. McNally's anti-EMDR conclusions are contested as premature and based on red herrings, selective neglect of the literature, and erroneous application of scientific principles. The importance of treatment fidelity is highlighted as a way of distinguishing between EMDR studies of widely varying quality.

Eye Movement Desensitization and Reprocessing: an analysis of specific versus nonspecific treatment factors

Incremental validity and incremental efficacy have become important issues in the evaluation of psychological assessment and intervention procedures. Incremental validity in assessment is that shown by novel measures over and above established ones. Incremental efficacy is that shown by novel treatments over and above nonspecific and established treatment effects. In this paper, we critically examine the question of whether Eye Movement Desensitization and Reprocessing (EMDR) possesses efficacy above and beyond nonspecific treatment effects and components that are shared with well-established interventions. A review of recently published efficacy studies reveals that (a) the effects of EMDR are largely limited to verbal report indices, (b) eye movements and other movements appear to be unnecessary, and (c) reported effects are consistent with nonspecific treatment features. Examination of individual studies shows that control procedures for nonspecific features have been minimal. We analyze EMDR for nonspecific treatment features and suggest experimental controls to examine the incremental efficacy of EMDR.