Are Quick-Fix Therapies for Trauma and Stress too Good to be True?

Unconventional therapies promising rapid relief — like Eye Movement Desensitization and Reprocessing — are becoming more popular. Whether they work is up for debate.

Photo: Katiuscia Noseda/Moment/Getty Images

Traci Powell experienced a personal epiphany while watching the Disney movie Frozen.

A nurse practitioner from Florida, Powell had long struggled to keep memories of her childhood abuse at bay. As a way to cope, she organized her life so that she never had to develop intimate relationships: She conceived her children via an anonymous donor and padded her schedule with nonstop work, further graduate school, and volunteering. But it didn’t help.

Powell was increasingly plagued by flashbacks, and began having panic attacks. When on a tram entering the park at Disney World with her best friend, she was seated next to a man who reeked of beer and stale cigarettes, an aroma that reminded her of her abuser; the smell so unnerved her that her heart began racing, and she had to leap off the train at the park’s entrance and collect herself. She was so triggered by her teenage daughter’s deadbeat boyfriend — he had been caught doing drugs, which reminded her of the unstable environment in her childhood home — that she began screaming and cursing at the young lovers one day when she caught them on the phone, only to look up and see the tear-stained face of her terrified younger son. “I realized I was parenting them from the place of a frightened child,” she told me.

She assumed something was wrong with her. “I thought I had some genetic defect,” she says. But it was the movie Frozen, which features a heroine forced to hide a magical power (“Conceal, don’t feel, don’t let them know…), that made Powell realize what was happening: The trauma she had tried to bury for decades was negatively impacting every aspect of her life.

Not long after viewing the movie, Powell visited an internet forum for sexual abuse survivors. The other users encouraged her to find a therapist who specialized in trauma. Some suggested she specifically look into Eye Movement Desensitization and Reprocessing Therapy, or EMDR, which involves therapist-led eye movements to help lessen the impact of traumatic memories. “It seemed crazy that moving my eyes back on forth was going to change anything,” she said, but considering the talk therapy she’d undergone in the past hadn’t helped, she was willing to give something unconventional a try.

EMDR is one of a growing number of therapeutic methods that promise faster relief from everyday ruts to diagnosed mental illness, and everything in between. Multiple hospitals and research centers across the country are now offering short, intensive treatment programs lasting anywhere from two days to two weeks, most catering to people with trauma-related issues, phobias, Obsessive-Compulsive Disorder (OCD), or anxiety disorders. Some other short-term therapies, including Accelerated Resolution Therapy and hypnosis-based protocols, are also gaining traction among those with more everyday worries. Proponents say the limited time commitments enable more people to access help, allowing them to get back to their jobs, schooling, and families faster. But are treatments that prize brevity inherently more accommodating and patient-friendly, or are they just playing into our contemporary obsession with optimization at the expense of long-lasting healing and growth?

EMDR was created by a woman named Francine Shapiro in the late 1980s, when she was a graduate student in psychology studying stress. As she tells it, EMDR was discovered by accident: She was out for a walk one day, and she began thinking of distressing things. She says she doesn’t remember what those distressing thoughts were anymore, but in her book EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma, she describes them as “just one of those nagging negative thoughts that the mind keeps chewing over.”

Simultaneously Shapiro says she noticed that while ruminating, her eyes were “making rapid repetitive movements on a diagonal from lower left to upper right.” Her thoughts quickly “shifted from consciousness” — another way of saying she mentally moved on. She was curious as to what had happened, so she purposely brought the thoughts back, but she discovered that they no longer had the same impact as they did before.

Eager to explore her discovery further, Shapiro experimented on 22 people with Post Traumatic Stress Disorder (PTSD), which had just years earlier been formally recognized by the American Psychiatric Association. She told her subjects to think of a traumatic memory and then to follow her fingers as she moved them in front of their faces, mimicking the way she felt her eyes moved in the park. When her findings were later published in the Journal of Traumatic Stress in 1989, she asserted that 100% of her test subjects reported they were no longer anguished by a traumatic memory after a single session of EMDR.

Modern EMDR sessions have a similar format. A trained therapist takes the patient’s history and explains the treatment protocol, a process can last for more than one session. Then, the therapist will ask the patient to describe a single traumatic memory, image, or a negative feeling (for example, someone who suffered abuse as a child might tackle the belief that they are fundamentally unlovable). As the person is talking, the therapist moves his or her finger bilaterally in the person’s field of vision while the patient tracks it (other types of stimuli, including finger taps on the knee or pulsating handheld apparatuses, are sometimes used). A session usually lasts around 45–75 minutes, with the ocular tracking often done in 15 or 30-second increments, depending on the severity of the trauma (there are a number of demonstrations you can watch on YouTube, including this one.)

Why EMDR might be effective is very unclear. In a 2018 interview, Shapiro’s own explanations of why rapid eye movement works are vague — “during [a session] the brain makes the needed connections that transform the ‘stuck memory’ into a learning experience and take it to an adaptive resolution.”

One popular theory — that’s bolstered by research conducted by psychiatrist Robert Stickgold at Harvard University — is that the eye movements induced during EMDR mimic what happens during deep sleep when the brain is believed to sift through the day’s events and process them, serving as a kind of digestive system for the psyche. Molly Bahr, a licensed mental health counselor who practices EMDR in Miami, Florida, believes that “[The ocular tracking] helps the brain take what it needs (lessons, skills), and leave the rest. [It’s] part of why we can go to bed angry and wake up feeling much better.”

Another hypothesis is that the eye movements tax the brain’s working memory, essentially distracting the patient, thereby diminishing the impact of the recalled memory and allowing the patient to revisit it without as much fear and panic.

Studies have shown EMDR can yield positive results in a few sessions: One, funded by HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple-trauma victims no longer met the criteria PTSD after six 50-minute sessions — and all without the patient having to talk about the trauma at length or do substantial homework, as in conventional exposure therapy. Powell says her first experience with EMDR was nothing short of “miraculous;” another EMDR patient, Ryan Nelson of South Carolina — who sought treatment after the brutal murder of her best friend — says she quickly lost her fear of knives and of being alone thanks to the therapy. “At the end of each session, you come out and you’ve come to a better end,” she says.

Though EMDR was formulated with PTSD in mind, Shapiro and other EMDR practitioners have widened the pool of potential beneficiaries. Shapiro has said that EMDR might be effective for people with chronic pain, autism, fibromyalgia, bipolar disorder, anxiety, addiction, relationship problems, and even proclivities towards sexual violence. In her self-help book Getting Past Your Past, Shapiro contends that EMDR and EMDR-adjacent relaxation exercises can help “Olympic athletes to achieve peak performance and… people prepare for challenges like presentations, job interviews, and social situations.” Up until now, a sizable majority of the research on EMDR has focused on straightforward PTSD or cases where trauma has preceded another diagnosis like depression or Borderline Personality Disorder, so most of the other benefits touted are either based in anecdote or conjecture.

Other short therapies like EMDR include Accelerated Resolution Therapy, or ART. Like EMDR, ART was originally designed to treat trauma, but is also said to help depression, OCD, codependency, work stress, low self-esteem, and more. After undergoing EMDR training, Laney Rosenzweig, a marriage and family counselor, developed ART as her own protocol. Like EMDR, ART uses therapist-led eye movements, but incorporates elements of Gestalt and Cognitive Behavioral Therapy, among other modalities. It differs from EMDR in a few ways, including that it is a more somatically focused (patients are asked to focus on how their body feels during therapy) and a more rigidly structured protocol, which proponents say results in a “more rapid desensitization.” EMDR is marketed as the gentler option to exposure therapy because patients spend minimal time revisiting their trauma, but ART takes that to a new level by not requiring patients to describe their traumas. The practice is said to reprogram the ways in which traumatic memories are stored in the brain so that “they no longer trigger strong physical and emotional reactions.”

According to the Rosenzweig Center for Rapid Recovery, a professional organization based in Orlando, Florida, people can experience relief from symptoms after one to five sessions using ART. And they can do it without having to do homework, take any medication, or even talk about the trauma at all. All that being said, there have only been three studies on the therapy to date. “The most difficult aspect of discussing ART,” Rosenzweig has said, “is that it sounds too good to be true.” The research thus far is minimal: as of 2018, just a handful of case studies had been done on ART, and the only one to feature a control group concluded that “ART appears to be a safe and effective treatment for symptoms of combat-related PTSD.”

Another therapy gaining traction — at least in my area of Brooklyn — is Rapid Transformational Therapy, a type of hypnotherapy that “aims to deliver permanent change in 1–3 sessions,” according to the website of founder Marisa Peer, a British hypnotherapist and author. RTT is more explicitly a panacea than EMDR and ART: a promotional video on Peer’s site states RTT helps “improve overall well-being,” and testimonials credit it with a range of results from clearing up skin acne to alleviating depression to curing fear of public speaking. On a recent Monday afternoon in May I left my husband juggling my two young sons and a conference call to undergo a session.

In RTT, after the practitioner takes a basic history, you’re put into a state of hypnosis in order to “access the subconscious.” The practitioner then prompts you to see key scenes from your childhood, probes you about how those scenes contributed to your problematic current-day worldview, and instructs you on how to let go of them, using a combination of free dialog (much like traditional talk therapy) and scripted verbal exercises in which you renounce your past beliefs.

When I arrived at my therapist’s house for my own RTT session, I practically collapsed onto the couch while unleashing a torrent of worries: the difficulties of parenting two small children with a largely absent husband, the fear of failing (at work, at motherhood, at life), the residual anxiety leftover from the difficult and premature birth of my second son, the feeling that I’m constantly deprived of time to do basically anything. I breathed in the pleasant lavender aroma as the therapist sympathetically nodded along, then coaxed me into a dream-like state. I was told to lie down, close my eyes and envision that I was walking slowly down a flight of stairs. By the time I was at the bottom, I felt awake, but less inhibited and a bit woozy, almost a little drunk. When I left to make my way home, I tripped over a large garbage bag and into the street in an attempt to hail a taxi, probably prompting some bystanders to think I was drunk.

At the session’s conclusion, the practitioner sends you home with a personalized recording — mine is just over 15 minutes long, and functions as a kind of miniature version of the session, reminding me that I’ve moved on from my childhood and that I’m now operating in my “zone of genius,” which might be my new favorite empowering aphorism. You’re meant to listen to the recording daily for at least 21 days.

Short-term therapy methods, especially EMDR, have their detractors. Critics call into question everything from Shapiro’s schooling — her degree is from a never-accredited, now-defunct graduate school — to experimenter bias prevalent in early EMDR research studies. A 1999 article by three psychologists in Skeptic magazine outlined how Shapiro and EMDR advocates tended to tweak the definitions of good EMDR practices over time: When studies began showing less-than-stellar results for EMDR, proponents claimed the practitioners needed further training, or that they had recently determined that other forms of stimulation such as knee-tapping could also be efficacious. “The shifting procedures and training requirements for EMDR have created a seemingly endless catch-up game for scientists,” the psychologists wrote. “How can scientists test a method whose proponents insist on treatment fidelity for the induction of eye movements, then state that alternate tapping strategies are possible, next argue that various protocols must be followed, and then switch the decision rules for those protocols?”

Doubters and champions have also argued incessantly over whether the eye movements are a necessary component or just a neat parlor trick employed solely to distinguish EMDR from more conventional exposure-based therapies. A 2001 study in the Journal of Consulting and Clinical Psychology — just one of a number of early studies to zero in on the eye movements themselves — concluded bluntly that “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.” When a 2013 meta-analysis published in the Journal of Behavior Therapy and Experimental Psychiatry indicated that the addition of eye movements did further desensitize patients to traumatic memories, a trio of prominent psychologists published a critique in the same journal accusing the meta-analysis authors of, among other infractions, including studies that used students instead of actual PTSD sufferers, counting two favorable study more than once and “cherry-picking” the studies that had favorable outcomes. “Having set-up the meta-analysis exclusion criteria,” the psychologists write, “[the meta-analysis authors] accordingly exclude large numbers of studies which tested this exact phenomenon for various reasons of technicality or preference.”

There is also an ideological concern, mostly held by classical psychoanalysts and psychotherapists, over the brevity of treatment itself, the fact that studies often don’t follow patients long-term (this is a problem in most psychological and psychiatric studies), and the way EMDR tackles single memories at a time rather than view the patient holistically. Beneath this discussion lies another critical one, about whether painful emotions serve a purpose, and about whether we should be attempting to hack our way to mental health in ever-more expeditious ways.

Jonathan Shedler, PhD, a psychologist who has written about the false promise of short-term therapies for trauma, objects to the idea that you can spot-treat in counseling. “The kind of problems that bring people to therapy — with rare exceptions — are really woven into the person’s way of experiencing the world,” he says. “So when you say, ‘I’m going to treat this problem in isolation,’ you’re already saying something that doesn’t fit the reality.”

For Shedler, a therapist offering an accelerated cure is like a trainer offering to transform a slouch into a pro-weightlifter in a snap: “If you were physically out of shape and in poor health and overweight, and I said, ‘I’m going to get you fit and trim and muscular and you’re going to be in peak physical condition,’ people ought to understand this is going to take serious hard work over time.” He cites research that pooled information from 10,000 therapy patients, who presented with a variety of ailments including anxiety, mood disorders, and personal stress, that showed it takes more than 40 sessions of treatment — at a standard one session a week, that’s a little over nine months — for 75% of patients to show “meaningful improvement,” which doesn’t necessarily mean they were “cured.”

“The moment somebody makes a claim and it falls pretty far outside those general parameters, I think there’s really good reason to be suspicious,” he says.

Why should we expect healing to take that long? One reason might be because the driving force behind healing in therapy is what’s known as the “therapeutic alliance” — the trust patients have that the therapist likes them and has their best interests at heart. Numerous studies have shown the strength of the therapeutic alliance to be the number one indicator of treatment outcome, with the type of therapy mattering little if at all (this conclusion has been contested when it comes to certain problems, such as bulimia or specific phobias).

Simply put, people do better when they have a strong relationship with their therapist. And like most good relationships, this one often takes time to develop. The venerable psychoanalyst Irvin Yalom, in his recent book The Gift of Therapy: An Open Letter to a New Generation of Therapists and Their Patients, bemoans rigid treatment methodologies — those taught from manuals or in short certification courses, like EMDR — because they tend to stunt the development of a bond between patient and therapist: “Therapists must convey to the patient that their paramount tasks is to build a relationship together that will itself become the agent of change. It is extremely difficult to teach this skill in a crash course using a protocol.”

EMDR advocates say people who decry the therapy as a quick fix have mischaracterized it, and that Dr. Shapiro herself has never claimed that a patient could be cured in a single session, that five sessions was the average amount of time it took for most patients to recover. But that is still significantly faster than the traditional therapies studied in the analysis of 10,000 cases. Although many of the published studies on EMDR focus on short courses of treatment, most of the consumers I spoke to had been doing it off and on longer than five sessions.

Despite the criticism, EMDR continues to make inroads into the institutions that set the standards for treating mental illness. In the past 20 years, EMDR has been recognized as an effective treatment for trauma by the American Psychiatric Association and the World Health Organization; the United States Department of Defense classifies it as a “first-line” treatment for trauma, meaning it’s “recommended for all trauma populations at all times,” according to the EMDR Institute in Watsonville, California, a professional organization founded by Francine Shapiro. Despite this endorsement, the VA still prefers to employ more conventional exposure therapy.

It’s been four years since her first EMDR session, but Traci Powell continues to get the treatment. On average, she attends therapy twice a week, and does EMDR at one of those sessions. She had hoped for the quick relief she had read about in the research, but she says that she often self-sabotaged early on in the process. She’d be so anxious about revisiting traumatic memories that she’d sometimes refuse to do the eye movements themselves. She chalks up her early resistance to the fact that her PTSD is complex and the result of trauma sustained in childhood.

Though the process has been longer for her than for many of the test subjects EMDR proponents cite, Powell says she’s made more progress in the last six months than in the preceding five years. In fact, she’s become comfortable enough talking about her abuse that she’s built a side career as a mental health advocate and vocal sex abuse survivor, for which she credits EMDR. “You have to work up the courage to step into it,” she told me. “Fear is what holds us back.”

As for me, I’m not a meditation person, but in the days after my RTT session, I diligently listened to my recording. Hearing the practitioner’s voice assure me I was endlessly capable must have clicked some switch, because I did find myself feeling more resilient and energetic. Was it just the collateral benefit of unburdening myself to someone kind and understanding, or some mysterious, fast-acting component of RTT? Like Powell, I may never know for sure.

Author of How to Disappear Completely: On Modern Anorexia. Writes often about religion, literature, and health. kelseyosgood.com

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