Introduction: The Rise of Power Therapies

In the 1980s, several novel psychotherapeutic techniques were proposed for the rapid cure of post-traumatic stress disorder (PTSD). At the forefront of these “power therapies” was Eye Movement Desensitization and Reprocessing (EMDR), a method developed by Francine Shapiro (1948–2019) and still commonly used today.

Shapiro reported a 100 percent success rate treating trauma memories with multi-saccadic eye movements, and she assured clinicians who read her report that they could use eye movements to “achieve complete desensitization of 75–80% of any individually treated trauma-related memory in a single 50-minute session.” Shapiro then offered workshops that introduced her treatment to thousands of clinicians. Over time, EMDR came to enjoy the sun of scientific endorsement.

Questionable Origins

How a narrative begins influences what we subsequently come to understand, and thus we consider how EMDR first emerged. According to Shapiro, the therapeutic powers of rapid eye movements were discovered in May 1987, while she was walking in a park.

Shapiro’s account is inherently suspect, because people are generally oblivious of eye movements, particularly saccadic movements. Any such awareness is almost exclusively limited to situations of voluntary intention to shift the eyes from one point to another. There also is a deeper problem if one stops to ask why Shapiro focused on eye movements in the first place; after all, feelings of calm can be evoked by walking in a park because of the fresh air, flowers, the benefits of outdoor exercise, and being away from the bustle of life.

The NLP Connection

As it turns out, Shapiro already had a reason to be thinking about eye movements: prior to her now-famous walk, she was a devotee of neurolinguistic programming (NLP). In a 1985 interview, Shapiro expressed the view that NLP was “the most powerful vehicle for personal and social change in existence.” In an article, Shapiro advanced the idea that NLP’s “super-achievers” technologies empowered people to tap into unlimited sources of personal power so they could, for example, walk across burning coals.

Shapiro’s article also made clear that she understood the high importance that NLP theory placed on eye movement patterns:

Primed by her acceptance of NLP theory, Shapiro was ready to advance a belief in the therapeutic powers of eye movements. At the same time, she avoided acknowledging this influence, perhaps wanting to distance herself from those who viewed NLP as pseudoscience or perhaps hoping to obscure her intellectual indebtedness to others.

Shapiro’s Dissertation

Shapiro applied her claimed discovery of eye movement patterns to a doctoral dissertation that she completed in 1988. Here it is useful to provide more context to appreciate Shapiro’s circumstances and her thoughts about science. From 1981 to 1988, she was enrolled at the Professional School of Psychological Studies, an unaccredited program in San Diego described as a diploma mill.

During those seven years of working on her advanced degree, Shapiro launched New Age Health Services to sell wellness products, the Human Development Institute through which she offered NLP workshops, and MetaVox, whose lofty mission was to recruit the country’s most powerful speakers.

In her 1985 article, Shapiro promoted her NLP workshops, enthusiastically writing that “In NLP, the key is that since people share the same neurological system, responses are predictable, verifiable, and repeatable. In other words, Neuro-Linguistic Programming is scientifically rather than merely theoretically based.”

The National Academy of Sciences Assessment

As to the question of NLP being scientifically based, the National Academy of Sciences examined the potential value of these emerging claims. In their analysis, the Committee paid considerable attention to the fact that NLP had many enthusiastic supporters. They noted that people are highly influenced by testimonials of success, but following the scientific method is essential for winnowing the real from the illusory.

After reviewing decades of human enhancement research and their own studies, they concluded that “there is little or no empirical evidence to date to support either NLP assumptions or NLP effectiveness.”

Flawed Study Design

In the context of her business enterprises and academic pursuits, Shapiro conducted a dissertation study in which twenty-two patients diagnosed with PTSD received the newly discovered eye movement procedure or a control condition while imagining a trauma related memory. Change was measured with pre- and post- ratings of subjective stress.

Shapiro reported that 100 percent of participants who engaged in eye movements were completely desensitized to the targeted trauma memory, whereas control subjects reported little improvement or increased stress. Shapiro’s study was so poorly designed that one is left wondering if it would have qualified her for a PhD at an accredited university.

The control group in Shapiro’s study checked all the boxes discussed by Cuijpers and Cristea in their article “How to Prove That Your Therapy Is Effective, Even When It Is Not: A Guideline.” Participants in the treatment group engaged in sets of eye movements while imagining a trauma image, holding a positive cognition, and taking deep breaths. Participants in the control condition engaged in a frank discussion of the traumatic event absent any other treatment component or provision of support. Perhaps not surprisingly, six of the eleven control subjects experienced an increase in distress after recounting their traumatic experience.

Shapiro believed she had conducted a well-designed randomized controlled trial (RCT), and she submitted her study to the Journal of Traumatic Stress. The primary reviewer pointed out various flaws to the journal’s editor, who repeatedly asked Shapiro for revision and the reviewer for reconsideration. Eventually, the reviewer “just gave up,” and Shapiro’s paper was published, fatal flaws and all.

In her discussion of her findings, Shapiro rejected the influence of experimenter bias based on “the sheer magnitude” of observed effects. An equally reasonable conclusion would be that the sheer magnitude of reported findings was the very proof of extraordinary experimenter bias and demand effects.

Shapiro’s Responses to Negative Findings

A pattern emerged of Shapiro rejecting clinical and research findings as multiple publications failed to support her extraordinary claims of success. When several case failures were reported, Shapiro’s response was to blame the clinicians for not having obtained required levels of training. She cautioned, “clients can be at risk if untrained clinicians attempt EMDR” and revised her earlier assurances that clinicians could succeed merely by reading her 1989 article.

A year later, Jensen found that EMDR was not effective in treating veterans diagnosed with PTSD, after which Shapiro criticized him for being half-trained. As explained by Shapiro, Jensen had attended a Level I workshop but not Level II. Shapiro observed: “Such a lack of concern for standards of validity—both by the researcher and the published research reviewers—do a great disservice to the profession.”

When leveling this attack, Shapiro failed to take into account that at the time of Jensen’s study, only one workshop was the standard: there were no Levels I and II. In fact, Shapiro had sent Jensen—and, we assume, other workshop participants—a congratulatory letter that thanked him for caring enough to take the specialized training. Here Shapiro had created an impossible situation for researchers: demanding treatment fidelity on the one hand while changing training requirements on the other.

Changing Procedures and Theories

Shapiro also changed procedures and theories, at times conveniently accommodating negative data. For example, Pitman et al. assessed the contribution of eye movements for the treatment of veterans with PTSD. Participants were assigned to standard EMDR or to an “eye-fixed” procedure that included finger tapping as a control for activity. Contrary to the central role Shapiro gave to eye movements, Pitman and his colleagues reported no significant between-group differences.

At about the same time Pitman was collecting and analyzing his data, Shapiro began to propose that multiple forms of bilateral stimulation, rather than eye movements per se, accounted for EMDR’s effectiveness. Thus, therapists could snap fingers, tap on a patient’s knees, or employ bilateral audio stimuli, and they would still be practicing EMDR.

Shapiro’s Search for an Underlying Mechanism

Shapiro strived to find a science-based explanation that could lend credence to the notion that eye movements were an active ingredient contributing to treatment outcome. At first, she emphasized the notion of adaptive information processing and the “opening of an information processing ‘block’ caused by neural pathology.”

After proposing alternative forms of bilateral stimulation, Shapiro advanced the idea of interhemispheric communication. In a stinging rebuke of these theories, Lohr declared that Shapiro was advancing “little more than jargon” and “an embarrassing form of cognitive-neuro-pseudo-science.” As was the case with NLP, ill-conceived neuropsychological concepts did not assure scientifically sound theory.

Working Memory Hypothesis

A more recent attempt to explain the presumed therapeutic power of eye movements has focused on the hypothesis that dual tasks will tax working memory, thereby reducing the emotionality and vividness of imagery. While this explanation sounds science-based, the application of a working memory framework to EMDR rests on weak studies that have assessed nonclinical participants who focused on a single upsetting memory.

These analogue studies also yield inconsistent results. For example, Englehard et al. predicted that passive dual tasks that barely tax working memory (e.g., listening to beeps, finger tapping) should obtain fewer benefits than active tasks (e.g., eye movements). The authors cited publications in support of this prediction but ignored other studies that found no significant differences between eye movements and less taxing conditions.

Purple Hat Therapy Concept

EMDR appeared during a time when PTSD was a relatively new diagnosis, remission of post-traumatic symptoms was difficult to achieve, and enormous resources were being spent on treatment. These circumstances likely combined with Shapiro’s strident efforts to promote eye movements as a rapid cure for PTSD.

Looking at those efforts, it is almost as if Shapiro were applying the very NLP super-achiever technologies about which she had written back in 1985. Under the banner of a breakthrough discovery and pseudoscientific jargon, Shapiro packaged a nonessential novel technique (e.g., sets of bilateral stimulation) along with techniques that were already shown to be effective—exposure and imagery-based methods. Rosen and Davison called this type of treatment package a “purple hat therapy.”

Shapiro’s purple hat therapy had great success. She then directed the narrative: she pushed extraordinary claims, shifted her theories, taught ever more complicated methods, and insisted on treatment fidelity that required higher levels of training.

Concluding Observations

Despite its controversial history, numerous studies supported EMDR, and it came to be recognized as an effective and evidence-based treatment (e.g., by the American Psychiatric Association and the International Society for Traumatic Stress Studies). These endorsements are viewed not as testament to the therapeutic powers of eye movements but as indicants of just how deficient current criteria are for defining what it means to be an evidence-based treatment.

This scenario has become a reality as evidenced by an ever-expanding list of competing eye movement therapies, each with its own preferred pattern and claims of cure. In the spirit of perfecting how best to tax working memory, proponents of these methods have even gone so far as to shout “Whoosh!” after a set of eye movements.

The antidote for this developing madness is a science-based framework in which the burden of proof falls on those who promote novel claims. Whatever accounts for EMDR’s acceptance to this day, there is still no compelling reason nor science-based mechanism to justify therapists waving fingers in front of their patients’ eyes. The extraordinary evidence just isn’t there.

What is EMDR Therapy?

EMDR (Eye Movement Desensitization and Reprocessing) therapy is widely recognized as a treatment aimed at alleviating psychological stress from traumatic memories. Developed in the late 1980s by Francine Shapiro, EMDR was introduced as a “power therapy” promising rapid results for post-traumatic stress disorder (PTSD) symptoms through the use of eye movements.

Shapiro claimed a high success rate in desensitizing trauma memories within single therapy sessions, which spurred widespread adoption and training in the method. However, the origins and effectiveness of EMDR have been subjects of debate. Critics highlight that while EMDR incorporates effective cognitive and behavioral elements, the specific role of eye movements—its defining feature—remains controversial.

They argue that the scientific endorsements of EMDR often overlook the need for extraordinary evidence to support extraordinary claims, as emphasized by Carl Sagan’s “extraordinary evidence” standard. The therapy’s foundation on eye movements was serendipitously discovered by Shapiro during a walk, yet this aspect has faced scrutiny.

Skeptics suggest that the calming effects attributed to eye movements might instead be incidental to general relaxation experienced from walking outdoors. Furthermore, Shapiro’s engagement with neurolinguistic programming (NLP) before developing EMDR raises questions about the scientific grounding of her approach.

As EMDR continues to be a popular therapy, it is important for potential clients and clinicians to critically assess the evidence supporting its use, particularly the mechanisms purported to underlie its effectiveness. This balanced examination helps ensure that therapeutic practices are not only popular but also scientifically validated.