EMDR or ART: Which Should You Choose?

by | Dec 21, 2020 | Therapy Modalities | 0 comments

What’s the best way to approach the Eye Movement Desensitization and Reprocessing (EMDR) EMDR vs. Accelerated Resolution Therapy (ART) debate? First, I am not a fan of debating to decide which one is absolutely right and which one is absolutely wrong, or which if one is better than the other. You will see that each therapy has its place in the world of psychotherapy. Full disclosure, I am an EMDR therapist, certified in EMDR, and also, I am an approved consultant and an approved EMDRIA trainer as well as an author, so my world is the EMDR world.

I have been using EMDR since 1998, and in my full-time practice, I have probably administered over 14,000 EMDR sessions in my career. In terms of what I know about ART. I have searched the internet, watched videos, saw a brief documentary, and read the research. Three EMDR colleagues who attended the ART training described ART in surprisingly similar terms; ART is like EMDR lite. (This was a sample size of three.)

Perhaps the uninitiated are unaware of Francine Shapiro’s emphasis on integrating EMDR with other models of psychotherapy. I am a Jungian. Since EMDR is a psychoanalytic process at its core, a fact most people do not know, Jungian psychology and EMDR therapy, when integrated, create a synergistic effect when combined.

EMDR International Association (EMDRIA) has endorsed my thinking and has approved my advanced integrative EMDR course, Integrating EMDR Psychology with Jungian Psychology. Integrating EMDR with other models is part of the EMDR culture. This allows the therapist to be not only effective but creative. 

Shapiro edited the book published by the American Psychological Association, EMDR as an Integrative Psychotherapy Approach. In it, ten experts discuss how they integrate EMDR with each model.

So, in the spirit of rejecting the notion that EMDR is right and ART is wrong or vice versa, let’s examine these two therapeutic interventions. Let’s explore the similarities and differences between these two rapid eye movement therapies. 

This article is not an exhaustive meta-analysis of these two therapies: it’s a blog. Please keep that in mind. Its purpose is for those unfamiliar with each of these models to learn a little about each. Hopefully, to entice the reader to explore them more exhaustively on their own, especially if the reader is considering becoming trained in one or both.

Similarities and Difference

Research shows that ART provides promising results. ART is a short-term treatment requiring two to five sessions without homework—the same with EMDR therapy. The initial EMDR study published in1989 used 22 subjects, with each receiving three sessions, which caused incredible positive results as well, and at that time, set the world of psychotherapy on its head. Shapiro received a great deal of criticism after this study. The waving your hand in front of someone’s eyes, when first introduced, was scoffed at in most academic circles. Fortunately, she persisted. (Shapiro, 1989). 

Differences in Research, Procedure, and Model

Since that first EMDR research study, there have been over 500 additional researched studies done. These EMDR studies addressed an array of populations and diagnoses. Within these 500 studies, around 45 are randomized controlled studies, including ten randomized controlled studies with children. (Randomized Controlled Studies are the gold standard of research.)

More recently, an extensive three-year randomized controlled study was completed in Europe in which EMDR was used to treat depression. This research team won the EMDRIA award for research in 2018 and found EMDR to treat depression effectively. Additionally, there have been numerous neuro-imaging studies of the brain pre and post EMDR treatment resulting in significant normalization of blood flow post EMDR treatment.

Additionally, Springer Publishing, an academic publishing house, publishes The Journal of EMDR Practice, and Research published quarterly–research always continues. ART has also been researched and found to be effective; however, it is a newer therapy. The vastness of EMDR’s research and hundreds of books in the literature about EMDR is more compelling and informing than the limited amount of research that supports ART. The modest amount of research doesn’t mean ART isn’t worth pursuing. It is just a reality. EMDR’s discovery occurred 34 years ago versus ART’s development in 2008.

EMDR endorsed by the World Health Organizations for the treatment of trauma in children and adults. It’s one of only two approved therapies for the treatment of trauma in children. ART has no such endorsement. Over 25 other world health organizations also endorse EMDR therapy (e.g., Department of Veterans Affairs, United Kingdom Department of Health, French national Committee of Mental Health, etc.) In 2016 APA’s Clinical Practice Guidelines for PTSD elevated EMDR from “conditional” recommendation to “strong” recommendation. ART has no such endorsement. 

Some small research studies have been done with ART with promising outcomes. A three-year randomized, controlled study by Chard et al. is being conducted comparing ART’s effectiveness with cognitive processing therapy (CPT), using no therapy wait-list as the control for the treatment of PTSD. The primary outcome measure will be PTSD symptom severity, and the secondary outcome measure will be depression symptom severity. 

There are frontline therapies that have been well-tested and, as previously stated, endorsed by a variety of health organizations around the world. (e.g., CPT, PE, EMDR); thus, patients with PTSD have a chance of doing well using one of these frontline endorsed and heavily researched treatments. ART is not recommended as a frontline therapy, most likely because the research lags behind the positive results that seem to be occurring in clinical settings. 

While ART compares favorably to these other treatments, there are no long-term follow-up studies. History has shown us that medical errors can occur when a treatment is prescribed before adequate long-term studies have been performed. (Howe, E. G., Rosenzweig, L., and Shuman, A.)

Procedure or Model

ART is more like a procedure, much like EMDR was in its early development rather than a comprehensive therapy model. The stimulation is administered while integrating more traditional therapy models like CPT, which is being used in the long-term ART study mentioned above. 

EMDR today is not a procedure, but a comprehensive psychotherapy model made up of the 8-Phases, and 8-Procedural Steps that are viewed through the lens of the three-pronged approach of past, present, and future. It is no longer a procedure but a model. No other models need to be integrated with EMDR for it to be effective. It is a comprehensive free-standing model of psychotherapy, but the integration of another model can be employed.

Even during a session in which bilateral stimulation is not done, sessions in which there is only talk, the EMDR therapist hears this material through the lens of EMDR as a model. So every word is filtered through the EMDR model. Bilateral stimulation is only a small part of what EMDR Therapy is today.

One should also understand that employing bilateral stimulation in general, whether researching REM sleep or rapid eye movement therapies, is that any bilateral stimulation of a distressing image results in a reduction of image vividness and emotionality. This happens just by using bilateral stimulation outside the structure of any model or procedure. Andrade, J., Kavanaugh, D., and Baddeley, A., (1997); MacCulloch & Feldman (1996); Sack, et al. (2007); Elofsson et al., (2008); Sack et al., (2008); Stickhold, 2002 & 2008. 

Similarities

ART uses the psychotherapeutic practices of imaginal exposure and imagery re-scripting (IR) facilitated through sets of eye movements. EMDR therapists have employ this strategy since its inception. Without exception, the EMDR clinician develops a concise troubling image and asks the client, “What would you like to think about the situation (the distressing event) that is adaptive?” 

It would be misleading to let anyone sway you toward ART vs. EMDR by claiming that one works faster than the other or that one requires homework, and the other does not. Both of these rapid eye movement therapies offer these two fundamental benefits. We previously discussed the first EMDR research study that employed three therapy sessions and provided incredible results, while ART recommends two-five sessions. 

Homework is not part of either model. Homework is mentioned because many research studies over the past decades have compared EMDR to prolonged exposure therapy because they were the two most effective treatments available at that time. Exposure therapy does require homework, while EMDR and ART do not require homework. (Foa & Rothbaum, (1998); Shapiro, (1997, 2003, 2018).

Only patients who have experienced a single episode event will benefit from a short term treatment model that both EMDR and ART can provide. EMDR, however, can be used for comorbid diagnoses often caused by chronic abuse or more severe diagnoses like Dissociative Identity Disorder (formerly known as multiple personality). These more complex cases cannot be treated in three sessions and to suggest that they can is not true. Some of these chronic diagnoses can take years, even with the accelerated nature of these eye movement therapies. ART does not seem to treat these more complex cases and focuses more on single episode events or clustered events around the targeted event. EMDR has no such limitation.

ART is More Directive than EMDR 

A novel component of ART is the use of IR to “replace” negative imagery (and other sensations) with positive imagery in a directive manner. EMDR employs a similar component; however, it does not impose a positive image or script. As previously stated, EMDR has psychoanalytic elements at its core, so directing the client is avoided.

Another important tenet of EMDR is self-healing, thus trusting that the answer is within the client and not within the therapist. The self-healing element further reinforces the psychoanalytic approach, where the therapist trusts the client’s unconscious, not theirs. The EMDR therapists allow the psyche to heal itself and find its own adaptive script. Although the adaptive image is explored before the stimulation begins, the therapist trusts the process to get to where the client finds solace. The therapist’s job is to allow this to happen. The prepared adaptive material established at the outset is permitted to change; in fact, change is preferred. The therapist takes an entirely hands-off approach unless assistance is needed.

EMDR allows the positive image to emerge after the client has EMDR. It is less directive than ART.

Is ART easier to learn than EMDR?

The answer to this question is yes. ART in its infancy and is developing. It is more of a procedure than a comprehensive model of therapy. The original training manual for EMDR training was approximately 50 pages. The EMDR Educators manual for the 5-day training today is 350 pages with over 100 citations. Of course, a procedure is much easier to learn than a comprehensive model. One is not better than the other; it depends on what you are looking for as a clinician. If you want a new tool for your toolbox, ART would be the right choice. If you are looking for a new model that is a more significant endeavor, EMDR would require a closer look.

ART is probably easier to learn.

Other Differences Between ART and EMDR

  • ART uses a set number of eye movements, whereas EMDR numbers vary based on the EMDR therapist’s skill in tracking the client’s response to the stimulation.

  • ART focuses on emotions. EMDR focuses on nothing but instead allows whatever wants to happen to happen, to happen. The word focus is never used in EMDR therapy except in the most limited form of EMDR therapy known as EMD. Besides this most restricted form, EMDR instructs the client to allow thoughts, feelings, images, memories, and body sensations to manifest; in other words, anything can happen. It should be stated that there are strategies to manage the processing, but they are only employed if needed.

  • Some ART practitioners have the idea that EMDR causes trauma or retraumatizes clients. 

This is not true. It is probably based on a misunderstanding of what EMDR actually is and does. The endless endorsements of the World Health Organizations would not endorse a treatment that harms patients. Those who promote this idea are misinformed and sadly can do damage by spreading this misinformation to professionals who may be seeking training in a eye movement therapy.

Like all misinformation this is based on a kernel of truth and twisted into an enormous lie. Let’s unpack this piece of misinformation. In the early days of EMDR, the process was only done in an unrestricted manner, and a few clients needed to be hospitalized because there were limited safeguards in place. By the early 90s, Phase Two, the preparation phase was expanded. Today some courses focus only on Phase Two, resource building for the client teaching them to management affect.

  • Protocol development manages how little or how much information is processed in a session. Over the years, dozens of strategies are available to expand or limit the amount of psychological material that processes in a session. 

  • One such adjustment is EMDr, which is a way to limit EMDR processing. Within EMDR’s Basic Training, EMDr is taught, EMDr limits processing to a single event and material connected to that event. (Keissling, 2013, 2018) Basically, EMDr is very similar to ART. 

  • EMDR treatment can be administered on a continuum from very restricted process to completely unrestricted and choices in between. There is not just one way to design an EMDR session. So, any criticism that states EMDR traumatizes clients is completed unfounded and based on ignorance. The EMDR therapist can employ an extremely limited process called EMD, which only permits the processing of a single image, then a little more material can be processed with the EMDr. Then completely unrestricted processing is the original way EMDR was administered, which is what most people think of EMDR. Within EMDR, the negative cognition design can also limit or expand processing. The clinician has at least six strategies to choose from to manage processing from very restricted to not restricted at all.

So, the notion that EMDR traumatizes clients is not true. It is a ridiculous on its face.

If you are going to spend your money on these expensive but worthwhile trainings, perhaps these thoughts might help you decided. I am, of course, biased but encourage you to explore both models on your own if you are considering an eye movement therapy training. 

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