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Asked by Marina Silver, New York
I have been seeing a therapist for the past four months now. In that time she had diagnosed me with depression with symptoms of [Obsessive Compulsive Disorder]. She suggested I try medication but looking online I found a therapy called EMDR. I was wondering which is more effective: talk therapy plus medication or EMDR? I have never been on any type of antidepressants but I do have a history of various traumatic experiences. (I may have [post-traumatic stress disorder] as well).
Mental Health Expert
Dr. Charles Raison
Psychiatrist,
Emory University Medical School
Dear Marina:
Your question is a good one, and unfortunately I cannot give you a definitive answer based on the very brief amount of information you have provided about your condition.
Before addressing the possibilities let me briefly catch our readers up to speed on EMDR, which stands for "eye movement desensitization and reprocessing." This rather complex therapeutic intervention incorporates a number of elements common to a number of cognitive behavioral approaches, but in addition includes a unique practice of having patients hold in mind an image of a traumatic event in their lives while simultaneously tracking the therapist's finger as it moves back and forth across the patient's visual field. The combination of the mental activity and the external stimulus is believed to aid in reprocessing traumatic memories in ways that reduce their pain and damage to a person's life.
This brief description doesn't do justice to the complexities of the procedure. The EMDR Institute hosts agood website for obtaining more information. Despite a number of randomized clinical trials suggesting that EMDR is at least as effective as other commonly accepted therapies for traumatic disorders (i.e. such as post-traumatic stress disorder), it still viewed as a bit of a fringe procedure by many in the mental health field. On the other hand, it has deeply committed adherents who approach the procedure with an almost religious zeal. This dichotomy of opinion makes assessing EMDR more difficult than it would be otherwise, especially for a nonexpert in the practice, such as I.
To answer your questions I reviewed a fair amount of scientific literature on EMDR. Here is my sense of things:
It has pretty credible data as a treatment for PTSD. It does not have much hard evidence as an evidence for either major depression or obsessive compulsive disorder. This does not mean that it does not work for these conditions, only that we don't know whether it does.
So in your case, if you want to move forward based on our best scientific evidence, your course of action might be best determined by what you consider to be your most pressing problem. If you are most distressed by OCD, for example, the best demonstrated treatments are antidepressant medications (and selective serotonin reuptake inhibitors in particular) and a form of psychotherapy called response extinction. For depression, best evidence supports the use of either cognitive behavioral or interpersonal therapy in the behavioral realm and antidepressants in the realm of pharmacology.
On the other hand, if traumatic memories are your most distressing symptoms, it might make sense to commence your treatment with EMDR and then engage in other elements to cope with what is "left over." Let me emphasize that these options are not mutually exclusive, and if you have the means to do so, there is no reason why you cannot engage in any and all of them if this turns out to be useful for you. The specifics of each individual's situation differ, but a constant is that all mental conditions are best treated by thorough eradication of all symptoms. How you get to this point of remission is probably less important than getting there.
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