Research Review: Comparing EMDR and CA
If you’re familiar with trauma therapy, you’ve likely heard of Eye Movement Desensitization and Reprocessing (EMDR), a widely recognized approach designed to alleviate trauma symptoms. However, a newer therapy model, Constructed Awareness (CA) has emerged, bringing a fresh perspective to trauma treatment. A recent peer-reviewed journal article compared the effectiveness of these two methods, suggesting that CA may offer some distinct benefits. The purpose of this blog is to provide details about that comparative study. Let's dive into what makes CA different and how it measured up to EMDR.
EMDR: The Established Trauma Therapy
EMDR was developed in 1987 by Francine Shapiro after she noticed that her eye movements helped reduce distressing emotions tied to traumatic memories. Now backed by decades of research, EMDR has become a widely recognized and established treatment for trauma. It’s based on the Adaptive Information Processing (AIP) model, which suggests that unprocessed traumatic memories are at the root of many emotional and psychological issues. Bilateral stimulation—such as eye movements, tapping, or sound—is used to activate memory networks and help process traumatic memories. The goal is to integrate these memories into the brain’s adaptive network, reducing symptoms like anxiety, depression, and PTSD.
Constructed Awareness: A New Way to Treat Trauma
CA is a relatively new model designed to enhance how clients process trauma, focusing on helping clients become more aware of their thoughts, body sensations, and external environment—what CA calls the three building blocks of human experience. The idea is that by improving awareness of these building blocks, clients can better regulate their emotions and heal from trauma.
CA works through two main phases:
Resourcing Phase: Clients develop awareness of how their reality is constructed through the building blocks—thoughts, sensations, and external stimuli. The therapist helps the client identify which building block they orient toward most strongly, allowing for more tailored support to strengthen the other building blocks so the client has equal access to all three.
Reconstructing Phase: The therapist guides clients through a more focused and systematic process called Memory Reconstructing, which is designed to desensitize disturbing material by engaging all building blocks in a process called tuning. Tuning involves helping clients shift their focus between thoughts, sensations, and external stimuli, enabling them to process traumatic memories without feeling overwhelmed. This allows the client to confront and explore the distressing memory while staying connected to the present.
The Study: CA vs. EMDR
In a recent study, 30 participants experiencing trauma-related symptoms were randomly assigned to receive either EMDR or CA. To compare the effectiveness of these methods, the researchers used Mann-Whitney U tests, a nonparametric statistical test appropriate for small sample sizes and ordinal data. The goal was to see which model was more effective at:
Reducing trauma symptoms like intrusive thoughts, disturbing memories, anxiety, etc.
Reducing physical conditions like chronic pain linked to trauma,
Desensitizing disturbance when recalling traumatic memories.
Participants attended three therapy sessions, and researchers used three assessment tools to measure outcomes: the Trauma Symptom Checklist-40 (TSC-40), the Central Sensitization Inventory (CSI), and the Subjective Units of Disturbance Scale (SUDS).
The Results: How CA Outperformed EMDR
In the study, CA participants showed greater improvements across all three measures compared to those receiving EMDR. The results were statistically significant, with p-values below 0.05, indicating a high likelihood that the differences in results between CA and EMDR were not due to chance:
Trauma Symptoms: CA participants experienced a more significant reduction in trauma symptoms, with their scores on the TSC-40 dropping from 50 (pretest) to 23 (posttest; a 27-point reduction), compared to a 16-point reduction from 47 to 31 for EMDR participants.
Central Sensitization: CA also outperformed EMDR in reducing symptoms of central sensitization, such as chronic pain and fibromyalgia. CA participants’ scores on the CSI dropped 24 points from 49 to 25, while EMDR participants saw a more modest four-point decrease, from 42 to 38.
Disturbance Levels: In terms of how disturbed participants felt after processing traumatic memories (measured by SUDS), CA participants reported a significant eight-point reduction, from a level of 8 to 0, compared to EMDR participants, who experienced a five-point decrease from 7 to 2.
Why CA May Offer Greater Benefits
Though both groups benefited from CA and EMDR, CA pulled ahead of EMDR by the end of the study. Several factors could explain CA’s stronger performance. First, CA uses tuning while EMDR uses bilateral stimulation. CA’s tuning technique, which shifts focus between thoughts, sensations, and external stimuli, may offer a more flexible and tailored experience compared to EMDR’s bilateral stimulation. Second, CA takes a more holistic approach: CA’s focus on integrating thoughts, sensations, and external stimuli creates a comprehensive framework for processing trauma, helping clients engage with all parts of their experience. Finally, CA's tuning technique also teaches clients how to shift awareness between different elements of their experience, promoting self-regulation and helping them process trauma more effectively.
What Does This Mean for Trauma Therapy?
While EMDR is already a highly effective and well-established treatment for trauma, CA could offer a new way forward for clients who need a more custom-made and holistic approach. By focusing on increasing self-awareness and self-regulation, CA may be better suited for clients dealing with complex trauma or trauma-related physical conditions.
Looking Ahead: Limitations and Future Research
Although the results of this study are promising, there are a few limitations to consider. The sample size was relatively small (30 participants), and the study lacked demographic diversity, with most participants identifying as white/Caucasian. Future research should aim for larger, more diverse samples to determine whether CA’s effectiveness holds across different populations and specific trauma types.
That said, CA has the potential to become a valuable model for trauma therapists, especially for those looking for an approach that emphasizes self-awareness, holistic healing, and emotional regulation.
Final Thoughts
In this comparison of two trauma therapy models, CA showed superior outcomes in reducing trauma symptoms, chronic pain, and emotional regulation. While EMDR remains a trusted and effective method for treating trauma, CA offers a fresh, innovative approach that may benefit clients who need a more nuanced and structured way of processing traumatic memories.
If you’re interested in reading the full article, you can access it here:
https://www.tcacounselors.org/assets/Volume%209%20Number%201%202024.pdf