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Randomized Controlled Trial

Edible Bilateral Fixation Targets in Eye-Movement Desensitization and Reprocessing: Margherita-Right, Capricciosa-Left Saccadic Tracking Shortens Phase 4 Threefold and Reduces Body Mass — A Randomized Controlled Trial

Nelya Katsarava1,2

  1. 1Institute of Applied Reprocessing, Edible Fixation Unit
  2. 2Centre for Gastronomic Desensitization, Kept-Warm Division

Journal of Appetitive Reprocessing. 2026;4(3):e0144-e0162.

PMID: 81960726 · DOI: 10.1069/satire.2026.0037

Received 2025 Dec 8 · Accepted 2026 Feb 4 · Published 2026 Feb 24

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Abstract

Background: Phase 4 of Eye-Movement Desensitization and Reprocessing (EMDR), desensitization, depends on a neutral bilateral fixation target, conventionally the clinician's finger, which engages the patient only as much as a finger can. We hypothesized that a salient, appetitive target would raise saccadic velocity and attentional engagement, thereby accelerating Phase 4, and evaluated two warm pizzas as bilateral fixation points.

Methods: In a randomized controlled trial, adults in active EMDR (n = 64) were assigned to standard finger-tracking or to Bilateral Appetitive Fixation (BAF): a Margherita placed at 30° to the right and a Capricciosa at 30° to the left, both warm and uneaten, the patient instructed to alternate gaze between them at a brisk tempo. The pre-registered primary endpoint was Phase 4 duration; secondary endpoints were Subjective Units of Distress (SUDS; 0–10) reduction and change in body mass at 8 weeks. Two participants who ate a fixation target were excluded; one who swapped the pizzas, inverting the configuration, was analysed separately.

Results: BAF shortened Phase 4 threefold (mean 42 to 14 minutes; p < 0.049, barely) and produced greater SUDS reduction than finger-tracking (Δ = −2.6). Saccadic velocity was higher toward the Capricciosa, scaling with topping count (r = 0.94), suggesting salience is carried by the toppings. Unexpectedly, BAF participants lost weight (mean −3.1 kg) across eight weeks spent looking rapidly at warm pizza they were not permitted to eat — attributable to sustained appetitive exposure without consummation and to the cardiovascular cost of brisk bilateral saccades. The participant who swapped the pizzas reprocessed nothing and gained 0.4 kg.

Conclusion: Substituting two pizzas for the neutral fixation point accelerates desensitization threefold and incidentally reduces body mass, at the cost of a sustained low-grade craving the protocol designates 'therapeutic.' We recommend the Margherita-right, Capricciosa-left configuration; the laterality of toppings, and whether the patient should ever be allowed to eat the target, warrant further study.

Keywords: EMDR; Desensitization; Bilateral Stimulation; Appetitive Fixation; Weight Loss.

Figures

(down) Time since publication Citations
Figure 1.Phase 4 duration across sessions, finger-tracking versus Bilateral Appetitive Fixation. The lower curve is the pizza; the gap is desensitization the finger could not hurry.
r = 0.97 Donations (a.u.) Awakening (a.u.)
Figure 2.Saccadic velocity versus topping count. The fit is too clean to be appetite and too consistent to be anything but the Capricciosa.

Full text

A more interesting finger

Standard EMDR asks the patient to track a finger, an object with no particular reason to be looked at. Phase 4 is correspondingly slow: the eyes move because they are told to. We replaced the finger with two warm pizzas, placed left and right, and the eyes began to move because they wanted to. The desensitization that followed was, on every measure, faster.

The weight nobody prescribed

We had powered the trial for Phase 4 duration and SUDS. The −3.1 kg was an accident of the design: eight weeks of looking quickly at food one is forbidden to eat turns out to be both an attentional exercise and a dietary one. We report it as a secondary outcome and a cautionary one.

Limitations

The cohort was modest (n = 64), the targets were not blinded — a pizza cannot be — and the single participant who swapped the Margherita and the Capricciosa demonstrated that the configuration is directional and that the effect can be undone by lunch. Whether a patient who is eventually permitted to eat the target retains the benefit is unknown, and the pizzeria has asked us not to find out.

Conflict of Interest Statement
N. Katsarava holds a standing order at the pizzeria that supplied every fixation target and confirms the targets were reimbursed but not, by protocol, consumed. The author reports an unrelated and ongoing preference for the Capricciosa, which she does not consider to have biased the saccades, only the conclusion.
Funding
Supported by a neighbourhood pizzeria (Grant No. DUE-PIZZE-30). The funder supplied the targets fresh for each session and asked only that they be returned uneaten, which proved the harder condition.
Ethics Statement
Approved by an institutional review board that reviewed the protocol before lunch and declined to revisit it after. Informed consent was obtained while participants were hungry; the targets were kept warm throughout, which the board flagged as coercive and approved anyway.

Cite

Katsarava N. (2026). Edible Bilateral Fixation Targets in Eye-Movement Desensitization and Reprocessing: Margherita-Right, Capricciosa-Left Saccadic Tracking Shortens Phase 4 Threefold and Reduces Body Mass — A Randomized Controlled Trial. Journal of Appetitive Reprocessing. 2026;4(3):e0144-e0162. https://doi.org/10.1069/satire.2026.0037

References

  1. Katsarava N. The clinician's finger as a fixation target of minimal salience. J Appetitive Reprocess. 2025;3(2):e0121.
  2. Anon. Saccadic velocity as a function of target desirability. Ocular Motiv Stud. 2025;4(1):e0041.
  3. Katsarava N. Phase 4 duration and why it resists shortening. Desensitization Q. 2025;3(3):e0033.
  4. Anon. Appetitive exposure without consummation: a weight-management paradox. J Restrained Eating. 2026;1(1):e0003.
  5. Katsarava N. Margherita versus Capricciosa: a laterality of toppings. Bilateral Gastron. 2025;5(5):e0055.
  6. Anon. The cardiovascular cost of brisk bilateral saccades. Exerc Ophthalmol. 2025;6(2):e0061.
  7. Katsarava N. Two participants who ate the target: an exclusion narrative. Protocol Lett. 2026;1(1):e0009.
  8. Anon. Keeping the fixation target warm: fidelity or coercion? Ethics Reprocess. 2025;7(7):e0077.
  9. Katsarava N. The participant who swapped the pizzas and reprocessed nothing. Case Reprocess. 2026;1(1):e0001.
  10. Anon. Topping count as a salience metric: validation across nine pizzas. Methods Salience. 2025;8(8):e0088.
  11. Katsarava N. The standing order and the conflict it did not declare in time. Disclosure Lett. 2026;2(1):1-4.
  12. Anon. Brisk-tempo tracking and the −3.1 kg nobody had budgeted for. Incidental Outcomes. 2025;6(2):e0062.
  13. PubMedLie Editorial Office. Disclaimer: this is satire.
  14. Katsarava N. Returning the target uneaten: the harder experimental condition. Compliance Stud. 2026;2(1):1-2.
  15. Anon. Therapeutic craving: reclassifying a side effect as an endpoint. Reframe J. 2025;9(1):1-9.
  16. Katsarava N. Whether the patient should ever eat the target: an open question. Editorial. 2026;2(1):1-2.