|
| |
- " EMDR has been listed as an effective treatment by the American Psychiatric Association, Departments of Defense and Veterans Affairs, International Society for Traumatic Stress Studies, and numerous international agencies. See list below.
- More than a dozen controlled clinical trials support the use of EMDR
for trauma such as that resulting from natural disaster, and EMDR has been
used successfully to treat war- and terrorism-related trauma.
- With little modification, EMDR has been used successfully in response
to a variety of mass-casualty events, and can be integrated with
educational formats.
- EMDR has an impact on intrusive imagery (such as nightmares and
flashbacks), numbing, and hyperarousal symptoms of PTSD, as well as on
associated grief and depression.
- In several direct comparisons with cognitive-behavioral therapy, EMDR
offers equivalent effects more quickly (fewer sessions or no homework),
process analyses indicate less distress for individuals undergoing treatment.
International Treatment Guidelines
Meta-analyses
Randomized Clinical Trials
Non Randomized Studies
Adaptive Information Processing, and EMDR Procedures
Mechanism of Action
Randomized Studies of Hypotheses Regarding Eye Movements
Additional Psychophysiological and Neurobiological Evaluations
-
American Psychiatric Association (2004).
Practice Guideline for the Treatment of Patients with Acute Stress
Disorder and Posttraumatic Stress Disorder. Arlington, VA: American
Psychiatric Association Practice Guidelines
SSRI’s, CBT, and EMDR recommended as first-line
treatments of trauma.
-
Bleich, A., Kotler, M., Kutz, I., & Shalev,
A. (2002) A position paper of the (Israeli) National
Council for Mental Health: Guidelines for the assessment and professional
intervention with terror victims in the hospital and in the community.
Jerusalem, Israel.
EMDR is one of only three methods recommended for
treatment of terror victims.
-
Chambless, D.L. et al. (1998).
Update of empirically validated therapies, II. The Clinical Psychologist,
51, 3-16.
According to a taskforce of the Clinical Division
of the American Psychological Association, the only methods empirically
supported (“probably efficacious”) for the treatment of
any post-traumatic stress disorder population were EMDR, exposure
therapy, and stress inoculation therapy. Note that this evaluation
does not cover the last decade of research.
-
CREST (2003).
The management of post traumatic stress disorder in adults.
A publication of the Clinical Resource Efficiency Support Team of
the Northern Ireland Department of Health, Social Services and Public
Safety, Belfast.
EMDR and CBT were stated to be the treatments
of choice.
-
Department of Veterans Affairs & Department of
Defense (2004) VA/DoD Clinical Practice Guideline for the
Management Of Post-Traumatic Stress. Washington, DC. Veterans
Health Administration, Department of Veterans Affairs and Health Affairs,
Department of Defense. Office of Quality and Performance publication
10Q-CPG/PTSD-04.
EMDR was placed in the "A" category as "strongly
recommended" for the treatment of trauma.
-
Dutch National Steering Committee Guidelines Mental
Health Care (2003). Multidisciplinary Guideline Anxiety Disorders.
Quality Institute Heath Care CBO/Trimbos Intitute. Utrecht, Netherlands.
EMDR and CBT are both treatments of choice for PTSD
-
Foa, E.B., Keane, T.M., & Friedman, M.J. (2000).
Effective treatments for PTSD: Practice Guidelines of the International
Society for Traumatic Stress Studies New York: Guilford Press.
EMDR was listed as an effective treatment for
PTSD with further research needed for an “A” rating. Such
research has now been completed and the proposed revised Practice
Guidelines (posted 2007) have given EMDR an “A” rating
for chronic adult PTSD.
-
INSERM (2004). Psychotherapy: An evaluation
of three approaches. French National Institute of Health and Medical
Research, Paris, France.
EMDR and CBT were stated to be the treatments of choice
for trauma victims.
-
National Institute for Clinical Excellence (2005).
Post traumatic stress disorder (PTSD): The management of adults
and children in primary and secondary care. London: NICE Guidelines.
Trauma-focused CBT and EMDR were stated to be empirically
supported treatments for choice for adult PTSD.
-
Therapy Advisor (2004): www.therapyadvisor.com
An NIMH sponsored website listing empirically supported
methods for a variety of disorders. EMDR is one of three treatments
listed for PTSD.
-
United Kingdom Department of Health. (2001).
Treatment choice in psychological therapies and counselling evidence
based clinical practice guideline. London, England.
Best evidence of efficacy was reported for EMDR, exposure,
and stress inoculation
EMDR has been compared to numerous exposure therapy protocols, with
and without CT techniques. It should be noted that exposure therapy
uses one to two hours of daily homework and EMDR uses none. The most
recent meta-analyses are listed here.
-
Bisson, J., & Andrew, M. (2007). Psychological
treatment of post-traumatic stress disorder (PTSD). Cochrane Database
of Systematic Reviews 2007, Issue 3. Art. No: CD003388. DOI:
10.1002/14651858. CD003388.pub3.
“Trauma focused cognitive behavioural therapy and eye movement
desensitisation and reprocessing have the best evidence for efficacy
at present and should be made available to PTSD sufferers.”
-
Bradley, R., Greene, J., Russ, E., Dutra, L.,
& Westen, D. (2005). A multidimensional meta-analysis of psychotherapy
for PTSD. American Journal of Psychiatry, 162, 214-227.
EMDR is equivalent to exposure and other cognitive
behavioral treatments and all “are highly efficacious in reducing
PTSD symptoms.”
-
Davidson, P.R., & Parker, K.C.H. (2001).
Eye movement desensitization and reprocessing (EMDR): A meta-analysis.
Journal of Consulting and Clinical Psychology, 69, 305-316.
EMDR is equivalent to exposure and other cognitive
behavioral treatments.
-
Maxfield, L., & Hyer, L.A. (2002). The
relationship between efficacy and methodology in studies investigating
EMDR treatment of PTSD. Journal of Clinical Psychology, 58,
23-41
A comprehensive meta-analysis reported the more rigorous
the study, the larger the effect.
-
Seidler, G.H., & Wagner, F.E. (2006). Comparing
the efficacy of EMDR and trauma-focused cognitive-behavioral therapy
in the treatment of PTSD: a meta-analytic study. Psychological
Medicine, 36, 1515-1522.
“Results suggest that in the treatment of PTSD, both
therapy methods tend to be equally efficacious.”
-
Carlson, J., Chemtob, C.M., Rusnak, K., Hedlund,
N.L, & Muraoka, M.Y. (1998). Eye movement desensitization and
reprocessing (EMDR): Treatment for combat-related post-traumatic stress
disorder. Journal of Traumatic Stress, 11, 3-24.
Twelve sessions of EMDR eliminated post-traumatic stress disorder
in 77% of the multiply traumatized combat veterans studied. There
was 100% retention in the EMDR condition. Effects were maintained
at follow-up. This is the only randomized study to provide a full
course of treatment with combat veterans. Other studies (e.g., Boudewyns/Devilly/Jensen/
Pitman et al/Macklin et al.) evaluated treatment of only one or two
memories, which, according to the International Society for Traumatic
Stress Studies Practice Guidelines (2000), is inappropriate for multiple-trauma
survivors. The VA/DoD Practice Guideline (2004) also indicates these
studies (often with only two sessions) offered insufficient treatment
doses for veterans.
-
Ahmad A, Larsson B, Sundelin-Whalsten V. (2007).
EMDR treatment for children with PTSD: Results of a randomized controlled
trial. Nord J Psychiatry, 61, 349-54.
EMDR was found to be an effective treatment in children with PTSD
from various sources and who were suffering from a variety of co-morbid
conditions.
-
Chemtob, C.M., Nakashima, J., & Carlson, J.G.
(2002). Brief-treatment for elementary school children with
disaster-related PTSD: A field study. Journal of Clinical Psychology,
58, 99-112.
EMDR was found to be an effective treatment for children
with disaster-related PTSD who had not responded to another intervention.
-
Edmond, T., Rubin, A., & Wambach, K. (1999).
The effectiveness of EMDR with adult female survivors of childhood
sexual abuse. Social Work Research, 23, 103-116.
EMDR treatment resulted in lower scores (fewer clinical
symptoms) on all four of the outcome measures at the three-month follow-up,
compared to those in the routine treatment condition. The EMDR group
also improved on all standardized measures at 18 months follow up
(Edmond & Rubin, 2004, Journal of Child Sexual Abuse).
-
Edmond, T., Sloan, L., & McCarty, D. (2004)
Sexual abuse survivors' perceptions of the effectiveness of EMDR and
eclectic therapy: A mixed-methods study. Research on Social Work
Practice, 14, 259-272.
Combination of qualitative and quantitative analyses
of treatment outcomes with important implications for future rigorous
research. Survivors' narratives indicate that EMDR produces greater
trauma resolution, while within eclectic therapy, survivors more highly
value their relationship with their therapist, through whom they learn
effective coping strategies.
- Hogberg, G. et al., (2007). On treatment with eye
movement desensitization and reprocessing of chronic post-traumatic
stress disorder in public transportation workers: A randomized controlled
study. Nordic Journal of Psychiatry, 61, 54-61.
Employees who had experienced “person-under-train accident
or had been assaulted at work were recruited.” Six sessions of
EMDR resulted in remission of PTSD in 67% compared to 11% in the wait
list control. Significant effects were documented in Global Assessment
of Function (GAF) and Hamilton Depression (HAM-D) score.
- Ironson, G.I., Freund, B., Strauss, J.L., & Williams,
J. (2002). Comparison of two treatments for traumatic stress:
A community-based study of
EMDR and prolonged exposure. Journal of Clinical Psychology,
58, 113-128.
Both EMDR and prolonged exposure produced a significant
reduction in PTSD and depression symptoms. This is the only research
comparing EMDR and exposure therapy that equalized homework. The study
found that 70% of EMDR participants achieved a good outcome in three
active treatment sessions, compared to 29% of persons in the prolonged
exposure condition. EMDR also had fewer dropouts
-
Jaberghaderi, N., Greenwald, R., Rubin, A., Dolatabadim
S., & Zand, S.O. (2004). A comparison of CBT and EMDR for sexually
abused Iranian girls. Clinical Psychology and Psychotherapy, 11, 358-368.
Both EMDR and CBT produced significant reduction in
PTSD and behavior problems. EMDR was significantly more efficient,
using approximately half the number of sessions to achieve results.
-
Lee, C., Gavriel, H., Drummond, P., Richards,
J. & Greenwald, R. (2002). Treatment of post-traumatic stress
disorder: A comparison of stress inoculation training with prolonged
exposure and eye movement desensitization and reprocessing. Journal
of Clinical Psychology, 58, 1071-1089.
Both EMDR and stress inoculation therapy plus prolonged
exposure (SITPE) produced significant improvement, with EMDR achieving
greater improvement on PTSD intrusive symptoms. Participants in the
EMDR condition showed greater gains at three-month follow-up. EMDR
required three hours of homework compared to 28 hours for SITPE.
-
Marcus, S., Marquis, P. & Sakai, C. (1997).
Controlled study of treatment of PTSD using EMDR in an HMO setting.
Psychotherapy, 34, 307-315
Funded by Kaiser Permanent. Results show that 100% of single-trauma
and 77% of multiple-trauma survivors were no longer diagnosed with post-traumatic
stress disorder after six 50-minute sessions.
- Marcus, S., Marquis, P. & Sakai, C. (2004).
Three- and 6-month follow-up of EMDR treatment of PTSD in an HMO setting.
International Journal of Stress Management, 11, 195-208.
Funded by Kaiser Permanent, follow-up evaluation indicates
that a relatively small number of EMDR sessions result in substantial
benefits that are maintained over time.
-
Power, K.G., McGoldrick, T., Brown, K., et al.
(2002). A controlled comparison of eye movement desensitization
and reprocessing versus exposure plus cognitive restructuring, versus
waiting list in the treatment of post-traumatic stress disorder. Journal
of Clinical Psychology and Psychotherapy, 9, 299-318.
Both EMDR and exposure therapy plus cognitive
restructuring (with daily homework) produced significant improvement.
EMDR was more beneficial for depression, and social functioning, and
required fewer treatment sessions. Subsequent reevaluation of the
data indicated that “For pre- to post-treatment IES mean change
score, EMDR patients also appeared to have had better treatment outcome
than E+CR patients” and EMDR therapy was a predictor of positive
outcome: Karatzias, A., Power, K. McGoldrick, T., Brown, K.,
Buchanan, R., Sharp, D. & Swanson, V. (2006). Predicting
treatment outcome on three measures for post-traumatic stress disorder.
Eur Arch Psychiatry Clin Neuroscience, 20, 1-7.
-
Rothbaum, B. (1997). A controlled study
of eye movement desensitization and reprocessing in the treatment
of post-traumatic stress disordered sexual assault victims. Bulletin
of the Menninger Clinic, 61, 317-334.
Three 90-minute sessions of EMDR eliminated post-traumatic
stress disorder in 90% of rape victims.
-
Rothbaum, B.O., Astin, M.C., & Marsteller, F.
(2005). Prolonged exposure versus eye movement desensitization
(EMDR) for PTSD rape victims. Journal of Traumatic Stress,
18, 607-616.
In this NIMH funded study both treatments were
effective: “An interesting potential clinical implication is
that EMDR seemed to do equally well in the main despite less exposure
and no homework. It will be important for future research to explore
these issues.”
-
Scheck, M., Schaeffer, J.A., & Gillette, C. (1998).
Brief psychological intervention with traumatized young women: The
efficacy of eye movement desensitization and reprocessing. Journal
of Traumatic Stress, 11, 25-44.
Two sessions of EMDR reduced psychological distress
in traumatized young women and brought scores within one standard
deviation of the norm.
-
Shapiro, F. (1989). Efficacy of the eye
movement desensitization procedure in the treatment of traumatic memories.
Journal of Traumatic Stress Studies, 2, 199–223.
Seminal study appeared the same year as first controlled
studies of CBT treatments. Three-month follow-up indicated substantial
effects on distress and behavioral reports. Marred by lack of standardized
measures and the originator serving as sole therapist.
-
Soberman, G. B., Greenwald, R., & Rule, D. L.
(2002). A controlled study of eye movement desensitization
and reprocessing (EMDR) for boys with conduct problems. Journal
of Aggression, Maltreatment, and Trauma, 6, 217-236.
The addition of three sessions of EMDR resulted in
large and significant reductions of memory-related distress, and problem
behaviors by 2-month follow-up.
-
Taylor, S. et al. (2003). Comparative efficacy,
speed, and adverse effects of three PTSD treatments: Exposure therapy,
EMDR, and relaxation training. Journal of Consulting and Clinical
Psychology, 71, 330-338.
The only randomized study to show exposure statistically
superior to EMDR on two subscales (out of 10). This study used therapist
assisted “in vivo” exposure, where the therapist takes the person
to previously avoided areas, in addition to imaginal exposure and
one hour of daily homework (@ 50 hours). The EMDR group used only
standard sessions and no homework.
-
Vaughan, K., Armstrong, M.F., Gold, R., O'Connor,
N., Jenneke, W., & Tarrier, N. (1994). A trial of eye movement
desensitization compared to image habituation training and applied
muscle relaxation in post-traumatic stress disorder. Journal of
Behavior Therapy & Experimental Psychiatry, 25, 283-291.
All treatments led to significant decreases in PTSD
symptoms for subjects in the treatment groups as compared to those
on a waiting list, with a greater reduction in the EMDR group, particularly
with respect to intrusive symptoms. In the 2-3 weeks of the study,
40-60 additional minutes of daily homework were part of the treatment
in the other two conditions.
-
Van der Kolk, B., Spinazzola, J., Blaustein, M., Hopper,
J., Hopper, E., Korn, D., & Simpson, W. (2007). A randomized
clinical trial of EMDR, fluoxetine and pill placebo in the treatment
of PTSD: Treatment effects and long-term maintenance. Journal
of Clinical Psychiatry, 68, 37-46.
EMDR was superior to both control conditions in the
amelioration of both PTSD symptoms and depression. Upon termination
of therapy, the EMDR group continued to improve while the Fluoxetine
participants again became symptomatic.
-
Wilson, S., Becker, L.A., & Tinker, R.H. (1995).
Eye movement desensitization and reprocessing (EMDR): Treatment for
psychologically traumatized individuals. Journal of Consulting
and Clinical Psychology, 63, 928-937.
Three sessions of EMDR produced clinically significant
change in traumatized civilians on multiple measures.
-
Wilson, S., Becker, L.A., & Tinker, R.H. (1997).
Fifteen-month follow-up of eye movement desensitization and reprocessing
(EMDR) treatment of post-traumatic stress disorder and psychological
trauma. Journal of Consulting and Clinical Psychology, 65,
1047-1056.
Follow-up at 15 months showed maintenance of positive
treatment effects with 84% remission of PTSD diagnosis.
-
Devilly, G.J., & Spence, S.H. (1999). The
relative efficacy and treatment distress of EMDR and a cognitive behavioral
trauma treatment protocol in the amelioration of post-traumatic stress
disorder. Journal of Anxiety Disorders, 13, 131-157.
This study found CBT superior to EMDR. The research
is marred by higher expectations in the CBT condition. Treatment was
delivered in both conditions by the developer of the CBT protocol.
-
Fernandez, I., Gallinari, E., Lorenzetti, A. (2004)
A School- Based EMDR Intervention for Children who Witnessed the Pirelli
Building Airplane Crash in Milan, Italy. Journal of Brief Therapy.,
2, 129-136
A group intervention of EMDR was provided to 236 schoolchildren
exhibiting PTSD symptoms 30 days post-incident. At four-month follow
up, teachers reported that all but two children evinced a return to
normal functioning after treatment.
-
Grainger, R.D., Levin, C., Allen-Byrd, L., Doctor,
R.M. & Lee, H. (1997). An empirical evaluation of eye movement
desensitization and reprocessing (EMDR) with survivors of a natural
catastrophe. Journal of Traumatic Stress, 10, 665-671.
A study of Hurricane Andrew survivors found significant
differences on the Impact of Event Scale and subjective distress in
a comparison of EMDR and non-treatment condition
-
Jarero, I., Artigas, L., & Hartung, J. (2006).
EMDR integrative group treatment protocol: A post-disaster trauma
intervention for children and adults. Traumatology, 12 (2).
A study of 200 children treated with a group protocol
after a flood in Mexico indicates that one session of treatment reduced
trauma symptoms from the severe range to low (subclinical) levels
of distress. Data from successful treatment at other disaster sites
are also reported.
-
Konuk, E., Knipe, J., Eke, I., Yuksek, H., Yurtsever,
A., & Ostep, S. (2006). The effects of EMDR therapy on post-traumatic
stress disorder in survivors of the 1999 Marmara, Turkey, earthquake.
International Journal of Stress Management, 13, 291-308.
Data reported on a representative sample of 1500 earthquake
victims indicated that five sessions of EMDR successfully eliminated
PTSD in 92.7% of those treated, with a reduction of symptoms in the
remaining participants.
-
Puffer, M.; Greenwald, R. & Elrod, D. (1997).
A single session EMDR study with twenty traumatized children and adolescents.
Traumatology-e, 3(2), Article 6.
In this delayed treatment comparison, over half of
the participants moved from clinical to normal levels on the Impact
of Events Scale, and all but 3 showed at least partial symptom relief
on several measures at 1-3 m following a single EMDR session.
-
Silver, S.M., Brooks, A., & Obenchain, J. (1995).
Eye movement desensitization and reprocessing treatment of Vietnam
war veterans with PTSD: Comparative effects with biofeedback and relaxation
training. Journal of Traumatic Stress, 8, 337-342.
One of only two EMDR research studies that evaluated
a clinically relevant course of EMDR treatment with combat veterans
(e.g., more than one or two memories; see Carlson et al., above).
The analysis of an inpatient veterans’ PTSD program (n=100) found
EMDR to be superior to biofeedback and relaxation training on seven
of eight measures.
-
Silver, S.M., Rogers, S., Knipe, J., & Colelli,
G. (2005). EMDR therapy following the 9/11 terrorist attacks:
A community-based intervention project in New York City. International
Journal of Stress Management, 12, pp. 29-42.
Clients made highly significant positive gains on
a range of outcome variables, including validated psychometrics and
self-report scales. Analyses of the data indicate that EMDR is a useful
treatment intervention both in the immediate aftermath of disaster
as well as later.
-
Solomon, R.M. & Kaufman, T.E. (2002) A
peer support workshop for the treatment of traumatic stress of railroad
personnel: Contributions of eye movement desensitization and reprocessing
(EMDR). Journal of Brief Therapy, 2, 27-33.
60 railroad employees who had experienced fatal grade
accident crossing accidents were evaluated for workshop outcomes,
and for the additive effects of EMDR treatment. Although the workshop
was successful, in this setting, the addition of a short session of
EMDR (5-40 minutes) led to significantly lower, sub clinical, scores
which further decreased at follow up.
-
Sprang, G. (2001). The use of eye movement
desensitization and reprocessing (EMDR) in the treatment of traumatic
stress and complicated mourning: Psychological and behavioral outcomes.
Research on Social Work Practice, 11, 300-320.
In a multi-site study, EMDR significantly reduced
symptoms more often than the CBT treatment on behavioral measures,
and on four of five psychosocial measures. EMDR was more efficient,
inducing change at an earlier stage and requiring fewer sessions.
The Adaptive Information Processing model (Shapiro, 2001, 2002, 2007)
is used to explain EMDR's clinical effects and guide clinical practice.
This model is not linked to any specific neurobiological mechanism since
the field of neurobiology is as yet unable to determine this in any
form of psychotherapy (nor of most medications). This section includes
literature to provide an overview of the model and procedures, as well
as selected research and case reports that demonstrate the predictive
value of the model in the treatment of life experiences that appear
to underlie a variety of clinical complaints.
-
Brown, K. W., McGoldrick, T., & Buchanan, R. (1997).
Body dysmorphic disorder: Seven cases treated with eye movement desensitization
and reprocessing. Behavioural and Cognitive Psychotherapy,
25, 203–207.
Seven consecutive cases were treated with up to three sessions
of EMDR. Complete remission of BDD symptoms were reported in five
cases with effects maintained at one- year follow-up.
-
Mol, S. S. L., Arntz, A., Metsemakers, J. F. M., Dinant,
G., Vilters-Van Montfort, P. A. P., & Knottnerus, A. (2005).
Symptoms of post-traumatic stress disorder after non-traumatic events:
Evidence from an open population study. British Journal of Psychiatry,
186, 494–499.
Supports a basic tenet of the Adaptive Information Processing
model that “Life events can generate at least as many PTSD symptoms
as traumatic events.” In a survey of 832 people, “For
events from the past 30 years the PTSD scores were higher after life
events than after traumatic event.”
-
Perkins, B.R. & Rouanzoin, C.C.
(2002). A critical evaluation of current views regarding eye
movement desensitization and reprocessing (EMDR): Clarifying points
of confusion. Journal of Clinical Psychology, 58, 77-97.
Reviews common errors and misperceptions of the procedures, research,
theory.
-
Raboni, M.R., Tufik, S., and Suchecki, D. (2006).
Treatment of PTSD by eye movement desensitization and reprocessing
improves sleep quality, quality of life and perception of stress Annals
of the New York Academy of Science , 1071, 508-513.
Specifically citing the hypothesis that EMDR induces
processing effects similar to REM sleep (see also Stickgold, 2002),
polysomnograms indicated a change in sleep patterns post treatment,
and improvement on all measures including anxiety, depression, and quality
of life after a mean of five sessions.
-
Ray, A. L. & Zbik, A. (2001). Cognitive
behavioral therapies and beyond. In C. D. Tollison, J. R. Satterhwaite,
& J. W. Tollison (Eds.) Practical Pain Management (3rd ed.;
pp. 189-208). Philadelphia: Lippincott.
The authors note that the application of EMDR guided
by the Adaptive Information Processing model appears to afford benefits
to chronic pain patients not found in other treatments..
-
Ricci, R. J., Clayton, C. A., & Shapiro, F. (in
press)Some effects of EMDR treatment with previously abused
child molesters: Theoretical reviews and preliminary findings.
Journal of Forensic Psychiatry and Psychology.
As predicted by the Adaptive Information Processing
model the EMDR treatment of the molesters' own childhood victimization
resulted in a decrease in deviant arousal as measured by the plethysmograph,
a decrease in sexual thoughts, and increased victim empathy. Effects
maintained at one year follow up.
-
Russell, M. (in press). Treating traumatic amputation-related
phantom limb pain: a case study utilizing eye movement desensitization
and reprocessing (EMDR) within the armed services. Clinical Case
Studies.
“Since September 2006, over 725 service-members from the
global war on terrorism have survived combat-related traumatic amputations
that often result in phantom limb pain (PLP) syndrome. . . . Four
sessions of Eye Movement Desensitization and Reprocessing (EMDR) led
to elimination of PLP, and a significant reduction in PTSD, depression,
and phantom limb tingling sensations.”
-
Schneider, J., Hofmann, A., Rost, C., & Shapiro, F. (in
press). EMDR in the treatment of chronic phantom limb pain.
Pain Medicine. doi: 10.1111/j.1526-4637.2007.00299.x
As predicted by the Adaptive Information Processing model the
EMDR treatment of the event involving the limb loss, and the stored
memories of the pain sensations, resulted a decrease or elimination
of the phantom limb pain which maintained at 1 year follow up.
-
Schneider, J., Hofmann, A., Rost, C., & Shapiro, F.
(2007). EMDR and phantom limb pain: Case study, theoretical
implications, and treatment guidelines. Journal of EMDR Science
and Practice, 1, 31-45.
Detailed presentation of case treated by EMDR that resulted in
complete elimination of PTSD, depression and phantom limb pain with
effects maintained at 18-month follow-up.
-
Shapiro, F. (2001) Eye movement desensitization
and reprocessing: Basic principles, protocols and procedures (2nd
ed.). New York: Guilford Press.
EMDR is an eight-phase psychotherapy with standardized
procedures and protocols that are all believed to contribute to therapeutic
effect. This text provides description and clinical transcripts and
an elucidation of the guiding Adaptive Information Processing model.
-
Shapiro, F. (2002). (Ed.). EMDR as an integrative
psychotherapy approach: Experts of diverse orientations explore the
paradigm prism. Washington, DC: American Psychological Association
Books
EMDR is an integrative approach distinct from other
forms of psychotherapy. Experts of the major psychotherapy orientations
identify and highlight various procedural elements.
-
Shapiro, F. (2007). EMDR, adaptive information processing,
and case conceptualization. Journal of EMDR Practice and Research,
1, 68-87.
Overview of EMDR treatment based upon an Adaptive Information
Processing case conceptualization. Early life experiences are viewed
as the basis of pathology and used as targets for processing. The
three-pronged protocol includes processing of the past events that
have set the foundation for the pathology, the current triggers, and
templates for appropriate future functioning to address skill and
developmental deficits.
-
Wilensky, M. (2006). Eye movement desensitization
and reprocessing (EMDR) as a treatment for phantom limb pain. Journal
of Brief Therapy, 5, 31-44.
“Five consecutive cases of phantom limb pain were treated
with EMDR. Four of the five clients completed the prescribed treatment
and reported that pain was completely eliminated, or reduced to a
negligible level. . . The standard EMDR treatment protocol was used
to target the accident that caused the amputation, and other related
events.”
Top of Page
EMDR contains many procedures and elements that contribute to treatment
effects. While the methodology used in EMDR has been extensively validated
(see above), questions still remain regarding mechanism of action.
However, since EMDR achieves clinical effects without the need for
homework, or the prolonged focus used in exposure therapies, attention
has been paid to the possible neurobiological processes that might
be evoked. Although the eye movements (and other dual attention stimulation)
comprise only one procedural element, this element has come under
greatest scrutiny. Randomized controlled studies evaluating mechanism
of action of the eye movement component follow this section.
- Elofsson, U.O.E., von Scheele, B., Theorell, T., & Sondergaard,
H.P. (in press). Physiological correlates of eye movement desensitization
and reprocessing. Journal of Anxiety Disorders. doi:10.1016/j.janxdis.2007.05.012
Changes in heart rate, skin conductance and LF/HF-ratio, finger
temperature, breathing frequency, carbon dioxide and oxygen levels were
documented during the eye movement condition. It was concluded the "eye
movements during EMDR activate cholinergic and inhibit sympathetic systems.
The reactivity has similarities with the pattern during REM sleep."
- Lee, C., Taylor, G., & Drummond, P.D. (2006)
The active ingredient in EMDR: Is it traditional exposure or dual focus
of attention? Clinical Psychology and Psychotherapy, 13, 97-107
This study tested whether the content of participants’ responses
during EMDR is similar to that thought to be effective for traditional
exposure treatments (reliving), or is more consistent with distancing
which would be expected given Shapiro’s proposal of dual focus
of attention. Greatest improvement on a measure of PTSD symptoms occurred
when the participant processed the trauma in a more detached manner.
- MacCulloch, M. J., & Feldman, P. (1996). Eye
movement desensitization treatment utilizes the positive visceral element
of the investigatory reflex to inhibit the memories of post-traumatic
stress disorder: A theoretical analysis. British Journal of Psychiatry,
169, 571–579.
One of a variety of articles positing an orienting response as a
contributing element (see Shapiro, 2001 for comprehensive examination
of theories and suggested research parameters). This theory has received
controlled research support (Barrowcliff et al., 2003, 2004).
- Propper, R., Pierce, J.P., Geisler, M.W., Christman, S.D.,
& Bellorado, N. (2007). Effect of bilateral eye movements
on frontal interhemispheric gamma EEG coherence: Implications for EMDR
therapy. Journal of Nervous and Mental Disease, 195, 785-788.
“Specifically, the EM manipulation used in the present
study, reported previously to facilitate episodic memory, resulted
in decreased interhemispheric EEG coherence in anterior prefrontal
cortex. Because the gamma band includes the 40 Hz wave that may indicate
the active binding of information during the consolidation of long-term
memory storage (e.g., Cahn and Polich, 2006), it is particularly notable
that the changes in coherence we found are in this band. With regard
to PTSD symptoms, it may be that by changing interhemispheric coherence
in frontal areas, the EMs used in EMDR foster consolidation of traumatic
memories, thereby decreasing the memory intrusions found in this disorder.”
-
Rogers, S., & Silver, S. M. (2002) Is EMDR an
exposure therapy? A review of trauma protocols Journal of Clinical
Psychology , 58, 43-59. Philadelphia: Lippincott.
Theoretical, clinical, and procedural differences referencing
two decades of CBT and EMDR research.
-
Rogers, S., Silver, S., Goss, J., Obenchain, J., Willis,
A., & Whitney, R. (1999). A single session, controlled
group study of flooding and eye movement desensitization and reprocessing
in treating posttraumatic stress disorder among Vietnam war veterans:
Preliminary data. Journal of Anxiety Disorders 13, 119-130.
Philadelphia: Lippincott.
This study was designed as primarily a process report to compare
EMDR and exposure. A different recovery pattern was observed with
the EMDR group demonstrating a more rapid decline in self-reported
distress.
-
Servan-Schreiber, D., Schooler, J., Dew, M.A., Carter, C.,
& Bartone, P. (2006). EMDR for PTSD: A pilot blinded,
randomized study of stimulation type. Psychotherapy and Psychosomatics.,
75, 290-297.
Twenty-one patients with single-event PTSD (average IES: 49.5)
received three consecutive sessions of EMDR with three different types
of auditory and kinesthetic stimulation. All were clinically useful.
However, alternating stimulation resulted appeared to confer an additional
benefit to the EMDR procedure.
-
Stickgold, R. (2002). EMDR: A putative neurobiological
mechanism of action. Journal of Clinical Psychology, 58,
61-75.
Comprehensive explanation of the potential links to the processes
that occur in REM sleep. Controlled studies have evaluated these theories
(see below; Christman et al., 2004; Kuiken et al. 2001-2002
-
Suzuki, A., et al. (2004). Memory reconsolidation
and extinction have distinct temporal and biochemical signatures.
Journal of Neuroscience, 24, 4787– 4795.
The article explores the differences between memory reconsolidation
and extinction. This new area of investigation is worthy of additional
attention. Reconsolidation may prove to be the underlying mechanism
of EMDR, as opposed to extinction caused by prolonged exposure therapies.
“Memory reconsolidation after retrieval may be used to update
or integrate new information into long-term memories ... Brief exposure
… seems to trigger a second wave of memory consolidation (reconsolidation),
whereas prolonged exposure ... leads to the formation of a new memory
that competes with the original memory (extinction).”
-
Wilson, D., Silver, S. M., Covi, W., & Foster, S. (1996)
Eye movement desensitization and reprocessing: Effectiveness and autonomic
correlates. Journal of Behavior Therapy and Experimental Psychiatry,
27, 219-229.
Study involving biofeedback equipment has supported the hypothesis
that the parasympathetic system is activated by finding that eye movements
appeared to cause a compelled relaxation response. More rigorous research
with trauma populations is needed.
Top of Page
A number of International Practice Guideline committees have reported
that the clinical component analyses reviewed by Davidson & Parker
(2001) are not well designed (International Society for Traumatic
Stress Studies/ISTSS; DoD/DVA). Davidson & Parker note that there
is a trend toward significance for eye movements when the studies
conducted with clinical populations are examined separately. Unfortunately
even these studies are flawed. As noted in the ISTSS guidelines (Chemtob
et al., 2000), since these clinical populations received insufficient
treatment doses to obtain substantial main effects, they inappropriate
for component analyses. However, as noted in the DoD/DVA (2004) guidelines,
numerous memory researchers have evaluated the eye movements used
in EMDR. These studies have found a direct effect on emotional arousal,
imagery vividness, attentional flexibility, and memory association.
In addition, a new study has examined the hypothesis that the eye
movements cause a “distancing effect” (Lee & Drummond,
in press) and is listed below as well.
-
Andrade, J., Kavanagh, D., & Baddeley, A. (1997).
Eye-movements and visual imagery: a working memory approach to the
treatment of post-traumatic stress disorder. British Journal of
Clinical Psychology, 36, 209-223.
Tested the working memory theory. Eye movements were
superior to control conditions in reducing image vividness and emotionality.
-
Barrowcliff, A.L., Gray, N.S., Freeman, T.C.A.,
& MacCulloch, M.J. (2004). Eye-movements reduce the vividness,
emotional valence and electrodermal arousal associated with negative
autobiographical memories. Journal of Forensic Psychiatry and Psychology,
15, 325-345.
Tested the reassurance reflex model. Eye movements
were superior to control conditions in reducing image vividness and
emotionality.
-
Barrowcliff, A.L., Gray, N.S., MacCulloch, S.,
Freeman, T. C.A., & MacCulloch, M.J. (2003). Horizontal rhythmical
eye-movements consistently diminish the arousal provoked by auditory
stimuli. British Journal of Clinical Psychology, 42, 289-302.
Tested the reassurance reflex model. Eye movements
were superior to control conditions in reducing arousal provoked by
auditory stimuli.
-
Christman, S. D., Garvey, K. J., Propper, R. E.,
& Phaneuf, K. A. (2003). Bilateral eye movements enhance the
retrieval of episodic memories. Neuropsychology. 17, 221-229.
Tested cortical activation theories. Results provide
indirect support for the orienting response/REM theories suggested
by Stickgold (2002). Saccadic eye movements, but not tracking eye
movements were superior to control conditions in episodic retrieval.
-
Kavanagh, D. J., Freese, S., Andrade, J., & May,
J. (2001). Effects of visuospatial tasks on desensitization
to emotive memories. British Journal of Clinical Psychology, 40,
267-280.
Tested the working memory theory. Eye movements were
superior to control conditions in reducing within-session image vividness
and emotionality. There was no difference one-week post.
-
Kuiken, D., Bears, M., Miall, D., & Smith, L.
(2001-2002). Eye movement desensitization reprocessing facilitates
attentional orienting. Imagination, Cognition and Personality,
21, (1), 3-20.
Tested the orienting response theory related to REM-type
mechanisms. Indicated that the eye movement condition was correlated
with increased attentional flexibility. Eye movements were superior
to control conditions.
- Lee, C.W., & Drummond, P.D. (in press). Effects
of eye movement versus therapist instructions on the processing of distressing
memories. Journal of Anxiety Disorders. doi:10.1016/j.janxdis.2007.08.007
“There was no significant effect of therapist’s
instruction on the outcome measures. There was a significant reduction
in distress for eye movement at post-treatment and at follow-up. ...
The results were consistent with other evidence that the mechanism
of change in EMDR is not the same as traditional exposure.”
-
Sharpley, C. F. Montgomery, I. M., & Scalzo, L.
A. (1996). Comparative efficacy of EMDR and alternative procedures
in reducing the vividness of mental images. Scandinavian Journal
of Behaviour Therapy, 25, 37-42.
Results suggest support for the working memory theory.
Eye movements were superior to control conditions in reducing image
vividness.
-
Van den Hout, M., Muris, P., Salemink, E., & Kindt,
M. (2001). Autobiographical memories become less vivid and
emotional after eye movements. British Journal of Clinical Psychology,
40, 121-130.
Tested their theory that eye movements change the
somatic perceptions accompanying retrieval, leading to decreased affect,
and therefore decreasing vividness. Eye movements were superior to
control conditions in reducing image vividness. Unlike control conditions,
eye movements also decreased emotionality.
All studies have indicated significant effects following EMDR treatment,
including changes in cortical, and limbic activation patterns, and increase
in hippocampal volume.
- Bossini L. Fagiolini, A. & Castrogiovanni, P. (in
press) Neuroanatomical changes after EMDR in PTSD. Journal
of Neuropsychiatry and Clinical Neuroscience.
- Lamprecht, F., Kohnke, C., Lempa, W., Sack, M.,
Matzke, M., & Munte, T. (2004). Event-related potentials and
EMDR treatment of post-traumatic stress disorder. Neuroscience Research,
49, 267-272.
- Lansing, K., Amen, D.G., Hanks, C. & Rudy, L. (2005).
High resolution brain SPECT imaging and EMDR in police officers with
PTSD. Journal of Neuropsychiatry and Clinical Neurosciences.
- Levin, P., Lazrove, S., & van der Kolk, B. A. (1999).
What psychological testing and neuroimaging tell us about the treatment
of posttraumatic stress disorder PTSD) by eye movement desensitization
and reprocessing (EMDR). Journal of Anxiety Disorders, 13, 159-172.
- Oh, D.-H., & Choi, J. (2004). Changes in
the regional cerebral perfusion after Eye Movement Desensitization and
Reprocessing: A SPECT study of two cases . Journal of EMDR Practice
and Research, 1, 24-30.
- Pagani, M. et al. (2007). Effects of EMDR psychotherapy
on 99mTc-HMPAO distribution in occupation-related post-traumatic stress
disorder. Nuclear Medicine Communications, 28, 757–765.
- Sack, M., Lempa, W., & Lemprecht, W. (2007).
Assessment of psychophysiological stress reactions during a traumatic
reminder in patients treated with EMDR. Journal of EMDR Practice
and Research, 1, 15-23.
- Sack, M., Nickel, L., Lempa, W., Lamprecht, F. (2003)
Psychophysiological regulation in patients suffering from PTSD: Changes
after EMDR treatment. Journal of Psychotraumatology and Psychological
Medicine, 1, 47 -57. (German)
- van der Kolk, B., Burbridge, J., & Suzuki, J. (1997).
The psychobiology of traumatic memory: Clinical implications of neuroimaging
studies. Annals of the New York Academy of Sciences, 821, 99-113.
|
|
|
