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Can EMDR help trauma victims move on or is it all hocus pocus?

Teresita Lambertt

November 13, 2008

What is EMDR?

Eye Movement Desensitization and Reprocessing (EMDR) is a relatively new form of therapy developed by the psychologist Dr. Francine Shapiro in 1987. It is most commonly used in the treatment of trauma victims and individuals with Post Traumatic Stress Disorder (PTSD). Yet, its efficacy is currently being tried out on different disorders. EMDR involves remembering a traumatic event and “reprogramming” your mind to see the memory in light of a positive belief, while simultaneously using rapid eye movements to facilitate this process (http://helpguide.org/mental/emdr_therapy.htm ).

How does EMDR work? What is the rationale behind this treatment?

In EMDR a person is asked to concentrate on a disturbing image that is part of the traumatic memory they have experienced and on the emotions and cognitive elements connected with it. For example, a rape victim would be asked to recall a specific image of the rape that she remembers often and the accompanying emotions and thoughts that she normally has when this image comes up. Once the person can envision this image, the therapist attempts to stimulate both sides of the brain. The most common method used to provoke the bilateral stimulation involves the therapist moving their fingers back and forth in front of the person’s face and having them follow the movement with their eyes. Other ways of inducing bilateral stimulation of the brain are through auditory or tactile stimulation.

EMDR consists of an eight-step approach that consists of the following: (1) Getting a complete patient history and developing a treatment plan (2) preparing the client for utilizing EMDR ( 3 ) determining the components of the main issues (4) desensitizing the patient to the traumatic material with some form of stimulation (5) implementing the alternative positive belief (6) Determining if any residual material from the painful issues remain (7) closure; and (8) re-evaluation. Stage three is exceptionally important because it is when the components of the treatment target are determined. In stage five EMDR utilizes dual attention awareness to allow the individual to shift between the traumatic material and the safety of the present moment. This prevents retraumatization from exposure to the disturbing memory

At this time it is unknown how or why EMDR is effective in treating PTSD. This treatment is believed to have arisen from cognitive-behavioral therapies and yet it is not based on any specific theory. Just like any other poorly understood realm of science plenty of tentative propositions and theories have been proposed. For example, explanations have included things such as overcoming blocked neural patterns, the mimicking of REM sleep, and reciprocal inhibition. The creator of this treatment, Shapiro, has developed a hypothesis for an "accelerated information processing" model. She believes that trauma obstructs the information processing system, and consequently prevents traumatic events from being resolved and this leads to the development of debilitating disorders. EMDR allows a person to access their traumatic memories and to activate the information processing system. It allows information to be resolved in a faster and more efficient manner than with any other treatment available (http://www.emdr.com/briefdes.htm ).

Who is making what sorts of claims about the effectiveness of EMDR?

According to the EMDR Institute EMDR is now accepted as the treatment of choice by numerous mental health departments, and trauma organizations. It has many published case reports and experimental studies which support it as an empirically valid treatment of trauma. The Department of Defense/Department of Veterans Affairs Practice Guidelines has placed EMDR in the highest category, recommending it for all populations exposed to and dealing with trauma. In addition, the International Society for Traumatic Stress Studies has designated EMDR as an effective treatment for PTSD. Finally, the American Psychiatric Association has stated that the medication class-Selective Serotonin Reuptake Inhibitors (SSRI’s), Cognitive-Behavioral Therapy (CBT) and EMDR are the recommended treatments for trauma. On the other hand, the most common negative aspect that critics still use is that the EMDR studies done have all involved only a small number of participants and therefore are not very reliable. The EMDR institute is a website based on facts where the makers are not backing up any false claims hoping to achieve personal gain from the misfortune of others; they are genuinely presenting a new form of treatment for trauma victims. The quality of the evidence presented in this website is exceptional, it is very thorough and insightful (http://www.emdr.com/efficacy.htm ).

On the other hand, I found one website that was created by a therapist herself which made outlandish claims which have not been supported by any kind of scientific evidence, in order to profit from the unfortunate clients that believe that this treatment could help them, even if there is absolutely no data indicating such. For example, the site makes the claim that EMDR has been proven to alleviate things such as insomnia, chronic pain, and eating disorders. Even if such a study has been done it would still not be enough evidence to make this claim without corroborating evidence or at least having others replicate the study to see if they get the same results. The author of this site makes EMDR seem like the miracle “quick fix “cure for an array of ailments and disorders that plague people. The truth is that this relatively new approach has only been proven to be effective on trauma victims and using it for any other reason is completely speculative and therefore certainly not a “quick fix” of any type. Although some evidence is presented in this site, the quality of it is not very good and it is certainly not comprehensive. Only studies that are convenient to cite are used as evidence, therefore not showing all the sides of the arguments (http://www.emdr-therapy.com/ ).

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References

EMDR Institute, Inc. (2005). The Efficacy of EMDR. Retrieved October 8, 2008, from

http://www.emdr.com/efficacy.htm

EMDR Institute, Inc. (2005). A Brief Description of EMDR. Retrieved October 8, 2008, from http://www.emdr.com/briefdes.htm

EMDR-Therapy. (2006). EMDR Therapy Offers New Hope. Retrieved October 9, 2008, from http://www.emdr-therapy.com/

Helpguide.org. (2008). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Guide to making an informed decision. Retrieved October 8, 2008, from

http://helpguide.org/mental/emdr_therapy.htm

EMDR and trauma victims-Literature Review

According to the National Institute of Mental Health, an estimated 5.2 million American adults ages 18 to 54 have PTSD. The largest group of people with PTSD in America is those that have been raped. A national survey of 4000 women found that 1 in 8 reported being the victim of rape. Nearly half had been raped more than once. Nearly 1/3 was younger than 11 and over 60% were under 18. In the present paper, the effectiveness of EMDR in treating people with PTSD and other traumas is investigated. I believe that the effectiveness of EMDR in treating PTSD and victims of trauma is not only effective but is actually superior to others traditional forms of treatment. The following literature review attempts to demonstrate and support this hypothesis.

Seidler and Wagner (2006) conducted a meta-analytic study reviewing seven studies comparing the effectiveness of EMDR to that of trauma-focused cognitive behavioral therapy in the treatment of PTSD. They found that the difference in effectiveness between the two treatments is not clinically significant. The data showed that moderator variables influenced the effectiveness of treatments and yet the authors of the study believed that little additional knowledge could be gained from examining the variables more closely because their were such few original studies to begin with. It was concluded that before further review of the data could be done more research and experimentation using randomly controlled trials had to be conducted. What did remain quite unclear in the study was the contribution, assuming there is any, of the eye movement component in EMDR in influencing the outcome of the treatment.

This next study is much more specific in actually examining the efficacy of EMDR in trauma patients. This experimental study by Edmond, Rubin, and Wambach (1999), investigates the effectiveness of EMDR in treating adult female survivors of childhood sexual abuse. The 59 subjects participating in this study were randomly assigned to one of three groups. The groups consisted of the individual EMDR treatment group, the routine individual treatment group, and the delayed treatment control group. Routine individual treatment was defined as a variety of methods and techniques that are typically employed by therapists to treat people with sexual abuse trauma. The EMDR treatment resulted in fewer clinical symptoms on all four of the outcome measures at the three-month follow-up compared to those in the other two experimental groups. The amount of clinical symptoms present after the treatment was measured in pretests and posttests on four standardized exams that were used as the primary outcome measures. One of the major flaws in this study was that the findings did not show any significant differences between EMDR and routine individual treatment in the posttest findings, instead the differences were observed in the follow up measures. Also, the study only had 59 participants which allow room for a lot of error and the therapists involved in the study had limited experience using EMDR.

This next study not only uniquely examines PTSD but it also evaluates the effectiveness of EMDR on a long term basis. In a randomized clinical trial of a fifteen-month follow-up conducted by Wilson, Becker, and Tinker (1997) the long term effectiveness of the EMDR treatment in individuals with PTSD and other psychological trauma is investigated. Of the 66 subjects who participated in the study, 32 were diagnosed with PTSD prior to treatment. The participants were first contacted by telephone, letter, or both and were asked to come to a follow-up interview and testing session that would be like the one they would be doing 3 months after their EMDR sessions. Of the 80 original participants, 69 returned for the follow-up. PTSD participants improved as much as those that did not have PTSD. Also, both groups still showed their improvements after 15 months. At the 15-month follow-up the three 90 minute sessions of EMDR that had been previously administered produced an astonishing 84% reduction in the PTSD diagnosis and a 68% reduction in PTSD symptoms in general. In other words, 84% of the individuals showed a complete remission after three 90 minute sessions of EMDR! The effectiveness of EMDR was measured through numerous tests. The tests were: impact of event scale, state-trait anxiety inventory, symptom checklist, posttraumatic stress disorder interview and SUDS. One of the flaws of this study was that it did not check for the probability of comorbidity, which is when people have more than one diagnosis at a time. Another flaw was the loss of a number of participants at the 15month follow-up.

All in all, these studies prove that EMDR treatment is an effective treatment for trauma victims, such as people with PTSD and women who have been sexually abused. It is not only effective after only a few sessions but the benefits stay with the individuals on a long-term basis. Also, EMDR is proven to be just as effective as the traditional treatment for trauma victims, cognitive-behavioral therapy. If I had to give any advice to trauma victims I would say to try out EMDR as their first treatment option. Although it is relatively new and subsequently scarier, it offers the benefits of a speedy recovery that will endure through time.

References

Edmond, T., Rubin, A., & Wambach, K., (1999). The effectiveness of EMDR with adult female survivors of childhood sexual abuse. Social Work Research, 23(2), 103

116.

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.

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.

 

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