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Treating Post-Traumatic Stress Disorder (PTSD) with EMDR

 

Christoph Rothmayr

 

 

 

 

 

 

What is PTSD?

 

The History of EMDR

 

The Eight Stages of EMDR Treatment

 

The Theory behind EMDR

 

What does Science Think about EMDR? – A Literature Review

 

 

 

 

It’s probably one of the most controversial and fascinating discoveries psychologists have come up with in the past few years: EMDR. The abbreviation stands for “ Eye Movement Desensitization and Reprocessing “.

During EMDR treatment the therapist waves his fingers in front of the patient’s eyes, the patient follows the therapist’s finger as they move slowly from the left to the right.  For many therapists EMDR is the treatment of choice when it comes to clients with Post-Traumatic Stress Disorder (PTSD).

 

The following paragraphs will try to focus on where EMDR comes from, what it exactly is, how it works and what scientists think about it. All of this will be considered with a special emphasis on PTSD.

First of all we want to discuss what PTSD actually is.

 

 

 

 

What is PTSD?

 

Post-Traumatic Stress Disorder is a severe psychiatric disorder that may occur after a traumatic experience that involves actual or threatened death or serious injury, or other threats to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person (according to the Diagnostical and Statistical Manual of Mental Disorders (DSM IV-TR) by the American Psychiatric Association).

Such threatening experiences may be rape, physical attack, natural disasters, automobile accidents, military combat, or terrorist attacks.

      

 

People with PTSD often relive such experiences through nightmares and flashbacks (components of the threatening event are relived as though experiencing the event at the moment), sleeping problems, fear, helplessness and horror. People with PTSD have a higher probability to suffer from depression, anxiety or phobias.

About 8% of Americans will experience PTSD at some point in their lives. Women are twice as likely as men to develop PTSD.  Next to EMDR PTSD is also treated with cognitive-behavioral therapy and/or drugs such as Zoloftâ or Prozacâ. (For more information on PTSD go to www.ncptsd.org)

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The History of EMDR

 

As mentioned before, EMDR is a rather new way of treating mental disorders such as PTSD.

EMDR was discovered in 1987 by Francine Shapiro, Ph.D.

Dr. Shapiro was suffering from negative distressing memories that caused her negative emotions. While walking in a park one day she realized that moving her eyes while thinking about he threatening experiences helped her decrease the negative symptoms associated with the stressful event.

She then further investigated her discovery and did some research on how this finding, which she first called EMD (Eye Movement Desensitization) might be applied to disorders like PTSD.

After several studies in which she investigated the effect of EMDR on PTSD she changed the name EMD to EMDR (Eye Movement Desensitization and Reprocessing) in 1991.

(A detailed biography of Dr. Shapiro can be found at: www.emdr.com)

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The Eight Stages of EMDR Treatment

 

Treating patients suffering from PTSD with EMDR includes more than just moving fingers in front of somebody’s eyes. EMDR actually also integrates elements from other psychotherapies such as cognitive-behavioral, interpersonal, experiential and body-centered therapies.

 

In the first phase the assessment of the client’s stressful experiences takes place. The symptoms and thoughts the patient wants to get rid off are discussed and goals of the treatment are set.

 

In the second phase the therapist makes sure that the patient is in a relatively stable phase before talking about the threatening experiences. The client may want to learn special relaxation techniques if he or she does not seem stable enough to once again go through the threatening events mentally.

 

In phases three to six images, beliefs, emotions and body sensations that are related to the threatening event are identified and discussed. After identifying these items the client focuses on them while following the therapist’s finger that is moving back and forth. This is repeated until the patient does not feel distressed anymore while thinking of the formerly bad memories. The client is then instructed to think of a positive belief that the therapist and the patient have agreed on before.

 

Afterwards in phase seven the client is asked to write down anything that is referred to the stressful event and may occur in the time after the last treatment session.

 

In phase eight, which is usually conducted in the next treatment session, changes to the client’s situation are evaluated.

(For further information go to www.emdr.com)

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The Theory behind EMDR

 

One of the most popular theories of how EMDR works comes from Francine Shapiro who has, as mentioned before, developed EMDR therapy.  Her theory of explaining EMDR is called the “Adaptive Information Processing Model”.

The basic assumption of the model is that all humans possess an information processing system that processes experiences and stores these as memories in a way that they are easily accessible and linked to a network of accompanying images, sensations, emotions and beliefs.

 

When it comes to a threatening and traumatic event such as those causing PTSD, that processing system may sometimes not work sufficiently. As a result of this the event is linked only with negative images, beliefs and sensations. A connection with more adaptive (=alternative explanatory) information does not take place. This may be due to the strong negative feelings involved.  Therefore whenever the person thinks of the traumatic event again only bad memories will come up again since the event has not yet been processed and stored in an entire and appropriate way.

 

EMDR can then help to further process stressful events by a learning process that first links the negative memories to the eye-movements. The negative memories are then connected to more adaptive and positive beliefs that the client and the therapist have discussed previously.

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What does Science Think about EMDR? – A Literature Review

 

EMDR is probably one of the most spectacular and most popular therapies in recent years for the treatment of mental disorders, especially for PTSD. EMDR has also been controversly discussed in the scientific world like no other treatment since it was first presented more than 10 years ago.

 

Is EMDR effective?

 

The most important questions that the treatment had and still has to face are definitely: is it more (or even less) effective than no treatment? and also: is it more (or less) effective than other common treatments?  A lot of research has been conducted to answer this question that may be crucial for the survival of EMDR as a treatment for disorders like PTSD.

 

One of the research articles clearly in favor of the effectiveness of EMDR for the treatment of PTSD is a study by M.M.Scheck, J.A.Schaeffer and C.Gilette in the Journal of Traumatic Stress (1998). In this study 60 traumatized women were treated with either EMDR or an active listening (AL) control treatment. The AL control consisted of listening to the patient and non-evaluative acknowledgement of the patient’s reports. With the AL control condition the authors tried to control so called “placebo” factors such as rapport, sympathetic attention and expectation of gain. For the outcome-measures the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Penn Inventory for PTSD, the Impact of Event Scale and the Tennessee Self-Concept Scale were used. Factorial ANOVA revealed that in both treatments an improvement of the patients’ state had taken place. However in the EMDR group this effect was significantly larger than in the AL group. This finding therefore stands for the superiority of EMDR against an AL treatment in PTSD treatment.

 

However, this study tells us nothing about the effectiveness of EMDR in PTSD compared to more commonly used PTSD treatments other than AL (not a broadly used PTSD treatment).  One of the most recent evaluations on the effectiveness of EMDR was a meta-analysis conducted by Paul R. Davidson and Kevin C.H. Parker from the Queen’s University in Kingston, Ontario, Canada (Davidson & Parker, 2001). A meta-analysis takes a look at a number of scientific research articles  that all have one thing in common: The investigation of certain topic. These articles are then all put together. An overall test of statistical significance is then conducted in order to get an insight to a question all of those articles have dealt with.

 

In the Davidson & Parker meta-analysis EMDR treatment was compared to no treatment, treatment with not using exposure to anxiety-provoking stimuli and exposure therapy (a commonly used technique in PTSD treatment).

34 studies from 1988 to April 2000 were included in this meta-analysis. Effect sizes were then estimated for each study using Rosenthal’s formula. Effect sizes range from –1 to +1, a positive number indicates a positive effect of a treatment.  After that was done an ANOVA with the obtained data was conducted.

 

The statistical evaluation showed an overall effect of EMDR when comparing pre- and post- treatment values (p£.01). According to the statistical analysis EMDR is also more effective than a no-treatment or a waiting list condition (p£.01) and more effective than non-specific (no-exposure) treatment (p£.05). However, there was no significant difference in the effectiveness of EMDR compared to exposure-therapy (in vivo or not in vivo) or to cognitive-behavioral therapy (CBT).

 

The question if EMDR is better than other widely used treatments for PTSD, such as exposure-based treatments, must therefore be answered with no. At least in the Davidson & Parker meta-analysis there was no evidence that EMDR is to be preferred over exposure-based treatments. Nonetheless EMDR has shown to be more effective than non exposure-based treatments or no treatment at all.

 

How essential are the eye-movements?

 

In a sub-analysis included in the Davidson & Parker meta-analysis 13 studies were examined that compared EMDR treatments with an eye-movement condition to an EMDR treatment with an eyes-fixed condition. After calculating effect-sizes and comparing those in a statistical analysis using multiple t-tests no benefit of EMDR treatments with eye-movements could be shown. Therefore there is no evidence that eye-movements, that once gave EMDR its name and probably are part of its fame, are a necessary component of EMDR therapy.

 

Conclusion

 

EMDR has so far failed to prove that is more effective than other standard treatments used for the treatment of PTSD. Also eye-movements that were supposed to be an essential part of EMDR seem to be of no significance. Since EMDR is such a new treatment it still suffers from a substantial variance in findings from study to study, which may account for its lack of superiority to other standard treatments. Even if EMDR may not be as successful as many therapists still believe it has definitely shown us one thing: that we must not only rely on old-fashioned therapies but that we should always keep our eyes and ears open for innovative treatments in the future.

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 References:

 

American Psychiatric Association. (1997). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: Author

 

Davidson, P. R. & Parker, K. C. H. (2001). Eye Movement Desensitization and Reprocessing (EMDR): A Meta-Analysis. Journal of Counseling and Clinical Psychology, 69 (2), 305-316

 

Shapiro, F. (1995). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures. New York: Guilford Press

 

Scheck, M. M., Schaeffer, J. A., Gilette, C. (1998). Brief Psychological Intervention with Traumatized Young Women: The Efficacy of Eye Movement Desensitization and Reprocessing. Journal of Traumatic Stress, 11 (1), 35-42

 

 

 

 

Ó Christoph Rothmayr, 9/24/2003

 

 

 

 

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