 |
Health Psychology Home PagePapers written by students providing scientific reviews of topics related to health and well being |
| Search | Home | Weight Loss | Alternative Therapy | Supplements | Eating Disorders | Fitness | Links | Self-Assessment | About this Page | |
Treating
Post-Traumatic Stress Disorder (PTSD) with EMDR
Christoph Rothmayr
The Eight Stages
of EMDR Treatment
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.
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.
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.
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)
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)
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.
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 (
However, this study tells us nothing about the effectiveness of EMDR in
PTSD compared to more commonly used PTSD treatments other than
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.
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.
References:
American Psychiatric Association. (1997). Diagnostic and Statistical Manual
of Mental Disorders (4th ed.).
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.
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,
|
Psychology DepartmentThe Health Psychology Home Page is
produced and maintained by David Schlundt, PhD. |
|
|
|
Vanderbilt Homepage | Introduction to Vanderbilt | Admissions | Colleges & Schools | Research Centers | News & Media Information | People at Vanderbilt | Libraries | Administrative Departments | Medical |
Return to the Health Psychology Home
Page |
Send E-mail
comments or questions to Dr. Schlundt |
|
Search |
