Sub-Total: $0.00
The Efficacy of EMDR
EMDR is now accepted as a treatment of choice by numerous mental health departments and trauma organizations.
EMDR has a broad base of published case reports and controlled research that supports it as an empirically validated treatment of trauma and other adverse life experiences.
EMDR has a broad base of published case reports and controlled research that supports it as an empirically validated treatment of trauma and other adverse life experiences.
The Department of Defense/Department of Veterans Affairs Practice Guidelines have placed EMDR in the highest category, recommended for all trauma populations at all times. In addition, the International Society for Traumatic Stress Studies current treatment guidelines have designated EMDR as an effective treatment for PTSD (Foa, Keane, Friedman, & Cohen, 2009) as have the Departments of Health of both Northern Ireland and Israel (see below), which have indicated EMDR to be one of only two or three treatments of choice for trauma victims.
The American Psychiatric Association Practice Guideline (2004) has stated that SSRI's, CBT, and EMDR are recommended as first-line treatments of trauma. Most recently, the World Health Organization (2013) has stated that trauma-focused CBT and EMDR are the only psychotherapies recommended for children, adolescents, and adults with PTSD. “Like CBT with a trauma focus, EMDR aims to reduce subjective distress and strengthen adaptive cognitions related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure, or (d) homework.” (p.1)
See Shapiro (1999, 2001, 2002) for procedures, protocols, theories, and discussion of clinically valid research criteria. See Shapiro (2012) for a comprehensive narrative of cases, and in-session transcripts, and "EMDR for Trauma" in APA Psychotherapy Videotape series. More than twenty randomized studies support EMDR therapy as an effective and efficient treatment of trauma. More than two-dozen randomized studies and a recent meta-analysis (Lee & Cuijpers, 2013) have demonstrated the positive effects of the eye movement component. For discussion of studies investigating the eye movement and other bilateral stimulation, please see Frequently Asked Questions.
Efficacy/Validation Overviews
International Treatment Guidelines
Meta-Analyses
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.
Randomized Clinical Trials
Non-Randomized Studies
Adaptive Information Processing
and EMDR Procedures
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.
Randomized Studies of Hypotheses
Regarding Eye Movements
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 (2000); 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 methodologically 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 are 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, 2008) and is listed below as well.
Mechanism of Action
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 one 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.
Additional Psychophysiological and Neurobiological Evaluations of EMDR Treatment
All psychophysiological studies have indicated significant de-arousal. All neurobiological studies have indicated significant effects, including changes in cortical, and limbic activation patterns, and increase in hippocampal volume.
Combat Veteran Treatment
As noted in the American Psychiatric Association Practice Guidelines (2004, p.18), in EMDR “traumatic material need not be verbalized; instead, patients are directed to think about their traumatic experiences without having to discuss them.” Given the reluctance of many combat veterans to divulge the details of their experience, this factor is relevant to willingness to initiate treatment, retention and therapeutic gains. It may be one of the factors responsible for the lower remission and higher dropout rate noted in this population when CBT techniques are used.
As described previously, Carlson et al. (1998) reported that after twelve treatment sessions, 77.7% of the combat veterans no longer met criteria for PTSD. There were no dropouts and effects were maintained at 3- and 9-month follow-up. In addition, the Silver et al., (1995) analysis of an inpatient veterans’ PTSD program (n = 100) found EMDR to be superior to biofeedback and relaxation training on seven of eight measures. All other randomized studies of veterans have used insufficient treatment doses to assess PTSD outcomes (e.g., two sessions; see ISTSS, 2000; DVA/DoD, 2005). Sufficient treatment time must be used for multiply traumatized veterans (e.g., see below: Russell et al., 2007). However, in a process analysis, Rogers et al. (1999) compared one session of EMDR and exposure therapy with inpatient veterans, and a different recovery pattern was observed. The EMDR group demonstrated a more rapid decline in self-reported distress (e.g., SUD levels decreased with EMDR and increased with exposure).
As stated in the American Psychiatric Practice Guidelines (2004, p. 36), if viewed as an exposure therapy, “EMDR employs techniques that may give the patient more control over the exposure experience (since EMDR is less reliant on a verbal account) and provides techniques to regulate anxiety in the apprehensive circumstance of exposure treatment. Consequently, it may prove advantageous for patients who cannot tolerate prolonged exposure as well as for patients who have difficulty verbalizing their traumatic experiences. Comparisons of EMDR with other treatments in larger samples are needed to clarify such differences.”
Such research is highly recommended. In addition, since EMDR utilizes no homework to achieve its effects it may be particularly suited for front line alleviation of symptoms (see Russell, 2006; Wesson & Gould, 2009). Further, the prevalent somatic and chronic pain problems experienced by combat veterans indicate the need for additional research based upon the reports of Russell (2008), Schneider et al., (2007, 2008) and Wilensky (2007), which demonstrate EMDR’s capacity to successfully treat phantom limb pain (see also Ray & Zbik, 2001). The ability of EMDR to simultaneously address PTSD, depression, and pain can have distinct benefits for DVA/DoD treatment.
The following contain clinically relevant information for the treatment of veterans, including therapy parameters.