DIAGNOSIS: Posttraumatic Stress Disorder
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Eye Movement Desensitization and Reprocessing for Post-Traumatic Stress Disorder
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Please refer to APA's Clinical Practice Guidelines for the treatment of PTSD.
Eye Movement Desensitization Reprocessing, or EMDR, pairs eye movements with cognitive processing of the traumatic memories. The initial phases of EMDR involve affect management techniques, such as relaxation. During the processing stage of therapy, the patient describes the traumatic memory and identifies and labels the images, beliefs, and physiological symptoms elicited by it. The patient is instructed to focus on these aspects of the traumatic memory while moving his/her eyes back and forth by tracking the therapists' finger (although other bilateral stimulation, such as finger-tapping, is used). The theoretical basis for EMDR is that PTSD symptoms result from insufficient processing/integration of sensory, cognitive, and affective elements of the traumatic memory. The bilateral eye movements are proposed to facilitate information processing and integration, allowing clients to fully process traumatic memories.
The efficacy of EMDR for PTSD is an extremely controversial subject among researchers, as the available evidence can be interpreted in several ways. On one hand, studies have shown that EMDR produces greater reduction in PTSD symptoms compared to control groups receiving no treatment. On the other hand, the existing methodologically sound research comparing EMDR to exposure therapy without eye movements has found no difference in outcomes. Thus, it appears that while EMDR is effective, the mechanism of change may be exposure - and the eye movements may be an unnecessary addition. If EMDR is indeed simply exposure therapy with a superfluous addition, it brings to question whether the dissemination of EMDR is beneficial for patients and the field. However, proponents of EMDR insist that it is empirically supported and more efficient than traditional treatments for PTSD. In any case, more concrete, scientific evidence supporting the proposed mechanisms is necessary before the controversy surrounding EMDR will lift.
For a review of the controversy surrounding EMDR, see:
- Davidson, P.R. & Parker, K.C. (2001). Eye movement desensitization and reprocessing (EMDR): a meta-analysis. Journal of Consulting and Clinical Psychology, 69, 305-316.[link]
- Herbert, J. D., Lilienfeld, S. O., Lohr, J. M., Montgomery, R. W., O'Donohue, W. T., Rosen, G. M., et al. (2000). Science and pseudoscience in the development of eye movement desensitization and reprocessing: Implications for clinical psychology. Clinical Psychology Review, 20, 945-971. [link]
Key References (in reverse chronological order)
- Devilly, G.J. and 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.
- Rothbaum, B. O. (1997). A controlled study of eye movement desensitization and reprocessing in the treatment of posttraumatic stress disordered sexual assault victims. Bulletin of the Menninger Clinic, 61, 317-334.
- Wilson, S. A., 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.
- Jensen, J.A. (1994). An investigation of eye movement desensitization and reprocessing (EMDR) as a treatment of posttraumatic stress disorder (PTSD) symptoms of Vietnam combat veterans. Behavior Therapy, 25, 311-325.
- Boudewyns, P.A., Stwertka, S.A., Hyer, L.A., Albrecht, J.W. and Sperr, E.V. (1993). Eye movement desensitization for PTSD of combat: A treatment outcome pilot study. The Behavior Therapist, 16, 29-33.
- Shapiro, F. (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures (2nd ed.). New York: Guilford Press.
- The EMDR Institute in Watsonville, CA offers training in EMDR.
Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice