Eye-movement desensitisation to overcome post-traumatic stress disorder

Eye movement desensitisation and reprocessing

Eye movement desensitisation and reprocessing (EMDR) was described by Shapiro (1989a,b) as a new method for treating post-traumatic stress disorder (PTSD). In May 1987, while walking in the park, Shapiro noticed that her own disturbing thoughts changed then disappeared “without any conscious effort” (Shapiro, 1995) when they had been temporally paired with diagonal upward to and fro eye movements. Over the next six months Shapiro worked with approximately 70 people to develop a procedure based on the temporal pairing of distressing images and thoughts with various eye movements. Shapiro began to develop strategies to unblock stalled emotional processing, which was initiated by EMDR in non-patients. She successfully tried the method on a Vietnam veteran suffering from severe PTSD and then embarked upon a trial of EMDR on a mixed group of victims of rape, molestation and Vietnam combat trauma. Initially, EMDR achieved wide recognition as a new breakthrough treatment for PTSD. This was, in part, because of very positive early reports (e.g. Wolpe & Abrams, 1991), but also because the EMDR effect appeared to occur with unprecedented speed, often in cases of PTSD that had previously resisted treatment by many other methods over a long period.

Brief psychological intervention with traumatized young women: the efficacy of eye movement desensitization and reprocessing

To study the efficacy of eye movement desensitization and reprocessing (EMDR) with traumatized young women, 60 women between the ages of 16 and 25 were randomly assigned to two sessions of either EMDR or an active listening (AL) control. Factorial ANOVA interaction effects and simple main effects for outcome measure (Beck Depression Inventory, State-Trait Anxiety Inventory, Penn Inventory for Posttraumatic Stress Disorder, Impact of Event Scale, Tennessee Self-Concept Scale) indicated significant improvement for both groups and significantly greater pre-post change for EMDR-treated participants. Pre-post effect sizes for the EMDR group averaged 1.56 compared to 0.65 for the AL group. Despite treatment brevity, the posttreatment outcome variable means of EMDR-treated participants compared favorably with nonpatient or successfully treated norm groups on all measures.

Emotional processing during eye movement desensitization and reprocessing therapy of Vietnam veterans with chronic posttraumatic stress disorder

This study examined emotional processing and outcome in 17 Vietnam veterans with chronic posttraumatic stress disorder (PTSD) who underwent eye movement desensitization and reprocessing (EMDR) therapy, with and without the eye movement component, in a crossover design. Results supported the occurrence of partial emotional processing, but there were no differences in its extent in the eye-movement versus eyes-fixed conditions. Therapy produced a modest to moderate overall improvement, mostly on the impact of Event Scale. There was slightly more improvement in the eyes-fixed than eye-movement condition. There was little association between the extent of emotional processing and therapeutic outcome. In our hands, EMDR was at least as efficacious for combat-related PTSD as imaginal flooding proved to be in a previous study, and was better tolerated by subjects. However, results suggest that eye movements do not play a significant role in processing of traumatic information in EMDR and that factors other than eye movements are responsible for EMDR's therapeutic effect.

The consequence of land mines on public health

An estimated 110 million land mines scattered in 64 countries continue to terrorize people and destroy human lives long after wars and fighting have ceased. Despite efforts to clear these devices, their numbers continue to increase and their presence constitutes a substantial threat to public health in affected countries. Direct consequences include both the physical and emotional injuries from the impact, flying debris, and structural collapse associated with their detonation. Indirect consequences include increases in the incidence of waterborne diseases, diarrhea, malnutrition, infectious diseases, and spread of the human immunodeficiency virus associated with the increased use of blood. Those at highest risk of these later consequences are mostly the disadvantaged poor, especially children. Psychiatric disorders, such as post-traumatic stress disorder, occur in those not directly injured as well as those physically wounded by the explosion. Besides efforts to ban production, stockpiling and export of land mines, a comprehensive and integrated health program aimed at the prevention, treatment, and rehabilitation of those injured directly or indirectly by land mines is needed urgently. Strategies should include mine-awareness programs, enhanced transport of those directly injured, training the villagers in first aid, augmenting the capacity and quality of treatment facilities, improving the psychological support and treatment capabilities, development of rehabilitation programs, and the institution and enhancement of public-health programs directed at the indirect consequences associated with the presence of land mines. Land mines constitute a major public health problem in the world that must be addressed.

The empirical status of the clinical application of eye movement desensitization and reprocessing

The published reports of the clinical application of eye movement desensitization and reprocessing (EMDR) are reviewed in terms of empirical validity. Case studies, single-subject experiments and group design experiments on clinical problems are evaluated for the effectiveness of the protocol, component effects, comparative effects and treatment fidelity. Classification of disorders and measurement issues are addressed. The protocol frequently reduces verbal report and independent observer ratings of distress--strikingly in some instances. Psychophysiologic measures show little effect of treatment. There is little empirical evidence to indicate the effect of treatment on motoric or behavioral indices. Eye movements do not appear to be an essential component of treatment, and there have been no substantial comparisons with other treatments. No studies have adequately controlled for nonspecific (placebo) effects of treatment. Suggestions are made for applying improved methodological controls for future applications of EMDR to clinical disorders.

A trial of eye movement desensitization compared to image habituation training and applied muscle relaxation in post-traumatic stress disorder

Thirty-six patients with PTSD were randomly allocated to individual treatment with imaginal exposure (image habituation training -- IHT), or applied muscle relaxation (AMR) or eye movement desensitization (EMD). Assessment by a blind independent rater and self-report instruments applied pre and posttreatment and at 3-month follow-up indicated that all groups improved significantly compared with a waiting list and that treatment benefits were maintained at follow-up. Despite a failure to demonstrate differences among groups, there was some suggestion that immediately after treatment EMD was superior for intrusive memories.

Eye movement desensitization and reprocessing: treating trauma and substance abuse

Eye Movement Desensitization and Reprocessing (EMDR) is a new psychological methodology that has been applied to a wide range of psychological disorders. Clinical reports over the past three years indicate that it is an important addition to the treatment of substance abuse. EMDR offers a structured, client-centered model that integrates key elements of intrapsychic, behavioral, cognitive, body-oriented, and interactional approaches. Treatment effects are quite rapid and, during an individual session, the therapist may witness accelerated processing of information involving a shift of cognitive structures (including the assimilation of positive beliefs) along with the desensitization of attendent traumata. The application of EMDR apparently stimulates an inherent physiological processing system that allows dysfunctional information to be adaptively resolved, resulting in increased insight and more functional behavior. The judicious use of EMDR includes a comprehensive client history and extensive preparation, allowing the client to deal with the high levels of disturbance often engendered by the treatment itself. After the inauguration of a sufficient therapeutic alliance, adequately addressing potential issues of secondary gain, and appropriate client stabilization, EMDR may be used to ameliorate the effects of earlier memories that contribute to the dysfunction, potential relapse triggers, and physical cravings. In addition, EMDR is used to incorporate new coping skills and assist in learning more adaptive behaviors. Other potential targets for reprocessing include treatment noncompliance, ambivalence about abstinence, and present crises. Finally, EMDR should be used on this clinical population only by a trained clinician who is educated and experienced with this problem area.