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Program Profile: Eye Movement Desensitization and Reprocessing (EMDR)

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on June 15, 2011

Program Summary

A therapeutic approach designed to help individuals who have experienced traumatic stress to reprocess and adaptively store dysfunctionally stored traumatic memories. The program is rated Promising. There were significant pre–post gains on all outcome measures for the treatment and comparison group that received the active listening approach. However, the differential improvement on depression, anxiety, PTSD and impact resulted in greater pre–post changes for the treatment group.

Program Description

Program Goals/Program Theory

Eye Movement Desensitization and Reprocessing (EMDR) is a therapeutic approach designed to treat individuals who are dealing with the aftermath of a traumatic life event, including children exposed to violence. The approach is guided by the adaptive information processing model. As the brain slowly processes memories of everyday life experiences, these memories are transferred to the left cerebral cortex, where they are filed away with other neutral memories, becoming part of an individual’s life story. Traumatic experiences, however, are often highly emotionally charged and can overwhelm the brain’s capacity to process information. Instead of being properly connected and stored with other memories, episodic memory of traumatic experiences may be indefinitely stored in the limbic system. Dysfunctionally stored traumatic memories can in turn lead to maladaptive coping strategies and cause intense anxiety and other symptoms of posttraumatic stress disorder (PTSD).

 

The goal of EMDR treatment is therefore to help individuals who have experienced traumatic stress to reprocess and adaptively store dysfunctionally stored traumatic memories. Treatment sessions focus on the past experiences that may have caused PTSD or other psychological disorders; the current circumstances that trigger dysfunctional emotions, beliefs, and sensations; and the positive experiences that can improve future adaptive behaviors and mental health.

 

Program Components

EMDR treatment involves an eight-phase protocol that addresses an individual’s past, present, and future experience and behavior. During phase 1, treatment focuses on obtaining the individual’s history and determining if the individual is a good candidate for EMDR. If treatment is appropriate, the therapist creates a treatment plan and works with the individual to identify traumatic experiences that can be targeted for EMDR processing. During phase 2 (the preparation phase), a therapeutic alliance is established between the individual and the therapist, and the process of EMDR is fully explained. Individuals in treatment are taught about strategies to manage intense feelings of distress and to reduce stress that may occur during or between sessions. Ideally, individuals will not need to use these strategies once therapy is complete.

 

Phase 3 (assessment phase), involves identifying and accessing the target memory that will be processed. Therapists ask the individuals to focus on a vivid, disturbing image that represents the traumatic event and to identify negative beliefs about the self that are rooted in that experience. Individuals must create a positive cognition or belief that could replace the negative belief. The individual is also asked to notice the feelings and body sensations that may be associated with the disturbing memory. Baseline measurements of reactivity are assessed during the exercise.

 

During phase 4 (desensitization), the traumatic event and present stimuli that trigger the past experience are processed. Individuals are told to hold the disturbing images of the traumatic event in their mind along with the associated negative belief, feelings, and sensations in their body while focusing on external stimulus. The external stimulus is the therapists’ fingers or hands that are moved back and forth in front of the individuals’ eyesight for about 20 to 50 seconds. After each set of bilateral stimulation, individuals are asked about any changes or thoughts they experience. Through each treatment session, rating scales are used to keep track of any changes in the intensity of feelings and body sensations. As individuals focus on the traumatic experiences, the episodic memory is processed and individuals should experience noticeable shifts in cognitions, emotions, and sensations. The memory of the traumatic event can then be integrated and consolidated as a narrative memory. As a result, individuals are brought to an adaptive resolution through adaptive information processing.

 

In phase 5 (installation), individuals indentify the most positive belief about themselves (either the initial positive cognition from phase 3 or another one that may emerge during treatment sessions). Using bilateral stimulation, therapists help individuals increase the connection of the new positive cognition with existing positive cognitive networks. The effects can then be generalized within associated neural networks.

 

During phase 6 (body scan), therapists assist individuals in identifying and processing residual body sensations. In phase 7 (closure), therapists ensure individuals’ stability, and individuals are told about what they might experience between treatment sessions. The final phase (reevaluation) is the assessment that occurs at the beginning of each subsequent session. In each new session, the individual’s psychological state guides the next step of treatment.

Evaluation Outcomes

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Study 1

Scheck, Schaeffer, and Gillette (1998) found that 77 percent of study participants (n= 46) met all of the symptom, duration, and exposure criteria to be classified as having posttraumatic stress disorder (PTSD).

 

Treatment Outcomes: Depression, Anxiety, PTSD, and Impact

The results showed that there were significant pre–post improvements on all outcome measures for both the Eye Movement Desensitization and Reprocessing (EMDR) treatment group and the comparison group that received the active listening (AL) approach. However, the differential improvement on four outcome measures (the Beck Depression Inventory, the State–Trait Anxiety Inventory, the Penn Inventory for PTSD, and the Impact of Event Scale) resulted in significantly greater pre–post changes for the EMDR treatment group on measures of depression, anxiety, PTSD, avoidance, and intrusive thoughts. The effect size for EMDR group members averaged 1.56, compared to 0.65 for AL group members.

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Evaluation Methodology

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Study 1

Scheck, Schaeffer, and Gillette (1998) studied the efficacy of Eye Movement Desensitization and Reprocessing (EMDR) with a group of traumatized young women. The study randomly assigned 60 women between the ages of 16 and 25 to attend two sessions of either EMDR or an active listening (AL) approach. Study participants in the treatment group received EMDR treatment that followed the standard protocol devised by Shapiro (2001), consisting of manualized steps. Participants in the comparison group received AL treatment that followed a nondirective, Rogerian-based model: Comparison group participants were asked to say more about the traumatic memory. Therapists then used attentive silence and non-evaluative acknowledgement of what the participants shared.

 

Individuals were recruited from local municipal agencies in Colorado Springs, Colorado. They were eligible for the study if they were female, under 25 years of age, had a recent history of at least two of eight dysfunctional behaviors, and had a self-reported traumatic memory. Dysfunctional behaviors were assessed using an eight-item questionnaire that measured arrests, sexual promiscuity, runaway behavior, and drug and alcohol abuse. The final group of study participants was 62 percent white, 15 percent African American, 15 percent Hispanic, and 8 percent Native American. Almost all of the study participants (90 percent) reported being victims of physical or emotional abuse as a child. Over half of the traumas that participants self-reported were traumatic sexual experiences, such as rape or child molestation. There were no significant differences between the EMDR treatment group and AL comparison group on age, education level, and ethnicity.

 

There were several outcome measures of interest. The Posttraumatic Stress Disorder Interview (or PTSD–I) used a structured interview format to estimate the Diagnostic and Statistical Manual of Mental Disorders (or DSM–IV) diagnosis for PTSD. In addition, the Beck Depression Inventory, a 21-item self-report scale, was used to assess the severity of depression. The State–Trait Anxiety Inventory, a 40-item self-report scale, included two subscales that measured trait anxiety (how the participant generally feels) and state anxiety (how the participant feels right now). The Penn Inventory for Posttraumatic Stress Disorder, a 26-item self-report scale, measured the strength or intensity of posttraumatic symptoms. The Impact of Event Scale, a 15-item scale, included two subscales that assessed avoidance and intrusions concerning the traumatic event that participants have experienced over the most recent 7 days. Finally, the Tennessee Self-Concept Scale, a 100-item self-report scale, included a number of subscales and measured overall level of self-esteem.

 

Pretest assessments were collected with the female participants once they agreed to join the study. Posttest assessments were administered following participants’ attendance in two therapy sessions of either EMDR or AL. A follow-up interview was conducted about 90 days after the posttest assessment. Follow-up data was only collected on 32 of the 60 participants (53 percent) who were available for follow-up interviews and did not have additional psychotherapy during the 3-month follow-up period.

 

A factorial analysis of variance (or ANOVA) technique was used to analyze the outcomes measures, with one between-subjects factor (type of treatment) and one within-subjects factor (pre–post). Analyses of simple main effects that used an unweighted means approach was also applied to analyze the data.

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Cost

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There is no cost information available for this program.
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Implementation Information

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A manual for conducting Eye Movement Desensitization and Reprocessing (EMDR) with adults is available: Shapiro, Francine. 2001. Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures (2nd ed.). New York, N.Y.: Guilford Press.

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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Scheck, Margaret M., Judith Ann Schaeffer, and Craig Gillette. 1998. “Brief Psychological Intervention With Traumatized Young Women: The Efficacy of Eye Movement Desensitization and Reprocessing.” Journal of Traumatic Stress 11(1):25–44.
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Additional References

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These sources were used in the development of the program profile:

Ahmad, Abdulbaghi, Bo Larsson, and Viveka Sundelin–Wahlsten. 2007. “EMDR Treatment for Children With PTSD: Results of a Randomized Controlled Trial.” Nordic Journal of Psychiatry 61(5):349–54. (This study was reviewed but did not meet CrimeSolutions.gov criteria for inclusion in the overall program rating.)

Ahmad, Abdulbaghi, and Viveka Sundelin–Wahlsten. 2008. “Applying EMDR on Children With PTSD.” European Child & Adolescent Psychiatry 17(3):127–32.

EMDR Institute, Inc. 2011 “Home.” Accessed June 14, 2011.
http://www.emdr.com/

Jaberghaderi, Nasrin, Ricky Greenwald, Allen Rubin, Shahin Oliaee Zand, and Shiva Dolatabadi. 2004. “A Comparison of CBT and EMDER for Sexually-Abused Iranian Girls.” Clinical Psychology and Psychotherapy 11:358–68.

Oras, R., S. Candela de Ezpeleta, and A. Ahmad. 2004. “Treatment of Traumatized Refugee Childrenw with Eye Movement Desensitization and Reprocessing in a Psychodynamic Context.” Nordic Journal of Psychiatry 58:199–203.

Shapiro, Francine. 2001. Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures (2nd ed.). New York, N.Y.: Guilford.

Solomon, Eldra P., Roger M. Solomon, and Kathleen M. Heide. 2009. “EMDR: An Evidence-Based Treatment for Victims of Trauma.” Victims & Offenders 4(4):391–97.
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Related Practices

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Following are CrimeSolutions.gov-rated practices that are related to this program:

Psychotherapies for Victims of Sexual Assault
This practice examines interventions for adult sexual assault victims that reduce psychological distress, symptoms of post-traumatic stress disorder (PTSD), and rape trauma through counseling, structured or unstructured interaction, training programs, or predetermined treatment plans. The practice is rated Effective in reducing symptoms of trauma and PTSD in victims of sexual assault and rape.

Evidence Ratings for Outcomes:
Effective - More than one Meta-Analysis Mental Health & Behavioral Health - Trauma/PTSD
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Program Snapshot

Age: 16 - 25

Gender: Female

Race/Ethnicity: Black, American Indians/Alaska Native, Hispanic, White

Geography: Suburban, Urban

Setting (Delivery): Inpatient/Outpatient, Other Community Setting

Program Type: Cognitive Behavioral Treatment, Individual Therapy, Victim Programs

Targeted Population: Females, Victims of Crime

Current Program Status: Active

Listed by Other Directories: National Registry of Evidence-based Programs and Practices

Researcher:
Christopher Lee
Programme Chair, Clinical Psychology
Murdoch University
Perth
Phone: +61421131042
Fax: +61863168580
Email