Eye Movement Desensitisation and Reprocessing)

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Category: Allied Health Options

What is it?

Eye Movement Desensitisation and Reprocessing (EMDR) is a relatively new method of therapy for post-traumatic stress disorder (PTSD) where the client is asked to focus on a traumatic or disturbing image, thought, emotion and a bodily sensation whilst receiving bilateral stimulation most commonly in the form of eye movements.

How does it work?

EMDR is based on the notion that symptoms arise when information related to a distressing or traumatic experience are not fully processed. The initial perceptions, emotions, and distorted thoughts will be stored as they were experienced at the time of the event. EMDR relieves symptoms by linking the disturbing memory with a more adaptive interpretation of the experience. This transforms the emotional, sensory, and cognitive components of the memory so that when it is accessed the individual no longer feels distressed. These adaptive cognitions or visualised images and body sensations are coupled with eye movements, which is a unique feature of EMDR. While some studies have found that eye movements in EMDR reduce the vividness of the negative emotions, a recent review reported that the contribution of the eye movement component to treatment outcomes remains unclear.

Is it effective?

The results of a recent study which investigated different psychological treatments for PTSD have shown evidence for the effectiveness of EMDR. EMDR was better than wait list control in reducing traumatic symptoms. It appeared to have similar effectiveness as the trauma focused cognitive behavioural therapy and was more effective than stress management and other therapies (counselling, psychodynamic therapy and hypnotherapy) in reducing PTSD symptoms.

Similar positive findings were reported in another recent study which compared the effectiveness of EMDR with drug therapy.

Recently published clinical guidelines for post-traumatic stress disorder reported that EMDR combined with in vivo exposure is a potent intervention for the treatment of adults with PTSD. However, indications from random controlled trials are that treatment gains may be more likely associated with cognitive processing and exposure elements of the therapy rather than eye movement. Caution should be exercised when the client presents with severe co-morbid borderline personality disorder, psychotic illness, severe depression and suicide risk, or ongoing threat.

Are there any disadvantages?

There may be a temporary increase in distress when unresolved memories emerge, which may even continue after the treatment session. Clients may also demonstrate high levels of emotional or physical sensation during treatment.

Where do you get it?

EMDR can only be administered by registered health professionals specifically trained to conduct EMDR. The health professional should have completed the basic training in EMDR.

What are the evidence limitations?

Some studies included in the review had individuals with traumatic stress symptoms who were diagnosed using different criteria from DSM-IV.

Recommendations

Based on current evidence, EMDR can be recommended as frontline intervention for those diagnosed with PTSD.

Key References

Australian Centre for Posttraumatic Mental Health (2007). Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder. ACPMH, Melbourne, Victoria

Bisson, J & Andre, M 2007, ‘Psychological treatment of post traumatic stress disorder (PTSD)’, Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD003388. DOI: 10.1002/14651858.CD003388.pub3

Seidler, GH & Wagner, FE 2006, ‘Comparing the efficacy of EMDR and trauma-focused cognitive behavioural therapy in the treatment of PTSD: a meta-analytic study’, Psychological Medicine, vol. 36, pp. 1515-1522.

Van der Kolk, BA, Spinazzola, J, Blaustein, ME, et al. 2007, ‘A randomised controlled trial of eye movement desensitisation and reprocessing (EMDR), Fluoxetine and pill placebo in the treatment of post traumatic stress disorder: treatment effects and long term maintenance’, Journal of Clinical Psychiatry, vol. 68, no. 1, pp. 37-46.

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