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STUDIES of the model and procedures,

selected research and case reports*

REVIEW ARTICLE by Francine Shapiro Ph.D

The Role of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in Medicine: Addressing the Psychological and Physical Symptoms Stemming from Adverse Life Experiences. Addressing the Psychological and Physical Symptoms Stemming from Adverse Life Experiences. Permanente Journal, 2014 Winter;18(1):71-77:

Background:
A substantial body of research shows that adverse life experiences contribute to both psychological and biomedical pathology. Eye movement desensitization and reprocessing (EMDR) therapy is an empirically validated treatment for trauma, including such negative life experiences as commonly present in medical practice. The positive therapeutic outcomes rapidly achieved without homework or detailed description of the disturbing event offer the medical community an efficient treatment approach with a wide range of applications.

This is the link where the article can downloaded:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951033/pdf/permj18_1p0071.pdf
 
 
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.

· Bae, H., Kim, D. & Park, Y.C. (2008).Eye movement desensitization and reprocessing for adolescent depression.Psychiatry Investigation, 5,60-65.

Processing of etiological disturbing memories, triggers and templates resulted in complete remission of Major Depressive Disorder in two teenagers. Treatment duration was 3-7 sessions and effects were maintained at follow-up.

· Brown, S. & Shapiro, F. (2006). EMDR in the treatment of borderline personality disorder.Clinical Case Studies, 5,403-420.

20 EMDR sessions that focused on reprocessing the memories seemingly at the foundation of the pathology, along with triggers and future templates resulted in a complete remission of BPD, including symptoms of affect dysregulation, as measured on theInventory of Altered Self Capacities.

· Brown, K. W., McGoldrick, T., & Buchanan, R. (1997).Body dysmorphic disorder: Seven cases treated with eye movement desensitization and reprocessing.Behavioural and Cognitive Psychotherapy, 25,203–207.

Seven consecutive cases were treated with up to three sessions of EMDR. Complete remission of BDD symptoms were reported in five cases with effects maintained at one- year follow-up.

· Gauvreau, P. & Bouchard, S. (2008)Preliminary evidence for the efficacy of EMDR in treating generalized anxiety disorder.Journal of EMDR Practice and Research, 2. 26-40.

Four subjects were evaluated using a single case design with multiple baselines Results indicate that subsequent to targeting the experiential contributors, at posttreatment and at 2 months follow-up, all four participants no longer presented with GAD diagnosis.

· McGoldrick, T., Begum, M. & Brown, K.W. (2008).EMDR and olfactory reference syndrome: A case series.Journal of EMDR Practice and Research 2,63-68.

EMDR treatment of four consecutive cases of ORS whose pathological symptoms had endured for 8–48 years resulted in a complete resolution of symptoms in all four cases, which was maintained at follow-up.

· Mol, S. S. L., Arntz, A., Metsemakers, J. F. M., Dinant, G., Vilters-Van Montfort, P. A. P., & Knottnerus, A. (2005).Symptoms of post-traumatic stress disorder after non-traumatic events: Evidence from an open population study.British Journal of Psychiatry, 186,494–499.

Supports a basic tenet of the Adaptive Information Processing model that “Life events can generate at least as many PTSD symptoms as traumatic events.” In a survey of 832 people, “For events from the past 30 years the PTSD scores were higher after life events than after traumatic event.”

· Perkins, B.R. & Rouanzoin, C.C. (2002).A critical evaluation of current views regarding eye movement desensitization and reprocessing (EMDR): Clarifying points of confusion.Journal of Clinical Psychology,58, 77-97.

Reviews common errors and misperceptions of the procedures, research, and theory.

· Raboni, M.R., Tufik, S., and Suchecki, D. (2006).Treatment of PTSD by eye movement desensitization and reprocessing improves sleep quality, quality of life and perception of stress.Annals of the New York Academy of Science, 1071,508-513.

Specifically citing the hypothesis that EMDR induces processing effects similar to REM sleep (see also Stickgold, 2002, 2008), polysomnograms indicated a change in sleep patterns post treatment, and improvement on all measures including anxiety, depression, and quality of life after a mean of five sessions.

· Ray, A. L. & Zbik, A. (2001).Cognitive behavioral therapies and beyond. In C. D. Tollison, J. R. Satterhwaite, & J. W. Tollison (Eds.)Practical Pain Management(3rd ed.; pp. 189-208). Philadelphia: Lippincott.

The authors note that the application of EMDR guided by the Adaptive Information Processing model appears to afford benefits to chronic pain patients not found in other treatments.

· Ricci, R. J., Clayton, C. A., & Shapiro, F. (2006).Some effects of EMDR treatment with previously abused child molesters: Theoretical reviews and preliminary findings.Journal of Forensic Psychiatry and Psychology, 17, 538-562.

As predicted by the Adaptive Information Processing model the EMDR treatment of the molesters’ own childhood victimization resulted in a decrease in deviant arousal as measured by theplethysmograph, a decrease in sexual thoughts, and increased victim empathy. Effects maintained at one year follow up.

· Russell, M. (2008).Treating traumatic amputation-related phantom limb pain: a case study utilizing eye movement desensitization and reprocessing (EMDR) within the armed services.Clinical Case Studies, 7,136-153.

“Since September 2006, over 725 service-members from the global war on terrorism have survived combat-related traumatic amputations that often result in phantom limb pain (PLP) syndrome. . . . Four sessions of Eye Movement Desensitization and Reprocessing (EMDR) led to elimination of PLP, and a significant reduction in PTSD, depression, and phantom limb tingling sensations.”

· Schneider, J., Hofmann, A., Rost, C., & Shapiro, F. (2008).EMDR in the treatment of chronic phantom limb pain. Pain Medicine, 9,76-82.doi: 10.1111/j.1526-4637.2007.00299.x

As predicted by the Adaptive Information Processing model the EMDR treatment of the event involving the limb loss, and the stored memories of the pain sensations, resulted a decrease or elimination of the phantom limb pain which maintained at 1 year follow up.

· Schneider, J., Hofmann, A., Rost, C., & Shapiro, F. (2007).EMDR and phantom limb pain: Case study, theoretical implications, and treatment guidelines.Journal of EMDR Science and Practice, 1,31-45.

Detailed presentation of case treated by EMDR that resulted in complete elimination of PTSD, depression and phantom limb pain with effects maintained at 18-month follow-up.

· Shapiro, F. (2001).Eye movement desensitization and reprocessing: Basic principles, protocols and procedures(2nd ed.). New York: Guilford Press.

EMDR is an eight-phase psychotherapy with standardized procedures and protocols that are all believed to contribute to therapeutic effect. This text provides description and clinical transcripts and an elucidation of the guiding Adaptive Information Processing model.

· Shapiro, F. (2002).(Ed.).EMDR as an integrative psychotherapy approach: Experts of diverse orientations explore the paradigm prism.Washington, DC: American Psychological Association Books.

EMDR is an integrative approach distinct from other forms of psychotherapy. Experts of the major psychotherapy orientations identify and highlight various procedural elements.

· Shapiro, F. (2007).EMDR, adaptive information processing, and case conceptualization.Journal of EMDR Practice and Research, 1, 68-87.

Overview of EMDR treatment based upon an Adaptive Information Processing case conceptualization. Early life experiences are viewed as the basis of pathology and used as targets for processing. The three-pronged protocol includes processing of the past events that have set the foundation for the pathology, the current triggers, and templates for appropriate future functioning to address skill and developmental deficits.

· Shapiro, F. (2006). EMDR and new notes on adaptive information processing: Case formulation principles, scripts and worksheets. Camden, CT: EMDR Humanitarian Assistance Programs (http://www.emdrhap.org/)

Overview of Adaptive Information Processing model, including how the principles are reflected in the procedures, phases and clinical applications of EMDR. Comprehensive worksheets for client assessment, case formulation, and treatment as well as scripts for various procedures.

· Shapiro, F., Kaslow, F., & Maxfield, L. (Eds.) (2007).Handbook of EMDR and Family Therapy Processes. New York: Wiley.

Using an Adaptive Information Processing conceptualization a wide range of family problems and impasses can be addressed through the integration of EMDR and family therapy techniques. Family therapy models are also useful for identifying the targets in need of processing for those engaged in individual therapy.

· Solomon, R. & Shapiro, F, (2008). EMDR and the adaptive information processing model: Potential mechanisms of change.Journal of EMDR Practice and Research, 2,315-325.

This article provides a brief overview of some of the major precepts of the Adaptive Information Processing model, a comparison and contrast to extinction-based information processing models and treatment and a discussion of a variety of mechanisms of action.

· Uribe, M. E. R., & Ramirez, E. O. L. (2006).The effect of EMDR therapy on the negative information processing on patients who suffer depression.Revista Electrónica de Motivación y Emoción (REME), 9,23-24.

The study evaluated the impact of EMDR treatment on bias mechanisms in depressed subjects in regard to negative emotional valence evaluation. “The results indicated that it generated important cognitive emotional changes in such mechanisms.” Priming tests indicated changes in the negative valence evaluation of emotional information indicative of recovery with decreased reaction times in the neutral and positive stimuli processing.”

· Wilensky, M. (2006).Eye movement desensitization and reprocessing (EMDR) as a treatment for phantom limb pain.Journal of Brief Therapy, 5,31-44.

“Five consecutive cases of phantom limb pain were treated with EMDR. Four of the five clients completed the prescribed treatment and reported that pain was completely eliminated, or reduced to a negligible level. . .The standard EMDR treatment protocol was used to target the accident that caused the amputation, and other related events.”

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.

· Elofsson, U.O.E., von Scheele, B., Theorell, T., & Sondergaard, H.P. (2008).Physiological correlates of eye movement desensitization and reprocessing.Journal of Anxiety Disorders, 22,622-634.

Changes in heart rate, skin conductance and LF/HF-ratio, finger temperature, breathing frequency, carbon dioxide and oxygen levels were documented during the eye movement condition. It was concluded the“eye movements during EMDR activate cholinergic and inhibit sympathetic systems. The reactivity has similarities with the pattern during REM sleep.”

· Lee, C.W., Taylor, G., & Drummond, P.D. (2006)The active ingredient in EMDR: Is it traditional exposure or dual focus of attention?Clinical Psychology and Psychotherapy,13, 97-107

This study tested whether the content of participants’ responses during EMDR is similar to that thought to be effective for traditional exposure treatments (reliving), or is more consistent with distancing which would be expected given Shapiro’s proposal of dual focus of attention. Greatest improvement on a measure of PTSD symptoms occurred when the participant processed the trauma in a more detached manner, which indicates the underlying mechanisms of EMDR and exposure therapy are different.

· MacCulloch, M. J., & Feldman, P. (1996).Eye movement desensitization treatment utilizes the positive visceral element of the investigatory reflex to inhibit the memories of post-traumatic stress disorder: A theoretical analysis.British Journal of Psychiatry, 169, 571–579.

One of a variety of articles positing an orienting response as a contributing element (see Shapiro, 2001 for comprehensive examination of theories and suggested research parameters). This theory has received controlled research support (Barrowcliff et al., 2003, 2004).

· Propper, R., Pierce, J.P., Geisler, M.W., Christman, S.D., & Bellorado, N. (2007). Effect of bilateral eye movements on frontal interhemispheric gamma EEG coherence: Implications for EMDR therapy.Journal of Nervous and Mental Disease, 195, 785-788.

“Specifically, the EM manipulation used in the present study, reported previously to facilitate episodic memory, resulted in decreased interhemispheric EEG coherence in anterior prefrontal cortex. Because the gamma band includes the 40 Hz wave that may indicate the active binding of information during the consolidation of long-term memory storage (e.g., Cahn and Polich, 2006), it is particularly notable that the changes in coherence we found are in this band. With regard to PTSD symptoms, it may be that by changing interhemispheric coherence in frontal areas, the EMs used in EMDR foster consolidation of traumatic memories, thereby decreasing the memory intrusions found in this disorder.”

· Rogers, S., & Silver, S. M. (2002).Is EMDR an exposure therapy? A review of trauma protocols.Journal of Clinical Psychology, 58,43-59.

Theoretical, clinical, and procedural differences referencing two decades of CBT and EMDR research.

· Rogers, S., Silver, S., Goss, J., Obenchain, J., Willis, A., & Whitney, R. (1999).A single session, controlled group study of flooding and eye movement desensitization and reprocessing in treating posttraumatic stress disorder among Vietnam war veterans: Preliminary data.Journal of Anxiety Disorders, 13, 119–130.

This study was designed as primarily a process report to compare EMDR and exposure therapy. A different recovery pattern was observed with the EMDR group demonstrating a more rapid decline in self-reported distress.

· Sack, M., Hofmann, A., Wizelman, L., & Lempa, W. (2008).Psychophysiological changes during EMDR and treatment outcome.Journal of EMDR Practice and Research, 2,239-246

During-session changes in autonomic tone were investigated in 10 patients suffering from single-trauma PTSD. Results indicate that information processing during EMDR is followed by during-session decrease in psychophysiological activity, reduced subjective disturbance and reduced stress reactivity to traumatic memory.

· Sack, M., Lempa, W. Steinmetz, A., Lamprecht, & Hofmann, A. (2008).Alterations in autonomic tone during trauma exposure using eye movement desensitization and reprocessing (EMDR) - results of a preliminary investigation.Journal of Anxiety Disorders, 22,1264-1271.

The psycho-physiological correlates of EMDR were investigated during treatment sessions of trauma patients. The initiation of the eye movements sets resulted in immediate changes that indicated a pronounced de-arousal.

· Servan-Schreiber, D., Schooler, J., Dew, M.A., Carter, C., & Bartone, P. (2006).EMDR for PTSD: A pilot blinded, randomized study of stimulation type.Psychotherapy and Psychosomatics. 75, 290-297.

Twenty-one patients with single-event PTSD (average IES: 49.5) received three consecutive sessions of EMDR with three different types of auditory and kinesthetic stimulation. All were clinically useful. However, alternating stimulation appeared to confer an additional benefit to the EMDR procedure.

· Stickgold, R. (2002).EMDR: A putative neurobiological mechanism of action.Journal of Clinical Psychology, 58, 61-75.

· Stickgold, R. (2008). Sleep-dependent memory processing and EMDR action.Journal of EMDR Practice and Research, 2, 289-299.

Comprehensive explanations of mechanisms and the potential links to the processes that occur in REM sleep. Controlled studies have evaluated these theories (see next section; Christman et al., 2003; Kuiken et al. 2001-2002).

· Suzuki, A., et al. (2004).Memory reconsolidation and extinction have distinct temporal and biochemical signatures.Journal of Neuroscience, 24,4787– 4795.

The article explores the differences between memory reconsolidation and extinction. This new area of investigation is worthy of additional attention. Reconsolidation may prove to be the underlying mechanism of EMDR, as opposed to extinction caused by prolonged exposure therapies. “Memory reconsolidation after retrieval may be used to update or integrate new information into long-term memories . . . Brief exposure … seems to trigger a second wave of memory consolidation (reconsolidation), whereas prolonged exposure . . leads to the formation of a new memory that competes with the original memory (extinction).”

· Wilson, D., Silver, S. M., Covi, W., & Foster, S. (1996).Eye movement desensitization and reprocessing: Effectiveness and autonomic correlates.Journal of Behaviour Therapy and Experimental Psychiatry, 27, 219–229.

Study involving biofeedback equipment has supported the hypothesis that the parasympathetic system is activated by finding that eye movements appeared to cause a compelled relaxation response. More rigorous research with trauma populations is needed.

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.

· Andrade, J., Kavanagh, D., & Baddeley, A. (1997).Eye-movements and visual imagery: A working memory approach to the treatment of post-traumatic stress disorder.British Journal of Clinical Psychology, 36,209-223.

Tested the working memory theory. Eye movements were superior to control conditions in reducing image vividness and emotionality.

· Barrowcliff, A.L., Gray, N.S., Freeman, T.C.A., & MacCulloch, M.J. (2004).Eye-movements reduce the vividness, emotional valence and electrodermal arousal associated with negative autobiographical memories.Journal of Forensic Psychiatry and Psychology, 15,325-345.

Tested the reassurance reflex model. Eye movements were superior to control conditions in reducing image vividness and emotionality.

· Barrowcliff, A.L., Gray, N.S., MacCulloch, S., Freeman, T. C.A., & MacCulloch, M.J. (2003). Horizontal rhythmical eye-movements consistently diminish the arousal provoked by auditory stimuli.British Journal of Clinical Psychology, 42,289-302.

Tested the reassurance reflex model. Eye movements were superior to control conditions in reducing arousal provoked by auditory stimuli.

· Christman, S. D., Garvey, K. J., Propper, R. E., & Phaneuf, K. A. (2003).Bilateral eye movements enhance the retrieval of episodic memories.Neuropsychology. 17, 221-229.

Tested cortical activation theories. Results provide indirect support for the orienting response/REM theories suggested by Stickgold (2002, 2008). Saccadic eye movements, but not tracking eye movements were superior to control conditions in episodic retrieval.

· Gunter, R.W. & Bodner, G.E. (2008).How eye movements affect unpleasant memories: Support for a working-memory account.Behaviour Research and Therapy 46,913– 931.

Three studies were done with cumulatively support a working-memory account of the eye movement benefits in which the central executive is taxed when a person performs a distractor task while attempting to hold a memory in mind.

· Kavanagh, D. J., Freese, S., Andrade, J., & May, J. (2001).Effects of visuospatial tasks on desensitization to emotive memories.British Journal of Clinical Psychology, 40, 267-280.

Tested the working memory theory. Eye movements were superior to control conditions in reducing within-session image vividness and emotionality. There was no difference one-week post.

· Kuiken, D., Bears, M., Miall, D., & Smith, L. (2001-2002).Eye movement desensitization reprocessing facilitates attentional orienting.Imagination, Cognition and Personality, 21, (1),3-20.

Tested the orienting response theory related to REM-type mechanisms. Indicated that the eye movement condition was correlated with increased attentional flexibility. Eye movements were superior to control conditions.

· Lee, C.W., & Drummond, P.D. (2008).Effects of eye movement versus therapist instructions on the processing of distressing memories.Journal of Anxiety Disorders, 22,801-808.

“There was no significant effect of therapist’s instruction on the outcome measures. There was a significant reduction in distress for eye movement at post-treatment and at follow-up.
. . . The results were consistent with other evidence that the mechanism of change in EMDR is not the same as traditional exposure.”

· Maxfield, L., Melnyk, W.T. & Hayman, C.A. G. (2008). Aworking memory explanation for the effects of eye movements in EMDR.Journal of EMDR Practice and Research, 2,247-261.

In two experiments participantsfocused on negative memories while engaging in three dual-attention eye movement tasks of increasing complexity. Results support a working memory explanation for the effects of eye movement dual-attention tasks on autobiographical memory.

· Parker, A., Buckley, S. & Dagnall, N. (2009).Reduced misinformation effects following saccadic bilateral eye movements.Brain and Cognition, 69, 89-97.

Bilateral saccadic eye movements were compared to vertical and no eye movements. “It was found that bilateral eye movements increased true memory for the event, increased recollection, and decreased the magnitude of the misinformation effect.” This study supports hypotheses regarding effects of interhemispheric activation and episodic memory.

· Sharpley, C. F. Montgomery, I. M., & Scalzo, L. A. (1996).Comparative efficacy of EMDR and alternative procedures in reducing the vividness of mental images.Scandinavian Journal of Behaviour Therapy, 25, 37-42.

Eye movements were superior to control conditions in reducing image vividness.

· Van den Hout, M., Muris, P., Salemink, E., & Kindt, M. (2001).Autobiographical memories become less vivid and emotional after eye movements.British Journal of Clinical Psychology, 40,121-130.

Tested their theory that eye movements change the somatic perceptions accompanying retrieval, leading to decreased affect, and therefore decreasing vividness. Eye movements were superior to control conditions in reducing image vividness. Unlike control conditions, eye movements also decreased emotionality.

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.

Bossini L.Fagiolini, A. & Castrogiovanni, P.(2007).Neuroanatomical changes after EMDR in Posttraumatic Stress Disorder.Journal of Neuropsychiatry and Clinical Neuroscience, 19,457-458.

Kowal, J. A. (2005).QEEG analysis of treating PTSD and bulimia nervosa using EMDR.Journal of Neurotherapy, 9(Part 4),114-115.

Lamprecht, F., Kohnke, C., Lempa, W., Sack, M., Matzke, M., & Munte, T. (2004).Event-related potentials and EMDR treatment of post-traumatic stress disorder.Neuroscience Research, 49, 267-272.

Lansing, K., Amen, D.G., Hanks, C. & Rudy, L. (2005).High resolution brain SPECT imaging and EMDR in police officers with PTSD.Journal of Neuropsychiatry and Clinical Neurosciences, 17,526-532.

Levin, P., Lazrove, S., & van der Kolk, B. A. (1999).What psychological testing and neuroimaging tell us about the treatment of posttraumatic stress disorder (PTSD) by eye movement desensitization and reprocessing (EMDR).Journal of Anxiety Disorders, 13,159-172.

Oh, D.-H., & Choi, J. (2004).Changes in the regional cerebral perfusion after Eye Movement Desensitization and Reprocessing: A SPECT study of two cases.Journal of EMDR Practice and Research, 1,24-30.

Pagani, M. et al. (2007).Effects of EMDR psychotherapy on 99mTc-HMPAO distribution in occupation-related post-traumatic stress disorder.Nuclear Medicine Communications, 28,757–765.

Richardson, R., Williams, S.R., Hepenstall, S., Sgregory, L., McKie, & Corrigan, F. (2009).A single-case fMRI study EMDR treatment of a patient with posttraumatic stress disorder.Journal of EMDR Practice and Research, 3,10-23.

Sack, M., Lempa, W., & Lemprecht, W. (2007).Assessment of psychophysiological stress reactions during a traumatic reminder in patients treated with EMDR.Journal of EMDR Practice and Research, 1,15-23.

Sack, M., Nickel, L., Lempa, W., & Lamprecht, F. (2003) Psychophysiological regulation in patients suffering from PTSD: Changes after EMDR treatment.Journal of Psychotraumatology and Psychological Medicine, 1,47 -57. (German)

van der Kolk, B., Burbridge, J., & Suzuki, J. (1997).The psychobiology of traumatic memory: Clinical implications of neuroimaging studies.Annals of the New York Academy of Sciences, 821,99-113.

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.

Carlson, J., Chemtob, C.M., Rusnak, K., Hedlund, N.L, & Muraoka, M.Y. (1998).Eye movement desensitization and reprocessing (EMDR): Treatment for combat-related post-traumatic stress disorder.Journal of Traumatic Stress, 11,3-24.

Errebo, N. & Sommers-Flanagan, R. (2007).EMDR and emotionally focused couple therapy for war veteran couples. In F. Shapiro, F. Kaslow, & L. Maxfield (Eds.)Handbook of EMDR and family therapy processes.New York: Wiley

Lipke, H. (2000).EMDR and psychotherapy integration.Boca Raton, FL: CRC Press.

Russell, M. (2006).Treating combat-related stress disorders: A multiple case study utilizing eye movement desensitization and reprocessing (EMDR) with battlefield casualties from the Iraqi war.Military Psychology, 18,1-18.

Russell, M. (2008).Treating traumatic amputation-related phantom limb pain: A case study utilizing eye movement desensitization and reprocessing (EMDR) within the armed services.Clinical Case Studies,7,136-153.

Russell, M.C. (2008).War-related medically unexplained symptoms, prevalence,
and treatment: utilizing EMDR within the armed services.Journal of EMDR Practice and Research, 2, 212-226.

Russell, M.C. (2008).Scientific resistance to research, training and utilization of eye movement desensitization and reprocessing (EMDR) therapy in treating post-war disordersSocial Science & Medicine,67,1737–1746.

Russell, M.C., & Silver, S.M. (2007). Training needs for the treatment of combat-related posttraumatic stress disorder.Traumatology, 13, 4-10.

Russell, M.C., Silver, S.M., Rogers, S., & Darnell, J. (2007).Responding to an identified need: A joint Department of Defense-Department of Veterans Affairs training program in eye movement desensitization and reprocessing (EMDR) for clinicians providing trauma services.International Journal of Stress Management, 14,61-71.

Silver, S.M. & Rogers, S. (2002).Light in the heart of darkness: EMDR and the treatment of war and terrorism survivors. New York: Norton.

Silver,S.M., Rogers, S., & Russell, M.C. (2008). Eye movement desensitization and reprocessing (EMDR) in the treatment of war veterans.Journal of Clinical Psychology: In Session, 64,947—957.

Wesson, M. & Gould, M. (2009).Intervening early with EMDR on military operations: A case study.Journal of EMDR Practice and Research, 3,91-97.

*Material from the EMDR Institute, Inc.

 
 
 
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