06a+EMDR

=EMDR for PTSD= Three studies 1,2,3 have indicated an elimination of posttraumatic stress disorder (PTSD) diagnosis in 77-90% of civilian participants after three to seven sessions. Other studies using participants with PTSD4,5,6 have found significant decreases in a wide range of symptoms after two or three active treatment sessions. Treatment effects are well maintained at follow-up assessments. For example, one study reported an 84% remission of PTSD diagnosis at 15 month follow-up7.

Studies using waitlist controls found EMDR superior; studies comparing EMDR to commonly used treatments such as biofeedback assisted relaxation8, active listening5, and various forms of individual therapy in a Kaiser Permanente HMO facility2 found EMDR superior to the control condition on measures of posttraumatic stress.

Five randomized clinical trials have compared EMDR to exposure therapies4,9,15 and to cognitive therapies plus exposure1,10. These studies have found substantially no difference between EMDR and the cognitive/behavioral (CBT) control, with a superiority in two studies for EMDR on measures of PTSD intrusive symptoms and in one for CBT (using imaginal and therapist-assisted in vivo exposure) on intrusion and avoidance. There were two controlled studies without randomization; one11 found the CBT condition superior to EMDR and the other12 found EMDR superior to the CBT control on multiple measures. EMDR is more efficient than CBT, as it does not require homework and some studies have indicated that it may also take fewer sessions. Treatment effects have generally been well maintained. [For more information, see  **[|Comparison of EMDR and Cognitive Behavioral Therapies]**]. Several controlled field studies have tested EMDR in community settings such as low cost agencies5, an HMO facility2 and a university based clinic serving the outside community4. Such studies, which reported good results, have excellent external validity. In the only controlled study that has treated disaster-related PTSD13, school children’s PTSD symptoms were markedly reduced after EMDR treatment, with an improvement in overall health measured by fewer health visits to the school nurse. This was also the first controlled outcome study of any treatment for children with PTSD.

Studies with combat veterans were hampered by insufficient treatment time and fidelity to treatment. The only randomized study using the 12 session suggested minimum treatment14 indicated that 77% of the Vietnam veterans no longer had PTSD after the 12 sessions8. A post hoc analysis of a PTSD program in the VA found a superiority of EMDR over the two other treatments used.16

=Bibliography=

__ International Treatment Guidelines __[|Back to Top]
//EMDR is recommended as an effective treatment for trauma.// //EMDR is one of three methods recommended for treatment of terror victims.// //According to a taskforce of the Clinical Division of the American Psychological Association, the only methods empirically supported (“probably efficacious”) for the treatment of any post-traumatic stress disorder population were EMDR, exposure therapy, and stress inoculation therapy. Note that this evaluation does not cover the last decade of research.// //EMDR and CBT were stated to be the treatments of choice.// //EMDR was placed in the "A" category as “strongly recommended” for the treatment of trauma.// //EMDR and CBT both designated as treatments of choice for PTSD// //EMDR was listed as an effective and empirically supported treatment for PTSD, and was given an AHCPR “A” rating for adult// //PTSD////. This guideline specifically rejected the findings of the previous Institute of Medicine report, which stated that more research was needed to judge EMDR effective for adult PTSD. With regard to the application of EMDR to children, an AHCPR rating of Level B was assigned. Since the time of this publication, three additional randomized studies on EMDR have been completed (see below).// //EMDR and CBT were stated to be the treatments of choice for trauma victims.// //Trauma-focused CBT and EMDR were stated to be empirically supported treatments for choice for adult PTSD.// //An NIMH sponsored website listing empirically supported methods for a variety of disorders. EMDR is one of three treatments listed for PTSD.// //Best evidence of efficacy was reported for EMDR, exposure, and stress inoculation// **__ Meta-analyses __** [|Back to Top] EMDR has been compared to numerous exposure therapy protocols, with and without CT techniques. It should be noted that exposure therapy uses one to two hours of daily homework and EMDR uses none. The most recent meta-analyses are listed here. //“Trauma focused cognitive behavioural therapy and eye movement desensitisation and reprocessing have the best evidence for efficacy at present and should be made available to PTSD sufferers.”// //EMDR is equivalent to exposure and other cognitive behavioral treatments and all “////are highly efficacious in reducing PTSD symptoms.”// //EMDR is equivalent to exposure and other cognitive behavioral treatments.// //A comprehensive meta-analysis reported the more rigorous the study, the larger the effect.// //“Results indicate efficacy of EMDR when effect sizes are based on comparisons between EMDR and non-established trauma treatment or no-treatment control groups, and incremental efficacy when effect sizes are based on comparisons between EMDR and established (CBT) trauma treatment.”// //“Results suggest that in the treatment of PTSD, both therapy methods tend to be equally efficacious.”//
 * American Psychiatric Association (2004).** //Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder.// Arlington, VA: American Psychiatric Association Practice Guidelines.
 * Bleich, A., Kotler, M., Kutz, I., & Shalev, A. (2002).** A position paper of the (Israeli) National Council for Mental Health: //Guidelines for the assessment and professional intervention with terror victims in the hospital and in the community.// Jerusalem, Israel.
 * Chambless, D.L. et al. (1998).** Update of empirically validated therapies, II. //The Clinical Psychologist, 51,// 3-16.
 * CREST (2003).** //The management of post traumatic stress disorder in adults.// A publication of the Clinical Resource Efficiency Support Team of the Northern Ireland Department of Health, Social Services and Public Safety, Belfast.
 * Department of Veterans Affairs & Department of Defense (2004).** //VA/DoD Clinical Practice Guideline for the Management of Post-Traumatic Stress.// Washington, DC: Veterans Health Administration, Department of Veterans Affairs and Health Affairs, Department of Defense. Office of Quality and Performance publication 10Q-CPG/PTSD-04.
 * Dutch National Steering Committee Guidelines Mental Health Care (2003).** Multidisciplinary Guideline Anxiety Disorders. Quality Institute Heath Care CBO/Trimbos Intitute. Utrecht, Netherlands.
 * Foa, E.B., Keane, T.M., Friedman, M.J., & Cohen, J.A. (2009)**. //Effective treatments for PTSD//: //Practice Guidelines of the International Society for Traumatic Stress Studies// New York: Guilford Press.
 * INSERM (2004).** //Psychotherapy: An evaluation of three approaches.// French National Institute of Health and Medical Research, Paris, France.
 * National Collaborating Centre for Mental Health** **(****2005).** //Post traumatic stress disorder (PTSD): The management of adults and children in primary and secondary care.// London: National Institute for Clinical Excellence.
 * Therapy Advisor (2004-7): [|http://www.therapyadvisor.com]**
 * United Kingdom Department of Health (2001).** Treatment choice in psychological therapies and counselling evidence based clinical practice guideline. London, England.
 * Bisson, J., & Andrew, M.** **(2007).** Psychological treatment of post-traumatic stress disorder (PTSD). //Cochrane Database of Systematic Reviews// 2007, Issue 3. Art. No.: CD003388. DOI: 10.1002/14651858.CD003388.pub3.
 * Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005).** A multidimensional meta-analysis of psychotherapy for PTSD. //American Journal of Psychiatry, 162,// 214-227.
 * Davidson, P.R., & Parker, K.C.H. (2001****)**. Eye movement desensitization and reprocessing (EMDR): A meta-analysis. Journal of Consulting and Clinical Psychology, 69, 305-316.
 * Maxfield, L., & Hyer, L.A. (2002).** The relationship between efficacy and methodology in studies investigating EMDR treatment of PTSD. //Journal of Clinical Psychology, 58, 23-41.//
 * Rodenburg, R., Benjamin, A., de Roos, C, Meijer, A.M., & Stams, G.J. (2009).** Efficacy of EMDR in children: A meta – analysis. //Clinical Psychology Review, 29//, 599-606//.//
 * Seidler, G.H., & Wagner, F.E. (2006).** Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: a meta-analytic study. //Psychological Medicine, 36,// 1515-1522.

__ Randomized Clinical Trials __ [|Back to Top]
//Twelve sessions of EMDR eliminated post-traumatic stress disorder in 77.7% of the multiply traumatized combat veterans studied. There was 100% retention in the EMDR condition. Effects were maintained at follow-up. This is the only randomized study to provide a full course of treatment with combat veterans. Other studies (e.g., Boudewyns/Devilly/Jensen/Pitman et al./Macklin et al.) evaluated treatment of only one or two memories, which, according to the International Society for Traumatic Stress Studies Practice Guidelines (2000), is inappropriate for multiple-trauma survivors. The VA/DoD Practice Guideline (2004) also indicates these studies (often with only two sessions) offered insufficient treatment doses for veterans.// //“EMDR is effective in reducing earthquake anxiety and negative emotions (e.g. PTSD, grief, fear, intrusive thoughts, depression, etc) resulting from earthquake experience. Furthermore, results show that, improvement due to EMDR was maintained at a one month follow up.”// //Thirty-three 6-16-year-old children with a DSM-IV diagnosis of PTSD were randomly assigned to eight weekly EMDR sessions or the WLC group. EMDR was found to be an effective treatment in children with PTSD from various sources and who were suffering from a variety of co-morbid conditions.// //EMDR was found to be an effective treatment for children with disaster-related PTSD who had not responded to another intervention.// //EMDR treatment of disturbing life events (small “t” trauma) was compared to active listening, and wait list. EMDR produced significantly lower scores on the Impact of Event Scale (mean reduced from “moderate” to “subclinical”) and a significantly smaller increase on the STAI after memory recall.// //EMDR treatment resulted in lower scores (fewer clinical symptoms) on all four of the outcome measures at the three-month follow-up, compared to those in the routine treatment condition. The EMDR group also improved on all standardized measures at 18 months follow up (Edmond & Rubin, 2004, Journal of Child Sexual Abuse).// //Combination of qualitative and quantitative analyses of treatment outcomes with important implications for future rigorous research. Survivors’ narratives indicate that EMDR produces greater trauma resolution, while within eclectic therapy, survivors more highly value their relationship with their therapist, through whom they learn effective coping strategies.// //Employees who had experienced “person-under-train accident or had been assaulted at work were recruited.” Six sessions of EMDR resulted in remission of PTSD in 67% compared to 11% in the wait list control. Significant effects were documented in Global Assessment of Function (GAF) and Hamilton Depression (HAM-D) score. **Follow-up:**// **Högberg, G. et al. (2008).** Treatment of post-traumatic stress disorder with eye movement desensitization and reprocessing: Outcome is stable in 35-month follow-up//. Psychiatry Research. 159,// 101-108. //Both EMDR and prolonged exposure produced a significant reduction in PTSD and depression symptoms. This is the only research comparing EMDR and exposure therapy that equalized homework. The study found that 70% of EMDR participants achieved a good outcome in three active treatment sessions, compared to 29% of persons in the prolonged exposure condition. EMDR also had fewer dropouts////.// //Both EMDR and CBT produced significant reduction in PTSD and behavior problems. EMDR was significantly more efficient, using approximately half the number of sessions to achieve results.// //“An effect for EMDR was identified on primary outcome and process measures including the Child Post-Traumatic Stress – Reaction Index, clinician rated diagnostic criteria for PTSD, Subjective Units of Disturbance and Validity of Cognition scales. All participants initially met two or more PTSD criteria. After EMDR treatment, this decreased to 25% in the EMDR group but remained at 100% in the wait-list group.”// //Both EMDR and stress inoculation therapy plus prolonged exposure (SITPE) produced significant improvement, with EMDR achieving greater improvement on PTSD intrusive symptoms. Participants in the EMDR condition showed greater gains at three-month follow-up. EMDR required three hours of homework compared to 28 hours for SITPE.// //Funded by Kaiser Permanent. Results show that 100% of single-trauma and 77% of multiple-trauma survivors were no longer diagnosed with post-traumatic stress disorder after six 50-minute sessions//. //Funded by Kaiser Permanent, follow-up evaluation indicates that a relatively small number of EMDR sessions result in substantial benefits that are maintained over time.// //Both EMDR and exposure therapy plus cognitive restructuring (with daily homework) produced significant improvement. EMDR was more beneficial for depression, and social functioning, and required fewer treatment sessions. Subsequent reevaluation of the data indicated that// “For pre- to post-treatment IES mean change score, EMDR patients also appeared to have had better treatment outcome than E+CR patients” and EMDR therapy was a predictor of positive outcome: //Three 90-minute sessions of EMDR eliminated post-traumatic stress disorder in 90% of rape victims.// //In this NIMH funded study both treatments were effective:// //“An interesting potential clinical implication is that EMDR seemed to do equally well in the main despite less exposure and no homework. It will be important for future research to explore these issues.”// //Two sessions of EMDR reduced psychological distress in traumatized adolescents/ young women and brought scores within one standard deviation of the norm.// //Seminal study appeared the same year as first controlled studies of CBT treatments. Three-month follow-up indicated substantial effects on distress and behavioral reports. Marred by lack of standardized measures and the originator serving as sole therapist.// //The addition of three sessions of EMDR resulted in large and significant reductions of memory-related distress, and problem behaviors at 2-month follow-up.// //The only randomized study to show exposure statistically superior to EMDR on two subscales (out of 10). This study used therapist assisted “in vivo” exposure, where the therapist takes the person to previously avoided areas, in addition to imaginal exposure and one hour of daily homework (@ 50 hours). The EMDR group used only standard sessions and no homework.// //All treatments led to significant decreases in PTSD symptoms for subjects in the treatment groups as compared to those on a waiting list, with a greater reduction in the EMDR group, particularly with respect to intrusive symptoms. In the 2-3 weeks of the study, 40-60 additional minutes of daily homework were part of the treatment in the other two conditions.// //EMDR was superior to both control conditions in the amelioration of both PTSD symptoms and depression. Upon termination of therapy, the EMDR group continued to improve while the Fluoxetine participants again became symptomatic.// //Twenty-six children (average age 10.4 years) with behavioral problems were randomly assigned to receive either 4 sessions of EMDR or CBT. Both were found to have significant positive effects on behavioral and self-esteem problems, with the EMDR group showing significantly larger changes in target behaviors////.// //Three sessions of EMDR produced clinically significant change in traumatized civilians on multiple measures.// //Follow-up at 15 months showed maintenance of positive treatment effects with 84% remission of PTSD diagnosis.// __ Non Randomized Studies __ [|Back to Top] //A comprehensive group intervention with 124 children, who experienced disaster related trauma during a massive flood utilizing a one session group protocol. Significant differences were obtained and maintained at 3-month follow up.// //This study found CBT superior to EMDR. The research is marred by higher expectations in the CBT condition: Treatment was delivered in both conditions by the developer of the CBT protocol.// //This field study explores the effectiveness of EMDR and the level of post-traumatic reactions in a post-emergency context on 22 children victims of an earthquake. The results show that EMDR contributed to the reduction or remission of PTSD symptoms and facilitated the processing of the traumatic experience.// //A group intervention of EMDR was provided to 236 schoolchildren exhibiting PTSD symptoms 30 days post-incident. At four-month follow up, teachers reported that all but two children evinced a return to normal functioning after treatment.// //A study of Hurricane Andrew survivors found significant differences on the Impact of Event Scale and subjective distress in a comparison of EMDR and non-treatment condition.// //36 children and adolescents ranging in age from 1 year 9 months to 18 years 1 month were assessed at intake, post-waitlist/pretreatment, and at follow up. EMDR treatment resulted in significant improvement, demonstrating that children younger than 4 years of age showed the same benefit as the school-age children.// //A study of 200 children treated with a group protocol after a flood in Mexico indicates that one session of treatment reduced trauma symptoms from the severe range to low (subclinical) levels of distress. Data from successful treatment at other disaster sites are also reported.// //“In this study the EMDR-IGTP was used with 16 bereaved children after a human provoked disaster in the Mexican State of Coahuila in 2006. Results showed a significant decrease in scores on the Child’s Reaction to Traumatic Events Scale that was// //maintained at 3-month follow-up.”// //Data reported on a representative sample of 1500 earthquake victims indicated that five sessions of EMDR successfully eliminated PTSD in 92.7% of those treated, with a reduction of symptoms in the remaining participants.// //In this delayed treatment comparison, over half of the participants moved from clinical to normal levels on the Impact of Events Scale, and all but 3 showed at least partial symptom relief on several measures at 1-3 m following a single EMDR session.// //One of only two EMDR research studies that evaluated a clinically relevant course of EMDR treatment with combat veterans (e.g., more than one or two memories; see Carlson et al., above). The analysis of an inpatient veterans’ PTSD program (n=100) found EMDR to be superior to biofeedback and relaxation training on seven of eight measures.// //Clients made highly significant positive gains on a range of outcome variables, including validated psychometrics and self-report scales. Analyses of the data indicate that EMDR is a useful treatment intervention both in the immediate aftermath of disaster as well as later.// //60 railroad employees who had experienced fatal grade crossing accidents were evaluated for workshop outcomes, and for the additive effects of EMDR treatment. Although the workshop was successful, in this setting, the addition of a short session of EMDR (5-40 minutes) led to significantly lower, sub clinical, scores which further decreased at follow up.// //In a multi-site study, EMDR significantly reduced symptoms more often than the CBT treatment on behavioral measures, and on four of five psychosocial measures. EMDR was more efficient, inducing change at an earlier stage and requiring fewer sessions. Positive recall of the deceased was significantly greater post treatment in the EMDR condition.// //Results indicate that the EMDR approach can be effective in a group setting, and in an acute situation, both in reducing symptoms of posttraumatic and peritraumatic stress and in “inoculation” or building resilience in a setting of ongoing conflict and trauma.// **__ Adaptive Information Processing, and EMDR Procedures, __** [|Back to Top] 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. //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.// //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 the// //Inventory of Altered Self Capacities.// //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.// //As predicted by AIP, the processing of etiological events, triggers and memory templates was sufficient to alleviate the diagnosis without the use of therapist-assisted in vivo exposure.// //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.// //EMDR processing of experiential contributors to bonding disruption, in addition to current triggers, and a memory template of an alternative/problem free pregnancy and birth resulted in the repair of maternal bonding, analogous to the positive findings with the repair of disrupted attachment.// //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.// //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.”// //“A substantive body of work has established that environmental adversity can have a deleterious effect on children’s functioning” “Exposure to adverse, stressful events. . .has been linked to socioemotional behavior problems and cognitive deficits.//” //Reviews common errors and misperceptions of the procedures, research, and theory.// //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.// //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.// //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 the plethysmograph, a decrease in sexual thoughts, and increased victim empathy. Effects maintained at one year follow up.// //10 consecutive cases of phantom limb pain were treated with EMDR resulting in the reduction or elimination of pain in all but two cases. Results were maintained at 2.8-year follow-up.// //“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.”// //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.// //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.// //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.// //EMDR is an integrative approach distinct from other forms of psychotherapy.// //E////xperts of the major psychotherapy orientations identify and highlight various procedural elements.// //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.// //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.// //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.// //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.// //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.”// //Subsequent to EMDR treatment// //“all three patients made positive changes in attachment status as measured by the [Adult Attachment Inventory], and all three reported positive changes in emotions and relationships.”// //“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.”// 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. //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.”// //EMDR treatment of autobiographic worries causing moderate distress// //resulted in an “increase in the smoothness of// //pursuit [which] presumably reflects an improvement in the use of visual attention needed to follow the target accurately. Perhaps EMDR reduces distress thereby activating a cholinergic effect known to improve ocular pursuit.////”// //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.// //Tested patients awaiting PTSD treatment and demonstrated that the eye movement condition had a significant effect on vividness of trauma memory and emotionality compared to counting and exposure only. In addition, “the counting task had no effect on vividness compared to exposure only, suggesting that the eye-movement task had a specific effect rather than serving as a general distractor” (p. 317)// //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).// //“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.”// //Theoretical, clinical, and procedural differences referencing two decades of CBT and EMDR research.// //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.// //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.// //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.// //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.// //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).// //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).”// //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.//
 * 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.
 * Abbasnejad, M., Mahani, K. N., & Zamyad, A. (2007).** Efficacy of "eye movement desensitization and reprocessing" in reducing anxiety and unpleasant feelings due to earthquake experience. //Psychological Research, 9//, 104-117.
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 * Scheck, M., Schaeffer, J.A., & Gillette, C. (1998).** Brief psychological intervention with traumatized young women: The efficacy of eye movement desensitization and reprocessing. //Journal of Traumatic Stress, 11,// 25-44.
 * Shapiro, F. (1989).** Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. //Journal of Traumatic Stress, 2//, 199–223.
 * Soberman, G. B., Greenwald, R., & Rule, D. L. (2002).** A controlled study of eye movement desensitization and reprocessing (EMDR) for boys with conduct problems. //Journal of Aggression, Maltreatment, and Trauma, 6,// 217-236.
 * Taylor, S. et al. (2003).** Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training. //Journal of Consulting and Clinical Psychology, 71, 330-338.//
 * Vaughan, K., Armstrong, M.F., Gold, R., O'Connor, N., Jenneke, W., & Tarrier, N. (1994)**. A trial of eye movement desensitization compared to image habituation training and applied muscle relaxation in post-traumatic stress disorder. //Journal of Behavior Therapy & Experimental Psychiatry, 25,// 283-291.
 * Van der Kolk, B., Spinazzola, J. Blaustein, M., Hopper, J. Hopper, E., Korn, D., & Simpson, W. (2007).** A randomized clinical trial of EMDR, fluoxetine and pill placebo in the treatment of PTSD: Treatment effects and long-term maintenance. //Journal of Clinical Psychiatry, 68,// 37-46.
 * Wanders, F., Serra, M., & de Jongh, A. (2008).** EMDR Versus CBT for Children With Self-Esteem and Behavioral Problems: A Randomized Controlled Trial. //Journal of EMDR Practice and Research, 2,// 180-189.
 * Wilson, S., 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.
 * Wilson, S., Becker, L.A., & Tinker, R.H. (1997).** Fifteen-month follow-up of eye movement desensitization and reprocessing (EMDR) treatment of post-traumatic stress disorder and psychological trauma. //Journal of Consulting and Clinical Psychology//, 65, 1047-1056.
 * Aduriz, M.E., Bluthgen, C. & Knopfler, C. (2009).** Helping child flood victims using group EMDR intervention in Argentina: Treatment outcome and gender differences. //International Journal of Stress Management. 16,// 138-153//.//
 * Devilly, G.J., & 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.
 * Fernandez, I. (2007).** EMDR as treatment of post-traumatic reactions: A field study on child victims of an earthquake. //Educational and Child Psychology. Special Issue: Therapy//, //24//, 65-72.
 * Fernandez, I., Gallinari, E., & Lorenzetti, A. (2004).** A school- based EMDR intervention for children who witnessed the Pirelli building airplane crash in Milan, Italy. //Journal of Brief Therapy, 2//, 129-136.
 * Grainger, R.D., Levin, C., Allen-Byrd, L., Doctor, R.M. & Lee, H. (1997).** An empirical evaluation of eye movement desensitization and reprocessing (EMDR) with survivors of a natural catastrophe. //Journal of Traumatic Stress, 10,// 665-671.
 * Hensel, T. (2009).** EMDR with children and adolescents after single-incident trauma an intervention study. //Journal of EMDR Practice and Research////, 3//, 2-9.
 * Jarero, I., Artigas, L., & Hartung, J. (2006).** //EMDR integrative group treatment protocol: A post-disaster trauma intervention for children and adults. Traumatology, 12,// 121-129.
 * Jarero, I., Artigas, L., Lopez-Lena, M. (2008).** The EMDR integrative group treatment protocol: Application with child victims of mass disaster. //Journal of EMDR Practice and Research, 2,// 97-105.
 * Konuk, E., Knipe, J., Eke, I., Yuksek, H., Yurtsever, A., & Ostep, S. (2006).** The effects of EMDR therapy on post-traumatic stress disorder in survivors of the 1999 Marmara, Turkey, earthquake. //International Journal of Stress Management, 13,// 291-308//.//
 * Puffer, M.; Greenwald, R. & Elrod, //D. (1997).//** A single session EMDR study with twenty traumatized children and adolescents. //Traumatology-e, 3(2), Article 6//.
 * Silver, S.M., Brooks, A., & Obenchain, J. (1995).** Eye movement desensitization and reprocessing treatment of Vietnam war veterans with PTSD: Comparative effects with biofeedback and relaxation training. //Journal of Traumatic Stress, 8//, 337-342.
 * Silver, S.M., Rogers, S., Knipe, J., & Colelli, G. (2005).** EMDR therapy following the 9/11 terrorist attacks: A community-based intervention project in New York City. //International Journal of Stress Management,// 12, 29-42.
 * Solomon, R.M. & Kaufman, T.E. (2002)**. A peer support workshop for the treatment of traumatic stress of railroad personnel: Contributions of eye movement desensitization and reprocessing (EMDR). //Journal of Brief Therapy, 2,// 27-33,
 * Sprang, G. (2001).** The use of eye movement desensitization and reprocessing (EMDR) in the treatment of traumatic stress and complicated mourning: Psychological and behavioral outcomes. //Research on Social Work Practice//, //11//, 300-320.
 * Zaghrout-Hodali****, M., Alissa, F. & Dodgson, P.W. (2008).** Building resilience and dismantling fear: EMDR group protocol with children in an area of ongoing trauma. //Journal of EMDR Practice and Research, 2,// 106-113.
 * Bae, H., Kim, D. & Park, Y.C. (2008).** Eye movement desensitization and reprocessing for adolescent depression. //Psychiatry Investigation, 5,// 60-65.
 * Brown, S. & Shapiro, F. (2006).** EMDR in the treatment of borderline personality disorder. //Clinical Case Studies, 5,// 403-420//.//
 * 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.
 * Fernandez, I., & Faretta, E. (2007).** EMDR in the treatment of panic disorder with agoraphobia. //Clinical Case Studies, 6,// 44-63.
 * 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.
 * Madrid, A., Skolek, S., & Shapiro, F. (2006)** Repairing failures in bonding through EMDR. //Clinical Case Studies. 5,// 271-286.
 * 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.
 * 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.
 * Obradovic´, J., Bush, N.R.,** **Stamperdahl, J., Adler, N.E. & Boyce, W.T.** **(2010).** Biological sensitivity to context: The interactive effects of stress reactivity and family adversity on socioemotional behavior and school readiness. //Child Development, 1,// 270–289.
 * 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.
 * Raboni, M.R., Tufik, S., & 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.
 * 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.
 * 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.//
 * Roos et al. (2010).** Treatment of chronic phantom limb pain (PLP) using a trauma-focused psychological approach. //Pain Research and Management, 15,// 65-71//.//
 * 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//.//
 * 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
 * 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.
 * Shapiro, F. (2001).** //Eye movement desensitization and reprocessing: Basic principles, protocols and procedures// (2nd ed.). New York: Guilford Press.
 * Shapiro, F. (2002).** (Ed.). //E////MDR as an integrative psychotherapy approach: Experts of diverse orientations explore the paradigm prism.// Washington, DC: American Psychological Association Books.
 * Shapiro, F. (2007).** EMDR, adaptive information processing, and case conceptualization. //Journal of EMDR Practice and Research, 1//, 68-87.
 * 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])
 * Shapiro, F., Kaslow, F., & Maxfield, L. (Eds.) (2007).** //Handbook of EMDR and Family Therapy Processes//. Hoboken, NJ: Wiley.
 * Solomon, R. M. & Shapiro, F, (2008).** EMDR and the adaptive information processing model: Potential mechanisms of change. //Journal of EMDR Practice and Research, 2,// 315-325.
 * 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.
 * Wesselmann, D. & Potter, A. E. (2009).** Change in adult attachment status following treatment with EMDR: Three case studies. //[|Journal of EMDR Practice and Research]//, 3, 178-191.
 * Wilensky, M. (2006).** Eye movement desensitization and reprocessing (EMDR) as a treatment for phantom limb pain. //Journal of Brief Therapy, 5,// 31-44.
 * __ Mechanism of Action __** [|Back to Top]
 * 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.
 * Kapoula Z, Yang Q, Bonnet A, Bourtoire P, Sandretto J (2010)**. EMDR Effects on Pursuit Eye Movements. //PLoS ONE 5(5): e10762//. doi:10.1371/journal.pone.0010762
 * 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
 * Lilley****, S.A.** **, Andrade****, J.****, Graham Turpin****, G.****,Sabin-Farrell****, R.** **& Emily A. Holmes****, E.A. (2009).** Visuospatial working memory interference with recollections of trauma. //British Journal of Clinical Psychology, 48,// 309–321.
 * 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.
 * 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.
 * Rogers, S., & Silver, S. M. (2002).** Is EMDR an exposure therapy? A review of trauma protocols. //Journal of Clinical Psychology, 58,// 43-59//.//
 * 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.
 * 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
 * Sack, M., Lempa, W. Steinmetz, A., Lamprecht, F. & 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//.//
 * 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.//
 * 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.//
 * Suzuki, A., et al. (2004).** Memory reconsolidation and extinction have distinct temporal and biochemical signatures. //Journal of Neuroscience, 24,// 4787– 4795.
 * 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.

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, 2004). 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. //Tested the working memory theory. Eye movements were superior to control conditions in reducing image vividness and emotionality.// //Tested the reassurance reflex model. Eye movements were superior to control conditions in reducing image vividness and emotionality.// //Tested the reassurance reflex model. Eye movements were superior to control conditions in reducing arousal provoked by auditory stimuli.// //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.// //“This study examined whether eye movements reduce vividness and emotionality of visual// //distressing images about feared future events. . . Relative to the no-dual task condition, eye movements while thinking of future-oriented images resulted in decreased ratings of image vividness and emotional intensity.”// //Three studies were done that 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.// //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.// //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.// //“////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.”// //In two experiments participants// //focused 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.// //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.// //“EMDR-with eye movements led to greater reduction in distress than EMDR-without eye movements. Heart rate decreased significantly when eye movements began; skin conductance decreased during eye movement sets; heart rate variability and respiration rate increased significantly as eye movements continued; and orienting responses were more frequent in the eye movement than no-eye movement condition at the start of exposure.”// //Eye movements were superior to control conditions in reducing image vividness.// //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.//
 * __ Randomized Studies of Hypotheses Regarding Eye Movements __** [|Back to Top]
 * 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.
 * 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//.//
 * 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.
 * 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.
 * Engelhard****, I.M.****, van den Hout, M.A., Janssen, W.C., & van der Beek, J. (2010).** Eye movements reduce vividness and emotionality of ‘‘flashforwards.’’ //Behaviour Research and Therapy, 48,// 442–447.
 * 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.
 * 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.
 * 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.
 * 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//.//
 * Maxfield, L., Melnyk, W.T. & Hayman, C.A. G. (2008). A** working memory explanation for the effects of eye movements in EMDR. //Journal of EMDR Practice and Research, 2,// 247-261.
 * Parker, A., Buckley, S. & Dagnall, N. (2009).** Reduced misinformation effects following saccadic bilateral eye movements. //Brain and Cognition, 69//, 89-97.
 * Schubert, S.J., Lee, C.W. & Drummond, P.D. (in press)**. The efficacy and psychophysiological correlates of dual-attention tasks in eye movement desensitization and reprocessing (EMDR). Journal of Anxiety Disorders.
 * 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.
 * 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.

All psychophysiological studies have indicated significant de-arousal. Neurobiological studies have indicated significant effects, including changes in cortical, and limbic activation patterns, and increase in hippocampal volume. 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.
 * __ Additional Psychophysiological and Neurobiological Evaluations __** [|Back to Top]
 * 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.
 * Ohta ni, T., Matsuo, K., Kasai, K., Kato, T., & Kato, N.** **(2009).** Hemodynamic responses of eye movement desensitization and reprocessing in posttraumatic stress disorder. //Neuroscience Research//, 65, 375–383.
 * Nardo D et al. (2009, in press).** Gray matter density in limbic and paralimbic cortices is associated with trauma load and EMDR outcome in PTSD patients. //Journal of Psychiatric Research//doi:10.1016/j.jpsychires.2009.10.014
 * 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.
 * 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.
 * 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 __** [|Back to Top]

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, 2004). 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. **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.
 * 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.
 * Cook, J.M.,** **Biyanova, T., & Coyne, J.C. (2009).** Comparative case study of diffusion of eye movement desensitization and reprocessing in two clinical settings: Empirically supported treatment status is not enough. //Professional Psychology: Research and Practice, 40,// 518–524.
 * 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 disorders //Social 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.
 * Wesson, M. & Gould, M. (2009).** Intervening early with EMDR on military operations: A case study. //Journal of EMDR Practice and Research, 3,// 91-97.