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This month’s EMDR video returns to the first major media coverage of EMDR in 1997 from ABC News 20/20 featuring interviews with Francine Shapiro and Steven Silver. Aired well before the subsequent publication of the many randomized controlled trials demonstrating EMDR’s efficacy versus other methods, this news report mentions the historic controversy over whether EMDR was effective. While that controversy has long since been settled, it has been replaced by a chorus of claims that the bilateral eye movements fail to add anything to what skeptics assert is merely an alternate form of exposure therapy.

Those interested in a thorough review of the scientific evidence that bilateral eye movements do make a difference and that EMDR works by mechanisms different from exposure therapy are encouraged to read Chris Lee’s (2006) “Efficacy and mechanisms of action of EMDR as a treatment for PTSD” available on the Murdoch Research Repository. My essay on “Extinction or Reconsolidation” also examines evidence that EMDR’s neurbiological mechanisms are different than exposure therapy. For those curious, that is Clifford Levin in the first segment on the 20/20 video waving a lighted wand from A.J. Popky of DeTUR fame.

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Cotraccia, A. J. (2012). Adaptive information processing and a systemic biopsychosocial model. Journal of EMDR Practice and Research, 6(1), 27-36. doi:10.1891/1933-3196.6.1.27

Anthony J. Cotraccia, 207 East Court Street, Ithaca, NY 14850. E-mail: cotracc@twcny.rr.com

Abstract

Shapiro's (2001) adaptive information processing (AIP) model portrays an innate healing system hypothesized to be composed of neurophysiological mechanisms of action causally related to the resolution of disturbing life experiences. The author expands the model to include psychosocial mechanisms and suggests that a model of a biopsychosocial system can best depict causal properties related to positive outcomes of eye movement desensitization and reprocessing (EMDR). Teleofunctionalist and evolutionary perspectives are applied: the first, to explain the inclusion of the psychological and social features highlighted in the updated model; the second, to support the hypothesis that AIP is a goal of the human attachment system. It is posited that bonding, following a disturbing life experience, facilitates the access of information related to previous states, thus allowing an update of self/world models. These interactions are analogous to psychotherapeutic encounters, with multiple levels of information processing at subpersonal, personal, and interpersonal levels. Analysis of the causal properties of personal and interpersonal levels supports a broader understanding of AIP's scope in conceptualizing psychopathology and informing treatment applications and research.

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Fleming, J. (2012). The effectiveness of eye movement desensitization and reprocessing in the treatment of traumatized children and youth. Journal of EMDR Practice and Research, 6(1), 16-26. doi:10.1891/1933-3196.6.1.16

Jocelyn Fleming, 7A The Terrace, Barnes, London SW13 0NP. E-mail: jossfleming@blueyonder.co.uk

Abstract

This article provides a summary of all the studies that have investigated eye movement desensitization and reprocessing (EMDR) treatment of traumatized children and adolescents. The effectiveness of the treatment is revealed in more than 15 studies. This article considers the differences between Type I and Type II traumas and specifically examines the effects of EMDR on traumatic stress experienced by children and youth following Type I and Type II traumas. There is a considerable body of research evaluating EMDR treatment of Type I traumas, showing strong evidence for its efficacy, but there are few studies that have specifically investigated EMDR treatment of Type II traumas. The effect of EMDR on various symptoms and problem areas is also examined. Recommendations are made for the clinical application of EMDR and for further research.

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Goodson, J., Helstrom, A., Halpern, J. M., Ferenschak, M. P., Gillihan, S. J., & Powers, M. B. (2011). Treatment of posttraumatic stress disorder in U.S. Combat veterans: A meta-analytic review. Psychological Reports, 109(2), 573-99.

Jason Goodson, Philadelphia VAMC, University of Pennsylvania, USA.

Abstract

Among U.S. veterans who have been exposed to combat-related trauma, significantly elevated rates of posttraumatic stress disorder (PTSD) are reported. Veterans with PTSD are treated for the disorder at Veterans Affairs (VA) hospitals through a variety of psychotherapeutic interventions. Given the significant impairment associated with PTSD, it is imperative to assess the typical treatment response associated with these interventions. 24 studies with a total sample size of 1742 participants were quantitatively reviewed. Overall, analyses showed a medium between-groups effect size for active treatments compared to control conditions. Thus, the average VA-treated patient fared better than 66% of patients in control conditions. VA treatments incorporating exposure-based interventions showed the highest within-group effect size. Effect sizes were not moderated by treatment dose, sample size, or publication year. Findings are encouraging for treatment seekers for combat-related PTSD in VA settings.

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Lombardo, M. (2012). EMDR target time line. Journal of EMDR Practice and Research, 6(1), 37-46. doi:10.1891/1933-3196.6.1.37

Marina Lombardo, 1151 Blackwood Ave., Suite 120, Orlando, FL 34761. E-mail: Marinalcsw@yahoo.com

Abstract

This Clinical Q&A section responds to a question about organizing a client's historical information into a targeting sequence within a treatment plan that is consistent with Shapiro's (2001) three-pronged protocol. The procedures for identifying and prioritizing treatment eye movement desensitization and reprocessing (EMDR) targets are reviewed in the context of Shapiro's theoretical model, and various time line models are summarized. The author then presents her EMDR Target Time Line, which provides a practical simple visual tool for documenting past, present, and future aspects of the presenting problem. It allows the therapist to note if disturbing past experiences present around a core theme, such as negative cognitions, physical symptoms, or situations/persons/circumstances. Three clinical cases are used to illustrate the form's application with various types of treatment targets.

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Marr, J. (2012). EMDR treatment of obsessive-compulsive disorder: Preliminary research. Journal of EMDR Practice and Research, 6(1), 2-15. doi:10.1891/1933-3196.6.1.2

John Marr, Finchale Training College, Durham, Country Durham, DH1 5RX, United Kingdom. E-mail: johnmarr@finchalecollege.co.uk or g4wui@kelloe.plus.com

Abstract

This article reports the results of two experiments, each investigating a different eye movement desensitization and reprocessing (EMDR) protocol for obsessive-compulsive disorder (OCD) and each with two young adult male participants with long-standing unremitting OCD. Two adaptations of Shapiro's (2001) phobia protocol were developed, based on the theoretical view that OCD is a self-perpetuating disorder, with OCD compulsions and obsessions and current triggers reinforcing and maintaining the disorder. Both adaptations begin by addressing current obsessions and compulsions, instead of working on past memories; one strategy delays the cognitive installation phase; the other uses mental video playback in the desensitization of triggers. The four participants received 14-16 one-hour sessions, with no assigned homework. They were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), with scores at pretreatment in the extreme range (mean = 35.3). Symptom improvement was reported by participants after 2 or 3 sessions. Scores at posttreatment were in the subclinical/mild range for all participants (mean = 8.5). Follow-up assessments were conducted at 4-6 months, indicating maintenance of treatment effects (mean = 7.5). Symptom reduction was 70.4% at posttreatment and 76.1% at follow-up for the Adapted EMDR Phobia Protocol and 81.4% at posttreatment and at follow-up for the Adapted EMDR Phobia Protocol with Video Playback. Theoretical implications are discussed, and future research is recommended.

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Nijdam, M. J., Gersons, B. P., Reitsma, J. B., de Jongh, A., & Olff, M. (2012). Brief eclectic psychotherapy v. Eye movement desensitisation and reprocessing therapy for post-traumatic stress disorder: Randomised controlled trial. The British Journal of Psychiatry: The Journal of Mental Science, 200, 224-31. doi:10.1192/bjp.bp.111.099234

Mirjam J. Nijdam, MSc, Centre for Psychological Trauma, Department of Psychiatry, Academic Medical Centre at the University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands. E:mail: m.j.nijdam@amc.uva.nl

Abstract

Background: Trauma-focused cognitive-behavioural therapy (CBT) and eye movement desensitisation and reprocessing therapy (EMDR) are efficacious treatments for post-traumatic stress disorder (PTSD), but few studies have directly compared them using well-powered designs and few have investigated response patterns.

Aims: To compare the efficacy and response pattern of a trauma-focused CBT modality, brief eclectic psychotherapy for PTSD, with EMDR (trial registration: ISRCTN64872147).

Method: Out-patients with PTSD were randomly assigned to brief eclectic psychotherapy (n = 70) or EMDR (n = 70) and assessed at all sessions on self-reported PTSD (Impact of Event Scale - Revised). Other outcomes were clinician-rated PTSD, anxiety and depression.

Results: Both treatments were equally effective in reducing PTSD symptom severity, but the response pattern indicated that EMDR led to a significantly sharper decline in PTSD symptoms than brief eclectic psychotherapy, with similar drop-out rates (EMDR: n = 20 (29%), brief eclectic psychotherapy: n = 25 (36%)). Other outcome measures confirmed this pattern of results.

Conclusions: Although both treatments are effective, EMDR results in a faster recovery compared with the more gradual improvement with brief eclectic psychotherapy.

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Oren, U. (2012). Obituary. David Servan-Schreiber (1961-2011). Journal of EMDR Practice and Research, 6(1), 47-48. doi:10.1891/1933-3196.6.1.47

Abstract

In June 2007, Dr. David Servan-Schreiber, psychiatrist, researcher, EMDR (eye movement desensitization and reprocessing) trainer, and one of the best speakers I have ever met, was giving the keynote address to the 900 participants at the EMDR Europe Association annual meeting that took place in the School of Medicine of the University of Paris. He was talking about his new understanding regarding cancer research that would later become part of his best-selling book Anticancer.
The point I remember most clearly was a slide showing a graph of the length of survival after being diagnosed with cancer. It was the classic upside down U shape of most statistical distributions, with some people dying very early on, many surviving a few months and a few surviving for longer periods of time. So what’s new? Well, David was pointing to the fact that some people continued living against all odds. Since some people succeeded in doing this, the question in his mind was how did they do it? How does one continue living in the face of the biggest challenge? How does one use all the knowledge that has been gathered by science and by human wisdom to win the battle? The statement I remember him stressing on the podium was clear: The median is NOT the message!

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Scott, G. G., O'Donnell, P. J., & Sereno, S. C. (2012). Emotion words affect eye fixations during reading. Journal of Experimental Psychology. Learning, Memory, and Cognition. doi:10.1037/a0027209

Sara C. Sereno, Institute of Neuroscience and Psychology, 58 Hillhead Street, University of Glasgow, Glasgow G12 8QB, Scotland, United Kingdom. E-mail: Sara.Sereno@glasgow.ac.uk

Abstract

Emotion words are generally characterized as possessing high arousal and extreme valence and have typically been investigated in paradigms in which they are presented and measured as single words. This study examined whether a word's emotional qualities influenced the time spent viewing that word in the context of normal reading. Eye movements were monitored as participants read sentences containing an emotionally positive (e.g., lucky), negative (e.g., angry), or neutral (e.g., plain) word. Target word frequency (high or low) was additionally varied to help determine the temporal locus of emotion effects, with interactive results suggesting an early lexical locus of emotion processing. In general, measures of target fixation time demonstrated significant effects of emotion and frequency as well as an interaction. The interaction arose from differential effects with negative words that were dependent on word frequency. Fixation times on emotion words (positive or negative) were consistently faster than those on neutral words with one exception-high-frequency negative words were read no faster than their neutral counterparts. These effects emerged in the earliest eye movement measures, namely, first and single fixation duration, suggesting that emotionality, as defined by arousal and valence, modulates lexical processing. Possible mechanisms involved in processing emotion words are discussed, including automatic vigilance and desensitization, both of which imply a key role for word frequency. Finally, it is important that early lexical effects of emotion processing can be established within the ecologically valid context of fluent reading.

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Stramrood, C. A., van der Velde, J., Doornbos, B., Marieke Paarlberg, K., Weijmar Schultz, W. C., & van Pampus, M. G. (2012). The patient observer: Eye-Movement desensitization and reprocessing for the treatment of posttraumatic stress following childbirth. Birth (Berkeley, Calif.), 39(1), 70-76. doi:10.1111/j.1523-536X.2011.00517.x

C.A.I. Stramrood, MD, Department of Obstetrics and Gynecology, CB 21, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands.

Abstract

Background:  No standard intervention with proved effectiveness is available for women with posttraumatic stress following childbirth because of insufficient research. The objective of this paper was to evaluate the possibility of using eye-movement desensitization and reprocessing treatment for women with symptoms of posttraumatic stress disorder following childbirth. The treatment is internationally recognized as one of the interventions of choice for the condition, but little is known about its effects in women who experienced the delivery as traumatic.
Methods:  Three women suffering from posttraumatic stress symptoms following the birth of their first child were treated with eye-movement desensitization and reprocessing during their next pregnancy. Patient A developed posttraumatic stress symptoms following the lengthy labor of her first child that ended in an emergency cesarean section after unsuccessful vacuum extraction. Patient B suffered a second degree vaginal rupture, resulting in pain and inability to engage in sexual intercourse for years. Patient C developed severe preeclampsia postpartum requiring intravenous treatment.
Results:  Patients received eye-movement desensitization and reprocessing treatment during their second pregnancy, using the standard protocol. The treatment resulted in fewer posttraumatic stress symptoms and more confidence about their pregnancy and upcoming delivery compared with before the treatment. Despite delivery complications in Patient A (secondary cesarean section due to insufficient engaging of the fetal head); Patient B (second degree vaginal rupture, this time without subsequent dyspareunia); and Patient C (postpartum hemorrhage, postpartum hypertension requiring intravenous treatment), all three women looked back positively at the second delivery experience.
Conclusions:  Treatment with eye-movement desensitization and reprocessing reduced posttraumatic stress symptoms in these three women. They were all sufficiently confident to attempt vaginal birth rather than demanding an elective cesarean section. We advocate a large-scale, randomized controlled trial involving women with postpartum posttraumatic stress disorder to evaluate the effect of eye-movement desensitization and reprocessing in this patient group.

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