Volume 13, Issue 4 of the Journal of EMDR Practice and Research (JEMDR) is an important issue for EMDR therapy. In the editorial, Louise Maxfield, JEMDR Editor, points to the growing body of evidence regarding the efficacy of EMDR therapy, as well as the need for continued research. Conceptualized as a guide for clinicians, this issue includes articles about the use and effects of EMDR across a range of populations, diagnoses, and symptom clusters. Many clinicians familiar with EMDR therapy know that although EMDR therapy has been proven effective for the treatment of posttraumatic stress disorder (PTSD) symptoms, the research body is not as extensive when looking at the use of EMDR therapy for other diagnoses and issues. This issue addresses this concern, and looks more closely at how EMDR has been conducted in these other contexts: specifically, clients with depression, complex PTSD, bipolar disorder, anxiety disorders, psychosis, substance use disorder, OCD, and pain treatment as well as with the child and adolescent population and as an early intervention. The articles are written by EMDR therapy experts familiar with these areas, and include overviews of research already conducted in these areas as well as suggestions for moving forward. This issue focuses attention on where EMDR therapists can target their efforts while pursuing further research and also celebrates the extensive evidence base that EMDR therapy already has.
Maxfield, L. (2019). A clinician’s guide to the efficacy of EMDR therapy [Editorial]. Journal of EMDR Practice and Research, 13(4), 239-246. http://dx.doi.org/10.1891/1933-3220.127.116.11
Thirty years after its introduction in 1989, eye movement desensitization and reprocessing (EMDR) therapy has evolved to become a comprehensive psychotherapy, guided by Shapiro’s adaptive information processing model. Her model views most mental health disorders as stemming from unprocessed earlier disturbing events. This understanding of the etiological role of trauma has opened the door for EMDR treatment of multiple types of presentations. There are now more than 44 randomized controlled trials that have investigated EMDR treatment of posttraumatic stress disorder (PTSD), early traumatic stress, and traumatized children. In addition, there are 28 randomized controlled trials which have evaluated its use with major depressive disorder, bipolar disorder, psychosis, anxiety disorders, obsessive compulsive disorder, substance use disorder, and pain. Seventy-five percent of these studies provided Shapiro’s standardized procedure, while others tested modifications developed for specific populations. The focus of treatment varied across the studies, with various targets being processed to achieve good outcomes. The research demonstrates EMDR’s effectiveness in reducing/eliminating PTSD and trauma-related symptoms, and in improving symptoms related to presenting problems and disorders. EMDR can be considered to have well-established efficacy for the treatment of PTSD. The emerging evidence for EMDR’s efficacy with disorders other than PTSD must be considered preliminary and in need of replication conducted with randomized controlled trials using rigorous methodology. EMDR’s position in various treatment guidelines is discussed, and the needs for future research are elaborated.
List of Articles and Abstracts:
Dominguez, S., & Lee, C. W. (2019). Differences in international guidelines regarding EMDR for posttraumatic stress disorder: Why they diverge and suggestions for future research. Journal of EMDR Practice and Research, 13(4), 247-260. http://dx.doi.org/10.1891/1933-318.104.22.168
In the last 24 months, three separate practice guidelines for posttraumatic stress disorder (PTSD) have emerged from well-respected organizations that differed in the degree to which they recommend eye movement desensitization and reprocessing (EMDR) as a treatment. An international guideline was published by the International Society for Traumatic Stress Studies (ISTSS), and national guidelines were published by the American Psychological Association (APA) and the National Institute for Health Care Excellence (NICE). ISTSS reported that EMDR was effective and as potent as the best available therapies we can currently provide. NICE was more circumspect, and APA suggested other treatments had a stronger evidence base. In this review we focus on how these differences emerged and highlight the role of the time when the analysis was conducted, differences in inclusion criteria, and errors in determining appropriate measures. The 2017 APA guidelines were found to have the least validity when all these factors were considered. However, the fact that evaluating EMDR research is susceptible to such variations in methodology highlights certain research priorities that are then discussed.
de Jongh, A., Amann, B. L., Hofmann, A., Farrell, D., & Lee, C. W. (2019). The status of EMDR therapy in the treatment of posttraumatic stress disorder 30 years after its introduction. Journal of EMDR Practice and Research, 13(4), 261-269. http://dx.doi.org/10.1891/1933-322.214.171.1241
Given that 2019 marks the 30th anniversary of eye movement desensitization and reprocessing (EMDR) therapy, the purpose of this article is to summarize the current empirical evidence in support of EMDR therapy as an effective treatment intervention for posttraumatic stress disorder (PTSD). Currently, there are more than 30 randomized controlled trials (RCT) demonstrating the effectiveness in patients with this debilitating mental health condition, thus providing a robust evidence base for EMDR therapy as a first-choice treatment for PTSD. Results from several meta-analyses further suggest that EMDR therapy is equally effective as its most important trauma-focused comparator, that is, trauma-focused cognitive behavioral therapy, albeit there are indications from some studies that EMDR therapy might be more efficient and cost-effective. There is emerging evidence showing that EMDR treatment of patients with psychiatric disorders, such as psychosis, in which PTSD is comorbid, is also safe, effective, and efficacious. In addition to future well-crafted RCTs in areas such as combat-related PTSD and psychiatric disorders with comorbid PTSD, RCTs with PTSD as the primary diagnosis remain pivotal in further demonstrating EMDR therapy as a robust treatment intervention.
Barron, I. G., Bourgaize, C., Lempertz, D., Swinden, C., & Darker-Smith, S. (2019). Eye movement desensitization reprocessing for children and adolescents with posttraumatic stress disorder: A systematic narrative review. Journal of EMDR Practice and Research, 13(4), 270-283. http://dx.doi.org/10.1891/1933-3126.96.36.1990
There is currently a limited number of studies into the efficacy of eye movement desensitization reprocessing (EMDR) therapy with children and adolescents with posttraumatic stress disorder (PTSD). The current study utilizes a systematic narrative review of methodologies and findings of previous literature reviews and meta-analyses as well as analyzing randomized control trials (RCTs) conducted from 2002 to 2018. Following initial scoping of the extent of studies, two systematic literature searches were conducted, firstly for literature reviews and secondly for recent RCTs. Nine databases were utilized. Eight reviews and seven RCTs were identified and analyzed for quality of methodology and outcome as measured by impact on PTSD symptoms. EMDR was found to be efficacious in reducing children’s PTSD symptoms compared to waitlist conditions, with similar outcomes to cognitive behavior therapy (CBT). EMDR was effective with both single-event trauma as well as cumulative trauma such as sexual abuse. EMDR was equally effective with girls and boys as well as children from different cultures. EMDR achieved medium to large effect sizes. Reductions in PTSD were maintained at 2-, 3-, 6-, and 12-month follow-up. In conclusion, EMDR was consistently found to be an efficacious treatment for children with PTSD. Recommendations are made for future practice and research.
de Jongh, A., Bicanic, E., Matthijssen, S., Amann, B. L., Hofmann, A., Farrell, D. . . . & Maxfield, L. (2019). The current status of EMDR therapy involving the treatment of complex posttraumatic stress disorder. Journal of EMDR Practice and Research, 13(4), 284-290. http://dx.doi.org/10.1891/1933-3188.8.131.524
Complex posttraumatic stress disorder (CPTSD) is a diagnostic entity that will be included in the forthcoming edition of the International Classification of Diseases, 11th Revision (ICD-11). It denotes a severe form of PTSD, comprising not only the symptom clusters of PTSD (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV-TR]), but also clusters reflecting difficulties in regulating emotions, disturbances in relational capacities, and adversely affected belief systems about oneself, others, or the world. Evidence is mounting suggesting that first-line trauma-focused treatments, including eye movement desensitization and reprocessing (EMDR) therapy, are effective not only for the treatment of PTSD, but also for the treatment of patients with a history of early childhood interpersonal trauma who are suffering from symptoms characteristic of CPTSD. However, controversy exists as to when EMDR therapy should be offered to people with CPTSD. This article reviews the evidence in support of EMDR therapy as a first-line treatment for CPTSD and addresses the fact that there appears to be little empirical evidence supporting the view that there should be a stabilization phase prior to trauma processing in working with CPTSD.
Shapiro, E., & Maxfield, L. (2019). The efficacy of EMDR early interventions. Journal of EMDR Practice and Research, 13(4), 291-301. http://dx.doi.org/10.1891/1933-3184.108.40.2061
This brief narrative review begins with an overview of posttraumatic response and explains the value of early treatment in reducing/eliminating symptoms of distress and possibly preventing the development of posttraumatic stress disorder (PTSD) or other disorders. The article then summarizes the efficacy of eye movement desensitization and reprocessing (EMDR) therapy as an early intervention treatment. It outlines the historical context of EMDR early interventions and describes the three protocols which have research support from randomized controlled trials (RCTs), elaborating on their supportive evidence in seven RCTs conducted within 3 months of the traumatic event. These studies showed that EMDR early interventions significantly reduced symptoms of traumatic stress and prevented any exacerbation of symptoms. EMDR was superior to wait-list and to control conditions of critical incident stress debriefing, reassurance therapy, and supportive counseling. The article also examines the disparate evaluations of EMDR early interventions in the PTSD treatment guidelines, from the International Society for Traumatic Stress Studies, the World Health Organization, and the National Institute for Health and Clinical Excellence. Despite promising clinical experience and initial controlled studies, there are still substantive gaps in the evidence base for EMDR early interventions. The article concludes with recommendations for future research, emphasizing that future trials adhere to the highest standards for clinical research and that they investigate whether EMDR early intervention prevents the development of PTSD or increases resilience.
Malandrone, F., Carletto, S., Hase, M., Hofmann, A., & Ostacoli, L. (2019). A brief narrative summary of randomized controlled trials investigating EMDR treatment of patients with depression. Journal of EMDR Practice and Research, 13(4), 302-306. http://dx.doi.org/10.1891/1933-3220.127.116.112
Depression, one of the most common mental disorders, is characterized by enormous social costs and limited rates of treatment success, even though psychotherapeutic and pharmacological treatments currently contribute to an increase in the remission rate. In light of recent studies that have shown that traumas and adverse life experiences may represent risk factors for the onset of depression, the therapeutic approach of eye movement desensitization and reprocessing (EMDR) therapy has been seen as potentially effective in the treatment of depression. The purpose of the present brief narrative review is to summarize the current literature on the efficacy of EMDR in patients with depression, in particular by referring to randomized controlled clinical trials (RCTs) that examined depression as a primary outcome. The data examined are updated to March 2019 and count seven RCT studies covering the years from 2001 to 2019. They are heterogeneous by type of intervention and demographic characteristics of the sample. Although the selected studies are few and with different methodological critical issues, the findings reported by the different authors suggest in a preliminary way that EMDR can be a useful treatment for depression.
Valiente-Gomez, A., Moreno-Alcazar, A., Gardoki-Souto, I., Masferrer, C., Porta, S., Royuela, O., . . . & Amann, B. L. (2019). Theoretical background and clinical aspects of the use of EMDR in patients with bipolar disorder. Journal of EMDR Practice and Research, 13(4), 307-312. http://dx.doi.org/10.1891/1933-318.104.22.1687
Bipolar disorder (BD) is associated with a lifelong episodic course of severe mood and behavioral disturbance. In last decades treatment improved with numerous pharmacological and psychosocial treatments; however, subsequent mood episode rates are still high and possible risk factors for subsequent mood episodes are not sufficiently addressed. Of note, childhood trauma and stressful life events represent significant, under-recognized, and often neglected environmental risk factors in the etiology and course of BD. Here, we summarize the evidence of eye movement desensitization and reprocessing (EMDR) therapy in BD with posttraumatic stress disorder (PTSD) or life traumatic events. So far, one case report study and one pilot randomized controlled trial (RCT) have been published suggesting positive effect of EMDR therapy in BD. Currently, two larger further RCTs are ongoing to increase scientific evidence of the use of EMDR therapy in this indication, especially with a focus on its effect on relapse prevention. In addition, a functional neuroimaging case report of a bipolar subject versus 30 healthy controls showed first evidence that EMDR might modulate the default mode network. These preliminary results suggest that EMDR could be a promising and safe psychotherapeutic approach for the add-on treatment of bipolar subjects, but confirmative large RCT are needed, with two currently being conducted.
de Bont, P., de Jongh, A., & van den Berg, D. (2019). Psychosis: An emerging field for EMDR research and therapy. Journal of EMDR Practice and Research, 13(4), 313-324. http://dx.doi.org/10.1891/1933-322.214.171.1243
It has only been in this last decade that trauma-focused treatments (TFT) have been studied in patients with psychotic disorders. Before, the paradigm stated that TFT was contraindicated in these patients because clinicians and researchers assumed the risk of exacerbation of symptoms was too high. The purpose of this article is to examine the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy in the treatment of psychosis. To this end, we will present a brief narrative review of the current state of research in this particular field. The results suggest that, contrary to the “no-TFT-in-psychosis” paradigm, TFTs such as EMDR therapy can successfully be used to reduce trauma-related symptoms in patients with psychosis. Moreover, there are now provisional indications that psychotic symptoms such as delusions and hallucinations can be targeted directly and indirectly using EMDR therapy.
Faretta, E., & Dal Farra, M. (2019). Efficacy of EMDR therapy for anxiety disorders. Journal of EMDR Practice and Research, 13(4), 325-332. http://dx.doi.org/10.1891/1933-3126.96.36.1995
Six randomized controlled trials (RCTs) investigated the efficacy of eye movement desensitization and reprocessing (EMDR) therapy for adults with anxiety disorders over a span of 20 years (1997–2017). Three RCTs focused on panic disorder, with or without agoraphobia (PDA); two studies targeted specific phobias, whereas the dependent variable of another RCT was “self-esteem,” considered as a mediator factor for anxiety disorders. In four RCTs, EMDR therapy demonstrated a positive effect on panic and phobic symptoms, whereas one RCT on PDA was partly negative and one study failed in improving self-esteem in patients with anxiety disorders. Considered as a whole, these preliminary data suggest EMDR therapy may be effective not only for PD but also for specific phobias. Further controlled studies are needed to corroborate these findings and also to systematically evaluate the efficacy of EMDR therapy for generalized anxiety disorder, social anxiety, and agoraphobia. Because cognitive behavioral therapy (CBT) is presently considered a first-line treatment for anxiety disorders, controlled comparisons between EMDR therapy and CBT would be especially useful in future investigations of EMDR treatment of anxiety disorders.
Rudiger Bhom, K. (2019). EMDR’s efficacy for obsessive compulsive disorder. Journal of EMDR Practice and Research, 13(4), 333-336. http://dx.doi.org/10.1891/1933-3188.8.131.523
This article evaluates eye movement desensitization and reprocessing (EMDR) therapy for individuals with a diagnosis of obsessive compulsive disorder (OCD). Two randomized controlled trials (RCTs) have been conducted on 55 and 90 patients with OCD. One RCT showed that EMDR was superior to citalapram in reducing OCD symptoms, and the other found EMDR treatment and exposure and response prevention equally effective in decreasing symptoms, with results maintained at 6-month follow-up. In addition to examining these RCTs, this article looks at several case studies to discuss three types of EMDR treatment targets (past, present, and future), and the integration of EMDR therapy with cognitive behavioral strategies such as in vivo exposure. Future research is needed before any definitive conclusions can be made.
Tesarz, J., Wicking, M., Bernardy, K., & Seidler, G. H. (2019). EMDR therapy’s efficacy in the treatment of pain. Journal of EMDR Practice and Research, 13(4), 337-344. http://dx.doi.org/10.1891/1933-3184.108.40.2067
Chronic pain is the most common global cause of functional and quality of life limitations. Although there are many effective therapies for the treatment of acute pain, chronic pain is often unsatisfactory. Against this background, there is currently an urgent need to develop innovative therapies that enable more efficient pain relief. Psychosocial factors play an important role in the development and persistence of chronic pain. Especially in patients with high levels of emotional stress, significant anxiety, or relevant psychological comorbidity, classical pain therapy approaches often fail. This is in line with the results of recent pain research, which has shown that dysfunctions in emotion processing have a significant influence on the persistence of pain symptoms. The recognition that pain can become chronic through maladaptive emotional processing forms the pathophysiological basis for the application of eye movement desensitization and reprocessing (EMDR) in the treatment of chronic pain. In this sense, EMDR can be used as an established method for desensitizing and processing of emotional distress from trauma therapy specifically for processing emotional stress in patients with chronic pain. Against this background, it is not surprising that the implementation of EMDR for patients with chronic pain is expanding. However, the increasing clinical use of EMDR in the treatment of chronic pain has also led to a reputation to test the efficacy of EMDR in pain management through randomized clinical trials. In addition to numerous case control studies, there are now also six randomized controlled clinical trials available that demonstrate the efficacy and safety of EMDR in the treatment of different pain conditions. However, in order to overcome several methodological limitations, large multicenter studies are needed to confirm the results.
Tapia, G. (2019). Review of EMDR interventions for individuals with substance use disorder with/without comorbid posttraumatic stress disorder. Journal of EMDR Practice and Research, 13(4), 345-353. http://dx.doi.org/10.1891/1933-3220.127.116.115
A large proportion (11%–60%) of people with posttraumatic stress disorder (PTSD) also suffer from substance use disorder (SUD). As the high cooccurrence of PTSD and SUD leads to a worsening of psychopathological severity, development and evaluation of integrated treatments become highly valuable for individuals presenting with both diagnoses. Eye movement desensitization and reprocessing (EMDR) therapy may fit these needs. This article summarized all studies that investigated EMDR treatment for SUD, to clarify whether EMDR might be a useful approach. A comprehensive Title/Abstract/Keyword search was conducted on PsycInfo, PsychArticle, PubMed, and Scopus databases. A total of 135 articles were retrieved, and 8 articles met inclusion/exclusion criteria. One RCT and one case study evaluated trauma-focused EMDR; one clinical RCT, one non-clinical RCT, one cross-over study, and one case study evaluated addiction-focused EMDR; and one quasi-experimental and one multiphase case study evaluated the combination of addiction-focused and trauma-focused EMDR. Results show that EMDR treatment consistently reduces posttraumatic symptoms, but that its effects on SUD symptoms are less evident. Although EMDR should be considered as a promising tool for this population due to its possible potential to improve SUD outcomes, further research is needed to see whether EMDR therapy, either trauma-focused or addiction-focused, is effective for SUD. We conclude with suggestions for future research and clinical practice in this area.
Shapiro, F. (2019). Future research: Global implications. Journal of EMDR Practice and Research, 13(4), 354-360. http://dx.doi.org/10.1891/1933-318.104.22.1684
Therapists trained to provide eye movement desensitization and reprocessing (EMDR) therapy have a global responsibility. This article summarizes the multiple impacts of high stress events, and their long-term effects on individuals, families, communities, and nations. While it is well documented that EMDR treatment will remediate the individual symptoms of posttraumatic stress, research is still needed to determine how far-reaching such outcomes are. Future studies should determine whether treatment reverses the neurobiological changes, cognitive deficits, and affective dysregulation, which are associated with exposure to traumatic events. Research should also investigate whether successful treatment decreases high-risk and/or perpetrator behavior, and whether these effects are translated into behavioral and attitudinal changes sufficient to bring an end to intergenerational trauma and ethnopolitical conflicts. It seems self-evident that the ideal way to address pressing societal needs, on both local and global levels, is by the integration of science and practice. The article also discusses the development of nonprofit EMDR humanitarian assistance programs, and their essential work in the alleviation of suffering around the world. In addition to recommending the examination of EMDR’s efficacy in treating traumatization from direct, natural, structural, and cultural causes, this article advocates that research resources be dedicated for testing interventions in the areas of the world with the greatest needs. The alleviation of suffering is the duty of our profession.