More about EMDR
“Eye Movement Desensitization and Reprocessing,” abbreviated to EMDR, is a therapy for people who continue to suffer from the effects of a shocking experience, such as an accident, sexual assault or violent incident. EMDR was first described by American psychologist Francine Shapiro more than 25 years ago. In the years since, this procedure has been further elaborated and developed into a fully-fledged and effective online psychology method.”
EMDR association the Netherlands
EMDR is increasingly used for anxiety disorders and especially when there are traumatizing experiences that caused that anxiety disorder(s) to develop.
EMDR is also becoming more widely used. Among other things, in depression.
EMDR further explained in treating traumatizing memories
The online psychologist will ask you to think back to the event, including the associated images, thoughts and feelings. First, this is done to gather more information about the traumatic experience. Then the processing process is started. The online psychologist will ask you to recall the event again. During this procedure, the online psychologist sees the client through the camera and responses are closely monitored. But now this is done in conjunction with a distracting stimulus. At GGZonline, this is a little ball that moves quickly across the image. The online psychologist can adjust the shape, size and color of the ball.
It works with ‘sets’ (= series) of stimuli.
After each set, a short rest is taken. The online psychologist will ask the client what comes to mind. The EMDR procedure usually triggers a flow of thoughts and images, but sometimes also feelings and physical sensations. Often things change. After each set, the client is asked to focus on the most noticeable change, after which a new set follows.
What are the expected effects?
The sets will gradually cause the memory to lose its power and emotional charge. So it becomes easier and easier to think back to the original event. The anxiety and tension that the client normally feels with these thoughts decreases more and more. In many cases, the memory images themselves also change, becoming blurrier or smaller, for example. But it may also be that less unpleasant aspects of the same situation emerge. Alternatively, new thoughts or insights may spontaneously arise that give a different, less threatening, meaning to the event. These effects contribute to the shocking experience becoming more and more part of the person’s life history.
What else is EMDR appropriate for?
There is growing evidence that emotionally charged memories and images also play an important role in other complaints such as chronic pain, depression, eating disorders, addictions and psychosis. For this reason, EMDR is increasingly used with these problems and disorders, usually as part of a broader treatment plan. At GGZonline, EMDR is used for anxiety disorders including PTSD and for depression.
EMDR a 1st choice treatment
A lot of research has also been done. There are now more than 20 randomized controlled clinical trials on the effectiveness of EMDR for PTSD. This makes EMDR one of the most evaluated treatments in the field of psychological trauma.
According to the most recent guidelines of the International Society for Traumatic Stress Studies (ISTSS), the American Psychiatric Association (APA) and numerous other guideline committees, including the National Steering Committee for Multidisciplinary Guidelines in Mental Health (www.ggzrichtlijnen.nl) and the World Health Organization, EMDR, along with imaginal exposure, is ‘treatment of choice‘ for PTSD. This means that EMDR is a 1
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choice treatment.
Scientific research on EMDR
EMDR was compared in scientific research to both waitlist control conditions and active treatments. Several meta-analyses have shown that EMDR is an effective treatment for acute and chronic PTSD, in which a one-time trauma can be processed in a limited number of sessions to the point that patients no longer meet the criteria for PTSD (e.g., Bisson et al., 2007; Chen, Zhang, Hu, & Liang, 2015; Gerger et al. ,2014; Watts et al., 2015). A meta-analysis of studies on the effect of EMDR for PTSD due to early childhood traumatization also shows a relatively large effect (Ehring et al., 2014). EMDR and other forms of trauma-focused cognitive behavioral therapy provide better outcomes than regular care or wait-list (Bisson, Roberts, Andrew, Cooper, & Lewis, 2013). Accordingly, the Multidisciplinary Guideline on Anxiety Disorders states:
“That EMDR is one of the most eligible psychological interventions for PTSD. The method is effective and, by its nature, is perceived by many patients and online psychologists as relatively unemotional.”
The thrust of this guideline is consistent with that of other international expert panels and advisory committees in the field of psychotrauma. For example, the so-called NICE guideline, which is highly regarded internationally, expects online psychologists to offer patients with PTSD nothing but the evidence-based treatments EMDR or trauma-focused-cognitive behavioral therapy (TF-CBT):
“When PTSD sufferers request other forms of psychological treatment (for example supportive therapy, non-directive thera
“When PTSD sufferers request other forms of psychological treatment (for example supportive therapy, non-directive therapy, hypnotherapy, psychodynamic therapy), they should be informed that there is as yet no convincing evidence for a clinically important effect of these treatments on PTSD.”
Randomized effect studies also show that EMDR is effective when there is PTSD with severe comorbidity, such as psychotic disorder (Van den Berg et al., 2015; De Bont et al, 2015), specific phobias (e.g., Doering, Ohlmeier, De Jongh, Hofmann, & Bisping, 2013), obsessive-compulsive disorder (Nazari, Momeni, Jariani, & Tarrahi, 2011), and bipolar disorder (Novo et al., 2014). Empirical research on the effectiveness of EMDR in other forms of psychopathology is in progress.
References
Bisson J.I., Ehlers A., Matthews R., Pilling S., Richards D., & Turner S. (2007). Psychological treatments for chronic post-traumatic stress disorder. Systematic review and meta-analysis. Brit j Psychiat, 190, 97-104.
Bisson J.I., Roberts N.P., Andrew M., Cooper R., & Lewis C. (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews 12, CD003388.
Chen L., Zhang G., Hu M., & Liang X. (2015). Eye movement desensitization and reprocessing versus cognitive-behavioral therapy for adult posttraumatic stress disorder: systematic review and meta-analysis. J Nerv Ment Dis, 203(6), 443-451.
Bont P.A.J.M. de, Berg D.P.G. van den, Vleugel B.M. van der, Roos C. de, Jongh A. de, Gaag M. A. van der, Minnen M. van (2015). Predictive validity of the Trauma Screening Questionnaire in detecting post-traumatic stress disorder in patients with psychotic disorders. British Journal of Psychiatry, 206 (5), 408-416. doi: 10.1192/bjp.bp.114.148486
Ehring T., Welboren R., Morina N., Wicherts J.M., Freitag J., & Emmelkamp P.M.G. (2014). Meta-analysis of psychological treatments for posttraumatic stress disorder in adult survivors of childhood abuse. Clinical Psychology Review, 34, 645-657.
Doering S., Ohlmeier M.C., Jongh A. de, Hofmann A., & Bisping V. (2013). Efficacy of a trauma-focused treatment approach for dental phobia: A randomized clinical trial. European Journal of Oral Sciences, 121, 584-593.
Gerger H., Munder T., Gemperli A., Nüesch E., Trelle S., Jüni P., Barth J. (2014). Integrating fragmented evidence by network meta-analysis: relative effectiveness of psychological interventions for adults with post-traumatic stress disorder. Psychological Medicine. Published online: April 16, 2014. doi:10.1017/S0033291714000853.
Multidisciplinary Guideline on Anxiety Disorders (2003). National steering committee on multidisciplinary guidelines in mental health. Quality Institute for Healthcare CBO/Trimbos Institute. Available at: www.ggzrichtlijnen.nl.
National Collaborating Centre for Mental Health. (2005). Post-Traumatic Stress Disorder: The Management of PTSD in Adults and Children in Primary and Secondary Care. Clinical Guideline 26. London, UK: National Institute for Clinical Excellence.
Nazari H., Momeni N., Jariani M., & Tarrahi M. (2011). Comparison of eye movement desensitization and reprocessing with citalopram in treatment of obsessive compulsive disorder. International Journal of Psychiatry in Clinical Practice, 15, 270-274.
Novo P., Landin-Romero R., Radua J., Vicens V., Fernandez I., Garcia F., Amann, B. (2014). Eye movement desensitization and reprocessing therapy in subsyndromal bipolar patients with a history of traumatic events: A randomized, controlled pilot study. Psychiatry Research, 219, 122-128.
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. Psychol Med, 36, 1515-1522.
Shapiro F. (1995). Eye movement desensitization and reprocessing: Basic principles, protocols and procedures. New York: Guilford Press.
Berg D. van den, Bont P. de, Vleugel B. van der, Roos C. de, Jongh A. de, Minnen A. van, & Gaag M. van der (2015). Prolonged exposure vs eye movement desensitization and reprocessing vs waiting list for posttraumatic stress disorder in patients with a psychotic disorder. Jama Psychiatry, 72, 259-267.
Watts B.V., Schnurr P.P., Mayo L., Young-Xu Y., Weeks W.B., & Friedman M.J. (2013). Meta-analysis of the efficacy of treatments for posttraumatic stress disorder. Journal of Clinical Psychiatry, 74, 541-550.
World Health Organization (WHO; 2013). Guidelines for the management of conditions that are specifically related to stress. Geneva: WHO.