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This study investigated the efficacy of eye movement desensitization and reprocessing (EMDR) psychotherapy in treating the primary diagnosis of major depressive disorder by processing past or present trauma that was affecting the quality of life. The 26 diagnosed participants were randomly assigned to 6–8 sessions of EMDR treatment or the waiting list control. Beck Depression Inventory-II, Trauma Symptom Checklist-40, and Quality of Life Index Inventory were used at pre- and postassessment to measure depressive and trauma symptoms and quality of life of the participants for both groups. The targets for EMDR therapy were selected by the participants determining the negative cognitions most strongly associated with reduced functioning and then identifying a related disturbing event. Paired and independent sample t tests were applied for data analysis. Results showed significant improvements on all measures with large effect sizes. At 95% confidence interval, the results found EMDR as an effective treatment for depressive and trauma symptoms and for improving the quality of life of the participants. A generalization effect was found for the depressogenic cognitions, with the number and strength of negative beliefs markedly decreased at posttreatment, even for beliefs not targeted in the therapy. Three-month follow-up interview with the EMDR participants confirmed that the results had been maintained.
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Journal of EMDR Practice and Research, Volume 10, Number 2, 2016 59
© 2016 EMDR International Association
least 2 weeks in activities that were previously enjoy-
able. Other symptoms may include low energy, guilt,
feelings of worthlessness, change in appetite and
sleep patterns, inability to concentrate, and suicidal
ideation. According to Shapiro’s (2001) adaptive infor-
mation processing (AIP) model, stressful life events,
loss, or “trauma” suffered in childhood or recently
can be factors underlying depression. Various stud-
ies have found an association between the onset of
depression and traumatic events (e.g., Brady, Killeen,
Brewerton, & Lucerini, 2000) and stressful life events
(e.g., Kendler, Hettema, Butera, Gardner, & Prescott,
2003; Risch et al., 2009).
Depression is medically managed through antide-
pressants. However, in a meta-analysis, Fournier et al.
(2010) concluded that although antidepressants have
only a small advantage over placebos, their usage in-
creases with increase in the severity of depression.
Weight gain as a side effect is also a disadvantage of
the pharmacological treatment (Reid & Barbui, 2010).
Depression is one of the foremost causes of
the worldwide disability and disease burden
(World Health Organization, 2014). It is a
risk factor for suicide (Malone, Haas, Sweeney, &
Mann, 1995). It is frequently comorbid with other
chronic diseases and can exacerbate their health-
related outcome (Moussavi et al., 2007). The U.S. Na-
tional Comorbidity Survey estimated that the lifetime
prevalence of depression is 17%–19%, 12 months
prevalence rate is 2.9%–12.6%, and relapse rate for
those who had earlier episodes is 50%–80% (Kessler
et al., 1994). Laursen, Munk-Olsen, Nordentoft, and
Montensen (2007) linked high mortality to depres-
sion. Chronic depression is often treatment resistant
(Wood & Ricketts, 2013).
The symptoms of depression according to
American Psychiatric Association in the Diagnostic and
Statistical Manual of Mental Disorders (4th ed., text rev.;
DSM-IV-TR; American Psychiatric Association, 2000)
include low mood or sadness and loss of interest for at
The Efficacy of EMDR in the Treatment of Depression
Yasmeen Wajid Mauna Gauhar
Growing Edge, Islamabad, Pakistan
This study investigated the efficacy of eye movement desensitization and reprocessing (EMDR) psy-
chotherapy in treating the primary diagnosis of major depressive disorder by processing past or present
trauma that was affecting the quality of life. The 26 diagnosed participants were randomly assigned to
6–8 sessions of EMDR treatment or the waiting list control. Beck Depression Inventory-II, Trauma Symp-
tom Checklist-40, and Quality of Life Index Inventory were used at pre- and postassessment to measure
depressive and trauma symptoms and quality of life of the participants for both groups. The targets for
EMDR therapy were selected by the participants determining the negative cognitions most strongly asso-
ciated with reduced functioning and then identifying a related disturbing event. Paired and independent
sample t tests were applied for data analysis. Results showed significant improvements on all measures
with large effect sizes. At 95% confidence interval, the results found EMDR as an effective treatment for
depressive and trauma symptoms and for improving the quality of life of the participants. A generaliza-
tion effect was found for the depressogenic cognitions, with the number and strength of negative beliefs
markedly decreased at posttreatment, even for beliefs not targeted in the therapy. Three-month follow-up
interview with the EMDR participants confirmed that the results had been maintained.
Keywords: eye movement desensitization and reprocessing (EMDR); depression; trauma; quality of life;
generalization effects; treatment outcome
60 Journal of EMDR Practice and Research, Volume 10, Number 2, 2016
protocols. The treatment includes a broad evaluation
of the client’s presenting problem and history; stabili-
zation and preparation of the client; and processing of
the client’s past traumatic memories, current stressful
situations, and future difficulties (Shapiro, 2014).
Theoretically, EMDR psychotherapy is based on
the AIP model (Solomon & Shapiro, 2008). It views
psychopathology in the light of former traumatic
experiences which may be large-T traumas (meeting
PTSD diagnostic criteria) or small-t traumas (dis-
tressing life events). The model posits that memory
networks holding the experiences of trauma seem
unable to connect to other neural networks holding
information of adaptive nature (Shapiro, 2001). These
networks get persistently triggered by various internal
and external stimuli and generate maladaptive re-
sponses (Shapiro, 1995, 2006). The EMDR treatment
uses standardized procedures to connect traumatic
memory networks with more adaptive networks, dur-
ing bilateral sensory stimulations, thus changing the
characteristics of the traumatic memory and bringing
it to an adaptive resolution and transforming associ-
ated cognitions, sensations, and emotions (Shapiro,
2001, 2002; Shapiro & Forrest, 1997). Successful
EMDR treatment alters individuals’ responses to ear-
lier experienced trauma (Shapiro, 2001).
EMDR Treatment of Depression
There have been several studies in which comorbid
depressive symptoms were assessed in studies inves-
tigating EMDR treatment of participants diagnosed
with PTSD. For example, in a randomized con-
trolled trial, van der Kolk et al. (2007) found EMDR
more effective than fluoxetine in reducing PTSD
and depression symptoms. A meta-analysis by Ho
and Lee (2012) determined that EMDR was more ef-
fective at reducing these comorbid depressive symp-
toms than CBT.
In 2013, Wood and Ricketts asserted that although
EMDR has the potential to treat symptoms of primary
depression, the application has not been adequately
researched, and currently, it cannot be considered an
evidence-based treatment for major depressive disor-
der. More recently, Hase et al. (2015) and Hofmann
et al. (2014) conducted controlled matched studies in
inpatient and outpatient settings with patients diag-
nosed with major depressive disorder. All participants
received treatment as usual, and EMDR was pro-
vided as an adjunctive therapy to a matched group.
Results showed significantly better improvement on
symptoms of depression for those participants who
received adjunctive EMDR.
Tol, Barbui, and van Ommeren (2013) suggested that
pharmacological management should be judicially
opted for and only in cases when psychotherapeutic
interventions are ineffective or unavailable or the level
of depression (i.e., concurrent moderate to severe)
requires it.
Cognitive Therapy for Depression
Beck’s (1979) cognitive theory is popularly used to
understand depression. It postulates that negative
thoughts, generated by dysfunctional beliefs, are
usually the major cause of depression. Beck also as-
serted that people with depression selectively attend
to features of their environment, which match their
negative expectations and confirm them. They are
usually inclined to amplify the significance and con-
notations placed on negative events and diminish the
importance and meaning of positive events. All of
these unconscious maneuvers function to help the
person with depression to maintain core negative
beliefs/schemas which contributes toward feelings
of hopelessness about the future even when the evi-
dence stands contrary to it. This process of selective
attention to events is known as faulty information pro-
cessing (Nemade, Reiss, & Dombeck, 2007). Patients
with depression had highly charged dysfunctional at-
titudes or beliefs about themselves that hijacked the
information processing and produced the negative
cognitive bias, which led to the symptoms of depres-
sion (2008).
Cognitive therapy (CT) and cognitive behavioral
therapy (CBT) are considered effective therapies for
depression, significantly reducing relapse recurrence
(Hollon, Stewart, & Strunk, 2006). In a meta-anal-
ysis of 28 studies, Vittengl, Clark, Dunn, and Jarrett
(2007) found that the posttreatment relapse rate was
29% after 1 year and 54% after 2 years. On the con-
trary, the meta-analysis of 70 studies by Johnsen and
Friborg (2015) reported a linear and steady decline
in the effectiveness of CBT across time, with con-
temporary CBT seemingly providing less relief from
depressive symptoms as compared to its effective-
ness reported in previous years.
Francine Shapiro introduced eye movement desensi-
tization and reprocessing (EMDR) as a treatment for
posttraumatic stress disorder (PTSD) in 1989. The
therapy has since been scientifically authenticated as a
psychotherapeutic intervention for PTSD (Foa, Keane,
Friedman, & Cohen, 2009). EMDR therapy is an
eight-phase treatment procedure with standardized
Journal of EMDR Practice and Research, Volume 10, Number 2, 2016 61
The Efficacy of EMDR in the Treatment of Depression
to here as small-t traumas), residual debilitating symp-
toms, no medication or any other form of therapy,
and a score of less than 35 on the Dissociative Expe-
rience Scale–II (Bernstein & Putnam, 1986). The in-
clusion conditions also required that the participants
were of sound mind, capable of comprehending the
terms of the study, and were physically capable of
participating in this project. Comorbidity with other
mental disorders and any substance use were the ex-
clusion criteria.
A total number of 52 participants were referred to
the researcher clinician, out of whom 29 met the in-
clusion criteria and were offered the opportunity to
participate in the study. Twenty-three were screened
out because of comorbid PTSD, use of antidepres-
sants, substance use (hash, opium), and/or a score of
more than 35 on Dissociative Experience Scale. Out
of 29, 3 participants declined to join the study without
giving any reason (Figure 1).
Twenty-six participants randomly assigned to ex-
perimental and waiting list were informed about the
study and its purpose. After discussing the treatment
procedure in detail, participants signed the informed
consent forms. The 26 participants ranged in age from
18 to 60 years (M 29.38); all had completed high
school, and some had postsecondary education.
Nine participants dropped out during the study.
Three participants from the experimental group did
not turn up for postassessment after completing EMDR
therapy because of law and order situation, some do-
mestic problem, and personal reasons not shared. Six
participants on the waiting list dropped out because of
opting for pharmacological management, loss of mo-
tivation, worsening of symptoms because of delayed
treatment, and logistic problems (see Figure 1).
Participants meeting the inclusion criteria were ran-
domly assigned to the waiting list control Group A
and to experimental Group B. Random assignment
was conducted by the research supervisor through
toss of coin (i.e., heads: control, tails: treatment)
without having knowledge of group condition. Par-
ticipants completed pretreatment assessment mea-
sures. The waiting list control participants attended
clinical interview regarding presenting complaints but
received no therapy during the 7 weeks of the study.
The experimental group was provided with six to
eight EMDR treatment session delivered in weekly
sessions. After the study was completed, posttreat-
ment assessment was administered and the waiting
list participants were provided treatment within the
Several case studies have reported positive treatment
outcome when depression was treated with EMDR.
For example, Uribe, Ramírez, and Mena (2010) found
EMDR had a positive effect both on emotional cogni-
tive processing and on long-term memory conceptual
organization in patients with depression. Bae, Kim, and
Park (2008) provided EMDR treatment to two teenagers
with major depressive disorder related to stressful life
events and found their depressive symptoms decreased
to full remission. Broad and Wheeler (2006) treated an
adult client having depression and attention deficit hy-
peractivity disorder (ADHD) with EMDR and reported
significant decreased level of depression and hypervigi-
lance and improved concentration ability which led to
the discontinuation of medication for depression and
ADHD. Krupnik (2015) successfully treated postpartum
depression by integrating EMDR with his evolutionary-
based treating depression downhill (TDD) therapy.
Grey (2011) treated comorbid severe major depressive
disorder and panic disorder with agoraphobia through
EMDR and found reduction in symptoms of depression
and anxiety.
In the light of earlier literature, it can be asserted
that EMDR has the potential to treat symptoms of
primary depression. However, no controlled study has
investigated the application of EMDR as a stand-alone
treatment for major depressive disorder. Hence, this
study compared EMDR therapy with waiting list for
participants with major depressive disorder. It was hy-
pothesized that (a) for the EMDR participants, there
would be significant postassessment reduction in
scores on depressive and traumatic stress inventories
and a significant postassessment improvement in qual-
ity of life scores after EMDR treatment compared to
pretreatment scores obtained on the same inventories
and (b) there would be significant differences between
waitlist control participants and EMDR participants
on pre- and postassessment change scores of depres-
sive, traumatic stress, and quality of life measures.
Participation in the study was voluntary, and potential
participants were selected from available client base
and from psychiatric and psychological referrals to an
outpatient facility of Institute of Professional Psychol-
ogy, Bahria University, Karachi Campus, Pakistan.
Participants who met the inclusion criteria were of-
fered the opportunity to participate. Inclusion criteria
included the diagnosis of major depressive disorder
(based on DSM-IV-TR; American Psychiatric Associa-
tion, 2000), exposure to stressful life events (referred
62 Journal of EMDR Practice and Research, Volume 10, Number 2, 2016
eight-phase EMDR therapy, postassessment, and
The Therapist. The study (as an MPhil thesis) was
conducted by the researcher clinician who has been an
EMDR certified practitioner Level II (EMDR Europe)
since 2008 in addition to holding a master’s degree in
applied psychology, diploma and advanced diploma in
counseling, and diploma in clinical supervision.
Treatment Fidelity. This research was supervised
by committee comprising an assistant professor and
two associate professors at Institute of Clinical Psy-
chology, Bahria University, Karachi, Pakistan, from the
time of synopsis presentation to completion of the re-
search. Session logs and transcripts were maintained
and presented to supervisor on fortnightly basis.
Treatment Description. During the first 3 weeks,
participants attended history and preparation phases
Institute of Professional Psychology. Follow-up in-
terviews were conducted by the therapist 3 months
after treatment completion with EMDR participants
to determine if there was any recurrence of depres-
sive symptoms.
EMDR Treatment
Participants assigned to the experimental group re-
ceived six to eight 1-hour EMDR treatment sessions
proved on weekly basis. During the first 2–3 weeks,
they went through first and second phases of EMDR
treatment which focused on history taking and
preparation. After preparation was completed, the
participants received three to five EMDR process-
ing sessions in which they targeted disturbing events
thought to be related to their depressive condition.
Ten experimental group participants completed
Assessed for
N 52
did not meet criteria
N 23
N 3
N 26
N 13
N 13
N 10
N 3
N 7
N 6
N 10
FIGURE 1. Participant flow through study.
Journal of EMDR Practice and Research, Volume 10, Number 2, 2016 63
The Efficacy of EMDR in the Treatment of Depression
that identifies the incidence and severity of depres-
sive symptoms and is sensitive to change in symptoms
(Beck, Steer, & Brown, 1996). The sum of scores on
21 items is compared to cutoff score guidelines in
given at the end of the inventory. The score of 0–13
is minimal range, 14–19 is mild depression, 20–28
is moderate depression, and 29–63 indicates severe
Trauma Symptoms Checklist-40. The Trauma
Symptoms Checklist-40 (TSC-40) is a 40-item self-
report research measure (Briere & Runtz, 1989). It
evaluates symptoms of trauma, distress, and some as-
pects of posttraumatic stress through self-report and
can yield a total score from 0 to 120 on a 4-point fre-
quency rating scale ranging from 0 (never) to 3 (often).
Respondents have to mark how often they experi-
enced the symptoms of trauma in the last 2 months.
TSC-40 has 6 subscales: Anxiety, Depression, Dis-
sociation, Sexual Abuse Trauma Index, Sexual Prob-
lems, and Sleep Disturbances. It is a relatively reliable
measure with alpha of the subscale ranges from .66
to .77 and alphas of the full scale averaging between
.89 and .91. TSC-33 and TSC-40 also have predictive
validity (Dutton, 1995) with reference to different
variety of traumatic experiences because it seems to
predict perpetration of intimate violence.
Quality of Life Index. The Quality of Life Index
(QLI) measures quality of life in terms of impor-
tance and satisfaction regarding various aspects of
life (Ferrans & Powers, 1984). The QLI produces five
scores: quality of life overall and in quality of life in
four domains, such as health and functioning domain,
psychological/spiritual domain, social and economic
domain, and family domain. The total scale of QLI
has high internal consistency and reliability (alpha co-
efficient range .73–.99; Ferrans & Powers, 1985). QLI
is significantly sensitive to change.
A mixed model between group and within group re-
search design was employed to analyze the data. Sta-
tistical analysis through SPSS Version 20.0 was carried
out for within group and between group mean com-
parisons for experimental and control groups. Pair
sample and independent sample t test were applied
to test the formulated hypothesis. The effect size was
calculated through Cohen’s d.
The data was screened for missing values so that
those could be reported and accurate results could
of EMDR. They provided history about the origin of
their disorder and learned containment exercises such
as relaxation breathing and safe place imagery use so
that they could deal with high level of physical and
emotional distress if it came up. In the following three
to five sessions, the participants experienced EMDR
treatment sessions.
Standard protocol was used during the EMDR
sessions with a slight modification in Phase 3 during
target assessment. In standard protocol, the identifi-
cation of negative cognition follows identification of
the traumatic event. In our modification, participants
identified the negative cognition most strongly associ-
ated with reduced functions and then identified the
related events. To accomplish this, we provided clients
with a list of self-referencing negative and positive be-
liefs (as used in EMDR therapy, from Shapiro, 2001)
and asked them to rank the negative beliefs according
to how each affected their functioning. Following this,
participants identified the related disturbing event and
completed the standard assessment phase.
The desensitization phase was carried out with
minimal interference from the researcher clinician.
During the installation phase, the concentration was
on full integration of client’s positive self-assessment
with targeted information. Completion of installation
phase was followed by body scan. When successful
installation of positive installation was achieved and
when the positive future template was used where
it was necessary, the session was closed on debrief-
ing the client about processing which may carry on
between sessions. If the processing of the targeted
material could not be completed in a given session,
participants were assured that it would be taken up
in the following session. Clients were encouraged to
self-regulate between sessions through containment
exercises or writing a diary. In the reevaluation phase,
previously targeted material was assessed by the cli-
ent for its resolution, and if new material surfaced, it,
too, was processed and integrated with new learning
regarding self. Before ending the treatment, an evalua-
tion was made regarding the processing of all targeted
events in relation to past, present, and future and cli-
ents adjustment to his social role.
Data was collected at pre- and posttreatment for
experimental group and pre- and postassessment
waiting list for control group on the following three
Beck Depression Inventory II. The Beck Depression
Inventory-II (BDI-II) is a 21-item self-report measure
64 Journal of EMDR Practice and Research, Volume 10, Number 2, 2016
the mean scores dropped from 24.90 (SD 4.84) to
3.60 (SD 4.50), a significant decrease, t(9) 9.789,
p .000. This was a large effect size with Cohen’s d
of 3.10. On the TSC-40, there was a significant differ-
ence in mean scores from pretreatment (M 55.40,
SD 14.58) to postintervention (M 9.60, SD
7.79), t(9) 11.131, p .000 with large effect size,
d 3.47. There was also significant improvement in
scores on the QLI, t(9) 6.734, p .000. Postinter-
vention quality of life scores (M 19.80, SD 2.40)
were significantly higher than preintervention quality
of life score (M 13.82, SD 2.40) with large treat-
ment effect, d 2.13.
Comparison of Pre- and Postassessment
Differences Between Experimental and
Control Groups
Independent t tests were conducted to compare the
mean difference scores (i.e., changes between pre- and
postassessment of experimental group participants
[n 10] and the control group participants [n 7];
see Table 1). On the BDI-II, the mean change score
of the experimental group (M 21.30, SD 6.88)
was significantly larger than that of control group
(M 5.85, SD 10.15), t(9) 9.789, p .001, with
large treatment effect size, d 1.97, indicating that
the experimental group showed a significant larger
decrease in depression compared to control group. On
the TSC-40, the mean difference score of the experi-
mental group was significantly larger (M 29.47,
be calculated. Descriptive and inferential analyses were
carried out through t-test application and effect sizes
were calculated. Three participants from the experi-
mental group (n 13) and 6 participants from the wait-
ing list control group (n 13) dropped out of the study,
and the analyses were conducted on data provided by
17 participants (N 17) who completed the study.
Demographic data was collected through demo-
graphic interview forms. The mean age of the 17 par-
ticipants was 29.4 years; 7 participants were male. The
participants included in the study belonged to diverse
educational and professional backgrounds, and eight
had completed graduate school. There were two
medical doctors, two psychologists one businessman,
two administration managers, two human resource
managers, five students, two unemployed, and one
house wife. Only one participant belonged to a lower
income group. Seven were married, one divorced, and
nine unmarried.
Comparison of Pre- and Post Treatment
Assessment Scores Within the
Experimental Group
Paired t test was conducted on the mean pre- and
post treatment assessment scores of the experimen-
tal group participants (Table 1). Results showed sig-
nificant improvement on all measures. On the BDI-II,
TABLE 1. Pre- and Postassessment Mean Scores
Beck Depression Inventory-II
Control Experimental
Preassessment 30.29 (9.25) 24.90 (4.84)
Postassessment 24.43 (12.38) 3.60 (4.45)
Change scores (post- and preasssessment) 5.86 (10.16) 21.30 (6.88)
Quality of Life Index Inventory
Preassessment 13.05 (2.13) 13.82 (2.02)
Postassessment 13.52 (4.11) 19.90 (2.40)
Change scores (post- and preassessment) 0.46 (2.62) 6.08 (2.85)
Trauma Symptoms Checklist-40
Preassessment 58.00 (4.56) 56.47 (6.77)
Postassessment 51.86 (5.66) 27.00 (7.45)
Change scores (post- and preassessment) 6.14 (19.35) 29.47 (13.01)
Journal of EMDR Practice and Research, Volume 10, Number 2, 2016 65
The Efficacy of EMDR in the Treatment of Depression
Follow-Up Interviews
In the 3-month follow-up interviews with the partici-
pants of experimental group, all participants reported
an improved sense of well-being and stated that they
had not experienced any recurrence of depressive
This study is the first randomized controlled study to
assess the efficacy of EMDR as the primary treatment
for major depressive disorder. The findings of the study
provide preliminary support for EMDR as a primary,
effective, and short-term therapy for major depressive
disorder, with effects maintained at 3-month follow-up.
Ten experimental group participants received six to
eight weekly EMDR treatment sessions. The seven
SD 13.01) than that of control group (M 6.14,
SD 19.35), t(15) –5.076, p .000, with large
treatment effect size, d 1.57. Similarly on QLI, the
experimental group showed a significantly greater im-
provement in quality of life (M 6.08, SD 2.85),
compared to control group (M 0.46, SD 2.62),
t(15) 4.13, p .000, with large effect size, d 2.16
(see Table 1).
Changes in Cognitions
Mostly at the end of fourth session, and beginning
of the fifth session, experimental participants were
asked to rerate the cognitions (not memories) which
they had rated before beginning EMDR treatment
(Table 2). It is apparent that the ratings of cognitions
which were not directly targeted in treatment changed
during treatment, suggesting generalization effects.
TABLE 2. Reduction in Depressogenic Cognition Because of Generalization Effect of EMDR
Level of
on BDI-II at
Number of
Cognitions at
Pretreatment Target Belief
Number of
Number of
Cognitions at
Memories of
Stressful Events
Mr. K Borderline 12 Not okay to
show emotion
8 3 Verbal/physical abuse
unable to defend self
Mrs. F Moderate 17 I am stupid 8 4 Neglect, physical/
sexual abuse, difficult
Miss I Moderate 3 Not good
6 1 Childhood parental
neglect, molestation
Miss Severe 4 I don’t belong 8 1 Childhood parental
neglect, molestation
Miss L Borderline 6 I am not lovable 6 2 Anger issues, critical
parenting, parental
Miss N Moderate 9 I am shameful 7 3 Sexual abuse relationship
Miss S Moderate 8 I am different 8 3 Parental criticism, sexual
Miss Zb Severe 14 I am
8 3 Loss of both parents,
broken relationships
Miss R Severe 10 I am shameful 8 4 Childhood abuse,
broken relationship
Mr. W Moderate 5 I should
have done
6 2 Death of girlfriend in
road accident
Note. BDI-II Beck Depression Inventory-II.
66 Journal of EMDR Practice and Research, Volume 10, Number 2, 2016
EMDR. Participants shared memories of parental ne-
glect, abuses, loss, and broken relationships. Frustaci,
Lanza, Fernandez, di Giannantonio, and Pozzi (2010)
suggested that such disturbing memories can be ef-
fective targets for EMDR processing because the life
events could be related to the onset or recurrence of
depressive episodes.
In our research, it appeared that the first memory
acted as a gateway to other dysfunctional memory
networks and also to associated negative beliefs. When
one memory got processed, another linked memory
would surfaced and would become the target of
EMDR for processing. As the targeted beliefs were
processed and closure was made, in the following ses-
sion, new targeted negative beliefs were identified for
processing. However, participants stated that many
of the other negative beliefs, which they had identi-
fied at the beginning of treatment, no longer felt true
(see Table 2). The shift in the validity of the targeted
cognition seemed to generalize to other untreated
negative cognitions.
Generalization Effects. It seemed that stressful
memories of different events were not only linked
together but they were also contributing to various
negative beliefs and that together, these memories
and beliefs maintained the participants’ depressive
state. Apparently, the treatment effect—with the
transformation of the initial negative cognition and
installation of positive beliefs/cognitions—had a
generalized effect and played a role in the reduction
of the number of negative beliefs and consequently
depressive symptoms. The participants in the experi-
mental group showed marked improvement after the
first desensitization session. The reason might be that
the irritants that caused depression were small-t trau-
mas and not the PTSD Criteria A events.
Observations that EMDR’s positive treatment ef-
fects generalize to untreated memories are frequently
reported. For example, Shapiro (2014) wrote, “Given
that EMDR treatment effects generalize to similar
memories, it is unnecessary to process each disturb-
ing event” (p. 75). In a study by Yurtsever et al. (2014),
participants indicated that the distress of untreated
memory images had decreased after processing a tar-
geted memory with EMDR. Our study may be the
first study to show that this generalization effect ex-
tends also to negative cognitions.
Targeting Memories of Stressful Life Events
EMDR treatment provided in this study targeted
memories of stressful life events (small-t trauma).
control group participants received no treatment for
7 weeks. Results showed that the mean scores of ex-
perimental group (within and between) showed sig-
nificant reduction in the symptoms of depression and
trauma and improved quality of life after EMDR treat-
ment, with effects maintained at 3-month follow-up.
Our results extend the findings of the earlier men-
tioned case studies, and the Hase et al. (2015) and
Hofmann et al. (2014) controlled studies and support
the efficacy of EMDR in the treatment of major de-
pressive disorder. It is noteworthy that remission in
depressive symptoms was achieved after six to eight
EMDR sessions. Although the Hofmann et al. (2014)
study provided a mean of 6.9 EMDR sessions, in that
study, EMDR therapy was adjunctive and participants
received treatment as usual for a mean total of 44.5
treatment sessions.
Changes in Negative Cognitions
According to Beck (1979), depression is the result
of faulty cognition about the self, the world, and
the future. Ehlers and Clark (2000) observed that
traumatic memories produce a certain belief about
the faultiness of “the self ” in relation to the traumatic
incidence(s). The AIP model (Solomon & Shapiro,
2008) postulates that memories of stressful events
are dysfunctionally stored, and these dysfunctionally
stored traumatic experiences leads to psychological
illness. Thus, we assumed that traumatic experiences
and their dysfunctionally stored memories lead to
faulty cognitions which cloud perceptual windows
and that depressive illness is experienced as a result.
We hypothesized that if negative beliefs could be
worked on (through processing the memories of the
contributing events) and be replaced by positive be-
liefs, there would be relief from symptoms. EMDR’s
AIP model posits that resolving memories of stressful
events (Shapiro, 2001) will provide relief from emo-
tional trauma (Shapiro & Maxfield, 2002). Hence,
the target for EMDR in this study was the negative
belief system that seemed to have been acquired and
maintained through experiencing small-t traumas and
which was related to depression.
During the assessment phase, the participants in
the experimental group identified several negative
beliefs (see Table 2). They were asked to rank those
beliefs according to severity from most to least. They
then selected one belief that they wanted to process at
the onset. The participants were then asked to focus
on the selected negative belief and identify any associ-
ated memory that came up for them. In case of several
memories, they were asked to choose one as target for
Journal of EMDR Practice and Research, Volume 10, Number 2, 2016 67
The Efficacy of EMDR in the Treatment of Depression
also investigate the use of EMDR in treating small-t
traumatic experiences producing depression in chil-
dren, adolescent, and older populations.
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We considered that these experiences may have
played a major role in the triggering and maintenance
of depression. Research support for this position is
found in the Risch et al. (2009) study that reported a
significant association between major depression and
small-t traumas. Similarly, Kendler et al. (2003) stated
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Treatment Tolerance. EMDR treatment was gen-
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(Hofmann et al., 2014; see Table 2).
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inventories after only six to eight sessions. Despite the
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trolled trial that used EMDR as the primary treatment
for major depressive disorder. In other controlled
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antidepressants (e.g., Hase et al., 2015). Observing the
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pothesized that EMDR could perhaps provide relief
from depression in less time compared to other treat-
ments. We also documented a large decrease in nega-
tive cognitions, with a generalization effect reducing
the number of untreated negative cognitions.
The modified EMDR protocol used in this study
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is recommended that future studies investigate its
effectiveness in treating affect disorders or other psy-
chological disorders in which the symptoms can be
related to stressful life events. Future research could
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... Studies investigating EMDR therapy as an adjacent therapy to CBT [27], to pharmacological treatment [28,29] and to inpatient treatment [30,31] obtained promising results. As a stand-alone treatment, EMDR was proven effective in reducing depressive symptoms [32], even for patients with long-term [33] or treatment-resistant depressive disorder [29]. Moreover, significant decreases of trauma [32] and anxiety symptoms [29] were obtained with EMDR treatment of MDD, as well as increases of social functioning [29] and quality of life [32]. ...
... As a stand-alone treatment, EMDR was proven effective in reducing depressive symptoms [32], even for patients with long-term [33] or treatment-resistant depressive disorder [29]. Moreover, significant decreases of trauma [32] and anxiety symptoms [29] were obtained with EMDR treatment of MDD, as well as increases of social functioning [29] and quality of life [32]. ...
... As a stand-alone treatment, EMDR was proven effective in reducing depressive symptoms [32], even for patients with long-term [33] or treatment-resistant depressive disorder [29]. Moreover, significant decreases of trauma [32] and anxiety symptoms [29] were obtained with EMDR treatment of MDD, as well as increases of social functioning [29] and quality of life [32]. ...
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Background Major depressive disorder (MDD) is one of the most common mental disorders in adolescence carrying a serious risk of adverse development later in life. Extant treatments are limited in effectiveness and have high drop-out and relapse rates. A body of literature has been published on the association between distressing/ traumatic experiences and development and maintenance of MDD, but the effectiveness of a trauma-focused treatment approach for MDD has hardly been studied. This study aims to determine the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy as stand-alone intervention in adolescents diagnosed with MDD. Methods This study will be a randomized controlled trial with two conditions: (1) EMDR treatment (6 sessions) and (2) waiting list condition (WL: 6 weeks, followed by EMDR treatment). First, participants receive a baseline measure after which they will be randomized. Participants will be assessed post-intervention after which the WL participants will also receive six EMDR sessions. Follow-up assessments will be conducted at 3 and 6 months follow-up. Study population: In total, 64 adolescents (aged 12–18) diagnosed with a major depressive disorder (DSM-5) and identified memories of at least one distressing or traumatic event related to the depressive symptomatology will be included. Main study parameters/endpoints: Primary outcome variables will be the percentage of patients meeting criteria for MDD classification, and level of depressive symptoms. Secondary outcome measures include symptoms of PTSD, anxiety, and general social-emotional problems. At baseline, family functioning and having experienced emotional abuse or neglect will be assessed to explore whether these factors predict post-treatment outcome. Discussion With the present study, we aim to investigate whether EMDR as a trauma-focussed brief intervention may be effective for adolescents with a primary diagnosis of MDD. EMDR has been proven an effective treatment for traumatic memories in other disorders. It is hypothesized that traumatic memories play a role in the onset and maintenance of depressive disorders. Particularly in adolescence, early treatment of these traumatic memories is warranted to prevent a more chronic or recurrent course of the disorder. Trial registration International Clinical Trial Registry Platform (ICTRP): NL9008 (30–10-2020).
... Sharpley et al. (1996) found EMDR therapy reduced the intensity of memory-based traumatic images by 32% over other relaxation methods. Gauhar (2016) found just six to eight sessions of EMDR therapy significantly improved depressive symptoms and quality of life while decreasing trauma symptoms. The powerful treatment effects of EMDR therapy seem promising for athletes suffering from athletic traumas and may be an option for golfers suffering from performance disruptions and anxiety related to difficulty recovering from athletic traumas. ...
This article discusses the possible benefit of using eye movement desensitization and reprocessing (EMDR) therapy in treating competitive state anxiety in two female golfers. Golfers may encounter adverse events during performances, which trigger performance blocks, anxiety, and negative symptomology. Adverse events, or small-t traumas referred to as “athletic traumas” in this study, occurring during performances and processed maladaptively can be associated with increased levels of anxiety in addition to negative symptomology. This research utilized a qualitative method, a case study design, to evaluate if EMDR therapy was beneficial in reducing anxiety related to athletic traumas in two professional golfers. The participants received an EMDR-based intervention related to a designated athletic trauma and self-recorded anxiety levels using the competitive-state anxiety inventory. A key theme noted was the reduction of anxiety levels and subjective units of distress associated with the athletic traumas after the EMDR-based intervention. The result of the study suggests EMDR therapy as an intervention for golfers seeking relief from anxiety related to athletic traumas. Implications of this research provide clinicians with an additional intervention tool when working with athlete populations.
... In traditional EMDR, patients follow the horizontal movement of the therapist's index finger while recalling details of the traumatic memory [20]. The attention devoted to finger movement during recall has been proposed to reduce the intensity and intrusiveness of memory disturbance [20][21][22][23][24]. EMDR is now widely supported as a treatment for PTSD and is being tested for other mental health conditions (eg, generalized anxiety disorders, addiction, and depression) [25,26]. ...
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Background: Exposures to "traumatic" events are widespread and can cause posttraumatic stress disorder (PTSD). Cognitive behavioral therapy and eye movement desensitization and reprocessing (EMDR) are frequently used and validated behavioral PTSD treatments. Despite demonstrated effectiveness, highly upsetting memory reactions can be evoked, resulting in extensive distress and, sometimes, treatment dropout. In recent years, multiple treatment approaches have aimed at reducing such upsetting memory reactions to traumatic memories while therapeutic progress proceeds. One of these methods, the flash technique (FT), a modification of standard EMDR (S-EMDR), appears effective in distressing memory reduction. This study will examine FT-EMDR and S-EMDR efficacies when both methods are delivered via web-based video. Objective: This study aims to assess the relative efficacy of (web-based) FT-EMDR versus S-EMDR in reducing the PTSD symptoms, anxieties, and depression associated with traumatic memories at postintervention and 1-month follow-up. Methods: This double-blinded, web-based, 2-arm randomized controlled trial will employ self-report outcomes. A total of 90 participants will be identified from the web-based CloudResearch platform and randomly allocated to the experimental or comparison group. Inclusion criteria are as follows: (1) approved for engagement by the CloudResearch platform; (2) 25-60 years of age; (3) residing in Canada or the United States; (4) a recalled disturbing memory of an event >2 years ago that has not repeated and was moderately or more upsetting during occurrence; (5) memory moderately or more upsetting at baseline and not linked to an earlier memory that is equally or more than equally disturbing. Exclusion criteria are bipolar disorder, borderline personality disorder, obsessive-compulsive disorder, schizophrenia, substance abuse or addiction in the past 3 months, suicidal ideation, and suicide attempt in the past 6 months. Interventions include guided video instruction of full FT or guided video of EMDR. Outcome measures are as follows: Primary outcome is PTSD symptoms that are measured by the PTSD Checklist for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders-5) at 1-month follow-up. Secondary outcomes are State Anxiety subscale of State-Trait Anxiety Inventory at baseline, postintervention, and 1-month follow-up; Trait Anxiety subscale of State-Trait Anxiety Inventory; depression (Patient Health Questionnaire-9); and Positive and Negative Affect Schedule measured at 1-month follow-up. Results: If, at 1-month follow-up, the web-based FT-EMDR intervention is more effective in reducing PTSD symptoms (as measured by the PTSD Checklist for DSM-5) than EMDR, it may help reduce traumatic memory distress in multiple contexts. Conclusions: This randomized controlled trial will advance current understandings of PTSD symptoms and interventions that target traumatic memory-related distress. Trial registration: NCT05262127;
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La thérapie de désensibilisation et de retraitement par les mouvements oculaires (EMDR) est considérée comme un traitement fondé sur des données probantes pour le traitement du trouble stress post-traumatique (TSPT) chez l’adulte, mais il y a des différences dans la façon dont les diverses directives internationales de traitement jugent la solidité de cette base de preuves. En outre, dans des domaines autres que le TSPT de l’adulte, les principales lignes directrices diffèrent encore davantage quant à la solidité de ces preuves et quant au moment où on utilisera l’EMDR. En 2019 a été lancée la Commission de chercheurs sur l’avenir de la thérapie EMDR ( Council of Scholars : The Future of EMDR Therapy Project ). Plusieurs groupes de travail ont été créés dans cette commission, l’un d’entre eux étant centré sur la recherche. Le présent article a été produit par ce groupe de travail. Le groupe a tout d’abord conclu qu’il y avait cinq domaines pour lesquels il existait une certaine base factuelle indiquant que l’EMDR était efficace, mais que davantage de données étaient nécessaires pour augmenter la probabilité qu’elle soit prise en compte dans les futures directives internationales de traitement. Ces domaines couvraient le TSPT chez les enfants et les adolescents, les interventions EMDR précoces, les TSPT liés aux conflits armés, la dépression unipolaire et la douleur chronique. Les recherches portant sur le rapport coût-efficacité de la thérapie EMDR ont été en outre identifiées comme l’une des priorités à aborder. Nous avons employé un système de hiérarchisation pour classer et évaluer les preuves dans les différents domaines abordés. Après avoir évalué les 120 études de résultats relatives à ces domaines, nous concluons ici que pour deux d’entre eux (le TSPT chez l’enfant et l’adolescent, et les recherches portant sur les interventions EMDR précoces), la force des preuves est évaluée au niveau le plus élevé, tandis que les autres domaines obtiennent le deuxième niveau le plus élevé. Nous formulons également quelques recommandations générales pour améliorer la qualité des futures recherches sur l’efficacité de la thérapie EMDR.
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Eye Movement Desensitisation and Reprocessing (EMDR) therapy is considered a gold standard treatment for post-traumatic stress disorder and other mental health conditions underpinned by trauma exposure. Despite EMDR’s evidence-base it remains under prescribed. This systematic review examined clinician perceptions of, and experiences with, EMDR to elucidate the reasons for under prescription. A systematic search of PsycInfo, PsychArticles, Psychology Database, Medline, PubMed, CINAHL, Scopus, and Google Scholar was conducted to identify literature on clinician perceptions of, attitudes towards, and prescription behaviours for, EMDR therapy. Seven studies met criteria for inclusion, however following initial quality appraisal only five were retained. Collectively the quality of the research appeared to be of low-moderate standard. The participant samples were varied across mental health disciplines with the majority of clinicians practicing in the USA. Qualitative, quantitative, and mixed approaches were used. Themes highlighted pragmatic obstacles to EMDR prescription including knowledge limitations, training access issues, and minimal post-training support. Additional themes suggested clinicians are hesitant to train in new modalities and that EMDR clinicians may be exposed to workplace bullying and harassment. EMDR under prescription will need to be addressed using a combination of increased resources and education at the individual and workplace/discipline levels.
Objective: Methods: To investigate the therapeutic benets of EMDR psychotherapy in treating MDD associated with PTSD. A pilot study was performed by using standardized EMDR psychotherapy in subjects with MDD associated with PTSD. The inclusion criteria were the followings; (1) Adults aged 18 years old or older, (2) Subjects being treated with antidepressants for at least two months assumably stable blood levels, (3) Subjects with depressive symptoms based upon the Patient Health Questionnaire (PHQ-9) depressive scale, (4) Subjects with positive score for traumatic events based upon the Children's Revised Impact of Events Scale-13 (CERIES-13, Thai version). The subjects were eligible if they fullled all four criterias. The subjects were treated with 60-90 minutes of EMDR psychotherapy twice a week for three weeks. The changes in PHQ-9 depressive scale, CERIES-13 scale, and Rosenberg self-esteem scale were obtained before the treatment, at the end of the treatment, and 3 months after treatment. The collective data was analyzed with a Paired t-test. Eighteen subjects with a mean age of 28 years were enrolled Results: in the study. The subjects had signicantly decreased PHQ-9 scale and CERIES-13 scale (mean difference [MD] = -11.47, p<0.001; MD = - 36.47, p<0.001, respectively), and had signicantly increased self-esteem scale (MD = 9.13, p<0.001) at 3 months after treatment when compared to prior results. The study demonstrated the therapeutic benets of adding EMDR psychothera Conclusion: py in MDD associated with PTSD patients who were currently treated with antidepressants. The benets of adding EMDR psychotherapy may possibly reduce depressive symptoms, PTSD symptoms and improve self-esteem in subjects. Further evaluation of the effectiveness of EMDR psychotherapy is in a guaranteed randomized controlled trial method
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To consolidate the research, knowledge and evidence on the impact of COVID-19 on key areas of mental health and emotional wellbeing and the likelihood of new inceptions of mental illness; the recommendations for ameliorating these i.e. prevention, early intervention and recovery and priorities for further research. This paper is a rolling review and a guide to planning and decision making agreed by the Mental Health and Emotional Wellbeing Surge Cell which was convened by the Health and Social Care Board in order to provide evidence to the Department of Health Northern Ireland.
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Dissociation is a lack of the normal integration of thoughts, feelings, and experiences into the stream of consciousness and memory. Dissociation occurs to some degree in normal individuals and is thought to be more prevalent in persons with major mental illnesses. The Dissociative Experiences Scale (DES) has been developed to offer a means of reliably measuring dissociation in normal and clinical populations. Scale items were developed using clinical data and interviews, scales involving memory loss, and consultations with experts in dissociation. Pilot testing was performed to refine the wording and format of the scale. The scale is a 28-item self-report questionnaire. Subjects were asked to make slashes on 100-mm lines to indicate where they fall on a continuum for each question. In addition, demographic information (age, sex, occupation, and level of education) was collected so that the connection between these variables and scale scores could be examined. The mean of all item scores ranges from 0 to 100 and is called the DES score. The scale was administered to between 10 and 39 subjects in each of the following populations: normal adults, late adolescent college students, and persons suffering from alcoholism, agoraphobia, phobic-anxious disorders, posttraumatic stress disorder, schizophrenia, and multiple personality disorder. Reliability testing of the scale showed that the scale had good test-retest and good split-half reliability. Item-scale score correlations were all significant, indicating good internal consistency and construct validity. A Kruskal-Wallis test. and post hoc comparisons of the scores of the eight populations provided evidence of the scale's criterion-referenced validity. The scale was able to distinguish between subjects with a dissociative disorder (multiple personality) and all other subjects.
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Posttraumatic stress disorder (PTSD) is a common reaction to traumatic events. Many people recover in the ensuing months, but in a significant subgroup the symptoms persist, often for years. A cognitive model of persistence of PTSD is proposed. It is suggested that PTSD becomes persistent when individuals process the trauma in a way that leads to a sense of serious, current threat. The sense of threat arises as a consequence of: (1) excessively negative appraisals of the trauma and/or ist sequelae and (2) a disturbance of autobiographical memory characterised by poor elaboration and contextualisation, strong associative memory and strong perceptual priming. Change in the negative appraisals and the trauma memory are prevented by a series of problematic behavioural and cognitive strategies. The model is consistent with the main clinical features of PTSD, helps explain several apparently puzzling phenomena and provides a framework for treatment by identifying three key targets for change. Recent studies provided preliminary support for several aspects of the model.
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Background Depression is a severe mental disorder that challenges mental health systems worldwide as the success rates of all established treatments are limited. Eye Movement Desensitization and Reprocessing (EMDR) therapy is a scientifically acknowledged psychotherapeutic treatment for PTSD. Given the recent research indicating that trauma and other adverse life experiences can be the basis of depression, the aim of this study was to determine the effectiveness of EMDR therapy with this disorder.Method In this study, we recruited a group of 16 patients with depressive episodes in an inpatient setting. These 16 patients were treated with EMDR therapy by reprocessing of memories related to stressful life events in addition to treatment as usual (TAU). They were compared to a group of 16 controls matched regarding diagnosis, degree of depression, sex, age and time of admission to hospital, which were receiving TAU only.ResultsSixty-eight percent of the patients in the EMDR group showed full remission at end of treatment. The EMDR group showed a greater reduction in depressive symptoms as measured by the SCL-90-R depression subscale. This difference was significant even when adjusted for duration of treatment. In a follow-up period of more than 1 year the EMDR group reported less problems related to depression and less relapses than the control group.ConclusionsEMDR therapy shows promise as an effective treatment for depressive disorders. Larger controlled studies are necessary to replicate our findings.
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Depression is a severe mental disorder that challenges mental health systems worldwide. About 30% of treated patients do not experience a full remission after treatment, and more than 75% of patients suffer from recurrent depressive episodes. Although psychotherapy and medication can improve remission rates, the success rates of current treatments are limited. In this nonrandomized controlled exploratory study, 21 patients with unipolar primary depression were treated with a mean of 44.5 sessions of Cognitive Behavioural Therapy (CBT) including an average 6.9 adjunctive sessions of Eye Movement Desensitization and Reprocessing (EMDR). A control group (n = 21) was treated with an average of 47.1 sessions of CBT sessions alone. The main outcome measure was the Beck Depression Inventory II (BDI-II). The treatment groups did not differ in their BDI-II scores before treatment, and both treatments resulted in significant improvement. There was an additional benefit for patients treated with adjunctive EMDR (p = .029). Also the number of remissions at posttreatment, as measured by a symptom level below a BDI-II score of 12, was significantly better in the adjunctive EMDR group, the group showing more remissions (n = 18) than the control group ( n = 8; p < .001). This potential effect of EMDR in patients with primary depression should be examined further in larger randomized controlled studies.
Depression is one of the most common psychiatric disorders. Postpartum depression affects about 9% of women who give birth. Despite significant advances in research and in pharmacotherapy and psychotherapy, depressive disorders remain difficult to treat. The application of eye movement desensitization and reprocessing (EMDR) therapy to depression has lagged behind its applications to trauma-related and anxiety disorders. I present 2 cases of postpartum depression successfully treated with a combined therapy, where EMDR is integrated into a novel therapeutic framework developed specifically for depressive disorders and based on evolutionary theory of depression, treating depression downhill (TDD). In the integrated TDD-EMDR therapy, I have made adjustments to the standard EMDR protocol such that the choice and nature of targets, the cognitive frame, and the objective for change in affect are determined by TDD framework. The described cases demonstrate the treatment process, including the modifications made to the standard EMDR procedures, and the treatment's outcome. I identify and discuss the differences between theories of EMDR and TDD.
A meta-analysis examining temporal changes (time trends) in the effects of cognitive behavioral therapy (CBT) as a treatment for unipolar depression was conducted. A comprehensive search of psychotherapy trials yielded 70 eligible studies from 1977 to 2014. Effect sizes (ES) were quantified as Hedge's g based on the Beck Depression Inventory (BDI) and the Hamilton Rating Scale for Depression (HRSD). Rates of remission were also registered. The publication year of each study was examined as a linear metaregression predictor of ES, and as part of a 2-way interaction with other moderators (Year × Moderator). The average ES of the BDI was 1.58 (95% CI [1.43, 1.74]), and 1.69 for the HRSD (95% CI [1.48, 1.89]). Subgroup analyses revealed that women profited more from therapy than did men (p < .05). Experienced psychologists (g = 1.55) achieved better results (p < .01) than less experienced student therapists (g = 0.98). The metaregressions examining the temporal trends indicated that the effects of CBT have declined linearly and steadily since its introduction, as measured by patients' self-reports (the BDI, p < .001), clinicians' ratings (the HRSD, p < .01) and rates of remission (p < .01). Subgroup analyses confirmed that the declining trend was present in both within-group (pre/post) designs (p < .01) and controlled trial designs (p = .02). Thus, modern CBT clinical trials seemingly provided less relief from depressive symptoms as compared with the seminal trials. Potential causes and possible implications for future studies are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
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Background: A substantial body of research shows that adverse life experiences contribute to both psychological and biomedical pathology. Eye movement desensitization and reprocessing (EMDR) therapy is an empirically validated treatment for trauma, including such negative life experiences as commonly present in medical practice. The positive therapeutic outcomes rapidly achieved without homework or detailed description of the disturbing event offer the medical community an efficient treatment approach with a wide range of applications. Methods: All randomized studies and significant clinical reports related to EMDR therapy for treating the experiential basis of both psychological and somatic disorders are reviewed. Also reviewed are the recent studies evaluating the eye movement component of the therapy, which has been posited to contribute to the rapid improvement attributable to EMDR treatment. Results: Twenty-four randomized controlled trials support the positive effects of EMDR therapy in the treatment of emotional trauma and other adverse life experiences relevant to clinical practice. Seven of 10 studies reported EMDR therapy to be more rapid and/or more effective than trauma-focused cognitive behavioral therapy. Twelve randomized studies of the eye movement component noted rapid decreases in negative emotions and/or vividness of disturbing images, with an additional 8 reporting a variety of other memory effects. Numerous other evaluations document that EMDR therapy provides relief from a variety of somatic complaints. Conclusion: EMDR therapy provides physicians and other clinicians with an efficient approach to address psychological and physiologic symptoms stemming from adverse life experiences. Clinicians should therefore evaluate patients for experiential contributors to clinical manifestations.
Introduction. - Treatment of choice for post-traumatic stress disorder (PTSD) is either eye movement desensitization and reprocessing (EMDR) or trauma-focused cognitive behaviour therapy (TFCBT). Objective. - The aim of the present meta-analysis was to determine whether there are any differences between these two treatments with respect to efficacy and efficiency in treating PTSD. Method. - We performed a comprehensive literature search using several electronic search engines as well as manual searches of other review papers. Eight original studies involving 227 participants were identified in this manner. Results. - There were no differences between EMDR and TFCBT on measures of PTSD. However, there was a significant advantage for EMDR over TFCBT in reducing depression (Hedge's g = 0.63). The analysis also indicated a difference in the prescribed homework between the treatments. Meta-regression analyses were conducted to examine the relationship between hours of homework and gains in depression and PTSD symptoms. Conclusion. - These findings are discussed in terms of efficacy and cost-effectiveness and the use of homework in therapy.