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The Status of EMDR Therapy in the Treatment of Posttraumatic Stress Disorder 30 Years After Its Introduction


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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.
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The Status of EMDR Therapy in the Treatment of
Posttraumatic Stress Disorder 30 Years After Its Introduction
Ad de Jongh
University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
Salford University, Manchester, United Kingdom
University of Worcester, Worcester, United Kingdom
Queen’s University, Belfast, Northern Ireland
Benedikt L. Amann
Institut de Neuropsiquiatria i Addiccions (INAD), Barcelona, Spain
Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
Autonomous University of Barcelona, CIBERSAM, Spain
Arne Hofmann
EMDR-Institute Germany, Wesseling, Germany
Derek Farrell
University of Worcester, Worcester, United Kingdom
Christopher W. Lee
Murdoch University, Perth, Australia
University of Western Australia, Perth, Australia
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
rst-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 ef-
cient and cost-effective. There is emerging evidence showing that EMDR treatment of patients with psy-
chiatric disorders, such as psychosis, in which PTSD is comorbid, is also safe, effective, and efcacious.
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.
Keywords: posttraumatic stress disorder (PTSD); eye movement desensitizing and reprocessing (EMDR)
therapy; randomized controlled trials; efcacy
Eye movement desensitization and reprocess-
ing (EMDR) therapy was introduced in 1989
as a treatment for symptoms of posttraumatic
stress disorder (PTSD) with the rst randomized
controlled trial (RCT), conducted by its developer,
Francine Shapiro (1989). In the following 30 years,
Journal of EMDR Practice and Research, Volume 13, Number 4, 2019 261
© 2019 EMDR International Association
EMDR therapy has not only developed into a mature
therapeutic procedure, but much research has been
conducted regarding its ecacy, mainly involving the
treatment of PTSD. This article aims to address the
question as to what we can say, 30 years after its
introduction, about the current international status
of EMDR therapy when it comes to the treatment
of PTSD. This question will be answered by review-
ing the empirical basis of EMDR therapy regarding
the treatment of PTSD in adults, children, and ado-
lescents, by providing a brief narrative overview of
the available evidence and the current recommenda-
tions of the most important international treatment
The Status of EMDR With Regard to PTSD
in Adults
Since Shapiro’s rst study in 1989, more than 30
RCTs have been published in which adult patients
with PTSD were randomly assigned to EMDR therapy
and one or more comparators. Studies where PTSD
was the primary diagnosis have compared individ-
ual EMDR therapy to a wait-list condition (Acarturk
et al., 2016; Högberg et al., 2007; Jensen, 1994; Marcus,
Marquis, & Sakai, 1997; Rothbaum, 1997; Van den
Berg et al., 2015, 2018) and a wide variety of active
comparison conditions, including relaxation training,
with/without biofeedback (e.g., Carletto et al., 2016;
Carlson, Chemtob, Rusnak, Hedlund, & Muraoka,
1998); imaginary rescripting (Alliger-Horn, Zimmer-
mann, & Mitte, 2015); counting method (Johnson &
Lubin, 2006); stabilization (Ter Heide, Mooren, Van
de Schoot, De Jongh, & Kleber, 2016), and phar-
macotherapy such as uoxetine (Van der Kolk et al.,
2007) and sertraline (Arnone, Orrico, D’Aquino, & Di
Munzio, 2012). There is also one study that explored
EMDR therapy delivered in a group format for partic-
ipants diagnosed with PTSD (Yurtsever et al., 2018).
In almost all EMDR RCTs on PTSD patients, partici-
pants were civilians, whereas types of trauma (i.e., cri-
terion A experiences) varied widely and ranged from
sexual assault to accidents to life-threatening health
Regarding the eectiveness, the studies that investi-
gated EMDR treatment of PTSD reported signicant
decreases in PTSD symptoms, with reported reduc-
tions in PTSD diagnosis, ranging from 36% (Devilly
& Spence, 1999) to 94%–95% (Capezzani et al., 2013;
Nijdam, Gersons, Reitsma, De Jongh, & Ol, 2012).
The same holds true for individuals who had addi-
tional other diagnoses besides their PTSD (e.g., Van
den Berg et al., 2015). To this end, there is emerging
evidence that also in cases of severe psychiatric disor-
ders, such as psychosis, in which PTSD is comorbid,
EMDR therapy is capable of producing stable long-
term eects and large eect sizes, with good tolerabil-
ity and results comparable to traumatized individuals
without comorbidity (Van den Berg et al., 2015, 2018).
Comparison of EMDR Therapy With Cognitive
Behavioral Therapy
In 13 RCTs EMDR therapy was compared to cogni-
tivebehavioral therapy(CBT), which,according tothe
World Health Organization (WHO, 2013), is another
rst-choice treatment for PTSD. See Table 1. In these
studies the active treatment was sometimes general
CBT and sometimes trauma-focused CBT (TF-CBT),
which included prolonged imaginal exposure with or
without in vivo exposure (see Table 1). Participants in
these trials comprised 758 individuals with ocially
diagnosed (i.e., according to Diagnostic and Statistical
Manual of Mental Disorders [DSM] or International Clas-
sication of Diseases [ICD] criteria) PTSD, and 298 of
them received EMDR t herapy. In 5 out of the 13 stud-
ies that compared EMDR with a variant of TF-CBT,
no dierence in eectiveness between EMDR ther-
apy and TF-CBT could be detected (Johnson & Lubin,
2006; Laugharne et al., 2016; Nijdam et al., 2012; Roth-
baum, Astin, & Marsteller, 2005; Van den Berg et al.,
2015). However, two studies found that TF-CBT was
signicantly more eective than EMDR therapy (Dev-
illy & Spence, 1999; Taylor et al., 2003), while six
studies found EMDR to be more eective than CBT
(Capezzani et al., 2013; Ironson, Freund, Strauss, &
Williams, 2002; Lee, Gavriel, Drummond, Richards,
& Greenwald, 2002; Power et al., 2002; Rogers et al.,
1999; Vaughan et al., 1994).
The variety in study outcome is also reected in
the meta-analyses that have been conducted. Most
meta-analyses did not show dierences in eective-
ness between TF-CBT and EMDR for PTSD symp-
toms (e.g., Bisson et al., 2013; Ehring, Morina,
Wicherts, Freitag, & Emmelkamp, 2014, Gerger
et al., 2014; Ho & Lee, 2012), albeit there were some
exceptions (Chen, Zhang, Hu, & Liang, 2015; Khan
et al., 2018). The Chen et al. (2015) meta-analysis
included 11 studies (N= 424) and found that EMDR
therapy was slightly superior to CBT. With regard
to PTSD symptoms, the results suggest that EMDR
might be better for intrusions and arousal severity
(but not for avoidance) compared to TF-CBT. Khan et
al. (2018) had slightly dierent inclusion criteria but
also ended up with 11 studies (n= 547) and revealed
that patients benet more from EMDR therapy than
262 Journal of EMDR Practice and Research, Volume 13, Number 4, 2019
Jongh et al.
TABLE 1. Overview of Controlled EMDR Studies on PTSD in A dults of Which the Results Were Compared to
Those of Trauma-Focused Cognitive Behavioral Therapy
Condition) Treatment
Number of
Treatment Sessions Main Result
Loss of
Vaughan et al.
36 (12) • EMDR
• R
• W
4 EMDR = IHT = R > W
(regarding intrusions)
Devilly and Spence
23 (11) • EMDR
9 EMDR < TTP also at
3-month follow-up
Rogers et al.
12 (6) • EMDR
(regarding intrusions)
Not reported
Ironson et al.
22 (10) • EMDR
4 EMDR > PE also at
3-month follow-up
Not reported
Lee et al.
23 (10) • EMDR
(regarding intrusions)
also at 3-month
Power et al.
105 (27) • EMDR
4.2 6.4 EMDR = PE+CR also
at 15-month follow-up
Not reported
Taylor et al.
60 (15) • EMDR
8 EMDR = PE = R
(regarding avoidance
and re-experiencing)
Rothbaum et al.
74 (20) • EMDR
• W
9 EMDR = PE > W 75
Johnson and Lubin
27 (9) • EMDR
• W
EMDR = PE = CM Not reported
Nijdam et al.
140 (70) • EMDR
EMDR more ecient
Capezzani et al.
21 (21) • EMDR
• CBT 8 EMDR > CBT 95
Journal of EMDR Practice and Research, Volume 13, Number 4, 2019 263
The Status of EMDR Therapy in the Treatment
TABLE 1. Overview of Controlled EMDR Studies on PTSD in A dults of Which the Results Were Compared to
Those of Trauma-Focused Cognitive Behavioral Therapy (Continued)
Condition) Treatment
Number of
Treatment Sessions Main Result
Loss of
Van den Berg et al.
155 (55) • EMDR
8 EMDR = PE > TAU 60
Laugharne et al.
20 (10) • EMDR
• 12
EMDR = PE Not reported
Note. BEP = brief eclectic psychotherapy; CBT = cognitive behavioral therapy; CM = counting method; CR = cognitive restructuring;
IHT = image habituation training; PE = prolonged exposure; R = relaxation; TTP = trauma treatment protocol;
SIT = stress inoculation training; TAU = treatment as usual; W = waiting list; > indicates “signicantly superior to”; < indicates
“signicantly inferior to.”
aBased upon clinical interview.
from CBT when the reduction of the three primary
symptom clusters of PTSD is concerned. However,
3 months follow-up analysis on four of these stud-
ies (n= 186) showed that this dierential eect was
no longer signicant. In addition, the meta-analysis of
Ho and Lee (2012) evaluated six studies that also inves-
tigated depression outcomes and found a large eect
size, suggesting that EMDR therapy may be more
advantageous for PTSD patients in case of comorbid .
While a number of meta-analyses have been pub-
lished that report large eect sizes, both with regard
to the eectiveness of EMDR therapy itself and the
ecacy of EMDR in comparison with other thera-
pies, it should be noted that some studies suered
from poor methodology. In their 2002 analysis, Max-
eld and Hyer (2002) identied lack of treatment
delity (e.g., Jensen, 1994), non-blinding of asses-
sors (e.g., Lee et al., 2002), and inadequate randomi-
sation processes (e.g., Devilly & Spence, 1999) as
common decits in the EMDR literature. Such
methodological issues reduce the condence in the
robustness of the scientic support for EMDR and
have impacted the recommendations made by some
treatment guidelines. For example, American Psy-
chological Association (APA, 2017) was less positive
in their recommendations regarding EMDR therapy,
stating “There is low strengthof evidence of a medium
to large magnitude benet for the critical outcome of
PTSD symptom reduction,” APA, 2017, p. 42. (See also
Dominguez & Lee, 2017, 2019)
The Status of EMDR With Regard to PTSD in
Children and Adolescents
The ecacy of EMDR therapy has also been stud-
ied in children and adolescents. A number of RCTs
have been conducted with children and adolescents
with trauma-associated symptoms, showing signi-
cant reductions in presenting problems. Details can
be seen in recent reviews (Barron, Bourgaize, Lem-
pertz, Swinden, & Smith, 2019; Beer, 2018) and a
meta-analysis (Moreno-Alcazar et al., 2017). Only four
RCTs (n= 216 in total) have been conducted with
EMDR (n= 145) and one or more control conditions
(three used a wait-list control condition) for children
and adolescents that were formally diagnosed with
PTSD (Ahmad, Larsson, & Sundelin-Wahlsten, 2007;
Chemtob, Nakashima, & Carlson, 2002; De Roos
et al., 2017; Diehle, Opmeer, Boer, Mannarino, & Lin-
dauer, 2015; see Table 2). The results of these four
studies suggest that EMDR therapy is superior to
wait-list control conditions, at least equally eective
in reducing PTSD symptoms compared to TF-CBT
(see also De Roos, Rommelse, Knipschild, Bicanic, &
De Jongh, 2019), while one study found EMDR ther-
apy to be more ecient (De Roos et al., 2017; see
“Discussion” section). A large proportion, ranging
from 45% (Diehle et al., 2015) to 93% (De Roos et
al., 2017), did not fulll the diagnostic criteria imme-
diately following treatment.
Of note is that the quality of these studies on
EMDR pertaining to PTSD in children and adolescents
264 Journal of EMDR Practice and Research, Volume 13, Number 4, 2019
Jongh et al.
show some limitations. For example, half of the stud-
ies presented in Table 2 lacked follow-up assessments
(Ahmad et al., 2007; Diehle et al., 2015), and only half
of the studies reported on loss of PTSD diagnoses.
Therefore, while the existing research shows promise,
these methodological problems, and the small num-
ber of studies on the eectiveness of EMDR regarding
children with PTSD, limit the condence that can be
placed in making strong statements. As discussed in
the next section, these issues also explain why some
published guidelines have been circumspect so far on
the ecacy of EMDR in this target group.
EMDR Therapy and the Treatment Guidelines
As highlighted earlier, WHO recommended EMDR
therapy—in addition to TF-CBT—as a rst-choice
treatment for PTSD (WHO, 2013). The recent guide-
lines released by the US Department of Veterans
Aairs in collaboration of the Department of Defense
(Department of Veterans Aairs and the Depart-
ment of Defense, 2017) and the International Soci-
ety of Traumatic Stress Studies (ISTSS Guidelines
Committee, 2018) recommend EMDR therapy along
with a series of variants of CBT therapy, particularly
prolonged exposure (i.e., imagery and in vivo) as
rst-line treatments for PTSD, for both adults and
children. In contrast, the new treatment guideline
of the APA (2017) gave EMDR therapy a condi-
tional recommendation and a lower rating than
CBT (see Table 3). Although the National Insti-
tute for Health Care and Care Excellence (NICE,
2018) recommended EMDR therapy for adults after
3 months post-trauma, they placed restrictions on its
use with children and adolescents with early trauma,
and for those with combat-related trauma. They
stated, “The evidence suggested EMDR was not eec-
tive in people with military combat-related trauma,
and this is in contrast to all other included trauma
types for which benets were observed” (NICE,
Table 1 shows the 13 studies that compared EMDR
to CBT in treating adults with an ocially established
PTSD diagnosis, while Table 2 shows the four studies
that compared EMDR to CBT in treating children. Of
the 13 adult studies, 9 were included in the guidelines
published by the WHO (2013), 2 in the APA (2017),
7 in NICE (2018), and 12 in the ISTSS (2018) treatment
TABLE 2. Overview of RCTs (Any Control Condition) on EMDR for PTSD in Children and Adolescents
Study NTreatment
Number of
Percentage Loss
of Diagnosis
EMDR Patients
After TreatmentaMain Results
et al.
• WL 8 Not reported EMDR > WL
et al.
• WL/delayed
3 Not reported EMDR > WL
Diehle et
al. (2015)
De Roos
et al.
• WL
(regarding eciency)
Result maintained at
3-month and 1-year
follow-up 
Note. CBWT = cognitive behavioral writing therapy; PTSD = posttraumatic stress disorder; RCT = randomized controlled trial;
TF-CBT = trauma-focused cognitive behavioral therapy; WL = waiting list; > indicates “signicantly superior to”; < indicates
“signicantly inferior to.”
aBased upon clinical interview.
Journal of EMDR Practice and Research, Volume 13, Number 4, 2019 265
The Status of EMDR Therapy in the Treatment
TABLE 3. Overview of the Most Recent Treatment Guidelines Recommending EMDR Therapy
Guideline Target Group Year Recommendation
WHO Adults 2013 “Should be considered” with moderate quality of evidence
WHO Youth 2013 “Should be considered” with low quality of evidence
Veterans Aairs and US
Department of Defense
Adults 2017 Recommendation with strong evidence
APA Adults 2017 “Suggested,” but not recommended
NICE Youth 2018 Only if they do not respond to or engage with trauma-focused CBT
NICE Adults 2018 During months 2 and 3 post-trauma, “Consider EMDR” after a
non-combat-related trauma if the person has a preference for
EMDR. EMDR is recommended for treatment more than 3
months after a non-combat-related trauma.
ISTSS Adults 2018 Strong recommendation
ISTSS Youth 2018 Strong recommendation
Note. APA = American Psychological Association (APA, 2017); CBT = cognitive behavioral therapy; ISTSS = International Society of
Traumatic Stress Studies (2018); NICE = National Institute for Health Care and Care Excellence (NICE, 2018); WHO = World Health
Organization (WHO, 2013).
Inconsistencies Between the Different
Treatment Guidelines
At this present moment there is a striking lack of con-
sistency between international treatment guidelines
for PTSD—raising the question as to why this may be
the case.
There are several factors to consider. Firstly,
while sometimes it is simply not clear which studies
formed the basis of the treatment recommendation
(e.g., VA/DOD, 2017), the authors of most of the
guidelines used dierent inclusion and exclusion cri-
teria (i.e., scoping question) for the studies selected
for their respective systematic literature searches,
which then impacted their subsequent meta-analyses
and nal recommendations. For instance, the authors
of the NICE (2018) and ISTSS (2018) guidelines,
in their assessment, excluded studies in which par-
ticipants with PTSD had severe psychiatric comor-
bidities. This led, for example, to the exclusion
of the largest EMDR outcome study on PTSD
that has been carried out to date (Van den Berg
et al., 2015, 2018, n= 155), as the participants
suered from a psychotic disorder in addition to
their PTSD. The same study was also excluded
in the meta-analysis underlying the APA guide-
lines, as they included only RCTs for their analy-
sis that had been conducted before 2012 (5 years
prior to the date that the guidelines were issued). If
this study would have been included in this meta-
analysis, conducted for APA, this probably would
have led to a recommendation similar to that for
TF-CBT. In the comments to feedback on the rst
draft of the guideline, the APA guideline com-
mittee wrote, “The panel decided to maintain its
conditional recommendation for EMDR, with the
caveat that there is greater uncertainty about this
recommendation than for other recommendations
and with future meta-analysis the recommendation
could be strong” (APA, 2017, p. 57).
The guidelines also handled the methodological
limitations dierently. For example, NICE excluded
studies with small sample sizes, ISTSS removed stud-
ies with too few sessions, and APA removed studies
with methodological limitations, viewed as “high risk
of bias.”
Regarding the status of EMDR therapy 30 years after
its introduction, we can conclude that, with regard
to PTSD, EMDR therapy can be used as an interven-
tion of rst choice because there is sucient scientic
support for its ecacy. Although some studies have
found no dierence in the eciency of EMDR and TF-
CBT for symptoms of PTSD (e.g., Diehle et al., 2015),
there are indications suggesting that EMDR ther-
apy may require fewer sessions than CBT (De Roos
et al., 2011; Jaberghaderi, Greenwald, Rubin, Zand,
& Dolatabadi, 2004; Nijdam et al., 2012). This notion
is most strongly supported by the results of a study
in which the researchers clocked the duration of the
trauma treatments using a stopwatch, thereby show-
ing that patients who received EMDR therapy lost
their PTSD diagnosis signicantly faster than CBT
266 Journal of EMDR Practice and Research, Volume 13, Number 4, 2019
Jongh et al.
(2 hours and 20 minutes versus 3 hours and 47
minutes; De Roos et al., 2017).
EMDR’s possible eciency advantage would sug-
gest cost savings compared to treatment with TF-CBT.
This hypothesized cost dierential was directly tested
in one study that investigated the health-economic
benets of treatment with EMDR therapy. Results
suggest that adding EMDR treatment to standard care
for individuals with PTSD (in case psychosis is comor-
bid) would yield higher savings than adding TF-CBT
(-1574 Euro and -422 Euro per patient per 6 months,
respectively; De Bont et al., 2019).
What is needed for EMDR therapy to ensure that it
will continue to be recommended as a rst-line ther-
apy in future PTSD treatment guidelines? There are
some categories of traumatic events for which the sci-
entic evidence of EMDR therapy is still weak com-
pared to CBT. This includes combat-related PTSD
and children with PTSD. Given that the systematic
reviews identied only a few large RCTs and signi-
cant statistical heterogeneity, improving the quality of
EMDR research remains an important issue to ag. It
is clear that the empirical groundwork of EMDR ther-
apy based on RCTs in this area is still rather weak and
more studies are needed.
In conclusion, EMDR therapy is generally consid-
ered to be an evidence-based therapy that can be
applied for both adults and children in the case of
PTSD. Of note, future well-crafted RCTs in areas
such as combat-related PTSD and psychiatric disor-
ders with comorbid PTSD are warranted. Further-
more, RCTs where PTSD is a primary diagnosis also
remain necessary to ensure that in the future, treat-
ment guidelines EMDR therapy will continue to be
recommended as a rst-line therapy for PTSD.
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The Status of EMDR Therapy in the Treatment
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Disclosure. Ad de Jongh receives income from published
books on EMDR therapy and for the training of postdoc-
toral professionals in this approach. Benedikt Amann is
the Chair of the EMDR Europe Research Committee and
has received fees for providing training in EMDR in work-
shops and national and international EMDR congresses.
Arne Hofmann receives income from book publications on
EMDR and training licensed professionals in this approach.
Chris Lee receives fees for providing training in trauma
therapies. Derek Farrell has no relevant nancial interest or
aliations with any commercial interests related to the sub-
jects discussed within this article.
Correspondence regarding this article should be directed
to Ad de Jongh, Gustav Mahlerlaan 3004, 1081 LA Amster-
dam, the Netherlands. E-mail:
Journal of EMDR Practice and Research, Volume 13, Number 4, 2019 269
The Status of EMDR Therapy in the Treatment
... Different treatments for PTSD, including eye movement desensitization and reprocessing (EMDR) therapy, prolonged exposure, and cognitive processing therapy have proven to be effective (3). EMDR therapy is currently recommended as one of the first-line treatments because of its strong evidence base (3)(4)(5)(6). Although meta-analyses have found that EMDR therapy has large beneficial effects on PTSD compared to control conditions, and has large effect sizes in reducing PTSD symptoms (7,8), there is still room for improvement. ...
... Although meta-analyses have found that EMDR therapy has large beneficial effects on PTSD compared to control conditions, and has large effect sizes in reducing PTSD symptoms (7,8), there is still room for improvement. For instance, controlled outcome studies show that 5-64% of patients still meet the diagnostic criteria for PTSD after treated with EMDR therapy (4). Furthermore, 18% of patients dropped out before treatment with EMDR was completed and consequently did not benefit from the therapy (9). ...
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Background Several widely studied therapies have proven to be effective in the treatment of post-traumatic stress disorder (PTSD). However, there is still room for improvement because not all patients benefit from trauma-focused treatments. Improvements in the treatment of PTSD can be achieved by investigating ways to enhance existing therapies, such as eye movement desensitization and reprocessing (EMDR) therapy, as well as exploring novel treatments. The purpose of the current study is to determine the differential effectiveness, efficiency, and acceptability of EMDR therapy, an adaptation of EMDR therapy, referred to as EMDR 2.0, and a novel intervention for PTSD, the so-called Flash technique. The second aim is to identify the moderators of effectiveness for these interventions. This study will be conducted among individuals diagnosed with PTSD using a randomized controlled trial design. Methods A total of 130 patients diagnosed with (complex) PTSD will be randomly allocated to either six sessions of EMDR therapy, EMDR 2.0, or the Flash technique. The primary outcomes used to determine treatment effectiveness include the presence of a PTSD diagnosis and the severity of PTSD symptoms. The secondary outcomes of effectiveness include symptoms of depression, symptoms of dissociation, general psychiatric symptoms, and experiential avoidance. All patients will be assessed at baseline, at 4-week post-treatment, and at 12-week follow-up. Questionnaires indexing symptoms of PTSD, depression, general psychopathology, and experiential avoidance will also be assessed weekly during treatment and bi-weekly after treatment, until the 12-week follow-up. Efficiency will be assessed by investigating the time it takes both to lose the diagnostic status of PTSD, and to achieve reliable change in PTSD symptoms. Treatment acceptability will be assessed after the first treatment session and after treatment termination. Discussion This study is the first to investigate EMDR 2.0 therapy and the Flash technique in a sample of participants officially diagnosed with PTSD using a randomized controlled trial design. This study is expected to improve the available treatment options for PTSD and provide therapists with alternative ways to choose a therapy beyond its effectiveness by considering moderators, efficiency, and acceptability. Trial registration The trial was retrospectively registered in the ISRCTN registry at 10th November 2022 under registration number ISRCTN13100019.
... The efficacy of EMDR was confirmed in many clinical trials. A summary of these findings in meta-analyses shows that EMDR is more efficacious than waiting lists and similarly efficacious to cognitive-behavioural therapies [32,[39][40][41]. At the same time, it should be noted that a meta-analysis of EMDR in veterans with PTSD did not show a visible advantage of this method. ...
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Aim: Around 2.5% of Poles will develop post-traumatic stress disorder (PTSD) during their lifetime. Recent events, i.e. the pandemic and the war in Ukraine, are the factors that will increase the number of people dealing with PTSD. Owing to that, this paper aims to review and familiarise readers with the available scientific evidence on psychotherapies of PTSD provided in Poland. Material and Methods: A review of meta-analyses of randomised controlled trials and a review of the most recent treatment guidelines concerning PTSD. Results: The best available evidence points to high efficacy of cognitive-behavioural therapy (CBT) with prolonged exposure and Eye Movement Desensitization and Reprocessing (EMDR). Humanistic therapy also proves effective to a certain degree, but not as effective as therapies that use exposure to stimuli and memories associated with trauma. There is no evidence of the efficacy of psychodynamic therapy and methods based on polyvagal theory. Organisations preparing guidelines recommend primarily CBT and EMDR. Conclusions: Efficacious treatment of PTSD should include a protocol with a component of exposure to trauma-related memories and stimuli. It is recommended to use such therapies in the psychotherapeutic treatment of PTSD.
... Immediately after its birth in the last decade of the last century, several meta-analyses investigated real evidence for EMDR therapy in treating post-traumatic stress disorder (PTSD) (Jonas et al., 2013;Watts et al., 2013;Chen et al., 2014Chen et al., , 2015Wilson et al., 2018;de Jongh et al., 2019;Yunitri et al., 2020;Carletto et al., 2021). ...
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Objective Dysfunctional cognitions play a central role in the development of post-traumatic stress disorder (PTSD). However the role of specific dissociation-related beliefs about memory has not been previously investigated. This study aimed to investigate the role of dissociation-related beliefs about memory in trauma-focused treatment. It was hypothesized that patients with the dissociative subtype of PTSD would show higher levels of dissociation-related beliefs, dissociation-related beliefs about memory would decrease after trauma-focused treatment, and higher pre-treatment dissociation-related beliefs would be associated with fewer changes in PTSD symptoms. Method Post-traumatic symptoms, dissociative symptoms, and dissociation-related beliefs about memory were assessed in a sample of patients diagnosed with PTSD (n = 111) or the dissociative subtype of PTSD (n = 61). They underwent intensive trauma-focused treatment consisting of four or eight consecutive treatment days. On each treatment day, patients received 90 min of individual prolonged exposure (PE) in the morning and 90 min of individual eye movement desensitization and reprocessing (EMDR) therapy in the afternoon. The relationship between dissociation-related beliefs about memory and the effects of trauma-focused treatment was investigated. Results Dissociation-related beliefs about memory were significantly associated with PTSD and its dissociative symptoms. In addition, consistent with our hypothesis, patients with the dissociative subtype of PTSD scored significantly higher on dissociation-related beliefs about memory pre-treatment than those without the dissociative subtype. Additionally, the severity of these beliefs decreased significantly after trauma-related treatment. Contrary to our hypothesis, elevated dissociation-related beliefs did not negatively influence treatment outcome. Conclusion The results of the current study suggest that dissociation-related beliefs do not influence the outcome of trauma-focused treatment, and that trauma-focused treatment does not need to be altered specifically for patients experiencing more dissociation-related beliefs about memory because these beliefs decrease in association with treatment.
The job duties of a police officer can vary and often include responsibilities that the general population will never experience. Given the unique and potentially traumatic nature of these responsibilities, police officers report high levels of chronic stress, job burnout, and a lack of social support from those both within and outside their profession. Consequently, this can place law enforcement professionals at an increased risk for experiencing numerous adverse mental health conditions, including posttraumatic stress disorder (PTSD). Research supports law enforcement populations are at an elevated risk for developing PTSD given the high rate of exposure to critical incidents reported, with rates ranging from 46% to 92% on a yearly basis (Wagner SL, White N, Fyfe T, Matthews LR, Randall C, Regehr C, White M, Alden LE, Buys N, Carey MG, Corneil W, Fraess-Phillips A, Krutop E, Fleischmann MH, Am J Ind Med 63:600–615, 2020). The law enforcement culture reinforces the use of avoidant coping strategies to mitigate the results of consistent exposure to potentially traumatic events, or “critical incidents,” such as substance use or social isolation (Arble E, Daugherty AM, Arnetz BB, Stress and Health 34:612–621, 2018); (Becker CB, Meyer G, Price JS, Graham MM, Arsena A, Armstrong DA, Ramon E, Behav Res Ther 47:245–253, 2009). While traditional stress management and other preventative techniques may be offered through in-service trainings within a police department, there is added benefit in offering evidence-based treatments for trauma, including eye movement desensitization and reprocessing (EMDR).
Mental health problems in refugee youth are not limited to post-traumatic stress disorder, but include anxiety, depression, and externalizing problems as well. Unaccompanied youth refugees are particularly vulnerable to develop emotional and behavioral problems, but received less trauma-focused interventions, cognitive behavior therapy, or anxiety management training than accompanied refugee minors. Treatments used with refugee children include trauma-focused therapy, narrative exposure therapy/KIDNET, writing therapy, EMDR, and classroom-based interventions (teaching recovery). Few studies have investigated “evidence-based” interventions in refugee youth. Trauma-focused cognitive behavior therapy is a promising treatment for minor refugees with post-traumatic stress; results generalize to reduction of symptoms of anxiety and depression as well. The results of the studies evaluating the effects of Teaching Recovery Techniques are inconclusive. Further studies are needed to investigate which treatment dealing with post-traumatic stress, anxiety, depression, and externalizing disorders is most effective in refugee minors.KeywordsPost-traumatic stressExternalizing problemsTrauma-focused therapyEMDRClassroom-based interventionsKIDNET
Background and objectives: Lab studies show that the emotionality and vividness of aversive memories decrease as a result of engaging in a working memory task during the recall of that memory. Translation of the dual tasking working mechanism to a VR program would allow for future VR-EMDR clinical and dissemination trials. The current study took the first step towards that goal by assessing the non-inferiority of a Virtual Reality (VR) eye movement task compared to computerized eye movements in amelioration of aversive autobiographical memory in a student sample. Methods: In a cross-over design, university students (N = 195) recalled three aversive autobiographical memories and received VR Eye Movements (VR EM), Computerized Eye Movements (EM), and Exposure Only (EO). Emotionality and vividness of the memories were assessed before and after each condition. Results: We found VR EM to be non-inferior to Computerized EM and EO in reducing emotionality and vividness. Both EM conditions outperformed the EO condition. Against our expectations, we found steeper declines of emotionality scores in the VR EM condition compared to the Computerized EM. Lastly, we found a sensitization effect in our EO condition: emotionality and vividness increased due to this procedure. Limitations: Despite our efforts in standardizing working memory taxation between the dual tasking conditions (such as viewing angle and speed of eye movements), characteristics of the VR eye movements task might have unintentionally loaded additional working memory. Conclusions: These findings show that VR eye movements could be a viable dual task and might serve as the first step to research VR eye movements in clinical practice.
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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.
When exposed to actual or threatened death or serious injury in austere settings, expedition members are at risk of acute stress reactions, as are search and rescue members involved with extricating the patient. Acute stress reactions are a normal response to significant trauma and commonly resolve on their own. If they do not, they can lead to post-traumatic stress disorder (PTSD), a set of persistent symptoms that cause significant effects on the person's life. Medication has a limited preventive role in the field for treatment of stress partly because so few are trained to administer it. Contrastingly, psychological first aid can be performed by lay team members with minimal training. Psychological first aid consists of interventions attempting to encourage feelings of safety, calm, self-efficacy, connection, and hope. These are interventions that provide guidance to not make the situation emotionally worse and might have a preventive effect on later development of PTSD. They are valuable in the field not only for the patient but also for affected team members as well as for search and rescue team members who may be indirectly affected by the trauma and experience repercussions later.
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Background Post-traumatic stress disorder (PTSD) is prevalent in children, adolescents and adults. It can occur alone or in comorbidity with other disorders. A broad range of psychotherapies such as cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) have been developed for the treatment of PTSD. Aim Through quantitative meta-analysis, we aimed to compare the efficacy of CBT and EMDR: (i) relieving the post-traumatic symptoms, and (ii) alleviating anxiety and depression, in patients with PTSD. Methods We systematically searched EMBASE, Medline and Cochrane central register of controlled trials (CENTRAL) for articles published between 1999 and December 2017. Randomized clinical trials (RCTs) that compare CBT and EMDR in PTSD patients were included for quantitative meta-analysis using RevMan Version 5. Results Fourteen studies out of 714 were finally eligible. Meta-analysis of 11 studies (n = 547) showed that EMDR is better than CBT in reducing post-traumatic symptoms [SDM (95% CI) = -0.43 (-0.73 – -0.12), p = 0.006]. However, meta-analysis of four studies (n = 186) at three-month follow-up revealed no statistically significant difference [SDM (95% CI) = -0.21 (-0.50 – 0.08), p = 0.15]. The EMDR was also better than CBT in reducing anxiety [SDM (95% CI) = -0.71 (-1.21 – -0.21), p = 0.005]. Unfortunately, there was no difference between CBT and EMDR in reducing depression [SDM (95% CI) = -0.21 (-0.44 – 0.02), p = 0.08]. Conclusion The results of this meta-analysis suggested that EMDR is better than CBT in reducing post-traumatic symptoms and anxiety. However, there was no difference reported in reducing depression. Large population randomized trials with longer follow-up are recommended to build conclusive evidence.
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The number of refugees has increased significantly over the past few years. PTSD and depression are among the most common mental health problems among refugees. Eye Movement Desensitization and Reprocessing (EMDR), an effective treatment for PTSD, is usually administered individually. The availability of mental health resources would be greatly enhanced when EMDR can be delivered to groups. The EMDR G-TEP is a group protocol based on Early EMDR intervention protocols. There is clinical evidence and one field study published on the effect of EMDR G-TEP and there is only one RCT published on the treatment of PTSD and depression in a refugee camp. The aim of our study was to investigate the efficacy of EMDR G-TEP in treating post-trauma symptoms and depression and preventing the development of chronic PTSD among refugees living in a refugee camp. 47 adult participants with PTSD symptoms were randomly allocated to experimental (n = 18) and control (n = 29) groups. We measured Impact of Event Scale (IES-R), Beck Depression Inventory-II (BDI-II) and International Neuropsychiatric Interview (MINI) at pre-, post- and 4-week follow-up. Analysis of the results showed that the EMDR G-TEP group had significantly lower PTSD and depression symptoms after intervention. The percentage of PTSD diagnosis decreased from 100 to 38.9% in the EMDR G-TEP group and was unchanged in the control group. Following the EMDR G-TEP intervention 61.1% of the experimental group no longer had a PTSD diagnosis; this decrease was maintained at 4 weeks follow-up. In the control group the percentage of people who no longer met the diagnostic criteria for PTSD was 10.3% post-test and 6.9% at 4 weeks follow-up. A significant decrease in depression symptoms from pre-test levels was found in EMDR group but not in the control group follow up-test. This study indicated that EMDR G-TEP effectively reduced PTSD symptoms among refugees living in a camp, after two treatment sessions conducted over a period of 3 days. Further studies need to be performed using a larger number of participants, followed for a longer period of time and given more treatment sessions to strengthen our findings.
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We present 12-month follow-up results for a randomised controlled trial of prolonged exposure and eye movement desensitisation and reprocessing (EMDR) therapy in 85 (78.8%) participants with psychotic disorder and comorbid post-traumatic stress disorder (PTSD). Positive effects on clinician-rated PTSD, self-rated PTSD, depression, paranoid-referential thinking and remission from schizophrenia were maintained up to 12-month follow-up. Negative post-traumatic cognitions declined in prolonged exposure and were stable in EMDR. A significant decline in social functioning was found, whereas reductions in interference of PTSD symptoms with social functioning were maintained. These results support that current PTSD guidelines apply to individuals with psychosis. Declaration of interest M.v.d.G. and D.v.d.B. receive income for published books on psychotic disorders and for the training of postdoctoral professionals in the treatment of psychotic disorders. A.d.J. receives income for published books on EMDR therapy and for the training of postdoctoral professionals in this method. A.v.M. receives income for published book chapters on PTSD and for the training of postdoctoral professionals in prolonged exposure. C.d.R. receives income for the training of postdoctoral professionals in EMDR therapy.
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The American Psychological Association (APA) Practice Guidelines for the Treatment of Posttraumatic Stress Disorder (PTSD) concluded that there was strong evidence for cognitive behavioral therapy (CBT), cognitive processing therapy (CPT), cognitive therapy (CT), and exposure therapy yet weak evidence for eye movement desensitization and reprocessing (EMDR). This is despite the findings from an associated systematic review which concluded that EMDR leads to loss of PTSD diagnosis and symptom reduction. Depression symptoms were also found to improve more with EMDR than control conditions. In that review, EMDR was marked down on strength of evidence (SOE) for symptom reduction for PTSD. However, there were several problems with the conclusions of that review. Firstly, in assessing the evidence in one of the studies, the reviewers chose an incorrect measure that skewed the data. We recalculated a meta-analysis with a more appropriate measure and found the SOE improved. The resulting effect size for EMDR on PTSD symptom reduction compared to a control condition was large for studies that meet the APA inclusion criteria (SMD = 1.28) and the heterogeneity was low (I2= 43%). Secondly, even if the original measure was chosen, we highlight inconsistencies with the way SOE was assessed for EMDR, CT, and CPT. Thirdly, we highlight two papers that were omitted from the analysis. One of these was omitted without any apparent reason. It found EMDR superior to a placebo control. The other study was published in 2015 and should have been part of APA guidelines since they were published in 2017. The inclusion of either study would have resulted in an improvement in SOE. Including both studies results in standard mean difference and confidence intervals that were better for EMDR than for CPT or CT. Therefore, the SOE should have been rated as moderate and EMDR assessed as at least equivalent to these CBT approaches in the APA guidelines. This would bring the APA guidelines in line with other recent practice guidelines from other countries. Less critical but also important, were several inaccuracies in assessing the risk of bias and the failure to consider studies supporting strong gains of EMDR at follow-up.
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Abstract Background Practice guidelines for childhood posttraumatic stress disorder (PTSD) recommend trauma-focused psychotherapies, mainly cognitive behavioral therapy (CBT). Eye movement desensitization and reprocessing (EMDR) therapy is a brief trauma-focused, evidence-based treatment for PTSD in adults, but with few well-designed trials involving children and adolescents. Methods We conducted a single-blind, randomized trial with three arms (n = 103): EMDR (n = 43), Cognitive Behavior Writing Therapy (CBWT; n = 42), and wait-list (WL; n = 18). WL participants were randomly reallocated to CBWT or EMDR after 6 weeks; follow-ups were conducted at 3 and 12 months posttreatment. Participants were treatment-seeking youth (aged 8–18 years) with a DSM-IV diagnosis of PTSD (or subthreshold PTSD) tied to a single trauma, who received up to six sessions of EMDR or CBWT lasting maximally 45 min each. Results Both treatments were well-tolerated and relative to WL yielded large, intent-to-treat effect sizes for the primary outcomes at posttreatment: PTSD symptoms (EMDR: d = 1.27; CBWT: d = 1.24). At posttreatment 92.5% of EMDR, and 90.2% of CBWT no longer met the diagnostic criteria for PTSD. All gains were maintained at follow-up. Compared to WL, small to large (range d = 0.39–1.03) intent-to-treat effect sizes were obtained at posttreatment for negative trauma-related appraisals, anxiety, depression, and behavior problems with these gains being maintained at follow-up. Gains were attained with significantly less therapist contact time for EMDR than CBWT (mean = 4.1 sessions/140 min vs. 5.4 sessions/227 min). Conclusions EMDR and CBWT are brief, trauma-focused treatments that yielded equally large remission rates for PTSD and reductions in the severity of PTSD and comorbid difficulties in children and adolescents seeking treatment for PTSD tied to a single event. Further trials of both treatments with PTSD tied to multiple traumas are warranted.
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Background: Up to 60% of patients with bipolar disorder (BD) have a history of traumatic events, which is associated with greater episode severity, higher risk of comorbidity and higher relapse rates. Trauma-focused treatment strategies for BD are thus necessary but studies are currently scarce. The aim of this study is to examine whether Eye Movement Desensitization and Reprocessing (EMDR) therapy focusing on adherence, insight, de-idealisation of manic symptoms, prodromal symptoms and mood stabilization can reduce episode severity and relapse rates and increase cognitive performance and functioning in patients with BD. Methods/design: This is a single-blind, randomized controlled, multicentre trial in which 82 patients with BD and a history of traumatic events will be recruited and randomly allocated to one of two treatment arms: EMDR therapy or supportive therapy. Patients in both groups will receive 20 psychotherapeutic sessions, 60 min each, during 6 months. The primary outcome is a reduction of affective episodes after 12 and 24 months in favour of the EMDR group. As secondary outcome we postulate a greater reduction in affective symptoms in the EMDR group (as measured by the Bipolar Depression Rating Scale, the Young Mania Rating Scale and the Clinical Global Impression Scale modified for BD), and a better performance in cognitive state, social cognition and functioning (as measured by the Screen for Cognitive Impairment in Psychiatry, The Mayer-Salovey-Caruso Emotional Intelligence Test and the Functioning Assessment Short Test, respectively). Traumatic events will be evaluated by The Holmes-Rahe Life Stress Inventory, the Clinician-administered PTSD Scale and the Impact of Event Scale. Discussion: The results of this study will provide evidence whether a specific EMDR protocol for patients with BD is effective in reducing affective episodes, affective symptoms and functional, cognitive and trauma symptoms. Trial registration: The trial is registered at, identifier: NCT02634372 . Registered on 3 December 2015.
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Objective: Multiple Sclerosis (MS) is a demyelinating autoimmune disease that imposes a significant emotional burden with heavy psychosocial consequences. Several studies have investigated the association between MS and mental disorders such as depression and anxiety, and recently researchers have focused also on Post-traumatic Stress Disorder (PTSD). This is the first study that investigates the usefulness of proposing a treatment for PTSD to patients with MS. Methods: A randomized controlled trial with patients with MS diagnosed with PTSD comparing Eye Movement Desensitization and Reprocessing (EMDR; n = 20) and Relaxation Therapy (RT; n = 22). The primary outcome measure was the proportion of participants that no longer meet PTSD diagnosis as measured with Clinician Administered PTSD Scale 6-months after the treatment. Results: The majority of patients were able to overcome their PTSD diagnosis after only 10 therapy sessions. EMDR treatment appears to be more effective than RT in reducing the proportion of patients with MS suffering from PTSD. Both treatments are effective in reducing PTSD severity, anxiety and depression symptoms, and to improve Quality of Life. Conclusion: Although our results can only be considered preliminary, this study suggests that it is essential that PTSD symptoms are detected and that brief and cost-effective interventions to reduce PTSD and associated psychological symptoms are offered to patients, in order to help them to reduce the psychological burden associated with their neurological condition. Trial registration: NCT01743664,
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.
The rationale is synthesized for the urgency of empirical studies demonstrating the efficacy of eye movement desensitization and reprocessing (EMDR) therapy for children and adolescents with posttraumatic stress disorder (PTSD), symptoms of PTSD, or other trauma-related symptoms. This literature review examined 15 studies (including nine randomized clinical trials) that tested the efficacy of EMDR therapy for the treatment of children and adolescents with these symptoms. All studies found that EMDR therapy produced significant reductions in PTSD symptoms at posttreatment and also in other trauma-related symptoms, when measured. A methodological analysis identified limitations in most studies, reducing the value of these findings. Despite these shortcomings, the methodological strength of the identified studies has increased over time. The review also summarized three meta-analyses. The need for additional rigorous research is apparent, and in order to profit from experiences of the past, the article provides some guidelines for clinicians seeking to conduct future research in their agencies.