Medicine:Eye movement desensitization and reprocessing

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Short description: Form of psychotherapy (started 1988)

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy in which the person being treated is asked to recall distressing images; the therapist then directs the patient in one type of bilateral stimulation, such as side-to-side eye rapid movement or hand tapping.[1] EMDR was developed by Francine Shapiro starting in 1988. According to the 2013 World Health Organization (WHO) practice guideline: "This therapy [EMDR] is based on the idea that negative thoughts, feelings and behaviours are the result of unprocessed memories. The treatment involves standardized procedures that include focusing simultaneously on (a) spontaneous associations of traumatic images, thoughts, emotions and bodily sensations and (b) bilateral stimulation that is most commonly in the form of repeated eye movements."[2]

EMDR is included in several evidence-based guidelines for the treatment of post-traumatic stress disorder (PTSD), with varying levels of recommendation and evidence (very low to moderate per WHO stress guidelines).[3][2][4] As of 2020, the American Psychological Association lists EMDR as an evidence-based treatment for PTSD[5] but stresses that "the available evidence can be interpreted in several ways" and notes there is debate about the precise mechanism by which EMDR appears to relieve PTSD symptoms with some evidence EMDR may simply be a variety of exposure therapy.[6] Even though EMDR is effective, critics call it a pseudoscience because only the desensitization component has scientific support.

History

Exposure therapy began in the 1950s, when South African psychologists and psychiatrists used it to reduce pathological fears.[7] They then brought their methods to England in the Maudsley Hospital training program.[7] Since the 1950s several sorts of exposure therapy have been developed, including systematic desensitization, flooding, implosive therapy, prolonged exposure therapy, in vivo exposure therapy, and imaginal exposure therapy.[7]

EMDR therapy was first developed by American psychologist Francine Shapiro after noticing, in 1987,[8] that eye movements appeared to decrease the negative emotion associated with her own distressing memories.[9][10][11] She then conducted a scientific study with trauma victims in 1988 and the research was published in the Journal of Traumatic Stress in 1989.[12] Her hypothesis was that when a traumatic or distressing experience occurs, it may overwhelm normal coping mechanisms, with the memory and associated stimuli being inadequately processed and stored in an isolated memory network.[13]

Shapiro noted that, when she was experiencing a disturbing thought, her eyes were involuntarily moving rapidly. She further noted that her anxiety was reduced when she brought her eye movements under voluntary control while thinking a traumatic thought.[14] Shapiro developed EMDR therapy for post-traumatic stress disorder (PTSD). She speculated that traumatic events "upset the excitatory/inhibitory balance in the brain, causing a pathological change in the neural elements".[14]

Delivery

EMDR consists of eight essential phases. The first phase includes history taking and treatment planning. The second phase includes preparation. The third phase is an assessment phase followed by the fourth phase of desensitisation. Phases 5 & 6 involve installing positive cognitions and body scan. The last phase is the reevaluation phase [2]EMDR is typically undertaken in a series of sessions with a trained therapist.[15]The number of sessions can vary depending on the progress made. A typical EMDR therapy session lasts from 60-90 minutes.[16]

Medical uses

Trauma and PTSD

The person being treated is asked to recall an image, phrase and emotions which represents a level of distress related to a trigger while generating one of several types of bilateral sensory input, such as side-to-side eye movements or hand tapping.[1][3] The 2013 World Health Organization practice guideline says that "Like cognitive behavioral therapy (CBT) with a trauma focus, EMDR aims to reduce subjective distress and strengthen adaptive beliefs related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure, or (d) homework."[2]

Evidence of effectiveness

While multiple meta-analyses have found EMDR to be as effective as trauma focused cognitive behavioral therapy for the treatment of PTSD, these findings have been regarded as tentative given the low numbers in the studies, high risk rates of researcher bias, and high dropout rates.[17][18][19]

  • A 2020 systematic review and meta-analysis was the "first systematic review of randomized trials examining the effects of EMDR for any mental health problem." The authors raised concerns about bias in previous studies, concluding:
Despite these limitations, the results of this meta-analysis aid us in concluding that EMDR may be effective in the treatment of PTSD in the short term and possibly have comparable effects as other treatments. However, the quality of studies is too low to draw definite conclusions. Further, it is evident that the long-term effects of EMDR are unclear and that there is certainly not enough evidence to advise its use in patients with mental health problems other than PTSD.[19]
  • A 2013 systematic review examined 15 clinical trials of EMDR with and without the eye movements, finding that the effect size was larger when eye movements were used.[20][17] Again, interpretation of this meta-analysis was tentative. Lee and Cuijpers (2013) stated that "the quality of included studies was not optimal. This may have distorted the outcomes of the studies and our meta-analysis. Apart from ensuring adequate checks on treatment quality, there were other serious methodological problems with the studies in the therapy context."[17] A meta-analysis in 2020, could not confirm the results of this 2013 study, due to "differences in inclusion criteria."[19]
  • A Cochrane systematic review comparing EMDR with other psychotherapies in the treatment of Chronic PTSD, found EMDR to be just as effective as Trauma-Focused Cognitive Behavior Therapy (TF-CBT) and more effective than the other non-TF-CBT psychotherapies.[18][21] Caution was urged interpreting the results due to low numbers in included studies, risk of researcher bias, high drop out rates, and overall "very low" quality of evidence for the comparisons with other psychotherapies.[18]
  • A 2010 meta-analysis concluded that all "bona fide" treatments were equally effective, but there was some debate regarding the study's selection of which treatments were "bona fide".[22]
  • A 2009 review of rape treatment outcomes concluded that EMDR had some efficacy.[23] Another 2009 review concluded EMDR to be of similar efficacy to other exposure therapies and more effective than SSRIs, problem-centered therapy, or "treatment as usual".[24]
  • Two meta-analyses in 2006 found EMDR to be at least equivalent in effect size to specific exposure therapies.[17][25]
  • A 2005 and a 2006 meta-analysis each suggested that traditional exposure therapy and EMDR have equivalent effects immediately after treatment and at follow-up.[26][25]
  • A 2002 meta-analysis concluded that EMDR is not as effective, or as long lasting, as traditional exposure therapy.[27]
  • A 1998 meta-analysis found that EMDR was as effective as exposure therapy and SSRIs.[28]

Some smaller studies have produced positive results.[29]

Position statements

The 2009 International Society for Traumatic Stress Studies practice guidelines categorized EMDR as an evidence-based level A treatment for PTSD in adults.[30] Other guidelines recommending EMDR therapy – as well as CBT and exposure therapy – for treating trauma have included NICE starting in 2005,[31][4][32] Australian Centre for Posttraumatic Mental Health in 2007,[33] the Dutch National Steering Committee Guidelines Mental Health and Care in 2003,[34] the American Psychiatric Association in 2004,[35] the Departments of Veterans Affairs and Defense in 2010,[36] SAMHSA in 2011,[37] the International Society for Traumatic Stress Studies in 2009,[38] and the World Health Organization in 2013 (only for PTSD, not for acute stress treatment).[2] The American Psychological Association "conditionally recommends" EMDR for the treatment of PTSD.[39]

Children

EMDR is included in a 2009 practice guideline for helping children who have experienced trauma.[40] EMDR is often cited as a component in the treatment of complex post-traumatic stress disorder.[41][42]

A 2017 meta-analysis of randomized controlled trials in children and adolescents with PTSD found that EMDR was at least as efficacious as cognitive behavior therapy (CBT), and superior to waitlist or placebo.[43]

Other conditions

Several small studies have indicated EMDR efficacy for other mental health conditions,[44] but more research is needed.[19]

Depression

Studies have indicated EMDR effectiveness in depression.[45][46] A 2019 review found that "Although the selected studies are few and with different methodological critical issues, the findings reported by the different authors suggest in a preliminary way that EMDR can be a useful treatment for depression."[47]

Anxiety related disorders

Small studies have found EMDR to be effective with GAD,[48] OCD,[44] other anxiety disorders,[49] and distress due to body image issues.[50]

Dissociative identity disorder

EMDR has been found to cause strong effects on DID patients, causing recommendation for adjusted use.[51][52]

Other conditions

EMDR may have application for psychosis when co-morbid with trauma,[44] Other studies have investigated EMDR therapy’s efficacy with borderline personality disorder,[53] and somatic disorders such as phantom limb pain.[54][55] EMDR has also been found to improve stress management symptoms.[56] EMDR has been found to reduce suicide ideation,[57] and help low self-esteem.[58] Other studies focus on effectiveness in substance craving[59] and pain management.[60] EMDR may help people with autism who suffer from exposure to distressing events.[61]

Reviews

  • A 2021 major review that included RCT's, group studies and case studies that specifically did not focus on the use of EMDR in the treatment of trauma or PTSD, found that EMDR may be beneficial in at least fourteen conditions that included: addictions, somatoform disorders, sexual dysfunction, eating disorders, disorders of adult personality, mood disorders, reaction to severe stress, anxiety disorders, performance anxiety, Obsessive-Compulsive Disorder (OCD), pain, neurodegenerative disorders, mental disorders of childhood and adolescence, and sleep. The authors concluded that "Results shed light on several aspects that support the interest of its practice in mental health care. Despite the clear need for more rigorous research, our review also demonstrated that EMDR has translational interests. The fact that this therapy could be helpful in non-pathological situations (e.g., performance) broadens the scope of its benefits and invites for interdisciplinary research. Also, because of its potential advantages, we believe that EMDR could be considered in major crisis situations, such as to alleviate the imminent and disproportionate mental health sequelae of a world pandemic(...)" .[62]
  • A 2020 systematic review and meta-analysis was the "first systematic review of randomized trials examining the effects of EMDR for any mental health problem." The authors concluded: "it is evident that the long-term effects of EMDR are unclear, and... there is certainly not enough evidence to advise its use in patients with mental health problems other than PTSD."[19]
  • A 2013 overall literature review covered research up to that time.[63][specify]

Mechanism

Possible mechanisms

Incomplete processing of experiences in trauma

Many proposals of EMDR efficacy share an assumption that, as Shapiro posited, when a traumatic or very negative event occurs, information processing of the experience in memory may be incomplete. The trauma causes a disruption of normal adaptive information processing, which results in unprocessed information being dysfunctionally held in memory networks.[64] According to the 2013 World Health Organization practice guideline: "This therapy [EMDR] is based on the idea that negative thoughts, feelings and behaviours are the result of unprocessed memories."[2]

EMDR allowing correct processing of memories

EMDR is posited to help in the correct processing of the components of the contributing distressing memories.[65][66] EMDR may allow the client to access and reprocess negative memories (leading to decreased psychological arousal associated with the memory).[67] This is sometimes known as the Adaptive Information Processing (AIP) model.[68][69][unreliable medical source]

Proposed mechanisms by which EMDR achieves efficacy

The mechanism by which EMDR achieves efficacy is unknown, with no definitive finding. Several possible mechanisms have been posited;

  • EMDR impacts working memory.[70] By having the patient perform a bilateral stimulation task while retrieving memories of trauma, the amount of information they can retrieve about the trauma is limited, and thus the resulting negative emotions are less intense.[71] This is seen by some as causing a distancing effect which enables the client to 'stand back' from the trauma. The client is enabled to re-evaluate the trauma and their understanding of it, and thus process it correctly, because they can re-experience it whilst not feeling overwhelmed by it.[44]
  • EMDR enables ‘dual attention’ (recalling the trauma whilst keeping ‘one foot in the present’ assisted by bilateral stimulation). This allows the brain to access the dysfunctionally stored experience and stimulate the innate processing system, allowing it to transform the information to an adaptive resolution.[44]
  • Connectivity among several brain regions has been found to be changed by bilateral eye movement and by EMDR. In one 15 person study, EMDR was found to lead to reduced connectivity between some brain areas.[72] These changes may cause EMDRs efficacy.[73][74]
  • EMDR efficacy has been linked to the Zeigarnik effect (i.e. better memory for interrupted rather than completed tasks).[75]
  • Horizontal eye movement triggers an evolutionary 'orienting response' in the brain, used in scanning the environment for threats and opportunities.[76]
  • EMDR gives an effect similar to the effects of sleep,[77] and posit that traumatic experiences are processed during sleep.
  • Trauma can be overcome or mastered, and EMDR facilitates a form of mindfulness or other form of mastery over the trauma.[44]

A 2013 meta-analysis focused on two mechanisms: (1) taxing working memory and (2) orienting response/REM sleep.[17]

It may be that several mechanisms are at work in EMDR.[44]

Bilateral stimulation, including eye movement

Bilateral stimulation is a generalization of the left and right repetitive eye movement technique first used by Shapiro. Alternative stimuli include auditory stimuli that alternate between left and right speakers or headphones, and physical stimuli such as tapping of the therapist's hands.[78] Research has attempted to correlate other types of rhythmic side-to-side stimuli, such as sound and touch, with mood, memory and cerebral hemispheric interaction.

Research results and opinions have been mixed on the effectiveness and importance of the technique;

  • 2020 research showed that bilateral alternating stimulation caused a significant increase in connectivity between several areas of the brain, including the two superior temporal gyri, the precuneus, the middle frontal gyrus and a set of structures involved in multisensory integration, executive control, emotional processing, salience and memory.[79]
  • A 2020 review questioned the consistency and generalizability of the technique.[80]
  • A 2013 meta-study found the effect size of eye movement was large and significant, with the strongest effect size difference being for vividness measures.[17][44]
  • A 2012 review found that the evidence provided support for the contention that eye movements are essential to this therapy and that a theoretical rationale exists for their use.[76]
  • A 2002 review reported that the eye movement is irrelevant, and that the effectiveness of EMDR was solely due to its having properties similar to CBT, such as desensitization and exposure.[81]
  • A 2001 meta-analysis suggested that EMDR with the eye movements was no more efficacious than EMDR without the eye movements (Davidson & Parker, 2001).[20][82][83]
  • A 2000 review found that the eye movements did not play a central role, and that the mechanisms of eye movements were speculative.[84]
  • A small 1996 study found that the eye movements employed in EMDR did not add to its effectiveness.[85]

Francine Shapiro noticed that eye movements appeared to decrease the negative emotion associated with her own distressing memories.[86][87][88] Bilateral stimulation seems to cause dissipation of emotions.[89][90]

Criticisms

EMDR has historically been controversial within the psychological community.[91][92]

Effectiveness and theoretical basis

Concerns have included questions about its effectiveness and the importance of the eye movement component of EMDR. In 2012, Hal Arkowitz, and Scott Lilienfeld summed up the state of the research at the time, saying that while EMDR is better than no treatment and probably better than merely talking to a supportive listener,

Yet not a shred of good evidence exists that EMDR is superior to exposure-based treatments that behavior and cognitive-behavior therapists have been administering routinely for decades. Paraphrasing British writer and critic Samuel Johnson, Harvard University psychologist Richard McNally nicely summed up the case for EMDR: "What is effective in EMDR is not new, and what is new is not effective."[93]

Client perceptions of effectiveness are also mixed.[94]

Pseudoscience

Skeptics of the therapy argued that EMDR is a pseudoscience, because the underlying theory is unfalsifiable. Also, the results of the therapy are non-specific, especially if the eye movement component is irrelevant to the results. What remains is a broadly therapeutic interaction and deceptive marketing.[84][27] According to Yale neurologist and skeptic Steven Novella:

[T]he false specificity of these treatments is a massive clinical distraction. Time and effort are wasted clinically in studying, perfecting, and using these methods, rather than focusing on the components of the interaction that actually work.[95]

Excessive training

Shapiro has been criticized for repeatedly increasing the length and expense of training and certification, allegedly in response to the results of controlled trials that cast doubt on EMDR's efficacy.[96][84] This included requiring the completion of an EMDR training program in order to be qualified to administer EMDR properly, after researchers using the initial written instructions found no difference between no-eye-movement control groups and EMDR-as-written experimental groups. Further changes in training requirements and/or the definition of EMDR included requiring level II training when researchers with level I training still found no difference between eye-movement experimental groups and no-eye-movement controls and deeming "alternate forms of bilateral stimulation" (such as finger-tapping) as variants of EMDR by the time a study found no difference between EMDR and a finger-tapping control group.[96] Such changes in definition and training for EMDR have been described as "ad hoc moves [made] when confronted by embarrassing data".[97]

References

  1. ↑ 1.0 1.1 Feske, Ulrike (June 1998). "Eye Movement Desensitization and Reprocessing Treatment for Posttraumatic Stress Disorder". Clinical Psychology: Science and Practice 5 (2): 171–181. doi:10.1111/j.1468-2850.1998.tb00142.x. 
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Guidelines for the management of conditions that are specifically related to stress. Geneva: World Health Organization. 2013. p. Glossary page 1. PMID 24049868. https://www.who.int/mental_health/emergencies/stress_guidelines/en/. 
  3. ↑ 3.0 3.1 Shapiro, Francine; Laliotis, Deany (2015). "EMDR Therapy for Trauma-Related Disorders". Evidence Based Treatments for Trauma-Related Psychological Disorders: A Practical Guide for Clinicians. Springer International Publishing. pp. 205–228. doi:10.1007/978-3-319-07109-1_11. ISBN 978-3-319-07109-1. 
  4. ↑ 4.0 4.1 "Post-traumatic stress disorder – NICE Pathways" (in en). NICE pathways – (2005) NICE guideline CG26. 2005. https://pathways.nice.org.uk/pathways/post-traumatic-stress-disorder#content=view-node%3Anodes-interventions-for-symptoms-present-for-more-than-3-months-after-a-trauma. 
  5. ↑ Psychological Treatments, Association of Clinical Psychologists, Division 12 of the American Psychological Association, accessed 25 March 2020
  6. ↑ "Eye Movement Desensitization and Reprocessing for Post-Traumatic Stress Disorder | Society of Clinical Psychology". 6 March 2017. https://www.div12.org/treatment/eye-movement-desensitization-and-reprocessing-for-post-traumatic-stress-disorder/. 
  7. ↑ 7.0 7.1 7.2 Abramowitz, Jonathan S.; Deacon, Brett Jason; Whiteside, Stephen P. H. (2010). Exposure Therapy for Anxiety: Principles and Practice. Guilford Press. ISBN 978-1-60918-016-4. https://books.google.com/books?id=pnoznH2c7esC. 
  8. ↑ EMDR Basic Protocols, Shapiro, 2001, page xi
  9. ↑ Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2, 199-223.
  10. ↑ Shapiro, F. & Forrest, M. (1997). EMDR The Breakthrough Therapy for Overcoming Anxiety, Stress and Trauma. New York: Basic Books
  11. ↑ "History of EMDR - EMDR Institute - EYE MOVEMENT DESENSITIZATION AND REPROCESSING THERAPY". https://www.emdr.com/history-of-emdr/. 
  12. ↑ Glaser, Tom. "How was EMDR Developed?". http://www.tomglaserlp.com/emdr/emdr-history. 
  13. ↑ Shapiro, Francine; Laliotis, Deany (12 October 2010). "EMDR and the adaptive information processing model: Integrative treatment and case conceptualization". Clinical Social Work Journal 39 (2): 191–200. doi:10.1007/s10615-010-0300-7. 
  14. ↑ 14.0 14.1 Shapiro, F (1989). "Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories". Journal of Traumatic Stress 2 (2): 199–223. doi:10.1002/jts.2490020207. 
  15. ↑ UK Nice guidelines: 1.6.20 EMDR for adults should: be based on a validated manual typically be provided over 8 to 12 sessions, but more if clinically indicated, for example if they have experienced multiple traumas be delivered by trained practitioners with ongoing supervision be delivered in a phased manner and include psychoeducation about reactions to trauma; managing distressing memories and situations; identifying and treating target memories (often visual images); and promoting alternative positive beliefs about the self use repeated in-session bilateral stimulation (normally with eye movements[1]) for specific target memories until the memories are no longer distressing include the teaching of self-calming techniques and techniques for managing flashbacks, for use within and between sessions. [2018]
  16. ↑ "Experiencing EMDR Therapy". https://www.emdria.org/about-emdr-therapy/experiencing-emdr-therapy/. 
  17. ↑ 17.0 17.1 17.2 17.3 17.4 17.5 "A meta-analysis of the contribution of eye movements in processing emotional memories". Journal of Behavior Therapy and Experimental Psychiatry 44 (2): 231–239. 2013. doi:10.1016/j.jbtep.2012.11.001. PMID 23266601. https://researchrepository.murdoch.edu.au/id/eprint/13100/1/A_meta-analysis_of_the_contribution_of_eye_movements_in_processing_emotional_memories.pdf. 
  18. ↑ 18.0 18.1 18.2 Bisson, Jonathan I; Roberts, Neil P; Andrew, Martin; Cooper, Rosalind; Lewis, Catrin (13 December 2013). "Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults". Cochrane Database of Systematic Reviews (12): CD003388. doi:10.1002/14651858.CD003388.pub4. PMID 24338345. 
  19. ↑ 19.0 19.1 19.2 19.3 19.4 Cuijpers, Pim; Veen, Suzanne C. van; Sijbrandij, Marit; Yoder, Whitney; Cristea, Ioana A. (11 February 2020). "Eye movement desensitization and reprocessing for mental health problems: a systematic review and meta-analysis". Cognitive Behaviour Therapy 49 (3): 165–180. doi:10.1080/16506073.2019.1703801. PMID 32043428. 
  20. ↑ 20.0 20.1 McNally, Richard J. (Fall 2013). "The evolving conceptualization and treatment of PTSD: A very brief history". Trauma Psychology Newsletter: 7–11. http://traumapsychnews.com/wp-content/uploads/2016/01/newsletter_2013_fall.pdf. 
  21. ↑ "Meta-analysis of the efficacy of treatments for posttraumatic stress disorder". Journal of Clinical Psychiatry 74 (6): e541–550. 2013. doi:10.4088/JCP.12r08225. PMID 23842024. 
  22. ↑ Ehlers, Anke; Bisson, Jonathan; Clark, David M.; Creamer, Mark; Pilling, Steven; Richards, David; Schnurr, Paula P.; Turner, Stuart et al. (March 2010). "Do all psychological treatments really work the same in posttraumatic stress disorder?". Clinical Psychology Review 30 (2): 269–276. doi:10.1016/j.cpr.2009.12.001. PMID 20051310. 
  23. ↑ Vickerman, K. A.; Margolin, G. (2009). "Rape treatment outcome research: Empirical findings and state of the literature". Clinical Psychology Review 29 (5): 431–448. doi:10.1016/j.cpr.2009.04.004. PMID 19442425. 
  24. ↑ Cloitre M (January 2009). "Effective psychotherapies for posttraumatic stress disorder: a review and critique". CNS Spectrums 14 (1 Suppl 1): 32–43. PMID 19169192. 
  25. ↑ 25.0 25.1 Seidler, Guenter H.; Wagner, Frank E. (2 June 2006). "Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: a meta-analytic study". Psychological Medicine 36 (11): 1515–1522. doi:10.1017/S0033291706007963. PMID 16740177. 
  26. ↑ Bradley, R.; Greene, J.; Russ, E.; Dutra, L.; Westen, D. (2005). "A multidimensional meta-analysis of psychotherapy for PTSD". The American Journal of Psychiatry 162 (2): 214–227. doi:10.1176/appi.ajp.162.2.214. PMID 15677582. 
  27. ↑ 27.0 27.1 Devilly, Grant (2002). "Eye movement desensitization and reprocessing: a chronology of its development and scientific standing". The Scientific Review of Mental Health Practice 1 (2): 132. http://devilly.org/Publications/EMDR-review.pdf. 
  28. ↑ Van Etten M. L.; Taylor, S (1998). "Comparative efficacy of treatments for post-traumatic stress disorder: a meta-analysis". Clinical Psychology & Psychotherapy 5 (3): 126–144. doi:10.1002/(SICI)1099-0879(199809)5:3<126::AID-CPP153>3.0.CO;2-H. 
  29. ↑ Schwarz, Jill E.; Baber, Dana; Barter, Ariel; Dorfman, Katherine (2020-01-02). "A Mixed Methods Evaluation of EMDR for Treating Female Survivors of Sexual and Domestic Violence". Counseling Outcome Research and Evaluation 11 (1): 4–18. doi:10.1080/21501378.2018.1561146. 
  30. ↑ Foa EB; Keane TM; Friedman MJ (2009). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies. New York: Guilford Press. 
  31. ↑ National Institute for Clinical Excellence (2005). Post traumatic stress disorder (PTSD): The management of adults and children in primary and secondary care. London: NICE Guidelines. http://www.nice.org.uk/guidance/index.jsp?action=byID&r=true&o=10966. 
  32. ↑ National Institute for Health and Care Excellence (2016). Post-traumatic stress disorder overview: Interventions for symptoms present for more than 3 months after a trauma [1]
  33. ↑ Australian Centre for Posttraumatic Mental Health. (2007). Australian guidelines for the treatment of adults with acute stress disorder and post traumatic stress disorder. Melbourne, Victoria: ACPTMH.. ISBN 978-0-9752246-6-3. http://www.acpmh.unimelb.edu.au/resources/resources-guidelines.html#1. 
  34. ↑ Dutch National Steering Committee Guidelines Mental Health and Care (2003). Guidelines for the diagnosis treatment and management of adult clients with an anxiety disorder. Utrecht, Netherlands: The Dutch Institute for Healthcare Improvement (CBO). [page needed]
  35. ↑ Ursano, RJ; Bell, C; Eth, S; Friedman, M; Norwood, A; Pfefferbaum, B; Pynoos, JD; Zatzick, DF et al. (November 2004). "Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder". The American Journal of Psychiatry 161 (11 Suppl): 3–31. PMID 15617511. 
  36. ↑ Department of Veterans Affairs & Department of Defense (2010). VA/DoD Clinical Practice Guideline for the Management of Post-Traumatic Stress. Washington, DC: Veterans Health Administration, Department of Veterans Affairs and Health Affairs, Department of Defense
  37. ↑ SAMHSA’s National Registry of Evidence-based Programs and Practices (2011)
  38. ↑ Foa, E.B., Keane, T.M., Friedman, M.J., & Cohen, J.A. (2009). Effective Treatments for PTSD: Practice Guidelines of the International Society for Traumatic Stress Studies. New York: Guilford Press.[page needed]
  39. ↑ "Eye Movement Desensitization and Reprocessing (EMDR) Therapy". https://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing. 
  40. ↑ Foa B; Keane TM; Friedman MJ Cohen JA (eds.) (2009). Effective treatments for PTSD: practice guidelines from the International Society for Traumatic Stress Studies (2nd ed.). New York: Guilford Press. ISBN 978-1-60623-001-5. [page needed]
  41. ↑ Adler-Tapia R; Settle C (2008). EMDR and The Art of Psychotherapy With Children. New York: Springer Publishing Co.. ISBN 978-0-8261-1117-3. [page needed]
  42. ↑ Scott CV; Briere J (2006). Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment. Thousand Oaks, California: Sage Publications. pp. 312. ISBN 978-0-7619-2921-5. 
  43. ↑ Moreno-Alcázar, Ana; Treen, Devi; Valiente-Gómez, Alicia; Sio-Eroles, Albert; Pérez, Víctor; Amann, Benedikt L.; Radua, Joaquim (10 October 2017). "Efficacy of Eye Movement Desensitization and Reprocessing in Children and Adolescent with Post-traumatic Stress Disorder: A Meta-Analysis of Randomized Controlled Trials". Frontiers in Psychology 8: 1750. doi:10.3389/fpsyg.2017.01750. PMID 29066991. 
  44. ↑ 44.0 44.1 44.2 44.3 44.4 44.5 44.6 44.7 Logie, Robin (July 2014). "EMDR - more than just a therapy for PTSD?". The Psychologist 27 (7): 512–517. https://thepsychologist.bps.org.uk/volume-27/edition-7/emdr-more-just-therapy-ptsd. 
  45. ↑ Hogan, William Andrew (2001). The comparative effects of eye movement desensitization and reprocessing (EMDR) and cognitive behavioral therapy (CBT) in the treatment of depression (Thesis). OCLC 50743943.[page needed]
  46. ↑ Gauhar, Yasmeen Wajid Mauna (1 January 2016). "The Efficacy of EMDR in the Treatment of Depression". Journal of EMDR Practice and Research 10 (2): 59–69. doi:10.1891/1933-3196.10.2.59. 
  47. ↑ Malandrone, Francesca; Carletto, Sara; Hase, Michael; Hofmann, Arne; Ostacoli, Luca (1 November 2019). "A Brief Narrative Summary of Randomized Controlled Trials Investigating EMDR Treatment of Patients With Depression". Journal of EMDR Practice and Research 13 (4): 302–306. doi:10.1891/1933-3196.13.4.302. 
  48. ↑ Gauvreau, Philippe; Bouchard, Stéphane (March 2008). "Preliminary Evidence for the Efficacy of EMDR in Treating Generalized Anxiety Disorder". Journal of EMDR Practice and Research 2 (1): 26–40. doi:10.1891/1933-3196.2.1.26. 
  49. ↑ Faretta, Elisa; Farra, Mariella Dal (1 November 2019). "Efficacy of EMDR Therapy for Anxiety Disorders". Journal of EMDR Practice and Research 13 (4): 325–332. doi:10.1891/1933-3196.13.4.325. 
  50. ↑ Markus, Wiebren; de Weert – van Oene, Gerdien H.; Woud, Marcella L.; Becker, Eni S.; DeJong, Cornelis A. J. (1 September 2016). "Are addiction-related memories malleable by working memory competition? Transient effects on memory vividness and nicotine craving in a randomized lab experiment". Journal of Behavior Therapy and Experimental Psychiatry 52: 83–91. doi:10.1016/j.jbtep.2016.03.007. PMID 27038191. 
  51. ↑ Recommended Guidelines: A General Guide to EMDR’s Use in the Dissociative Disorders (authored by the EMDR Dissociative Disorders Task Force and published in Shapiro, 1995, 2001)
  52. ↑ p159, Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision, International Society for the Study of Trauma and Dissociation Available online: 03 Mar 2011
  53. ↑ Brown, Susan; Shapiro, Francine (October 2006). "EMDR in the Treatment of Borderline Personality Disorder". Clinical Case Studies 5 (5): 403–420. doi:10.1177/1534650104271773. 
  54. ↑ "Treatment of chronic phantom limb pain using a trauma-focused psychological approach". Pain Research & Management 15 (2): 65–71. 2010. doi:10.1155/2010/981634. PMID 20458374. 
  55. ↑ Wilensky M (2006). "Eye movement desensitization and reprocessing (EMDR) as a treatment for phantom limb pain". Journal of Brief Therapy 5 (1): 31–44. http://emdrtraining.com/files/EMDRforPhantomLimbPain.pdf. 
  56. ↑ Wilson, Sandra A.; Tinker, Robert H.; Becker, Lee A.; Logan, Carol R. (2001). International Journal of Stress Management 8 (3): 179–200. doi:10.1023/A:1011366408693. 
  57. ↑ Fereidouni, Zhila; Behnammoghadam, Mohammad; Jahanfar, Abdolhadi; Dehghan, Azizallah (August 2019). "The Effect of Eye Movement Desensitization and Reprocessing (EMDR) on the severity of suicidal thoughts in patients with major depressive disorder: a randomized controlled trial". Neuropsychiatric Disease and Treatment 15: 2459–2466. doi:10.2147/NDT.S210757. PMID 31695382. 
  58. ↑ Griffioen, Brecht T.; van der Vegt, Anna A.; de Groot, Izaäk W.; de Jongh, Ad (8 November 2017). "The Effect of EMDR and CBT on Low Self-esteem in a General Psychiatric Population: A Randomized Controlled Trial". Frontiers in Psychology 8: 1910. doi:10.3389/fpsyg.2017.01910. PMID 29167649. 
  59. ↑ Markus, Wiebren; de Weert – van Oene, Gerdien H.; Woud, Marcella L.; Becker, Eni S.; DeJong, Cornelis A. J. (1 September 2016). "Are addiction-related memories malleable by working memory competition? Transient effects on memory vividness and nicotine craving in a randomized lab experiment". Journal of Behavior Therapy and Experimental Psychiatry 52: 83–91. doi:10.1016/j.jbtep.2016.03.007. PMID 27038191. 
  60. ↑ Tesarz, Jonas; Wicking, Manon; Bernardy, Kathrin; Seidler, Günter H. (1 November 2019). "EMDR Therapy's Efficacy in the Treatment of Pain". Journal of EMDR Practice and Research 13 (4): 337–344. doi:10.1891/1933-3196.13.4.337. 
  61. ↑ Lobregt-van Buuren, Ella; Sizoo, Bram; Mevissen, Liesbeth; de Jongh, Ad (25 July 2018). "Eye Movement Desensitization and Reprocessing (EMDR) Therapy as a Feasible and Potential Effective Treatment for Adults with Autism Spectrum Disorder (ASD) and a History of Adverse Events". Journal of Autism and Developmental Disorders 49 (1): 151–164. doi:10.1007/s10803-018-3687-6. PMID 30047096. 
  62. ↑ Scelles, Charles; Bulnes, Luis Carlo. (20 September 2021). "EMDR as a treatment option for conditions other than PTSD: A Systematic Review". Frontiers in Psychology 12: 644369. doi:10.3389/fpsyg.2021.644369.  CC-BY icon.svg Text was copied from this source, which is available under a Creative Commons Attribution 4.0 International License.
  63. ↑ Valiente-Gómez, Alicia; Moreno-Alcázar, Ana; Treen, Devi; Cedrón, Carlos; Colom, Francesc; Pérez, Víctor; Amann, Benedikt L. (26 September 2017). "EMDR beyond PTSD: A Systematic Literature Review". Frontiers in Psychology 8: 1668. doi:10.3389/fpsyg.2017.01668. PMID 29018388. 
  64. ↑ Solomon, Roger M.; Shapiro, Francine (November 2008). "EMDR and the Adaptive Information Processing ModelPotential Mechanisms of Change". Journal of EMDR Practice and Research 2 (4): 315–325. doi:10.1891/1933-3196.2.4.315. 
  65. ↑ "Theory - EMDR Institute - EYE MOVEMENT DESENSITIZATION AND REPROCESSING THERAPY". https://www.emdr.com/theory/. 
  66. ↑ "Mel B is watching flashing lights to help with trauma. But does EMDR therapy really work?". 10 September 2018. https://www.theguardian.com/lifeandstyle/2018/sep/10/mel-b-is-watching-flashing-lights-to-help-with-trauma-but-does-emdr-therapy-really-work. 
  67. ↑ Boccia, Maddalena; Piccardi, Laura; Cordellieri, Pierluigi; Guariglia, Cecilia; Giannini, Anna Maria (21 April 2015). "EMDR therapy for PTSD after motor vehicle accidents: meta-analytic evidence for specific treatment". Frontiers in Human Neuroscience 9: 213. doi:10.3389/fnhum.2015.00213. PMID 25954183. 
  68. ↑ Shapiro, Francine (October 2007). "EMDR, Adaptive Information Processing, and Case Conceptualization". Journal of EMDR Practice and Research 1 (2): 68–87. doi:10.1891/1933-3196.1.2.68. 
  69. ↑ "The AIP Model of EMDR Therapy and Pathogenic Memories". Frontiers in Psychology 8: 1578. 2017-09-21. doi:10.3389/fpsyg.2017.01578. PMID 28983265. 
  70. ↑ van den Hout, Marcel A.; Engelhard, Iris M.; Beetsma, Daniel; Slofstra, Christien; Hornsveld, Hellen; Houtveen, Jan; Leer, Arne (1 December 2011). "EMDR and mindfulness. Eye movements and attentional breathing tax working memory and reduce vividness and emotionality of aversive ideation". Journal of Behavior Therapy and Experimental Psychiatry 42 (4): 423–431. doi:10.1016/j.jbtep.2011.03.004. PMID 21570931. 
  71. ↑ Chen, Ling; Zhang, Guiqing; Hu, Min; Liang, Xia (June 2015). "Eye Movement Desensitization and Reprocessing Versus Cognitive-Behavioral Therapy for Adult Posttraumatic Stress Disorder". The Journal of Nervous and Mental Disease 203 (6): 443–451. doi:10.1097/NMD.0000000000000306. PMID 25974059. 
  72. ↑ Verger, A.; Rousseau, P. F.; Malbos, E.; Chawki, M. B.; Nicolas, F.; Lançon, C.; Khalfa, S.; Guedj, E. (2020). "Involvement of the cerebellum in EMDR efficiency: a metabolic connectivity PET study in PTSD". European Journal of Psychotraumatology 11 (1). doi:10.1080/20008198.2020.1767986. PMID 33029312. 
  73. ↑ Rousseau, Pierre-François; Boukezzi, Sarah; Garcia, René; Chaminade, Thierry; Khalfa, Stéphanie (August 2020). "Cracking the EMDR code: Recruitment of sensory, memory and emotional networks during bilateral alternating auditory stimulation". Australian & New Zealand Journal of Psychiatry 54 (8): 818–831. doi:10.1177/0004867420913623. PMID 32271126. 
  74. ↑ Verger, A.; Rousseau, P. F.; Malbos, E.; Chawki, M. B.; Nicolas, F.; Lançon, C.; Khalfa, S.; Guedj, E. (2020-12-31). "Involvement of the cerebellum in EMDR efficiency: a metabolic connectivity PET study in PTSD". European Journal of Psychotraumatology 11 (1): 1767986. doi:10.1080/20008198.2020.1767986. PMID 33029312. 
  75. ↑ Fox, Jeremy G. (2020-08-01). "Recovery, Interrupted: The Zeigarnik Effect in EMDR Therapy and the Adaptive Information Processing Model". Journal of EMDR Practice and Research 14 (3): 175–185. doi:10.1891/EMDR-D-20-00011. 
  76. ↑ 76.0 76.1 Jeffries, Fiona W.; Davis, Paul (29 October 2012). "What is the Role of Eye Movements in Eye Movement Desensitization and Reprocessing (EMDR) for Post-Traumatic Stress Disorder (PTSD)? A Review". Behavioural and Cognitive Psychotherapy 41 (3): 290–300. doi:10.1017/S1352465812000793. PMID 23102050. 
  77. ↑ A slowing of brain waves has been seen during bilateral stimulation (eye movement), somewhat similar to what occurs during sleep.Pagani, Marco; Amann, Benedikt L.; Landin-Romero, Ramon; Carletto, Sara (7 November 2017). "Eye Movement Desensitization and Reprocessing and Slow Wave Sleep: A Putative Mechanism of Action". Frontiers in Psychology 8: 1935. doi:10.3389/fpsyg.2017.01935. PMID 29163309. [unreliable medical source] A possibly related finding is that brain waves during EMDR treatment shows changes in brain activity, specifically the limbic system showed its highest level of activity prior to commencing EMDR treatment."Neurobiological correlates of EMDR monitoring – an EEG study". PLOS ONE 7 (9): e45753. 2012-09-26. doi:10.1371/journal.pone.0045753. PMID 23049852. Bibcode: 2012PLoSO...745753P. [unreliable medical source]
  78. ↑ Rodenburg, Roos; Benjamin, Anja; de Roos, Carlijn; Meijer, Ann Marie; Stams, Geert Jan (November 2009). "Efficacy of EMDR in children: A meta-analysis". Clinical Psychology Review 29 (7): 599–606. doi:10.1016/j.cpr.2009.06.008. PMID 19616353. 
  79. ↑ Rousseau, Pierre-François; Boukezzi, Sarah; Garcia, René; Chaminade, Thierry; Khalfa, Stéphanie (August 2020). "Cracking the EMDR code: Recruitment of sensory, memory and emotional networks during bilateral alternating auditory stimulation". Australian & New Zealand Journal of Psychiatry 54 (8): 818–831. doi:10.1177/0004867420913623. PMID 32271126. 
  80. ↑ Roberts, Brady R. T.; Fernandes, Myra A.; MacLeod, Colin M.; Manelis, Anna (27 January 2020). "Re-evaluating whether bilateral eye movements influence memory retrieval". PLOS ONE 15 (1): e0227790. doi:10.1371/journal.pone.0227790. PMID 31986171. Bibcode: 2020PLoSO..1527790R. "No evidence of a SIRE effect was found: Bayesian statistical analyses demonstrated significant evidence for a null effect. Taken together, these experiments suggest that the SIRE effect is inconsistent. The current experiments call into question the generalizability of the SIRE effect and suggest that its presence is very sensitive to experimental design. Future work should further assess the robustness of the effect before exploring related theories or underlying mechanisms.". 
  81. ↑ Salkovskis P (February 2002). "Review: eye movement desensitization and reprocessing is not better than exposure therapies for anxiety or trauma". Evidence-Based Mental Health 5 (1): 13. doi:10.1136/ebmh.5.1.13. PMID 11915816. 
  82. ↑ Davidson, Paul R.; Parker, Kevin C. H. (2001). "Eye movement desensitization and reprocessing (EMDR): A meta-analysis.". Journal of Consulting and Clinical Psychology 69 (2): 305–316. doi:10.1037//0022-006x.69.2.305. PMID 11393607. 
  83. ↑ McNally, Richard J (November 1999). "On Eye Movements and Animal Magnetism". Journal of Anxiety Disorders 13 (6): 617–620. doi:10.1016/S0887-6185(99)00020-1. 
  84. ↑ 84.0 84.1 84.2 "Science and pseudoscience in the development of eye movement desensitization and reprocessing: implications for clinical psychology". Clinical Psychology Review 20 (8): 945–71. November 2000. doi:10.1016/s0272-7358(99)00017-3. PMID 11098395. 
  85. ↑ Pitman, Roger K; Orr, Scott P; Altman, Bruce; Longpre, Ronald E; Poiré, Roger E; Macklin, Michael L (November 1996). "Emotional processing during eye movement desensitization and reprocessing therapy of vietnam veterans with chronic posttraumatic stress disorder". Comprehensive Psychiatry 37 (6): 419–429. doi:10.1016/s0010-440x(96)90025-5. PMID 8932966. 
  86. ↑ Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2, 199-223.
  87. ↑ Shapiro, F. & Forrest, M. (1997). EMDR The Breakthrough Therapy for Overcoming Anxiety, Stress and Trauma. New York: Basic Books
  88. ↑ "History of EMDR - EMDR Institute - EYE MOVEMENT DESENSITIZATION AND REPROCESSING THERAPY". https://www.emdr.com/history-of-emdr/. 
  89. ↑ Armstrong, Michael S; Vaughan, Kevin (March 1996). "An orienting response model of eye movement desensitization". Journal of Behavior Therapy and Experimental Psychiatry 27 (1): 21–32. doi:10.1016/0005-7916(95)00056-9. PMID 8814518. 
  90. ↑ Shapiro; "FS: It’s been demonstrated in about 16 randomized controlled trials now that the eye movement also rapidly causes the vividness to shift and emotion to decrease." https://www.psychotherapy.net/interview/francine-shapiro-emdr#section-eye-movement
  91. ↑ McNally, Richard J. (1999). "Research on eye movement desensitization and reprocessing (EMDR) as a treatment for PTSD". PTSD Research Quarterly 10 (1): 1–7. https://www.hsdl.org/?view&did=13105. 
  92. ↑ Sikes, Charlotte; Sikes, Victoria (2003). "EMDR: Why the controversy?". Traumatology 9 (3): 169–182. doi:10.1177/153476560300900304. 
  93. ↑ Arkowitz, Hal; Lilienfeld, Scott (August 1, 2012). "EMDR: Taking a Closer Look Can moving your eyes back and forth help to ease anxiety?". https://www.scientificamerican.com/article/emdr-taking-a-closer-look/. "So, now to the bottom line: EMDR ameliorates symptoms of traumatic anxiety better than doing nothing and probably better than talking to a supportive listener. Yet not a shred of good evidence exists that EMDR is superior to exposure-based treatments that behavior and cognitive-behavior therapists have been administering routinely for decades. Paraphrasing British writer and critic Samuel Johnson, Harvard University psychologist Richard McNally nicely summed up the case for EMDR: 'What is effective in EMDR is not new, and what is new is not effective.'" 
  94. ↑ Shipley, Gemma; Wilde, Sarah; Hudson, Mark (April 2021). "What do clients say about their experiences of Eye Movement Desensitisation and Reprocessing therapy? A systematic review of the literature.". European Journal of Trauma & Dissociation: 100226. doi:10.1016/j.ejtd.2021.100226. 
  95. ↑ Novella, Steven (March 30, 2011). "EMDR and Acupuncture – Selling Non-specific Effects". Society for SBM. https://sciencebasedmedicine.org/emdr-and-acupuncture-selling-non-specific-effects/. 
  96. ↑ 96.0 96.1 Rosen, Gerald M; Mcnally, Richard J; Lilienfeld, Scott O (1999). "Eye Movement Magic: Eye Movement Desensitization and Reprocessing". Skeptic 7 (4). http://www.skeptic.com/eskeptic/14-05-21/#feature. 
  97. ↑ McNally, R. J. (2003). "The demise of pseudoscience". The Scientific Review of Mental Health Practice 2 (2): 97–101. https://www.srmhp.org/0202/pseudoscience.html. 




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