Vad är EMDR


Forskning: Research and Evidence Base for EMDR
(from EMDR-Europe)

Marco Pagani:

Pretreatment, Intratreatment, and Posttreatment EEG
Imaging of EMDR: Methodology and Preliminary
Results From a Single Case 2011 pdf »

Marco Pagani:

Neurobiological Correlates of EMDR Monitoring – An EEG
Study, 2012 pdf »

Francine Shapiro Library:

Research Findings 101027 from EMDR HAP
Senaste i Forskningen som redovisades på EMDR-Europe konferens i Amsterdam 4-7 juni 2009.  LÄNK: Reseach-2009-fin.pdf

Göran Högbergs doktorsavhandling:

Post-Traumatic Stress Disorder, Neurobiology and Effects of Eye Movement Desensitization and Reprocessing

EMDR behandling för barn med PTSD:

En kontrollerad studie av Abdulbaghi Ahmad, Viveka Sundelin
Applying EMDR-on-children.pdf

Post-Traumatic Stress Disorder, Neurobiology and Effects of Eye Movement Desensitization and Reprocessing.
Göran Högberg,  akademisk avhandling för avläggande av medicine doktorsexamen vid Karolinska Institutet. Avhandlingen försvarades offentligen den 25 April, kl 9.00.

2005 SBU-sammanfattning, EMDR (Eye Movement Desensitization and Reprocessing), som omfattar en kombination av ögonrörelser och beteendeterapi, har effekt vid PTSD (Evidensstyrka 2) men ögonrörelserna saknar specifik terapeutisk betydelse (Evidensstyrka 1).pdf

Bisson-2007-Cochrane1.pdf

Authors’ conclusions:

There was evidence individual TFCBT, EMDR, stress management and group TFCBT are effective in the treatment of PTSD. Other non-trauma focused psychological treatments did not reduce PTSD symptoms as significantly. There was some evidence that individual TFCBT and EMDR are superior to stress management in the treatment of PTSD at between 2 and 5 months following treatment, and also that TFCBT, EMDR and stress management were more effective than other therapies. There was insufficient evidence to determine whether psychological treatment is harmful. There was some evidence of greater drop-out in active treatment groups. The considerable unexplained heterogeneity observed in these comparisons, and the potential impact of publication bias on these data, suggest the need for caution in interpreting the results of this review.

Plain language summery:

Psychological treatments can reduce symptoms of post traumatic stress disorder (PTSD). Trauma focused treatments are more effective than non-trauma focused treatments.
This review concerns the efficacy of psychological treatment in the treatment of PTSD. There is evidence that individual trauma focused cognitive-behavioural therapy (TFCBT), eye movement desensitisation and reprocessing (EMDR), stress management and group TFCBT are effective in the treatment of PTSD. Other non-trauma focused psychological treatments did not reduce PTSD symptoms as significantly. There is some evidence that individual TFCBT and EMDR are superior to stress management in the treatment of PTSD at between 2 and 5 months following treatment, and also that TFCBT, EMDR and stress management are more effective than other therapies. There is insufficient evidence to show whether or not psychological treatment is harmful. Trauma focused cognitive behavioural therapy or eye movement desensitisation and reprocessing should be considered in individuals with PTSD.

2007-Psychological-treatment-of-PTSD-Cochrane-MetaReview-la.doc

Recent Research Articles on EMDR June 2006 EMDRIA Newsletter
Please click EMDR efficacy to see current research relating to the efficacy of EMDR

Introduction:

EMDR was originally designed to treat traumatic or ”dysfunctional” memories and experiences and their psychological consequences, and although the procedure has increasingly been used to treat a wide range of experientially based disorders, e.g., anxiety, panic attacks, sexual dysfunction, work performance, panic disorder, pain etc., it has primarily been used in the treatment of post traumatic stress disorder.

The evidence base for modern psychotherapies is usually assessed through what are known as randomised controlled studies (RCTs). These are scientific and objective ways of comparing the treatment with another treatment, or with a waiting list control, or by comparing the effectiveness of the procedure with some of its elements removed. There were only six RCTs across all psychological treatments for PTSD from 1980 when the diagnosis of PTSD entered the psychiatric diagnostic system (DSM-III) up until 1992 (Solomon et al 1992). In contrast since Shapiro (1989) published her seminal study on EMDR and PTSD there have been well over 100 case studies published on EMDR and 18 RCTs just on EMDR and PTSD alone (up until 2003). This amounts to significantly more research into EMDR then for any other psychological or psychopharmacological approach to PTSD, and provides the strong basis on which evidence can be adjudged. Morover there are now a number of national and professional guidelines endorsing EMDR as an effective psychotherapy on the basis of the research to date.

Outlined below are some of the most important research and guideline references relating to the evidence base of EMDR.

National and International Guidelines:

1. In an independent study for the American APA (American Psychological Association) Chambless et al (1998) found that EMDR, together with exposure, and ”stress inoculation training” were the only empirically supported treatments for civilian PTSD.

2. In the U.S.A. the VA/DoD Clinical Guideline for the Management of PTSD for the Department of Veterans Affairs, Department of Defence 2004 only 4 Psychotherapies including EMDR, and one drug have the highest level of recommendation.

3. The ISTSS (The International Society for Traumatic Stress Studies) in a study carried out by Chemtob et al (2000) designated EMDR as efficacious for PTSD.

4. The Swedish Council on Technology Assessment in Healthcare (SBU 2001) assigned only EMDR a ”moderate” scientific evidence rating for treatment of PTSD in young people. No other methods were given such a rating.

5. In Northern Ireland the CREST official guidelines on the management of PTSD in adults in Northern Ireland (2003) designated EMDR and Cognitive Behavioural Therapy as effective in the treatment of PTSD.

6. The Israeli National Council for Mental Health guidelines for the assessment and professional intervention with terror victims (Bleich et al 2002) designated only EMDR, Cognitive Behavioural Therapy and some hypnotic techniques as effective treatments.

7. The U.K. Department of Health evidence based clinical practice guidelines for the treatment of PTSD (DOH 2001) or (www.doh.gov.uk/mentalhealth/treatmentguideline) designated cognitive behavioural methods, stress inoculation and EMDR as having ”best evidence of efficacy”.

Meta-Analyses:

Meta-Analyses are studies which analyse a wide range of RCTs on a particular area such as EMDR and synthesise the results into overall conclusions.

1. Van Etten and Taylor (1998). Comparative efficacy of treatments for PTSD:- A Meta-Analysis. This Meta-Analysis determined that EMDR and behaviour therapy were superior to psychopharmaceuticals. EMDR was more efficient than behaviour therapy with results obtained in one third of the time.

2. Davidson and Parker (2001). Eye movement desensitisation and reprocessing (EMDR):- A Meta-Analysis. They concluded EMDR was equivalent to exposure and other cognitive behavioural treatments. It should be noted that exposure therapy uses one to two hours of daily homework and EMDR uses none.

3. Maxfield and Hyer (2002). The relationship between efficacy and methodology in studies investigating EMDR treatment of PTSD. This comprehensive Meta-Analysis reported that the more rigorous the study the larger the effect size was in favour of EMDR.

Randomised Controlled Trials (RCTs):

1. Shapiro (1989). This seminal study indtroduced the EMD procedure to the scientific and clinical community and demonstrated its effectiveness with a group of rape, molestation and war veterans with PTSD.

2. Boudewyns et al (1993). This study had mixed results for EMDR but conclusions were limited by the absence of blind assessors and the use of only two sessions with complex PTSD clients.

3. Vaughan et al (1994). The first study to compare EMDR with an exposure treatment indicated greater reductions in PTSD symptoms in the EMDR group across all measure with significantly greater reductions for intrusive memories.

4. Renfrey and Spates (1994). In a component analysis compared EMDR to the procedure with visual attention held static. No significant differences were found between treatment conditions although the authors acknoweledged ”an observed tendency for the two treatment conditions that involved eye movements to appear more efficient”.

5. Wilson et al (1995). Compared EMDR to wait list controls and demonstrated significant improvements in the EMDR group across all measures maintained at three month follow up.

6. Pitman et al (1996). In a component analysis they compared EMDR with a control group where eyes were held static. No significant differences were found between treatment conditions although Pitman et al commented on the speed of improvements in the EMDR procedure in relation to their imaginal flooding procedure in the same journal edition.

7. Boudewyns and Hyer (1996). Showed EMDR and EMDR without eye movements were roughly equal in significantly improving outcomes over a standard group in-patient treatment.

8. Wilson et al (1996). Compared EMDR to the procedure with eyes held static in a component analysis. Only the eye movement group showed complete desensitisation to anxiety.

9. Rothbaum (1997). Compared female rape victims treated with EMDR to those on a wait list control. Results showed that after EMDR 90% of the participants no longer met full criteria for PTSD and EMDR treated subjects improved significantly more on PTSD and depression than wait list controls.

10. Marcus et al (1997). Showed EMDR produced significantly greater improvements over a standard care treatment group on measures of PTSD, depression and anxiety.

11. Carlson et al (1998). Showed EMDR to be significantly more effective than a biofeedback assisted relaxation group and a wait list control.

12. Scheck et al (1998). Compared EMDR with an ”active listening” approach with EMDR showing significantly greater improvements on all measures.

13. Rogers et al (1999) *. Compared process of EMDR versus exposure over one extended session, with EMDR showing greater positive changes over significant measures.

14. Devilly and Spence (1999). Found cognitive behaviour therapy significantly more effective than EMDR. However, both delivery of EMDR, and the randomisation procedures in this study, were unorthodox.

15. Ironson et al (2002) *. Found EMDR and prolonged exposure equally effective in treating PTSD victims although EMDR was significantly more efficient (faster) with a significantly lower drop out rate.

16. Lee et al (2002) *. Compared EMDR with stress inoculation training plus prolonged exposure. EMDR showed significantly greater improvement on trauma and distress measures at 3 month follow up. Otherwise there were no significant differences between treatments.

17. Power et al (2002) *. In the largest comparison of EMDR with exposure so far, with the longest follow up (15 months), EMDR and exposure plus cognitive restructuring were shown to be equally effective but EMDR was shown to be 50% more efficient (faster).

18. Taylor et al (2003). Found exposure superior to EMDR on two out of ten sub scales. However, the exposure group had the addition of ”in vivo” exposure, as well as one hour of daily homework, extras not available to the EMDR group.

Overall Conclusions:

Overall, EMDR appears to be an effective and particularly efficient therapeutic procedure for the treatment of civilian PTSD. As with all other current PTSD treatments, evidence for its utility in treating complex and multiple trauma is less convincing although when sufficient treatment time is given (in excess of the three sessions so commonly applied), eg., Marcus et al 1997, and Carlson et al 1998, the effectiveness of EMDR is impressive even with complex trauma. Five out of seven direct comparisons of EMDR with exposure treatments for PTSD indicate superiority for EMDR, especially in terms of efficiency (speed of effects).