I wanted to expand on this. In practice, you will see many different types of intervention, but they can be broken down into groups. Below are some of those groups. I'll try to expand on them later...
You have Evidence Based Therapies, usually with multiple studies to back up their outcomes, the best compare to waitlist, alternative generally recognized therapy, and some form of placebo.
On the darker side of things you have therapies that fall into the categories of Unscientific/Pseudoscientific and Scientific but Not Indicated by Research.
In the Unscientific/Pseudoscientific category you have your Energy therapies that generally can't be tested or that you have to "believe in."
In the Scientific But Not Indicated By Research categories you have NLP, EMDR, and others that make claims about the way something works that are testable, but despite the ability to be tested have not shown been evidenced as having a valid mechanism of function.
EMDR psychotherapy has been empirically validated in over 24 randomized studies of trauma victims. It is considered one of the three treatments of choice for trauma (along with CBT and PE) by organizations such as ISTSS (International Society for Traumatic Stress Studies), American Psychiatric Association American Psychological Association, Dept of Veteran Affairs, Dept of Defense, Departments of Health in Northern Ireland, UK, Israel, the Netherlands, France, and other countries and organizations.
See 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. EMDR was listed as an effective and empirically supported treatment for PTSD, and was given an AHCPR A rating for adult PTSD.
Last summer the World Health Organization invited me to peer review draft mhGAP WHO guidelines in the area of PTSD, acute stress and bereavement. Since then, these guidelines have been finalized by the Guidelines Development Group of external experts and approved by the WHO Guideline Review Committee. As one of the reviewers on their panel of PTSD experts who spent a year poring scrupulously over all the research, I am able to share their guidelines with you.
First, the WHO description of EMDR for PTSD:
"Eye movement desensitization and reprocessing (EMDR) therapy is based on the idea that negative thoughts, feelings and behaviours are the result of unprocessed memories. The treatment entails standardized procedures that include focusing simultaneously on (a) spontaneous associations of traumatic images, thoughts, emotions and bodily sensations and (b) bilateral stimulation most commonly in the form of repetitive eye movements. Like CBT with a trauma focus, EMDR therapy aims to reduce subjective distress and strengthen adaptive cognitions related to the traumatic event. Unlike CBT with a trauma focus, EMDR therapy involves treatment that is conducted without detailed descriptions of the event, without direct challenging of beliefs, and without extended exposure."
Here are WHO's "guidelines on problems and disorders specifically related to stress." (In press):
Individual or group cognitive behavioural therapy (CBT) with a trauma focus, eye movement desensitization and reprocessing (EMDR), or stress management should be considered for adults with posttraumatic stress disorder (PTSD).
"Individual or group cognitive behavioural therapy (CBT) with a trauma focus or eye movement desensitization and reprocessing (EMDR) should be considered for children and adolescents with posttraumatic stress disorder (PTSD)."
In addition, as noted in the American Psychiatric Association Practice Guidelines (2004, p.18), in EMDR traumatic material need not be verbalized; instead, patients are directed to think about their traumatic experiences without having to discuss them. Given the reluctance of many combat veterans to divulge the details of their experience, this factor is relevant to willingness to initiate treatment, retention and therapeutic gains. It may be one of the factors responsible for the lower remission and higher dropout rate noted in this population when CBT techniques are used."
And, unlike CBT or Prolonged Exposure (PE), without any homework between sessions. The lack of the necessity for detailed descriptions of memories is a major benefit for survivors or war trauma, as well as survivors of any violence.
The Department of Veterans Affairs & Department of Defense's 2010 VA/DoD Clinical Practice Guideline for the Management of Post-Traumatic Stress placed EMDR in the category of the most effective PTSD psychotherapies. This A category is described as A strong recommendation that clinicians provide the intervention to eligible patients. Good evidence was found that the intervention improves important health outcomes and concludes that benefits substantially outweigh harm."
So you can continue to believe the detractors, like Lilienfeld & Lohr, or others that were cited on this site (all research from around 1999) or look at subsequent research such as:
SAMHSAs National Registry of Evidence-based Programs and Practices (2011)
http://nrepp.samhsa.gov/ViewIntervention.aspx?id=199
"The Substance Abuse and Mental Health Services Administration (SAMHSA) is an agency of the U.S. Department of Health and Human Services (HHS). This national registry (NREPP) cites EMDR as evidence based practice for treatment of PTSD, anxiety, and depression symptoms. Their review of the evidence also indicated that EMDR leads to an improvement in mental health functioning."
And, see Arabia, E., Manca, M.L. & Solomon, R.M. (2011). EMDR for survivors of life-threatening cardiac events: Results of a pilot study. Journal of EMDR Practice and Research, 5, 2-13.
Forty-two patients undergoing cardiac rehabilitation... were randomized to a 4-week treatment of EMDR or imaginal exposure (IE)... EMDR was effective in reducing PTSD, depressive, and anxiety symptoms and performed significantly better than IE for all variables... Because the standardized IE procedures used were those employed in-session during [prolonged exposure] the results are also instructive regarding the relative efficacy of both treatments without the addition of homework.
And, note, for a diagnosis other than PTSD, see Wanders, F., Serra, M., & de Jongh, A. (2008). EMDR Versus CBT for children with self-esteem and behavioral problems: A randomized controlled trial. Journal of EMDR Practice and Research, 2, 180-189.
"Twenty-six children (average age 10.4 years) with behavioral problems were randomly assigned to receive either 4 sessions of EMDR or CBT. Both were found to have significant positive effects on behavioral and self-esteem problems, with the EMDR group showing significantly larger changes in target behaviors."
Re: mechanism of action, see Lee, C.W., Taylor, G., & Drummond, P.D. (2006). The active ingredient in EMDR: Is it traditional exposure or dual focus of attention? Clinical Psychology and Psychotherapy, 13, 97-107.
"This study tested whether the content of participants responses during EMDR is similar to that thought to be effective for traditional exposure treatments (reliving), or is more consistent with distancing which would be expected given Shapiros proposal of dual focus of attention. Greatest improvement on a measure of PTSD symptoms occurred when the participant processed the trauma in a more detached manner, which indicates the underlying mechanisms of EMDR and exposure therapy are different."
For the most up-to-date research, see <http://www.emdr.com/index.php?option=com_content&view=article&id=12&Itemid=18>
Respectfully,
Dr. Patti Levin
