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Emerald Group Publishing Limited
Copyright © 2011, Emerald Group Publishing Limited
Article Type: Internet review From: Health Education, Volume 111, Issue 6
Eye movement desensitisation and reprocessing (EMDR)
EMDR is a relatively new form of treatment for Acute Stress Disorder (ASD), Post Traumatic Stress Disorder (PTSD), as well as a number of other anxiety related disorders, and even the symptoms associated with traumatic events, such as sexual abuse.
In the original method developed by Dr Francine Shapiro in 1987, patients would be asked to recall an image or negative cognition associated with the traumatic event while watching the therapist’s finger as it was moved from side-to-side. This would be repeated until the distressing memory was reduced and replaced by more adaptive cognitions. It was assumed that EMDR worked by reprocessing suppressed distressing memories.
The use of EMDR is controversial, not least because there appears to be very little undersatnding of the theoretical basis for the treatment. Indeed, some people argue that the eye movements themselves are irrelevant, and that EMDR is really only another form of cognitive desensitisation.
Despite these controversies, EMDR has now been recognised as an effective treatment, particularly for PTSD, by the National Institute for Clinical Excellence (NICE), the USA Committee on the treatment of PTSD, the American Psychiatric Association, and the Australian Centre for Posttraumatic Mental Health.
There are also an increasing number of online EMDR services that can be used for self-help, or in conjunction with an existing therapeutic regime. These are the focus of this review.
Eye movement desensitisation and reprocessing (EMDR) in treatment of post-traumatic stress disorder (PTSD): www.acc.co.nz/PRD_EXT_CSMP/groups/external_communications/documents/reports_results/prd_ctrb075418.pdf
This brief report is only six pages long but it does give a very good overview and summary of the status of EMDR as a treatment for PTSD. The published report begins with a very short description of EMDR and how it is practiced by therapists.
Based on published systematic reviews of EMDR this report brings together the main findings in a format that is easily accessible and quickly digested. Ten different sources were used for the report including psychInfo, scopus, Medline, the Cochrane Central Register of Controlled Trials, as well as Google and Google Scholar, so the findings have considerable legitimacy.
The information from these sources was distilled into four key papers, three of which gives full support for the use of EMDR in the treatment of PTSD.
The overall conclusion reached in this publication is that the evidence published to date does suggest, that despite some controversy, and the need for further clinical trials, the clinical benefits of EMDR in the management of PTSD have been clearly identified.
For someone new to EMDR, who wants a quick overview, that is evidence based, then this report would be an excellent place to start.
Kali Munro: www.kalimunro.com/emdr7.html
Kali Munro is a Psychotherapist based in Toronto, Canada, who specializes in online psychotherapy, either through e-mails or telephone conversations. She can help with a wide range of problems including relationships, addictions, body image, and emotional difficulties. Her primary psychotherapeutic tool appears to be EMDR and the web site provides an excellent insight into the treatment. She describes in detail a typical treatment session, what will happen, how you will feel, and she even makes a limited attempt to explain how EMDR might work. The language used is non-technical and easy to follow and it is presented in manageable chunks that do not overwhelm the user. The major problem with this web site is that it preaches the virtues of EMDR, it professes to be an online psychotherapy web site, and yet it is not possible to access EMDR online. In fact the web site does not make it clear just how EMDR can be accessed. Presumably, it will be through the therapist’s office, and indeed the full address is given, but nowhere is it made clear that this is the route that must be taken if EMDR is required. The designers of this web site should consider adding an online EMDR service if they want to meet the expectations of their users.
Sonoma Psychotherapy Training Institute: www.sonomapti.com/index.html
The Sonoma Psychotherapy Training Institute, based in Santa Rosa, California, describes itself as an evidence-based postgraduate training institution, specializing in the diagnosis and treatment of trauma. The courses on offer are available on site or via distance learning. The web site does not offer any online therapy, but is does provide a large number of online resources for interested users. Under the heading of “About EMDR” there are links to Treatment Guidelines taken from reputable sources (including NICE) across the world. There are links to meta-analyses, controlled studies, neurobiological evaluations, online EMDR databases, and much more. For the academic, clinician or even the layperson seeking therapeutic help, they will all find something useful in this web site. The web site also has a comprehensive online bookshop, though the books themselves are actually purchased through the Amazon Bookstore.
EMDR was originally developed for the treatment of stress and anxiety. However, therapists and clinicians are now seeking to expand the use of EMDR into other clinical problems and the web site gives some examples of many of these. They include using EMDR for the treatment of phantom limb pain, vaginismus, depression, OCD and even paedophilia. In most cases only the reference is provided, but occasionally there is a link to the actual publication.
Whether you are looking for EMDR training or simply want to acquaint yourself with the literature on EMDR, this is an excellent web site and is highly recommended.
EMDR International Association: www.emdria.org/
EMDRIA is the professional body for EMDR practitioners. Its mission statement reads, “The EMDR International Association (EMDRIA) is a membership organization of mental health professionals dedicated to the highest standards of excellence and integrity in EMDR.” Founded in 1995 the association provides professional support and training for clinicians who wish to use EMDR. For laypeople the main interest in this site will be the section on finding a therapist. This appears to be quite sophisticated in that users can give details of their particular problem, where they live, type of therapist required and so on. Unfortunately, if the user specifies that all terms entered should be used in the search, the results are invariably zero. If the user specifies any of the terms entered should be used, then the whole list of therapists on the database is returned. Not much use if the user is looking for a therapist in the UK and the vast majority returned are based in the USA.
Academics and health professionals who have an interest in EMDR will find this web site useful. The research section is excellent and includes access to the Francine Shapiro Library, which is based at Northern Kentucky University and gives access to a collection of papers going back 15 years. The library has over 600 journals, though, for copyright reasons, not all are fully accessible. Presumably, the journals are listed because at some time they have published something on EMDR, though why the Journal of Swimming Research would be included seems a little incongruent.
Resources for Researchers is a very interesting addition to this section. Here, researchers into EMDR can find advice on designing research projects, a list of outcome measures that can be used in psychotherapy research, and even advice on how to ensure the fidelity of the EMDR protocol used in research.
The web site also has a shop, though the stock is rather meagre, a DVD of Francine Shapiro giving a conference presentation, EMDR brochures for clients, and two items of jewellery, but surprisingly no books.
For professionals and academics this web site has a lot to offer, but laypeople will not find much of interest.
Is this the future for online therapy? This web site offers an online package of therapy that doesn’t involve any interaction with a real therapist. The therapy used is described as Eye Movement Memory Processing (EMMP), though the description given makes it sound very like EMDR, and the URL is something of a giveaway as well! For $10 a user can buy a single session and since the web site guarantees “less stress in 20 minutes”, this could be something of a bargain!
The difficulty of course is in assessing the efficacy of this type of web site, which might well deliver what it promises. Of course there are testimonials provided but there is no way of testing the veracity of the claims made. Interestingly, all the testimonials are positive, they would be more convincing if just occasionally a testimonial reported that the therapy did not work as expected.
Potentially, this type of web site may have a great deal to offer if it actually works, and can be shown to be safe. Research has shown that EMDR has the potential to awaken memories that might trigger psychosis and users may not even be aware of this. Certainly, there are no warnings given in this web site though there is a disclaimer and a suggestion that the web site should not be used as a substitute for professional medical advice. Whether users will actually heed this advice of course is another matter. Given the waiting times for therapy and the costs, inexpensive online therapy probably is the way forward. But we need to know a great deal more about the possible dangers and side effects of these types of therapy, and how these might be mitigated, before embarking on this route to a major extent.