Empirical Evidence

The working mechanisms that underlie the effectiveness of EMDR, and whether the eye movement component in EMDR contributes to its clinical effectiveness are still points of uncertainty and contentious debate.[citation needed] Based on the evidence of controlled research both the practice guidelines of the American Psychiatric Association[29] and the Department of Veterans Affairs and Defense[30] have placed EMDR in the highest category of effectiveness and research support in the treatment of trauma. This status is reflected in a number of international guidelines where EMDR is a recommended treatment for trauma.[31][32][33][34][35][36] EMDR was found in the first ever meta-analysis of PTSD to be equally effective as exposure therapy and SSRIs.[37] Two recent meta-analyses concluded that traditional exposure therapy and EMDR have equivalent effects both immediately after treatment and at follow-up.[38][39] The most recent meta-analysis looked at 38 randomized controlled trials for PTSD treatment and concluded that the first-line psychological treatment for PTSD should be Trauma-Focused CBT or EMDR.[40]

Compared to typical treatments

EMDR has been demonstrated to have significant advantages over usual treatment for PTSD in an HMO setting, and improvement was maintained at a six month follow-up.[41] EMDR has been shown to be effective on measures of trauma, depression and anxiety in women and men who have been sexually abused as children.[42][43]

Compared to medication

To date EMDR has only been compared directly to medication in one study. Van der Kolk et al. found EMDR to be more effective than fluoxetine, an SSRI in treating trauma, especially six months post-treatment. The study also suggests a role for SSRIs as a reliable first-line intervention.[44]

Compared to exposure treatment

EMDR proved significantly better than stress inoculation training with prolonged exposure in a study with 24 participants diagnosed with post traumatic stress disorder.[45] Although reduction in symptom severity was equivalent post treatment, at follow-up, EMDR lead to greater gains on both self report and observer rated measures of PTSD and self report measures of depression. In another study of 22 participants who had also been diagnosed with PTSD, both EMDR and prolonged exposure were found to be effective post treatment.[46] Participants receiving EMDR appeared to improve quicker in that 70% had reached a level of clinically significant improvement in PTSD after three EMDR sessions compared to only 17% in the prolonged exposure condition.

EMDR was also found to work more quickly than exposure based treatments in a larger trial with 105 participants.[47] At a fifteen-month follow-up, gains for both treatments were generally maintained. The only significant difference at follow-up was an improvement in depression according to an independent observer in favour of EMDR.

EMDR and Prolonged Exposure (PE) were found to be equivalently efficacious and both superior to a waitlist control in a controlled trial of 74 female rape victims.[48] Measures used by blind assessors included PTSD, depression, dissociation and state anxiety. Unlike other studies noted above, there was no difference between the active treatments in rate of improvement. However EMDR seemed to do adequately well despite utilising no homework tasks and less exposure. The study met the highest criteria for methodological rigour proposed by Foa and Meadows.[49]

Compared to cognitive behavioral therapy

Although most studies show EMDR and CBT to be about the same, one study reported an opposite effect.[50] Analysis of changes in symptoms for the 15 participants who completed treatment indicated greater reductions on symptom measures of avoidance and re-experiencing for imaginal exposure treatment over EMDR but equivalent reductions on hyper arousal. However there were no differences between the two treatments in the intent to treat analysis and no differences between the two treatments on percentage of people with PTSD diagnosis at follow-up.

The effectiveness of EMDR compared to Cognitive behavioral therapy (CBT) is not limited to English speaking cultures. In a study involving Iranian girls who had been sexually abused, EMDR was found to be significantly more efficient than CBT, with similar treatment effects achieved within fewer sessions of EMDR than CBT.[51]

Source: Wikipedia