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Abstract

This brief narrative review begins with an overview of posttraumatic response and explains the value of early treatment in reducing/eliminating symptoms of distress and possibly preventing the development of posttraumatic stress disorder (PTSD) or other disorders. The article then summarizes the efficacy of eye movement desensitization and reprocessing (EMDR) therapy as an early intervention treatment. It outlines the historical context of EMDR early interventions and describes the three protocols which have research support from randomized controlled trials (RCTs), elaborating on their supportive evidence in seven RCTs conducted within 3 months of the traumatic event. These studies showed that EMDR early interventions significantly reduced symptoms of traumatic stress and prevented any exacerbation of symptoms. EMDR was superior to wait-list and to control conditions of critical incident stress debriefing, reassurance therapy, and supportive counseling. The article also examines the disparate evaluations of EMDR early interventions in the PTSD treatment guidelines, from the International Society for Traumatic Stress Studies, the World Health Organization, and the National Institute for Health and Clinical Excellence. Despite promising clinical experience and initial controlled studies, there are still substantive gaps in the evidence base for EMDR early interventions. The article concludes with recommendations for future research, emphasizing that future trials adhere to the highest standards for clinical research and that they investigate whether EMDR early intervention prevents the development of PTSD or increases resilience.

Tables

TABLE 1.
Early Interventions Recommended in the Treatment Guidelines
Within First Month
NICETF-CBT
WHO
Within Months 2 and 3
NICETF-CBT
WHOEMDRTF-CBTStress mGroup CBT
Within Months 1, 2, and 3, Single Session
ISTSSEMDRaGroup 512PMa
Within Months 1, 2, and 3, Multiple Sessions
ISTSSEMDRCTTF-CBT

Note. CT = cognitive therapy; ISTSS = International Society for Traumatic Stress Studies; NICE = National Institute for Health and Clinical Excellence; TF-CBT = trauma-focused cognitive behavioral therapy, or cognitive processing therapy, cognitive therapy for PTSD, narrative exposure therapy, and prolonged exposure therapy; stress m = stress management; WHO = World Health Organization. Group 512 PM is debriefing “supplemented with cohesion training exercises” such as games requiring team cooperation (ISTSS Guidelines Committee, 2018, p. 22).

a emerging evidence.

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TABLE 2.
Randomized Controlled Trials Investigating EMDR Treatment Within 3 Months of Traumatic Event
ProtocolStudyTime Since TraumaTrauma TypeNumber of SessionsConditions NComparison of Symptoms at Pre and PostComparison of Conditions
PRECIJarero, Artigas, and Luber (2011)Within 14 daysEarthquakeOne session 80–130 mImmediate N = 9Significant decrease also at F-UpImmediate> 4 day waiting
4-day waiting N = 9No change
Delayed N = 9Significant decrease also at F-Up
PROPARAJarero, Amaya, Givaudan, and Miranda (2013)Within 3 monthsRelated to work as first respondersTwo sessions 90 mPROPARA N = 19Significant decrease also at F-UpPROPARA> Supportive counseling
Supportive counseling N = 20No change
R-TEPE. Shapiro and Laub (2015)Within 3 monthsFatal rocket attackTwo sessions 90 mImmediate N = 8Significant decreaseImmediate>1 week waiting
1 wk Wait N = 9 (5)No change
Delayed Tx N = 7 (5)Significant decrease also at F-Up
PRECIJarero, Uribe, Artigas, and Givaudan (2015)Within 25 days“Technological disaster” fatal explosion in workplaceTwo sessions 60 mImmediate

N = 13
Significant decrease also at F-UpImmediate> 9 day waiting
9-day waiting N = 12No change
Delayed Tx N = 12Significant decrease
EMDR-RETarquinio et al. (2016)48 hoursWorkplace violenceOne session 90–120 mEMDR-RE N = 19Significant decrease
CISD N = 23No changeEMDR-RE > CISD
48-hour waitingNo changeEMDR-RE> 48h waiting
48-hour delayed EMDR-RE N = 18Significant decreaseEMDR-RE =Delayed EMDR REDelayed EMDR-RE > CISD
R-TEPE. Shapiro, Laub, and Rosenblat (2018)Within 3 monthsIntense rocket attacksThree sessions 90mImmediate N = 13Significant decreaseImmediate> 1 month waiting
1 month Wait N = 12No change
R-TEPGil-Jardiné et al. (2018)Within 24 hoursPhysical injury or acuteOne session 60 mR-TEP N = 42At 3 months

For PCLS:

R-TEP =Reassurance

R-TEP >TAU

Reassurance > TAU

For PTSD diagnosis:

R-TEP=reassurance=TAU
medical crisis, at risk for PCLSReassurance N = 47
TAU, N = 41

Note. m = minutes; PCLS = post-concussion-like symptoms; PROPARA = protocol for paraprofessional use; PTSD = posttraumatic stress disorder; R-TEP = recent traumatic episode protocol; TAU = treatment as usual. by the RECI = protocol for recent critical incidents EMDR-RE = recent traumatic event protocol

“>” is significantly superior re symptom improvement and “=” is no significant difference between conditions.

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