Research Article
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Abstract
While eye movement desensitization and reprocessing (EMDR) is considered an evidence-based treatment for posttraumatic stress disorder (PTSD) in adults, there are differences as to how various international treatment guidelines judge the strength of this evidence base. Furthermore, in areas other than adult PTSD, major guidelines differ even more as to the strength of the evidence base and when to use EMDR. In 2019, the Council of Scholars: The Future of EMDR Therapy Project was initiated. Several working groups were established, with one assigned to the focus area of research. This article is a product of that working group. Firstly the group concluded that there were five areas where there was some base that EMDR was effective, but more data were needed to increase the likelihood that it would be considered in future international treatment guidelines. These areas were PTSD in children and adolescents, early EMDR interventions, combat PTSD, unipolar depression, and chronic pain. In addition, research into cost-effectiveness of EMDR therapy was identified as one of the priorities. A hierarchical system was used for classifying and rating evidence in the focus areas. After assessing the 120 outcome studies pertaining to the focus areas, we conclude that for two of the areas (i.e., PTSD in children and adolescents and EMDR early interventions research) the strength of the evidence is rated at the highest level, whereas the other areas obtain the second highest level. Some general recommendations for improving the quality of future research on the effectiveness of EMDR therapy are formulated.
Tables
TABLE 1.
Levels of Evidence Based on Sackett (1989)
| Level | Type of Evidence |
|---|---|
| I | Large RCTs with clear-cut results |
| II | Small RCTs with unclear results |
| III | Cohort and case-control studies |
| IV | Historical cohort or case-control studies |
| V | Case series, studies with no controls |
TABLE 2.
Levels of Evidence Based on Sackett (1989) for the Different Target Areas
| Level | Target Area |
|---|---|
| I | PTSD in children and adolescents |
| I | EMDR as an early intervention |
| II | Combat-related PTSD |
| II | Unipolar depression |
| II | Chronic pain |
| Author(s) | N | Sample | Intervention and Number of Sessions | Memories/Phenomena Targeted | Outcomes/Dependent Variables | Measure(s) | Significant Results |
|---|---|---|---|---|---|---|---|
| EMDR individual therapy RCTs | |||||||
| Ahmad and Sundelin-Wahlsten (2008) | 33 | Children 6–16 years who grew up in psychosocially exposed condition | EMDR eight sessions (n = 17) versus WL (n = 16) | Disturbing memories of a traumatic event | PTSD symptoms, treatment session measures (severity of negative emotions) | DICA, PTSS-C | EMDR > WL: reduced PTSD symptoms. |
| Chemtob et al. (2002) | 32 | Children 6–12 years who experienced a hurricane | EMDR three sessions (n = 17) versus WL (n = 15) | Disturbing memories of the hurricane | PTSD symptoms, anxiety, depression, number of visits to school nurse | CRI, RCMAS, CDI | EMDR: pre- to 6-month FU reduced anxiety, depressive, PTSD symptoms, and healthcare visits. EMDR > WL on all. |
| De Roos et al. (2011) | 52 | Children 4–18 years who experienced a fireworks factory explosion | EMDR (n = 26) versus CBT (n = 26), both max four sessions | Disturbing memories of the fireworks factory explosion | PTSD, anxiety, depression, emotional/behavioral symptoms | UCLA PTSD-RI, CROPS, PROPS, BDS, MASC, CBCL | EMDR = CBT: reduced PTSD, anxiety, depression, emotional/behavioral symptoms at post and 3-month FU. EMDR fewer sessions (3.2 vs. 4). |
| De Roos et al. (2017) | 103 | Children 8–18 years who experienced a single traumatic event | Max six sessions EMDR (n = 43) versuscognitive behavioral writing therapy (n = 42) versus WL (n = 18) | Disturbing memories of single event trauma (e.g., physical or sexual abuse, accident/injury, traumatic loss) | PTSD diagnosis and symptoms, anxiety, depression, emotional/behavioral symptoms, somatic symptoms, negative trauma-related beliefs, quality of life | ADIS-C/P, CRTI-C/P, RCADS-C/P, SDQ-Y/P, CSI-C-P, CPTCI, Kidscreen27 C/P | CBWT = EMDR > WL: at post, 3- and 12-month FU: reduced PTSD, anxiety, depression, emotional/behavioral symptoms, negative trauma-related beliefs, quality of life. EMDR fewer sessions (4.1 vs. 5.4). |
| Diehle et al. (2015) | 48 | Children 8–18 years who experienced single or multiple traumatic events | EMDR (n = 25) versus TF-CBT (n = 23), both8 sessions | Disturbing memories of single or multiple traumatic event | PTSD diagnosis and symptoms, anxiety, depression, behavioral problems | CAPS-CA, ADIS-P, CRIES-C, RCADS-C/P, SDQ-P | EMDR = TF-CBT: reduced PTSD symptoms. TF-CBT: reduced depression, hyperactivity. Number of sessions: EMDR = TF-CBT. |
| Jaberghaderi et al. (2004) | 14 | Girls 12–13 years who experienced sexual abuse | EMDR (n = 7) versus CBT (n = 7), both max. 12 sessions | Disturbing memories of sexual abuse | PTSD symptoms, problematic behavior in school | CROPS, PROPS, Rutter Teacher Scale | EMDR = CBT: reduced PTSD symptoms and behavioral problems. EMDR fewer sessions (6.1 vs. 11.6). |
| Jaberghaderi et al. (2019) | 139 | Children aged 8–12 years who experienced domestic violence | CBT, 6–12 sessions (n = 40) versus EMDR, 3–12 sessions (n = 40) versus control (n = 59) | Disturbing memories of physical abuse and witnessing domestic violence | PTSD symptoms, problematic behavior exhibited in school | LITES, CROPS, PROPS, RTS | EMDR = CBT > Control: reduction in PTSD symptoms. No classroom behavior change. EMDR fewer sessions (5 vs. 9). |
| Jiménez et al. (2020) | 32 | Children aged 12–17 years old who experienced sexual and/or physical violence | EMDR-PRECI, 2–9 sessions (n = 16) versus TAU, mean 12.6 sessions (n = 16) | Disturbing memories related to sexual and/or physical violence | PTSD diagnosis and symptoms, anxiety, depression | CAPS-5-CA, PCL-5, HADS | EMDR > TAU: Reduction in PTSD diagnosis and symptoms at 1- and 3-month FU. EMDR > TAU: Anxiety and depressive symptoms at 3-month FU (no 1-month measure). |
| Kemp et al. (2010) | 27 | Children 6–12 years who experienced a motor vehicle accident | EMDR, four sessions (n = 13) versus WL (n = 14) | Disturbing memories of the motor vehicle accident | PTSD symptoms, anxiety, depression, behavioral problems | CPTS-RI, PTS-RI/P, STAI, CDSCBCL | EMDR > WL: reduction in PTSD symptoms and diagnostic criteria, depression, anxiety, behavior. Gains maintained at 3- and 12-month FU. |
| Meentken et al. (2020) | 74 | Children 4–15 years who experienced medical trauma | EMDR, mean 3.5 sessions (n = 37) versus CAU (n = 37) | Disturbing memories of medically related trauma/s | Subthreshold PTSD symptoms (CAPS-CA/DIPA), anxiety, quality of sleep | CRTI, SCARED-NL, CDI-2, SSR/CSHQ | EMDR > CAU: reduction in blood injection-injury phobia symptoms, depression, sleep problems: EMDR = CAU: subthreshold PTSD symptoms. |
| Soberman et al. (2002) | 29 | Boys 10–16 years with conduct problems in residential or day treatment | TAU (n = 15) versus TAU + EMDR, three sessions (n = 14) | PTSD symptoms, behavioral problems | IES-8, CROPS, PROPS, PRS, BRS | TAU + EMDR > TAU: reduced parent reported PTSD symptoms at post. TAU + EMDR > TAU: problem behavior at 2-month FU. | |
| EMDR group therapy RCTs | |||||||
| Molero et al. (2019) | 184 | Refugee minors 13–17 years exposed to war | Intensive EMDR IGTP-OTS nine sessions during three consecutive days (n = 93) versus no treatment (n = 91) | Disturbing memories of life as refugee | PTSD symptoms, depression, anxiety | PCL-5, HADS | EMDR IGTP-OTS > no treatment: reduced PTSD symptoms at post, 3-month FU. Reduced depression and anxiety at 3-month FU. |
| Osorio et al. (2018) | 23 | Adolescents and young adults 13–22 years with different types of cancer | Intensive EMDR IGTP-OTS six sessions during two consecutive days (n = 11) versus no treatment (n = 12) | Disturbing memories of cancer diagnosis, treatment | PTSD symptoms, depression, anxiety | PCL-5, HADS | EMDR IGTP-OTS > no treatment; reduced PTSD symptoms, depression, anxiety at post, 3-month FU. |
| EMDR individual therapy, nonrandomized controlled studies and case series or studies not controlled | |||||||
| Hensel (2009) | 32 | Children 1.9–18 years. Extended case series design | EMDR (mean 1.5 sessions) | Disturbing memories of single traumas | PTSD | PROPS | Reduced PTSD symptoms at post, 6-month FU. |
| Karadag et al. (2019) | 30 | Children 6–18 years who experienced single or multiple traumatic events. Extended case series design | EMDR (up to six sessions, mean 4.15) | Disturbing memories of traumatic event(s) | PTSD symptoms, anxiety | K-SADS-PL, CPTS-RI, STAI (C) | Reduced PTSD and anxiety symptoms 6 weeks posttreatment. |
| Puffer et al. (2000) | 20 | Children 8–17 years, nonrandomized delayed treatment comparison design | EMDR one session (n = 10) versus delayed treatment (n = 10) | Disturbing memories of single traumas | PTSD symptoms, anxiety | CRIES-8, RMAS | Reduced PTSD symptoms for EMDR only. |
| Ribchester et al. (2010) | 11 | Children 8–16 years with PTSD from a road traffic accident. Extended case series design | EMDR (one to four sessions, mean 2.4) | Disturbing memories of road traffic accident | PTSD symptoms, anxiety, depression, attentional deficits | ADIS, CRIES-8, RCMAS, BDRS, CASQ-R, CAWS | Reduced PTSD, anxiety, depression, and attentional bias at post and FU. All patients lost PTSD diagnosis. |
| Tang et al. (2015) | 83 | Children 12–15 years who experienced a typhoon. Nonrandomized control group | EMDR, four sessions (n = 41) versus TAU (n = 42) | Disturbing memories of typhoon | PTSD disaster related symptoms, general anxiety, depression | C-IES-R, MASC, CES-D | EMDR > TAU: reduced PTSD symptoms, anxiety, depression. |
| Wadaa et al. (2010) | 37 | Children 7–12 years exposed to war-related trauma. Nonrandomized control group | EMDR, 12 sessions (n = 12) versus no treatment (NT) (n = 25) | Disturbing memories of war and violence | PTSD symptoms | UCLA-PTSD-index | EMDR > NT: PTSD symptoms. |
| EMDR group therapy case series or studies not controlled | |||||||
| Hurn and Barron (2018) | 8 | Child refugees 6–11 years exposed to war. Qualitative study design. | EMDR-IGTP in second session of four-session psychosocial program | Disturbing memories of war and bereavement | Emotional distress, therapist view on IGTP's effectiveness and appropriateness, Arab interpreter perspectives on cultural appropriateness | SUD, therapists program report, interpreters focus group | Qualitative analysis was performed. Reported positive outcomes. |
| Jarero et al. (2006) | 44 | Children 8–15 years, who experienced flood | EMDR-IGTP (one session, 50–60 minutes) | Disturbing memories of the flood | PTSD symptoms | CRTES | No statistical analysis performed. Reported positive outcomes. |
| Jarero et al. (2013b) | 34 | Children 8–17 years who experienced severe interpersonal trauma | Daily EMDR-IGTP over 3 days (n = 34), plus individual EMDR (1–2 sessions) (n = 26 of 34) during weeklong psychological recovery camp | Disturbing memories of interpersonal trauma | PTSD symptoms | CRTES, SPRINT | IGTP + recovery camp: Reduced PTSD symptoms at post and 3-month FU. |
| Lempertz et al. (2020) | 10 | Refugee children 4–6 years who experienced war | EMDR-based group therapy (5 sessions, 50–60 minutes) over 5 consecutive days | Disturbing memories of war | PTSD symptoms | DLTC, CBCL 1.5–5, parent and teacher report | Teacher-reported PTSD symptoms decreased at post, 3-month FU. |
| Perilli et al. (2019) | 14, 8 analyzed | Child refugees 3–18 years exposed to war | EMDR-IGTP, three sessions | Disturbing memories of war | PTSD symptoms, depression, anxiety | CRIES, DSRS, SCARED | Reduced PTSD symptoms. |
| Smyth-Dent et al. (2019) | 48 | Refugee adolescents 12–17 years exposed to war | Intensive EMDR IGTP-OTS (six sessions in 5 hours over two consecutive days) | Disturbing memories of life as refugees | PTSD symptoms, depression, anxiety | PCL-5, HADS | Reduced PTSD symptoms, depression, anxiety. |
Note. ADIS = Anxiety Disorders Interview Schedule; BDRS = Birleson Depression Rating Scale; BRS = Behavioral Reward Scale; C/P/A = Child version/Parent version/Adolescent version; CAPS-CA = Clinician-Administered PTSD Scale for Children and Adolescents; CASQ-R = Children's Attributional Style Questionnaire Revised; CAU = Care as usual; CAWS = Children's Assumptive World Scale; CBCL = Child Behavior Checklist; CBWT = cognitive behavioral writing therapy; CDI = Children's Depression Inventory; CDS = Children's Depression Scale; CES-D = Center for Epidemiological Studies Depression Scale; C-IES-R = Chinese Impact of Events Scale-Revised; C-PTCI = Child Post-Traumatic Cognitions Inventory; CPTS-RI = Child Post-Traumatic Stress Reaction Index; CRI = Child Reaction Index; CRIES- 8 = Children's Revised Impact of Events Scale; CRTES = Child's Reaction to Traumatic Events Scale; CRTI = Revised Childs Response to Trauma Inventory; CRI = Children's Reaction Index; CRIES = Children Revised Impact of Event Scale; CROPS = Child Report of Post-traumatic Stress Symptoms; CSI = Child Somatization Inventory; CSHQ = Child Sleep Habits Questionnaire; DICA = Diagnostic Interview for Children and Adolescents; DIPA = Diagnostic Infant and Preschool Assessment; DLTC = Daily Life Test for Children; DSRS = Depression Self-Rating Scale; FU = Follow-up; HADS = The Hospital Anxiety and Depression Scale; IGTP = Integrative Group Treatment Protocol; IGTP-OTS = Integrative Group Treatment Protocol for Ongoing Traumatic Stress; K-SADS-PL = Schedule for Affective Disorders and Schizophrenia for school-age Children at Present and Throughout Life; LITES = Life Incidence of Traumatic Events Scale; MASC = Multidimensional Anxiety Scale for Children; PCL-5 = Posttraumatic Stress Disorder Checklist for DSM-5; PROPS = Parent Report of Post-traumatic Stress Symptoms; PTSD = posttraumatic stress disorder; PTSS-C = Post-Traumatic Stress Symptom Scale for Children; PRS = Problem Rating Scale; PTS-RI = Post-Traumatic Stress Reaction Index; RCADS = Revised Children's Anxiety and Depression Scale; SCARED-NL = Dutch Screen for Child Anxiety Related Emotional Disorders; RCMAS = Revised Children's Manifest Anxiety Scale; RTS = Rutter Tacher Scale; SCARED = Screen for Child Anxiety Related Disorders; SDQ = Strengths and Difficulties Questionnaire; SPRINT = Short PTSD Rating Interview; SSR = Sleep Self Report; STAIC = State-Trait Anxiety Inventory for Children; SUDS = Subjective Units of Disturbance; TF-CBT = trauma-focused cognitive behavioral therapy; UCLA PTSD-RI = University of California Los Angeles PTSD Reaction Index; VOC = Validity of Cognition; WL = waitlist.
| Author(s) | N | Sample and Time Since Event | Intervention and Number of Sessions | Memories Targeted | Outcomes/Dependent Variables | Measure(s) | Significant Results |
|---|---|---|---|---|---|---|---|
| RCTs | |||||||
| Chiorino et al. (2020) | 37 | Women with postpartum trauma, within 1–3 days | Recent Birth Trauma Protocol (EMDR) (n = 19) versus TAU (n = 18). One session, 90 minutes | Disturbances relating to traumatic childbirth | Symptoms postpartum PTSD and depression, mother-to-infant bonding | IES-R, MIBS, PDEQ, EPDS | EMDR > TAU: reduced PTSD symptoms at 6 weeks post. |
| Gil-Jardiné et al. (2018) | 130 | Emergency room (accident injury or acute medical crisis), at risk for PCLS, within 24 hours | R-TEP (EMDR) one session 60 minutes (n = 42) versus reassurance one session 15 minutes (n = 47) versus TAU (n = 41) one session | Disturbances related to recent trauma | PCLS symptoms, PTSD diagnosis, PTSD symptoms | PCSLS, PCL-5 | At 3 months, R-TEP > TAU for lower incidence of PCSLS: 18% (R-TEP), 37% (reassurance), and 65% (TAU). |
| Jarero et al. (2011) | 18 | Earthquake survivors 14 days | PRECI (EMDR) immediate (n = 9) versus 4 day waitlist/delayed tx (n = 9). One session, 80–130 minutes | Worst memory of the earthquake | PTSD symptoms | IES | PRECI > WL: reduced PTSD symptoms at post. PRECI = DT: reduced PTSD symptoms at 12-week FU. |
| Jarero et al. (2013a) | 39 | First responders within 3 months | EMDR PROPARA (n = 19) versus supportive counseling (n = 20). Two sessions, 90 minutes | Worst memory of recent trauma | PTSD symptoms | SPRINT | PROPARA > supportive counseling: reduced PTSD symptoms at post and 3-month FU. |
| Jarero et al. (2015) | 25 | Explosion in workplace 25 days | PRECI (EMDR) (13) versus 1 week waitlist/delayed tx (12). Two sessions, 60 minutes | Worst memory of the explosion | PTSD symptoms | SPRINT | PRECI > WL: reduced PTSD symptoms PTSD at 1 week post. PRECI = DT: reduced PTSD symptoms at 90-day FU. |
| Shapiro et al. (2018) | 25 | Rocket attacks within 3 months | R-TEP (EMDR) (n = 13) versus delayed tx (n = 12). Three sessions, 90 minutes | Disturbances related to recent trauma | PTSD and depression symptoms and resilience | PCL-5, PHQ-9, BRCS | R-TEP > WL: reduced PTSD, depression symptoms at 1-month post. |
| Shapiro and Laub (2015) | 16 | Rocket attack within 3 months | R-TEP (EMDR) immediate (n = 9) versus 1 week waitlist/delayed tx (n = 7). Two sessions, 90 minutes | Disturbances related to recent trauma | PTSD and symptoms of depression | IES-R, PHQ-9 | R-TEP > WL: decreased PTSD, depression symptoms at 1 week. R-TEP = DT: decreased PTSD, depression at 3-month FU. |
| Tarquinio et al. (2016) | 60 | Workplace violence 48 hours | EMDR-RE (n = 19) versus CISD (n = 23) versus 48 hour delayed tx (n = 18). One session 90–120 minutes | Disturbances related to recent trauma | PTSD symptoms | PCLS | Reduced PTSD symptoms for EMDR-RE and delayed EMDR-RE, but not CISD. EMDR-RE = delayed EMDR-RE > CISD at 3-month FU. |
| Cohort and case controlled studies | |||||||
| Brennstuhl et al. (2013) | 34 | Workplace violence or accident within 48 hours | URG (EMDR) (n = 19) versus eclectic (n = 15), nonrandom matched controls. One session 60–90 minutes | Disturbances related to recent trauma | PTSD symptoms | PCL-S | Reduced PTSD symptoms for URG and eclectic. URG > eclectic therapy. |
| Jarero and Uribe (2011, 2012) | 32 | Workers at human massacre site, under threat ongoing trauma | PRECI (EMDR) immediate for those with severe symptoms (n = 18) versus 17-day waitlist/delayed tx for moderate symptoms (n = 14). One session 90–120 minutes | Worst memory related to ongoing forensic work | PTSD symptoms | IES, SPRINT | Immediate PRECI > WL: PTSD symptom reduction at 17 days. Reduced PTSD symptoms for immediate treatment and delayed treatment at post, 3- and 5-month FU. |
| Historical cohort or case-control studies | |||||||
| Saltini et al. (2018) | 529 | Earthquake survivors within first month (early) and within second, third months (late) of earthquake | R-TEP (EMDR): Early (n = 239), late (n = 290), two to four sessions, control group analogue | Disturbances related to earthquake | PTSD symptoms | IES-R | Early = Late: reduction in PTSD symptoms. |
| Silver et al. (2005) | 24 | Post 9/11, within 3 months (early treatment, ET (n = 12), after 11 weeks (delayed treatment, DT, n = 12) | EMDR-RE, 4–5 sessions, analogue control | Disturbances relating to 9/11 trauma | Subjective distress | SUD, VOC | ET = DT for SUD, VOC. |
| Case series or studies not controlled | |||||||
| Adúriz et al. (2009) | 124 | Child survivors, of flood within 3 months | EMDR-IGTP, one session 2 hours | Worst memory of the flood | PTSD symptoms | CRTES | Reduction of PTSD symptoms at post and 3-month FU. |
| Brennstuhl et al. (2019) | 36 | Children (mean age 12–13 years) who experienced terrorist attack, within 48 hours | EMDR-IGTP, one session | Worst memory of the terrorist attack | PTSD symptoms | PCLS | Reduction of PTSD symptoms at post and 3-month FU. |
| Buydens et al. (2014) | 7 | Bank robbery (n = 6), suicide of colleague (n = 1) | EMDR-RE, 7–10 days, mean 5.2 sessions | Disturbances related to recent trauma | PTSD symptoms | IES-R | No statistical analysis of reduced PTSD symptoms. |
| Fernandez et al. (2003) | 236 | Children exposed to plane crash adjacent to the school, within 30 days | EMDR-IGTP, 1 session of 90 minutes | Worst memory of the plane crash | Distress symptoms | Teachers' observations | No statistical analysis. Reports positive outcome. |
| Jarero et al. (2006) | 44 | Child survivors of flood, within 2 months. | EMDR-IGTP, 1 session of 90 minutes | Worst memory of the flood | PTSD symptoms | CRTES | No statistical analysis of reduced PTSD symptoms. |
| Jarero et al. (2008) | 16 | Children whose fathers were killed in mine explosion, within 3 months | EMDR-IGTP, 1 session of 90 minutes | Worst memory of father's death | PTSD symptoms | CRTES | Reduction of PTSD symptoms at post and 3-month FU. |
| Jarero and Artigas (2010) | 20 | Adults stranded during violent geopolitical crisis. Provided during the crisis | EMDR-IGTP, 3 sessions of 90 minutes | Worst phenomena related to the danger | PTSD symptoms | IES | Reduction of PTSD symptoms at post and 14 weeks FU despite exposure to ongoing crisis. |
| Maslovaric et al. (2017) | 116 | Youth (age 13–20 years) who survived earthquake, within 3 months | EMDR-IGTP, 3 sessions of 90 minutes | Worst memory of the earthquake | PTSD symptoms | IES-R | Reduction of PTSD symptoms at post and 3-month FU. |
| Tarquinio et al. (2012) | 17 | Women who had been raped, within 24–78 hours | URG (EMDR), single session | Memory of sexual assault | PTSD symptoms, anxiety, sexual behavior | IES, questions regarding sexual desire and excitation | Reduction of PTSD symptoms at post, 4 weeks, and 6 months, and increase in sexual desire and excitation at 4 weeks and 6-month FU. |
| Trentini et al. (2018) | 332 | Child earthquake survivors, within 3 months | EMDR-IGTP, 3 sessions of 60–90 minutes | Worst memory of earthquake | PTSD symptoms | CRIES, Emotion Thermometers | Reduction of PTSD and anxiety symptoms at post. |
| Zaghrout-Hodali et al. (2008) | 7 | Children during the ongoing war | EMDR-IGTP, 4 sessions | Worst memory of ongoing war | Distress symptoms | SUDS, behavioral observations | No statistical analysis of reduced SUD scores. Reports positive outcome. |
Note. BDI = Beck Depression Inventory; BRCS = Brief Resilience Coping Scale; CISD = Critical Incident Stress Debriefing; CRTES = Child's Reaction to Traumatic Events Scale; DT = delayed treatment; EMDR = Eye Movement Desensitization and Reprocessing; ET = early treatment; EPDS = Edinburgh Postnatal Depression Scale; HADS = Hospital Anxiety and Depression Scale; IES = Impact of Event Scale; IES-R = Impact of Event Scale-Revised; MIBS = Mother-to-Infant Bonding Scale; PDEQ = Peritraumatic Dissociative Experiences Questionnaire; PRECI = EMDR protocol for recent critical incidents and ongoing traumatic stress; PCL-C = PTSD Checklist-Civilian Version; PDEG = Peritraumatic Dissociative Experience Questionnaire; PCL-S = Post traumatic Checklist Scale; PCLS = Post Concussion-Like Symptoms; PDEG = Peritraumatic Dissociative Experience Questionnaire; PROPARA = protocol for paraprofessional use in acute trauma situations; RE = EMDR Recent Event Protocol; R-TEP = Recent Traumatic Episode Protocol; SPRINT = Short PTSD Rating Interview; SUD = Subjective Units of Disturbance Scale; tx = treatment; URG = EMDR emergency protocol; VOC: Validity of Cognition.
| Author(s) | N | Setting and Military Population | Intervention and Number of Sessions | Memories/Phenomena Targeted | Outcomes/Dependent Variables | Measure(s) | Significant Results |
|---|---|---|---|---|---|---|---|
| RCTs | |||||||
| Ahmadi et al. (2015) | 33 | Iran military service men admitted to hospital, active duty | EMDR (n = 11), REM-Desensitization (n = 10), no treatment (n = 12) | Not described. | PTSD, depression, sleep, death anxiety | MSPTSD, PSQI, DAQ. | At post, EMDR = REM > control: reduction in PTSD symptoms. EMDR > REM reduction of depression. REM > EMDR on intrusive thoughts, total sleep quality. |
| Boudewyns and Hyer (1996) | 61 | In- and outpatient U.S. treatment unit | EMDR (n = 21), EMDR eyes closed (n = 18), group therapy (n = 22). EMDR: five to seven sessions, group tx: eight sessions | Most disturbing memory | PTSD symptoms | SCID, WSI, CAPS, IES, POMS, physiology: HR, SC, BP, EMG | At post, EMDR = EMDR eyes closed = group tx: reduction in PTSD symptoms on the CAPS. EMDR = EMDR eyes closed > group tx: reduction in anxiety. No FU data. |
| Carlson et al. (1998) | 35 | VA Medical center and community veteran centers ex-serving | EMDR (n = 10), biofeedback relaxation (n = 13), WL (n = 12), 12 weekly sessions | Most traumatic scene targeted first. | PTSD, depression, anxiety, physiology (HR, Temp, SCL) | CAPS-1, MISS, IES, PSS-SR, BDI, STAI, SSCQ. | At post, 3-month FU, EMDR > WL and biofeedback: reduction on PTSD measures (MISS, PSS-SR); EMDR = biofeedback = WL on IES. At 3-, 9-month FU EMDR > Biofeedback reduced CAPS scores. |
| Devilly et al. (1998) | 51 | VA counseling service or hospital outpatient clinic, ex-serving veterans (Vietnam) | EMDR (n = 19), EMDR without EM (n = 16), TAU (n = 16), two sessions for 5 weeks of 90 minutes max | Participants described a traumatic scenario | PTSD, depression, anxiety, physiological measures (HR, BP) | PTSD-I, MSPTSD-C, IES, STAI-Y2, BDI, PPD, COT | At post, EMDR = EMDR without EM = TAU: reductions on PTSD, depression, anxiety, personal problems. EMDR = EMDR without EM > TAU: reliable clinical change. At 6-month FU, improvement not maintained on any measure. |
| Jensen (1994) | 25 | VA medical center, ex-serving veterans (Vietnam) | EMDR (n = 13), WL/TAU (n = 12) two sessions | Single picture of traumatic memory | PTSD | SI-PTSD, MSPTSD-C | No significant effects. |
| Lee et al. (2002)a | 24 | One-third participants recruited from government defense service. | EMDR (n = 12), SITPE (n = 12), 7 weekly sessions of 90 minutes | Most disturbing trauma memory | PTSD, depression | SI-PTSD, MMPI-K, IES, BDI | At post EMDR = SITPE: reduction in PTSD and depression. At 3-month FU: EMDR > STIPE. |
| Cohort and case controlled studies, and EMDR as Adjunctive Treatment | |||||||
| Alliger-Horn et al. (2015)b | 40 | Inpatient war-traumatized German soldiers | TAU + EMDR, TAU + IRRT (n unable to extract) | Unable to extract | PTSD symptoms, comorbid symptoms. | Unable to extract | TAU + EMDR = TAU + IRRT: reduction in trauma complaints, comorbid symptoms. |
| Köhler et al. (2017) | 96 | German soldier inpatient treatment facility | TAU + EMDR (n = 78) versus WL (n = 18) EMDR: 2–3 90–100 minutes sessions a week for 4 weeks | Distressing memories underlying symptoms | PTSD symptoms, depression, general mental health symptoms | PDS, BDI-II, SCL-90-R | At post, TAU + EMDR > WL: reduction of PTSD symptoms and depression. No FU data. |
| Rogers et al. (1999) | 12 | Inpatient treatment program, ex-serving veteran (Vietnam) | EMDR (n = 6) versus Exposure (n = 6) one session 60–90 minutes | Most distressing war experience | PTSD symptoms | CAPS, IES, SUD, Physiological: HR, BP. | EMDR = Exposure: reduction in PTSD symptoms. EMDR > exposure: reduction in within treatment SUD and self-reported intrusions. No FU data. |
| Silver et al. (1995) | 83 | Inpatient, veterans (Vietnam) from VA PTSD program | TAU + EMDR (n = 13) 1 session minimum, TAU + biofeedback (n = 6), TAU + relaxation (n = 9), both 3 sessions minimum. TAU (n = 55). | Not mentioned | Anxiety, anger, depression, isolation, intrusions, flashbacks, nightmares, relationships | PRF | At post, EMDR > biofeedback, relaxation, control: improvement on anxiety, isolation. EMDR > biofeedback: improvement on intrusive thoughts, flashbacks, nightmares. |
| Historical cohort or case-control studies | |||||||
| Bandelow et al. (2012) | 117 | German military hospital (archived records) | CBT (n = 15), EMDR (n = 102). Sessions CBT and EMDR ranged 1–22, average 2.3 | Memories associated with presenting PTSD | PTSD symptoms | PTSD-10, IES-R | Report about successful treatment, no statistical analyses. |
| Hurley (2018) | 30 | Community outpatient military treatment center. (Archived treatment data), ex-serving military | EMDR intensive (n = 15), 20 sessions/10 days. EMDR weekly (n = 15), 18–20 sessions | Memories associated with PTSD | PTSD symptoms | IES-R, PCL-M, PCL-5 | 1-year FU: EMDR intensive = EMDR weekly: reduction in PTSD symptoms on IES-R. |
| Macklin et al. (2000); Pitman et al. (1996) | 17 | Ex-serving veterans (Vietnam) | 1996: Crossover design:6 sessions EMDR-with-EM, 6 with EMDR-with-eyes fixed + tapping versus no treatment. 2000: Follow-up cohort comparison: EMDR treated (N = 13) versus historical cohort (N-14) | Each session focused on the worst aspect of two traumatic combat experiences | PTSD diagnosis and symptoms, specifically avoidance, intrusions | SCID, CAPS, SCL-90, IES, MSPTSD-C, physiology: HR, SC, EMT, EM | 1996 post, EMDR conditions: reduction in PTSD symptoms. At 5-year FU, EMDR therapy = control: significant worsening of symptoms reported on the CAPS, MISS, SCL-90 pre- to FU. Only avoidance reduction maintained for EMDR. Of note, EMDR treatment fidelity scores were low. |
| Case series or studies not controlled | |||||||
| Brickell et al. (2015) | 99 | U.S. military community outpatient counseling centers (archived treatment data),(military and nonmilitary sample) | EMDR. Average 7.2 sessions, duration not reported | Traumatic events (both combat and noncombat PTSD treated) | PTSD symptoms, anxiety, depression | BDI-II, BAI, PCL-M | At post, in active military cases, reduction in PTSD, anxiety, depression. |
| Carlson et al. (1996) | 4 | U.S. VA medical center, veterans (Vietnam) | EMDR 12 biweekly sessions, 60–75 minutes | Combat memories targeted | PTSD, anxiety, depression | MSPTSD-C, IES, CAPS, BDI, STAI, SSCQ, physiology | No statistical analysis. Reports positive outcome for 3 of 4 clients. |
| Lipke and Botkin (1992) | 5 | U.S. VA inpatient medical center. Ex-serving veterans (Vietnam) | EMDR, 1 session | The most troubling memory of Vietnam | PTSD | MSPTSD-C | No statistical analysis. Discusses EMDR procedural issues and symptom complexity. |
| McLay et al. (2016) | 331 | Military mental health clinics (archived treatment data), active duty | EMDR (n = 46), TAU; included CBT, exposure, CPT, and nontrauma-focused therapy (n = 285). Number of sessions: 7–10 | – | PTSD symptoms, depression, sleep, functioning | PCL-M | EMDR > TAU: fewer therapy sessions over 10 weeks, and greater improvement in PTSD symptoms. |
| Russell (2006) | 4 | Iraq War casualties in field hospital, active duty | EMDR, 1 session | Memory of most disturbing event | PTSD—intrusive symptoms | SCI, IES | No statistical analysis. Reports positive outcome. |
| Russell (2008a) | 1 | Military outpatient clinic, active duty | EMDR, 4 sessions | Memories related to leg amputation | PTSD symptoms, phantom limb pain | IES, BDI, NRS | No statistical analysis. Reports positive outcome. |
| Russell (2008b) | 1 | Iraq war combat veteran | EMDR, 5 weekly sessions 60 minutes | Most distressing combat memories | Medically unexplained symptoms, PTSD symptoms | IES-R, BDI | No statistical analysis. Reports positive outcome. |
| Silver et al. (2008) | 2 | Inpatient VA medical center, veteran (Iraq, Vietnam), ex-serving | EMDR: Case 1: 4 sessions in 2 weeks. Case 2: 2 sessions | Recent and most distressing war-related memories | Anxiety, depression, anger, pain, myoclonic jerking | IES, BDI, BHS | No statistical analysis. Reports positive outcome. |
| Wesson and Gould (2009) | 1 | U.K. soldier on front line, active duty | EMDR, 4 sessions over 4 days (recent event protocol) | Memory of landmine event | Acute stress, PTSD symptoms, depression | PCL-C, IES-R, HADS, BDI | No statistical analysis. Reports positive outcome. |
| Wright and Russell (2013) | 1 | Army mental health outpatient clinic, active duty | EMDR, 7 weekly sessions | Memories related to violent impulses | PTSD symptoms, depression | PCL-M, BDI | No statistical analysis. Reports positive outcome. |
| Young (1995) | 1 | Veterans outreach clinic (Vietnam), ex-serving | EMDR, 1 session 60 minutes | Distressing memories of friend's death | Refractory PTSD | SUD, VoC | No statistical analysis. Reports positive outcome on SUD and VoC. |
Note. FU = follow-up; > means significantly better than. Treatments. EMDR = eye movement desensitization and reprocessing; CBT-TTP = cognitive behavior therapy-trauma treatment protocol; IRRT = Imagery rescripting and reprocessing therapy; SITPE = Stress Inoculation Training with Prolonged Exposure; TAU = Treatment as usual. Measures. BAI = Beck Anxiety Inventory; BDI = Beck Depression Inventory; BHS = Beck Hopelessness Scale; CAPS: = Clinically Administered PTSD Scale; CES = Combat Exposure Scale; COT = Credibility of Therapy Questionnaire; DAQ = Death anxiety questionnaire; FU = follow-up; GAS = Goal Attainment Scaling; HADS = Hospital Anxiety and Depression Scale; IES (-R) =: Impact of Events Scale (-Revised); MMPI = Minnesota Multiphasic Personality Inventory; MSPTSD-C = Mississippi Scale for Combat-Related PTSD; NRS = Numeric Rating Scale; PCL-C: = PTSD checklist—Civilian; PCL-M = PTSD checklist—Military; PDS = Posttraumatic Stress Diagnostic Scale; PPD = Personal Problem Definition Questionnaire; PRF = Problem Report Form; PSQI = Pittsburgh Sleep Quality Index; POM = Profile of Moods Scale; PTSD-I = PTSD Interview; PSS-SR = PTSD Symptom Scale-Self Report; PTSD-10 = Posttraumatic Stress Scale; SCI = Structured Clinical Interview-DSM-IV; SCID = Structured Clinical Interview for DSM-III-R; SI-PTSD = Davidson's Structured Interview for PTSD; STAI-Y2 = Spielberger State-Trait Anxiety Inventory; SSCQ = Stressful Scene Construction Questionnaire: SCL-90 = Symptom Check List; SUD = Subject Units of Distress Scale; VoC = Validity of Cognition Scale; WSI = War Stress Inventory. Physiological measures (HR = heart rate; BP = blood pressure; SC/SCL/SCR = skin conductance; Temp = skin temperature; EMT/EMG = electromyographic sensors).
a Only one-third participants were military.
b Article published in German (abstract only in English).
| Author(s) | N | Setting/Sample | Intervention and Number of Sessions | Memories/Phenomena Targeted | Outcomes/Dependent Variables | Measures | Significant Results |
|---|---|---|---|---|---|---|---|
| RCTs | |||||||
| Behnammoghadam et al. (2015) | 60 | Adult outpatients with depression (BDI > 17) up to 4 months after myocardial infraction | EMDR (n = 30) versus no intervention (n = 30) EMDR 3 sessions | Most impacting part of the cardiac incident | Depression | BDI | EMDR > no treatment: reduction in BDI scores at 4 months post. |
| Dominguez et al. (2020) | 49 | Adult outpatients at a psychiatric hospital with diagnosis of depression or anxiety | Three sessions EMDR + TAU (n = 16) versus 3 sessions assertiveness training + TAU (n = 17) versus TAU (n = 16). TAU was 10-day CBT group tx | Past or recent events that led to negative emotions | Major depressive episodes (MDE), PTSD symptoms | DASS-42, IES-R, RAS | At post, EMDR + TAU = TAU = assertiveness + TAU for improvement. At 6 weeks, EMDR + TAU = assertiveness + TAU > TAU, and at 12 weeks, EMDR + TAU was superior. |
| Gauhar (2016) | 17 | Adult outpatients with MDD without ADM | EMDR (n = 10) versus WL (n = 7), 6 to 8 sessions of EMDR | Disturbing events thought to be related to depressive cognition | Depression, PTSD symptoms, quality of life | BDI-II, Trauma Symptom Checklist-40, QOL Index | EMDR > WL: Improvement in depression, PTSD and quality of life: at post and 3-month FU. |
| Hase et al. (2018) | 30 | Adult inpatients of a psychiatric/psychosomatic rehabilitation clinic with BDI scores of > 12 and current ADM treatment | 4–12 sessions EMDR + TAU (n = 14) versus TAU (n = 16). TAU: Inpatient program and psychodynamic or behavior therapy | One unprocessed memory per week | Depression and overall burden on patients | BDI-II, SCL-90-R, depression subscale, GSI | EMDR + TAU > TAU: decrease in depressive symptoms and diagnosis remission, at post and 1-year FU. |
| Hogan (2002)a | 30 | Adults with MDD, dysthymia, or adjustment disorder with depressed mood | EMDR (n = 15) versus CBT (n = 15). Treatment information not available | Information not available | Depression, global severity | BDI-II, SCL-90-R | EMDR = CBT: Improvement in depression. |
| Kao et al. (2018) | 57 | Depression in adults with heart failure at an outpatient clinic | EMDR (n = 25) versus control: routine care (n = 32). 4 weekly EMDR sessions 60–90 minutes. No information about routine care | Most unpleasant experience of heart failure | Depression, impact of heart failure on QOL, heart rate variability | BDI-II, MLHFQ, HRV | EMDR > control: Improvement in depression, health-related QOL and HRV at post, 1- and 3-month FU. |
| Lei and Zhenying (2007)b | 64 | Adult outpatient with depression (CCMD-3 and HDS ≥ 17) | EMDR + Sertraline (n = 32) versus Sertraline only (n = 32). EMDR: 6 weekly sessions | Information not available | Depression | HMS CGS TESS | EMDR + Sertraline > Sertraline: Improved depression at week 1 and week 2. EMDR + Sertraline = Sertraline at week 6. |
| Minelli et al. (2019) | 22 | Adults with treatment-resistant depression in an inpatient setting | Trauma-focused (TF)-CBT (n = 10) versus EMDR (n = 12). Both 24 sessions of 60 minutes over 8 weeks | EMDR: traumatic events. TF-CBT: trauma-related emotional, psychological difficulties | Depression, anxiety, sleep quality | MADRS, BDI-II, BAI, PSQI, MINI-ICF-APP | At post, TF-CBT = EMDR: Improvement in depression. At FU: EMDR > TF-CBT for depression, including neurovegetative and cognitive symptoms. At post and FU, TF-CBT = EMDR: improvement in anxiety, sleep, psychosocial deficits. |
| Ostacoli et al. (2018) | 66 | Adults with recurrent depression already receiving ADM | EMDR (n = 31) versus CBT (n = 35). Mean number of sessions = 15 of EMDR or CBT for at least 4 weeks | EMDR: Episode triggers, belief systems, depressive states, suicidal states | Depression, anxiety, quality of life, PTSD symptoms | BDI-II, BAI, IES-R, QOL-Bref, GAF | At post EMDR > CBT: Improvement in depression. At 6 months FU, EMDR = CBT for depression. At post and FU, EMDR = CBT for anxiety, QoL, PTSD, global functioning. |
| Passoni et al. (2018) | 44 | Caregivers of dementia patients at a hospital | EMDR-Integrative Group Treatment Protocol (IGTP), 8 weekly 2-hour group sessions. Immediate treatment versus WL/delayed. | Traumatic memory or highly stressful recollections related to the dementia | Depression, anxiety, trauma, caregiver needs, and burden. | IES-R (AD-R) | At post, immediate > WL: improvement in PTSD, depression. At 2-month FU, improvement in PTSD only. Delayed: depression reduced at posttreatment, not at 2-month FU. |
| Rahimi et al. (2019) | 90 | Adult patients undergoing hemodialysis at a hospital | TAU + EMDR (n = 45): 3x/week for 2 weeks versus routine care (TAU; n = 45) TAU: weight measurement and blood pressure control | EMDR target: trauma re hemodialysis | Anxiety, depression | HADS (Farsi version) | TAU + EMDR > TAU at posttreatment for improvement in depression and anxiety. |
| Su (2018) | 16 | Adults with MDD in an outpatient clinic | Quasi-experiment. Phase 1: EMDR (n = 8). Phase 2: EMDR (n = 4) versus CBT (n = 4). 10 sessions (2 sessions/week) | Depressive symptoms | Depression | PHQ-9 | Phase 1 EMDR: Improvement in depression. Phase 2 EMDR = CBT: Improved depression. |
| Cohort and case-control studies | |||||||
| Hase et al. (2015) | 32 | Adult inpatients with depressive episodes at a rehabilitation clinic | Nonrandomized controlled trial: EMDR (mean 4.6 sessions, 1–2x week) + TAU (n = 16) versus TAU only (n = 16). TAU: group tx, psychodynamic, psychoeducation, sports, relaxation | Memory of adverse life events related to depression | Depression and overall burden on patients | BDI-II, SCL-90-R depression subscale, GSI | EMDR + TAU > TAU: Improvement in depression: at post and 1-year FU. |
| Hofmann et al. (2014) | 21 | Adults with primary unipolar depression without PTSD. ADM: 9 in EMDR + CBT and 6 in CBT group | Nonrandomized controlled study: EMDR + CBT (n = 21) versus CBT (n = 21). Mean number EMDR sessions: 6.9. + 44.5 CBT. Control group: 47.1 CBT only | EMDR group: Memories related to current depression | Depression | BDI-II | At post, EMDR + CBT > CBT: Improvement in depression and remissions. |
| Lehnung et al. (2017) | 18 | Adult refugees with PTSD and depression | EMDR G-TEP: Partial randomization: EMDR G-TEP (n = 12) versus 1 week WL/DT(n = 6). (2 two-hour sessions on consecutive days) | Disturbing memories or memory fragments | PTSD symptoms, depression | IES-R, BDI | EMDR G-TEP > WL. reduced PTSD. EMDR G-TEP = DT, no significant reduction in depression. |
| Szpringer et al. (2018) | 37 | Adults at an Oncology Center with glioblastoma multiforme, within 2 years of diagnosis, not qualifying for surgical intervention. No ADM | Nonrandomized, controlled trial: consent to EMDR (n = 18) versus control—no consent to EMDR (n = 19). EMDR: 10–12 sessions over 4 months. | No information available | Anxiety, depression, anger | HADS, SOC-29, Patient Caregiver questionnaire | At 4-month FU: EMDR > control: Improvement in depression, anxiety, and anger, sense of coherence. |
| Tang et al. (2015) | 39 | Adolescents with MDD, PTSD, or suicide risk, resulting from a natural disaster | Nonrandomized controlled trial: EMDR (n = 20) versus TAU (psychoeducation) (n = 19) EMDR: 4 sessions over 2 months | Physical distress associated with flashback memories of disaster | Anxiety, depression | C-IES-R, CES-D, MASC-T | At post, EMDR > TAU: Improvement in depression and anxiety. No FU. |
| Case series | |||||||
| Bae et al. (2008) | 2 | Adolescents with MDD | Three to 7 sessions EMDR | Memories of recent stressful events | Depression | HDS | No statistical analysis. Reported depression remission and maintenance at 3-month FU. |
| Grey (2011) | 1 | Adult with MDD and comorbid panic disorder with agoraphobia | Three sessions EMDR per week over 1 month | Cognitive themes: over-responsibility, lack of power, a sense of worthlessness | Depression, anxiety | BDI-II, BAI | No statistical analysis. Reported improvement in comorbid depression and panic disorder with agoraphobia. |
| Guina and Guina (2018) | 1 | Adult with expressive aphasia poststroke | EMDR 24 months poststroke with weekly 1-hour sessions over 2 months | Stroke and suicide attempt | Depression, aphasia | PHQ-9 | No statistical analysis. Reported improvement in depression and aphasia. Depression remission maintained at 4-month FU. |
| Paauw et al. (2019) | 32 | Adolescents with MDD | 6 weekly individual EMDR sessions | Memories of distressing event related to depressive symptoms | PTSD—symptoms, depression, anxiety, somatic complaints, and socioemotional problems | UCLA PTSD-RI, CSI, CDI, SCARED, SDQ | At post, 3-month FU: improvement in depression, PTSD, anxiety, somatic complaints, and socioemotional functioning. |
| Semiz et al. (2016) | 3 | Adults with MDD after a traumatic experience. Current ADM | Six to eight session EMDR | Trauma from violence | Depression, anxiety | BDI, BAI | No statistical analysis. Reported improvement in depression and anxiety scores posttreatment. |
| Wood et al. (2018) | 13 | Adults with long-term depression (2 or more years) | Single case experiment with multiple baselines.2 EMDR sessions per week (max 20 sessions) | Target of treatment was not described | PTSD symptoms, depression | HDS, IES-R, PHQ-9, BDI-II | No statistical analysis. Reported improvement in depression for 7 of 8 completers. |
Note. ADIS-C = Anxiety Disorders Interview Schedule for DSM-IV Child version; ADM = antidepressant medication; BAI = Beck Anxiety Inventory; BDI = Beck Depression Inventory; CBT = cognitive behavioral therapy; CCMD = Chinese classification of mental disorders; CDI = Dutch version Children's Depression Inventory; C-IES-R = Chinese version of the Impact of Events Scale-Revised; CES-D = Mandarin version of the Center for Epidemiologic Studies Depression Scale; CGI = Clinical Global Impression Scale; CSI = Children's Somatization Inventory; DASS = Depression, Anxiety and Stress Scale; DT = Delayed treatment; EMDR = Eye Movement Desensitization and Reprocessing; GAF = Global Assessment of Functioning Scale; GSI = Global Severity Index; HDS = Hamilton Depression Scale; HRV = Heart Rate Variability; G-TEP = Group Traumatic Episode Protocol; HADS-M = Hospital Anxiety and Depression Scale; HSC = Hopkins Symptoms Checklist; HTQ = Harvard Trauma Questionnaire; IES-R = Impact of Events Scale-Revised; MADRS = Montgomery–Åsberg Depression Rating Scale; MASC-T = Taiwanese version of the Multidimensional Anxiety Scale for Children; MDD = Major Depressive Disorder; MINI = Mini International Neuropsychiatric Interview; MLHFQ = Minnesota Living with Heart Failure Questionnaire; PHQ = Patient Health Questionnaire; PTSD = posttraumatic stress disorder; QOL = Quality of Life; RAS = Rathus Assertiveness Schedule; RCT = randomized controlled trial; SCARED = Dutch version of the Screen for Child Anxiety Related Emotional Disorders; SCID = Structured Clinical Interview for DSM; SCL-90-R = Symptom Checklist 90 items revised; SDQ = Dutch adolescent version of the Strengths and Difficulties Questionnaire; SOC = Sense of Coherence Scale; TAU = Treatment as Usual; TESS = Treatment Emergent Symptom Scale; UCLA PTSD RI = University of California at Los Angeles Posttraumatic Stress Disorder Reaction Index Adolescent version; WL = Waiting list.
a Abstract available only, data stem from doctoral thesis.
b Article published in Chinese (abstract only in English).
| Author(s) | N | Setting | Intervention (Number of Sessions) | Memories/Phenomena Targeted | Outcomes/Dependent Variables | Measure(s) | Significant Results |
|---|---|---|---|---|---|---|---|
| RCTs | |||||||
| Arias-Suárez et al. (2020) | 28 | Outpatients with chronic pain conditions | 12 TAU (n = 14; 90-minute sessions; for example, medication, physiotherapy, CBT) versus 12 EMDR pain Protocol +TAU (n = 14; 90 minutes sessions) over 3 months | Disturbing memories associated with traumatic experiences and pain experiences | Pain intensity, quality of life, anxiety, depression | VAS, PDI, EQ-5D-5L, HADS | At post and 3-month FU, EMDR + TAU > TAU for improvement in pain intensity quality of life, anxiety, and depressive symptoms. |
| Brennstuhl et al. (2016) | 45 | Inpatients with chronic pain conditions | EMDR standard protocol (n = 15) versus EMDR pain protocol (n = 15) versus eclectic therapy (ET; n = 15) in addition to multidisciplinary pain management program. Five EMDR sessions in EMDR conditions | EMDR standard protocol: specific elements of traumatic events. EMDR pain protocol: sensation of pain and a mental image of this perception | Pain intensity, feelings, beliefs, and cognitions related to pain, PTSD symptoms | VAS, PBPI, PCL-S | Both EMDR protocols > ET: improvements in pain intensity, feelings, beliefs, and cognitions related to pain, and traumatic components of pain at post and 1-month FU. |
| Estergard (2008) | 37 | Outpatients with chronic pain | EMDR (n = 20) versus control/delayed treatment group (n = 17) EMDR: 6 sessions, 90 minutes | Pain-related disturbing memories | Intensity of pain, mood, and dysphoria | SF-MPQ, MAACL-Ra | EMDR > WL for reduction of chronic pain and dysphoria. |
| Gerhardt et al. (2016) | 40 | Outpatients with chronic back pain | EMDR + TAU (n = 20) versus TAU (n = 20). EMDR: 10 sessions, 90 minutes | Disturbing memories, current pain perceptions, and anticipated future painful situations | Pain intensity, disability, treatment satisfaction | NRS, MPI-D, PGIC | EMDR plus TAU > TAU for pain reduction at post and 6-month FU. |
| Marcus (2008) | 52 | Outpatients with acute migraine | One 60-minute session of integrated EMDR (n = 26) versus standard care medication (SCM; n = 26) | Interoception/focus on diaphragmatic breathing | Intensity of pain | SPL, MIDAS, HDI | Integrated EMDR > SCM for immediate pain relief. EMDR = SCM at 1, 2, and 7-day FU. |
| Maroufi et al. (2016) | 56 | Adolescent inpatients with acute pain after abdominal surgery | EMDR (n = 28) versus neutral interview (NI) (n = 28). Both EMDR and NI, 1 session, 60 minutes | Negative beliefs or images associated with the surgery | Intensity of pain | WBFS | EMDR > NI: pain reduction at post. |
| Nia et al. (2018) | 75 | Outpatients with chronic musculoskeletal pain due to rheumatoid arthritis | EMDR (n = 25) versus guided imagery (GI) (n = 25) versus TAU (n = 25). EMDR 6 sessions, 45–90 minutes, GI 6 sessions | Disturbing memories | Intensity of pain | RAPS | EMDR > GI > TAU for reduction in pain intensity. |
| Rostaminejad et al. (2017) | 60 | Outpatients with phantom limb pain | EMDR (n = 30) versus no treatment (n = 30). EMDR 12–60 minutes sessions in 1 month | Memories of initial injury, amputation, related difficulties in functioning, pain sensation | Intensity of pain | SUD, PRS | EMDR > no treatment for pain intensity at post and 24-month FU. |
| Case series or studies not controlled | |||||||
| Allen (2004) | 4 | Outpatients with chronic pain conditions | Nine EMDR sessions | Disturbing memories associated with traumatic experiences and pain experiences | Pain intensity, trauma symptoms, anxiety, depression | IES, BAI, BDI, VAS, SFMPQ | EMDR: improvement in pain, negative affect, and self-efficacy in managing pain at post and FU. |
| Brennstuhl et al. (2015) | 2 | Outpatients with phantom breast syndrome | 9–12 sessions EMDR, 90 minutes | Traumatic events related to disease experience and phantom breast sensation | Pain intensity, intensity of the sensation, depression, anxiety | STAI, CES-D, PBS | No statistical analysis. Reported positive results. |
| De Roos et al. (2010) | 10 | Outpatients with phantom limb pain | 3–10 EMDR sessions (mean 5.9), 90 minutes | Memories of traumatic experiences and pain experiences, actual pain | Pain intensity, fatigue, psychological distress, PTSD symptoms, quality of life | SCL-90, CIS-20R, IES, SIL, SF-36 | At post and long-term FU, EMDR: decrease in pain, and on most psychological measures. No effect for physical function. |
| Friedberg (2004) | 6 | Outpatients with fibromyalgia and chronic fatigue syndrome | Two EMD sessions, 60 minutes | Most salient sensation or feeling | Fibromyalgia impact, fatigue, depression, anxiety | FIQ, FS, BAI, BDI | No statistical analysis. Reported positive results. |
| Gauvry et al. (2013) | 1 | Inpatient adolescent with CRPS | Five EMDR sessions, 90 minutes over 2 weeks | Memories of medical experiences and pain | Pain intensity, trauma symptoms | CPSRI, SUD | No statistical analysis. Reported positive results. |
| Grant and Threlfo (2002) | 3 | Outpatient with chronic musculoskeletal pain | EMDR Chronic Pain Protocol, 9 sessions, 60 minutes | Disturbing memories associated with traumatic experiences and pain experiences | Intensity of pain, cognitive and behavioral pain-coping strategies | SFMPQ, CSQ, SUD | No statistical analysis. Reported positive results. |
| Hassard (1995) | 27 | Outpatients with chronic pain | EMD combined with medication or CBT if deemed necessary. 1–11 sessions, mean 4 | Disturbing memories associated with traumatic experiences and pain experiences | Pain intensity disability, mood state | NHP, HADS | At post: a large decrease in some, but not all, psychological measures. No effects observed with sleep or pain. At 3-month FU, only effect was for emotion reactions and energy. |
| Hughes (2014) | 1 | Outpatient with CRPS | 14 EMDR sessions | Memories of traumatic experiences and pain experiences | Pain intensity, substance dependence, mood state | – | No statistical analysis. Reported positive results. |
| Kavakci et al. (2012) | 7 | Outpatients with fi bromyalgia | Five to 8 EMDR sessions, 60–90 minutes | Disturbing memories associated with traumatic experiences and pain experiences, actual pain | Pain intensity disability, mood state, tender points, sleep, anger, PTSD | VAS, FIQ, BDI, TPC, PSQI, STAS, PDS | EMDR; decrease in perceived pain, tender point counts, trauma and depressive symptoms, and improved sleep and quality of life. |
| Konuk et al. (2011) | 11 | Outpatients with migraine | Variable amount of sessions (mean 8) | Trauma memories associated with headaches | Pain intensity, duration, medication, emergency room (ER) visits, psychological state | EMDR-HTIF, SCID, SA-45, WHQ | At post, 3-month FU, EMDR: decrease in headache frequency and duration but not pain intensity. Decrease in the use of painkillers and ER visits. |
| Mazzola et al. (2009) | 38 | Outpatients with chronic pain | 12 EMDR sessions, 90 minutes | Memories of traumatic experiences and pain experiences | Pain intensity, depression, quality of life | SF-36, STAI, BDI, SCID, VAS | EMDR: decrease in pain sensations, pain-related negative affect, anxiety, depression. |
| Russell (2008a) | 1 | Outpatient with phantom limb pain | Five EMDR sessions | Memories related to pathology, triggers, future adaptive responses | Pain intensity, depression, PTSD symptoms | IES, BDI, NRS | No statistical analysis. Reported positive results. |
| Schneider et al. (2007) | 1 | Outpatient with phantom limb pain | Nine EMDR sessions | Memories related to physical condition, phantom limb pain | Pain intensity, PTSD symptoms, depression | SCID, IES, BDI, VAS | No statistical analysis. Reported positive results. |
| Schneider et al. (2008) | 5 | In- and-outpatients with phantom limb pain | Three to15 EMDR sessions, 50–90 minutes | Memories of pain, self-esteem, triggers, thoughts of the future | PTSD symptoms, depression | IES, BDI | No statistical analysis. Reported positive results. |
| Wilensky (2006) | 5 | Outpatient with phantom limb pain | Three to 9 EMDR sessions | Memories of accident, related events, physical sensations | Pain intensity, trauma symptoms, depression | IES, PDI, TSI, BDI | No statistical analysis. Reported positive results. |
Note. BAI = Beck Anxiety Inventory; BDI = Beck Depression Inventory; CLBP = Chronic low back pain; CIS-20R = Checklist Individual Strength-Revised; CRPS = Complex Regional Pain Syndrome; CSQ = Coping Skills Questionnaire; EMDR = Eye Movement Desensitization and Reprocessing; FIQ = Fibromyalgia Impact Scale; FS = Fatigue Scale; HADS = Hospital Anxiety and Depression Scale; HDI = Headache Disability Inventory; IES = Impact of Event Scale; IES-R = Impact of Event Scale-Revised; MAACL-R = Multiple Affect Adjective Checklist-Revised; MBHI = Millon Behavioral Health Inventory; MIDAS = Migraine Disability Assessment Scale; NHP = Nottingham Health Profile; NRS = Numeric Rating Scale; PDI = Pain Disability Index; PDS = PostTraumatic Diagnostic Scale; PLP = Phantom limb pain; PPI = Present Pain Intensity; PRI = Pain Rating Index; PSQI = Pittsburgh Sleep Quality Index; PTSD = posttraumatic stress disorder; SA-45 = Symptom Assessment-45 Questionnaire (derived from the SCL-90); SCM = Standard Care Medication'; SF-36 = Short-Form Health Survey; SFMPQ = Short-Form McGill Melzack Pain Questionnaire; SIL = Self-Inventory List; STAI = State-Trait Anxiety Inventory; STAS = State-Trait Anger Scale; SUD = Subjective Units of Discomfort; TAU = Treatment as Usual; TPC = Tender Point Count; VAS = Visual Analogue Scale; WHQ = Weekly Headache Questionnaire.
a As data were reported incompletely, no pre/post-calculations were possible.
Article usage
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