Review Article
Abstract
Natural disasters affect whole communities both at an individual level as well as economically and socially. However, the impact of natural disasters on an individual’s mental health is substantial; yet, the response to one’s mental health needs after a disaster is underdeveloped. Nevertheless, the Humanitarian Assistance Programme has attempted to address these needs by providing eye movement desensitization and reprocessing (EMDR) to natural disaster survivors. This systematic review provides evidence for the effectiveness and efficacy of EMDR in the treatment of psychological distress in survivors of natural disasters. Of the 8 studies reviewed, 4 were controlled trials and 1 study part-controlled. All the studies demonstrated statistical and clinical significance in reducing posttraumatic stress disorder (PTSD) symptoms, anxiety, depression, and other distress experienced by survivors of natural disasters. In addition, 4 of the 8 studies demonstrated clinical significance after just 1 session, presenting EMDR as resource-, time-, and cost-efficient intervention. Theoretical framework, adaptation in intervention, methodological issues, and quality assessment of studies are discussed. Implications for future research and clinical practice are also discussed.
Tables
GS 1 | Reliable and valid measures |
0 : did not use reliable and valid measures | |
.5: measures used inadequate to measure change | |
1 : reliable, valid, and adequate measures | |
GS 2 | Use of blind independent assessor |
0 : assessor was therapist | |
.5: assessor was not blind | |
1 : assessor was blind and independent | |
GS 3 | Assessor reliability |
0 : no training in administration of instruments used in the study | |
.5: training in administration of instruments used in the study | |
1 : training with performance supervision, or reliability checks | |
GS 4 | Manualized, replicable, specific treatment |
0 : treatment was not replicable or specific | |
1 : treatment followed EMDR training manual, Shapiro 1995 | |
GS 5 | Unbiased assignment to treatment |
0 : assignment not randomized | |
.5: only one therapist, OR semi-randomized designs | |
1 : unbiased assignment to treatment | |
GS 6 | Treatment adherence |
0 : treatment fidelity poor | |
.5: treatment fidelity unknown, or variable | |
1 : treatment fidelity checked and accurate | |
GS 7 | No confounded conditions |
0 : most subjects receiving concurrent psychotherapy | |
.5: a few subjects receiving concurrent psychotherapy, or unspecified and no exclusion for current treatment | |
1 : no subjects receiving concurrent psychotherapy | |
GS 8 | Use of multimodal measures |
0 : self-report measures only | |
.5: self-report plus interview or physiological or behavioral measures | |
1 : self-report plus two or more other types of measures |
Note. GS = Gold Standard. Adapted from “The Relationship Between Efficacy and Methodology in Studies Investigating EMDR Treatment of PTSD,” by L. Maxfield and L. Hyer, 2002, Journal of Clinical Psychology, 58, p. 31.
Authors | Disaster | N | Study Type | Type of Psychological Distress | EMDR Protocol | Number of Treatment Sessions | Measures Used | Follow-up | Makes Claim Regarding Effectiveness |
Abbasnejad et al. (2007) | Earthquake, Bam, Iran | 41 | Randomized controlled trial | PTSD symptoms, anxiety, depression, fear, phobia, grief, and other unpleasant feelings | Computerized EMDR (“There and Back”) | 4 | BDI, BAI, and SUD | 1 month | Yes, if appropriate |
Aduriz et al. (2011) | Flood, Sante Fe, Argentina | 124 | Uncontrolled | PTSD symptoms | EMDR-IGTP | 1 | CRTES, SUD | 3 months | Yes, if appropriate |
Chemtob et al. (2002) | Hurricane Iniki, Hawaii | 32 | Randomized controlled trial | PTSD, anxiety, and depression | Standard protocol | 3 | CRI, RCMAS, CDI | 6 months | Yes, if appropriate |
Fernandez (2007) | Earthquake, Molise, Italy | 22 | Uncontrolled field study | PTSD | Standard protocol | 8 | SCID-1 supported assessment | 1 year | Yes, if appropriate |
Grainger et al. (1997) | Hurricane Andrew, Florida | 40 | Randomized controlled trial | PTSD symptoms | Standard protocol | 1 | IES, SUD | 1 and 3 months | Yes, if appropriate |
Jarero et al. (2006) | Flood, Mexico | 44 | Uncontrolled field study | PTSD symptoms | EMDR-IGTP | 1 | CRTES SUD | 1 month | Yes, if appropriate |
Jarero et al. (2011) | Earthquake, Mexico | 18 | Randomized controlled field study | PTSD symptoms | EMDR-PRECI | 1 | IES | 3 months | Yes, if appropriate |
Konuk et al. (2006) | Earthquake, Marmara, Turkey | 41 (21 available at follow-up) | Part-controlled | PTSD | Standard protocol | 5 | PSS-SR, SUD, VOC | 6 months | Yes, if appropriate |
Note. BDI = Beck Depression Inventory; BAI = Beck Anxiety Inventory; SUD = Subjective Units of Disturbance; CRTES = Child’s Reaction to Traumatic Events Scale; CRI = Children’s Reaction Inventory; RCMAS = Revised Children’s Manifest Anxiety Scale; CDI = Child Depression Inventory; SCID-1 = Structured Clinical Interview for DSM-IV Axis I Disorders; IES = Impact of Events Scale; PSS-SR = PTSD Symptom Scale–Self-Report; VOC = Validity of Cognitions.
Pretreatment | Posttreatment | Follow-up | |||||||
Authors | Measures | Condition | M | SD | M | SD | M | SD | Significance |
Abbasnejad et al. (2007) | BDI | Experimental | 33.51 | 6.63 | 16.42 | 4.54 | 15.42 | 5.75 | p < .001 |
Delayed | 34.45 | 6.56 | 31.55 | 8.84 | — | — | |||
BAI | Experimental | 33.80 | 5.69 | 16.19 | 6.54 | 13.57 | 6.27 | p < .001 | |
Delayed | 33.60 | 7.02 | 31.8 | 8.58 | — | — | |||
SUD | Experimental | 7.19 | 1.36 | 2.57 | 1.03 | 2.21 | 1.32 | p < .001 | |
Delayed | 7.37 | 1.03 | 6.40 | 2.12 | — | — | |||
Aduriz et al. (2011) | CRTES | Experimental | 26.40 | — | — | — | 10.80 | — | p < .001 |
SUD | Experimental | 7.20 | — | 2.19 | — | — | — | p < .001 | |
Chemtob et al. (2002) | CRI | Experimental | 36.54 | 11.57 | 16.47 | 12.98 | 10.59 | 8.23 | p < .001 |
Delayed | 39.60 | 21.04 | 22.60 | 20.21 | 18.87 | 20.39 | |||
RCMAS | Experimental | 18.00 | 5.87 | 14.29 | 8.26 | 10.00 | 8.28 | p < .001 | |
Delayed | 18.07 | 8.17 | 11.78 | 10.99 | 13.57 | 9.47 | |||
CDI | Experimental | 55.94 | 9.86 | 48.71 | 13.03 | 48.35 | 14.22 | p < .01 | |
Delayed | 59.73 | 19.84 | 53.87 | 21.82 | 51.67 | 18.34 | |||
Fernandez (2007) | SCID-1 supported assessment | Experimental | — | — | — | — | — | — | p < .01 |
Grainger et al. (1997) | IES | Experimental | 37.39 | — | 21.60 | — | 24.33 | — | p < .001 |
Delayed | 18.73 | — | 21.57 | — | — | — | |||
SUD | Experimental | 7.72 | 1.58 | 1.94 | 2.05 | — | — | p < .001 | |
Delayed | 34.36 | — | 37.91 | — | — | — | |||
Jarero et al. (2006) | CRTES | Experimental | 32.77 | — | — | — | 8.27 | — | Clinically significant |
SUD | Experimental | 9.24 | — | 1.29 | — | — | — | ||
Jarero et al. (2011) | IES | Experimental | 54.22 | 11.00 | 24.89 | 4.83 | 22.67 | 4.85 | p < .001 |
Delayed | 55.67 | 8.37 | 49.22 | 8.03 | 22.78 | 5.47 | |||
Konuk et al. (2006) | PSS-SR | Combined means of early- and late-treated group | 34.29 | 7.96 | 5.37 | 4.76 | 7.76 | 7.79 | p < .001 |
SUD | Combined | 8.15 | 2.21 | 0.42 | 0.79 | — | — | p < .01 | |
VOC | Combined | 2.34 | 1.44 | 6.42 | 1.08 | — | — |
Note. BDI = Beck Depression Inventory; BAI = Beck Anxiety Inventory; SUD = Subjective Units of Disturbance; CRTES = Child’s Reaction to Traumatic Events Scale; CRI = Children’s Reaction Inventory; RCMAS = Revised Children’s Manifest Anxiety Scale; CDI = Child Depression Inventory; SCID-1 = Structured Clinical Interview for DSM-IV Axis I Disorders; IES = Impact of Events Scale; PSS-SR = PTSD Symptom Scale–Self-Report; VOC = Validity of Cognitions.
Authors | #1 | #2 | #3 | #4 | #5 | #6 | #7 | #8 | Quality Score |
Abbasnejad et al. (2007) | 1 | 0 | .5 | 0 | 1 | .5 | .5 | 0 | 3.5 |
Aduriz et al. (2011) | 1 | 0 | .5 | 0 | 0 | .5 | .5 | 0 | 2.5 |
Chemtob et al. (2002) | 1 | 0 | 1 | 1 | 1 | 1 | .5 | 1 | 6.5 |
Fernandez (2007) | 1 | 1 | 1 | 1 | 0 | 1 | .5 | .5 | 6 |
Grainger et al. (1997) | 1 | 0 | 1 | 1 | 1 | .5 | .5 | .5 | 5.5 |
Jarero et al. (2006) | 1 | 0 | .5 | 1 | 0 | 1 | .5 | 0 | 4 |
Jarero et al. (2011) | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 0 | 6 |
Konuk et al. (2006) | 1 | 0 | 1 | 1 | .5 | 1 | .5 | 1 | 6 |
Period | Abstract | Full | Total | |
---|---|---|---|---|
Nov 2024 | 11 | 43 | 4 | 58 |
Oct 2024 | 5 | 12 | 1 | 18 |
Sep 2024 | 22 | 15 | 4 | 41 |
Aug 2024 | 1385 | 16 | 3 | 1404 |
Jul 2024 | 32 | 4 | 2 | 38 |
Jun 2024 | 34 | 9 | 4 | 47 |
May 2024 | 257 | 14 | 8 | 279 |
Apr 2024 | 43 | 52 | 17 | 112 |
Mar 2024 | 50 | 12 | 11 | 73 |
Feb 2024 | 44 | 4 | 5 | 53 |
Jan 2024 | 56 | 14 | 7 | 77 |
Dec 2023 | 58 | 8 | 10 | 76 |
Nov 2023 | 36 | 6 | 7 | 49 |
Oct 2023 | 39 | 8 | 7 | 54 |
Sep 2023 | 55 | 4 | 6 | 65 |
Aug 2023 | 42 | 3 | 5 | 50 |
Jul 2023 | 31 | 9 | 13 | 53 |
Jun 2023 | 45 | 13 | 8 | 66 |
May 2023 | 65 | 11 | 20 | 96 |
Apr 2023 | 42 | 21 | 22 | 85 |
Mar 2023 | 63 | 26 | 13 | 102 |
Feb 2023 | 53 | 30 | 12 | 95 |
Jan 2023 | 30 | 37 | 23 | 90 |
Dec 2022 | 40 | 12 | 12 | 64 |
Nov 2022 | 71 | 19 | 12 | 102 |
Oct 2022 | 61 | 26 | 22 | 109 |
Sep 2022 | 37 | 20 | 7 | 64 |
Aug 2022 | 22 | 13 | 3 | 38 |
Jul 2022 | 20 | 20 | 4 | 44 |
Jun 2022 | 41 | 12 | 7 | 60 |
May 2022 | 41 | 11 | 13 | 65 |
Apr 2022 | 43 | 49 | 30 | 122 |
Mar 2022 | 26 | 8 | 10 | 44 |
Feb 2022 | 49 | 10 | 9 | 68 |
Jan 2022 | 26 | 7 | 6 | 39 |
Dec 2021 | 28 | 11 | 10 | 49 |
Nov 2021 | 19 | 13 | 5 | 37 |
Oct 2021 | 18 | 9 | 5 | 32 |
Sep 2021 | 16 | 16 | 4 | 36 |
Aug 2021 | 13 | 12 | 5 | 30 |
Jul 2021 | 15 | 15 | 6 | 36 |
Jun 2021 | 16 | 16 | 5 | 37 |
May 2021 | 46 | 24 | 21 | 91 |
Apr 2021 | 69 | 28 | 13 | 110 |
Mar 2021 | 41 | 19 | 11 | 71 |
Feb 2021 | 35 | 9 | 8 | 52 |
Jan 2021 | 183 | 42 | 9 | 234 |
Dec 2020 | 41 | 34 | 5 | 80 |
Nov 2020 | 22 | 42 | 12 | 76 |
Oct 2020 | 23 | 38 | 14 | 75 |
Sep 2020 | 16 | 34 | 6 | 56 |
Aug 2020 | 28 | 33 | 10 | 71 |
Jul 2020 | 18 | 35 | 10 | 63 |
Jun 2020 | 9 | 28 | 10 | 47 |
May 2020 | 22 | 80 | 29 | 131 |
Apr 2020 | 39 | 133 | 63 | 235 |
Mar 2020 | 45 | 19 | 8 | 72 |
Feb 2020 | 18 | 13 | 6 | 37 |
Jan 2020 | 30 | 27 | 9 | 66 |
Dec 2019 | 30 | 25 | 3 | 58 |
Nov 2019 | 13 | 10 | 3 | 26 |
Oct 2019 | 15 | 5 | 6 | 26 |
Sep 2019 | 4 | 4 | 0 | 8 |
Aug 2019 | 2 | 6 | 1 | 9 |
Jul 2019 | 2 | 11 | 5 | 18 |
Jun 2019 | 5 | 14 | 3 | 22 |
May 2019 | 2 | 23 | 3 | 28 |
Apr 2019 | 5 | 34 | 12 | 51 |
Mar 2019 | 4 | 20 | 6 | 30 |
Feb 2019 | 7 | 9 | 3 | 19 |
Jan 2019 | 8 | 3 | 1 | 12 |
Dec 2018 | 0 | 1 | 0 | 1 |
Nov 2018 | 6 | 0 | 0 | 6 |
Oct 2018 | 17 | 1 | 2 | 20 |
Sep 2018 | 8 | 0 | 0 | 8 |
Aug 2018 | 4 | 0 | 1 | 5 |
Jul 2018 | 8 | 0 | 0 | 8 |