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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

Table 1
The Adapted Revised Gold Standard Scale
GS 1Reliable 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 2Use of blind independent assessor
0 : assessor was therapist
.5: assessor was not blind
1 : assessor was blind and independent
GS 3Assessor 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 4Manualized, replicable, specific treatment
0 : treatment was not replicable or specific
1 : treatment followed EMDR training manual, Shapiro 1995
GS 5Unbiased assignment to treatment
0 : assignment not randomized
.5: only one therapist, OR semi-randomized designs
1 : unbiased assignment to treatment
GS 6Treatment adherence
0 : treatment fidelity poor
.5: treatment fidelity unknown, or variable
1 : treatment fidelity checked and accurate
GS 7No 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 8Use 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.

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Table 2
Characteristics of the Studies in the Present Review
AuthorsDisasterNStudy TypeType of Psychological DistressEMDR ProtocolNumber of Treatment SessionsMeasures UsedFollow-upMakes Claim Regarding Effectiveness
Abbasnejad et al. (2007)Earthquake, Bam, Iran41Randomized controlled trialPTSD symptoms, anxiety, depression, fear, phobia, grief, and other unpleasant feelingsComputerized EMDR (“There and Back”)4BDI, BAI, and SUD1 monthYes, if appropriate
Aduriz et al. (2011)Flood, Sante Fe, Argentina124UncontrolledPTSD symptomsEMDR-IGTP1CRTES, SUD3 monthsYes, if appropriate
Chemtob et al. (2002)Hurricane Iniki, Hawaii32Randomized controlled trialPTSD, anxiety, and depressionStandard protocol3CRI, RCMAS, CDI6 monthsYes, if appropriate
Fernandez (2007)Earthquake, Molise, Italy22Uncontrolled field studyPTSDStandard protocol8SCID-1 supported assessment1 yearYes, if appropriate
Grainger et al. (1997)Hurricane Andrew, Florida40Randomized controlled trialPTSD symptomsStandard protocol1IES, SUD1 and 3 monthsYes, if appropriate
Jarero et al. (2006)Flood, Mexico44Uncontrolled field studyPTSD symptomsEMDR-IGTP1CRTES SUD1 monthYes, if appropriate
Jarero et al. (2011)Earthquake, Mexico18Randomized controlled field studyPTSD symptomsEMDR-PRECI1IES3 monthsYes, if appropriate
Konuk et al. (2006)Earthquake, Marmara, Turkey41 (21 available at follow-up)Part-controlledPTSDStandard protocol5PSS-SR, SUD, VOC6 monthsYes, 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.

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Table 3
Mean Scores of Outcome Measures at Pretreatment, Posttreatment, and Follow-up
PretreatmentPosttreatmentFollow-up
AuthorsMeasuresConditionMSDMSDMSDSignificance
Abbasnejad et al. (2007)BDIExperimental33.516.6316.424.5415.425.75p < .001
Delayed34.456.5631.558.84
BAIExperimental33.805.6916.196.5413.576.27p < .001
Delayed33.607.0231.88.58
SUDExperimental7.191.362.571.032.211.32p < .001
Delayed7.371.036.402.12
Aduriz et al. (2011)CRTESExperimental26.4010.80p < .001
SUDExperimental7.202.19p < .001
Chemtob et al. (2002)CRIExperimental36.5411.5716.4712.9810.598.23p < .001
Delayed39.6021.0422.6020.2118.8720.39
RCMASExperimental18.005.8714.298.2610.008.28p < .001
Delayed18.078.1711.7810.9913.579.47
CDIExperimental55.949.8648.7113.0348.3514.22p < .01
Delayed59.7319.8453.8721.8251.6718.34
Fernandez (2007)SCID-1 supported assessmentExperimentalp < .01
Grainger et al. (1997)IESExperimental37.3921.6024.33p < .001
Delayed18.7321.57
SUDExperimental7.721.581.942.05p < .001
Delayed34.3637.91
Jarero et al. (2006)CRTESExperimental32.778.27Clinically significant
SUDExperimental9.241.29
Jarero et al. (2011)IESExperimental54.2211.0024.894.8322.674.85p < .001
Delayed55.678.3749.228.0322.785.47
Konuk et al. (2006)PSS-SRCombined means of early- and late-treated group34.297.965.374.767.767.79p < .001
SUDCombined8.152.210.420.79p < .01
VOCCombined2.341.446.421.08

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.

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Table 4
Quality Assessment of Selected Studies Using the Revised Gold Standard Scale
Authors#1#2#3#4#5#6#7#8Quality Score
Abbasnejad et al. (2007)10.501.5.503.5
Aduriz et al. (2011)10.500.5.502.5
Chemtob et al. (2002)101111.516.5
Fernandez (2007)111101.5.56
Grainger et al. (1997)10111.5.5.55.5
Jarero et al. (2006)10.5101.504
Jarero et al. (2011)101111106
Konuk et al. (2006)1011.51.516
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