The comparative treatment efficiency of eye movement desensitization and reprocessing (EMDR) therapy and prolonged exposure (PE) therapy for the treatment of posttraumatic stress disorder (PTSD) was tested for 20 participants diagnosed with PTSD. Efficiency was operationalized as the total exposure time to traumatic memories during and between sessions; the number of trauma memories processed over the course of therapy; how many sessions were required to resolve the primary trauma; and lower subjective units of disturbance (SUD) levels after the initial treatment session. Participants were randomized to each condition and received 12 90-minute sessions of therapy over 6 weeks. Symptoms were assessed by treatment-blind assessors at posttreatment, and at 3 and 6 months follow-up. Results demonstrated a significant decrease in symptoms posttreatment for PTSD (d = .64), depression (d = .46), anxiety (d = .52) and stress (d = .57) for both groups, which was maintained at 3 months. At 6 months there was a small increase in symptoms compared to the 3-month time point on the Clinician-Administered PTSD Scale (CAPS) but no significant change in any self-report symptoms EMDR was significantly more efficient than PE. EMDR participants had less total exposure time to traumatic memories when homework hours were included (d = .66), reported lower SUD scores after the first session (d = .45), required fewer sessions for the target memory to decrease to near zero distress levels (d = .84), and processed more traumatic memories.

In the last 24 months, three separate practice guidelines for posttraumatic stress disorder (PTSD) have emerged from well-respected organizations that differed in the degree to which they recommend eye movement desensitization and reprocessing (EMDR) as a treatment. An international guideline was published by the International Society for Traumatic Stress Studies (ISTSS), and national guidelines were published by the American Psychological Association (APA) and the National Institute for Health Care Excellence (NICE). ISTSS reported that EMDR was effective and as potent as the best available therapies we can currently provide. NICE was more circumspect, and APA suggested other treatments had a stronger evidence base. In this review we focus on how these differences emerged and highlight the role of the time when the analysis was conducted, differences in inclusion criteria, and errors in determining appropriate measures. The 2017 APA guidelines were found to have the least validity when all these factors were considered. However, the fact that evaluating EMDR research is susceptible to such variations in methodology highlights certain research priorities that are then discussed.

This study compared the effectiveness of eye movement desensitization and reprocessing (EMDR) with an integrated cognitive behavioral therapy (CBT) intervention for grief. Nineteen participants (12 females and 7 males) who identified themselves as struggling with grief were randomly allocated to treatment conditions. Each participant was wait-listed for 7 weeks and then received 7 weeks of therapy. There were no significant improvements on any measure in the wait-list period. In contrast, participants in both treatment groups improved on measures of grief (η_p² = .47), trauma symptoms (η_p² = .60), and distress (η_p² = .34). There was no significant improvement in participants’ scores on a quality of life measure (η_p² = .11). Neither treatment approach produced better outcomes than the other. For those who scored in the clinical range at intake, 72% achieved clinical and reliable change on the grief measure and 82% on the trauma measure. The study had several strengths, including randomization to treatment condition, multiple therapists, formal assessment of treatment fidelity, and the pretreatment and follow-up assessments were conducted by researchers blind to treatment assignment. Overall, the findings indicate that EMDR and CBT are efficacious in assisting those struggling with grief, and that those individuals reporting higher levels of distress and lower levels of functioning may benefit the most from an intervention.

The processes that underlie the effectiveness of eye movement desensitization and reprocessing (EMDR) are examined by evaluating the procedural differences between it and exposure therapy. Major factors include the degree of emphasis placed on reliving versus distancing in the therapies and the degree to which clients are encouraged to focus on direct trauma experiences versus experiences associated with the trauma. Research results indicate that, unlike traditional imaginal exposure, reliving responses in EMDR did not correlate with symptom improvement. Instead, consistent with an information processing model, the degree of distancing in EMDR was significantly associated with improvement. A case study is described to highlight these methodological divergences in the respective therapies relating to reliving. Finally, the research regarding the possible sources of the distancing response within EMDR was examined. The results indicate that the distancing process was more likely to be an effect produced by eye movements than by any therapist instructions. Theoretical and research evaluations indicate that the mechanisms underlying EMDR and traditional exposure therapy are different.

This article provides an overview of selective issues relating to adult posttraumatic stress disorder (PTSD) and its treatment with eye movement desensitization and reprocessing (EMDR). The article begins by providing a historical overview of PTSD, and debates about the etiology and definition of PTSD are discussed. The most predominant theories of PTSD are summarized by highlighting how they have evolved from traditional behavioral accounts based on the assumption that PTSD is an anxiety disorder to theories that now incorporate information-processing models. This article then examines the development of EMDR and the corresponding body of research that clearly demonstrates its efficacy for the treatment for adult PTSD. The underlying mechanisms of EMDR are discussed, with a focus on the importance of the eye movement component and how the therapeutic processes in EMDR differ from those of traditional exposure therapy. Finally, the adaptive information-processing (AIP) model that underlies EMDR is outlined, and evidence for the model is summarized. The article concludes by suggesting future research based on questions raised about PTSD and its treatment with EMDR when the AIP model is compared to other information-based theories of PTSD.

This preliminary study examined the physiological correlates of eye movement desensitization and reprocessing (EMDR) therapy when effectively used to treat trauma symptoms in a postconflict, developing nation, Timor-Leste. Participants were 20 Timorese adults with posttraumatic stress disorder (PTSD) symptoms treated with EMDR therapy. PTSD, depression, and anxiety decreased significantly after an average of 4.15 (SD = 2.06) sessions. Continuous measures of heart rate, skin conductance, and respiration were collected during the first and last desensitization sessions. Physiological activity decreased in EMDR desensitization sessions, and eye movement sets were associated with an immediate significant decrease in heart rate and an increase in skin conductance, consistent with an orienting response. This response habituated within and across eye movement sets. These findings suggest that effective EMDR therapy is associated with de-arousal within sessions and that eye movement sets are associated with distinct physiological changes that may aid memory processing. The findings offer insight into the working mechanisms of EMDR when used to treat PTSD symptoms in a real-world, cross-cultural, postwar/conflict setting.

Complex posttraumatic stress disorder (CPTSD) is a diagnostic entity that will be included in the forthcoming edition of the International Classification of Diseases, 11th Revision (ICD-11). It denotes a severe form of PTSD, comprising not only the symptom clusters of PTSD (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV-TR]), but also clusters reflecting difficulties in regulating emotions, disturbances in relational capacities, and adversely affected belief systems about oneself, others, or the world. Evidence is mounting suggesting that first-line trauma-focused treatments, including eye movement desensitization and reprocessing (EMDR) therapy, are effective not only for the treatment of PTSD, but also for the treatment of patients with a history of early childhood interpersonal trauma who are suffering from symptoms characteristic of CPTSD. However, controversy exists as to when EMDR therapy should be offered to people with CPTSD. This article reviews the evidence in support of EMDR therapy as a first-line treatment for CPTSD and addresses the fact that there appears to be little empirical evidence supporting the view that there should be a stabilization phase prior to trauma processing in working with CPTSD.

Given that 2019 marks the 30th anniversary of eye movement desensitization and reprocessing (EMDR) therapy, the purpose of this article is to summarize the current empirical evidence in support of EMDR therapy as an effective treatment intervention for posttraumatic stress disorder (PTSD). Currently, there are more than 30 randomized controlled trials (RCT) demonstrating the effectiveness in patients with this debilitating mental health condition, thus providing a robust evidence base for EMDR therapy as a first-choice treatment for PTSD. Results from several meta-analyses further suggest that EMDR therapy is equally effective as its most important trauma-focused comparator, that is, trauma-focused cognitive behavioral therapy, albeit there are indications from some studies that EMDR therapy might be more efficient and cost-effective. There is emerging evidence showing that EMDR treatment of patients with psychiatric disorders, such as psychosis, in which PTSD is comorbid, is also safe, effective, and efficacious. In addition to future well-crafted RCTs in areas such as combat-related PTSD and psychiatric disorders with comorbid PTSD, RCTs with PTSD as the primary diagnosis remain pivotal in further demonstrating EMDR therapy as a robust treatment intervention.

Although treatment fidelity measures for eye movement desensitization and reprocessing (EMDR) have been cited in past research, none have been subject to any empirical investigation of reliability. This three-phase study aimed to quantify the interrater reliability of a measure of EMDR treatment fidelity. First, two raters refined the reprocessing section of the EMDR Fidelity Checklist (Leeds, 2016) by developing a descriptive item-by-item scoring system to improve interpretation and reliability. The resultant checklist was piloted on recordings of five EMDR session recordings from the Laugharne et al. (2016) study. The checklist was then revised. Next, the raters used the checklist to assess 15 other recorded EMDR sessions from the same study. The intraclass correlations (ICCs) were in the excellent range for all subscales and total session scores (i.e., >0.75), with an exception of the Desensitization subscale, ICC = 0.69 (0.08, 0.90). Finally, individual items in that subscale were evaluated, finding that five items did not contribute to the ICC. When these were removed/revised, the ICC for this subscale moved into the excellent range, ICC = 0.81(0.43, 0.94). The findings of this study indicate that this checklist may be a reliable measure of treatment fidelity for single reprocessing EMDR sessions with the possible exception of the Body Scan phase. Future research using the checklist with raters who were not involved in checklist development is needed to confirm the generalizability of these findings.

A recently released report by the Institute of Medicine (IOM, 2008) commissioned by the U.S. Department of Veterans Affairs examined the evidence for psychotherapeutic and pharmacological treatments for posttraumatic stress disorder (PTSD). It concluded that the evidence was inadequate to determine the efficacy of eye movement desensitization and reprocessing (EMDR) in the treatment of PTSD. However, a critical examination of the basis for this conclusion reveals errors in three areas. First, the findings of key studies that reported positive outcomes for EMDR were misrepresented; second, a number of positive studies were excluded without apparent justification; and, finally, the IOM report failed to consider additional readily available studies that also reported benefits for EMDR. These factors appear to explain why the conclusions of the IOM report are at odds with the numerous meta-analyses and practice guidelines of PTSD treatments issued by other scientific committees worldwide.