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.

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.

Thirty years after its introduction in 1989, eye movement desensitization and reprocessing (EMDR) therapy has evolved to become a comprehensive psychotherapy, guided by Shapiro's adaptive information processing model. Her model views most mental health disorders as stemming from unprocessed earlier disturbing events. This understanding of the etiological role of trauma has opened the door for EMDR treatment of multiple types of presentations. There are now more than 44 randomized controlled trials that have investigated EMDR treatment of posttraumatic stress disorder (PTSD), early traumatic stress, and traumatized children. In addition, there are 28 randomized controlled trials which have evaluated its use with major depressive disorder, bipolar disorder, psychosis, anxiety disorders, obsessive compulsive disorder, substance use disorder, and pain. Seventy-five percent of these studies provided Shapiro's standardized procedure, while others tested modifications developed for specific populations. The focus of treatment varied across the studies, with various targets being processed to achieve good outcomes. The research demonstrates EMDR's effectiveness in reducing/eliminating PTSD and trauma-related symptoms, and in improving symptoms related to presenting problems and disorders. EMDR can be considered to have well-established efficacy for the treatment of PTSD. The emerging evidence for EMDR's efficacy with disorders other than PTSD must be considered preliminary and in need of replication conducted with randomized controlled trials using rigorous methodology. EMDR's position in various treatment guidelines is discussed, and the needs for future research are elaborated.

Cancer is not only a debilitating disease; it can also have devastating effects on a patient’s mental health and quality of life. Although the literature shows that mortality rates may be improved with the provision of effective treatment, most psychotherapy provided to patients with cancer tends to be quite generic and not always effective. Very few research studies have investigated the provision of trauma-focused therapies to this underserved population. Eye movement desensitization and reprocessing (EMDR) therapy has well-established efficacy in the treatment of traumatic stress and preliminary evidence in the treatment of depression and anxiety. It is a very effective and accessible treatment for patients with cancer. Because it does not require homework, it is less demanding than many other forms of treatment. It can be provided on an intensive (twice) daily basis, making it available to patients traveling from out of town for their cancer treatment. For those patients unable to manage trauma-focused treatment during a difficult time, it can be used to enhance personal resources. EMDR therapy can be administered in individual, group, and couple formats and is suitable for children as well as adults. New research provides promising results for the application of EMDR for patients with cancer.

This editorial introduces the special issue of the Journal of EMDR Practice and Research that commemorates the 25th anniversary of eye movement desensitization and reprocessing (EMDR) therapy by highlighting EMDR humanitarian programs around the world—in North America, Europe, Africa, the Middle East, Asia, Latin America, and the Caribbean. EMDR therapy is a valuable and appropriate intervention in humanitarian crises, given its effectiveness as a brief individual treatment, consecutive-day application, and group therapy. There are many compelling clinical vignettes in this issue, including some from a refugee camp in Syria, a hurricane in South America, and earthquakes in India and Italy. The authors in this issue bring years of experience to their articles, and their commentary on the challenges, future needs, and concerns is illuminating and thought-provoking.

This review provides the groundwork for a basic understanding of articles written about eye movement desensitization and reprocessing (EMDR), including a brief overview of theory and practice. It documents EMDR’s established efficacy in the treatment of posttraumatic stress disorder and specifies specific subsets of this population in need of further investigation. The article also provides a review of recent studies evaluating a range of EMDR’s clinical applications and outlines new directions for research investigations and for developments in clinical practice. It concludes with an overview of current research evaluating pre- and post-neurobiological changes, and mechanisms of action. Specific recommendations for future areas of investigations are outlined, and rigorous evaluation is strongly encouraged.