Since its inception in 1989, eye movement desensitization and reprocessing (EMDR) therapy has evolved from a simple desensitization technique to treat posttraumatic stress disorder to a comprehensive psychotherapy approach that treats a broad range of clinical problems in a variety of contexts and with diverse populations. This position paper is the result of a two-year project by the Council of Scholars' “What is EMDR?” workgroup that was tasked with the particular challenge of defining EMDR therapy, as innovations in the field continue to develop and the need for a consensus definition has become essential. In addition to proposing categories of EMDR therapy, that is, EMDR psychotherapy, EMDR treatment protocols, and EMDR-derived techniques, we identified core elements of EMDR therapy that can serve as a guideline to evaluate future innovations. Additionally, with concepts and procedures evolving over the years, some of the language needed revising to be consistent with current practices. The adoption of these three categories of treatment by the EMDR community would have broad-reaching implications that would generate more qualitative as well as quantitative studies in all categories. For training and clinical practice, it offers clinicians the opportunity to train with a focus on their particular treatment setting in addition to the foundational training that would be universal to all EMDR-trained clinicians. Finally, the interplay in the Council of Scholars between the “What is EMDR?” workgroup and the research, clinical practice, and training and accreditation workgroups will lead to further developments as these areas all inform one another.

The Clinical column is a regular Journal of EMDR Practice and Research feature in which master clinicians answer a question posed by a reader who is requesting assistance with clinical challenges. In this issue’s column, the response is written by Elan Shapiro, who is a psychologist near Haifa, Israel; an EMDR institute facilitator; and an approved EMDR Europe consultant. Readers can send questions for future issues to [email protected]

This article examines existing early EMDR intervention (EEI) procedures, presents a conceptual model, and proposes a new comprehensive protocol: the Recent-Traumatic Episode protocol (R-TEP). A review of research and important professional issues regarding application and parameters are presented. The commonly used EEI protocols and procedures are summarized, with the inclusion of descriptive case examples from the Lebanon war and a review of related research. Then a theoretical model is presented in which traumatic information processing is conceptualized as expanding from a narrow focus on the sensory image (perceptual level) to a wider focus on the event/episode (experiential level) and finally to a broad focus on the theme/identity (meaning level). The relationship of this model to the Recent-Traumatic Episode protocol is articulated and case examples are presented. Theoretical speculations are discussed relating to attention regulation and the Adaptive Information Processing (AIP) model. Further research is encouraged.

In 2015, more than 1.5 million refugees arrived in Germany, many severely traumatized. Eye movement desensitization and reprocessing (EMDR) therapy has been proven to be an effective treatment for acute and chronic traumatic stress symptoms. A modification for provision in group settings was developed by E. Shapiro: the EMDR Group Traumatic Episode Protocol (G-TEP). In this field study, we investigated the effectiveness of 2 sessions of EMDR G-TEP in treating traumatized refugees. After receiving a psychoeducation session, 18 Arabic-speaking refugees from Syria and Iraq who had come to Germany during the previous 5 months were assigned to treatment and/or waitlist. The Impact of Event Scale-Revised (IES-R) and Beck Depression Inventory (BDI) were administered at pre- and posttreatment. Analysis was conducted using the Mann–Whitney U test and planned Kolmogorov–Smirnov tests. Results showed significant differences between the treatment and the waitlist groups, indicating a significant decline in IES-R scores (p < .05). Although differences in BDI scores did not reach significance (p = .06), a large decline in BDI scores was seen in the treatment group. These results provide preliminary evidence that it might be effective to treat groups of traumatized refugees with EMDR G-TEP.

Le but de cette étude était d'investiguer l'efficacité de l'intervention EMDR (désensibilisation et retraitement par les mouvements oculaires) rapide à l'aide du protocole EMDR de l'épisode traumatique récent (EMDR recent traumatic episode protocol [R-TEP]) après un événement traumatique dans une collectivité, lors duquel un missile a frappé un bâtiment dans un quartier très fréquenté de la ville. Dans un essai contrôlé randomisé de groupes parallèles avec liste d'attente/traitement reporté, 17 rescapés manifestant une détresse post-traumatique ont été traités avec la psychothérapie EMDR en utilisant le protocole R-TEP. Des praticiens EMDR bénévoles ont effectué le traitement lors de deux journées consécutives. Les participants étaient assignés de manière aléatoire à la condition du traitement immédiat ou à celle de la liste d'attente/traitement reporté. Les évaluations à l'aide de l'échelle Impact of Event Scale-Revised (Échelle révisée d'impact de l'événement [IES-R]) et de l'inventaire bref de la dépression du Patient Health Questionnaire (PHQ-9) ont été réalisées lors du pré- et du post-traitement ainsi qu'au suivi après trois mois. Une semaine post-traitement, les scores du groupe de traitement immédiat s'étaient significativement améliorés sur l'IES-R en comparaison du groupe liste d'attente/traitement reporté qui n'a montré aucune amélioration avant le traitement. Lors du suivi après trois mois, les résultats de l'IESR étaient maintenus et les scores PHQ-9 montraient une amélioration significative. Cette étude pilote apporte des preuves préliminaires qui soutiennent l'efficacité de l'EMDR R-TEP dans la réduction du stress post-traumatique chez les victimes civiles d'hostilités et qui montrent que ce modèle d'intervention, brièvement ajouté aux services locaux à la suite d'incidents traumatiques à grande échelle, fondé sur une intervention EMDR sur deux jours consécutifs, peut être efficace.

Note de l’Editeur: les Questions & Réponses cliniques sont une rubrique régulière de la revue. Des cliniciens chevronnés y répondent à la question posée par un lecteur face à une difficulté clinique. Dans ce numéro, les réponses viennent de deux cliniciens qui sont superviseurs EMDR certifiés: Farnsworth Lobenstine, travailleur social clinicien qui exerce en libéral à Amherst, Massachusetts, et Elan Shapiro, psychologue libéral de la région de Haïfa, en Israël. Les lecteurs peuvent adresser leurs questions à journal.org.

Although eye movement desensitization and reprocessing (EMDR) has demonstrated efficacy in treating chronic posttraumatic stress disorder and old trauma memories, EMDR treatment of recent traumatic events has not received adequate attention from EMDR researchers or clinicians. This article presents current thinking and findings about early psychological intervention following recent traumatic events and examines the status of early EMDR intervention (EEI) concepts and research. It is contended that this area has not developed sufficient awareness and definition among EMDR clinicians. Francine Shapiro’s theoretical adaptive information-processing model predicts that dysfunctionally stored trauma memories underlie many current psychological disorders. Consequently, the assumption that memories of a recent traumatic event and its sequelae are not fully consolidated offers a unique role for EEI not only in reducing acute distress but also in preventing the sensitization and accumulation of trauma memories. A call is made for a more comprehensive approach to the field of EEI to promote interest and awareness among EMDR practitioners and to generate research.

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.

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.

En 2015, plus de 1,5 million de réfugiés sont arrivés en Allemagne, beaucoup d’entre eux gravement traumatisés. La thérapie de désensibilisation et de retraitement par les mouvements oculaires (EMDR) a prouvé son efficacité dans le traitement des symptômes de stress traumatique aigus ou chroniques. Une modification de la thérapie permettant son utilisation en groupe a été développée par E. Shapiro : c’est le protocole EMDR de traitement en groupe d’épisodes traumatiques (G-TEP). Dans cette étude de terrain, nous avons étudié l’efficacité de deux séances d’EMDR G-TEP pour traiter des réfugiés victimes de traumas. Après une séance de psychoéducation, 18 réfugiés provenant de Syrie et d’Irak, arabophones, arrivés en Allemagne au cours des cinq mois précédents, ont été affectés au traitement et/ou à une liste d’attente. On utilisa en pré- et post-traitement l’échelle révisée d’impact des événements (IES-R) et l’inventaire de dépression de Beck (BDI) et les analyses furent conduites à l’aide du test U de Mann-Whitney et des tests planifiés Kolmogorov-Smirnov. Les résultats montrèrent des différences importantes entre le groupe de traitement et le groupe en liste d’attente, avec une baisse significative des notes IES-R (p > .05). Bien que les différences des notes BDI n’aient pas atteint le niveau de signification statistique (p = .06), une baisse importante des notes BDI fut observée dans le groupe de traitement. Ces résultats fournissent une preuve préliminaire indiquant que l’EMDR G-TEP pourrait permettre de traiter efficacement des personnes réfugiées souffrant de traumatismes.