Cet article présente la technique éclair, une nouvelle technique utilisée pendant la phase de préparation de la thérapie EMDR (désensibilisation et retraitement par les mouvements oculaires) pour faciliter le traitement de souvenirs traumatiques intenses auxquels les patients hésiteraient autrement à accéder. Les premières données, demeurant à confirmer, suggèrent que cette technique pourrait permettre aux patients d’accéder à ces souvenirs d’abord de manière la moins perturbante possible, réduisant leur intensité émotionnelle, afin de pouvoir ensuite les aborder plus pleinement et les traiter à l’aide de la thérapie EMDR. La technique semble aisément tolérée par les patients de tous âges, y compris les enfants ; elle paraît rapide et relativement indolore pour les patients, même ceux qui possèdent des souvenirs cibles particulièrement perturbants ; elle s’enseigne facilement aux cliniciens. Elle se distingue par le fait que les patients qui évitent un souvenir terriblement perturbant peuvent se voir offrir une façon de le traiter sans devoir le ramener clairement à l’esprit. Quatre exemples de cas, dans lesquels quatre cliniciens différents ont utilisé la technique, sont présentés brièvement. Des suggestions sont formulées pour des études à venir. Cet article présente des hypothèses pour expliquer divers mécanismes d’action et évoque les effets en termes de la théorie de reconsolidation mnésique.

Healthcare workers and mental health clinicians are at heightened risk for mental health issues while they support their communities during the COVID-19 pandemic, and early psychological intervention is crucial to protect them. The Self-Care Traumatic Episode Protocol (STEP) is a computerized intervention adapted from the Eye Movement Desensitization and Reprocessing Group Traumatic Episode Protocol (EMDR G-TEP). This study evaluated the effectiveness of STEP for mental health clinicians in the context of COVID-19. Thirty-four mental health clinicians were randomly allocated to treatment (n = 17) or waitlist (n = 17). The Generalized Self-Efficacy Scale (GSE) and Depression and Anxiety Stress Scale (DASS-21) were completed by the treatment group at baseline and 1-week follow-up postintervention and by the waitlist group at baseline, preintervention, and 1-week follow-up postintervention. Pre–post comparisons showed a significant decrease in depression, anxiety, and stress for Immediate Treatment, t(15) = −3.64, p < .01, d = .73, and for Delayed Treatment, t(15) = −3.53, p < .01, d = .68, There was also a significant increase in general self-efficacy for Immediate Treatment, t(15) = 2.87, p < .05, d = .46, and Delayed Treatment, t(15) = 3.72, p < .01, d = .56. The randomized controlled trial (RCT) indicated that STEP may be effective in increasing general self-efficacy and reducing symptoms of depression, anxiety, and stress among mental health clinicians in the context of COVID-19. Further research investigating the potential of utilizing the STEP intervention on a larger scale and with other populations is needed.

There is currently a limited number of studies into the efficacy of eye movement desensitization reprocessing (EMDR) therapy with children and adolescents with posttraumatic stress disorder (PTSD). The current study utilizes a systematic narrative review of methodologies and findings of previous literature reviews and meta-analyses as well as analyzing randomized control trials (RCTs) conducted from 2002 to 2018. Following initial scoping of the extent of studies, two systematic literature searches were conducted, firstly for literature reviews and secondly for recent RCTs. Nine databases were utilized. Eight reviews and seven RCTs were identified and analyzed for quality of methodology and outcome as measured by impact on PTSD symptoms. EMDR was found to be efficacious in reducing children's PTSD symptoms compared to waitlist conditions, with similar outcomes to cognitive behavior therapy (CBT). EMDR was effective with both single-event trauma as well as cumulative trauma such as sexual abuse. EMDR was equally effective with girls and boys as well as children from different cultures. EMDR achieved medium to large effect sizes. Reductions in PTSD were maintained at 2-, 3-, 6-, and 12-month follow-up. In conclusion, EMDR was consistently found to be an efficacious treatment for children with PTSD. Recommendations are made for future practice and research.

The present study was carried out to investigate the efficacy of eye movement desensitization and reprocessing (EMDR) therapy in treating pain and subjective distress of patients with cancer. A randomized controlled trial was performed on patients with cancer suffering from moderate to severe cancer pain in Yasuj, Iran, in 2019 and 2020. Sixty patients aged 30–60 years who fulfilled the inclusion criteria were selected using a consensus sampling technique. Patients were randomly assigned to EMDR therapy or control groups based on random block allocation. EMDR therapy was administered in six to eight daily 1-hour sessions. The control group received the standard treatment provided by the hospital. A Numeric Pain-Rating Scale (NRS) and the Subjective Units of Disturbance Scale (SUDS) were used to assess pain and subjective distress before and after the intervention in each session. The collected data were analyzed by descriptive statistics, chi-square test, and independent t test using Statistical Package for the Social Sciences (SPSS) version 24. The mean pain intensity and subjective distress score in the experimental group before and after the EMDR intervention were significantly reduced (p < .001). In the control group, no decreases in NRS and SUDS scores occurred at any time (p > .05). Differences in pain scores between the groups were statistically significant (p < .001). EMDR can effectively and sustainably reduce the pain and subjective distress experienced by patients with cancer. Thus, EMDR is a recommended therapeutic option to mitigate pain and subjective distress among patients with cancer.

It has only been in this last decade that trauma-focused treatments (TFT) have been studied in patients with psychotic disorders. Before, the paradigm stated that TFT was contraindicated in these patients because clinicians and researchers assumed the risk of exacerbation of symptoms was too high. The purpose of this article is to examine the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy in the treatment of psychosis. To this end, we will present a brief narrative review of the current state of research in this particular field. The results suggest that, contrary to the “no-TFT-in-psychosis” paradigm, TFTs such as EMDR therapy can successfully be used to reduce trauma-related symptoms in patients with psychosis. Moreover, there are now provisional indications that psychotic symptoms such as delusions and hallucinations can be targeted directly and indirectly using EMDR therapy.

This article reports on the first 3 randomly allocated cases treated by the author in an ongoing trial comparing eye movement desensitization and reprocessing (EMDR) with cognitive behavioral therapy (exposure and response prevention) in the treatment of obsessive-compulsive disorder in a U.K. primary care setting. This article describes the treatment and data collection procedures, followed by a summary of each of the 3 cases supported by quantitative and qualitative data. The Adapted EMDR Phobia Protocol (Marr, 2012) was provided, following the trial protocol of 1-hour, 16-session treatment. The Yale-Brown Obsessive Compulsive Scale was administered at every 4th session. At posttreatment, 2 of the 3 cases showed more than a 50% reduction on validated psychometric measures, with symptoms below diagnostic cutoff. The final case started treatment below the diagnostic cutoff on the primary outcome measure and showed a slight improvement. Six-month follow-up data showed maintenance of treatment effects. Transcripts from a semistructured telephone interview carried out by an independent researcher following treatment were analyzed using a 6-stage thematic analysis method, which identified 3 themes: the role of traumatic experiences, role of shame, and importance of therapeutic alliance. This article concludes with a discussion of implications for EMDR practice and theory.

This study compared the effect of eye movement desensitization and reprocessing (EMDR) therapy versus guided imagery on insomnia severity in patients with rheumatoid arthritis (RA). In this randomized controlled trial, 75 patients with RA were selected via convenience sampling before using block randomization to assign patients into three groups comprised of (a) six sessions of EMDR, (b) six sessions of guided imagery, and (c) a control group. The Persian version of the Insomnia Severity Index was implemented at preintervention and 2 weeks' postintervention as the outcome measure. The EMDR group obtained respective pre-and postintervention mean scores of 23.5 ± 5.2 and 11±2.1, whereas the guided imagery group obtained scores of 24 ± 3 and 15.3 ± 2.3, and the control group obtained scores of 24.2 ± 3.3 and 23.6 ± 3. Pairwise comparisons showed statistically significant differences in insomnia severity between patients from each group, with the EMDR group experiencing a greater reduction in insomnia severity than guided imagery. EMDR and guided imagery were both effective in reducing insomnia severity in RA patients, although the degree of insomnia reduction for patients from the EMDR group was greater than that of the guided imagery group.

Little is known of the usability of eye movement desensitization and reprocessing (EMDR) as an intervention for those experiencing psychosis. This study aimed to explore therapists' experience of using EMDR with this population. A qualitative design was employed using an inductive approach and a thematic analysis. Twenty therapists, who had used EMDR with this client group, took part in a semi-structured interview to explore their experiences of the intervention. Key themes were generated from the data: (a) familiarity with psychosis and EMDR, (b) acceptability of EMDR, (c) the importance of systemic factors, and (d) keeping key therapy principles in mind. Findings highlighted the importance of supervision to build therapist confidence, the value of the multidisciplinary team, and the need for a shift in beliefs surrounding the usefulness of EMDR to the wider system. Recommendations for individuals and services are provided.

In recent years, different studies have observed a strong association between chronic pain (CP) and psychological trauma. Therefore, a trauma-focused psychotherapy, such as eye movement desensitization and reprocessing (EMDR), could be an innovative treatment option. The aim of this pilot study was to assess whether a specific EMDR protocol for CP leads to (a) a reduction in pain intensity, (b) an improvement in anxiety and depressive symptoms, and (c) an improvement in quality of life. 28 CP patients were randomly assigned to EMDR + treatment as usual (TAU; n = 14) or to TAU alone (n = 14). Patients in the EMDR group received 12 psychotherapeutic sessions of 90 minutes over 3 months. Pain intensity was measured using the Visual Analog Scale and the Pain Disability index, quality of life using the EQ-5D-5L, and anxiety and depressive symptoms using the Hamilton Anxiety and Depression Scale. Measures were taken for both conditions at pre- and post-treatment, and a follow-up in the EMDR condition was taken at 3 months post-treatment. Patients in the EMDR group showed significantly reduced pain intensity and improved quality of life and anxiety and depressive symptoms compared to TAU alone at post-treatment. Improvements were largely maintained at 3-month follow-up. This study suggests that EMDR may be an effective and safe psychological intervention to be used within the multidisciplinary treatment plan of patients with CP.

Research on psychotherapy with children is generally underrepresented in the empirical literature. Currently, there are four randomized clinical trials (RCT) evaluating EMDR in individual psychotherapy with traumatized children—two for children diagnosed with PTSD and two for children presenting with symptoms of posttraumatic stress. Since the first case studies of EMDR with children were published in 1993, 19 studies were identified that met the inclusion criteria for this review. The gold standards identified by Foa and Meadows (1997) to assess the methodology of studies designed to treat trauma were applied to the research on EMDR with children. This analysis discusses the challenges to conducting research on psychotherapy with children including the debate regarding the assessment and diagnosis of PTSD in children. Recommendations for future studies designed with methodological rigor are suggested to investigate the efficacy of EMDR with children who have experienced trauma and other mental health symptoms and diagnoses.

The purpose of this pre-experimental case study was to explore the efficacy and safety of the Eye Movement Desensitization and Reprocessing (EMDR) Group Traumatic Episode Protocol (G-TEP) in the psychological treatment of cancer survivors and its potential effects on posttraumatic stress, anxiety, and depressive symptoms. Participants (N = 35) were patients with various types of cancer, in different stages, initial or recurring, with diagnosis or oncology treatment received within the past year. Following an individual psychoeducational intake session, participants received two 90-minute EMDR G-TEP sessions, administered on consecutive days. They were randomly assigned to a treatment group or a delayed treatment group. Assessments were administered at pre, post, and follow-up using the Short PostTraumatic Stress Disorder Interview (SPRINT), State-Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI-II). Repeated measures comparisons of PTSD symptoms, anxiety, and depression revealed significant differences between pretest and posttest, with most results maintained at follow-up. Pre-follow-up effect sizes showed medium effects. These promising results suggest the value in providing a lengthier course of treatment. They support the need for research with large sample, randomized clinical trials to examine the viability of providing EMDR G-TEP in the psychological treatment of cancer survivors. No serious adverse effects were reported and we conclude that the EMDR G-TEP may be effective and safe in the psychological treatment of an oncology population.

Este artículo presenta una revisión completa de literatura acerca del impacto neurocognitivo del trastorno por estrés postraumático (TEPT) e informa acerca de un caso de estudio único cuantitativo, el cual investigó si la terapia de reprocesamiento y desensibilización a través del movimiento ocular (EMDR por sus siglas en inglés) cambiaría las respuestas neuropsicológicas y fisiológicas de una paciente de 18 años de edad de sexo femenino diagnosticada con TEPT comórbido y trastorno depresivo mayor. Se proporcionaron once sesiones de terapia EMDR, de 90 minutos cada una, administradas una vez a la semana. Utilizamos equipo de bioretroalimentación (Equipo Infiniti-ProComp5) para obtener registros de frecuencia cardiaca y conductividad de la piel mientras que la paciente estaba en fases de reprocesamiento de la terapia EMDR. Los resultados mostraron una disminución de ritmo cardiaco entre las bases de referencia del principio y fin del tratamiento. Las evaluaciones neuropsicológicas de atención, memoria y las funciones ejecutivas del cerebro mostraron deficiencias de pre-tratamiento en los procesos de atención, velocidad de procesamiento de información y memoria de trabajo, así como mejora en el post-tratamiento de estas funciones cognitivas con diferencias significativas en la Prueba de Adición del Ritmo de Serie Auditiva (PASAT, siglas en inglés). Encontramos una disminución importante pos-tratamiento en los puntajes promedio del Inventario de Depresión de Beck-II y en la Escala de Experiencias Disociativas. Además, la paciente no mostró signos de TEPT después de la intervención basado en la Escala Global de Estrés Postraumático. Discutimos como la mejora de los síntomas de TEPT está asociada con los resultados neurocognitivos mejorados.

Parmi les maladies potentiellement mortelles, le cancer est l'une des plus traumatisantes et des plus génératrices de détresse. Il impacte le sens même de l'identité de l'individu et perturbe chez lui des caractéristiques essentielles, en rapport direct avec la conscience de soi et le caractère unique de la personne. Il attaque l'intégrité physique des patients, amenant la question de la mort au premier plan, et peut mettre en cause directement leur sentiment d'appartenance aux micro- et macro-systèmes sociaux autour d'eux. Cet article souligne l'importance de comprendre que souffrance psychologique et douleur physique sont étroitement interconnectées et, dans le contexte de la psycho-oncologie, propose une perspective clinique basée sur l'approche de désensibilisation et de retraitement par les mouvements oculaires (EMDR), approche pour laquelle l'événement qu'est le cancer est inscrit dans l'histoire de vie du patient. L'EMDR est une approche thérapeutique fondée sur le modèle du traitement adaptatif de l'information (TAI). Le modèle TAI postule que la psychopathologie apparaît quand des expériences non traitées sont enregistrées dans leur propre réseau neuronal et se trouvent dans l'impossibilité de se connecter à d'autres réseaux plus adaptatifs. Dans cette perspective, on suppose que le noyau de la souffrance clinique est enchâssé dans ces souvenirs qui demeurent en suspens de façon dysfonctionnelle. Selon des articles scientifiques récents que nous présentons dans cet article, il semble que les traumas du passé et les traumas liés au cancer entretiennent un cercle vicieux entre la santé psychologique et physique de l'individu, et l'objectif de la thérapie EMDR est de briser ce cercle. De récentes recherches scientifiques avancent l'hypothèse que le thérapie EMDR est efficace au niveau psychologique comme au niveau physique. Cependant, à cause de l'hétérogénéité générale des protocoles de recherche, les résultats rapportés dans cet article soulignent la nécessité de mener d'autres recherches contrôlées afin de permettre une analyse plus complète.

The results of preliminary research investigating the application of eye movement desensitization and reprocessing (EMDR) treatment in panic disorder and panic disorder with agoraphobia suggests that reprocessing of past traumas produces significant reduction of anxiety and consequently, remission from panic attacks and avoidance behavior. This article describes the case study of a 30-year-old working professional where EMDR treatment, used to target early childhood traumas, led to reduction in symptoms of panic disorder with agoraphobia. Panic attacks diminished after 17 sessions of EMDR treatment, which followed Leeds’s treatment model. Treatment gains were maintained 5 years after termination. The study shows the value of solid preparation work, and of addressing the current triggers and recent events, before targeting historical traumas. EMDR worked as a first-line treatment to resolving the roots of the panic attacks, suggesting that the resolution of traumatic childhood memories can make a significant difference to current symptoms of panic disorder with agoraphobia.

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.

Of the many life-threatening illnesses, cancer can be one of the most traumatic and distressful. It impacts the individual’s sense of identity and interferes with essential features intrinsic to the person’s uniqueness and self-awareness. It attacks patients’ physical integrity, bringing death into the foreground and can directly threaten their sense of belonging to micro and macro social systems. This article stresses the importance of understanding that psychological pain and physical suffering are closely interconnected and, within the context of psycho-oncology, proposes a clinical perspective based on the eye movement desensitization and reprocessing (EMDR) approach, in which the cancer event is nested in the history of life of the patient. EMDR is a therapeutic approach guided by the adaptive information processing (AIP) model. The AIP model postulates that psychopathology results when unprocessed experiences are stored in their own neural network, incapable of connecting with other more adaptive networks. In this perspective, the core of the clinical suffering is hypothesized as embedded in these dysfunctionally suspended memories. In line with recent scientific literature presented in this article, it appears that previous and cancer-related traumas maintain a vicious cycle between psychological and physical health, and the aim of EMDR therapy is to break this cycle. Recent scientific research has hypothesized that EMDR therapy is effective at both the psychological and physical levels. However, because of the consistent heterogeneity of the research design, the findings reported in this article highlight the need for further controlled research for more comprehensive examination.

Después de asegurarse de que haya seguridad, el tratamiento de las víctimas de violencia interpersonal (VIP) suele centrarse en las experiencias adversas y traumáticas, y en las emociones negativas relacionadas. Además, en muchos casos, la idealización del perpetrador y la emoción positiva desadaptativa son elementos iniciales que también han de tenerse en cuenta. El concepto de información almacenada disfuncionalmente (DSI, siglas en inglés de Dysfunctionally Stored Information)–descrito en el modelo de Procesamiento Adaptativo de la Información (PAI)–va más allá de las emociones negativas desadaptativas de los recuerdos de experiencias adversas y puede incluir defensas disfuncionales como emoción positiva desadaptativa y experiencias vitales idealizadas. La idealización autodestructiva, disfuncional e irreal en una relación puede tratase haciendo diana, con tandas focalizadas de estimulación bilateral, sobre recuerdos específicos de emociones positivas que son el origen de la idealización distorsionada. De esta manera, la paciente es capaz de desarrollar una resolución adaptativa, es decir, una percepción más precisa tanto de los acontecimientos pasados como de la naturaleza actual de la relación. Este abordaje para trabajar las defensas de la idealización se ilustra con tres ejemplos de casos de mujeres que se sentían ambivalentes con respecto a dejar a un compañero muy abusivo.

On pense que l’efficacité particulière de l’EMDR (désensibilisation et retraitement par les mouvements oculaires) dans le traitement de l’état de stress post-traumatique résulte de changements dans l’état cérébral et mental du sujet qui sont induits par la stimulation sensorielle bilatérale, mais la nature spécifique de ces changements et leurs conséquences demeurent inconnues. La possibilité que la stimulation bilatérale induise un état psychologique et cérébral semblable à celui qui est induit par les mouvements oculaires rapides, lors du sommeil paradoxal, est corroborée par des études montrant que le sommeil favorise certaines formes de traitement du souvenir, sans doute nécessaires à la résolution du traumatisme. Ces études, parallèlement à des recherches directes sur l’effet de la stimulation bilatérale sur le traitement des souvenirs et des émotions, et à des études comparatives identifiant les caractéristiques que doit revêtir la stimulation bilatérale pour traiter efficacement les traumatismes, nous conduiront finalement à comprendre le fondement neurobiologique de l’EMDR.

Experiencing cancer is a peculiar stressor within the infrastructure of posttraumatic stress disorder (PTSD) because this debilitating disease involves ongoing stressors and is both acute and potentially chronic. The experience can include a wide range of associated adverse events, such as tumor detection, diagnosis, severity of disease, and prognosis; aggressive treatment; disfigurement and bodily dysfunction; side effects of treatment; impaired physical, social, and occupational functioning; and sometimes, recurrence and diagnosis of terminal illness. This article provides a detailed description of the clinical application of the Eye Movement Desensitization and Reprocessing (EMDR) Integrative Group Treatment Protocol (EMDR-IGTP) Adapted for Adolescents and Adults Living with Ongoing Traumatic Stress for the patients with cancer. This protocol administers the eight phases of EMDR individual treatment to a group of patients using an art therapy format (i.e., drawings) and the butterfly hug (a self-administered bilateral stimulation method to process traumatic material). A previous study (Jarero et al., 2015) showed that after 6 sessions of EMDR-IGTP, there was a significant decrease in PTSD symptoms related to the diagnosis and treatment of different types of cancer in adult women. Effects were maintained at 90-day follow-up. In this article, we discuss how this protocol can be used to effectively provide intensive EMDR treatment to large groups of patients, and we provide detailed instructions for its provision to address one of the major psychological dimensions of cancer: the ongoing traumatic stress responses experienced by patients with cancer. A clinical example illustrates the treatment process.

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.

El trastorno narcisista de la personalidad y los rasgos narcisistas están asociados con conductas egoístas y falta de empatía hacia los demás. Los pacientes con alguna de estas presentaciones iniciales en terapia muestran un perfil centrado en sí mismos y una falta de empatía o preocupación por el sufrimiento que pueden causar a otras personas, pero esto es sólo parte de la historia. En ocasiones, la falta de empatía y el egoísmo son sólo una defensa. Para entender completamente este problema, también es necesario ser consciente de los problemas subyacentes de autodefinición que llevan a las manifestaciones conductuales del narcisismo. Como en cualquier problema psicológico, el tratamiento con la terapia de desensibilización y reprocesamiento por movimientos oculares exige comprender la manera en la que las primeras experiencias dan lugar a los futuros síntomas. Es fundamental comprender el recorrido desde las experiencias tempranas a las características narcisistas (incluidas las presentaciones encubiertas) para poder realizar una buena conceptualización del caso, así como entender las estructuras mentales de defensa que impiden acceder a las experiencias adversas nucleares que subyacen a los síntomas.

This article presents four brief reports that illustrate EMDR’s potential in addressing a range of pathologies and problems. These include traumatized groups, families and couples, sex offenders, and individuals with performance anxiety. Each brief report provides a short summary of the research, highlights current EMDR research, and points out what is needed for future investigations. Preliminary results suggest that the EMDR–integrative group treatment protocol may be an effective means of providing mental health care to large groups of people affected by critical incidents. The report titled “EMDR in Couples and Family Therapy” provides an overview of the field and describes the various ways in which EMDR is being incorporated. The presenting issue with performance anxiety is debilitating evaluation anxiety at the prospect of having to perform some important activity in front of an audience that matters a great deal to the client. Sex offender treatment is enhanced by an effective means of resolving psychological mechanisms that contribute to the dynamics of the offense chain.

To test the psychometric properties of the Subjective Units of Disturbance Scale (SUDS), this study analyzed the data from 61 patients treated with EMDR. The pretreatment self-reported questionnaires, the in-session records of EMDR, and the Clinical Global Impression–Change (CGI-C) scale at the termination of EMDR were reviewed. The initial score of the SUDS at the first session was significantly correlated with the patient’s level of depression, the state anxiety, and distress from the impact of events. The final score of the SUDS at the first session was significantly correlated with the CGI-C score at termination. Consequently, this study confirmed that the SUDS in EMDR sessions has good psychometric properties.

Eye movement desensitization and reprocessing (EMDR) was used with 11 children who developed posttraumatic stress disorder (PTSD) after road traffic accidents. All improved such that none met criteria for PTSD on standardized assessments after an average of only 2.4 sessions. Significant improvements in PTSD, anxiety, and depression were found both immediately after treatment and at follow-up. Attentional, memory, and attributional processes associated with PTSD were assessed and their relationship to therapeutic change examined. Treatment was associated with a significant trauma-specific reduction in attentional bias on the modified Stroop task, with results apparent both immediately after therapy and at follow-up.

The literature on the efficacy of eye movement desensitization and reprocessing (EMDR) for treating depression is heterogeneous due to research design, quality issues, and trials methodology. The current meta-analysis seeks to examine EMDR for depression with the aim of answering the aforementioned limitations. Thirty-nine studies were included for analysis after a review of the relevant literature. Univariate meta-regressions were run to examine dose-response and the effect of moderating variables. Subanalysis for primary and secondary depression showed a large, significant, and heterogeneous effect-size estimates, where EMDR significantly improved symptoms of depression in contrast to all control types. At post hoc, data were reexamined and a significant and large, yet heterogeneous, effect-size estimate emerged between the EMDR and control arm after the removal of two outliers [Hedges' g = 0.70, 95% CI =0.50–0.89, p-value < .01, I² = 70%, K = 37]. This is the first meta-analysis examining for the effect of EMDR comparing to various control modalities on depression with dose-response. We found (a) that studies were balanced at onset in terms of depression severity, and (b) a large and significant effect of EMDR on depression at the end of trials. Additionally, the significance of the aggregate effect-size estimate at the end of trials was unchanged by the intake of psychotropic medications, reported demographic variables, or EMDR methodology.

There are commonalities between neurologic syndromes arising from lesions of the parietal cortex and psychiatric syndromes secondary to psychological trauma. Additionally some posttraumatic syndromes may reflect functional disruption of parietal areas. Directional or bilateral alternating peripheral sensory stimulation appear to assist in the amelioration of a wide range of clinical conditions, including the neglect syndrome and Posttraumatic Stress Disorder. It is posited that the stimulation may exert its effect through activation of parietal higher-order functions. The activation may result in an integration of sensory information and an updating of the current representation of person and space, which incorporates an awareness of current body reality, sense of self, and world view. It is hypothesized that the EMDR procedure is ideally constructed to facilitate parietal activation through multimodal sensory stimulation, attention and episodic memory retrieval and focus on internal and external body, space, and self. Further investigations and an integration of data between disciplines are suggested, in order to expand our range of effective treatments.

There have been suggestions in the literature since 1994 that eye movement desensitization and reprocessing (EMDR) may serve as an effective adjunct to the addiction treatment process; however, follow-up research in this area has been limited. This case study of a cross-addicted female includes a case review illustrating how EMDR was used in the continuing care process and a semistructured phenomenological interview conducted at 6-month follow-up. Prior to this course of treatment, the participant was treated 12 times with traditional approaches but was unable to achieve more than 4 months of sobriety at any given time. Following EMDR, the participant reported 18 months of sobriety and important changes in functional life domains. The phenomenological interview revealed six critical themes about the addiction and recovery process that can offer insight to clinicians treating co-occurring addiction and trauma.

Eye movement desensitization and reprocessing (EMDR) is a therapeutic approach guided by the adaptive information processing (AIP) model. This article provides a brief overview of some of the major precepts of AIP. The basis of clinical pathology is hypothesized to be dysfunctionally stored memories, with therapeutic change resulting from the processing of these memories within larger adaptive networks. Unlike extinction-based exposure therapies, memories targeted in EMDR are posited to transmute during processing and are then again stored by a process of reconsolidation. Therefore, a comparison and contrast to extinction-based information processing models and treatment is provided, including implications for clinical practice. Throughout the article a variety of mechanisms of action are discussed, including those inferred by tenets of the AIP model, and the EMDR procedures themselves, including the bilateral stimulation. Research suggestions are offered in order to investigate various hypotheses.

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.

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.

<pol>Katastrofy naturalne mają wpływ na całe społeczności ludzkie, zarówno w wymiarze indywidualnym, jak i ekonomicznym czy społecznym. Chociaż oddziaływanie tego typu zdarzeń na zdrowie psychiczne ludzi jest ogromne, to wciąż brak adekwatnych środków zaradczych w obszarze zdrowia psychicznego osób, które doświadczyły i przeżyły katastrofy. W ramach programu Humanitarian Assistance Programme, podjęto próbę zajęcia się potrzebami osób, które przez. yły katastrofę naturalną, poprzez wykorzystanie terapii EMDR (Eye Movement Desensitization and Reprocessing). Niniejszy przegląd przedstawia dowody skuteczności terapii EMDR w leczeniu dystresu psychicznego u osób, które wyszły cało z katastrofy naturalnej. Spośród ośmiu omówionych badań, cztery badania były próbami kontrolowanymi, a jedno badanie było kontrolowane częściowo. Wszystkie badania wykazały zarówno statystyczną, jak i kliniczną istotność w redukowaniu intensywności objawów zespołu stresu pourazowego (PTSD), lęku, depresji oraz innych typów dystresu, doświadczanych przez osoby ocalone z katastrof naturalnych. Co więcej, cztery spośród ośmiu badań wykazały istotność kliniczną zaledwie po jednej sesji terapeutycznej. Oznacza to, że EMDR jest terapią pozwalającą zaoszczędzić zasoby, czas oraz koszty. Zagadnieniami omawianymi w niniejszym przeglądzie są ramy teoretyczne, adaptacja podczas interwencji, kwestie metodologiczne oraz ocena jakości badań, jak również implikacje na przyszłość i praktyka kliniczna.</pol>

Self-harm is frequently a trauma-driven coping strategy that can be understood from the perspective of the adaptive information processing (AIP) model and treated with eye movement desensitization and reprocessing (EMDR) therapy (Shapiro, 1995, 2001). Self-harm is often connected with memories of adverse and traumatic life experiences. Identifying and processing these memories with EMDR therapy can put an end to the self-injurious behavior. In addition, self-harm is often based on a lack of regulation skills, and these skill deficits can be addressed in EMDR therapy as well. In this article, the authors describe strategies for treating self-harm throughout the 8 phases of EMDR. Although there is no single approach that applies to all cases, the therapist needs to take a careful history of self-harm, its historical origins, and its triggers and functions in the present to formulate a treatment plan. Often, in the authors’ experience, self-harm functions as a self-soothing strategy that redissociates traumatic affect from childhood. Treatment strategies for Phases 3–8 of EMDR therapy are illustrated through case vignettes.

Violence and aggression in the workplace is an increasing international concern. No studies have yet determined the most efficacious psychotherapeutic strategies to alleviate the consequences of workplace violence, and none have identified interventions that might fortify workers who are repeatedly exposed to danger. This case series describes the eye movement desensitization and reprocessing (EMDR) treatment of seven bank employees and one transportation worker who suffered repeated acute traumatization. The Impact of Events Scale, the Post-Traumatic Stress Syndrome 10-Questions Inventory, and the Beck Depression Inventory were used to measure changes in symptom severity. Results showed that EMDR effectively reduced symptoms and may provide a possible protective buffer in situations of ongoing workplace violence.

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.

A vignette is a brief case report that makes a contribution to the literature, but which has used only EMDR’s standard protocol measures. This vignette describes the treatment of a woman who developed a severe choking phobia following an allergic reaction to a herbal beverage. She was hospitalized on several occasions because of her resultant inability to consume food and liquids. She received four years of various types of treatment for this phobia, including eating disorder treatment, brief psychodynamic therapy, cognitive behavioral therapy, and psychopharmacological treatment. None were successful in eliminating the disorder. Then when Mary received a course of EMDR treatment, addressing childhood etiological events, there was complete remission of the choking phobia and elimination of all related behaviors.

Eye Movement Desensitization and Reprocessing (EMDR) – Psychotherapie kann eine bedeutende Rolle in der phasenorientierten Behandlung von komplexen traumabezogenen Störungen spielen. In einem vorangegangenen Artikel wurde die Behandlungsphase 1 im Sinne der Theorie der strukturellen Persönlichkeitsdissoziation und der ihr zugeordneten Aktionspsychologie – Stabilisation, Symptomreduktion und Skills-Training – beschrieben und die Anwendung von EMDR-Verfahren in dieser Phase hervorgehoben. Behandlungsphase 2 beinhaltet im Wesentlichen EMDR-Anwendungen zur Überwindung der Phobie vor traumatischen Erinnerungen und deren anschließende Integration. Behandlungsphase 3 legt den Schwerpunkt auf weitere Persönlichkeitsintegration, was die Überwindung verschiedener das adaptive Funktionieren im Alltag betreffender Phobien mit einschließt. Dieser Artikel hebt Behandlungsansätze hervor, die Therapeuten bei der Integration von EMDR-Protokollen in Phase 2 und 3 einer phasenorientierten Behandlung unterstützen, ohne dabei die integrativen Kapazitäten oder das Toleranzfenster der Patienten zu überschreiten.

The exposure to a life-threatening disease such as cancer may constitute a traumatic experience that in some cases may lead to the development of posttraumatic stress disorder (PTSD). In recent years, several studies investigated this syndrome in patients with cancer, but few focused on the underlying neurobiology. The aim of this work was to review the current literature of neurobiology of PTSD in oncological diseases, focusing on a comparison with the results of neurobiological studies on PTSD in non-oncological patients and on treatments resulted effective for such disorder. Brain structures having a role in the appearance of PTSD in psycho-oncology, and in particular, in intrusive symptoms, seem to be the same involved in non-oncologic PTSD. These findings may have important implications also at clinical level, suggesting that psychotherapies found to be effective to treat PTSD in different populations may be offered also to patients with cancer-induced posttraumatic symptoms. Further studies are needed to deepen our knowledge about cancer-related PTSD neurobiology and its treatment, aiming at transferring the results into clinical practice.

This randomized controlled trial aimed to evaluate the effectiveness of the Eye Movement Desensitization and Reprocessing Protocol for Recent Critical Incidents and Ongoing Traumatic Stress (EMDR-PRECI) in reducing posttraumatic stress disorder (PTSD), anxiety, and depression symptoms related to the work of first responders on active duty. Participants were randomly assigned to two 60-minute individual treatment sessions (N = 30) or to a no-treatment control condition (N = 30). They completed pre-, post-, and follow-up measurements using the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) (PCL-5) and the Hospital Anxiety and Depression Scale (HADS). Data analysis by repeated measures analysis of variance (ANOVA) showed clear effects of the EMDR-PRECI in reducing PTSD work-related symptoms in the treatment group with symptom reduction maintained at 90-day follow-up with a large effect size (d = 3.99), while participants continued to experience direct exposure to potentially traumatic work-related events during the follow-up period. Data analysis by repeated measures ANOVA revealed a significant interaction between time and group, F (2,116) = 153.83, p < .001, η_P² = .726 for PTSD, and for anxiety F (1,58) = 37.40, p < .005, ηP2 = .090, but not for depression. A t-test showed a clear decrease for depression symptoms for the treatment group with statistically significant results. The study results suggest that the EMDR-PRECI could be an efficient and effective way to address first responders' work-related PTSD, anxiety and depression symptoms. Future research is recommended to replicate these results and to investigate if symptom improvement also results in the reduction of physical health symptoms and early retirement for PTSD-related reasons among first responders.

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.

Cette recherche visait à évaluer l’efficacité du protocole de désensibilisation et de retraitement par les mouvements oculaires pour les incidents critiques récents (EMDR-PRECI) pour réduire les symptômes de stress post-traumatique liés à l’explosion d’une usine d’explosifs, au nord de Mexico, qui avait coûté la vie à sept salariés. On a administré l’EMDR-PRECI pendant deux journées consécutives à 25 rescapés présentant des symptômes de stress post-traumatique liés à l’incident critique. La moyenne des résultats des participants, au SPRINT (entretien bref d’évaluation de l’ESPT — Short PTSD Rating Interview), était de 22, bien supérieure à la valeur seuil clinique de 14. Ils furent assignés de façon aléatoire à deux conditions de traitement (l’une en traitement immédiat et l’autre en liste d’attente/traitement différé) et la thérapie fut mise en place dans les quinze jours qui suivirent l’explosion. Les résultats montrèrent un effet principal significatif pour le facteur de condition, F(1, 80) = 67.04, p < .000. Les résultats SPRINT étaient significativement différents au cours du temps, démontrant l’efficacité de la thérapie EMDR sur la durée, F(3, 80) = 150.69, p < .001. On trouva également un effet d’interaction important entre condition et temps, F(2, 80) = 55.45, p < .001. La mesure de temps 2 mit en évidence des différences significatives entre les deux conditions de traitement (post-traitement immédiat vs. post-traitement différé), t(11) = -10.08, p < .000. Les effets du traitement s’étaient maintenus lors du suivi, 90 jours plus tard. Les résultats montrèrent également une amélioration subjective importante chez les participants. Cet essai contrôlé randomisé fournit une preuve de l’efficacité de l’EMDR-PRECI à réduire les symptômes de stress post-traumatique consécutifs à une catastrophe technologique.

Shapiro’s adaptive information processing (AIP) model hypothesizes that chronic parenting stress may result from past distressing parental experiences that were not adaptively processed. Our correlational study conducted a preliminary test of the AIP model to determine if current levels of parenting stress were associated with the number of reported distressing parental experiences. Thirty-five parents, whose children were being treated in a community clinic, were interviewed to identify memories of events related to the onset and aggravation of parenting stress. Standardized measure of present parenting stress was obtained. Regression analysis indicated that the number of reported unprocessed parenting experiences was a strong predictor for the level of parenting stress. The results support the AIP conceptualization of parenting stress and are discussed in the context of the development of an eye movement desensitization and reprocessing (EMDR) intervention to reduce parenting stress.

Cet entretien avec Dr Francine Shapiro, inventrice et conceptrice de la thérapie EMDR (Eye Movement Desensitization and Reprocessing : thérapie d’intégration neuro-émotionnelle par des stimulations bilatérales alternées) apporte un aperçu de l’histoire et de l’évolution de l’EMDR depuis ses origines jusqu’aux résultats actuels et à leur utilisation, ainsi que les directions futures pour la recherche et le développement de la clinique. Dr Shapiro examine les traditions psychologiques qui ont guidé le développement de l’EMDR et le modèle de l’information adaptative, ainsi que les implications pour les traitements actuels. La logique qui sous-tend l’application de l’EMDR à un large éventail de troubles est envisagée, tout comme son intégration avec d’autres approches thérapeutiques. Les sujets évoqués comprennent la recherche sur le rôle des mouvements oculaires, l’utilisation de l’EMDR avec les vétérans de guerre, les troubles somatoformes, les questions de l’attachement et les caractéristiques uniques de l’EMDR qui ont permis son utilisation lors d’interventions de crise à travers le monde.

Research has consistently demonstrated that performance is degraded when participants engage in two simultaneous tasks that require the same working memory resources. This study tested predictions from working memory theory to investigate the effects of eye movement (EM) on the components of autobiographical memory. In two experiments, 24 and 36 participants, respectively, focused on negative memories while engaging in three dual-attention EM tasks of increasing complexity. Compared to No-EM, Slow-EM and Fast-EM produced significantly decreased ratings of image vividness, thought clarity, and emotional intensity, and the more difficult Fast-EM resulted in larger decreases than did Slow-EM. The effects on emotional intensity were not consistent, with some preliminary evidence that a focus on memory-related thought might maintain emotional intensity during simple dual-attention tasks (Slow-EM, No-EM). The findings of our experiments support a working memory explanation for the effects of EM dual-attention tasks on autobiographical memory. Implications for understanding the mechanisms of action in EMDR are discussed.

Alcohol use disorder (AUD) treatment presents a serious challenge. While there are evidence-based treatment options available, there is still a substantial group of treatment-seeking patients who do not complete regular AUD treatment. In addition, accomplished reductions in drinking behavior during treatment are often lost posttreatment. Therefore, both feasibility and effectiveness of AUD treatment are important. Innovative interventions, such as addiction-focused eye movement desensitization and reprocessing (AF-EMDR) therapy (Markus & Hornsveld, 2017), may hold promise as adjunctive treatments. Here the results of a feasibility study of adjunctive AF-EMDR therapy in outpatients with AUD and without comorbid posttraumatic stress disorder (PTSD) are described. A multiple baseline design across four participants was used. They received AF-EMDR alongside treatment as usual (TAU). The results suggest that, while challenging, AF-EMDR therapy in outpatients with AUD can be safe, acceptable, and feasible. Whether it is effective, under what conditions and for whom, requires further study however.

Recognition of posttraumatic stress disorder (PTSD) in older adults is often difficult due to its complicated presentation. Once recognized, trauma symptoms can, in accordance with (inter)national guidelines, be successfully treated with eye movement desensitization and reprocessing (EMDR) therapy. However, limited empirical research has been done on the expression and treatment of PTSD in older adults. This article explains trauma and age in the context of psychotherapy. It discusses the interaction between age and pathology and summarizes the cognitive issues related to age, PTSD, and anxiety. It provides practical suggestions for how these can be addressed in treatment. Age-related challenges related to motivation are identified with practical suggestions for addressing them. The case illustrates the necessary additions and subtractions for older adults, with clear explanations and instructions. This article points the way for future research.

Un trouble dissociatif de l'identité (TDI) jusque-là non diagnostiqué peut exister chez des individus qui sont évalués en vue de l'EMDR (désensibilisation et retraitement par les mouvements oculaires). Un TDI jusque-là non diagnostiqué était présent chez 3,9 % des 1 529 patients adultes hospitalisés en psychiatrie générale dans 10 études menées dans 6 pays différents. Cet article présente un cas de TDI probable qui n'a pas été détecté dans un rapport de cas publié et apporte des lignes directrices pour déterminer quand suspecter et comment diagnostiquer le TDI. De telles lignes directrices manquent à la formation de nombreux professionnels en santé mentale.

De nombreuses études ont identifié des liens entre la psychopathologie et des antécédents d’événement de vie traumatiques et de relations d’attachement dysfonctionnelles. Compte tenu des origines traumatiques possibles de cette pathologie, il pourrait être utile d’apporter une intervention centrée sur le trauma comme la thérapie EMDR (désensibilisation et retraitement par les mouvements oculaires). Cet article s’appuie sur un cas clinique pour décrire les résultats positifs de la thérapie EMDR dans le rétablissement d’une anorexie mentale résistante chez une patiente de 17 ans en hospitalisation. Elle avait déjà été hospitalisée à quatre reprises au cours des quatre dernières années et avait suivi des thérapies psychodynamique et cognitive comportementale. Au début de la prise en charge, la patiente pesait 28 kg et son indice de masse corporelle était 14. Elle s’est vu attribuer un style d’attachement désengagé/évitant sur l’entretien de l’attachement adulte (Adult Attachment Interview). La thérapie EMDR lui a été proposée à l’hôpital sur une durée de six mois sous la forme de séances de 50 minutes, deux fois par semaine, correspondant aux procédures standard qui se centraient principalement sur ses traumas relationnels ; elle était combinée à des séances de psychoéducation et intégrée à la thérapie des états du moi. À la fin de la prise en charge, la patiente pesait 55 kg et son indice de masse corporelle était 21,5. Elle ne remplissait plus les critères diagnostiques de l’anorexie mentale et son style d’attachement s’était modifié en faveur d’un état d’esprit libre-autonome acquis. Elle décrivait une confiance en soi accrue et une plus grande capacité à gérer différentes situations sociales. Les résultats étaient maintenus lors du suivi après 12 et 24 mois. Les implications de cette étude de cas pour la prise en charge sont examinées.

The U.K. armed forces are currently involved in a number of military operations throughout the world. Offering structured psychological interventions such as eye movement desensitization and reprocessing (EMDR) in theater has a number of potential advantages. This single-case study describes how the EMDR recent event protocol (Shapiro, 1995) was used in theater with a 27-year-old active-duty U.K. soldier who was experiencing an acute stress reaction after treating a land mine casualty. The intervention took place 2 weeks posttrauma with four sessions conducted on consecutive days, resulting in a positive outcome, with the soldier able to return immediately to frontline duties. Treatment response was assessed with administration of four standardized measures at pretreatment, posttreatment, and 18-month follow-up. Treatment effects remained at 18-month follow-up. The challenges of conducting EMDR in operational theaters and clinical implications are explored.

Existing literature on co-occurring posttraumatic stress disorder (PTSD) and addictive disorders suggests improved outcomes when both diagnoses are treated concurrently. Eye movement desensitization and reprocessing (EMDR) using the 8-phase protocol and standard 11-step targeting sequence has been investigated within integrated treatment models. However, use of newer EMDR addiction-specific protocols (e.g., desensitization of triggers and urge reprocessing [DeTUR], feeling-state addiction protocol [FSAP], craving extinguished [CravEx]) in treatment has been studied less extensively. A qualitative, phenomenological design was employed to investigate the lived experience of 9 participants with co-occurring PTSD and addictive disorders. These participants experienced both standard protocols/targeting sequences and the addiction-specific protocols as part of their treatment. Creswell’s system for interpreting meaning units in qualitative data, based largely on the work of Moustakas, was used to analyze the data gleaned from semistandardized interviews. All participants reported positive outcomes from the combined EMDR approaches; 4 major themes emerged. Participants recognized their trauma and addictions as related. As a result of this insight, their thoughts and addictive behaviors changed. All recognized remission of symptoms of both disorders; EMDR therapy was reported to be effective whether the traumatic symptoms were treated before or after the addictive symptoms. All indicated that integrated treatments (including other supportive services) were optimum for their ongoing recovery. The relationship with the therapist was integral to the overall success of treatment.

Historically, mechanisms of action have often been difficult to ascertain. Thus far, the definitive discovery of eye movement desensitization and reprocessing (EMDR)’s underlying mechanisms has been equally elusive. We review the neurobiological studies of EMDR, as well as the theoretically driven speculative models that have been posited to date. The speculative theoretically driven models are reviewed historically to illustrate their growth in neurobiological complexity and specificity. Alternatively, the neurobiological studies of EMDR are reviewed with regard to their object of investigation and categorized as follows: findings before and after EMDR therapy (neuroimaging and psychophysiological studies) and findings during the EMDR set (psychophysiological, neuroimaging, and qEEG studies).

This article introduces the flash technique, a new technique used during the preparation phase of eye movement desensitization and reprocessing (EMDR) therapy to facilitate processing of intense, traumatic memories that clients might otherwise be resistant to access. Anecdotal evidence suggests that this technique may make it possible for clients to access these memories initially in a minimally disturbing way, reducing their emotional intensity so that they can then be more easily and fully processed using EMDR therapy. The technique appears to be easily tolerated by clients of all ages, including children; and to be rapid and relatively painless for clients, even those with particularly disturbing target memories; and can be easily taught to clinicians. It has the distinct feature that clients who are avoiding a terribly disturbing memory can be offered a way of processing it without having to bring it clearly to mind. Four case examples, in which the technique was used by four different clinicians, are presented briefly. Suggestions are made for further study. This article hypothesizes various mechanisms of action and discusses the effects in terms of memory reconsolidation theory.

This article proposes a dialectical perspective on the adaptive information processing (AIP) model (F. Shapiro, 1995, 2001) with application to eye movement desensitization and reprocessing (EMDR) therapy. Dialectical principles may contribute to a more detailed understanding of the way the AIP system works as well as adding new therapeutic guidelines. Our dialectical perspective is based on 2 propositions. The first is that the movement of the AIP system toward integration consists of 2 dialectical movements: horizontal and vertical. The horizontal movement is between various opposites of the individual such as danger versus safety, dependence versus independence, worthlessness versus self-worth. The vertical movement relates to whole/part shifts in which a whole becomes a part of the next higher whole. The synergetic flow of both dialectical movements is depicted as a spiral of the AIP system. The second proposition suggests that the AIP system operates through cycles of differentiation and linking. These cycles separate the condensed and fragmented memory network into parts, enabling new links to occur. Differentiation and linking are also discussed in relation to dialectical attunement and mindful dual awareness. Using clinical vignettes, we illustrate how this perspective can supply the EMDR therapist a map of the client’s associative processing, enhance attuned therapeutic presence, and promote effective dialectical interweaves when processing is stuck.

The mental health impact of war is often underestimated by military, government, and media officials who focus primarily on well-known conditions like depression and posttraumatic stress disorder (PTSD) while ignoring the complex toll of modern warfare. These effects are clearly evident in “war syndromes,” many of which can be collectively understood as medically unexplained symptoms (MUS). The current study provides a brief historical review of combat-related MUS as well as an analysis of present evidence of a possible “Iraqi War Syndrome.” An overview of past and current treatments for combat MUS is followed by a single case study treating an Iraqi war combat veteran with combat-related MUS with eye movement desensitization and reprocessing (EMDR). Therapy resulted in significant improvement of the patient’s 1-year psychophysical condition and comorbid PTSD. We provide a detailed account of those treatment sessions as well as a discussion of EMDR’s potential to simultaneously treat a range of combat-related psychophysical conditions without requiring extensive homework or self-disclosure that some military patients may resist. The results are promising, but they require further research.

Evidence shows that sexual offenders have higher levels of adverse childhood experiences (ACE) than either the general population or other criminal populations. Historically, it was considered standard practice for sex offender therapists to dissuade their clients from addressing childhood trauma or adversity for fear of excuse making for his offending. The pathways model, which highlights etiology, made room for trauma treatment for offender’s ACE as a legitimate treatment intervention. The adaptive information processing model inherent in eye movement desensitization and reprocessing (EMDR) trauma therapy is theorized to reorganize the maladaptively stored clustering of cognitions and emotions related to overwhelming or traumatic experiences such as childhood sexual abuse. We suggest EMDR therapy as a means of restructuring distorted implicit cognitions and personal vulnerability factors which are theorized to drive offending behavior. Through a comprehensive literature review, the authors considered 5 extant models in the sex offender literature and developed the offense drivers model. This model is designed to guide and inform EMDR therapy with sex offenders. A case example illustrates the implementation of this treatment process. A checklist of offense drivers is provided to assist in case conceptualization and treatment.

Wie bereits in einem früheren Artikel in dieser Zeitschrift dargelegt, können Eye Movement Desensitization and Reprocessing (EMDR)-Behandler, die Patienten mit komplexen traumabezogenen Störungen behandeln, von der Kenntnis und der Anwendung der Theorie der strukturellen Persönlichkeitsdissoziation (TSPD) und der ihr zugehörigen Aktionspsychologie profitieren. TSPD postuliert, dass Persönlichkeitsdissoziation das Hauptmerkmal von Traumatisierung und einer großen Anzahl traumabezogener Störungen ist; von der einfachen posttraumatischen Belastungsstörung (PTBS) bis hin zur dissoziativen Identitätsstörung (DIS). Die Theorie kann Therapeuten dabei helfen, ein umfassendes Verständnis für die Probleme von Patienten mit komplexen traumabezogenen Störungen zu entwickeln, sowie einen Behandlungsplan zu erstellen und auszuführen. Das Experten-Konsensus-Modell bei komplexem Trauma besteht in einer phasenorientierten Behandlung, in der eine Stabilisierungs- und Vorbereitungsphase der Behandlung von traumatischen Erinnerungen vorangeht. Fokus dieses Artikels ist die initiale Stabilisierungs- und Vorbereitungsphase, die sehr wichtig ist, um EMDR sicher und effektiv zur Behandlung komplexer Traumata einsetzen zu können. Zentrale Themen sind (a) die Arbeit mit maladaptiven Überzeugungen, (b) die Überwindung dissoziativer Phobien und (c) ein erweiterter Einsatz von Ressourcen-Arbeit.

This article presents the first experiences of using eye movement desensitization and reprocessing (EMDR) therapy to aid in the treatment of gamma-hydroxybutyric acid (GHB) dependency. A case presented itself as a result of intense, treatment-resistant cravings despite pharmacological treatment. The patient received 7 weekly sessions using a subset of the palette of EMDR interventions in addiction (PEIA; Markus & Hornsveld, 2017) targeting both negative and positive valenced addiction-related memory representations from the past, present, and future. Patient-reported GHB craving showed a gradual and prolonged reduction. Urine samples showed that the patient remained abstinent during and at least 6 months after EMDR therapy. Further research regarding the effectiveness of EMDR therapy in this particularly challenging group of substance users is warranted.

This Point/Counterpoint concludes the interchange in Greenwald, R. and Shapiro, F. (2010) What is EMDR?: Commentary by Greenwald and Invited Response by Shapiro Journal of EMDR Practice and Research, 4, 170–179. Greenwald Rejoinder: In this rejoinder, I highlight areas of agreement between Shapiro and me that were obscured by Shapiro’s (2010) response to my (Greenwald, 2010) commentary. I also address some of the erroneous statements made by Shapiro (2010) in her arguments against my positions. Finally, I summarize our disagreements, and again assert that until we have an empirical basis for preferring a particular theoretical model of eye movement desensitization and reprocessing (EMDR), it is premature for professional organizations to endorse Shapiro’s model. Shapiro Response: In response to Greenwald, I again confine myself to addressing some of the errors and misconceptions in his arguments in relation to important aspects of EMDR therapy, theory, and research. Further, contrary to his assertion, there is already a sufficient empirical basis to support the preferential use of the adaptive information processing (AIP) model from which the EMDR procedures were formulated. His argument against this position is antithetical to the traditional process by which foundational models are challenged, refined, or replaced. Implications are salient to both training and practice.

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.

Trauma and its ensuing accommodations, including challenging behaviors, have been a growing consideration for practitioners working with people with intellectual and developmental disabilities (IDD). Recognizing the importance of one’s client’s trauma history, practitioners are seeking effective methods of providing therapy to IDD clients with posttraumatic stress disorder (PTSD) and other trauma-related diagnoses. In this exploratory study, using a multiple single case study design, six individuals with IDD and known trauma histories were treated with eye movement desensitization and reprocessing (EMDR). The researchers employed the standard EMDR protocol, adapting it when necessary to accommodate the needs of each participant. Outcomes provide preliminary evidence that EMDR may be an effective method of trauma treatment for clients with intellectual abilities, pointing to EMDR as a treatment with potential for facilitating healing from trauma with IDD clients.

Disasters, both natural and “man-made,” affect a large portion of the Earth’s population and can be expected to increase in intensity over the coming decades. The impact of disasters on mental health of affected populations is substantial and likely to be insufficiently addressed in the overall context of disaster response. While successful mental health intervention has been demonstrated in a variety of cases, including through the use of EMDR treatment, this problem needs more attention. Effective mental health response will be greatly supported by increased research on questions related to the incidence, form, and prognosis of disaster-generated traumatic stress, as these are affected by type of disaster, culture of affected population, sociological conditions, and neuropsychological factors, and the interactions among these. A brief summary of desirable research is presented that could help responders meet these challenges.

Eye Movement Desensitization and Reprocessing (EMDR) hat sich als wirkungsvoll in der Behandlung von posttraumatischen Belastungsstörungen (PTBS) erwiesen. Dieser Fall zeigt den erfolgreichen Einsatz von EMDR zur Behandlung von PTBS bei einem Patienten mit Asperger-Syndrom und untersucht potenzielle Schwierigkeiten beim Erkennen und Behandeln von PTBS bei Patienten mit Autismus-Spektrums-Störungen. Unsere Patientin war eine 21-jährige Frau mit diagnostiziertem Asperger-Syndrom und multiplen Traumata, die primär von körperlicher Misshandlung durch ihre Mitschüler herrührten. Die Behandlung wurde hochfrequent durchgeführt und erfolgte an drei Tagen pro Woche über einen Zeitraum von ungefähr drei Wochen mit mindestens einem Tag Intervall zwischen den Sitzungen. Nach 8 EMDRSitzungen verbesserte sich ihr Punktwert auf der Posttraumatic Checklist; diese Ergebnisse waren bei der Katamnese nach 8 Monaten unverändert.

In dismantling eye movement desensitization and reprocessing (EMDR) therapy, researchers have found that the central executive is likely responsible for the effect of eye movements on negative memories. Arguably, however, researchers have not satisfactorily explained central executive mechanisms responsible. One possible central executive mechanism is that of suppression. The aim of this research was to evaluate the effect of eye movements on vividness, emotionality, and suppression of memories. Thirty-one nonclinical participants in Experiment 1 completed fast- and no-eye-movement conditions. Thirty-three nonclinical participants in Experiment 2 completed fast-, slow-, and no-eye-movement conditions. Number of intrusions during a suppression period and self-ratings of vividness and emotionality were the dependent variables in both experiments. Experiment 2 also included a measure of central executive capacity. Results from both experiments supported the hypotheses and showed that fast eye movements resulted in fewer intrusions than no- and slow-eye-movement conditions. Experiment 2 also found a correlation between number of intrusions after fast eye movements and central executive capacity. Limitations of this research are discussed as well as possibilities for future research and implications for understanding EMDR therapy.

Tinnitus is a common and distressing symptom affecting at least 10% of the population. It is poorly understood. There are many proposed therapies but a significant lack of well-controlled trials. This study is a secondary analysis from our recent study to determine the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy as a treatment for tinnitus. It was designed as a single-site prospective interventional clinical trial and took place at a teaching hospital in the United Kingdom. Participants received a maximum of 10 sessions of EMDR. The EMDR used was a bespoke protocol: EMDR-for-tinnitus protocol (tEMDR). Outcome measures included evidence-based tinnitus and mood questionnaires recorded at baseline, discharge, and at 6 months post-discharge. The main outcome measure was the Tinnitus Handicap Inventory, and scores demonstrated a statistically significant improvement. Secondary analyses conducted indicate statistically significant improvement for tinnitus patients with and without probable posttraumatic stress disorder (PTSD) diagnoses. There was no significant decrease in depression and anxiety measures, however these were at the minimal range at the start. The purpose of this article is to describe the rationale behind the use of EMDR in tinnitus, the process of administrating a bespoke EMDR protocol, and the differences between tinnitus sufferers with differing experiences of trauma. To date our study is one of only two published studies investigating the use of EMDR for tinnitus; we therefore introduce an evolving and exciting application for EMDR therapy.

Since 2001, the wars in Iraq and Afghanistan have caused considerable strain on military medicine to effectively manage the growing mental health demand from deployed personnel. This article examines the ability of the U.S. Department of Defense to provide quality mental health services based on the availability of (a) clinical training, (b) mental health interventions, and (c) funded research of treatments for posttraumatic stress disorder. While notable progress has been made in cognitive-behavioral treatment access and research, eye movement desensitization and reprocessing is far less available—perhaps attributable to ongoing controversy over the technique. We suggest that underserved veterans would benefit from increased availability of evidence-based behavioral treatments, perhaps through continuation of a recent regional training program.

This theoretical article proposes that the Zeigarnik effect (ZE) (i.e., better memory for interrupted rather than completed tasks) explains the formation of traumatic memories as incomplete tasks. These tasks are thought to foster pathological rumination toward their completion while simultaneously stoking avoidance. After looking at the role of the ZE in the development and maintenance of posttraumatic stress disorder (PTSD), the article examines the physiological substrates of the ZE, including brain network imbalance, excessive autonomic nervous system activation, and prospective memory acuity for incomplete events. Eye movement desensitization and reprocessing (EMDR) therapy is proposed as uniquely capable of providing closure to interrupted facets of traumatic recollection, as this treatment may facilitate greater memory reconsolidation and inhibition of Zeigarnik reminders than extinction-based models. The ZE may be implicated in the overall EMDR treatment effect, as it is activated in several EMDR phases. Specifically, the use of brief interrupted exposures during EMDR reprocessing may benefit from the ZE in resolving traumatic events. Eye movements themselves are also considered interruptions to rumination upon traumatic memory. Recommendations for the further use of the ZE are described, and suggestions are made for future research. Protocol modifications and interweaves which mobilize the preceding insights are also provided.

Unlike high-intensity treatment, in which clients have face-to-face contact with a mental health specialist, clients in low-intensity treatment have limited or no contact with a specialist. Instead, their treatment is usually provided through self-help procedures, which are delivered via (guided) computer programs, books, or “mHealth" apps. Other treatments sometimes considered low-intensity are brief treatments, group therapy, and interventions delivered by nonspecialists. Advantages include effectiveness, accessibility, efficiency, and affordability. Concerns related to safety, engagement, and adherence to self-help programs may be addressed by (asynchronous) therapist guidance. This article describes low-intensity treatments and their relevance for eye movement desensitization and reprocessing (EMDR) therapy. Hundreds of randomized controlled trials (RCTs) have found self-help interventions to be efficacious, with many producing the same level of results as the traditional face-to-face procedure. Guided self-help cognitive behavioral therapy is recommended for the treatment of posttraumatic stress disorder in the guidelines of both the National Institute for Health and Care Excellence and International Society of Traumatic Stress Studies. Only three self-help-EMDR RCTs have been conducted. This author advocates for reconceptualizing EMDR group therapy as “guided self-help-EMDR therapy,” because it is a highly manualized, heavily scripted treatment in which the client works independently on their own material. In this respect, it offers an excellent template for the future development of efficacious low-intensity EMDR interventions. Developing safe, easy-to-use, affordable, and readily available low-intensity interventions will make effective EMDR treatment available to many millions of people around the world.

Self-help treatments are an important intervention tool, with high accessibility and ease of application. To our knowledge, no research has previously been conducted on any self-help intervention derived from eye movement desensitization and reprocessing (EMDR) therapy. In this study, we evaluated the mental health status of children not directly affected by the pandemic and investigated the effects of using an EMDR-derived self-help intervention in children as a low-intensity treatment. The mental health status of 178 children was evaluated online via the State-Trait Anxiety Inventory for Children (STAIC) and Childhood Posttraumatic Stress Reaction Index (CPTS-RI). Then, children were randomly assigned to intervention and waitlist. A booklet containing EMDR-derived techniques was sent via the school online portal and the intervention was conducted. Posttests were administered 4 weeks later. The attrition rate was 45.5%, with 97 children completing the trial (intervention: 52; waitlist: 45). At baseline, 76.4% of children showed posttraumatic stress symptoms (PTSS) above threshold. Results showed a statistically significant decrease in the posttest PTSS scores for the intervention group compared to waitlist. The intervention group had significant pre–post improvement on all but one subscale, while the waitlist group showed a significant increase in state anxiety on the STAIC. In conclusion, posttraumatic stress was found to be high in children during the COVID-19 outbreak period, and EMDR-derived self-help intervention appeared to be an effective psychosocial intervention tool.

Research has shown that the Flash Technique (FT) appears to reduce memory-related disturbance and may reduce symptoms of posttraumatic stress disorder. This paper discusses the connections between FT and eye movement desensitization and reprocessing (EMDR) therapy. In FT, clients remind themselves of a traumatic memory without dwelling on it and focus instead on a positive engaging focus and then blink their eyes when prompted. This paper summarizes numerous models describing how the brain processes traumatic material and presents a model for how FT may work in the brain. It proposes that during the blinking, the patient's periaqueductal gray (PAG) may take over, sensing the reminder of the traumatic memory and reflexively triggering the amygdala. In Porges's neuroception model, the PAG assesses danger without going through the conscious brain. Recent fMRI data show that for patients with posttraumatic stress disorder, there is enhanced connectivity from the amygdala to the left hippocampus. Thus, triggering the amygdala may, in turn, activate the left hippocampus, which may then provide a brief access to the traumatic memory. Given the brief access, there is insufficient time for the amygdala to go into overactivation. The client remains calm while accessing the traumatic memory, thus setting up the prediction error necessary for possible memory reconsolidation. This process is repeated during blinking in FT allowing memory reconsolidation to proceed. This model requires experimental confirmation.

The current research used a quantitative single-case study design to investigate the effectiveness of eye movement desensitization and reprocessing (EMDR) treatment for a participant diagnosed with comorbid major depressive disorder (MDD), severe without psychotic features, and panic disorder with agoraphobia. Treatment frequency was three sessions per week, with twelve 90-minute reprocessing sessions provided over a period of 1 month; the study also evaluated this application of “concentrated EMDR.” At baseline, mean scores on the Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) were 49 and 38, and at 3-month follow-up, the scores had decreased to 8 and 7 respectively. The results of this pilot study indicate that concentrated EMDR may be effective in treating comorbid MDD and panic disorder with agoraphobia. The study also evaluated the application of concentrated EMDR, with treatment frequency increased from one session to three sessions per week. Twelve 90-minute reprocessing sessions were provided over a period of 1 month. Results show the apparent effectiveness of concentrated EMDR.

Trauma related to sexual violence and intimate partner violence (IPV) affects millions of women, resulting in detrimental impacts to economic, physical, and mental health. Survivors are often subjected to repeated acts of violence or abuse, compounding the trauma and its effects. Participants in this mixed-methods research study included 41 women who experienced trauma related to sexual violence or IPV and were seeking counseling services at a nonprofit community agency. Quantitative assessment of depression, anxiety, and posttraumatic stress disorder (PTSD) through validated measures showed statistically significant improvement in all areas after eight sessions of eye movement desensitization and reprocessing (EMDR). Qualitative analysis through semi-structured individual interviews revealed improvements in assertiveness, self-control, functionality, and self-acceptance. Increasing access to EMDR across underserved communities, which are disproportionately affected by trauma, is discussed.

This randomized controlled study investigated the effects of eye movement desensitization and reprocessing (EMDR) in the treatment of alcohol dependency. EMDR was applied to reprocess the addiction memory (AM) in chronically dependent patients. The AM includes memories of preparatory behavior, drug effects (drug use), and loss of control (Wolffgramm, 2002). It is understood to involve extensive brain circuitry, drive part of conscious and unconscious craving, change environmental response at an organic level, and modify circuits that link to feelings of satisfaction, future planning, and hope. Thirty-four patients with chronic alcohol dependency were randomly assigned to one of two treatment conditions: treatment as usual (TAU) or TAU plus two sessions of EMDR (TAU+EMDR). The craving for alcohol was measured by the Obsessive–Compulsive Drinking Scale (OCDS) pre-, post-, and 1 month after treatment. The TAU+EMDR group showed a significant reduction in craving posttreatment and 1 month after treatment, whereas TAU did not. Results indicate that EMDR might be a useful approach for the treatment of addiction memory and associated symptoms of craving.

Research indicates that EMDR is effective for the treatment of posttraumatic stress disorder (PTSD), with numerous studies showing a high percentage of symptom remission after 3 sessions. The case of a tsunami survivor with acute PTSD is presented. Treatment for overt trauma symptoms was completed within 3 sessions, including all 8 phases and the 3-pronged protocol (i.e., past, present, future targets). One EMDR session was sufficient to process the trauma and alleviate the related symptoms, while another session was necessary for re-evaluation and processing present triggers and future templates. Resource installation was particularly helpful to prepare him for those future situations that had been generating anxiety as a result of his traumatization.

Forty-three individuals diagnosed with classic or common migraine headache were randomly assigned to either phase 1 of integrated eye movement desensitization reprocessing (EMDR) treatment or a standard care medication treatment. Integrated EMDR combines diaphragmatic breathing, cranial compression, and EMDR for abortive migraine treatment. The comparison standard care medication group received various abortive medications, including Demerol, DHE, oral triptans, Excedrin, Fiorinal, Percocet, Toradol, and Vicodin. Participants were treated during mid- to late-stage acute migraine and assessed by an independent evaluator at pretreatment, posttreatment, 24 hours, 48 hours, and 7 days for migraine pain level. Both standard care medication and integrated EMDR treatment groups demonstrated reduced migraine pain levels immediately at posttreatment, 24 hours, 48 hours, and 7 days. However, integrated EMDR treatment reduced or eliminated migraine pain with greater rapidity and showed significantly greater improvement compared to standard care medication immediately posttreatment.

The recent traumatic episode protocol (R-TEP) is an adaptation of the eye movement desensitization reprocessing (EMDR) standard protocol to the acute phases following trauma. In this article, the R-TEP structure and procedures were analyzed from a developmental/integrative perspective. It is proposed that the therapist’s developmental understanding and attunement can enhance the therapeutic dyad and can promote flexible decision making while using the R-TEP procedures. One case illustration of a recent trauma intervention demonstrates the advantage of developmental attunement in using the R-TEP. This perspective enables the therapist to pace the various styles of processing as they relate to the different stages of the memory consolidation process.

There are three large-scale neural networks in the brain. The default mode network functions in autobiographical memory, self-oriented and social cognition, and imagining the future. The central executive network functions in engagement with the external world, goal-directed attention, and execution of actions. The salience network mediates interoception, emotional processing, and network switching. Flexible, balanced participation of all three networks is required for the processing of memory to its most adaptive form to support optimal behavior. The triple network model of psychopathology suggests that aberrant function of these networks may result in diverse clinical syndromes of psychopathology (Menon, 2011). Acute stress causes a shift in the balance of the large-scale networks, favoring the salience network and rapid, evolutionarily proven survival responses. This shift results in memory being processed by the amygdala and hippocampus, with limited participation of the prefrontal cortex. Typically following the resolution of stress, balance of the three networks is restored, and processing of memory with prefrontal cortex participation resumes spontaneously. The Network Balance Model of Trauma and Resolution posits that failure to restore network balance manifests clinically as posttraumatic stress disorder (PTSD), with inadequately processed and dysfunctionally stored memory (Chamberlin, 2014). Using eye movement desensitization and reprocessing (EMDR) therapy as an example, the model illustrates how the phases of the standard protocol activate specific networks, restoring network balance and the optimal processing of memory. The model offers a physiological mechanism of action for the resolution of psychological trauma in general, and EMDR therapy in particular.

A theoretical analysis of the psychodynamic dimension of cognitions in the eye movement desensitization and reprocessing (EMDR) protocol can be beneficial in addressing the specific issues affecting the choice of appropriate cognitions in working with clients with personality disorders. This group of patients share the biographic commonality of emotional-narcissistic abuse and neglect in childhood by primary attachment figures and significant others in their lives. Arising from these experiences, a subtle dissociation (in childhood) can cause the development of parts of self with an emotional and cognitive fixation on a self-image. This is defined by the child’s attachment figures and other significant people, and has subsequently been internalized by the child themselves. In such cases, the actual goal of treatment is not primarily the event on which the EMDR session is initially focused, but rather the complex emotional and cognitive significance that the event has on the client’s self-perception and self-evaluation.

The majority of people who experience mild traumatic brain injury (mTBI) have a healthy recovery, where initial somatic, cognitive, psychological, and behavioral mTBI-related symptoms resolve naturally within hours or days. Unfortunately, a significant minority of people develop persistent post-concussion symptoms, sometimes referred to as persistent post-concussion syndrome (pPCS), often causing severe long-term reduction in well-being and daily function. Psychological and neuropsychological treatments are typically limited to antidepressants, psychoeducation on mTBI and pPCS, basic neurorehabilitative cognitive compensatory strategies, traditional cognitive behavioral therapy, or no treatment at all. This paper discusses a single case study which demonstrates how eye movement desensitization and reprocessing (EMDR) therapy might provide psychological improvement in clients who sustain mTBI and develop pPCS. The case example describes a 57-year-old man who sustained a mTBI from a serious road traffic collision as a pedestrian and who developed pPCS. Treatment included nine 1.5-hour EMDR sessions across a 5-month period (the first being an assessment). Measures of psychological symptom change and client feedback were taken at pretreatment, midtreatment, posttreatment, and aftertreatment had ceased to gauge long-term status. Measures were taken at 18-month follow-up and 4-year review (which followed litigation settlement). The novel viability for the application of EMDR for this client group isdiscussed.

Eye movement desensitization and reprocessing (EMDR) has been shown to be a structured, noninvasive, time-limited, and evidence-based treatment for unprocessed memories and related conditions. This paper focuses on EMDR as a treatment for specific fears and phobias. For this purpose, the application of EMDR is conceptualized as the selection and the subsequent processing of a series of strategically important memories of earlier negative learning experiences concerning specific objects or situations. Firstly, the practical application and conceptualization of the treatment of phobias with EMDR is presented and compared with an exposure-based treatment approach. Next, specific attention is given to the assessment and selection of appropriate memories for processing. It is hypothesized that phobias with a non-traumatic background, or those in later stages of treatment after some reduction in anxiety has been achieved, would profit more from the application of a gradual in vivo exposure, whereas trauma-based specific phobias and those with high initial levels of anxiety would respond most favorably to EMDR.

This article provides three case descriptions to demonstrate the use of the “Sleeping Dogs” method to engage children who initially refused to participate in EMDR therapy. The metaphor “sleeping dogs” refers to traumatic memories that children refuse to or cannot discuss; by waking up the “sleeping dogs,” traumatic memories become accessible and treatable. Children in the cases discussed displayed severe symptoms and refused to discuss memories of traumatic experiences. All resided in a residential facility and their symptoms were preventing transition into foster care. Case 1 (age 6) displayed increasingly violent behavior. He witnessed his father kill his mother and was the crown witness in his father’s trial, which isolated him from his family. Case 2 (age 3), was abused by her biological family, and experienced foster placement breakdown. Case 3 (age 6) was abused by her mother, yet idolized her and denied past abuse. This article describes how the Sleeping Dogs method was applied in each case, created stabilization, and led to engagement in EMDR, in which trauma memories were processed. After treatment all children transitioned into foster care. The cases demonstrate the benefits of involving (extended) family members, even when they have abused or neglected the child and may have little or no contact with them, and when reunification is no option. The implications for utilizing the Sleeping Dogs method to engage chronically traumatized children in trauma-focused therapy are discussed.

This article provides a comprehensive review of the challenges faced by chronically abused children and their treatment providers. The main aim of this pilot study was to explore whether chronically traumatized children, who presented as unable or unwilling to engage in eye movement desensitization and reprocessing (EMDR) therapy, could be prepared with the “Sleeping Dogs” method to complete EMDR therapy. The second aim was to determine whether there was sufficient reduction in posttraumatic stress symptoms to enable positive placement decisions. Participants were 14 children, age 3–9 years (M = 5.1), refusing to participate in EMDR therapy. All were living in residential care (n = 12) or with foster families (n = 2) and were considered stuck cases because of their severe problems. With the treatment package of “Sleeping Dogs” plus EMDR therapy, all children completed EMDR therapy in an average of 7.57 sessions leading to the resolution of all identified traumatic memories. At posttest, the Trauma Symptom Checklist for Young Children showed a significant reduction of scores on the Intrusion and Depression subscales. Two thirds of the children (n = 8) who were in residential care at study onset were placed in foster families within 2 months after the last session, some even during treatment. This is the first study on the “Sleeping Dogs” method and even though the limited sample size and research design restricts generalization of results, the present findings suggest important directions for future study.

Exposure to adverse events during childhood and adolescence is associated with problematic outcomes across the life span, including the development of posttraumatic stress disorder (PTSD). A growing body of research examining the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy in treating PTSD among young people has yielded mixed findings. More work is needed that elucidates whether EMDR is linked to positive and sustained reductions in symptoms among youth who experience potentially traumatic events. For this open trial, we analyzed data from 143 youth (M_age = 12.9, standard deviation [SD] = 3.4, Range = 6–18) who received outpatient behavioral health clinic services, including EMDR. We assessed whether the number of types of exposure to family-related and non-family-related traumatic events, as well as differences in severity of PTSD symptomatology, was associated with changes in internalizing and externalizing problem behaviors from intake to 6 months. Results indicated that youth with (a) fewer exposures to non-family-related potentially traumatic events and (b) more severe PTSD symptoms, showed greater improvements in externalizing problem behaviors. We discuss limitations of the present study and implications for future research.

This case study presents case conceptualization, therapeutic intervention, and the subjective and objective therapeutic progress of a 14-year-old adolescent hospitalized with posttraumatic stress disorder (PTSD) following emotional, physical, and sexual abuse by his father. The adaptive information processing (AIP) model that informs eye movement desensitization and reprocessing (EMDR) therapy and the theory of structural dissociation of the personality (TSDP) were used to conceptualize and guide the treatment. Stabilization and orientation to the present were essential to integrate his traumatic memories into a life narrative, and this became a major goal and an outcome of treatment. A single-case AB design was applied in assessing the impact of intervention. The UCLA PTSD Symptom Scale, Strengths and Difficulties Questionnaire—HEL (SDQ-HEL), State-Trait Anxiety Inventory (STAI), and Dissociative Experiences Scale II were administered at 5 different time points to assess changes in the youth’s subjective emotional state and indicated substantial improvement. In addition, objective behavior change (using O’Neill’s Behavior Checklist) was recorded on a daily basis for 7 months and showed a large decrease in the frequency of targeted maladaptive behaviors. The article describes the treatment process which helped the youth to regain a sense of time; establish a coherent sense of self; and maintain adaptive perceptions, emotions, attitudes, and behaviors.

Many studies have shown that the relationship between child and caregivers is critical for healthy development of the child’s brain function, and for intergenerational transmission of attachment. Here, we propose a useful eye movement desensitization and reprocessing (EMDR) target for treatment of maternal emotional dysregulation that can cause maltreatment of the child, with the goal of interrupting intergenerational transmission of attachment trauma. First, we use schematics to demonstrate a hypothetical model of the interaction between a child’s attachment behavior and a mother’s bonding behavior. This schematic shows that the child’s physiologic reaction activates or triggers the mother’s negative affect and somatic sensations in her limbic system and brain stem and that, in turn, evokes the mother’s maltreatment behavior. The negative affect and somatic sensation (maternal emotional dysregulation) are Dysfunctionally Stored Information (DSI) that was produced in the mother’s past experience. We propose that the mother’s negative affect and somatic sensations activated by the child’s behaviors can be useful targets for EMDR therapy based on this hypothetical model. Two Japanese case reports (mothers with 4-year-old daughters) are described to illustrate this application. Further discussion highlights the feature of Japanese cultural relationship and the dissociation, and the meaning and scope of targeting maternal emotional dysregulation with EMDR therapy.

After 15 years of dedicated and outstanding service, Dr. Louise Maxfield, Founding Editor of the Journal of EMDR Practice and Research, has retired from her editorial responsibilities. This editorial introduces the first issue under the joint editorship of Dr. Derek Farrell and Jenny Ann Rydberg, who highlight the need to address the future of EMDR therapy in general and the Journal of EMDR Practice and Research in particular, and welcome a community-informed discussion on new directions.

Sport psychologists are increasingly confronted with performance problems in sport where athletes suddenly lose the ability to execute automatic movements (Rotheram, Maynard, Thomas, Bawden, & Francis, 2012). Described as performance blocks (Bennett, Hays, Lindsay, Olusoga, & Maynard, 2015), these problems manifest as locked, stuck, and frozen movements and are underpinned by an aggressive anxiety component. This research used both qualitative and quantitative methods in a single case study design to investigate the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy with graded exposure as a treatment method. The participant was a 58-year-old professional male golfer who had been suffering a performance block for 11 years. Specifically, the participant was experiencing involuntary spasms, shaking, muscle tension, and jerking in the lower left forearm while executing a putting stroke. Physical symptoms were coupled with extreme anxiety, panic, and frustration. The study tested the hypothesis that reprocessing related significant life events and attending to dysfunctional emotional symptoms would eliminate the performance block and related symptoms and that the individual would regain his ability to execute the affected skill. Pre-, mid-, and postintervention performance success, using the Impact of Event scale, subjective units of distress (SUD; Wolpe, 1973), and kinematic testing revealed improvements in all associated symptoms in training and competition. These findings suggest that previous life experiences might be associated with the onset of performance blocks and that EMDR with graded exposure might offer an effective treatment method.

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.

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.

Effective presentation skills are vital for success in most organizations. Preparing students for their careers, college educators often require that students demonstrate effective presentation skills. While traditional approaches to managing presentation anxiety help some students, EMDR may offer an effective intervention for those with serious presentation anxiety. This case study involves a student with presentation anxiety referred for EMDR from an organizational communication class. The subject delivered videotaped presentations and completed the State-Trait Anxiety Inventory (STAI) prior to and after completing three EMDR sessions. The subject’s pre–post STAI scores reduced from the 98th to the 55th percentile. Blind expert ratings of the videotaped presentations indicated pronounced performance improvement. At 12-month follow-up, the subject was successfully employed in a management position, making effective presentations without intense anxiety.