Program Profile: Eye Movement Desensitization and Reprocessing (EMDR) for Traumatized Young Women

This is a therapeutic approach designed to treat individuals who are dealing with the aftermath of a traumatic life event. The goal is to help those who have experienced traumatic stress to reprocess and store traumatic memories adaptively. The program is rated Promising. Program participants reported statistically significant improvements in posttraumatic stress disorder, depression, anxiety, self-concept, avoidance, and intrusive thoughts, compared with control group participants.

A Promising rating implies that implementing the program may result in the intended outcome(s).

A Promising rating implies that implementing the program may result in the intended outcome(s).

Program Goals/Program Theory

Eye Movement Desensitization and Reprocessing (EMDR) is a therapeutic approach designed to treat individuals who are dealing with the aftermath of a traumatic life event, including children exposed to violence. The approach is guided by the adaptive information processing model. As the brain slowly processes memories of everyday life experiences, these memories are transferred to the left cerebral cortex, where they are filed away with other neutral memories, becoming part of an individual’s life story. Traumatic experiences, however, are often highly emotionally charged and can overwhelm the brain’s capacity to process information. Instead of being properly connected and stored with other memories, episodic memory of traumatic experiences may be indefinitely stored in the limbic system. Dysfunctionally stored traumatic memories can in turn lead to maladaptive coping strategies and cause intense anxiety and other symptoms of posttraumatic stress disorder (PTSD).

The goal of EMDR treatment is therefore to help individuals who have experienced traumatic stress to reprocess and adaptively store dysfunctionally stored traumatic memories. Treatment sessions focus on the past experiences that may have caused PTSD or other psychological disorders; the current circumstances that trigger dysfunctional emotions, beliefs, and sensations; and the positive experiences that can improve future adaptive behaviors and mental health.

Program Components

EMDR treatment involves an eight-phase protocol that addresses an individual’s past, present, and future experience and behavior. During phase 1, treatment focuses on obtaining the individual’s history and determining if the individual is a good candidate for EMDR. If treatment is appropriate, the therapist creates a treatment plan and works with the individual to identify traumatic experiences that can be targeted for EMDR processing. During phase 2 (the preparation phase), a therapeutic alliance is established between the individual and the therapist, and the process of EMDR is fully explained. Individuals in treatment are taught about strategies to manage intense feelings of distress and to reduce stress that may occur during or between sessions. Ideally, individuals will not need to use these strategies once therapy is complete.

Phase 3 (assessment phase), involves identifying and accessing the target memory that will be processed. Therapists ask the individuals to focus on a vivid, disturbing image that represents the traumatic event and to identify negative beliefs about the self that are rooted in that experience. Individuals must create a positive cognition or belief that could replace the negative belief. The individual is also asked to notice the feelings and body sensations that may be associated with the disturbing memory. Baseline measurements of reactivity are assessed during the exercise.

During phase 4 (desensitization), the traumatic event and present stimuli that trigger the past experience are processed. Individuals are told to hold the disturbing images of the traumatic event in their mind along with the associated negative belief, feelings, and sensations in their body while focusing on external stimulus. The external stimulus is the therapists’ fingers or hands that are moved back and forth in front of the individuals’ eyesight for about 20 to 50 seconds. After each set of bilateral stimulation, individuals are asked about any changes or thoughts they experience. Through each treatment session, rating scales are used to keep track of any changes in the intensity of feelings and body sensations. As individuals focus on the traumatic experiences, the episodic memory is processed and individuals should experience noticeable shifts in cognitions, emotions, and sensations. The memory of the traumatic event can then be integrated and consolidated as a narrative memory. As a result, individuals are brought to an adaptive resolution through adaptive information processing.

In phase 5 (installation), individuals identify the most positive belief about themselves (either the initial positive cognition from phase 3 or another one that may emerge during treatment sessions). Using bilateral stimulation, therapists help individuals increase the connection of the new positive cognition with existing positive cognitive networks. The effects can then be generalized within associated neural networks.

During phase 6 (body scan), therapists assist individuals in identifying and processing residual body sensations. In phase 7 (closure), therapists ensure individuals’ stability, and individuals are told about what they might experience between treatment sessions. The final phase (reevaluation) is the assessment that occurs at the beginning of each subsequent session. In each new session, the individual’s psychological state guides the next step of treatment.

Study

Scheck, Schaeffer, and Gillette (1998) studied the efficacy of Eye Movement Desensitization and Reprocessing (EMDR) with a group of traumatized young women. The study randomly assigned 60 women between the ages of 16 and 25 to attend two sessions of either EMDR or an active listening (AL) approach. Study participants in the treatment group received EMDR treatment that followed the standard protocol devised by Shapiro (2001), consisting of manualized steps. Participants in the comparison group received AL treatment that followed a nondirective, Rogerian-based model: Comparison group participants were asked to say more about the traumatic memory. Therapists then used attentive silence and non-evaluative acknowledgement of what the participants shared.

Individuals were recruited from local municipal agencies in Colorado Springs, Colorado. They were eligible for the study if they were female, under 25 years of age, had a recent history of at least two of eight dysfunctional behaviors, and had a self-reported traumatic memory. Dysfunctional behaviors were assessed using an eight-item questionnaire that measured arrests, sexual promiscuity, runaway behavior, and drug and alcohol abuse. The final group of study participants was 62 percent white, 15 percent African American, 15 percent Hispanic, and 8 percent Native American. Almost all of the study participants (90 percent) reported being victims of physical or emotional abuse as a child. Over half of the traumas that participants self-reported were traumatic sexual experiences, such as rape or child molestation. There were no significant differences between the EMDR treatment group and AL comparison group on age, education level, and ethnicity.

There were several outcome measures of interest. The Posttraumatic Stress Disorder Interview (or PTSD–I) used a structured interview format to estimate the Diagnostic and Statistical Manual of Mental Disorders (or DSM–IV) diagnosis for PTSD. In addition, the Beck Depression Inventory, a 21-item self-report scale, was used to assess the severity of depression. The State–Trait Anxiety Inventory, a 40-item self-report scale, included two subscales that measured trait anxiety (how the participant generally feels) and state anxiety (how the participant feels right now). The Penn Inventory for Posttraumatic Stress Disorder, a 26-item self-report scale, measured the strength or intensity of posttraumatic symptoms. The Impact of Event Scale, a 15-item scale, included two subscales that assessed avoidance and intrusions concerning the traumatic event that participants have experienced over the most recent 7 days. Finally, the Tennessee Self-Concept Scale, a 100-item self-report scale, included a number of subscales and measured overall level of self-esteem.

Pretest assessments were collected with the female participants once they agreed to join the study. Posttest assessments were administered following participants’ attendance in two therapy sessions of either EMDR or AL. Follow-up data were collected 90 days after the posttreatment evaluation.

A factorial analysis of variance (or ANOVA) technique was used to analyze the outcomes measures, with one between-subjects factor (type of treatment) and one within-subjects factor (pre–post). Analyses of simple main effects that used an unweighted means approach was also applied to analyze the data.

A manual for conducting Eye Movement Desensitization and Reprocessing (EMDR) with adults is available: Shapiro, Francine. 2001. Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures (2nd ed.). New York, N.Y.: Guilford Press.

More information about the program can be found on the website of the EMDR Institute, Inc: http://www.emdr.com/

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Ahmad, Abdulbaghi, Bo Larsson, and Viveka Sundelin–Wahlsten. 2007. “EMDR Treatment for Children With PTSD: Results of a Randomized Controlled Trial.” Nordic Journal of Psychiatry 61(5):349–54. (This study was reviewed but did not meet CrimeSolutions criteria for inclusion in the overall program rating.)

Ahmad, Abdulbaghi, and Viveka Sundelin–Wahlsten. 2008. “Applying EMDR on Children With PTSD.” European Child & Adolescent Psychiatry 17(3):127–32.

Jaberghaderi, Nasrin, Ricky Greenwald, Allen Rubin, Shahin Oliaee Zand, and Shiva Dolatabadi. 2004. “A Comparison of CBT and EMDER for Sexually-Abused Iranian Girls.” Clinical Psychology and Psychotherapy 11:358–68.

Oras, R., S. Candela de Ezpeleta, and A. Ahmad. 2004. “Treatment of Traumatized Refugee Children with Eye Movement Desensitization and Reprocessing in a Psychodynamic Context.” Nordic Journal of Psychiatry 58:199–203.

Shapiro, Francine. 2001. Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures (2nd ed.). New York, N.Y.: Guilford.

Solomon, Eldra P., Roger M. Solomon, and Kathleen M. Heide. 2009. “EMDR: An Evidence-Based Treatment for Victims of Trauma.” Victims & Offenders 4(4):391–97.

Following are CrimeSolutions-rated programs that are related to this practice:

Psychotherapies for Victims of Sexual Assault

This practice examines interventions for adult sexual assault victims that reduce psychological distress, symptoms of post-traumatic stress disorder (PTSD), and rape trauma through counseling, structured or unstructured interaction, training programs, or predetermined treatment plans. The practice is rated Effective in reducing symptoms of trauma and PTSD in victims of sexual assault and rape.

Evidence Ratings for Outcomes

Mental Health & Behavioral Health - Trauma/PTSD

Psychotherapy with Adults Sexually Abused in Childhood

This practice comprises therapeutic approaches for adults who were sexually abused in childhood, and is designed to improve psychological distress, reduce maladaptive behavior, or enhance adaptive behavior through counseling, structured or unstructured interaction, or a predetermined treatment plan. The practice is rated Promising for decreasing posttraumatic stress disorder, trauma, and internalizing and externalizing symptoms.

Evidence Ratings for Outcomes

	Mental Health & Behavioral Health - Trauma/PTSD
	Mental Health & Behavioral Health - Internalizing behavior
	Mental Health & Behavioral Health - Externalizing behavior

Trauma-Focused Treatment for Juveniles and Young Adults With Trauma Symptoms and Externalizing Behaviors

This practice consists of trauma-focused interventions to treat trauma symptoms and externalizing behaviors in juveniles and young adults. The practice is rated Effective for reducing trauma symptoms and for externalizing behaviors in juveniles and young adults, compared with juveniles and young adults in the control group who did not receive treatment.

Evidence Ratings for Outcomes

	Mental Health & Behavioral Health - Trauma/PTSD
	Mental Health & Behavioral Health - Externalizing behavior

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?