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Eye movement desensitization and reprocessing (EMDR) and trauma.

Since its introduction in a 1989 randomized controlled trial, eye movement desensitization and reprocessing (EMDR) has been used for a variety of psychological problems, particularly trauma-induced ones, as well as stress-induced physical disorders, according to Francine Shapiro, PhD. EMDR therapy has standardized protocols and procedures that include history taking, self-care techniques that support emotional stability, and reprocessing with dual attention stimuli. During reprocessing, clients focus on the worst part of a traumatic event, associated negative beliefs, and body responses while performing eye movements, tapping, or toning and then release the memory with a deep exhalation. The thoughts and feelings that arise during a reprocessing session can provide therapists with information for another session, if needed. "Completed processing is posited to involve an alteration of the originally stored memory through a process of integration and reconsolidation," says Shapiro. EMDR produces brain imaging changes, according to a 2005 study involving six police officers with PTSD, as well as significant clinical changes. Most symptoms from a single trauma usually resolve with three to six sessions.

EMDR's effectiveness for posttraumatic stress disorder (PTSD) has been verified by numerous studies over the years, including a randomized, placebo-controlled clinical trial led by Bessel A. van der Kolk. That 2007 study randomly assigned 88 patients with PTSD to receive 8 weekly, 90-minute EMDR sessions; 8 weeks of fluoxetine (Prozac) treatment; or placebo pill. At 6 months after treatment's end, 75% of adult-onset trauma patients who used EMDR were asymptomatic compared with none in the fluoxetine group. Only 33.3% of child-onset trauma patients who had EMDR therapy were asymptomatic at 6-month follow-up. The authors noted that child-onset trauma usually requires more than 8 sessions. Child-onset trauma patients also had a greater response to fluoxetine at posttreatment assessment than the adult-onset group, but fluoxetine treatment had no effect 6 months after treatment was discontinued.

Although we tend to associate PTSD with life-threatening and violent/abusive events, Shapiro says that posttraumatic stress symptoms can also arise from life experiences such as debilitating illness; the death of a loved one; and problems with relationships, work, or study. She suggests trying EMDR before turning to medication when patients relate their anxiety, depression, hypervigilance, nightmares, insomnia, or anger to a difficult experience. EMDR has also relieved migraine headaches, "phantom" pain, and stress-related skin disorders, such as atopic dermatitis and psoriasis, in clinical studies.

Lansing K, Amen DG, Hanks C, Rudy L. High-resolution brain SPECT imaging and eye movement desensitization and reprocessing in police officers with PTSD. I Neuropsychiatry Clin Neurosci. Fall 2005;17(4):526--532. Available at www.researchgate.net. Accessed July 15, 2015.

Shapiro F. The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences. Permanente J. Winter 2014;18(1):71-77. Available at www.ncbi.nlm.nih.gov/ pmc/articles/PMC3951033. Accessed July 29, 2015.

Van der Kolk, BA, Spinazzola J, Blaustein ME et al. A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: treatment effects and long-term maintenance. Clin Psychiatry. January 2007;68(1):37-46. Available at www.researchgate.net. Accessed July 8, 2015.

briefed by Jule Klotter

jule@townsendletter.com
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Title Annotation:Shorts
Author:Klotter, Jule
Publication:Townsend Letter
Date:Oct 1, 2015
Words:538
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