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EMDR is now accepted as a treatment of choice by numerous mental health departments, and trauma organizations. EMDR has a broad base of published case reports and controlled research that supports it as an empirically validated treatment of trauma. The Department of Defense/Department of Veterans Affairs Practice Guidelines have placed EMDR in the highest category, recommended for all trauma populations at all times.
In addition, the International Society for Traumatic Stress Studies current treatment guidelines have designated EMDR as an effective treatment for PTSD (Foa, Keane, Friedman, & Cohen, 2009) as have the Departments of Health of both Northern Ireland and Israel , which have indicated EMDR to be one of only two or three treatments of choice for trauma victims. The American Psychiatric Association Practice Guideline (2004) has stated that SSRI's, CBT, and EMDR are recommended as first-line treatments of trauma.
See Shapiro (1999, 2001, 2002) for procedures, protocols, theories, and discussion of clinically valid research criteria. See Shapiro & Forrest (1997) for a comprehensive narrative of cases, and in-session transcripts, and "EMDR for Trauma" in APA Psychotherapy Videotape series. For a comprehensive review of areas of debate see Perkins and Rouanzoin (2002).
American Psychiatric Association (2004). Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder. Arlington, VA: American Psychiatric Association Practice Guidelines.
EMDR is recommended as an effective treatment for trauma.
Bleich, A., Kotler, M., Kutz, I., & Shalev, A. (2002). A position paper of the (Israeli) National Council for Mental Health: Guidelines for the assessment and professional intervention with terror victims in the hospital and in the community. Jerusalem, Israel.
EMDR is one of three methods recommended for treatment of terror victims.
Chambless, D.L. et al. (1998). Update of empirically validated therapies, II. The Clinical Psychologist, 51, 3-16.
According to a taskforce of the Clinical Division of the American Psychological Association, the only methods empirically supported ("probably efficacious") for the treatment of any post-traumatic stress disorder population were EMDR, exposure therapy, and stress inoculation therapy. Note that this evaluation does not cover the last decade of research.
CREST (2003). The management of post traumatic stress disorder in adults. A publication of the Clinical Resource Efficiency Support Team of the Northern Ireland Department of Health, Social Services and Public Safety, Belfast.
EMDR and CBT were stated to be the treatments of choice.
Department of Veterans Affairs & Department of Defense (2004). VA/DoD Clinical Practice Guideline for the Management of Post-Traumatic Stress. Washington, DC: Veterans Health Administration, Department of Veterans Affairs and Health Affairs, Department of Defense. Office of Quality and Performance publication 10Q-CPG/PTSD-04.
EMDR was placed in the "A" category as "strongly recommended" for the treatment of trauma.
Dutch National Steering Committee Guidelines Mental Health Care (2003). Multidisciplinary Guideline Anxiety Disorders. Quality Institute Heath Care CBO/Trimbos Intitute. Utrecht, Netherlands.
EMDR and CBT both designated as treatments of choice for PTSD
Foa, E.B., Keane, T.M., Friedman, M.J., & Cohen, J.A. (2009). Effective treatments for PTSD: Practice Guidelines of the International Society for Traumatic Stress Studies New York: Guilford Press.
EMDR was listed as an effective and empirically supported treatment for PTSD, and was given an AHCPR "A" rating for adult PTSD. This guideline specifically rejected the findings of the previous Institute of Medicine report, which stated that more research was needed to judge EMDR effective for adult PTSD. With regard to the application of EMDR to children, an AHCPR rating of Level B was assigned. Since the time of this publication, two additional randomized studies on EMDR have been completed (see below).
INSERM (2004). Psychotherapy: An evaluation of three approaches. French National Institute of Health and Medical Research, Paris, France.
EMDR and CBT were stated to be the treatments of choice for trauma victims.
National Institute for Clinical Excellence (2005). Post traumatic stress disorder (PTSD): The management of adults and children in primary and secondary care. London: NICE Guidelines.
Trauma-focused CBT and EMDR were stated to be empirically supported treatments for choice for adult PTSD.
An NIMH sponsored website listing empirically supported methods for a variety of disorders. EMDR is one of three treatments listed for PTSD.
United Kingdom Department of Health (2001). Treatment choice in psychological therapies and counselling evidence based clinical practice guideline. London, England.
Best evidence of efficacy was reported for EMDR, exposure, and stress inoculation
EMDR has been compared to numerous exposure therapy protocols, with and without CT techniques. It should be noted that exposure therapy uses one to two hours of daily homework and EMDR uses none. The most recent meta-analyses are listed here.
Bisson, J., & Andrew, M. (2007). Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD003388. DOI: 10.1002/14651858.CD003388.pub3.
"Trauma focused cognitive behavioural therapy and eye movement desensitisation and reprocessing have the best evidence for efficacy at present and should be made available to PTSD sufferers."
Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005). A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162, 214-227.
EMDR is equivalent to exposure and other cognitive behavioral treatments and all "are highly efficacious in reducing PTSD symptoms."
Davidson, P.R., & Parker, K.C.H. (2001). Eye movement desensitization and reprocessing (EMDR): A meta-analysis. Journal of Consulting and Clinical Psychology, 69, 305-316.
EMDR is equivalent to exposure and other cognitive behavioral treatments.
Maxfield, L., & Hyer, L.A. (2002). The relationship between efficacy and methodology in studies investigating EMDR treatment of PTSD. Journal of Clinical Psychology, 58, 23-41.
A comprehensive meta-analysis reported the more rigorous the study, the larger the effect.
Rodenburg, R., Benjamin, A., de Roos, C, Meijer, A.M., & Stams, G.J. (in press). Efficacy of EMDR in children: A meta – analysis. Clinical Psychology Review.
"Results indicate efficacy of EMDR when effect sizes are based on comparisons between EMDR and non-established trauma treatment or no-treatment control groups, and incremental efficacy when effect sizes are based on comparisons between EMDR and established (CBT) trauma treatment."
Seidler, G.H., & Wagner, F.E. (2006). Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: a meta-analytic study. Psychological Medicine, 36, 1515-1522.
Results suggest that in the treatment of PTSD, both therapy methods tend to be equally efficacious."
Carlson, J., Chemtob, C.M., Rusnak, K., Hedlund, N.L, & Muraoka, M.Y. (1998). Eye movement desensitization and reprocessing (EMDR): Treatment for combat-related post-traumatic stress disorder. Journal of Traumatic Stress, 11, 3-24.
Twelve sessions of EMDR eliminated post-traumatic stress disorder in 77.7% of the multiply traumatized combat veterans studied. There was 100% retention in the EMDR condition. Effects were maintained at follow-up. This is the only randomized study to provide a full course of treatment with combat veterans. Other studies (e.g., Boudewyns/Devilly/Jensen/Pitman et al./Macklin et al.) evaluated treatment of only one or two memories, which, according to the International Society for Traumatic Stress Studies Practice Guidelines (2000), is inappropriate for multiple-trauma survivors. The VA/DoD Practice Guideline (2004) also indicates these studies (often with only two sessions) offered insufficient treatment doses for veterans.
Abbasnejad, M., Mahani, K. N., & Zamyad, A. (2007). Efficacy of "eye movement desensitization and reprocessing" in reducing anxiety and unpleasant feelings due to earthquake experience. Psychological Research, 9 (3-4), 104-117.
"EMDR is effective in reducing earthquake anxiety and negative emotions (e.g. PTSD, grief, fear, intrusive thoughts, depression, etc) resulting from earthquake experience. Furthermore, results show that, improvement due to EMDR was maintained at a one month follow up."
Ahmad A, Larsson B, & Sundelin-Wahlsten V. (2007). EMDR treatment for children with PTSD: Results of a randomized controlled trial. Nord J Psychiatry, 61, 349-54.
Thirty-three 6-16-year-old children with a DSM-IV diagnosis of PTSD were randomly assigned to eight weekly EMDR sessions or the WLC group. EMDR was found to be an effective treatment in children with PTSD from various sources and who were suffering from a variety of co-morbid conditions.
Chemtob, C.M., Nakashima, J., & Carlson, J.G. (2002). Brief-treatment for elementary school children with disaster-related PTSD: A field study. Journal of Clinical Psychology, 58, 99-112.
EMDR was found to be an effective treatment for children with disaster-related PTSD who had not responded to another intervention.
Cvetek, R. (2008). EMDR treatment of distressful experiences that fail to meet the criteria for PTSD. Journal of EMDR Practice and Research, 2, 2-14.
EMDR treatment of disturbing life events (small "t" trauma) was compared to active listening, and wait list. EMDR produced significantly lower scores on the Impact of Event Scale (mean reduced from "moderate" to "subclinical") and a significantly smaller increase on the STAI after memory recall.
Edmond, T., Rubin, A., & Wambach, K. (1999). The effectiveness of EMDR with adult female survivors of childhood sexual abuse. Social Work Research, 23, 103-116.
EMDR treatment resulted in lower scores (fewer clinical symptoms) on all four of the outcome measures at the three-month follow-up, compared to those in the routine treatment condition. The EMDR group also improved on all standardized measures at 18 months follow up (Edmond & Rubin, 2004, Journal of Child Sexual Abuse).
Edmond, T., Sloan, L., & McCarty, D. (2004). Sexual abuse survivors' perceptions of the effectiveness of EMDR and eclectic therapy: A mixed-methods study. Research on Social Work Practice, 14, 259-272.
Combination of qualitative and quantitative analyses of treatment outcomes with important implications for future rigorous research. Survivors' narratives indicate that EMDR produces greater trauma resolution, while within eclectic therapy, survivors more highly value their relationship with their therapist, through whom they learn effective coping strategies.
Hogberg, G. et al., (2007). On treatment with eye movement desensitization and reprocessing of chronic post-traumatic stress disorder in public transportation workers: A randomized controlled study. Nordic Journal of Psychiatry, 61, 54-61.
Employees who had experienced "person-under-train accident or had been assaulted at work were recruited." Six sessions of EMDR resulted in remission of PTSD in 67% compared to 11% in the wait list control. Significant effects were documented in Global Assessment of Function (GAF) and Hamilton Depression (HAM-D) score. Follow-up: Högberg, G. et al. (2008). Treatment of post-traumatic stress disorder with eye movement desensitization and reprocessing: Outcome is stable in 35-month follow-up. Psychiatry Research. 159, 101-108.
Ironson, G.I., Freund, B., Strauss, J.L., & Williams, J. (2002). Comparison of two treatments for traumatic stress: A community-based study of EMDR and prolonged exposure. Journal of Clinical Psychology, 58, 113-128.
Both EMDR and prolonged exposure produced a significant reduction in PTSD and depression symptoms. This is the only research comparing EMDR and exposure therapy that equalized homework. The study found that 70% of EMDR participants achieved a good outcome in three active treatment sessions, compared to 29% of persons in the prolonged exposure condition. EMDR also had fewer dropouts.
Jaberghaderi, N., Greenwald, R., Rubin, A., Dolatabadim S., & Zand, S.O. (2004). A comparison of CBT and EMDR for sexually abused Iranian girls. Clinical Psychology and Psychotherapy, 11, 358-368.
Both EMDR and CBT produced significant reduction in PTSD and behavior problems. EMDR was significantly more efficient, using approximately half the number of sessions to achieve results.
Lee, C., Gavriel, H., Drummond, P., Richards, J. & Greenwald, R. (2002). Treatment of post-traumatic stress disorder: A comparison of stress inoculation training with prolonged exposure and eye movement desensitization and reprocessing. Journal of Clinical Psychology, 58, 1071-1089.
Both EMDR and stress inoculation therapy plus prolonged exposure (SITPE) produced significant improvement, with EMDR achieving greater improvement on PTSD intrusive symptoms. Participants in the EMDR condition showed greater gains at three-month follow-up. EMDR required three hours of homework compared to 28 hours for SITPE.
Marcus, S., Marquis, P. & Sakai, C. (1997). Controlled study of treatment of PTSD using EMDR in an HMO setting. Psychotherapy, 34, 307-315
Funded by Kaiser Permanent. Results show that 100% of single-trauma and 77% of multiple-trauma survivors were no longer diagnosed with post-traumatic stress disorder after six 50-minute sessions.
Marcus, S., Marquis, P. & Sakai, C. (2004). Three- and 6-month follow-up of EMDR treatment of PTSD in an HMO setting. International Journal of Stress Management, 11, 195-208.
Funded by Kaiser Permanent, follow-up evaluation indicates that a relatively small number of EMDR sessions result in substantial benefits that are maintained over time.
Power, K.G., McGoldrick, T., Brown, K., et al. (2002). A controlled comparison of eye movement desensitization and reprocessing versus exposure plus cognitive restructuring, versus waiting list in the treatment of post-traumatic stress disorder. Journal of Clinical Psychology and Psychotherapy, 9, 299-318.
Both EMDR and exposure therapy plus cognitive restructuring (with daily homework) produced significant improvement. EMDR was more beneficial for depression, and social functioning, and required fewer treatment sessions. Subsequent reevaluation of the data indicated that "For pre- to post-treatment IES mean change score, EMDR patients also appeared to have had better treatment outcome than E+CR patients" and EMDR therapy was a predictor of positive outcome: Karatzias, A., Power, K. McGoldrick, T., Brown,
K., Buchanan, R., Sharp, D. & Swanson, V. (2006). Predicting treatment outcome on three measures for post-traumatic stress disorder. Eur Arch Psychiatry Clin Neuroscience, 20, 1-7.
Rothbaum, B. (1997). A controlled study of eye movement desensitization and reprocessing in the treatment of post-traumatic stress disordered sexual assault victims. Bulletin of the Menninger Clinic, 61, 317-334.
Three 90-minute sessions of EMDR eliminated post-traumatic stress disorder in 90% of rape victims.
Rothbaum, B.O., Astin, M.C., & Marsteller, F. (2005). Prolonged exposure versus eye movement desensitization (EMDR) for PTSD rape victims. Journal of Traumatic Stress, 18, 607-616.
In this NIMH funded study both treatments were effective: "An interesting potential clinical implication is that EMDR seemed to do equally well in the main despite less exposure and no homework. It will be important for future research to explore these issues."
Scheck, M., Schaeffer, J.A., & Gillette, C. (1998). Brief psychological intervention with traumatized young women: The efficacy of eye movement desensitization and reprocessing. Journal of Traumatic Stress, 11, 25-44.
Two sessions of EMDR reduced psychological distress in traumatized adolescents/ young women and brought scores within one standard deviation of the norm.
Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress, 2, 199–223.
Seminal study appeared the same year as first controlled studies of CBT treatments. Three-month follow-up indicated substantial effects on distress and behavioral reports. Marred by lack of standardized measures and the originator serving as sole therapist.
Soberman, G. B., Greenwald, R., & Rule, D. L. (2002). A controlled study of eye movement desensitization and reprocessing (EMDR) for boys with conduct problems. Journal of Aggression, Maltreatment, and Trauma, 6, 217-236.
The addition of three sessions of EMDR resulted in large and significant reductions of memory-related distress, and problem behaviors by 2-month follow-up.
Taylor, S. et al. (2003). Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training. Journal of Consulting and Clinical Psychology, 71, 330-338.
The only randomized study to show exposure statistically superior to EMDR on two subscales (out of 10). This study used therapist assisted "in vivo" exposure, where the therapist takes the person to previously avoided areas, in addition to imaginal exposure and one hour of daily homework (@ 50 hours). The EMDR group used only standard sessions and no homework.
Vaughan, K., Armstrong, M.F., Gold, R., O'Connor, N., Jenneke, W., & Tarrier, N. (1994). A trial of eye movement desensitization compared to image habituation training and applied muscle relaxation in post-traumatic stress disorder. Journal of Behavior Therapy & Experimental Psychiatry, 25, 283-291.
All treatments led to significant decreases in PTSD symptoms for subjects in the treatment groups as compared to those on a waiting list, with a greater reduction in the EMDR group, particularly with respect to intrusive symptoms. In the 2-3 weeks of the study, 40-60 additional minutes of daily homework were part of the treatment in the other two conditions.
Van der Kolk, B., Spinazzola, J. Blaustein, M., Hopper, J. Hopper, E., Korn, D., & Simpson, W. (2007).A randomized clinical trial of EMDR, fluoxetine and pill placebo in the treatment of PTSD: Treatment effects and long-term maintenance. Journal of Clinical Psychiatry, 68, 37-46.
EMDR was superior to both control conditions in the amelioration of both PTSD symptoms and depression. Upon termination of therapy, the EMDR group continued to improve while the Fluoxetine participants again became symptomatic.
Wanders, F., Serra, M., & de Jongh, A. (2008). EMDR Versus CBT for Children With Self-Esteem and Behavioral Problems: A Randomized Controlled Trial. Journal of EMDR Practice and Research, 2, 180-189.
Twenty-six children (average age 10.4 years) with behavioral problems were randomly assigned to receive either 4 sessions of EMDR or CBT. Both were found to have significant positive effects on behavioral and self-esteem problems, with the EMDR group showing significantly larger changes in target behaviors.
Wilson, S., Becker, L.A., & Tinker, R.H. (1995). Eye movement desensitization and reprocessing (EMDR): Treatment for psychologically traumatized individuals. Journal of Consulting and Clinical Psychology, 63,928-937.
Three sessions of EMDR produced clinically significant change in traumatized civilians on multiple measures.
Wilson, S., Becker, L.A., & Tinker, R.H. (1997). Fifteen-month follow-up of eye movement desensitization and reprocessing (EMDR) treatment of post-traumatic stress disorder and psychological trauma. Journal of Consulting and Clinical Psychology, 65, 1047-1056.
Follow-up at 15 months showed maintenance of positive treatment effects with 84% remission of PTSD diagnosis.
Aduriz, M.E., Bluthgen, C. & Knopfler, C. (2009). Helping child flood victims using group EMDR intervention in Argentina: Treatment outcome and gender differences. International Journal of Stress Management. 16, 138-153.
A comprehensive group intervention with 124 children, who experienced disaster related trauma during a massive flood utilizing a one session group protocol. Significant differences were obtained and maintained at 3-month follow up.
Devilly, G.J., & Spence, S.H. (1999). The relative efficacy and treatment distress of EMDR and a cognitive behavioral trauma treatment protocol in the amelioration of post-traumatic stress disorder. Journal of Anxiety Disorders, 13, 131-157.
This study found CBT superior to EMDR. The research is marred by higher expectations in the CBT condition: Treatment was delivered in both conditions by the developer of the CBT protocol.
Fernandez, I. (2007). EMDR as treatment of post-traumatic reactions: A field study on child victims of an earthquake. Educational and Child Psychology. Special Issue: Therapy, 24, 65-72.
This field study explores the effectiveness of EMDR and the level of post-traumatic reactions in a post-emergency context on 22 children victims of an earthquake. The results show that EMDR contributed to the reduction or remission of PTSD symptoms and facilitated the processing of the traumatic experience
Fernandez, I., Gallinari, E., & Lorenzetti, A. (2004). A school- based EMDR intervention for children who witnessed the Pirelli building airplane crash in Milan, Italy. Journal of Brief Therapy, 2, 129-136.
A group intervention of EMDR was provided to 236 schoolchildren exhibiting PTSD symptoms 30 days post-incident. At four-month follow up, teachers reported that all but two children evinced a return to normal functioning after treatment.
Grainger, R.D., Levin, C., Allen-Byrd, L., Doctor, R.M. & Lee, H. (1997). An empirical evaluation of eye movement desensitization and reprocessing (EMDR) with survivors of a natural catastrophe. Journal of Traumatic Stress, 10, 665-671.
A study of Hurricane Andrew survivors found significant differences on the Impact of Event Scale and subjective distress in a comparison of EMDR and non-treatment condition.
Hensel, T. (2009). EMDR with children and adolescents after single-incident trauma an intervention study. Journal of EMDR Practice and Research, 3, 2-9.
36 children and adolescents ranging in age from 1 year 9 months to 18 years 1 month were assessed at intake, post-waitlist/pretreatment, and at follow up. EMDR treatment resulted in significant improvement, demonstrating that children younger than 4 years of age showed the same benefit as the school-age children.
Jarero, I., Artigas, L., & Hartung, J. (2006). EMDR integrative group treatment protocol: A post-disaster trauma intervention for children and adults. Traumatology, 12, 121-129.
A study of 200 children treated with a group protocol after a flood in Mexico indicates that one session of treatment reduced trauma symptoms from the severe range to low (subclinical) levels of distress. Data from successful treatment at other disaster sites are also reported.
Konuk, E., Knipe, J., Eke, I., Yuksek, H., Yurtsever, A., & Ostep, S. (2006). The effects of EMDR therapy on post-traumatic stress disorder in survivors of the 1999 Marmara, Turkey, earthquake. International Journal of Stress Management, 13, 291-308.
Data reported on a representative sample of 1500 earthquake victims indicated that five sessions of EMDR successfully eliminated PTSD in 92.7% of those treated, with a reduction of symptoms in the remaining participants.
Puffer, M.; Greenwald, R. & Elrod, D. (1997). A single session EMDR study with twenty traumatized children and adolescents. Traumatology-e, 3(2), Article 6.
In this delayed treatment comparison, over half of the participants moved from clinical to normal levels on the Impact of Events Scale, and all but 3 showed at least partial symptom relief on several measures at 1-3 m following a single EMDR session.
Silver, S.M., Brooks, A., & Obenchain, J. (1995). Eye movement desensitization and reprocessing treatment of Vietnam war veterans with PTSD: Comparative effects with biofeedback and relaxation training. Journal of Traumatic Stress, 8, 337-342.
One of only two EMDR research studies that evaluated a clinically relevant course of EMDR treatment with combat veterans (e.g., more than one or two memories; see Carlson et al., above). The analysis of an inpatient veterans' PTSD program (n=100) found EMDR to be superior to biofeedback and relaxation training on seven of eight measures.
Silver, S.M., Rogers, S., Knipe, J., & Colelli, G. (2005). EMDR therapy following the 9/11 terrorist attacks: A community-based intervention project in New York City. International Journal of Stress Management, 12, 29-42.
Clients made highly significant positive gains on a range of outcome variables, including validated psychometrics and self-report scales. Analyses of the data indicate that EMDR is a useful treatment intervention both in the immediate aftermath of disaster as well as later.
Solomon, R.M. & Kaufman, T.E. (2002). A peer support workshop for the treatment of traumatic stress of railroad personnel: Contributions of eye movement desensitization and reprocessing (EMDR). Journal of Brief Therapy, 2, 27-33,
60 railroad employees who had experienced fatal grade crossing accidents were evaluated for workshop outcomes, and for the additive effects of EMDR treatment. Although the workshop was successful, in this setting, the addition of a short session of EMDR (5-40 minutes) led to significantly lower, sub clinical, scores which further decreased at follow up.
Sprang, G. (2001). The use of eye movement desensitization and reprocessing (EMDR) in the treatment of traumatic stress and complicated mourning: Psychological and behavioral outcomes. Research on Social Work Practice, 11, 300-320.
In a multi-site study, EMDR significantly reduced symptoms more often than the CBT treatment on behavioral measures, and on four of five psychosocial measures. EMDR was more efficient, inducing change at an earlier stage and requiring fewer sessions. Positive recall of the deceased was significantly greater post treatment in the EMDR condition.
Zaghrout-Hodali, M., Alissa, F. & Dodgson, P.W. (2008). Building resilience and dismantling fear: EMDR group protocol with children in an area of ongoing trauma. Journal of EMDR Practice and Research, 2, 106-113.
Results indicate that the EMDR approach can be effective in a group setting, and in an acute situation, both in reducing symptoms of posttraumatic and peritraumatic stress and in "inoculation" or building resilience in a setting of ongoing conflict and trauma.
The Adaptive Information Processing model (Shapiro, 2001, 2002, 2007) is used to explain EMDR's clinical effects and guide clinical practice. This model is not linked to any specific neurobiological mechanism since the field of neurobiology is as yet unable to determine this in any form of psychotherapy (nor of most medications). This section includes literature to provide an overview of the model and procedures, as well as selected research and case reports that demonstrate the predictive value of the model in the treatment of life experiences that appear to underlie a variety of clinical complaints.
Bae, H., Kim, D. & Park, Y.C. (2008). Eye movement desensitization and reprocessing for adolescent depression. Psychiatry Investigation, 5, 60-65.
Processing of etiological disturbing memories, triggers and templates resulted in complete remission of Major Depressive Disorder in two teenagers. Treatment duration was 3-7 sessions and effects were maintained at follow-up.
Brown, S. & Shapiro, F. (2006). EMDR in the treatment of borderline personality disorder. Clinical Case Studies, 5, 403-420.
20 EMDR sessions that focused on reprocessing the memories seemingly at the foundation of the pathology, along with triggers and future templates resulted in a complete remission of BPD, including symptoms of affect dysregulation, as measured on the Inventory of Altered Self Capacities.
Brown, K. W., McGoldrick, T., & Buchanan, R. (1997). Body dysmorphic disorder: Seven cases treated with eye movement desensitization and reprocessing. Behavioural and Cognitive Psychotherapy, 25, 203–207.
Seven consecutive cases were treated with up to three sessions of EMDR. Complete remission of BDD symptoms were reported in five cases with effects maintained at one- year follow-up.
Gauvreau, P. & Bouchard, S. (2008) Preliminary evidence for the efficacy of EMDR in treating generalized anxiety disorder. Journal of EMDR Practice and Research, 2. 26- 40.
Four subjects were evaluated using a single case design with multiple baselines Results indicate that subsequent to targeting the experiential contributors, at posttreatment and at 2 months follow-up, all four participants no longer presented with GAD diagnosis.
McGoldrick, T., Begum, M. & Brown, K.W. (2008). EMDR and olfactory reference syndrome: A case series. Journal of EMDR Practice and Research 2, 63-68.
EMDR treatment of four consecutive cases of ORS whose pathological symptoms had endured for 8–48 years resulted in a complete resolution of symptoms in all four cases, which was maintained at follow-up.
Mol, S. S. L., Arntz, A., Metsemakers, J. F. M., Dinant, G., Vilters-Van Montfort, P. A. P., & Knottnerus, A. (2005). Symptoms of post-traumatic stress disorder after non-traumatic events: Evidence from an open population study. British Journal of Psychiatry, 186, 494–499.
Supports a basic tenet of the Adaptive Information Processing model that "Life events can generate at least as many PTSD symptoms as traumatic events." In a survey of 832 people, "For events from the past 30 years the PTSD scores were higher after life events than after traumatic event."
Perkins, B.R. & Rouanzoin, C.C. (2002). A critical evaluation of current views regarding eye movement desensitization and reprocessing (EMDR): Clarifying points of confusion. Journal of Clinical Psychology, 58, 77-97.
Reviews common errors and misperceptions of the procedures, research, and theory.
Raboni, M.R., Tufik, S., and Suchecki, D. (2006). Treatment of PTSD by eye movement desensitization and reprocessing improves sleep quality, quality of life and perception of stress. Annals of the New York Academy of Science, 1071, 508-513.
Specifically citing the hypothesis that EMDR induces processing effects similar to REM sleep (see also Stickgold, 2002, 2008), polysomnograms indicated a change in sleep patterns post treatment, and improvement on all measures including anxiety, depression, and quality of life after a mean of five sessions.
Ray, A. L. & Zbik, A. (2001). Cognitive behavioral therapies and beyond. In C. D. Tollison, J. R. Satterhwaite, & J. W. Tollison (Eds.) Practical Pain Management (3rd ed.; pp. 189-208). Philadelphia: Lippincott.
The authors note that the application of EMDR guided by the Adaptive Information Processing model appears to afford benefits to chronic pain patients not found in other treatments.
Ricci, R. J., Clayton, C. A., & Shapiro, F. (2006). Some effects of EMDR treatment with previously abused child molesters: Theoretical reviews and preliminary findings. Journal of Forensic Psychiatry and Psychology, 17, 538-562.
As predicted by the Adaptive Information Processing model the EMDR treatment of the molesters' own childhood victimization resulted in a decrease in deviant arousal as measured by the plethysmograph, a decrease in sexual thoughts, and increased victim empathy. Effects maintained at one year follow up.
Russell, M. (2008).Treating traumatic amputation-related phantom limb pain: a case study utilizing eye movement desensitization and reprocessing (EMDR) within the armed services. Clinical Case Studies, 7, 136-153.
"Since September 2006, over 725 service-members from the global war on terrorism have survived combat-related traumatic amputations that often result in phantom limb pain (PLP) syndrome. . . . Four sessions of Eye Movement Desensitization and Reprocessing (EMDR) led to elimination of PLP, and a significant reduction in PTSD, depression, and phantom limb tingling sensations."
Schneider, J., Hofmann, A., Rost, C., & Shapiro, F. (2008). EMDR in the treatment of chronic phantom limb pain. Pain Medicine, 9, 76-82. doi: 10.1111/j.1526-4637.2007.00299.x
As predicted by the Adaptive Information Processing model the EMDR treatment of the event involving the limb loss, and the stored memories of the pain sensations, resulted a decrease or elimination of the phantom limb pain which maintained at 1 year follow up.
Schneider, J., Hofmann, A., Rost, C., & Shapiro, F. (2007). EMDR and phantom limb pain: Case study, theoretical implications, and treatment guidelines. Journal of EMDR Science and Practice, 1, 31-45.
Detailed presentation of case treated by EMDR that resulted in complete elimination of PTSD, depression and phantom limb pain with effects maintained at 18-month follow-up.
Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols and procedures (2nd ed.). New York: Guilford Press.
EMDR is an eight-phase psychotherapy with standardized procedures and protocols that are all believed to contribute to therapeutic effect. This text provides description and clinical transcripts and an elucidation of the guiding Adaptive Information Processing model.
Shapiro, F. (2002). (Ed.). EMDR as an integrative psychotherapy approach: Experts of diverse orientations explore the paradigm prism. Washington, DC: American Psychological Association Books.
EMDR is an integrative approach distinct from other forms of psychotherapy. Experts of the major psychotherapy orientations identify and highlight various procedural elements.
Shapiro, F. (2007). EMDR, adaptive information processing, and case conceptualization. Journal of EMDR Practice and Research, 1, 68-87.
Overview of EMDR treatment based upon an Adaptive Information Processing case conceptualization. Early life experiences are viewed as the basis of pathology and used as targets for processing. The three-pronged protocol includes processing of the past events that have set the foundation for the pathology, the current triggers, and templates for appropriate future functioning to address skill and developmental deficits.
Shapiro, F. (2006). EMDR and new notes on adaptive information processing: Case formulation principles, scripts and worksheets. Camden, CT: EMDR Humanitarian Assistance Programs (http://www.emdrhap.org)
Overview of Adaptive Information Processing model, including how the principles are reflected in the procedures, phases and clinical applications of EMDR. Comprehensive worksheets for client assessment, case formulation, and treatment as well as scripts for various procedures.
Shapiro, F., Kaslow, F., & Maxfield, L. (Eds.) (2007). Handbook of EMDR and Family Therapy Processes. New York: Wiley.
Using an Adaptive Information Processing conceptualization a wide range of family problems and impasses can be addressed through the integration of EMDR and family therapy techniques. Family therapy models are also useful for identifying the targets in need of processing for those engaged in individual therapy.
Solomon, R. & Shapiro, F, (2008). EMDR and the adaptive information processing model: Potential mechanisms of change. Journal of EMDR Practice and Research, 2, 315-325.
This article provides a brief overview of some of the major precepts of the Adaptive Information Processing model, a comparison and contrast to extinction-based information processing models and treatment and a discussion of a variety of mechanisms of action.
Uribe, M. E. R., & Ramirez, E. O. L. (2006). The effect of EMDR therapy on the negative information processing on patients who suffer depression. Revista Electrónica de Motivación y Emoción (REME), 9, 23-24.
The study evaluated the impact of EMDR treatment on bias mechanisms in depressed subjects in regard to negative emotional valence evaluation. "The results indicated that it generated important cognitive emotional changes in such mechanisms." Priming tests indicated changes in the negative valence evaluation of emotional information indicative of recovery with decreased reaction times in the neutral and positive stimuli processing."
Wilensky, M. (2006). Eye movement desensitization and reprocessing (EMDR) as a treatment for phantom limb pain. Journal of Brief Therapy, 5, 31-44.
"Five consecutive cases of phantom limb pain were treated with EMDR. Four of the five clients completed the prescribed treatment and reported that pain was completely eliminated, or reduced to a negligible level. . . The standard EMDR treatment protocol was used to target the accident that caused the amputation, and other related events."
EMDR contains many procedures and elements that contribute to treatment effects. While the methodology used in EMDR has been extensively validated (see above), questions still remain regarding mechanism of action. However, since EMDR achieves clinical effects without the need for homework, or the prolonged focus used in exposure therapies, attention has been paid to the possible neurobiological processes that might be evoked. Although the eye movements (and other dual attention stimulation) comprise one only one procedural element, this element has come under greatest scrutiny.Randomized controlled studies evaluating mechanism of action of the eye movement component follow this section.
Elofsson, U.O.E., von Scheele, B., Theorell, T., & Sondergaard, H.P. (2008). Physiological correlates of eye movement desensitization and reprocessing. Journal of Anxiety Disorders, 22, 622-634.
Changes in heart rate, skin conductance and LF/HF-ratio, finger temperature, breathing frequency, carbon dioxide and oxygen levels were documented during the eye movement condition. It was concluded the "eye movements during EMDR activate cholinergic and inhibit sympathetic systems. The reactivity has similarities with the pattern during REM sleep."
Lee, C.W., Taylor, G., & Drummond, P.D. (2006) The active ingredient in EMDR: Is it traditional exposure or dual focus of attention? Clinical Psychology and Psychotherapy, 13, 97-107
This study tested whether the content of participants' responses during EMDR is similar to that thought to be effective for traditional exposure treatments (reliving), or is more consistent with distancing which would be expected given Shapiro's proposal of dual focus of attention. Greatest improvement on a measure of PTSD symptoms occurred when the participant processed the trauma in a more detached manner, which indicates the underlying mechanisms of EMDR and exposure therapy are different.
MacCulloch, M. J., & Feldman, P. (1996). Eye movement desensitization treatment utilizes the positive visceral element of the investigatory reflex to inhibit the memories of post-traumatic stress disorder: A theoretical analysis. British Journal of Psychiatry, 169, 571–579.
One of a variety of articles positing an orienting response as a contributing element (see Shapiro, 2001 for comprehensive examination of theories and suggested research parameters). This theory has received controlled research support (Barrowcliff et al., 2003, 2004).
Propper, R., Pierce, J.P., Geisler, M.W., Christman, S.D., & Bellorado, N. (2007). Effect of bilateral eye movements on frontal interhemispheric gamma EEG coherence: Implications for EMDR therapy. Journal of Nervous and Mental Disease, 195, 785-788.
"Specifically, the EM manipulation used in the present study, reported previously to facilitate episodic memory, resulted in decreased interhemispheric EEG coherence in anterior prefrontal cortex. Because the gamma band includes the 40 Hz wave that may indicate the active binding of information during the consolidation of long-term memory storage (e.g., Cahn and Polich, 2006), it is particularly notable that the changes in coherence we found are in this band. With regard to PTSD symptoms, it may be that by changing interhemispheric coherence in frontal areas, the EMs used in EMDR foster consolidation of traumatic memories, thereby decreasing the memory intrusions found in this disorder."
Rogers, S., & Silver, S. M. (2002). Is EMDR an exposure therapy? A review of trauma protocols. Journal of Clinical Psychology, 58, 43-59.
Theoretical, clinical, and procedural differences referencing two decades of CBT and EMDR research.
Rogers, S., Silver, S., Goss, J., Obenchain, J., Willis, A., & Whitney, R. (1999). A single session, controlled group study of flooding and eye movement desensitization and reprocessing in treating posttraumatic stress disorder among Vietnam war veterans: Preliminary data. Journal of Anxiety Disorders, 13, 119–130.
This study was designed as primarily a process report to compare EMDR and exposure therapy. A different recovery pattern was observed with the EMDR group demonstrating a more rapid decline in self-reported distress.
Sack, M., Hofmann, A., Wizelman, L., & Lempa, W. (2008). Psychophysiological changes during EMDR and treatment outcome. Journal of EMDR Practice and Research, 2, 239-246
During-session changes in autonomic tone were investigated in 10 patients suffering from single-trauma PTSD. Results indicate that information processing during EMDR is followed by during-session decrease in psychophysiological activity, reduced subjective disturbance and reduced stress reactivity to traumatic memory.
Sack, M., Lempa, W. Steinmetz, A., Lamprecht, & Hofmann, A. (2008). Alterations in autonomic tone during trauma exposure using eye movement desensitization and reprocessing (EMDR) – results of a preliminary investigation. Journal of Anxiety Disorders, 22, 1264-1271.
The psycho-physiological correlates of EMDR were investigated during treatment sessions of trauma patients. The initiation of the eye movements sets resulted in immediate changes that indicated a pronounced de-arousal.
Servan-Schreiber, D., Schooler, J., Dew, M.A., Carter, C., & Bartone, P. (2006). EMDR for PTSD: A pilot blinded, randomized study of stimulation type. Psychotherapy and Psychosomatics. 75, 290-297.
Twenty-one patients with single-event PTSD (average IES: 49.5) received three consecutive sessions of EMDR with three different types of auditory and kinesthetic stimulation. All were clinically useful. However, alternating stimulation appeared to confer an additional benefit to the EMDR procedure.
Stickgold, R. (2002). EMDR: A putative neurobiological mechanism of action. Journal of Clinical Psychology, 58, 61-75.
Stickgold, R. (2008). Sleep-dependent memory processing and EMDR action. Journal of EMDR Practice and Research, 2, 289-299.
Comprehensive explanations of mechanisms and the potential links to the processes that occur in REM sleep. Controlled studies have evaluated these theories (see next section; Christman et al., 2003; Kuiken et al. 2001-2002).
Suzuki, A., et al. (2004). Memory reconsolidation and extinction have distinct temporal and biochemical signatures. Journal of Neuroscience, 24, 4787– 4795.
The article explores the differences between memory reconsolidation and extinction. This new area of investigation is worthy of additional attention. Reconsolidation may prove to be the underlying mechanism of EMDR, as opposed to extinction caused by prolonged exposure therapies. "Memory reconsolidation after retrieval may be used to update or integrate new information into long-term memories . . . Brief exposure … seems to trigger a second wave of memory consolidation (reconsolidation), whereas prolonged exposure . . leads to the formation of a new memory that competes with the original memory (extinction)."
Wilson, D., Silver, S. M., Covi, W., & Foster, S. (1996). Eye movement desensitization and reprocessing: Effectiveness and autonomic correlates. Journal of Behaviour Therapy and Experimental Psychiatry, 27, 219–229.
Study involving biofeedback equipment has supported the hypothesis that the parasympathetic system is activated by finding that eye movements appeared to cause a compelled relaxation response. More rigorous research with trauma populations is needed.
A number of International Practice Guideline committees have reported that the clinical component analyses reviewed by Davidson & Parker (2001) are not well designed (International Society for Traumatic Stress Studies/ISTSS (2000); DoD/DVA). Davidson & Parker note that there is a trend toward significance for eye movements when the studies conducted with clinical populations are examined separately. Unfortunately even these studies are methodologically flawed. As noted in the ISTSS guidelines (Chemtob et al., 2000), since these clinical populations received insufficient treatment doses to obtain substantial main effects, they are inappropriate for component analyses. However, as noted in the DoD/DVA (2004) guidelines, numerous memory researchers have evaluated the eye movements used in EMDR. These studies have found a direct effect on emotional arousal, imagery vividness, attentional flexibility, and memory association. In addition, a new study has examined the hypothesis that the eye movements cause a "distancing effect" (Lee & Drummond, 2008) and is listed below as well.
Andrade, J., Kavanagh, D., & Baddeley, A. (1997). Eye-movements and visual imagery: A working memory approach to the treatment of post-traumatic stress disorder. British Journal of Clinical Psychology, 36, 209-223.
Tested the working memory theory. Eye movements were superior to control conditions in reducing image vividness and emotionality.
Barrowcliff, A.L., Gray, N.S., Freeman, T.C.A., & MacCulloch, M.J. (2004). Eye-movements reduce the vividness, emotional valence and electrodermal arousal associated with negative autobiographical memories. Journal of Forensic Psychiatry and Psychology, 15, 325-345.
Tested the reassurance reflex model. Eye movements were superior to control conditions in reducing image vividness and emotionality.
Barrowcliff, A.L., Gray, N.S., MacCulloch, S., Freeman, T. C.A., & MacCulloch, M.J. (2003). Horizontal rhythmical eye-movements consistently diminish the arousal provoked by auditory stimuli. British Journal of Clinical Psychology, 42, 289-302.
Tested the reassurance reflex model. Eye movements were superior to control conditions in reducing arousal provoked by auditory stimuli.
Christman, S. D., Garvey, K. J., Propper, R. E., & Phaneuf, K. A. (2003). Bilateral eye movements enhance the retrieval of episodic memories. Neuropsychology. 17, 221-229.
Tested cortical activation theories. Results provide indirect support for the orienting response/REM theories suggested by Stickgold (2002, 2008). Saccadic eye movements, but not tracking eye movements were superior to control conditions in episodic retrieval.
Gunter, R.W. & Bodner, G.E. (2008). How eye movements affect unpleasant memories: Support for a working-memory account. Behaviour Research and Therapy 46, 913– 931.
Three studies were done with cumulatively support a working-memory account of the eye movement benefits in which the central executive is taxed when a person performs a distractor task while attempting to hold a memory in mind.
Kavanagh, D. J., Freese, S., Andrade, J., & May, J. (2001). Effects of visuospatial tasks on desensitization to emotive memories. British Journal of Clinical Psychology, 40, 267-280.
Tested the working memory theory. Eye movements were superior to control conditions in reducing within-session image vividness and emotionality. There was no difference one-week post.
Kuiken, D., Bears, M., Miall, D., & Smith, L. (2001-2002). Eye movement desensitization reprocessing facilitates attentional orienting. Imagination, Cognition and Personality, 21, (1), 3-20.
Tested the orienting response theory related to REM-type mechanisms. Indicated that the eye movement condition was correlated with increased attentional flexibility. Eye movements were superior to control conditions.
Lee, C.W., & Drummond, P.D. (2008). Effects of eye movement versus therapist instructions on the processing of distressing memories. Journal of Anxiety Disorders, 22, 801-808.
"There was no significant effect of therapist's instruction on the outcome measures. There was a significant reduction in distress for eye movement at post-treatment and at follow-up.
. . . The results were consistent with other evidence that the mechanism of change in EMDR is not the same as traditional exposure."
Maxfield, L., Melnyk, W.T. & Hayman, C.A. G. (2008). A working memory explanation for the effects of eye movements in EMDR. Journal of EMDR Practice and Research, 2, 247-261.
In two experiments participants focused on negative memories while engaging in three dual-attention eye movement tasks of increasing complexity. Results support a working memory explanation for the effects of eye movement dual-attention tasks on autobiographical memory.
Parker, A., Buckley, S. & Dagnall, N. (2009). Reduced misinformation effects following saccadic bilateral eye movements. Brain and Cognition, 69, 89-97.
Bilateral saccadic eye movements were compared to vertical and no eye movements. "It was found that bilateral eye movements increased true memory for the event, increased recollection, and decreased the magnitude of the misinformation effect." This study supports hypotheses regarding effects of interhemispheric activation and episodic memory.
Sharpley, C. F. Montgomery, I. M., & Scalzo, L. A. (1996). Comparative efficacy of EMDR and alternative procedures in reducing the vividness of mental images. Scandinavian Journal of Behaviour Therapy, 25, 37-42.
Eye movements were superior to control conditions in reducing image vividness.
Van den Hout, M., Muris, P., Salemink, E., & Kindt, M. (2001). Autobiographical memories become less vivid and emotional after eye movements. British Journal of Clinical Psychology, 40, 121-130.
Tested their theory that eye movements change the somatic perceptions accompanying retrieval, leading to decreased affect, and therefore decreasing vividness. Eye movements were superior to control conditions in reducing image vividness. Unlike control conditions, eye movements also decreased emotionality.
All psychophysiological studies have indicated significant de-arousal. All neurobiological studies have indicated significant effects, including changes in cortical, and limbic activation patterns, and increase in hippocampal volume.
Bossini L. Fagiolini, A. & Castrogiovanni, P. (2007). Neuroanatomical changes after EMDR in Posttraumatic Stress Disorder. Journal of Neuropsychiatry and Clinical Neuroscience, 19, 457-458.
Kowal, J. A. (2005). QEEG analysis of treating PTSD and bulimia nervosa using EMDR. Journal of Neurotherapy, 9(Part 4), 114-115.
Lamprecht, F., Kohnke, C., Lempa, W., Sack, M., Matzke, M., & Munte, T. (2004). Event-related potentials and EMDR treatment of post-traumatic stress disorder. Neuroscience Research, 49, 267-272.
Lansing, K., Amen, D.G., Hanks, C. & Rudy, L. (2005). High resolution brain SPECT imaging and EMDR in police officers with PTSD. Journal of Neuropsychiatry and Clinical Neurosciences, 17, 526-532.
Levin, P., Lazrove, S., & van der Kolk, B. A. (1999). What psychological testing and neuroimaging tell us about the treatment of posttraumatic stress disorder (PTSD) by eye movement desensitization and reprocessing (EMDR). Journal of Anxiety Disorders, 13, 159-172.
Oh, D.-H., & Choi, J. (2004). Changes in the regional cerebral perfusion after Eye Movement Desensitization and Reprocessing: A SPECT study of two cases. Journal of EMDR Practice and Research, 1, 24-30.
Pagani, M. et al. (2007). Effects of EMDR psychotherapy on 99mTc-HMPAO distribution in occupation-related post-traumatic stress disorder. Nuclear Medicine Communications, 28, 757–765.
Richardson, R., Williams, S.R., Hepenstall, S., Sgregory, L., McKie, & Corrigan, F. (2009). A single-case fMRI study EMDR treatment of a patient with posttraumatic stress disorder. Journal of EMDR Practice and Research, 3, 10-23.
Sack, M., Lempa, W., & Lemprecht, W. (2007). Assessment of psychophysiological stress reactions during a traumatic reminder in patients treated with EMDR. Journal of EMDR Practice and Research, 1, 15-23.
Sack, M., Nickel, L., Lempa, W., & Lamprecht, F. (2003) Psychophysiological regulation in patients suffering from PTSD: Changes after EMDR treatment. Journal of Psychotraumatology and Psychological Medicine, 1, 47 -57. (German)
van der Kolk, B., Burbridge, J., & Suzuki, J. (1997). The psychobiology of traumatic memory: Clinical implications of neuroimaging studies. Annals of the New York Academy of Sciences, 821, 99-113.
As noted in the American Psychiatric Association Practice Guidelines (2004, p.18), in EMDR "traumatic material need not be verbalized; instead, patients are directed to think about their traumatic experiences without having to discuss them." Given the reluctance of many combat veterans to divulge the details of their experience, this factor is relevant to willingness to initiate treatment, retention and therapeutic gains. It may be one of the factors responsible for the lower remission and higher dropout rate noted in this population when CBT techniques are used.
As described previously, Carlson et al. (1998) reported that after twelve treatment sessions, 77.7% of the combat veterans no longer met criteria for PTSD. There were no dropouts and effects were maintained at 3- and 9-month follow-up. In addition, the Silver et al., (1995) analysis of an inpatient veterans' PTSD program (n = 100) found EMDR to be superior to biofeedback and relaxation training on seven of eight measures. All other randomized studies of veterans have used insufficient treatment doses to assess PTSD outcomes (e.g., two sessions; see ISTSS, 2000; DVA/DoD, 2005). Sufficient treatment time must be used for multiply traumatized veterans (e.g., see below: Russell et al., 2007). However, in a process analysis, Rogers et al. (1999) compared one session of EMDR and exposure therapy with inpatient veterans, and a different recovery pattern was observed. The EMDR group demonstrated a more rapid decline in self-reported distress (e.g., SUD levels decreased with EMDR and increased with exposure).
As stated in the American Psychiatric Practice Guidelines (2004, p. 36), if viewed as an exposure therapy, "EMDR employs techniques that may give the patient more control over the exposure experience (since EMDR is less reliant on a verbal account) and provides techniques to regulate anxiety in the apprehensive circumstance of exposure treatment. Consequently, it may prove advantageous for patients who cannot tolerate prolonged exposure as well as for patients who have difficulty verbalizing their traumatic experiences. Comparisons of EMDR with other treatments in larger samples are needed to clarify such differences."
Such research is highly recommended. In addition, since EMDR utilizes no homework to achieve its effects it may be particularly suited for front line alleviation of symptoms (see Russell, 2006; Wesson & Gould, 2009). Further, the prevalent somatic and chronic pain problems experienced by combat veterans indicate the need for additional research based upon the reports of Russell (2008), Schneider et al., (2007, 2008) and Wilensky (2007), which demonstrate EMDR's capacity to successfully treat phantom limb pain (see also Ray & Zbik, 2001). The ability of EMDR to simultaneously address PTSD, depression, and pain can have distinct benefits for DVA/DoD treatment.
The following contain clinically relevant information for the treatment of veterans, including therapy parameters.
Carlson, J., Chemtob, C.M., Rusnak, K., Hedlund, N.L, & Muraoka, M.Y. (1998). Eye movement desensitization and reprocessing (EMDR): Treatment for combat-related post-traumatic stress disorder. Journal of Traumatic Stress, 11, 3-24.
Errebo, N. & Sommers-Flanagan, R. (2007). EMDR and emotionally focused couple therapy for war veteran couples. In F. Shapiro, F. Kaslow, & L. Maxfield (Eds.) Handbook of EMDR and family therapy processes. New York: Wiley
Lipke, H. (2000). EMDR and psychotherapy integration. Boca Raton, FL: CRC Press.
Russell, M. (2006). Treating combat-related stress disorders: A multiple case study utilizing eye movement desensitization and reprocessing (EMDR) with battlefield casualties from the Iraqi war. Military Psychology, 18, 1-18.
Russell, M. (2008).Treating traumatic amputation-related phantom limb pain: A case study utilizing eye movement desensitization and reprocessing (EMDR) within the armed services. Clinical Case Studies, 7, 136-153.
Russell, M.C. (2008). War-related medically unexplained symptoms, prevalence,
and treatment: utilizing EMDR within the armed services. Journal of EMDR Practice and Research, 2, 212-226.
Russell, M.C. (2008). Scientific resistance to research, training and utilization of eye movement desensitization and reprocessing (EMDR) therapy in treating post-war disorders Social Science & Medicine, 67, 1737–1746.
Russell, M.C., & Silver, S.M. (2007). Training needs for the treatment of combat-related posttraumatic stress disorder. Traumatology, 13, 4-10.
Russell, M.C., Silver, S.M., Rogers, S., & Darnell, J. (2007). Responding to an identified need: A joint Department of Defense-Department of Veterans Affairs training program in eye movement desensitization and reprocessing (EMDR) for clinicians providing trauma services. International Journal of Stress Management, 14, 61-71.
Silver, S.M. & Rogers, S. (2002). Light in the heart of darkness: EMDR and the treatment of war and terrorism survivors. New York: Norton.
Silver,S.M., Rogers, S., & Russell, M.C. (2008). Eye movement desensitization and reprocessing (EMDR) in the treatment of war veterans. Journal of Clinical Psychology: In Session, 64, 947—957.
Wesson, M. & Gould, M. (2009). Intervening early with EMDR on military operations: A case study. Journal of EMDR Practice and Research, 3, 91-97.


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3 students arrested in Delaware casino brawl
WILMINGTON, Del. -- A brawl that involved about 200 people in the parking lot of a casino is being reviewed by officials at Delaware State University after three of their students were arrested early Thursday.
"Any time a student is involved in problems off campus it's certainly something that we get the information about and we deal with through our judicial affairs process," Delaware State spokesman Carlos Holmes said in a statement. He did not say what sanctions the students could face.
The incident occurred about at 12:50 a.m. at Dover Downs Hotel & Casino, said Dover police Cpl. Mark Hoffman.
Arriving Dover officers called for help from university and state police in dispersing the crowd.
Lance Chadwick, 19, of Brooklyn, N.Y., was arrested for disorderly conduct and resisting arrest, Hoffman said. Christopher Cox, 21, also of Brooklyn, and Danessa Claye, 22, of Staten Island, N.Y., also were charged with disorderly conduct.
Police said Chadwick was fighting with Cox when officers arrived, and the crowd built as others began to cheer them on.
Most of the crowd had been at Doc Magrogan's Oyster House inside Dover Downs prior to the brawl, which began as people were leaving the building, Hoffman said.
The function at the restaurant was not university related, Holmes said.
A Doc Magrogan manager would not comment on the incident.
Dover Downs officials did not return calls seeking comment. on Thursday's incident.
There was another large brawl at the establishment June 2 in which 50 to 100 people were fighting inside the casino. Four people were arrested.
Holmes said the university encourages its students to make the right decisions and be on their best behavior while in public. He said most students obey the rules.
"We will continue to do that," he said. "This does not prevent students from making bad choices."

subset: commoncrawl


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Advanced Micro Devices turned a profit in 2009 after three successive annual losses, but CEO Dirk Meyer's total compensation fell 15%.
Meyer received compensation in fiscal 2009 valued at $US4.5 million, compared to $5.3 million in 2008, according to documents filed with the U.S. Securities and Exchange Commission.
His pay package includes a $792,685 salary, plus a $45,000 bonus. The bonus Meyer and other AMD employees received is a one-time payment to supplement their base salaries, which were temporarily decreased by 15% to 20% during 2009.
CEO payday: How much tech chiefs made in '08
Meyer also received stock and option awards valued at $3.7 million at the time they were granted (down 16% from $4.4 million in 2008). His other compensation and perquisites totaled $7,478, which includes matching contributions to his 401(k) account.
As a company, AMD's revenue fell 7% in 2009, but the company turned an annual profit for the first time since 2005. AMD reported a net profit of $304 million on revenue of $5.4 billion for the year ended Dec. 26. AMD reported a loss of $3.1 billion on revenue of $5.8 billion in 2008.
Meyer's total pay is calculated using data supplied in a proxy statement filed with the SEC on March 5. The following figures are taken from the summary compensation table: salary, bonus, and all other compensation. Added to those figures is the estimated value of stock options and awards granted during the year; that figure is taken from the table that summarizes grants of plan-based awards.
Read more about data center in Network World's Data Center section.


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- Perennialresource.com
Indian Grass
Sorghastrum nutans • Zones 5 to 8
Indian grass will add stunning greens, glowing bronzes and cool blues to your garden throughout the year with little work on your part. It grows up to 4 feet high and 2 feet wide, giving it a spectacular columnar effect.
Blue Fescue
Festuca glauca • Zones 4 to 8
Lovers of this ornamental grass don't mind having the blues at all. You'll warm up to blue fescue, too, for its compact, container-friendly tufts and bright hue. It grows to about 6 to 12 inches tall.
Japanese Blood Grass
Imperata cylindrica • Zones 4 to 9
Get ready for color when you plant Japanese blood grass. Its showy apple-green blades turn blood-red from middle to top in the summer and stay lovely through autumn. This ornamental grass stands erect, topping out at 2 feet, and tolerates a variety of soils. It can become invasive.
- W. Atlee Burpee & Co.
Pampas Grass
Cortaderia selloana • Zones 6 to 11
Add some drama to your yard with these fast-growing, eye-catching plumes. Feathery pampas grass grows up to 10 feet high and 5 feet wide, but some of the more compact cultivars, including Pumila and Compacta, produce plants that are about 6 feet tall.
- Perennialresource.com
Blue Oat Grass
Helictotrichon sempervirens • Zones 4 to 8
Planted in a border or container, or used as a stand-alone accent, gardening with ornamental grasses like the blue oat grass makes a big statement in any backyard. This ornamental attains greater height and stronger blades than blue fescue while showing off a similarly striking shade of blue. For best foliage color, give it full sun in cool regions and light shade in warm areas.
Fountain Grass
Pennisetum alopecuroides • Zones 5 to 9
With full tufts of fuzzy flower spikes, this ethereal ornamental grass seems to be heaven-sent. One or more of its many varieties will add charm to your backyard paradise. This grass reaches just 2 to 5 feet.
Panicum virgatum • Zones 4 to 9
This easygoing and versatile ornamental grass is a good choice for wet conditions, drought or partial shade, as long as it's planted in moist, well-draining soil. Growing narrow and upright with a cloud of seed heads in fall, switchgrass can reach more than 5 feet tall. This grass is native to North America.
- Perennialresource.com
Miscanthus sinensis • Zones 4 to 9
You'll be on cloud nine with the fluffy tops of this ornamental grass. The big, showy flower heads and height of up to 12 feet give it a graceful profile. In autumn, its silky gray panicles turn maroon or purplish-brown. Plant miscanthus in a sun-drenched area.
Japanese Forest Grass
Hakonechloa macra • Zones 5 to 9
This slow-growing plant has dense masses of arching golden stems that take on a reddish-pink tinge in fall. To enliven a shady area, plant it as a specimen, ground cover or border.
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Comments (5)
Pampas Grass is extremely hard to eradicate. I believe it is considered an invasive species in California (I believe it originates from Australia). The seeds blow everywhere in the wind.
They've come out with a sterile variety, but I really don't know much about its performance as I'm not a big fan of Pampas begin with.
Use caution with the Japanese Blood Grass also. Although I used it with excellent results when I lived in SoCal, but I've since learned that it's been banned in 25 states due to its invasive nature and its high silica content. The silica renders it ungrazable and it can crowd out all of the nutritious & beneficial pasture area plants within 2-3 years.
Personally, I would still use it, but I'd be vigilant about removing any inflorescences before they matured. I'd also just pot it. That's so much easier than using deep root isolation if putting it in the ground. I might be OCD, but there are many times when I'm a lazy OCD.


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Blog of Dr. Miland Brown that features different aspects of world history. Not everything can be covered but sites dealing with any historical issue or topic are possible future posts. Also includes sites which discuss teaching history. Dr. Brown is an academic in North America.
Sunday, November 11, 2007
Comments Policy
Here are some rules that govern their approval:
1. Comments with links to other sites will be assumed to be spam and deleted. If you feel you must link to another url, do so and I will look at it. However, unless the link is helpful and not a disguised SEO (search engine optimization) trick attempting to get free Google PR juice, it will be deleted and never published.
2. Comments must be related to the post. If you are attempting to contact Miland Brown, post a comment on the contact page. I will respond if I am interested.
3. Comments must be respectful. You are welcome to disagree with me and I will approve your post. If your comment is hostile and disrespectful, I will delete it. I am very tolerant and will be forgiving. However...
4. Comments should not be posted just to refer to a book. Even if you do not link to the publisher's url, I will not approve comments which appear to just be hyping a book.
This post will be linked to from the main page of the World History Blog and be considered a core policy.
Thank you.
3 comments:
- Paul said...
Miland, not too sure how to email you. Hopefully you will be able to read this.
I like the idea of this blog. I've subscribed to it via Google Reader. Just a couple of recommendations: you might want to make the "subscribe to feed/post/atom" a bit more visible. Its in text at the bottom of the page. I didn't see it and I found it via search. Most pages have the rss icons to click on--that's what folks look for. You'd probably get more subscribers that way.
Trying to get this message to you, I looked for a "contact me" link and didn't find one. Is there any way you can have something like that, either via email or a "comments" section at this site?
I know these are little details. Again, I like the themes you write about and look forward to future posts. Take care.
- M said...
Thanks for the comment. I have implemented both of your suggestions. Is this better?
- Paul said...
Yes, Miland. Those links are very noticeable--in a place folks naturally look (one of the top corners of the main page). Much better.


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heavy articles
"follow" me on Twitter at @newtownpentacle
– photo by Mitch Waxman
Just a short one today, the tug Mary Alice rolling along at twilight. Back tomorrow with something a bit more substantial, but today must be spent with loved ones as the world soon ends.
Only 12 days left until the 13th b'ak'tun ends, initiating the Mayan Apocalypse on December 21st, after all.
One Response
Speaking of time" "Ralph Kramden will never be accused ofdnot putting a horse down with a clock in its stomach." (The Marathon – minus 23)


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NEW YORK -- The Carolina Panthers wanted to be playing in New Jersey on Sunday. Instead, they were the big winners at the "NFL Honors" ceremony in New York on Saturday night.
Ron Rivera was the surprise winner of the Coach of the Year Award, while Luke Kuechly won the Defensive Player of the Year award. (Even if he wouldn't have received our vote.)
Both of the above awards had a number of great candidates. Still, it was eye-opening that Pete Carroll, Bruce Arians and Chip Kelly received just eight combined votes. Andy Reid and Bill Belichick came in second and third, respectively, in the voting behind Rivera.
Kuechly won a crowded defensive-player field, where Robert Mathis came in second. Earl Thomas and Richard Sherman split the Seahawk vote. NaVorro Bowman, our pick, was ignored. Robert Quinn came in fourth.
There weren't a ton of other major surprises, although we were pleasantly surprised to see Jets defensive lineman Sheldon Richardson win Defensive Rookie of the Year. Peyton Manning won the MVP award, as expected.
The coolest moment of the night came when the 2014 Pro Football Hall of Fame class was announced. It was the first time this was done at "NFL Honors," and it won't be the last. The ovation for the seven men was like a scene out of a movie.
Michael Strahan and Walter Jones are headed to Canton, but the biggest news was one name that was left off this list. We're stunned that Marvin Harrison was not inducted.
The complete list of award winners are below. First, a few observations from our intrepid reporter Marc Sessler:
» Andre Reed and Ray Guy stood out as the most thrilled to make the Hall of Fame. Both men waited a long time for this moment, and they were relieved. There was an audible gasp when Guy, a Veterans Committee candidate, was announced.
"There's been a lot of frustration (over the wait)," Guy said, before calling it a "moment so precious."
Guy says the news gives a younger generation of punters hope. It will be a cool Raiders moment when John Madden presents Guy in Canton.
» Reed repeatedly praised Buffalo as a sports town.
"That was one of the greatest cities to play for," Reed said.
Here is a list of the winners:
» AP Offensive Rookie of the Year: Eddie Lacy, RB, Green Bay Packers
» AP Defensive Rookie of the Year: Sheldon Richardson, DE, New York Jets
» Salute to Service Award presented by USAA: John Harbaugh, head coach, Baltimore Ravens
» Fantasy Player of the Year: Jamaal Charles, RB, Kansas City Chiefs
» Greatness on the Road presented by Courtyard: Nick Foles, QB, Philadelphia Eagles
» AP Comeback Player of the Year: Philip Rivers, QB, San Diego Chargers
» AP Coach of the Year: Ron Rivera, Carolina Panthers
» Don Shula High School Coach of the Year: Mike Grant, Eden Prairie (Minn.) H.S.
» Defensive Player of the Year: Luke Kuechly, LB, Carolina Panthers
» AP Offensive Player of the Year: Peyton Manning, QB, Denver Broncos
» Pepsi Next Rookie of the Year: Keenan Allen, WR, San Diego Chargers
» GMC Never Say Never Moment of the Year: Aaron Rodgers, QB, Green Bay Packers
» Deacon Jones Player of the Year: Robert Mathis, DE, Indianapolis Colts
» Walter Payton NFL Man of the Year: Charles Tillman, CB, Chicago Bears
» Bridgestone Performance Play of the Year: Calvin Johnson, WR, Detroit Lions
» FedEx Air Player of the Year: Peyton Manning, QB, Denver Broncos
» FedEx Ground Player of the Year: LeSean McCoy, RB, Philadelphia Eagles
» AP Most Valuable Player: Peyton Manning, QB, Denver Broncos
Live from New York, it's the NFL "Around The League Podcast" Super Bowl Preview!


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China is divided on how to celebrate Mao Zedong's birthday
A curious thing happened two weeks ago as China was preparing celebrations for the 120th anniversary of Mao Zedong's birth. One of the main events - a symphony of favorite Communist songs at the Great Hall of the People - got an abrupt name change.
No longer would it be called "The Sun is Reddest, Chairman Mao is Dearest." Instead, all traces of China's founding father were quietly scrubbed from posters, ticketing websites and programs. The show repackaged as a more generic New Year's gala called "Singing the Motherland's Praises."
The sudden alteration is just one of many signs these days of the Communist Party's uneasy feelings about the late Chairman Mao ahead of his birthday, on Thursday.
Even decades after his death, there is uncertainty about how to tackle the legacy of the man who cemented the party's grip on power but was responsible for the deaths of tens of millions and brutal purges.
At the heart of that ambivalence is a debate over China's future. Die-hard leftists are pushing for the country's new leaders to revive Mao's teachings as a path to stronger nationalism and economic equality. Meanwhile, liberals say the time has come for an honest assessment of China's troubled past.
Currently, Mao is everywhere. He appears on most of China's bank notes, is invoked countless times a day in party speeches and remains a staple of state-sponsored TV dramas and movies.
This month, however, the Mao industry shifted into overdrive, with restaurants flogging his favorite dishes, cities plastering his sayings on walls and a plethora of statues making their debut, including a $16.5 million gold version inlaid with gems.
For Cao Zhaojin, Mao represents a simpler time before China became so money-obsessed. The 59-year-old retired Beijing factory worker keeps large poster boards of the Great Helmsman at home, which is lined with Mao's selected works and calendars with classic quotes.
"Chairman Mao represents a belief in communism, in putting the collective good ahead of yourself, in selfless contribution and values," he said. "Look at our society today. . . . Nobody believes in anything anymore but money and personal gain."
Representing the opposition, Bao Tong - a former aide to party leader Zhao Ziyang, who was purged during the 1989 Tiananmen Square crackdown - penned a scathing editorial Monday decrying the creation of a false "myth of Mao" that "still haunts China today."
In his essay, Bao described Mao as a megalomaniac who sold Chinese workers on a pipe dream of equality, sacrificed millions in pursuit of vanity and ruthlessly killed all rivals.
In a phone interview from his home, where he is under house arrest, Bao said he had his essay smuggled out to Radio Free Asia because he believes that how China thinks of Mao has a huge effect on its present and future. "China cannot turn a blind eye to these facts," he said.
Such outspoken criticism of Mao remains rare in the party. But official assessments have slowly evolved over time.
An editorial this week in the Global Times, a nationalistic state-controlled newspaper, dismissed recent repudiations of Mao as "a childish fantasy." But even it acknowledged that assessing his legacy these days "is not easy because we are still living in the 'era of Mao.' "
As a result, many officials this year are carefully taking their cues from China's new top leader, President Xi Jinping.
Xi's term began last year with Maoists secretly hopeful that he shared their views. But Xi has since proven more complex and pragmatic than leftists or liberals would prefer. His actions have appeared driven not by ideology but by consolidation of power above all else, analysts and party officials say.
Last month, on a visit to Mao's home province of Hunan, Xi warned officials to tone down the Mao worship this year, calling for events that are "grand" but "simple and pragmatic."
While Xi's message may have encouraged some to scale back their plans, local jurisdictions with historical ties to Mao have largely ignored it.
Mao's home town of Shaoshan has spent $320 million in preparation - renovating historical sites and museums, organizing galas, and building new roads and other infrastructure. Hundreds of thousands of people are expected to pass through. Many hotels have been fully booked for days leading up to the anniversary.
Whatever else Mao may mean politically or ideologically these days, at least for a week, those in the industry hope that interest in the founder of China's socialist state will translate into little mountains of cash.


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Advice Section
Fri 1st May '20
Dion - St Pauls
Introducing Friday night speed dating in The City. This is probably London's busiest weekly speed dating event. You'll meet up to 22-25 people for 'dates' lasting four minutes each at this smart venue next to St Pauls. Taking part in this event is the ultimate start to your weekend and you're certain to meet a lot of people. This location attracts a fun, professional crowd of people from across London, not just those working in the square mile. Join us and you'll be amazed how sociable Londoners can be and be left wondering why you never tried speed dating sooner. The next day you'll find out who you mutually matched with either on our website or via our unique mobile app, Mixeo. Get in touch again via our private messaging system and you'll be meeting for real dates in no time. Sign up now - this event will sell out fast!


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