EMDR Psychotherapy for the Treatment of PTSD

Effectiveness of EMDR Psychotherapy for the Treatment of PTSD
Introduction
Most people who undergo traumatic life experiences often find it difficult to cope and adjust and may, from time to time, not only contend with uncontrollable thoughts about the experience, but also experience severe anxiety. In essence, this could effectively impede their day-to-day functioning. It should be noted that in the past, various interventions have been applied with an intention of treating post-traumatic stress disorder (PTSD) amongst adults. The said interventions include, but they are not limited to, eye movement desensitization and reprocessing (EMDR), trauma-focused cognitive-behavioral therapy (CBT), psychological first aid (PFA), and critical incident stress debriefing (CISD). This text concerns itself with eye movement desensitization and reprocessing (EMDR). In so doing, the text will seek to assess and evaluate current research on EMDR as applied to adults suffering from PTSD. It should be noted that in the past, the effectiveness of EMDR as a psychotherapeutic intervention for persons suffering from PTSD has been questioned, with most deeming it a controversial intervention. In that regard, therefore, the relevance of reviewing current research on this particular intervention with an aim of assessing its effectiveness cannot be overstated.
Discussion
A traumatic event, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), could be defined “as an event experienced, witnessed, or confronted by a person that involves (a) actual or threatened death, (b) serious injury, or (c) a threat to the physical integrity of self or others” (Vieweg, Julius, Fernandez, Beatty-Brooks, Hettema, and Pandurangi, 2006, p. 385). When exposure to a traumatic event goes untreated in some people, normal stress reactions (such as anger and anxiety) could worsen and lead to the development of PTSD-like symptoms. The post-traumatic stress disorder diagnostic criterion (DSM-IV-TR) highlights the criterion as well as the description or symptom. EMDR, in the words of Shapiro (2014) “is an empirically validated treatment for trauma, including such negative life experiences as commonly present in medical practice” (71). As a psychological treatment approach to persons exposed to trauma, EMDR attempts to lessen or diminish the impact of the feelings a person experiences in relation to their recollection of a traumatic event. It is important to note that this intervention happens to be largely focused on both the symptoms as well as emotions associated with the traumatic event, as opposed to the traumatic event itself. The treatment process is in this case inclusive of the utilization of hand motions to guide the movements of the patient’s eyes from one side to another – in what is believed to mute or diminish the power of memories that happen to be emotionally charged. It should, however, be noted that as it has been pointed out in the introductory section, the effectiveness of PTSD as a psychotherapeutic intervention has been questioned in the past. While some studies have questioned the workings of the intervention, other studies indicate that the intervention is not only effective, but also potent in the treatment of various mental-health conditions such as PTSD.
In an attempt evaluate and assess the role eye movement desensitization as well as reprocessing therapy plays in medical sciences, especially with regard to the treatment of symptoms of a physical or psychological nature arising from exposure to life experiences that happen to be adverse, Shapiro (2014) finds out that EMDR comes in handy in clinical settings as an important tool for clinicians as they seek to attend to persons exhibiting symptoms (physiologic and psychological) consistent with exposure to traumatic life events. This is more so the case given that the intervention comes in handy in the determination of the extent to which the traumatic event serves as a contributing factor. In the words of the author, “EMDR therapy research has shown that processing memories of such experiences results in the rapid amelioration of negative emotions, beliefs, and physical sensations” (Shapiro, 2014, p. 76). As far as the relevance of these findings to advanced nursing practice is concerned, it is clear from the said findings that EMDR does have practical application amongst patients exhibiting symptoms that are consistent with disorders that are stress-related. As a matter of fact, Shapiro (2014) is of the opinion that EMDR therapy should be embraced by the medical community as a rehabilitative as well as preventive approach in seeking to advance further support to not only patients, but also their family members. In essence, the approach Shapiro (2014) utilizes in this study, i.e. in relation to the review of clinical reports and randomized studies relating to the intervention, enables him to present a strong case for EMDR as a potent tool as far as memory processing is concerned in seeking to treat physiologic and psychological symptoms amongst those with exposure to adverse life events.
Like Shapiro, Siedler and Wagner (2006) are also of the opinion that EMDR is highly effective in the treatment of PTSD. In their study seeking to compare two PTSD intervention approaches – i.e. trauma-focused cognitive-behavioral therapy (CBT) and EMDR, the authors found out that both methods are equally effective. In their own words, “in the treatment of PTSD, both therapy methods tend to be equally efficacious” (Siedler and Wagner, 2006, p. 1522). According to the authors, although both approaches have been widely utilized in PTSD treatment, concerns had been raised over how they compared as far as their efficacy is concerned. The authors in this case undertake a comprehensive review of literature in an attempt to assess how both approaches relate when it comes to their treatment outcomes. This effectively enhances the reliability of their findings. It is important to note that trauma-focused CBT happens to be an evidence-based treatment approach especially when it comes to the resolution of various behavioral as well as emotional problems associated with exposure to traumatic events. The fact that trauma-focused CBT lacks a clear leverage over EMDR as far as treatment outcomes are concerned is a clear indication of the efficacy of EMDR. It should, however, be noted that as per the outcomes of the Siedler and Wagner study, the contribution the eye movement component makes to the overall outcomes of treatment remains unclear (Siedler and Wagner, 2006). The finding there are no clinically significant differences between EMDR and trauma-focused CBT is of great relevance to advanced psychiatric nursing practice as it indicates that little benefit can be gained from the discrimination of one over another.
It should, however be noted that while a study conducted by Chen et al. (2014) confirmed that indeed EMDR was a valid psychotherapeutic intervention, the effectiveness of EMDR in the elevation of PTSD symptoms was found to be largely influenced or affected by the experience of the therapist in the conduction of PTSD group therapy. In this particular study, the authors sought to perform a “meta-analysis of clinical studies by investigating the effects of eye-movement desensitization and reprocessing (EMDR) therapy on the symptoms of posttraumatic stress disorder (PTSD), depression, anxiety, and subjective distress in PTSD patients treated” within a 20 year span (Chen et al., 2014, p. 75). The authors in this case appreciate the complex nature of the intervention approach and point out that it largely works by both the desensitization of those suffering from PSTD and stress, and the integration of information processing. It should be noted that as has been pointed out elsewhere in this text, the contribution the eye movement component makes to the overall outcomes of treatment remains unclear (Siedler and Wagner, 2006). However, as Chen et al. (2014) observe, eye movement in this intervention approach happens to be the dual-attention stimulus. In that regard, therefore, the authors are of the opinion that the said eye movement should be considered to be a critical EMDR constituent/element “because it induces certain physiological conditions that activate information processing” (Chen et al., 2014). The findings of this particular study are of relevance to advanced psychiatric nursing practice as they introduce the concept of therapist experience into the effectiveness equation. It is also important to note that as the authors further point out, “a duration of treatment >60 min per session also contributed to reductions in the symptoms of PTSD, depression, anxiety, and subjective distress in PTSD patients following EMDR therapy” (Chen et al., 2014, p. 76). This is a critical component that should also be taken into consideration in session planning and design. It should, however, be stated that the accuracy of the findings of this study could have been impacted upon by the data collection methods which were largely inconsistent across the randomized controlled trials.  
In their study titled, the effectiveness of eye movement desensitization and reprocessing in German armed forces soldiers with post-traumatic stress disorder under routine inpatient care conditions, Kohler, Eggert, Lorenz, Herr, Willmund, Zimmerman, and Alliger-Horn (2017) found out that when it comes to the reduction of depression and PTSD symptoms, EMDR happens to be an effective treatment approach. In contrast to the other studies that have been highlighted herein, this particular research piece seeks to assess how effective this particular psychotherapeutic intervention is in the military context, i.e. in relation to soldiers exposed to traumatizing events. It should be noted that unlike civilians, soldiers in combat situations happen to be exposed to traumatizing events on a fairly regular basis. The relevance as well as the reliability of the study in so far as assessing the effectiveness of EMDR in the treatment of PTSD is in this case further enhanced by the selection of the suitable population, i.e. a population exposed to the worst forms of trauma in various war scenarios. Like their American counterparts, German forces have in the past routinely participated in a wide range of military interventions across the world. Some of the unique and extremely traumatizing events soldiers in battle face, according to Kohler et al. (2017) include, but they are not limited to “having to recover semi-decayed bodies from mass graves, being subjected to injury and death by suicide bombers, improvised explosive devices, and intense combat” (1673). In the final analysis, the authors come to the expected conclusion that EMDR, despite the criticism that has been leveled against it, is an effective psychotherapeutic intervention as far as the treatment of PTSD is concerned. More specifically, the authors, in their own words, observe that their “effectiveness study provides evidence that EMDR is a solid and beneficial treatment option under real-life conditions in the framework of inpatient treatment of GAF soldiers with comorbid conditions and psychiatric multimorbidity” (Kohler et al., 2017, p. 1675). It should, however, be noted that the sample utilized in the study could in this case affect the transferability of findings. This is more so the case given the fact that a significant portion of respondents constituted of male soldiers. This is a concern that the authors ought to have addressed in both groups. The research findings in this case are greatly relevant for advanced psychiatric nursing practice as they present new viewpoints and perceptions in the treatment of war-related trauma, especially in the context of our country’s active involvement in the war against terror.
As Wilson, Farrell, Barron, Hutchins, Whybrow and Kiernan (2018) point from the onset, there is no shortage of research seeking to assess the effectiveness of EMDR in the treatment of PSTD. According to the authors, EMDR makes use of adaptive information processing as a theoretical framework – with the key postulation in this case being that memories of traumatic events processed by the human brain in an inadequate way happen to be the main basis or foundation of psychopathology. As the authors further point out, the relevance of researching the effectiveness of psychotherapeutic interventions in the treatment of conditions related to psychological trauma cannot be overstated. This is more so the case given that as the authors observe, “the global burden of psychological trauma continues unabated” (Wilson, Farrell, Barron, Hutchins, Whybrow and Kiernan, 2018, p. 413). Towards this end, the authors essentially restate the same conclusion that most of those cited herein have arrived at – that is, there is robust and extensive affirmation to the effect that “EMDR therapy is an effective treatment to improve diagnosis of PTSD, and reduce symptoms of PTSD, and other trauma-related symptoms” (Wilson et al. 2018, p. 413). As far as how these findings relate to advanced psychiatric nursing practice, it is important to note that the need to ensure that persons who present symptoms consistent with PTSD have access to EMDR as a treatment option is restated. The authors have, however, utilized a relatively small sample. This could have an adverse impact on the generalizability of the study.
In recent times, there are various other interventions and treatment approaches that have been proposed in the treatment of PTSD. One of these is the Brainspotting (BSP) therapy approach which Hildebrand, Grand, and Stemmler (2017) describe as “brain-wise and body-aware relational attunement process” (44). In their study, the authors attempt to compare this relatively new approach to EMDR and thus assess how effective both are in the treatment of PTSD. According to the authors, various meta-analyses have validated EMDR as an effective PTSD treatment approach. In the final analysis, Hildebrand, Grand, and Stemmler (2017) find out that EMDR is effective in a variety of areas, i.e. in the treatment of “cardinal symptoms of PTSD, anxiety and depression” (47). The authors also find out that there is no difference with regard to the advancement of impairment between those treated with EMDR and those treated with BSP. This effectively indicates that EMDR is as effective as any other valid psychotherapeutic intervention. These findings are of value to advanced psychiatric nursing practice as they indicate that EMDR is a valid alternative to other PTSD treatment approaches. One of the key limitations of this study, however, is the fact that the authors fail to make use of a randomized trial. As a consequence, the evaluation of the treatment efficacy could be affected.
Although this text concerns itself with how effective EMDR is in the treatment of PTSD amongst adults, for purposes of continued research, it would be prudent to briefly assess how effective the same is in children. According to Rodenburg, Benjamin, Roos, Meijer, and Stams (2009), children are also prone to trauma as a consequence of exposure to assault, abuse, or even domestic violence. In the words of the authors, “after exposure to a traumatic event, children may display a range of disorders, including acute stress disorder (ASD), post-traumatic stress disorder, depression, generalized anxiety disorder, childhood traumatic grief” etc. (599). The results of this study indicate that in line with the results of the various adult sample meta-analytic studies that have been conducted in the past (and that have been cited in this text), EMDR interventions appear to benefit children as well. In the words of the authors, the “meta-analysis of EMDR in children showed that EMDR is efficacious in treating PTSD symptoms” (Rodenburg, Benjamin, Roos, Meijer, and Stams, 2009, p. 605). It should be noted that in the meta-analytic review, authors in this case made use of a total of 7 studies. This could, in essence, get in the way of generalizability. However, the study is of great relevance to advanced psychiatric nursing practice as it effectively demonstrates the efficiency of EMDR in a wider scope. Thus, its use in children, especially on the basis of its incremental efficacy in relation to other interventions, is beneficial as it is for adults.
Conclusion
There is mounting evidence to the effect that many psychological disorders have various negative life events as well as trauma as the main causal factors. This text sought to assess the effectiveness of EMDR in the treatment of PTSD – a psychological disorder triggered by adverse or traumatic life experiences. On the basis of the findings above, EMDR comes across as an effective psychotherapeutic intervention for PTSD among adults. Also, the fact that EMDR happens to be effective in military contexts, where exposure to traumatic events tends to be worse and more frequent underlines its relevance and effectiveness as a psychotherapeutic intervention in the treatment of PTSD. It should, however, be noted that the findings above also indicate that future studies should attempt to indicate how effective EMDR is in the treatment of various categories of trauma patients, i.e. children. This is an assertion supported by, amongst others, Seidler and Wagner who in their research piece point out that future studies must focus on not only the efficiency, effectiveness, as well as efficacy of EMSR, but also on the specific trauma patients likely to derive greater benefit from the intervention. Further, there is also need for further studies to assess the utility of the eye movement component to the entire psychological setup. The efficacy of EMDR as an effective psychotherapeutic intervention for PTSD is also further underlined by the fact that it has been recognized by, amongst others, the World Health Organization (WHO) and the National Institute for Health and Clinical Excellence (NICE).







References
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Hildebrand, A., Grand, D. & Stemmler, M. (2017). Brainspotting – The Efficacy of a New Therapy Approach for the Treatment of Posttraumatic Stress Disorder in Comparison to Eye Movement Desensitization and Reprocessing. Mediterranean Journal of Clinical Psychology, 5(1), 45-53.
Kohler, K., Eggert, P., Lorenz, S., Herr, K., Willmund, G., Zimmerman, P. & Alliger-Horn, C. (2017). Effectiveness of Eye Movement Desensitization and Reprocessing in German Armed Forces Soldiers with Post-Traumatic Stress Disorder under Routine Inpatient Care Conditions. Military Medicine, 182(5/6), 1672-1680.
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Wilson, G., Farrell, D., Barron, I., Hutchins, J., Whybrow, D. & Kiernan, M.D. (2018). The Use of Eye-Movement Desensitization Reprocessing (EMDR) Therapy in Treating Post-traumatic Stress Disorder— A Systematic Narrative Review. Frontiers in Psychology, 6(9), 412-418.