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EMDR – psychotherapy in posttraumatic stress syndrome in young people

Report type: Alert
Published: 2001-04-17
Contact person SBU: Sofia Tranæus  E-mail: tranaeus@sbu.se

Findings by SBU Alert

Version: 1

Method and Target Group

EMDR (Eye Movement Desensitization and Reprocessing) is a new psychotherapeutic method aimed at processing memories of traumatic events, thereby ameliorating the psychological consequences of these memories. EMDR involves elements from several different psychological approaches. It is uncertain which of the treatment elements are effective. Clients with post traumatic stress disorder (PTSD) are the main target group for EMDR treatment. Although both children and adults have been treated with EMDR, this document is aimed particularly at children and adolescents. 

Patient Benefits, Risks, and Side Effects

Published studies of EMDR mainly cover adults with PTSD. There are two randomized and controlled studies, one of which has yet to be published, of EMDR treatment in 47 children and adolescents. One of the studies suggests that EMDR yields a better treatment outcome in the short term compared to the control treatment (active listening). In the second study, no significant difference was found between EMDR treatment in combination with standard treatment and standard treatment alone as regards reduction in avoidance and invading thoughts. However, the PTSD symptom of behavioral disorders declined significantly in the EMDR group. Furthermore, numerous case studies suggest that EMDR has a positive treatment effect in children and adolescents with PTSD. No harmful effects have been reported.

Economic Aspects

There are no economic assessments of EMDR. Limited data suggest that fewer treatments are needed to achieve the desired outcome with EMDR compared to other psychotherapeutic methods. This suggests that EMDR is a potentially cost-effective method in relation to the alternatives, under the assumption that the effects of treatment are permanent.

Current Scientific Evidence

There is moderate* scientific evidence to show the benefits of EMDR treatment in children and adolescents. There is no* documentation concerning the cost-effectiveness or effects beyond 6 months.

Since the scientific documentation is limited, the effects of EMDR treatment in both the short and long term should be compared in studies with other treatment alternatives, including standard treatment. Furthermore, the cost-effectiveness of the method should be studied under Swedish conditions.

*This assessment by SBU Alert uses a 4-point scale to grade the quality and evidence of the scientific documentation. The grades indicate: (1) good, (2) moderate, (3) poor, or (4) no scientific evidence on the subject.

This summary is based on a report prepared at SBU in collaboration with Kerstin Bergh Johannesson, Lic. Psychol., Akademiska Hospital, Uppsala and has been reviewed by Prof. Mats Fredriksson, Uppsala University, Uppsala.

The complete report is available in Swedish only.

Alert is a joint effort by the Swedish Council on Technology Assessment in Health Care (SBU), the Medical Products Agency, the National Board of Health and Welfare, and the Federation of Swedish County Councils.

References

  1. Cahill SP, Carrigan MH, Frueh BC. Does EMDR work? And if so, why? A critical review of controlled outcome and dismantling research. J Anxiety Disord 1999;13(1-2):5-33.
  2. Chemtob CM, Nakashima J, Hamada R, Carlson J. Brief treatment for elementary school children with disaster-related PTSD: a field study. J Clin Psychol, in press.
  3. Chemtob et al. Eye movement desensitization and reprocessing. In: Foa EB, Keane TM, Friedman MJ, eds. Effective treatments for PTSD. New York: Guilford, 2000.
  4. Devilly GJ, Spence SH. The relative efficacy and treatment distress of EMDR and a cognitive-behavior trauma treatment protocol in the amelioration of posttraumatic stress disorders. J Anxiety Disord 1999;13(1-2):131-57.
  5. Lovett J. Small Wonders: Healing childhood trauma with EMDR. New York: Free Press, 1999.
  6. Macklin ML, Metzger LJ, Lasko NB, Berry NJ, Orr SP, Pitman RK. Five-year follow-up study of eye movement desensitization and reprocessing therapy for combat-related post traumatic stress disorder. Comprehensive Psychiatry 2000;41(1),24-27.
  7. Puffer MK, Greenwald R, Elrod DE. A treatment outcome study of eye movement desensitization and reprocessing (EMDR) with traumatized children and adolescents. Presented at the annual conference of the EMDR International Association, Denver, June 1996.
  8. Renfrey G, Spates CR. Eye movement desensitization and reprocessing: A partial dismantling procedure. J Behav Ther Experiment Psychiatr 1994;25:231-239.
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  12. Soberman GB, Greenwald R, Rule DL. A controlled study of eye movement desensitization and reprocessing (EMDR) for boys with conduct problems. J Aggression Maltreatment Trauma, in press.
  13. Tinker RH, Wilson SA. Through the Eyes of a Child: EMDR with children. New York: Norton & Co, 1999.
  14. van der Kolk B. Biological response to psychic trauma. In: Wilson JP, Raphael B, eds. International Handbook of Traumatic Stress Syndromes. New York: Plenum Press, 1993:25-33.
  15. van der Kolk B, Burbridge J, Susuki J. The psychobiology of traumatic memory; clinical implications of neuroimagery studies. Annals of the New York Academy of Sciences 1997;821:99-113.
  16. van Etten M, Taylor S. Comparative efficacy of treatments for post-traumatic stress disorder: a meta-analysis. Clin Psychol Psychother 1998;5:126-144.
  17. Wilson SA, Becker LA, Tinker RH. Fifteen-month follow-up of eye movement desensitization and reprocessing (EMDR) treatment for posttraumatic stress disorder and psychological trauma. J Consult Clin Psychol 1997;65(6):1047-1056.
  18. Wilson SA, Tinker RH, Hoff
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