Background: Eye movement desensitization and reprocessing (EMDR) is becoming a recognized and accepted form of psychotherapy for posttraumatic stress disorder (PTSD). Yet, its mechanism of action remains unclear and much controversy exists about whether eye movements or other forms of bilateral kinesthetic stimulation contribute to its clinical effects beyond the exposure elements of the procedure. Methods: Twenty-one patients with single-event PTSD (average Impact of Event Scale score: 49.5) received three consecutive sessions of EMDR with three different types of auditory and kinesthetic stimulation (tones and vibrations): intermittent alternating right-left (as commonly used with the standard EMDR protocol), intermittent simultaneous bilateral, and continuous bilateral. Therapists were blinded to the type of stimulation they delivered, and stimulation type assignment was randomized and counterbalanced. Results: All three stimulation types resulted in clinically significant reductions of subjective units of distress (SUD). Yet, alternating stimulation resulted in faster reductions of SUD when only sessions starting with a new target memory were considered. Conclusions: There are clinically significant effects of the EMDR procedure that appear to be independent of the nature of the kinesthetic stimulation used. However, alternating stimulation may confer an additional benefit to the EMDR procedure that deserves attention in future studies.

1.
Bleich A, Berstein J, et al: Guidelines for the Assessment and Professional Intervention with Terror Victims in the Hospital and in the Community. Jerusalem, National Council for Mental Health, Ministry of Health, 2002.
2.
American Psychiatric Association: Guidelines for the Psychiatric Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder. Washington, American Psychiatric Association, 2004.
3.
Chemtob CM, Tolin D, van der Kolk BA, Pitman RK: Eye movement desensitization and reprocessing; in Foa EA, Keane TM, Friedman MJ (eds): Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies. New York, Guilford Press, 2000, pp 139–155, 155, 333–335.
4.
Clinical Resource Efficiency Support Team: The Management of Posttraumatic Stress Disorder in Adults. Belfast, Clinical Resource Efficiency Support Team of the Northern Ireland Department of Health, Social Services and Public Safety, 2003.
5.
Evidence-Based Clinical Practice Guidelines. Department of Health, UK, 2001 (accessed on 05/15, 2001, at www.doh.gov.uk/mentalhealth/treatmentguideline/).
6.
Canceil O, Cottraux J, et al: Psychothérapie: trois approches évaluées. Paris, Institut national de la santé et de la recherche médicale, 2004.
7.
Veterans Administration/Department of Defense Clinical Practice Guideline Working Group: Management of Post-Traumatic Stress. Washington, Veterans Health Administration, Department of Veterans Affairs and Health Affairs, Department of Defense, 2003, Office of Quality and Performance publication 10Q-CPG/PTSD-04.
8.
National Institute for Clinical Excellence: Post-Traumatic Stress Disorder (PTSD): The Management of PTSD in Adults and Children in Primary and Secondary Care. London, NICE, 2005.
9.
Sack M, Lempa W, Lamprecht F: Study quality and effect sizes – A meta-analysis of EMDR-treatment for posttraumatic stress disorder. Psychother Psychosom Med Psychol 2001;51:350–355.
10.
Maxfield L, Hyer LA: The relationship between efficacy and methodology in studies investigating EMDR treatment of PTSD. J Clin Psychol 2002;58:23–41.
11.
Spector J, Read J: The current status of eye movement desensitization and reprocessing (EMDR). Clin Psychol Psychother 1999;6:165–174.
12.
van Etten ML, Taylor S: Comparative efficacy of treatments for post-traumatic stress disorder: a meta-analysis. Clin Psychol Psychother 1998;5:126–144.
13.
Levin P, Lazrove S, van der Kolk BA: What psychological testing and neuroimaging tell us about the treatment of posttraumatic stress disorder (PTSD) by eye movement desensitization and reprocessing (EMDR). J Anxiety Disord 1999;13:159–172.
14.
Shapiro F: Eye Movement Desensitization and Reprocessing (EMDR) and the anxiety disorders: clinical and research implications of an integrated psychotherapy treatment. J Anxiety Disord 1999;13:35–67.
15.
Shapiro F: Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures. New York, Guilford, 2001.
16.
Lohr JM, Lilienfeld SO, Tolin DF, Herbert JD: Eye movement desensitization and reprocessing: an analysis of specific versus nonspecific treatment factors. J Anxiety Disord 1999;13:185–207.
17.
Lohr JM, Tolin DF, Lilienfeld SO: Efficacy of eye movement desensitization and reprocessing: implications for behavior therapy. Behav Ther 1998;29:123–156.
18.
Tolin DF, Montgomery RW, Kleinknecht RA, Lohr JM: An evaluation of Eye Movement Desensitization and Reprocessing (EMDR); in Vandercreek L, Knapp S, Jackson TL (eds): Innovations in Clinical Practice: A Sourcebook. Sarasota, Professional Resources Press, 1995, pp 423–437.
19.
Davidson PR, Parker KCH: Eye Movement Desensitization and Reprocessing (EMDR): a meta-analysis. J Consult Clin Psychol 2001;69:305–316.
20.
Perkins BR, Rouanzoin CC: A critical evaluation of current views regarding Eye Movement Desensitization and Reprocessing (EMDR): clarifying points of confusion. J Clin Psychol 2002;58:77–97.
21.
Lohr JM, Kleinknecht RA, Tolin DF, Barrett RH: The empirical status of the clinical application of eye movement desensitization and reprocessing. J Behav Ther Exp Psychiatry 1995;26:285–302.
22.
Lohr JM, Tolin DF, Kleinknecht RA: An intensive design investigation of eye movement desensitization and reprocessing of claustrophobia. J Anxiety Disord 1996;10:73–88.
23.
Montgomery RW, Ayllon T: Eye movement desensitization across subjects: subjective and physiological measures of treatment efficacy. J Behav Ther Exp Psychiatry 1994;3:217–230.
24.
Wilson D, Silver SM, Covi W, Foster S: Eye movement desensitization and reprocessing: effectiveness and autonomic correlates. J Behav Ther Exp Psychiatry 1996;27:219–229.
25.
Boudewyns PA, Hyer LA: Eye movement desensitization and reprocessing (EDMR) as treatment for posttraumatic stress disorder (PTSD). Clin Psychol Psychother 1996;3:185–195.
26.
Devilly GJ, Spence SH, Rapee RM: Statistical and reliable change with eye movement desensitization and reprocessing: treating trauma within a veteran population. Behav Ther 1998;29:435–455.
27.
Renfrey G, Spates CR: Eye movement desensitization and reprocessing: a partial dismantling procedure. J Behav Ther Exp Psychiatry 1994;25:231–239.
28.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Press, 1994. 28b Horowitz M, Wilner N, Alvarez W: Impact of Event Scale: A measure of subjective stress. Psychosom Med 1979;41:209–218.
29.
Brady K, Pearlstein T, Asnis G, Baker D, Rothbaum B, Sines CR, Farfel GM: Efficacy and safety of sertraline treatment of posttraumatic stress disorder. JAMA 2000;283:1837–1844.
30.
Davidson JRT, Rothbaum BO, Van Der Kolk B, Sikes CR, Farfel GM: Multicenter, double-blind comparison of sertraline and placebo in the treatment of posttraumatic stress disorder. Arch Gen Psychiatry 2001;58:485–492.
31.
Wolpe J: The Practice of Behavior Therapy, ed 4. New York, Pergamon Press, 1990.
32.
Rosenthal R, Rosnow RL: Essentials of Behavioral Research Methods and Data Analysis. New York, McGraw-Hill, 1984.
33.
Andrade J, Kavanagh D, Baddeley A: Eye movements and visual imagery: a working memory approach to the treatment of post-traumatic stress disorder. Br J Clin Psychol 1997;36:209–223.
34.
Barrowcliff AL, Gray NS, Freeman TCA, MacCulloch MJ: Eye movements reduce the vividness, emotional valence and electrodermal arousal associated with negative autobiographical memories. J Forensic Psychiatry Psychol 2004;15:325–345.
35.
van den Hout M, Muris P, Salemink E, Kindt M: Autobiographical memories become less vivid and emotional after eye movements. Br J Clin Psychol 2001;410:121–130.
36.
Manfield P: Symposium II: the role of eye movements and other bilateral stimulation in EMDR – Double-blind alternating tone research. EMDR Int Assoc Annu Conf, Austin, June 2001.
37.
Lamprecht F: Diagnosis and therapy of post-traumatic stress disorder. Helping to cope with memories. MMW Fortschr Med 2001;143:44–46.
38.
Foa EB: Psychological processes related to recovery from a trauma and an effective treatment for PTSD. Ann NY Acad Sci 1997;821:410–424.
39.
Linehan MM: Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York, Guilford Press, 1993.
40.
Marks IM, Lovell K, Noshirvani H, Livanou M, Thrasher S: Treatment of posttraumatic stress disorder by exposure and/or cognitive restructuring: a controlled study. Arch Gen Psychiatry 1998;55:317–325.
41.
Rogers S, Silver SM: Is EMDR an exposure therapy? A review of trauma protocols. J Clin Psychol 2002;58:43–59.
42.
Lee CW, Taylor G, Drummond PD: The active ingredient in EMDR: is it traditional exposure or dual focus of attention? Clin Psychol Psychother, in press.
43.
Marks I, Dar R: Fear reduction by psychotherapies. Recent findings, future directions. Br J Psychiatry 2000;176:507–511.
44.
Lohr JM, Tolin DF, Lilienfeld SO: Final comments on Lipke’s critique of Lohr, Tolin and Lilienfeld (1998). Behav Ther 2000;23:145–147.
45.
Barrowcliff AL, Gray NS, MacCulloch S, Freeman TC, MacCulloch MJ: Horizontal rhythmical eye movements consistently diminish the arousal provoked by auditory stimuli. Br J Clin Psychol 2003;42:289–302.
46.
Stickgold R: EMDR: a putative neurobiological mechanism. J Clin Psychol 2002;58:61–75.
47.
Power K, McGoldrick T, Brown K, et al: 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. J Clin Psychol Psychother 2002;9:299–318.
48.
Taylor S, Thordarson DS, Maxfield L, Fedoroff IC, Lovell K, Ogrodniczuk J: Comparative efficacy, speed, and adverse effects of three PTSD treatments: exposure therapy, EMDR, and relaxation training. J Consult Clin Psychol 2003;71:330–338.
49.
Basoglu M, Salcioglu E, Livanou M, Kalender D, Acar G: Single-session behavioral treatment of earthquake-related posttraumatic stress disorder: a randomized waiting list controlled trial. J Trauma Stress 2005;18:1–11.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.