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EMDR and PTSD

A recent clinical trial found that, six months after treatment, patients with post-traumatic stress disorder (PTSD) and depression who had received eye movement desensitization and reprocessing (EMDR) had fewer symptoms than patients treated with Prozac.

When undergoing EMDR, the patient is usually asked to focus on the clinician’s finger or blinking lights for several minutes while, at the same time, remembering the events that are causing problems in everyday life. Occasionally, practitioners will instead play tones or apply electrical stimulation to the hands. EMDR is a type of treatment that can be administered by counselors and other non-physician mental health professionals.

Unlike with prolonged “talk” therapy, such as analysis or cognitive behavioral therapy, in some cases EMDR can provide relief in an incredibly short amount of time.

When EMDR was first introduced to the mental health community in 1987, it was a very controversial treatment that was ridiculed by many. Since them, it has been investigated by scores of clinical researchers. In the late 1990’s, Kaiser Permanente sponsored a clinical trial and found that HMO patients with single trauma were virtually cured after as few as 5 hours of treatment; for those who suffered multiple traumas, PTSD was eliminated in almost 80% of the cases.

In the past few years, both the APA and the US military have recommended EMDR as a way to treat PTSD in soldiers and the general public. Earlier this year, SAMHSA acknowledged that eye movement desensitization and reprocessing can also be helpful when treating depression or anxiety. Although many in the mental health community have come to accept that EMDR is effective in some cases, there are still those who remain skeptical. Clinicians who treat combat veterans, for example, still recommend trying both cognitive behavioral therapy (CBP) and exposure therapy before resorting to EMDR. Also, for patients who have co-occurring issues, such as substance abuse, more traditional mental health treatment will need to be employed to address the non-traumatic aspects of the patient’s history.

EMDR has been shown to be effective in treating military veterans who participated in or witnessed traumatic events in the field. In one particular case, a soldier was experiencing flashbacks from when a young child died after drowning; he couldn’t shake the memory of handling her body. He would continue to see her face in his mind, even 15 years after the incident had happened. Coupled with memories garnered from subsequent work in the field, the former soldier began to experience significant sleep disturbances, which eventually led him to resign from his job as a cop. He then sought treatment for PTSD at a veteran’s hospital and was exposed to EMDR. His flashbacks are gone and he can now remember the incidents with dispassion, not panic.

Although soldiers do experience PTSD on a large scale, it can also be found in people who have suffered some other sort of physical or emotional trauma such as abuse, death, or divorce. For instance, adults who suffered physical abuse as children often experience panic attacks and anxiety as a form of post-traumatic stress disorder much later in life. With EMDR, some of these patients can learn to face and address the feelings associated with the violations, which leads to a reduction in anger, anxiety and depression.

In some patients, relief from PTSD symptoms can be experienced in a small number of sessions or even in just the first session. For others, EMDR must be administered over a period of months. What still stumps researchers, however, is that there is no definitive explanation of how EMDR actually works. Many believe that reliving the trauma when parts of the patient’s brain are being stimulated (either by lights, movement, sounds, or electricity) causes the patient to replace those memories that are currently being accessed with a more benign one. One Harvard University sleep researcher suggests that the continual shifting of the eye’s focus actually alters the chemicals in the brain and puts it in a REM-like state. Since REM sleep allows the brain to process and compartmentalize the past day’s events, it is believed that the EMDR allows the brain to re-process the old traumatic memories in a less-threatening way. Brain studies have shown that EMDR expands the hippocampus, an area of the brain that is reduced in patients suffering with PTSD.

Now that US government agencies have publicly recognized EMDR as a viable PTSD treatment option, it is likely that more research money will be made available in order to find out why, exactly, EMDR is so effective. A recent study in Cambridge, MA used subjects suffering from PTSD or depression and compared results of treatment with EMDR as opposed to Prozac. When interviewed six months after the end of treatment, those who were treated with Prozac had more PTSD and depression symptoms than those who had experienced EMDR.

There is still hope.

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