Transcript EMDR Presentation - cevcounseling.com

The EMDRIA Presentation Packet
for Use with Professional Audiences
Updated 2007
1
What is EMDR?
•EMDR-- Eye Movement Desensitization and Reprocessing
is a psychological method for treating emotional difficulties that
are caused by disturbing life experiences, ranging from
traumatic events such as combat stress, assaults and natural
disasters, to upsetting childhood events.
•EMDR is also being used to alleviate performance anxiety and
to enhance the functioning of people at work, on the playing
field, and in the performing arts.
•EMDR is a complex method that brings together elements from
well-established clinical theoretical orientations including
psychodynamic, cognitive, behavioral, and client-centered. For
many clients, EMDR provides more rapid relief from emotional
distress than conventional therapies.
2
What is the origin of EMDR?
•In 1987, psychologist Francine Shapiro discovered that her
voluntary eye movements reduced the intensity of negative,
disturbing thoughts.
•Dr. Shapiro initiated a research study (Shapiro, 1989)
examining the efficacy of EMDR in treating traumatized Vietnam
combat veterans and victims of sexual assault.
•EMDR significantly reduced the symptoms of post traumatic
stress disorder (PTSD) in these research subjects.
•Although EMDR was originally developed by Dr. Shapiro with
lateral eye movements as a core feature of its methodology,
alternate forms of bilateral stimulation are now being used, such
as alternate right-left auditory tones and taps on the client’s
hands.
3
EMDR: An Accelerated Information
Processing Model
• Traumatization has been described as a disruption of the
inherent information processing system that normally leads to
integration and adaptive resolution following upsetting
experiences (van der Kolk & Fisler, 1995)
• Under normal circumstances, this information processing may
occur during thinking, talking, expressive/artistic activities,
and/or dreaming.
• In trauma, however, a malfunction of this natural information
processing system occurs such that the experience of the
trauma remains “frozen”, manifesting in persistent intrusive
thoughts, negative emotions and self-referenced beliefs, and
unpleasant body sensations.
4
Components of Traumatic Memory
TRIGGERS
PICTURES
EMOTIONS
TRAUMA
SENSATIONS
BELIEFS
5
EMDR: An Accelerated Information
Processing Model (cont.)
• EMDR specifically targets traumatic material and appears to
restart this ‘stalled’ information processing in a focused manner,
facilitating the resolution of the traumatic memories through the
activation of neurophysiological networks in which appropriate
and positive information is stored.
6
What Happens during EMDR?
•During EMDR, the clinician works with the client to identify the
specific problem that will be the focus of treatment.
•Utilizing a structured protocol, the practitioner guides the client
through a description of a disturbing event related to his or her
presenting problem(s). The practitioner asks the client to identify
and focus on the image, cognitions, emotions, and somatic
distress associated with the traumatic memory.
•While the client is engaged in eye movements or some other
form of bilateral stimulation, he or she is experiencing various
aspects of the initial memory or other related memories.
•The practitioner pauses with the eye movements or bilateral
stimulation at regular intervals to ensure that the client is
processing adequately on his or her own.
7
What Happens during EMDR? (cont.)
•The practitioner guides the process, making clinical decisions about
the direction of the intervention. The client may process at cognitive,
affective, and/or somatic levels over the course of a given session.The
goal is the client's rapid processing of information about the negative
experience, bringing it to an "adaptive resolution."
•In Shapiro's words, this means a reduction in the symptomatology, a
shift in the negative belief to the client's new positive belief, and the
prospect of functioning more optimally.
•The comprehensive "three-pronged approach" employed in the EMDR
method addresses:
1) earlier life experience;
2) present-day stressors; and
3) desired thoughts and actions for the future.
•EMDR treatment may last from 1-3 sessions to 1 year or longer for
complex problems.
8
Why Do Clients Seem to
Respond Well to EMDR?
•EMDR is a client-centered approach that allows the clinician to
facilitate the mobilization of a client's own inherent healing
mechanism which stimulates an innate information processing
system in the brain.
• The EMDR model acknowledges the physiological component
in emotional difficulties. The EMDR protocol directly targets
these physical sensations, along with negative beliefs,
emotional states, and other disturbing symptoms.
9
Why and how does EMDR work?
Hypothesized Mechanisms
• Dr. Francine Shapiro wrote in her 1995 textbook (p.310):
“Theories as to why EMDR works are currently only
speculations - and will probably remain so for many years.
Fortunately we do not have to know why a demonstrably
effective treatment works before using it. By analogy, although
it took decades to discover why penicillin works, it was used in
the meantime because its positive effects were dramatic and
reliable.”
10
EMDR: Hypothesized
Mechanisms (cont.)
•Many hypotheses have been put forth to explain the possible
mechanism of change related to EMDR, but a definitive
explanation has not been confirmed. One theory proposed by
Harvard Medical School sleep researcher Robert Stickgold was
recently published in the Journal of Clinical Psychology (2002)
•He stated:
"Several lines of evidence suggest that EMDR may help in the
treatment of PTSD by turning on memory processing systems
normally activated during Rapid Eye Movement (REM) sleep
but dysfunctional in the PTSD patient. Two separate memory
systems store information in the brain. One, located in the
hippocampus, stores 'episodic' memories, the memories of
actual events in our lives. The second, located in the neocortex,
stores general information and associations.
11
EMDR: Hypothesized
Mechanisms (cont.)
•He proposed that recovery from trauma depends on the processing of
traumatic memories in their episodic form into general semantic
memories. He reviews the literature that suggests that this normally
occurs during REM sleep but is prevented from occurring for people
who have PTSD. In particular the arousal associated with PTSD
results in associations between the trauma event and other
related events failing to develop.
•EMDR through the repetitive redirecting of attention, activates brain
systems normally present during REM sleep. Any alternating,
lateralized stimulation regimen, whether eye movements, tapping, or
binaural sound, could activate these systems by forcing the brain to
constantly reorient to new locations in space. In this manner, EMDR
can 'push-start' the broken-down REM machinery that is required for
the brain to effectively process traumatic memories.”
12
EMDR: Hypothesized Mechanisms
(cont.)
•
Other interesting thoughts about how and why EMDR might work are offered by
Bessel van der Kolk, M.D. of Boston University School of Medicine. I n an
article in the Journal of Anxiety Disorders (1999). Levin, Lazrove and van der
Kolk reported their analysis of brain scans used to measure how brain activity
changes during and after EMDR treatment.
•
During EMDR two areas of the brain had increased activation: the anterior
cingulate gyrus and the left frontal lobe. It is tempting to say that these changes
reflect an increased ability to differentiate between exposure to a real traumatic
event and confrontation with a mere reminder of a shocking event that occurred
many years ago.
•
These brain scans do not tell us how this new treatment works. But they
illustrate how new and unexpected ways can be found to help people overcome
the legacies of their past, and that psychological events can cause changes in
the brain which effective, psychologically based interventions can alter and
reverse.”
13
The Eight Stages of EMDR Treatment
The eight phases of the EMDR protocol represent a
comprehensive treatment approach incorporating many
well-established elements of psychotherapy and the novel
element of bilateral stimulation.
1. Client History and Treatment Planning
2. Client Preparation
3. Assessment
4. Desensitization
5. Installation
6. Body Scan
7. Closure
8. Reevaluation
14
The Core of EMDR Treatment
ASSESSMENT PHASE
Presenting Issue
Picture
Negative Cognition (NC) and Positive Cognition (PC)
Validity of Cognition (VOC)
Emotions/Feelings
Subjective Units of Distress (SUDS)
Location of Body Sensation
DESENSITIZATI0N PHASE
Potential Responses: Pictorial Processing, Cognitive Processing, Emotional
Processing, Sensory Processing
Associative Links and Feeder Memories
Informational Plateaus: Responsibility, Safety, and Choices
INSTALLATI0N PHASE
Integration of Positive Cognition with Targeted Information and VOC Check
15
Examples of Cognition
Negative Cognitions
Positive Cognitions
I am a bad person.
I am a good person.
I am worthless (inadequate).
I am worthy; I am worthwhile.
I am shameful.
I am honorable.
I deserve only bad things.
I deserve good things.
I cannot trust my judgment.
I can trust my judgment.
I cannot succeed.
I can succeed.
I am not in control.
I am now In control.
I am powerless.
I now have choices.
I am weak.
I am strong.
I cannot protect myself.
I can (learn to) take care of myself.
I am stupid.
I have intelligence.
I am Insignificant (unimportant).
I am significant (important).
I am a disappointment.
I am okay just the way I am.
I deserve to die.
I deserve to live.
I deserve to be miserable.
I deserve to be happy.
I cannot get what I want.
I can get what I want.
I am a failure (will fail).
I can succeed.
I have to be perfect (please everyone). I can be myself (make mistakes).
I am permanently damaged.
I am (can be) healthy.
Reprinted with permission of the EMDR Institute, Inc. 16
Childhood Trauma Case Example
Client
A 35-year-old woman reports that she was sexually abused as a child by her
alcoholic father.
•Presenting Problems: Nightmares, flashbacks, avoidance of trauma-related
trigger situations, hypervigilence, guilt, self-hatred, mistrust of others, and a
sense of hopelessness and helplessness.
•Negative Cognitions: It was my fault. I'm bad. I'm always vulnerable and in
danger. I have no control.
•Positive Cognitions: I did the best I could. I'm a good person. It's over. I'm safe
now. I have choices and a reasonable degree of control now.
Assessment Components
•Picture: My father appears at the bedroom door late at night and tells me to
take off my clothes. I'm about 5 years old. He smells of alcohol.
•Negative Cognition: I'm in danger.
•Positive Cognition: I'm safe now.
•VOC=2
•Emotions/Feelings: Fear, sadness, anxiety
•SUDS=8
•Location of Body Sensation: Tension in the neck and shoulders, knots in
stomach, palpitations in chest.
17
Childhood Trauma Case Example (cont.)
TRIGGERS
•Watching a “sexual scene” in a movie
•Smell of alcohol
•Husband expressing desire for intimacy
•Excessive demands from boss
PICTURES
My father at my
bedroom door telling
me to take off my
clothes
EMOTIONS
Fear, sadness, anxiety
Traumatic Memory
Age 5
Sexual Abuse by
Alcoholic Father
SENSATIONS
•Tension in neck and shoulders
•Knots in stomach
•Palpitations in chest
BELIEFS
•It was my fault
•I’m bad
•I am always vulnerable
and in danger
18
•I have no control
Childhood Trauma Case Example (cont.)
Possible Information Processing Shifts Related to Concepts of
Responsibility, Safety, and Choices:
Responsibility:
•Client recognizes that she was an innocent child betrayed by the person who
was supposed to love and protect her.
•She mourns the loss of her "innocence" and expresses anger toward her father
for the first time.
•She experiences a greater sense of compassion for herself and an increased
sense of self-respect as a survivor.
Safety:
•Client experiences a dramatic increase in her distress level as her memories of
abuse are desensitized and reprocessed.
•She recognizes (at a cognitive, affective, and somatic level) that the abuse is
truly over and that her father can no longer hurt her.
19
Childhood Trauma Case Example (cont.)
Possible Information Processing Shifts Related to Concepts of
Responsibility, Safety, and Choices (cont.):
Choices:
•Client begins to acknowledge the choices she has made in her adult
life (establishing boundaries with her family of origin, connections with
supportive people, a commitment to therapy).
•She begins to consider new possibilities for the future.
•She expresses a desire to initiate new friendships and activities and
acknowledges a renewed sense of hope and confidence.
20
Work-Related Case Example
Client
A 40-year-old man who was laid off during the 'downsizing' of his company.
•Presenting Problem: Sleep-onset insomnia, loss of appetite, self-medicating with
alcohol, irritable, worried about the future, "paralyzed" in efforts to seek other work,
fighting with his children and sometimes with his wife.
•Negative Cognitions: I'm not worthwhile enough to retain at my company so they
let me go. I'm worthless.
•Positive Cognition: I have value to offer and can find an organization that
recognizes this about me and is a 'good fit' with my skills and who I am.
Assessment Components
•Picture: The Human Resources Director comes into my cubicle and tells me that I
have 10 minutes to clear out my desk and download my computer files before my exit
interview.
•Negative Cognition: I'm worthless.
•Positive Cognition: I have value.
•VOC=3
•Emotions/Feelings: Irritable, worried
•SUDS=7
•Location of Body Sensation: nausea, tightness in chest, tingling in arms
21
Work-Related Case Example (cont.)
TRIGGERS
•Friends who are still employed calling to ask how things are going
•wife asking how the job search is proceeding
•kids wanting more allowance
PICTURES
The Human Resources
Director comes into my
office and tells me I have
10 minutes to clear out
my desk...
EMOTIONS
Irritable, worried
BEING LAID OFF
AT HIS COMPANY
SENSATIONS
Nausea, tightness in chest, tingling in arms.
BELIEFS
I’m worthless.
22
Work-Related Case Example (cont.)
Possible Information Processing Shifts related to
Concepts of Responsibility, Safety, and Choices:
Responsibility:
•Client considers whether he is at “fault”, for being on the list
for layoffs. Practitioner and client explore client's history of
performance reviews and note that all were average or above
average.
•Client comes to understand that he is not at "fault." He
recognizes that this layoff had more to do with the company's
economic pressures than his worth.
•The client acknowledges that he has performed well, as
evidenced by his written reviews, but nevertheless, he has
been let go.
23
Work-Related Case Example (cont.)
Possible Information Processing Shifts related to
Concepts of Responsibility, Safety, and Choices:
Safety/Survival:
•Client explores the question, "Will I be okay?"
•In assessing his strengths, he arrives at the idea, "I will find
another position because of the skills and work experiences I
have accumulated. And I do have the financial resources to
last 6 months while I search for another position. I can borrow
money from my brother if I have to.”
24
Work-Related Case Example (cont.)
Possible Information Processing Shifts related to
Concepts of Responsibility, Safety, and Choices:
Choices:
•Client at first confronts his fear of "having no choices." He
questions whether he must remain in the same industry and
concludes that he can look at other industries hiring people
with his skill set.
•At this point, he assesses the time and costs needed to
change careers and decides that he will stay in the same line
of work but search within several different industries.
•He feels more encouraged for having arrived at this greater
sense of choice.
25
What is the Research
Indicating the Efficacy of EMDR?
26
Research Demonstrating the Efficacy
of EMDR
EMDR is now accepted by many organizations and agencies for trauma treatment:
•
•
•
•
•
•
The American Psychiatric Association Practice Guideline (2004) gave EMDR the
same status as Cognitive Behavior Therapy as an effective treatment for post
traumatic stress disorder (PTSD).
The U.S. Department of Veterans Affairs and Department of Defense has placed
EMDR in its highest category of therapies recommended for treatment of PTSD
(Clinical Practice Guidelines, 2004).
The Cochrane Database of Systematic Reviews found EMDR effective in the
treatment of PTSD (Psychological Treatment of Post-Traumatic Stress Disorder
(PTSD) (2007).
An American Psychological Association Task Force recognized EMDR as an
empirically valid treatment of civilian PTSD (1998).
The International Society for Traumatic Stress Studies (ISTSS) designates
EMDR as an effective treatment for post traumatic stress (Foa et al., 2009).
Several international health and governmental agencies including the United
Kingdom Department of Health (2001), the Israeli National Council for Mental
Health (2002), the Dutch National Steering Committee Guidelines Mental Health
Care (2003), and the Australian Centre for Posttraumatic Mental Health (2007).
27
Research Demonstrating the Efficacy
of EMDR for Civilian PTSD
•Since the people connected with the APA’s Division 12 Task Force
published its findings that EMDR was a “probably efficacious
treatment” for PTSD, there have been further studies
demonstrating its effectiveness. These include a follow-up report
of an earlier study (Wilson, Becker, & Tinker, 1997) and two other
studies that showed EMDR was superior to an alternative
treatment program (Marcus, Marquis, & Sakai, 1997; Scheck,
Schaeffer, & Gillette, 1998).
•Scheck et al., (1998). 60 women with trauma histories, ages 1625. EMDR was compared to an Active Listening Treatment. After 3
hours of intervention, both groups showed positive outcomes.
Effects were significantly greater for those in the EMDR group.
28
Research Demonstrating the Efficacy
of EMDR for Civilian PTSD (cont.)
•
Marcus, Marquis, & Sakai (1997). 67 adults with PTSD Dx assigned to either
EMDR or Kaiser HMO standard clinical care treatment groups. Treatment
sessions were 50 minutes long. "There was no (overall) set number of EMDR
treatment sessions" (p. 309) or standard care sessions.
•
After the first 3 sessions, 50% of the EMDR treatment subjects no longer met
criteria for PTSD Dx compared with 20% of the Kaiser standard care group
subjects. By post treatment, EMDR-treated subjects utilized significantly fewer
group therapy sessions and medication appointments than the Kaiser standard
care group subjects. EMDR was “more effective for reducing symptoms of
PTSD, co morbid depression, and anxiety” (p.312) than Kaiser standard care.
By the end of their EMDR treatment, 100% of the single trauma subjects and
80% of the multiple trauma subjects no longer met the criteria for PTSD Dx.
•
The projected cost saving was calculated to be $2.8 million annually for the
Northern California Kaiser Region if all Kaiser patients with PTSD DX received
EMDR treatment rather than Kaiser standard care.
29
Research Demonstrating the Efficacy
of EMDR for Civilian PTSD (cont.)
• Even more recently, and subsequent to the
ISTSS 2000 finding, there have been four
studies that directly compared EMDR to
specific CBT PTSD treatment protocols. In
three of these EMDR has been found to be
more efficient than traditional CBT (Ironson,
Freud, Strauss, & Williams, 2002; Lee,
Gavriel, Drummond, Richards, & Greenwald,
2002; Power et al., 2002) but in the forth the
reverse was found (Taylor et al., 2003).
30
Research Demonstrating the Efficacy
of EMDR for Civilian PTSD (cont.)
•
•
These four studies compared EMDR to a prolonged exposure based
treatment program that usually also included some training in coping
skills to help the participant deal with distress. Participant numbers
ranged from 22 to 105. All treatments in these studies were delivered
according to specific procedure manuals, participants were randomly
assigned, and most studies had fidelity ratings showing acceptable
adherence to the protocols. Outcome measures included self-report
and observer-rated measures of PTSD, and often self-report measures
of depression and anxiety.
All the studies found that both types of treatment were effective.
However in 3 of the 4 studies EMDR was found to be more efficient in
that it either required less sessions, or participants improved more
quickly or if the session numbers were the same, the magnitude of the
treatment effects were greater for EMDR at follow-up.
31
Research Demonstrating the Efficacy
of EMDR for Combat-related PTSD
• A controlled investigation shows EMDR is effective with combatrelated PTSD (Carlson, Chemtob, Rusnek, Hedlund, &
Muraoka, 1998). The subjects in this study were multiply
traumatized veterans of the Vietnam war and were outpatients
at a veterans administration facility. The 35 men, ages 41 to 70
were randomly assigned to one of three conditions: a standard
care condition, a relaxation with biofeedback treatment condition
(12 sessions of 40 minutes), or an EMDR condition (12 sessions
of 50-75 minutes).
32
Research Demonstrating the Efficacy of
EMDR for Combat-related PTSD (cont.)
• EMDR- treated subjects improved significantly more than those
in the other two groups on measures of self-reported global
PTSD symptoms and depression. In clinical ratings, seven of
nine EMDR subjects no longer met the criteria for PTSD
diagnosis at post treatment. For subjects in the relaxationbiofeedback group, two of nine subjects no longer met the
criteria for PTSD diagnosis. At nine months follow-up, 75% of
the EMDR subjects retained in the study no longer met the
criteria for PTSD.
33
Research Demonstrating the Efficacy
of EMDR: Meta-analysis of Treatments
for PTSD
•Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005).
EMDR is equivalent to exposure and other cognitive behavioral
treatments. It should be noted that exposure therapy uses one to two
hours of daily homework and EMDR uses none.
•Davidson, P.R., & Parker, K.C.H. (2001). EMDR is equivalent to
exposure and other cognitive behavioral treatments. It should be noted
that exposure therapy uses one to two hours of daily homework and
EMDR uses none.
•Maxfield, L., & Hyer, L.A. (2002). The relationship between efficacy
and methodology in studies investigating EMDR treatment of PTSD. A
comprehensive meta-analysis reported the more rigorous the study, the
larger the effect.
•Van Etten, M., & Taylor, S. (1998). This meta-analysis determined that
EMDR and behavior therapy were superior to psycho-pharmaceuticals.
EMDR was more efficient than behavior therapy, with results obtained in
one-third the time.
34
Are the Eye Movements Critical to the
Efficacy of EMDR?
•
To provide a conclusive answer to this question, more research is
needed in the form of methodologically sound investigations that
address the flawed methodology of the studies conducted so far.
•
To date, attempts to test the importance of the eye movements have
yielded mixed results. Studies have looked at the effect of eye
movements on emotional memory processing. Some studies found
that eye movements seem to lead to less distress and a greater sense
of distance to a negative emotional memory (van den Hout, et al., 2001;
Kavanagh et al., 2001). However when an EMDR protocols using a
fixed gaze has been compared to the same protocol using eye
movements, the results have been mixed.
•
Methodological issues in these studies make it difficult to determine the
extent to which eye movements adds to EMDR’s effectiveness.
35
Are the Eye Movements Critical to the
Efficacy of EMDR? (cont.)
•
Again, to provide a conclusive answer to the above question, methodologically
sound dismantling studies must be conducted, in contrast to those less well
designed studies with outcomes indicating that the eye movements make no
difference.
•
To ensure a fair and adequate test of the EMDR method, the entire EMDR
protocol must be used, with all eight phases of the treatment made available to
all subjects.
•
Treatment should be administered by practitioners fully trained in the EMDR
method.
•
The overall design of each study should be empirically sound - with random
assignment of subjects, control of treatment order effects, and the use of
measures that are powerful enough to detect treatment effects for the number
of participants in the study.
36
EMDR Research/
Panic Disorder or Phobias
•Feske & Goldstein (1994). 7 subjects with panic disorder,
of whom 5 also had a Dx for agoraphobia. All received 5
EMDR sessions lasting 90 minutes. At post treatment, all
reported fewer panic attacks, reduced anxiety, and
improvement in depressed mood.
•Two recent studies show EMDR's efficacy with choking
phobias (De Jongh, & ten Broeke, 1999) and with simple
phobias (De Jongh, ten Broeke, & Renssen,1999). A
1993 study showed EMDR’s efficacy with blood and
injection phobias (Kleinknecht, 1993).
37
Other EMDR Research
PUBLISHED STUDIES SUPPORTING EMDR'S EFFECTIVENESS
IN TREATING OTHER PROBLEMS:
•Symptoms arising after a natural catastrophe (Grainger, Levin, AllenByrd, Doctor, & Lee, 1997)
•Body dysmorphic disorder (Brown, McGoldrick, & Buchanan, 1997)
•Anxiety about body image specific to congenital anomaly and
disability (Hassard, 1993)
•PTSD following accidents, surgery, or severe burns, (Blore,
1997;McCann, 1992; Puk, 1992; Solomon & Kaufman, 2002)
•Traumatic memories (childhood sexual abuse, loss of sibling) (Puk,
1991)
•Trauma in children, conduct disorders (Greenwald, 2002; Puffer,
Greenwald, & Elrod, 1998)
•Phobic symptoms in a subject with multiple personality (Young,
1994)
•Restoring performance at work after setbacks (Foster & Lendl, 1996)
•Test Anxiety (Mayfield & Melnyk, 2000)
•Crisis Intervention (Solomon, 1998)
38
Optional slide selected reference details
Carlson, J.G., Chemtob, C.M., Rusnak, K., Hedlund, N.L., & Muraoka, M.Y.(1998). Eye movement desensitization and reprocessing
(EMDR) treatment for combat-related posttraumatic stress disorder. Journal of Traumatic Stress, 11(1), 3-24.
Chambless, D.L., Baker, M.J., Baucom, D.H., Beutler, L.E., Calhoun, K.S.,Crits-Christoph, P., Daiuto, A., DeRubeis, R., Detweiler,
J., Haaga, D.A.F.,Johnson, S.B., McCurry, S., Mueser, K.T., Pope, K.S., Sanderson, W.C.,Shoham, V., Stickle, T., Williams, D.A., &
Woody, S.R. (1998). Update on empirically validated treatments II. The Clinical Psychologist, 51(1), 3-16.
Chemtob, C.M., Nakashima, J., & Carlson, J.G. (2001). Brief treatment for elementary school children with disaster-related PTSD:
A field study. Journal of Clinical Psychology 51 (1), 99-112.
Chemtob, C. M., D. F. Tolin, B. A. van der Kolk and R. K. Pitman (2000). Eye movement desensitization and reprocessing. In E.
B. Foa and T. M. Keane (Eds). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic
Stress Studies. New York, NY, US, The Guilford Press: 333-335.
De Jongh, A., & ten Broeke, E. & Renssen, M.R. (1999). Treatment of specific phobias with eye movement desensitization and
reprocessing (EMDR): Research, protocol, and application. Journal of Anxiety Disorders, 13, 69-85.
Ironson, G., B. Freud, J. L. Strauss and J. Williams (2002). Comparison for two treatments for traumatic stress: A community-based
study of EMDR and prolonged exposure.Journal of Clinical Psychology, 58, 113-128.
Korn, D. L., & Leeds, A. M. (2002). Preliminary Evidence of Efficacy for EMDR Resource Development and Installation in the
Stabilization Phase of Treatment of Complex Posttraumatic Stress Disorder.
Journal of Clinical Psychology, 58, 1465-1487.
Lee, C., H. Gavriel, P. Drummond, J. Richards and R. Greenwald (2002). Treatment of PTSD: Stress inoculation training with
prolonged exposure compared to EMDR.Journal of Clinical Psychology, 58(9), 1071-1089.
Marcus, S.V., Marquis, P., & Sakai, C. (1997). Controlled study of treatment of PTSD using EMDR in an HMO setting.
Psychotherapy, 34(4), 307-315.
Power, K. G., T. McGoldrick, K. Brown, R. Buchanan, D. Sharp, V. Swanson and A. Karatzias (2002). A controlled comparison of
eye movement desensitisation and reprocessing versus exposure plus cognitive restructuring, versus waiting list in the treatment of
posttraumatic stress disorder. Journal of Clinical Psychology and Psychotherapy, 9(5): 299-318.
Scheck, M.M., Schaeffer, J.A., & Gillette, C.S. (1998). Brief psychological intervention with traumatized young women: The efficacy
of eye movement desensitization and reprocessing. Journal of Traumatic Stress, 11, 25-44.
Wilson, S.A., Becker, L.A., & Tinker, R.H. (1997). Fifteen-month follow-up of eye movement desensitization and reprocessing
(EMDR) treatment for posttraumatic stress disorder and psychological trauma. Journal of Consulting and Clinical Psychology,
65(6), 1047-1056.
39