Is eye movement important with eyes-closed EMDR therapy?

Is eye movement important with eyes-closed EMDR therapy?

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Original EMDR therapy involved a subject with open eyes tracking a target that moves side to side.

It is now common for EMDR to use devices like electronic "tappers" to alternately stimulate the left and right sides of the subject's body, leaving the subject free to close his eyes and engage in visualizations related to the trauma being treated.

In general, during wakeful visualizations with my eyes closed I often move my eyes in a manner similar to REM sleep. I have tried a few sessions of EMDR and found it to be uncannily effective. During closed-eye EMDR I sometimes find myself engaging in REM based on my visualizations, and other times find my eyes moving side to side in synchrony with the "tappers."

My question: Are there any studies or theories that suggest eye movement in closed-eye EMDR is relevant to the efficacy of the therapy? E.g., does it matter whether the closed eyes move side to side if there is some other bilateral stimulation?

The state of the art in EMDR research (if not yet in practice) supports a "working memory" (WM) explanation of the therapy that does not support earlier "bilateral stimulation" hypotheses of the method. A particularly salient summary from M.A. van den Hout et al. in Behaviour Research and Therapy 49 (2011) p.93:

Traditionally, during EMDR, eyes are moved horizontally. In line with the WM account, but in contrast to original explanations, moving eyes vertically is equally effective (Gunter & Bodner, 2008). Crucially, the same effects occur if WM is taxed during recall with non-eye-movement secondary tasks, like listening to a series of non-words (auditory shadowing; Gunter & Bodner, 2008), drawing a complex figure (Gunter & Bodner, 2008), or counting (Engelhard, van den Hout, & Smeets, 2011; van den Hout et al., 2010; Kemps & Tiggemann, 2007). Tasks that are presumably hardly taxing, like simple finger tapping, do not have beneficial effects (van den Hout et al., 2001), while more complex tapping does (Andrade et al., 1997). Likewise, activating memories about a previously seen trauma film while playing taxing computer game reduced flashbacks in the week afterwards (Holmes, James, Coode-Bate, & Deeprose, 2009).

This was backed up by correspondence with one of the authors who confirmed that in all their research protocols going back to at least 2000 research subjects must keep their eyes open so the researchers can confirm compliance. They have no evidence this reduces the effectiveness. In fact, the WM model suggests this should improve the effectiveness of the therapy vs. allowing subjects to close their eyes.

What is EMDR?

EMDR stands for Eye Movement Desensitization and Reprocessing. It is a procedure used in psychological therapy to help you reduce the impact of experiences from the past that intrude on your present-day life. Often, these experiences from the past involve a ‘Big T’ trauma such as assault, abuse, an accident, or a natural disaster or a ‘Little t’ trauma such as losing your job, getting a divorce, moving cities. Even though the trauma may have happened many months or even years ago, you still feel its impact in your daily life through posttraumatic symptoms including intrusive memories, flashbacks, reliving, emotional flooding or numbing, nightmares, anxiety, low self-esteem, feeling cutoff from others, being hypervigilant or easily startled, and difficulty getting on with your life.

EMDR has also been used to help people deal with anxiety and panic problems, grief issues, reactions to physical illness, attachment wounds and many other conditions where strong emotions are associated with life experiences.

There are more published studies on EMDR than any other treatment for resolving the effects of trauma. A summary of these studies may be found on the Internet at .

In daily life, we use our minds to make sense of ourselves, others and the world around us, to cope with predictable stresses, and regulate our emotions and self-esteem. The experience of trauma overwhelms our capacity to cope, and the trauma experience can get stored in our minds in ways that make it very difficult to use our usual ways of coping. For example, even though we know that a traumatic event happened in the past, it becomes impossible for us to think about it without starting to feel emotions and other sensations that occurred at the time of the original experience.

We also typically develop a negative way of thinking about ourselves in relation to trauma, such as “It’s my fault” or “I’m a bad person.” These negative thoughts often influence how we think and feel about ourselves in other situations. EMDR attempts to activate your coping skills to deal with the present-day impact of the trauma. The EMDR procedure can help desensitize the images and feelings associated with the trauma. It can help you to recognize and work on feelings and thoughts that come up with the trauma. And it can help you think differently about yourself others and the world in relation to the trauma.

I will talk with you about yourself in an effort to understand the history of your difficulties and how they are affecting your current life. This may take one or two sessions. If EMDR is recommended, I will explain the procedure. If you decide to go ahead with it, I will construct a description of your problem that includes: an image or picture that represents the past event, your current beliefs about yourself in relationship to the event, how you would prefer to think about yourself in relation to the event (positive belief), your emotions associated with the event, and your physical sensations associated with the event. You will also be asked to give numerical ratings to your degree of upset and the credibility of the positive belief so that your progress can be monitored during the session.

After the protocol described above is established, you will begin the processing phase of the procedure using the eye movements (or other kinds of bilateral attentional stimulation, if eye movements are not appropriate in your case). A typical EMDR processing session lasts up to 90 minutes. During this part of the treatment I will be sitting beside and facing you or you will be looking at an image of a dot on the computer screen. I will ask you to bring to mind the picture of the experience that is bothering you along with the negative self-thought, the emotions, and the physical sensations. You will be asked to hold this in mind as best you can while following with your eyes my fingers or the image of the dot on the computer screen, which are moving back and forth. I will not give you suggestions or talk to you much during the set of eye movements. After a series of roughly 30-50 eye movements (or more), I will ask you to stop, let go of the image (or thought) for a second, take a deep breath and then notice and describe briefly what thoughts, feelings, sensations or images arise for you. Usually, I will ask you to go on with those thoughts, feelings, sensations and images and will do another set of eye movements.

You will go through this process of moving your eves, pausing, and reflecting several times during the session. Typically, the images, emotions, and sensations you experience change as you go through this process. Assuming that your thoughts, feelings, images, and physical sensations become less distressing, I will ask you to bring up a positive self statement and will use EMDR to help you begin to associate this new way of thinking about yourself with the original troubling image. If your level of upset continues to be high toward the end of the session I will work with you to help you to calm down and prepare you to continue your work at your next session.

We will often know if EMDR is going to be useful to you in one or two sessions. It’s hard to predict, in general, how long EMDR treatment will take. You may experience sufficient relief from your symptoms in as few as two to six sessions or EMDR may be a procedure that you and I use as part of a longer-term therapy process for several months to deal with certain problems and issues.

EMDR processing can be upsetting. There are many safety procedures built into the EMDR process, but it can still be an intense experience for a brief time. The aim of each EMDR session is to help you feel less upset at the end of the session. But sometimes it’s hard to work through a difficult issue even in a 90-minute session. If staying upset or becoming upset after a session becomes a pattern for you, you should tell me that this is happening. In EMDR, you might remember events or parts of events you either hadn’t thought about before or hadn’t associated with the problem being worked on. Memories coming up in EMDR are no more or less accurate than any other memories that our mind constructs when reflecting on the past. Regardless of the absolute truth of the memories that emerge, they usually bring up important psychological issues that can be processed in EMDR.

[EMDR as a psychotherapeutic approach in the treatment of chronic pain : Is Eye Movement Desensitization and Reprocessing an effective therapy for patients with chronic pain who do not suffer from posttraumatic stress disorder?]

The efficacy of Eye Movement Desensitization and Reprocessing (EMDR) has been demonstrated for posttraumatic stress disorder. Despite promising research, it is still not clear if EMDR is a similarly effective treatment for chronic pain. Controlled trials are lacking and whether specific mechanisms underlie the effects remains unknown. The treatment of chronic pain aims at a reduction of subjective pain sensations. To achieve this goal without the usage of pain medications, i. e. through psychotherapy, is desirable for many reasons (e. g. reduction of treatment costs and side effects). Whether or not EMDR is an effective intervention for all chronic pain patients (or just a specific subgroup) constitutes an important question for psychological pain research.

Keywords: Chronic pain Eye Movement Desensitization and Reprocessing (EMDR) Posttraumatic stress disorder (PTSD) Psychotherapy Specificity.

The Role of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in Medicine: Addressing the Psychological and Physical Symptoms Stemming from Adverse Life Experiences

A substantial body of research shows that adverse life experiences contribute to both psychological and biomedical pathology. Eye movement desensitization and reprocessing (EMDR) therapy is an empirically validated treatment for trauma, including such negative life experiences as commonly present in medical practice. The positive therapeutic outcomes rapidly achieved without homework or detailed description of the disturbing event offer the medical community an efficient treatment approach with a wide range of applications.


All randomized studies and significant clinical reports related to EMDR therapy for treating the experiential basis of both psychological and somatic disorders are reviewed. Also reviewed are the recent studies evaluating the eye movement component of the therapy, which has been posited to contribute to the rapid improvement attributable to EMDR treatment.


Twenty-four randomized controlled trials support the positive effects of EMDR therapy in the treatment of emotional trauma and other adverse life experiences relevant to clinical practice. Seven of 10 studies reported EMDR therapy to be more rapid and/or more effective than trauma-focused cognitive behavioral therapy. Twelve randomized studies of the eye movement component noted rapid decreases in negative emotions and/or vividness of disturbing images, with an additional 8 reporting a variety of other memory effects. Numerous other evaluations document that EMDR therapy provides relief from a variety of somatic complaints.


EMDR therapy provides physicians and other clinicians with an efficient approach to address psychological and physiologic symptoms stemming from adverse life experiences. Clinicians should therefore evaluate patients for experiential contributors to clinical manifestations.

Dual Attention Stimuli

During phases 4 through 6 of EMDR 1 [see A Brief Description of EMDR for more information on the eight phases of EMDR] clients focus on their distressing or desired experiences at the same time as they attend to a dual attention stimulus. Eye movements are the most commonly used dual attention stimulus, but tapping, tactile stimulation, and auditory tones are also used 2 . These are usually presented in an alternating bilateral fashion – e.g., first to one ear, then the other, then the first ear, etc.

It is thought that the dual attention component of EMDR facilitates information processing but, as with all forms of psychotherapy, the underlying neurobiological reason for these effects are unknown although a variety of neurobiologists have proposed mechanisms of action. 3,4,5 Currently there is research support for working memory theories and the orienting response. A number of studies have indicated that the eye movement reduce emotional distress and memory vividness or enhance recall. 6,7,8,9,10,11,12

For more information, see the following topics in the Commonly Asked Questions section:

  • Are eye movements considered essential to EMDR?
  • What has research determined about EMDR's eye movement component?
  • Do eye movements contribute to outcome in EMDR?
  • What are some hypothesized mechanisms of action for eye movements in EMDR?

1 Shapiro, F., (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures (2nd edition). New York: Guilford Press

2 Shapiro, F., (1991). Eye movement desensitization & reprocessing procedure: From EMD to EMDR--a new treatment model for anxiety and related traumata. Behavior Therapist, 14, 133-135.

3 Siegel, D. J., (2002). The developing mind and the resolution of trauma: Some ideas about information processing and an interpersonal neurobiology of psychotherapy. In F. Shapiro [Ed.]. EMDR as an Iintegrative Psychotherapy Approach Experts of diverse orientations explore the paradigm prism. Washington, D.C.: American Psychological Association Books.

4 Stickgold, R. (2002). EMDR: A putative neurobiological mechanism of action. Journal of Clinical Psychology, 58, 61-75.

5 van der Kolk, B. A. (2002). Beyond the talking cure: Somatic experience and subcortical imprints in the treatment of trauma. In F. Shapiro (Ed.), EMDR as an Integrative Psychotherapy Approach: Experts of Diverse Orientations Explore the Paradigm Prism. Washington, DC: American Psychological Association Books.

6 Andrade, J., Kavanaugh, D., & Baddeley, A. (1997). Eye-movements and visual imagery: a working memory approach to the treatment of post-traumatic stress disorder. British Journal of Clinical Psychology, 36, 209-233.

7 Barrowcliff, A.L., Gray., N.S., MacCulloch, S., Freeman, T.C.A., & MacCulloch, M.J. (in press). Horizontal rhythmical eye-movements consistently diminish the arousal provoked by auditory stimuli. British Journal of Clinical Psychology.

8 Christman, S.D., Garvey, K.J., Propper, R.E., & Phaneuf, K.A. (in press). Bilateral eye movements enhance the retrieval of episodic memories. Neuropsychology.

9 Kavanagh, D.J., Freese, S., Andrade, J., May, J. (2001). Effects of visuospatial tasks on desensitization to emotive memories. British Journal of Clinical Psychology, 40, 267-280.

10 Kuiken, D., Bears, M., Miall, D., & Smith, L. (2001-2002). Eye movement desensitization reprocessing facilitates attentional orienting. Imagination, Cognition and Personality, 21, (1), 3-20.

11 Sharpley, C.F., Montgomery, I.M., & Scalzo, L.A. (1996). Comparative efficacy of EMDR and alternative procedures in reducing the vividness of mental images. Scandinavian Journal of Behaviour Threapy, 25, 37-42.

12 van den Jout, M., Muris, P., Salemink, E., & Kindt, M. (2001). Autobiographical memories become less vivid and emotional after eye movements. British Journal of Clinical Psychology, 40, 121-130

EMDR Therapists Understand Trauma

Eye movement desensitization reprocessing (EMDR) therapy is a technique that can help people recover from trauma. It's incredibly useful in treating trauma and post-traumatic stress disorder (PTSD). During EMDR therapy sessions, the therapist will help a client release traumatic experiences using eye movements. It will trigger the client in brief sessions, or &ldquobites," as they recall their traumatic events. The therapy allows them to do so while alleviating the emotional distress they experienced before. It works because the client is distracted by the therapist using their hands to guide the patient's eyes in different directions. This method allows the patient to be exposed to traumatic memories without experiencing a strong reaction because they're distracted by their vision being drawn in different directions. As a result, it lessens the impact that the trauma has on an individual.

Eye movement desensitization was developed by American psychologist, Francine Shapiro.

Francine Shapiro has become a worldwide speaker on EMDR and has co-authored many articles and books on the subject. She&rsquos also won many outstanding awards for her development of EMDR, which include the International Sigmund Freud Award, the American Psychological Association Trauma Division Award for Outstanding Contributions to Practice in Trauma Psychology, and the Distinguished Scientific Achievement in Psychology Award by the California Psychology Association. Francine Shapiro is still today very active in many organizations, facilitating and teaching the use of EMDR, as well as helping in further research for EMDR and treatment for PTSD.

EMDR has been researched thus far so well that it is being used as a very effective treatment for those who struggle with post traumatic stress disorder in particular. However, anyone who has had traumatic events in their life, whether or not they struggle from post traumatic stress, may benefit greatly from this form of trauma therapy.

EMDR can also be described as a form of exposure therapy. By having the client describe a traumatic event and even imagine the event during the EMDR session, the client then is face-to-face with the memories of the trauma, and they may even experience physical sensations brought on by the nervous system that are related to the trauma.

Eye movement desensitization is also considered to be reprocessing therapy. According to the International EMDR Institute, it helps the client to reprocess their thoughts around traumatic events. Afterward, the way that they frame the event may have changed, and the ways that they react to triggering stimuli may lessen.

What To Expect

EMDR sessions can last anywhere from 60-90 minutes. The therapist moves their fingers in front of a client's face, and the client follows the therapist's movements with their eyes as they recall a traumatic incident. They think about the physical feelings that go along with this trauma as they follow the fingers of their therapist. In an EMDR session, your therapist will guide you on a meditation of a certain kind. You'll start by thinking about the traumatic event, but it'll lead down to various memories. Some therapists might use tapping as a technique in EMDR, and they might also use music as an alternative. EMDR therapy exists in eight phases. The bilateral stimulation or eye movements are part of the first session, and after that first session, the clinician decides what to target next.

Francine Shapiro discovered EMDR as a Harvard researcher at the time. She was investigating rapid eye movement and sleep. They noticed that sensations and disturbing memories would occur during rapid eye movement. When EMDR works, the painful memories become less and less as the patient works through them by following the therapist's fingers with their eyes. Someone could come in for their initial session entirely frightened of being assaulted and might feel extreme guilt, shame, and fear. After treatment, they learn to accept that the event happened and don't experience as many symptoms after they've been strengthened and empowered through EMDR therapy. The wounds of trauma never heal, but they get less and less over time. Clients can work through traumatic events once the memories have less power over them. They're able to process these memories, sit with them, and move through them.

Phases Of EMDR Treatment

EMDR focuses on three different periods in time: the past, the present, and the future. The first part of treatment focuses on the past, and it helps the client to bring up their memories in treatment. In phase one, the therapist takes a patient's history and talks about their memories. They emphasize one particular memory to work on. Sometimes, an EMDR therapist will focus on a client&rsquos childhood first and then move into adulthood, depending on the trauma that the individual experienced. In phase two of EMDR treatment, the therapist helps their client deal with handling the emotional distress that they feel during the memories. The client will experience uncomfortable imagery and will work on staying grounded as they sit with the imagery and thoughts that arise. In phases 3-6, there's a target that the client and therapist agree on, and three things happen: there's a visual image that relates to the memory, a negative image of the person's self, and the body of the image that corresponds to that belief. After that, the therapist asks a client to relay a positive feeling about themselves to override the negative thinking, but the client will first focus on the negative thoughts that they have about themselves.

As they focus on these thoughts, they also have bilateral stimulation, meaning that they're watching the therapist's fingers move back and forth. After the stimulus happens, a client tells the therapist what they saw and what came up for them during the stimulation. The therapist will then interpret the images that came up for the client and what that imagery or those memories mean. In phase seven of EMDR therapy, the therapist asks a client to keep track of what happens during their week and express how or if they're able to use exercises to calm themselves down. In phase eight, the therapist and the client examine the events that have happened in the past that causes the client distress and how the client can respond in the future. In terms of how long the treatment takes, it depends on the individual and how distressed they are by their memories when they enter treatment as well as their trajectory as they progress. Like most other forms of therapy, the overall length of treatment will vary from person to person.

The Phases of EMDR

There are many phases of EMDR therapy.

The first phase of EMDR is the phase that involves treatment planning. During the treatment planning phase, a certified EMDR therapist will request information about the client&rsquos history. This helps the therapist to develop a treatment plan for the client and understand where to begin their focus. Trauma treatment may begin at varying levels, depending on the individual and the person&rsquos past experiences.

The second phase is the preparation phase. This is where the client and the therapist begin their therapeutic relationship and set expectations for the treatment plan. The therapist teaches the client how to maintain stability in between and during the sessions, as well as certain signals for stopping the treatment if it gets too intense.

The third phase is the assessment phase, where the therapist and client focus on the first target memory. The client is guided to focus on the details of this memory that stand out, imagining visuals and beliefs that have become associated with it. The therapist will ask the client to envision positive things about the incident too, such as what they have learned, etc.

In the fourth phase, the target event that was brought up in the third phase is evaluated and looked at deeper. This phase is called the desensitization phase. In this phase, the trauma-related sensations and sensory experiences begin to transform, and the client may begin to experience a brighter sense of self efficacy and insight. This is the phase where the client will focus on the event and the eye movement simultaneously.

The fifth phase is the installation phase, where the therapist will bring in positive cognition, which is aimed at replacing the negative cognition. The EMDR therapist measures the progress of this phase through the VOC, which is labeled successful if it reaches 7. Until then, both experiences, the positive and negative, are paired together. The goal is to get the positive to reach a higher score.

The sixth phase is the body scan phase. During the body scan phase, the client is asked if there is any physical sensation left from the trauma, felt anywhere in the body still. If there is, the therapist will target the specific body sensation and help to calm the nervous system.

The seventh phase is closure. The closure state helps bring the person back into equilibrium, and anything that has not been reprocessed can be helped with the control techniques taught earlier on. The therapist explains to the client what to expect in between sessions and and to keep track of any disturbances that happen.

The eighth phase is reevaluation. This phase is for review and to see how the treatment plan has worked. Reevaluation also helps the therapist and client develop a further treatment plan if needed. The therapist will check back in with the client about additional targets.

When a person is in EMDR therapy, they will be visualizing traumatic events. The therapist will tell them to focus on particular traumatic events and zero in on one moment that impacted them. They will imagine those moments as the therapist takes their two fingers and move them back-and-forth. Then they will close their eyes and report to the therapist what they see. The images that they envision may not make sense to them. They may seem strange or unrelated to the trauma. But they are related because the person is articulating what is in their memory bank. They are following the traumatic events and everything related to it. Their unconscious forces at work, and that's why trauma is so sneaky. It lives inside a person's brain and makes a home for itself. So the person will talk to their therapist about what they see with their eyes closed and try to stay in the moment. No image is wrong. During the visualization process, the person may feel anxious, and their heart might race. That's when their therapist will tell them to go to a safe place in their mind. They might imagine their partner holding them, or being with one of their children. A safe place can bring a person back from feeling in a state of fight-or-flight to a state of grounding.

Internal Family Systems And EMDR

There is an exercise in internal family systems therapy that is related to EMDR. It involves the therapist telling the client to imagine themselves as a child. They envision sitting with the younger version of themselves and talking to them. The client will ask the child what they need from them. It's the client's turn to give the younger version of themselves what they need emotionally. We are all broken in some way inside and during EMDR therapy you have the chance to address the pieces of yourself that need healing. And the inner child work is a powerful way to connect with yourself and be reunited with that part. Healing does come from within, and it's important to remember that there are times during this exercise that will be painful. As you begin to address your pain, you will start to feel less sadness or anxiety due to the trauma you experienced. Eventually, you'll feel more whole and one with yourself.

How Effective Is EMDR?

Many people have said that EMDR is effective in treating PTSD. The Department of Veterans Affairs strongly encourages and recommends this form of treatment for PTSD. A recent study of 30 veterans found EMDR was 100% effective in treating PTSD. In that study, the test group&rsquos delusions, anxiety, and depression all improved after moving through EMDR therapy. EMDR is shown to be effective long-term, and it has been looked at in numerous studies. What&rsquos more, increasing evidence shows that it is just as effective via online therapy. As a result, it is becoming more and more accessible.

Seeking Help For Trauma In Therapy

Trauma has a way of holding people back. But you don't have to let that happen. EMDR is one of the most effective forms of therapy for trauma. Via online counseling, it is available whenever it works for you. It's time to seek the help of mental health professionals who can help you through these painful memories. Whether you're looking for EMDR specifically or another method of therapy to treat trauma, it's imperative to find help for your experiences. There are mental health providers out there that care and can help you move through your trauma. You can work with a therapist online here at BetterHelp. Read what others have to say about their experiences below.

&ldquoTasha has been extremely helpful to me! She listens to my concerns, and has given me a variety of tools to work with to make progress. I am particularly pleased with the EMDR therapy.&rdquo

&ldquoScott Van Camp is an amazing listener, and I mean he takes time to really understand what you are going through, and asks questions to allow you to think for yourself. His skill in EMDR therapy has transformed my life, and has led to so much inner healing. I highly recommend Scott!&rdquo

What is the Role of Eye Movements in Eye Movement Desensitization and Reprocessing (EMDR) for Post-Traumatic Stress Disorder (PTSD)? A Review

Background: Controversy continues to exist regarding how EMDR works and whether its mechanisms differ from those at work in standard exposure techniques. Aims: To investigate first whether eye movement bilateral stimulation is an essential component of EMDR and, second, the current status of its theoretical basis. Method: A systematic search for relevant articles was conducted in databases using standard methodology. Results: Clinical research evidence is contradictory as to how essential EMs are in PTSD treatment. More positive support is provided by analogue studies. With regards to potential theoretical support, some evidence was found suggesting bilateral stimulation first increases access to episodic memories and second that it could act on components of working memory which makes focusing on the traumatic memories less unpleasant and thereby improves access to these memories. Conclusions: The results suggest support for the contention that EMs are essential to this therapy and that a theoretical rationale exists for their use. Choice of EMDR over trauma-focused CBT should therefore remain a matter of patient choice and clinician expertise it is suggested, however, that EMs may be more effective at reducing distress, and thereby allow other components of treatment to take place.

Therapy for Trauma and PTSD

When someone experiences trauma and develops trauma-related symptoms, they may assume a negative belief of self, which can lead to depression, anxiety, confusion, poor concentration and difficulty in maintaining positive relationships. Sometimes, reaction to the trauma can include invasive thoughts or flashbacks, disturbed sleep, exaggerated response to reminders and suicidal thoughts. Trauma can affect how the brain manages day to day events. We use a compassionate approach that addresses all aspects of a person’s life, and incorporate the most current treatments for healing, including, techniques for treating dissociative disorders, as well as CBT, Exposure Therapy, and Supportive Therapy. Some therapists also use EMDR Therapy (see here for more information on EMDR).

What to Expect

Comprehensive diagnostic assessment

Evaluation of symptoms to find the best form or blend of treatments. The type of trauma does matter and requires special focus. We may use EMDR and/or other interventions.

Support of adaptive coping skills and learning new strategies

Coordinated work with other professionals such as social workers, physicians, schools, when appropriate

Learning about trauma, understanding the experiences, and finding techniques to support healing

EMDR must be administered by a trained and certified practitioner to reduce the potential for side effects.

Potential side effects include vivid dreams or nightmares after a session, since the mind may continue processing the information during the REM stage of sleep (Parnell, 2013). Clients should be warned of the possibility of vivid dreams.

Other potential dangers include emotional distress during a session when the client is re-experiencing the traumatic event (Taylor et al., 2003).

Some emotional distress is expected in similar types of exposure therapy, and the distress is usually short lived. During an EMDR session, a client may feel temporarily worse, but a skilled practitioner will be able to use the installed safety protocols to avoid overwhelming distress in the client.

EMDR sessions tend to be twice as long as traditional therapy sessions so that a client has time to fully process a memory during one session (Shapiro, 2002). A client should leave each session feeling more empowered and calmer than they initially felt.

Trauma-focused cognitive behavioral therapy or eye movement desensitization and reprocessing: what works in children with posttraumatic stress symptoms? A randomized controlled trial

To prevent adverse long-term effects, children who suffer from posttraumatic stress symptoms (PTSS) need treatment. Trauma-focused cognitive behavioral therapy (TF-CBT) is an established treatment for children with PTSS. However, alternatives are important for non-responders or if TF-CBT trained therapists are unavailable. Eye movement desensitization and reprocessing (EMDR) is a promising treatment for which sound comparative evidence is lacking. The current randomized controlled trial investigates the effectiveness and efficiency of both treatments. Forty-eight children (8-18 years) were randomly assigned to eight sessions of TF-CBT or EMDR. The primary outcome was PTSS as measured with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). Secondary outcomes included parental report of child PTSD diagnosis status and questionnaires on comorbid problems. The Children's Revised Impact of Event Scale was administered during the course of treatment. TF-CBT and EMDR showed large reductions from pre- to post-treatment on the CAPS-CA (-20.2 95% CI -12.2 to -28.1 and -20.9 95% CI -32.7 to -9.1). The difference in reduction was small and not statistically significant (mean difference of 0.69, 95% CI -13.4 to 14.8). Treatment duration was not significantly shorter for EMDR (p = 0.09). Mixed model analysis of monitored PTSS during treatment showed a significant effect for time (p < 0.001) but not for treatment (p = 0.44) or the interaction of time by treatment (p = 0.74). Parents of children treated with TF-CBT reported a significant reduction of comorbid depressive and hyperactive symptoms. TF-CBT and EMDR are effective and efficient in reducing PTSS in children.


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  4. Dait

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