Eye Movement Therapy Offers Faster Recovery From PTSD

Deborah Brauser

March 13, 2012

March 13, 2012 — Eye movement desensitization and reprocessing (EMDR) therapy may offer an effective option for treating post-traumatic stress disorder (PTSD) that is more rapid than cognitive behavioral therapy (CBT), new research suggests.

In a randomized controlled trial with almost 150 outpatients with PTSD, both those who received EMDR and those who received a form of trauma-focused CBT known as brief eclectic psychotherapy had reductions in symptom severity. However, the EMDR-treated group also showed a significantly faster recovery.

"As far as I am aware, this is the first study that directly compares [these] treatments with sufficiently large numbers," lead author Mirjam J. Nijdam, MSc, postdoctorate researcher/psychologist at the Center for Anxiety Disorders at the Academic Medical Center at the University of Amsterdam, the Netherlands, told Medscape Medical News.

"It has long been claimed that EMDR leads to fast symptom reduction, and the fact that we were able to find that was a confirmation of what many clinicians already thought. It was also interesting to see that both treatments led to the same results, even though they reached this result by means of different trajectories," said Nijdam.

The study is published in the March issue of the British Journal of Psychiatry.

Seeking "Best Clinical Option"

The researchers report that brief eclectic psychotherapy was originally developed in the Netherlands in accordance with guidelines from the National Institute for Health and Clinical Excellence (NICE).

"Although it includes some elements of other therapeutic schools, its main treatment components overlap with those of other trauma-focused CBT interventions," they write.

It consists of 2 phases and focuses on psycho-education, imaginal exposure, cognitive restructuring (including elements of grief therapy), written assignments, and a farewell ritual.

"The aim is to relive the whole traumatic event in detail — in parts, over several sessions," explain the investigators.

In EMDR, a patient is asked to focus on the most distressing images from their traumatic event, which were identified and processed earlier.

"Current distress is rated every 5 to 10 minutes, until the distress level is 0 or 1, after which a more positive cognition is introduced in relation to the target image," write the researchers.

The process is repeated until the trauma memory is rated as neutral. At that time, the procedure is terminated.

Nijdam noted that she has worked with patients with PTSD since 2003.

"From the beginning, it was very important for me that they would be offered the best clinical care possible. I have a passion for combining clinical work with research that has a direct relevance for clinical practice," she said.

Faster Recovery

For this study, 140 civilian PTSD outpatients from the Center for Psychological Trauma in Amsterdam were randomly assigned to undergo weekly 90-minute EMDR sessions (n = 70; 51.4% women; mean age, 38.3 years) or weekly 45- to 60-minute sessions of brief eclectic psychotherapy (n = 70; 61.4% women; mean age, 37.3 years). Trial duration was 17 weeks.

At each treatment session, the participants used the Impact of Event Scale–Revised (IES-R) to self-report PTSD symptoms.

Secondary outcome measures included clinician-rated PTSD, as shown by the Structured Interview for PTSD (SI-PTSD), and general anxiety and depressive symptoms, as assessed using the Hospital Anxiety and Depression Scale (HADS).

Study inclusion criteria included experiencing a single traumatic event in the past. Of all participants, 55.7% experienced an assault of some type, 17.1% experienced an accident, and 10% experienced a sexual assault. A disaster, a war-related trauma, or other trauma was each experienced by 5.7% of the study population.

Results showed large effect sizes on the IES-R from baseline to end of the study for both treatment groups.

Although there were no significant between-group differences in IES-R scores at the end of the study, the response pattern showed a significantly sharper decline in PTSD symptoms at 6-weeks for those receiving EMDR therapy.

At the first post-assessment time point (after roughly 6 treatment sessions), the EMDR group also had significantly lower total scores on the SI-PTSD than did the psychotherapy group (19.94 vs 31.11; P < .001), as well as lower HADS depression (4.65 vs 8.68; P < .001) and HADS anxiety (5.94 vs 10.17; P < .001) scores.

However, there were no longer any significant differences between groups on the SI-PTSD, HADS depression, or HADS anxiety scores at the study's end.

Dropout rates were also similar between the 2 treatment groups (36% of the psychotherapy group vs 29% of the EMDR group).

Preference-Based Choices

"The main take-away message is that both treatments are equally effective, and that the patient and clinician can choose a certain treatment based on their preferences," said Nijdam.

"If a patient values fast symptom reduction, EMDR is the treatment of choice. If a patient feels the need to make meaning out of the traumatic experience and learn from it, brief eclectic psychotherapy is the best choice," she explained.

The researchers note that future studies should investigate the reasons for prematurely dropping out from these treatments, and that possibly "we should keep searching for new therapeutic strategies" for treating PTSD, including those that focus more on psycho-education and overcoming persistent avoidance.

"This may be especially true for younger patients, those from minority ethnic groups, and those who do not show symptom improvement over the first sessions," they write.

Nijdam and 3 of the other 4 study authors have disclosed no relevant financial relationships. A full list of disclosures for the remaining author is presented in the original article.

Br J Psychiatry. 2012;200:224-231. Abstract


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