Eye movement desensitization and reprocessing treatment for combat PTSD.

Four Vietnam veterans (aged 42–55 yrs) diagnosed with posttraumatic stress disorder (PTSD) were treated with 12 sessions of eye movement desensitization and reprocessing, targeting their combat memories. An extensive multimodal assessment battery showed very substantial clinical improvement for 3 of the veterans along a number of psychological dimensions that characterize the disorder, but not along several physiological parameters. A 4th veteran showed only very modest changes. Results are discussed in terms of the importance of several issues, including numbers of treatment sessions and differential effects of treatment on cognitive-behavioral and physiological symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eye movement desensitization and reprocessing (EMDR): A meta-analysis.

Eye movement desensitization and reprocessing (EMDR), a controversial treatment suggested for posttraumatic stress disorder (PTSD) and other conditions, was evaluated in a meta-analysis of 34 studies that examined EMDR with a variety of populations and measures. Process and outcome measures were examined separately, and EMDR showed an effect on both when compared with no treatment and with therapies not using exposure to anxiety-provoking stimuli and in pre–post EMDR comparisons. However, no significant effect was found when EMDR was compared with other exposure techniques. No incremental effect of eye movements was noted when EMDR was compared with the same procedure without them. R. J. DeRubeis and P. Crits-Christoph (1998) noted that EMDR is a potentially effective treatment for noncombat PTSD, but studies that examined such patient groups did not give clear support to this. In sum, EMDR appears to be no more effective than other exposure techniques, and evidence suggests that the eye movements integral to the treatment, and to its name, are unnecessary. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Eye movement desensitization and reprocessing treatment for combat PTSD": Commentary.

Comments on the article by J. G. Carlson et al (see record 84-01737) regarding the use of eye movement desensitization and reprocessing treatment (EMDR) to treat posttraumatic stress disorder (PTSD) in Vietnam veterans. The author suggests that EMDR seems simplistic and lacks face validity altogether. L. Waters proposes that EMDR works because of resolute perception, a process defined by F. J. Hanna and K. Puhakka (1991) as a deliberate sustained focus of attention on an identified problem with the goal of achieving clarity, at a point when the client is ready and willing to confront and perceive. Waters suggest that a way to test whether or not EMDR works because of resolute perception would be to assign a similar group of clients to a totally different task (e.g., drawing straight lines) while giving them the same instructions as are given in EMDR regarding their memories, thoughts, and desirable cognitions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eye movement desensitization and reprocessing (EMDR) treatment for psychologically traumatized individuals.

The effects of 3 90-min eye movement desensitization and reprocessing (EMDR) treatment sessions on traumatic memories of 80 participants were studied. Participants were randomly assigned to treatment or delayed-treatment conditions and to 1 of 5 licensed therapists trained in EMDR. Participants receiving EMDR showed decreases in presenting complaints and in anxiety and increases in positive cognition. Participants in the delayed-treatment condition showed no improvement on any of these measures across the 30 days before treatment, but after treatment participants in the delayed-treatment condition showed similar effects on all measures. The effects were maintained at 90-day follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fifteen-month follow-up of eye movement desensitization and reprocessing (EMDR) treatment for posttraumatic stress disorder and psychological trauma.

The present study is a 15-month follow-up of the effects of eye movement desensitization and reprocessing (EMDR) therapy on the functioning of 66 participants, 32 of whom were diagnosed with posttraumatic stress disorder (PTSD) prior to treatment. PTSD participants improved as much as those without the diagnosis, with both groups maintaining their gains at 15 months. At 15-month follow-up, the three 90-min sessions of EMDR previously administered (S. A. Wilson, L. A. Becker, & R. H. Tinker, 1995) produced an 84% reduction in PTSD diagnosis and a 68% reduction in PTSD symptoms. The average treatment effect size was 1.59; the average reliable change index was 3.37. Implications of the maintenance of EMDR treatment effects are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Case studies of eye movement desensitization and reprocessing (EMDR) with chronic post-traumatic stress disorder.

One session of EMDR treatment for 4 41–46 yr old Black and 1 38-yr- old White male Vietnam combat veteran inpatients with posttraumatic stress disorder (PTSD) resulted in marked decreases in distress associated with a severely troubling memory in 4 Ss. Ss had been asked to describe their most troubling memory of Vietnam, which they then visualized during the EMDR procedure. Two Ss sustained the feeling of relief. Three Ss reported alteration or diminution of the visual aspect of the memory, an experience they had not previously reported. Two Ss appeared to demonstrate new insight. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eye movement desensitization and reprocessing: Four case studies of a new tool for executive coaching and restoring employee performance after setbacks.

The effects of eye movement desensitization and reprocessing (EMDR) integrated into executive coaching are reported in 4 case studies illustrating varied job titles and industries. Participants received 1–10 hrs of coaching in which EMDR was used to desensitize an upsetting event that had impaired their performance at work. Outcomes indicated that EMDR desensitized the disturbing incident and that participants shifted their negative view to a more positive one. Work performance was restored or enhanced. In the 4th case EMDR appeared to decrease anxiety about job interviewing and the participant reported a satisfactory result. Findings suggest that EMDR is a promising adjunct to coaching for workplace performance enhancement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief cognitive therapy for panic disorder: A randomized controlled trial.

Cognitive therapy (CT) is a specific and highly effective treatment for panic disorder (PD). Treatment normally involves 12–15 1-hr sessions. In an attempt to produce a more cost-effective version, a briefer treatment that made extensive use of between-sessions patient self-study modules was created. Forty-three PD patients were randomly allocated to full CT (FCT), brief CT (BCT), or a 3-month wait list. FCT and BCT were superior to wait list on all measures, and the gains obtained in treatment were maintained at 12-month follow-up. There were no significant differences between FCT and BCT. Both treatments had large (approximately 3.0) and essentially identical effect sizes. BCT required 6.5 hr of therapist time, including booster sessions. Patients' initial expectation of therapy success was negatively correlated with posttreatment panic-anxiety. Cognitive measures at the end of treatment predicted panic-anxiety at 12-month follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A clinical study of autogenic training-based behavioral treatment for panic disorder

The present study investigated the effect of autogenic training-based behavioral treatment for panic disorder and identified the predictors of treatment outcome. Thirty-four patients meeting DSM-III-R criteria for panic disorder received autogenic training-based behavioral treatment from October 1981 to December 1994. They were treated individually by the author. The medical records of the patients were investigated for the purpose of this study. The results showed that this autogenic training-based behavioral treatment had successful results. Fifteen patients were cured, nine much improved, five improved, and five unchanged at the end of the treatment. Improvement trends were found as for the severity of panic attack and the severity of agoraphobic avoidance. No consistent findings about predictors emerged when such pretreatment variables as demographics and severity of symptoms were used to predict the outcome. Also, three treatment variables showed useful predictive power. First, practicing the second standard autogenic training exercise satisfactorily predicted better outcomes. Second, application of in vivo exposure was found to be positively associated with the treatment outcome in patients with agoraphobic avoidance. Third, longer treatment periods were associated with better outcomes. These findings suggested that the autogenic training-based behavioral treatment could provide relief to the majority of panic disorder patients.     

Long-term outcome in cognitive-behavioral treatment of panic disorder: Clinical predictors and alternative strategies for assessment.

Long-term outcome (24-month follow-up; 24 MFU) of cognitive-behavioral treatment was examined in 63 patients with panic disorder. When the traditional methods of cross-sectional assessment were used (e.g., panic frequency during past month), long-term outcome findings paralleled those of earlier studies. However, assessments of idiographic response and those that examined longer time periods revealed that a large proportion of the sample experienced a fluctuating symptom course of panic-related symptomatology that was not captured by the cross-sectional method. Many (27%) patients sought further treatment for panic during the follow-up period because of a less-than-adequate response to treatment; nevertheless, additional treatment did not result in further clinical improvement. Pretreatment severity of panic disorder was associated with poorer outcome at 24 MFU. Use of psychotropic medication during treatment was associated with poorer outcome, although to a weaker degree when pretreatment responding was controlled. Findings are discussed in the context of how the outcome of treatments for panic disorder should be evaluated and interpreted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative case study of diffusion of eye movement desensitization and reprocessing in two clinical settings: Empirically supported treatment status is not enough.

An in-depth comparative case study was conducted of two attempts at diffusion of an empirically supported, but controversial, psychotherapy: eye movement desensitization and reprocessing (EMDR). One Department of Veterans Affairs (VA) treatment setting in which there was substantial uptake was compared with a second VA setting in which it was not adopted. Qualitative interviews were conducted with 10 mental health clinicians at the first site, and 19 at the second. Critical selling points for EMDR were a highly regarded champion, the observability of effects with patients, and personally experiencing its effects during a role training session. Compatibility with existing psychotherapist practices and values further allowed the therapy to become embedded in the organizational culture. At the second site, a sense that EMDR was not theoretically coherent or compelling overwhelmed other considerations, including its empirical status. Comparative studies contrasting settings in which innovative therapies are implemented versus those in which they were rejected may aid in refining theories of and strategies for dissemination. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Instructional desensitization: A semantic behavior treatment of anxiety disorder.

Explored the efficacy of instructional desensitization (ID) in the treatment of public speaking anxiety, using 30 speech-anxious undergraduates as Ss. Three self-report measures of confidence, affect, and anxiousness were completed by Ss, and 20 behavioral manifestations of anxiety were observed during Ss' delivery of a 4-min speech. Ss were randomly assigned to ID, placebo, or waiting list groups. Ss in the placebo group were led to believe that they were receiving a new form of therapy. Results show that ID Ss showed a significant decrement in their anxiety reactions as measured by objective and subjective anxiety measures. A significant anxiety decrement was also found in placebo Ss. However, self-report gains were not verified by objective observations. It is concluded that ID is a new semantic behavior therapy intervention that may have beneficial effects in the treatment of a broad variety of anxiety disorders. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures.

Reviews the book, Eye movement desensitization and reprocessing: Bask principles, protocols, and procedures by Francine Shapiro (1995). This text is a carefully crafted, almost 400 page book on the theory, mechanisms and workings of eye movement desensitization and reprocessing (EMDR). Francine Shapiro espouses much of what is important in psychotherapy and puts aside much of what has been controversial as she describes EMDR. Simply put, this work is the best representation of the procedure to date. For the clinician who uses this procedure, this book is a must. It outlines its necessary ingredients, standard problems, newer uses, typical mistakes, and changes (over its six year oddessy). Several strengths are noteworthy, including EMDR's painstaking assessment of the client, client safety factors, client preparation, as well as the importance of identifying the moving goalpost of "best" targets, needed cognitions, emotions, and sensations. Importantly too, the focus of EMDR is targets and not disorders. Implied but important to underscore, EMDR applies an essential rubric of psychotherapy, the nondirective unfolding of the client according to a least restrictive principle of intervention (by the therapist). EMDR seems to have this down well. If movement is present, the therapist remains truly nondirective, and uses simple rules; if not, a more active "therapeutic intervention" is called for. A procedure that can perform these tasks and do this in a user-friendly manner is not easy to find. This book highlights this unfolding dynamic. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of treatment compliance on outcome in cognitive-behavioral therapy for panic disorder: Quality versus quantity.

Cognitive-behavioral therapy (CBT) is skill based and assumes active patient participation in regard to treatment-related assignments. The effects of patient compliance in CBT outcome studies are equivocal, however, and 1 gap in the literature concerns the need to account for the quality versus the quantity of assigned work. In this study, both quality and quantity of home-based practice were assessed to better evaluate the effects of treatment compliance in patients with panic disorder (N?=?48) who participated in a 12-session CBT protocol. Patient estimates of compliance were not significantly associated with most outcome measures. On the other hand, therapist ratings of compliance significantly predicted positive changes on most outcome measures. Moreover, therapist and independent rater estimates of the quality of the participant's work, relative to the quantity of the work, were relatively better predictors of outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analysis of treatments for panic disorder.

In a meta-analysis, the authors compared the effectiveness of psychological and pharmacological treatments for panic disorder. Percentage of agoraphobic Ss in the sample and duration of the illness were unrelated to effect size (ES). Type of dependent variable was generally unrelated to treatment outcome, although behavioral measures yielded significantly smaller ESs. Dependent measures of general anxiety, avoidance, and panic attacks yielded larger ESs than did depression measures. Choice of control was related to ES, with comparisons with placebo controls greater than comparisons with exposure-only or "other treatment" controls. Psychological coping strategies involving relaxation training, cognitive restructuring, and exposure yielded the most consistent ESs; flooding and combination treatments (psychological and pharmacological) yielded the next most consistent ESs. Antidepressants were the most effective pharmacological intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnostic comorbidity in panic disorder: effect on treatment outcome and course of comorbid diagnoses following treatment

The impact and course of additional diagnoses was examined in 126 patients undergoing cognitive-behavioral treatment for panic disorder. With the Anxiety Disorders Interview Schedule--Revised, a high comorbidity rate (51%) was observed at pretreatment. Pretreatment comorbidity was not predictive of premature termination, nor did it have a substantial impact on short-term treatment outcome. However, patients with comorbidity at posttreatment were more likely to have sought additional treatment over the follow-up interval. Although a significant and dramatic decline in the overall comorbidity rate was found at posttreatment (17%), at 24-month follow-up this rate had increased to a level (30.2%) that was no longer significantly different from pretreatment. This was despite the fact that patients maintained or improved on treatment gains for panic disorder over this interval. The implications of these findings for the treatment, conceptualization, and classification of emotional disorders are discussed.     

Nonpsychiatric medical comorbidity, health perceptions, and treatment outcome in patients with panic disorder.

Panic disorder is frequently complicated by high rates of co-occurring nonpsychiatric medical conditions. The present study examined the relationship between medical morbidity, perceived physical health, and treatment outcome in panic disorder Patients meeting the American Psychiatric Association's Diagnostic and Statistical Manual of mental disorders (1994) criteria for panic disorder (N?=?71) completed 12 sessions of cognitive-behavioral treatment and were assessed at posttreatment and 6-month follow-up. Medical comorbidity and perceived health were both found to be related to end-state functioning. Medical comorbidity did not uniquely predict outcome beyond its shared variance with perceived health. At posttreatment, 71% of patients who perceived their physical health as good met recovery criteria compared with only 35% of those who perceived their health as poor. At follow-up, 67% of those who perceived their physical health as good met composite recovery criteria compared with only 33% of those with perceived poor health. These findings offer preliminary support for the impact of physical health, both actual and perceived, on treatment outcome of patients with panic disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality disorders and the outcome of cognitive–behavioural treatment of panic disorder with agoraphobia.

In recent years, cognitive–behavioural interventions have proven to be effective in the treatment of Panic Disorder with Agoraphobia (PDA). However, there is controversy concerning treatment efficacy of PDA for patients with a comorbid diagnosis of Personality Disorder (PD). This study evaluates the impact of a PD on PDA treatment response. 81 patients suffering from PDA were recruited from a cognitive–behavioural group treatment program. Diagnoses on Axis I (N?=?81) and Axis II (N?=?36) were made at treatment onset according to Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) criteria. Validated questionnaires were used to assess agoraphobia at treatment onset, following treatment, and at the 3 mo follow-up. All patients improved markedly from pretest to posttest and at the 3 mo follow-up. Grouping of patients according to the presence or absence of a personality disorder revealed significant differences between the groups on pre- and posttreatment scores on agoraphobia. Results also reveal that patients with a personality disorder improve more slowly than patients without a personality disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological approaches to panic disorder: A review.

Panic disorder has been the subject of considerable research and controversy. Though biological conceptualizations have been predominant, psychological theorists have recently advanced conditioning, personality, and cognitive hypotheses to explain the etiology of panic disorder. The purpose of this article is to provide an empirical and conceptual analysis of these psychological hypotheses. This review covers variants of the "fear-of-fear" construal of panic disorder (i.e., Pavlovian interoceptive conditioning, catastrophic misinterpretation of bodily sensations, anxiety sensitivity), research on predictability (i.e., expectancies) and controllability, and research on information-processing biases believed to underlie the phenomenology of panic. Suggestions for future research are made. (PsycINFO Database Record (c) 2010 APA, all rights reserved)