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For Therapists Working with War and Disaster Victims

EMDR has been declared a first line treatment by the US Department of Defense/Department of Veterans Affairs, and the mental health departments of Northern Ireland, and of Israel. For a review of relevant studies: http://www.EMDRHAP.org/researchandresources.htm

As noted in the American Psychiatric Association Practice Guidelines (2004, p. 18) in EMDR, "traumatic material need not be verbalized; instead, patients are directed to think about their traumatic experiences without having to discuss them." Given the reluctance of many combat veterans to divulge the details of their experience, this factor is relevant to willingness to initiate treatment, retention, and therapeutic gains. It may be one of the factors responsible for the lower remission and higher dropout rate noted in this population when CBT techniques are used.

Carlson, et al. (1998) reported that after twelve treatment sessions 77.7% of the combat veterans no longer met criteria for PTSD. There were no dropouts and effects were maintained at 3 and 9 month followup. In addition, the Silver et al. (1995) analysis of an inpatient veterans' PTSD program (n=100) found EMDR to be superior to biofeedback and relax training on seven of eight measures. All other randomized studies of veterans have used insufficient treatment doses to assess PTSD outcomes (e.g., two sessions; see ISTSS, 2000; DVA/DoD, 2005). Sufficient treatment time must be used for multiple traumatized veterans (e.g.; see below: Russell, et al. 2007). However, in a process analysis, Rogers, et al. (1999) compared one session of EMDR and exposure therapy with inpatient veterans and a different recovery pattern was observed. The EMDR group demonstrated a more rapid decline in self-reported distress (e.g., SUD levels decreased with EMDR and increased with exposure).

As stated in the American Psychiatric Association Practice Guidelines (2004, p. 36), if viewed as an exposure therapy, "EMDR employs techniques that may give the patient more control over the exposure experience (since EMDR is less reliant on a verbal account) and provides techniques to regulate anxiety in the apprehensive circumstance of the exposure treatment. Consequently, it may prove advantageous for patients who cannot tolerate prolonged exposure as well as for patients who have difficulty verbalizing their traumatic experiences. Comparisons of EMDR with other treatments in larger samples are needed to clarify the differences."

Such research is highly recommended. In addition, since EMDR utilizes no homework to achieve its effects, it may be particularly suitable for frontline alleviation of symptoms (see Russell, 2006; Wesson & Gould, 2009). Further, the prevalent and somatic chronic pain problems experienced by combat veterans indicated the need for additional research based upon the reports of Russell (2008); Schneider, et al., (2007, 2008) and Wilensky (2007). which demonstrate the capacity of EMDR to successfully treat phantom limb pain. The ability of EMDR to simultaneously address PTSD, depression and pain can have distinct benefits for DVA/DoD treatment.

Clinically relevant combat studies:

For chronic PTSD (As noted on the DVA/DOD guidelines sufficient treatment time must be given).
Carlson, J., Chemtob, C.M., Rusnak, K., Hedlund, N.L, & Muraoka, M.Y. (1998). Eye movement desensitization and reprocessing (EMDR): Treatment for combat-related post-traumatic stress disorder. Journal of Traumatic Stress, 11, 3-24.
Silver, S.M., Brooks, A., & Obenchain, J. (1995). Eye movement desensitization and reprocessing treatment of Vietnam war veterans with PTSD: Comparative effects with biofeedback and relaxation training. Journal of Traumatic Stress, 8, 337-342.
For Acute Stress Disorder and Acute PTSD (Iraqi War Veterans on the battlefield or within days of evacuation)
Russell, M.C. (2006). Treating combat-related stress disorders: A multiple case study utilizing eye movement desensitization and reprocessing (EMDR) with battlefield casualties from the Iraqi war. Military Psychology, 18, 1-18.
Wesson, M. & Gould, M. (2009). Intervening early with EMDR on military operations: A case study. Journal of EMDR Practice and Research, 3, 91-97.

Additional relevant resources:

Errebo, N. & Sommers-Flanagan, R. (2007). EMDR and emotionally focused couple therapy for war veteran couples. In F. Shapiro, F. Kaslow, & L. Maxfield (Eds.)  Handbook of EMDR and family therapy processes. New York: Wiley.

Russell, M. (2008). Treating traumatic amputation-related phantom limb pain:  A case study utilizing eye movement desensitization and reprocessing (EMDR) within the armed services. Clinical Case Studies, 7, 136-153.

Russell, M.C. (2008). War-related medically unexplained symptoms, prevalence, and treatment: utilizing EMDR within the armed services. Journal of EMDR Practice and Research, 2, 212-226.

Russell, M.C., & Silver, S.M. (2007).  Training needs for the treatment of combat-related posttraumatic stress disorder. Traumatology, 13, 4-10.

Russell, M.C., Silver, S.M., Rogers, S., & Darnell, J. (2007). Responding to an identified need: A joint Department of Defense-Department of Veterans Affairs training program in eye movement desensitization and reprocessing (EMDR) for clinicians providing trauma services. International Journal of Stress Management, 14, 61-71.

Schneider, J., Hofmann, A., Rost, C.,  & Shapiro, F. (2008).  EMDR in the treatment of chronic phantom limb pain. Pain Medicine, 9, 76-82.
doi: 10.1111/j.1526-4637.2007.00299.

Silver,S.M., Rogers, S., & Russell, M.C. (2008).  Eye movement desensitization and reprocessing (EMDR) in the treatment of war veterans. Journal of Clinical Psychology: In Session, 64, 947—957.

Wilensky, M. (2006). Eye movement desensitization and reprocessing (EMDR) as a treatment for phantom limb pain. Journal of Brief Therapy, 5, 31-44.

Evaluation of EMDR treatment after September 11th attack:

Silver, S.M., Rogers,S., Knipe, J., & Colelli, G. (2005). EMDR therapy following the 9/11 terrorist attacks: A community-based intervention project in New York City. International Journal of Stress Management, 12, 29-42.

Published evaluations of both individual and group protocols for children and adults indicate that it has been used successfully in Europe and Latin America after natural and man-made disasters.

Aduriz, M.E., Bluthgen, C. & Knopfler, C. (2009). Helping child flood victims using group EMDR intervention in Argentina: Treatment outcome and gender differences.  International Journal of Stress Management. 16, 138-153.

Chemtob, C.M., Nakashima, J., & Carlson, J.G. (2002). Brief-treatment for elementary school children with disaster-related PTSD: A field study. Journal of Clinical Psychology, 58, 99-112.

Fernandez, I. (2007). EMDR as treatment of post-traumatic reactions: A field study on child victims of an earthquake. Educational and Child Psychology. Special Issue: Therapy, 24, 65-72.

Fernandez, I., Gallinari, E., Lorenzetti, A. (2004). A school- based EMDR intervention for children who witnessed the Pirelli building airplane crash in Milan, Italy. Journal of Brief Therapy, 2, 129-136.
Jarero, I., Artigas, L., Mauer, M., Lopez Cano, T., & Alcala, N. (1999, November). Children's post traumatic stess after natural disasters: Integrative treatment protocols. Poster presented at the annual meeting of the International Society for Traumatic Stress Studies, Miami, FL.

Grainger, R.D., Levin, C., Allen-Byrd, L., Doctor, R.M. & Lee, H. (1997). An empirical evaluation of eye movement desensitization and reprocessing (EMDR) with survivors of a natural catastrophe. Journal of Traumatic Stress, 10, 665-671.

Jarero, I., Artigas, L., & Hartung, J. (2006). EMDR integrative group treatment protocol: A post-disaster trauma intervention for children and adults. Traumatology, 12, 121-129.

Konuk, E., Knipe, J., Eke, I., Yuksek, H., Yurtsever, A., & Ostep, S. (2006). The effects of EMDR therapy on post-traumatic stress disorder in survivors of the 1999 Marmara, Turkey, earthquake.  International Journal of Stress Management, 13, 291-308.

Zaghrout-Hodali, M., Alissa, F. & Dodgson, P.W. (2008). Building resilience and dismantling fear: EMDR group protocol with children in an area of ongoing trauma. Journal of EMDR Practice and Research, 2, 106-113.

The EMDR Humanitarian Assistance Programs is a non-profit (501 C 3) organization that has coordinated with many agencies to train clinicians working in numerous countries worldwide. It has also coordinated relief efforts following the Oklahoma City bombing and the 9/11 terrorist attack http://www.EMDRHAP.org/ourefforts.htm

Mental health agencies can receive low cost assistance upon request. http://www.emdrhap.org

Suggested text:

Silver, S., & Rogers, S. (2001). Light in the heart of darkness: EMDR and the treatment of war and terrorism survivors. New York: Norton.