A clinical study evaluated the efficacy of the desensitization and reprogramming method by Eye Movement better known by its abbreviation EMDR to reduce the severity of symptoms of post-traumatic stress disorder.
A US randomized controlled trial of Van der Kolk and colleagues, published in the Journal of Clinical Psychiatry in 2007, for 6 months compares the effectiveness of EMDR psychotherapeutic approach to antidepressant treatment (fluoxetine) and placebo in reducing severity of symptoms of post-traumatic stress disorder. The results show that EMDR is more effective than antidepressant or a placebo in reducing long-term symptoms.
The Study Rationale
Exposure to a traumatic experience is common in society: 60% of men and 51% of women in the general population have experienced at least one traumatic episode in their lives. For men, the experiences related to the war and the attacks are the main triggers of post traumatic stress disorder. In women, physical assault due to the spouse is the most common cause. Many psychotherapeutic techniques for these health problems have proven effective. Serotonin reuptake inhibitors such as antidepressants, including fluoxetine, have also proved effective for civil suffering from post-traumatic stress disorder. But it appears less effective drug treatment for veterans.
Desensitization and Reprogramming method by Eye Movement (EMDR) is a psychotherapeutic exposure technique in which patients perform saccadic eye movements while thinking of a traumatic experience. EMDR allows patients to go their own way, to move freely, to be sensitive to internal and cognitive sensations. EMDR is recommended for the treatment of post-traumatic stress disorder according to international guidelines such as the US Defense Department, the American Psychological Association and the American Psychiatric Association. Yet, questions remain in the comparison with anti-depressant medications.
Are EMDR and comparable antidepressant to reduce the symptoms of post-traumatic stress disorder? Are the benefits more sustainable than a placebo?
The randomized controlled van der Kolk and colleagues, published in the Journal of Clinical Psychiatry in 2007, for six months compares the effectiveness of EMDR versus taking an antidepressant or a placebo clinical symptoms of post-traumatic stress disorder. The study focuses on 88 people aged 18-65 years. They were diagnosed with post-traumatic stress disorder using DSM-IV. The selected patients had to have been exposed to a traumatic event at least one year before the start of the intervention. Patients were randomly assigned to either EMDR group or the fluoxetine group or the placebo group.
The main measures concern the severity of symptoms of post-traumatic stress disorder assessed by the Clinician Administered PTSD Scale, diagnosis and comorbid posttraumatic stress disorder assessed using DSM-IV. The evaluations were performed at the beginning and end of the intervention to eight weeks and after six months of follow up.
The Non-Pharmacological Intervention (NPI) assessed
Four clinical psychologists with a level 2 training in EMDR supervised sessions. They also had a minimum of three years experience with patients suffering from post-traumatic stress disorder. EMDR sessions were individual and last 90 minutes. On average, six meetings were devoted to the treatment of trauma. The intervention targeted at primary trauma memories associated identified before the start of the intervention.
The effectiveness of EMDR is superior to placebo in reducing the symptoms of post-traumatic stress disorder. EMDR is as effective as antidepressants in reducing symptoms between the start and end of the intervention. However, EMDR is more effective than antidepressant to sustainably reduce symptoms of post-traumatic stress disorder and depression symptoms six months after treatments. In addition, at six months, 58% of patients in the EMDR group reached the asymptomatic state compared to 0% in the antidepressant group.
What it means for Patients
EMDR is a more effective response to an antidepressant to reduce the severity of symptoms of long-term post-traumatic stress for people who have experienced trauma in adulthood. For cons, the study shows that fluoxetine-based antidepressant should remain the first line treatment for people who have experienced trauma in childhood.
What it means for Healthcare Professionals
EMDR a type of non drug intervention of six 90-minute sessions during a month long term reduces the severity of symptoms of post-traumatic stress disorder and depression in victims of trauma in adulthood . However, for adults who have experienced childhood trauma, treatment with fluoxetine remains the baseline to relieve moderate symptoms of post-traumatic stress disorder.
What it means for Researchers
This study is the first randomized controlled trial to show the superiority of the EMDR method antidepressants on reducing the severity of symptoms of post-traumatic stress disorder. Research is needed to determine the most responsive patients depending on the nature of the trauma (recent or childhood) and comorbidities. Studies will also evaluate the possibility of synergy between psychotherapy and drug treatment.
What it means for Policymakers
The comparison of the effectiveness of non-pharmacological interventions to conventional drug treatments on rigorous scientific and clinical basis is essential. This study shows that for the majority of patients with post-traumatic stress occurred in adulthood, symptoms of post-traumatic stress disorder can be reduced by four to six 90-minute sessions of EMDR . Moreover, the benefits are sustainable over time.
Van der Kolk BA, Spinazzola J, Blaustein ME, Hopper JW, Hopper EK, Korn DL, Simpson WB (2007). A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: Treatment effects and long-term maintenance. Journal of Clinical Psychiatry, 68, 1-10.
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To reference this Blog en Sante © article
Ninot G (2015). Treating post-traumatic stress disorder by EMDR. Blog en Sante, A71.
© Copyright 2015 Gregory Ninot. All rights reserved.