Author Archives: Brad Cini

The efficacy of online EMDR therapy

October 19th, 2021| Brad Cini | Uncategorized

During the COVID-19 pandemic, online mental health treatments which are evidence-based are needed urgently. The social distancing measures that have been implemented around the world to reduce the spread of COVID-19 give clinicians no other choice but to deliver treatment via internet, audio/video call, or even e-mail. The continuation of distant-delivered treatment during this time is crucial, because clients and psychiatric patients seem to be more vulnerable.As a matter of fact, the COVID-19 outbreak has generated a worsening of symptoms in psychiatric patients compared with individuals without psychiatric complaints. Online EMDR clinic based in Melbourne is working to assist the delivering of online mental health services.

However, researchers started assessing the results of online EMDR sessions long before the pandemic started. For instance, a 2020 systematic review which identified one trial examining the effects of online EMDR therapy in treating PTSD in children and adults. The aforementioned uncontrolled trial was conducted in 2013 and it combined internet-delivered EMDR and CBT, both of which successfully diminished clinician-rated, but not self-rated PTSD symptom severity from pre treatment to post treatment,and both clinician-rated and self-rated PTSD from pre treatment to follow-up. Even so, this study was limited by the lack of a control group (consequently, it cannot be concluded that the improvements were determined by natural recovery), as well as bya small sample. Furthermore, due to the fact that EMDR and CBT were delivered together, the relative impact of the two forms of therapy is unknown. Also, no explicit description of the used web-based EMDR tool was provided, which makes the replication of this study impossible.After an introduction by a therapist, the EMDR tool was self-guided. This differs from the procedures used during the pandemic. When utilising a web based EMDR tool, eye movements are usually made by following the light ball of a light tube, with pulsators in both hands, and/or headphones with bilateral stimulation. Ideally,the therapist and the client have a synchronous video-connection. This would allow the therapist to tailor the working memory taxation through bilateral stimulation (e.g., the speed of the light ball) according to the patient’s needs. This procedure best mimics real-life EMDR. In this 2013 study, therapist involvement was minimal. Thus, it is still uncertain whether guided web-based EMDR sessions produce the same effects as face-to-face EMDR sessions.

Another 2020 study had more helpful results in terms of online EMDR efficacy. The study used a “mock name” and presented a new treatment without mentioning EMDR while utilising the working memory task as designed by Homer et al. in 2016. This task similarly induced horizontal eye movements, but it did so by making letters appear alternately on both sides of the screen and by having participants react whenever they saw a target letter. This task was unfamiliar for all participants, soit was more suitable to induce eye movements while recalling a memory without disclosing the real intention.The purpose of the study was twofold: the authors assessed whether an online analogue of EMDR is successful in diminishing the negative valence of autobiographical memories and whether manipulating outcome expectations impact the reduction in emotionality and vividness.Findings showed that a short online working memory task was effective in lowering both the emotionality and the vividness of unpleasantautobiographical memories. Therefore, the first hypothesis of the authors was confirmed. The results were consistent with earlier research supporting the 1997 and 2012 working memory theory of EMDR. The individuals in the positive information condition did not show a more significantreduction in emotionality and vividnessrelated to an autobiographical memory than did the individuals in the negative information condition. This disconfirmed their second hypothesis. Such results imply that EMDR is a robust therapy, and that the effects of outcome expectancy have too little of an impact to interfere with the particular components of this form of therapy.

The interest in online EMDR efficacy increased exponentially during the pandemic, so another study was conducted in 2021. This one aimed to compare the efficaciousness of two psychotherapeutic interventions for individuals and Italian health professionals who have been affected by the circumstances determined by the spread of COVID-19. In order to reach this goal, TF-CBT and EMDR sessions were provided online to treat the ongoing trauma related to isolation, quarantine, or work in COVID-19 hospital wards.The findings indicated that the EMDR and TF-CBT therapy sessions significantly improved the outcome measures and that they were equally effective. After the 7-session treatment, state anxiety was reduced by around 30%, while the depressive and the traumatic symptoms decreased by around 55%, in line with preceding investigations suggesting that PTSD treatments were also linked with reductions in depressive symptoms. These findings were confirmed at the 1-month follow-up, where traumatic symptoms decreased by an additional 11%.Even if they are not statistically significant, these follow-up data are very useful to the treatment target and its long-term stability.

While it is reassuring to see that online EMDR presently produces positive results, such results were also reached in a 2018 study, before the COVID-19 outbreak. In this case, the author utilized a remotely controlled software program that allowed the therapist to deliver EMDR treatment through telehealth. The results showed that online EMDR therapy sessions allowed the client to build and maintain a satisfactory rapport with the therapist just as they would have through face-to-face therapy. There was no relevant difference between the results obtained from each online EMDR therapy session and a face-to-face mode of treatment. The author of this study showed that an online EMDR tool can produce the same results as working face-to-face with a client. However, the preparation of the client is essential. If they engage with online therapy from an environment which does not allow them to focus (e.g., in the presence of their young children), the sessions cannot be very effective.

All things considered, online EMDR therapy seems to be efficacious. Online EMDR clinic in Melbourne will continue to deliver online services to clients.

Introduction to EMDR and the EEI Protocol

October 19th, 2021| Brad Cini | Uncategorized

The standard EMDR protocol consists of a three-pronged approach in which past, present, and future events are targeted in therapy. The processing of past situations is usually the starting point when it comes to the processing phase of EMDR, and it is considered to resolve current mental health issues. According to Shapiro, the standard three-pronged protocol is a guide in the overall EMDR treatment of the client. According to the aforementioned protocol, each reprocessing session has to be directed at a certain target.Online EMDR clinic is located in Melbourne and works with client’s 15 years and above.

The generic target categories are described in the three-pronged protocol as follows. Initially, the past events which are the cause of pathology need to be fully processed. Then, the processing of particular triggers that are presently disturbing for the client needs to be completed. However, some triggers can remain active despite the processing of the original traumas. Shapiro indicated that these triggers may persist due to residual information from past events which have not been fully processed, or they may be the result of second order conditioning. The triggers could be either internal sensation, or an external event(e.g., symptoms of anticipatory fear, such as dizziness).

Lastly, the treatment allows the client to successfully visualise dealing with an anticipated future situation. In conformity with the standard procedure, if there are any fears, anxieties, or blocks which appear when a client actively thinks about a future event, they will be asked to focus on these limits and the therapist should introduce several sets of eye moments. If the client is unable to overcome the blocks, they have to be provided with appropriate resources, information, and skills that allow them to comfortably think about the future coping scene or with certain methods to discover old targets linked with anxieties, fears, or blocks. The therapist then applies the standard protocol in order to address the aforementioned targets. If there are no identifiable blocks and the client can visualize the future event clearly and confidently, the third prong is applied. This is achieved by helping the client focus on the positive beliefs, sensations, and images associated with the future experience, and by introducing eye movement sets to help them assimilate the information and incorporate it into a positive template.

Due to a growing body of research on the adaptation of the most used EMDR protocols to a wide range of mental health issues, elements of the three-prong protocol were used in the Recent Traumatic Episode Protocol (R-TEP), which describes an integrative approach incorporating and extending the main EMDR protocols with further measures for safety and containment. The R-TEP has introduced four essential procedural concepts by adapting the eight phases in EMDR therapy:

The Traumatic Episode (T-Episode) is a concept that presents the original traumatic event and its consequences as atrauma continuum (Traumatic Episode) from the past situation until the present, and it is comprised of several disturbance targets which have to be integrated.

The second concept is called The Episode Narrative. During the first two phases, only general information regarding the trauma is evoked, and the client is purposely not asked to recall the details of the traumatic event in order to avoid a premature trigger activation. The treatment phases begin with the Episode Narrative, which involves recounting the T-Episode story out loud, together with bilateral stimulation.

The third concept, Google Search (G-Search), is named after a metaphor used for a mechanism that can help identify the disturbance targets within the T-Episode. In order to achieve this, the client is asked to silently perform a non sequential scanning of the T-Episode with bilateral stimulation. When they identify a disturbance, it is used as a target for processing.

Lastly, Telescopic Processing introduces the idea of a “telescopic processing” strategy for each known target, which allows the expansion of the association focus (if needed). Association regulation is seen as a continuum which has the EMDR standard protocol without associative chain regulation at one end and the EMD protocol strategy with precise associative chain regulation at the other end. The intermediate between the two is called the EMDR strategy, which maintains the association chains of the client within a present trauma focus. This allows managing the focus of the processing without addressing other clinical issues, as it is normally done when using the standard EMDR protocol. Therefore, telescopic processing is a staged approach through which the focus is adjusted to the level where the information processing has stopped, for minimal intervention. The G-Search and Telescopic processing phases are repeated until there is no more disturbance in the T-Episode.

If traumatic memories accumulate, EMDR could facilitate prevention with early intervention as a comparatively short treatment focusing on the adaptive processing of traumatic events. In terms of advantages, EEI could simply be conducted over multiple consecutive days. The AIP model predicts that inappropriately stored memories are the cause of numerous current psychological disorders. As a consequence, it is anticipated that EEI could promote resilience and mental health and prevent both sensitization and accumulation of negative associative links before these traumatic memories become inadequately consolidated into negative theme networks. The idea that recent traumatic memories lack consolidation is a disadvantage which can become an advantage. This can be seen as an appropriate time to assure the occurrence of adaptive processing. Before the consolidation of the traumatic memory, the therapist may be able to facilitate adaptive integration, encourage positive coping (particularly if this is does not occur spontaneously),promote resilience, and reduce the effects of disturbances and subsequent complications.

Another advantage of EEI is that it could prevent the development of dysfunctional withdrawal and avoidance from seeking professional help,which tend to grow in intensity later on in life. It is suggested that EEI can successfully facilitate adaptive processing and may have the potential to remove obstacles that preempt the release of spontaneous processing. It can be used by clinicians to diminish distress by checking for sub clinical blocks which can obstruct AIP and do not always appear on the DSM radar.

EMDR therapy and addiction

October 19th, 2021| Brad Cini | Uncategorized

In clinical settings it is understood that a high number of individuals seeking substance abuse treatment have a trauma history in childhood, adulthood, or both. For many of them, this leads to long-term PTSD symptoms which reduce the quality of recovery and makeit difficult to have extended periods of abstinence. These symptoms include flashbacks, irritability, nightmares, heightened reactivity and vigilance, as well as a tendency to numb out. All of the aforementioned symptoms could negatively impact every aspect of life, from intellectual achievements to interpersonal relationships. Numerous clinicians view PTSD as a significant factor that influences addiction treatment outcomes. Developing more efficacious interventions for this condition is the key to improvement. PTSD symptoms make it difficult to get clean and sober and to have an enjoyable life without the use of alcohol or other drugs. Another thing clinicians have noted is that even subthreshold symptoms which do not meet PTSD criteria can still impactthe mastery of recovery tasks. Online EMDR can provide an effective treatment model for PTSD whether clients are in Melbourne or further out.

Systematic work is in progress to create treatments which can be utilised in any setting, and research plays a crucial role in this. For instance, a 2014 pilot study investigated the efficacy of EMDR therapy in chronically dependent individuals. The authors randomly assigned 12 participants with alcohol and/or drug dependency to either treatment as usual (TAU) or to TAU plus 8 EMDR sessions (TAU+EMDR). Measures of addiction symptoms, PTSD symptoms, alexithymia, anxiety, self-esteem, and depression were included in the study. The results showed that the participants in the TAU+EMDR group had a significant decrease in symptoms of PTSD, but not in addiction symptoms. EMDR therapy was also linked with a major diminution of depressive symptoms, while those receiving TAU showed no improvements in this area. The TAU+EMDR group also had significant changes in alexithymia and self-esteem post treatment. This study concludes that PTSD symptoms can be efficaciously treated in substance abuse patients by using standard EMDR protocol.

Similarly, a 2008 study also investigated the potential of EMDR in the treatment of alcohol dependency. In this case, EMDR therapy was used in chronically dependent participants to reprocess the addiction memory. 34 individuals with chronic alcohol dependency were randomly assigned to TAU or to TAU plus 2 EMDR sessions (TAU+EMDR). Pre treatment, post treatment, and 1 month after the treatment, the Obsessive–Compulsive Drinking Scale (OCDS) was used to measure the alcohol craving. The TAU+EMDR group showed a major decrease in craving both post treatment and 1 month after the treatment, while the TAU group did not. Findings indicated that EMDR could be an efficacious approach for treating addiction memory, as well as any other associated symptoms of craving.

A 2018 pilot study was conducted in Italy to assess the efficaciousness of a combined AF-EMDR and trauma-focused EMDR (TF-EMDR) intervention in treating stress-related and post traumatic symptoms of individuals with substance use disorder. 40 participants with different substance use disorders were included in the study. 20participants underwent TAU, while the other 20 were treated with TAU plus 24 weekly EMDR sessions. All individuals were evaluated for several psychological dimensions both before and after the intervention. The TAU+EMDR group showed a significant post traumatic and dissociative symptom improvement, along with a decrease in anxiety and overall levels of psychopathology. The TAU group only showed a significant reduction in post traumatic symptoms. While the results can only be regarded as preliminary, this study concludes that a combined TF- and AF- EMDR protocol could be an efficacious add-on treatment for individuals with substance abuse disorder.

However, not all studies that investigated the efficacy of EMDR in treating addiction focused on substance dependency. A study conducted in 2020 involved 8 individuals with gambling disorder who were provided Addiction-Focused Eye Movement Desensitization and Reprocessing (AF-EMDR) therapy. 6 weekly sessions of AF-EMDR during the treatment phase were preceded by a baseline phase involving3 to 7 weeks of non treatment. The participants kept a daily diary in both phases. An interrupted time series analysis along with visual inspection demonstrated mixed findings. Results indicated that two participants did not respond to treatment,3 experienced spontaneous recovery in the baseline period, while 3 others showed improvements in the EMDR phase. There were no adverse effects. To sum up, AF-EMDR therapy could be useful in the treatment of gambling addiction. Even so, more research is required regarding the focus, efficacy, application, andcontra-indications of this form of therapy.

While women are more likely to have a substance use disorder and comorbid PTSD, their unique needs have often been overlooked. In order to change this, a 2010 study explored the experiences of several women taking part in EMDR treatment during their addiction continuing care, as well as the impact EMDR had on them as individuals who are recovering from addiction. Overall, the participants showed positive results with EMDR therapy as part of the addiction continuing care. All 10 of the individuals who participated in the established recruitment process expressed positive emotion sregarding their EMDR treatment, and they all concluded that it was an essential component of their processes of addiction continuing-care. The EMDR therapy sessions were provided in a manner which sheltered their individual safety. The treatment program structure and the encouragement that the staff conveyed were crucial to the reinforcement of safety. A similar qualitative study which assesses negative cases is required for clinicians to obtain even more relevant insights regarding the situations in which the use of EMDR therapy can be inappropriate with a recovering addict.

EMDR provides much promise and significant challenges to the providers of addiction treatments and delivering online EMDR can help provide treatment to a wider range of clients. EMDR is a valuable trauma resolution tool, but it has to be integrated carefully into addiction treatment. Both individual and organisational safety structures must be in place in order to offer this opportunity under conditions that maximise the chances for success of vulnerable individuals. Efforts are being made to gain funding for controlled trials, and it is aspired that further research will clarify any questions regarding safety or efficacy, along with numerous clinical issues which arise as more clinicians use this method.

A Short Introduction to the AIP Model

October 19th, 2021| Brad Cini | Uncategorized

The Adaptive Information Processing (AIP) Model is the foundation of EMDR therapy. It involves the transmutation of maladaptively stored memories into adaptive resolutions which facilitate psychological health. In order to apply EMDR effectively, clinicians need a framework to help them identify the appropriate target memories and processing order to achieve optimal treatment results. The AIP model contains a variety of predictions and tenets which involvenumerous potential agents of change.Online EMDR clinic will present some basic information on the AIP model.

The AIP model describes the basis of pathology,guides case conceptualisation and treatment procedures, and predicts positive clinical results. In agreement with other learning theories, itpostulates the existence of an information processing system which integrates new experiences into memory networks that already exist. The aforementioned memory networks are the foundation of behavior, perception, and attitudes. The perceptions of present situations are linked with associated memory networks.When working correctly, the inherent information processing system assimilates new experiences. The sensory perceptions of current experiences are integrated and associated with related information which is already stored in the memory networks.This allows us to understand our experiences. The relevant information is learned, deposited in memory networks in relation to appropriate emotions, and it remains available for future guidance.

However, inadequately processed experiences are the ones that cause problems. Shapiro’s AIP model postulates that a particularly painful experience may be stored in state-specific form, which means that it remains stuck in its own neural network, thus being unable to link with other memory networks which store adaptive information. Shapirohypothesises that when a memory is encoded in distressing, state-specific form, the initial perceptions can keep being triggered by a wide range of both internal and external stimuli, leading to inappropriate emotional, behavioral, and cognitive reactions, as well as easily observable symptoms (e.g., nightmares, high anxiety, intrusive thoughts). Due to the fact that perceptions of current experiences are connected to associated memory networks,inappropriately stored memories are considered to constitute the foundation of future maladaptive responses. Childhood events may also involve inappropriate feelings of danger for adults. Even so, these past events maintain their power due to their inappropriate assimilation into adaptive networks over time. The AIP model describes negative personality traits and behaviors as results of inappropriate lystoredmemories.

Although the AIP model considers pathology to be the result of unprocessed experiences, processed experiences are regarded as the basis of mental health. The EMDR protocol involves reaching the inappropriately stored information, using the standardized protocols and procedures (including bilateral stimulation) to stimulate the innate processing system, and enabling dynamic linkages to healthy, adaptive memory networks.These phases facilitate the change of the memory’s characteristics, due to the transmutation to an adaptive resolution.As noted by Shapiro, the AIP hypothesis seems to be consistent with several neuro biological theories of memory reconsolidation which bring forward the idea that accessed memories can be restored in an altered form.

In some ways, the AIP model is consistent with the emotional processing model,which is the foundation of the most popular exposure-based treatments. In short, Foa and Kozak suggested that two conditions must be met for fear reduction to take place. Firstly, the fear memory has to be activated. Secondly, there must be provided corrective information with components which are incompatible with the fear structure in order to generate a new memory. Once the new information is incorporated, the fear responses will diminish (through in-session and between-session habituation), thus enabling modifications in the meaning of the memory. The AIP model is similar to the extent that protocols and procedures allow the incorporation of new information and the accessing of the emotional networks. In exposure-based therapies such as prolonged exposure, the corrective information is considered to comeas a result of habituation and of the therapeutic situation. Even so, the changes which occur in EMDR indicate that clients incorporate new information not only from the therapeutic situation, but also from memories of past life experiences. The connection of information within and between memories seems to be spontaneous, without therapeutic intervention, rather than the result of recurrent and maintained memory exposure. Rogers and Silver concluded in 2002 that EMDR therapyis shown to be consistent with the process of assimilation, accommodation, and information processing, rather than with habituation. While these observations are speculative, they are nonetheless consistent with the fact that the target memory becomes adaptively stored as a result of reconsolidation, and not due to the changes that take place by forming a new memory.

As we have already discussed, the AIP model concurs with the idea that processing consists of the incorporation of new, corrective information. However, it does not consider the modifications in cognitive appraisal to be the key determinant. Instead, the AIP model describes processing as the integration of the inappropriately stored experience within already existing networks which contain adaptive information. Because of this, it highlights the fact that processing can only occur if positive memory networks have already been established. Thus, the history taking phase requires the therapist to assess whether the aforementioned positive networks exist, and topurposelyincorporate them in case they do not. This principleis also applied in EMDR clinical practice when processing stalls during treatment sessions. In such a case, the clinician has to imitatespontaneous processing, and they do so by accessing the next available positive network in the client’s history, or by infusing the information needed in order to form a positive network which can be linked in. Online EMDR clinic embraces the AIP model when using the standard protocol with EMDR processing.

While there are still many questions regarding the AIP model and its accuracy, there is also a growing body of research indicating that memories can contribute to pathology when it comes to numerous mental disorders. Research findings seem to support the extension of the range of disorders which are connected to inappropriately processed memories beyond PTSD and other trauma-based disorders. This is in accordance with the EMDR literature, in which the AIP model of EMDR has already predicted that there are other memory-based disorders besides PTSD and has connected many other disorders to inappropriately stored memories.

Neuropsychological Research on EMDR

October 4th, 2021| Brad Cini | Uncategorized

Eye movement desensitisation and reprocessing (EMDR) is a standardised protocol of emotional, physical, and cognitive assessment associations of distress to painful memories. One of the main components of EMDR is bilateral stimulation, which involves either somaesthetic, visual, or auditory stimulithat alternate between the left and right sides of the body. The important therapeutic results of EMDR areachieved by associating the traumatic memory of the clientand the presentation of bilateral stimulation. This association can lead to a rapid reduction of emotional responses generated by the painful memory. Online EMDR clinic will present some information on the topic.

More and more advanced neuroimaging studies have been conducted over the past yearsin order to discover the neurobiological mechanisms of EMDR therapy. These studies seem to be appropriate for answering persistent questions regarding the way EMDR works, while also addressing some limitations of early research. The following paragraphs provide relevant details regarding a few of the aforementioned studies, along with the hope that more conclusive research will be conducted in the future. The research is conducive to EMDR therapy delivered online.

Emotion and memory processing structures have been investigated through a set of brain imaging studies with the purpose of learning more about the brain correlates of EMDR therapy. Nardo et al. carried out a magnetic resonance imaging [MRI] study in 22 healthy controls compared with 21 participants with a PTSD diagnostic. They found that, in comparison with participants who were responsive to EMDR, those who were unresponsive had a decreased level of gray matter density in several paralytic and limbic regions. Reduced gray matter density in the insular, parahippocampal, and posteriorcortices was associated with PTSD diagnosis, poor therapy outcome, and trauma load, suggesting that lower neuronal integrity in the aforementioned regions may determine the lack of response to EMDR therapy. Bossini et al. used high-resolution MRI scansto study structural modifications in 10individualswith PTSD and manually delineatedhippocampi. After concluding that the participantsshowed great bilateralhippocampal increases in volume and stopped meeting PTSD criteria after eight weeks of EMDR treatment, the authors speculated on the prospect of volumetric effects generated by psychotherapy. However, this speculation should not be accepted without objection, as these structural modificationscould have been determined by increased water/electrolyte content or neurogenesis.

The first functional imaging study was conducted by Levin and cols. and it examined modifications in metabolism with single-proton emission computer tomography [SPECT], as well as a symptom provocation paradigmin oneindividual with PTSDbefore and after 3EMDR sessions. The outcome showed increased activity in the left frontal lobe and the anterior cingulate gyrus post-EMDR treatment. The authors suggested that the activation of these regionshelps individuals make the distinction between painful memories which are not connected with current experiences and real threats. Lansing et al. also studied brain activation with SPECT during the recollection of a traumatic memory in six traumatized police officers before and after EMDR therapy. After the removal of PTSD symptoms, they discoveredgreat metabolic reductions in left parietal, posterior frontal andoccipitallobes, as well asmetabolic increases in the left inferior frontal gyrus. These results suggest that successful EMDR therapy may determine an increase in prefrontal control over hyperactive limbic subsystems. At the same time, they provide preliminary evidencein favor of neural integration models. A further SPECT study conducted by Pagani et al. in15 participants and 22 controls who displayed no symptoms despite having experienced the same trauma confirmed these results. A subgroup of individuals who were responsive to the EMDR treatment showed a great metabolic normalization in the hippocampus and in posterior cortical regions after therapy, as well as ablood perfusion increase in the lateral prefrontal cortex. Oh et al. have conducted another SPECT EMDR study in 2participantswith psychological traffic trauma and 10 healthy controls. They discovered decreased metabolism in the temporal association cortex and increased metabolism in bilateral dorsolateral prefrontal cortex post-EMDR therapy.

However, SPECT isn’t the only neuroimaging technique which has been used for the examination of EMDR-related brain functional changes. Ohtani et al. carried out the first near-infrared spectroscopy (NIRS) study with the purpose of monitoring brain hemodynamic modifications related to EMDR treatment during memory recollection. In this study, recall with eye movements was associated with majorblood flow decreasesin the lateral prefrontal cortex, as opposed to recall without eye movements. Furthermore, the concentration of oxygenated hemoglobin was associated with post-treatment clinical improvement. The authors speculated that the efficacy of EMDR may be related to the reduction of lateral prefrontal cortex due to activation during trauma-related recollection. In another fMRI study, Landin-Romero et al. studiedbrain activity modifications after successful EMDR therapy in a traumatized and subsyndromal bipolar individuals. The findings showed that, compared with 30 healthy controls, post-treatment symptom recovery was followed by a functional normalization of brain activity. This normalization was marked in the default mode network, which is generally accepted as dysfunctional in numerous severe mental disorders such as PTSD. The authors suggested that large scale network modulation, particularly in the default mode network, could be a prospective neurobiological correlate of EMDR therapy.

The studies discussed in this article were conducted in order to discover the underlying mechanisms of EMDR. While this form of psychotherapy has led to impressive results in a lot of cases, particularly in terms of treating PTSD, specialists are still unaware of how it works – EMDR has many components, so there could be countless possible explanations. Because of this, some researchers believe that its effects can only be captured by using an integrative model. Several proposals have already been made: in 2016, an integrative model involving EMDR theories, functional brain imaging of individuals with PTSD, and neurophysiological findings on eye movements was developed by Olivier Coubard. A few other integrative models were proposed much earlier on, in 2008.

While it is true that progress is being made, the neural mechanisms of EMDR therapy will not be fully understood anytime soon. In order to get there, well-designed studies need to be conducted in the meantime, and they should involve multidimensional neurobiological indexes which are reliable. Online EMDR clinic was happy to present a summary of these findings.

Neuropsychological Findings on BLS

October 4th, 2021| Brad Cini | Uncategorized

EMDR is considered a complex protocol due to itsvarious components: cognitive, behavioral, physical, and emotional. Several therapeutic aspects emerge in this form of psychotherapy, such as exposure and desensitisation, focus on physical sensations self-mastery reinforcement, reconnection of disseminated parts of the painful memory and the integration of these parts into memory, cognitive reprocessing,and bilateral stimulation.

During bilateral stimulation, therapists typically move their fingers horizontally (left-right) or vertically in order to elicit a response in the form of eye movements. As an alternative, they can also use an ellipsoid or oblique trajectory, or they can operate a technical device to replace finger movement, such as a light bar. Bilateral stimulation can also be auditory (i.e., an alternating sound in left and right ears) or tactile (i.e., a stimulation of anypart of the body from left to right) as well, not just visuomotor. Online EMDR Clinic in Melbourne uses software to produce both visual and auditory BLS.

A 2013 study conducted in the US examined the effects of eye movements on episodic memory retrieval by using bilateral eye movementsin order to temporarily increase the amount of interaction between the left and right hemispheres. Undergraduate students participated in two experiments that involved episodic memory tests. Beforetaking the tests, the participants engaged in eye movements. The movements were either smooth or saccadic pursuit, and either vertical or horizontal. Only bilateral horizontal saccadic eye movements facilitated retrieval of episodic memories. The authors suggestedthat bilateral saccadic eye movements enhance interhemispheric interaction, which subsequently facilitates episodic memory retrieval. The authors also suggested that the role of eye movements in EMDR may be that of helping clients retrieve episodic memories of their traumatic experiences. The study highlighted that it was just horizontal saccadic, and not smooth pursuit eye movements that generatedmajor improvements in retrieving episodic memories.More research is required in order to differentiate between the effects of distinct types of eye movements in terms of episodic memory retrieval.

Another study conducted in 2009 also found that the performance of the participants on episodic memory retrieval test improved when preceded by horizontal eye movements compared to vertical eye movements or an eyes-stationary condition. In addition, eye movements improved performance exclusively on tasks which required large amounts of left and right hemisphere processing. These results reinforce the notion that bilateral horizontal eye movements increase interhemispheric interaction. Thus, the eye movement component of EMDR therapy could facilitate both the recollection and the integration of episodic memories by using the interhemispheric interaction mechanism.Even so, results vary in terms of what is most effective regarding bilateral stimulation. For instance, a 2012 study conducted in the Netherlands showed that, while horizontal eye movements and alternating left-right tactile stimulation had beneficial effects on memory retrieval, alternating left–right auditory stimuli did not lead to the same outcome.

Also related to the neuropsychological effects of this form of psychotherapy and its components, a 2015 quantitative single-case studyon the neurocognitive impact of PTSD investigated whether EMDRcouldmodify the neuropsychological and physiological responses of a female client aged 18. The participant was diagnosed with comorbid PTSD and major depressive disorder. Eleven 90-minute sessions of EMDR therapy were provided on a weekly basis. The study found a heart rate decrease between baselines at the start and end of treatment. Neuropsychological evaluations of memory, attention, and brain executive functions showed pretreatment impairments related to information processing speed, attentional processes, and working memory and posttreatment improvement of the aforementioned cognitive functions, with major differences on the Paced Auditory Serial Addition Test. The authors discovered a significant posttreatment decrease in mean scores on the Beck Depression Inventory-II, as well as on the Dissociative Experiences Scale. In addition, the participant showed no symptoms of PTSD after the treatment,based on Posttraumatic Stress Global Scale. At the 1-year follow-up, the participant reported continuity of treatment effects. While the results were positive, the case study had its limitations. Firstly, generalisation is impossible due to the fact that there was only one participant. Secondly, the participant did not have any appointment with a therapist, so there were no third parties to confirm the positive changes. The study was successful, but further research is required in order to better understand whether EMDR therapy leads to the neurocognitive changes and how.

There are also studies which have generated less favorable conclusions regarding bilateral stimulation and EMDR. For instance, research conducted in 2011showed no increase in interhemisphericelectroencephalogram(EEG) coherence, indicatingthat more research is needed to discover firstly whether eye movements increase interhemispheric interaction and, if so, precisely how they do so. Similarly, a 2007 study showeddecreased gamma frequency coherence linked to engaging in 30 seconds of bilateral eye movementswhile keeping the eyes open. These findings were surprising, but they correspond with a 2005 functional magnetic resonance imaging study. The latterfound decreased functional interaction between the left and right hemispheres in the anterior prefrontal cortex during episodic memory retrieval.The reason why this should be the case exclusively when the eyes are kept open after eye movements are yet unclear; this issue should certainly be addressed in future studies.

EMDR is a complex form of psychotherapy which involves a number of underlying processes that work simultaneously. Multiple mechanisms may produce positive results in EMDR; because of this, an integrative model could be necessary in order to discover its numerous effects. At the present, EMDR online clinic in Melbourne uses to horizontal eye movements through online software and auditory stimulus to produce BLS.

An appropriate example of this is the 2016 integrative model for the neural mechanism of EMDR, which was proposed by Coubard. The model integrates neurophysiological findings on eye movement, theories of EMDR, as well as functional brain imaging of PTSD to analyse attentional and/or emotional disorders (for instance, anxiety disorders).The neurobiological underpinning of limbic regulation, temporal binding, reciprocal anterior cingulate cortex suppression, and frontal lobe activation are sufficiently interconnected to prevent mutual exclusion and should be evaluated in well-designed studies in which reliable, multidimensional neurobiological indexes are used. Future results will certainly shed increasing light on the way in which different mechanisms interact in the treatment outcomes of EMDR therapy.

EMDR and TF-CBT in the treatment of PTSD

October 4th, 2021| Brad Cini | Uncategorized

Among the severaltreatment alternatives for post-traumatic stress disorder (PTSD), Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) and Eye Movement Desensitisation and Reprocessing (EMDR) therapy have led to promising results in helping individualsmanage PTSD symptoms. However, due to the different theoretical and methodological mechanisms of EMDR and TF-CBT, a potentially different effect on the brain could be hypothesised for the aforementioned interventions, as well as a distinct interaction between the trauma-specific PTSD symptomatology and the response to a particularform of psychotherapy.Delivering online EMDR is a helpful way to reach a larger population of clients.

In an often-cited meta-analysis conducted in 1998, van Etten and Taylor concluded that, in the treatment of PTSD, cognitive-behavioral methods and EMDR are superior to other forms of therapy, such as relaxation training, hypnotherapy, and dynamic psychotherapy. The authors showed that these two types of treatment had similar effect sizes, both after the end of the treatment and in a subsequent follow-up study. While the efficacy was similar, the authors found EMDR to be more efficient due to the lower average treatment duration it requires compared to cognitive-behavioral therapies.However, critical methodological examination of the comparison between EMDR and cognitive-behavioral therapy (CBT) in the study showed that its interpretability is limitedby the calculation of the average effect sizes in the treatment and control groups on the basis of pre/post comparisons exclusively. While pre/post comparisons can be used to conclude on the effectiveness of a form of therapy, on condition that one has knowledge of the corresponding pre/post effect sizes in the untreated control groups, the interpretability of a direct comparison between two therapies is limited by such an approach.

Later on, a 2006 meta-analysiswas conducted in order tocompare the same forms of therapy.Seven studies were used,involving a total of 209 participants with the average age of 35.4 years, all of whom had gone through all the treatment sessions. 65% of the subjects were women. The superiority of either EMDR or TF-CBT over the other could not be demonstrated, as theyshowed to be equally efficacious. The authors suggested that distinctions between the twotreatments are most likely not of clinical significance.

However, the results of a 2013 Italian study showed that this may not be the case for CBT as well, at least for one particular group. The most relevant result emerging from this study is that most participants in the cancer follow-up phase who had been treated with EMDR were able to overcome theirPTSD diagnosis after 8 therapy sessions; on the contrary, almost all of the patients in the same stage of disease who had been treated with CBT still had a PTSD diagnosis one month after the end of the treatment.The group of participants treated with EMDR had lowerClinician-Administered PTSD Scale(CAPS) andImpact of Event Scale – Revised(IES-R) intrusive symptom subscale scores after the treatment, compared with the group of participants treated with CBT. Depression, anxiety, and psychophysiological reactions improved in both of the groups, showing that both EMDR and CBT are effective on these symptoms in a limited number of sessions.Even so,the results indicated that EMDR may be a more efficacious therapy for cancer patients who have a PTSD diagnosis, particularly for intrusive symptoms, both in an active treatment and a follow-up stage of the disease.

While researchers are still trying to pinpoint the distinctions between EMDR and TF-CBT, the findings of a 2019 study conducted in Italy showed that the two might not be as different as it seems. During this study, the psychological and spontaneous functional connectivity fMRI patterns were monitored in two groups of individuals with PTSD who experienced the same traumatic situation(i.e., natural disaster), before and after participating in psychotherapy sessions based on EMDR and TF-CBT. 37individuals with PTSD were enrolled from a larger sample of people who had been exposed to a single, acute psychological stress. Patients were randomly assigned to TF-CBT or EMDR therapy. Clinical assessment was conducted using the CAPS, the Davidson Trauma Scale (DTS), and the Work and Social Adjustment Scale (WSAS), both at baseline and posttreatment. All participants underwent an fMRI data acquisition session both before and after the treatment in order to assess their functional connectivity (FC) profile at rest and the potential connectivity changes related to the clinical impact of psychotherapy. Both TF-CBT and EMDRgenerated statistically significant changes in clinical scores, with no distinction in the clinical impact of the two therapies. Specific changes in FC correlated with the improvement in the distinct clinical scores, and in different ways for EMDR and TF-CBT. Even so, a similarity in the connectivity changes related to changes in CAPS in both groups was also noticed.Specifically, changes at CAPS in the entire sample correlated with a connectivity increase between the bilateral superior medial frontal gyrus and the right temporal pole, as well as a decrease in connectivity between the left cuneus and the left temporal pole. In the case of individuals with natural disaster PTSD, results pointed to a similar positive psychological impact of both EMDR and TF-CBT. Neuroimaging data indicated a similar neurophysiological substrate for clinical improvement following the two forms of therapy, involving changes that affected bilateral temporal pole connectivity.EMDR online clinic provides EMDR over telehealth for all of Australia and is based in Melbourne.

In the same year, a randomised trial whichinvolved participants (18-70 years) with PTSD diagnosis or subthreshold symptoms from 3 outpatient clinics in the Netherlands was also conducted. Subjective distress and PTSD symptoms decreased comparably in both forms of therapy. The PTSD symptom decrease was more significant in patients with more depressive symptoms. This decrease was not influenced by either social support or negative cognitions. No participant characteristics were found that could guide the choice for either EMDR or TF-CBT.Therefore, professionals should followthe current recommendations from clinical guidelines.

While TF-CBT is considered a first-line treatment for PTSD, it is clear that EMDR can generate very similar results, sometimes even with a lower treatment duration. However, discovering the full potential of EMDR therapy leaves no room for bias. Further research conducted in a correct manner will certainly show more of what this form of psychotherapy has to offer.

EMDR and TF-CBT in the treatment of young people

October 4th, 2021| Brad Cini | Uncategorized

Childhood is a crucial time for social, psychological, and emotional development, all of which can be impacted by trauma. The experience of childhood trauma not only impacts an individual’s immediate functioning, but it can also impair long-term functioning. In spite of the effects trauma can have on both short-term and long-term functioning, research indicates that just a small percentage of adolescents with mental health issues receive the treatment they need. Online EMDR therapy provides an excellent pathway to engage in a professional to help resolve trauma.

Research also shows that lack of access to treatment increases the risk of developing a wide range of mental disorders, including personality disorders such as Borderline Personality Disorder (BPD). These findingsemphasise the importance of providing proper and early treatment for children and adolescents who need it.To learn more about the most appropriate forms of psychotherapy for young people with trauma, we will discuss the comparative efficacy of the two main evidence-based treatments, respectively Eye Movement Desensitization and Reprocessing (EMDR) and Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT).

These forms of therapy were assessed in a randomised controlled trial (RCT) conducted in 2015.48 children were randomised to either EMDR or TF-CBT. 18 were male (38%). In terms of age, the children were 8-18 years old, with an average age of 13. The majority was Dutch, with 33% having Dutch fathers and 46% having Dutch mothers. No significant differences were remarked in baseline characteristics for participants in the two treatment conditions. The children had experienced different types of single-event traumas: sexual assault (17%), accidents (23%),threat (with weapon) (13%), serious illness (7%), kidnapping (10%), or other (30%). The multiple-event traumas experiences included exposure to domestic violence (44%), sexual assault (39%), and other (17%). The results showed that, in terms of Clinician Administered PTSD Scale for Children and Adolescents (CAPS-CA) severity scores, children who experienced multiple-event trauma did not differ from children who experienced a single-event trauma. This RCThighlights that both treatments are effective in children with Posttraumatic Stress Syndrome (PTSS) in an outpatient setting. Findings on both child and parent measures are in favor of this conclusion. Nomajor differences were found between EMDR and TF-CBT on the CAPS-CA.

The effects of the two therapies were also assessed in a 2020 systematic review including 27 studies in relation to PTSD in children, adolescents, and young adults. TF-CBT is the psychological intervention which was investigated most frequently. Most of the studies involved mixed populations spanning childhood, adolescence, and young adulthood, while seven studies investigated the efficacy of psychological interventions in adolescents and young adults exclusively.Three of the studies assessed the efficacy of interventions in children exclusively. The meta-analysis consisted of 16 eligible RCTs. There was a moderate effect of the interventions at diminishing PTSD symptoms in children, adolescents, and young adults. Both EMDR and TF-CBT had a moderate effect size and were more efficacious to general (non-trauma-focused) CBT at diminishing PTSD symptoms in this population. EMDR had the greatest effect in terms of PTSD symptom reduction. Interventions for adolescents and young adults exclusively did not have significant effects on PTSD symptoms. This review demonstrated that established adult treatments should not be presumed to be effective in children, adolescents, and young adults, with no modifications to the study protocol particularly targeted towards children.

Due to the general interest in early intervention, several other studies have been conducted to discover whether there is an optimal form of therapy for particular age groups. For instance, two early intervention service case studies were performed in 2018 to assess the efficacy of TF-CBT and EMDR for young individuals with trauma and psychosis. Both of the participants achieved positive outcomes by the end of therapy, as well as at the 6-month follow-up. The final measures have shown clinically significant reductions on measures of post-traumatic stress and mood,lowering to below thresholds. The results of this study suggested that both EMDR and TF-CBTwereefficient for the participants. The therapies were used in an integrated manner, incorporating other approaches to psychosis, such as methods of managing distressing voices. The phasic approach wasbeneficial for both the therapist and the client, and it allowed time to expand the clients’ understanding and coping skills.Because of this,both participantsfelt more prepared to face their traumatic memories. It is rather exciting to see that, although cognitive-behavioral therapy (CBT) and the treatments which incorporate its techniques are preferred by many professionals, EMDR therapy can be just as efficient (maybe even slightly more efficient than CBT/TF-CBT in some cases).

In 2021, a study was conducted in The Netherlands to assess the efficacy of EMDR in young children (ages 4-8) with PTSD. The study had 9 participants. A non-concurrent multiple baseline experimental design was utilizedin combination with standardised measures. Participants received six 1-hour sessions of EMDR. Post-treatment results showed that EMDR was efficacious in reaching PTSD diagnostic remission (85.7%), as well asin diminishing PTSD symptom severity, and emotional and behavioral problems. All positive effects were maintained at the 3-month follow-up. The authors have concluded that EMDR appears to be an effective treatment for PTSD in young childrenaged 4 to 8 years.

While studies seem to be in favor of EMDR, many are still skeptical. One of the studies in favor of maintaining TF-CBT as first-line treatment due to a larger evidence base is a 2018 meta-analysis conducted in the US regarding the effectiveness of TF-CBT and EMDR for children and adolescents. According to the results, TF-CBT seemed to be marginally more effective than EMDR in treating PTSS, especially with presence of comorbidity in diagnosis. However, a 2020 response to the aforementioned meta-analysis showed that it involved significant statistical and methodological flaws which led to inconsistencies. Some of the most relevant limitations were the errors in calculating the effect sizes of the EMDR studies, the unmentioned outcome parameters per study, and the suboptimal choice for the REM.Providing EMDR therapy online to clients can be an effective way to reach a larger population in providing effective treatment.



Introduction to EMDR Therapy

September 6th, 2021| Brad Cini | Uncategorized

Eye Movement Desensitisation and Reprocessing (EMDR) is a scientifically supported, integrative psychotherapy approach based on the Adaptive Information Processing (AIP) model. Developed in the 1980s by Francine Shapiro, EMDR therapy is shown to be effective and is endorsed by the World Health Organization (WHO). It was initially designed as a treatment procedure for posttraumatic stress disorder (PTSD) but is presently used for the treatment of many disorders, including anxiety disorders and depression. EMDR is compatible with every main orientation in psychotherapy. EMDR online clinic would like to present a brief introduction to the topic which was written in Melbourne. 

            Unprocessed memories caused by traumatic and painful events are the main focus of EMDR therapy. According to Shapiro, traumatic memories generate pathological modifications within the neural element (the brain). These modifications prevent the brain from fully processing information and experiences, allowing unprocessed memories to generate negative emotions, sensations and cognitions felt when the event was first experienced. Unprocessed traumatic memories usually determine an escape or avoidance behavior which ceases the recalling of those negative emotions. The manner in which the brain stores and responds to traumatic and painful experiences is better understood through the AIP model.  

            As opposed to other forms of therapy, the focus of EMDR is not a talk-based therapy. EMDR involves working with a distressing memory with the aim of adaptive processing of traumatic event/s. This ultimately results in the elimination or alleviation of the symptoms associated with the distressing memory.

            While focusing on particular aspects of the unpleasant memory, the client is provided bilateral (left-right) stimulation. This involves eye movement in most cases, but it can also involve alternating physical taps, sounds, or hand-held pulsars. Bilateral stimulation possible generates a REM like state in which both sides of the brain are activated. This reduces the vividness of the trauma and facilitates the establishment of reprocessing.  

            EMDR therapy is a systematic approach that includes eight steps which address the treatment of multiple disorders:

            Step 1: Client History

            The negative and positive life experiences of the client need to be acknowledged by the therapist within the AIP model. This allows the therapist to understand whether the client is ready for memory reprocessing or not. Some clients manage to develop healthy emotional and cognitive connections, as well as adaptive behaviors and positive self-concepts simply by reprocessing the memory. However, those who have had on-going, complex trauma, may need to develop or enhance certain resources during EMDR therapy. Positive resources can be created during the sessions, consequently being stored in memory and intensified through specific procedures.

            Step 2: Preparation

            During preparation, the therapeutic relationship is a central focus. The therapist explains the EMDR model and treatment plan, provides clarifications and addresses concerns, and establishes the mechanics of the treatment administration. This is the phase in which the client learns about the procedures and is taught how to use stop signals in case they need to take a break during the session. It is also important for the client to understand their own symptoms and how the reprocessing of traumatic memories works.

            Step 3: Assessment

            Together, the client and the therapist identify the target memory which causes emotional distress. The sensory components of the traumatic or painful experience are then established; the most relevant image, the body sensation, the negative and positive beliefs associated with the experience, and the dominant emotions. The therapist uses the Subjective Units of Disturbance (SUD) scale and the Validity of Cognition (VOC) scale in order to assess how true the client considers a particular belief to be and how disturbing a certain emotion is.

            Step 4: Desensitisation

            The desensitisation phase begins with a rational evaluation of the disturbing event. The target memory and the associations start being reprocessed. While the client focuses on the traumatic or painful memory, they also engage in multiple sets of bilateral stimulation. After each set of bilateral stimulation, the client is asked to communicate the insights that emerge. The client’s response dictates factors such as the type of bilateral stimulation used and the length of each set. The purpose is to lower the level of distress that occurs when the client focuses on their memory.

            Step 5: Installation

            The therapist works on strengthening the preferred positive cognition, in order to replace the original negative cognition. How deeply the client believes the positive one will be measured on the VOC scale, with the goal being a rating of 7.

            Step 6: Body scan

            The client is asked to focus again on the disturbing memory, but this time to also pay attention to their physical response and positive cognition. If the therapist learns about any residual somatic tension, they can target it for reprocessing. Standardised procedures for bilateral stimulation are used.

            Step 7: Closure

            This step is particularly important, as it is essential for the client to return to a state of calmness and equilibrium at the end of the EMDR session. There are several self-calming techniques which can be used, and some of them involve guided imagery.

            Step 8: Re-evaluation

            During re-evaluation, the therapist checks the level of distress with the last processed memory and makes sure that their positive treatment results have maintained. At the same time, the therapist checks for additional targets to reprocess.

            EMDR therapy is a relatively new approach, but the research and clinical trials conducted to date show its strong efficacy. As it does not require extended exposure to the traumatic or painful memory, it is sometimes preferred by individuals with severe trauma. Sexual abuse, childhood trauma, and substance abuse are some of the problems which can be processed through EMDR therapy.

             Clients who choose this form of psychotherapy may encounter positive changes after an EMDR session. Being more sensitive to external stimuli, having vivid dreams, sleeping differently, and feeling lightheaded are all possible side effects. However, such post-processing symptoms normally disappear as they continue treatment. Although mental health professionals who are trained in EMDR therapy typically follow standard procedures and protocols to obtain positive results, their approach is tailored to the needs of each individual client.

EMDR online clinic was started in Melbourne, Australia.

Evidence on EMDR

September 6th, 2021| Brad Cini | Uncategorized

Thirty years after Francine Shapiro introduced eye movement desensitisation and reprocessing (EMDR) therapy, it has become a comprehensive psychotherapy guided by the adaptive information processing (AIP) model. Online EMDR clinic will provide an overview of the research written from our home base in Melbourne.

Extensive research has been conducted regarding EMDR’s efficacy in the treatment of several different disorders. When it comes to PTSD in adults, three studies from 1999, 2012, and 2013 showed notable decreases in the symptoms of the subjects after participating in EMDR therapy sessions, with reductions between 36% and 94%-95% in PTSD diagnosis. Several other studies from 2002 found that, in comparison with exposure therapy, EMDR determined a faster symptom reduction.

Regarding children and adolescents with PTSD symptoms, trauma-focused cognitive behavioral therapy (TF-CBT) and EMDR therapy are both recommended by the World Health Organization (WHO) as first-choice treatments. Consequently, studies were conducted in order to compare the efficacy of both treatments. A 2018 meta-analysis involving 30 studies with a total of 1192 subjects showed that TF-CBT was slightly more effective than EMDR when it comes to reducing posttraumatic stress syndrome (PTSS) posttreatment. However, the analyses demonstrated that children with PTSD diagnoses have had less favorable responses in comparison with children who did not meet the criteria for a full diagnosis, thus providing insight into the relevance of early intervention.

A 2018 study conducted in Mexico provides evidence regarding the efficacy of early intervention EMDR protocols in the reduction of symptoms provoked by traumatic or life-changing experiences that cause continuing disruption and retraumatisation. A Turkish study conducted in the same year supports this evidence. Also related to early intervention, a 2016 French study showed that EMDR therapy was more successful than critical incident stress debriefing in diminishing posttraumatic symptoms. Although it seems clear that early intervention is beneficial for individuals of all ages, there are still many discussions on which EMDR protocols are the most efficient.

Because depression is linked to high mortality and chronic depression is, in many cases, treatment resistant, many clinicians have been trying to discover whether EMDR therapy could be an effective treatment for individuals who experience depressive disorders. A 2012 meta-analysis provided evidence that EMDR was more effective than cognitive behavioral therapy (CBT) in terms of comorbid depressive symptom reduction. Also related to comorbidity, a 2006 USA case study in which EMDR was not evaluated in comparison with another form of therapy described the treatment of a patient who experiences from both depression and ADHD. The case study showed that EMDR therapy had such a positive impact on the patient that the medications for both of the disorders were discontinued. The treatment also led to an improvement in terms of concentration and to a decrease in hypervigilance. It will be helpful to observe online EMDR case studies in the future.

Medication for depression has been often scrutinised. WHO suggests that pharmacological methods should be taken into consideration only if psychotherapeutic interventions are unavailable or ineffective. Thus, it would be optimal to find an effective form of therapy for depressive disorders which would not require or would at least reduce the adjacent use of antidepressants. A small step towards such a possibility is represented by a 2007 USA study which showed that EMDR therapy was more effective in the reduction of depression and PTSD symptoms than fluoxetine. Furthermore, the first randomised controlled study on EMDR efficacy as a primary major depressive disorder treatment (2016) provides preliminary evidence that EMDR could be a viable short-term form of therapy. The effects of EMDR in this study maintained at the 3-month follow-up. After 6-8 therapy sessions, remission in depressive symptoms was reached. However, the study requires replication and future research is needed in order to reach a feasible conclusion on this matter.

Until 2019, six randomised control trials were conducted to investigate whether EMDR therapy was efficacious for adults who experience anxiety disorders. On account of three studies conducted in 2007, 2012, and 2013, it has been theorised that EMDR can be helpful when treating panic disorders (PD), especially when it comes to addressing early contributory experiences, triggers, and memories of panic attacks. Further, a randomised control trial conducted in the Netherlands in 2013 showed that EMDR therapy was just as efficacious as CBT for treating PD. At the follow-up, the participants experiencing PD or panic disorder with agoraphobia (PDA) exhibited a constant reduction in the frequency of panic attacks in the EMDR condition. This reduction was substantially greater than the one exhibited by the participants in the CBT treatment group.

Another serious problem which could be addressed through EMDR therapy is chronic pain. It is estimated that around 1 in 5 people worldwide suffer from this impairment, so finding a proper treatment for it would make a significant difference. A randomised controlled trial conducted in Iran in 2017 on phantom limb pain (PLP) showed that EMDR therapy was successful. The effects of EMDR maintained at the 24-month follow-up, making EMDR a recommended method of treating PLP.

A 2011 Turkish pilot study was conducted to investigate the efficacy of EMDR on migraine headache. The 11 subjects, all suffering from daily chronic headache, showed a considerable reduction in headache duration and frequency which maintained at the 3-month follow-up. However, there was no pain intensity decrease. Despite this, ER visits and painkiller usage became less frequent. Such results provide preliminary evidence that EMDR therapy could be used as an alternative form of migraine treatment. A study which confirms this was conducted in the USA in 2008 by Steven V. Marcus.

When it comes to treating certain illnesses, such as social anxiety disorder, it is yet inconclusive whether EMDR could be more efficient than other forms of therapy. Even so, many advances have been made in the field of psychology since the introduction of EMDR. Although further research needs to be conducted in order to discover its true potential, EMDR is presently regarded as an evidence-based form of psychotherapy and as a new, viable method of treating numerous trauma-based disorders. More research would be needed to test the effectiveness on EMDR online. This article was written from Online EMDR Clinic’s home base in Melbourne.