Introduction
Post-traumatic stress disorder (PTSD) follows a traumatic event or series of traumatic events and may be severe and/or persisting. Symptoms may include re-experiencing symptoms (nightmares, flashbacks and distressing thoughts), avoidance of traumatic reminders, negative cognition and mood associated with the traumatic event, and hyperarousal symptoms.
Trauma-focused psychological treatments are recommended as the treatment of choice for PTSD.
Intervention
Trauma-focused psychological therapy involving dual attention. An example is eye movement desensitisation and reprocessing (EMDR), which involves bilateral stimulation (eye movement).
Indication
Treatment of post-traumatic stress disorder (PTSD)
Precautions
The treatment is thought to be more applicable for adult trauma than childhood trauma, and for single traumatic events rather than complex trauma histories.
Adverse effects
Like all psychotherapies for PTSD the treatment involves recall of traumatic events which can be painful for patients and requires professional sensitivity.
Availability
Trauma-focused therapies should be delivered by trained practitioners, who can be found through the Australian Psychological Society website.
Description
EMDR therapy consists of a standard protocol with 8 phases, and uses horizontal saccadic eye movements to desensitise the discomfort caused by traumatic memories. The theory is that these memories have been stored in an abnormal way, and they can be reprocessed and integrated with the patient’s standard biographical memories. During therapy the therapist asks the patient to follow with their eyes the therapist’s fingers in an oscillating horizontal movement while recalling traumatic events (a dual attention task).
Australian PTSD guidelines recommend a number of psychological treatments for adults with clinically relevant PTSD, including the use of EMDR.1 The guidelines note that EMDR includes most of the core elements of standard trauma-focused cognitive behaviour therapy but with the dual attention task. The contribution of these eye movements as an active treatment component has been greatly debated and the precise mechanism of action is unknown.1
A meta-analysis of EMDR for PTSD found the overall reduction in PTSD symptoms following EMDR therapy was statistically significant compared with a control group, with a moderate effect size.2
EMDR has been included in HANDI as although seemingly improbable, there is RCT evidence of effectiveness. The trials indicate superiority to wait list controls, and possible superiority to some alternate psychological therapies.
Tips and Challenges
How to find EMDR-trained practitioners:
Grading
Moderate. (We are moderately confident in this research evidence, ie further research could have an important impact, which may change the estimates.)