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EMDR and the Anxiety Disorders: Exploring the Current Status

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EMDR and the Anxiety Disorders: Exploring the Current Status EMDR and the Anxiety Disorders: Exploring the Current Status Ad de Jongh University of Amsterdam and Vrije Universiteit, The Netherlands Erik ten Broeke Visie, Deventer, The Netherlands Based on the assumptions of Shapiro’s adaptive information-processing model, it could be argued that a large proportion of people suffering from an anxiety disorder would benefi t from eye movement desen- sitization and reprocessing (EMDR). This article provides an overview of the current empirical evidence on the application of EMDR for the anxiety disorders spectrum other than posttraumatic stress disorder (PTSD). Reviewing the existing literature, it is disappointing to fi nd that 20 years after its introduction, support for the effi cacy of EMDR for other conditions than PTSD is still scarce. Randomized outcome research is limited to panic disorder with agoraphobia and spider phobia. The results suggest that EMDR is generally more effective than no-treatment control conditions or nonspecifi c interventions but less ef- fective than existing evidence-based (i.e., exposure-based) interventions. However, since these studies were based on incomplete protocols and limited treatment courses, questions about the relative effi cacy of EMDR for the treatment of anxiety disorders remain largely unanswered. Keywords: eye movement desensitization and reprocessing (EMDR); anxiety disorders; specifi c phobia; panic disorder he past three decades have witnessed signifi - At the end of the 1980s, the fi rst publications of a cant advances and growth in research on anxi- newly developed method, eye movement desensitiza- ety disorders (Boschen, 2008). Growth has T tion and reprocessing (EMDR), emerged. This began been strong for its treatment for which a wide array with Shapiro’s (1989) study on the effects of EMDR of behavioral and cognitive interventions have been on a single traumatic memory. After its publication, proposed and investigated. With regard to the effec- it took years before the fi rst randomized clinical trial tiveness of these procedures, the results of a recent was published that supported the notion that EMDR comprehensive meta-analysis demonstrated not only was capable of treating full-blown posttraumatic stress that cognitive behavioral interventions are particu- disorder (PTSD) within a limited number of sessions larly effi cacious but also that there are marked differ- (Wilson, Becker, & Tinker, 1995). In the years there- ences in treatment responsiveness among the different after, many other studies followed, and now, 20 years types of anxiety disorders (Hofmann & Smits, 2008). after the fi rst EMDR publication, there is enough evi- Treatment effects appear particularly large for acute dence to conclude that the method is an established, stress disorder (ASD) and obsessive-compulsive dis- time-limited treatment for PTSD (Bisson et al., 2007). orders (OCDs) but are less strong for panic disorder Based on the notion that EMDR is capable of re- and generalized anxiety disorder (GAD). The authors solving disturbing memories of traumatic events that conclude that there is still considerable room for are critical in the development and maintenance of improvement in the treatment of anxiety disorders PTSD, it could be asserted that other types of anxiety (Hofmann & Smits, 2008). disorders that developed following a distressing event Journal of EMDR Practice and Research, Volume 3, Number 3, 2009 133 © 2009 EMDR International Association DOI: 10.1891/1933-3196.3.3.133 would also be responsive to EMDR. This notion is at From a theoretical point of view, EMDR could play the basis of Shapiro’s adaptive information-processing a role in the treatment of panic disorder, as there are (AIP) model, a framework that is considered to be indications that panic disorder and agoraphobia often helpful to therapists when developing a problem start after a stressful life event (Kleiner & Marshall, formulation in terms of a relationship between 1987). In addition, there is evidence to suggest that memories of disturbing events and clients’ current many panic patients suffer from PTSD-like symptoms anxiety symptoms and the use of EMDR for resolv- as a result of their fi rst panic attack (McNally & Lukach, ing these memories (Solomon & Shapiro, 2008). 1992). Indeed, since the development of EMDR, a large Beside incidental reports of therapists suggesting number of articles have appeared, suggesting a posi- that EMDR can be successfully applied to panic disor- tive effect of EMDR on the symptoms of individuals der with agoraphobia (de Jongh & ten Broeke, 1996; suffering from various anxiety-related conditions. Be- Fernandez & Faretta, 2007), not many studies have cause anxiety symptoms are common in patients who been published, and those that have been conducted use primary and secondary mental health services, it were carried out by the same research group (Feske & is important to evaluate the potential of EMDR as a Goldstein, 1997; Goldstein, de Beurs, Chambless, & contribution to the treatment of anxiety disorders. Wilson, 2001; Goldstein & Feske, 1994). Their fi rst This article provides an overview of the current publication that concerned a series of seven persons empirical evidence on the application of EMDR for diagnosed with panic disorder yielded promising anxiety disorders beyond the typical traumatically results (Goldstein & Feske, 1994). It was found that induced conditions like PTSD and ASD. First, the most patients benefi ted signifi cantly from EMDR, key symptoms of each condition within the spectrum with reductions in number of panic attacks, sever- of anxiety disorders (i.e., panic disorder with and with- ity of anticipatory anxiety, and occurrence of general out agoraphobia, social phobia, specifi c phobia, OCD, symptoms of distress. In a subsequent randomized and GAD) are initially reviewed, as are the assumptions controlled study of the same researchers using a simi- as to why this condition may be suitable for the appli- lar treatment protocol, the effectiveness of EMDR cation of EMDR. Next, the available research is sum- was compared with a protocol in which the eye move- marized. Finally, some general conclusions are drawn. ments were omitted and a wait-list condition (Feske & Goldstein, 1997; see Table 1). EMDR appeared to be Panic Disorder With or Without more effective than both no-treatment and an EMDR Agoraphobia protocol, in which the eye movements were lacking, on a number of self-report measures. However, at The central clinical features of panic disorder are the the 3-month follow-up, these differences could not be panic attacks, the associated feelings of losing con- maintained. Four years later, the same research group trol, and the fact that these are recurrent (American published another randomized clinical trial for panic Psychiatric Association, 2000). Many panic patients disorder with agoraphobia (Goldstein et al., 2001) in suffer from agoraphobia, as they tend to avoid situa- which the effectiveness of EMDR was compared with tions from which escape might be diffi cult or in which a relaxation condition used as an attention-placebo help may not be available in the event of having a control condition (association and relaxation therapy panic attack (e.g., being outside the home alone). [ART]). The use of ART in this study appeared to be Strictly speaking, there is no indication for EMDR very similar to EMDR with the exception of EMDR’s in the treatment of panic disorder because there are distraction/bilateral stimulation component. Patients already evidence-based psychological interventions in the ART condition received 30 to 45 minutes of available with cognitive-behavioral therapy being the progressive muscle relaxation training, after which most important. A number of treatment approaches they were asked to describe the scene of their most have been established in controlled trials as being frightening panic-related memory in detail, to close effective, including exposure treatment, reduction their eyes, and to speak out loud as they followed of avoidance, and cognitive treatments focusing on themselves to associate to this image (“let come up the modifi cation of panic attacks (National Institute whatever comes up”) for about 45 to 60 minutes of for Clinical Excellence, 2004). However, the long- association. As to the results, it appeared that the cli- term outcome of these studies appears to be limited, ents in the EMDR condition did not fare better on any and the vast majority of panic disorder patients need of the measures than those who were asked to just prolonged additional treatment (van Balkom, de associate on the target memory. Conversely, EMDR Beurs, Koele, Lange, & van Dyck, 1996). appeared to be signifi cantly superior to the wait-list 134 Journal of EMDR Practice and Research, Volume 3, Number 3, 2009 de Jongh and ten Broeke TABLE 1. Randomized Clinical Trials Pertaining to EMDR’s Effectiveness on the Area of Anxiety Disorders No. (and duration of Sample sessions in Authors Year Treatment (n) Characteristics minutes) Outcome Variables Effects Panic Disorder With Agoraphobia Feske and 1997 1. EMDR (15) Panic disorder 1, 3, 4: fi vea a. Social concerns 1 > 2 (a–f ) Goldstein 2. Wait list (12) with almost all (one 120-minute and general 3 > 4 (b, d, f ) and having and four anxiety 3-month 3. EMDR (18) agoraphobia 90-minute b. Anticipated follow-up: 4. EMDR with sessions) panic and coping 1 = 2 eye movements c. Physical concerns 3 = 4 omitted (18) d. General anxiety and fear of panic e. Panic frequency f. Variety of secondary measures Goldstein, 2001 1. EMDR (18) Outpatients 1–2: four a. Panic/agorapho- 1 = 2 (a–d) de Beurs, 2. Attention- applying for (90-minute bia severity 1 > 3 (a–b) Chambless, placebo, ART treatment; panic sessions) b. Diary 1 = 3 (c–d) and Wilson (13) disorder with c. Frequency of Same results 3. Wait list (14) agoraphobia anxious for 1-month (based on cognitions follow-up Structured d. Frequency of Clinical panic attacks Interview for DSM Disorders) Specifi c Phobia Muris and 1997 1.
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