fluoxetine, and placebo, and failed to show significant improvement despite the LOCF treatment of missing values that in this case should have biased the study toward showing a positive outcome.

The committee also identified two RCTs comparing EMDR with a coping skills training therapy, namely, applied muscle relaxation and relaxation training (Taylor et al., 2003; Vaughan et al., 1994). However, both studies had major limitations such as high dropouts or uninterpretable aggregation of data, and in any case neither demonstrated a statistically significant benefit.

The committee noted that some experts have questioned whether the eye movement component adds benefit to the reprocessing component, but the committee identified no adequately designed studies testing the hypothesis and so was unable to reach a conclusion.


Synthesis: The committee found the overall body of evidence for EMDR to be low quality to inform a conclusion regarding treatment efficacy. Four studies, three of medium and one of small sample size, had no major limitations, but only two showed a positive effect for EMDR. The committee is uncertain about the presence of an effect, and believes that future well-designed studies will have an important impact on confidence in the effect and the size of the effect.

Conclusion: The committee concludes that the evidence is inadequate to determine the efficacy of EMDR in the treatment of PTSD.

Exclusion Notes

Three trials that did not include a comparison or control group were excluded (Ironson et al., 2002; Raboni et al., 2006; Rogers et al., 1999) as were comparison studies (Cusack and Spates, 1999; Devilly and Spence, 1999; Lee et al., 2002; Pitman et al., 1996). Many trials included participants not formally diagnosed with PTSD, or only part of the sample was diagnosed so were excluded (Devilly et al., 1998;15 Renfrey and Spates, 1994;16 Sanderson and Carpenter, 1992;17 Scheck et al., 1998;18 Wilson et

15

War veterans with PTSD “symptomatology.”

16

Patients “were screened positive for traumatic events as defined by the DSM-III-R, and experienced current intrusive symptoms as similarly defined.” This trial evaluated active components of EMDR, standard EMD, a variant of EMD in which eye movements were engendered with light tracking task, and a variant of EMD with fixed visual attention.

17

The patient sample from this trial only included those with phobias, and a subgroup of phobias that “nearly resemble” PTSD.

18

PTSD diagnosis was not a requirement for study inclusion. In addition this sample included patients ages16–25, so did not meet the committee’s criteria for only adult populations.



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