Virtual EMDR Therapy
Treatment of Military Personnel
As noted in the WHO (2013) guidelines and the American Psychiatric Association Practice Guidelines (2004, p.18), in EMDR therapy “traumatic material need not be verbalized; instead, patients are directed to think about their traumatic experiences without having to discuss them.” Given the reluctance of many combat veterans to divulge the details of their experience, this factor is relevant to willingness to initiate treatment, retention and therapeutic gains. It may be one of the factors responsible for the lower remission and higher dropout rate noted in this population when CBT techniques are used.
As described previously, an RCT by Carlson et al. (1998) reported that after twelve EMDR treatment sessions, 77.7% of the combat veterans no longer met criteria for PTSD. There were no dropouts and effects were maintained at 3- and 9-month follow-up. In addition, the Silver et al., (1995) analysis of an inpatient veterans’ PTSD program (n = 100) found EMDR to be superior to biofeedback and relaxation training on seven of eight measures. Russell et al. (2007) evaluated 72 active-duty military personnel, 48 diagnosed with combat PTSD and reported that pre-post changes were significant on all measures. A recent program evaluation of active duty military by McLay et al. (2016) compared various forms of treatment and reported, “Results indicated that patients receiving EMDR had significantly fewer therapy sessions over 10 weeks but had significantly greater gains in their PCL–M scores than did individuals not receiving EMDR.”
All other RCT of veterans have used insufficient treatment doses to assess PTSD outcomes (e.g., two sessions; see ISTSS, 2000; DVA/DoD, 2004). Sufficient treatment time must be used for multiply traumatized veterans (e.g., see below: Russell et al., 2007). However, in a process analysis, Rogers et al. (1999) compared one session of EMDR and exposure therapy with inpatient veterans, and a different recovery pattern was observed. The EMDR group demonstrated a more rapid decline in self-reported distress (e.g., SUD levels decreased with EMDR and increased with exposure).
As stated in the American Psychiatric Practice Guidelines (2004, p. 36), if viewed as an exposure therapy, “EMDR employs techniques that may give the patient more control over the exposure experience (since EMDR is less reliant on a verbal account) and provides techniques to regulate anxiety in the apprehensive circumstance of exposure treatment. Consequently, it may prove advantageous for patients who cannot tolerate prolonged exposure as well as for patients who have difficulty verbalizing their traumatic experiences. Comparisons of EMDR with other treatments in larger samples are needed to clarify such differences.”
Such research is highly recommended. In addition, since EMDR utilizes no homework to achieve its effects it may be particularly suited for front line alleviation of symptoms (see Russell, 2006; Wesson & Gould, 2009). Further, the prevalent somatic and chronic pain problems experienced by combat veterans indicate the need for additional research based upon the reports of Russell (2008), Schneider et al., (2007, 2008) and Wilensky (2007), which demonstrate EMDR’s capacity to successfully treat phantom limb pain (see also Ray & Zbik, 2001). The ability of EMDR to simultaneously address PTSD, depression, and pain can have distinct benefits for DVA/DoD treatment.
The following contain clinically relevant information for the treatment of veterans, including therapy parameters.
Carlson, J., Chemtob, C.M., Rusnak, K., Hedlund, N.L, & Muraoka, M.Y. (1998). Eye movement desensitization and reprocessing (EMDR): Treatment for combat-related post-traumatic stress disorder. Journal of Traumatic Stress, 11, 3-24.
Cook, J.M., Biyanova, T., & Coyne, J.C. (2009). Comparative case study of diffusion of eye movement desensitization and reprocessing in two clinical settings: Empirically supported treatment status is not enough. Professional Psychology: Research and Practice, 40, 518–524.
Errebo, N. & Sommers-Flanagan, R. (2007). EMDR and emotionally focused couple therapy for war veteran couples. In F. Shapiro, F. Kaslow, & L. Maxfield (Eds.) Handbook of EMDR and family therapy processes. New York: Wiley.
Hurley, E.C. (2018). Effective Treatment of Veterans With PTSD: Comparison Between Intensive Daily and Weekly EMDR Approaches. Frontiers in Psychology, 24 August 2018.
Lipke, H. (2000). EMDR and psychotherapy integration. Boca Raton, FL: CRC Press.
McLay, R. N., Webb-Murphy, J. A., Fesperman, S. F., Delaney, E. M., Gerard, S. K.,
Roesch, S. C., Nebeker, B. J., Pandzic, I., Vishnyak, E. A., & Johnston, S. L. (2016, March 10). Outcomes from eye movement desensitization and reprocessing in active-duty service members with posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. http://dx.doi.org/10.1037/tra0000120.
Russell, M. (2006). Treating combat-related stress disorders: A multiple case study utilizing eye movement desensitization and reprocessing (EMDR) with battlefield casualties from the Iraqi war.Military Psychology, 18, 1-18.
Russell, M. (2008). Treating traumatic amputation-related phantom limb pain: A case study utilizing eye movement desensitization and reprocessing (EMDR) within the armed services. Clinical Case Studies, 7, 136-153.
Russell, M.C. (2008). War-related medically unexplained symptoms, prevalence, and treatment: Utilizing EMDR within the armed services. Journal of EMDR Practice and Research, 2, 212-226.
Russell, M.C. (2008). Scientific resistance to research, training and utilization of eye movement desensitization and reprocessing (EMDR) therapy in treating post-war disorders Social Science & Medicine, 67, 1737–1746.
Russell, M.C. & Figley, C.R. (2013). Treating traumatic stress injuries in military personnel: An EMDR practitioner’s guide. New York: Routledge.
Russell, M.C., & Silver, S.M. (2007). Training needs for the treatment of combat-related posttraumatic stress disorder. Traumatology, 13, 4-10.
Russell, M.C., Silver, S.M., Rogers, S., & Darnell, J. (2007). Responding to an identified need: A joint Department of Defense-Department of Veterans Affairs training program in eye movement desensitization and reprocessing (EMDR) for clinicians providing trauma services. International Journal of Stress Management, 14, 61-71.
Silver, S.M. & Rogers, S. (2002). Light in the heart of darkness: EMDR and the treatment of war and terrorism survivors. New York: Norton.
Silver, S.M., Rogers, S., & Russell, M.C. (2008). Eye movement desensitization and reprocessing (EMDR) in the treatment of war veterans. Journal of Clinical Psychology: In Session, 64, 947—957.
Wesson, M. & Gould, M. (2009). Intervening early with EMDR on military operations: A case study. Journal of EMDR Practice and Research, 3, 91-97.