EMDR: implications of the use of reprocessing therapy in nursing practice.

TOPIC. Eye movement desensitization and reprocessing (EMDR). PURPOSE. To examine the available evidence base for EMDR treatment in psychiatric nursing practice. SOURCES. Evidenced-based research findings, published case and anecdotal reports, and primary source documents on the development of the treatment method. CONCLUSIONS. EMDR use remains controversial. Although it is safe, little is known regarding the mechanism of action of any therapeutic effect; more rigorous empirical establishment of efficacy is needed. Search terms: Clinical efficacy, eye movement desensitization and reprocessing (EMDR) ********** Trauma, and the associated disturbing memories that can result, are a common reason why individuals seek mental health care. While many treatment modalities can provide relief to patients experiencing traumatic memories, perhaps none is so acclaimed, so scorned, or so steeped in controversy as eye movement desensitization and reprocessing (EMDR). Reasons why this therapeutic intervention is gaining popularity include the apparent simplicity of the procedure and reports of dramatic, rapid improvement after only brief treatment with EMDR. Yet while volumes of case and anecdotal reports attest to the value of EMDR in reducing complex patient symptoms, questions linger regarding the scientific bases and empirical evidence supporting rational use of the modality. In surprisingly polarizing fashion, EMDR is touted as either science or wizardry, with little middle ground. As EMDR continues to attract attention, nurses in clinical practice need a basis for deciding if this treatment is a neurobiological-based repatterning of neuronal information storage, or if it is a mesmeric, placebo-based, ineffective treatment. This article attempts to wade through the rhetoric and reports and examine the available evidence base for the use of EMDR treatment in psychiatric nursing practice. It examines the known and hypothesized scientific bases for the treatment, the levels of empirical evidence regarding efficacy, and the indications and counterindications for its use. This knowledge is essential for psychiatric nurses who want a framework for decision making to allow accurate discussion of this treatment with patients and/or for deciding to use or refer patients for EMDR treatment. EMDR: What It Is and Where It Came From A patient is troubled by intrusive and disturbing memories of past traumatic events and is feeling a significant level of distress. He seeks help from a therapist, who quickly moves a finger back and forth in front of the patient's face, all the while asking him to hold traumatic images and memories in mind, and then asking the patient to shift associated memories to positive thoughts. After this activity, the patient self-rates his level of distress, and treatment is continued until significant improvement is noted. That is the core of EMDR treatment. While it appears simplistic, some proponents have reported serious disabling symptoms being extinguished in patients with as little as one 90-minute EMDR session. Such reports of almost miraculous recovery have been widely circulated and have fueled the almost legendlike belief among supporters of the value of EMDR. EMDR, a form of psychotherapy, was originated in 1989 by psychologist Francine Shapiro after a chance observation while walking in the woods. She noticed that moving her eyes rapidly from side to side appeared to lessen the intensity of her own disturbing thoughts and related anxiety (Blore, 1996; Davidson & Parker, 2001; Shapiro, Vogelmann-Sine, & Sine, 1994). Shapiro tested her notion on post-traumatic stress disorder (IYFSD) patients and reported significant improvement in their subjective distress levels after the treatment she called EMDR. Despite original reports that EMDR is a complex technique requiring extensive training (Shapiro, 1996a), it is now being taught in brief workshops and used by a wide array of practitioners in diverse settings. …