EMDR in combat-related PTSD: A controlled study

In view of potential, but largely undocumented benefits of eye movement desensitization and reprocessing (EMDR) as an intervention for PTSD in combat veterans, in our laboratory a study of EMDR treatment included (1) randomized patient assignment, (2) clinically appropriate comparison (treatment and control) groups, (3) a 12-session EMDR protocol administered by experienced, EMDR trained clinicians, and (4) extensive clinical assessment, including physiological evaluation at pre-treatment, post-treatment, and 3-month follow-up. Thirty-five veterans who met DSM-IV criteria for PTSD completed an extensive multimodal assessment protocol. Assessment instruments included: The Mississippi Scale for Combat-Related PTSD, the Impact of Events Scale (IES), the Clinician Administered PTSD Scale (CAPS), a self-rating of overall severity of "PTSD symptoms," the Beck Depression Inventory, and the Spielberger State and Trait Anxiety Inventories (STAI). In addition, each subject completed a Stressful Scene Construction Questionnaire (SSCQ) in which scripts of specific traumatic combat incidents were prepared for presentation during psychophysiological assessment. Following pre-assessment, a subset of the subjects constituted a waiting list control (CON, N = 12). Routine clinical care for these subjects was available at the VA Medical Center. Seven of these subjects also participated in group sessions for discussion of PTSD designed as an attentional control. There were no differences between the two control subgroups and their data was combined for all subsequent analyses. For the treatment groups, subjects assigned to the EMDR (EMD, N = 10) and relaxation (RXT, N = 13) groups were seated in a semi-reclined chair and continuous measures were taken of muscle tension levels (four sites), hand temperature, skin conductance levels, heart rate, and blood pressure. For all subjects, there were 20 minutes in each of the baseline sessions with no additional stimuli presented. At the end of session 2 of baseline, the patients remained in the experimental room and were assessed for an additional 20 minutes (pre-treatment) during which the SSCQ scripts also were presented. There were two sessions per week with a minimum of one day between sessions. Each subsequent treatment session for the EMD and RXT subjects was approximately 60 minutes in duration, allowing for set-up time and briefing. In the EMD group, a standard protocol for the EMDR interventions was administered, including periodic SUDS ratings and VoC scaling of combat and related images and cognitions (cf Shapiro, 1995). In the RXT group, home relaxation tapes and biofeedback on four sites (face, neck, arm, and back) to assist lowered muscle tension were provided. Following 12 treatment sessions (post-treatment), and again after three months (follow-up) the psychometric instruments and psychophysiological assessment were readministered using the format outlined above. Relative to the other conditions, the EMDR treatment produced substantially more positive clinical effects at post-treatment and follow-up. Comparing the EMD group to the CON group, significant effects (p

Conference

English

John G. Carlson
Claude M. Chemtob
Kristin Rusnak
Nancy L. Hedlund
Miles Y. Muroaka

Carlson, J. G., Chemtob, C. M., Rusnak, K., Hedlund, N. L., & Muroaka, M. Y. (1995, June). EMDR in combat-related PTSD: A controlled study. Presentation at the EMDR Network Conference, Santa Monica, CA