What is the Effect of Eye Movement Desensitization and Reprocessing on Post-Traumatic Stress
What is the Effect of Eye Movement Desensitization and Reprocessing on Post-Traumatic Stress Disorder among Female Survivors of Sexual Assault?
Living through a situation in which you feel your life or someone else’s is in danger can be traumatic, given you might not have power over the situation and therefore, feel terrified. Experiencing such traumatic events can lead to developing post-traumatic stress disorder (PTSD). Research has shown that going through traumatic events is not uncommon, for instance, at least half of Americans have had a traumatic event in their lives. From those who have had trauma, about 2 in 10 women will develop PTSD (National Center for PTSD, 2008). Going through specific traumatic events such as combat and sexual assault is more common to lead to PTSD, but it is important to note that there is no way of knowing who will develop PTSD. When studying PTSD, it is important to look at the four symptoms that people tend to illustrate such as, constantly reliving the event, avoiding things that remind them of the event, having more negative thoughts than before, and feeling on the edge. Additionally, some may begin engaging in unhealthy ways by either smoking, abusing drugs and alcohol (Korn, 2009).
Given that the symptoms of PTSD can be very upsetting and disrupt someone’s life, it is very important for individuals to seek treatment. There are different treatment options for people with PTSD such as, medications and trauma-focused psychotherapies. When it comes to selecting treatment, exposure therapy is often supported as a treatment of choice for PTSD. Exposure treatment tends to require an extensive number of hours from the client, for instance, 15- 85 hours and up to 24 hours of homework. Controlled studies have illustrated a 60% decrease of PTSD when using exposure therapy (Rothbaum, Astin, & Marsteller, 2005). In comparison, studies have illustrated that when using eye movement desensitization and reprocessing (EMDR), there has been an elimination of PTSD in 77-90% of the participants. In addition, studies have illustrated a significant decrease in a wide range of symptoms after two or three active treatment sessions and without homework. EMDR is known to help the client focus on specific sounds or movements while talking about the trauma, which helps the brain work through the traumatic events. Another form of therapy is cognitive behavioral therapy (CBT), which consists of one to two hours of daily homework, as opposed to EMDR which is implemented without homework. This factor has proven to favor EMDR as it makes the overall time significantly less and easier for many clients (Rothbaum et al., 2005).
The purpose of this research is to increase the knowledge of EMDR as an intervention for PTSD. It is the intent of this study to assess the effects EMDR when treating female survivors of sexual assault. The research question of this study is: What is the effect of EMDR on PTSD among female survivors of sexual assault? The hypothesis of this study is that individuals diagnosed with PTSD who select EMDR as their treatment therapy will show a decrease in the symptoms caused by PTSD. Additionally, such improvements are to continue even after the therapy has terminated. If EMDR proves to be a more effective and long-term treatment for PTSD, then the results of this study will benefit mental health professionals working with female survivors of sexual assault. In non-profit organizations as well as county-based programs in which therapists have a high caseload and are often time are overworked, using such intervention that not only shows to be more effective, but also requires fewer sessions while achieving similar results in comparison to other interventions that demand a substantial number of hours, will be more time effective not only for the therapist but for the client as well.
Conceptual Framework: Information Processing Theory
Adaptive information processing (AIP) model was developed by Francine Shaprio with the intention to explain and predict the treatment effects seen with EMDR (Solomon, 2008). It is based on a theoretical information processing model, which suggests that symptoms result from events that are ineffectively processed and may be eliminated when the memories are fully processed and incorporated (Maxfield, 2007). The AIP model is known to integrate new experiences into already existing memory networks. These memory networks are the foundation of insight, attitudes, and behavior. When someone undergoes a new experience it is automatically connected with associated memory networks (Solomon, 2008). For example, when performing new tasks in a job, one might be able to complete the task accurately because of the previous experiences one has encountered at the job. However, when someone undergoes a traumatic event, information processing may be inadequate given that the negative feelings that one experiences, affect information processing as it stops the individual from making relations with more adaptive information that is retained in other memory networks. This is a problem as such experiences are inadequately processed. For example, someone who has been sexually abused may be aware that their rapist committed a criminal act, yet this information might not connect with their feeling that he/she is not the one to blame. This memory is then inadequately stored without appropriate associated connections and with many elements still unprocessed. This causes the survivor to feel like they are reliving the trauma whenever they think about it or when the memory is triggered by similar situations. This can also cause them to experience strong emotions, emotional disturbance, think negatively about self, and PTSD (Solomon, 2008).
Shapiro believed that EMDR could decrease such symptoms by treating the factors that contribute to the disturbing memories. This would be done thorough the AIP model given that information processing is assumed to occur when the affected memory is connected with other more adaptive information. Furthermore, learning then occurs, and the experience is grouped with appropriate emotions, able to properly direct the person in the future (Solomon, 2008). AIP model and EMDR will generate successful results for individuals with PTSD as EMDR uses a structured eight-phase approach and addresses the past, present, and future outcomes of the distressed stored memories. Moreover, the processing phases of EMDR influence the client’s focus of attention through the appropriate memory associated with the aimed clinical matter (Maxfield, 2007).
PTSD and Female Survivors of Sexual Assault
PTSD is a common condition as illustrated by a survey conducted by the National Co-morbidity in which results found that 7.8% of 5,877 American adults had suffered from PTSD at some point in their lives (Bisson, 2007). When analyzing specific traumas, sexual assault amongst women led to a lifetime prevalence of 50% for PTSD (Wilson, 2006). Nearly 12 million American women have a lifetime history of PTSD because of rape, therefore making rape victims the largest number of PTSD victims in the United States. Moreover, sexual assault is the most common cause of PTSD in women (Rothbaum et al., 2005). When an individual experience any sexual contact without voluntary consent and that violates their control over their body they are prone to experience PTSD (Wilson, 2006). Some of the symptoms they might experience given their condition consist of, nightmares, frequent distressing thoughts of the event, avoidance and numbing by not wanting to talk about the event and avoiding people and/or places that remind them of the traumatic event (Bisson, 2007). One study found that 94% of women experienced PTSD symptoms during the first two weeks of their assault (Wilson, 2006). When treating the survivor for PTSD, not only is it important to help decrease the symptoms or get them to forget about the traumatic event, but rather help them increase their interest by attaining the necessary skills to regain control over their life, overcome the guilt, shame or any other negative perceptions as well as improve their overall functioning. When one experiences sexual assault the consequences of such traumatic event may be displayed biologically, psychologically, and sociologically (Wilson, 2006).
After experiencing the sexual assault, survivors experience The Rape Trauma Syndrome (RTS) which is categorized by three phases (Wilson, 2006). The first phase is the Acute Phase, this occurs instantly following the assault. In this phase, the survivor is in crisis and goes through a range of emotional reactions such as, shaking, crying, yelling or have a flattened effect. In the second phase known as Outwards Adjustment, the survivor loses focus on the assault and rather experience denial and pretend as if nothing happened. The final phase is Long term Reorganization, in which the survivor might experience psychological effects such as feelings of shame, guilt, anxiety or depression. If the survivor does not receive the appropriate support and treatment and believe that others have failed to react in a positive manner, there is a greater risk of PTSD. A problem that arises with individuals who have been sexually assaulted is the fact that less than half disclose the assault and therefore do not receive the support required. This is an important factor given that research illustrates support as an important factor to recovery. Furthermore, survivors who do disclose their assault can also experience secondary victimization given that some physicians, medical staff, law enforcement, and/or family and friends can exhibit and use victim-blaming behaviors, and therefore increase survivor’s psychological and physical distress. In addition to experiencing such traumatic event, women are also exposed to further trauma given that they are required to undergo a forensic rape exam when seeking medical assistance (Wilson, 2006). In addition, given the medical conditions that can arise from physical injuries following a sexual assault, this can also be major risk factor for persistent PTSD symptoms. Moreover, such traumatic event can not only lead to PTSD but also to other mental health and medical disorders.
EMDR, PTSD, and Female Survivors of Sexual Assault
The trauma caused by sexual assault is very traumatic therefore, the symptoms that follow such traumatic event can be devastating and affect one’s everyday life. Statistics show that within the United States, one of every five women (18.3%) has been raped in their lifetime, which equals to nearly 22 million women (Edmond, Lawrence, ; Schrag, 2016). Apart from experiencing PTSD, survivors of sexual assault can also have experience other significant mental health consequences such as substance abuse and depression. Therefore, it is imperative to seek support and treatment to help establish effective coping skills and through this decrease the negative symptoms. Given the need to treat the symptoms of PTSD there has been a number of effective therapeutic treatments developed to treat this condition. Even though, studies have illustrated that treatments such as CBT and prolonged exposure (PE) are effective as they have illustrated a significant reduction in PTSD symptoms, EMDR has shown to be not only as effective but also provide faster and cost-effective results. For instance, in a pilot study in which it compared the effectiveness of PE and EMDR among rape victims, results illustrated that successful treatment was faster with EMDR as a large number of people, seven of ten, had a 70% reduction in PTSD symptoms after three active sessions compared to two of 12 with PE. Furthermore, five studies have been conducted to compare EMDR to different treatments, and results illustrated that in four of the five the studies, EMDR was superior to other type of individual treatments, group therapy and/or medication (Ironson, Freund, Strauss, ; Williams, 2002).
EMDR follows a procedure in which the therapist helps the client process the memories related to the abuse, sensory experiences, affects and perceptions through an imaginal exposure technique. This is done by following an approach that addresses the cause of traumatic memories, the symptoms, and the inaccurate perceptions that develop following traumatic experiences (Ringel, 2014). In this treatment technique, the survivor is asked to imagine a scene that represents the worst part of the trauma as this will help them concentrate on the feelings of distress in their body and through this practice the negative thoughts that match that picture. The survivor is then asked to follow the therapist’s fingers moving back and forth for approximately 20 times each repetition. The survivor is asked to rate the level of discomfort using a 0 to 10 scale, once the level of distress reaches a level of 0 or 1, she is asked to track the therapist’s finger using a new image (Rothbaum et al., 2005). By doing this, the therapist is able to assist the survivor in identifying her target image and through this link her consciousness with the memory stored in her neural memory. The therapist is then able to ask the survivor to identify any negative perceptions associated with the identified target image as it is important for the therapist to be aware how the survivor feels about self. Once the negative belief is identified, the survivor is able to identify a desired and realistic achievable positive cognition about self. The number of sets that the psychotherapist performs during the session depends on the client and their level of tolerance and how comfortable they feel as well as the level of the trauma, but in most cases, this consists of three to four sessions (Posmontier, Dovydaitis, ; Lipman, 2010).
Gaps in Current Research
Even though, EMDR has been ranked in the highest category of effectiveness and research support in the PTSD practice guidelines of both the American Psychiatric Association and U.S. Department of Veterans Affairs and Department of Defense, critiques argue that EMDR has not been used long enough to draw long-term conclusions about its effectiveness, therefore have found limitations (Maxfield, 2007). A study conducted to illustrate the effectiveness of EMDR among female survivors of childhood sexual abuse, did in fact demonstrate effectiveness, however noted the need for more definite evidence as to the immediate and log-term benefits of EMDR. Furthermore, it found the need for larger sample sizes, longer-term treatment with more than six sessions of EMDR before post-testing as well as ethical ways to decrease participants use of consequent treatment between post-testing and follow-ups (Edmond ; Rubin, 2004). Moreover, multiple studies have been performed to help illustrate whether EMDR is more effective than other treatments such as PE or CBT, however such studies have failed to demonstrate this as the differences between EMDR and other effective exposure treatments are minimal. Therefore, researchers have suggested the need for “carefully designed, executed, and analyzed research that pays attention to issues of effect size, power, measurement, and reproducibility as well as issues of clinical significance” (Davidson ; Parker, 2001, p.313). Hence, future studies should attempt to establish whether EMDR is more effective than exposure therapies. For future research, it would be beneficial to further investigate how effective is EMDR with disorders other than PTSD as the evidence supporting the effectiveness of EMDR is much less convincing when focusing on anxiety, phobias, panic disorders, and depression. By doing so, this would help EMDR be a stronger treatment. In addition, in a study conducted in a rape crisis center, reports showed that there is a lack of knowledge on EMDR and how it works, therefore it would be beneficial for counselors to increase their knowledge on EMDR therapy as this would increase the likelihood of using it effectively and consequently, increase effectiveness on future studies (Edmund et al., 2016).
Understanding PTSD and PTSD treatment. (2018). National Center for PTSD. Retrieved from http://www.ptsd.va.gov/public/understanding_ptsd/booklet.pdf