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Trauma Therapy's New Focus

EMDR uses eye movements to ease patients' emotional distress. Skeptics suggest a placebo effect.

March 25, 2002|LINDA MARSA | TIMES STAFF WRITER

Watching a therapist's hands move back and forth in front of your face while recalling painful memories may seem an unlikely way to alleviate trauma. But hundreds of thousands of people have reportedly tried the technique, and some psychologists--and their patients--say it works.

The therapy, called eye-movement desensitization reprocessing, involves a combination of hand movements (or sometimes finger taps or sounds), accompanied by verbal commands. The patient follows the therapists' movements with his or her eyes while discussing the event or problem that led the patient to seek help.

FOR THE RECORD
Los Angeles Times Thursday March 28, 2002 Home Edition Main News Part A Page 2 A2 Desk 2 inches; 52 words Type of Material: Correction
EMDR therapy--A March 25 story on eye-movement desensitization reprocessing incorrectly said the American Psychological Assn. has endorsed EMDR as a treatment for trauma. Although the clinical psychology division of the association has said there is some evidence to suggest that EMDR is an effective treatment for trauma, the APA does not endorse specific therapies.
For the Record
Los Angeles Times Monday April 1, 2002 Home Edition Health Part S Page 3 View Desk 2 inches; 53 words Type of Material: Correction
EMDR therapy--A story last Monday on eye-movement desensitization reprocessing incorrectly said the American Psychological Assn. has endorsed EMDR as a treatment for trauma. Although the clinical psychology division of the association has said there is some evidence to suggest that EMDR is an effective treatment for trauma, the APA does not endorse specific therapies.

"EMDR sounds like utter nonsense, but this weird thing has a profound effect on people," says Dr. Bessel A. van der Kolk, a professor of psychiatry at Boston University who has studied EMDR.

Once employed mostly to treat severely traumatized patients, EMDR is now used for such common problems as depression, loneliness, fear of flying, claustrophobia and stage fright. Since it was first devised by California psychologist Francine Shapiro in 1987, more than 40,000 therapists in the United States and abroad have attended EMDR workshops, and an estimated 2 million patients have been treated with this technique, according to the EMDR Institute in Pacific Grove, Calif., which conducts training workshops in the technique.

Even though no one is quite sure how EMDR works, it has received some notable endorsements. The American Psychological Assn., the nation's primary professional organization for psychologists, has determined that it's an effective treatment for civilian post-traumatic stress disorder, and Kaiser Permanente, one of the nation's biggest HMOs, uses the technique to treat patients at mental health clinics in Northern California.

EMDR's increasing acceptance is part of a larger trend in psychotherapy. Conventional talk therapy, which can be a lengthy process, has been augmented or supplanted by techniques that emphasize problem-solving, such as cognitive behavioral therapy, which tries to change abnormal reactions to ordinary stresses. Such experiential techniques, which seem to help patients more quickly, have been inspired by new insights into brain chemistry and how the mind deals with trauma.

"We thought that if people can talk about something, they will feel better--but we've discovered just talking doesn't necessarily change your life," van der Kolk says. Today, psychotherapy has been significantly influenced by research into the brain and how it processes information. Many doctors and therapists, however, doubt that EMDR is any more effective than other treatments. They point out that the placebo effect, which is the belief that a treatment will work, is quite potent in psychotherapy, especially with new treatments. Patients expect a therapy to be effective, and because they trust their therapists, it can become a self-fulfilling prophecy.

Skeptics also argue there's nothing unique about EMDR, and they fault proponents for touting it as a major breakthrough. They contend it's just a clever repackaging of existing therapies in which patients are repeatedly exposed to sensations or objects they fear to gradually diminish their anxiety.

"Patch this together with the placebo effect, and it's not surprising that it's helpful," says Richard J. McNally, a psychology professor at Harvard University in Cambridge, Mass. "There are a bunch of syndromes where EMDR does seem to work well--with PTSD, phobias and panic disorder. But people are now using EMDR for everything--even for improving golf games."

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Pinpointing, Treating Specific Traumas

EMDR was first used on patients suffering from PTSD: Vietnam veterans; victims of rape, incest or child abuse; and survivors of natural disasters or traumatic events, like car accidents, earthquakes, the shootings at Columbine High School and the Oklahoma City bombing. And when terrorists attacked the Pentagon and the World Trade Center, EMDR therapists traveled to Washington and New York to counsel survivors, victims' families, and rescue and recovery workers.

Therapists who use the technique say it helps people come to terms with their experience without being re-traumatized. "EMDR is much more accurate than conventional therapy," says Steven V. Marcus, a psychologist at Kaiser Hospital in Santa Clara.

In an often-cited study funded by Kaiser and published in the journal Psychotherapy in 1997, Marcus randomly assigned 67 PTSD sufferers to either EMDR or standard treatment. At the end of three sessions, 50% of the EMDR participants no longer met the criteria for PTSD, compared to 20% receiving standard therapy. After treatment, 77% of the EMDR group no longer met the PTSD criteria, compared to 50% of those receiving standard therapy.

"With EMDR," says Marcus, "you can pinpoint a specific trauma and target that like a laser beam."

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