Que es EMDR .:EMDR MEXICO:.

Eficacia del EMDR

El EMDR tiene una amplia base de reportes de casos publicados e investigación controlada que soportan a esta metodología como un tratamiento validado empíricamente para tratar trauma.

Las directrices de Práctica Clínica para el Tratamiento de Pacientes con Trastorno por Estrés Agudo y Trastorno por Estrés Postraumático de la American Psychiatric Association Han designado al EMDR como un Tratamiento Efectivo para dichos trastornos (17)

Las directrices de Práctica Clínica para el manejo de Estrés Postraumático del Departamento de Asuntos para Veteranos del Departamento de Defensa de los Estados Unidos han designado al EMDR como un Tratamiento Efectivo para tratar el Estrés Postraumático. Con nivel de recomendación "A": Fuerte recomendación de que la intervención con esta metodología es siempre indicada y aceptable. (1)

Las directrices de actuales del Instituto Nacional de Salud e Investigación Médica de Francia han designado al EMDR como un Tratamiento Efectivo para tratar a las víctimas de trauma. (2)

Las recomendaciones regionales de tratamiento para trastornos de ansiedad de Suecia han designado al EMDR como un Tratamiento Efectivo para tratar TEPT (3)

Las directrices de actuales de Cuidados en Salud Mental de Holanda han designado al EMDR como un Tratamiento Efectivo para tratar el TEPT. (4)

Las directrices actuales de tratamiento del Departamento de Salud de Irlanda han designado al EMDR como un Tratamiento Efectivo para tratar a las víctimas de Trauma.(5)

Las directrices actuales de tratamiento del Departamento de Salud del Reino Unido 6 y el Consejo Nacional Israelí de Salud Mental 7 han designado al EMDR como un Tratamiento Efectivo para tratar el TEPT y a víctimas del terror.

Las directrices actuales de tratamiento de la International Society for Traumatic Stress Studies (ISTSS) han designado al EMDR como un Tratamiento Efectivo para tratar el Trastorno por Estrés Postraumático (TEPT). (8)

1998. Meta-análisis de todos los tratamientos psicológicos y de farmacoterapia para tratar el TEPT. Van Etten & Taylor revisan 59 estudios. Concluyen: "EMDR es efectivo para el tratamiento del TEPT, y es más eficiente que otros tratamientos." (9)

De acuerdo a la Fuerza de Trabajo de la División Clínica de la American Psychological Association, el EMDR es una metodología validada empíricamente para tratar TEPT (10)

Nota Importante: En el año de 1997, el Consejo Directivo de la ISTSS inició el proyecto de desarrollar un grupo de directrices para tratamiento, basadas en una extensiva revisión de la literatura clínica e investigaciones, preparada por expertos en el campo. Así como en estudios bien controlados que cumplieran con los criterios de la Agency of Health Care Policy and Research Classification of Level of Evidence.

En el años 2000 se publicaron dichas directrices(11), con la intención de informar a los clínicos de todo el mundo de cuales eran las mejores metodologías para tratar individuos con el diagnóstico de TEPT (niños, adolescentes y adultos), que es una condición psicológica seria que puede ocurrir como resultado de experienciar un evento traumático.

Los pacientes con TEPT usualmente tienen al menos otro trastorno psiquiátrico. El departamento de epidemiología de los Estados Unidos, encontró que el 80 % de los pacientes con TEPT sufren de depresión, otro trastorno de ansiedad o dependencia/abuso químico.

Por lo que en el desarrollo de estas directrices, la fuerza de trabajo de la ISTSS reconoció que el TEPT es frecuentemente acompañado de otras condiciones psicológicas y que esa comorbidad requiere de sensibilidad clínica, atención, y evaluación diagnóstica durante todo el proceso del tratamiento.

Las aproximaciones terapéuticas que obtuvieron las más altas calificaciones (niveles A y B) *on EMDR y Terapia Cognitiva Conductualen su modalidad de exposición(exposure): inundación/imaginal/envivo/prolongada/dirigida.

Tres estudios(12) (13) (14) han indicado la eliminación del Diagnóstico de TEPT en un rango del 77 al 99% de los pacientes después de 3 a7 sesiones de 90 min.

Otros estudios han mostrado decrementos significativos en un amplio rango de los síntomas del TEPT después de 2-3 sesiones. (15)

Los efectos del tratamiento con EMDR se mantienen. Un estudio reporta 84% de remisión del diagnóstico de TEPT en un seguimiento a 15 meses. (16)

Notas

1 Department of Veterans Affairs & Department of Defense (2004). VA/DoD CLINICAL PRACTICE GUIDELINES FOR THE MANAGEMENT OF POST- TRAUMATIC STRESS. www.oqp.med.va.gov/cpg/ptsd

2 INSERM (2004). Psychotherapy: An evaluation of three approaches. French National Institute of Health and Medical Research. Paris, France.

3 Sjoblom, P.O., Andréewitch, S. Bejerot, S., Mortberg, E (2003). Regional treatment recommendation for anxiety disorders. Stockholm: Medical Program Commmmittee/Stockholm City Council, Sweden.

4 Dutch National Steering Committee Guidelines Mental Health Care (2003). Multidisciplinary Guidelines Anxiety Disorders. Quality Institute Health Care CBO/Trimbos Institute. Utrecht, Netherlands.

5 CREST (2003). The management of PTSD in adults. A publication of the Clinical Resource Efficiency Support team of the Northern Ireland Department of Health, Social Services and Public Safety, Belfast.

6 United Kingdom Department of Health. (2001). Treatment choice in psychological therapies and counseling evidence based clinical practice guidelines. London: Author WEB:
http://www.doh.gov.uk/mentalhealth/treatmentguidelines/

7 Bleich, A. Kotler, M., Kutz, E., & Shaley, A. (2002). A position paper of the (Israeli) National Council for Mental Health: Guidelines for the assessment and professional intervention with terror victims in the hospital and in the community.

8 Chemtob, Tolin, van der Kolk & Pitman (2000). EMDR in Edna A. Foa, Terence M. Keane & Matthew J. Friedman [Eds.]. Effective treatments for PTSD: Practice Guidelines from the ISTSS. New York: Guilford Press, p.139-155, 155, 333-335.

9 Van Etten, M.L. & Taylor, S. (1998). Comparative efficacy of treatments for posttraumatic stress disorder: A meta- analysis. Clinical Psychology & Psychotherapy, 5, 126-144.

10 Chambless, D.L., et al. (1998). Update of empirically validated therapies, II. The Clinical Psychologist, 51, 3-16.

11 Effective treatments for PTSD: Practice Guidelines from the ISTSS. New York: Guilford Press, p.139-155, 155, 333-335.

12 Lee, C & Gavriel, H., Drummond, P., Richards, J. & Greenwald, R. (2002). Treatment of post-traumatic stress disorder: A comparison of stress inoculation training with prolonged exposure and EMDR. Journal of Clinical Psychology, 58, 1071-1089.

13 Marcus, S., Marquis, P. & Sakai, C. (1997). Controlled study of treatment of PTSD using EMDR in an HMO setting. Psychotherapy, 34, 307-315.

14 Rothbaum, B.O. (1997). A controlled study of EMDR for PTSD sexual assault victims.Bulletin of the Menninger Clinic, 61, 317-334.

15 Ironson, G.I., Freund, B., Strauss, J.L., & Williams, J. (2002) A comparison of two treatmentsfor traumatic stress: A community based study of EMDR and prolonged exposure. Journal of Clinical Psychology, 58, 113-128.

16 Wilson, S.A., Becker, L.A., & Tinker, R.H. (1995) Fifteen-month follow-up of EMDR treatment for PTSD and psychological trauma. Journal of Consulting and Clinical Psychology, 65, 928-937.

17. APA: Practice Guidelines for the Treatment od Patients with Acute Stress Disorder and PTSD (November 2004)

Neuro Imagenes

Poblaciones Tratadas con EMDR en Estudios Controlados

Estudios de Neurofisiología

Rauch, van der Kolk, y colegas (1996) condujeron estudios con la metodología de emisión de positrones en pacientes con TEPT.

Los pacientes fueron expuestos a narrativas vívidas y detalladas de lo que ellos habían escrito acerca de sus propias experiencias traumáticas.

Los pacientes mostraron un aumento de la actividad solo en el hemisferio derecho, en las áreas más involucradas con la excitación emocional.

También mostraron aumento de la actividad en la corteza visual derecha, cuando reportaban sus flashbacks (vívidas memorias).

Quizá lo más significativo fue que el área de Broca – la parte del hemisferio izquierdo responsable de convertir las experiencias personales en lenguaje “se apagó”. Estos hallazgos indican que los síntomas del TEPT se reflejan en cambios de la actividad cerebral.(1)

En un estudio publicado en 1999, los doctores Levin, Lazrove y van der Kolk notaron cambios neurofisiológicos, utilizando el método SPECT para escanear el funcionamiento del cerebro de pacientes antes y después de recibir EMDR.

Esta es una evidencia preliminar de que puede haber cambios en los patrones de activación cerebral después de un tratamiento efectivo.

Se llevó a cabo un escaneo con el método SPECT antes y después de recibir tratamiento con EMDR.

Los hallazgos indicaron cambios metabólicos después de EMDR en dos regiones específicas del cerebro.

Primero, hubo un incremento en la actividad bilateral de la circunvolución cingular anterior .

Esta área modera la experiencia de amenazas reales contra percibidas.

Después del tratamiento con EMDR los pacientes diagnosticados clínicamente con TEPT dejaron de estar hipervigilantes.

Segundo, hubo un incremento en el metabolismo del lóbulo frontal, lo que puede indicar una mejoría en la habilidad de dar sentido a la estimulación sensorial recibida.(2)

Para mayor información sobre la evidencia científica de EMDR visitar:

www.emdr.com

Secciones de: Efficacy. Research y Trauma Research

Notas

1 Rauch, S., van der Kolk, B. A., Fisler, R., Alpert, N. M., Orr, S. P., Savage, C.R., Fischman, A. J., Jenike, M. A., & Pitman, R. K. (1996). Symptom provocation study of post traumatic stress disorder using positron emission tomography and script-drive imagery. Archives of General Psychiatry, 53, 380-387.

2 (Levin, Patti, Lazrove, Steven y van der Kolk, Bessel, 1999. “What psychological testing and neuroimaging tell us about the treatment of posttraumatic stress disorder by eye movement desensitization and reprocessing.” Journal of Anxiety Disorders, Vol. 13, No. 1-2, pp. 159-172.)

Se recomienda consultar: Bergmann, Uri, Speculations on the neurobiology of EMDR, TRAUMATOLOGYe, 4:1, Article 2, 1998, www.fsu.edu/-trauma

Investigaciones y lecturas

Bleich, A., Kotler, M., Kutz, I., & Shalev, A. (2002) A position paper of the (Israeli) National Council for Mental Health: Guidelines for the assessment and professional intervention with terror victims in the hospital and in the community. Jerusalem, Israel.

EMDR is one of only three methods recommended for treatment of terror victims.

Chambless, D.L. et al. (1998). Update of empirically validated therapies, II. The Clinical Psychologist, 51, 3-16.

According to a taskforce of the Clinical Division of the American Psychological Association, the only methods empirically supported for the treatment of any post-traumatic stress disorder population were EMDR, exposure therapy, and stress inoculation therapy.

CREST (2003). The management of post traumatic stress disorder in adults. A publication of the Clinical Resource Efficiency Support Team of the Northern Ireland Department of Health, Social Services and Public Safety, Belfast.

Of all the psychotherapies, EMDR and CBT were stated to be the treatments of choice for trauma victims.

Department of Veterans Affairs & Department of Defense (2004) VA/DoD Clinical Practice Guideline for the Management of Post-Traumatic Stress. Washington, DC.
http://www.oqp.med.va.gov/cpg/PTSD/PTSD_cpg/frameset.htm

EMDR was one of four therapies given the highest level of evidence and recommended for treatment of PTSD.

Dutch National Steering Committee Guidelines Mental Health Care (2003). Multidisciplinary Guideline for Anxiety Disorders. Quality Institute Heath Care CBO/Trimbos Intitute. Utrecht, Netherlands.

EMDR and CBT are both treatments of choice for PTSD

Foa, E.B., Keane, T.M., & Friedman, M.J. (2000). Effective treatments for PTSD: Practice Guidelines of the International Society for Traumatic Stress Studies New York: Guilford Press.

In the Practice Guidelines of the International Society for Traumatic Stress Studies, EMDR was listed as an efficacious treatment for PTSD.

INSERM (2004). Psychotherapy: An evaluation of three approaches. French National Institute of Health and Medical Research, Paris, France.

Of the different psychotherapies, EMDR and CBT were stated to be the treatments of choice for trauma victims.

Sjöblom, P.O., Andréewitch, S . Bejerot, S., Mörtberg, E. , Brinck, U., Ruck, C., & Körlin, D. (2003) Regional treatment recommendation for anxiety disorders. Stockholm: Medical Program Committee / Stockholm City Council, Sweden.

Of all psychotherapies CBT and EMDR are recommended as treatments of choice for PTSD.

United Kingdom Department of Health. (2001). Treatment choice in psychological therapies and counselling evidence based clinical practice guideline. London, England.

Best evidence of efficacy was reported for EMDR, exposure, and stress inoculation Meta-analyses.

Davidson, P.R., & Parker, K.C.H. (2001). Eye movement desensitization and reprocessing (EMDR): A meta-analysis. Journal of Consulting and Clinical Psychology, 69, 305-316.

EMDR is equivalent to exposure and other cognitive behavioral treatments. It should be noted that exposure therapy uses one to two hours of daily homework and EMDR uses none.

Maxfield, L., & Hyer, L.A. (2002). The relationship between efficacy and methodology in studies investigating EMDR treatment of PTSD. Journal of Clinical Psychology, 58, 23-41.

A comprehensive meta-analysis reported the more rigorous the study, the larger the effect.

Van Etten, M., & Taylor, S. (1998). Comparative efficacy of treatments for post-traumatic stress disorder: A meta-analysis. Clinical Psychology and Psychotherapy, 5, 126-144.

This meta-analysis determined that EMDR and behavior therapy were superior to psychopharmaceuticals. EMDR was more efficient than behavior therapy, with results obtained in one-third of the time.

Randomized Clinical Trials

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

Twelve sessions of EMDR eliminated post-traumatic stress disorder in 77% of the multiply traumatized combat veterans studied. Effects were maintained at follow-up. This is the only randomized study to provide a full course of treatment with combat veterans. Other studies (e.g., Macklin et al.) evaluated treatment of only one or two memories, which, according to the International Society for Traumatic Stress Studies Practice Guidelines, is inappropriate for multiple-trauma survivors. The VA/DoD Practice Guideline also indicates these studies (often with only two sessions) offered insufficient treatment doses for veterans.

Chemtob, C.M., Nakashima, J., & Carlson, J.G. (2002). Brief-treatment for elementary school children with disaster-related PTSD: A field study. Journal of Clinical Psychology, 58, 99-112.

EMDR was found to be an effective treatment for children with disaster-related PTSD who had not responded to another intervention. This is the first controlled study for disaster-related PTSD, and the first controlled study examining the treatment of children with PTSD.

Edmond, T., Rubin, A., & Wambach, K. (1999). The effectiveness of EMDR with adult female survivors of childhood sexual abuse. Social Work Research, 23, 103-116.

EMDR treatment resulted in lower scores (fewer clinical symptoms) on all four of the outcome measures at the three-month follow-up, compared to those in the routine treatment condition. The EMDR group also improved on all standardized measures at 18 months follow up (Edmond & Rubin, in press, Journal of Child Sexual Abuse).

Edmond, T., Sloan, L., & McCarty, D. (2004). Sexual abuse survivors' perceptions of the effectiveness of EMDR and eclectic therapy: A mixed-methods study. Research on Social Work Practice, 14, 259-272.

Combination of qualitative and quantitative analyses of treatment outcomes with important implications for future rigorous research. Survivors' narratives indicate that EMDR produces greater trauma resolution, while within eclectic therapy, survivors more highly value their relationship with their therapist, through whom they learn effective coping strategies.

Ironson, G.I., Freund, B., Strauss, J.L., & Williams, J. (2002). Comparison of two treatments for traumatic stress: A community-based study of EMDR and prolonged exposure. Journal of Clinical Psychology, 58, 113- 128.

Both EMDR and prolonged exposure produced a significant reduction in PTSD and depression symptoms. Study found that 70% of EMDR participants achieved a good outcome in three active treatment sessions, compared to 29% of persons in the prolonged exposure condition. EMDR also had fewer dropouts.

Jaberghaderi, N., Greenwald, R., Rubin, A., Dolatabadim S., & Zand, S.O. (In press). A comparison of CBT and EMDR for sexually abused Iranian girls. Clinical Psychology and Psychotherapy.

Both EMDR and CBT produced significant reduction in PTSD and behavior problems. EMDR was significantly more efficient, using approximately half the number of sessions to achieve results.

Lee, C., Gavriel, H., Drummond, P., Richards, J. & Greenwald, R. (2002). Treatment of post-traumatic stress disorder: A comparison of stress inoculation training with prolonged exposure and eye movement desensitization and reprocessing. Journal of Clinical Psychology, 58, 1071-1089.

Both EMDR and stress inoculation therapy plus prolonged exposure (SITPE) produced significant improvement, with EMDR achieving greater improvement on PTSD intrusive symptoms. Participants in the EMDR condition showed greater gains at three-month follow-up. EMDR required three hours of homework compared to 28 hours for SITPE.

Marcus, S., Marquis, P. & Sakai, C. (1997). Controlled study of treatment of PTSD using EMDR in an HMO setting. Psychotherapy, 34, 307-315

Funded by Kaiser Permanent. Results show that 100% of single-trauma and 80% of multiple-trauma survivors were no longer diagnosed with post-traumatic stress disorder after six 50-minute sessions. Follow up indicated maintenance of effects (Marcus et al., 2004, International Journal of Stress Management).

Power, K.G., McGoldrick, T., Brown, K., et al. (2002). A controlled comparison of eye movement desensitization and reprocessing versus exposure plus cognitive restructuring, versus waiting list in the treatment of post-traumatic stress disorder. Journal of Clinical Psychology and Psychotherapy, 9, 299-318.

Both EMDR and exposure therapy plus cognitive restructuring (with daily homework) produced significant improvement. EMDR was more beneficial for depression and required fewer treatment sessions.

Rothbaum, B. (1997). A controlled study of eye movement desensitization and reprocessing in the treatment of post-traumatic stress disordered sexual assault victims. Bulletin of the Menninger Clinic, 61, 317-334.

Three 90-minute sessions of EMDR eliminated post-traumatic stress disorder in 90% of rape victims.

Scheck, M., Schaeffer, J.A., & Gillette, C. (1998). Brief psychological intervention with traumatized young women: The efficacy of eye movement desensitization and reprocessing. Journal of Traumatic Stress, 11, 25-44.

Two sessions of EMDR reduced psychological distress scores in traumatized young women and brought scores within one standard deviation of the norm.

Soberman, G. B., Greenwald, R., & Rule, D. L. (2002). A controlled study of eye movement desensitization and reprocessing (EMDR) for boys with conduct problems. Journal of Aggression, Maltreatment, and Trauma, 6, 217-236.

The addition of three sessions of EMDR resulted in large and significant reductions of memory-related distress, and problem behaviors by 2-month follow-up.

Taylor, S. et al. (2003). Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training. Journal of Consulting and Clinical Psychology, 71, 330-338. The only randomized study to show exposure statistically superior to EMDR on two subscales (out of 10).

This study used therapist assisted "in vivo" exposure, where the therapist takes the person to previously avoided areas, in addition to imaginal exposure and one hour of daily homework (@ 50 hours). The EMDR group used only standard sessions and no homework.

Vaughan, K., Armstrong, M.F., Gold, R., O'Connor, N., Jenneke, W., & Tarrier, N. (1994). A trial of eye movement desensitization compared to image habituation training and applied muscle relaxation in post- traumatic stress disorder. Journal of Behavior Therapy & Experimental Psychiatry, 25, 283-291.

All treatments led to significant decreases in PTSD symptoms for subjects in the treatment groups as compared to those on a waiting list, with a greater reduction in the EMDR group, particularly with respect to intrusive symptoms. In the 2-3 weeks of the study, 40-60 additional minutes of daily homework were part of the treatment in the other two conditions.

Wilson, S., Becker, L.A., & Tinker, R.H. (1995). Eye movement desensitization and reprocessing (EMDR): Treatment for psychologically traumatized individuals. Journal of Consulting and Clinical Psychology, 63, 928-937.

Three sessions of EMDR produced clinically significant change in traumatized civilians on multiple measures.

Wilson, S., Becker, L.A., & Tinker, R.H. (1997). Fifteen-month follow-up of eye movement desensitization and reprocessing (EMDR) treatment of post-traumatic stress disorder and psychological trauma. Journal of Consulting and Clinical Psychology, 65, 1047-1056.

Follow-up at 15 months showed maintenance of positive treatment effects with 84% remission of PTSD diagnosis.

Non Randomized Studies

Devilly, G.J., & Spence, S.H. (1999). The relative efficacy and treatment distress of EMDR and a cognitive behavioral trauma treatment protocol in the amelioration of post-traumatic stress disorder. Journal of Anxiety Disorders, 13, 131-157.

The only EMDR research study that found CBT superior to EMDR. The study is marred by poor treatment delivery and higher expectations in the CBT condition. Treatment was delivered in both conditions by the developer of the CBT protocol.

Fernandez, I., Gallinari, E., Lorenzetti, A. (2004) A school- based EMDR intervention for children who witnessed the Pirelli building airplane crash in Milan, Italy. Journal of Brief Therapy, 2, 129-136.

A group intervention of EMDR was provided to 236 schoolchildren exhibiting PTSD symptoms 30 days post- incident. At four-month follow up, teachers reported that all but two children evinced a return to normal functioning after treatment.

Grainger, R.D., Levin, C., Allen-Byrd, L. , Doctor, R.M. & Lee, H. (1997). An empirical evaluation of eye movement desensitization and reprocessing (EMDR) with survivors of a natural catastrophe. Journal of Traumatic Stress, 10, 665-671.

A study of Hurricane Andrew survivors found significant differences on the Impact of Event Scale and subjective distress in a comparison of EMDR and non-treatment condition.

Puffer, M.; Greenwald, R. & Elrod, D. (1997). A single session EMDR study with twenty traumatized children and adolescents. Traumatology-e, 3(2), Article 6.

In this delayed treatment comparison, over half of the participants moved from clinical to normal levels on the Impact of Events Scale, and all but 3 showed at least partial symptom relief on several measures at 1-3 m following a single EMDR session.

Silver, S.M., Brooks, A., & Obenchain, J. (1995). Eye movement desensitization and reprocessing treatment of Vietnam war veterans with PTSD: Comparative effects with biofeedback and relaxation training. Journal of Traumatic Stress, 8, 337-342.

One of only two EMDR research studies that evaluated a clinically relevant course of EMDR treatment with combat veterans (e.g., more than one or two memories; see Carlson et al., above). The analysis of an inpatient veterans' PTSD program (n=100) found EMDR to be vastly superior to biofeedback and relaxation training on seven of eight measures.

Solomon, R.M. & Kaufman, T.E. (2002) A peer support workshop for the treatment of traumatic stress of railroad personnel: Contributions of eye movement desensitization and reprocessing (EMDR). Journal of Brief Therapy, 2, 27-33,

60 railroad employees who had experienced fatal grade accident crossing accidents were evaluated for workshop outcomes, and for the additive effects of EMDR treatment. Although the workshop was successful, in this setting, the addition of a short session of EMDR (5-40 minutes) led to significantly lower, sub clinical, scores which further decreased at follow up.

Sprang, G. (2001). The use of eye movement desensitization and reprocessing (EMDR) in the treatment of traumatic stress and complicated mourning: Psychological and behavioral outcomes. Research on Social Work Practice, 11, 300-320.

In a multi-site study, EMDR significantly reduced symptoms more often than the CBT treatment on behavioral measures, and on four of five psychosocial measures. EMDR was more efficient, inducing change at an earlier stage and requiring fewer sessions.

Additional Information

Therapy Advisor: An NIMH sponsored website listing empirically supported methods for a variety of disorders http://www.therapyadvisor.com

Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols and procedures (2nd ed.). New York: Guilford Press.

Shapiro, F. (2002). (Ed.). EMDR as an integrative psychotherapy approach: Experts of diverse orientations explore the paradigm prism. Washington, DC: American Psychological Association Books.

EMDR for trauma: Eye Movement Desensitization and Reprocessing. American Psychological Association Psychotherapy Videotape series II.

Perkins, B.R. & Rouanzoin, C.C. (2002). A critical evaluation of current views regarding eye movement desensitization and reprocessing (EMDR): Clarifying points of confusion. Journal of Clinical Psychology, 58, 77-97. http://www.perkinscenter.net

Rogers, S., & Silver, S. M. (2002). Is EMDR an exposure therapy? A review of trauma protocols. Journal of Clinical Psychology. 58, 43-59.

Stickgold, R. (2002). EMDR: A putative neurobiological mechanism of action. Journal of Clinical Psychology, 58, 61-75.

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