Use of Eye Movement Desensitisation and Reprocessing for Treating Post-Traumatic Stress Disorder after a Motor Vehicle Accident

Article excerpt

Abstract

This case report illustrates the utilisation of eye movement desensitisation reprocessing for treating a patients with post-traumatic stress disorder after a motor vehicle accident. Standardised measurements (Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised) were adopted to monitor treatment effectiveness during various treatment phases. This case demonstrates the possible application of eye movement desensitisation reprocessing for the Chinese population and the treatment efficacy of eye movement desensitisation reprocessing for post-traumatic stress disorder. The implications for future research are discussed.

Key words: Eye movement desensitization reprocessing, Motor vehicle accident, Post-traumatic stress disorder, Treatment effectiveness

Introduction

Eye movement desensitisation and reprocessing (EMDR) was developed by Shapiro (1,2) as a new method for treating post-traumatic stress disorder (PTSD). In brief, EMDR involves eliciting rhythmic, bilateral eye movements from the patient. During this movement, the patient is asked to visualise an image related to the traumatic memory while internally repeating the negative self-statement associated with the memory. Throughout this process, the emotional and physiological arousal originally associated with the memory is desensitised.

The next treatment phase involves installation of positive self-statement, which is then followed by reduction of body tension associated with the trauma. EMDR is completed as the dysfunctional impact of psychological trauma is reprocessed, and the positive self-statement becomes totally valid to the person.

The theoretical underpinning of EMDR is mainly hypothetical. An accelerated information-processing model was used as a working hypothesis to guide the use of EMDR. According to this model, a severe psychological trauma will lead to changes in the nervous system in patients with PTSD. Thus, the information acquired at the time of the traumatic event, including images, sounds, affect, and physical sensations, is neurologically maintained in its disturbing state.

The original material, which is held in this distressing state, continues to be triggered by a variety of internal or external stimuli and is expressed in the form of intrusive thoughts, avoidance behaviour, and increased arousal. The eye movements (or alternative stimuli) used in EMDR trigger a physiological mechanism that activates the information-processing system.

The mechanisms proposed for this activation include the dual focus of attention for both the past trauma and alternative stimuli, a differential effect of neuronal burst caused by the various stimuli, and deconditioning caused by a relaxation response. The main assumption of EMDR is that activating the processing of the trauma memory will naturally enhance adaptability and lead to resolution. Thus, borrowing the hypothesis of the information-processing system, EMDR is conceptualised as working through memory networks. When using EMDR, it is necessary to 'clean out' each associative channel of a target traumatic memory for example, images, sounds, and affect by reprocessing all of the dysfunctionally stored material connected to the target.

According to a project initiated by the American Psychological Association Division 12 (Clinical Psychology) to determine the degree to which therapeutic methods were supported by solid empirical evidence, EMDR was placed by independent reviewers on a list of "empirically validated treatments" as "probably efficacious for civilian PTSD". The other treatment methods listed as "probably efficacious for PTSD" only include exposure therapy and stress inoculation therapy. (4) Despite the rising popularity of EMDR as a treatment for PTSD in the West and the research evidence accumulated, there is a lack of case reports or study of the technique in the Chinese population. …