Conclusion

Overall, EMDR appears to be an effective and efficient therapeutic procedure for the treatment of civilian PTSD. Evidence for its utility in treating complex and multiple trauma is less convincing, although when sufficient treatment time is given (in excess of the three sessions so commonly applied) for this difficult group (see, for example, Carlson et al., 1998; Marcus et al., 1997) EMDR appears to have some effectiveness. Evidence for EMDR's effectiveness for problems other than PTSD is not yet extensive or rigorous enough to draw firm conclusions.

Developments in the theoretical basis of EMDR are becoming more interesting, cogent and testable. However, theory has developed post hoc from clinical findings and no direct link between theory and clinical practice and observations has been as yet conclusively proven.

The role of eye movements or bilateral stimulation remains controversial, although the much replicated work of Andrade et al. (1997), demonstrating that eye movements do have specific effects in reducing the vividness of emotional imagery in traumatised persons, may be relevant to this debate, as may the studies of Cristman et al. (2003) and Kuiken et al. (2002) suggesting particular benefits for eye moments.

It is clear that EMDR is an amalgam of different therapeutic elements, of which eye movements or bilateral stimulation are just one element. Other than having evidence that the procedure in its totality is effective and efficient, we still do not know which elements are the most therapeutically potent, although Shapiro (2002) gives some guidelines as to how future research might elucidate some of these questions.

Finally, there is some evidence from direct comparisons between EMDR and exposure for the treatment of PTSD that EMDR and exposure are roughly equal in effectiveness, with some evidence for greater efficiency in EMDR.

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