Allen Rubin, Ph.D.
Duration: 9/02 – 12/04
This study aims to conduct a randomized experimental evaluation of the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) in reducing the frequency of serious incident reports of behavioral problems among girls aged 7 to 17 who reside at a residential treatment center for girls at the Settlement Home in Austin, Texas. Eye Movement Desensitization and Reprocessing (EMDR) was developed in 1987 to help victims of trauma resolve distressing memories, feelings and cognitions associated with the trauma and to replace negative cognitions with positive ones. Although EMDR incorporates various cognitive-behavioral strategies, its most distinguishing feature is the use of bilateral stimulation in conjunction with these strategies. Eye movements usually comprise the bilateral stimulation. Other forms of bilateral stimulation include alternating right and left hand taps or alternating sounds in the right and left ear for clients with vision problems or who have difficulty thinking about stressful material while concentrating on tracking the therapist’s rapidly moving fingers with their eyes.
During bilateral stimulation, the client focuses on a mental picture of the traumatic memory or the current stressful situation, identifies an undesired self-statement about the image, identifies a positive self-statement that they would like to replace the undesired one, reports unpleasant emotional sensations connected with the image, notes where in the body the emotional unpleasantness is felt, and provides a subjective rating of the severity of the distress they feel and how true their preferred self-statement seems to them. The client is asked to hold all of the identified target components in mind while the therapist induces the eye movements or an alternate form of bilateral stimulation. The emphasis during this phase is on relying upon the bilateral stimulation, not talk therapy, to achieve the desensitization and the cognitive restructuring.
More than 40,000 mental health practitioners have been trained in EMDR. More controlled studies have been done supporting the effectiveness of EMDR in treating posttraumatic stress disorder (PTSD) among adults than has been the case for any other psychotherapy for PTSD. Research using brain scans has found that neurobiological problems in brain asymmetry among traumatized individuals appeared to be corrected after EMDR treatment. Despite the foregoing support among adults, however, we still do not know whether EMDR is effective with children and adolescents, especially those who have experienced multiple traumas.
All residents who have not had EMDR treatment prior to the study, and who are deemed appropriate by the clinical staff for EMDR treatment, will be invited to participate. Approximately 84 girls are expected to participate in this study over the study’s two-year period. Each participant will be assigned randomly to either the EMDR (experimental) treatment condition or the routine (control) treatment condition. Throughout the study participants in both conditions will receive all of the services routinely provided by the residential treatment center. The only difference will be whether they receive EMDR in addition to those services.
The EMDR treatment will be provided over a period of three months. After the three-month study period, each control group participant will receive the EMDR treatment protocol (plus routine services). Each participant originally assigned to EMDR treatment will continue to receive EMDR treatment (plus routine services) as long as needed. The dependent variable in this study will be the frequency of serious incident reports of behavioral problems per girl completed by Settlement Home staff members during each girl’s three-month treatment phase in this study. Whenever any serious behavioral incident warranting special intervention is observed by any staff member, the staff member observing the incident is expected to complete a Serious Incident Report Form, which identifies the nature of the incident, the circumstances surrounding it, and the interventions required to deal with it – including whether some form of restraint was required. Serious incident reports are completed any time the following are observed or experienced: restraint, property damage, injury to staff or restraint that required medical attention, threat to staff or resident, anything related to gangs, sexually acting out, refused medication, possession of a weapon, short personal restraint, suspension/expulsion/referral from school, suicidal ideation or behavior, monitoring communication, drug/alcohol use, verbal aggression, auto accident, escort, physical aggression, self-abuse, hospitalization/ER, smoking, theft/shoplifting, runaway, and other incidents that do not fit into the above categories, but qualify as a serious incidents. The study’s hypothesis will be tested with a t-Test (alpha=.05; 2-tailed; power=.80 assuming a medium ES and an N of 84), comparing the mean number of serious incident reports for the EMDR and routine treatment groups. Cohen’s d will be calculated to assess effect size. The group receiving EMDR is expected to have significantly fewer serious incident reports than the group receiving routine treatment only.
Center for Social Work Research, The University of Texas at Austin
Keywords: substance abuse