بايوفيدباك / EMDR

The International Society for Traumatic Stress Studies (ISTSSS- the leader in determining effective treatments for PTSD) identifies EMDR as a Level A treatment for PTSD, based on a multitude of well-controlled randomized trials and systematic meta-analytic reviews. There has been a dramatic improvement in research quality since 1989 when EMDR was first introduced. ISTSS' critical review of the evidence is based exclusively on a review of RCTs of EMDR for PTSD published in peer-reviewed journals since publication of the guidelines. EMDR has been compared to other front line treatments, including medications that target PTSD and Exposure Therapy, and it has performed comparably in all such trials. Compared to other treatments targeting PTSD, the status of the evidence supporting EMDR is substantial and of high quality. It received AHCPR (Agency for Health Care Policy and Research) Level A rating for treatment of adults with a diagnosis of PTSD. EMDR for children warrants an AHCPR Level B rating. EMDR appears to be well tolerated by most patients, possibly to a degree not characteristic of alternative psychological treatments. It has a much lower level of treatment attrition (drop outs) than Exposure Therapy because it is a more comfortable process. Children also seem to benefit from an adapted procedure, and EMDR receives a level B rating with children. Existing data support the use of EMDR in children and adolescents, but compared to adults, there have been fewer RCTs evaluating this. Hence the lower rating. Single episode traumas appear to respond the most favorably to EMDR treatment, though EMDR is effective for multiple traumas as well. Elevated depression scores do seem to respond favorably to EMDR, even when they are not targeted specifically for intervention. The treatment of panic disorder has benefited from EMDR. EMDR may have some advantages over conventional exposure to trauma memories, which may be due to the dosed intermittent exposure combined with post-exposure "mindful awareness."

"In a January 2011 study in the Journal of Anxiety Disorders, for example, some patients with PTSD went through a session of EMDR while others completed all the components of a typical EMDR session but kept their eyes closed rather than moving them. The patients whose session included eye movements reported a more significant reduction in distress than did patients in the control group. Their level of physiological arousal, another common symptom of PTSD, also decreased during the eye movements, as measured by the amount of sweat on their skin. One of the ways EMDR's eye movements are thought to reduce PTSD symptoms is by stripping troubling memories of their vividness and the distress they cause. A study in the May 2012 Behaviour Research and Therapy examined the effectiveness of using beep tones instead of eye movements during EMDR. The researchers found that eye movements outperformed tones in reducing the vividness and emotional intensity of memories. Those studies relied on self-reports of symptom severity, however, so researchers at Utrecht University in the Netherlands sought more objective confirmation of a change in vividness by also measuring participants' reaction times to fragments of a previously viewed picture. The work, published online in July 2012 in Cognition and Emotion, compared two groups of participants who had committed one detailed picture to memory. When asked to recall the picture and focus on it mentally, one group was instructed to perform eye movements. That group had slower reaction times to the familiar picture fragments in a subsequent memory test, and subjects reported that the vividness of the recalled pictures had decreased. These studies and others from the past several years have helped validate EMDR—so much so that the American Psychiatric Association, the International Society for Traumatic Stress Studies, and the Departments of Defense and of Veterans Affairs have deemed it an effective therapy."