Self-administered EMDR therapy: potential solution for expanding the availability of psychotherapy for PTSD or unregulated recipe for disaster?

Abstract

Background Post-traumatic stress disorder (PTSD) carries a high disease burden worldwide, yet significant barriers exist to providing and accessing treatment for PTSD, particularly in refugee populations and in low- and middle-income countries. There is emerging evidence that self-administered psychological therapies, such as those accessed via online and mobile applications, are efficacious for many mental illnesses and increase access to treatment. Online and mobile applications offering self-help tools for eye movement desensitisation reprocessing (EMDR) therapy, an internationally recommended treatment for PTSD, are already widely distributed to the public. Aims To present a commentary evaluating the potential benefits and risks of self-administered EMDR therapy: first, by conducting a search for existing peer-reviewed evidence relating to self-administered EMDR therapy; second, by presenting existing evidence for other self-help psychotherapies and evaluating what additional insight this could provide into the potential efficacy, safety, tolerability and accessibility of self-administered EMDR therapy; and, third, by describing the conflicting views of EMDR experts on the topic. Method A search was conducted for articles related to internet, mobile, book or computerised self-help EMDR therapy. The following databases were searched systematically: Medline, PsycInfo, EMBASE, AMED, CINAHL, Psychology and Behavioural Sciences, Cochrane Database and the EMDR Library. Results Only one small primary research study was found relating to self-administered EMDR therapy. The results indicated significantly reduced symptoms of PTSD, depression, anxiety, distress and disability between pre-treatment and 3 month follow-up. No serious adverse events were reported. However, substantial methodological issues were discovered. Conclusions There is evidence that self-administered psychotherapies, in general, can be safe, effective and highly accessible. However, controversies persist regarding the safety and potential efficacy of self-administered EMDR therapy, and more robust research is needed. It is vital that methods are found to improve worldwide access to effective PTSD treatment, particularly given the current scale of migration to flee civil unrest.

An Efficient System for Eye Movement Desensitization and Reprocessing (EMDR) Therapy: A Pilot Study

“…Even if the intervention involved only one session, our findings are similar to those of previous research, which showed that even after a single session of EMDR, symptoms decreased significantly, effects of the intervention being constant after follow-up [ 32 , 33 , 34 , 35 , 36 , 37 ]. Moreover, this decrease in terms of symptoms was also found in other research where participants were treated remotely and the intervention was self-administered [ 3 , 38 ].…”

“…From a theoretical and practical point of view, this paper responds to some gaps reported in previous literature, having an important contribution [ 3 ]. Firstly, the proposed system is accompanied by an intelligent chatbot based on the protocol developed by F. Shapiro.…”

“…We are aware of the fact that there are some risks associated with this intervention, such as increased short-term distress for some participants. Still, studies have shown that such risks are minor and are based on anecdotal evidence [ 3 ]. We have improved our system by taking into account the recommendation for designing safe, affordable, and easy-to-use interventions for self-help that have the potential to be used by many people [ 41 ].…”

“…Secondly, because there is a constant need to test the potential effectiveness of self-administered EMDR therapy [ 3 ], this study aimed to address this need in testing the feasibility and efficiency of a virtual assistant for EMDR in reducing negative symptoms associated with traumatic memories.…”

“…Although studies have shown that EMDR is an efficient method of intervention for different mental conditions, there are still controversies regarding the working mechanism. The studies so far on EMDR efficiency and the role of eye movement have captured variable results [ 2 ], which makes the emergence of more rigorous research an imperative [ 3 ]. In this context, the tools for self-administration of EMDR therapy can facilitate the understanding of the role of eye movement in EMDR therapy.…”