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Fernandez, Faretta / Panic Disorder and EMDR Treatment
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Since its introduction in 1989, several controlled studies have compared EMDR with
other types of treatment for PTSD. The findings indicate that EMDR and cognitive behav-
ioral therapy (CBT), including exposure, appear to be equally effective, although EMDR
may involve fewer treatment sessions and requires no daily homework (Ironson, Freund,
Strauss, &Williams, 2002; Lee, Gavriel, Drummond, Richards, & Greenwald, 2002; Power
et al., 2002; Rothbaum, 2001; Taylor, Thordarson, Maxfield, Fedoroff, Lovell, & Ogrodniczuk,
2003; Vaughan et al., 1994). Civilian studies of single-trauma victims (Lee et al., 2002;
Marcus, Marquis, & Sakai, 1997; Rothbaum, 1997; Scheck, Schaeffer, & Gillette, 1998;
Wilson, Becker, & Tinker, 1995, 1997) indicate a 77% to 100% remission of PTSD after
three to six sessions of EMDR treatment.
Although clearly efficacious in its approach to trauma, published case histories also pro-
vide support for the use of EMDR in the treatment of a variety of disorders, including those
related to anxiety, such as phobia and panic disorder (De Jongh & Ten Broeke, 1998;
De Jongh, Ten Broeke, & Renssen, 1999; Goldstein & Feske, 1994; Nadler, 1996; Shapiro
& Forrest, 1997). However, most of the controlled phobia research failed to use the EMDR
protocol in its entirety (see De Jongh et al., 1999; De Jongh, Van den Oord, & Ten Broeke,
2002; Shapiro, 1999), a factor that may explain the minimal to modest success of EMDR
reported in their findings. Studies using a greater length of treatment demonstrated positive
effects in the treatment of panic disorder (Feske & Goldstein, 1997), although not with
panic-disordered participants also experiencing agoraphobia (Goldstein, de Beurs,
Chambless, &Wilson, 2000). As a possible explanation for these findings, Goldstein noted
that “people with agoraphobia are more avoidant of intense affect, that they have highly dif-
fused fear networks, and that they have difficulty making accurate cause-effect attribution
for anxiety and fear responses” (Shapiro, 2001, p. 363). Thus, as the client is at risk of
becoming overwhelmed, thoroughly preparing the client to tolerate the intense affect that
often accompanies the processing phase of EMDR is an essential component of therapy.
Traditionally, treatments for panic disorder, with or without agoraphobia, have consisted
of pharmacological and CBT approaches, both of which are considered effective treatments
for this disorder (Sturpe & Weissman, 2002). However, there is some evidence to suggest
that use of benzodiazepines to alleviate panic symptoms as needed (as opposed to more
regular use), is related to poorer CBT outcomes (Westra, Stewart, & Conrad, 2002).
Interoceptive exposure and cognitive therapy alone appear to be equally effective in treat-
ing panic disorder without agoraphobia (Arntz, 2002), and panic-control treatment alone
and in vivo exposure both effectively reduce panic-related fears and agoraphobia (Craske
et al., 2002). Furthermore, the positive treatment effects associated with panic-control treat-
ment, with and without exposure, appear to positively affect other comorbid conditions
(Tsao, Mystkowski, Zucker, & Craske, 2002). Some therapies requiring minimal therapist
contact, such as various forms of bibliotherapy, computer-administered vicarious exposure,
problem-solving, palmtop computer-administered therapy, and some forms of CBT have
shown some promise in the treatment of panic symptoms, although clients with agoraphobia
appear to require more therapist-initiated exposure (see Newman, Erickson, Przeworski, &
Dzus, 2003, for a review).
Although CBT has been established as an efficacious form of treatment for panic disor-
ders, less is known about its effectiveness over time. Analyses of long-term outcomes (van
Balkom, de Beurs, Lange, & Van Dyck, 1999) indicated that the clinical effectiveness of