Anxiety. It’s a term that’s often tossed around in conversation—as a casual synonym for stress, or worry, or that feeling you get when you look at your to-do list. But for 40 million Americans, anxiety disorders are debilitating and omnipresent, and women are twice as likely to suffer as men, according to the Anxiety Disorders Association of America.
“There is an intense, constant fear that is hard to describe,” says Laura Rowe, 34, of Denver. “It’s a sinking feeling in your stomach—almost as if someone is stalking you and you never know when those arms are going to wrap around you and drag you away.” And more and more of us are being diagnosed: A recent study of about 63,700 college students found that five times as many young adults are dealing with high levels of anxiety as in the late 1930s (itself a stressful time!).
The signs of anxiety’s prevalence among women are everywhere: Ads for anti-anxiety drugs run frequently on TV shows often aimed at women; young female stars, like the actress Amanda Seyfried, confide their own experiences in the press; websites like findthelight.net attract thousands of users.
And though no national data of rates in women exist, many experts believe the surge is not just media hype—it’s real. “I think there’s little question that there’s more anxiety today, and that women, in particular, are feeling it,” says JoAnn E. Manson, M.D., chief of the division of preventive medicine at Boston’s Brigham and Women’s Hospital. “I see it not only among patients but with friends, colleagues and people I interact with daily.”
Diagnosis and help are late to come
One general practitioner—not a psychiatrist—estimates that one in five of the patients she sees now is there for anxiety issues, making it one of the most common reasons young women show up in her exam room. Megan Catalano, 34, of Berkeley Heights, New Jersey, is living proof of all the statistics. “In my M.F.A. program last year, Xanax was everywhere,” she says. “I always thought my anxiety was a quirk particular to me. It was shocking to realize how many of my girlfriends and classmates felt the same way.”
Ironically, despite the condition’s seeming ubiquity, experts Glamour spoke to agree that anxiety is actually underdiagnosed among women. “The average length of time between the onset of symptoms—the time a woman starts feeling bad—and when she gets actual diagnosis is between nine and 12 years,” says Robert Leahy, Ph.D., a clinical professor of psychology and psychiatry at Weill Cornell Medical College in New York. “And of those who are diagnosed, only a very small percentage get adequate help.”
Part of the problem, say doctors, is that a woman with anxiety may fail to seek help quickly, even if she’s seriously on edge. “To her, that is normal,” says Richard A. Friedman, M.D., a professor of clinical psychiatry at Weill Cornell Medical College. “If you’re a healthy woman and you come down with the flu, you know you’re sick. You know what it’s like to feel good , and you know you feel worse now. But if you have this sickness that’s been hanging on since you were 5, that’s your baseline. You believe it’s normal, and that everyone else must feel this way too.”
It took BasseyIkpi, 34, a writer and performer in Washington, D.C., nine years of panic attacks and stress headaches before she finally realized that what she had was a real medical condition. “Anxiety is a very real and serious—yet treatable—disorder. I didn’t know that until I took a college-prep psych class,” she says. “All of a sudden I was like, This is me. This is what I have.”
And when women do seek help, doctors often confuse their symptoms with those of other mental-health conditions. Kristen Nilsen, 27, of Arlington, Va., remembers having her first panic attack as a child. When she finally found the courage to see a doctor at age 17, she was told she had depression and was prescribed meds that didn’t ease her attacks. She wasn’t correctly diagnosed with generalized anxiety disorder and panic disorder until she was 23, and didn’t find a medication that worked for her until four years after that. “Anxiety can be just as debilitating as a physical injury, but it’s often not given the same immediate attention that, say, a broken leg would receive,” says Nilsen. “If I could shout it from the tallest building, I would: Seek help. You deserve to live an unafraid life.”
Stressful news taking a toll?
So what is anxiety? And why are so many young women grappling with it now? “Anxiety is a normal emotion which helps us recognize real problems and solve them. In its healthy form, anxiety helps you perform at your top form when you’re adjusting to, say, a new job or a new baby,” says Terrie Moffitt, Ph.D., a professor of psychology and neuroscience at Duke University in North Carolina. “That said, in some people anxiety grows out of proportion and becomes disabling. Generally, we say anxiety is not normal when it lasts days beyond a specific stressful event, or when it interferes with a person’s life.”
There are multiple, distinct types of anxiety disorder: The most common is social phobia, which is an extreme fear of being judged by others. There’s also panic disorder (with its trademark panic attacks), and generalized anxiety disorder, defined as persistent and unrealistic worry. But all anxiety disorders share common denominators: Unlike depression, which is marked by unshakable sadness, they feel physically more like fear, with symptoms like insomnia, heart palpitations and headaches. And they happen young: Nearly three quarters of afflicted adults develop symptoms by age 22.
As for the rise in anxiety, experts point to a range of factors. “There is a sense that the world is not as safe as it used to be, and that creates a lot of anxiety,” says Leahy. In any given day, he argues, women worry about environmental hazards, their job security, the odds of their boyfriend cheating (see: Tiger and Jesse James). “There’s so much stressful news that it starts to take a toll on you,” says Susan Nolen-Hoeksema, Ph.D., a professor of psychology at Yale University who specializes in stress and women’s health. “If I watch CNN for an hour, I [get] fidgety.”
Could a shift in cultural values be to blame?
Fine—and all true. But wasn’t the Great Depression stressful too? And why should we get more worked up about Tiger than, say, our grandmothers did over a social system that kept many of them from working outside the home or dating whomever they wished? Are our modern lives really that much more stressful? “The answer appears to be yes,” says anxiety researcher Jean Twenge, Ph.D., a professor at San Diego State University and author of “Generation Me.” “Anxiety rates have risen steadily over the past seven decades, during good economic times and bad.”
She believes the rise is related to a cultural shift, over the last 70 years, away from “intrinsic” values—appreciating things like close relationships and having a real love for your work—toward more “extrinsic” ones, like money and status.
In fact, her research found that anxiety rates rose at the same pace with this change in mind-set. “Recent generations have been told over and over again, ‘You can be anything you want to be. You can have the big job title. You can have the big bank account.’ And in the case of women, ‘You can have this perfect body .’ That puts a lot on a person’s shoulders—and it’s also not really true. These are things that aren’t always under your control, but that disconnect creates a lot of anxiety about how hard you need to work to achieve them—and a deep fear of failure,” she explains. “And although these extrinsic values—the latest iPad, the cutest shoes—seem important, all the evidence shows that at the end of the day they don’t leave us very happy or satisfied.”
The argument, in other words, is that our grandmothers and great-grandmothers were able to tune out their stresses in part because they had more satisfying personal values to fall back on. They also probably had more quiet time to contemplate their worries in a productive way—something in short supply now.
“Everyone works all the time, and there are no boundaries between work and personal life anymore,” says a 29-year-old Glamour reader from Jersey City, N.J., who recently began struggling with panic attacks. “Your to-do list is enormous, and then you have to go home, cook dinner, work out, check in with friends, spend time with your boyfriend or family. There’s just a lot of pressure.”
Nolen-Hoeksema agrees: “People feel they should always be on, and that they could be called upon at any moment to do something. Our e-mail and iPhones are constantly pinging, which keeps anxiety heightened all the time.” That’s exactly what exacerbated Ikpi’s panic attacks a few years ago. “Every time my cell phone rang, or I heard an e-mail or text come through, I’d get this overwhelming feeling of dread,” she says. “My heart raced. I got nauseous and dizzy and couldn’t breathe. It was so intense at times that I truly believed I was going to die.” At that time, she was experiencing two to three panic attacks each day.
Social networking, experts say, is also problematic, since connecting virtually with a friend is not the same as seeing them, hugging them or hearing the tone of their voice. “Having a Twitter- or Facebook-only friend,” says Twenge, “is like having a junk food relationship.” You may be keeping in touch, but without face-to-face interaction, you miss out on the true bonding that studies show can help protect against mental health problems.
All of these factors hit women harder than men because, experts are learning, we may be wired to worry. Just-released research from the Children’s Hospital of Philadelphia suggests that the female brain may be more sensitive to stress hormones and less able to adapt to high levels of them. We also have a well-known propensity to ruminate and let problems roll around and around in our heads, says Nolen-Hoeksema: “We’re more aware about our feelings, and we get more hung up on them than men do.” And yet another emerging theory is that our diets are having a biological impact on our anxiety levels: “A diet high in sugar and saturated fat can disrupt brain functioning,” says Fernando Gómez-Pinilla, Ph.D., a professor of neurosurgery and physiological science at UCLA, who researches the effects of diet on mood disorders. “That contributes to mental disorders, particularly anxiety.”
Thankfully, experts say there are several proven ways to soothe those feelings of panic and fear. Here, strategies to calm anxieties both extreme and everyday:
Exercise three to four days a week
The link between exercise and improved mental health is almost irrefutable. “I’m a therapist—a ‘head guy’—and I was shocked at how effective our research showed exercise to be. It can work as well as medication,” says Michael Otto, Ph.D., a professor of psychology at Boston University.
Beyond alleviating pent-up angst, physical activity can actually teach your brain to be anxiety-resistant. “The physical stress that working out has on the body engages a lot of the same responses that mental stress does,” says Michael Hopkins, a researcher at the Neurobiology of Learning and Memory Laboratory at Dartmouth College. “Your heart beats faster; your blood pressure goes up. Over time, exercise appears to train the body to handle those changes, so when anxiety strikes, your body says, ‘Oh, OK, this is like when we go jogging. I know how to deal with this.’” And nearly every woman Glamour interviewed agreed workouts improved her symptoms. “It releases so much of the tension I have built up in my mind,” says one student in Mooresville, N.C. “After a run I feel clear and at peace.”
Exactly how much exercise do you need to feel better? Roughly 30 minutes of cardio—any kind—three or more days a week. What matters most is that you simply do something on a regular basis.
More whole foods, less junk
“The vitamins, minerals and other compounds in food act almost like medications on the brain,” says Gómez-Pinilla. Australian research recently found that women who ate a whole-foods diet, with lots of fruits, vegetables, whole grains, lean meat and fish, were 32 percent less likely to experience anxiety. (By comparison, women on a diet high in refined, processed foods and saturated fats were 50 percent more prone to depression.) “Eating too much of the wrong kind of foods produces an inflammation effect that can cause disease in our brains,” says David Heber, M.D., Ph.D., director of the Center for Human Nutrition at UCLA. Fruits and vegetables, on the other hand, have the opposite effect and fight inflammation. And foods rich in omega-3 fats (like salmon and walnuts) and those containing tryptophan (like skim milk and turkey) can be like natural Xanax when eaten on a regular basis, says Gómez-Pinilla. “When my doctor suggested I change my diet, I kind of thought, Really?” says anxiety sufferer Nilsen. “But cutting back on all the starchy fast foods I was eating and getting more fresh produce made a huge difference. I was less lethargic and emotional.”
Caffeine can also increase anxiety—and even trigger panic attacks, according to research. “Most of us sip our morning coffee and don’t notice if it makes our heart rate and blood pressure go up,” says Jonathan Abramowitz, Ph.D., director of the Anxiety and Stress Disorders Clinic at the University of North Carolina at Chapel Hill. “But women with panic disorder are really tuned in to their body channel, and they’ve got the volume turned way up. They sense those internal changes, which feel so similar to the onset of a panic attack, and become so stressed that they actually bring one on.”
“Relaxation techniques are effective in so many aspects of your life, but they’re particularly good for generalized anxiety disorders,” says Otto. “They should be taught as a requirement in school, as the fourth R: reading, ‘riting, ‘rithmetic and relaxation!” Yoga, meditation and hypnotherapy have all been shown to help, as can deep breathing, relaxing to soothing music, and massage. “When we’re stressed, most of us breathe shallowly from our chest, which triggers the sympathetic nervous system—that’s the classic ‘fight or flight’ reaction,” says Lizabeth Roemer, Ph.D., a professor of psychology at the University of Massachusetts, Boston. “If you inhale and exhale more deeply, that activates the opposite, parasympathetic response. Your body physically settles down.” Also, “this type of relaxation prompts the release of feel-good endorphins,” which can buffer against the biological response to stress, says London-based clinical hypnotherapist Georgia Foster.
Eye Movement Desensitization & Reprocessing
EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences. Repeated studies show that by using EMDR people can experience the benefits of psychotherapy that once took years to make a difference. It is widely assumed that severe emotional pain requires a long time to heal. EMDR therapy shows that the mind can in fact heal from psychological trauma much as the body recovers from physical trauma. When you cut your hand, your body works to close the wound. If a foreign object or repeated injury irritates the wound, it festers and causes pain. Once the block is removed, healing resumes. EMDR therapy demonstrates that a similar sequence of events occurs with mental processes. The brain’s information processing system naturally moves toward mental health. If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can causes intense suffering. Once the block is removed, healing resumes. Using the detailed protocols and procedures learned in EMDR training sessions, clinicians help clients activate their natural healing processes.
Twenty positive controlled outcome studies have been done on EMDR. Some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions. Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six 50-minute sessions. In another study, 77% of combat veterans were free of PTSD in 12 sessions. There has been so much research on EMDR that it is now recognized as an effective form of treatment for trauma and other disturbing experiences by organizations such as the American Psychiatric Association, the American Psychological Association and the Department of Defense. Given the worldwide recognition as an effective treatment of trauma, you can easily see how EMDR would be effective in treating the “everyday” memories that are the reason people have low self-esteem, feelings of powerlessness, and all the myriad problems that bring them in for therapy. Over 70,000 clinicians throughout the world use the therapy. Millions of people have been treated successfully over the past 20 years.
EMDR therapy is an eight-phase treatment. Eye movements (or other bilateral stimulation) are used during one part of the session. After the clinician has determined which memory to target first, he asks the client to hold different aspects of that event or thought in mind and to use his eyes to track the therapist’s hand as it moves back and forth across the client’s field of vision. As this happens, for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and the clients begin to process the memory and disturbing feelings. In successful EMDR therapy, the meaning of painful events is transformed on an emotional level. For instance, a rape victim shifts from feeling horror and self-disgust to holding the firm belief that, “I survived it and I am strong.” Unlike talk therapy, the insights clients gain in EMDR result not so much from clinician interpretation, but from the client’s own accelerated intellectual and emotional processes. The net effect is that clients conclude EMDR therapy feeling empowered by the very experiences that once debased them. Their wounds have not just closed, they have transformed. As a natural outcome of the EMDR therapeutic process, the clients’ thoughts, feelings and behavior are all robust indicators of emotional health and resolution—all without speaking in detail or doing homework used in other therapies.
EMDR therapy combines different elements to maximize treatment effects. A full description of the theory, sequence of treatment, and research on protocols and active mechanisms can be found in F. Shapiro (2001) Eye movement desensitization and reprocessing: Basic principles, protocols and procedures (2nd edition) New York: Guilford Press.
EMDR involves attention to three time periods: the past, present, and future. Focus is given to past disturbing memories and related events. Also, it is given to current situations that cause distress, and to developing the skills and attitudes needed for positive future actions. With EMDR therapy, these items are addressed using an eight-phase treatment approach.
Phase 1: The first phase is a history-taking session(s). The therapist assesses the client’s readiness and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include distressing memories and current situations that cause emotional distress. Other targets may include related incidents in the past. Emphasis is placed on the development of specific skills and behaviors that will be needed by the client in future situations.
Initial EMDR processing may be directed to childhood events rather than to adult onset stressors or the identified critical incident if the client had a problematic childhood. Clients generally gain insight on their situations, the emotional distress resolves and they start to change their behaviors. The length of treatment depends upon the number of traumas and the age of PTSD onset. Generally, those with single event adult onset trauma can be successfully treated in under 5 hours. Multiple trauma victims may require a longer treatment time.
Phase 2: During the second phase of treatment, the therapist ensures that the client has several different ways of handling emotional distress. The therapist may teach the client a variety of imagery and stress reduction techniques the client can use during and between sessions. A goal of EMDR is to produce rapid and effective change while the client maintains equilibrium during and between sessions.
Phases 3-6: In phases three to six, a target is identified and processed using EMDR procedures. These involve the client identifying three things:
1. The vivid visual image related to the memory
2. A negative belief about self
3. Related emotions and body sensations.
In addition, the client identifies a positive belief. The therapist helps the client rate the positive belief as well as the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously engaging in EMDR processing using sets of bilateral stimulation. These sets may include eye movements, taps, or tones. The type and length of these sets is different for each client. At this point, the EMDR client is instructed to just notice whatever spontaneously happens.
After each set of stimulation, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client’s report, the clinician will choose the next focus of attention. These repeated sets with directed focused attention occur numerous times throughout the session. If the client becomes distressed or has difficulty in progressing, the therapist follows established procedures to help the client get back on track.
When the client reports no distress related to the targeted memory, (s)he is asked to think of the preferred positive belief that was identified at the beginning of the session. At this time, the client may adjust the positive belief if necessary, and then focus on it during the next set of distressing events.
Phase 7: In phase seven, closure, the therapist asks the client to keep a log during the week. The log should document any related material that may arise. It serves to remind the client of the self-calming activities that were mastered in phase two.
Phase 8: The next session begins with phase eight. Phase eight consists of examining the progress made thus far. The EMDR treatment processes all related historical events, current incidents that elicit distress, and future events that will require different responses.
What is the theoretical basis for EMDR?
Shapiro (1995) developed the Accelerated Information Processing model to describe and predict EMDR’s effect. More recently, Shapiro (2001) expanded this into the Adaptive Information Processing (AIP) model to broaden its applicability. She hypothesizes that humans have an inherent information processing system that generally processes the multiple elements of experiences to an adaptive state where learning takes place. She conceptualizes memory as being stored in linked networks that are organized around the earliest related event and its associated affect. Memory networks are understood to contain related thoughts, images, emotions, and sensations. The AIP model hypothesizes that if the information related to a distressing or traumatic experience is not fully processed, the initial perceptions, emotions, and distorted thoughts will be stored as they were experienced at the time of the event. Shapiro argues that such unprocessed experiences become the basis of current dysfunctional reactions and are the cause of many mental disorders. She proposes that EMDR successfully alleviates mental disorders by processing the components of the distressing memory. These effects are thought to occur when the targeted memory is linked with other more adaptive information. When this occurs, learning takes place, and the experience is stored with appropriate emotions able to guide the person in the future.
Is EMDR a one-session cure?
Not generally although many people, usually already blessed with a stable personality and well-functioning nervous system, have experienced what could only be described as life-changing changes after a single sessions of EMDR.
When Shapiro (1989a) first introduced EMDR into the professional literature, she included the following caveat: “It must be emphasized that the EMD procedure, as presented here, serves to desensitize the anxiety related to traumatic memories, not to eliminate all PTSD-symptomology and complications, nor to provide coping strategies to victims” (p 221). In this first study, the focus was on one memory, with effects measured by changes in the Subjective Units of Disturbance (SUD) scale. The literature consistently reports similar effects for EMDR with SUD measures of in-session anxiety. Since that time, EMDR has evolved into an integrative approach that addresses the full clinical picture. Two studies (Lee, Gavriel, Drummond, Richards, & Greenwald, 2002; Rothbaum, 1997) have indicated an elimination of diagnosis of post traumatic stress disorder (PTSD) in 83-90% of civilian participants after four to seven sessions. Other studies using participants with PTSD (e.g. Ironson, Freund, Strauss, & Williams, 2002; Scheck, Schaeffer, & Gillette, 1998; S. A. Wilson, Becker, & Tinker, 1995) have found significant decreases in a wide range of symptoms after three-four sessions. The only study (Carlson, Chemtob, Rusnak, Hedlund, &Muraoka, 1998) of combat veterans to address the multiple traumas of this population reported that 12 sessions of treatment resulted in a 77% elimination of PTSD. Clients with multiple traumas and/or complex histories of childhood abuse, neglect, and poor attachment may require more extensive therapy, including substantial preparatory work in phase two of EMDR (Korn& Leeds, 2002; Maxfield &Hyer, 2002; Shapiro, 2001).
Is EMDR an efficacious treatment for PTSD?
Yes. EMDR is the most researched psychotherapeutic treatment for PTSD. Twenty controlled outcome studies have investigated the efficacy of EMDR in PTSD treatment. Sixteen of these have been published, and the preliminary findings of four have been presented at conferences. Studies using waitlist controls found EMDR superior; six studies compared EMDR to treatments such as biofeedback relaxation (Carlson et al., 1998), active listening (Scheck et al., 1998), standard care (group therapy) in a VA hospital (Boudewyns&Hyer, 1996), and standard care (various forms of individual therapy) in a Kaiser HMO facility (Marcus, Marquis, & Sakai, 1997). These studies all found EMDR superior to the control condition on measures of post traumatic stress.
Seven randomized clinical trials have compared EMDR to exposure therapies (Ironson et al., 2002; McFarlane, 2000; Rothbaum, 2001; Thordarson et al., 2001; Vaughan et al., 1994) and to cognitive therapies plus exposure (Lee et al., 2002; Power et al., 2002). These studies have found EMDR and the cognitive/behavioral (CBT) control to be relatively equivalent, with a superiority in two studies for EMDR on measures of PTSD intrusive symptoms, and for CBT in the study by Taylor and colleagues Taylor, Thordarson, and Maxfield (2002) on PTSD symptoms of intrusion and avoidance. There were two controlled studies without randomization; one (Devilly& Spence, 1999) found the CBT condition superior to EMDR and the other (Sprang, 2001) found EMDR superior to the CBT control on multiple measures.
Two studies found EMDR to be more efficient than the CBT control condition, with EMDR using fewer treatment sessions to achieve effects (Ironson et al., 2002; Power et al., 2002). Two studies that compared treatment response on a session-by-session basis (Thordarson et al., 2001) and at mid-point (Rothbaum, 2001), reported that EMDR did not result in more rapid treatment effects than exposure. However, in both these studies the exposure treatment sessions were supplemented with one hour of daily homework, while the EMDR condition was implemented without homework. The only study to control for the ancillary effects of homework (Ironson et al., 2002) supplemented both exposure and EMDR treatments with the same number of hours of exposure homework (see above). Most studies noted that because EMDR has minimal homework requirements the overall treatment time was much shorter for EMDR (e.g., Lee et al., 2002; Vaughan et al., 1994). Treatment effects have generally been well maintained (see below).
The efficacy of EMDR in the treatment of PTSD is now well recognized. In 1998, independent reviewers (Chambless et al., 1998) for the APA Division of Clinical Psychology placed EMDR, exposure therapy, and stress inoculation therapy on a list of empirically supported treatments, as “probably efficacious” ; no other therapies for any form of PTSD were judged to be empirically supported by controlled research. In 2000, after the examination of additional published controlled studies, the treatment guidelines of the International Society for Traumatic Stress Studies gave EMDR an A/B rating (Chemtob, Tolin, van der Kolk, & Pitman, 2000) and EMDR was found efficacious for PTSD. The United Kingdom Department of Health (2001) has also listed EMDR as an efficacious treatment for PTSD.
Foa, Riggs, Massie, and Yarczower (1995) suggested that exposure therapy may not be very effective with clients whose prominent affect is anger, guilt, or shame. Reports by clinicians treating combat veterans (e.g., Lipke,1999; Silver & Rogers, 2002) indicate that EMDR may be effective with such PTSD presentations. A preliminary study found that EMDR reduced symptoms of guilt in combat-related PTSD (Cerone, 2000). Taylor et al. (2002) reported equivalent and significant effects for exposure therapy and EMDR on reducing symptoms of anger and guilt.
Is EMDR effective in the treatment of phobias, panic disorder, or agoraphobia?
There is much anecdotal information that EMDR is effective in the treatment of specific phobias. It also seems likely that since EMDR is effective with PTSD, which is the stomach cancer of anxiety disorders, it ought to work for less serious anxiety disorders. Unfortunately, the research that has investigated EMDR treatment of phobias, panic disorder, and agoraphobia has failed to find strong empirical support for such applications. Although these results are due in part to methodological limitations in the various studies, it is also possible that EMDR may not be consistently effective with these disorders. De Jongh, Ten Broeke, and Renssen (1999) suggest that since EMDR is a treatment for distressing memories and related pathologies, it may be most effective in treating anxiety disorders which follow a traumatic experience (e.g., dog phobia after a dog bite), and less effective for those of unknown onset (e.g., snake phobia).
There have been several randomized clinical trials assessing EMDR treatment of spider phobia (Muris&Merckelbach, 1997; Muris, Merckelbach, van Haaften, &Nayer, 1997; Muris, Merkelbach, Holdrinet, &Sijsenaar, 1998). These studies indicated that EMDR was less effective than in vivo exposure therapy in eliminating the phobia. Methodological limitations of these studies include failure to use the full EMDR treatment protocol (see Shapiro, 1999) and confounding of effects, by using the exposure treatment protocol as the post-treatment assessment. When the full EMDR phobia protocol was used in case studies with medical and dental phobias (De Jongh et al., 1999; De Jongh, van den Oord, & Ten Broeke, 2002), good results were achieved.
Clinical utility is an important consideration in treatment selection. The application of in vivo exposure may be impractical for clinicians who do not have easy access to feared objects (e.g., spiders) in their office settings; some phobias are limited to specific events (e.g., thunderstorms) or places (e.g., bridges). EMDR may be a more practical treatment than in vivo exposure, and the in vivo aspect can often be added as homework (De Jongh et al., 1999).
There have been three studies that investigated EMDR treatment of panic disorder with/out agoraphobia. The first two studies were preliminary (Feske& Goldstein, 1997;Goldstein&Feske, 1994) and provided a short course (six sessions) of treatment for panic disorder. The results were promising, but limited by the short course of treatment. Feske and Goldstein write, “Even 10 to 16 sessions of the most powerful treatments rarely result in a normalization of panic symptoms, especially when these are complicated by agoraphobia” (p. 1034). The EMDR effects were generally maintained at follow-up. A third study (Goldstein et al., 2000) was conducted to assess the benefits of a longer treatment course. This study however changed the target population and treated agoraphobic patients. Participants suffering from Panic Disorder with Agoraphobia did not respond well to EMDR. Goldstein (quoted in Shapiro, 2001) suggests that these participants needed more extensive preparation, than was provided in the study, to develop anxiety tolerance. The authors suggest that EMDR may not be as effective as CBT in the treatment of panic disorder with/out agoraphobia; however no direct comparison studies have yet been conducted.
The right treatment
You should be able to tell after one to two months whether the lifestyle changes above will make a difference. If they don’t, you might need therapy or medication intervention. It’s fine to turn to your GP; you don’t need to start with a psychiatrist. She may refer you to a therapist, or prescribe medication. But tell her all of your symptoms in detail. More and more women are doing so, and their assertiveness is paying off. “Emergency rooms used to be flooded with people thinking they were having a heart attack when really it was a panic attack,” says Edna B. Foa, Ph.D., director of the Center for the Treatment and Study of Anxiety at the University of Pennsylvania. “Now a lot of women with anxiety problems diagnose themselves because they’re more educated. It’s become part of the culture we’re in to be able to talk about anxiety without feeling you’re going to be judged.” No judgment, just help. That’s what every woman deserves.
Adapted from an article by Shaun Dreisbach, originally published in Glamour Magazine.updated 10/15/2010 8:22:27 AM ET And from information provided by the EMDR Institute
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