At online therapy, we have been working 100% online for almost two years and therefore have a lot of experience with it. Due to the Corona crisis, we receive many questions about working online as a GZ psychologist. This also raised the question of whether EMDR is online? If so, how then? We would like to share our experiences with you. Keep reading!
Research On Online Emdr Therapy
A lot of research has been done into the effectiveness in particular of PTSD and scientific research shows that the efficacy of EMDR has now been sufficiently proven. EMDR is already being used online, but there is little scientific evidence available. On Pubmed dd. 15-07-2019, only 1 small study was found with 11 people with positive effects. Contact with the EMDR Netherlands Association (VEN) confirms the lack of scientific evidence for online EMDR. However, the VEN website states: In principle, we treat the same problems online as in a treatment room where we see patients face-to-face.
Because there is a great demand for online EMDR, we have started a practical study into the feasibility, effectiveness, and experiences of the client and therapist at online EMDR. The investigation is still ongoing, but given the current events, we would like to share some preliminary results, trends, and experiences, so that everyone can now take advantage of them.
Literature shows that a 10-point drop on the PCL-5 score is clinically significant. We have now completed a full process of 10 clients, including post-measurement, after one month. We see an average decrease in the PCL-5 score of 33.5 points between the start of treatment and the end of treatment. The difference between treatment start and one month after the end is 40 points on the PCL-5 score. These results can, therefore, be classified as clinically significant improvements.
The average score given by clients for a session is 8.6. The sessions are generally experienced as positive. Negative experiences are hardly mentioned except that a session can be intensive, a lot of emotions can arise during a session and people feel tired afterward. This is no different from face-to-face EMDR. Clients seem to be very satisfied with online treatment with EMDR.
The average score given by therapists for a session is 8.1. Some critical comments mentioned by therapists are:
Treatment may be hindered by an unstable video connection; this causes unrest in the treatment and is undesirable when the tension in the client is high.
Making eye-tracking movement sacross the screen seems a little trickier to do online than in the doctor’s office. It requires more precise coordination of movement.
At the same time, the screen in which the client can be seen should be watched, so that more of the divided attention is required of the therapist.
As positive feedback it is clear that the treatment effect seems very good; even referred to by some as better than in the doctor’s office. The charge/voltage on the target image drops quickly and much. The number of sessions averages 1.9 sessions.
In summary, the first results and experiences can be called positive and in line with what is found face-to-face! There is a clear decrease in complaints and both clients and therapists appoint a large 8 score for the treatment. This seems to be in line with the advice of VEN.6 The study will be continued and the final results will be published as soon as the study is completed in the summer.
Tips & Tricks
Finally, some tips & tricks for anyone who wants to work with online EMDR:
- Ensure a fast and stable internet connection, so that the session is not interrupted. Discuss in advance with your client what he can do / you will do if this happens unexpectedly. This removes tension and creates clarity.
- If the image falters slightly and the finger movement does not always go smoothly, this is not an obstacle: the client has to do his / her best at such a moment to follow the finger movement, which leads to an extra load on the working memory which can promote the effect of the EMDR.
- Work from an online platform or application in which you have a large image and can see yourself. A large image is needed to maximize the client’s eye rash and make it easier for the therapist to coordinate hand movements.
- Practice making the hand movements in advance, for example with a colleague, so that you know at what height on the screen and with what stroke and speed you can best move.
- Also, practice eye movements well with the client, paying attention to the distance the client has to the screen
- Make good agreements about what the client can do, let it be known if the tension is high. Prepare the client explicitly for this.
- Also, ask the client to sit in a quiet environment so that it cannot be distracted by stimuli/people.
- Ask the client to turn off any pop-ups that could interrupt treatment.
- Sit out of the picture yourself so that only your hand and arm are visible and provide an otherwise quiet background.
- Are you reading the protocol? Make sure that it is slightly behind your screen so that you do not have to look sideways.