( u Carlson, Chemiab, Rusnak, Hedlund, and Muraoka movement desensitization and reprocessing stress disorder (PTSD) symptoms of Vietnam pathology. New York: Harper & Row 96). The Misi Sale for Combat related Joumal of Consuling and Cinta adel, J. M., & Zimering, R. (1989). Irmposive (Nooding) ‘Vietnam combat veteran. Behavior Therapy, 2, ane, tM Fb. A. Cadel JM, Ziesing, RT & Bender, M.E. (985). sear ing PISD in Veinam veterans in C. Fgey 928.93 The practice of behavior thera (Ath ed). New York: Pergamon Press. ( Journal of Trauma Sires, Vol 11, No, 1 1998 Brief Psychological Intervention with ‘Traumatized Young Women: The Efficacy of Eye Movement Desensitization and Reprocessing Margaret M. Scheck,!? Judith Ann Schaeffer and Craig Gillette! To study the efficacy of eye movement desen: ion and reprocessing (EMI tween the ages of 16 EMDR or an active effects for outcom Inventory, Penn Invent. Scale, Tennessee ieasures (Beck Depressi for 4o.0.65 for the AL group, Despite treat ie variable means of EMD! ympared favorably with nonpatient or successfully non groups on all measures. 11 Paso Count rado Springs, Colorado 80910, fo whom all ton Road, Colorado Springs, (Colorado 80808, 2Eranciscan Family Wellness Program, 1d0 Springs, Colorado 80019. ‘Private Practice, Colorado Springs, Col 36 ‘Scheck, Schaeffer, and Gillet post fs about both themselves and their world; of traumatic events (Browne te, Polusny, Bechtle, & Naugle, 1996; van der Kolk, 1994). Furthermore, herent victimization set up a pattern of adult revictimi lative negative effect (Finkelkor & Browne, 1985; Follette et al., 1996; sd women may be quite obstacles. For example, ¢ El Paso County Health Department in Colorado Springs, Colorado, found that traumatized women changed ners and moved frequently, cutting ties with professionals and even ‘own families. They presented for medical help, for the most pat, only when . Numbed by 5; Weise, Donnenberg, focal short-term therapy; anxiety- ing sh sd psychodynamic therapy {(Marmar, 1991; Ursano & Hales, 1996; Weiss & Marmar, 1993). More re- cently, cye movement desensitization and reprocessing (EMDR) has been shown to be efficacious as well (Shapiro, 1995). EMDR is a specific dese designed around a complex method. Using a series of manu: ps, the client reactivates the trou- bling memory while the practitioner intervenes at a variety of choice points. community has been slow no, Tremont, Last, & ( [EMDR with Traumatized Women n However, encouraging positive findings have been reported in trauma- focused published case studies and single-subject experiments (Kleinknecht, 1993; Lohr et al 1995; Puk, 1991; Vaughan et al, 1994); group design treatment comparison studies (Bauman & Melnyk, 1994; Boudewyns, 1996; Carlson, Chemtob, Rusnak, Hedlund, & Muraoka, _ Levin, Allen-Byrd, Doctor, & Lee, in press; Vaughan et al., 1994); and wait- controlled research (Rothbaum, 199: studies have also revealed that EMDR is an appro reduction of trauma symptoms in (Greenwald, 1994), in a 4-year-old crime in a 1O;year-old suffering from gruesome 1 \s of Hurricane Andrew controlled studies also show wee matized youth are treated with EMDR (Chemtob, 1 & Elrod, 1996). EMDR used with young persons appears to mect the ight occur because of the nonspecific rapport, expectation of gain, and sym- show positive changes beyond those produced in the active Ii ticipants on measures of psychological functioning, including depress anxiety, and self-concept, and on the trauma-related symptoms of avoid- ance/numbing and intrusive reliving of the trauma.Fa Seheek, Schaeffer, and Gillette Method Panicipants: Recruitment and Screening and recruiting participants Colorado Springs, Colo- ff Health and Environ- ion‘and fliers advertising the stuc age under 25, (3) a recent behaviors assessed, and (4) a self-reported traumatic the study because of medical problems or conc tory of convulsions, pregnancy), as judged by El Paso County Sexually aff, or because of severe dissociation, to schedule an appointment, were refered by their helping agency counselors, or were to participate when they came for appoi participants were informed of fe of the study and the ‘and asked to sign con- sent forms. Parents of partic consent. Participants were not fat no cost with the assigned therapist or another therapist at the conclusion of the study. -QL167 women mecting the inclusion and excision ceria, 19 decided [EMDR with Traumatised Women 2» Participants: Descriptive Information Participants were women between the ages of 16 and 25 (M = 20.93). 10 the pa iple sex partners (four or more partner and alcohol frequently, 33% claimed knowledge of a rked in prostitution, 62% had partners who had rtners who used drugs or alcohol frequently. Institute of Mental Health Disgsorte I Taterview Schedule (Version posttraumatic stress disorder section, was acceptable (kappa = .84; Watson vide a rating for = 46) of the participants met al f the symptom, duration and exposure0 Seheck, Schaffer, and Gillette Beck Depression Invenhe BECK (Beck & Steet, 1993) sm self-report scaassess severity of depression. Anxiety Inve The STATE (Spielberger, Gor- such, Luchene, Vagg, & has two subscales, erally feels”), “right now”). We used Penn Inventory for Poss Disorder (PENN). The PENN (Hammarberg, 1992) is aeport scale that measures the strength or intensity of poptoms. Impact of Event Scales (Horowitz, Wilner, & Alvarez, 1979) is a 15-item measureies that assess trusions concerning the tratt have been experienced over the ‘most recent 7 days. We usescore as an outcome measure. Tennessee Sel i is a self-report 100-item moncept that contai of subscales. We used the 2ore, which reflects over of self-esteem. Procedure story on an intakeppleted the ‘TSCS. They were then schiterview with the prin tigator, who wrote in the p words a description of the most troubling memory the parte principal investigator then ad- ministered the PENN, PTS ts were rando either EMDR or AL therapy. amt’s schedule and gender prefer- t¢and four participants. who was blind to group asistered the standardized instru- using a written setind read a debriefing statement formed participants «d goal of the study. Participants EMDR with Traumatized Women En then met with the principal investigator, who addressed participants’ ques- tions about the study. A follow-up interview was conducted by the principal investigator via in person about 90 days after the post-test assessment. During thi , participants were asked the present status of their health, rel ‘of 9 women and 2 men with a median psychotherapy experience of 8 years. | All AL therapists reported extensive experience with the active listening paradigm. Therapists were provided an orientation, special monthly super- vision groups, and a roster of consulting therapists. Treatments ‘Approximately 1 week apart two treatment sessions for each subject ‘were conducted at the El Paso County Health Department or at the private oor agency offices of individual therapists. Treatment manuals were devel- ‘oped for both EMDR and AL. and scale a more reasonable posi ‘of Cognition Scale (VOC). Fi itement using the 7-point Val the participant was given an opportunity[ n Seheck, Schaffer, and Gillette to self-report the degree of disturbance the overall event created using the int Subjective Units of Disturbance Scale (SUD). The desensitization to follow the movement of the therapist's fingers while holding ‘a comprehensive awareness of the troubling event. After each set of eye movements the therapist requested i nthe therapist de- nd SUD measures ‘a high VOC score (6-7) and a low SUD scores on the targeted {quested to keep a written journal between sessions containing memories, images, or feelings about the trauma. s followed a nondirective, Rogerian-ba model outlined by Gordon (1974), The pat ‘memory described to the pri silence and non-eval 's ication. th session, both EMDR and AL thers int was invited to say more investigator. The indicating greatest he EMDR and AL therapists, 4.41 respectively, were no ically different. ‘The time between the two treatment sessions sometimes varied from several days to 2 of 3 weeks, depending on the availablity ofthe participant and the therapist, but usually therapy was completed: in 2 weeks. Results Participants Meeting PTSD Diagnostic Criteria Using the PTSD-1, 77% (1 = 46) of the participants met all of the 1. and exposure criteria to be classified as havi participants who met the diagnostic se who did not (n = 14) revealed no significant EMDR with Traumatized Women 3 . Means, Standard Deviations and Efe Sizes for Outcome Measures* Title Mears, Standard Deviations and Efet Sizes for Outcome Measures’ Oucone Preeament Mean Postretnent Mean PrePaxt TxD cm 6) 0) ee Se Eon Se << EMDR 30 23971024) 927098 re as 064 i eC euDR Fs a wa 2) Ost EMDR 39 on a OP on EMDR 28 2m os wD ost EMDR 328457 (an94 AL 9 285.24 (38.23) ee “Elect sles ae represented by Cohet Comparability of Treatment Groups Pretreatment differences between EMDR group and AL group par- s were examined for age, education level, and ethnicity. There were no significant differences between EMDR and AL participants, indicating group equivalence. Treatment Outcome ategy was to analyze each ANOVA with one between-subjects factor (type of anon subjects factor (pre-post). Conceptu: ‘Type I error for these contrasts was set at a = .0S per com- parison (Kirk, 1982).,See Table 1 for means and standard deviations for Pre- and post n as this. More germane to our hypotheses are the hich measure differences in change scores between teraction effects between type of treatment and pre- Post change were significant for BECK, F (1,58) = 5.39, p = 024; STATESeheck, Schaeffer, and Gillette 57) = 4.89, p = .031; PENN F (1,55) = 6.03, p = .02; 1003; and TSCS F (1, 57) = 4.57, p = .04. EMDR with Traumatized Women as lar demographic charact ‘group is not possible because the item content addresses a specific traumatic event. Therefore, for this measure, the average of unweighted means and standard deviations for samples repre- sentative of people who either had litte response to a stressful event, or who shown on the the means te anxiety (STATE). The remaining. the normative z scores of 1.0 and 2.0. comparisons all p > 30). Since t low-up (BECK and IES) were collected in nonstandardized fashion (Partici- low-up interviews, 16 had ionth follow-up period. Table 2 present jew and had not had addi jenerally speaking treatment means on two outcome measures.% Scheck, Schaefer, and Gillette EMDR with Traumatized Women ” ‘Table 2. Pre-treatment, Pos-reatment, ud Follow-up Means for Two Outcome Measures ny fo z ‘Outcome nt Posttreatment Follow-op Foal ls Measure " ‘Mean Mean Mean 7 s po br c BECK, © 44 io ° EMDR ey 24s 600 530 ® ® . AL 2 2642 1558 1433 34 poe IES Wl = EMDR 48.42 a1 1584 PRE AL 4872 3536 26.18 reat PSF Aix; a: ae i Fae POT nt means. Error bars represent 95° presenis nonnathe ‘symbols represent Summary ye general pattern of outcome measure change was improvement for oth EMDR and AL teen, For all outcome ‘measures, the EMDR group improved more than the AL group, resulting in significant differ- fences between the groups in post-treatment means for four of the five out come measures. This difference is also reflected in pre-post effect sizes for EMDR which were about double the AL effect sizes. The EMDR group algo showed a degree of change that resulted in post-treatment means that were more comparable to normative group data than AL group means. vo participants didnot complete the TES scale Self-concept variables, however, generally reflected less of a difference be- tween EMDR and AL groups. Discussion The intention of this study was to evaluate the effectiveness of a brief ‘rauma-focused psychological intervention, EMDR, for producing symptom reduction and self-concept a young, traumatized female and sometimes negative a lved no more than sup- ing for two sessions reduced symptoms of on, anxiety, and intrusion of traumatic images and though EMDR procedure provided improvement well beyond these non: s. In the areas we measured, EMDR pre-post effect sizes wximately double those of active listening. The largest effect size *¢ was for the IES, the measure that was most trauma specific.8 ‘cheek, Schaffer, and Gillete ¢ Eh is designed to keep this event in facig of feelings and thoughts about the event aus on a traumatic event may be a key to-improving other nperienced symptoms and self-con- cept deficits. our study didio-treatment control, it may be il- ing to contrast ouose obtained from a similar popu- screened by the sastrumen (1995) El Paso Céepartment’s STD troubled young women w-reduction messages, and materials the referral package, iment. Measures of de- pression and self-esteem ficant changes from pre-treatment to post-treatment. In facf severe depression was seen as a ‘major reason why particieffectively access the social service ‘community. completely remove t have such complex mal” people experience, anxiety and depression. Hopefully this would provide the jude to constructively address dys- functional behavior pattot able to address and to rethink By rewure for collecting information, at ing stonwere able to evaluate 80% of those EMDR with Traumatized Women » both groups were not diminished. Follow-up means were even less elevated than post-treatment means. remarkable considering the ongoing stressful that characterize this population Future efforts to evaluate the effectiveness of EMDR treatment with traumatized young women might well address several limitations of the pre- sent study. Long-term effects are realistically unknown. There is evidence that treatments that appear effect effective at further follow-up periods. orders.of youth “reflect debi group are facing major tra developmental processes. |. EMDR is not a self-contained one method to be used as part of a more en- fer behavior patterns. Without behavioral meas- term behavioral measures, the extent to which the reports were consistently made; therefore, the evider jons should incorporate behavioral dicated that they were high! therapists’ subjective evaluations could not be verified because outside ob- servers, recorders, or camcorders were not used.« Scheck, Schaffer, and Gillette In summary, within the context of these onstrates that EMDR can produce clear-cut result Acknowledgements ‘We would like to extend special thanks to the STD clinic of the El Paso County Department of Health and Environment, especially Lynn Plummer, John Potterat, Steve Muth, and John Muth. In addition we would like to acknowledge the therapy group facilitators; Beverly Schoninger and Marilyn Doenges, consultants; Wayne Boucher, Kelli Klebe, Jim Kni retarial assistant; Suzette Martinez, therapi ‘Archombeau, Rae Barge, Val Curuso, MarySo Dase, Vicki Duval, Mary Heintz, Susan Hykes, Carol Jarecki, Linda Klein, Scott Leonard, Suzanne Martin, Kathy ym Nelson, Craig Penner, Mary Robbins, Liz ideris, Jan Sorenson, Sharon Swanson, Veron- sand scorers; Bev Ernest Anderson, Tim Ferguson, Cheryl Haller, Pamela Jones, Bev ‘Travis Marher, Anne Parker, Donna Prudhomme, Jennifer Scheck, References 5 patient. Joumal of Arsiety rolled comparison of eye movements and finger iment of test anxiety. Journal of Behavior Therapy and Experimental 2 Behavior Modificavion, 30, EMDR with Traumatized Women Ope norenent dace behaviors informer sexual sbuse victims. 42h sexual abuse: A review ofthe research , PM. (195). ore of Tana Sees, 7 237.255 disaster. Joumal of Traumatic Soess, 10, 665-572. 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Dillerential effects of women's child seal ‘abuse and subsequent sexual revitimization Jounal of Consuling and Clinical Pychology, 60, 167-173, Jounal of Taumatc Stress, Vol 11, No, 1, 1998 The Gulf Crisis Experience of Kuwaiti Children: Psychological and Cognitive Factors Foaziah A. Hadi! and Maria M. Llabre? This study examined a stratified random sample of 233 Kuwaiti 8-10 T2year-old boys and girls, in order to assess the during the Iraqi occupation of Kuwait and intelligence, posttraumatic stress, and What has become known as the Gulf invasion of Kuwait by Iraqi soldiers on Aug the burning of oil fields. Although thousands of Kuwaiti civilians were able "Educational Psychology Department, P.O. Box 1328, Kaan 71953, Kuwait Univesity, Ku- To whom correspondence shouldbe addresed Behavioral Medicine Research Center and Department of Psychology, Univesity of Miami, Coral Cables, Flride 3124