EMD treatment protocol

The procedures of EMD intervention will be carried out in line with the standard EMDR protocol [62]. Since we aimed to evaluate the effects of eye movement during retrieval of a traumatic memory, we decided to omit the installation phase from the original EMDR procedure in both study groups. It has been suggested that the installation phase may be counter-effective, since performing eye movements when retrieving a positive cognition or image (as done in the installation phase) may render that positive image less vivid and positive [9]. EMD will be given during 4 to a maximum of 6 sessions, and each session lasts 45–60 min. The therapist will provide at least 4 sessions, even if their Subjective Units Distress (SUDs) scores decrease to 0 or 1 in less than 4 sessions and stop when SUDs = 0 or 1 for all target memories. If the participant does not reach 0 or 1 in 6 sessions, the therapy will be ended nevertheless, to minimize heterogeneity. In addition, reductions in distress may also take place after the therapy has ended. SUDs measure the level of distress before and after target memory processing, where 0 is no disturbance or neutral and 10 is the highest disturbance.

EMD consists of the following steps: (1) Client History and treatment planning: obtaining information regarding the clients’ clinical condition, including intrusive emotions and physical sensations. (2) Preparation: building a therapeutic bond with the client, the explanation of EMDR process and its effects. (3) Assessment: identification of the target visual image of the traumatic memory and associated negative emotions. The participant describes the intensity of the negative emotions on a 0–10 SUDs scale). (4) Desensitization: clients will be asked to focus on target traumatic events, while focusing their eyes on the therapist’s finger that moves from left to right an back in the participant’s visual field. The therapist will conduct EM for 24 cycles several times. This phase will end if SUD scores reach 0 or 1. Next, participants will scan their body until any tension disappears. (5) Closure: the session is closed, and the stabilization techniques and relaxation exercises are reviewed. Sessions 2–4 will start with a reevaluation of the patient’s progress and SUD scores of target events to guide the choice of continuing with the target traumatic event or choosing a new event.

The EMD treatments will be performed by experienced psychotherapists with at least 1 year of experience in treating PTSD patients. Eight therapists are recruited through colleagues from the Clinical Psychologist Association (IPK). An accredited EMDR supervisor will supervise therapists weekly.