Correspondence to research@projectcamus.com.
This study investigated the effectiveness of self-administered Eye Movement Desensitization and Reprocessing (EMDR) sessions delivered via the Project Camus mental health application.
The study utilized deidentified data from 500 users, tracking their self-reported distress levels associated with a traumatic memory before and after 1, 2, or 3+ EMDR sessions.
Users who completed one EMDR session experienced a 24% reduction in distress intensity. This effect was amplified with increased sessions, with two sessions yielding a 33% reduction and three or more sessions producing a 40% reduction. An ANOVA test confirmed that the differences in distress reductions across these groups were statistically significant (F-value: 8.17, p-value: 0.0003).
Thematic analysis of post-session reviews revealed key themes of direct improvement, emotional reprocessing, and behavioral reprocessing, supporting the quantitative findings. These results suggest that self-administered EMDR via digital platforms may significantly reduce distress related to traumatic memories, with increased sessions leading to greater reductions. This study has implications for enhancing the accessibility and scalability of EMDR treatment, though further research is warranted to optimize this intervention strategy.
Traumatic memories are highly distressing and can significantly impair an individual's quality of life [2,4].
Eye Movement Desensitization and Reprocessing (EMDR) therapy has been endorsed as an effective treatment for trauma and post-traumatic stress disorder by multiple organizations, such as the World Health Organization [5] and the American Psychiatric Association [3].
Despite this, access to EMDR therapy can often be limited due to factors such as the cost of treatment [6], the availability of trained therapists, and the stigma associated with seeking mental health treatment.
Recently, advancements in technology have paved the way for novel methods of treatment delivery, including online and self-administered interventions. The benefits of such approaches include increased accessibility and the potential to reach individuals who might not otherwise have access to these therapeutic interventions. However, the effectiveness of self-administered EMDR is a relatively unexplored area in the realm of mental health research.
The current study aimed to examine the impact of self-administered EMDR therapy on reducing distress associated with traumatic memories. In particular, we sought to investigate the efficacy of an online, self-administered EMDR program among 500 users. Furthermore, this study explored whether the number of self-administered EMDR sessions conducted had a dose-response relationship with the magnitude of distress reduction.
This study utilized an exploratory, quasi-experimental design, leveraging the real-world setting of an existing mental health application, Project Camus. The sample comprised 500 users who utilized the self-administered Eye Movement Desensitization and Reprocessing (EMDR) tool within the app. The investigation was retrospective and anonymized to ensure user privacy and confidentiality.
Participants were selected based on their voluntary use of the self-administered EMDR tool on Project Camus. The total participant pool consisted of 500 individuals, including both self-reported experienced and novice users of EMDR. All participants remained anonymous throughout the study, and data were collected and analyzed in a de-identified manner.
The self-administered EMDR tool guided users through a series of eleven prompts, designed to facilitate the visualization and processing of a traumatic memory. These prompts were carefully crafted to align with the principles of EMDR therapy and provide users with a structured approach to address their distressing memories.
Each prompt served a specific purpose in the therapeutic process. The first prompt instructed users to visualize an image that represents the worst part of their memory. This step aimed to enhance the clarity and vividness of the targeted memory, facilitating focused attention during subsequent prompts.
The subsequent prompts focused on exploring the beliefs associated with the memory, introducing a preferred self-belief, and assessing distress levels at various stages. By addressing negative beliefs and introducing positive self-beliefs, users were encouraged to reframe their cognitive responses and develop a more adaptive perspective.
To simulate the bilateral stimulation integral to EMDR therapy, the intervention concluded with a visual aid that users tracked with their eyes. This bilateral movement helps engage the brain's adaptive processing mechanisms, potentially leading to the reconsolidation and integration of distressing memories.
The prompt language used in the self-administered EMDR tool was derived from established EMDR practices and adapted for the online platform. These prompts represent a systematic and evidence-based approach to trauma processing, adhering to the therapeutic process outlined by Shapiro in her seminal work on EMDR therapy [1].
By utilizing these prompts, the self-administered EMDR tool aimed to provide users with a structured and replicable experience that mirrors the fundamental components of traditional in-person EMDR therapy.
In selecting a measurement scale to assess distress levels associated with traumatic memories, one of the key considerations was the familiarity and ease of use for participants. Consequently, a Likert scale was chosen as the measurement scale for this study's self-administered EMDR tool.
The Likert scale, ranging from 1 to 7 (in line with the VOC scale), provides participants with a familiar response format that is widely used in various research and clinical contexts. By using a Likert scale, participants can rate their distress levels by selecting a numerical rating that aligns with their subjective experience, with higher values indicating higher levels of distress.
While the Subjective Units of Disturbance (SUDs) scale is commonly employed in in-person EMDR therapy [1, 7], its adaptation to a digital self-administered format may introduce challenges in terms of user familiarity and ease of use. The Likert scale, on the other hand, offers a familiar and intuitive response format that promotes participant engagement and accurate distress level assessment.
Data was collected through users' interactions with the self-administered EMDR tool. The tool recorded users' responses to the prompts, capturing their self-reported distress levels on a 1-7 Likert scale. Participants were asked to rate their distress levels before and after each EMDR session, allowing for the assessment of distress reduction.
Alongside the Likert scale ratings, users were encouraged to reflect on their feelings and experiences following each EMDR session. After completing the session, participants were prompted to write a review capturing their thoughts, emotions, and any observations they made during the session. This qualitative review data provided valuable insights into the personal experiences and subjective responses of users, offering a more nuanced understanding of the effects of the self-administered EMDR tool.
The combination of quantitative distress ratings and qualitative user reviews allowed for a comprehensive analysis of the data. The quantitative data provided numerical indicators of distress reduction, while the qualitative data enriched the analysis by capturing participants' narratives and providing deeper context to the numerical findings.
A mixed-methods approach was employed to analyze the data collected in this study, allowing for a comprehensive understanding of the efficacy of self-administered EMDR in reducing distress associated with traumatic memories.
Quantitative data from the Likert-scale responses were subjected to statistical analysis to evaluate the change in distress levels across different sessions. Specifically, a repeated measures analysis of variance (ANOVA) was conducted to examine the significance of distress level changes over one, two, and three or more EMDR sessions. This quantitative analysis provided statistical evidence for the effectiveness of self-administered EMDR in reducing distress.
In addition to the quantitative analysis, qualitative data from the self-reviews were analyzed using thematic analysis to identify common themes and insights regarding users' experiences with the self-administered EMDR tool. As part of this analysis, two indices were developed for each theme: the positivity index and the impact index.
The positivity index measured the degree of positive emotion expressed within each theme. Themes associated with more positive emotions, such as feelings of calmness or happiness, were assigned higher positivity index values.
The impact index, on the other hand, measured the perceived significance of each theme in relation to the overall improvement in distress levels. Themes that were frequently mentioned and were considered influential in reducing distress were assigned higher impact index values, indicating their importance in the overall outcome of self-administered EMDR.
By incorporating both the positivity index and the impact index into the analysis, a more comprehensive understanding of the themes and their potential impact on distress reduction was obtained. This approach allowed for a nuanced interpretation of the qualitative data, capturing both the emotional aspects of the participants' experiences and the themes that had a notable impact on distress reduction.
The integration of both quantitative and qualitative analyses, along with the development of the positivity and impact indices, provided a comprehensive and multi-dimensional exploration of the data. This approach enhanced the validity and reliability of the study's findings and offered valuable insights into the potential benefits of self-administered EMDR in the reduction of distress associated with traumatic memories.
A one-way Analysis of Variance (ANOVA) was conducted to compare the efficacy of one, two, and three or more self-administered EMDR sessions in reducing distress associated with traumatic memories. The ANOVA showed a significant main effect for the number of EMDR sessions, F(2, 497) = 8.17, p < .001, indicating that the number of sessions significantly impacts distress reduction.
Table 1 presents the average pre-session and post-session distress levels for each session group, along with the average change in distress levels. Users who completed one session started with an average distress level of 5.46 and ended with an average level of 4.17, reflecting an average reduction of 1.29 points. Users who completed two sessions began with an average distress level of 5.98 and ended with an average of 3.96, demonstrating an average reduction of 1.98 points. Users who completed three or more sessions started with an average distress level of 6.00 and ended with an average of 3.60, yielding an average reduction of 2.40 points.
Figure 1 displays the distribution of participants in each session cohort. Of the 500 users, 284 completed one session, 144 completed two sessions, and 72 completed three or more sessions.
Figure 2 presents these average distress reductions as a percentage of the maximum possible score of 7. This provides another way of understanding the relative magnitude of the distress reduction in each session cohort.
A qualitative analysis of self-reviews provided additional insights into the participant experience. Entries were coded for themes and categorized into three main buckets: Direct Improvement, Emotional Reprocessing, and Behavioral Reprocessing. These themes were graphed in a bubble chart according to their positivity and impact indices.
Direct Improvement themes were characterized by words indicating immediate relief, such as "calm," "less," and "better." Emotional Reprocessing themes involved words indicating particular emotions, such as "sad," "happy," "anger," and "confusion." Behavioral Reprocessing themes included instances of the word "should," indicating a potential shift in users' thought patterns or behaviors.
The bubble chart shows that themes in the Direct Improvement and Behavioral Reprocessing categories tended to have higher positivity indices, indicating more positive sentiment, and were also more likely to be associated with greater reductions in negative feelings attached to traumatic memories. Further analysis is needed to determine the specific nature of these associations and their implications for EMDR therapy.
Overall, these results suggest that the self-administered EMDR tool is effective in reducing distress levels associated with traumatic memories, with greater reductions observed with more sessions. The thematic analysis of self-reviews provides valuable additional context for understanding the user experience and the potential mechanisms underlying these observed effects.
This study aimed to explore the effectiveness of self-administered EMDR sessions delivered through Project Camus, an online mental health platform, in reducing distress associated with traumatic memories. The findings demonstrate that the number of EMDR sessions significantly impacts the level of distress reduction, with a greater number of sessions correlating with a higher reduction in distress.
The analysis of average distress levels from pre- to post-session revealed a significant reduction across all session cohorts. Notably, participants who engaged in three or more sessions experienced the largest average reduction in distress, suggesting a cumulative effect where additional sessions contribute to greater overall relief. This cumulative effect may be attributed to the repetitive and focused attention on traumatic memories, which may progressively lessen their emotional intensity, aligning with the principles of EMDR theory.
The qualitative analysis of participants' self-reviews provided additional insights into their experiences with the self-administered EMDR tool. Themes such as Direct Improvement, Emotional Reprocessing, and Behavioral Reprocessing emerged, indicating that users not only experienced immediate relief but also underwent a process of emotional and behavioral change. These themes underscore the potential of self-administered EMDR to bring about positive cognitive and behavioral shifts, extending beyond mere distress reduction.
The study acknowledges certain limitations, including the reliance on self-reported data and the potential influence of self-selection bias due to the observed dropout rate between different session cohorts. Future research should consider controlling for these variables to gain a clearer understanding of the effectiveness of self-administered EMDR sessions. Despite these limitations, the study provides compelling evidence for the effectiveness of self-administered EMDR sessions facilitated through a digital platform, offering substantial implications for increasing the accessibility and scalability of trauma-focused therapy.
Our study provides compelling evidence supporting the effectiveness of self-administered EMDR sessions, delivered through an online platform (Project Camus), in reducing distress related to traumatic memories. Participants who engaged in multiple EMDR sessions demonstrated a higher reduction in distress, suggesting a possible cumulative effect of this intervention.
The analysis of users' self-reviews, in conjunction with the quantitative findings, provided a more comprehensive understanding of the EMDR process and its impact on participants. The emergence of themes such as Direct Improvement, Emotional Reprocessing, and Behavioral Reprocessing highlighted the immediate relief experienced by users, as well as their journey of emotional and behavioral change throughout the intervention.
While the study employed a rigorous methodology and generated valuable findings, it also revealed potential areas for further research. Exploring the underlying mechanisms driving the observed cumulative effect, investigating the influence of self-selection bias in continued session engagement, and implementing methods to control for potential biases associated with self-reported data are important considerations for future studies.
In conclusion, our study underscores the promising potential of self-administered EMDR strategies delivered through digital platforms. As the field of digital mental health interventions continues to evolve, these findings contribute valuable insights, demonstrating the feasibility and effectiveness of translating established therapeutic methods, such as EMDR, into self-administered, online formats. Future research endeavors can further optimize these digital EMDR strategies, enhancing accessibility and expanding the reach of this transformative therapeutic approach.
[1] Shapiro, F. (1995). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures. Guilford Press.
[2] Brewin, C. R., Gregory, J. D., Lipton, M., & Burgess, N. (2010). Intrusive images in psychological disorders: Characteristics, neural mechanisms, and treatment implications. Psychological Review, 117(1), 210–232.
[3] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing.
[4] Breslau, N., Kessler, R. C., Chilcoat, H. D., Schultz, L. R., Davis, G. C., & Andreski, P. (1998). Trauma and posttraumatic stress disorder in the community: The 1996 Detroit Area Survey of Trauma. Archives of General Psychiatry, 55(7), 626–632.
[5] World Health Organization. (2013). Guidelines for the management of conditions that are specifically related to stress. World Health Organization.
[6] Roehrig, C. (2016) 'Mental disorders top the list of the most costly conditions in the United States', Health Affairs, 35(6), pp. 1130–1135. doi:10.1377/hlthaff.2015.1659.
[7] Kim, Daeho, et al. “Validity of the Subjective Units of Disturbance Scale in Emdr.” Journal of EMDR Practice and Research, vol. 2, no. 1, 2008, pp. 57–62, https://doi.org/10.1891/1933-3196.2.1.57.