title: A Comparison of Dual Attention, Eye Movements, and Exposure Only during Eye Movement Desensitization and Reprocessing for Posttraumatic Stress Disorder: Results from a Randomized Clinical Trial.
abstract: BACKGROUND
  Currently, there is controversy on the possible benefits of dual-attention tasks during eye movement desensitization and reprocessing (EMDR) for patients with posttraumatic stress disorder (PTSD).
  
  
  METHODS
  A total of 139 consecutive patients (including 85 females) suffering from PTSD were allocated randomly among 3 different treatment conditions: exposure with eyes moving while fixating on the therapist's moving hand (EM), exposure with eyes fixating on the therapist's nonmoving hand (EF), and exposure without explicit visual focus of attention as control condition (EC). Except for the variation in stimulation, treatment strictly followed the standard EMDR manual. Symptom changes from pre- to posttreatment were measured with the Clinician-Administered PTSD Scale (CAPS) by an investigator blinded to treatment allocation.
  
  
  RESULTS
  In total, 116 patients completed the treatment, with an average of 4.6 sessions applied. Intention-to-treat analysis revealed a significant improvement in PTSD symptoms with a high overall effect size (Cohen's d = 1.96, 95% CI: 1.67-2.24) and a high remission rate of PTSD diagnosis (79.8%). In comparison to the control condition, EM and EF were associated with significantly larger pre-post symptom decrease (ΔCAPS: EM = 35.8, EF = 40.5, EC = 31.0) and significantly larger effect sizes (EM: d = 2.06, 95% CI: 1.55-2.57, EF: d = 2.58, 95% CI: 2.01-3.11, EC: d = 1.44, 95% CI: 0.97-1.91). No significant differences in symptom decrease and effect size were found between EM and EF.
  
  
  CONCLUSIONS
  Exposure in combination with an explicit external focus of attention leads to larger PTSD symptom reduction than exposure alone. Eye movements have no advantage compared to visually fixating on a nonmoving hand.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Sack
authors.forename: Stefanie
authors.initials: S
authors.lastname: Zehl
authors.forename: Alexander
authors.initials: A
authors.lastname: Otti
authors.forename: Claas
authors.initials: C
authors.lastname: Lahmann
authors.forename: Peter
authors.initials: P
authors.lastname: Henningsen
authors.forename: Johannes
authors.initials: J
authors.lastname: Kruse
authors.forename: Markus
authors.initials: M
authors.lastname: Stingl
mesh_terms: D000328:Adult; D001288:Attention; D057169:Eye Movement Desensitization Reprocessing / Q000379:methods*; D005133:Eye Movements; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D016896:Treatment Outcome