EMDR in paediatrics and rehabilitation: an effective tool for reduction of stress reactions?

Having to cope with life-threatening injury or illness can be very stressful for children and their parents. In medical settings children—and parents—can be traumatized by various events both before and during hospitalization as well as during the rehabilitation-phase (e.g. for children: acutely becoming injured, painful medical procedures or unpleasant treatment by medical staff, having permanent scars; for parents: hearing that ones child has a life-threatening condition, seeing the child suffering or having to deal with the temporary or permanent consequences for their child). Although most children and parents display remarkable resilience over time, stress levels can remain extremely high for a part of these children and parents throughout the entire hospital period and thereafter, culminating in various stress reactions. These reactions can be summarized in a framework of Paediatric Medical Traumatic Stress (PMTS). PMTS is defined as ‘a constellation of psychological and physiological responses of children and their families to pain, injury, serious illness, medical procedures and invasive or frightening treatment experiences’ [1]. Typical PMTS reactions are: nightmares, intrusive images, fear reactions, anger outbursts and depression. PMTS reactions not only affect paediatric patients, but also their families and healthcare systems [1]. Around 30% of children and parents show severe PMTS reactions in the first month after life-threatening injury or onset of illness, influencing recovery and development negatively. Around 10–15% will remain symptomatic even after 3–6 months [1–5]. Identifying factors that might be associated with severe PMTS reactions is important, since medical events are not by definition traumatic for all children and their families. Whether a medical event is experienced as traumatic is determined by the subjective experience of the event and not so much by objective markers like severity of illness or survival statistics [1–5]. For example, children that experience a lot of pain or perceive the injury or illness as life-threatening have a higher risk of developing chronic and pathological reactions. Parents that experience high levels of stress (intense fear) during the hospital period or had mental health problems existing already before also have an increased risk for severe PMTS reactions. In short, the objective severity of the injury or illness is apparently not a strong risk factor for the development of pathological reactions [1–5]. Children and parents at risk should be identified early by paediatricians and other members of medical staff. Accordingly these children should be referred to a behavioural health specialist (i.e. paediatric psychologist, psychiatrist), because this specialist is able to provide treatment interventions that can prevent chronic and pathological PMTS reactions to arise. Early application of treatment interventions in paediatrics is not common, unfortunately. However, several evidence-based interventions are available presently. In paediatrics, for instance, the Creating Opportunities for Parent Empowerment (COPE) programme and the Surviving Cancer Competently Intervention Programme (SCCIP) are promising stress reduction interventions [6,7]. In general traumatic stress literature, more efficacious treatment interventions are mentioned [8]. Both children and their parents could profit from them if these interventions would be applied sooner and more often. One of these evidence-based treatment interventions is Eye Movement Desensitization and Reprocessing (EMDR), developed by Shapiro [9]. Clinical efficiency of EMDR for children has been demonstrated by a recent meta-analysis [10] and other studies [11,12]. Support for the use of EMDR in adults can be found in 20 randomized controlled studies in adults [13]. EMDR is now recommended as one of the first choice treatments for Posttraumatic Stress Disorder, together with Trauma Focused Cognitive Behaviour Therapy—in several practice guidelines [14–16]. An example of an extensively researched programme for TFCBT is the one developed by Cohen et al. [17]. With EMDR various stress reactions, resulting from disturbing memories of stressful life experiences, can be reduced. The procedure is characterized by a structured protocol and starts