APA Citation
Marcus, S., Marquis, P., & Sakai, C. (2004). Three- and 6-month follow-up of EMDR treatment of PTSD in an HMO setting. *International Journal of Stress Management*, 11(3), 195-208. https://doi.org/10.1037/1072-5245.11.3.195
Summary
This study demonstrated EMDR's remarkable effectiveness in a real-world healthcare setting, finding that 77% of multiple-trauma victims—including those with Complex PTSD from prolonged abuse—achieved remission after just six sessions. For single-trauma victims, 84-90% no longer met PTSD criteria after three 90-minute sessions. Unlike laboratory studies, this research was conducted in an HMO setting with typical patients, making results highly applicable to clinical practice. The findings establish EMDR as one of the most efficient trauma treatments available, with particular relevance for narcissistic abuse survivors who often have complex, multi-layered trauma.
Why This Matters for Survivors
If you've been struggling with trauma symptoms from narcissistic abuse and wondering whether treatment can actually help, this research provides concrete evidence: 77% of people with multiple traumas (like the accumulated harm from prolonged abuse) achieved remission in just six sessions. EMDR doesn't require detailed retelling of trauma—important when your experiences were gaslit and denied. The treatment works by helping your brain reprocess traumatic memories so they lose their emotional charge. Healing from narcissistic abuse isn't just possible—it's documented to happen for the majority of people who try this treatment.
What This Research Found
77% remission for multiple-trauma patients. The study demonstrated that EMDR achieved remarkable results with complex cases: 77% of patients with multiple traumas no longer met PTSD criteria after six 90-minute sessions. This is exactly the presentation common in narcissistic abuse—accumulated harm from prolonged exposure rather than single traumatic events.
84-90% remission for single-trauma patients. For those with single-incident trauma, results were even more striking: 84-90% achieved remission after just three sessions. While narcissistic abuse typically involves multiple traumas, this finding establishes EMDR’s overall effectiveness.
Real-world effectiveness confirmed. Unlike laboratory studies with carefully selected participants, this research was conducted in an HMO setting with typical patients. Results demonstrate that EMDR works in ordinary clinical practice, not just controlled research conditions.
Gains maintained at follow-up. Patients were assessed at 3- and 6-month follow-up, and improvements were maintained. EMDR’s effects appear durable, not temporary symptom relief.
Why This Matters for Survivors
Healing is documented and achievable. If you’ve been suffering from trauma symptoms—intrusive memories, hypervigilance, emotional numbness, flashbacks—this research shows that treatment works for most people. 77% of those with complex trauma like narcissistic abuse achieved remission. You have good reason to hope.
No detailed retelling required. For survivors who were gaslit into doubting their own experiences, who struggle to find words for what happened, EMDR offers an alternative to talk therapy’s demand for detailed narrative. You don’t need to convince the therapist—or yourself—that the trauma was “bad enough.” You don’t need perfect memory of events.
Relatively quick results. Unlike therapies requiring years of work, EMDR often produces significant improvement in weeks or months. While complex trauma from narcissistic abuse may take longer than single-incident trauma, the timeline is still much shorter than traditional approaches. This doesn’t mean healing is instant, but it does mean progress can be measurable.
Your body’s symptoms can be addressed. EMDR works with body-stored trauma, not just cognitive memories. The racing heart when you hear a certain tone of voice, the tension when anticipating criticism, the freeze response triggered by conflict—these physical manifestations of trauma can be processed and reduced.
Clinical Implications
EMDR should be considered for narcissistic abuse survivors. Given the high remission rates for multiple-trauma patients and EMDR’s fit with narcissistic abuse dynamics (no retelling required, addresses negative core beliefs), clinicians should consider EMDR as a primary treatment option for this population.
Prepare for complex trauma presentations. Narcissistic abuse survivors typically present with complex trauma requiring more sessions than single-incident trauma. The 77% remission rate after six sessions is encouraging, but many survivors will need 12-20 or more sessions, often with a stabilization phase before trauma processing.
Address negative core beliefs. EMDR’s protocol explicitly targets negative beliefs installed by trauma—“I’m worthless,” “I can’t trust myself,” “I deserve bad treatment.” For narcissistic abuse survivors, these beliefs are often central to their presentation and respond well to EMDR’s approach.
Consider EMDR for patients struggling with verbal processing. Survivors who can’t clearly articulate their experience—due to gaslighting, dissociation, or trauma’s effects on memory—may do better with EMDR’s internally-focused approach than with therapies requiring detailed verbal recounting.
How This Research Is Used in the Book
This study appears in Chapter 21: Breaking the Spell to establish EMDR’s effectiveness for narcissistic abuse survivors:
“Research on EMDR’s effectiveness compels: 84-90% of single-trauma victims no longer meet PTSD criteria after just three 90-minute sessions. For multiple-trauma victims, including those with Complex PTSD from prolonged narcissistic abuse, 77% achieve remission after six sessions.”
The chapter goes on to explain why EMDR is particularly suited to narcissistic abuse: “The gaslighting that made them doubt their perceptions has created fragmented, dissociated memories that feel simultaneously hyperreal and unreal. EMDR helps integrate these fragments into coherent narrative. The core negative beliefs installed by the narcissist—‘I’m worthless,’ ‘I’m crazy,’ ‘I cannot trust myself’—are systematically challenged and replaced with adaptive beliefs.”
Historical Context
EMDR was developed by Francine Shapiro in 1987 after she noticed that eye movements reduced the intensity of disturbing thoughts. Initial skepticism was understandable—the mechanism seemed implausible—but controlled research consistently demonstrated effectiveness. By 2004, when this study was published, EMDR had accumulated substantial evidence and was gaining mainstream acceptance.
This study contributed by demonstrating real-world effectiveness. Laboratory studies, while important, often exclude complex cases. By showing that EMDR works in ordinary HMO practice with typical patients, this research strengthened the case for EMDR as a practical treatment option. Today, EMDR is recognized by the World Health Organization, American Psychological Association, and other major bodies as a first-line PTSD treatment.
Further Reading
- Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures (3rd ed.). Guilford Press.
- van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.
- Shapiro, R. (2010). The Trauma Treatment Handbook: Protocols Across the Spectrum. W.W. Norton.
- de Jongh, A., et al. (2021). The Current Status of EMDR Therapy, Specific Target Areas, and Goals for the Future. Journal of EMDR Practice and Research, 15(4).
- Carlson, J.G., et al. (1998). Eye movement desensitization and reprocessing (EMDR) treatment for combat-related posttraumatic stress disorder. Journal of Traumatic Stress, 11(1), 3-24.
About the Author
Steven V. Marcus, PhD and colleagues conducted this research to assess EMDR's effectiveness in real-world clinical settings rather than controlled laboratory conditions. The study was conducted within a Kaiser Permanente health maintenance organization, providing data on how EMDR performs with typical patients in ordinary clinical practice.
This practical focus is valuable because laboratory studies often have strict inclusion criteria that exclude complex cases. By studying EMDR in an HMO setting, the researchers provided evidence more directly applicable to the patients clinicians actually see.
Historical Context
Published in 2004, this study appeared as EMDR was transitioning from controversial newcomer to established treatment. EMDR had been developed by Francine Shapiro in 1987 and initially met with skepticism—how could eye movements help process trauma? By 2004, multiple controlled studies had demonstrated effectiveness, and EMDR was gaining recognition from organizations like the American Psychological Association. This study added important real-world validation: EMDR works not just in controlled studies but in ordinary clinical practice.
Frequently Asked Questions
EMDR (Eye Movement Desensitization and Reprocessing) is a trauma therapy using bilateral stimulation—usually eye movements following a therapist's hand, but sometimes taps or tones—to help the brain reprocess traumatic memories. Unlike traditional talk therapy requiring detailed trauma description, EMDR allows healing with minimal retelling. The exact mechanism isn't fully understood, but the treatment may mimic REM sleep's memory processing or reduce working memory load during trauma recall.
Remission means patients no longer meet diagnostic criteria for PTSD—they've recovered to the point where they don't have the disorder. 77% of multiple-trauma patients (people with several traumatic experiences) achieved this after just six 90-minute sessions. This is a remarkable success rate, especially for complex trauma that often resists treatment.
Several features make EMDR well-suited to narcissistic abuse: (1) No detailed retelling required—important when your experiences were denied and you struggle to trust your own narrative; (2) Works on negative core beliefs like 'I'm worthless' or 'I can't trust myself'; (3) Addresses body-stored trauma, not just cognitive memories; (4) Relatively quick results compared to traditional talk therapy; (5) Can process the accumulated small traumas that characterize narcissistic abuse, not just single dramatic events.
While mechanisms aren't fully understood, leading theories suggest: (1) Bilateral stimulation may mimic REM sleep, when the brain naturally processes and consolidates memories; (2) The dual attention—holding trauma in mind while tracking eye movements—may reduce emotional intensity by taxing working memory; (3) The structured protocol helps identify and reprocess negative beliefs attached to traumatic memories. Whatever the mechanism, controlled studies consistently show it works.
Yes—EMDR is now recommended as a first-line PTSD treatment by the World Health Organization, American Psychological Association, Department of Veterans Affairs, and numerous other bodies. The initial skepticism has given way to recognition based on extensive research showing effectiveness comparable to or exceeding other trauma treatments, often with fewer sessions required.
Yes, though complex trauma typically requires more sessions than single-incident trauma. The 77% remission rate in this study was specifically for multiple-trauma patients—exactly the presentation common in narcissistic abuse survivors. EMDR protocols have been adapted for complex trauma, often using a phased approach that establishes stability before processing traumatic material.
A typical session involves: identifying a target memory and associated negative belief ('I'm worthless'); identifying the desired positive belief ('I'm worthy'); rating distress and how true the positive belief feels; bilateral stimulation while holding the memory in mind; noticing whatever comes up (other memories, emotions, sensations); continuing sets until distress decreases and positive belief strengthens. Most of the 'work' happens internally, without detailed verbal description.
For single-incident trauma, 3-6 sessions often suffice. For complex trauma from prolonged abuse, 12-20 sessions is more typical, sometimes more. This study found 77% remission after 6 sessions for multiple-trauma patients, but individual variation exists. Complex trauma also often requires a longer stabilization phase before trauma processing begins.