EMDR Research News April 2017
2 Randomized Clinical Trials
- Full text: Morphovolumetric changes after EMDR treatment in drug-naïve PTSD patients
- Efficacy of EMDR on phantom limb pain of patients with amputations with 24-month follow-up
5 Meta-analysis or reviews
- Full text: Psychosocial interventions for children and adolescents after man-made and natural disasters
- Reviewing outcomes of psychological interventions with torture survivors
- Early child disaster mental health interventions
- Psychological interventions for PTSD in people with severe mental illness
- Psychological interventions for post-traumatic stress symptoms in psychosis
1 APA Practice Guideline (pre-publication)
- Full text: Clinical practice guideline for the treatment of PTSD in adults (Adopted as APA Policy February 24, 2017)
2 Case reports
- Performance blocks in sport: Recommendations for treatment and implications for sport psychology practitioners
• EMDR therapy for PTSD in a child and an adolescent with mild to borderline intellectual disability
3 Laboratory studies
- Eye movement during retrieval of emotional autobiographical memories
- Eye movement during recall reduces objective memory performance: An extended replication
- Attenuating physiological arousal through the manipulation of simple hand movements
Bennett, J., & Maynard, I. (2017). Performance blocks in sport: Recommendations for treatment and implications for sport psychology practitioners. Journal of Sports Psychology in Action, 8(1), 60-68.
Jenn Bennett Sheffield Hallam University, Sheffield, UK. Email: email@example.com
Sport psychologists are increasingly confronted with performance difficulties where athletes mysteriously lose the ability to execute automatic movements. Traditionally referred to as the yips or lost move syndrome, the generic term performance blocks has recently been put forward to encompass these types of problems that manifest in locked, stuck, and frozen movements, loss of fine and/or gross motor control, and debilitating anxiety. Two recent investigations examined the effectiveness of eye movement desensitization and reprocessing with graded exposure to treat two performance block-affected individuals. Evaluation of the interventions showed improved performance of the affected skills and reduced anxiety in both cases. Interview data collected on completion of each intervention confirmed that associated symptoms were also alleviated. The success of these two interventions offers considerable value to sport psychologists, the implications of which the current article hopes to address. Specifically, the manuscript provides an overview of current research pertaining to performance blocks, followed by recommendations for treatment and implications for sport psychologists. The importance of involving clinical psychology support in formulation and treatment processes of performance blocks is highlighted, and a call for further research investigating treatment is put forward.
Bossini, L., Santarnecchi, E., Casolaro, I., Koukouna, D., Caterini, C., Cecchini, F., . . . Fagiolini, A. (2017). Morphovolumetric changes after EMDR treatment in drug-naïve PTSD patients. Rivista Di Psichiatria, 52(1), 24-31. doi:10.1708/2631.27051
Letizia Bossini, Department of Molecular Medicine and Development, Psychiatry Section, University of Siena, Italy. E-mail: firstname.lastname@example.org
Open access: http://www.rivistadipsichiatria.it/articoli.php?archivio=yes&vol_id=2631&id=27051
INTRODUCTION: Few studies have investigated the effects of efficacious psychotherapy on structural alterations of discrete brain regions associated with posttraumatic stress disorder (PTSD). We therefore proposed to evaluate the neurobiological effects of eye movement desensitization and reprocessing (EMDR) on 19 patients with drug-naïve PTSD without comorbidity, matched with 19 untreated healthy controls.
METHODS: We administered the Clinician Administered PTSD Scale (CAPS) and conducted brain MRI measurements (with Optimized Voxel-Based Morphometry). Patients received 12 EMDR sessions over three months. Then patients and controls were reassessed.
RESULTS: At baseline, grey matter volume (GMV) differed significantly between patients and controls (F 1,35 =3.674; p=.008; η 2=.298). Analyses of 3-month scans showed no changes for controls, while significant changes were highlighted for patients post-EMDR, with a significant increase in GMV in left parahippocampal gyrus, and a significant decrease in GMV in the left thalamus region. The diagnosis of PTSD was effectively eliminated in 16 of 19 patients, reflected in a significant improvement on the CAPS (t(35)=2.132, p<.004).
DISCUSSION AND CONCLUSIONS: Results indicated post-EMDR changes for patients in brain morphology. We discuss whether EMDR’s mechanism of action may work at the level of the thalamus, an area implicated in PTSD pathology.
Brown, R. C., Witt, A., Fegert, J. M., Keller, F., Rassenhofer, M., & Plener, P. L. (2017). Psychosocial interventions for children and adolescents after man-made and natural disasters: A meta-analysis and systematic review. Psychological Medicine, 1-13. doi:10.1017/S0033291717000496
R. C. Brown, Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Steinhoevelstr. 5, 89075 Ulm, Germany. Email: email@example.com
Open access: https://www.cambridge.org/core/journals/psychological-medicine/article/psychosocial-interventions-for-children-and-adolescents-after-manmade-and-natural-disasters-a-metaanalysis-and-systematic-review/3ED2739C6082718680C830FA7CAFAA5A
Children and adolescents are a vulnerable group to develop post-traumatic stress symptoms after natural or man-made disasters. In the light of increasing numbers of refugees under the age of 18 years worldwide, there is a significant need for effective treatments. This meta-analytic review investigates specific psychosocial treatments for children and adolescents after man-made and natural disasters. In a systematic literature search using MEDLINE, EMBASE and PsycINFO, as well as hand-searching existing reviews and contacting professional associations, 36 studies were identified. Random- and mixed-effects models were applied to test for average effect sizes and moderating variables. Overall, treatments showed high effect sizes in pre-post comparisons (Hedges' g = 1.34) and medium effect sizes as compared with control conditions (Hedges' g = 0.43). Treatments investigated by at least two studies were cognitive-behavioural therapy (CBT), eye movement desensitization and reprocessing (EMDR), narrative exposure therapy for children (KIDNET) and classroom-based interventions, which showed similar effect sizes. However, studies were very heterogenic with regard to their outcomes. Effects were moderated by type of profession (higher level of training leading to higher effect sizes). A number of effective psychosocial treatments for child and adolescent survivors of disasters exist. CBT, EMDR, KIDNET and classroom-based interventions can be equally recommended. Although disasters require immediate reactions and improvisation, future studies with larger sample sizes and rigorous methodology are needed.
Courtois, C. A., Sonis, J., Brown, L. S., Cook, J., Fairbank, J. A., Friedman, M., . . . Schulz, P. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. Adopted as APA Policy February 24, 2017.
Open access https://www.apa.org/about/offices/directorates/guidelines/ptsd.pdf
[To be written at time of submitting for publication]
El Haj, M., Nandrino, J. L., Antoine, P., Boucart, M., & Lenoble, Q. (2017). Eye movement during retrieval of emotional autobiographical memories. Acta Psychologica, 174, 54-58. doi:10.1016/j.actpsy.2017.02.002
M. El Haj, Laboratoire SCALab UMR CNRS 9193, University of Lille, Domaine du Pont de Bois, 59653 Villeneuve d'Ascq, France. E-mail address: firstname.lastname@example.org
This study assessed whether specific eye movement patterns are observed during emotional autobiographical retrieval. Participants were asked to retrieve positive, negative and neutral memories while their scan path was recorded by an eye-tracker. Results showed that positive and negative emotional memories triggered more fixations and saccades but shorter fixation duration than neutral memories. No significant differences were observed between emotional and neutral memories for duration and amplitude of saccades. Positive and negative retrieval triggered similar eye movement (i.e., similar number of fixations and saccades, fixation duration, duration of saccades, and amplitude of saccades). Interestingly, the participants reported higher visual imagery for emotional memories than for neutral memories. The findings demonstrate similarities and differences in eye movement during retrieval of neutral and emotional memories. Eye movement during autobiographical retrieval seems to be triggered by the creation of visual mental images as the latter are indexed by autobiographical reconstruction.
Leer, A., Engelhard, I. M., Lenaert, B., Struyf, D., Vervliet, B., & Hermans, D. (2017). Eye movement during recall reduces objective memory performance: An extended replication. Behaviour Research and Therapy, 92, 94-105. doi:10.1016/j.brat.2017.03.002
Arne Leer, Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands. E-mail: A.Leer@uu.nl.
Eye Movement Desensitization and Reprocessing (EMDR) therapy for posttraumatic stress disorder involves making eye movements (EMs) during recall of a traumatic image. Experimental studies have shown that the dual task decreases self-reported memory vividness and emotionality. However valuable, these data are prone to demand effects and little can be inferred about the mechanism(s) underlying the observed effects. The current research aimed to fill this lacuna by providing two objective tests of memory performance. Experiment I involved a stimulus discrimination task. Findings were that EM during stimulus recall not only reduces self-reported memory vividness, but also slows down reaction time in a task that requires participants to discriminate the stimulus from perceptually similar stimuli. Experiment II involved a fear conditioning paradigm. It was shown that EM during recall of a threatening stimulus intensifies fearful responding to a perceptually similar yet non-threat-related stimulus, as evidenced by increases in danger expectancies and skin conductance responses. The latter result was not corroborated by startle EMG data. Together, the findings suggest that the EM manipulation renders stimulus attributes less accessible for future recall.
Mevissen, L., Didden, R., Korzilius, H., & de Jongh, A. (2017). Eye movement desensitisation and reprocessing therapy for posttraumatic stress disorder in a child and an adolescent with mild to borderline intellectual disability: A multiple baseline across subjects study. Journal of Applied Research in Intellectual Disabilities: JARID. doi:10.1111/jar.12335
Liesbeth Mevissen, Mental Health Organisation (MHO) GGZ Friesland, Leeuwarden, the Netherlands. Emails: email@example.com; firstname.lastname@example.org
BACKGROUND: This study explored the effectiveness of eye movement desensitisation and reprocessing (EMDR) therapy for post-traumatic stress disorder (PTSD) in persons with mild to borderline intellectual disability (MBID) using a multiple baseline across subjects design.
METHODS: One child and one adolescent with MBID, who met diagnostic criteria for PTSD according to a PTSD clinical interview (i.e., ADIS-C PTSD section), adapted and validated for this target group, were offered four sessions of EMDR. PTSD symptoms were measured before, during and after EMDR, and at six weeks follow-up.
RESULTS: For both participants, number of PTSD symptoms decreased in response to treatment and both no longer met PTSD criteria at post-treatment. This result was maintained at 6-week follow-up.
CONCLUSIONS: The results of this study add further support to the notion that EMDR can be an effective treatment for PTSD in children and adolescents with MBID. Replication of this study in larger samples and using a randomized controlled design is warranted
Patel, N., Williams, A., & Kellezi, B. (2016). Reviewing outcomes of psychological interventions with torture survivors: Conceptual, methodological and ethical issues. Torture, 26(1), 2-16.
Amanda C. de C Williams, Ph.D. Research Department of Clinical, Educational and Health Psychology, University College London, UK. E-mail:email@example.com
Background: Torture survivors face multiple problems, including psychological difficulties, whether they are refugees or remain in the country where they were tortured. Provision of rehabilitation varies not only with the needs of survivors and resources available, but also with service models, service provider preferences and the local and country context. Despite increasing efforts in research on effectiveness of psychological interventions with torture survivors, results are inconclusive.
Methods: We undertook a Cochrane systematic review of psychological, social and welfare provision, with meta-analysis to best estimate efficacy. The process raised conceptual, methodological and ethical issues of relevance to the wider field.
Findings: We searched very widely, but rejected hundreds of papers which recommended treatment without providing evidence. We found nine randomised controlled trials, from developed and under-resourced settings. All conceptualised survivors’ problems in psychiatric terms, using outcomes of post-traumatic stress symptoms, distress, and quality of life, by self-report, with or without translation or unstandardised interpretation, and with little mention of cultural or language issues. None used social or welfare interventions.
Four related studies used narrative exposure therapy (NET) in a brief form, and without ensuring a safe setting as recommended. Five used mixed methods, including exposure, cognitive behavioural therapy, and eye movement desensitisation. Combined, the studies showed no immediate improvement in PTSD, distress, or quality of life; at six months follow-up, a minority showed some improvement in PTSD and distress, although participants remained severely affected.
Conclusions: While applauding researchers’ commitment in running these trials, we raise ethical issues about exposure in particular, and about the effects of shortcomings in methodology, particularly around assessment using unfamiliar cultural frameworks and language, and the lack of concern about dropout which may indicate harm. The issues addressed aid interpretation of existing research, and guide clinical practice as well as future studies evaluating its effectiveness.
Pfefferbaum, B., Nitiéma, P., Tucker, P., & Newman, E. (2017). Early child disaster mental health interventions: A review of the empirical evidence. Child & Youth Care Forum, 1-22. doi:10.1007/s10566-017-9397-y
Pfefferbaum, Betty: Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard, Williams Pavillion, WP 3417, Oklahoma City, OK, US, 73126-0901, E-mail: Betty-Pfefferbaum@ouhsc.edu
The need to establish an evidence base for early child disaster interventions has been long recognized.
This paper presents a descriptive analysis of the empirical research on early disaster mental health interventions delivered to children within the first 3 months post event.
Characteristics and findings of the included studies were summarized in frequency tables. The long-term effect of the interventions was evaluated using the findings at follow-up assessments.
Eleven empirical studies examining 16 interventions delivered to children within 3 months post disaster were identified for review. The studies included only four randomized controlled trials. The studies examined a range of intervention types (e.g., cognitive behavioral therapy, narrative exposure, meditation relaxation, debriefing, eye movement desensitization and reprocessing) and reported positive effects for various outcomes including posttraumatic stress disorder caseness and posttraumatic stress symptoms, depression, anxiety, and functioning.
Reflecting the difficulty mounting services and conducting research in the early post-disaster phase, this descriptive analysis of the research on early child disaster mental health interventions revealed a dearth of studies but also the successful implementation of a number of interventions.
Rostaminejad, A., Behnammoghadam, M., Rostaminejad, M., Behnammoghadam, Z., & Bashti, S. (2017). Efficacy of eye movement desensitization and reprocessing on the phantom limb pain of patients with amputations within a 24-month follow-up. International Journal of Rehabilitation Research. doi:10.1097/MRR.0000000000000227
Akbar Rostaminejad, Department of Anesthesiology, Yasuj Islamic Azad University, Yasuj, Iran.
The aim of this study was to evaluate the efficacy of eye movement desensitization and reprocessing (EMDR) on the phantom limb pain (PLP) of patients with amputations within a 24-month follow-up. This study was a randomized-controlled trial. A total of 60 patients with amputations were selected by a purposive sampling and patients were divided randomly into two experimental and control groups. Samples were assigned through randomized allocation. EMDR therapy was administered individually to the experimental group participants in 12 one-hour sessions over a 1-month period, In each session, the patient completed the Subjective Units of Distress Scale and a pain-rating scale before and after the intervention. Follow-up measures were obtained 24 months later for the experimental group. The participants in the control group were measured on the two scales at an initial session and again after 1- and 24-month follow-up. The mean PLP decreased in the experimental group between the first and last sessions and remained so at a 24-month follow-up. No decrease occurred for the control group over the 1- and 24-month period. The differences were statistically significant (P<0.001) according to a repeated-measures analysis of variance. EMDR therapy proved to be a successful treatment for PLP. Because of its efficacy and the fact that the positive effects were maintained at the 24-month follow-up, this therapy is recommended for the treatment of PLP.
Sin, J., Spain, D., Furuta, M., Murrells, T., & Norman, I. (2017). Psychological interventions for post-traumatic stress disorder (PTSD) in people with severe mental illness. Cochrane Database of Systematic Reviews (Online), 1, CD011464. doi:10.1002/14651858.CD011464.pub2
Jacqueline Sin, Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neu-roscience, King’s College London, David Goldberg Centre, 16 de Crespigny Park, Denmark Hill, London, SW5 8AF, UK. Jacqueline.firstname.lastname@example.org, email@example.com.
BACKGROUND: Increasing evidence indicates that individuals who develop severe mental illness (SMI) are also vulnerable to developing post-traumatic stress disorder (PTSD), due to increased risk of exposure to traumatic events and social adversity. The effectiveness of trauma-focused psychological interventions (TFPIs) for PTSD in the general population is well-established. TFPIs involve identifying and changing unhelpful beliefs about traumatic experiences, processing of traumatic memories, and developing new ways of responding to cues associated with trauma. Little is known about the potential feasibility, acceptability and effectiveness of TFPIs for individuals who have a SMI and PTSD.
OBJECTIVES: To evaluate the effectiveness of psychological interventions for PTSD symptoms or other symptoms of psychological distress arising from trauma in people with SMI.
SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Trials Study-Based Register (up until March 10, 2016), screened reference lists of relevant reports and reviews, and contacted trial authors for unpublished and/or specific outcome data.
SELECTION CRITERIA: We included all relevant randomised controlled trials (RCTs) which investigated TFPIs for people with SMI and PTSD, and reported useable data.
DATA COLLECTION AND ANALYSIS: Three review authors (DS, MF, IN) independently screened the titles and abstracts of all references identified, and read short-listed full text papers. We assessed risk of bias in each case. We calculated the risk ratio (RR) and 95% confidence interval (CI) for binary outcomes, and the mean difference (MD) and 95% CI for continuous data, on an intention-to-treat basis. We assessed quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and created 'Summary of findings' tables.
MAIN RESULTS: Four trials involving a total of 300 adults with SMI and PTSD are included. These trials evaluated three active intervention therapies: trauma-focused cognitive behavioural therapy (TF-CBT), eye movement desensitisation and reprocessing (EMDR), and brief psychoeducation for PTSD, all delivered via individual sessions. Our main outcomes of interest were PTSD symptoms, quality of life/well-being, symptoms of co-morbid psychosis, anxiety symptoms, depressive symptoms, adverse events and health economic outcomes. 1. TF-CBT versus usual care/waiting list Three trials provided data for this comparison, however, continuous outcome data available were more often found to be skewed than unskewed, leading to the necessity of conducting analyses separately for the two types of continuous data. Using the unskewed data only, results showed no significant differences between TF-CBT and usual care in reducing clinician-rated PTSD symptoms at short term (1 RCT, n =13, MD 13.15, 95% CI -4.09 to 30.39,low-quality evidence). Limited unskewed data showed equivocal results between groups in terms of general quality of life (1 RCT, n = 39, MD -0.60, 95% CI -4.47 to 3.27, low-quality evidence), symptoms of psychosis (1 RCT, n = 9, MD -6.93, 95% CI -34.17 to 20.31, low-quality evidence), and anxiety (1 RCT, n = 9, MD 12.57, 95% CI -5.54 to 30.68, very low-quality evidence), at medium term. The only available data on depression symptoms were skewed and were equivocal across groups at medium term (2 RCTs, n = 48, MD 3.26, 95% CI -3.66 to 10.18, very low-quality evidence). TF-CBT was not associated with more adverse events (1 RCT, n = 100, RR 0.44, 95% CI 0.09 to 2.31, low-quality evidence) at medium term. No data were available for health economic outcomes. Very limited data for PTSD and other symptoms were available over the long term. 2. EMDR versus waiting listOne trial provided data for this comparison. Favourable effects were found for EMDR in terms of PTSD symptom severity at medium term but data were skewed (1 RCT, n = 83, MD -12.31, 95% CI -22.72 to -1.90, very low-quality evidence). EMDR was not associated with more adverse events (1 RCT, n = 102, RR 0.21, 95% CI 0.02 to 1.85, low-quality evidence). No data were available for quality of life, symptoms of co-morbid psychosis, depression, anxiety and health economics.3. TF-CBT versus EMDROne trial compared TF-CBT with EMDR. PTSD symptom severity, based on skewed data (1 RCT, n = 88, MD -1.69, 95% CI -12.63 to 9.23, very low-quality evidence) was similar between treatment groups. No data were available for the other main outcomes.4. TF-CBT versus psychoeducationOne trial compared TF-CBT with psychoeducation. Results were equivocal for PTSD symptom severity (1 RCT, n = 52, MD 0.23, 95% CI -14.66 to 15.12, low-quality evidence) and general quality of life (1 RCT, n = 49, MD 0.11, 95% CI -0.74 to 0.95, low-quality evidence) by medium term. No data were available for the other outcomes of interest.
AUTHORS' CONCLUSIONS: Very few trials have investigated TFPIs for individuals with SMI and PTSD. Results from trials of TF-CBT are limited and inconclusive regarding its effectiveness on PTSD, or on psychotic symptoms or other symptoms of psychological distress. Only one trial evaluated EMDR and provided limited preliminary evidence favouring EMDR compared to waiting list. Comparing TF-CBT head-to-head with EMDR and brief psychoeducation respectively, showed no clear effect for either therapy. Both TF-CBT and EMDR do not appear to cause more (or less) adverse effects, compared to waiting list or usual care; these findings however, are mostly based on low to very low-quality evidence. Further larger scale trials are now needed to provide high-quality evidence to confirm or refute these preliminary findings, and to establish which intervention modalities and techniques are associated with improved outcomes, especially in the long term.
Stearns, S. S., Fleming, R., & Fero, L. J. (2017). Attenuating physiological arousal through the manipulation of simple hand movements. Applied Psychophysiology and Biofeedback, 42(1), 39-50. doi:10.1007/s10484-017-9350-8
Shaun S. Stearns, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80918, USA E-mail: firstname.lastname@example.org
The current study tests whether manipulating simple motor movements can regulate one's physiological reactivity to negative images. Healthy college age participants were randomly assigned to no tapping, steady tapping, or slow tapping conditions and viewed two sets of 15 negative images from the international affective picture system. Participants viewed the first image set without manipulation. During the second image set, they were instructed to tap at a steady pace, a slow pace or not at all. Steady tapping suppressed the vagal component of the cardiovascular defense response, and produced a significant increase in respiration rate and skin conductance level (SCL). Slow tapping suppressed the sympathetic and enhanced the vagal components of the cardiovascular defensive response, and produced a decrease in heart rate, SCL and skin conductance responses to negative images. Results suggest that manipulating simple motor movements is an effective way to both up-regulate and more importantly, down-regulate one's physiological response to negative affective images. Manipulation of slow and simple motor movements may be an effective means to attenuate autonomic arousal.
Swan, S., Keen, N., Reynolds, N., & Onwumere, J. (2017). Psychological interventions for post-traumatic stress symptoms in psychosis: A systematic review of outcomes. Frontiers in Psychology, 8, 341. doi:10.3389/fpsyg.2017.00341
Sarah Swan, South London and Maudsley NHS Foundation Trust London, UK. E-mail: email@example.com
Individuals with severe mental health problems, such as psychosis, are consistently shown to have experienced high levels of past traumatic events. They are also at an increased risk of further traumatisation through victimization events such as crime and assault. The experience of psychosis itself and psychiatric hospitalization have also been recognized to be sufficiently traumatic to lead to the development of post-traumatic stress (PTS) symptoms. Rates of post-traumatic stress disorder (PTSD) are elevated in people with psychosis compared to the general population. The current guidance for the treatment of PTSD is informed by an evidence base predominately limited to populations without co-morbid psychiatric disorders. The systematic review therefore sought to present the current available literature on the use of psychological treatments targeting PTS symptoms in a population with a primary diagnosis of a psychotic disorder. The review aimed to investigate the effect of these interventions on PTS symptoms and also the effect on secondary domains such as psychotic symptoms, affect and functioning. Fifteen studies were identified reporting on cognitive behavior therapy, prolonged exposure, eye movement desensitisation and reprocessing and written emotional disclosure. The review provides preliminary support for the safe use of trauma-focused psychological interventions in groups of people with severe mental health problems. Overall, the interventions were found to be effective in reducing PTS symptoms. Results were mixed with regard to secondary effects on additional domains. Further research including studies employing sufficiently powered methodologically rigorous designs is indicated.