EMDR Research News April 2020
4 Randomized Controlled Trials
- A RCT examining individual trauma‐focused therapy for individuals receiving group treatment for depression
- Efficacy of EMDR on the Quality of Life in Patients with Major Depressive Disorder
- Comparative Efficiency of EMDR and Prolonged Exposure in Treating Posttraumatic Stress Disorder
- EMDR for children with medically related subthreshold PTSD: effects on PTSD, blood-injection-injury phobia, depression and sleep
- EMDR for mental health problems: a systematic review and meta-analysis
- Psychological interventions for common mental disorders in women experiencing intimate partner violence in low-income and middle-income countries
- Psychological interventions for post-traumatic stress disorder and depression in refugees
- Psychological therapies for post-traumatic stress disorder in adults
- Dropout from psychological therapies for PTSD in adults
- Psychological treatments for post-traumatic stress disorder in adults: a network meta-analysis
- Interventions to Reduce Posttraumatic Stress in Youth Exposed to Mass Trauma: A Review and Meta-Analysis
- The effectiveness of EMDR toward anxiety disorder
- EMDR for the treatment of psychosis: a systematic review
- Drivers of Preference for Evidence-Based PTSD Treatment: A Qualitative Assessment
- The potential role of EMDR on trauma in affective disorders: A narrative review
- Treatment of post-traumatic stress disorder in people with intellectual disability
- Do emotion regulation difficulties affect outcome of intensive trauma-focused treatment of patients with severe PTSD
- EMDR Group Protocol With Children: A Field Study
- Pre-Post Study to Assess EMDR-Based Group Therapy for Traumatized Refugee Preschoolers
- Using EMDR therapy with patients in an acute mental health crisis
- Addition-Focused EMDR Therapy in Gambling Disorder: A Multiple Baseline Study
- Do emotion regulation difficulties affect outcome of intensive trauma-focused treatment of patients with severe PTSD
- A Multicenter Phase II RCT to Compare the Effectiveness of EMDR Versus TAU in Patients With a First-Episode Psychosis and Psychological Trauma
2 Individual Case Reports
- Trichotillomania Treatment Based on Trauma: Case Report
- EMDR with Body-Oriented Interventions within the field of adoption
3 Analogue laboratory studies
- Increases of correct memories and spontaneous false memories due to eye movements when memories are retrieved after a time delay
- The Effect of modality specific interference on working memory in recalling aversive auditory and visual memories
- Eye movements support behavioral pattern completion
With each reference below, you will find the citation, abstract and author contact information (when available). Previous posting to this blog can be viewed by year in the sidebar below right (visible on computer and tablet - landscape). Summary listings by topic are available at EMDR Research. Prior quarterly summaries of journal articles can be found on the EMDRIA website and a comprehensive listing of all EMDR-related research is available at the Francine Shapiro Library. EMDRIA members can access recent Journal of EMDR Practice and Research articles in the member’s area on the EMDRIA website. JEMDR issues older than 12 months are available open access on Connect - Springer Publishing Company.
Adams, R., Ohlsen, S., & Wood, E. (2020). Eye Movement Desensitization and Reprocessing (EMDR) for the treatment of psychosis: a systematic review. European Journal of Psychotraumatology, 11(1), 1711349. doi:10.1080/20008198.2019.1711349
Open access: http://dx.doi.org/10.1080/20008198.2019.1711349
Rosie Adams, School of Nursing and Midwifery, The University of Sheffield, Barber House Annexe, 3a Clarkhouse Road, Sheffield S10 2LA, UK. E-mail: email@example.com
Background: Psychosis is a public health concern. There is increasing evidence suggesting trauma can play a pivotal role in the development and maintenance of psychosis. Eye Movement Desensitization and Reprocessing (EMDR) is an effective treatment for trauma and could be a vital addition to the treatment of psychosis.
Objective: To explore the evidence for EMDR as a treatment for psychosis, focussing on the safety, effectiveness and acceptability of this intervention for this population.
Methods: Four databases (Cochrane, EMBASE, MEDLINE PsychINFO), and the Francine Shapiro Library were systematically searched, along with grey literature and reference lists of relevant papers. No date limits were applied as this is an area of emerging evidence. Studies were screened for eligibility based on inclusion and exclusion criteria. The included studies were quality assessed and data was extracted from the individual studies, and synthesized using a narrative synthesis approach.
Results: Six studies met the inclusion criteria (1 RCT, 2 Pilot studies, 2 Case series and 1 Case report). Across the studies EMDR was associated with reductions in delusional and negative symptoms, mental health service and medication use. Evidence for reductions in auditory hallucinations and paranoid thinking was mixed. No adverse events were reported, although initial increases in psychotic symptoms were observed in two studies. Average dropout rates across the studies were comparable to other trauma-focused treatments for PTSD. The acceptability of EMDR was not adequately measured or reported.
Conclusion: EMDR appears a safe and feasible intervention for people with psychosis. The evidence is currently insufficient to determine the effectiveness and acceptability of the intervention for this population. Larger confirmative trials are required to form more robust conclusions.
Cuijpers, P., Veen, S. C. V., Sijbrandij, M., Yoder, W., & Cristea, I. A. (2020). Eye movement desensitization and reprocessing for mental health problems: a systematic review and meta-analysis. Cognitive Behaviour Therapy, 1-16. doi:10.1080/16506073.2019.1703801
Open access: https://doi.org/10.1080/16506073.2019.1703801
Pim Cuijpers, Clinical Psychology, Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, Amsterdam 1081 BT, The Netherlands. E-mail: firstname.lastname@example.org
There is no comprehensive meta-analysis of randomised trials examining the effects of Eye Movement Desensitization and Reprocessing (EMDR) on post-traumatic stress disorder (PTSD) and no systematic review at all of the effects of EMDR on other mental health problems. We conducted a systematic review and meta- analysis of 76 trials. Most trials examined the effects on PTSD (62%). The effect size of EMDR compared to control conditions was g = 0.93 (95% CI: 0.67–.18), with high heterogeneity (I2= 72%). Only four of 27 studies had low risk of bias, and there were indications for publication bias. EMDR was more effective than other therapies (g = 0.36; 95% CI: 0.14–0.57), but not in studies with low risk of bias. Significant results were also found for EMDR in phobias and test anxiety, but the number of studies was small and risk of bias was high. EMDR was examined in several other mental health problems, but for none of these problems, sufficient studies were available to pool outcomes. EMDR may be effective in the treatment of PTSD in the short term, but the quality of studies is too low to draw definite conclusions. There is not enough evidence to advise it for the use in other mental health problems.
De Jongh, A., Groenland, G. N., Sanches, S., Bongaerts, H., Voorendonk, E. M., & Van Minnen, A. (2020). The impact of brief intensive trauma-focused treatment for PTSD on symptoms of borderline personality disorder. European Journal of Psychotraumatology, 11(1), 1721142. doi:10.1080/20008198.2020.1721142
Open access: http://dx.doi.org/10.1080/20008198.2020.1721142
Ad De Jongh, Gustav Mahlerlaan 3004, Amsterdam 1081 LA, The Netherlands. E-mail: email@example.com
Background: It is generally recommended to exercise caution in applying trauma-focused treatment to individuals with posttraumatic stress disorder (PTSD) and comorbid borderline personality disorder (BPD).
Objective: To investigate the effects of a brief, intensive, direct trauma-focused treatment programme for individuals with PTSD on BPD symptom severity.
Methods: Individuals (n = 72) with severe PTSD (87.5% had one or more comorbidities; 52.8% fulfilled the criteria for the dissociative subtype of PTSD) due to multiple traumas (e.g. 90.3% sexual abuse) participated in an intensive eight-day trauma-focused treatment programme consisting of eye movement desensitization and reprocessing (EMDR) and pro- longed exposure (PE) therapy, physical activity, and psychoeducation. Treatment did not include any form of stabilization (e.g. emotion regulation training) prior to trauma-focused therapy. Assessments took place at pre- and post-treatment (Borderline Symptom List, BSL- 23; PTSD symptom severity, Clinician Administered PTSD Scale for DSM-5, CAPS-5), and across the eight treatment days (PTSD Checklist, PCL-5).
Results: Treatment resulted in significant decreases of BPD symptoms (Cohen’s d = 0.70). Of the 35 patients with a positive screen for BPD at pre-treatment, 32.7% lost their positive screen at post-treatment. No adverse events nor dropouts occurred during the study time frame, and none of the patients experienced symptom deterioration in response to treatment.
Conclusion: The results suggest that an intensive trauma-focused treatment is a feasible and safe treatment for PTSD patients with clinically elevated symptoms of BPD, and that BPD symptoms decrease along with the PTSD symptoms.
Dominguez, S., Drummond, P., Gouldthorp, B., Janson, D., & Lee, C. W. (2020). A randomized controlled trial examining the impact of individual trauma‐focused therapy for individuals receiving group treatment for depression. Psychology and Psychotherapy: Theory, Research and Practice. doi:10.1111/papt.12268
Open access: https://doi.org/10.1111/papt.12268
Sarah Dominguez, Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, South Street, Murdoch, WA, Australia. E-mail: firstname.lastname@example.org
Objectives. Adverse life events are associated with increased likelihood of depression and poorer prognosis. Trauma-focused treatments (TFT) appear to be effective in decreasing comorbid depressive symptoms. Accordingly, the aim of this study was to evaluate the effectiveness of a TFT on the memories of aversive events for individuals with a primary diagnosis of depression.
Methods. A randomized controlled trial was conducted with 49 participants recruited from a 10-day outpatient group programme. All participants showed symptoms of depression with a subgroup (80%) meeting the DSM-5 criteria for a major depressive episode. Participants received treatment as usual (TAU); three additional individual trauma-focused sessions; or three additional individual assertiveness training sessions. Participants were assessed with regards to depression diagnosis and related symptoms.
Results. For participants with a major depressive episode, the addition of trauma-focused sessions significantly increased the likelihood of remission when compared to TAU, or additional assertiveness training. While no significant treatment difference was noted in depressive symptom change post-treatment, six weeks after treatment those who received an adjunct treatment were more likely to maintain treatment gains than those who received TAU. Furthermore, at 12-week follow-up, participants who received a TFT reported significantly fewer depressive symptoms than those who received assertiveness training.
Conclusions. While differences in outcomes were minimal immediately post-treatment, differences among treatment groups increased over time. Thus, as few as three additional TFT sessions may impact positively on symptom change for people completing a group programme for the treatment of depression.
Etingen, B., Grubbs, K. M., & Harik, J. M. (2020). Drivers of Preference for Evidence-Based PTSD Treatment: A Qualitative Assessment. Mil Med, 185(Supplement_1), 303-310. doi:10.1093/milmed/usz220
Open access: https://academic.oup.com/milmed/article/185/Supplement_1/303/5740682
INTRODUCTION: Mental health treatment utilization among persons with posttraumatic stress disorder (PTSD) tends to be low but may be improved by aligning treatment with patient preferences. Our objective was to characterize the reasons that drive a person's selection of a specific evidence-based PTSD treatment.
MATERIALS AND METHODS: Data were collected using an online survey of adults who screened positive for PTSD. Participants viewed descriptions of five evidence-based PTSD treatments (cognitive processing therapy, prolonged exposure, eye movement desensitization and reprocessing, stress inoculation training, antidepressant medication) and identified their most preferred treatment. Participants then explained why they selected their top choice. These free-text responses (n = 249) were analyzed using thematic coding and constant comparative methods.
RESULTS: Identified themes included (1) perceived effectiveness, (2) perceived suitability, (3) requirements of participation, (4) familiarity with the modality, (5) perception of the option as 'better than alternatives,' (6) perception of the option as 'not harmful,' (7) accessibility, and (8) delivery format. Differences in themes were also examined by treatment modality.
CONCLUSIONS: By highlighting which pieces of information may be most important to detail when presenting different treatment options, these results can help guide treatment planning conversations, as well as the development of shared decision-making tools.
Gorgulu, S. A. (2020). Trichotillomania Treatment Based on Trauma: Case Report. Archives of Clinical and Medical Case Reports, 04(01). doi:10.26502/acmcr.96550181
Open access: http://dx.doi.org/10.26502/acmcr.96550181
Dr. Serap Akdeniz Görgülü, Devrek Public Hospital Psychiatry Clinic, Zonguldak,
Turkey, E-mail: email@example.com
Trichotillomania is characterized by recurrent pulling out of hair. It is a chronic disorder that causes functional impairment. Although trichotillomania has been known for a long time, no algorithms for its treatment have been created by now. In its etiology, trauma has also been suggested in addition to other factors. In this case study, a trichotillomania patient of 27 years with increasing severity accompanied by a history of trauma is reported. As medical treatment, aripiprazole augmentation was used, and for trauma therapy, EMDR (Eye Movement Desensitization and Reprocessing) was applied. The effects working through the trauma had on the treatment of our case was observed and discussed.
Houben, S. T. L., Otgaar, H., Roelofs, J., Smeets, T., & Merckelbach, H. (2020). Increases of correct memories and spontaneous false memories due to eye movements when memories are retrieved after a time delay. Behav Res Ther, 125, 103546. doi:10.1016/j.brat.2019.103546
Open access: https://doi.org/10.1016/j.brat.2019.103546
Sanne T. L. Houben, Maastricht University, Clinical Psychological Science, Universiteitssingel 40, 6229 ER, Maastricht, the Netherlands. E-mail: firstname.lastname@example.org
Eye Movement Desensitization and Reprocessing (EMDR) is an effective treatment for post-traumatic stress disorder. However, literature on possible adverse memory effects of EMDR is scarce. Using the Deese/Roediger-McDermott (DRM) false memory paradigm, we examined the susceptibility to spontaneous false memories after performing eye movements, as used in EMDR. In Experiment 1, 72 undergraduates received word lists containing negative and neutral associated words and immediately after this they were given a free recall and recognition test. In Experiment 2, 68 undergraduates underwent the free recall and recognition test 48 h later. During the free recall phase in both experiments, participants either performed eye movements or not (control condition). In Experiment 1, the two conditions did not differ statistically with regard to correct and false recall/recognition. In Experiment 2, correct memory rates were higher in the eye movement than in the control condition and this was accompanied by an increase in spontaneous false memories on both free recall and recognition. Although our experimental approach is far removed from clinical practice, our findings suggest that eye movements as used in EMDR might amplify both correct and false memory rates.
Jahanfar, A., Fereidouni, Z., Behnammoghadam, M., Dehghan, A., & Bashti, S. (2020). Efficacy of Eye Movement Desensitization and Reprocessing on the Quality of Life in Patients with Major Depressive Disorder: A Randomized Clinical Trial. Psychology Research and Behavior Management, Volume 13, 11-17. doi:10.2147/prbm.s232589
Open access: https://doi.org/10.2147/PRBM.S232589
Zhila Fereidouni Department of Medical Surgical Nursing, Nursing School, Fasa University of Medical Sciences, Fasa, Fars, Iran. E-mail email@example.com
Introduction: The present study was conducted with the aim of investigating the efficacy of eye movement desensitization and reprocessing (EMDR) on the quality of life (QOL) in patients with major depressive disorder (MDD).
Methods: This is a randomized clinical trial study that investigated the efficacy of EMDR on the QOL in patients with MDD. In this study, all patients suffered from psychological trauma were currently in a major depressive episode and had a history of depression. 70 patients with MDD were selected through convenience sampling. Patients were then assigned to two groups of intervention and control (35 patients in each group). The assignment was performed randomly. For the intervention group, EMDR were performed in eight 90 mins sessions over 3 weeks. For the control group, no intervention was considered. Data on the QOL were collected using the WHO Quality of Life-BREF instrument before and after the treatment, and analysed using descriptive tests, paired t-test, independent t-test, and chi-square with SPSS v19.
Results: This study showed that the QOL in all its domains (physical health, psychological health, social relationships and environments) was significantly improved in patients with MDD in the intervention group after 8 sessions of EMDR. The post-treatment effect for the EMDR condition was 2.11, with a confidence interval of 1.3 to 2.7. Another finding of this study was that there was a statistically significant difference in the QOL scores in patients in the control group before and after the treatment; however, the mean difference in the intervention group was more than the control.
Conclusion: The results of this study showed that EMDR were effective on the QOL in patients with major depressive disorder, and improved individuals’ QOL and all its domains. Treatment team members may use this technique as an effective and supportive one to improve the QOL in patients.
Keynejad, R. C., Hanlon, C., & Howard, L. M. (2020). Psychological interventions for common mental disorders in women experiencing intimate partner violence in low-income and middle-income countries: a systematic review and meta-analysis. The Lancet Psychiatry, 7(2), 173-190.
Open access: https://www.sciencedirect.com/science/article/pii/S2215036619305103
Dr Roxanne C Keynejad, Section of Women’s Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK. E-mail: firstname.lastname@example.org
Background: Evidence on the effectiveness of psychological interventions for women with common mental disorders (CMDs) who also experience intimate partner violence is scarce. We aimed to test our hypothesis that exposure to intimate partner violence would reduce intervention effectiveness for CMDs in low-income and middle-income countries (LMICs).
Methods: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, trials registries, 3ie, Google Scholar, and forward and backward citations for studies published between database inception and Aug 16, 2019. All randomised controlled trials (RCTs) of psychological interventions for CMDs in LMICs which measured intimate partner violence were included, without language or date restrictions. We approached study authors to obtain unpublished aggregate subgroup data for women who did and did not report intimate partner violence. We did separate random-effects meta-analyses for anxiety, depression, post-traumatic stress disorder (PTSD), and psychological distress outcomes. Evidence from randomised controlled trials was synthesised as differences between standardised mean differences (SMDs) for change in symptoms, comparing women who did and who did not report intimate partner violence via random-effects meta-analyses. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42017078611.
Findings: Of 8122 records identified, 21 were eligible and data were available for 15 RCTs, all of which had a low to moderate risk of overall bias. Anxiety (five interventions, 728 participants) showed a greater response to intervention among women reporting intimate partner violence than among those who did not (difference in standardised mean differences [dSMD] 0·31, 95% CI 0·04 to 0·57, I2=49·4%). No differences in response to intervention were seen in women reporting intimate partner violence for PTSD (eight interventions, n=1436; dSMD 0·14, 95% CI –0·06 to 0·33, I2=42·6%), depression (12 interventions, n=2940; 0·10, –0·04 to 0·25, I2=49·3%), and psychological distress (four interventions, n=1591; 0·07, –0·05 to 0·18, I2=0·0%, p=0·681).
Interpretation: Psychological interventions treat anxiety effectively in women with current or recent intimate partner violence exposure in LMICs when delivered by appropriately trained and supervised health-care staff, even when not tailored for this population or targeting intimate partner violence directly. Future research should investigate whether adapting evidence-based psychological interventions for CMDs to address intimate partner violence enhances their acceptability, feasibility, and effectiveness in LMICs.
Kip, A., Priebe, S., Holling, H., & Morina, N. (2020). Psychological interventions for post-traumatic stress disorder and depression in refugees. A meta-analysis of randomized controlled trials. Clin Psychol Psychother. doi:10.1002/cpp.2446
Open access: https://onlinelibrary.wiley.com/doi/pdf/10.1002/cpp.2446
Nexhmedin Morina, University of Münster Fliednerstr. 21, 48149 Münster, Germany. E-Mail: email@example.com
Millions of refugees around the globe suffer from post-traumatic stress disorder (PTSD) and/or depression. We conducted a meta-analysis of randomized controlled trials (RCTs) to determine the efficacy of psychological interventions for PTSD and/or depression in refugees. The meta-analysis was registered on the PROSPERO database (CRD42017071384). A search using the Medline, PsycINFO, and PILOTS databases was conducted in January 2019, resulting in 17 RCTs, of which 14 were conducted with adult refugees (1,108 participants) and three with young refugees (<18 years; 151 participants). Further inclusion criteria were at least ten participants completing an active psychological intervention for PTSD, depression or both, and less than 50% of participants receiving concurrent psychotropic drugs. Random effects models showed that active interventions for adult PTSD yielded a medium to large aggregated effect size (g = 0.77; 95% CI = [0.26; 1.28]) at post-treatment when compared to passive and active control conditions. Active interventions for adult depression also produced large controlled effect sizes at post-treatment (g = 0.82; 95% CI = [0.24; 1.40]). The effects appeared to persist over the average follow-up period of six months. The findings suggest that psychological interventions can effectively reduce symptoms of both PTSD and depression in adult refugees. However, the considerable heterogeneity between studies indicates that the efficacy may vary significantly. Future studies should aim to explore the substantial heterogeneity in effect sizes between studies with adult refugees. Additionally, more trials with young refugees suffering from PTSD or depression are needed to determine treatment efficacy for this population.
Korkmazlar, Ü., Bozkurt, B., & Tan Tunca, D. (2020). EMDR Group Protocol With Children: A Field Study. Journal of EMDR Practice and Research, 14(1), 13-30. doi:10.1891/1933-318.104.22.168
Ümran Korkmazlar, Gayrettepe Mahallesi Yildizposta Cad Yesil Apt. B/Blok 7/21 Besiktas/ Istanbul, Turkey. E-mail: firstname.lastname@example.org
The Eye Movement Desensitization and Reprocessing Group Protocol with Children (EMDR-GP/C) was first developed by Korkmazlar following the Marmara earthquake in Turkey in 1999 and can be adapted for different populations. This study focused on EMDR-GP with children who lost their fathers in the mine explosion that occurred in 2014 in Soma, Turkey. The EMDR-GP/C was used with 41 children (7−12 years old) in the early intervention, 3 weeks after the disaster, and used with 25 other children (6−13 years old) in the late intervention, 18 months after the disaster, when posttraumatic stress disorder symptoms had developed. The differences between the early and late implementations of EMDR-GP/C are presented in this article. In the early intervention, children processed the trauma by focusing on the “events” as they saw or heard them; however, 18 months after the disaster, children processed their “emotions” about the event in the desensitization phase. Results show a significant decrease in scores of subjective units of disturbance (SUDs) for both intervention periods. An analysis was also conducted, comparing decreases in SUD scores for younger and older children, with no differences found in their response to treatment. Pre and follow-up data were collected for the late intervention condition, using the Child Report of Posttraumatic Symptoms (CROPS), and showed a significant decrease at 18-month follow-up. Further studies are suggested to determine effectiveness of EMDR-GP/C with other populations.
Lewis, C., Roberts, N. P., Andrew, M., Starling, E., & Bisson, J. I. (2020). Psychological therapies for post-traumatic stress disorder in adults: systematic review and meta-analysis. European Journal of Psychotraumatology, 11(1), 1729633. doi:10.1080/20008198.2020.1729633
Open access: http://dx.doi.org/10.1080/20008198.2020.1729633
Catrin Lewis, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK. E-mail: LewisCE7@Cardiff.ac.uk
Background: Psychological therapies are the recommended first-line treatment for post- traumatic stress disorder (PTSD). Previous systematic reviews have grouped theoretically similar interventions to determine differences between broadly distinct approaches. Consequently, we know little regarding the relative efficacy of the specific manualized therapies commonly applied to the treatment of PTSD.
Objective: To determine the effect sizes of manualized therapies for PTSD.
Methods: We undertook a systematic review following Cochrane Collaboration guidelines. A pre-determined definition of clinical importance was applied to the results and the quality of evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach.
Results: 114 randomized-controlled trials (RCTs) of 8171 participants were included. There was robust evidence that the therapies broadly defined as CBT with a trauma focus (CBT-T), as well as Eye Movement Desensitization and Reprocessing (EMDR), had a clinically important effect. The manualized CBT-Ts with the strongest evidence of effect were Cognitive Processing Therapy (CPT); Cognitive Therapy (CT); and Prolonged Exposure (PE). There was also some evidence supporting CBT without a trauma focus; group CBT with a trauma focus; guided internet-based CBT; and Present Centred Therapy (PCT). There was emerging evidence for a number of other therapies.
Conclusions: A recent increase in RCTs of psychological therapies for PTSD, results in a more confident recommendation of CBT-T and EMDR as the first-line treatments. Among the CBT- Ts considered by the review CPT, CT and PE should be the treatments of choice. The findings should guide evidence informed shared decision-making between patient and clinician.
Lewis, C., Roberts, N. P., Gibson, S., & Bisson, J. I. (2020). Dropout from psychological therapies for post-traumatic stress disorder (PTSD) in adults: systematic review and meta-analysis. European Journal of Psychotraumatology, 11(1), 1709709. doi:10.1080/20008198.2019.1709709
Open access: http://dx.doi.org/10.1080/20008198.2019.1709709
Catrin Lewis, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ. E-mail: LewisCE7@Cardiff.ac.uk
Background: Despite the established efficacy of psychological therapies for post-traumatic stress disorder (PTSD) there has been little systematic exploration of dropout rates. Objective: To ascertain rates of dropout across different modalities of psychological therapy for PTSD and to explore potential sources of heterogeneity.
Method: A systematic review of dropout rates from randomized controlled trials (RCTs) of psychological therapies was conducted. The pooled rate of dropout from psychological therapies was estimated and reasons for heterogeneity explored using meta-regression.
Results: The pooled rate of dropout from RCTs of psychological therapies for PTSD was 16% (95% CI 14–18%). There was evidence of substantial heterogeneity across studies. We found evidence that psychological therapies with a trauma-focus were significantly associated with greater dropout. There was no evidence of greater dropout from therapies delivered in a group format; from studies that recruited participants from clinical services rather than via advertisements; that included only military personnel/veterans; that were limited to participants traumatized by sexual traumas; that included a higher proportion of female participants; or from studies with a lower proportion of participants who were university educated. Conclusions: Dropout rates from recommended psychological therapies for PTSD are high and this appears to be particularly true of interventions with a trauma focus. There is a need to further explore the reasons for dropout and to look at ways of increasing treatment retention.
Lempertz, D., Wichmann, M., Enderle, E., Stellermann-Strehlow, K., Pawils, S., & Metzner, F. (2020). Pre-Post Study to Assess EMDR-Based Group Therapy for Traumatized Refugee Preschoolers. Journal of EMDR Practice and Research, 14(1), 31-45. doi:10.1891/1933-322.214.171.124.
Daniela Lempertz, Private Practice for Child and Youth Psychotherapy, Unkel, Germany, Lühlingsgasse 3, 53572 Unkel, Germany. E-mail: email@example.com
Cross-culturally effective, low-threshold therapies for refugees that can be carried out quickly are urgently required. Worldwide, therapies are lacking, particularly for preschool refugee children, which support coping and prevent chronification of posttraumatic stress. This pilot study examined eye movement desensitization and reprocessing (EMDR)-based group treatment for preschool refugee children in German daycare centers. Ten refugee preschool children aged 4–6 years (n = 5 female) with posttraumatic stress disorder (PTSD) symptoms took part in an EMDR-based group treatment (with 2–4 children per group). PTSD symptoms were rated by parents and preschool teachers using items from the Child Behavior Checklist (CBCL 11⁄2–5), pre- and posttreatment, and at 3-month follow-up. After treatment children tended to display less fear of animals or situations than before treatment. According to preschool teachers’ perspective, the total number of PTSD symptoms dropped significantly at posttreatment (d = .93) and at follow-up (d = .81). Before the intervention, preschool teachers rated the children as being more defiant than their parents did (p = .020). After the intervention, the PTSD symptoms of boys were significantly higher than those of girls (p = .036) according to preschool teachers. The results indicate that timely psychotherapeutic interventions can be conducted with refugee children displaying PTSD symptoms in daycare centers. The efficacy of this intervention needs to be studied in a larger sample under controlled randomized conditions.
Matthijssen, S. J. M. A., van Schie, K., & Van den Hout, M. A. (2019). The Effect of modality specific interference on working memory in recalling aversive auditory and visual memories. Cognition and Emotion, 33(6), 1169-1180. doi:10.1080/02699931.2018.1547271
Suzy Johanna Martina Adriana Matthijssen, Clinical Psychology, Utrecht University, Utrecht, Netherlands. E-mail: firstname.lastname@example.org
Both auditory and visual emotional memories can be made less emotional by loading working memory (WM) during memory recall. Taxing WM during recall can be modality specific (giving an auditory [visuospatial] load during recall of an auditory [visual] memory) or cross modal (an auditory load during visual recall or vice versa). We tested whether modality specific loading taxes WM to a larger extent than cross modal loading. Ninety-six participants undertook a visual and auditory baseline Random Interval Repetition task (i.e. responding as fast as possible to a visual or auditory stimulus by pressing a button). Then, participants recalled a distressing visual and auditory memory, while performing the same visual and auditory Random Interval Repetition task. Increased reaction times (compared to baseline) were indicative of WM loading. Using Bayesian statistics, we compared five models in terms of general and modality specific taxation. There was support for the model describing the effect on WM of dual tasking in general, irrespective of modality specificity, and for the model describing the effect of modality specific loading. Both models combined gained the most support. The results suggest a general effect of dual tasking on taxing WM and a superimposed effect of taxing in matched modality.
Mavranezouli, I., Megnin-Viggars, O., Daly, C., Dias, S., Welton, N. J., Stockton, S., . . . Pilling, S. (2020). Psychological treatments for post-traumatic stress disorder in adults: a network meta-analysis. Psychol Med, 1-14. doi:10.1017/S0033291720000070
Ifigeneia Mavranezouli, Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational & Health Psychology, University College London. E-mail: email@example.com
BACKGROUND: Post-traumatic stress disorder (PTSD) is a potentially chronic and disabling disorder affecting a significant minority of people exposed to trauma. Various psychological treatments have been shown to be effective, but their relative effects are not well established.
METHODS: We undertook a systematic review and network meta-analyses of psychological interventions for adults with PTSD. Outcomes included PTSD symptom change scores post-treatment and at 1-4-month follow-up, and remission post-treatment.
RESULTS: We included 90 trials, 6560 individuals and 22 interventions. Evidence was of moderate-to-low quality. Eye movement desensitisation and reprocessing (EMDR) [standardised mean difference (SMD) -2.07; 95% credible interval (CrI) -2.70 to -1.44], combined somatic/cognitive therapies (SMD -1.69; 95% CrI -2.66 to -0.73), trauma-focused cognitive behavioural therapy (TF-CBT) (SMD -1.46; 95% CrI -1.87 to -1.05) and self-help with support (SMD -1.46; 95% CrI -2.33 to -0.59) appeared to be most effective at reducing PTSD symptoms post-treatment v. waitlist, followed by non-TF-CBT, TF-CBT combined with a selective serotonin reuptake inhibitor (SSRI), SSRIs, self-help without support and counselling. EMDR and TF-CBT showed sustained effects at 1-4-month follow-up. EMDR, TF-CBT, self-help with support and counselling improved remission rates post-treatment. Results for other interventions were either inconclusive or based on limited evidence.
CONCLUSIONS: EMDR and TF-CBT appear to be most effective at reducing symptoms and improving remission rates in adults with PTSD. They are also effective at sustaining symptom improvements beyond treatment endpoint. Further research needs to explore the long-term comparative effectiveness of psychological therapies for adults with PTSD and also the impact of severity and complexity of PTSD on treatment outcomes.
McGuire Stanbury, T. M., Drummond, P. D., Laugharne, J., Kullack, C., & Lee, C. W. (2020). Comparative Efficiency of EMDR and Prolonged Exposure in Treating Posttraumatic Stress Disorder: A Randomized Trial. Journal of EMDR Practice and Research, 14(1), 2-12. doi:10.1891/1933-3126.96.36.199.
Christopher W. Lee, University of Western Australia, 90 Selway Road Brentwood, WA, 6153, Australia. E-mail: firstname.lastname@example.org
The comparative treatment efficiency of eye movement desensitization and reprocessing (EMDR) therapy and prolonged exposure (PE) therapy for the treatment of posttraumatic stress disorder (PTSD) was tested for 20 participants diagnosed with PTSD. Efficiency was operationalized as the total exposure time to traumatic memories during and between sessions; the number of trauma memories processed over the course of therapy; how many sessions were required to resolve the primary trauma; and lower subjective units of disturbance (SUD) levels after the initial treatment session. Participants were randomized to each condition and received 12 90-minute sessions of therapy over 6 weeks. Symptoms were assessed by treatment-blind assessors at posttreatment, and at 3 and 6 months follow-up. Results demonstrated a significant decrease in symptoms posttreatment for PTSD (d = .64), depression (d = .46), anxiety (d = .52) and stress (d = .57) for both groups, which was maintained at 3 months. At 6 months there was a small increase in symptoms compared to the 3-month time point on the Clinician-Administered PTSD Scale (CAPS) but no significant change in any self-report symptoms EMDR was significantly more efficient than PE. EMDR participants had less total exposure time to traumatic memories when homework hours were included (d = .66), reported lower SUD scores after the first session (d = .45), required fewer sessions for the target memory to decrease to near zero distress levels (d = .84), and processed more traumatic memories.
Meentken, M. G., van der Mheen, M., van Beynum, I. M., Aendekerk, E. W. C., Legerstee, J. S., van der Ende, J., . . . Utens, E. M. W. J. (2020). EMDR for children with medically related subthreshold PTSD: short-term effects on PTSD, blood-injection-injury phobia, depression and sleep. Eur J Psychotraumatol, 11(1), 1705598. doi:10.1080/20008198.2019.1705598
Open access: https://www.tandfonline.com/doi/full/10.1080/20008198.2019.1705598
Elisabeth M. W. J. Utens, Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC – Sophia Children’s Hospital, Wytemaweg 8, 3015 CN, Rotterdam, The Netherlands. E-mail: email@example.com
Background: Paediatric illness, injury and medical procedures are potentially traumatic experiences with a range of possible negative psychosocial consequences. To prevent psychosocial impairment and improve medical adherence, evidence-based psychotherapy should be offered if indicated. Eye movement desensitization and reprocessing (EMDR) has been found to reduce symptoms of posttraumatic stress disorder (PTSD) in adults. The evidence for the use with children is promising. Furthermore, recent studies indicate its effectiveness for the treatment of other psychological symptomatology. However, the effectiveness of EMDR in children with subthreshold PTSD after medically related trauma has not yet been investigated.
Objective: Investigating the short-term effectiveness of EMDR on posttraumatic stress, anxiety, depression and sleep problems in children with subthreshold PTSD after hospitalization through a randomized controlled trial (RCT).
Method: Following baseline screening of 420 children from various Dutch hospitals, 74 children (4-15 years old) with medically related subthreshold PTSD were randomized to EMDR (n = 37) or care-as-usual (CAU; n = 37). Follow-up assessment took place after M = 9.7 weeks. Generalized Estimating Equation (GEE) analyses were performed to examine the effectiveness of EMDR compared to CAU.
Results: Children in both groups improved significantly over time on all outcomes. However, the EMDR group improved significantly more as to child-reported symptoms of blood-injection-injury (BII) phobia and depression, and child-, and parent-reported sleep problems of the child. There was no superior effect of EMDR compared to CAU on subthreshold PTSD symptom reduction. Conclusions: EMDR did not perform better than CAU in reducing PTSD symptoms in a paediatric sample of children with subthreshold PTSD after hospitalization. However, the study results indicate that EMDR might be superior in reducing symptoms of blood-injection-injury phobia, depression and sleep problems.
Perlini, C., Donisi, V., Rossetti, M. G., Moltrasio, C., Bellani, M., & Brambilla, P. (2020). The potential role of EMDR on trauma in affective disorders: A narrative review. Journal of Affective Disorders, 269, 1-11. doi:10.1016/j.jad.2020.03.001
Marcella Bellani, Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, P. Le Scuro 10, 37134 Verona, Italy. E-mail: firstname.lastname@example.org
Background: Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapeutic approach that has originally been developed to treat post-traumatic stress disorder (PTSD). Recently it has been suggested as a complementary therapy in a wide range of clinical conditions. In particular, affective disorders as bipolar disorder (BD) and major depressive disorder (MDD) have a higher lifetime prevalence of traumatic or stressful life events (SLEs) compared to the general population, which makes them good candidates for the application of EMDR.
Methods: A bibliographic search on PUBMED, Scopus, and ScienceDirect of studies applying EMDR to people with a primary diagnosis of bipolar disorder (BD) and major depressive disorder (MDD) (with or without a comorbid PTSD) was conducted.
Results: Literature search retrieved 15 studies, of which 3 were focused on BD and 12 on MDD. Overall, they suggest EMDR as an effective tool in reducing trauma-related but also manic and depressive symptoms, with few effect sides and high adherence rates.
Limitations: Few small studies exist with heterogeneous and not gold-standard methodology, especially for BD. Conclusions: Overall, retrieved studies can be considered as first attempts at investigating the applicability of EMDR in affective disorders. Although far to be conclusive, preliminary evidence suggests EMDR as a useful adjunctive approach in the treatment of BD and MDD, especially when other treatments have failed. It is now the time to implement such trauma-focused therapy to larger samples of patients using more rigorous methods.
Pfefferbaum, B., Nitiéma, P., Newman, E., & Patel, A. (2019). The Benefit of Interventions to Reduce Posttraumatic Stress in Youth Exposed to Mass Trauma: A Review and Meta-Analysis. Prehospital and Disaster Medicine, 34(05), 540-551. doi:10.1017/s1049023x19004771
Betty Pfefferbaum, MD, JD, The University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard, WP 3217 Oklahoma City, Oklahoma, USA 73126-0901. E-mail: email@example.com
Numerous interventions to address posttraumatic stress (PTS) in youth exposed to mass trauma have been delivered and evaluated. It remains unclear, however, which interventions work for whom and under what conditions. This report describes a meta-analysis of the effect of youth mass-trauma interventions on PTS to determine if interventions were superior to inactive controls and describes a moderator analysis to examine whether the type of event, population characteristics, or income level of the country where the intervention was delivered may have affected the observed effect sizes. A comprehensive literature search identified randomized controlled trials (RCTs) of youth mass-trauma interventions relative to inactive controls. The search identified 2,232 references, of which 25 RCTs examining 27 trials (N = 4,662 participants) were included in this meta-analysis. Intervention effects were computed as Hedge’s g estimates and combined using a random effects model. Moderator analyses were conducted to explain the observed heterogeneity among effect sizes using the following independent variables: disaster type (political violence versus natural disaster); sample type (targeted versus non-targeted); and income level of the country where the intervention was delivered (high- versus middle- versus low-income). The correlation between the estimates of the intervention effects on PTS and on functional impairment was estimated. The overall treatment effect size was converted into a number needed to treat (NNT) for a practical interpretation. The overall intervention effect was statistically significant (g = 0.57; P < .0001), indicating that interventions had a medium beneficial effect on PTS. None of the hypothesized moderators explained the heterogeneity among the intervention effects. Estimates of the intervention effects on PTS and on functional impairment were positively correlated (Spearman’s r = 0.90; P < .0001), indicating a concomitant improvement in both outcomes. These findings confirm that interventions can alleviate PTS and enhance functioning in children exposed to mass trauma. This study extends prior research by demonstrating improvement in PTS with interventions delivered to targeted and non-targeted populations, regardless of the country income level. Intervention populations and available resources should be considered when interpreting the results of intervention studies to inform recommendations for practice.
Proudlock, S., & Peris, J. (2020). Using EMDR therapy with patients in an acute mental health crisis. BMC Psychiatry, 20(1). doi:10.1186/s12888-019-2426-7
Open access: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2426-7
Simon Proudlock, Prospect Park Hospital, Honey End Lane, Tilehurst, Reading RG30 4EL, UK. E-mail: firstname.lastname@example.org
Background: Death by suicide continues to be a global public health concern with little research demonstrating the effectiveness of treatment options. This exploratory study exams the efficacy of Eye Movement Desensitisation and Reprocessing (EMDR) Therapy delivered to patients experiencing an acute mental health crisis to explore if by treating their background trauma, improvements could be seen in their general psychopathology and if there was a resulting decrease in their desire for suicide.
Methods: A practice-based service development project was conducted within a mental health hospital. A non-randomised, exploratory pre-test post-test design was utilised. Participants were identified from adult patients currently receiving care from either an inpatient mental health ward or the Crisis Resolution and Home Treatment Team (CRHTT). Those who had reported experiencing at least one event that they considered to be traumatic were offered EMDR Therapy. Notes from the electronic database were analysed to assess contact with services 12 months prior to treatment and following treatment.
Results: 72 patients were offered treatment in the study with 57 completing treatment. Patients made significant improvements across all the psychometrics, including a reduction in suicidal ideation. The majority needed less than 10 sessions and needed no onward referral for further psychological therapy. Cost savings were realised by retracting referrals for further therapy and in early discharge from CRHTT and acute wards, and by preventing admissions. Contact with services post treatment also reduced.
Conclusions: EMDR Therapy can be an effective treatment for patients experiencing a mental health crisis who have a trauma picture, resulting in significant improvements in their mental well-being and substantial cost savings for the National Health Service (NHS).
Valiente-Gómez, A., Pujol, N., Moreno-Alcázar, A., Radua, J., Monteagudo-Gimeno, E., Gardoki-Souto, I., . . . the FEP-EMDR Group. (2020). A Multicenter Phase II RCT to Compare the Effectiveness of EMDR Versus TAU in Patients With a First-Episode Psychosis and Psychological Trauma: A Protocol Design. Frontiers in Psychiatry, 10. doi:10.3389/fpsyt.2019.01023
Open access: http://dx.doi.org/10.3389/fpsyt.2019.01023
E-mail: Alicia Valiente-Gómez email@example.com
Background: Patients with a first episode psychosis (FEP) who are admitted for the first time to a psychiatric hospital frequently have experienced prior psychological trauma. Additionally, 40–80% develop posttraumatic stress symptoms, which are summarized as a post-psychotic post-traumatic syndrome (PPS). Eye Movement Desensitization and reprocessing (EMDR) therapy could be an effective psychotherapy to treat a PPS and prior psychological traumas in this population.
Objectives: To assess if EMDR therapy leads to: 1) a reduction of relapses after intervention, 2) an improvement of trauma-related, psychotic and affective symptoms, 3) an improvement of overall functioning, and 4) an improvement in quality of life.
Methods: This is a multicenter phase II rater-blinded randomized controlled trial in which 80 FEP patients with a history of psychological trauma will be randomly assigned to EMDR (n = 40) or to TAU (n = 40). Traumatic events will be measured by the Global Assessment of Posttraumatic Stress Questionnaire, the Cumulative Trauma Screening, the Impact of Event Scale-Revised, the Dissociative Experiences Scale, the Childhood Trauma Scale, the Holmes–Rahe Life Stress Inventory, and the Dissociative Experiences Questionnaire. Clinical symptomatology will be evaluated using the Suicide and Drug Consumption module of the International Neuropsychiatric Interview, Structured Clinical Interview for Positive and Negative Syndrome Scale, Young’s Scale for Mania Evaluation, and Beck Depression II Questionnaire. Functionality will be assessed with the Global Assessment of Functioning and the Quality of Life with the Standardized Instrument developed by the EuroQol Group. The cognitive insight and adherence to the treatment will be assessed with the Beck Cognitive Insight Scale and the Drug Attitude Inventory. All variables will be measured at baseline, post-treatment and at 12-month follow-up.
Conclusion: This study will provide evidence of whether EMDR therapy is effective in reducing trauma and clinical symptoms, reducing relapses and in improving functionality and quality of life in patients with FEP and a history of trauma.
Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03991377
van den Brink, A., van Turnhout, T., & Aldenkamp, E. (2019). Treatment of post-traumatic stress disorder in people with intellectual disability [Behandeling van posttraumatische stressstoornis bij mensen met een laag IQ]. Tijdschrift voor Psychiatrie, 61(11), 804-808.
Open access: https://www.tijdschriftvoorpsychiatrie.nl/issues/546/articles/12068
A. van den Brink, Poli+, Rijnsburgerweg 10, 2333 AA Leiden. E-mail: firstname.lastname@example.org
Background: Patients with borderline intellectual functioning (BIF) or intellectual disability (ID) are more likely to develop post-traumatic stress disorder (PTSD). However, co-occurrence of BIF/ID and PTSD symptoms often leads to exclusion for treatment in regular mental health care centers.
Aim: To determine whether standard treatment programs for PTSD can be used in the treatment of patients with BIF/ID.
Method: Qualitative review of good practices, scientific literature and recent reports about BIF, ID and PTSD.
Results: Literature on evidence-based treatment programs for PTSD suggests that there is no need to be reluctant in starting treatment in patients with BIF/ID. Adjustment of communication and tempo is recommended.
Conclusion: There is reason to believe that standard treatment can be used in treating patients with a low IQ. More research to confirm this assumption is necessary, taken into account the size of this patient group.
van Minnen, M., Markus, W., & Blaauw, E. (2020). Addition-Focused EMDR Therapy in Gambling Disorder: A Multiple Baseline Study. Journal of EMDR Practice and Research, 14(1), 46-59. doi:10.1891/1933-3188.8.131.52.
Marja van Minnen, clinical psychologist at Verslavingszorg Noord Nederland, the Netherlands E-mail: M.email@example.com
Eye movement desensitization and reprocessing (EMDR) therapy is an evidence-based treatment for posttraumatic stress disorder (PTSD). Preliminary findings suggest the application of an adapted, addiction-focused EMDR procedure, AF-EMDR therapy, may also be helpful in treating addictions, such as gambling disorder (GD). In this study eight participants with GD received AF-EMDR therapy, using modules from Markus and Hornsveld’s Palette of EMDR Interventions in Addiction (PEIA). A multiple baseline design was used to investigate whether AF-EMDR therapy reduced gambling urge and increased experienced self-control. Six weekly AF-EMDR sessions (treatment phase) were preceded by a 3- to 7- week non-treatment baseline phase. During both phases, participants kept a daily diary. Visual inspection as well as an interrupted time series analysis demonstrated mixed findings. Results showed that three participants experienced spontaneous recovery during the baseline period, two did not respond to treatment, and three others showed improvements during the EMDR phase. No adverse effects were noted. In sum, AF-EMDR therapy may have potential in the treatment of gambling addiction. However, more research is needed regarding the efficacy, contra-indications, focus, and application as well as the optimal dose of AF-EMDR therapy using the PEIA modules.
Vanfraussen, K. (2020). Eye Movement Desensitization and Reprocessing with Body-Oriented Interventions within the field of adoption: Translating neuroscience into a clinical case study. International Journal of Psychotherapy, 24(1). doi:10.36075/IJP.2020.24.1.2/Vanfraussen
Open access: http://www.ijp.org.uk/docs/EMDR_with_Adopted_Children_Vanfraussen.pdf
Katrien Vanfraussen, Vrije Universiteit, Brussels, Belgium. E-mail: Katrien.Vanfraussen@uzbrussel.be
This article describes the positive effects of a trauma-based approach with an adopted adolescent girl, diagnosed with Somatic Symptom Disorder (SSD). Although symptoms seemed at first sight trauma- unrelated, exploration of her pre- and post-adoption history revealed that re-activated early life adversities (ELA) probably played a crucial role in the development of her condition. In this case study, we describe in depth the content of the trauma-focused sessions, using different forms of Eye Movement Desensitization and Reprocessing (EMDR) and body-oriented exercises, as well as the theoretical rationale behind the clinical interventions.
This case study aims to support clinicians in the treatment of children who must deal with the sequelae of early traumatic events, by illustrating how the current neuroscientific knowledge on brain development and trauma can be used during the diagnostic and therapeutic process.
van Toorenburg, M. M., Sanches, S. A., Linders, B., Rozendaal, L., Voorendonk, E. M., Van Minnen, A., & De Jongh, A. (2020). Do emotion regulation difficulties affect outcome of intensive trauma-focused treatment of patients with severe PTSD. European Journal of Psychotraumatology, 11(1), 1724417. doi:10.1080/20008198.2020.1724417
Ad De Jongh, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands. E-mail: firstname.lastname@example.org
Open Access: https://doi.org/10.1080/20008198.2020.1724417
Background: There is ongoing debate as to whether emotion regulation problems should be improved first in order to profit from trauma-focused treatment, or will diminish after successful trauma processing.
Objective: To enhance our understanding about the importance of emotion regulation difficulties in relation to treatment outcomes of trauma-focused therapy of adult patients with severe PTSD, whereby we made a distinction between people who reported sexual abuse before the age of 12, those who were 12 years or older at the onset of the abuse, individuals who met the criteria for the dissociative subtype of PTSD, and those who did not. Methods: Sixty-two patients with severe PTSD were treated using an intensive eight-day treatment programme, combining two first-line trauma-focused treatments for PTSD (i.e. prolonged exposure and EMDR therapy) without preceding interventions that targeted emotion regulation difficulties. PTSD symptom scores (CAPS-5) and emotion regulation difficulties (DERS) were assessed at pre-treatment, post-treatment, and six month follow-up. Results: PTSD severity and emotion regulation difficulties significantly decreased following trauma-focused treatment. While PTSD severity scores significantly increased from post- treatment until six month follow-up, emotion regulation difficulties did not. Treatment response and relapse was not predicted by emotion-regulation difficulties. Survivors of childhood sexual abuse before the age of 12 and those who were sexually abused later in life improved equally well with regard to emotion regulation difficulties. Individuals who fulfilled criteria of the dissociative subtype of PTSD showed a similar decrease on emotion regulation difficulties during treatment than those who did not.
Conclusion: The results support the notion that the severity of emotion regulation difficul- ties is not associated with worse trauma-focused treatment outcomes for PTSD nor with relapse after completing treatment. Further, emotion regulation difficulties improved after trauma-focused treatment, even for individuals who had been exposed to early childhood sexual trauma and individuals with dissociative subtype.
Wynn, J. S., Ryan, J. D., & Buchsbaum, B. R. (2020). Eye movements support behavioral pattern completion. Proc Natl Acad Sci U S A, 117(11), 6246-6254. doi:10.1073/pnas.1917586117
Jordana S. Wynn, Department of Psychology, University of Toronto, Toronto, ON M55 3G3, Canada. E-mail: email@example.com
The ability to recall a detailed event from a simple reminder is supported by pattern completion, a cognitive operation performed by the hippocampus wherein existing mnemonic representations are retrieved from incomplete input. In behavioral studies, pattern completion is often inferred through the false endorsement of lure (i.e., similar) items as old. However, evidence that such a response is due to the specific retrieval of a similar, previously encoded item is severely lacking. We used eye movement (EM) monitoring during a partial-cue recognition memory task to index reinstatement of lure images behaviorally via the recapitulation of encoding-related EMs or gaze reinstatement. Participants reinstated encoding-related EMs following degraded retrieval cues and this reinstatement was negatively correlated with accuracy for lure images, suggesting that retrieval of existing representations (i.e., pattern completion) underlies lure false alarms. Our findings provide evidence linking gaze reinstatement and pattern completion and advance a functional role for EMs in memory retrieval.
Yunitri, N., Kao, C.-C., Chu, H., Voss, J., Chiu, H.-L., Liu, D.,. . . Chou, K.-R. (2020). The effectiveness of eye movement desensitization and reprocessing toward anxiety disorder: A meta-analysis of randomized controlled trials. Journal of Psychiatric Research, 123, 102-113. doi:10.1016/j.jpsychires.2020.01.005
Open access: https://doi.org/10.1016/j.jpsychires.2020.01.005
Kuei-Ru Chou, School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, No.250, Wu-Hsing Street, Taipei, 110, Taiwan, ROC. E-mail address: firstname.lastname@example.org
Background: Eye Movement Desensitization and Reprocessing (EMDR) has been well established as an effective treatment for post-traumatic stress disorder (PTSD). However, PTSD has been re-categorized as part of trauma and stressor-related disorders instead of anxiety disorders. We conducted the first meta-analysis on Randomized Controlled Trials to evaluate the effectiveness of EMDR on reducing symptoms of anxiety disorders.
Methods: A manual and systematic search using various databases and reference lists of systematic review ar- ticles published up to December 2018 was conducted. The symptoms of anxiety, phobia, panic, traumatic feelings and behaviors/somatic symptoms were examined. Hedges’ g effect sizes were computed, and random effect models were used for all analyses.
Results: A total of 17 trials with 647 participants were included in this meta-analysis. EMDR was associated with a significant reduction of anxiety (g = −0.71; 95% CI: −0.96 to −0.47), panic (g = −0.62; 95% CI: −1.10 to −0.14), phobia (g = −0.45; 95% CI: −0.81 to −0.08), behavioural/somatic symptoms (g = −0.40; 95% CI: −0.63 to −0.12), but not traumatic feelings (g = −0.48; 95% CI: −1.14 to −0.18). Subgroup analysis revealed greater effects of EMDR if compared to passive control. However, the effects were not significantly different based on the duration, number of therapy sessions, or the number of weekly sessions.
Conclusions: Our meta-analysis indicates that EMDR is efficacious for reducing symptoms of anxiety, panic, phobia, and behavioural/somatic symptoms. Further research is needed to explore EMDR's long term efficacy on anxiety disorders.