EMDR Research News April 2021
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. 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.
Abdi, N., Malekzadeh, M., Fereidouni, Z., Behnammoghadam, M., Zaj, P., Mozaffari, M. A., . . . Salehi, Z. (2021). Efficacy of EMDR Therapy on the Pain Intensity and Subjective Distress of Cancer Patients. Journal of EMDR Practice and Research, 15(1), 18-28. doi:10.1891/emdr-d-20-00036
Mohammad Behnammoghadam, Yasuj University of Medical Sciences, Social Determinants of Health Research Center, Yasuj, Iran. E-mail: email@example.com
The present study was carried out to investigate the efficacy of eye movement desensitization and reprocessing (EMDR) therapy in treating pain and subjective distress of patients with cancer. A randomized controlled trial was performed on patients with cancer suffering from moderate to severe cancer pain in Yasuj, Iran, in 2019 and 2020. Sixty patients aged 30–60 years who fulfilled the inclusion criteria were selected using a consensus sampling technique. Patients were randomly assigned to EMDR therapy or control groups based on random block allocation. EMDR therapy was administered in six to eight daily 1-hour sessions. The control group received the standard treatment provided by the hospital. A Numeric Pain-Rating Scale (NRS) and the Subjective Units of Disturbance Scale (SUDS) were used to assess pain and subjective distress before and after the intervention in each session. The collected data were analyzed by descriptive statistics, chi-square test, and independent t test using Statistical Package for the Social Sciences (SPSS) version 24. The mean pain intensity and subjective distress score in the experimental group before and after the EMDR intervention were significantly reduced (p < .001). In the control group, no decreases in NRS and SUDS scores occurred at any time (p > .05). Differences in pain scores between the groups were statistically significant (p < .001). EMDR can effectively and sustainably reduce the pain and subjective distress experienced by patients with cancer. Thus, EMDR is a recommended therapeutic option to mitigate pain and subjective distress among patients with cancer.
Bongaerts, H., Voorendonk, E. M., van Minnen, A., & de Jongh, A. (2021). Safety and effectiveness of intensive treatment for complex PTSD delivered via home-based telehealth. European Journal of Psychotraumatology, 12(1), 1860346. doi:10.1080/20008198.2020.1860346
Open access: http://dx.doi.org/10.1080/20008198.2020.1860346
Ad de Jongh, PSYTREC, Professor Bronkhorstlaan 2, 3723 MB Bilthoven, The Netherlands. E-mail: firstname.lastname@example.org
Background: Home-based psychotherapy delivered via telehealth has not been investigated in the context of intensive trauma-focused treatment for individuals with severe or Complex posttraumatic stress disorder (PTSD).
Objective: To examine the feasibility, safety and effectiveness of an intensive treatment programme containing prolonged exposure, EMDR therapy, physical activities and psycho- education, delivered via home-based telehealth.
Method: The treatment was carried out within four consecutive days during the outbreak of the COVID-19 pandemic. The sample consisted of six (four female) patients suffering from severe or Complex PTSD resulting from exposure to multiple traumatic events, mostly during early childhood. Four of them fulfilled the diagnostic criteria of complex PTSD. Outcome measures were the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), the PTSD Checklist for DSM-5 (PCL-5), and the International Trauma Questionnaire (ITQ). Results: CAPS-5 and PCL-5 scores decreased significantly from pre- to post-treatment (Cohen’s ds 1.04 and 0.93), and from post-treatment to follow-up (Cohen’s ds 0.92 and 1.24). Four of the six patients lost their PTSD or Complex PTSD diagnostic status. No patient dropped out, no personal adverse events and no reliable symptom worsening occurred. Conclusions: The results suggest that intensive, trauma-focused treatment of severe or Complex PTSD delivered via home-based telehealth is feasible, safe and effective, and can be a viable alternative to face-to-face delivered intensive trauma-focused treatment.
Brandtner, A., Pekal, J., & Brand, M. (2020). Investigating properties of imagery-induced flash-forwards and the effect of eye movements on the experience of desire and craving in gamers. Addict Behav, 105, 106347. doi:10.1016/j.addbeh.2020.106347
Matthias Brand, University of Duisburg-Essen, Department of General Psychology: Cognition and Center for Behavioral Addiction Research (CeBAR), Duisburg, Germany.
Vivid and emotionally laden imagery is a symptom across a wide range of psychiatric disorders. Flash-forwards describe the mental simulation of anticipated future events which might also be relevant in the context of gaming disorder. The aim of this laboratory study was to investigate flash-forwards and the experience of desires and craving in gamers, and to examine the effect of eye movements on their vividness and related desires. A sample of 77 gamers formed a mental picture of themselves gaming in the future and rated the vividness and emotionality of this imagination, and their current desire and craving for gaming. Thereafter, one half of the gamers conducted a dual task (i.e., horizontal eye movements while retrieving the picture), whereas the other half let their eyes rest on the middle of the computer screen while retrieving the picture (non-dual task). Vividness of the flash-forward and intensity of desire and craving were again measured after the dual or non-dual task. In the overall sample, more imagery-related desire correlated positively with associated positive affect and vividness of flash-forwards. However, in a subsample of problematic gamers, flash-forwards are experienced less vivid and less pleasurable with increasing symptom severity. Eye movements while retrieving the flash-forwards led to significantly decreased ratings of imagery-related desire intensity, which was not the case for the non-dual condition. Results suggest different properties of flash-forwards between recreational and problematic gamers. Moreover, an attention-demanding task taxing the working memory seems beneficial for reducing desires related to imagery-induced flash-forwards.
Conijn, T., Haverman, L., Wijburg, F. A., & De Roos, C. (2021). Reducing posttraumatic stress in parents of patients with a rare inherited metabolic disorder using eye movement desensitization and reprocessing therapy: a case study. Orphanet J Rare Dis, 16(1), 126. doi:10.1186/s13023-021-01768-7
Open access: https://pubmed.ncbi.nlm.nih.gov/33691734
Frits A. Wijburg, Pediatric Metabolic Diseases, Emma Children’s Hospital and Amsterdam Lysosome Centre “Sphinx”, Amsterdam UMC, University of Amsterdam, H8-264, Meibergdreef 9, Amsterdam, The Netherlands. E-mail: email@example.com
Parents of children with severe inborn errors of metabolism frequently face stressful events related to the disease of their child and are consequently at high risk for developing parental posttraumatic stress disorder (PTSD). Assessment and subsequent treatment of PTSD in these parents is however not common in clinical practice. PTSD can be effectively treated by Eye Movement Desensitization and Reprocessing (EMDR), however no studies have been conducted yet regarding the effect of EMDR for parental PTSD. EMDR is generally offered in multiple weekly sessions which may preclude participation of parents as they are generally overburdened by the ongoing and often intensive care for their child. Therefore, we offered time-limited EMDR with a maximum of four sessions over two subsequent days to two parents of mucopolysaccharidosis type III (MPS III) patients to explore its potential effects. Both qualitative and quantitative outcomes were used to evaluate treatment effects. Both parents felt more resilient and competent to face future difficulties related to the disease of their child, and no adverse effects were reported. Quantitative outcomes showed a clinically significant decrease in post traumatic stress symptoms and comorbid psychological distress from pre- to post treatment, and these beneficial effects were maintained at follow-up. In conclusion, time-limited EMDR may be a highly relevant treatment for traumatized parents of children with MPS III, and probably also for parents of children with other rare progressive disorders. Further research is needed to validate the efficacy of EMDR in this specific population.
de Behrends, M. R. (2021). Treating Cognitive Symptoms of Generalized Anxiety Disorder Using EMDR Therapy With Bilateral Alternating Tactile Stimulation. Journal of EMDR Practice and Research, 15(1), 44-59. doi:10.1891/emdr-d-20-00026
Marisa Rodriguez de Behrends, Pontificia Universidad Católica Argentina, Cespedes 2438, 5 to B, CABA, C1426DUH, Argentina. E-mail: firstname.lastname@example.org
This article reports preliminary evidence for the effectiveness of eye movement desensitization and reprocessing psychotherapy (EMDR) therapy, applying bilateral alternating tactile stimulation in treating cognitive symptoms in patients with generalized anxiety disorder (GAD). A single-case experimental design was used in seven clinical cases. The Penn State Worry Questionnaire, Intolerance of Uncertainty, Cognitive Avoidance Questionnaire, and Negative Problem Orientation Questionnaire were administered at five points during pretreatment (which established the baseline phase serving as each participant’s control), at three points during the treatment phase, at the end of it, and at the 3- and 6-month follow-ups. Each participant received 16 treatment sessions. Visual, statistical, and clinical significance analyses were conducted. The cognitive symptoms treated were: excessive worry, intolerance of uncertainty, cognitive avoidance, and negative orientation to problems. All four cognitive symptoms subsided, with large effect sizes in all cases, between pre- and posttreatment, which can be observed in the visual and statistical analysis of each case. Pre- and post-cognitions are specified in each case. According to the clinical significance analysis, all participants evidenced a change towards an improvement. Finally, evidence is given in favor of the usefulness of EMDR therapy for the treatment of cognitive symptoms in participants diagnosed with GAD. However, these results must be considered cautiously when generalizing data.
Edwards‐Stewart, A., Smolenski, D. J., Bush, N. E., Cyr, B., Beech, E. H., Skopp, N. A., & Belsher, B. E. (2021). Posttraumatic Stress Disorder Treatment Dropout Among Military and Veteran Populations: A Systematic Review and Meta‐Analysis. Journal of Traumatic Stress, 0, 1-11. doi:10.1002/jts.22653
Amanda Edwards-Stewart, 9933 West Hayes St., JBLM, Tacoma, WA 98433. E-mail: email@example.com
High treatment dropout rates reported in recent literature have brought into question the effectiveness of trauma-focused posttraumatic stress disorder (PTSD) treatments among military populations. The aim of the current systematic review was to evaluate PTSD treatment dropout rates among military populations by treatment type and other study-level variables. We searched four databases as well as gray literature for randomized controlled trials that evaluated evidence-based PTSD treatments in samples of active duty personnel and/or veterans. In total, 26 studies were included in this review, with a total of 2,984 participants. We analyzed dropout rates across treatment types using multivariate meta-analysis. Across all forms of treatment, the aggregated dropout rate was 24.2%. Dropout percentages based on treatment type were 27.1% for trauma-focused treatments, 16.1% for non–trauma-focused treatments, and 6.8% for waitlist groups. We found substantial heterogeneity between studies that was not explained by military status or other study-level covariates. Summary risk ratios (RRs) comparing relative dropout between treatment groups indicated that trauma-focused treatment groups had a higher risk of dropout compared to non–trauma-focused treatments, RR = 1.60. The statistical heterogeneity of within-treatment dropout risk ratios was negligible. Dropout rates among military patients receiving trauma-focused therapies were only slightly higher than those reported in the literature among civilian populations and were not explained by study-level covariates.
Fisher, N. (2021). Using EMDR Therapy to Treat Clients Remotely. Journal of EMDR Practice and Research, 15(1), 73-84. doi:10.1891/emdr-d-20-00041
Naomi Fisher, 18 St Keyna Ave., Hove, BN3 4PP, United Kingdom. E-mail: firstname.lastname@example.org
During the COVID-19 pandemic, eye movement desensitization and reprocessing (EMDR) therapists have been faced with the choice of either abruptly terminating therapy with their clients or moving to working remotely, usually by videoconferencing. This poses particular challenges to therapists who may have never worked online. The standard EMDR protocol can be effectively delivered remotely when therapists are aware of how to make necessary adaptations. Based on clinical and supervision practice, this article describes ways in which EMDR therapists can adapt their ways of working in order to work effectively with clients remotely. This ensures that clients can still benefit from this effective and evidence-based treatment during a global health crisis. It suggests a number of ways in which bilateral stimulation can be achieved remotely, as well as discussing special considerations which arise with online therapeutic work. It considers adaptations which need to be made at each stage of EMDR therapy. It uses case examples from children and adults to illustrate how these adaptations work in real life. The case examples discussed in this article are illustrative of the techniques and adaptations necessary for remote EMDR and therefore reflect composites rather than individuals.
Fortin, M., Fortin, C., Savard-Kelly, P., Guay, S., & El-Baalbaki, G. (2021). The effects of psychotherapies for posttraumatic stress disorder on quality of life in the civilian population: A meta-analysis of RCTs. Psychol Trauma. doi:10.1037/tra0000992
Ghassan El-Baalbaki, Université du Québec a` Montréal, C.P. 8888 Succursale Centre- Ville, Quebec, Canada H3C 3P8, Canada. Email: el-baalbaki.ghassan@
Objective: Posttraumatic stress disorder (PTSD) has been shown to significantly impair quality of life (QOL), although no meta-analysis has evaluated the effect of psychotherapies for PTSD on QOL in the civilian population. The current meta-analysis aimed to assess these effects in the adult civilian population. Method: An exhaustive search of 13 databases revealed 9 studies of moderate to strong methodological quality evaluating mainly cognitive-behavioral therapy (8 of 9 studies). A total of 421 participants were allocated to a psychotherapy condition, 174 to a waitlist control group, and 203 were allocated to an active control group. Waitlist and active-controlled random effects of psychotherapies on QOL were computed. Risk of bias was assessed using multiple indices. Results: Pre-post treatment pooled effect sizes were small to moderate for QOL (active-controlled: Hedges’ g 0.37, 95% confidence interval [CI;0.14, 0.59]; waitlist-controlled: g 0.63, CI [0.44, 0.83]) and were both large (waitlist-controlled: g 1.36, CI [1.85, 0.88]) and small (active-controlled: g 0.40, CI [0.57, 0.23]) for PTSD. Risk of bias analyses support robust and conservative results. Conclusions: The results, mainly with respect to cognitive-behavioral therapy, suggest that psychotherapies for PTSD improve QOL. More research is required to determine whether improvements are adequate in restoring QOL to a clinically acceptable level. Future studies should evaluate the effects of psychotherapies on the different dimensions of QOL as well as the specific effects of additional QOL-focused interventions.
Gainer, D., Alam, S., Alam, H., & Redding, H. (2020). A flash of hope: Eye Movement Desensitization and Reprocessing (EMDR) Therapy. Innovations in Clinical Neuroscience, 17(7-9), 12-20.
Danielle Gainer, MD; Email: email@example.com
Eye movement desensitization and reprocessing (EMDR) is a specific treatment modality that utilizes bilateral stimulation to help individuals who have experienced trauma. This stimulation can occur in a variety of forms, including left-right eye movements, tapping on the knees, headphones, or handheld buzzers, known as tappers. This type of psychotherapy allows the individuals to redefine their self-assessment and responses to a given traumatic event in eight defined steps. While EMDR is relatively new type of psychotherapy, existing literature has demonstrated positive results using this form of therapy when treating patients with post-traumatic stress disorder (PTSD)
by utilizing eye movements to detract from negative conceptualizations as a response to a specific trigger, while reaffirming positive self-assessments. Research indicates that EMDR could be a promising treatment for mental health issues other than PTSD, including bipolar disorder, substance use disorders, and depressive disorders. In this article, the eight fundamental processes of EMDR are illustrated through a composite case vignette and examined alongside relevant research regarding its efficacy in treating PTSD.
Gerger, H., Werner, C. P., Gaab, J., & Cuijpers, P. (2021). Comparative efficacy and acceptability of expressive writing treatments compared with psychotherapy, other writing treatments, and waiting list control for adult trauma survivors: a systematic review and network meta-analysis. Psychological Medicine, 1-13. doi:10.1017/s0033291721000143
Open access: http://dx.doi.org/10.1017/s0033291721000143
Heike Gerger, E-mail: firstname.lastname@example.org
Background. Expressive writing about a traumatic event is promising in treating post- traumatic stress disorder (PTSD) symptoms in adult trauma survivors. To date, the comparative efficacy and acceptability of this approach is uncertain. Therefore, we aimed to examine the comparative efficacy and acceptability of expressive writing treatments.
Methods. We included 44 RCTs with 7724 participants contributing 54 direct comparisons between expressive writing (EW), enhanced writing (i.e. including additional therapist contact or individualized writing assignments; EW+), PTSD psychotherapies (PT), neutral writing (NW), and waiting-list control (WL).
Results. EW, EW+, PT, and NW were statistically significantly more efficacious than WL at the longest available follow-up, with SMDs (95% CI) of −0.78 (−1.10 to −0.46) for PT, −0.81 (−1.02 to −0.61) for EW+ , −0.43 (−0.65 to −0.21) for EW, and −0.37 (−0.61 to −0.14) for NW. We found small to moderate differences between the active treatments. At baseline mean PTSD severity was significantly lower in EW+ compared with WL. We found considerable heterogeneity and inconsistency and we found elevated risk of bias in at least one of the bias dimensions in all studies. When EW+-WL comparisons were excluded from the analyses EW+ was no longer superior compared with EW.
Conclusions. The summarized evidence confirms that writing treatments may contribute to improving PTSD symptoms in medium to long-term. Methodological issues in the available evidence hamper definite conclusions regarding the comparative efficacy and acceptability of writing treatments. Adequately sized comparative randomized controlled trials preferably including all four active treatment approaches, reporting long-term data, and including researchers with balanced preferences are needed.
Houben, S. T. L., Otgaar, H., & Roelofs, J. (2021). Psychological Myths as Therapeutic Instructions in Eye Movement Desensitization and Reprocessing. J Psychol, 155(2), 129-139. doi:10.1080/00223980.2020.1839374
Sanne T. L. Houben, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. E-mail: email@example.com
The Dutch protocol for Eye Movement Desensitization and Reprocessing (EMDR) uses two psychological myths as part of the therapeutic instruction: memory works as a video camera and individuals can have a photographic memory. This study explored how participants experience and evaluate such instructions and if these instructions affect their beliefs on memory. Participants received a video, photo, or a control instruction. Participants indicated on a visual analog scale how vivid and emotional they expected to recall the traumatic memory, how credible the therapeutic instruction was, and how reliable they would consider a therapist providing such an instruction. Next, participants completed a memory belief survey. Participants who received the video instruction were most likely to expect to vividly recall a memory. The credibility of the instructions and the reliability of the therapist providing the instruction were at chance level, which might pose problems for the therapeutic alliance and therapy outcome.
Huang, H.-h., & Pfuetze, M. (2021). Using EMDR to Address Social Anxiety With Clients Who Stutter: Treatment Considerations. Journal of EMDR Practice and Research, 15(1), 60-72. doi:10.1891/emdr-d-20-00035
Hsin-hsin Huang, Aquinas Institute of Theology, 23 South Spring Avenue, St. Louis, MO 63108. E-mail: firstname.lastname@example.org
This article describes the treatment considerations when providing eye movement desensitization and reprocessing (EMDR) therapy to treat clients who stutter. Since stuttering is often developed in childhood and persists into adulthood, it has long-term impacts on the educational, social, psychological, and professional development of those who stutter. While stuttering can present with physiological impairments not amendable to psychological interventions, EMDR therapy may effectively decrease the psychological stressors (such as social anxiety and shame) that can intensify stuttering. The authors present an extensive literature review on the traumatic experiences and adverse effects of stuttering. They also discuss essential treatment guidelines when using EMDR to work with people who stutter (PWS), including processing developmental trauma when stuttering, experiences of being bullied because of stuttering, shame and internalized negative self-statements, distrust of one’s body due to inability to control one’s speaking, and the social anxiety and avoidance in dealing with triggering situations. The clinical instructions are illustrated with a case example of a 40-year-old college professor who experienced anxiety and shame related to persistent developmental stuttering, and who sought treatment due to difficulties speaking in front of his classes. After completing 20 sessions of EMDR therapy, the client reported decreased social anxiety and shame and was able to teach courses comfortably. Further research considerations using EMDR treatment with PWS are recommended.
Inoue, J., Matsuo, K., Iwabuchi, T., Takehara, Y., & Yamasue, H. (2021). How Memory Switches Brain Responses of Patients with Posttraumatic Stress Disorder. Cerebral Cortex Communications. doi:10.1093/texcom/tgab021/36648367/tgab021.pdf
Open access: https://academic.oup.com/cercorcomms/advance-article/doi/10.1093/texcom/tgab021/6179206
Dr. Kayako Matsuo, Center for Research Collaboration and Support, Dokkyo Medical University 880 Kita-Kobayashi, Mibu-machi, Shimotsuga-gun, Tochigi 321-0293 Japan. Email: email@example.com
To characterize the brain responses to traumatic memories in posttraumatic stress disorder (PTSD), we conducted task-employed functional magnetic resonance imaging and, in the process, devised a simple but innovative approach—correlation computation between task conditions. A script-driven imagery task was used to compare the responses to a script of the patients’ own traumatic memories and that of tooth brushing as a daily activity and to evaluate how eye movement desensitization and reprocessing (EMDR), an established therapy for PTSD, resolved the alterations in patients. Nine patients with PTSD (7 females, aged 27–50 years) and nine age- and gender-matched healthy controls participated in this study. Six patients underwent the second scan under the same paradigm after EMDR. We discovered intense negative correlations between daily and traumatic memory conditions in broad areas, including the hippocampus; patients who had an intense suppression of activation during daily recognition showed an intense activation while remembering a traumatic memory, whereas patients who had a hyperarousal in daily recognition showed an intense suppression while remembering a traumatic memory as a form of “shut-down.” Moreover, the magnitude of the discrepancy was reduced in patients who remitted after EMDR, which might predict an improved prognosis of PTSD.
Landkroon, E., Salemink, E., & Engelhard, I. M. (2021). Threat memory devaluation by a dual-task intervention: Testing return of fear and intrusive memory over 48 hours. J Behav Ther Exp Psychiatry, 72, 101639. doi:10.1016/j.jbtep.2021.101639
Open access: https://pubmed.ncbi.nlm.nih.gov/33639440
Elze Landkroon, Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, the Netherlands. E-mail: firstname.lastname@example.org
BACKGROUND AND OBJECTIVES: In dual-tasking, individuals recall a threat-related memory while performing a demanding dual-task. This is a fruitful approach to reduce the unpleasantness and vividness of aversive memories and to reduce conditioned fear responses. Crucially, it remains unclear whether dual-tasking can also reduce conditioned fear responses and intrusive memories over time. In this pre-registered two-day fear conditioning paradigm, we examined whether a dual-task intervention reduces return of fear and the frequency of intrusive memories of an aversive film over time.
METHODS: On Day 1, 76 healthy participants underwent fear acquisition with aversive film clips. They were then randomly allocated to one of three conditions: dual-tasking, memory recall without a dual-task ('recall only'), or no task. Afterwards, they underwent an extinction phase and were asked to record intrusive film memories over 48 h. On Day 3, return of fear was assessed.
RESULTS: On Day 1, fear acquisition and extinction were successful. On Day 3, spontaneous recovery and renewal were evident, but, overall, participants reported few intrusions. The dual-task and recall only groups reported reduced unpleasantness of threat memory compared to the no task group, but they did not show reduced (return of) fear responses or fewer intrusions.
LIMITATIONS: Intrusion frequency was low in all three groups, which limits the detection of intervention effects.
CONCLUSIONS: Even though dual-tasking and recall only devalued threat memory temporarily compared to no task, these interventions did not reduce (return of) fear responses and intrusions. Future studies could focus on improving the potency of imagery-based interventions.
Mbazzi, F. B., Dewailly, A., Admasu, K., Duagani, Y., Wamala, K., Vera, A., . . . Roth, G. (2021). Cultural Adaptations of the Standard EMDR Protocol in Five African Countries. Journal of EMDR Practice and Research, 15(1), 29-43. doi:10.1891/emdr-d-20-00028
Femke Bannink Mbazzi, Ghent University, Faculty of Psychology and Educational Sciences, 9000 Ghent, Belgium & Clinical Psychologist, Psychology Practice, The Surgery, Naguru Drive 42, Kampala, Uganda. E-mail: email@example.com
Since 2007, mental health workers in sub-Saharan Africa have been trained in eye movement desensitization and reprocessing (EMDR) therapy. This qualitative study used an Afrocentric design with thematic analysis to investigate adaptations to the EMDR standard protocol that make it culturally relevant for African clients. Participants were 25 EMDR therapists (three male, age range 32–60 years, x̄ = 44) from five African countries, who practiced EMDR for 1–11 years (x̄ = 7). All answered a survey questionnaire, eight participated in a focus group discussion, and two provided a supervision notes analysis. Participants found EMDR a useful and beneficial therapy and preferred it over other therapies because of its nonnarrative nature and quick results. We identified four areas in which African therapists consistently made adaptations to the standard protocol: wording of the protocol text, cultural expression of thoughts and emotions, stimulation choice, and simplification of quantitative scales. Based on the study results, we make numerous recommendations for cultural adaptions to the EMDR protocol. These include language changes to take into account the clients’ “we oriented” communication; cultural interpretations of positive and negative thoughts and events; adding cultural activities such as dance, music, and religious practices as resourcing exercises; using hand gestures or the pictorial faces scale instead of ordinal scales; and using tapping for bilateral stimulation instead of eye movements, which were sometimes seen as “witchcraft.” The relevance of the findings for EMDR practice and training are discussed. We recommend that African researchers further study the acceptability, use, and effectiveness of EMDR in their countries.
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. (2021). Long-term effectiveness of eye movement desensitization and reprocessing in children and adolescents with medically related subthreshold post-traumatic stress disorder: a randomized controlled trial. Eur J Cardiovasc Nurs. doi:10.1093/eurjcn/zvaa006
Open access: https://pubmed.ncbi.nlm.nih.gov/33709117
Elisabeth M.W.J. Utens, Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC—Sophia Children’s Hospital, Rotterdam, The Netherlands.
E-mail: Email: firstname.lastname@example.org
AIMS: Medical procedures and hospitalizations can be experienced as traumatic and can lead to post-traumatic stress reactions. Eye movement desensitization and reprocessing (EMDR) shows promising results but very few long-term studies have been published. Therefore, our aim was to test the long-term (8 months post-treatment) effectiveness of EMDR in children and adolescents with medically related subthreshold post-traumatic stress disorder (PTSD). METHODS AND RESULTS: Seventy-four children (including 39 with congenital or acquired heart disease) aged 4-15 (M = 9.6 years) with subthreshold PTSD after previous hospitalization were included into a parallel group randomized controlled trial. Participants were randomized to EMDR (n = 37) or care-as-usual (CAU) (n = 37; medical care only). The primary outcome was PTSD symptoms of the child. Secondary outcomes were symptoms of depression and blood-injection-injury (BII) phobia, sleep problems, and health-related quality of life (HrQoL) of the child. Assessments of all outcomes were planned at baseline and 8 weeks and 8 months after the start of EMDR/CAU. We hypothesized that the EMDR group would show significantly more improvements on all outcomes over time. Both groups showed improvements over time on child's symptoms of PTSD (only parent report), depression, BII phobia, sleep problems, and most HrQoL subscales. GEE analyses showed no significant differences between the EMDR group (nT2 = 33, nT3 = 30) and the CAU group (nT2 = 35, nT3 = 32) on the primary outcome. One superior effect of EMDR over time was found for reducing parent-reported BII phobia of the child. CONCLUSION: EMDR did not perform better than CAU in reducing subthreshold PTSD up to 8 months post-treatment in previously hospitalized children. Possible explanations and clinical implications are discussed.
Peters, L., & McIlvennan, C. (2021). Trauma after the Gift of Life: Identification and Treatment of Post-Traumatic Stress Disorders in Heart Transplant Recipients. The Journal of Heart and Lung Transplantation, 40(4), S488. Retrieved from https://www.sciencedirect.com/science/article/pii/S1053249821020350
Orthotopic heart transplantation (OHT) recipients have rates of post-traumatic stress disorder (PTSD) over double that of the general population. PTSD after OHT is associated with increased mortality. Use of eye movement desensitization and reprocessing (EMDR) therapy is a novel treatment strategy for PTSD and recently shown to be more effective than cognitive behavioral therapy (CBT). EMDR after OHT has not been reported in the literature. We present two cases that highlight successful use of EMDR therapy post-OHT with improvement of PTSD symptoms.
A 31-year-old female with non-compaction cardiomyopathy occurring during the post-partum period underwent OHT 6 weeks after delivery. Post-OHT course was uncomplicated with no episodes of rejection. Patient treated for depression with sertraline during first year post-OHT. Patient reported symptoms of PTSD with decreased functional capacity. Patient referred for consideration of EMDR therapy, found to be appropriate candidate by psychologist and underwent EMDR. Psychologist reported that patient experienced complete reduction in distress for targets. Patient reported resolution of PTSD symptoms and improved functional capacity.
A 52-year-old male with hypertrophic cardiomyopathy underwent OHT, then required second OHT 5 years later due to graft dysfunction from progressive coronary vasculopathy. Course after re-OHT was notable for persistent, moderate cellular rejection requiring treatment with thymoglobulin, increase in baseline oral immunosuppression, and eventual addition of methotrexate. Patient treated for chronic, stable depression with sertraline and CBT. Patient reported symptoms of PTSD, specifically noting fear of needing a third transplant. Patient referred for consideration of EMDR therapy, found to be appropriate candidate by psychologist and underwent EMDR. Psychologist reported patient experienced significant but incomplete reductions in distress for targets and did not complete all sessions of EMDR therapy due to difficulties in the therapy. Patient reported improvement, but not resolution, of his PTSD symptoms.
Increased mortality is associated with PTSD after OHT. Therefore, OHT recipients experiencing PTSD symptoms should be referred for further evaluation. Additionally, the use of EMDR therapy could be considered.
Reichel, V., Sammer, G., Gruppe, H., Hanewald, B., Garder, R., Bloß, C., & Stingl, M. (2021). Good vibrations: Bilateral tactile stim1ulation decreases startle magnitude during negative imagination and increases skin conductance response for positive imagination in an affective startle reflex paradigm. European Journal of Trauma & Dissociation, 5(3), 100197. doi:10.1016/j.ejtd.2020.100197
Valeska Reiche, University Medicine Giessen, Institute of Psychiatry and Psychotherapy, Klinikstraße 36, 35392 Giessen, Germany. E-mail address: email@example.com
Objectives. – Applying bilateral stimuli while recalling traumatic memories is a technique used in Eye Movement Desensitization and Reprocessing Therapy (EMDR), a well-established treatment of posttraumatic stress disorder. The component of bilateral stimulation is the supposed impact factor of this method. For expanding the knowledge of the underlying physiological and psychological mechanisms, healthy subjects performing an imagination task were observed, and different types of stimulation and different types of measurement methods were compared.
Methods. – A non-clinical sample of 30 healthy volunteers was confronted with imagination scripts of varying valence while bilateral tactile stimuli were applied. Monolateral tactile stimulation and no stimulation served as control conditions. Startle reflex and skin conductance responses were used for physiological reactions, while the Self-Assessment Manikin was used as subjective measure.
Results. – The results clearly demonstrate that bilateral tactile stimulation has benefits compared to no stimulation: Startle reflex during negative imagination was reduced, and skin conductance response (i.e. attention) for positive imagination was increased. These findings correlated with a reduced level of distress for negative scripts and an increased arousal for positive scripts. Monolaterally, no influence on subjective experience but unspecific physiological effects were found.
Conclusions and significance. – The study is the first to demonstrate a valence-dependent startle-reducing and attention-increasing effect of bilateral tactile stimulation using objective physiological measures. Further studies including a clinical sample are necessary to validate the findings.
Sepehry, A. A., Lam, K., Sheppard, M., Guirguis-Younger, M., & Maglio, A.-S. (2021). EMDR for Depression: A Meta-Analysis and Systematic Review. Journal of EMDR Practice and Research, 15(1), 2-17. doi:10.1891/emdr-d-20-00038
Amir Ali Sepehry, Adler University, Vancouver Campus, 520 Seymour Street, Vancouver, BC, Canada V6B 3J5. E-mail: firstname.lastname@example.org
The literature on the efficacy of eye movement desensitization and reprocessing (EMDR) for treating depression is heterogeneous due to research design, quality issues, and trials methodology. The current meta-analysis seeks to examine EMDR for depression with the aim of answering the aforementioned limitations. Thirty-nine studies were included for analysis after a review of the relevant literature. Univariate meta-regressions were run to examine dose-response and the effect of moderating variables. Subanalysis for primary and secondary depression showed a large, significant, and heterogeneous effect-size estimates, where EMDR significantly improved symptoms of depression in contrast to all control types. At post hoc, data were reexamined and a significant and large, yet heterogeneous, effect-size estimate emerged between the EMDR and control arm after the removal of two outliers [Hedges’ g = 0.70, 95% CI = 0.50–0.89, p-value < .01, I2 = 70%, K = 37]. This is the first meta-analysis examining for the effect of EMDR comparing to various control modalities on depression with dose-response. We found (a) that studies were balanced at onset in terms of depression severity, and (b) a large and significant effect of EMDR on depression at the end of trials. Additionally, the significance of the aggregate effect-size estimate at the end of trials was unchanged by the intake of psychotropic medications, reported demographic variables, or EMDR methodology.
Sheikhi, M. R., Moradibaglooei, M., Ghiasvand, M., Assistant Professor, D. O. P. N., School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran, Faculty member, D. O. P. N., School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran, & M.Sc. Student, D. O. P. N., School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran. (2021). The Effect of Eye Movement Desensitization and Reprocessing (EMDR) on Depression in Spinal Cord Injury Patients. Avicenna Journal of Nursing and Midwifery Care, 29(1), 72-80. doi:10.30699/ajnmc.29.1.72
Open access: http://dx.doi.org/10.30699/ajnmc.29.1.72
Mohammad Moradibaglooei, Faculty member, Department of Psychiatric Nursing, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran Email: email@example.com
Introduction: Depression is the most common psychological consequences of spinal cord injury. The purpose of this study was to determine the effect of eye movement desensitization and reprocess (EMDR) on depression in patients with spinal cord injury.
Methods: In this clinical trial study, 40 patients with Spinal cord injury (SCI) who were treated at Hadith Rehabilitation Center of Qazvin in 2018-2019 were selected by random sampling and randomly divided into two groups. The methods of eye movements and reprocessing were performed for experimental group in five sessions of 90 minutes. The research instruments included demographic characteristics form and Beck’s depression inventories that were completed by patients in both groups. Depression was measured before, one, three and six months after the intervention. Data were analyzed using SPSS 23, by descriptive and inferential statistics proportional to the data. The data was analyzed with, Chi-square, independent t-test, Paired t-test and ANOVA.
Results: The results of this study showed that before intervention the mean depression score was not significantly different between the control and experimental groups (31.4 ±10.4), (30.5 ±6.3) (P=0.7, t=-0.3). After intervention, the experimental group had a significant increase in the mean score of depression compared with the control group (22.3±7.7), (30.3±6.6) (P<0.001, t=-4.1). The mean depression score in the experimental group showed statistically significant differences three and six months after the intervention (P=0.001, t=-4.05).
Conclusion: Considering that EMDR, as a non-pharmacological intervention, reduced depression in patients with spinal cord injury.
Snyder, M., & Trang, D. (2021). Is EMDR effective in treatment of PTSD. Evidence-Based Practice. doi:10.1097/EBP.0000000000001258
Nellis Family Medicine Residency, Las Vegas, NV
In adults with posttraumatic stress disorder (PTSD) eye movement desensitization and reprocessing (EMDR) appears as effective as the standard of care (trauma-based cognitive behavioral therapy (CBT) in improving PTSD. EMDR may be minimally to moderately superior to CBT in decreasing intrusion, arousal, anxiety and posttraumatic symptoms of PTSD (SOR; B, metanalyses of small randomized controlled trials (RCTs). EMDR is more effective than fluoxetine in achieving long-term PTSD symptom reduction at six month for adult-onset compared with child-onset trauma survivors (SOR; C, small RCT).
Susanty, E., Sijbrandij, M., Srisayekti, W., & Huizink, A. C. (2021). Eye Movement Desensitization (EMD) to reduce posttraumatic stress disorder-related stress reactivity in Indonesia PTSD patients: a study protocol for a randomized controlled trial. Trials, 22(1), 181. doi:10.1186/s13063-021-05100-3
Open access: https://pubmed.ncbi.nlm.nih.gov/33663549
Eka Susanty, Faculty of Psychology, Universitas Jenderal Achmad Yani, Cimahi, Indonesia. E-mail: firstname.lastname@example.org
BACKGROUND: Posttraumatic stress disorder (PTSD) may develop after exposure to a traumatic event. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based psychological treatment for PTSD. It is yet unclear whether eye movements also reduce stress reactivity in PTSD patients. This study aims to test whether eye movements, as provided during Eye Movement Desensitization (EMD), are more effective in reducing stress reactivity in PTSD patients as compared to a retrieval-only control condition.
METHODS: The study includes participants who meet criteria of PTSD of the public psychological services in Jakarta and Bandung, Indonesia. One hundred and ten participants are randomly assigned to either an (1) Eye Movement Desensitization group (n = 55) or (2) retrieval-only control group (n = 55). Participants are assessed at baseline (T0), post-treatment (T1), 1 month (T2), and at 3 months follow-up (T3). Participants are exposed to a script-driven imagery procedure at T0 and T1. The primary outcome is heart rate variability (HRV) stress reactivity during script-driven imagery. Secondary outcomes include heart rate (HR), pre-ejection period (PEP), saliva cortisol levels, PTSD symptoms, neurocognitive functioning, symptoms of anxiety and depression, perceived stress level, and quality of life.
DISCUSSION: If the EMD intervention is effective in reducing stress reactivity outcomes, this would give us more insight into the underlying mechanisms of EMDR's effectiveness in PTSD symptom reduction.
TRIAL REGISTRATION: ISRCTN registry ISRCTN55239132. Registered on 19 December 2017.
Szabó, J., & Tóth, S. (2021). Collision Every Night: Treating Nightmares with Trauma-focused Methods: Case Report. Sleep Vigil, 1-6. doi:10.1007/s41782-021-00126-8
Open access: https://pubmed.ncbi.nlm.nih.gov/33554009
József Szabó, Faculty of Humanities and Social Sciences, Pázmány Péter Catholic University, Mikszáth Kálmán tér 1, Budapest 1088, Hungary. E-mail: email@example.com
Introduction: We would like to present the case of a young patient with acute stress disorder and recurrent nightmares following the psychological trauma caused by a severe road traffic accident. The comprehensive therapy carried out at the Department of Traumatology included medication, trauma processing and a psychological method whose aim is to cease the development of nightmares. Case Presentation: Psychiatric assessment and treatment was asked for a polytraumatised female patient at the Intensive Care Unit after she had undergone a neurosurgical intervention. Her medicinal treatment was continued at the Department of Traumatology. Besides the antidepressant venlafaxine she was treated in accordance with the EMDR protocol for acute stress disorder, and we also applied imagery rescripting to prevent her from having recurrent (daily) nightmares. As a result of the therapy, her symptoms were fast relieved, the nightmares stopped almost instantly, her mood improved, rumination and anxiety decreased significantly. Conclusions: In view of the fast and significant symptomatic improvement, we can expect that the EMDR therapy and its protocol for acute stress disorder have successfully reactivated information processing, and besides the subjective relief we have managed to prevent a mental crisis that could lead to a suicide risk as well as the development of post-traumatic stress disorder. We also hope that the improvement will be long-lasting.
Varker, T., Jones, K. A., Arjmand, H.-A., Hinton, M., Hiles, S. A., Freijah, I., . . . O’Donnell, M. (2021). Dropout from guideline-recommended psychological treatments for posttraumatic stress disorder: A systematic review and meta-analysis. Journal of Affective Disorders Reports, 4, 100093. doi:10.1016/j.jadr.2021.100093
Open access: http://dx.doi.org/10.1016/j.jadr.2021.100093
Tracey Varker, Phoenix Australia- Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry St, Carlton, VIC 3053, Australia. E-mail: firstname.lastname@example.org
Background: Many patients drop out of guideline-recommended treatments for posttraumatic stress disorder (PTSD), yet there has been little systematic investigation of this issue. We aimed to examine dropout proportions from randomized controlled trials (RCTs) of guideline-recommended treatments for PTSD and whether proportions differed by type of treatment or trauma, PTSD severity or chronicity, or medication being permitted.
Methods: Systematic review and meta-analysis of RCTs of guideline-recommended treatments for PTSD.
Results: Eighty-five trials, with data for 6804 participants were included in the meta-analyses. The mean dropout proportion for guideline-recommended treatment was 20.9% (95%CI 17.2, 24.9) with evidence of high heterogeneity across studies. Military trauma was associated with higher dropout than civilian trauma. The civilian trauma group had similar dropout rates from guideline-recommended treatments, and active, waitlist or treatment as usual controls. In the military trauma group, dropout was higher from guideline-recommended treatments compared to active, waitlist or treatment as usual controls. Within this group, dropout from trauma-focused treatment was significantly higher than from non-trauma focused treatments overall, with the greatest difference in dropout rates occurring between randomization and treatment initiation.
Limitations: Most RCTs exclude participants who have comorbid substance use disorder, suicidal behaviour, or history of psychosis, which limits the generalizability of findings.
Conclusion: Dropout from guideline-recommended treatment for PTSD is higher in populations who have experienced military trauma and this population dropout from treatment in higher proportions when it is trauma- focused. The reasons for disparate rates of dropouts from recommended PTSD treatments require further investigation.
Yoshii, T. (2021). The Role of the Thalamus in Post-Traumatic Stress Disorder. Int J Mol Sci, 22(4). doi:10.3390/ijms22041730
Open access: https://pubmed.ncbi.nlm.nih.gov/33572198
Takanobu Yoshii, Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan. E-mail: email@example.com
Post-traumatic stress disorder (PTSD) has a high lifetime prevalence and is one of the more serious challenges in mental health care. Fear-conditioned learning involving the amygdala has been thought to be one of the main causative factors; however, recent studies have reported abnormalities in the thalamus of PTSD patients, which may explain the mechanism of interventions such as eye movement desensitization and reprocessing (EMDR). Therefore, I conducted a miniature literature review on the potential contribution of the thalamus to the pathogenesis of PTSD and the validation of therapeutic approaches. As a result, we noticed the importance of the retinotectal pathway (superior colliculus-pulvinar-amygdala connection) and discussed therapeutic indicators.