EMDR Research News August 2019

In this third posting of 2019 there are 26 new articles to report related to EMDR therapy. 9 articles have links to the open access full text article.

3 Randomized Controlled Trials
  • Effect of eye movement desensitization and reprocessing (EMDR) on severity of stress in emergency medical technicians
  • Abstinence Following a Motivation-Skill-Desensitization-Mental Energy Intervention for Heroin Dependence
  • The effect of the EMDR intervention on anxiety and depression among patients undergoing hemodialysis

3 Meta-Analyses
  • A Review

5 Review articles
  • A Review

3 individual case reports
  • The
3 Quasi-experimental
  • Psychotherapy for posttraumatic stress disorders among cardiac patients after implantable cardioverter defibrillator shocks
  • A Mixed Methods Evaluation of EMDR for Treating Female Survivors of Sexual and Domestic Violence
  • Feasibility of EMDR for posttraumatic stress disorder in patients with personality disorders
    2 Study Protocols
    • Treating repetitive suicidal intrusions using eye movements: study protocol for a multicenter randomized clinical trial
    • Investigating the effect of EMDR on pain intensity in patients with primary dysmenorrhea

    2 Analogue laboratory studies
    • No evidence for the inverted U-Curve: More demanding dual tasks cause stronger aversive memory degradation
    • On EMDR: Measuring the working memory taxation of various types of eye (Non-) Movement conditions

    3 Neurophysiological
    • Neurobiological features and response to EMDR treatment of posttraumatic stress disorder in patients with breast cancer
    • Neurobiological correlates of EMDR therapy effect in PTSD
    • Increase of precuneus metabolism correlates with reduction of PTSD symptoms after EMDR therapy in military veterans

    2 Commentaries
    • Lateral eye movements, EMDR, and memory changes: A critical commentary on Houben et al.
    • A smorgasbord of PTSD treatments: What does this say about integration


    With each reference below, you will find the citation, abstract and author contact information (when available). 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.

    The
    book of the month is the latest book from Dolores Mosquera, Working with Voices and Dissociative Parts: A trauma-informed approach.


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    Dolores Mosquera latest book, Working with Voices and Dissociative Parts: A trauma-informed approach, is a master study of practical steps for working with some of the most challenging patients clinicians confront. From the start, the reader discovers the calm, steady voice of the author who guides the reader to consider a easy to grasp framework of fundamental principles that structure the book as a whole. Those familiar with the conceptual and procedural breakthroughs in the earlier EMDR and Dissociation: The Progressive Approach will find a broader exploration of these ideas now illustrated by in-depth clinical case descriptions.

    Mosquera Voices

    “Instead of being afraid of the voices, or seeing them as a sign of schizophrenia, or something to get rid of, she explains to us, step by step and in the clearest way, how to work with these voices with our clients. Throughout the book, she teaches us to encourage our clients to start exploring and listening to the voices instead of avoiding them; to lower the dissociative phobias towards the voices and understand and validate their functions: to identify alternative ways of responding, and to address the “voices’ needs” and missing pieces.” (From the publisher’s description.)

    Of this book, Onno van der Hart, PhD writes in part: “Dolores Mosquera calls her perspective a trauma-informed approach. Yes it is! But it is also a highly practical systems approach, and, moreover, a truly integrative one. Working with voices and dissociative parts is a wonderful gift for both novice and experienced clinicians; their clients will benefit greatly because of it.”

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    Behnammoghadam, M., Kheramine, S., Zoladl, M., Cooper, R. Z., & Shahini, S. (2019). Effect of eye movement desensitization and reprocessing (EMDR) on severity of stress in emergency medical technicians. Psychol Res Behav Manag, 12, 289-296.

    Sharif Shahini, Student Committee Research, Yasuj University of Medical Sciences, Next to Imam Sajad Hospital, PO Box: 2591994 Yasuj, Iran. Email: sharif.shahini@yahoo.com

    Abstract

    Background and objectives: People working in health care centers and hospitals, especially the emergency departments, often experience severe stresses due to the nature of their jobs. The current study was aimed at determining the effect of eye movement desensitization and reprocessing (EMDR) on severity of stress of medical emergency technicians. Materials and methods: In the current field trial, 50 emergency medical technicians working in emergency medical centers were selected by convenience sampling method and randomly assigned to either the intervention or control group; each group had 25 subjects. In the intervention group, EMDR training was provided during five consecutive sessions, while in the control group the subjects did not receive any intervention. The data collection instrument in the study, in addition to the demographic questionnaire, was the Alken stress scale. Data had normal distribution and were analyzed using independent t, the Mann– Whitney, or chi-squared tests, and their within-group comparisons were performed by paired t and marginal homogeneity tests.
    Results: The mean score of stress before and after the intervention in the intervention and control groups was 32.2±7.8 and 33.6±13.8, respectively. However, after EMDR implementation, the intensity of stress in the intervention and control groups was 25.9±7.3 and 33 ±13.1, respectively and the difference between the groups was statistically significant (P<0.05). Chi-squared test showed that after the intervention, the degree of stress intensity in the experimental group was lower than that of the control group, and there was a significant difference between the groups in terms of stress intensity (P<0.05). Conclusion: The current study results indicated that EMDR technique significantly reduced the intensity of stress in the intervention group and can be helpful to control stress experienced by emergency medical staff.

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    Carletto, S., Porcaro, C., Settanta, C., Vizzari, V., Stanizzo, M. R., Oliva, F. et al. (2019). Neurobiological features and response to eye movement desensitization and reprocessing treatment of posttraumatic stress disorder in patients with breast cancer. European Journal of Psychotraumatology, 10(1), 1600832.

    Carmen Settanta, Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, Orbassano, TO 10043, Italy. E-mail: carmen.settanta@unito.it


    Abstract

    Background: Breast cancer (BC) is one of the most common invasive types of cancer among women, with important consequences on both physical and psychological functioning. Patients with BC have a great risk of developing posttraumatic stress disorder (PTSD), but few studies have evaluated the efficacy of psychological interventions to treat it. Furthermore, no neuroimaging studies have evaluated the neurobiological effects of psychotherapeutic treatment for BC-related PTSD.
    Objective: The study aimed to evaluate the efficacy of Eye Movement Desensitization and Reprocessing therapy (EMDR) as compared to Treatment as Usual (TAU) in BC patients with PTSD, identifying by electroencephalography (EEG) the neurophysiological changes underlying treatments effect and their correlation with clinical symptoms.
    Method: Thirty patients with BC and PTSD diagnosis were included, receiving either EMDR (n = 15) or TAU (n = 15). Patients were assessed before and after treatments with clinical questionnaires and EEG. The proportion of patients who no longer meet criteria for PTSD after the intervention and changes in clinical scores, both between and within groups, were evaluated. Two-sample permutation t-tests among EEG channels were performed to investigate differences in power spectral density between groups. Pearson correlation analysis was carried out between power bands and clinical scores.
    Results: At post-treatment, all patients treated with EMDR no longer met criteria for PTSD, while all patients treated with TAU maintained the diagnosis. A significant decrease in depressive symptoms was found only in the EMDR group, while anxiety remained stable in all patients. EEG results corroborated these findings, showing significant differences in delta and theta bands in left angular and right fusiform gyri only in the EMDR group. Conclusions: It is essential to detect PTSD symptoms in patients with BC, in order to offer proper interventions. The efficacy of EMDR therapy in reducing cancer-related PTSD is supported by both clinical and neurobiological findings.

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    Chen, J.-y., Yu, J.-c., Cao, J.-p., Xiao, Y., Gu, H., Zhong, R.-l. et al. (2019). Abstinence Following a Motivation-Skill-Desensitization-Mental Energy Intervention for Heroin Dependence: A Three-year Follow-up Result of a Randomized Controlled Trial. Current Medical Science, 39(3), 472-482.

    Corresponding author, Zeng-Zhen Wang, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. E-mail: zzhwang@hust.edu.cn

    Abstract

    The high rate of relapse among heroin users remains a significant public concern in China. In the present study, we utilized a Motivation-Skill-Desensitization-Mental Energy (MSDE) intervention and evaluated its effects on abstinence and mental health. Eighty-nine male heroin users in a drug rehabilitation center were enrolled in the study. The participants in the MSDE intervention group (n=46) received MSDE intervention, which included motivational interviewing, coping skills training, eye movement desensitization and reprocessing, and mindfulness-based psychotherapy. The participants in the control group (n=43) received a series of lectures on skills training. A significant increase in Contemplation Ladder score (P<0.001) and decreases in scores on the Obsessive Compulsive Drug Use Scale (P<0.001), Beck Depression Inventory (P<0.001), and Aggression Questionnaire (P=0.033) were found immediately after intervention. Compared to the control group, the MSDE intervention group reported significantly higher abstinence rates (P=0.027) and retention rates (P<0.001) at follow-up. Overall, the MSDE intervention, which uses a combined strategy for relapse prevention, could be a promising approach for preventing relapse among heroin users in China.

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    de Bruijn, L., A I Stramrood, C., Lambregtse-van den Berg, M. P., & Rius Ottenheim, N. (2019). Treatment of posttraumatic stress disorder following childbirth. J Psychosom Obstet Gynaecol, 1-10.

    Lisa de Bruijn PIeter de la Courtstraat 9, 2313 BP Leiden, The Netherlands. E-mail: bruijn.l@gmail.com

    Abstract

    Aim: The aim of this systematic review is to give an overview of the literature on treatment options for posttraumatic stress disorder (PTSD) following childbirth and to assess their efficacy. Method: PubMed, Embase, Web of Science, Cochrane and PsycINFO were searched using “PTSD”, “childbirth” and “therapy” as terms for studies in English language published between 2000 and 2017. Additional studies were identified by checking reference lists. Studies were included when presence of PTSD was confirmed prior to treatment and childbirth was the traumatic event focused on. All studies were reviewed on sample size, study design, used instruments, sample characteristics, type of treatment and the result of treatment regarding PTSD (symptoms).
    Results: Six studies met the inclusion criteria. One study on debriefing, three studies on cognitive behavioral therapy (CBT) and two studies on eye movement desensitization and reprocessing (EMDR) were identified. Both EMDR and CBT appear to be promising therapies for PTSD following childbirth. Debriefing seems to be beneficial when women request it themselves. Conclusions: EMDR and CBT seem to be effective as therapy for PTSD following childbirth. However, evidence is still limited and more controlled trials are needed to draw conclusive results.

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    de Roos, C., Rommelse, N., Donders, R., Knipschild, R., Bicanic, I., & de Jongh, A. (2019). Response to “Comparing the Effectiveness of EMDR and TF-CBT for Children and Adolescents: a Meta-Analysis. Journal of Child & Adolescent Trauma, 1-3. https://doi.org/10.1007/s40653-019-00257-1

    Carlijn de Roos. E-mail c.deroos@debascule.com


    Abstract

    With interest we read the article by Lewey and colleagues describing the results of a meta-analysis, entitled “Comparing the Effectiveness of EMDR and TF-CBT for Children and Adolescents: A Meta-Analysis” (Lewey et al. 2018). In this article, the authors presented the available evidence on the effectiveness of Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) therapy for children and adolescents with symptoms of Posttraumatic Stress Disorder (PTSD). The authors included studies from 1989 until 2015 that applied TF-CBT and/or EMDR therapy in children and adolescents with full or subclinical PTSD, and compared these treatments to waiting list, head to head or other active treatment control conditions. Based on the results of this meta-analysis, the authors concluded that both TF-CBT and EMDR therapy were effective in treating PTSD, and that TF-CBT was marginally more effective than EMDR. We are highly concerned that the…

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    Gilmoor, A. R., Adithy, A., & Regeer, B. (2019). The Cross-Cultural Validity of Post-Traumatic Stress Disorder and Post-Traumatic Stress Symptoms in the Indian Context: A Systematic Search and Review. Frontiers in Psychiatry, 10. doi:10.3389/fpsyt.2019.00439

    Open access: https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00439/full

    Andrew Roderick Gilmoor, Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University Amsterdam, Amsterdam, Netherlands. E-mail: andrewgilmoor@gmail.com


    Abstract
    Background: The cross-cultural validity of the construct of post-traumatic stress disorder (PTSD) has been a life-long debate in the field of trauma. Its validation in a setting such as India—a nation prone to considerably traumatic events such as conflict, natural disasters, and sexual violence against women—warrants exploration.
    Objective: To describe how PTSD and post-traumatic stress symptoms (PTSS) are conceptualized in the Indian context by systematically examining the evidence of studies that investigate PTSD and PTSS in India.
    Methods: A systematic search in PubMed, Web of Science, and Science Direct yielded a total of 56 studies that discussed one or multiple aspects of PTSD and PTSS in India. Data relating to types of events, populations, diagnostic tools, manifestations, and interventions were extracted and analyzed.
    Results: Eleven of 29 Indian states and 2/7 union territories were represented in the 56 included studies, with most studies (n = 21) originating from Tamil Nadu. Natural Disasters (n = 28), War/Conflict (n = 10), and Medical conditions (n = 7) were the top three most commonly investigated traumatic events. The majority of studies focused on entire communities (n = 16), while children and adolescents made up the second largest group (n = 14). Less attention was paid explicitly to male (n = 3) or female (n = 4) victims. Twenty-five different methods for screening for PTSD were identified, with the most common being the impact of events scale (n = 14). The majority of studies reported the screening and clinical diagnosis of PTSD by professional health care providers (n = 24). Abuse scored the highest average prevalence of PTSD at 52.3%, while the lowest was 16.4% due to man-made accidents. Overall, there was a lack of assessment on trauma-specific interventions, though psychosocial support was the most commonly mentioned intervention.
    Conclusions: Results indicate diversity in approaches for identifying, measuring, and treating PTSD and PTSS in the Indian population and how sociocultural norms influence its manifestation in this population. Future research calls for the development of culturally sensitive approaches to identifying and addressing PTSD and PTSS in India.

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    Goldstein, E., McDonnell, C., Atchley, R., Dorado, K., Bedford, C., Brown, R. L. et al. (2019). The Impact of Psychological Interventions on Posttraumatic Stress Disorder and Pain Symptoms. The Clinical Journal of Pain, 1.
    https://doi.org/10.1097/AJP.0000000000000730

    Ellen Goldstein, Ph.D. University of Wisconsin-Madison, Department of Family, Medicine and Community Health 1100 Delaplaine Ct, Madison, WI 53715. E-mail: ellengoldstein8@gmail.com

    Abstract

    Objectives: Posttraumatic stress disorder (PTSD) and pain often co-occur, introducing clinical challenges and economic burden. Psychological treatments are considered effective for each condition, yet it is not known which therapies have the potential to concurrently address PTSD and pain-related symptoms.
    Methods: To conduct a systematic review and meta-analysis, databases were searched for articles published between January 2007 and December 2017 describing results from clinical trials of interventions addressing PTSD and pain-related symptoms in adults. Two independent reviewers finalized data extraction and risk of bias assessments. A random effects model was used for meta-analysis and to calculate pooled and subgroup effect sizes (ESs) of psychological-only (single modality) and multimodal interventions.
    Results: Eighteen trials (7 uncontrolled, 11 randomized controlled trials, RCTs), totaling 1,583 participants, were included in the systematic review. RCT intervention types included exposure-based, cognitive-behavioral, and mindfulness-based therapies. Data from 10 RCTs (N=1,435) were available for meta-analysis, which demonstrated moderate effect for reduced PTSD severity (ES=-0.55, CI: -0.83, -0.26) and non-significant effect for pain intensity (ES=-0.14, CI: -0.43, 0.15) and pain interference (ES=-0.07, CI: -0.35, 0.20) outcomes. Findings from uncontrolled trials supported meta-analytic results from RCTs. Using GRADE assessment, the quality of evidence was deemed as moderate for RCTs and low for non-RCTs.
    Discussion: Findings indicated that the majority of the interventions appeared to have greater impact on reducing PTSD rather than pain-related symptoms. There remains a need to further develop interventions that consistently impact PTSD and pain-related outcomes when these two conditions co-occur.

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    Guido, C. A., Zicari, A. M., Duse, M., & Spalice, A. (2019). Eye movement desensitisation and reprocessing (EMDR) treatment associated with parent management training (PMT) for the acute symptoms in a patient with PANDAS syndrome: a case report. Italian Journal of Pediatrics, 45(1). doi:10.1186/s13052-019-0667-1

    Open access: https://ijponline.biomedcentral.com/articles/10.1186/s13052-019-0667-1

    Cristiana A. Guido, Department of Pediatrics, Child Neurology Division, Sapienza University of Rome, 00161 Rome, Italy. E-mail: alberto.spalice@uniroma1.it


    Abstract
    Background: The purpose of this report was to present the results of eye movement desensitisation and reprocessing (EMDR) therapy associated with parent management training (PMT) in a child with paediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS), who had previously only been treated with pharmacological treatment.
    Case presentation: The case concerns an 11-year-old boy who presented with simple and complex vocal tics, motor tics, obsessive-compulsive traits and irritability from the age of 6 years, in addition to a positive result for streptococcal infection. The course of symptoms followed a relapsing-remitting trend with acute phases that were contingent on the infectious episodes.
    Conclusions: Following eight sessions of EMDR, preceded by training sessions with the parents, the child showed a significant reduction in symptoms and disappearance of the exacerbation. These results indicate the possibility of improving the treatment outcomes of patients with PANDAS by a combined approach using both antibiotic and EMDR therapies.


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    Haour, F., Dobbelaere, E., & Beaurepaire…, C. D. (2019). Scientific Evaluation of EMDR Psychotherapy for the Treatment of Psychological Trauma Summary: Scientific evaluation of EMDR psychotherapy. jneurology.com.


    Dr. France Hour, EMDR France Association, 9 rue Papillon, 75009 Paris, France; Email: fhaour@gmail.com.


    Abstract

    A recently described integrative psychotherapy, Eye Movement Desensitization and Reprocessing (EMDR), developed by F. Shapiro since 1989, has been confronted to the validation procedure used in pharmacological treatment (randomized control trials). This paper is a current review of the scientific validation steps of EMDR psychotherapy and its mechanisms of action. This EMDR therapy, focused on the resolutions of traumas, was started by treating patients with post-traumatic stress disorders (PTSD). The integrative EMDR protocol obtained the highest level of efficiency, for PTSD treatment. The efficiency of the protocol is now under study and scientific evaluation for troubles in which the trauma experiences are triggers or factors of maintenance of the troubles: anxiety, depression, phobia, sexual troubles, schizophrenia, etc. This new integrative psychotherapy follows the pathways and the timing observed for the evaluation and the validation of other therapies.

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    Lee, C. W., de Jongh, A., & Hase, M. (2019). Lateral eye movements, EMDR, and memory changes: A critical commentary on Houben et al.(2018). Clinical Psychological Science, 2167702619830395. https://journals.sagepub.com/doi/10.1177/2167702619830395

    Christopher William Lee, University of Western Australia Faculty of Law, Faculty of Health and Medical Sciences, Crawley, Australian Capital Territory, 6009, Australia E-mail: chris.lee@uwa.edu.au

    No Abstract

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    Littel, M., & van Schie, K. (2019). No evidence for the inverted U-Curve: More demanding dual tasks cause stronger aversive memory degradation. J Behav Ther Exp Psychiatry, 65, 101484.

    M. Little. E-mail address: littel@essb.eur.nl

    Abstract

    Background and objectives: Simultaneously making eye movements and recalling a memory leads to competition in working memory (WM), which reduces memory vividness and emotionality. The dose-response relationship between WM taxation and aversive memory degradation is predicted to be either linear (i.e., more cognitively demanding tasks exhibit stronger effects) or follow an inverted U-curve (i.e., there should not be too little, but also not too much taxation).
    Methods: Participants (N = 44) recalled four aversive autobiographical memories under four conditions that differed in WM taxation: complex, intermediate, simple, or no counting. Before and after each intervention, and at 24 h follow-up, participants recalled the aversive memory and rated it on vividness and unpleasantness. Using a Bayesian approach the linear and inverted U-shape relationships were directly compared.
    Results: Pretest to posttest drops in vividness and unpleasantness became larger with increased WM taxation of the counting conditions. There was no support for either hypotheses from pretest to follow-up for memory unpleasantness, whereas for memory vividness anecdotal evidence was found for a linear relationship. Limitations: A reaction time (RT) task was used to select counting tasks of varying difficulties. However, the validity of this task appears to be compromised under very strenuous conditions. Higher levels of WM taxation might have been possible with more difficult counting tasks.
    Conclusions: There is strong evidence for a linear dose-response relationship between WM taxation and memory degradation immediately after the intervention, and some unconvincing evidence for this pattern one day later. There was no evidence for an inverted U-curve.

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    Maddox, S. A., Hartmann, J., Ross, R. A., Ressler - Neuron, K. J., & 2019. (2019). Deconstructing the gestalt: Mechanisms of fear, threat, and trauma memory encoding. Neuron, 102(1), 60-74.

    https://doi.org/10.1016/j.neuron.2019.03.017


    Stephanie A. Maddox, Neurobiology of Fear Laboratory, Division of Depression and Anxiety Disorders, McLean Hospital, 115 Mill Street, Belmont, MA 02478. E-mail: kressler@mclean.harvard.edu

    Abstract

    Threat processing is central to understanding debilitating fear- and trauma-related disorders such as posttraumatic stress disorder (PTSD). Progress has been made in understanding the neural circuits underlying the “engram” of threat or fear memory formation that complements a decades-old appreciation of the neurobiology of fear and threat involving hub structures such as the amygdala. In this review, we examine key recent findings, as well as integrate the importance of hormonal and physiological approaches, to provide a broader perspective of how bodily systems engaged in threat responses may interact with amygdala-based circuits in the encoding and updating of threat-related memory. Understanding how trauma-related memories are encoded and updated throughout the brain and the body will ultimately lead to novel biologically-driven approaches for treatment and prevention.


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    Merz, J., Schwarzer, G., & Gerger, H. (2019). Comparative Efficacy and Acceptability of Pharmacological, Psychotherapeutic, and Combination Treatments in Adults With Posttraumatic Stress Disorder: A Network Meta-analysis. JAMA Psychiatry.

    Heike Gerger, PhD, Division of Clinical Psychology and Psychotherapy, University of Basel, Missionsstrasse 62, 4055 Basel, Switzerland. E-mail: heike.gerger@gmail.com


    Abstract

    Importance: Posttraumatic stress disorder (PTSD) is a prevalent mental disorder, with a high risk of chronicity, comorbidity, and functional impairment; PTSD is complicated to treat, and the debate on the best treatment approach is ongoing. Objective: To examine comparative outcomes and acceptability of psychotherapeutic and pharmacological treatments and their combinations in adults with PTSD. Data Sources: Embase, MEDLINE, PsycINFO, Cochrane Controlled Trials Register, and PSYNDEX were searched for studies published from January 1, 1980, to February 28, 2018. Reference lists of included studies and of previously published guidelines and systematic reviews were also searched. Study Selection: Of 11
    417 records identified, 12 published randomized clinical trials (RCTs) comprising 922 participants, contributing 23 direct comparisons between psychotherapeutic and pharmacological treatments or their combinations were included. Data Extraction and Synthesis: Standardized mean differences (SMDs) and odds ratios were aggregated using random-effects network and pairwise meta-analyses. Risk of bias and indirectness was rated for each study, and network confidence was rated using the Confidence in Network Meta-Analysis framework. Main Outcomes and Measures: The primary outcome was the comparative benefit between 2 treatment approaches to PTSD symptom improvement, and secondary outcome was the comparative acceptability of the treatment approaches, as indicated by patient dropout rates before treatment termination. Results: No treatment approach was found to be superior at the end of treatment (for all, 95% CI included 0). At the last follow-up, psychotherapeutic treatments showed greater benefit than pharmacological treatments in both network (SMD, -0.83; 95% CI, -1.59 to -0.07) and pairwise (SMD, -0.63; 95% CI, -1.18 to -0.09, 3 RCTs) meta-analyses. No difference was found between combined treatments and psychotherapeutic treatments at long-term follow-up, and combined treatments were associated with better outcomes than pharmacological treatments in the network meta-analysis (SMD, -0.96; 95% CI, -1.87 to -0.04), but not in the pairwise meta-analysis, which included 2 RCTs (SMD, -1.02; 95% CI, -2.77 to 0.72). No evidence was found for differential acceptability of the 3 treatment approaches. Conclusions and Relevance: These results suggest superiority of psychotherapeutic treatments over pharmacological treatments; network, but not pairwise, meta-analyses suggest superiority of combined treatments over pharmacological treatments in improving PTSD symptom severity in the long term. The scarcity of reported long-term findings hampers definite conclusions and demonstrates the need for robust evidence from large-scaled comparative trials providing long-term follow-up data.

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    Nicosia, G. J., Minewiser, L., & Freger, A. (2019). World Trade Center: A longitudinal case study for treating Post Traumatic Stress Disorder with Emotional Freedom Technique and Eye Movement Desensitization and Reprocessing. Work, 63(2), 199-204. doi:10.3233/WOR-192921

    Gregory J. Nicosia, Ph.D., Advanced Diagnostics PC, 3519 Bigelow Boulevard, Pittsburgh PA 15213, USA. E-mail: thoughtenergy@aol.com.

    Abstract

    BACKGROUND: Emotional Freedom Techniques (EFT) and Eye Movement Desensitization and Reprocessing (EMDR) have been empirically validated as effective psychotherapeutic interventions for treating Post Traumatic Stress Disorder (PTSD). This single subject design case study is of a survivor of the Twin Towers collapse who was treated for prolonged PTSD complicated by dissociated memories.
    OBJECTIVE: EMDR and EFT's effectiveness in treating PTSD were evaluated.
    METHOD: Multiple assessments using Trauma Symptom Inventory (TSI) and Personality combination with EMDR were conducted.
    RESULTS: Effects of a single session of EFT assessed immediately after treatment demonstrated an elimination of clinically significant scores on both the TSI and PAI. The participant concluded treatment with nearly complete symptom remediation and a return to work.
    CONCLUSION: The combination of treatment methods appears to be highly effective and allowed this subject to return to work after many years of disability.

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    Opheim, E., Andersen, P. N., Jakobsen, M., Aasen, B., & Kvaal, K. (2019). Poor quality in systematic reviews on PTSD and EMDR–an examination of search methodology and reporting. Frontiers in Psychology, 10, 1558.

    https://www.frontiersin.org/articles/10.3389/fpsyg.2019.01558/abstract

    Elin Opheim, Inland Norway University of Applied Sciences, Elverum, Norway, E-mail: elin.opheim@inn.no

    Abstract

    Background: Different user groups regard systematic reviews as reliable and valuable sources for answering research questions. For systematic reviews to fulfill their purpose, methodological quality in all stages are of importance. The studies identified in a systematic search form the basis of the review, thus the search process methodology is important for both performing and reporting the search. The purpose of the present study was to evaluate the quality of non-Cochrane systematic reviews by analyzing how they perform and report the search. The focus of this article is eye movement desensitization and reprocessing (EMDR), a trauma-focused therapy commonly used for post-traumatic stress disorder (PTSD).
    Methods and results: We examined the method chapters of 20 systematic reviews on the subject, and rated their searches and reporting using relevant elements from the Cochrane Handbook and PRISMA. We found inadequacies in the methods employed for searching and reporting the search strategy, which could have been avoided by greater adherence to guiding documents for performing systematic reviews.
    Conclusions: Our findings raise important questions for future debate on the risk of omitting studies, thus impairing the conclusions in a systematic review. For clinical purposes, researchers should investigate if, and how, the search strategy in a systematic review affects the body of knowledge and the results.

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    Peregrinova, L., & Jordan, J. (2017). Psychotherapy for posttraumatic stress disorders among cardiac patients after implantable cardioverter defibrillator shocks. Feasibility and implementation of a psychocardiological therapy manual in inpatient cardiac rehabilitation. Heart and Mind, 1, 42.
    http://www.heartmindjournal.org/text.asp?2017/1/1/42/206963


    Ludmila Peregrinova,Department of Psychocardiology, Kerckhoff-Clinic Heart and Thorax Center, Ludwigstr. 41, Bad Nauheim 61231, Germany.

    Abstract

    Context: The reported psychopathological symptoms in patients following implantable cardioverter defibrillator (ICD) shocks differ. Reports concern mostly psychosocial distress with trauma-related symptoms: high hyperarousal, re-experiencing, and avoidance behavior. Patients suffering from these impairments require targeted therapy. Until now, only a few publications report psychological treatment for patients with ICD shocks. The aim of the present work was to examine whether the implementation of the specific psychotherapy, including eye movement desensitization and reprocessing (EMDR), during inpatient cardiac rehabilitation is safe and feasible (health-care study) and to explore whether this intervention leads to a reduction of psychopathology in cardiac patients after ICD shocks. As we have no control group design, we can only describe the change but we do not know whether the health status would be the same without our intervention.
    Methods: Twenty cardiac patients who were distressed after receiving ICD shocks were included in this study. Before and after the 3–5-week psychocardiological inpatient treatment (cardiac rehabilitation including psychotherapy) as well as 6 and 12 months after discharge, the patients were assessed for the following psychological variables: posttraumatic stress, depression, anxiety, and various measures of vital exhaustion and self-efficacy (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-4th Edition Disorders [SCID], Impact of Events Scale-Revised [IES-R], Beck Depression Inventory [BDI], Hospital Anxiety and Depression Scale [HADS] [Hospital Anxiety and Depression Scale-Anxiety (HADS [A])/Hospital Anxiety and Depression Scale-Depression (D)], Shortened Maastricht Exhaustion Questionnaire [MQ], and General Self-Efficacy Scale [SE]).
    Results: At baseline, 84.2% (n = 16) of the participants suffered from posttraumatic stress symptoms as assessed by the SCID (68.4% [n = 13] measured by the IES-R). Symptoms of depression were observed in 72.2% (BDI) or in 63.2% (HADS [D]) of patients and anxiety in 78.9% of patients (HADS [A]). The measurements confirm a significant reduction in the symptoms of posttraumatic stress (IES-R: P =0.000), depression (BDI: P = 0.009; HADS [D]: P = 0.000), anxiety (HADS [A]: P = 0.000), and vital exhaustion (MQ: P = 0.006), 1 year after patients underwent treatment. No significant changes were observed in perceived SE (P = 0.194). No significant correlations between medical variables and psychopathology were found (adequate/inadequate shocks; number of shocks; primary/secondary prevention). No appropriate/inappropriate shocks were delivered within the treatment period.
    Conclusion: Our results suggest that an inpatient cardiac rehabilitation program with intensive targeted psychotherapy including EMDR is a safe intervention for posttraumatic stress in patients who are distressed after receiving ICD shocks. In particular, patients accepted the EMDR treatment, emotional arousal was tolerable, and no cardiac complications occurred during EMDR confrontation. Future strategies could be investigating the impact of intervention on long-term effect, stability, and mortality in this population. In addition, our study showed that some patients had a very long time between ICD shocks and the beginning of the professional therapy. Hence, this leads to the finding that a waiting control group could be acceptable by the ethical commission.

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    Rahimi, F., Rejeh, N., Bahrami, T., Heravi‐Karimooi, M., Tadrisi, S. D., Griffiths, P. et al. (2019). The effect of the eye movement desensitization and reprocessing intervention on anxiety and depression among patients undergoing hemodialysis: A randomized controlled trial. Perspectives in Psychiatric Care.

    Nahid Rejeh. E-mail: reje@shahed.ac.ir

    Abstract

    Purpose: This study examined the effect of the eye movement desensitization and reprocessing intervention on depression and anxiety in patients undergoing hemodialysis.
    Design and Methods: In this randomized controlled trial, 90 patients were enrolled. The intervention group received six sessions of the eye movement desensitization and reprocessing intervention. Data were collected before and 2 weeks after the intervention using the Hospital Anxiety and Depression Scale.
    Findings: Measured levels of anxiety and depression were significantly reduced in the intervention group compared with preintervention levels and to the control group.
    Practice implications: Nurses can use the eye movement desensitization and reprocessing intervention in clinical practice in combination with psychotropic drugs for the reduction of depression and anxiety in patients undergoing hemodialysis.

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    Rousseau, P. F., El Khoury-Malhame, M., Reynaud, E., Zendjidjian, X., Samuelian, J. C., & Khalfa, S. (2019). Neurobiological correlates of EMDR therapy effect in PTSD. European Journal of Trauma & Dissociation, 3(2), 103-111.
    http://dx.doi.org/10.1016/j.ejtd.2018.07.001

    P.F. Rousseau. CNRS and Aix-Marseille University, Timone Institute of Neuroscience, UMR 7289, Faculte ́ de Medecine, 27, boulevard Jean-Moulin, 13005 Marseille, France.
    E-mail address: paf.0526@gmail.com

    Abstract

    Objective. – Posttraumatic stress disorder (PTSD) is a trouble that arises in the aftermath of a traumatic event. The overwhelming resulting stressful memory can be desensitized by a brief therapy, Eye Movement Desensitization and Reprocessing (EMDR). The aim of the present study is to explore the functional brain correlate of such an effective treatment (EMDR) in PTSD.
    Method. – Sixteen PTSD patients underwent fMRI during negative emotional face recognition task, before and after EMDR treatment. Brain activity changes at test and retest (P < 0.005) were compared to those of 16 healthy controls matched for age, gender, and education.
    Results. – In PTSD patients, EMDR therapy elicited significant functional decreases in deep gray matter (including the amygdala, thalamus, and caudate nucleus) and cortical activities (including notably the precuneus, and the ventromedial and dorsolateral prefrontal cortex), as compared to healthy controls (P < 0.005). The right thalamic activity decrease was positively correlated with PTSD symptom reduction as assessed by PCL-S (r = 0.62, n = 16, P < 0.01).
    Conclusions. – The healing process of traumatic memory desensitization by EMDR would act through a functional decrease in brain regions shown to be disrupted in PTSD. Given the role of these structures in memory, self-perception, fear extinction, REM sleep, reward, and attention, we discuss possible explanations of EMDR mechanisms of action in PTSD that may help further improve this therapy.

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    Rousseau, P. F., Malbos, E., Verger, A., Nicolas, F., Lançon, C., Khalfa, S. et al. (2019). Increase of precuneus metabolism correlates with reduction of PTSD symptoms after EMDR therapy in military veterans: an 18F-FDG PET study during virtual reality exposure to war. European journal of nuclear medicine and molecular imaging, 1-5.

    https://dx.doi.org/10.1007/s00259-019-04360-1


    Eric Gued. Laboratoire de Neurosciences Sensorielles et CognitivesAix-Marseille Université CNRS Marseille, France. E-mail: eric.guedj@ap-hm.fr

    Abstract

    Purpose
    The prevalence of posttraumatic stress disorder (PTSD) is higher among veterans, and can lead to disastrous consequences such as suicide. Eye movement desensitization and reprocessing (EMDR) is recommended in first-line psychotherapies for PTSD. Virtual reality exposure (VRE) coupled with 18F-FDG PET imaging can highlight the activated brain regions during stress exposure. The objective of this study is to identify, after EMDR therapy, the regions of brain metabolism that evolve during the stress exposure of a war scene with symptomatic remission in a group of military veterans suffering from PTSD, and to secondarily search for predictive metabolic features.
    Methods
    We recruited 15 military veterans suffering from PTSD who performed an 18F-FDG PET sensitized by the exposure to a virtual war scene, before (T0) and after (T1) EMDR therapy. Statistical parametric mapping was used to compare brain metabolism before and after treatment and to study correlations between metabolism and evolution scores on PTSD clinical scales (PTSD Checklist Scale, PCLS; Clinician-Administered PTSD Scale, CAPS).
    Results
    The metabolic activity of the precuneus was increased after EMDR therapy (p <
    0.005 uncorrected, k>180) and correlated with clinical improvement with the CAPS scale (r=−0.73 and p<0.001). Moreover, the precuneus metabolic value before therapy predicted the clinical improvement on the PCLS scale (T1-T0) after EMDR (r=−0.667 and p<0.006).
    Conclusion
    The clinical improvement in military patients with PTSD after EMDR is related to increased precuneus metabolism upon VR stress exposure.


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    Schwarz, J. E., Baber, D., Barter, A., & Dorfman, K. (2019). A Mixed Methods Evaluation of EMDR for Treating Female Survivors of Sexual and Domestic Violence. Counseling Outcome Research and Evaluation, 1-15. https://doi.org/10.1080/21501378.2018.1561146

    Jill E. Schwartz, Department of counselor Education, The College of New Jersey, Ewing, NJ. E-mail: schwarz@tcnj.edu


    Abstract

    This study assessed the efficacy of eye movement desensitization and reprocessing (EMDR) for women who experienced trauma due to sexual or domestic violence. Twenty-one adult female clients at a nonprofit agency participated in this mixed-methods study during which they completed 8 sessions of EMDR, pre- and post-assessments, and an in-person interview (four counselors were also interviewed). Levels of depression, anxiety, posttraumatic stress, and overall wellness were assessed through the Beck Depression Inventory-II, Generalized Anxiety Disorder–7, PTSD Checklist (PLC-5) for DSM–5, and the Outcome Questionnaire–45.2. Paired sample t tests revealed statistically significant improvement for each measure. Qualitative analysis of individual interviews with clients and counselors further corroborated these results and indicated that engaging in EMDR accelerated and enhanced the therapeutic process and client progress, decreased depression, and increased confidence and hope in clients. These results support EMDR as an effective treatment modality for survivors of sexual and domestic violence and highlight the need for its inclusion in counselor education programs.


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    Slotema, C. W., van den Berg, D. P. G., Driessen, A., Wilhelmus, B., & Franken, I. H. A. (2019). Feasibility of EMDR for posttraumatic stress disorder in patients with personality disorders: a pilot study. Eur J Psychotraumatol, 10(1), 1614822.

    Christina W. Slotema, Parnassia Psychiatric Institute, The Hague, the Netherlands. E-mail: c.slotema@psyq.nl


    Abstract

    Background: Trauma and posttraumatic stress disorder (PTSD) are prevalent in patients with personality disorders. Despite the established efficacy of eye movement desensitisation and reprocessing (EMDR) for PTSD, EMDR has barely been examined in patients with comorbid PTSD and personality disorders.
    Objective: The aim of this study was to explore what changes occur in symptom severity of PTSD, dissociative symptoms, insomnia, non-suicidal self-injurious behaviour and auditory verbal hallucinations in patients with personality disorders during treatment with EMDR. Method: This uncontrolled open feasibility study on EMDR for PTSD was an addition to treatment-as-usual for personality disorders. The outcome measures were the severity of PTSD symptoms, dissociation, insomnia, non-suicidal self-injury, and auditory verbal hallucinations.
    Results: Forty-seven participants (22 with a borderline personality disorder, 25 with other personality disorders) were included. A significant reduction in the severity of symptoms of PTSD, dissociation and insomnia was observed after EMDR treatment (median of four sessions), and 40% of the participants scored below the threshold for PTSD diagnosis. No differences in efficacy were found between patients with borderline personality disorder and other personality disorders. EMDR treatment was completed by 68% of the participants. Conclusions: The addition of EMDR techniques to treatment, as usual, may be beneficial in the treatment of PTSD in patients with personality disorders in order to reduce symptoms of PTSD, dissociation and insomnia. Although one-third of these patients did not complete the additional EMDR treatment, no severe complications (e.g. suicidal behaviour or hospitalisation) occurred. Controlled studies are needed to further investigate the validity of these findings.



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    Taylor, A., & McLachlan, N. H. (2019). Treating a 16 Year Old with a History of Severe Bullying: Supplementing Cognitive Behavioural Therapy with EMDR within the Context of a Case Formulation Approach. Journal of Child & Adolescent Trauma, 1-10.

    Alice Taylor, Child & Adolescent Mental Health ServicesCambridgeshire & Peterborough Foundation Trust Peterborough, UK. E-mail: alice_taylor_16@yahoo.co.uk


    Abstract

    This article describes the use of a case formulation approach, integrating evidence-based treatment in the context of individual clinical traits. It focuses on the supplementation of cognitive behavioural therapy (CBT) with eye movement desensitization and reprocessing (EMDR) in the treatment of a young person, presenting with an initial diagnosis of obsessive-compulsive disorder (OCD). A case formulation suggested the possibility of a differential diagnosis of Adjustment Disorder, indicating the usefulness of the addition of EMDR sessions to process memories of severe bullying. Previous studies promote the idea of using EMDR in cases that do not meet the threshold for Post-Traumatic Stress Disorder (PTSD), in order to reduce the presentation of anxiety. Earlier research suggests that each of these models has specific strengths and attributes in the treatment of mental health difficulties and, whilst based within the context of a well-established case conceptualisation, can be effectively integrated.

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    Valedi, S., Alimoradi, Z., MoradiBaglooei, M., Pakpour, A. H., Ranjbaran, M., & Chegini, V. (2019). Investigating the effect of Eye Movement Desensitization and Reprocessing on pain intensity in patients with primary dysmenorrhea: a protocol for a randomized controlled trial. Trials, 20(1). doi:10.1186/s13063-019-3507-0

    Open access: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-019-3507-0

    Sahar Valedi, Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Bahonar blv., Qazvin 34197-59811, Iran. E-mail: zainabalimoradi.sbmu.ac.ir@gmail.com


    Abstract

    Background: Unpleasant experience with the previous menstruation can increase the sensitivity to pain which may lead to moderate to severe pain in patients with dysmenorrhea. Eye movement desensitization and reprocessing (EMDR) is a psychological method to alleviate the distress from unpleasant memories and related events and can be used for other conditions such as anxiety, depression, and chronic pain. This protocol was designed to investigate the effect of EMDR therapy on pain intensity in patients with dysmenorrhea.
    Methods/Design: A randomized clinical trial was designed in compliance with the Consolidated Standards of Reporting Trials (CONSORT). Female students who have moderate to severe primary dysmenorrhea (based on a visual analogue scale [VAS] score of at least 4 for two consecutive months) and who live in dormitories at Qazvin University of Medical Sciences in Qazvin, Iran will be invited to participate in the study. The total sample size will be 88 girls, who will be randomly assigned to intervention (N = 44) and control (N = 44) groups. EMDR therapy will be performed for the intervention group, while the control group can use sedative or other pain relief methods as their routine. There will be six treatment sessions, which will be held twice a week. The duration of each session is 30–90 min, according to the convenience of each participant. The data will be collected using the demographic characteristics questionnaire, the VAS, the Subjective Units of Anxiety or Distress Scale (SUD), and the Validity of Cognition Scale (VOC). The data on pain intensity due to primary dysmenorrhea in both groups will be collected at 1 and 2 months before the intervention (to identify eligible participants) and 1 and 2 months after the intervention (follow-ups). Data will be analyzed by using SPSS version 25 software and analysis of variance (ANOVA) with repeated measures with appropriate post hoc tests. A P value of less than 0.05 will be considered significant.
    Discussion: The results are expected to provide the information on the efficacy of EMDR therapy to manage moderate to severe pain in patients with primary dysmenorrhea.
    Ethics and dissemination: The research proposal is approved by the human ethics committee of Qazvin University of Medical Sciences (IR.QUMS.REC.1397.100). The results of this trial will be submitted for publication in a peer-reviewed research journal.

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    van Bentum, J. S., Sijbrandij, M., Kerkhof, A. J. F. M., Huisman, A., Arntz, A. R., Holmes, E. A. et al. (2019). Treating repetitive suicidal intrusions using eye movements: study protocol for a multicenter randomized clinical trial. BMC Psychiatry, 19(1), 143.


    J. S. van Bentum, Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. E-mail: j.s.van.bentum@vu.nl


    Abstract

    BACKGROUND: Suicide is a major public health problem, and it remains unclear which processes link suicidal ideation and plans to the act of suicide. Growing evidence shows that the majority of suicidal patients diagnosed with major depression or bipolar disorder report repetitive suicide-related images and thoughts (suicidal intrusions). Various studies showed that vividness of negative as well as positive intrusive images may be reduced by dual task (e.g. eye movements) interventions taxing the working memory. We propose that a dual task intervention may also reduce frequency and intensity of suicidal imagery and may be crucial in preventing the transition from suicidal ideation and planning to actual suicidal behaviour. This study aims a) to evaluate the effectiveness of an Eye Movement Dual Task (EMDT) add-on intervention targeting suicidal imagery in depressed patients, b) to explore the role of potential moderators and mediators in explaining the effect of EMDT, and c) to evaluate the cost-effectiveness of EMDT. METHODS: We will conduct a multi-center randomized clinical trial (RCT) evaluating the effects of EMDT in combination with usual care (n
    =45) compared to usual care alone (n=45). Participants will fill in multiple online batteries of self-report questionnaires as well as complete a semi-structured interview (Intrusion Interview), and online computer tasks. The primary outcome is the frequency and intrusiveness of suicidal imagery. Furthermore, the vividness, emotionality, and content of the suicidal intrusions are evaluated; secondary outcomes include: suicidal behaviour and suicidal ideation, severity of depression, psychological symptoms, rumination, and hopelessness. Finally, potential moderators and mediators are assessed. DISCUSSION: If proven effective, EMDT can be added to regular treatment to reduce the frequency and vividness of suicidal imagery. TRIAL REGISTRATION: The study has been registered on October 17th, 2018 at the Netherlands Trial Register, part of the Dutch Cochrane Centre ( NTR7563 ).

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    van Veen, S. C., Kang, S., & van Schie, K. (2019). On EMDR: Measuring the working memory taxation of various types of eye (Non-) Movement conditions. Journal of Behavior Therapy and Experimental Psychiatry, 101494.

    https://doi.org/10.1016/j.jbtep.2019.101494

    Suzanne C. van Veen, Utrecht University, Department of Clinical Psychology, PO Box 80140, Utrecht, 3508, TC, the Netherlands. E-mail: s.c.vanveen@uu.nl


    Abstract

    Background and objective
    A recent large randomized controlled trial employing different forms of eye (non-) movements in Eye Movement Desensitization and Reprocessing (EMDR) showed that fixating eyes on a therapist's moving or non-moving hand led to equal reductions in symptoms of post-traumatic stress disorder (PTSD). However, numerous EMDR lab analogue studies found that eye movements produce larger memory effects than eyes stationary. These beneficial effects are typically explained by differences in working memory (WM) taxation. We tested the degree of WM taxation of several eye (non-) movement conditions used in the clinical trial.
    Methods
    All participants (N
    =40) performed: (1) eyes moving by following the experimenter's moving finger, (2) eyes fixed on the experimenter's stationary finger, (3) eyes closed, or (4) looking unfocused into the room. Simultaneously they performed a simple reaction time task. Reaction times are an objective index of the extent to which different dual attention tasks tax WM.
    Results
    Eyes moving is more taxing than eyes fixed, while eyes fixed did not differ from eyes unfocused. All conditions were more taxing than eyes closed.
    Limitations
    We studied WM taxation in a laboratory setting; no clinical interventions were applied.
    Conclusions
    In line with previous lab studies, making eye movements was more taxing than eyes fixed. We discuss why this effect was not observed for reductions in PTSD symptoms in the clinical trial (e.g., differences in dependent variables, sample population, and intervention duration). For more comprehensive future insights, we recommend integration of mechanistically focused lab analogue studies and patient-oriented clinical studies.

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    Wampold, B. E. (2019). A smorgasbord of PTSD treatments: What does this say about integration. Journal of Psychotherapy Integration, 29(1), 65.

    Abstract

    In this special section of the Journal of Psychotherapy Integration a variety of treatments for PTSD, including prolonged exposure, EMDR, interpersonal therapy, memory specific training, schema therapy, and narrative-emotion process therapy, were described. In this comment, two issues were discussed (a) psychotherapy integration, and (b) mechanisms of change and treatment effectiveness. A case is made that all the treatments for PTSD are integrative, whether or not this is explicit in their presentation. It is noted that all treatments for PTSD are approximately equally effective and that the evidence for the mechanisms of change underlying the various treatments is weak.

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