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Books of the Month

The books of the month are The Finding Solid Ground Program Workbook: Overcoming Obstacles in Trauma Recovery together with the companion textbook Finding Solid Ground: Overcoming Obstacles in Trauma Treatment from the research team who carried out the TOP DD longitudinal research on the treatment of those with dissociative disorders.

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A few comments from the editor

I generally exercise little editorial oversight in indexing peer reviewed journal articles for these blog entries. In contrast, I carefully select which articles appear in the comprehensive listings in the Clinicians Guide to EMDR Therapy Research. In the August 2022 blog listing below, careful readers will come across more than one article of the review/meta-analysis/guideline category that fails to offer a balanced and unbiased examination of the literature. These distorted summaries are included not as a signal of agreement or failure to recognize their distortions, but to keep those interested in the research aware that the "old" problems of bias against the actual scientific status of the EMDR research is not old, but continues.

I encourage those with access to current issues of the Journal of EMDR Practice and Research to read the editorial by Farrell & Rydberg (2022, Volume 16, Number 3) "EMDR Therapy: To Call Out Is to Strengthen" which is indexed below. The editors of JEMDR highlight the work of Howard Lipke in calling out the misleading findings published in Harik, Grubbs & Hamblen (2020). As it happens, Dr. Lipke and I had corresponded on this article which I had already elected to omit from indexing in these blogs when it appeared. I commented on a draft of Dr. Lipke's rejoinder about the bias in the summary of EMDR in the Harik, et al report which he submitted for publication. Farrell and Rydberg explain the Harik et al article was withdrawn by the authors two years after its publication when they became aware of Dr. Lipke's rejoinder. There was no further comment by the editor of the journal in which it appeared and and the editor did not publish Dr. Lipke's well-crafted rejoinder. By then of course further damage to the status of EMDR therapy had occurred. I hesitated this month about including more than one misleading article in what follows. I will leave it to astute readers to determine for themselves what they think of these articles. Crafting careful rejoinders to every one of these misleading articles could easily occupy a team of scholars. Perhaps one of you will step forward. Fortunately, most of the research articles that meet general inclusion criteria for these blog listings are thoughtful, well-balanced articles that fairly present their findings in an unbiased way.

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Altmeyer, S., Wollersheim, L., Kilian-Hütten, N., Behnke, A., Hofmann, A., & Tumani, V. (2022). Effectiveness of treating depression with eye movement desensitization and reprocessing among inpatients–A follow-up study over 12 months. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.937204

Susanne Altmeyer, Gezeitenhaus Traumahospital Schloss Eichholz, Wesseling, Germany. E-mail: s.altmeyer@gezeitenhaus.de

Open Access: http://dx.doi.org/10.3389/fpsyg.2022.937204

Abstract

Increasing prevalence of depression poses a huge challenge to the healthcare systems, and the success rates of current standard therapies are limited. While 30% of treated patients do not experience a full remission after treatment, more than 75% of patients suffer from recurrent depressive episodes. Eye Movement Desensitization and Reprocessing (EMDR) therapy represents an emerging treatment option of depression, and preliminary studies show promising effects with a probably higher remission rate when compared to control-therapies such as cognitive behavioral therapy. In the present study, 49 patients with severe depression were treated with an integrated systemic treatment approach including EMDR therapy that followed a specific protocol with a treatment algorithm for depression in a naturalistic hospital setting. Following their discharge from the hospital, the patients were followed up by a structured telephone interview after 3 and 12 months. 27 of the 49 (55%) patients fulfilled the Beck’s depression criteria of a full remission when they were discharged. At the follow-up interview, 12 months after discharge, 7 of the 27 patients (26%) reported a relapse, while the remaining 20 patients (74%) had stayed relapse-free. The findings of our observational study confirm reports of earlier studies in patients with depression, showing that EMDR therapy leads to a high rate of remission, and is associated with a decreased number of relapses. Patients with depression receiving EMDR treatment may be more resilient to stressors.

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Bandelow, B., Allgulander, C., Baldwin, D. S., Costa, D. L. D. C., Denys, D., Dilbaz, N., Domschke, K., Eriksson, E., Fineberg, N. A., Hättenschwiler, J., Hollander, E., Kaiya, H., Karavaeva, T., Kasper, S., Katzman, M., Kim, Y. K., Inoue, T., Lim, L., Masdrakis, V., . . . Zohar, J. (2022). World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders - Version 3. Part I: Anxiety disorders. World J Biol Psychiatry, 1-39. https://doi.org/10.1080/15622975.2022.2086295

Borwin Bandelow, Department of Psychiatry and Psychotherapy, University Medical Centre (UMG), von-Sieboldstr. 5, D-37075 Grottingen, Germany.
E-mail: bbandel@gwdg.de

URL: https://pubmed.ncbi.nlm.nih.gov/35900161

Abstract

AIM: This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders (published in 2002, revised in 2008). METHOD: A consensus panel of 33 international experts representing 22 countries developed recommendations based on efficacy and acceptability of available treatments. In total, 1007 RCTs for the treatment of these disorders in adults, adolescents, and children with medications, psychotherapy and other non-pharmacological interventions were evaluated, applying the same rigorous methods that are standard for the assessment of medications. RESULT: This paper, Part I, contains recommendations for the treatment of panic disorder/agoraphobia (PDA), generalised anxiety disorder (GAD), social anxiety disorder (SAD), specific phobias, mixed anxiety disorders in children and adolescents, separation anxiety and selective mutism. Selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-line medications. Cognitive behavioural therapy (CBT) is the first-line psychotherapy for anxiety disorders. The expert panel also made recommendations for patients not responding to standard treatments and recommendations against interventions with insufficient evidence. CONCLUSION: It is the goal of this initiative to provide treatment guidance for these disorders that has validity throughout the world.

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Bandelow, B., Allgulander, C., Baldwin, D. S., Costa, D. L. D. C., Denys, D., Dilbaz, N., Domschke, K., Hollander, E., Kasper, S., Möller, H. J., Eriksson, E., Fineberg, N. A., Hättenschwiler, J., Kaiya, H., Karavaeva, T., Katzman, M. A., Kim, Y. K., Inoue, T., Lim, L., . . . Zohar, J. (2022). World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders - Version 3. Part II: OCD and PTSD. World J Biol Psychiatry, 1-17. https://doi.org/10.1080/15622975.2022.2086296

Borwin Bandelow, Department of Psychiatry and Psychotherapy, University Medical Centre (UMG), von-Sieboldstr. 5, D-37075 Grottingen, Germany.
E-mail: bbandel@gwdg.de

URL: https://pubmed.ncbi.nlm.nih.gov/35900217

Abstract

Aim: This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders which was published in 2002 and revised in 2008.
Method: A consensus panel of 34 international experts representing 22 countries developed recommendations based on efficacy and acceptability of the treatments. In this version, not only medications but also psychotherapies and other non-pharmacological interventions were evaluated, applying the same rigorous methods that are standard for the assessment of medication treatments.
Result: The present paper (Part II) contains recommendations based on published randomised controlled trials (RCTs) for the treatment of OCD (n = 291) and PTSD (n = 234) in children, adolescents, and adults. The accompanying paper (Part I) contains the recommendations for the treatment of anxiety disorders. For OCD, first-line treatments are selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioural therapy (CBT). Internet-CBT was also superior to active controls. Several second-line medications are available, including clomipramine. For treatment-resistant cases, several options are available, including augmentation of SSRI treatment with antipsychotics and other drugs. Other non-pharmacological treatments, including repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS) and others were also evaluated. For PTSD, SSRIs and the SNRI venlafaxine are first-line treatments. CBT is the psychotherapy modality with the best body of evidence. For treatment-unresponsive patients, augmentation of SSRI treatment with antipsychotics may be an option.
Conclusion: OCD and PTSD can be effectively treated with CBT and medications.

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Brennstuhl, M.-J., Pascale, T., Ann, R. J., Camille Louise, T., Lydia, P., Christine, R., & Cyril, T. (2022). Treating COVID-19 patients with EMDR: A pilot study. European Journal of Trauma & Dissociation, 6(3), 100276. https://doi.org/10.1016/j.ejtd.2022.100276

T. Camille Louise: UFR Sciences Humaines et Sociales, EPSAM/APEMAC, University of Lorraine, Ile du Saulcy, BP 60228 57045 Metz Cedex 01, France.
E-mail address: camilletarquinio@gmail.com

Open Access: http://dx.doi.org/10.1016/j.ejtd.2022.100276

Abstract

The threatening and unpredictable nature of the coronavirus disease (COVID-19) pandemic presents unprecedented mental-health challenges worldwide. For those directly affected by the disease, the stress of facing potential death and overcoming fear can overwhelm their personal coping resources and can lead to symptoms of posttraumatic stress disorder and anxiety and depression. The objective of our study was to investigate the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) therapy to reduce anxio- depressive symptoms, distress and fear of the unknown in COVID-19 patients hospitalized for intensive care. A pilot study was conducted with 21 participants hospitalized for COVID-19 (11 women and 10 men) who were treated with EMDR therapy and assessed for anxio-depressive symptoms (Hospital Anxiety and Depression Scale, HADS), intensity of distress (Subjective Units of Disturbance, SUD scale), and levels of experienced fear (i.e., fear of the unknown) (Multidimensional Assessment of COVID-19-Related Fears, MAC-RF). After the 4-session treatment, the EMDR therapy showed to be effective in reducing all of the evaluated symptoms in all patients and allowed for stabilization. All patients maintained improved psychological states for one week following the four sessions. EMDR therapy has been shown to be an effective strategy for helping patients process exposure to adverse events by relieving symptoms of acute stress and trauma. EMDR is a focused approach that with as few as 4 sessions can strengthen adaptive coping strategies for dealing with an ongoing situation, restore optimism and can rapidly prevent the onset of potentially long-lasting psycho- logical disorders.

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Cotraccia, A. J. (2022). Trauma as Absence: A Biopsychosocial-AIP Definition of Trauma and Its Treatment in EMDR. Journal of EMDR Practice and Research, EMDR-2022. https://doi.org/10.1891/emdr-2022-0011

Anthony Cotraccia, 4372 River Road, New Hope, PA 18938. E-mail: cotracc@gmail.com

URL: http://dx.doi.org/10.1891/emdr-2022-0011

Abstract

This paper advances the biopsychosocial adaptive information processing model (BPS-AIP) and theory (Cotraccia, 2012) by adding consciousness as a mechanism of action activated via social behavior in EMDR. An attention schema is conceptualized as content integrated with dynamic self-models that maintain subjective mental states of biopsychosocial connectivity or disconnectivity. These implicit self-models are portrayed as determining 1) the disposition of the BPS-AIP system of clients presenting for EMDR as more or less connected or disconnected prior to, at the time of, and following, a stressful event; and 2) whether or not stressful events become traumatizing over time. Attention schema theory (Graziano, 2021) is integrated to further describe how establishing and enhancing attentional agency when addressing simple and complex-PTSD facilitates consolidation of autobiographical memory. Self-integration in the context of an attuned therapeutic relationship is described in terms of patterns of tracking attention to promote heightened states of self/other consciousness and activate the innate healing system. Attention schema theory, as a prominent theory of consciousness, adds to BPS-AIP’s compelling description of how an innate neurophysiological system can be integrated with psychosocial components that explain how both subjective and intersubjective experiences are causally relevant to the processing of autobiographical memory.

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Cougle, J. R., & Grubaugh, A. L. (2022). Do psychosocial treatment outcomes vary by race or ethnicity? A review of meta-analyses. Clin Psychol Rev, 96, 102192. https://doi.org/10.1016/j.cpr.2022.102192

J. R. Cougle, Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL 32306, USA. E-mail: cougle@psy.fsu.edu

URL: https://pubmed.ncbi.nlm.nih.gov/35964521

Abstract

The past two decades have seen an increase in the number of psychotherapy clinical trials that were adequately powered to compare clinical outcomes across different racial and ethnic groups. Reviews have concluded that outcomes are generally equivalent, though there is still widespread skepticism of how these therapies perform in diverse populations. The current study reviewed 23 meta-analyses that considered race/ethnicity as a predictor of treatment outcome in psychotherapies across a range of psychiatric disorders. In general, these reviews did not find differences in outcomes between ethnic/racial minorities relative to White participants. Cumulative evidence of no race/ethnic differences in reported outcomes was strong for some disorders (e.g., depression, PTSD), though data were lacking or insufficient for other mental health conditions (e.g., borderline personality disorder, eating disorders). We also identified several gaps in the literature that provide directions for future research to better understand racial-ethnic differences in psychotherapy outcomes.

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Dinapoli, L., Ferrarese, D., Belella, D., Carnevale, S., Camardese, G., Sani, G., & Chieffo, D. P. R. (2022). Psychological Treatment of Traumatic Memories in Covid-19 Survivors. Clin Psychol Psychother. https://doi.org/10.1002/cpp.2771

Loredana Dinapoli, Psy.D., Ph.D. UOS di Psicologia Clinica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma. E-mail: loredana.dinapoli@guest.policlinicogemelli.it

URL: https://pubmed.ncbi.nlm.nih.gov/35916065

Abstract

The COVID-19 pandemic, which has affected a significant number of individuals worldwide, is generating serious mental health issues. Recovered COVID-19 patients have experienced traumatic events related to their symptoms, isolation, possible hospitalization, bereavement, fear of infecting loved ones, and the physical consequences of COVID-19. One effective psychological treatment for these patients is Eye Movement Desensitization and Reprocessing (EMDR). The aim of this paper is to describe the therapeutic intervention and effects of EMDR in a pool of COVID-19 survivors referred to an integrated psychological/psychiatric outpatient service. Twelve patients, comprising of nine males and three females, underwent EMDR psychotherapy from October 2020 to February 2022. Each patient received 8 to 16 weekly treatment sessions. The standard EMDR protocol of eight stages was administered to enable desensitization and reprocessing of four main targets: first positive swab, hospitalization, isolation, and fear for relatives' health. Efficacy of EMDR was demonstrated by the significant improvement at clinical scale for subjective distress caused by traumatic events. For the therapists, carrying out these treatments was an intense and challenging experience. In fact, the perceived distance between therapist and patient was less defined than in other hospital settings because the pandemic affects everyone equally. However, with the widespread availability of vaccines and although the pandemic is still ongoing with the emergence of new variants, a window of improvement in the mental health landscape is starting to open up.

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Dolbeault, S., Terrasson, J., Rault, A., Malinowski, D., Bisch, A. M., Soulié, O., & Brédart, A. (2022). [Psycho-oncological interventions: What type of psychotherapeutic innovations?]. Bull Cancer, 109(5), 548-556. https://doi.org/10.1016/j.bulcan.2022.03.001

Sylvie Dolbeault, Institut Curie, PSL University, Supportive Care Department, Psycho-Oncology and Social Service, 26, rue d'Ulm, Paris, 75005 Paris cedex 05, France. E-mail: sylvie.dolbeault@curie.fr

URL: https://pubmed.ncbi.nlm.nih.gov/35527072

Abstract

Psycho-oncology is evolving in line with oncology progress and increasing complexity, but also with change in cancer care organization. Alongside the more traditional psycho-oncological interventions, such as the support or verbal psychotherapy of various inspirations (psychodynamic, integrative, systemic, existential) and body-mediated approaches, that allow the patient to be accompanied throughout his/her cancer care trajectory, psycho-oncology is now benefiting from the development of more structured interventions, often brief and targeted at a specific situation or symptom. This article reviews three of these new psychotherapeutic approaches, which are largely developed in the Anglo-Saxon world: the management of fear of recurrence by CBT third wave strategies, ACT therapy or, more recently, EMDR to answer to psychotraumatic situations. We describe here the principles, the main indications in oncology patients and the expected clinical benefits. It also presents tools such as Questionnaire Prompt Lists for optimizing the communication between patients and health professionals, which constitute a psychotherapeutic intervention by itself.

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Faretta, E., Garau, M. I., Gallina, E., Pagani, M., & Fernandez, I. (2022). Supporting healthcare workers in times of COVID-19 with eye movement desensitization and reprocessing online: A pilot study. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.964407

Eugenio Gallina, Centro di Ricerca e Studi in Psicotraumatologia (CRSP), Milan, Italy. E-mail: eugenioggallina@gmail.com

Open Access: http://dx.doi.org/10.3389/fpsyg.2022.964407

Abstract

We report the results of a pilot study regarding the adaptation of the group eye movement desensitization and reprocessing (EMDR) protocol for the treatment online, for the management of trauma associated with the COVID-19 Pandemic in Italy. The target group were healthcare workers in a nursing home (Residenza sanitaria assistita, RSA) who decided to live and stay on site during the most acute phase of the Pandemic in order to protect the residents of the home. Scores for perceived post traumatic stress disorder (PTSD) symptoms and quality of emotional experience improved significantly following participation in the therapy programme. These preliminary results confirm the innovative potential of the EMDR protocol when used online on early intervention, to prevent the development of later psychological disturbances.

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Farrell, D., & Rydberg, J. A. (2022). EMDR Therapy: To Call Out Is to Strengthen. Journal of EMDR Practice and Research, 16(3), 106-107. https://doi.org/10.1891/emdr-2022-0027

Jenny Ann Rydberg, University of Lorraine, APEMAC, Metz, France. E-mail: jemdreditor@emdria.org

URL: http://dx.doi.org/10.1891/emdr-2022-0027

Abstract

No abstract for this Editorial.

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Fisher, N., van Diest, C., Leoni, M., & Spain, D. (2022). Using EMDR with autistic individuals: A Delphi survey with EMDR therapists. Autism, 0, 1509-1521. https://doi.org/10.1177/13623613221080254

Debbie Spain, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, de Crespigny Park, PO Box 80, Denmark Hill, London SE5 8AF, UK. E-mail: debbie.spain@kcl.ac.uk

Open Access: https://pubmed.ncbi.nlm.nih.gov/35384753/

Abstract

Eye Movement Desensitisation and Reprocessing (EMDR) is a psychological therapy that can help people process memories and distress about past events, so they have less impact on their daily lives. EMDR can be effective for treating symptoms of post-traumatic stress disorder, including nightmares and anxiety. Psychological therapies usually require adaptation so they are more accessible and effective for autistic people, but minimal research has focused on how best EMDR can be adapted. In this online survey study, we asked 103 EMDR therapists about barriers they think autistic people face when trying to have EMDR and what adaptations they use in their everyday practice. Four barriers were highlighted: client-related characteristics, therapist-related characteristics, differences in the therapeutic relationship and broader issues. Therapists identified a range of adaptations that can potentially be useful for autistic people, relating to being flexible, communicating clearly and having an awareness of individual differences. Many therapists emphasised the importance of not making assumptions about a person based on their autism diagnosis. Overall, the study findings suggest adaptations to EMDR are likely to be useful, but how relevant they are depends on each person.

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Fisher, N., Patel, H., van Diest, C., & Spain, D. (2022). Using eye movement desensitisation and reprocessing (EMDR) with autistic individuals: A qualitative interview study with EMDR therapists. Psychology and Psychotherapy: Theory, Research and Practice. https://doi.org/10.1111/papt.12419

Debbie Spain, SGDP Centre, IoPPN, King's College London, de Crespigny Park, London, SE5 8AF, UK. E-mail: debbie.spain@kcl.ac.uk

Open Access: http://dx.doi.org/10.1111/papt.12419

Abstract

Objectives: Eye Movement Desensitisation and Reprocessing (EMDR) is an evidence-based psychological therapy that targets distress associated with trauma and affective disturbance. Few studies have examined EMDR for autistic individuals who have co-occurring mental health conditions, but there is preliminary evidence of effectiveness. The current study explored EMDR therapists' experiences of working with autistic individuals, and adaptations incorporated into clinical practice to make this more accessible and effective.
Design: A qualitative interview design was used. Data were thematically analysed.
Method: Twenty-three UK-based EMDR therapists attended one-off semi-structured qualitative interviews.
Results: Four main themes emerged: (1) the experience of being autistic; (2) factors around accessing EMDR; (3) adapting EMDR; and (4) supervision and support for EMDR therapists. Participants described offering a nuanced and tailored approach; one that retained the integral components of the eight phases of EMDR, while also being flexible and responsive to each client.
Conclusions: Findings reinforce the importance of offering formulation-based psychological therapy that flexes in an evidence-informed way, according to the preferences and needs of autistic individuals. Further research should establish factors influencing accessibility and effectiveness of EMDR for autistic individuals, and the impact of autism-relevant training on the knowledge, skills and confidence of EMDR therapists and clinical supervisors working with this client group.

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Herzog, P., & Kaiser, T. (2022). Is it worth it to personalize the treatment of PTSD? - A variance-ratio meta-analysis and estimation of treatment effect heterogeneity in RCTs of PTSD. J Anxiety Disord, 91, 102611. https://doi.org/10.1016/j.janxdis.2022.102611

Philipp Herzog, Department of Psychology, University of Koblenz-Landau, Ostbahnstraße 10, D-76829 Landau, Germany. E-mail: herzog@uni-landau.de.
URL: https://pubmed.ncbi.nlm.nih.gov/35963147

Abstract

Several evidence-based treatments for posttraumatic stress disorder (PTSD) are recommended by international guidelines (e.g., APA, NICE). While their average effects are in general high, non-response rates indicate differential treatment effects. Here, we used a large database of RCTs on psychotherapy for PTSD to determine a reliable estimate of this heterogeneity in treatment effects (HTE) by applying Bayesian variance ratio meta-analysis. In total, 66 studies with a total of 8803 patients were included in our study. HTE was found for all psychological treatments, with varying degrees of certainty, only slight differences between psychological treatments, and active control groups yielding a smaller variance ratio compared to waiting list control groups. Across all psychological treatment and control group types, the estimate for the intercept was 0.12, indicating a 12% higher variance of posttreatment values in the intervention groups after controlling for differences in treatment outcomes. This study is the first to determine the maximum increase in treatment effects of psychological treatments for PTSD by personalization. The results indicate that there is comparatively high heterogeneity in treatment effects across all psychological treatment and control groups, which in turn allow personalizing psychological treatments by using treatment selection approaches.

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Hoppen, T. H., Lindemann, A. S., & Morina, N. (2022). Safety of psychological interventions for adult post-traumatic stress disorder: meta-analysis on the incidence and relative risk of deterioration, adverse events and serious adverse events. Br J Psychiatry, 1-10. https://doi.org/10.1192/bjp.2022.111

Thole H Hoppen, Institute of Psychology, University of Münster, Germany.

Open Access: https://pubmed.ncbi.nlm.nih.gov/35959698

Abstract

BACKGROUND: Attention on harmful effects of psychological interventions for adult post-traumatic stress disorder (PTSD) has increased, yet a comprehensive meta-analysis is lacking. AIMS: To summarise incidences and relative risks of deterioration, adverse events (AEs) and serious adverse events (SAEs) in trials of psychological interventions for adult PTSD. METHOD: We searched MEDLINE, PsycInfo, Web of Science and PTSDpubs from inception to 21 April 2022 for sufficiently large (n ≥ 20) randomised controlled trials (RCTs) reporting on the incidence of harms. RESULTS: We included 56 RCTs (4230 patients). Incidences of harms were generally low (0-5%). Psychological interventions were associated with decreased risk of deterioration relative to passive (RR = 0.21, 95% CI 0.15-0.28) and active control conditions (RR = 0.36, 95% CI 0.14-0.92). Decreased risk was even more pronounced in sensitivity analyses on trials exclusively delivering treatments face to face. When compared with other psychological interventions, trauma-focused cognitive-behavioural therapy (TF-CBT) was associated with decreased risk of SAEs (RR = 0.54, 95% CI 0.31-0.95) and with no differential risk of deterioration and AEs. CONCLUSIONS: The current evidence base suggests that psychological interventions are safe for most adults with PTSD. In none of the analyses were psychological interventions associated with an increased risk of harm compared with control conditions. TF-CBT was found at least as safe as other psychological interventions. Individual face-to-face delivery might be the safest delivery format. However, more data are needed to draw firmer conclusions. We encourage research teams to routinely and thoroughly assess and report the incidence of harms and their causes.

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Jaswetz, L., de Voogd, L. D., Becker, E. S., & Roelofs, K. (2022). No evidence for disruption of reconsolidation of conditioned threat memories with a cognitively demanding intervention. Sci Rep, 12(1), 6663. https://doi.org/10.1038/s41598-022-10184-1

Lars Jaswetz, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands. E-mail: Lars.Jaswetz@ru.nl

Open Access: https://pubmed.ncbi.nlm.nih.gov/35459769

Abstract

Simultaneous execution of memory retrieval and cognitively demanding interventions alter the subjective experience of aversive memories. This principle can be used in treatment to target traumatic memories. An often-used interpretation is that cognitive demand interferes with memory reconsolidation. Laboratory models applying this technique often do not meet some important procedural steps thought necessary to trigger reconsolidation. It remains therefore unclear whether cognitively demanding interventions can alter the reconsolidation process of aversive memories. Here, 78 (41 included) healthy participants completed an established 3-day threat conditioning paradigm. Two conditioned stimuli were paired with a shock (CS+ s) and one was not (CS-). The next day, one CS+ (CS+ R), but not the other (CS+), was presented as a reminder. After 10 min, participants performed a 2-back working memory task. On day three, we assessed retention. We found successful acquisition of conditioned threat and retention (CS+ s > CS-). However, SCRs to the CS+ R and the CS+ during retention did not significantly differ. Although threat conditioning was successful, the well-established cognitively demanding intervention did not alter the reconsolidation process of conditioned threat memories. These findings challenge current views on how cognitively demand may enhance psychotherapy-outcome.

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Mattera, A., Cavallo, A., Granato, G., Baldassarre, G., & Pagani, M. (2022). A Biologically Inspired Neural Network Model to Gain Insight Into the Mechanisms of Post-Traumatic Stress Disorder and Eye Movement Desensitization and Reprocessing Therapy. Front Psychol, 13, 944838. https://doi.org/10.3389/fpsyg.2022.944838

Andrea Mattera, Institute of Cognitive Sciences and Technologies, National Research Council, Rome, Italy. E-mail: andrea.mattera@istc.cnr.it

Open Access: https://pubmed.ncbi.nlm.nih.gov/35911047

Abstract

Eye movement desensitization and reprocessing (EMDR) therapy is a well-established therapeutic method to treat post-traumatic stress disorder (PTSD). However, how EMDR exerts its therapeutic action has been studied in many types of research but still needs to be completely understood. This is in part due to limited knowledge of the neurobiological mechanisms underlying EMDR, and in part to our incomplete understanding of PTSD. In order to model PTSD, we used a biologically inspired computational model based on firing rate units, encompassing the cortex, hippocampus, and amygdala. Through the modulation of its parameters, we fitted real data from patients treated with EMDR or classical exposure therapy. This allowed us to gain insights into PTSD mechanisms and to investigate how EMDR achieves trauma remission.

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Papanikolopoulos, P., Prattos, T., & Foundoulakis, E. (2022). Pandemic Times and the Experience of Online EMDR Practice in Greece: A Qualitative Study on Obstacles and Perspectives. Journal of EMDR Practice and Research, EMDR-2021. https://doi.org/10.1891/emdr-2021-0033

Penny Papanikolopoulos PhD, ΕMDR Europe Trainer, Consultant and Practitioner, Hellenic American University: 436 Amherst St, Nashua, NH 03063 USA. E-mail: pennypa- panikolopoulos@gmail.com

URL: http://dx.doi.org/10.1891/emdr-2021-0033

Abstract

The COVID-19 pandemic has had a biopsychosocial impact on the Greek mental health system by worsening symptoms of depression and stress in the general population. As the need for mental health services increased, the pandemic strongly affected EMDR practice, and training which was mainly online, during 2020. In a small sample consisting of 40 EMDR practitioners, a brief online questionnaire was administered concerning the obstacles that professionals believe they face doing online EMDR therapy in Greece during the pandemic. A conventional qualitative analysis was conducted on the respondents’ feedback by coding the content. Among others, the results showed two categories of practical and psychosocial defects in the efficient application of online EMDR practice. Lack of physical contact, poor application of bilateral stimulation based on technical difficulties, poor computer skills, and physical exhaustion due to continuous lockdown were some of the content subcategories. The results are discussed concerning the current context of the pandemic and local characteristics. Moreover, practical implications for online EMDR practice are discussed.

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Poli, A., Gemignani, A., & Miccoli, M. (2022). Randomized Trial on the Effects of a Group EMDR Intervention on Narrative Complexity and Specificity of Autobiographical Memories: A Path Analytic and Supervised Machine-Learning Study. Int J Environ Res Public Health, 19(13), 7684. https://doi.org/10.3390/ijerph19137684

Andrea Poli, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy. E-mail: andrea.poli@med.unipi.it

Open Access: https://pubmed.ncbi.nlm.nih.gov/35805348

Abstract

Narratives of autobiographical memories may be impaired by adverse childhood experiences, generating narrative fragmentation and increased levels of perceived distress. Eye movement desensitization and reprocessing (EMDR) proved to be an effective treatment to overcome traumatic experiences and to promote coherent autobiographical narratives. However, the specific mechanisms by which EMDR promotes narrative coherence remains largely unknown. We conducted a randomized controlled pilot trial (ClinicalTrials.gov Identifier NCT05319002) in a non-clinical sample of 27 children recruited in a primary school. Participants were randomly assigned to the experimental and control groups. The experimental group underwent a three-week group EMDR intervention. Subjective unit of distress (SUD), validity of cognition (VoC), classification of autobiographical memories, narrative complexity and specificity were assessed before and after the group EMDR intervention. The group EMDR intervention was able to improve SUD and VoC scales, narrative complexity and specificity, and promoted the classification of autobiographical memories as relational. The path analysis showed that SUD was able to predict VoC and narrative specificity, which, in turn, was able to predict both narrative complexity and the classification of autobiographical memories as relational. Machine-learning analysis showed that random tree classifier outperformed all other models by achieving a 93.33% accuracy. Clinical implications are discussed.

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Rew, G., Clark, L., & Rogers, G. (2022). Making Sense of Offence Related Trauma: Exploring Two Patients Lived Experience. Journal of EMDR Practice and Research, EMDR-2022. https://doi.org/10.1891/emdr-2022-0004

Gemma Rogers, E-mail: gemma.rogers3@nhs.net

URL: http://dx.doi.org/10.1891/emdr-2022-0004

Abstract

Offence related trauma refers to a trauma reaction following the perpetration of a violent offence. This research explores the lived experience of offence related trauma, in two forensic patients. The meaning and understanding these individuals make of their own coping strategies, triggers and treatment and how this contributes to their behaviour was explored using a semi-structured interview and analysed using Interpretative Phenomenological Analysis. Two super-ordinate themes emerged from the data: ‘Journey to Forgiveness’ and ‘Living with the Whole Me.’ These themes and their subthemes highlight the nuances of offence related trauma and raise the question of how processes such as complicated grief and associated shame can impact on recovery and rehabilitation. The implications of the findings for professionals providing treatment in forensic settings are considered.

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Tortes Saint-Jammes, J., Sorel, O., Zara-Jouillat, E., Martin, C.-H., Gil-Jardiné, C., & Lavandier, A. (2022). COVID-19 and Healthcare Professionals: The Psychological Impact of the Pandemic on Healthcare Professionals and the Use of EMDR Early Interventions. Journal of EMDR Practice and Research, 16(3), 156-168. https://doi.org/10.1891/emdr-2022-0006

Juliane Tortes St Jammes. E-mail: jtsj.emdr@hotmail.com

URL: http://dx.doi.org/10.1891/emdr-2022-0006

Abstract

Recent research has provided new information on the impact of COVID-19 and previous pandemics on the mental health of healthcare professionals (HCP). Several studies have found that HCP are greatly affected by pandemics and may develop anxiety disorders, mood disorders, and posttraumatic stress disorder. The stress caused by the intense working conditions and the fear of contracting and transmitting the virus are major vulnerability factors for these workers, increasing their risk of developing a mental health condition. It is therefore essential to provide appropriate support to this population in order to reduce and avoid the psychological burden of the current pandemic on their mental health. Considering the data previously published on the COVID-19 pandemic and past epidemics, the present article aims to provide an epidemiological review of the psychological impact of a pandemic on healthcare professionals. Furthermore, it examines, from a theoretical perspective, whether EMDR early interventions (EEI) may constitute an effective solution in order to provide psychological support to HCP in hospitals. Lastly, the article will identify various protocols for EEI, which, it argues, should be the approaches of choice for providing early support following a potentially traumatic event.

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van Diest, C., Leoni, M., Fisher, N., & Spain, D. (2022). Using EMDR With Autistic Clients: How Do Therapists Adapt. Journal of EMDR Practice and Research, 16(3), 123-134. https://doi.org/10.1891/emdr-2022-0014

Naomi Fisher, Independent Clinical Psychologist, Hove, England. E-mail: naomicfisher@gmail.com

URL: http://dx.doi.org/10.1891/emdr-2022-0014

Abstract

Autistic people commonly experience co-morbid mental health conditions, including post-traumatic stress disorder (PTSD), anxiety, and low mood. General consensus is that autistic people can benefit from evidence-based psychological therapies, with the acceptability and effectiveness of eye movement desensitization and reprocessing (EMDR) therapy becoming a growing area of interest. One hundred and three EMDR therapists were asked if and how they adapt the standard EMDR protocol to make the process and content more tailored to the needs and preferences of autistic people. We analyzed the qualitative responses of participants to these questions, including barriers and adaptations to all eight phases of the EMDR standard protocol. Overall, therapists emphasized the need for flexibility and responsiveness to the individual client, and the importance of autism-specific knowledge and autism-informed clinical supervision. Implications and future directions are discussed.

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van Schie, K., Burghart, M., Kang, S., Mertens, G., & Smeets, T. (2022). Boosting long-term effects of degraded memories via acute stress. Compr Psychoneuroendocrinol, 11, 100154. https://doi.org/10.1016/j.cpnec.2022.100154

K. van Schie, Department of Medical and Clinical Psychology, Tilburg University, the Netherlands. E-mail: k.vanschie@tilburguniversity.edu

Open Access: https://pubmed.ncbi.nlm.nih.gov/35811786

Abstract

Combining recall of an emotional memory with simultaneous horizontal eye movements (i.e., Recall + EM) reduces memory aversiveness. However, the long-term persistence of this effect is inconsistent across studies. Given that stress may aid in the consolidation of memories, we examined whether acute stress can boost the long-term effects of degraded memories. To test this, participants recalled two negative memories, which were assigned to a Recall + EM or Recall Only condition. Before and after each intervention they rated memory aversiveness (i.e., immediate effects) followed by a stress-induction or control procedure. After a 24h-period, participants rated each memory again (i.e., long-term effects). We found that Recall + EM produces immediate effects but that these effects dissolve over time. Moreover, acute stress did not boost potential long-term effects of Recall + EM. Degraded memories were not retained better by applying stress. We discuss these results and how long-term effectiveness may still be achieved.

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Vanderschoot, T., & Dessel, P. V. (2022). EMDR Therapy and PTSD: A Goal-Directed Predictive Processing Perspective. Journal of EMDR Practice and Research, EMDR-2022. https://doi.org/10.1891/emdr-2022-0009

Pieter Van Dessel, Department of Experimental-Clinical and Health Psychology, Ghent University, Gent, 9000, Belgium. E-mail: Pieter.VanDessel@UGent.be

URL: http://dx.doi.org/10.1891/emdr-2022-0009

Abstract

Eye movement desensitization and reprocessing (EMDR) therapy is a widely used evidence-based treatment for posttraumatic stress disorder (PTSD). The mental processes underlying both PTSD and EMDR treatment effects are often explained by drawing on processes that involve the automatic formation and change of mental associations. Recent evidence that contrasts with these explanations is discussed and a new perspective to PTSD and EMDR treatment effects is proposed that draws on automatic inferential processes and can be readily integrated with the dominant (Adaptive Information Processing) model. This new perspective incorporates insights from cognitive theories that draw on predictive processing and goal-directed processes to elucidate (changes in) automatic inferences that underlie PTSD symptoms and EMDR treatment effects. Recommendations for clinical practice are provided based on this new perspective.

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Virgilio, E., Solara, V., Sarnelli, M. F., Vecchio, D., & Comi, C. (2022). Early Successful Eye Movement Desensitization and Reprocessing (EMDR) Therapy for Verbal Memory Impairment in an Adjustment Disorder: A Case Report in a Newly-Diagnosed Multiple Sclerosis Patient. Reports, 5(2), 17. https://doi.org/10.3390/reports5020017

Cristoforo Comi, Neurology Unit, S. Andrea Hospital, Department of Translational Medicine, University of Piemonte Orientale, 13100 Vercelli, Italy.
E-mail: cristoforo.comi@med.uniupo.it

Open Access: http://dx.doi.org/10.3390/reports5020017

Abstract

Multiple sclerosis (MS) is a chronic inflammatory disease of the immune system affecting the central nervous system. Several phenotypes are possible, and cases usually present with a relapsing-remitting (RR) course with disease onset at a young age. MS diagnosis can represent a traumatic event for the patient, possibly evolving into adjustment disorder (AD). AD is defined by the presence of emotional or behavioral symptoms in response to identifiable stress occurring within the prior three months and similarly to post-traumatic stress disorder (PTSD) can significantly affect quality of life. Usually, neuropsychological disorders are not associated with AD. Several treatments are available for AD, and among them, eye movement desensitization and reprocessing (EMDR) is one of the most effective in relieving depression and anxiety. However, little is known about AD and PTSD in the MS population and no data are available on the effectiveness of EMDR for cognitive impairment associated with AD. We describe a 25-year-old patient with RR MS developing an AD with a verbal memory deficit after being diagnosed. Both the psychological and cognitive deficits were diagnosed using an extensive neuropsychological battery. Considering the high impact of the verbal memory deficit, on the patient’s quality of life, an EMDR intervention was planned. After a six-month EMDR intervention performed by two trained neuropsychologists, the patient was retested. There was an improvement in verbal memory tests and depression anxiety scales and the Dissociative Experiences Scale. It is recognized that emotional changes and psychiatric disorders, frequently affect MS patients at diagnosis. It is imperative to recognize this and promptly set a neuropsychological treatment. Moreover, we suggest checking cognition along with depression and anxiety. Finally, to our knowledge, this is the first report of AD with an isolated neuropsychological deficit (verbal memory) developed after the MS diagnosis and treated beneficially with e EMDR. More studies are needed to confirm the efficacy of EMDR in treating cognitive impairment associated with AD in MS patients.

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Wadji, D. L., Martin-Soelch, C., & Camos, V. (2022). Can Working Memory Account for EMDR Efficacy in PTSD. Preprint. https://doi.org/10.21203/rs.3.rs-1639383/v1

Dany Laure Wadji, University of Fribourg. E-mail: dany.nkonlack@unifr.ch

Open Access: https://doi.org/10.21203/rs.3.rs-1639383/v1

Abstract

Although eye movement desensitization and reprocessing (EMDR) has been shown to be effective in the treatment of PTSD for years, it remains highly controversial due to the lack of understanding of its mechanisms of action. We examined whether the working memory (WM) hypothesis –the competition for limited WM resources induced by the dual task attenuates the vividness and emotionality of the traumatic memory – would provide an explanation for the beneficial effect induced by bilateral stimulation. We followed the Prisma guidelines and identified 11 articles categorized in two types of designs: studies involving participants with current PTSD symptoms and participants without PTSD diagnosis. Regardless of the types of studies, the results showed a reduction of vividness and emotionality in the recall of traumatic stimuli under a dual-task condition compared to a control condition, such as recall alone. However, two studies used a follow-up test to show that this effect does not seem to last long. Our results provide evidence for the WM hypothesis and suggest that recalling a traumatic memory while performing a secondary task would shift the individual’s attention away from the retrieval process and result in a reduction in vividness and emotionality, also associated with the reduction of symptoms

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