EMDR Research News December 2013
Among the ten articles, there are three case reports: A case report on treatment of separation anxiety disorder in a 10-year-old child; from South Korea, a case series examining DeTUR for pathological gambling; and from the UK, a case study on compassionate mind training as a resource in EMDR.
There are two clinical articles from the Netherlands: a clinical article on treatment of sexual issues associated with trauma with a case example; and guidelines for EMDR conceptualization and treatment with psychosis.
There are three review articles: an update of the 2005 and 2007 Cochrane Database of Systematic Reviews of psychological therapies for chronic post-traumatic stress disorder in adults; a review of studies on EMDR treatment of chronic pain patients; and from Germany a review of EMDR as an evidenced-based treatment for depression.
There is an article on the evaluation of EMDR supervisor training in Pakistan using q-methodology.
Finally there is a research study on the mechanism of EMDR investigating hemispheric contributions to episodic memory performance through an examination of the effects of saccadic bilateral eye movements on fluency in recall of episodic and semantic autobiographical memory.
In the books section is an overview of Marilyn Luber’s latest book available on CD-ROM, paperback and kindle: Implementing EMDR Early Mental Health Interventions for Man-Made and Natural Disasters: Models, Scripted Protocols and Summary Sheets as well as a new edited anthology from Daniel J Siegel and Marion Solomon on Healing Moments in Psychotherapy.
The video of the month features Dayna Cakebread from Portland speaking from the heart about “How EMDR Completed my Daughters' Recoveries!”
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 IngentaConnect.
Video of the month
This month, our video features Dayna Cakebread at Ignite Portland in an event held on Thursday November 14th, 2013, in Portland, Oregon, speaking from heart about “How EMDR Completed my Daughters' Recoveries!”
Books on EMDR
Marilyn Luber’s latest book, Implementing EMDR Early Mental Health Interventions for Man-Made and Natural Disasters: Models, Scripted Protocols and Summary Sheets provides a wealth of practical resources for EMDR trained clinicians working in a range of settings. As in her earlier edited books, she focuses on offering scripted protocols and summary worksheets for recording treatment sessions. Scripts offered include: The Butterfly Hug, Emergency Response Procedures and Emergency Room and Wards protocol, the classic Recent Events Protocol from Francine Shapiro, the Recent Traumatic Episode Protocol (R-TEP) from Elan Shapiro, as well as a large number of group EMDR protocols. Those working in international relief, combat trauma, hospital settings, and mining disaster settings will find resources here to guide you. The book provides full citations to published references, while leaving out reviews of the literature, summaries of reports evidence of efficacy and clinical illustrations.
Healing Moments in Psychotherapy edited by Daniel J. Siegel and Marion Solomon brings readers chapters from the editors as well as Jaak Panksepp, Ian McGilchrist, Ruth Lanius, Francine Shapiro, Debra Wesselmann, Daniel Hughes, Pat Ogden, and Diana Fosha exploring mindful awareness, neural integration, affective neuroscience, and therapeutic presence. Ed Tronick, well known for his research on the “still face paradigm”, wrote in a review, “This book moves away from the dominant concern with categories and prediction of attachment theory to focus on co-creative, regulatory, multi-leveled meaning-making processes between individuals.”
Bae, H., Han, C., & Kim, D. (2013). Desensitization of triggers and urge reprocessing for pathological gambling: A case series. Journal of Gambling Studies. doi:10.1007/s10899-013-9422-5
Hwallip Bae, Department of Psychiatry, Myongji Hospital, Goyang, Gyeonggi, South Korea. email@example.com
This case series introduces the desensitization of triggers and urge reprocessing (DeTUR), as a promising adjunctive therapy in addition to comprehensive treatment package for pathological gambling. This addiction protocol of eye movement desensitization and reprocessing was delivered to four male inpatients admitted to a 10-week inpatient program for pathological gambling. The therapist gave three 60-min weekly sessions of the DeTUR using bilateral stimulation (horizontal eye movements or alternative tactile stimuli) focusing on the hierarchy of triggering situations and the urge to initiate gambling behaviors. After treatment, self-reported gambling symptoms, depression, anxiety, and impulsiveness were all improved, and all the participants reported satisfaction with the therapy. They were followed up for 6 months and all maintained their abstinence from gambling and their symptomatic improvements. Given the efficiency (i.e., brevity and efficacy) of the treatment, a controlled study to confirm the effects of the DeTUR on pathological gambling would be justified.
Beaumont, E., & Hollins Martin, C. J. (2013). Using compassionate mind training as a resource in EMDR: A case study. Journal of EMDR Practice and Research, 7(4), 186-199. doi:10.1891/1933-3184.108.40.206
Elaine Beaumont, Mary Seacole (Room MS3.17), School of Nursing, Midwifery and Social Work, College of Health and Social Care, University of Salford, Frederick Road, Salford, Greater Manchester, M6 6PU. E-mail: E.A.Beaumont@salford.ac.uk
This case study examines the contribution of compassionate mind training (CMT) when used as a resource in the eye movement desensitization and reprocessing (EMDR) treatment of a 58-year-old man, who presented after a recent trauma with psychological distress and somatic symptoms—an inability to sign his name. Self-report questionnaires (Hospital Anxiety and Depression Scale [HADS], Impact of Events Scale-R [IES-R], and Self-Compassion Scale [SCS]) were administered at pretherapy, midtherapy, posttherapy, and 9-month follow-up. EMDR with CMT facilitated recall of forgotten memories about his sister's traumatic death decades previously, with related emotions of shame and grief, creating insight into how these past events linked to his current signature-signing phobia. Eight sessions of therapy resulted in an elimination of the client's signature-signing phobia and a reduction in trauma-related symptoms, elevation in mood, and increase in self-compassion. Effects were maintained at 9-month follow-up. The "Discussion" section highlights the value of working collaboratively with clients to best meet their individual needs.
Bisson, J. I., Roberts, N. P., Andrew, M., Cooper, R., & Lewis, C. (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews (Online), 12, CD003388. doi:10.1002/14651858.CD003388.pub4
Jonathan I Bisson, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK. firstname.lastname@example.org. email@example.com.
BACKGROUND: Post-traumatic stress disorder (PTSD) is a distressing condition, which is often treated with psychological therapies. Earlier versions of this review, and other meta-analyses, have found these to be effective, with trauma-focused treatments being more effective than non-trauma-focused treatments. This is an update of a Cochrane review first published in 2005 and updated in 2007.
OBJECTIVES: To assess the effects of psychological therapies for the treatment of adults with chronic post-traumatic stress disorder (PTSD).
SEARCH METHODS: For this update, we searched the Cochrane Depression, Anxiety and Neurosis Group's Specialised Register (CCDANCTR-Studies and CCDANCTR-References) all years to 12th April 2013. This register contains relevant randomised controlled trials from: The Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). In addition, we handsearched the Journal of Traumatic Stress, contacted experts in the field, searched bibliographies of included studies, and performed citation searches of identified articles.
SELECTION CRITERIA: Randomised controlled trials of individual trauma-focused cognitive behavioural therapy (TFCBT), eye movement desensitisation and reprocessing (EMDR), non-trauma-focused CBT (non-TFCBT), other therapies (supportive therapy, non-directive counselling, psychodynamic therapy and present-centred therapy), group TFCBT, or group non-TFCBT, compared to one another or to a waitlist or usual care group for the treatment of chronic PTSD. The primary outcome measure was the severity of clinician-rated traumatic-stress symptoms.
DATA COLLECTION AND ANALYSIS: We extracted data and entered them into Review Manager 5 software. We contacted authors to obtain missing data. Two review authors independently performed 'Risk of bias' assessments. We pooled the data where appropriate, and analysed for summary effects.
MAIN RESULTS: We include 70 studies involving a total of 4761 participants in the review. The first primary outcome for this review was reduction in the severity of PTSD symptoms, using a standardised measure rated by a clinician. For this outcome, individual TFCBT and EMDR were more effective than waitlist/usual care (standardised mean difference (SMD) -1.62; 95% CI -2.03 to -1.21; 28 studies; n = 1256 and SMD -1.17; 95% CI -2.04 to -0.30; 6 studies; n = 183 respectively). There was no statistically significant difference between individual TFCBT, EMDR and Stress Management (SM) immediately post-treatment although there was some evidence that individual TFCBT and EMDR were superior to non-TFCBT at follow-up, and that individual TFCBT, EMDR and non-TFCBT were more effective than other therapies. Non-TFCBT was more effective than waitlist/usual care and other therapies. Other therapies were superior to waitlist/usual care control as was group TFCBT. There was some evidence of greater drop-out (the second primary outcome for this review) in active treatment groups. Many of the studies were rated as being at 'high' or 'unclear' risk of bias in multiple domains, and there was considerable unexplained heterogeneity; in addition, we assessed the quality of the evidence for each comparison as very low. As such, the findings of this review should be interpreted with caution.
AUTHORS' CONCLUSIONS: The evidence for each of the comparisons made in this review was assessed as very low quality. This evidence showed that individual TFCBT and EMDR did better than waitlist/usual care in reducing clinician-assessed PTSD symptoms. There was evidence that individual TFCBT, EMDR and non-TFCBT are equally effective immediately post-treatment in the treatment of PTSD. There was some evidence that TFCBT and EMDR are superior to non-TFCBT between one to four months following treatment, and also that individual TFCBT, EMDR and non-TFCBT are more effective than other therapies. There was evidence of greater drop-out in active treatment groups. Although a substantial number of studies were included in the review, the conclusions are compromised by methodological issues evident in some. Sample sizes were small, and it is apparent that many of the studies were underpowered. There were limited follow-up data, which compromises conclusions regarding the long-term effects of psychological treatment
Farrell, D., Keenan, P., Knibbs, L., & Hicks, C. (2013). A q-methodology evaluation of an EMDR Europe HAP facilitators training in Pakistan. Journal of EMDR Practice and Research, 7(4), 174-185. doi:10.1891/1933-3220.127.116.11
Derek Farrell, University of Worcester, Institute of Health Sciences, Henwick Grove, Worcester, UK WR2 6AJ. E-mail: firstname.lastname@example.org
This article is an evaluation of eye movement desensitization and reprocessing (EMDR) Europe Humanitarian Assistance Program (HAP) facilitators' training in Pakistan based on a project set up in the aftermath of the 2005 earthquake. Q-methodology was the method of choice for this research because it permits the systematic study of subjective experiences by combining the richness of qualitative protocols with the rigors of quantitative ones. Research participants were 6 recently trained EMDR Pakistan consultants and facilitators, of which 5 were consultant psychiatrists and 1 was a general practitioner (GP)/psychologist. The Q concourse addressed issues such as EMDR clinical practice, cultural application of EMDR in Pakistan, EMDR research and development, and their experiences of their EMDR-HAP training. Results highlighted issues around professional role and application of EMDR, the teaching and learning experience of EMDR, clinical supervision, the importance of the therapeutic relationship, and the cultural sensitivity and application of EMDR in Pakistan. The article also considers how the EMDR-HAP training program could be improved in Pakistan.
Groot, J. V., de Jongh, P. D. A., & Leusink, P. (2013). Geen zin meer in seks? Denk aan psychisch trauma! [Not interested in sex? Think of mental trauma!]. Huisarts En Wetenschap, 56(3), 134-137. doi:10.1007/s12445-013-0072-8
Jacqueline van Groot, Academisch Centrum Tandheelkunde, NVVS, Amsterdam, The Netherlands. email@example.com
Sexual problems can have several causes, both biological and psychosocial. During the investigation, the general practitioner should bear in mind that some patients with sexual problems may have been abused sexually or have had other unpleasant experiences, sexual or otherwise. In such cases the patient should be referred to a psychologist-sexologist for treatment that is primarily focused on the processing of negative (sexual) experiences, in addition to conventional sex therapy. This article describes the spectrum of sexual problems and indicates in which cases trauma therapy might be useful. This is illustrated by means of a case in which eye movement desensitization and reprocessing (EMDR) was used.
Morrissey, M. (2013). EMDR as an integrative therapeutic approach for the treatment of separation anxiety disorder. Journal of EMDR Practice and Research, 7(4), 200-207. doi:10.1891/1933-318.104.22.168
Michelle Morrissey, Spanish Peaks Behavioral Health Centers, 1304 Chinook Lane, Pueblo, CO 81001. E-mail: MichelleM@spanishpeaks.org
This case study reports the use of eye movement desensitization and reprocessing (EMDR) and family therapy for a 10-year-old boy with severe separation anxiety disorder (SAD). It illustrates how the use of the standard EMDR protocol for the boy and his mother combined with family therapy, led to symptom alleviation and restored appropriate developmental functioning as evidenced by behavioral outcomes. The participant initially presented with severe anxiety about separating from his mother, several years after his parents went through a painful divorce. Treatment focused on processing the boy's disturbing memories of past nontraumatic events in 14 EMDR sessions; his mother received 4 EMDR sessions to address her perceived marital failure and guilt about the effects of her ensuing depression on him. Eight family therapy sessions were used to help the family spend positive time together. Prior to treatment, the child had been unable to play outside, checked on his mother frequently, and could not attend activities without her. At the end of treatment, he was able to play with friends outside, ride his bike around town, engage in after school activities, and sleep over at his friends' houses. Gains were maintained at 6-month follow-up. Treatment did not include instruction in parenting skills or psychoeducation for the mother, or any exposure therapy for the child.
Parker, A., Parkin, A., & Dagnall, N. (2013). Effects of saccadic bilateral eye movements on episodic and semantic autobiographical memory fluency. Frontiers in Human Neuroscience, 7(630). doi:10.3389/fnhum.2013.00630
Andrew Parker, Department of Psychology, Manchester Metropolitan University, Hathersage Road, M13 OJA Manchester, UK e-mail: firstname.lastname@example.org
Full text available online: http://www.frontiersin.org/Human_Neuroscience/10.3389/fnhum.2013.00630/abstract
Performing a sequence of fast saccadic horizontal eye movements has been shown to facilitate performance on a range of cognitive tasks, including the retrieval of episodic memories. One explanation for these effects is based on the hypothesis that saccadic eye movements increase hemispheric interaction, and that such interactions are important for particular types of memory. The aim of the current research was to assess the effect of horizontal saccadic eye movements on the retrieval of both episodic autobiographical memory (event/incident based memory) and semantic autobiographical memory (fact based memory) over recent and more distant time periods. It was found that saccadic eye movements facilitated the retrieval of episodic autobiographical memories (over all time periods) but not semantic autobiographical memories. In addition, eye movements did not enhance the retrieval of non-autobiographical semantic memory. This finding illustrates a dissociation between the episodic and semantic characteristics of personal memory and is considered within the context of hemispheric contributions to episodic memory performance.
Tesarz, J., Leisner, S., Gerhardt, A., Janke, S., Seidler, G. H., Eich, W., & Hartmann, M. (2013). Effects of eye movement desensitization and reprocessing (EMDR) treatment in chronic pain patients: A systematic review. Pain Medicine. doi:10.1111/pme.12303
Jonas Tesarz, MD, Department of General Internal Medicine and Psychosomatics, Medical Hospital, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany. Tel: +49-6221-56-37862; Fax: +49-6221-56-8450; E-mail: email@example.com
OBJECTIVE: This study systematically reviewed the evidence regarding the effects of eye movement desensitization and reprocessing (EMDR) therapy for treating chronic pain.
DESIGN: Systematic review.
METHODS: We screened MEDLINE, EMBASE, the Cochrane Library, CINHAL Plus, Web of Science, PsycINFO, PSYNDEX, the Francine Shapiro Library, and citations of original studies and reviews. All studies using EMDR for treating chronic pain were eligible for inclusion in the present study. The main outcomes were pain intensity, disability, and negative mood (depression and anxiety). The effects were described as standardized mean differences.
RESULTS: Two controlled trials with a total of 80 subjects and 10 observational studies with 116 subjects met the inclusion criteria. All of these studies assessed pain intensity. In addition, five studies measured disability, eight studies depression, and five studies anxiety. Controlled trials demonstrated significant improvements in pain intensity with high effect sizes (Hedges' g: -6.87 [95% confidence interval (CI95 ): -8.51, -5.23] and -1.12 [CI95 : -1.82, -0.42]). The pretreatment/posttreatment effect size calculations of the observational studies revealed that the effect sizes varied considerably, ranging from Hedges' g values of -0.24 (CI95 : -0.88, 0.40) to -5.86 (CI95 : -10.12, -1.60) for reductions in pain intensity, -0.34 (CI95 : -1.27, 0.59) to -3.69 (CI95 : -24.66, 17.28) for improvements in disability, -0.57 (CI95 : -1.47, 0.32) to -1.47 (CI95 : -3.18, 0.25) for improvements in depressive symptoms, and -0.59 (CI95 : -1.05, 0.13) to -1.10 (CI95 : -2.68, 0.48) for anxiety. Follow-up assessments showed maintained improvements. No adverse events were reported.
CONCLUSIONS: Although the results of our study suggest that EMDR may be a safe and promising treatment option in chronic pain conditions, the small number of high-quality studies leads to insufficient evidence for definite treatment recommendations.
van den Berg, D. P. G., Van der Vleugel, B. M., Staring, A. B. P., De Bont, P. A. J., & De Jongh, A. (2013). EMDR in psychosis: Guidelines for conceptualization and treatment. Journal of EMDR Practice and Research, 7(4), 208-224. doi:10.1891/1933-322.214.171.124
David P. G. Van den Berg, Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN, Den Haag, The Netherlands. E-mail: firstname.lastname@example.org
A significant proportion of clients with psychosis have experienced childhood trauma and suffer from comorbid posttraumatic stress disorder. Research indicates that exposure to distressing early life events plays an important role in the emergence and persistence of psychotic symptoms—either directly or indirectly. The Two Method Approach of EMDR conceptualization and recent findings on reprocessing of psychosis-related imagery fit with the existing cognitive models of psychosis. This article presents a series of preliminary guidelines for conceptualizing EMDR treatment in psychosis, which are based on both theory and clinical experience and are illustrated with case examples. Several obstacles and related treatment strategies for using EMDR in psychosis are described. EMDR in psychosis can very well be combined with other standard interventions such as psychotropic medication and cognitive behavioral therapy.
Wood, E., & Ricketts, T. (2013). Is EMDR an evidenced-based treatment for depression? A review of the literature. Journal of EMDR Practice and Research, 7(4), 225-235. doi:10.1891/1933-3126.96.36.199
Emily Wood, School of Health and Related Research (ScHARR), University of Sheffield, 30 Regent Street, Shef- field, UK, S1 4DA. E-mail: email@example.com
It is not unusual for proponents of eye movement desensitization and reprocessing (EMDR) to claim it can be used to treat many mental health problems. Depression is an illness that affects the lives of millions across the world; the costs are high, economically and socially, and depression can be devastating for the individual. Despite this, depression is not well treated, so a desire to find other treatments is admirable. However, these treatments must be evidence based and although there is some evidence that EMDR may be a promising new approach, it cannot currently be described as an evidenced-based treatment for depression. There are studies under way across Europe that may produce the evidence needed to expand the recommendations for using EMDR with more than just posttraumatic stress disorder (PTSD).