EMDR Research News December 2016
There are three new articles on PTSD issues related to EMDR therapy with abstracts.
- Review of the evidence base for psychosocial treatments for trauma exposed children and adolescents
- Predicting post-traumatic stress disorder treatment response with EMDR therapy in refugees
- Practice comparisons between treatments for posttraumatic stress disorder
There are four EMDR therapy articles with abstracts
- An expanded report on a randomized controlled trial of resource activation (RDI) for treating PTSD conducted in Cambodia
- A near-infrared spectroscopy study of the effects of eye movements during EMDR therapy
- A pilot functional MRI study on degrading traumatic memories with eye movements
- EMDR HAP UK training for Bosnia-Herzegovina mental health workers leads to the Bosnia-Herezegovina EMDR association joining EMDR Europe
- Three full text articles are available for immediate download including the following excellent review of PTSD and two others:
- Overview of evidence-based assessment and treatment for posttraumatic stress disorder
- A pilot functional MRI study on degrading traumatic memories with eye movements
- EMDR training for Bosnia-Herzegovina mental health workers leads to the Bosnia-Herezegovina EMDR association joining EMDR Europe
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.
Dorsey, S., McLaughlin, K. A., Kerns, S. E. U., Harrison, J. P., Lambert, H. K., Briggs, E. C., . . . Amaya-Jackson, L. (2016). Evidence base update for psychosocial treatments for children and adolescents exposed to traumatic events. Journal of Clinical Child & Adolescent Psychology, 1-28. doi:10.1080/15374416.2016.1220309
Shannon Dorsey, Department of Psychology, University of Washington, Guthrie Hall, Box 351525, Seattle, WA 98195. Tele: 206.543.2640. E-mail: firstname.lastname@example.org
Child and adolescent trauma exposure is prevalent, with trauma exposure-related symptoms, including posttraumatic stress, depressive, and anxiety symptoms often causing substantial impairment. This article updates the evidence base on psychosocial treatments for child and adolescent trauma exposure completed for this journal by Silverman et al. (2008). For this review, we focus on 37 studies conducted during the seven years since the last review. Treatments are grouped by overall treatment family (e.g., cognitive behavioral therapy), treatment modality (e.g., individual vs. group), and treatment participants (e.g., child only vs. child and parent). All studies were evaluated for methodological rigor according to Journal of Clinical Child & Adolescent Psychology evidence-based treatment evaluation criteria (Southam-Gerow & Prinstein, 2014), with cumulative designations for level of support for each treatment family. Individual CBT with parent involvement, individual CBT, and group CBT were deemed well-established; group CBT with parent involvement and eye movement desensitization and reprocessing (EMDR) were deemed probably efficacious; individual integrated therapy for complex trauma and group mind-body skills were deemed possibly efficacious; individual client-centered play therapy, individual mind-body skills, and individual psychoanalysis were deemed experimental; and group creative expressive + CBT was deemed questionable efficacy. Advances in the evidence base, with comparisons to the state of the science at the time of the Silverman et al. (2008) review, are discussed. Finally, we present dissemination and implementation challenges and areas for future research.
Haagen, J. F., Ter Heide, F. J., Mooren, T. M., Knipscheer, J. W., & Kleber, R. J. (2016). Predicting post-traumatic stress disorder treatment response in refugees: Multilevel analysis. The British Journal of Clinical Psychology / the British Psychological Society. doi:10.1111/bjc.12121
Joris F. G. Haagen, Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC Utrecht, The Netherlands. Email: email@example.com.
OBJECTIVES: Given the recent peak in refugee numbers and refugees' high odds of developing post-traumatic stress disorder (PTSD), finding ways to alleviate PTSD in refugees is of vital importance. However, there are major differences in PTSD treatment response between refugees, the determinants of which are largely unknown. This study aimed at improving PTSD treatment for adult refugees by identifying PTSD treatment response predictors.
DESIGN: A prospective longitudinal multilevel modelling design was used to predict PTSD severity scores over time. We analysed data from a randomized controlled trial with pre-, post-, and follow-up measurements of the safety and efficacy of eye movement desensitization and reprocessing and stabilization in asylum seekers and refugees suffering from PTSD.
METHODS: Lack of refugee status, comorbid depression, demographic, trauma-related and treatment-related variables were analysed as potential predictors of PTSD treatment outcome. Treatment outcome data from 72 participants were used.
RESULTS: The presence (B = 6.5, p = .03) and severity (B = 6.3, p < .01) of a pre-treatment depressive disorder predicted poor treatment response and explained 39% of the variance between individuals.
CONCLUSIONS: Refugee patients who suffer from PTSD and severe comorbid depression benefit less from treatment aimed at alleviating PTSD. Results highlight the need for treatment adaptations for PTSD and comorbid severe depression in traumatized refugees, including testing whether initial targeting of severe depressive symptoms increases PTSD treatment effectiveness.
PRACTITIONER POINTS: There are differences in post-traumatic stress disorder (PTSD) treatment response between traumatized refugees. Comorbid depressive disorder and depression severity predict poor PTSD response. Refugees with PTSD and severe depression may not benefit from PTSD treatment. Targeting comorbid severe depression before PTSD treatment is warranted. This study did not correct for multiple hypothesis testing. Comorbid depression may differentially impact alternative PTSD treatments.
Hasanović, M., Morgan, S., Oakley, S., Richman, A., Pajević, I., & Sabanović, S. (2016). EMDR training for Bosnia-Herzegovina mental health workers resulted with the founding of Bosnia-Herezegovina EMDR association, which became a full member of EMDR Europe in 2015. European Psychiatry, 33, S694.
M. Hasanović. University Clinical Center Tuzla, Department of Psychiatry, Tuzla, Bosnia and Herzegovina.
The Humanitarian Assistance Programmes UK and Ireland (HAP) work in partnership with mental health professionals in Bosnia-Herzegovina (BH), the country affected by war 1992–1995, providing knowledge and expertise in the treatment of trauma, and specifically in the use of EMDR (eye movement desensitisation and reprocessing).
In this way, we aim to build a body of qualified and experienced professionals who can establish and sustain their own EMDR training and professional associations in BH.
Authors described educational process considering the history of idea and its realization through training levels and process of supervision which was provided from the Humanitarian Assistance Program (HAP) of UK and Ireland with non profit, humanitarian approach in sharing skills of EMDR to mental health therapists in BH.
HAP UK and Ireland started its Bosnia Project in 2009. This is a long-term project, aiming ultimately to bring BH to the point where its trauma professionals can continue the training themselves, with their own national EMDR organisation. Since 2009, HAP UK and Ireland has trained over 100 professionals with EMDR. In 2015, the newly founded EMDR Association of Bosnia-Herecegovina became a full member of EMDR Europe. HAP UK and Ireland is continuing to provide training and supervision support in Bosnia and several clinicians are now EMDR Accredited Practitioners.
Four training of Bosnia-Herzegovina mental health workers to effectively use EMDR with enthusiastic help of EMDR trainers from HAP UK and Ireland resulted with foundation of Bosnia-Herzegovina EMDR Association, which became a full member of EMDR Europe.
Hernandez, D. F., Waits, W., Calvio, L., & Byrne, M. (2016). Practice comparisons between accelerated resolution therapy, eye movement desensitization and reprocessing and cognitive processing therapy with case examples. Nurse Education Today, 47, 74-80. doi:10.1016/j.nedt.2016.05.010
Recent outcomes for Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy indicate that as many as 60-72% of patients retain their PTSD diagnosis after treatment with CPT or PE. One emerging therapy with the potential to augment existing trauma focused therapies is Accelerated Resolution Therapy (ART). ART is currently being used along with evidence based approaches at Fort Belvoir Community Hospital and by report has been both positive for clients as well as less taxing on professionals trained in ART. The following is an in-practice theoretical comparison of CPT, EMDR and ART with case examples from Fort Belvoir Community Hospital. While all three approaches share common elements and interventions, ART distinguishes itself through emphasis on the rescripting of traumatic events and the brevity of the intervention. While these case reports are not part of a formal study, they suggest that ART has the potential to augment and enhance the current delivery methods of mental health care in military environments.
Lancaster, C. L., Teeters, J. B., Gros, D. F., & Back, S. E. (2016). Posttraumatic stress disorder: Overview of evidence-based assessment and treatment. J Clin Med, 5(11). doi:10.3390/jcm5110105
Full text: http://www.mdpi.com/2077-0383/5/11/105
Sudie E. Back, Ralph H. Johnson Veterans Affairs Medical Center, 109 Bee Street, Charleston, SC 29401, USA. E-mail: firstname.lastname@example.org.
Posttraumatic stress disorder (PTSD) is a chronic psychological disorder that can develop after exposure to a traumatic event. This review summarizes the literature on the epidemiology, assessment, and treatment of PTSD. We provide a review of the characteristics of PTSD along with associated risk factors, and describe brief, evidence-based measures that can be used to screen for PTSD and monitor symptom changes over time. In regard to treatment, we highlight commonly used, evidence-based psychotherapies and pharmacotherapies for PTSD. Among psychotherapeutic approaches, evidence-based approaches include cognitive-behavioral therapies (e.g., Prolonged Exposure and Cognitive Processing Therapy) and Eye Movement Desensitization and Reprocessing. A wide variety of pharmacotherapies have received some level of research support for PTSD symptom alleviation, although selective serotonin reuptake inhibitors have the largest evidence base to date. However, relapse may occur after the discontinuation of pharmacotherapy, whereas PTSD symptoms typically remain stable or continue to improve after completion of evidence-based psychotherapy. After reviewing treatment recommendations, we conclude by describing critical areas for future research.
Rimini, D., Molinari, F., Liboni, W., Balbo, M., Darò, R., Viotti, E., & Fernandez, I. (2016). Effect of ocular movements during eye movement desensitization and reprocessing (EMDR) therapy: A near-infrared spectroscopy study. PLoS ONE, 11(10), e0164379. doi:10.1371/journal.pone.0164379
Full text: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0164379
Daniele Rimini, Biolab, Department of Electronics and Telecommunication, Politecnico di Torino, Torino, Italy. E-mail: email@example.com
INTRODUCTION: Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapeutic treatment resolving emotional distress caused by traumatic events. With EMDR, information processing is facilitated by eye movements (EM) during the recall of a traumatic memory (RECALL). The aim of this study is to investigate the effects of ocular movements of EMDR on the hemodynamics of the prefrontal cortex (PFC).
MATERIAL AND METHODS: Two groups were recruited: a trial group (wEM) received a complete EMDR treatment, whereas a control group (woEM) received a therapy without EM. PFC hemodynamics was monitored by near-infrared spectroscopy during RECALL and during focusing on the worst image of the trauma (pre-RECALL). The parameters of oxy- (oxy-Hb), and deoxy-hemoglobin (deoxy-Hb) were acquired and analyzed in time domain, by calculating the slope within pre-RECALL and RECALL periods, and in the frequency domain, by calculating the mean power of oxy-Hb and deoxy-Hb in the very-low frequency (VLF, 20-40 mHz) and low frequency (LF, 40-140 mHz) bandwidths. We compared pre-RECALL with RECALL periods within subjects, and pre-RECALL and RECALL parameters of wEM with the corresponding of woEM.
RESULTS: An effect of group on mean slope of oxy-Hb and deoxy-Hb in pre-RECALL and oxy-Hb in RECALL periods was observed. wEM showed a lower percentage of positive angular coefficients during pre-RECALL with respect to RECALL, on the opposite of woEM. In the frequency domain, wEM had significant difference in oxy-Hb and deoxy-Hb LF of left hemisphere, whereas woEM showed no difference.
DISCUSSION AND CONCLUSION: We observed the effect of EM on PFC oxygenation during EMDR, since wEM subjects showed a mean increase of oxy-Hb during RECALL and a decrease during pre-RECALL, as opposed to woEM. Frequency analysis evidenced a reduction of activity of sympathetic nervous system in wEM group during pre-RECALL. Our outcomes revealed a different hemodynamics induced by eye movements in wEM with respect to woEM group.
Steinert, C., Bumke, P. J., Hollekamp, R. L., Larisch, A., Leichsenring, F., Mattheß, H., . . . Kruse, J. (2016). Resource activation for treating post-traumatic stress disorder, co-morbid symptoms and impaired functioning: A randomized controlled trial in Cambodia. Psychological Medicine, 1-12. doi:10.1017/S0033291716002592
Christiane Steinert, Ph.D., University of Giessen, Clinic for Psychosomatic Medicine and Psychotherapy, Ludwigstrasse 76, 35392 Giessen, Germany. Email: firstname.lastname@example.org
BACKGROUND: Mental health morbidity in post-conflict settings is high. Nevertheless, randomized controlled trials of psychotherapy on site are rare. Our aim was to integrate rigorous research procedures into a humanitarian programme and test the efficacy of resource activation (ROTATE) in treating post-traumatic stress disorder (PTSD), co-morbid symptoms and impaired functioning in Cambodia.
METHOD: A total of 86 out-patients with PTSD were randomly assigned to five sessions of ROTATE (n = 53) or a 5-week waiting-list control (WLC) condition (n = 33). Treatment was provided by six Cambodian psychologists who had received extensive training in ROTATE. Masked assessments were made before and after therapy.
RESULTS: PTSD remission rates according to the DSM-IV algorithm of the Harvard Trauma Questionnaire were 95.9% in ROTATE and 24.1% in the WLC condition. Thus, patients receiving ROTATE had a significantly higher likelihood of PTSD remission (odds ratio 0.012, 95% confidence interval 0.002-0.071, p < 0.00001). Additionally, levels of anxiety, depression and impaired functioning were significantly reduced compared with the WLC condition (p < 0.00001, between-group effect sizes d = 2.41, 2.26 and 2.54, respectively). No harms were reported.
CONCLUSIONS: ROTATE was efficacious in treating Cambodian patients with high symptom levels of PTSD, emotional distress and impaired functioning. ROTATE is a brief, culturally adaptable intervention focusing on stabilization and strengthening resources rather than trauma confrontation. It can be taught to local professionals and paraprofessionals and enhance access to mental health care for patients in need.
Thomaes, K., Engelhard, I. M., Sijbrandij, M., Cath, D. C., & Heuvel, O. A. V. D. (2016). Degrading traumatic memories with eye movements: A pilot functional MRI study in PTSD. European Journal of Psychotraumatology, 7(0). doi:10.3402/ejpt.v%v.31371
Kathleen Thomaes, GGZ Ingeest, AJ Ernststraat 1187, 1081 HL Amsterdam. Email: email@example.com
Full text: http://www.ejpt.net/index.php/ejpt/article/view/31371
Background: Eye movement desensitization and reprocessing (EMDR) is an effective treatment for post-traumatic stress disorder (PTSD). During EMDR, the patient recalls traumatic memories while making eye movements (EMs). Making EMs during recall is associated with decreased vividness and emotionality of traumatic memories, but the underlying mechanism has been unclear. Recent studies support a ‘‘working-memory’’ (WM) theory, which states that the two tasks (recall and EMs) compete for limited capacity of WM resources. However, prior research has mainly relied on self-report measures.
Methods: Using functional magnetic resonance imaging, we tested whether ‘‘recall with EMs,’’ relative to a ‘‘recall-only’’ control condition, was associated with reduced activity of primary visual and emotional processing brain regions, associated with vividness and emotionality respectively, and increased activity of the dorsolateral prefrontal cortex (DLPFC), associated with working memory. We used a randomized, controlled, crossover experimental design in eight adult patients with a primary diagnosis of PTSD. A script-driven imagery (SDI) procedure was used to measure responsiveness to an audio-script depicting the participant’s traumatic memory before and after conditions.
Results: SDI activated mainly emotional processing-related brain regions (anterior insula, rostral anterior cingulate cortex (ACC), and dorsomedial prefrontal cortex), WM-related (DLPFC), and visual (association) brain regions before both conditions. Although predicted pre- to post-test decrease in amygdala activation after ‘‘recall with EMs’’ was not significant, SDI activated less right amygdala and rostral ACC activity after ‘‘recall with EMs’’ compared to post-‘‘recall-only.’’ Furthermore, functional connectivity from the right amygdala to the rostral ACC was decreased after ‘‘recall with EMs’’ compared with after ‘‘recall-only.’’
Conclusions: These preliminary results in a small sample suggest that making EMs during recall, which is part of the regular EMDR treatment protocol, might reduce activity and connectivity in emotional processing-related areas. This study warrants replication in a larger sample.