EMDR Research News December 2021
With each reference below, you will find the citation, abstract and author contact information (when available). Previous posting to this blog can be viewed by year in the sidebar below right (visible on computer and tablet - landscape). Summary listings by topic are available at EMDR Research. A comprehensive listing of all EMDR-related research is available at the Francine Shapiro Library. EMDRIA members can access recent Journal of EMDR Practice and Research articles in the member’s area on the EMDRIA website. JEMDR issues older than 12 months are available open access on Connect - Springer Publishing Company.
Alting van Geusau, V. V. P., Mulder, J. D., & Matthijssen, S. J. M. A. (2021). Predicting Outcome in an Intensive Outpatient PTSD Treatment Program Using Daily Measures. J Clin Med, 10(18), 4152. doi:10.3390/jcm10184152
Open Access: https://pubmed.ncbi.nlm.nih.gov/34575263
Suzy J. M. A. Matthijssen, Department of Clinical Psychology, Utrecht University, 3584 CS Utrecht, The Netherlands, E-mail: firstname.lastname@example.org
It is useful to investigate factors that could predict treatment outcomes for PTSD. The current study aims to investigate the relationship between daily measured PTSD symptoms during an intensive six-day treatment program and overall post-treatment outcomes. The treatment program combines eye movement desensitization with reprocessing and prolonged exposure, as well as physical activity and psychoeducation. It was expected that for the entire duration of treatment, as well as the first half of the treatment, a greater decline in daily PTSD symptoms would be a predictor for a greater decline in PTSD symptoms at a four-week follow-up. Data from 109 PTSD-patients (87.2% female, mean age = 36.9, SD = 11.5) were used. PTSD symptoms were measured with the CAPS-5 and the self-reported PTSD checklist for DSM-5 (PCL-5). Daily PTSD symptoms were measured with an abbreviated version of the PCL-5 (8-item PCL). Latent growth curve models were used to describe changes in daily PTSD symptoms and predict treatment outcome. Results show that a greater decline in daily PTSD symptoms measured by the 8-item PCL predicts better treatment outcome (CAPS-5 and PCL-5), but that a patient's PTSD symptoms on the first day of treatment has no predictive effect. A decline in PTSD symptoms only during the first half of treatment was also found to predict treatment outcomes. Future research should be focused on replicating the results of the current study.
Bayhan, B. B., Tarquinio, C., Rydberg, J., & Korkmazlar, Ü. (2022). The study of the group intervention containing EMDR therapy for children and mothers in the field of trauma after a mine explosion in Turkey. European Journal of Trauma & Dissociation, 6(1), 100248. doi:10.1016/j.ejtd.2021.100248
Cyril Tarquinio, Université de Lorraine France APEMAC, Centre Pierre Janet, F-57000 Metz, France. E-mail: email@example.com
On the 13th of May 2014, 301 miners lost their lives in a coal mine explosion in Soma, Turkey. A field study was conducted by volunteers under the roof of the EMDR Humanitarian Assistance Programs: Trauma Recovery (EMDR-HAP-TR) organization.
All the interventions in this study were aimed to help victims of the disaster. Furthermore, the study aimed to assess the effectiveness of the intervention, specifically the EMDR Group Protocol (EMDR-GP) with Children and Caregivers, which was administered to children and mothers who lost their fathers and husbands in the Soma mine disaster.
Participants in the study were 25 children and 16 mothers in the intervention group and 25 children and 16 mothers in the control group. The Child's Reaction to Traumatic Events Scale (CROPS) was administered to the children and the Impact of Event Scale-Revised (IES-R) was administered to the mothers. In the intervention groupe, the Subjective Units of Disturbance scale (SUD) was administered both to children and to mothers at different times during the intervention, including before and after desensitization, and at the end of the intervention. CROPS and IES-R were administered before the intervention and 1-year post-intervention. In the control group, CROPS was administered to 25 children and IES-R was administered to 16 mothers. As there was no initial inclusion for a control group due to the field intervention, pre-test measures are not available for the control group.
The SUD ratings and one-year follow-up results on CROPS and IES-R showed that the EMDR-GP reduced all scores for both children and mothers. Compared to the control group, the decrease of CROPS scores in children was found to be significant, while the decrease of IES-R scores in mothers was not. It can be suggested that the EMDR-GP with Children and Caregivers is an effective treatment.
Boyraz, R. K., Kirpinar, I., Yilmaz, O., Özyurt, O., Kiliçarslan, T., & Aralasmak, A. (2021). A Treatment-Response Comparison Study of Resting-State Functional Magnetic Resonance Imaging Between Standard Treatment of SSRI and Standard Treatment of SSRI Plus Non-dominant Hand-Writing Task in Patients With Major Depressive Disorder. Front Psychiatry, 12, 698954. doi:10.3389/fpsyt.2021.698954
Open Access: https://pubmed.ncbi.nlm.nih.gov/34539460
Rabia Kevser Boyraz, E-mail: firstname.lastname@example.org
Background: Researches have recently shifted from functional/structural imaging studies to functional connectivity (FC) studies in major depressive disorder (MDD). We aimed to compare treatment response of two treatment groups before and after treatment, in terms of both with psychiatric evaluation scales and resting-state functional connectivity (RSFC) changes in order to objectively demonstrate the possible contribution of the non-dominant hand-writing exercise (NHE) effect on depression treatment.
Methods: A total of 26 patients who were right-handed women with similar sociodemographic characteristics were enrolled. Their pre-treatment resting-state functional magnetic resonance imaging (rs-fMRI) and neuropsychiatric tests were recorded, and then, patients were divided into two groups randomly. A standard treatment (ST) (fix sertraline 50 mg/day) was given to both groups. One randomly selected group was given the NHE in addition to the ST. After 8 weeks of treatment, all patients were reevaluated with rs-fMRI and neuropsychiatric tests. Pre- and post-treatment FC changes within the groups and post-treatment connectivity changes between groups were evaluated.
Results: Post-treatment neuropsychiatric tests were significantly different in both groups. Post-treatment, two brain regions’ connectivity changed in the ST group, whereas 10 brain regions’ connectivity changed significantly in the ST + NHE group. When treatment groups were compared with each other after the treatment, the FC of 13 regions changed in the ST + NHE group compared to the ST group (p-unc/p-PFD < 0.05). The density of connectivity changes in the frontal and limbic regions, especially connectivities shown to change in depression treatment, in the ST + NHE group indicates a positive contribution to depression treatment, which is also supported by neuropsychiatric scale changes.
Conclusion: NHE, which we developed with inspiration from the Eye Movement Desensitization and Reprocessing (EMDR) method, showed significantly more connectivity changes related with MDD treatment. Beyond offering a new additional treatment method, our study will also contribute to the current literature with our efforts to evaluate all brain regions and networks that may be related to MDD and its treatment together, without being limited to a few regions.
Covers, M. L. V., de Jongh, A., Huntjens, R. J. C., de Roos, C., van den Hout, M., & Bicanic, I. A. E. (2021). Early intervention with eye movement desensitization and reprocessing (EMDR) therapy to reduce the severity of post-traumatic stress symptoms in recent rape victims: a randomized controlled trial. Eur J Psychotraumatol, 12(1), 1943188. doi:10.1080/20008198.2021.1943188
Open Access: https://pubmed.ncbi.nlm.nih.gov/34531963
Milou L. V. Covers, National Psychotrauma Center for Children and Youth, University Medical Center Utrecht, Lundlaan 6, Utrecht 3584 EA, The Netherlands. E-mail: E-mail: email@example.com
Background: About 40% of rape victims develop post-traumatic stress disorder (PTSD) within three months after the assault. Considering the high personal and societal impact of PTSD, there is an urgent need for early (i.e. within three months after the incident) interventions to reduce post-traumatic stress in victims of rape.
Objective: To assess the effectiveness of early intervention with eye movement desensitization and reprocessing (EMDR) therapy to reduce symptoms of post-traumatic stress, feelings of guilt and shame, sexual dysfunction, and other psychological dysfunction (i.e., general psychopathology, anxiety, depression, and dissociative symptoms) in victims of rape.
Method: This randomized controlled trial included 57 victims of rape, who were randomly allocated to either two sessions of EMDR therapy or treatment as usual ('watchful waiting') between 14- and 28-days post-rape. Psychological symptoms were assessed at pre-treatment, post-treatment, and 8- and 12-weeks post-rape. Linear mixed models and ANCOVAs were used to analyse differences between conditions over time.
Results: Within-group effect sizes of the EMDR condition (d = 0.89 to 1.57) and control condition (d = 0.79 to 1.54) were large, indicating that both conditions were effective. However, EMDR therapy was not found to be more effective than watchful waiting in reducing post-traumatic stress symptoms, general psychopathology, depression, sexual dysfunction, and feelings of guilt and shame. Although EMDR therapy was found to be more effective than watchful waiting in reducing anxiety and dissociative symptoms in the post-treatment assessment, this effect disappeared over time.
Conclusions: The findings do not support the notion that early intervention with EMDR therapy in victims of rape is more effective than watchful waiting for the reduction of psychological symptoms, including symptoms of post-traumatic stress. Further research on the effectiveness of early interventions, including watchful waiting, for this specific target group is needed.
de Roos, C., Zijlstra, B., Perrin, S., van der Oord, S., Lucassen, S., Emmelkamp, P., & de Jongh, A. (2021). Predictors and moderators of treatment outcome for single incident paediatric PTSD: a multi-centre randomized clinical trial. Eur J Psychotraumatol, 12(1), 1968138. doi:10.1080/20008198.2021.1968138
Open Access: https://pubmed.ncbi.nlm.nih.gov/34621497
Carlijn de Roos, Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centre, Amsterdam, The Netherlands. E-mail: firstname.lastname@example.org
Background: With few RCTs having compared active treatments for paediatric PTSD, little is known about whether or which baseline (i.e. pre-randomization) variables predict or moderate outcomes in the evaluated treatments.
Objective: To identify predictors and moderators of paediatric PTSD outcomes for Eye Movement Desensitization and Reprocessing Therapy (EMDR) and Cognitive Behavioural Writing Therapy (CBWT).
Method: Data were obtained as part of a multi-centre, randomized controlled trial of up to six sessions (up to 45 minutes each) of either EMDR therapy, CBWT, or wait-list, involving 101 youth (aged 8-18 years) with a PTSD diagnosis (full/subthreshold) tied to a single event. The predictive and moderating effects of the child's baseline sociodemographic and clinical characteristics, and parent's psychopathology were evaluated using linear mixed models (LMM) from pre- to post-treatment and from pre- to 3- and 12-month follow-ups.
Results: At post-treatment and 3-month follow-up, youth with an index trauma of sexual abuse, severe symptoms of PTSD, anxiety, depression, more comorbid disorders, negative posttraumatic beliefs, and with a parent with more severe psychopathology fared worse in both treatments. For children with more severe self-reported PTSD symptoms at baseline, the (exploratory) moderator analysis showed that the EMDR group improved more than the CBWT group, with the opposite being true for children and parents with a less severe clinical profile.
Conclusions: The most consistent finding from the predictor analyses was that parental symptomatology predicted poorer outcomes, suggesting that parents should be assessed, supported and referred for their own treatment where indicated. The effect of the significant moderator variables was time-limited, and given the large response rate (>90%) and brevity (<4 hours) of both treatments, the present findings suggest a focus on implementation and dissemination, rather than tailoring, of evidence-based trauma-focused treatments for paediatric PTSD tied to a single event.
Doğan, C. K., Yaşar, A. B., & Gündoğmuş, İ. (2021). Effects of the EMDR Couple Protocol on Relationship Satisfaction, Depression, and Anxiety Symptoms. Journal of EMDR Practice and Research, 15(4), 218-230. doi:10.1891/EMDR-D-21-00008
Alişan Burak Yaşar, MD, İstanbul Gelişim University, Department of Psychology, İstanbul, Turkey. E-mail: email@example.com
The aim of the present study was to evaluate the effect of the eye movement desensitization and reprocessing (EMDR) Couple Protocol on the relationship-satisfaction, depression, and anxiety levels of couples. This protocol differs from standard EMDR procedures in that the partners are together in the treatment session, and engage in bidirectional stimulation simultaneously. The treatment targets are disturbing events that the couples have experienced together. Couples have the opportunity to accept, recognize, and witness each other's recovery process during the session. The EMDR Couple Protocol consists of eight phases, and it was developed for couples wanting to improve their relationship. The study sample consisted of 18 couples suitable for the application of the EMDR Couple Protocol. Treatment was provided by an EMDR Europe Level 2 EMDR psychotherapist to the couples. The mean number of sessions was 14.27 ± 4.04. The couples showed significant improvement between pre-EMDR, post-EMDR, and at three months follow-up with large effect sizes for relationship satisfaction (η² = 0.944), depression (η² = 0.385), and anxiety (η² = 0.258). The present study evaluating the effectiveness of the EMDR Couple Protocol showed a positive effect on the relationship-satisfaction, depression and anxiety symptoms of the couples. The EMDR Couple Protocol appeared to be safe and effective.
Doherty, A., Benedetto, V., Harris, C., Boland, P., Christian, D. L., Hill, J., . . . Clegg, A. J. (2021). The effectiveness of psychological support interventions for those exposed to mass infectious disease outbreaks: a systematic review. BMC Psychiatry, 21(1), 592. doi:10.1186/s12888-021-03602-7
Open Access: https://pubmed.ncbi.nlm.nih.gov/34814859
Alison Doherty, Synthesis, Economic Evaluations and Decision Science (SEEDS) Group, Faculty of Health & Care, University of Central Lancashire (UCLan), Preston PR1 2HE, UK. E-mail: firstname.lastname@example.org
BACKGROUND: Mass outbreaks such as pandemics are associated with mental health problems requiring effective psychological interventions. Although several forms of psychological interventions may be advocated or used, some may lack strong evidence of efficacy and some may not have been evaluated in mass infectious disease outbreaks. This paper reports a systematic review of published studies (PROSPERO CRD:42020182094. Registered: 24.04.2020) examining the types and effectiveness of psychological support interventions for the general population and healthcare workers exposed to mass infectious disease outbreaks.
METHODS: A systematic review was conducted. Randomised Controlled Trials (RCT) were identified through searches of electronic databases: Medline (Ovid), Embase (Ovid), PsycINFO (EBSCO) and the Cochrane Library Database from inception to 06.05.2021 using an agreed search strategy. Studies were included if they assessed the effectiveness of interventions providing psychological support to the general population and / or healthcare workers exposed to mass infectious disease outbreaks. Studies were excluded if they focused on man-made or natural disasters or if they included armed forces, police, fire-fighters or coastguards.
RESULTS: Twenty-two RCTs were included after screening. Various psychological interventions have been used: therapist-guided therapy (n = 1); online counselling (n = 1); 'Emotional Freedom Techniques' (n = 1); mobile phone apps (n = 2); brief crisis intervention (n = 1); psychological-behavioural intervention (n = 1); Cognitive Behavioural Therapy (n = 3); progressive muscle relaxation (n = 2); emotional-based directed drawing (n = 1); psycho-educational debriefing (n = 1); guided imagery (n = 1); Eye Movement Desensitization and Reprocessing (EMDR) (n = 1); expressive writing (n = 2); tailored intervention for patients with a chronic medical conditions (n = 1); community health workers (n = 1); self-guided psychological intervention (n = 1), and a digital behaviour change intervention (n = 1). Meta-analyses showed that psychological interventions had a statistically significant benefit in managing depression (Standardised Mean Difference [SMD]: -0.40; 95% Confidence Interval [CI]: - 0.76 to - 0.03), and anxiety (SMD: -0.72; 95% CI: - 1.03 to - 0.40). The effect on stress was equivocal (SMD: 0.16; 95% CI: - 0.19 to 0.51). The heterogeneity of studies, studies' high risk of bias, and the lack of available evidence means uncertainty remains.
CONCLUSIONS: Further RCTs and intervention studies involving representative study populations are needed to inform the development of targeted and tailored psychological interventions for those exposed to mass infectious disease outbreaks.
Ergüney-Okumuş, F. E. (2021). Integrating EMDR With Enhanced Cognitive Behavioral Therapy in the Treatment of Bulimia Nervosa: A Single Case Study. Journal of EMDR Practice and Research, 15(4), 231-243. doi:10.1891/EMDR-D-21-00012
Istanbul Sabahattin Zaim University, Faculty of Humanities and Social Sciences, Department of Psychology, Halkali Campus, 34303, Halkali-Kucukcekmece, Istanbul. E-mail: email@example.com
Eating disorders (EDs) are complex and treatment-resistant problems. Despite evidence-based methods like enhanced cognitive behavioral therapy (CBT-E), the number of clients who do not respond positively to treatment is also remarkable. Eye movement desensitization and reprocessing (EMDR) therapy has been adapted for EDs. As far as it is known, no case study has been reported in which EMDR was integrated with CBT-E in the treatment of EDs. This study provides a detailed description of the treatment of a participant with bulimia nervosa (BN) who received 20 sessions of CBT-E followed by five sessions of EMDR with a focus on body image. Presenting symptoms were measured on the Eating Attitudes Test-26, Eating Disorder Examination Questionnaire, Eating Disorder Belief Questionnaire, Bulimia Nervosa Stages of Change Questionnaire, and Body Satisfaction Scale. Results showed that the client had important improvements in terms of symptoms (binge-eating, restricting, and preoccupation with weight, shape, and eating) as well as motivation, body satisfaction, and social relations. This single case study provides preliminary evidence for the possible effectiveness of CBT-E plus EMDR in the treatment of BN. It also indicates that EMDR can make unique positive contributions to treatment. In this context, the use of EMDR as an integrative method appeared to increase the effectiveness of treatment results.
Farrell, D., Fadeeva, A., Zat, Z., Knibbs, L., Miller, P., Barron, I., . . . Kiernan, M. D. (2021). A Stage 1 Pilot Cohort Exploring the Use of EMDR Therapy as a Video-Conference Psychotherapy During Covid-19 – A Proof of Concept Study Utilising a Virtual Blind 2 Therapist Protocol. Preprint under review BMC Psychology. doi:10.21203/rs.3.rs-886940/v1
Open Access: http://dx.doi.org/10.21203/rs.3.rs-886940/v1
Derek Farrell, University of Worcester. E-mail: firstname.lastname@example.org
The Covid-19 pandemic has had a major impact in the delivery of psychological treatment. Due to social distancing requirements provision moved to video-conferencing psychotherapy (VCP). There is a paucity of empirical data supporting the efficacy of EMDR therapy as a VCP. This stage 1 pilot study tested an EMDR therapy scripted protocol – Virtual Blind 2 Therapist (VB2T) as a VCP regarding fitness for purpose, distinctiveness, relevance, and efficiency.
Twenty-four participants were recruited to the study. The design included a one-session treatment intervention obtaining measures pre, post, one-month, and six-month follow-up. This treatment session used a ‘Blind 2 Therapist’ EMDR therapy scripted protocol as video-conference psychotherapy that involves non-disclosure of traumatic memory. The research explored the treatment effect on the core characteristics of the trauma memory including subjective disturbance, belief systems, memory intensity, vividness, and levels of emotionality. Additionally, the research explored participant’s experiences of adverse and benevolent childhood experiences (ACEs/BCEs) during their childhood.
Regarding the four tests - fitness for purpose, distinctiveness, relevance, and efficiency results are favourably suggesting potential clinical benefits of using EMDR as video-conference psychotherapy. That said this is a proof-of-concept study showing positive results, however, no clinical population or control group was used. The purpose of the study is to explore the potential for scalability towards a larger clinical trial. The treatment intervention was achieved irrespective of either adverse or benevolent childhood experiences (ACEs/BCEs) during childhood.
The research tentatively supports the case for EMDR therapy as a credible treatment when used as a video conference psychotherapy. More research is needed to scale towards a clinical trial.
Flint, T., & Elkins, Y. (2021). F-TEP: Fragmented traumatic episode protocol. Practice Innovations, 6(1), 17-29. doi:10.1037/pri0000135
Tuly Flint, Bnei Hanevi’im 8, Ramat-Gan, Israel 5222144. Email: email@example.com
This article presents a protocol for treating recent trauma at the acute stress reaction (ASR) stage when the event is still fresh and overwhelming, and the trauma survivor does not yet have a coherent narrative. This protocol is for treating those who have endured a traumatic episode from a few hours to a few days prior. It may also help patients who suffer from a “fragmented narrative” from earlier events. The protocol incorporates a procedure for building a coherent narrative of the trauma, enabling EMDR processing while utilizing the principals of the Recent Traumatic Episode Protocol (Shapiro & Laub, 2008, 2015). We present the theoretical background for the protocol, which integrates the narrative approach, the R-TEP protocol and the Adaptive Information Processing (AIP) Model. A description of the protocol, its differences from the classic EMDR R-TEP, and case studies are presented.
Grau, P. P., Kusch, M. M., Williams, M. T., Loyo, K. T., Zhang, X., Warner, R. C., & Wetterneck, C. T. (2021). A review of the inclusion of ethnoracial groups in empirically supported posttraumatic stress disorder treatment research. Psychol Trauma. doi:10.1037/tra0001108
Peter P Grau, Department of Counselor Education and Counseling Psychology, Marquette University. https://orcid.org/0000-0003-4520-1941
OBJECTIVE: Empirically supported treatments (ESTs) have been criticized for lack of ethnoracial representation, which may limit the generalizability of findings for non-White patients. This study assessed ethnoracial representation in United States-based randomized controlled trials (RCTs) for three evidence-based treatments for posttraumatic stress disorder (PTSD)-Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and Eye-Movement Desensitization and Reprocessing (EMDR).
METHOD: Representation was measured by explicit inclusion of people of color in published PTSD RCTs. Follow-up emails were sent to corresponding authors if full demographic information was not included in the reviewed manuscripts. Information concerning participant remuneration was collected for descriptive purposes.
RESULTS: All three treatment modalities reported White participants as the majority in their sample. PE and CPT trials reported similar levels of ethnoracial diversity, while EMDR efficacy studies reported the least ethnoracial diversity. Across the reviewed studies, with few exceptions, we found low numbers of non-White participants in the majority of reviewed studies, which was compounded by poor or unclear methods of reporting ethnoracial information.
CONCLUSIONS: This study demonstrates that the ESTs for PTSD are not adequately representative of the majority of non-White participants. Future RCTs should place a stronger emphasis on broad ethnoracial diversity in study participants to improve generalizability of findings.
Hafkemeijer, L., Starrenburg, A., van der Palen, J., Slotema, K., & de Jongh, A. (2021). Does EMDR Therapy Have an Effect on Memories of Emotional Abuse, Neglect and Other Types of Adverse Events in Patients with a Personality Disorder? Preliminary Data. J Clin Med, 10(19), 4333. doi:10.3390/jcm10194333
Open Access: https://pubmed.ncbi.nlm.nih.gov/34640349
Laurian Hafkemeijer, GGZ Delfland, Sint Jorisweg 2, 2612 GA Delft, The Netherlands. E-mail: firstname.lastname@example.org
BACKGROUND: Little is known about the effectiveness of trauma-focused therapies for memories of events not meeting the A-criterion of post-traumatic stress disorder (PTSD).
OBJECTIVE: Determining the effect of EMDR therapy on memories of emotional abuse, neglect and other types of adverse events in patients with a personality disorder (PD).
METHOD: We conducted a secondary analysis of the data from our study, which aimed to determine the effectiveness of five sessions of EMDR therapy in 49 patients with a PD. Patients were divided into three different groups depending on their most prevalent type of adverse event. Data were analyzed with Generalized Estimating Equations.
RESULTS: Of all patients, 49% reported emotional neglect, 22.4% emotional abuse and 26.5% other types. Only one patient reported memories that predominantly fulfilled the A-criterion of PTSD. After five sessions of EMDR therapy, medium to large treatment effects for memories related to neglect (ds between 0.52 and 0.79), medium treatment effects for memories involving emotional abuse (ds between 0.18 and 0.59) and other types of adverse events were found (ds between 0.18 and 0.53). No significant differences in symptom reduction associated with the application of EMDR therapy among memories involving these three different types of adverse events could be revealed.
CONCLUSIONS: The results support the notion that EMDR therapy is not only an effective therapy for memories related to A-criteria-worthy events, but that it also has a symptom-reducing effect on memories involving other types of adverse events. This suggests that EMDR might be a valuable addition to the treatment of PD without PTSD.
Jager, I., Vulink, N., de Roos, C., & Denys, D. (2021). EMDR therapy for misophonia: a pilot study of case series. Eur J Psychotraumatol, 12(1), 1968613. doi:10.1080/20008198.2021.1968613
Open Access: https://pubmed.ncbi.nlm.nih.gov/34589178
Inge Jager, Outpatient Clinic for Affective disorders, GGZ inGeest, Amsterdam, the Netherlands. E-mail: email@example.com
Background: Misophonia is a disorder in which patients suffer from anger or disgust when confronted with specific sounds such as loud chewing or breathing, causing avoidance of cue-related situations resulting in significant functional impairment. Though the first treatment studies with cognitive behavioural therapy (CBT) showed promising results, an average of 50% of the patients has not improved much clinically.
Objective: The aim of this pilot study was to assess the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy as a trauma-focused approach in treating misophonia symptoms.
Method: A sample of 10 adult participants with misophonia was studied at the outpatient clinic of the Academic Medical Center in Amsterdam. Participants were either on the waiting list for CBT or non-responders to CBT. EMDR was focused on misophonia-related emotionally disturbing memories and delivered in a mean of 2.6 sessions of 60-90 minutes. Pre- and post-treatment self-assessed ratings of misophonia symptoms (AMISOS-R, primary outcome), of general psychopathology (SCL-90-R) and of quality of life (SDS) were administered. The co-primary outcome was the Clinical Global Impression Improvement scale (CGI-I). Results: A paired t-test (n = 8) showed improvement on the primary outcome (-6.14 [MD], 5.34 [SD]) on the AMISOS-R (P = .023). Three of the eight patients showed clinically significant improvement measured with the CGI-I. No significant effect on secondary outcomes was found.
Conclusions: These preliminary results suggest that EMDR therapy focused on emotionally disturbing misophonia-related memories can reduce misophonia symptoms. RCTs with sufficient sample sizes are required to firmly establish the value of EMDR therapy for misophonia.
Jericho, B., Luo, A., & Berle, D. (2021). Trauma-focused psychotherapies for post-traumatic stress disorder: A systematic review and network meta-analysis. Acta Psychiatr Scand. doi:10.1111/acps.13366
David Berle, Discipline of Clinical Psychology Graduate School of Health, Vicki Sara Building, University of Technology Sydney 15 Broadway, Ultimo NSW 2007, Australia. E-mail: firstname.lastname@example.org
INTRODUCTION: Meta-analytic reviews suggest similar outcomes across trauma-focused psychotherapies for adults with post-traumatic stress disorder (PTSD). However, this conclusion may be premature due to suboptimal statistical-review methodologies. Network meta-analysis (NMA) allows a detailed rank-ordering of the efficacy of established psychotherapy interventions derived from indirect evidence as well as results from direct head-to-head comparisons.
OBJECTIVE: We sought to determine the efficacy and attrition rates of psychotherapy interventions for PTSD by applying NMA.
METHODS: We searched EMBASE, PsychINFO, PTSDPubs and PubMed for randomised controlled trials that compared psychotherapies either head-to-head or against controls for adults with PTSD. A frequentist NMA was used to compare direct and indirect effects to determine the efficacy and attrition rates of psychotherapy interventions.
RESULTS: Of the 5649 papers identified, 82 trials comprising of 5838 patients were included. The network comprised 17 psychotherapies and four control conditions. Network estimates indicated superior efficacy of meta-cognitive therapy and cognitive processing therapy over other psychotherapies (ESs between = 0.26 and 2.32). Written exposure therapy and narrative exposure therapy were associated with lower risk of drop out when considered alongside other psychotherapies. Confidence in the network meta-analytic estimates was considered moderate for both outcomes.
CONCLUSIONS: In broad terms, therapeutic commensurability was evident. Nevertheless, with additional studies and larger sample sizes, meta-cognitive and written exposure therapies could indeed differentiate themselves from other approaches as having favourable efficacy and acceptability respectively. These findings may inform clinical decision-making, as well as guide future research for PTSD.
Jones, C., Cruz, A. M., Smith-MacDonald, L., Brown, M. R. G., Vermetten, E., & Breamult-Phillips, S. (2021). Technology Acceptance and Usability of a Virtual Reality Intervention for Military Members and Veterans with Posttraumatic Stress Disorder: A Mixed Methods UTAUT Study. JMIR Rehabilitation and Assistive Technologies. Retrieved from https://preprints.jmir.org/preprint/33681
Open Access: https://preprints.jmir.org/preprint/33681
Chelsea Jones PhD, Heroes in Mind, Advocacy and Research Consortum Faculty of Rehabilitation Medicine, University of Alberta, 1-94 Corbett Hall, 8205 - 114 Street, Edmonton, CA.
Introduction: Military members (MMs) and veterans exhibit higher rates of injuries and illnesses such as posttraumatic stress disorder (PTSD) due to their increased exposure to combat and other traumatic scenarios. Novel treatments for PTSD are beginning to emerge and increasingly leverage advances in gaming and other technologies, such as virtual reality. Without assessing the degree of technology acceptance and perception of usability to the end users, including the MMs, veterans, as well as their attending therapists and staff, it is difficult to know if a technology-based assessment will be used successfully in wider clinical practice. The Unified Theory of Acceptance and Use of Technology (UTAUT) model is commonly utilized to address technology acceptance and usability of applications in 5 domains.
Purpose: Utilizing the UTAUT model, the purpose of this study is to determine the technology acceptance and usability of Multi-modal Motion-assisted Memory Desensitization and Reconsolidation (3MDR) on a virtual reality system in the primary user group (MMs and veterans with treatment resistant PTSD, 3MDR therapists, and virtual reality environment (VRE) operators).
Methods: This mixed-methods embedded pilot study had MMs (n=3) and veterans (n=8), with a diagnosis of combat-related PTSD, as well as their therapists (n=13), and operators (n=5) complete pre/post questionnaires prior to and on completion of 6 weekly sessions of 3MDR. A partial least squares structural equation model was utilized to analyze questionnaire results. Qualitative data from interviews were assessed via thematic analysis.
Results: Effort expectancy, which was the most notable predictor of behavioural intention, increased after a course of 3MDR with the virtual reality system while all over variables demonstrated no significant change. Participants’ expectations of the technology were met, demonstrated by non-significant differences in pre/post scores. The key qualitative themes included: (1) Feasibility and Function, (2) Technical Support, and (3) Tailored Immersion.
Conclusion: 3MDR via a VRE appears to be a feasible, usable, and accepted technology for delivering 3MDR to MMs and veterans who experience PTSD as well as the 3MDR therapists and operators who facilitate their treatment.
Kapteijn, C. M., van der Borg, J. A. M., Vinke, C. M., & Endenburg, N. (2021). On the applicability of eye movement desensitization and reprocessing (EMDR) as an intervention in dogs with fear and anxiety disorders after a traumatic event. Behaviour, 158(14-15), 1471-1487. doi:10.1163/1568539x-bja10123
Open Access: http://dx.doi.org/10.1163/1568539x-bja10123
C.M. Kapteijn, Department of Animals in Science & Society, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands E-mail: email@example.com
Fear and anxiety disorders are prevalent in dogs. These disorders are not adequately resolved by current interventions, which urges exploration of additional interventions. In humans, fear and anxiety disorders such as post-traumatic stress disorder (PTSD), are effectively treated by Eye Movement Desensitization and Reprocessing (EMDR). EMDR is a non-invasive and non- pharmacological intervention involving bilateral sensory stimulation while memorizing the traumatic event, resulting in decreased emotionality of the memory. We argue EMDR might be applied as an intervention for fear and anxiety disorders in dogs, adding to the currently available interventions for the field of Clinical Ethology. Particularly nonverbal EMDR protocols used in preverbal children can be applied and the setup can be adapted for dogs. Future research should focus on the development of nonverbal EMDR protocols including proper controls, and on clinical effectiveness of such EMDR protocols for dogs. Apart from behavioural measures, psychophysiological variables should be incorporated as well.
Kemal Kaptan, S., & Brayne, M. (2021). A qualitative study on clinicians’ perceptions of Attachment‐Focused eye movement desensitisation and reprocessing therapy. Counselling and Psychotherapy Research. doi:10.1002/capr.12479
Safa Kemal Kaptan, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Jean McFarlane Building, Oxford Road, M13 9PL Manchester, UK. E-mail: firstname.lastname@example.org
First identified and codified in the late 1980s by Dr Francine Shapiro, eye movement desensitisation and reprocessing (EMDR) therapy is increasingly recommended as a front-line response to post-traumatic stress disorder (PTSD). As PTSD is itself becoming understood as a consequence not just of single potentially traumatic events (PTEs) but also of experiences of dysfunctional attachment with primary caregivers in earlier childhood, EMDR therapy is starting to embrace attachment theory, and the need to factor an awareness of developmental trauma into therapeutic treatment. A development of the Standard EMDR Protocol, which builds on this understanding, has become known as Attachment-Focused EMDR (AF-EMDR). Although increasingly widely used by EMDR therapists, to date there has indeed been no published research into how AF-EMDR is experienced in practice by qualified and accredited AF-EMDR-trained therapists. This paper aims to begin to fill that gap.
A qualitative approach was employed, analysing semi-structured online interviews with eight experienced and AF-EMDR-trained UK-based therapists accredited at Consultant level with the EMDR Europe Association. Data were analysed using reflexive thematic analysis.
Three broad themes were generated from thematic analysis, namely perceptions of AF-EMDR; it is not versus, it is with; and EMDR itself as an innovative approach.
The study found AF-EMDR to be highly appreciated by therapists trained and experienced in this approach. Considering the nature of developmental trauma, the authors propose that core training and supervision in EMDR should allow more room for an explicit focus, in both case conceptualisation and treatment, on clients’ early-childhood attachment histories.
Laliotis, D., Luber, M., Oren, U., Shapiro, E., Ichii, M., Hase, M., . . . Tortes St. Jammes, J. (2021). What Is EMDR Therapy? Past, Present, and Future Directions. Journal of EMDR Practice and Research, 15(4), 186-201. doi:10.1891/EMDR-D-21-00029
Deany Laliotis, The Center for Excellence in EMDR Therapy, 3931 Jenifer Street, NW, Washington, DC 20015 USA. E-mail: email@example.com
Since its inception in 1989, eye movement desensitization and reprocessing (EMDR) therapy has evolved from a simple desensitization technique to treat posttraumatic stress disorder to a comprehensive psychotherapy approach that treats a broad range of clinical problems in a variety of contexts and with diverse populations. This position paper is the result of a two-year project by the Council of Scholars' “What is EMDR?” workgroup that was tasked with the particular challenge of defining EMDR therapy, as innovations in the field continue to develop and the need for a consensus definition has become essential. In addition to proposing categories of EMDR therapy, that is, EMDR psychotherapy, EMDR treatment protocols, and EMDR-derived techniques, we identified core elements of EMDR therapy that can serve as a guideline to evaluate future innovations. Additionally, with concepts and procedures evolving over the years, some of the language needed revising to be consistent with current practices. The adoption of these three categories of treatment by the EMDR community would have broad-reaching implications that would generate more qualitative as well as quantitative studies in all categories. For training and clinical practice, it offers clinicians the opportunity to train with a focus on their particular treatment setting in addition to the foundational training that would be universal to all EMDR-trained clinicians. Finally, the interplay in the Council of Scholars between the “What is EMDR?” workgroup and the research, clinical practice, and training and accreditation workgroups will lead to further developments as these areas all inform one another.
Lazzaroni, E., Invernizzi, R., Fogliato, E., Pagani, M., & Maslovaric, G. (2021). Coronavirus Disease 2019 Emergency and Remote Eye Movement Desensitization and Reprocessing Group Therapy With Adolescents and Young Adults: Overcoming Lockdown With the Butterfly Hug. Front Psychol, 12, 701381. doi:10.3389/fpsyg.2021.701381
Open Access: https://pubmed.ncbi.nlm.nih.gov/34512458
Elisa Lazzaroni, Asst Lecco, Lecco, Italy. E-mail: firstname.lastname@example.org
The coronavirus disease 2019 (COVID-19) pandemic has represented an individual and collective trauma with an impact on mental health. Restrictive measures such as lockdowns have increased risk factors for the development or triggering of various psychopathologies. Timely psychological intervention has constituted a protective factor that has been indicated as a form of prevention. The main objective of this study was to measure changes in the levels of traumatic stress and anxiety in a clinical population of adolescents and young adults aged 13 to 24 years - already assisted by the local primary and specialty care services before the pandemic - following a trauma-focused psychotherapeutic group intervention according to the eye movement desensitization and reprocessing protocol, conducted remotely before the end of the first lockdown. The Impact of Event Scale-Revised (IES-R), State-Trait Anxiety Inventory (STAI) scales, and the Emotion Thermometer were administered pre- and post-treatment. At the end of the treatment, the Post-Traumatic Growth Inventory (PTGI) questionnaire was administered. The results show that there was a significant improvement pre- and post-intervention in the scores of the scales STAI, IES-R, and Emotion Thermometer with a reduction in post-traumatic symptoms related in particular to the domains of intrusiveness and hyperarousal. The domain of avoidance was less significantly modified by therapy. This overall clinical improvement did not correlate with any of the demographic variables of the sample. In addition, the results show a significant positive global perceived change (PTGI) that did not correlate with the reduction of anxiety or post-traumatic symptoms measured by the other self-report scales. The explored use of telemedicine has revealed a valuable clinical opportunity.
Lee, E., Faber, J., & Bowles, K. (2021). A Review of Trauma Specific Treatments (TSTs) for Post-Traumatic Stress Disorder (PTSD). Clinical Social Work Journal. doi:10.1007/s10615-021-00816-w
Eunjung LeeView, Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1A1, Canada. E-mail: email@example.com
Trauma is a significant public health concern that has widespread and adverse effects on people. There is a high prevalence of trauma and PTSD in general populations, and that prevalence greatly increases among the clinical populations that social workers serve. To address the hidden epidemic of trauma, there are various trauma-specific treatments for PTSD. Scholars have highlighted a critical use of research evidence as a starting consideration in clinical decision-making and named the necessity to map out effective interventions according to population and types of trauma, including both conventional and non-conventional treatments. A rapid systematic review was conducted to fill this gap and found thirty-four empirically supported studies, including nineteen conventional and seven non-conventional treatment approaches for PTSD. The included conventional therapies are cognitive behavioral therapy (CBT), sleep-specific CBT, trauma-focused CBT, internet CBT, virtual reality exposure therapy, prolonged exposure, narrative exposure therapy, cognitive processing therapy, eye movement desensitization and reprocessing (EMDR), hypnotherapy, emotion focused therapy, skills training in affect and interpersonal regulations (STAIR), interpersonal psychotherapy (IPT), dialectical behavioral therapy (DBT), seeking safety, trauma incident reduction, accelerated resolution therapy (ART), metacognitive therapy, and imaginary rehearsal therapy. The non-conventional approaches included are yoga, physical activities, emotion freedom technique, acupuncture, mantram repetition program, mind–body therapy, and music therapy. We further explored the therapy content, population, type of trauma, outcomes, and strengths/limitations under each treatment to guide clinicians to select the best practice for idiosyncratic clients. Lastly, we discussed limitations of the current review, clinical considerations in selecting empirically supported treatment for PTSD and future research implications to guide clinical social workers.
Le Roux, I. H., & Cobham, V. E. (2021). Psychological Interventions for Children Experiencing PTSD After Exposure to a Natural Disaster: A Scoping Review. Clin Child Fam Psychol Rev. doi:10.1007/s10567-021-00373-1
Vanessa E. Cobham, School of Psychology, The University of Queensland, Brisbane, QLD, Australia. E-mail: firstname.lastname@example.org
Exposure to a natural disaster can have a myriad of significant and adverse psychological consequences. Children have been identified as a particularly vulnerable population being uniquely susceptible to post-disaster psychological morbidity, including post-traumatic stress disorder (PTSD). Without effective intervention, the impact of natural disasters on children's developmental trajectory can be detrimental, however, research is yet to find evidence to definitively establish the comparative efficacy or unequivocal superiority of any specific psychological intervention. A scoping review was undertaken according to the Preferred Reporting Items extension for Scoping Reviews Guidelines (PRISMA-ScR), to evaluate the current research regarding psychological interventions for children (below 18 years of age) experiencing PTSD after exposure to natural disasters, a single incident trauma. Fifteen studies involving 1337 children were included in the review. Overall, psychological interventions, irrespective of type, were associated with statistically significant and sustained reductions in PTSD symptomatology across all symptom clusters. However, whilst evidence supported the general efficacy of psychological interventions in this population, the majority of studies were considered retrospective field research designed in response to the urgent need for clinical service in the aftermath of a natural disaster. Consequently, studies were largely limited by environmental and resource constraints and marked by methodological flaws resulting in diverse and highly heterogeneous data. As such, definitive conclusions regarding the treatment efficacy of specific psychological interventions, and furthermore their ameliorative contributions constituting the necessary mechanisms of change remains largely speculative. As natural disasters can have a catastrophic impact on human lives, establishing levels of evidence for the efficacy of different psychological interventions for children represents a global public health priority.
Leutner, S., & Piedfort-Marin, O. (2021). The concept of ego state: From historical background to future perspectives. European Journal of Trauma & Dissociation, 5(4), 100184. doi:10.1016/j.ejtd.2020.100184
Olivier Piedfort-Marin, University of Lorraine, Metz, France. E-mail: email@example.com
Ego state theory (EST) and therapy was developed by Watkins and Watkins, based on Federn who first proposed the concept of ego state. The Watkins state that EST is based on three pillars: psychoanalysis, hypnosis and Janet’s concept of dissociation. EST has been a major theory and therapy for the treatment of complex traumatization, in particular dissociative disorders, and is also a therapy helpful for other types of difficulties and pathologies.
This paper aims at clarifying the theoretical background of EST, as well as recent inputs from EST therapists, and how new concepts on trauma and dissociation challenged and influenced modern EST.
Method and results
After a thorough analysis of the literature, we provide with a detailed presentation of the main concepts of EST, their strengths and coherence, as well as the lack of coherence of some of these concepts. The development of EST stretches over several decades and attests to the richness of this integrative therapy and to the challenging development of the understanding of trauma and its sequalae.
Even if the theoretical foundation of EST is imperfect, EST has developed an integrative model of psychotherapy for traumatized individuals that is still valuable today. EST should be acknowledged for its great influence on modern psychotraumatology and on the treatment of dissociative identity disorder.
Lortye, S. A., Will, J. P., Marquenie, L. A., Goudriaan, A. E., Arntz, A., & de Waal, M. M. (2021). Treating posttraumatic stress disorder in substance use disorder patients with co-occurring posttraumatic stress disorder: study protocol for a randomized controlled trial to compare the effectiveness of different types and timings of treatment. BMC Psychiatry, 21(1), 442. doi:10.1186/s12888-021-03366-0
Open Access: https://pubmed.ncbi.nlm.nih.gov/34493253
Sera A. Lortye, Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands. E-mail: firstname.lastname@example.org
BACKGROUND: Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) have high comorbidity. Although prior research indicated that PTSD can effectively be treated with Prolonged Exposure (PE) in these patients, reported effects are small and treatment dropout rates high. Eye Movement Desensitization and Reprocessing (EMDR) and Imagery Rescripting (ImRs) are other promising treatment options for PTSD, that have not yet been examined in this patient group. Furthermore, it is unclear whether PTSD treatment is most effective when offered simultaneous to or after SUD treatment.
METHODS: In this article, the Treatment Of PTSD and Addiction (TOPA) study is described: a Dutch randomized controlled trial (RCT) that studies the effectiveness of PTSD treatment as an add-on to regular SUD treatment in patients with SUD and co-occurring PTSD. Effects of PE, EMDR, ImRs, and a 3-month SUD treatment only condition will be compared, as well as simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment. The primary outcome measure is PTSD symptoms. Secondary outcomes are: treatment completion, psychological distress, substance use, interpersonal problems, emotion dysregulation, and trauma-related emotions guilt, shame, and anger.
DISCUSSION: This study is the first to compare effects of PE, EMDR, and ImRs in one study and to compare simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment as well. This RCT will provide more knowledge about the effectiveness of different treatment strategies for PTSD in patients with co-occurring SUD and will ultimately improve treatment outcomes for patients with this common co-morbidity worldwide.
TRIAL REGISTRATION: Netherlands Trial Register (NTR), Identifier: NL7885. Registered 22 July 2019.
Malik, N., Facer-Irwin, E., Dickson, H., Bird, A., & MacManus, D. (2021). The Effectiveness of Trauma-Focused Interventions in Prison Settings: A Systematic Review and Meta-Analysis. Trauma Violence Abuse, 15248380211043890. doi:10.1177/15248380211043890
Nabeela Malik, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, Camberwell, SE5 8AF, United Kingdom. E-mail: email@example.com
BACKGROUND: Posttraumatic stress disorder (PTSD) is overrepresented in prison relative to community populations and can be difficult to manage in an environment which can inherently exacerbate trauma-related symptomology. Little is known about the effectiveness of trauma-focused interventions in prison and less is known about factors that moderate the effectiveness of these interventions.
AIM/METHODS: We examined the effectiveness of trauma-focused interventions in prison relative to prison controls using meta-analytic techniques. We further used meta-regression analysis to examine treatment, methodological and participant-level moderators to determine factors that increased the effectiveness of these interventions.
RESULTS: From 16 studies eligible for the meta-analysis, we found a small but significant effect size for trauma-focused interventions. Phase 2 trauma processing interventions and interventions delivered individually led to greater reductions in PTSD symptoms. Studies utilizing an active treatment control resulted in smaller effect sizes than those using waitlist or no contact controls. Treatment length, study quality, outcome type, and gender were not significant moderators of treatment effectiveness.
CONCLUSION: Findings from this review are encouraging but should be interpreted with caution. Results suggest that trauma processing therapies, and individual modality trauma-focused interventions can be effective and delivered successfully in prison. However, inadequate comparison groups do not allow a firm conclusion to be drawn. There is a need for high quality Randomized Controlled Trial's that additionally measure Complex PTSD, utilize a modular treatment approach, and include treatments recommended in the National Institute for health and Care Excellence (NICE) guidelines such as Trauma-focused CBT and Eye Movement Desensitization Reprocessing (EMDR).
Martin, A., Naunton, M., Kosari, S., Peterson, G., Thomas, J., & Christenson, J. K. (2021). Treatment Guidelines for PTSD: A Systematic Review. Journal of Clinical Medicine, 10(18), 4175. doi:10.3390/jcm10184175
Open Access: http://dx.doi.org/10.3390/jcm10184175
Background: The aim of this review was to assess the quality of international treatment guidelines for post-traumatic stress disorder (PTSD), and identify differences between guideline recommendations, with a focus on the treatment of nightmares.
Methods: Guidelines were identified through electronic searches of MEDLINE, CINAHL, PubMed, Embase and Science Direct, as well as web-based searches of international guideline repositories, websites of psychiatric organisations and targeted web-searches for guidelines from the three most populous English-speaking countries in each continent. Data in relation to recommendations were extracted and the AGREE II criteria were applied to assess for quality. Results: Fourteen guidelines, published between 2004–2020, were identified for inclusion in this review. Only five were less than 5 years old. Three guidelines scored highly across all AGREE II domains, while others varied between domains. Most guidelines consider both psychological and pharmacological therapies as first-line in PTSD. All but one guideline recommended cognitive behavioural therapy (CBT) as first-line psychological treatment, and selective serotonin reuptake inhibitors (SSRIs) as first-line pharmacological treatment. Most guidelines do not mention the targeted treatment of nightmares as a symptom of PTSD. Prazosin is discussed in several guidelines for the treatment of nightmares, but recommendations vary widely. Most PTSD guidelines were deemed to be of good quality; however, many could be considered out of date. Recommendations for core PTSD symptoms do not differ greatly between guidelines. However, despite the availability of targeted treatments for nightmares, most guidelines do not adequately address this. Conclusions: Guidelines need to be kept current to maintain clinical utility. Improvements are most needed in the AGREE II key domains of ‘applicability’, ‘rigour of development’ and ‘stakeholder involvement’. Due to the treatment-resistant nature of nightmares, guideline development groups should consider producing more detailed recommendations for their targeted treatment. More high-quality trials are also required to provide a solid foundation for making these clinical recommendations for the management of nightmares in PTSD.
Martinmäki, S. E., van der Aa, N., Nijdam, M. J., Pommée, M., & Ter Heide, F. J. J. (2021). Treatment response and treatment response predictors of a multidisciplinary day clinic for police officers with PTSD. Psychol Trauma. doi:10.1037/tra0001128
Correspondence concerning this article should be addressed to Saara E.
Martinmäki, ARQ National Psychotrauma Centre, PO Box 240, 1110 AE Diemen, the Netherlands. E-mail: s .firstname.lastname@example.org
OBJECTIVE: Police officers typically face multiple potentially traumatic events and consequently have a higher conditional probability of developing PTSD. Although most police officers with PTSD benefit from first-line treatment, it is unknown whether recommended intensification of treatment for low responders is effective and which factors contribute to response. This study aimed to examine the treatment response of a day clinic for police officers with PTSD and identify predictors of treatment response.
METHOD: Between 2009 and 2019, routine outcome monitoring measurements consisting of PTSD symptom severity and general psychological distress were administered at two timepoints among 102 patients undergoing a day clinic treatment consisting of trauma-focused therapy, sociotherapy, and psychomotor therapy. Hierarchical regression was used to assess whether change in PTSD symptom severity was associated with baseline PTSD and depression severity, gender, age, and eligibility for a recognition procedure.
RESULTS: Significant improvements in PTSD symptom severity were found over the course of the treatment (d = .59), with 47% of patients showing statistically reliable improvement in their symptoms. The only significant predictor of treatment response was eligibility for a recognition procedure, with the total model explaining approximately 10% of the variation in treatment response.
CONCLUSIONS: Intensifying treatment for police officers with PTSD who do not respond to previous trauma-focused treatment appears beneficial for a substantial number of patients. However, eligibility for a recognition procedure may negatively impact treatment response.
Matthijssen, S. J. M. A., Brouwers, T., van Roozendaal, C., Vuister, T., & de Jongh, A. (2021). The effect of EMDR versus EMDR 2.0 on emotionality and vividness of aversive memories in a non-clinical sample. Eur J Psychotraumatol, 12(1), 1956793. doi:10.1080/20008198.2021.1956793
Open Access: https://pubmed.ncbi.nlm.nih.gov/34567439
Suzy J.M.A. Matthijssen, SH 3524, Altrecht Academic Anxiety Centre, Altrecht GGZ, Nieuwe Houtenseweg 12, Utrecht, The Netherlands. E-mail: email@example.com
Background: Eye movement desensitization and reprocessing (EMDR) therapy is a treatment meant to reduce vividness and emotionality of distressing memories. There is accumulating evidence that working memory taxation is the core of the working mechanism of EMDR therapy and that EMDR derives its effect by taxing the working memory (WM) with a dual task while actively keeping a disturbing memory in mind. From a theoretical stance, based upon assumptions derived from the WM theory, the effectiveness of EMDR therapy could be improved by several adaptations.
Objectives: To test the assumption that integrating these elements into the standard EMDR protocol would enhance EMDR therapy, this adapted version of EMDR (i.e. EMDR 2.0), was compared to standard EMDR in a laboratory setting. It was hypothesized that EMDR 2.0 would be more efficacious than standard EMDR, and show a greater decrease in emotionality and vividness than standard EMDR therapy. Our second hypothesis was that EMDR 2.0 would be more efficient than standard EMDR in that this variant needs less session time and a smaller number of sets (i.e. approximately 30 seconds of WM taxation).
Method: Non-clinical participants (N = 62, 79% female, mean age = 35.21) with a disturbing autobiographical memory were randomly allocated to receive either EMDR or EMDR 2.0. Emotionality and vividness of the memory were measured pre- and post-intervention, and at 1- and 4-week follow-up.
Results: The results showed no difference between EMDR and EMDR 2.0 in decreasing emotionality and vividness, and no difference in session time. However, participants in the EMDR 2.0 condition needed fewer sets than those in the standard EMDR condition. Conclusion: The notion that EMDR 2.0 is more efficient is partially supported by the results showing participants needed less sets than in standard EMDR to reach the same results. Future research with clinical samples is warranted.
McGowan, I. W., Fisher, N., Havens, J., & Proudlock, S. (2021). An evaluation of eye movement desensitization and reprocessing therapy delivered remotely during the Covid-19 pandemic. BMC Psychiatry, 21(1), 560. doi:10.1186/s12888-021-03571-x
Open Access: https://pubmed.ncbi.nlm.nih.gov/34763697
Iain W. McGowan, School of Nursing and Midwifery, Queens University, Belfast, UK. E-mail: firstname.lastname@example.org
BACKGROUND: In addition to having a negative impact on the physical and emotional health of the population, the global Covid-19 pandemic has necessitated psychotherapists moving their practice to online environments. This service evaluation examines the efficacy of Eye Movement Desensitization and Reprocessing (EMDR) Therapy delivered via the internet.
METHODS: A real-world service evaluation was conducted from a self-selecting group of EMDR therapists that subscribe to either a JISCMail discussion list or either the UK or All Ireland National EMDR Associations. Author designed questionnaires were used to gather information on the efficacy of EMDR delivered online as well as client and therapist characteristics.
RESULTS: Thirty-three therapists provided efficacy data on a total of 93 patients. Statistically significant and clinically meaningful reductions were found in all four-psychometrics used both in adult and children and young people populations. Client outcome was not related to therapist experience.
CONCLUSIONS: EMDR delivered via the internet can be an effective treatment for clients experiencing mental health issues.
Mertens, G., Lund, M., & Engelhard, I. M. (2021). The effectiveness of dual-task interventions for modulating emotional memories in the laboratory: A meta-analysis. Acta Psychol (Amst), 220, 103424. doi:10.1016/j.actpsy.2021.103424
Open Access: https://pubmed.ncbi.nlm.nih.gov/34619553
Gaetan Mertens, Department of Medical and Clinical Psychology, Warandelaan 2, room T526, Tiburg University, 5037 AB Tilburg, the Netherlands.
E-mail address: email@example.com
Dual-tasks (e.g., making horizontal eye-movements) while recollecting a memory are often used both in the lab and the clinic (such as in EMDR therapy) to attenuate emotional memories and intrusive mental images. According to working memory theory, dual-task interventions are effective because they limit cognitive resources available for the processing of emotional memories. However, there is still ongoing debate about the extent to which and under what conditions dual-task interventions are effective to interfere with emotional memories. In this meta-analysis, we assessed k = 53 laboratory studies investigating the effects of dual-task interventions on negative and positive memories. The effects were measured with the raw mean reduction in vividness and emotionality self-report ratings of emotional memories before compared to after the intervention on 100-point rating scales. Results showed that the dual-task interventions made both negative and positive memories less vivid (mean reduction negative images = 9.18, 95% CI [7.06, 11.29]; mean reduction positive images = 11.73, 95% CI [8.59, 14.86]) and less emotional (mean reduction negative images = 6.22, 95% CI [4.50, 7.94]; mean reduction positive images = 6.71, 95% CI [2.21, 11.20]). Several moderators were tested and are discussed in the light of working memory theory.
Mischler, C., Hofmann, A., Behnke, A., Matits, L., Lehnung, M., Varadarajan, S., . . . Tumani, V. (2021). Therapists’ Experiences With the Effectiveness and Feasibility of Videoconference-Based Eye Movement Desensitization and Reprocessing. Front Psychol, 12, 748712. doi:10.3389/fpsyg.2021.748712
Open Access: https://pubmed.ncbi.nlm.nih.gov/34675854
Corinna Mischler, Department of Psychiatry, Ulm University Hospital, Ulm, Germany. E-mail: firstname.lastname@example.org
Research on the effectiveness and applicability of eye movement desensitization and reprocessing (EMDR) via videoconference is sparse. Considering the emerging use of internet-based psychotherapy during the COVID-19 pandemic, information on videoconference-based EMDR (eEMDR) would be beneficial for many therapists. In this study, 23 therapists from the EMDR-Institute in Germany provided information about their experiences with eEMDR in a questionnaire-based survey. Information on the effectiveness and the course of 102 eEMDR sessions was recorded. Results showed the potential of eEMDR as an effective and viable method. The decrease in the subjective unit of disturbance (SUD), which is an important indicator of treatment outcome, was found to be at a similar level compared to that of previous EMDR studies that were not administered in eEMDR format. The most important predictor of the SUD decrease was the type of bilateral stimulation used in eEMDR sessions. Eye movements resulted in significantly greater SUD reductions than tapping. Perceived disadvantages and impediments for the implementation of eEMDR were mainly of bureaucratic and technical concerns. In addition, about one-third of the therapists stated that some patients were not willing to engage in eEMDR. In our study, eEMDR proved to be a practically applicable therapy method and therefore, therapists can consider using eEMDR. These findings will hopefully encourage EMDR therapists and their patients to use eEMDR due to its effectiveness and viability as an online treatment approach.
Olivier, E., de Roos, C., & Bexkens, A. (2021). Eye Movement Desensitization and Reprocessing in Young Children (Ages 4-8) with Posttraumatic Stress Disorder: A Multiple-Baseline Evaluation. Child Psychiatry Hum Dev. doi:10.1007/s10578-021-01237-z
Eline Olivier, Psymens, Korenmolenlaan 1D, 3447 GG Woerden, The Netherlands. E-mail: email@example.com
To reduce the acute and long-term effects of trauma, early and effective treatment is necessary. Eye movement desensitization and reprocessing (EMDR) therapy is a brief treatment for posttraumatic stress disorder (PTSD), with a substantial evidence base for children and adolescents aged 8 to 18 years. In the present study we aimed to provide preliminary evidence of EMDR as a trauma treatment for young children. We studied 9 children, aged 4 to 8 years old with a DSM-5 diagnosis of PTSD. A non-concurrent multiple baseline experimental design was used combined with standardized measures. Participants received six 1-h sessions of EMDR. Results post-treatment showed that EMDR was effective in reaching diagnostic remission of PTSD (85.7%), and decreasing severity of PTSD symptoms and emotional and behavioral problems. All gains were maintained at follow-up 3 months after treatment. EMDR appears an effective treatment for PTSD in young children aged 4 to 8 years. Further research is warranted.
Pierce, Z. P., & Black, J. M. (2021). The Neurophysiology Behind Trauma-Focused Therapy Modalities Used to Treat Post-Traumatic Stress Disorder Across the Life Course: A Systematic Review. Trauma Violence Abuse, 15248380211048446. doi:10.1177/15248380211048446
Zachary P. Pierce, Boston College, School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA. E-mail: firstname.lastname@example.org
This review presents the current state of understanding of trauma-informed modalities in light of current research in neuroscience, analyzing which brain structures and processes are impacted by these modalities. Studies included in the present review met the inclusion criteria of 1) addressing post-traumatic stress disorder (PTSD) in a specific population, 2) treatment of PTSD using any of the evidence-based trauma-informed modalities considered in this review, and 3) presenting functional magnetic resonance imagery (fMRI) data, derived from BOLD signals and voxel-compression maps, of brain structures impacted by these trauma-informed modalities. Articles for this review were collated through PubMed and MEDLINE, using key terms in descending order, such as 'childhood trauma', 'adolescent trauma', and 'adulthood trauma', to 'PTSD', 'fMRI', and so on, depending on the modality in question. Based on these criteria and research methods, 37 studies remained for inclusion in the present review. Among a number of critical findings, this review demonstrates that eye movement desensitization and reprocessing (EMDR) and mindfulness therapy effectively deactivate hindbrain regions implicated in the downregulation of autonomic nervous system (ANS) hyperarousal. This review also shows that trauma-focused cognitive behavioral therapy (TF-CBT) and EMDR activate the hippocampus, anterior cingulate cortex (ACC), medial prefrontal cortex (mPFC), and orbitofrontal cortex (OFC)-areas that are implicated in crucial cognitive, affective, and behavioral processes that aid trauma survivors in navigating their challenges.
Reitmaier, J., Schiller, A., Mühlberger, A., Pfaller, M., Meyer, M., & Shiban, Y. (2021). Effects of rhythmic eye movements during a virtual reality exposure paradigm for spider-phobic patients. Psychol Psychother. doi:10.1111/papt.12363
Youssef Shiban, PFH – Private University of Applied Sciences, Weender Landstraße 3-7, 37073 Gottingen, Germany. E-mail: email@example.com
Rhythmic eye movements performed during eye movement desensitization and reprocessing (EMDR) therapy have been shown to evoke a physiological de-arousal pattern.
OBJECTIVES: Here, we examined whether the efficacy of a virtual reality exposure therapy (VRET) paradigm for phobic patients could be improved by adding rhythmic eye movements.
DESIGN: Spider-phobic patients (N = 53) were randomly assigned to either a group performing rhythmic eye movements or a control group undergoing exposure without such eye movements.
METHODS: During the VRET session, heart rate, electrodermal activity, eye movements, and subjective fear ratings were recorded. Participants underwent behavioural avoidance tests before and after treatment as well as a follow-up 10-14 days later. Questionnaire data were assessed before exposure and at follow-up.
RESULTS: There were clear treatment effects in both groups with almost no group differences (i.e., the subjective fear ratings and the skin conductance response).
CONCLUSIONS: Contrary to our expectation, the implementation of rhythmic eye movements during virtual exposure did not enhance the effectiveness of the treatment. However, the eye movement group did show a significantly lower heart rate during exposure compared with the control group which might indicate a less stressful treatment.
PRACTITIONER POINTS: One-session Virtual Reality Exposure Therapy reduced fear of spiders effectively. Performing rhythmic eye movements during exposure did not enhance therapy effects. Rhythmic eye movements during exposure resulted in lower heart rate than standard exposure.
Roque-Lopez, S., Llanez-Anaya, E., Álvarez-López, M. J., Everts, M., Fernández, D., Davidson, R. J., & Kaliman, P. (2021). Mental health benefits of a 1-week intensive multimodal group program for adolescents with multiple adverse childhood experiences. Child Abuse Negl, 122, 105349. doi:10.1016/j.chiabu.2021.105349
Open Access: https://pubmed.ncbi.nlm.nih.gov/34628152
Perla Kaliman, Center for Healthy Minds, University of Wisconsin-Madison, 625 W. Washington Ave., Madison, WI 53703, United States of America. E-mail address: firstname.lastname@example.org
BACKGROUND: Adverse childhood experiences (ACEs) are associated with a wide range of diseases, unsafe behavior and shorter life expectancy. However, there is scarce evidence on effective interventions for children or adolescents who report multiple ACEs, including abuse, neglect and household dysfunction.
OBJECTIVE: The aim of this study was to evaluate the mental health outcomes of a multimodal program designed for adolescents with multiple ACEs.
PARTICIPANTS: Forty-four girls (aged 13-16 years, mean ACE score > 5) were randomized to an intervention group or a care-as-usual control group.
METHODS: The intervention included mindfulness-based practices, expressive arts and EMDR (Eye Movement Desensitization and Reprocessing Integrative) group treatment. We used questionnaires for adolescents to assess trauma (SPRINT, CPSS) and attention/awareness-related outcomes (MAAS-A) at baseline (T1), post-intervention (T2) and two-months post-discharge (T3).
RESULTS: Linear mixed effects model analyses showed significant Group by Time interactions on all the scales (F = 11.0, p = 0.015; F = 12.5 p < 0.001; and F = 6.4, p = 0.001, for SPRINT, CPSS and MAAS-A, respectively). After completing the program, the intervention group showed significant reduction in trauma-related outcomes (SPRINT, Δ%|(T2-T1)| = -73%, p < 0.001; CPSS, Δ%|(T2-T1)| = -26%, p < 0.001) while attention/awareness-related outcomes were improved by 57% (p < 0.001). These changes remained stable two months after discharge. SPRINT and CPSS scales were highly correlated (r = 0.833, p < 0.001) and outcomes from both trauma-related scales negatively correlated with mindfulness scores (MAAS-A/SPRINT, r = -0.515, p = 0.007; MAAS-A/CPSS, r = -0.553, p < 0.001).
CONCLUSIONS: Results presented here support this multimodal group intervention as a feasible and promising program for reducing the psychological burden in adolescents with a history of multiple ACEs.
Scelles, C., & Bulnes, L. C. (2021). EMDR as Treatment Option for Conditions Other Than PTSD: A Systematic Review. Front Psychol, 12, 644369. doi:10.3389/fpsyg.2021.644369
Open Access: https://pubmed.ncbi.nlm.nih.gov/34616328
Charles Scelles, Adult Psychiatry Department, Université Catholique de Louvain – Saint Luc University Hospital, Brussels, Belgium. E-mail: email@example.com
Luis Carlo Bulnes, Brain, Body and Cognition Research Group, Vrije Universiteit Brussel, Brussels, Belgium. E-mail: firstname.lastname@example.org
Eye Movement Desensitisation and Reprocessing (EMDR) is a treatment for post-traumatic stress disorder (PTSD). The technique is known to facilitate reprocessing of maladaptive memories that are thought to be central to this pathology. Here we investigate if EMDR therapy can be used in other conditions. We conducted a systematic literature search on PubMed, ScienceDirect, Scopus, and Web of Science. We searched for published empirical findings on EMDR, excluding those centred on trauma and PTSD, published up to 2020. The results were classified by psychiatric categories. Ninety articles met our research criteria. A positive effect was reported in numerous pathological situations, namely in addictions, somatoform disorders, sexual dysfunction, eating disorders, disorders of adult personality, mood disorders, reaction to severe stress, anxiety disorders, performance anxiety, Obsessive-Compulsive Disorder (OCD), pain, neurodegenerative disorders, mental disorders of childhood and adolescence, and sleep. Some studies reported that EMDR was successful in usually uncooperative (e.g., Dementia) or unproductive cases (e.g., aphasia). Moreover, in some severe medical conditions, when psychological distress was an obstacle, EMDR allowed the continuation of treatment-as-usual. Furthermore, the effects observed in non-pathological situations invite for translational research. Despite a generally positive outlook of EMDR as an alternative treatment option, more methodologically rigorous studies are needed. We discuss the advantages and limitations and possible implications for the hypothesised mechanisms of action.
Schrader, C., & Ross, A. (2021). A Review of PTSD and Current Treatment Strategies. Missouri Medicine, 118(6), 546. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8672952
Open Access: https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8672952
Christian Schrader, MD, Carl R. Darnall Army Medical Center Psychiatry Residency, Fort Hood, Texas.
Current treatment strategies for control of trauma-associated symptoms of Post Traumatic Stress Disorder (PTSD) have recently been updated by the Veterans Affairs (VA) and the Department of Defense (DoD, after over a decade of dedicated research. The most recent evidence is compelling that its use of trauma-focused therapies such as Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PE), Eye Movement, Desensitization, and Restructuring (EMDR), and others with significant trauma focus are the current gold standard for treatment. Additional medication use may be of assistance in treatment of symptomology, with special avoidance of benzodiazepines or other sedative hypnotic medications which are causal of increased intrusive and dissociative symptoms over time.
Schwarz, J. E., Baber, D., Giantisco, E., & Isaacson, B. (2021). EMDR for Survivors of Sexual and Intimate Partner Violence at a Nonprofit Counseling Agency. Journal of EMDR Practice and Research, 15(4), 202-217. doi:10.1891/EMDR-D-21-00014
Jill E. Schwarz, Associate Professor and School Counseling Program Coordinator, The College of New Jersey, 2000 Pennington Road, Ewing, NJ 08628. E-mail: schwarz@ tcnj.edu
Trauma related to sexual violence and intimate partner violence (IPV) affects millions of women, resulting in detrimental impacts to economic, physical, and mental health. Survivors are often subjected to repeated acts of violence or abuse, compounding the trauma and its effects. Participants in this mixed-methods research study included 41 women who experienced trauma related to sexual violence or IPV and were seeking counseling services at a nonprofit community agency. Quantitative assessment of depression, anxiety, and posttraumatic stress disorder (PTSD) through validated measures showed statistically significant improvement in all areas after eight sessions of eye movement desensitization and reprocessing (EMDR). Qualitative analysis through semi-structured individual interviews revealed improvements in assertiveness, self-control, functionality, and self-acceptance. Increasing access to EMDR across underserved communities, which are disproportionately affected by trauma, is discussed.
Shorey, S., Downe, S., Chua, J. Y. X., Byrne, S. O., Fobelets, M., & Lalor, J. G. (2021). Effectiveness of Psychological Interventions to Improve the Mental Well-Being of Parents Who Have Experienced Traumatic Childbirth: A Systematic Review and Meta-Analysis. Trauma Violence Abuse, 15248380211060808. doi:10.1177/15248380211060808
Shefaly Shorey, PhD, RN, RM, Assistant Professor, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11 10 Medical Drive, 117597, Singapore.
Considering the adverse impact that traumatic childbirth experiences can have on parental mental well-being, studies that have investigated the potential of providing postnatal psychological support for this group of parents require evaluation. This systematic review aimed to examine the effectiveness of psychological interventions at improving the mental well-being of parents who have experienced traumatic childbirth in terms of anxiety, depression, fear of childbirth, and post-traumatic stress disorder (PTSD) symptoms. Seven electronic databases were searched from their respective inception dates up to January 2021. Only quantitative studies that reported the effects of psychological interventions on anxiety, depression, fear of childbirth, and/or PTSD symptoms in selective (at risk of traumatic childbirth experience) or indicated (self-defined childbirth experience as traumatic for any reason) populations of parents (mothers and/or fathers) were included. Eight studies were included and meta-analyses were conducted using a random-effect model. All studies were conducted on mothers only, and one study had minimal father involvement. Results showed that psychological interventions were more effective in reducing fear of childbirth and improving PTSD symptoms compared to anxiety and depression. Greater improvement in depression was reported at 3–8 weeks’ follow-up than at immediate post-intervention. Subgroup analyses showed that technology-based interventions were feasible, and indicated interventions were more effective than selective interventions. Conducting future interventions in more geographical regions, engaging and including fathers more actively, incorporating both personalized professional therapy and informal peer support, striving for flexibility and convenience, as well as addressing topics on self-doubt and coping skills can improve current interventions.
Storm, M. P., & Christensen, K. S. (2021). Comparing treatments for post-traumatic stress disorder-a systematic review. Danish medical journal, 68(9), A09200643. Retrieved from https://ugeskriftet.dk/dmj/comparing-treatments-post-traumatic-stress-disorder-systematic-review
Open Access: https://ugeskriftet.dk/dmj/comparing-treatments-post-traumatic-stress-disorder-systematic-review
Mette Pernille Storm. E-mail: email@example.com
INTRODUCTION. The recommended treatments for post-traumatic stress disorder (PTSD) are psychological therapies and medication, but the best approach is still discussed. Exposure to traumatic events in psychotherapy tends to cause high drop-out rates. Likewise, little effect or adverse events of medications may lead to attrition. The aim of this study was to compare the outcomes of treatment by psychotherapy and medications. An additional aim was to explore the combinations of treatment modalities in adults with PTSD and to investigate differences in drop-out rates.
METHODS. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. PubMed and Embase were searched for relevant randomised clinical trials. The Cochrane risk-of-bias tool was used to assess the quality of the retrieved trials.
RESULTS. Seven eligible studies were identified. Three studies showed that psychotherapy was superior to selective serotonin reuptake inhibitors. Two studies showed an augmenting effect with prolonged exposure. Two studies showed no differences across the treatment groups. In four of the included studies, patients treated with psychotherapy were more likely to drop out.
CONCLUSIONS. Extant evidence is insufficient to assess whether combined therapy is superior to monotherapy. Both medication and psychotherapy have an effect on PTSD, but psychotherapy tends to provide greater and more long-lasting outcome improvements. Trauma type, PTSD severity and other variables affect drop-out rates and treatment outcomes.
Straub, R. K., & Powers, C. M. (2021). Chronic Fatigue Syndrome: A Case Report Highlighting Diagnosing and Treatment Challenges and the Possibility of Jarisch-Herxheimer Reactions If High Infectious Loads Are Present. Healthcare (Basel), 9(11), 1537. doi:10.3390/healthcare9111537
Open Access: https://pubmed.ncbi.nlm.nih.gov/34828583
Rachel K. Straub, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E. Alcazar St., CHP-155, Los Angeles, CA 90089-9006, USA. E-mail: firstname.lastname@example.org
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex multi-system disease with no cure and no FDA-approved treatment. Approximately 25% of patients are house or bedbound, and some are so severe in function that they require tube-feeding and are unable to tolerate light, sound, and human touch. The overall goal of this case report was to (1) describe how past events (e.g., chronic sinusitis, amenorrhea, tick bites, congenital neutropenia, psychogenic polydipsia, food intolerances, and hypothyroidism) may have contributed to the development of severe ME/CFS in a single patient, and (2) the extensive medical interventions that the patient has pursued in an attempt to recover, which enabled her to return to graduate school after becoming bedridden with ME/CFS 4.5 years prior. This paper aims to increase awareness of the harsh reality of ME/CFS and the potential complications following initiation of any level of intervention, some of which may be necessary for long-term healing. Treatments may induce severe paradoxical reactions (Jarisch-Herxheimer reaction) if high infectious loads are present. It is our hope that sharing this case will improve research and treatment options for ME/CFS.
Tang, E., Jones, C., Smith-MacDonald, L., Brown, M. R. G., Vermetten, E. H. G. J. M., & Brémault-Phillips, S. (2021). Decreased Emotional Dysregulation Following Multi-Modal Motion-Assisted Memory Desensitization and Reconsolidation Therapy (3MDR): Identifying Possible Driving Factors in Remediation of Treatment-Resistant PTSD. Int J Environ Res Public Health, 18(22), 12243. doi:10.3390/ijerph182212243
Open Access: https://pubmed.ncbi.nlm.nih.gov/34831999
Suzette Brémault-Phillips, Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada. email@example.com
Multi-modal motion-assisted memory desensitization and reconsolidation therapy (3MDR), an interactive, virtual reality-assisted, exposure-based intervention for PTSD, has shown promising results for treatment-resistant posttraumatic stress disorder (TR-PTSD) among military members (MMs) and veterans in randomized controlled trials (RCT). Previous research has suggested that emotional regulation (ER) and emotional dysregulation (ED) may be factors which are correlated with symptom severity and maintenance of TR-PTSD. This embedded mixed-methods pilot study (n = 9) sought to explore the impact of 3MDR on ER and ED of MMs and veterans. Difficulties in Emotional Regulation Scale (DERS-18) data were collected at baseline, prior to each session, and at one week, one month, and three months postintervention and analyzed. Qualitative data collected from sessions, debriefs, and follow-up interviews were transcribed and descriptively analyzed. Results demonstrated statistically significant decreases in DERS-18 scores from preintervention to postintervention at each timepoint. Qualitatively, participants perceived improvements in ER within specified DERS-18 domains. We describe how 3MDR's unique and novel approach addresses ED through cognitive-motor stimulation, narration, divergent thinking, reappraisal of aversive stimuli, dual-task processing, and reconsolidation of traumatic memories. More studies are needed to better understand the underlying neurobiological mechanisms by which 3MDR addresses ER and PTSD.
Taylor Miller, P. G., Sinclair, M., Gillen, P., McCullough, J. E. M., Miller, P. W., Farrell, D. P., . . . Klaus, P. (2021). Early psychological interventions for prevention and treatment of post-traumatic stress disorder (PTSD) and post-traumatic stress symptoms in post-partum women: A systematic review and meta-analysis. Plos one, 16(11), e0258170. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258170
Open Access: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258170
M. Sinclair, Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University, Belfast, Northern Ireland, United Kingdom. E-mail: firstname.lastname@example.org
Pre-term or full-term childbirth can be experienced as physically or psychologically traumatic. Cumulative and trans-generational effects of traumatic stress on both psychological and physical health indicate the ethical requirement to investigate appropriate preventative treatment for stress symptoms in women following a routine traumatic experience such as childbirth.
The objective of this review was to investigate the effectiveness of early psychological interventions in reducing or preventing post-traumatic stress symptoms and post-traumatic stress disorder in post-partum women within twelve weeks of a traumatic birth.
Randomised controlled trials and pilot studies of psychological interventions preventing or reducing post-traumatic stress symptoms or PTSD, that included women who had experienced a traumatic birth, were identified in a search of Cochrane Central Register of Randomised Controlled Trials, MEDLINE, Embase, Psychinfo, PILOTS, CINAHL and Proquest Dissertations databases. One author performed database searches, verified results with a subject librarian, extracted study details and data. Five authors appraised extracted data and agreed upon risk of bias. Analysis was completed with Rev Man 5 software and quality of findings were rated according to Grading of Recommendation, Assessment, Development, and Evaluation.
Eleven studies were identified that evaluated the effectiveness of a range of early psycho- logical interventions. There was firm evidence to suggest that midwifery or clinician led early psychological interventions administered within 72 hours following traumatic childbirth are more effective than usual care in reducing traumatic stress symptoms in women at 4–6 weeks. Further studies of high methodological quality that include longer follow up of 6–12 months are required in order to substantiate the evidence of the effectiveness of specific face to face and online early psychological intervention modalities in preventing the effects of stress symptoms and PTSD in women following a traumatic birth before introduction to routine care and practice.
van Vliet, N. I., Huntjens, R. J. C., van Dijk, M. K., Bachrach, N., Meewisse, M.-L., & de Jongh, A. (2021). Phase-based treatment versus immediate trauma-focused treatment for post-traumatic stress disorder due to childhood abuse: randomised clinical trial. BJPsych Open, 7(6). doi:10.1192/bjo.2021.1057
Open Access: http://dx.doi.org/10.1192/bjo.2021.1057
Noortje I. van Vliet , Dimence Mental Health Group, Deventer, The Netherlands. E-mail: email@example.com
It is unclear whether people with post-traumatic stress disorder (PTSD) and symptoms of complex PTSD due to childhood abuse need a treatment approach different from approaches in the PTSD treatment guidelines.
To determine whether a phase-based approach is more effective than an immediate trauma-focused approach in people with childhood-trauma related PTSD (Netherlands Trial Registry no.: NTR5991).
Adults with PTSD following childhood abuse were randomly assigned to either a phase-based treatment condition (8 sessions of Skills Training in Affect and Interpersonal Regulation (STAIR), followed by 16 sessions of eye-movement desensitisation and reprocessing (EMDR) therapy; n = 57) or an immediately trauma-focused treatment condition (16 sessions of EMDR therapy; n = 64). Participants were assessed for symptoms of PTSD and complex PTSD, and other forms of psychopathology before, during and after treatment and at 3- and 6-month follow-ups.
Data were analysed with linear mixed models. No significant differences between the two treatments on any variable at post-
treatment or follow-up were found. Post-treatment, 68.8% no longer met PTSD diagnostic criteria. Self-reported PTSD symptoms significantly decreased for both STAIR–EMDR therapy (d = 0.93) and EMDR therapy (d = 1.54) from pre- to post- treatment assessment, without significant difference between the two conditions. No differences in drop-out rates between the conditions were found (STAIR–EMDR 22.8% v. EMDR 17.2%). No study-related adverse events occurred.
This study provides compelling support for the use of EMDR therapy alone for the treatment of PTSD due to childhood abuse as opposed to needing any preparatory intervention.
Wibbelink, C. J. M., Lee, C. W., Bachrach, N., Dominguez, S. K., Ehring, T., van Es, S. M., . . . Arntz, A. (2021). The effect of twice-weekly versus once-weekly sessions of either imagery rescripting or eye movement desensitization and reprocessing for adults with PTSD from childhood trauma (IREM-Freq): a study protocol for an international randomized clinical trial. Trials, 22(1), 848. doi:10.1186/s13063-021-05712-9
Open Access: https://pubmed.ncbi.nlm.nih.gov/34838102
Carlijn J. M. Wibbelink, Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS Amsterdam, the Netherlands. E-mail: C.J.M.Wibbelink@uva.nl
BACKGROUND: Trauma-focused treatments for posttraumatic stress disorder (PTSD) are commonly delivered either once or twice a week. Initial evidence suggests that session frequency affects treatment response, but very few trials have investigated the effect of session frequency. The present study's aim is to compare treatment outcomes of twice-weekly versus once-weekly sessions of two treatments for PTSD related to childhood trauma, imagery rescripting (ImRs) and eye movement desensitization and reprocessing (EMDR). We hypothesize that both treatments will be more effective when delivered twice than once a week. How session frequency impacts treatment response, whether treatment type moderates the frequency effect, and which treatment type and frequency works best for whom will also be investigated.
METHODS: The IREM-Freq trial is an international multicenter randomized clinical trial conducted in mental healthcare centers across Australia, Germany, and the Netherlands. We aim to recruit 220 participants, who will be randomized to one of four conditions: (1) EMDR once a week, (2) EMDR twice a week, (3) ImRs once a week, or (4) ImRs twice a week. Treatment consists of 12 sessions. Data are collected at baseline until one-year follow-up. The primary outcome measure is clinician-rated PTSD symptom severity. Secondary outcome measures include self-reported PTSD symptom severity, complex PTSD symptoms, trauma-related cognitions and emotions, depressive symptoms, dissociation, quality of life, and functioning. Process measures include memory, learning, therapeutic alliance, motivation, reluctance, and avoidance. Additional investigations will focus on predictors of treatment outcome and PTSD severity, change mechanisms of EMDR and ImRs, the role of emotions, cognitions, and memory, the optimization of treatment selection, learned helplessness, perspectives of patients and therapists, the network structure of PTSD symptoms, and sudden treatment gains.
DISCUSSION: This study will extend our knowledge on trauma-focused treatments for PTSD related to childhood trauma and, more specifically, the importance of session frequency. More insight into the optimal session frequency could lead to improved treatment outcomes and less dropout, and in turn, to a reduction of healthcare costs. Moreover, the additional investigations will broaden our understanding of how the treatments work and variables that affect treatment outcome.
TRIAL REGISTRATION: Netherlands Trial Register NL6965, registered 25/04/2018.
Winkler, O., Dhaliwal, R., Greenshaw, A., O’Shea, K., Abba-Aji, A., Chima, C., . . . Burback, L. (2021). Web-Based Eye Movement Desensitization and Reprocessing for Adults With Suicidal Ideation: Protocol for a Randomized Controlled Trial. JMIR Res Protoc, 10(11), e30711. doi:10.2196/30711
Open Access: https://pubmed.ncbi.nlm.nih.gov/34734835
Lisa Burback, MD, Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre 8440 112 St NW
Edmonton, AB, T6G 2B7, Canada. E-mail: firstname.lastname@example.org
BACKGROUND: Adversity and traumatic experiences increase the likelihood of suicidal thoughts and behaviors. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based, trauma-focused psychotherapy that desensitizes painful memories, so that reminders in the present no longer provoke overwhelming emotional responses. Preliminary evidence suggests that EMDR can be used as an acute intervention in suicidal patients, including those with major depressive disorder. In addition, because of social distancing restrictions during the COVID-19 pandemic, clinicians have been using EMDR on the web and, in the absence of formal evaluations of web-based EMDR, informal reports indicate good results.
OBJECTIVE: The primary aim of this randomized controlled trial is to investigate whether remotely delivered EMDR (targeting experiences associated with suicidal thinking) reduces suicidal thoughts. Secondary aims include examining the impact of remotely delivered EMDR on symptoms of depression, anxiety, posttraumatic stress, emotional dysregulation, and dissociation. We will also report on adverse events in the EMDR group to explore whether targeting suicidal ideation with EMDR is safe. Finally, we will compare dropout rates between the treatment groups.
METHODS: In this randomized controlled trial, 80 adults who express suicidal ideation and meet the study criteria will receive either 12 sessions of twice weekly EMDR plus treatment as usual or treatment as usual alone. EMDR sessions will focus on the most distressing and intrusive memories associated with suicidal ideation. Data for primary and secondary objectives will be collected at baseline, 2 months, and 4 months after enrollment. A subsequent longer-term analysis, beyond the scope of this protocol, will examine differences between the groups with respect to the number of posttreatment emergency room visits, hospitalizations, and overall health care use in the year before and after therapy.
RESULTS: The protocol was approved by the University of Alberta Research Health Ethics Board (protocol ID Pro00090989). Funding for this study was provided by the Mental Health Foundation (grant RES0048906). Recruitment started in May 2021, with a projected completion date of March 2023.
CONCLUSIONS: The results of this trial will contribute to knowledge on whether web-based delivery of EMDR is a safe and effective treatment for reducing suicidal ideation and potentially reducing the incidence of suicide attempts in this patient population.
TRIAL REGISTRATION: ClinicalTrials.gov NCT04181047; https://clinicaltrials.gov/ct2/show/NCT04181047. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/30711.
Xiang, Y., Cipriani, A., Teng, T., Del Giovane, C., Zhang, Y., Weisz, J. R., . . . Barth, J. (2021). Comparative efficacy and acceptability of psychotherapies for post-traumatic stress disorder in children and adolescents: a systematic review and network meta-analysis. Evidence-based mental health, 24(4), 153-160. Retrieved from https://ebmh.bmj.com/content/24/4/153.abstract
Open Access: https://ebmh.bmj.com/content/24/4/153.abstract
Professor Peng Xie, Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China; email@example.com.
cn and Professor Xinyu Zhou, Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 40016, China; firstname.lastname@example.org
Background Available evidence on the comparative efficacy and acceptability of psychotherapies for post- traumatic stress disorder (PTSD) in children and adolescents remains uncertain.
Objective We aimed to compare and rank the different types and formats of psychotherapies for PTSD in children and adolescents.
Methods We searched eight databases and other international registers up to 31 December 2020. The pairwise meta-analyses and frequentist network meta- analyses estimated pooled standardised mean differences (SMDs) and ORs with random-effects model. Efficacy at post-treatment and follow-up, acceptability, depressive and anxiety symptoms were measured.
Findings We included 56 randomised controlled trials with 5327 patients comparing 14 different types of psychotherapies and 3 control conditions. For efficacy, cognitive processing therapy (CPT), behavioural therapy (BT), individual trauma-focused cognitive–behavioural therapy (TF-CBT), eye movement desensitisation and reprocessing, and group TF-CBT were significantly superior to all control conditions at post-treatment and follow-up (SMDs between −2.42 and −0.25). Moreover, CPT, BT and individual TF-CBT were more effective than supportive therapy (SMDs between −1.92 and −0.49). Results for depressive and anxiety symptoms were similar to the findings for the primary outcome. Most of the results were rated as ’moderate’ to ’very low’ in terms of confidence of evidence.
Conclusions CPT, BT and individual TF-CBT appear to
be the best choices of psychotherapy for PTSD in young patients. Other types and different ways of delivering psychological treatment can be alternative options. Clinicians should consider the importance of each outcome and the patients’ preferences in real clinical practice.
Yaşar, A. B., Gündoğmuş, İ., Gündüz, A., & Konuk, E. (2021). The Effects of Single Session EMDR Flash Technique Group Application on Traumatic Symptoms. Israel Journal of Psychiatry, 58(2), 41-46. Retrieved from https://search.proquest.com/openview/5ebeff1316b5bab3a80d8e00d4eb593c/1?pq-origsite=gscholar&cbl=47717
Dr. İbrahim Gündoğmuş, Department of Psychiatry, Kırıkkale Yüksek İhtisas Hospital, Bağlarbaşı, Ahmet Ay Caddesi, 71300 Merkez/Kırıkkale, Turkey. E-mail: email@example.com
Introduction: Flash Technique method is an EMDR (Eye Movement Desensatization and Reprocessing) protocol specifically developed. In this protocol, there is little contact with the traumatic memories and focus is substantially on positive memories. For this reason, it might be convenient for group applications. In this study, we aimed at measuring the effects of EMDR Flash Technique group application on traumatic memories.
Method: The sample of the study consists of 36 participants. On this sample, one-session of 90-120 minutes EMDR Flash Technique was applied. Participants were evaluated with Impacts of Events Scale (IES), PTSD Checklist for DSM-5 (PCL-5) and Sociodemographic Variables Form before, one week later and one month later following the EMDR Flash Technique group application.
Results: Comparison of Subjective Unit of Disturbance (SUD) and IES scores obtained from measurements conducted before (SUD=6.08±1.69, IES-R=24.52±11.57), one week after (SUD=3.75±1.90, IES-R=14.13±11.78) and one month after (SUD=2.83±2.00, IES-R=9.86±11.84) EMDR Flash Technique application revealed statistically significant difference (SUD: p<0.001, IES-R: p<0.001 ). In addition, a statistically significant difference was found in the comparison of pre-session (24.38±17.78) and one month after session (11.44±11.06) PCL-5 scores (p<0.001).
Conclusion: In this study, the effects of EMDR Flash Technique application, which we thought to be easy to apply and less risky, were analyzed in a group consisting of 36 participants, and there were significant improvements in one-month follow-up scores in all of the three trauma measures. Examination of EMDR Flash Technique group application in other groups and with controlled long-term research may be a considerable option for future research.
Zhutovsky, P., Zantvoord, J. B., Ensink, J. B. M., Op den Kelder, R., Lindauer, R. J. L., & van Wingen, G. A. (2021). Individual prediction of trauma-focused psychotherapy response in youth with posttraumatic stress disorder using resting-state functional connectivity. Neuroimage Clin, 32, 102898. doi:10.1016/j.nicl.2021.102898
Open Access: https://pubmed.ncbi.nlm.nih.gov/34911201
Jasper B. Zantvoord, Department of Psychiatry Amsterdam University Medical Center, Meibergdreef 5, room PA0-226, 1105 AZ, Amsterdam, The Netherlands.
Randomized controlled trials have shown efficacy of trauma-focused psychotherapies in youth with posttraumatic stress disorder (PTSD). However, response varies considerably among individuals. Currently, no biomarkers are available to assist clinicians in identifying youth who are most likely to benefit from treatment. In this study, we investigated whether resting-state functional magnetic resonance imaging (rs-fMRI) could distinguish between responders and non-responders on the group- and individual patient level. Pre-treatment rs-fMRI was recorded in 40 youth (ages 8-17 years) with (partial) PTSD before trauma-focused psychotherapy. Change in symptom severity from pre- to post-treatment was assessed using the Clinician-Administered PTSD scale for Children and Adolescents to divide participants into responders (≥30% symptom reduction) and non-responders. Functional networks were identified using meta-independent component analysis. Group-differences within- and between-network connectivity between responders and non-responders were tested using permutation testing. Individual predictions were made using multivariate, cross-validated support vector machine classification. A network centered on the bilateral superior temporal gyrus predicted treatment response for individual patients with 76% accuracy (p|FWE| = 0.02, 87% sensitivity, 65% specificity, area-under-receiver-operator-curve of 0.82). Functional connectivity between the frontoparietal and sensorimotor network was significantly stronger in non-responders (t = 5.35, p|FWE| = 0.01) on the group-level. Within-network connectivity was not significantly different between groups. This study provides proof-of-concept evidence for the feasibility to predict trauma-focused psychotherapy response in youth with PTSD at an individual-level. Future studies are required to test if larger cohorts could increase accuracy and to test further generalizability of the prediction models.