EMDR Research News February 2019

In this first posting of 2019 there are 15 new articles to report related to EMDR therapy. 3 articles have links to the open access full text article.


4 Randomized Controlled Trials
  • Health–economic benefits of treating trauma in psychosis.
  • Clinical efficacy of trauma-focused psychotherapies in treatment-resistant depression in-patients
  • Treating complicated grief and posttraumatic stress in homicidally bereaved individuals
  • Effectiveness of CBT and EMDR in Child Victims of Domestic Violence

4 Review or Meta-analysis articles
  • Comparing the Effectiveness of EMDR and TF-CBT for Children and Adolescents: a Meta-Analysis
  • Retrieving and Modifying Traumatic Memories: Recent Research Relevant to Three Controversies
  • Older Adults as Caregivers for Veterans with PTSD
  • Military psychological trauma and therapy

2 case series reports
  • Treating Obsessive Compulsive Disorder using EMDR Therapy
  • EMDR as a treatment for tinnitus

2 individual case reports
  • EMDR as a treatment approach of PTSD complicated by comorbid psychiatric, somatic, and cognitive disorders
  • Efficacy of an EMDR intervention for a head and neck cancer patient with intolerable anxiety undergoing radiotherapy
2 qualitative outcome studies
  • Processing birth experiences: A content analysis of women’s preferences
  • EMDR for adults with intellectual disabilities
    1 mechanism of action outcome study
    • Fear extinction learning improvement in PTSD after EMDR therapy: an fMRI study

    With each reference below, you will find the citation, abstract and author contact information (when available). Prior quarterly summaries of journal articles can be found on the
    EMDRIA website and a comprehensive listing of all EMDR-related research is available at the Francine Shapiro Library. EMDRIA members can access recent Journal of EMDR Practice and Research articles in the member’s area on the EMDRIA website. JEMDR issues older than 12 months are available open access on IngentaConnect.


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    de Bont, P. A. J. M., van der Vleugel, B. M., van den Berg, D. P. G., de Roos, C., Lokkerbol, J., Smit, F., . . . van Minnen, A. (2019). Health–economic benefits of treating trauma in psychosis. European Journal of Psychotraumatology, 10(1), 1565032. doi:10.1080/20008198.2018.1565032

    Open access:
    http://dx.doi.org/10.1080/20008198.2018.1565032

    Paul A. J. M. de Bont, Postbox 103, Boxmeer 5830 AC, The Netherlands. E-mail: paj.de.bont@ggzoostbrabant.nl


    Abstract


    Background: Co-occurrence of posttraumatic stress disorder (PTSD) in psychosis (estimated as 12%) raises personal suffering and societal costs. Health–economic studies on PTSD treatments in patients with a diagnosis of a psychotic disorder have not yet been conducted, but are needed for guideline development and implementation. This study aims to analyse the cost-effectiveness of guideline PTSD therapies in patients with a psychotic disorder.
    Methods: This health–economic evaluation alongside a randomized controlled trial included 155 patients with a psychotic disorder in care as usual (CAU), with comorbid PTSD. Participants received eye movement desensitization and reprocessing (EMDR) (n = 55), prolonged exposure (PE) (n = 53) or waiting list (WL) (n = 47) with masked assessments at baseline (T0) and at the two-month (post-treatment, T2) and six-month follow-up (T6). Costs were calculated using the TiC-P interview for assessing healthcare consumption and productivity losses. Incremental cost-effectiveness ratios and economic acceptability were calculated for quality-adjusted life years (EQ-5D-3L-based QALYs) and PTSD ‘Loss of diagnosis’ (LoD, CAPS).
    Results: Compared to WL, costs were lower in EMDR (-€1410) and PE (-€501) per patient per six months. In addition, EMDR (robust SE 0.024, t = 2.14, p = .035) and PE (robust SE 0.024, t = 2.14, p = .035) yielded a 0.052 and 0.051 incremental QALY gain, respectively, as well as 26% greater probability for LoD following EMDR (robust SE = 0.096, z = 2.66, p = .008) and 22% following PE (robust SE 0.098, z = 2.28, p = .023). Acceptability curves indicate high probabilities of PTSD treatments being the better economic choice. Sensitivity analyses corroborated these outcomes.
    Conclusion: Adding PTSD treatment to CAU for individuals with psychosis and PTSD seem to yield better health and less PTSD at lower costs, which argues for implementation.


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    Dinapoli, L., Massaccesi, M., Colloca, G., Tenore, A., Dinapoli, N., & Valentini, V. (2019). Efficacy of an eye movement desensitization and reprocessing (EMDR) intervention for a head and neck cancer patient with intolerable anxiety undergoing radiotherapy. Psychooncology. doi:10.1002/pon.5000

    Dr Loredana Dinapoli, Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze Radiologiche, Radioterapiche ed Ematologiche. Roma, Italia. E-mail: loredana.dinapoli@gmail.com


    Abstract


    Anxiety is a common co-morbidity in Head and Neck Cancer (H&N-C) patients due to a restrictive device (“mask”) used during radiotherapy (RT). Psychological treatment of anxiety has been advocated to prevent these patients from becoming non-compliant or discontinue their RT altogether. Though data is limited, Eye Movement Desensitization and Reprocessing (EMDR), a newer psychological intervention for cancer patients appears to reduce psychological symptoms in less time that Cognitive Behavioral Therapy (CBT) (a better known psychological intervention). This real life case describes an H&N-C patient with severe anxiety treated successfully with EMDR in a short time period. This case study could encourage psycho-oncologists using CBT or other psychological treatment approaches to evaluate EMDR, especially in target populations like H&N-C patients, identified as at risk for anxiety.


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    Engelhard, I. M., McNally, R. J., & van Schie, K. (2019). Retrieving and Modifying Traumatic Memories: Recent Research Relevant to Three Controversies. Current Directions in Psychological Science, 0963721418807728. doi:10.1177/0963721418807728

    Open access:
    https://journals.sagepub.com/doi/pdf/10.1177/0963721418807728

    Iris M. Engelhard, Utrecht University, Department of Clinical Psychology, P. O. Box 80140, 3508 TC Utrecht, The Netherlands E-mail: i.m.engelhard@uu.nl


    Abstract


    The purpose of this article is to review recent research that is relevant to three controversies concerning memory for trauma. First, we briefly review the debate about recovered memories of childhood sexual abuse, summarizing a third interpretation distinct from both the repression and false-memory accounts. Second, we address new findings related to claims that memories of trauma, especially in people with posttraumatic stress disorder, are especially fragmented and disorganized. Third, we discuss research designed to test whether eye movements in eye-movement desensitization and reprocessing therapy are effective.


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    Frappell-Cooke, W., & McCauley, M. (2018). Military psychological trauma and therapy: a review of EMDR treatment and supervision in the UK Ministry of Defence. J R Army Med Corps. doi:10.1136/jramc-2018-001060

    Dr. Wendy Frappell-Cooke, DCPS, Defence Clinical Psychology Service, Staffs WS14 9PY, UK. E-mail: wfcpsych@icloud.com


    Abstract


    Psychological injury has been associated with military service, and this can result in a variety of mental health symptoms and disorders. A range of barriers to help-seeking have been identified in the military and mental health services have sought to address such factors through effective and efficient care and consultation. The use of eye movement desensitisation and reprocessing forms part of a repertoire of trauma-focused therapies within the UK's Armed Forces. This article will outline the application of this approach within the British military, along with the role of specialist clinical supervision in treating those affected by operational trauma.


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    Gielkens, E. M. J., Sobczak, S., Rossi, G., Rosowsky, E., & van Alphen, S. J. P. (2018). EMDR as a treatment approach of PTSD complicated by comorbid psychiatric, somatic, and cognitive disorders: A case report of an older woman with a borderline and avoidant personality disorder. Clinical Case Studies, 17(5), 328-347.

    Ellen M. J. Gielkens, Clinical Center of Excellence for Older Adults With Personality Disorders, Kloosterkensweg 10 6419 PJ Heerlen, The Netherlands. Email: e.gielkens@mondriaan.eu


    Abstract


    Traumatic life events can result in severe psychiatric conditions among which posttraumatic stress disorder (PTSD) is the most prevalent. Due to high comorbidity with other psychiatric diagnoses, PTSD treatment is challenging. In older adults, the presentation of PTSD symptoms is especially complicated because of even higher comorbidity, higher rates with other mental disorders, and cognitive and somatic conditions. Eye movement desensitization and reprocessing (EMDR) is an evidence-based treatment for trauma in younger adults. There is limited empirical research on the treatment effects of EMDR in older adults. Moreover, the impact of successful EMDR treatment on the comorbid disorders, especially personality and cognitive dysfunctions, is unclear. In this case report, EMDR treatment effects for late-onset PTSD with comorbid borderline and avoidant personality disorders, as well as cognitive disorders and multiple somatic problems, will be presented in an older woman.


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    Keenan, P., Farrell, D., Keenan, L., & Ingham, C. (2018). Treating Obsessive Compulsive Disorder (OCD) using Eye Movement Desensitisation and Reprocessing (EMDR) Therapy: An Ethno-Phenomenological Case Series. International Journal of Psychotherapy, 22(3), 74-91.

    Paul Keenan, Edge Hill University, Faculty of Health and Social Care, Lancashire, UK. E-mail: keenanp@edghill.ac.uk


    Abstract


    Obsessive Compulsive Disorder (OCD) is a bio-psycho-socio-cultural disorder that includes genetic, neural brain anomalies, traumatic experiences, and development of dysfunctional beliefs frequently learnt from others and from the environment.
    Current empirical research supports Cognitive Behavioural Therapy (Exposure and Response Prevention) as the ‘gold-standard’ psychological treatment intervention. However, clients with OCD often describe their anxieties as the result of an exposure to earlier adverse life experiences (past), or as a worst fear (future) related to their symptomatology, by onset or maintenance features.
    This case-series design study explored the impact of EMDR Therapy with eight clients diagnosed with OCD, yet despite having received previous treatment – CBT (ERP) – were still OCD symptomatic.
    The research methodology was that of Ethno-Phenomenology. Psychometric results highlighted a promising treatment effect of EMDR Therapy by reducing anxiety, depression, obsessions, compulsions and subjective levels of disturbance. Despite promising initial results with a small survey, more conducted research with this important clinical population is essential.


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    Klippel, C., & Sullivan, G. (2018). Older Adults as Caregivers for Veterans with PTSD. Generations, 42(3), 41-46.


    Abstract


    Posttraumatic stress disorder (PTSD) is a mental health condition with greater prevalence in military veterans. Caregivers and those providing support to individuals with PTSD may experience unique challenges due to this illness. This article includes a review of PTSD's core symptoms and treatment options and discusses considerations for older individuals providing care and support to a veteran with PTSD. Familiarity with communication pitfalls, issues in long-term care, and resources available to caregivers should help prepare an individual to provide care to a veteran with PTSD.


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    Lewey, J. H., Smith, C. L., Burcham, B., Saunders, N. L., Elfallal, D., & O’Toole, S. K. (2018). Comparing the Effectiveness of EMDR and TF-CBT for Children and Adolescents: a Meta-Analysis. Journal of Child & Adolescent Trauma, 11(4), 457-472. doi:10.1007/s40653-018-0212-1

    Jennifer H. Lewey. E-mail: jenniferhleweyphd@gmail.com


    Abstract


    Efficacy of EMDR and TF-CBT for posttraumatic stress symptoms (PTSS) was explored through meta-analysis. A comprehensive search yielded 494 studies of children and adolescents with PTSS who received treatment with these evidence-based therapeutic modalities. Thirty total studies were included in the meta-analysis. The overall Cohen’s d was small (−0.359) and statistically significant (p<0.05), indicating EMDR and TF-CBT are effective in treating PTSS. Major findings posit TF-CBT is marginally more effective than EMDR; those with sub-clinical PTSS responded more favorably in treatment than those with PTSD; and greater reductions in PTSS were observed with presence of comorbidity in diagnosis. Assessment of publication bias with Classic fail-safe N revealed it would take 457 nonsignificant studies to nullify these findings.


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    Minelli, A., Zampieri, E., Sacco, C., Bazzanella, R., Mezzetti, N., Tessari, E., . . . Bortolomasi, M. (2019). Clinical efficacy of trauma-focused psychotherapies in treatment-resistant depression (TRD) in-patients: A randomized, controlled pilot-study. Psychiatry Research, 273, 567-574. doi:10.1016/j.psychres.2019.01.070


    Alessandra Minelli, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy. E-mail: alessandra.minelli@unibs.it


    Abstract


    In major depressive disorder (MDD) patients, life stress events represent a risk factor for a severe, early-onset, treatment-resistant and chronic endophenotype. Treatment-resistant depression (TRD) patients who have experienced traumatic events could benefit from evidence-based trauma-focused psychotherapies. Because this topic has never been investigated, the aim of this pilot trial was to evaluate whether trauma-focused cognitive-behavioural therapy (TF-CBT) and/or eye movement desensitization and reprocessing (EMDR) can help achieve depressive symptom remission in TRD patients. We carried out a single-blind randomized controlled trial with TRD patients and we compared EMDR (N = 12) with TF-CBT (N = 10). Patients received 3 individual sessions per week over a period of 8 weeks. The symptomatological assessments were performed at 4 timepoints: baseline (T0), 4 (T4), 8 (T8) and 12 (T12) weeks. After 24 weeks, a clinical interview was carried out by phone. All TRD patients showed a significant improvement in depressive symptomatology; however, post hoc comparisons showed a significant difference between the two treatment groups, with lower depressive symptom scores in the EMDR than in the TF-CBT group at the follow-up (T12). This effect was partly maintained at 24 weeks. This pilot study suggests that evidence-based trauma-focused psychotherapies, particularly EMDR, can represent effective interventions to treat TRD patients.


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    Phillips, J. S., Erskine, S., Moore, T., Nunney, I., & Wright, C. (2019). Eye movement desensitization and reprocessing as a treatment for tinnitus. The Laryngoscope, 00, 1-7. doi:10.1002/lary.27841

    John S. Phillips, Department of Otolaryngology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk NR4 7UY, United Kingdom. E-mail: john.phillips@mac.com


    Abstract


    Objectives/Hypothesis: To determine the effectiveness of eye movement desensitization and reprocessing (EMDR) as a treatment for tinnitus.
    Study Design: Single-site prospective interventional clinical trial at a university hospital in the United Kingdom.
    Methods: Participants were provided with tEMDR. This is a bespoke EMDR protocol that was developed specifically to treat individuals with tinnitus. Participants received a maximum of 10 sessions of tEMDR. Outcome measures including tinnitus questionnaires and mood questionnaires were recorded at baseline, discharge, and at 6 months postdischarge.
    Results: Tinnitus Handicap Inventory and Beck Depression Inventory scores demonstrated a statistically significant improvement at discharge after EMDR intervention (P = .0005 and P = .0098, respectively); this improvement was maintained at 6 months postdischarge. There was also a moderate but not significant (P = .0625) improvement in Beck Anxiety Inventory scores.
    Conclusions: This study has demonstrated that the provision of tEMDR has resulted in a clinically and statistically significant improvement in tinnitus symptoms in the majority of those participants who took part. Furthermore, the treatment effect was maintained at 6 months after treatment ceased. This study is of particular interest, as the study protocol was designed to be purposefully inclusive of a diverse range of tinnitus patients. However, as a small uncontrolled study, these results do not consider the significant effects of placebo and therapist interaction. Larger high-quality studies are essential for the verification of these preliminary results.


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    Rousseau, P.-F., El Khoury-Malhame, M., Reynaud, E., Boukezzi, S., Cancel, A., Zendjidjian, X., . . . Khalfa, S. (2019). Fear extinction learning improvement in PTSD after EMDR therapy: an fMRI study. European Journal of Psychotraumatology, 10(1), 1568132. doi:10.1080/20008198.2019.1568132

    Open access:
    https://doi.org/10.1080/20008198.2019.1568132

    Pierre-Fran
    ois Rousseau, Laboratoire de Neurosciences Sensorielles et Cognitives, UMR 7260 CNRS, Fédération 3C, 3 place Victor Hugo, Marseille 13331, France. E-mail: paf.0526@gmail.com




    Abstract


    Objective: Neurobiological models of Posttraumatic Stress Disorder (PTSD) implicate fear processing impairments in the maintenance of the disorder. Eye Movement Desensitization and Reprocessing (EMDR) is one of the most efficient psychotherapies to treat PTSD. We aimed at exploring the brain mechanisms of the fear circuitry involved in PTSD patients’ symptom remission after EMDR therapy.
    Method: Thirty-six PTSD participants were randomly assigned to either EMDR group receiving EMDR therapy or Wait-List (WL) group receiving supportive therapy. Participants under- went a behavioural fear conditioning and extinction paradigm during functional magnetic resonance (fMRI). In the EMDR group, patients were scanned at baseline, before EMDR and one week after remission. In the WL group, patients were scanned at baseline and within the same time interval as the EMDR group.
    Results: In the EMDR group after treatment, fear responses in the late extinction were significantly lower than before therapy. In parallel, significant functional activity and connectivity changes were found in the EMDR group versus the WL during the late extinction. These changes involve the fear circuit (amygdalae, left hippocampus), the right inferior frontal gyrus, the right frontal eye field and insula (pFWE < .05).
    Conclusion: These functional modifications underlie a significant improvement of fear extinction learning in PTSD patients after EMDR therapy.


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    Sigurðardóttir, V. L., Gamble, J., Guðmundsdóttir, B., Sveinsdóttir, H., & Gottfreðsdóttir, H. (2019). Processing birth experiences: A content analysis of women’s preferences. Midwifery, 69, 29-38.

    Valgerður Lísa Sigurðardóttir, Landspítali – The National University Hospital of Iceland, Reykjavík, Iceland. Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavík, Iceland. Correspondence to: Eirberg, Eiríksgata 34, 101 Reykjavík, Iceland.
    E-mail: valgerds@hi.is

    Abstract


    Background: Negative birth experiences may have adverse effects on the wellbeing of women and babies. Knowledge about useful interventions to assist women in processing and resolving negative birth experiences is limited.
    Objective: To explore women’s experience and preferences of reviewing their birth experience at a special midwifery clinic.
    Design: The study is a qualitative content analysis of women's written text responses to semi-structured questions, included in a retrospective study.
    Setting: A special counselling clinic, ‘Ljáðu mér eyra’, at Landspitali University Hospital in Reykjavik, provides women with an opportunity to review their birth experience and discuss their fears about an upcoming birth with a midwife.
    Sample, recruitment and data collection: A questionnaire was sent to all women attending the clinic from 2006–2011 (n
    =301). Of the 131 women completing and returning the questionnaire, 125 provided written responses to the open-ended questions. The questionnaire consisted of demographic and reproductive characteristics of women, questions about why they attended the clinic, whether their expectations were fulfilled, helpful components of the interview and open-ended questions about women’s views of the process.
    Data analysis: Data on participant characteristics, the reason for attending the clinic, whether the interview fulfilled their expectations and helpful components were analysed using quantitative descriptive data, while written responses to semi-structured questions were analysed using content analysis.
    Findings: The main reasons for attending the clinic were a previous negative birth experience, anxiety about the upcoming birth, and/or loss of control during a prior birth. Two themes and three subthemes were identified. The overarching theme was ‘on my terms’ with the subthemes of ‘being recognised’, ‘listening is paramount’ and ‘mapping the unknown’. The final theme was ‘moving on’.
    Key conclusions: Women want to be recognised and invited to review their birth experience in a tailored conversation on their terms. By fulfilling their expectations of reviewing the birth experience, they regained control and strength to move on.
    Implications for practice: Findings support the importance of recognising women’s need to review their birth experiences and offer an intervention to reflect on their perceptions. A discussion of the birth experience should be a routine part of maternity services.


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    Unwin, G., Willott, S., Hendrickson, S., & Stenfert Kroese, B. (2019). Eye movement desensitization and reprocessing for adults with intellectual disabilities: Process issues from an acceptability study. Journal of Applied Research in Intellectual Disabilities. doi:10.1111/jar.12557

    Gemma Unwin, School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK. Email: G.L.Unwin@bham.ac.uk


    Abstract


    BACKGROUND: Eye movement desensitization and reprocessing (EMDR) is recommended for post-traumatic stress disorder and emerging evidence indicates that it is effective for people with intellectual disabilities. However, acceptability from the perspectives of clients with intellectual disabilities, their therapists and other key people has not been formally evaluated. This study investigates process issues in the implementation of EMDR from perspectives of multiple stakeholders.
    METHOD: Semi-structured interviews were conducted with two adults with intellectual disabilities and three clinical psychologists who had participated in EMDR as well as a key supporter (N = 6) to provide information relating to three cases. The interviews were analysed thematically either directly from the audio recording or from transcripts. RESULTS: Five themes were identified: EMDR feels very different; EMDR is a technical process; the need to work with the present; talking is important; cautious optimism.
    CONCLUSIONS: Whilst a range of client- and therapist-related factors served as barriers to using EMDR in this small-scale study, such as preferences in working with the present and inexperienced therapists, there was cautious optimism that EMDR may be useful for "the right person at the right time".


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    van Denderen, M., de Keijser, J., Stewart, R., & Boelen, P. A. (2018). Treating complicated grief and posttraumatic stress in homicidally bereaved individuals: A randomized controlled trial. Clinical Psychology & Psychotherapy, 25(4), 497-508.

    Mariëtte van Denderen, Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands. Email: m.van.denderen@fpcvanmesdag.nl


    Abstract


    Homicidally bereaved individuals may experience symptoms of Complicated Grief (CG) and Posttraumatic Stress Disorder (PTSD). This Randomized Controlled Trial examined the effectiveness of an 8‐session treatment encompassing Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) to reduce self‐rated CG and PTSD symptoms in 85 Dutch adult homicidally bereaved men and women. We compared changes in symptoms of CG (assessed using the Inventory of Complicated Grief) and PTSD (assessed using the Impact of Event Scale) between an intervention group and a waitlist control group. The treatment was effective in reducing CG and PTSD symptoms, from pretreatment to posttreatment. It can be concluded that EMDR and CBT seem promising treatments for homicidally bereaved individuals for both men and women, and regardless of the time since the loss. Further research is needed to examine whether a combined treatment of EMDR and CBT together is of added value in situations where grief and trauma are intertwined over offering only one of the two treatment modalities.


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