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Video of the month

The following video interview features Dr. Andrew Huberman, a Stanford Neuroscientist discussing the benefits of lateral eye movements in EMDR therapy. Dr. Haberman is a vision researcher with a special interest in stress. His up-tempo presentation is firmly anchored in science, yet is presented in a manner suitable for the general public.

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Baptist, J., Thompson, D. E., Spencer, C., Mowla, M. R., Love, H. A., & Su, Y. (2020). Clinical efficacy of EMDR in unipolar depression: Changes in theta cordance. Psychiatry Res, 296, 113696. doi:10.1016/j.psychres.2020.113696

URL: https://pubmed.ncbi.nlm.nih.gov/33387752

Joyce Baptist, Applied Human Sciences, 303 Justin Hall, Kansas State University, Manhattan, KS, 66506, USA. E-mail: jbaptist@ksu.edu

Abstract

Eye Movement Desensitization and Reprocessing (EMDR) has demonstrated efficacy in treating major depressive disorder. EMDR increases cerebral perfusion in the anterior cingulate cortex (ACC) and dorsolateral prefrontal cortex (dlPFC). Activity in the ACC and dlPFC can be measured by theta cordance (TC) but has not been examined in EMDR. Ten participants (3 men, 7 women, M age = 42.31 ± 15.03) received ten 75 ± 15 minute EMDR sessions over 6.5 ± .5 weeks. Results indicated that PHQ-9 depression scores reduced from T1 (M = 13.9 ± 3.31) to T11 (M = 6.30 ± 3.23) with EMDR (SMD = 2.30), and that fTC but not pfTC was significantly related to this change. Depression declined as fTC declined. EMDR may engage the dlPFC or ACC that modulates depression and aid in reducing fTC and thus depression levels.

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Bourassa, K. J., Hendrickson, R. C., Reger, G. M., & Norr, A. M. (2020). Posttraumatic Stress Disorder Treatment Effects on Cardiovascular Physiology: A Systematic Review and Agenda for Future Research. J Trauma Stress. doi:10.1002/jts.22637

URL: https://pubmed.ncbi.nlm.nih.gov/33277952

Kyle Bourassa. 2020 Main St. Suite 201, Durham, NC 27708 E-mail: kyle.bourassa@duke.edu


Abstract

Posttraumatic stress disorder (PTSD) is linked to both altered physiological functioning and poorer cardiovascular health outcomes, including an increased risk for cardiovascular disease and cardiovascular-related mortality. An important question is whether interventions for PTSD might ameliorate the risk for poorer health by improving cardiovascular physiological intermediaries. To begin to characterize the literature addressing this question, we conducted a systematic review of empirical studies examining the impact of PTSD interventions on cardiovascular physiological intermediaries, including blood pressure (BP), heart rate (HR), cardiac impedance, and subclinical atherosclerosis. Outcomes included both tonic (i.e., resting) cardiovascular functioning and cardiovascular reactivity (CVR). A total of 44 studies met the inclusion criteria. There was mixed evidence regarding whether PTSD treatment improved tonic cardiovascular functioning. There was stronger evidence that PTSD treatments reduced CVR to trauma-related stressors, particularly for higher-quality studies of cognitive behavioral interventions. No studies examined cardiac impedance or subclinical atherosclerosis. The studies had a high degree of heterogeneity in the populations sampled and interventions tested. Moreover, they generally included small sample sizes and lacked control conditions. Interventions for PTSD may improve cardiovascular physiological outcomes, particularly CVR to trauma cues, although additional methodologically rigorous studies are needed. We outline changes to future research that would improve the literature regarding this important question, including the more frequent use of control groups and larger sample sizes.

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Carr, P. (2020). The value of visioning: Augmenting EMDR with alpha-band alternating bilateral photic stimulation for trauma treatment in schizophrenia. Medical Hypotheses. Retrieved from https://www.sciencedirect.com/science/article/pii/S0306987720317205

URL: https://doi.org/10.1016/j.mehy.2020.110184

Peter Carr, Specialty Psychiatrist & Medical Psychotherapist, Psychotherapy & Eating Disorder Services, Greenfields House, New Craigs Hospital, 6-16 Leachkin Road, Inverness IV3 8NP, United Kingdom. E-mail: peter.carr3@nhs.net

Abstract

The value of addressing trauma-related issues in psychosis with therapies such as ṇEMDR is being increasingly recognised. The hypothesis of this paper is that augmentation of EMDR with alternating bilateral photic stimulation (ABPS) is especially suited to those on the schizotypal spectrum. Not only does Alternating Bilateral Photic Stimulation (ABPS) at alpha frequencies (8–12 Hz) directly compensate EEG deficits of schizophrenia by photic driving, it also stimulates pseudo- hallucinatory visual imagery (visions) and a waking dream state. In contrast to the REM-sleep state, the dorsolateral prefrontal cortex remains activated during the flicker-induced waking dream and its functions of reflective thought and insight are preserved. Recent EEG and neuroimaging studies are providing empirical support for the long-held conjecture that psychosis is caused by a conflation of REM-sleep / dreaming and waking states. Llewellyn's theory of de-differentiation between sleep-dreaming and waking accounts for both the creativity and psychopathology of the schizotypy spectrum. It is hypothesised that flicker-induced hypnagogic imagery reinforces the EMDR mechanism of action proposed by Stickgold, namely facilitation of memory integration during sleep, by creating greater linkage between EMDR therapy and dreaming. With ABPS-induced visioning EMDR progresses seamlessly from initial targeting of trauma and adversity to desensitisation of emotionally-charged brain-disturbing material related to identity, selfhood, and embodiment. Desensitisation of the affect allows the self-regulatory dynamics of sleep-dreaming to restore embodied selfhood by an integrative process of resynchronisation. This in turn leads to re-differentiation of waking embodiment from dream-embodiment. Evolutionary theories as to the aetiology of the schizotypy spectrum are positing a genetic origin in indigenous shamanic religions which are based on visioning ability. Patients with schizophrenia score better than normal controls on vividness of visual imagery and ability to generate, inspect, and manipulate mental images. Self-help EMDR glasses can be provided to patients for long-term regular practice of ABPS-induced visioning. It is proposed that many on the schizotypal spectrum, including some at the severe end, can improve and maintain their mental health by the regular practice of ABPS-induced visioning, and thereby transition progressively over time from negative to positive schizotypy.

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Dansiger, S., Chabra, R., Emmel, L., & Kovacs, J. (2020). The MET (T) A Protocol: Mindfulness and EMDR Treatment Template for Agencies. Substance Abuse: Research and Treatment, 14, 1178221820977483. Retrieved from https://journals.sagepub.com/doi/pdf/10.1177/1178221820977483

Open access: https://journals.sagepub.com/doi/pdf/10.1177/1178221820977483

Justine Kovacs, StartAgain Associates, 1107 Fair Oaks Avenue, #483, South Pasadena, CA 91030, USA. E-mail: justine@startagainassociates.com

Abstract

Evidence indicating the relationship between trauma and substance use disorders (SUDs), in addition to relapse and treatment retention rates for this population, suggests there is a need for a trauma-focused solution to treat SUDs. Eye movement desensitization and reprocessing (EMDR) therapy has been studied extensively as an effective approach for treating trauma and Posttraumatic Stress Disorder (PTSD). The research evaluating its treatment for other mental health disorders such as SUDs is promising. Merging mindfulness and ethical mindfulness practices with EMDR therapy lends additional evidence-based elements to make the case for this integrative system of treatment to be studied as a trauma-focused primary psychotherapy to treat SUDs. The resulting treatment, the MET(T)A Protocol (Mindfulness and EMDR Treatment Template for Agencies), has been created to address the need for a trauma-focused solution to treat SUDs. Procedures of the MET(T)A Protocol as applied in each of the 8 phases of EMDR therapy are described in detail. Clinical examples are provided to explain the application of the MET(T)A Protocol.

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de Voogd, L. D., & Phelps, E. A. (2020). A cognitively demanding working-memory intervention enhances extinction Research article. Sci Rep, 10(1), 7020. doi:10.1038/s41598-020-63811-0

Open access: https://pubmed.ncbi.nlm.nih.gov/32341373

Elizabeth A. Phelps, Department of Psychology, Harvard University, Cambridge, MA, 02138, USA. e-mail: phelps@fas.harvard.edu

Abstract

Improving extinction learning has the potential to optimize psychotherapy for persistent anxiety-related disorders. Recent findings show that extinction learning can be improved with a cognitively demanding eye-movement intervention. It is, however, unclear whether [1] any cognitively-demanding task can enhance extinction, or whether it is limited to eye movements, and [2] the effectiveness of such an intervention can be enhanced by increasing cognitive load. Participants (n = 102, n = 75 included in the final sample) completed a Pavlovian threat conditioning paradigm across two days. One group underwent standard extinction (Control), a second group underwent extinction paired with a 1-back working memory task (Low-Load), and a third group underwent extinction paired with a 2-back working memory task (High-Load). We found that the conditioned response during extinction was reduced for both the Low-Load and the High-Load groups compared to the Control group. This reduction persisted during recovery the following day when no working memory task was executed. Finally, we found that within the High-Load group, participants with lower accuracy scores on the 2-back task (i.e., for who the task was more difficult) had a stronger reduction in the conditioned response. We did not observe this relationship within the Low-Load group. Our findings suggest that cognitive load induced by a working memory intervention embedded during extinction reduces persistent threat responses.

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Eshuis, L. V., van Gelderen, M. J., van Zuiden, M., Nijdam, M. J., Vermetten, E., Olff, M., & Bakker, A. (2020). Efficacy of immersive PTSD treatments: A systematic review of virtual and augmented reality exposure therapy and a meta-analysis of virtual reality exposure therapy. J Psychiatr Res, in press. doi:10.1016/j.jpsychires.2020.11.030

Open access: https://pubmed.ncbi.nlm.nih.gov/33248674

L.V. Eshuis, Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ, Amsterdam, the Netherlands. E-mail: l.v.eshuis@amsterdamumc.nl

Abstract

BACKGROUND: Virtual reality exposure therapy (VRET) and augmented reality exposure therapy (ARET) are digitally assisted psychotherapies that potentially enhance posttraumatic stress disorder (PTSD) treatment by increasing a patient's sense of presence during exposure therapy. This study aimed to systematically review current evidence regarding the efficacy of VRET and ARET as PTSD treatment.
METHODS: A systematic electronic database search, a systematic quality assessment and two meta-analyses were conducted in accordance with PRISMA guidelines.
RESULTS: Eleven studies on the efficacy of VRET for PTSD (n = 438) were found, but no studies on the efficacy of ARET. The majority of VRET studies were of a low quality and had heterogeneous results. Meta-analyses showed VRET outperformed waitlist control (standardized mean difference -0.64 (95% CI -1.05 to -0.22)) while no significant difference was found between VRET and active treatment conditions (standardized mean difference -0.25 (95% CI -0.77 to 0.27)).
CONCLUSION: VRET was superior to waitlist control groups and as effective as other psychotherapies. However, the results showed considerable heterogeneity due to the low number of studies and variety of VRET methods. VRET may be an effective alternative to current treatments and shows promise for the treatment of PTSD patients that have not responded to previous treatment. Future research should focus on high quality RCTs, including information on side effects and adverse events, with sufficient numbers of participants. This study recognizes a research gap regarding the efficacy of ARET, while it may have potential for PTSD treatment.

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Gardoki-Souto, I., Martín de la Torre, O., Hogg, B., Redolar-Ripoll, D., Valiente-Gómez, A., Martínez Sadurní, L., . . . Moreno-Alcázar, A. (2021). Augmentation of EMDR with multifocal transcranial current stimulation (MtCS) in the treatment of fibromyalgia: study protocol of a double-blind randomized controlled exploratory and pragmatic trial. Trials, 22(1), 104. doi:10.1186/s13063-021-05042-w

Open access: https://doi.org/10.1186/s13063-021-05042-w

A. Moreno-Alcázar, Centre Forum Research Unit, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, C/ Llull 410, 08019 Barcelona, Spain. E-mail: amoreno.centreforum@gmail.com

Abstract

BACKGROUND: Fibromyalgia (FM) is a generalized, widespread chronic pain disorder affecting 2.7% of the general population. In recent years, different studies have observed a strong association between FM and psychological trauma. Therefore, a trauma-focused psychotherapy, such as eye movement desensitization and reprocessing (EMDR), combined with a non-invasive brain stimulation technique, such as multifocal transcranial current stimulation (MtCS), could be an innovative adjunctive treatment option. This double-blind randomized controlled trial (RCT) analyzes if EMDR therapy is effective in the reduction of pain symptoms in FM patients and if its potential is boosted with the addition of MtCS.
METHODS: Forty-five patients with FM and a history of traumatic events will be randomly allocated to Waiting List, EMDR + active-MtCS, or EMDR + sham-MtCS. Therapists and patients will be kept blind to MtCS conditions, and raters will be kept blind to both EMDR and MtCS. All patients will be evaluated at baseline, post-treatment, and follow-up at 6 months after post-treatment. Evaluations will assess the following variables: sociodemographic data, pain, psychological trauma, sleep disturbance, anxiety and affective symptoms, and wellbeing.
DISCUSSION: This study will provide evidence of whether EMDR therapy is effective in reducing pain symptoms in FM patients, and whether the effect of EMDR can be enhanced by MtCS.
TRIAL REGISTRATION: ClinicalTrials.gov NCT04084795 . Registered on 2 August 2019.

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IJdema, T., Laceulle, O. M., Karreman, A., de Vries, J., & Korrelboom, K. (2021). Does valence contribute to the effects of dual tasking in aversive autobiographical memory? Some unexpected findings. Journal of Behavior Therapy and Experimental Psychiatry, 71. doi:10.1016/j.jbtep.2020.101616

URL: https://doi.org/10.1016/j.jbtep.2020.101616

T. Ijdema, Department of Medical and Clinical Psychology, Centre of Research on Psychology in Somatic Diseases, Tilburg University, Postbus 90153, 5000 LE Tilburg, the Netherlands. E-mail: t.ijdema@uvt.nl


Abstract

Background and objectives: Lab experiments show that engaging in a working memory task while recalling an aversive memory reduces emotionality and vividness of memories. Studies targeting lab induced negative memory with valenced secondary tasks show promise, but work is needed on autobiographical memories to make it more in line with the original dual tasking research and PTSD treatment in clinical populations. In this study, we address this gap by evaluating differential effectiveness of valenced dual tasks on emotionality and vividness of aversive autobiographical memories.
Methods: University students (N = 178) recalled an aversive autobiographical memory while rating either positive pictures, negative pictures, or while looking at a cross in the exposure only condition. Participants were randomized to one of three aforementioned conditions and rated their memories before and after each intervention on emotionality and vividness.
Results: Against expectations, memories became more emotional and vivid regardless of condition. With regard to vividness, this effect was characterized by an interaction effect: memories became more vivid in the exposure only condition than in the combined dual tasking conditions. All effect sizes were small.
Limitations: Working memory load in the dual tasking conditions might have been insufficient.
Conclusions: The current study did not extend findings with regard to (valenced) dual tasking and revealed a possible sensitization effect of script driven autobiographical memory induction. Our study highlights the importance of aspects such as the total amount of exposure and characteristics of memory induction, specifically the addition of a script driven approach to the usual self-initiated memory activation in dual tasking research.

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Kaptan, S. K., Dursun, B. O., Knowles, M., Husain, N., & Varese, F. (2021). Group eye movement desensitization and reprocessing interventions in adults and children: A systematic review of randomized and nonrandomized trials. Clin Psychol Psychother. doi:10.1002/cpp.2549

Open access: https://pubmed.ncbi.nlm.nih.gov/33415797

Safa Kemal Kaptan, School of Health Sciences, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK. E-mail: safa.kaptan@manchester.ac.uk

Abstract

This review systematically synthesized existing literature on group protocols of eye movement desensitization and reprocessing (EMDR) therapy for treating a range of mental health difficulties in adults and children. We conducted database searches on PsychINFO, EMBASE, MEDLINE, Web of Science, The Cochrane Library and Francine Shapiro Library up to May 2020, using PRISMA guidelines. Studies were included if they used at least one standardized outcome measure, if they present a quantitative data on the effect of group EMDR protocols on mental health difficulties and if they were published in English. Twenty-two studies with 1739 participants were included. Thirteen studies examined EMDR Integrative Group Treatment Protocol (IGTP), four studies examined EMDR Group Traumatic Episode Protocol (G-TEP), four studies EMDR Integrative Group Treatment Protocol for Ongoing Traumatic Stress and one study considered EMDR Group Protocol with Children. Of the 22 studies included, 12 were one-arm trials and 10 were two-arm trials. We assessed risk of bias using a revised Tool to Assess Risk of Bias in Randomized Trials (ROB 2) and Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I). Overall, the results suggested that Group EMDR protocols might be an effective tool in improving a wide range of mental health-related outcomes including posttraumatic stress disorder (PTSD), depression and anxiety. However, the included studies are limited to methodological challenges. The limitations and future directions are discussed.

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Kenchel, J. M., Domagalski, K., Butler, B. J., & Loftus, E. F. (2020). The messy landscape of eye movements and false memories. Memory, 1-8. doi:10.1080/09658211.2020.1862234

URL: https://pubmed.ncbi.nlm.nih.gov/33356911

Jillian M. Kenchel, Department of Psychological Science, University of California, Irvine, CA, USA. E-mail: kenchelj@uci.edu

Abstract

Eye-Movement Desensitisation and Reprocessing (EMDR) therapy is a common treatment for PTSD. However, skeptics like James Ost question the theoretical underpinnings, highlight inconsistency of empirical findings surrounding the efficacy of such therapy, and warn against unknown drawbacks. Little is known about the impact of the eye movements, a critical component in EMDR, on susceptibility to false memories, and the existing literature is contradictory. We review the literature and present new findings to help tell the story of the effects of eye movements on memory. Taken as a whole, this small body of work suggests that eye movements do not reliably affect susceptibility to misinformation, nor do they appear to enhance memory, but they do seem to increase spontaneous false memories.

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Khalfa, S., & Poupard, G. (2020). MOSAIC: A New Pain-Free Psychotherapy for Psychological Trauma. The American Journal of Psychotherapy. doi:10.1176/appi.psychotherapy.202020200018

URL: https://doi.org/10.1176/appi.psychotherapy.202020200018

Stephanie Khalfa, Laboratory of Cognitive and Sensory Neuroscience, Aix Marseille University, Marseille, France. E-mail: stephanie.khalfa@gmail.com

Abstract
Eye movements and alternating stimuli for brain integration (MOSAIC) is a promising but untested new therapy. Its four-step protocol is based on the effects of bilateral alternating stimulation (BAS) (as in eye movement desensitization and reprocessing therapy) on the brain. This solution-oriented therapy promotes experiencing solutions through bodily sensations. Through BAS and bodily sensations, MOSAIC therapy aims to enrich the traumatic memory neuronal network with new information so that the client’s psychological trauma is no longer distressing. Thus, MOSAIC can be used to treat psychological trauma without the pain associated with reliving the traumatic situation. This method may be particularly adaptive for patients who have experienced complex trauma and who have dissociative experiences.

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Knaust, T., Felnhofer, A., Kothgassner, O. D., Höllmer, H., Gorzka, R. J., & Schulz, H. (2020). Virtual Trauma Interventions for the Treatment of Post-traumatic Stress Disorders: A Scoping Review. Front Psychol, 11, 562506. doi:10.3389/fpsyg.2020.562506

Open access: https://pubmed.ncbi.nlm.nih.gov/33281664

Thiemo Knaust, Center for Mental Health, Bundeswehr Hospital Hamburg, Hamburg, Germany. E-mail: thiemo1knaust@bundeswehr.org

Abstract

Some post-traumatic stress disorder (PTSD) patients do not benefit from imaginal exposure therapy. One possible approach to reach such patients are virtual trauma interventions. Herein, a qualitative scoping review was conducted. Different types of virtual trauma exposure interventions were identified. For each type of virtual trauma exposure interventions it was examined in detail: (1) which in sensu trauma exposure approach serves as therapeutic framework, how it was transferred into virtual reality, and if it was manualized; (2) which hardware and software were used; (3) whether the influence of spatial and social presence on the efficacy of virtual trauma interventions have been measured, and (4) whether the efficacy of virtual trauma interventions for PTSD patients having imagination difficulties was evaluated. These research questions were analyzed qualitatively. Accordingly, an extensive literature search was conducted using the databases Web of Science, PsycINFO, LIVIVO, PTSDpubs, and PubMed for scientific articles published between January 2013 and July 2020. Only studies aimed to reduce PTSD symptoms using virtual trauma interventions were included. The literature search was not limited to a specific study design, treatment/intervention method, or a minimum sample size. Eighteen studies were identified, which reported three different virtual trauma intervention approaches, namely, virtual reality exposure therapy (VRET), multi-modular motion-assisted memory desensitization and reconsolidation (3MDR), and action-centered exposure therapy (ACET). Seven randomized controlled trials (RCTs), two pilot studies, and one case study were focused on VRET; while two RCTs, one pilot study, and three case studies focused on 3MDR, and two case studies on ACET. Regarding the first research question (1), the results show that VRET is based on prolonged exposure, aiming for a virtual re-creation of the patient's traumatic recounting. Several treatment protocols exist for VRET. 3MDR is based on eye movement desensitization and reprocessing, aiming to reduce the patient's avoidance behavior. In 3MDR patients walk toward individualized trauma-related symbolic images in a cave automatic virtual environment (CAVE). One treatment protocol exists for 3MDR. ACET is based on the inhibitory learning theory, aiming for active interactions with a virtual trauma-associated environment to alter the anxiety structure through new secondary inhibitory learning. One treatment protocol exists for ACET. For the second research question (2), the results indicate that all VRET studies used head-mounted displays (HMDs) with a virtual version of the Iraq/Afghanistan or the World Trade Center attacks, while 3MDR studies utilized two different versions of a CAVE with personalized trauma-related images, and the ACET studies used HMDs with virtual street scenarios. For the third research question (3), the results demonstrate that the influence of spatial or social presence on the efficacy of virtual trauma interventions was not examined in any of the included studies. Similarly, for the fourth research question (4), the results show that empirical evidence for the efficacy of virtual trauma interventions on PTSD patients having imagination difficulties was lacking. Therefore, such empirical studies are needed to fill these research gaps.

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Manzoni, M., Fernandez, I., Bertella, S., Tizzoni, F., Gazzola, E., Molteni, M., & Nobile, M. (2021). Eye movement desensitization and reprocessing: The state of the art of efficacy in children and adolescent with post traumatic stress disorder. J Affect Disord, 282, 340-347. doi:10.1016/j.jad.2020.12.088

URL: https://pubmed.ncbi.nlm.nih.gov/33421861/

Martina Manzoni, Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy; Psychotraumatology Research Center, Milan, Italy. E-mail: martina.manzoni@lanostrafamiglia.it.

Abstract

BACKGROUND: PTSD in youth is more common and debilitating than it was previously thought. This untreated condition is highly correlated to critical mental health condition, such as depression, anxiety disruptive-behaviours, and substance use disorders. Despite the growing number of studies investigating Eye Movement Desensitization and Reprocessing (EMDR) treatment for posttraumatic stress disorder (PTSD) in childhood and adolescent, results have not been systematically revised since 2017. The aim of this work is to systematically reviewed all randomized controlled trials (RCTs) evaluating the effect of EMDR on PTSD symptoms in children and adolescent and assess whether EMDR therapy was effective to improve anxious and/or depressive symptoms. METHODS: In a short series of articles, we will review the efficacy of EMDR on children and adolescent with PTSD and comorbid symptoms. The present brief review will focus on randomized controlled trials with an EMDR group condition compared to a control group published until January 2020. RESULTS: eight studies (n = 150) met our inclusion criteria. Preliminary analyses showed that EMDR has a comparable efficacy to cognitive behavior therapy (CBT) in reducing PTSD, anxiety symptoms, depressive symptoms and was superior to waitlist/placebo condition. Moreover EMDR seems to be more effective in a shorter period of time. CONCLUSION: despite the small number of studies, the preliminary results suggest that EMDR therapy could be an effective treatment for children and adolescent with PTSD and anxious and/or depressive symptoms. Further research is needed to support these results.

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Niemeyer, H., van Aert, R. C. M., Schmidt, S., Uelsmann, D., Knaevelsrud, C., & Schulte-Herbrueggen. (2020). Publication Bias in Meta-Analyses of Posttraumatic Stress Disorder Interventions. Meta-Psychology, 4. doi:10.15626/MP.2018.884

Open access: https://doi.org/10.15626/MP.2018.884

Helen Niemeyer, Freie Universität Berlin, Department of Clinical Psychological Intervention, Germany.

Abstract
Meta-analyses are susceptible to publication bias, the selective publication of studies with statistically significant results. If publication bias is present in psychotherapy research, the efficacy of interventions will likely be overestimated. This study has two aims: (1) investigate whether the application of publication bias methods is warranted in psychotherapy research on posttraumatic stress disorder (PTSD) and (2) investigate the degree and impact of publication bias in meta-analyses of the efficacy of psychotherapeutic treatment for PTSD. A comprehensive literature search was conducted and 26 meta-analyses were eligible for bias assessment. A Monte-Carlo simulation study closely resembling characteristics of the included meta-analyses revealed that statistical power of publication bias tests was generally low. Our results showed that publication bias tests had low statistical power and yielded imprecise estimates corrected for publication bias due to characteristics of the data. We recommend to assess publication bias using multiple publication bias methods, but only include methods that show acceptable performance in a method performance check that researchers first have to conduct themselves.

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Patel, R., Redmond, N. M., Kesten, J. M., Linton, M.-J., Horwood, J., Wilcox, D., . . . Jeal, N. (2020). Drug Use in Street Sex worKers (DUSSK) study: results of a mixed methods feasibility study of a complex intervention to reduce illicit drug use in drug dependent female sex workers. BMJ open, 10(12), e036491. doi:10.1136/bmjopen-2019- 036491

Open access: https://bmjopen.bmj.com/content/10/12/e036491.abstract

Nicola Jeal, NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK. Dr E-mail: Nikki.Jeal1@nhs.net

Abstract

Objectives The majority of female street-based sex workers (SSWs) are dependent on illicit drugs and sell sex to fund their drug use. They typically face multiple traumatic experiences, starting at a young age, which continue through sex work involvement. Their trauma-related symptoms tend to increase when drug use is reduced, hindering sustained reduction. Providing specialist trauma care to address post-traumatic stress disorder (PTSD) alongside drug treatment may therefore improve treatment outcomes. Aims to (1) evaluate recruitment and retention of participants; (2) examine intervention experiences and acceptability; and (3) explore intervention costs using a mixed methods feasibility study. Setting Female SSW charity premises in a large UK inner city.
Participants Females aged 18 years or older, who have sold sex on the street and used heroin and/or crack cocaine at least once a week in the last calendar month. Intervention Female SSW-only drug treatment groups in a female SSW-only setting delivered by female staff. Targeted PTSD screening then treatment of positive diagnoses with eye movement desensitisation and reprocessing (EMDR) therapy by female staff from a specialist National Health Service trauma service.
Results (1) Of 125 contacts, 11 met inclusion criteria and provided informed consent, 4 reached the intervention final stage, (2) service providers said working in collaboration with other services was valuable, the intervention was worthwhile and had a positive influence on participants. Participants viewed recruitment as acceptable and experienced the intervention positively. The unsettled nature of participant’s lives was a key attendance barrier. (3) The total cost of the intervention was £11 710, with staff costs dominating.
Conclusions Recruitment and retention rates reflected study inclusion criteria targeting women with the most complex needs. Two participants received EMDR demonstrating that the three agencies working together was feasible. Staff heavy costs highlight the importance of supporting participant attendance to minimise per participant costs in a future trial.

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Portigliatti Pomeri, A., La Salvia, A., Carletto, S., Oliva, F., & Ostacoli, L. (2021). EMDR in Cancer Patients: A Systematic Review. Frontiers in Psychology, 11. doi:10.3389/fpsyg.2020.590204

Open access: http://dx.doi.org/10.3389/fpsyg.2020.590204


Sara Carletto, Clinical Psychology Unit, University Hospital City of Science and Health, Torino, Italy. E-mail: sara.carletto@unito.it

Abstract

Background: Psychological distress is common among patients with cancer, with severe consequences on their quality of life. Anxiety and depression are the most common clinical presentation of psychological distress in cancer patients, but in some cases cancer may represent a traumatic event resulting in posttraumatic stress disorder (PTSD). Currently, Eye Movement Desensitization and Reprocessing (EMDR) therapy is considered an evidence-based treatment for PTSD, but recent studies also showed its effectiveness for anxiety and depression. The aim of the present systematic review is to summarize the current literature on the effect of EMDR on cancer-related psychological distress.
Methods: A literature search was conducted for peer-reviewed articles about “EMDR” and “cancer patients” in the following electronic databases: PubMed, MEDLINE, Science Direct, Google Scholar, and Cochrane library.
Results: Our search identified 7 studies in which EMDR was used with a total of 140 cancer patients. The psychiatric diagnosis was PTSD in 3 studies. Otherwise, the diagnosis concerned the anxious and depressive disorder spectrum. Overall, EMDR treatment schedules used were highly heterogeneous, with a different number of sessions (from 2 to 12) and a different duration of therapy (up to 4 months). However, across all studies analyzed EMDR therapy was judged to be adequate in reducing symptoms of psychological distress in this population.
Conclusions: According to the results of our analysis, the level of evidence regarding EMDR efficacy in cancer patients is limited by the scarcity of studies and their low methodological quality. Although better quality research is needed, available data suggest that EMDR could be a promising treatment for psychological distress in patients with cancer.

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Rackham, L. A., & Lau-Zhu, A. (2021). Taxing working memory to modulate mental imagery of the 9/11 terrorist attacks following media exposure during childhood: a pilot study in young adult UK residents. Anxiety Stress Coping, 1-14. doi:10.1080/10615806.2020.1870107

Open access: https://pubmed.ncbi.nlm.nih.gov/33412932


Alex Lau-Zhu, Centre for Psychiatry, Division of Brain Sciences, Imperial College London, London, UK. E-mail: alex.lauzhu@hmc.ox.ac.uk

Abstract

BACKGROUND AND OBJECTIVES: Media trauma in civilians is linked to intrusive imagery-based memory symptoms. We investigated whether mental imagery of the 9/11 terrorist attacks following media exposure is dampened by taxing working memory (WM). METHODS: Forty-five young adult UK residents, who were exposed to the 9/11 terrorist attacks as children via the media, identified a personally-relevant mental image of the attacks. They were then randomly allocated to: (1) recall + Tetris, (2) recall + eye movements (EMs), or (3) recall-only. Ratings on imagery vividness and emotionality were provided at three time points: pre-, post-manipulations, and at 24-hr follow-up. RESULTS: Repeated measures ANOVAs revealed that recall + Tetris and recall + EMs (relative to recall-only) significantly reduced imagery vividness and emotionality from pre- to post-manipulations, but not to follow-up. LIMITATIONS: A passive control group is needed to fully rule out the role of natural memory decay; the follow-up was exploratory and took place outside the laboratory with reduced experimental control. CONCLUSIONS: Aversive memory imagery from media trauma in civilians can be dampened by taxing WM, at least temporarily, which could be therapeutically useful. The use of such cognitive techniques may also hold relevance for public health approaches to address the impact of collective trauma.

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van Gelderen, M. J., Nijdam, M. J., Dubbink, G. E., Sleijpen, M., & Vermetten, E. (2020). Perceived treatment processes and effects of interactive motion-assisted exposure therapy for veterans with treatment-resistant posttraumatic stress disorder: a mixed methods study. Eur J Psychotraumatol, 11(1), 1829400. doi:10.1080/20008198.2020.1829400

Open access: https://pubmed.ncbi.nlm.nih.gov/33244364


Marieke J. van Gelderen, ARQ Centrum ’45, ARQ National Psychotrauma Centre, Diemen, The Netherlands. E-mail: M.van.Gelderen@centrum45.nl

Abstract

Background: A novel intervention, Multi-modular motion-assisted memory desensitization and reconsolidation (3MDR), aims to reduce avoidance and improve engagement for patients with posttraumatic stress disorder (PTSD) who did not sufficiently respond to previous treatments. It has been found to effectively reduce PTSD symptoms for veterans with treatment-resistant PTSD. Symptomatic measures alone might not capture all treatment effects, and addition of qualitative outcomes may provide deeper understanding of treatment processes and treatment-induced changes.
Objective: To study the perspectives of veterans with treatment-resistant PTSD on 3MDR treatment processes and effects and explore the relation of their experiences to PTSD symptom improvement.
Method: A convergent parallel mixed methods design was applied. For the qualitative part, open-ended question interviews were conducted until data saturation was reached (N = 10). Thematic analysis, rooted in grounded theory, was performed. Quantitative data included pre- to posttreatment responder status based on a structured clinical interview for PTSD.
Results: Treatment processes endorsed by the veterans were engaging, regulating distress, feeling supported, facing traumatic memories, allowing emotions, associating, and disengaging from trauma. In terms of effects, veterans reported positive changes following 3MDR, including openness, new learning, self-understanding, closure, and reintegration. High comparability across themes was observed for responders and non-responders, except for the themes closure and reintegration, which were reported more often or more in depth by responders.
Conclusions: Veterans indicated 3MDR treatment processes that complied with its aims of breaking through avoidance and increasing engagement, thereby facilitating traumatic memory retrieval and processing. However, this did not necessarily translate into PTSD symptom improvement for all veterans. Walking towards trauma-related pictures was highlighted as unique component of 3MDR and connected to specific treatment processes and effects. Positive changes following 3MDR were experienced outside the domain of PTSD symptom improvement, implicating that 3MDR may beneficially impact veterans beyond symptom changes alone.

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Wallis, O. C., & de Vries, J. (2020). EMDR treatment for anxiety in MS patients: A pilot study. Mult Scler J Exp Transl Clin, 6(4), 2055217320974388. doi:10.1177/2055217320974388

Open access: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780185/

Olga C Wallis, Department of Medical Psychology, Elisabeth- TweeSteden Hospital, Elisabeth, Attn. O.C. Wallis, Postbus 90151, 5000 LC Tilburg, the Netherlands. E-mail: o.wallis@etz.nl

Abstract

Background: Patients with multiple sclerosis (MS) often experience high levels of anxiety, specifically about the (unpredictable) future related to MS. Worries about physical and cognitive declines can cause frightening mental representations of future 'worst-case scenarios'. Evidence of the applicability of eye movement desensitization reprocessing (EMDR) using flash-forward on anxiety is growing. Objective: This pilot study examines the flash-forward EMDR procedure as a treatment option in MS patients suffering from anxiety specifically related to future MS problems. Methods: Eight MS patients suffering from anxiety were treated with one to three sessions of EMDR with a flash-forward target. Treatment effects were evaluated with the use of questionnaires on anxiety, depression, worry, cognitive avoidance, and quality of life at three time points: pre-treatment, direct post-treatment, and three-month follow-up. Results: Significant improvement was shown post-treatment compared to pre-treatment on anxiety, depression, and worry. In a case series analysis, all but one participant showed a clinically important difference in anxiety. Conclusion: Before implementation on a larger scale can be recommended, the value of EMDR with flash forward targets for anxiety in MS need to be further examined. However, the positive results on this pilot can be seen as promising and motivation for future studies.

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