EMDR Research News January 2013
There are seven new treatment reviews mentioning EMDR. Of these, three are new reviews of trauma-informed treatment for adolescents (Black et al., 2012; Gillies et al., 2012; Greyber et al., 2012); plus, there are reviews of treatments for psychogenic nonepileptic seizures (Baslet, 2012), of women veterans with insomnia and PTSD (Hughes, et al., 2012), and sleep disturbances in PTSD (Schoenfeld, et al., 2012). There are two general reviews of EMDR: EMDR for post-traumatic stress (Norgate, 2012) and EMDR as a neurorehabilitation method (Zarghi, et al., 2013). There are two EMDR single case reports: sexual trauma and contamination fears (Nijdam et al., 2012), and treating violent impulses in a military client (Wright and Russell, 2012). There are two EMDR case series reports. The first is a series involving brief assessment and treatment from the Democratic Republic of the Congo of sexual trauma and mutilation (Mankuta et al., 2012) and from South Korean there is a series examining plasma levels of brain-derived neurotrophic factor and nerve growth factor before and after eight sessions of EMDR (Park, et al., 2012).
Then there are a series of five “non-EMDR articles” of potential interest to EMDR clinicians and researchers. First there is an article and a commentary on legal and ethical issues related to acute disaster mental health service which mentions EMDR (Call, et al., 2012; Howe, 2012). Then there are two non-EMDR randomized controlled trials. The first is of a manualized hypnotic treatment for Ego State Therapy (Christensen, et al., 2012). The second examines treatment effects on insular and anterior cingulate cortex activation during classic and emotional Stroop interference in child abuse-related complex post-traumatic stress disorder (Thomaes, et al., 2012) -- a research paradigm that has been used in some EMDR studies. Finally I include a listing for one non-EMDR review of exposure based treatment for PTSD (Rauch et al., 2012).
This month I feature the video (audio only) of EMDR For Pain Relief by Mark Grant.
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.
Featured EMDR book of the month
The Rite of Return:
Coming Back from Duty Induced PTSD
If you didn't already know who she was, seeing Karen Lansing sitting in the back of an EMDR Europe presentation you wouldn't have a clue how tough and dedicated this amazing woman is, an EMDR clinician known by the guys in the field as "the cop whisperer”, a "healer with a warriors heart". You wouldn't guess she has advanced weapons training or that she put her own money on the line to get the first SPECT images showing that EMDR changes the way memories are stored in the brains of police officers who have recovered from PTSD.
If you know a police officer or combat veteran with PTSD who doesn't know that real help, a real cure is available, then this is the book to give him or her. If you work with police, firefighters, special weapons or military personnel, you need to read this book. Karen Lansing has developed a specialized protocol that includes EMDR treatment, but also includes advanced weapons and tactical training. Karen's remarkable specialized training and professional experience make her a unique resource. We're fortunate Karen is such good writer and spokesperson. We are also fortunate she made it back to California all in one piece to explain the science and tell the truth about duty induced PTSD and the rite of return. As she explains in the book, it's not a journey for the faint of heart, but it is the remarkable and moving journey she shares with us in these pages.
Video of the month
Baslet, G. (2012). Psychogenic nonepileptic seizures: A treatment review. What have we learned since the beginning of the millennium? Neuropsychiatric Disease and Treatment, 8, 585-98. doi:10.2147/NDT.S32301
Full text available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3523560/
Gaston Baslet, Department of Psychiatry, Brigham and Women’s Hospital, 221 Longwood Avenue, Boston, MA 02115, USA. Email: email@example.com
Psychogenic nonepileptic seizures (PNES) can significantly affect an individual's quality of life, the health care system, and even society. The first decade of the new millennium has seen renewed interest in this condition, but etiological understanding and evidence-based treatment availability remain limited. After the diagnosis of PNES is established, the first therapeutic step includes a presentation of the diagnosis that facilitates engagement in treatment. The purpose of this review is to present the current evidence of treatments for PNES published since the year 2000 and to discuss further needs for clinical treatment implementation and research. This article reviews clinical trials that have evaluated the efficacy of structured, standardized psychotherapeutic and psychopharmacological interventions. The primary outcome measure in clinical trials for PNES is event frequency, although it is questionable whether this is the most accurate indicator of functional recovery. Cognitive behavioral therapy has evidence of efficacy, including one pilot randomized, controlled trial where cognitive behavioral therapy was compared with standard medical care. The antidepressant sertraline did not show a significant difference in event frequency change when compared to placebo in a pilot randomized, double-blind, controlled trial, but it did show a significant pre- versus posttreatment decrease in the active arm. Other interventions that have shown efficacy in uncontrolled trials include augmented psychodynamic interpersonal psychotherapy, group psychodynamic psychotherapy, group psychoeducation, and the antidepressant venlafaxine. Larger clinical trials of these promising treatments are necessary, while other psychotherapeutic interventions such as hypnotherapy, mindfulness-based therapies, and eye movement desensitization and reprocessing may deserve exploration. Flexible delivery of treatment that considers the heterogeneous backgrounds of patients is emphasized as necessary for successful outcomes in clinical practice.
Black, P. J., Woodworth, M., Tremblay, M., & Carpenter, T. (2012). A review of trauma-informed treatment for adolescents. Canadian Psychology/Psychologie Canadienne, 53(3), 192. doi:10.1037/a0028441
Michael Woodworth, Department of Psychology, University of British Columbia, ASC II, ASC 205, 3333 University Way, Kelowna, BC, V1V 1V7. E-mail: firstname.lastname@example.org
Experiencing trauma as a child or youth often has a variety of serious repercussions that have the potential to follow an individual into adulthood. These may include experiencing difficulties in key areas of functioning such as academic achievement and social interactions, the development of posttraumatic stress disorder (PTSD), or coming into contact with the criminal justice system. Unfortunately, it is estimated that approximately 1 in 4 youth will experience some type of substantive trauma during his or her developmental years (Duke, Pettingell, McMorris, & Borowsky, 2010). The current article provides a summary of the main trauma-informed therapies that are currently available for treating adolescents with PTSD or trauma-related symptoms, as well as the therapeutic techniques that are common to all of these main treatments. Further, recommendations are provided concerning trauma-informed therapies that might be most beneficial to employ with adolescents. Implementing therapies that specifically consider a youth's potential exposure to trauma will facilitate a reduction of negative trauma-related symptoms as well as an improvement in life functioning.
Call, J. A., Pfefferbaum, B., Jenuwine, M. J., & Flynn, B. W. (2012). Practical legal and ethical considerations for the provision of acute disaster mental health services. Psychiatry, 75(4), 305-22. doi:10.1521/psyc.2012.75.4.305
John A. Call, Ph.D., 416 Crown Colony Road, Edmond, OK 73034. E-mail: email@example.com
Mental health professionals who provide emergency psychosocial assistance in the immediate aftermath of disasters do so in the midst of crisis and chaos. Common roles undertaken by disaster mental health professionals include treating existing conditions of disaster survivors and providing psychosocial support to front line responders and those acutely affected. Other roles include participating in multidisciplinary health care teams as well as monitoring and supporting team members' mental health. When, in the immediate aftermath of a disaster, mental health professionals provide such assistance, they may take on legal and ethical responsibilities that they are not fully aware of or do not fully comprehend. Unfortunately, not much has been written about these obligations, and professional organizations have provided little guidance. Thus, the purpose of the present article is to outline and discuss an analysis framework and suggest recommendations that mental health professionals can use to help guide their actions during the chaos immediate post disaster.
Christensen, C., Barabasz, A., & Barabasz, M. (2012). Efficacy of abreactive ego state therapy for PTSD: Trauma resolution, depression, and anxiety. Intl. Journal of Clinical and Experimental Hypnosis, 61(1), 20–37. doi:10.1080/00207144.2013.729386
Full text available at: http://www.tandfonline.com/doi/full/10.1080/00207144.2013.729386
Ciara Christensen, Burrell Behavioral Health, Springfield, MO, USA.
Using manualized abreactive Ego State Therapy (EST), 30 subjects meeting DSM–IV–TR and Clinician-Administered PTSD Scale (CAPS) criteria were exposed to either 5–6 hours of treatment or the Ochberg Counting Method (placebo) in a single session. EST emphasized repeated hypnotically activated abreactive “reliving” of the trauma and ego strengthening by the cotherapists. Posttreatment 1-month and 3-month follow-ups showed EST to be an effective treatment for PTSD. Using the Davidson Trauma Scale, Beck Depression II, and Beck Anxiety Scales, EST subjects showed significant positive effects from pretreatment levels at all posttreatment measurement periods in contrast to the placebo treatment. Most of the EST subjects responded and showed further improvement over time.
Gillies, D., Taylor, F., Gray, C., O'Brien, L., & D'Abrew, N. (2012). Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents. Cochrane Database of Systematic Reviews (Online), 12, CD006726. doi:10.1002/14651858.CD006726.pub2
Donna Gillies, Western Sydney and Nepean Blue Mountains Local Health Districts - Mental Health, Cumberland Hospital, Locked Bag 7118, Parramatta, NSW, 2150, Australia. E-mail: Donna_Gillies@wsahs.nsw.gov.au
BACKGROUND: Post-traumatic stress disorder (PTSD) is highly prevalent in children and adolescents who have experienced trauma and has high personal and health costs. Although a wide range of psychological therapies have been used in the treatment of PTSD there are no systematic reviews of these therapies in children and adolescents.
OBJECTIVES: To examine the effectiveness of psychological therapies in treating children and adolescents who have been diagnosed with PTSD.
SEARCH METHODS: We searched the Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR) to December 2011. The CCDANCTR includes relevant randomised controlled trials from the following bibliographic databases: CENTRAL (the Cochrane Central Register of Controlled Trials) (all years), EMBASE (1974 -), MEDLINE (1950 -) and PsycINFO (1967 -). We also checked reference lists of relevant studies and reviews. We applied no date or language restrictions.
SELECTION CRITERIA: All randomised controlled trials of psychological therapies compared to a control, pharmacological therapy or other treatments in children or adolescents exposed to a traumatic event or diagnosed with PTSD.
DATA COLLECTION AND ANALYSIS: Two members of the review group independently extracted data. If differences were identified, they were resolved by consensus, or referral to the review team.We calculated the odds ratio (OR) for binary outcomes, the standardised mean difference (SMD) for continuous outcomes, and 95% confidence intervals (CI) for both, using a fixed-effect model. If heterogeneity was found we used a random-effects model.
MAIN RESULTS: Fourteen studies including 758 participants were included in this review. The types of trauma participants had been exposed to included sexual abuse, civil violence, natural disaster, domestic violence and motor vehicle accidents. Most participants were clients of a trauma-related support service. The psychological therapies used in these studies were cognitive behavioural therapy (CBT), exposure-based, psychodynamic, narrative, supportive counselling, and eye movement desensitisation and reprocessing (EMDR). Most compared a psychological therapy to a control group. No study compared psychological therapies to pharmacological therapies alone or as an adjunct to a psychological therapy.Across all psychological therapies, improvement was significantly better (three studies, n = 80, OR 4.21, 95% CI 1.12 to 15.85) and symptoms of PTSD (seven studies, n = 271, SMD -0.90, 95% CI -1.24 to -0.42), anxiety (three studies, n = 91, SMD -0.57, 95% CI -1.00 to -0.13) and depression (five studies, n = 156, SMD -0.74, 95% CI -1.11 to -0.36) were significantly lower within a month of completing psychological therapy compared to a control group. The psychological therapy for which there was the best evidence of effectiveness was CBT. Improvement was significantly better for up to a year following treatment (up to one month: two studies, n = 49, OR 8.64, 95% CI 2.01 to 37.14; up to one year: one study, n = 25, OR 8.00, 95% CI 1.21 to 52.69). PTSD symptom scores were also significantly lower for up to one year (up to one month: three studies, n = 98, SMD -1.34, 95% CI -1.79 to -0.89; up to one year: one study, n = 36, SMD -0.73, 95% CI -1.44 to -0.01), and depression scores were lower for up to a month (three studies, n = 98, SMD -0.80, 95% CI -1.47 to -0.13) in the CBT group compared to a control. No adverse effects were identified. No study was rated as a high risk for selection or detection bias but a minority were rated as a high risk for attrition, reporting and other bias. Most included studies were rated as an unclear risk for selection, detection and attrition bias.
AUTHORS' CONCLUSIONS: There is evidence for the effectiveness of psychological therapies, particularly CBT, for treating PTSD in children and adolescents for up to a month following treatment. At this stage, there is no clear evidence for the effectiveness of one psychological therapy compared to others. There is also not enough evidence to conclude that children and adolescents with particular types of trauma are more or less likely to respond to psychological therapies than others. The findings of this review are limited by the potential for methodological biases, and the small number and generally small size of identified studies. In addition, there was evidence of substantial heterogeneity in some analyses which could not be explained by subgroup or sensitivity analyses. More evidence is required for the effectiveness of all psychological therapies more than one month after treatment. Much more evidence is needed to demonstrate the relative effectiveness of different psychological therapies or the effectiveness of psychological therapies compared to other treatments. More details are required in future trials in regards to the types of trauma that preceded the diagnosis of PTSD and whether the traumas are single event or ongoing. Future studies should also aim to identify the most valid and reliable measures of PTSD symptoms and ensure that all scores, total and sub-scores, are consistently reported.
Greyber, L. R., Dulmus, C. N., & Cristalli, M. E. (2012). Eye movement desensitization reprocessing, posttraumatic stress disorder, and trauma: A review of randomized controlled trials with children and adolescents. Child and Adolescent Social Work Journal, 29(5), 1-17. doi:10.1007/s10560-012-0266-0
Laura R. Greyber, School of Social Work, University at Buffalo, 219 Parker Hall, Buffalo, NY, 14214-8007, USA, E-mail: firstname.lastname@example.org
This article examines the methodological rigor of randomized controlled trials (RCTs) of eye movement desensitization reprocessing (EMDR) conducted specifically with children and adolescents who had a diagnosis of posttraumatic stress disorder and history of trauma. A thorough search for RCTs of EMDR with children and adolescents that were published between 1998 and 2010 was conducted utilizing several databases. A total of five studies were identified. Following an extensive review of the literature, it became apparent that the number of RCTs conducted with EMDR with children and adolescents was negligible, though initial results suggest that it is a promising practice. Although current EMDR studies have been conducted with children and adolescents, and have indicated that EMDR is a promising practice, the state of knowledge at this point is insufficient. EMDR tends to produce less positive results when compared to other trauma-focused interventions, although some research indicates the opposite.
Howe, E. G. (2012). What legal risks should mental health care providers take during disasters? Psychiatry, 75(4), 323-30. doi:10.1521/psyc.2012.75.4.323
Edmund Howe, M.D., Department of Psychiatry, USUHS, 4301 Jones Bridge Road, Bethesda, MD 20814. E-mail: Edmund.email@example.com
No abstract: Commentary on Call, J. A., Pfefferbaum, B., Jenuwine, M. J., & Flynn, B. W. (2012). Practical legal and ethical considerations for the provision of acute disaster mental health services. Psychiatry, 75(4), 305-22. doi:10.1521/psyc.2012.75.4.305.
Hughes, J., Jouldjian, S., Washington, D. L., Alessi, C. A., & Martin, J. L. (2012). Insomnia and symptoms of post-traumatic stress disorder among women veterans. Behavioral Sleep Medicine, preprint, 1–17. doi:10.1080/15402002.2012.683903
Jaime Hughes, Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System.
Women will account for 10% of the Veteran population by 2020, yet there has been little focus on sleep issues among women Veterans. In a descriptive study of 107 women Veterans with insomnia (mean age = 49 years, 44% non-Hispanic white), 55% had probable post traumatic stress disorder (PTSD) (total score ≥33). Probable PTSD was related to more severe self-reported sleep disruption and greater psychological distress. In a regression model, higher PTSD Checklist-Civilian (PCL-C) total score was a significant independent predictor of worse insomnia severity index score while other factors were not. Women Veterans preferred behavioral treatments over pharmacotherapy in general, and efforts to increase the availability of such treatments should be undertaken. Further research is needed to better understand the complex relationship between insomnia and PTSD among women Veterans.
Nijdam, M., Pol, M. V. D., Dekens, R., Olff, M., & Denys, D. (2013). Treatment of sexual trauma dissolves contamination fear: Case report. European Journal of Psychotraumatology, 3(0).
Full text available: http://www.eurojnlofpsychotraumatol.net/index.php/ejpt/article/view/19157
Mirjam J. Nijdam, Department of Psychiatry, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands.
Background: In patients with co-morbid obsessive−compulsive disorder (OCD) and posttraumatic stress disorder (PTSD), repetitive behavior patterns, rituals, and compulsions may ward off anxiety and often function as a coping strategy to control reminders of traumatic events. Therefore, addressing the traumatic event may be crucial for successful treatment of these symptoms.
Objective: In this case report, we describe a patient with comorbid OCD and PTSD who underwent pharmacotherapy and psychotherapy.
Methods: Case Report. A 49-year-old Dutch man was treated for severe PTSD and moderately severe OCD resulting from anal rape in his youth by an unknown adult man.
Results: The patient was treated with paroxetine (60 mg), followed by nine psychotherapy sessions in which eye movement desensitization and reprocessing (EMDR) and exposure and response prevention (ERP) techniques were applied. During psychotherapy, remission of the PTSD symptoms preceded remission of the OCD symptoms.
Conclusions: This study supports the idea of a functional connection between PTSD and OCD. Successfully processing the trauma results in diminished anxiety associated with trauma reminders and subsequently decreases the need for obsessive−compulsive symptoms.
Mankuta, D., Aziz-Suleyman, A., Yochai, L., & Allon, M. (2012). Field evaluation and treatment of short-term psycho-medical trauma after sexual assault in the democratic republic of Congo. The Israel Medical Association Journal: IMAJ, 14(11), 653-7.
David Mankuta, Labor and Delivery Center, Department of Obstetrics and Gynecology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, Jerusalem, Israel. E-mail: firstname.lastname@example.org
BACKGROUND: During the horrific war in the Democratic Republic of Congo during the years 1996-2007 the number of casualties is estimated to be 5.4 million. In addition, 1.8 million women, children and men were raped, many as a social weapon of war. Many of these women still suffer from post-traumatic stress disorder (PTSD) and mutilated genitals.
OBJECTIVES: To assess a short-term interventional team for the evaluation and treatment of sexual trauma victims.
METHODS: The intervention program comprised four components: training the local staff, medical evaluation and treatment of patients, psychological evaluation and treatment of trauma victims, and evacuation and transport of patients with mutilated genitals. A diagnostic tool for posttraumatic stress disorder (PTSD)--the Impact Event Scale (IES)--was used. The psychological treatment was based on EMDR (eye movement desensitization and reprocessing) principles. Using questionnaires, the information was obtained from patients, medical staff and medical records.
RESULTS: Three primary care clinics were chosen for intervention. Of the 441 women who attended the clinics over a period of 20 days, 52 women were diagnosed with severe PTSD. Psychological intervention was offered to only 23 women because of transport limitations. The most common medical problems were pelvic inflammatory disease and secondary infertility. Nine patients suffered genital mutilation and were transferred for surgical correction. The 32 local nurses and 2 physicians who participated in the theoretical and practical training course showed improved knowledge as evaluated by a written test.
CONCLUSIONS: With the short-term interventional team model for sexual assault victims the combined cost of medical and psychological services is low. The emphasis is on training local staff to enhance awareness and providing them with tools to diagnose and treat sexual assault and mutilation.
Norgate, K. (2012). EMDR for post-traumatic stress and other psychological trauma. Nursing Times, 108(44), 24-6.
Child and Adolescent Mental Health Service, Central Manchester University Hospitals Foundation Trust.
Eye movement desensitisation and reprocessing (EMDR) is a powerful psychotherapy with well-researched benefits for adults and children who are experiencing post-traumatic stress and post-traumatic stress disorder. There is a wealth of research and practice-based evidence demonstrating the effectiveness of EMDR in many differing clinical presentations but the true potential of this extraordinarily beneficial therapeutic approach has not been fully embraced by the mental health nursing profession.
Park, S. C., Park, Y. C., Lee, M. S., & Chang, H. S. (2012). Plasma brain-derived neurotrophic factor level may contribute to the therapeutic response to eye movement desensitisation and reprocessing in complex post-traumatic stress disorder: A pilot study. Acta Neuropsychiatrica, 24(6), 384-386. doi:10.1111/j.1601-5215.2011.00623.x
Seon-Cheol Park, Department of Neuropsychiatry School of Medicine, Hanyang University. E-mail: email@example.com
This study assessed the potential of levels of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) as biological predictors of eye movement desensitization and reprocessing ( EMDR) responses in complex post-traumatic stress disorder (PTSD). Before and after eight-session EMDR, plasma levels of BDNF and NGF were obtained for eight men with complex PTSD. The results suggest that plasma BDNF levels, which are implicated in vulnerability to depression, may contribute to the therapeutic response to EMDR. The authors concluded that BDNF level might contribute to the therapeutic responsiveness to EMDR in complex PTSD.
Rauch, S. A. M., Eftekhari, A., & Ruzek, J. I. (2012). Review of exposure therapy: A gold standard for PTSD treatment. Review of Exposure Therapy: A Gold Standard for PTSD Treatment, 49(5), 679-688. doi:10.1682/JRRD.2011.08.0152
Full text available at: http://www.rehab.research.va.gov/jour/2012/495/pdf/rauch495.pdf
Sheila A. M. Rauch, PhD; VA Ann Arbor Healthcare System, 2215 Fuller Rd (116c), Ann Arbor, MI 48105.
Prolonged exposure (PE) is an effective first-line treatment for posttraumatic stress disorder (PTSD), regardless of the type of trauma, for Veterans and military personnel. Extensive research and clinical practice guidelines from various organizations support this conclusion. PE is effective in reducing PTSD symptoms and has also demonstrated efficacy in reducing comorbid issues such as anger, guilt, negative health perceptions, and depression. PE has demonstrated efficacy in diagnostically complex populations and survivors of single- and multiple-incident traumas. The PE protocol includes four main therapeutic components (i.e., psychoeducation, in vivo exposure, imaginal exposure, and emotional processing). In light of PE’s efficacy, the Veterans Health Administration designed and supported a PE training program for mental health professionals that has trained over 1,300 providers. Research examining the mechanisms involved in PE and working to improve its acceptability, efficacy, and efficiency is underway with promising results.
Schoenfeld, F. B., DeViva, J. C., & Manber, R. (2012). Treatment of sleep disturbances in posttraumatic stress disorder: A review. J Rehabil Res Dev, 49(5), 729-52. doi:10.1682/JRRD.2011.09.0164
Frank B. Schoenfeld, MD; VA Medical Center 4150 Clement St (116A), San Francisco, CA 94121.
Sleep disturbances are among the most commonly reported posttraumatic stress disorder (PTSD) symptoms. It is essential to conduct a careful assessment of the presenting sleep disturbance to select the optimal available treatment. Cognitive- behavioral therapies (CBTs) are at least as effective as pharmacologic treatment in the short-term and more enduring in their beneficial effects. Cognitive-behavioral treatment for insomnia and imagery rehearsal therapy have been developed to specifically treat insomnia and nightmares and offer promise for more effective relief of these very distressing symptoms. Pharmacotherapy continues to be an important treatment choice for PTSD sleep disturbances as an adjunct to CBT, when CBT is ineffective or not available, or when the patient declines CBT. Great need exists for more investigation into the effectiveness of specific pharmacologic agents for PTSD sleep disturbances and the dissemination of the findings to prescribers. The studies of prazosin and the findings of its effectiveness for PTSD sleep disturbance are examples of studies of pharmacologic agents needed in this area. Despite the progress made in developing more specific treatments for sleep disturbances in PTSD, insomnia and nightmares may not fully resolve.
Thomaes, K., Dorrepaal, E., Draijer, N., de Ruiter, M. B., Elzinga, B. M., van Balkom, A. J., . . . Veltman, D. J. (2012). Treatment effects on insular and anterior cingulate cortex activation during classic and emotional stroop interference in child abuse-related complex post-traumatic stress disorder. Psychological Medicine, 1-13. doi:10.1017/S0033291712000499
K. Thomaes, M.D., GGZ InGeest, A. J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands. Email : firstname.lastname@example.org
BACKGROUND: Functional neuroimaging studies have shown increased Stroop interference coupled with altered anterior cingulate cortex (ACC) and insula activation in post-traumatic stress disorder (PTSD). These brain areas are associated with error detection and emotional arousal. There is some evidence that treatment can normalize these activation patterns.
Method: At baseline, we compared classic and emotional Stroop performance and blood oxygenation level-dependent responses (functional magnetic resonance imaging) of 29 child abuse-related complex PTSD patients with 22 non-trauma-exposed healthy controls. In 16 of these patients, we studied treatment effects of psycho-educational and cognitive behavioural stabilizing group treatment (experimental treatment; EXP) added to treatment as usual (TAU) versus TAU only, and correlations with clinical improvement.
Results: At baseline, complex PTSD patients showed a trend for increased left anterior insula and dorsal ACC activation in the classic Stroop task. Only EXP patients showed decreased dorsal ACC and left anterior insula activation after treatment. In the emotional Stroop contrasts, clinical improvement was associated with decreased dorsal ACC activation and decreased left anterior insula activation.
Conclusions: We found further evidence that successful treatment in child abuse-related complex PTSD is associated with functional changes in the ACC and insula, which may be due to improved selective attention and lower emotional arousal, indicating greater cognitive control over PTSD symptoms
Wright, S. A., & Russell, M. C. (2012). Treating violent impulses: A case study utilizing eye movement desensitization and reprocessing with a military client. Clinical Case Studies. doi:10.1177/1534650112469461
Mark C. Russell, PhD, E-mail: email@example.com
The growing attention to acts of interpersonal violence and misconduct among military members has accompanied a host of research investigating the nature and causes associated with these behaviors. As such, a robust body of literature exists lending insight into risk factors and clinical presentations associated with anger and aggression; however, such factors are multidimensional and complex, particularly for those suffering with war stress injuries. Furthermore, mental health stigma and treatment compliance with exposure and cognitive-based models, particularly in clients with aggressive presentations, can impact successful outcomes. One active-duty marine was referred to an outpatient mental health clinic for the treatment of posttraumatic stress disorder (PTSD). Four sessions of eye movement desensitization and reprocessing (EMDR) were used to significantly reduce obsessive violent impulses, traumatic grief, and depression. The benefit of EMDR therapy as a treatment for violent impulses is explored. The results are promising, but more research is needed.
Zarghi, A., Zali, A., & Tehranidost, M. (2013). Eye movement desensitization and reprocessing (EMDR) as a neurorehabilitation method. Basic and Clinical Neuroscience, 4(1), 19-20.
A variety of nervous system components such as medulla, pons, midbrain, cerebellum, basal ganglia, parietal, frontal and occipital lobes have role in Eye Movement Desensitization and Reprocessing (EMDR) processes. The eye movement is done simultaneously for attracting client's attention to an external stimulus while concentrating on a certain internal subject. Eye movement guided by therapist is the most common attention stimulus. The role of eye movement has been documented previously in relation with cognitive processing mechanisms. A series of systemic experiments have shown that the eyes’ spontaneous movement is associated with emotional and cognitive changes and results in decreased excitement, flexibility in attention, memory processing, and enhanced semantic recalling. Eye movement also decreases the memory's image clarity and the accompanying excitement. By using EMDR, we can reach some parts of memory which were inaccessible before and also emotionally intolerable. Various researches emphasize on the effectiveness of EMDR in treating and curing phobias, pains, and dependent personality disorders. Consequently, due to the involvement of multiple neural system components, this palliative method of treatment can also help to rehabilitate the neuro-cognitive system.