EMDR Research News January 2024
With each reference below, you will find the citation, abstract and author contact information (when available). Previous posting to this blog can be viewed by year in the sidebar below right (visible on computer and tablet - landscape). Summary listings by topic are available at EMDR Research. A comprehensive listing of all EMDR-related research is available at the Francine Shapiro Library. EMDRIA members can access recent Journal of EMDR Practice and Research articles in the member’s area on the EMDRIA website. JEMDR issues older than 12 months are available open access on Connect - Springer Publishing Company.
The book of the month is EMDR Group Therapy edited by Regina Morrow Robinson and Safa Kemal Kaptan.
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Book of the Month
The international panel of 36 scholars clarify procedures for both in-person and remote delivery and for low-intensity interventions as well as those interventions that require more highly resourced professionals.
The wealth of resources includes a thorough checklist for cultural competence for practitioners of group EMDR therapy, and guidelines for working with forcibly displaced groups, survivors of sexual violence, use of EMDR within schools and universities, after disasters, with emergency responders, and with medical professionals.
The book represents the findings of more than 70 research studies compiled over more than 25 years. It is not only an encyclopedic reference and training manual, but also a harbinger of EMDR group therapy’s future listings in major national and international treatment guidelines. This book is an essential reference for emergency planners, government officials, humanitarian aid workers, prison reformers, and community leaders world-wide.
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Bal, Z., & Uçar, T. (2023). The effect of cognitive behavioural therapy and eye movement desensitization and reprocessing techniques on infertile women: a randomized controlled trial. Reprod Biomed Online, 48(2), 103612. https://doi.org/10.1016/j.rbmo.2023.103612
URL: https://doi.org/10.1016/j.rbmo.2023.103612
Zeynep Bal, Department of Midwifery, Faculty of Health Sciences, Gaziantep Islamic Science and Technology University, Gaziantep, Turkey. E-mail: zeynepp_ball@hotmail.com.
Abstract
Research question: What effects do training programmes based on cognitive behavioural therapy (CBT) and eye movement desensitization and reprocessing (EMDR) techniques applied to infertile women affected psychologically and emotionally by infertility have on post-traumatic stress disorder (PTSD) and psychological development?
Design: This randomized controlled study was conducted between May 2021 and August 2022. The study population included 90 infertile women referred to the IVF unit of a hospital in a province in eastern Turkey: 30 in the CBT group, 30 in the EMDR group and 30 in the control group. Data were collected using a personal information form, the Subjective Units of Disturbance Scale (SUDS), the Validity of Cognition (VoC) scale, the Infertility Distress Scale (IDS), the Impact of Event Scale-Revised (IES-R) and the Post-traumatic Growth Inventory (PTGI). Women in the experimental groups (CBT and EMDR groups) received the intervention in six sessions over 3 weeks. Pre-tests were administered to both experimental groups and the control group, and post-tests were conducted 3 weeks after the intervention.
Results: The mean scores on the SUDS, IDS and IES-R for women in the experimental groups were significantly lower compared with those for women in the control group following the interventions (P < 0.001). The mean scores on the VoC scale and PTGI for women in the experimental groups were significantly higher compared with those for women in the control group following the interventions (P < 0.001).
Conclusion: The use of CBT and EMDR techniques reduced the negative psychological and emotional effects of infertility among infertile women.
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De Jongh, A., Hafkemeijer, L., Hofman, S., Slotema, K., & Hornsveld, H. (2024). The AIP model as a theoretical framework for the treatment of personality disorders with EMDR therapy. Frontiers in Psychiatry, 15. https://doi.org/10.3389/fpsyt.2024.1331876
Open Access: https://doi.org/10.3389/fpsyt.2024.1331876
Ad De Jongh, Research Department, PSYTREC, Bilthoven, Netherlands. E-mail: info@psycho-trauma.nl
Abstract
Research has shown that the impact of traumatic events and circumstances on individuals is cumulative and potentially has a wide range of harmful consequences, including negative consequences on mental health. One such consequence is the development of a personality disorder, a persistent mental condition characterized by a pronounced pattern of difficulties in impulse control, emotional regulation, cognitive functions, self-esteem, and interpersonal relationships. A wide array of studies indicates that the personal history of individuals with a personality disorder is often marked by exposure to traumatic events or other types of adverse childhood experiences (ACEs). Because existing treatments for personality disorders are usually long and costly, it is essential to continue exploring alternative and complementary interventions. Nowadays, knowledge and clinical experience in regard to personality disorders have been gained in addressing ACEs by processing memories of these events through eye movement desensitization and reprocessing (EMDR) therapy. In this paper, we present a theoretical framework for this treatment approach, based on Shapiro’s Adaptive Information Processing (AIP) model, describe its current empirical basis, and provide guidance on how to formulate a useful case conceptualization that can serve as a basis for the treatment of personality disorders with EMDR therapy. This approach is illustrated with a case example.
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Every-Palmer, S., Flewett, T., Dean, S., Hansby, O., Freeland, A., Weatherall, M., & Bell, E. (2024). Eye movement desensitization and reprocessing (EMDR) therapy compared to usual treatment for posttraumatic stress disorder in adults with psychosis in forensic settings: Randomized controlled trial. Psychol Trauma. https://doi.org/10.1037/tra0001643
URL: https://pubmed.ncbi.nlm.nih.gov/38227442
Susanna Every-Palmer, Department of Psychological Medicine, University of Otago, 23A Mein Street, Newtown, Wellington 6242, New Zealand. Email: susanna.every-palmer@otago.ac.nz
Abstract
OBJECTIVE: Little direct evidence supports any particular treatment for posttraumatic stress disorder (PTSD) in people with schizophrenia, forensic histories, and/or multiple comorbidities. This trial assesses the efficacy and risks of eye movement desensitization and reprocessing (EMDR) for people with PTSD and psychotic disorders receiving forensic care, including inpatients and prisoners.
METHOD: Single-blind randomized controlled trial comparing EMDR therapy to wait-list (routine care) in forensic-treated adults with psychotic disorders and PTSD. The primary outcome was clinician-rated PTSD symptoms. Secondary outcomes included participant-rated PTSD symptoms, psychotic symptoms, social functioning, disability level, self-esteem, depressive symptoms, posttraumatic cognitions, complex posttraumatic difficulties, and adverse events. Blinded investigators assessed outcomes at baseline, and after 10 weeks and 6 months. Analysis of the primary outcome was by a mixed linear model. Twenty-four participants were randomized, recruitment being hindered by COVID-19 restrictions.
RESULTS: Clinician Administered PTSD Scale mean (SD) scores after 6 months were lower (better) in the EMDR group, 21.3 (13.3), compared with the control group, 31.5 (20.7). The point estimate [95% CI] difference, averaged over two measurement times, was 11.4 [1.3, 21.4], p = .028, favoring EMDR. Self-esteem increased in the EMDR group and depressive symptoms and disability reduced. There were no statistically significant differences in psychotic symptoms or adverse events, although point estimates favored EMDR.
CONCLUSIONS: This is the first EMDR trial in mental health inpatient, forensic, or custodial settings, where PTSD is common. There were improvements in PTSD and other symptomatology consistent with EMDR being a safe and effective treatment for PTSD in these settings.
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Ferguson, H. (2024). Meeting at the precipice: Creative visualization in the treatment of trauma. Psychoanalysis, Self and Context, 1-9. https://doi.org/10.1080/24720038.2024.2302364
URL: https://doi.org/10.1080/24720038.2024.2302364
Heather Ferguson, Institute for the Psychoanalytic Study of Subjectivity
E-mail: hfergusonlcsw@outlook.com
Abstract
This paper illustrates the integration of guided visualization, drawn from clinical hypnosis, in a self-psychologically informed treatment with a traumatized patient. In providing a hypnotic script, I serve as a witness and felt presence as I accompany the patient as she draws upon her imagination. Images and written reflections engage her capacity to creatively symbolize her childhood trauma with distance and reflective space. Eye Movement Desensitization and Reprocessing (EMDR) therapy unlocks state-dependent memories and stimulates new associations and self-compassion. Within a psychodynamic framework, these creative interventions titrate the destabilizing impact of traumatic recall by empowering the patient as an active agent, utilizing her creative resources to create an expanded, healing narrative.
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Greenwald, R., & Camden, A. A. (2024). A Pragmatic Randomized Comparison of Intensive EMDR and Intensive PC for Victims of Crime. Psychological Trauma: Theory, Research, Practice, and Policy, 16(1), 134-142. https://doi.org/10.1037/tra0001176
URL: https://doi.org/10.1037/tra0001176
Ricky Greenwald, Trauma Institute & Child Trauma Institute, 285 Prospect Street, Northampton, MA 01060, United States. E-mail: rg@childtrauma.com
Abstract
Objective: The intensive therapy format offers clients the opportunity to reduce time to treatment bene- fit, compared with conventional weekly therapy. Eye movement desensitization and reprocessing (EMDR) has been identified as the most efficient of the leading trauma therapies. Progressive counting (PC) is less resource-intensive for therapists to master and may be at least as efficient as EMDR. Our objective was to evaluate and compare intensive EMDR and intensive PC. Method: We randomized 96 treatment-seeking victims of crime to intensive EMDR or intensive PC.
Results: Participants experienced statistically and clinically significant improvements on measures of posttraumatic stress, presenting problems, level of functioning, and quality of life from pretreatment to posttreatment and follow-up, with large to very large effect sizes on all measures. There were no significant differences between EMDR on PC any outcome, including treatment efficiency, and dropout was minimal.
Conclusions: These results support previous findings regarding the value of intensive trauma-focused therapy and indicate that PC may be comparable to EMDR in the intensive therapy format.
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Hafkemeijer, L., Slotema, K., de Haard, N., & de Jongh, A. (2023). Case report: Brief, intensive EMDR therapy for borderline personality disorder: results of two case studies with one year follow-up. Front Psychiatry, 14, 1283145. https://doi.org/10.3389/fpsyt.2023.1283145
Open Access: https://doi.org/10.1037/tra0001176
Laurian Hafkemeijer, Department of Adult Psychiatry, GGZ Delfland, Delft, Netherlands, E-mail: l.hafkemeijer@ggz-delfland.nl
Abstract
BACKGROUND: Exposure to adverse childhood events plays an important role in the development of borderline personality disorder (BPD). Emerging evidence suggests that trauma-focused therapy using eye movement desensitization and reprocessing (EMDR) can be beneficial for patients with BPD symptoms. To date, the effects of brief, intensive EMDR treatment for this target group have not been investigated in this population.
OBJECTIVE: This study aimed to evaluate the effects of a brief and intensive trauma-focused therapy course using EMDR therapy in two patients diagnosed with BPD who did not fulfill the diagnostic criteria for post-traumatic stress disorder (PTSD). It was hypothesized that this approach would be associated with a decline in the core symptoms of BPD, and that this would have an enduring long-term effect on patients' diagnostic status.
METHOD: Ten sessions of EMDR therapy were carried out across four consecutive treatment days, with the aim of processing patients' core adverse childhood experiences. Both A-criterion-worthy memories (without intrusive reliving) and non-A-criterion-worthy memories that were considered responsible for the patients' most prominent symptoms were targeted. The effects of EMDR therapy on trauma symptom severity and BPD diagnostic status (as established by the Structured Clinical Interview DSM-5) were determined. Additionally, the effects on psychological distress, quality of life, and difficulties in emotion regulation were determined at intake, post-treatment, and at 3-, 6-, and 12-months follow-up.
RESULTS: Both patients showed a strong decline in psychological distress and difficulties in emotion regulation, and reported an improvement in their quality of life. At post-treatment, and at 3-, 6-, and 12-months follow-up they no longer met the DSM-5 criteria for BPD.
CONCLUSION: The findings of this small case study are in line with mounting evidence that a brief track of intensive trauma-focused therapy can result in long-term remission in patients with BPD. EMDR therapy seems to be a promising treatment approach for patients with BPD; however, the results need to be replicated in clinical trials.
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Hoppen, T. H., Meiser-Stedman, R., Kip, A., Birkeland, M. S., & Morina, N. (2024). The efficacy of psychological interventions for adult post-traumatic stress disorder following exposure to single versus multiple traumatic events: a meta-analysis of randomised controlled trials. Lancet Psychiatry, 11(2), 112-122. https://doi.org/10.1016/S2215-0366(23)00373-5
URL: https://doi.org/10.1016/S2215-0366(23)00373-5
Thole H. Hoppen, Ph.D., Institute of Psychology, University of Münster, Fliednerstr. 21
48149 Münster, Germany. E-mail: thoppen@uni-muenster.de
Abstract
BACKGROUND: Previous meta-analyses of psychological interventions for adult post-traumatic stress disorder (PTSD) did not investigate whether efficacy is diminished in individuals with PTSD related to multiple (vs single) traumatic events. We aimed to assess whether treatment efficacy would be lower in randomised controlled trials involving multiple-event-related PTSD versus single-event-related PTSD.
METHODS: For this meta-analysis, we searched PsycINFO, MEDLINE, Web of Science, and PTSDpubs from database inception to April 18, 2023. Randomised controlled trials involving adult clinical samples (≥70% meeting full PTSD criteria) with adequate size (≥10 participants per arm) were included. We extracted data on trial characteristics, demographics, and outcome data. Random-effects meta-analyses were run to summarise standardised mean differences (Hedges' g). Trials involving 100% of participants with single-event-related PTSD versus at least 50% of participants with multiple-event-related PTSD (ie, associated with ≥two traumatic events) were categorised. Quality of evidence was assessed using the Cochrane criteria. The review protocol was registered in PROSPERO (CRD42023407754).
FINDINGS: Overall, 137 (85%) of 161 randomised controlled trials were included in the quantitative synthesis, comprising 10 684 participants with baseline data and 9477 with post-treatment data. Of those randomly assigned, 5772 (54%) of 10 692 participants identified as female, 4917 (46%) as male, and three (<1%) as transgender or other. 34 (25%) of 137 trials exclusively involved women, 15 (11%) trials exclusively involved men, and the remainder were mixed samples. Mean age across the trials was 40·2 years (SD 9·0) ranging from 18·0 years to 65·4 years. 23 (17%) of 137 trials involved participants from low-income and middle-income countries (23 [17%] of 137). Data on ethnicity were not extracted. At treatment endpoint, psychological interventions were highly effective for PTSD when compared with passive control conditions in both samples with single-event-related PTSD (Hedges' g 1·04 [95% CI 0·77-1·31]; n=11; I^2^=43%) and multiple-event-related PTSD (Hedges' g 1·13 [0·90-1·35]; n=55, I^2^=87%), with no efficacy difference between these categories (p=0·48). Heterogeneity between studies was substantial but outlier-corrected analysis yielded similar results. Moderate-sized effects were found compared with active control conditions with no significant difference between single-trauma and multiple-trauma trials. Results were robust in various sensitivity analyses (eg, 90% cutoff for multiple-trauma trials) and analyses of follow-up data. The quality of evidence was moderate to high.
INTERPRETATION: Contrary to our hypothesis, we found strong evidence that psychological interventions are highly effective treatments for PTSD in patients with a history of multiple traumatic events. Results are encouraging for clinical practice and could counteract common misconceptions regarding treatment and treatment barriers. FUNDING: None.
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Kaptan, S. K., Kaya, Z. M., & Akan, A. (2023). Addressing mental health need after COVID-19: a systematic review of remote EMDR therapy studies as an emerging option. Front Psychiatry, 14, 1336569. https://doi.org/10.3389/fpsyt.2023.1336569
Open Access: https://doi.org/10.3389/fpsyt.2023.1336569
Safa Kemal Kaptan, Assistant Professor, Department of Psychology, Boğaziçi University, İstanbul, Türkiye, E-mail: safa.kaptan@manchester.ac.uk
Abstract
INTRODUCTION: The COVID-19 pandemic has been associated with a substantial rise in mental health challenges, prompting a need for accessible and effective therapeutic interventions. This review summarizes the evidence on remote Eye Movement Desensitization and Reprocessing (EMDR) therapy delivered in response to the increased need.
METHODS: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases including PsychINFO, EMBASE, MEDLINE, and Web of Science were searched to identify studies assessing the efficacy of EMDR therapy administered online.
RESULTS: Sixteen articles meeting the inclusion criteria were selected, involving 1,231 participants across various age groups. Studies covered remote individual and group EMDR sessions and self-administered computerized protocols. Findings indicate promising outcomes in reducing PTSD symptoms, anxiety, and depression.
DISCUSSION: The analysis of the selected studies demonstrates the feasibility and potential efficacy of online EMDR as an accessible therapeutic option for addressing mental health difficulties, particularly during times of limited in-person interaction. However, the studies revealed limitations such as small sample sizes, absence of control groups, and reliance on self-reported measures.
Systematic review registration: The present review was registered on "The International Database to Register Your Systematic Reviews" (INPLASY) with the registration number 2023120018 and DOI number 10.37766/inplasy2023.2.0068.
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Koweszko, T., de Barbaro, B., Izydorczyk, B., Mastalerz-Migas, A., Samochowiec, J., Szulc, A., Kowalska, A., Wachowska, K., & Gałecki, P. (2023). The position statement of the Working Group on the treatment of post-traumatic stress disorders in adults. Psychiatr Pol, 57(4), 705-727. https://doi.org/10.12740/PP/166172
Open Access: https://doi.org/10.12740/PP/166172
Tytus Koweszko Department of Psychiatry Faculty of Health Sciences Medical University of Warsaw E-mail: koweszko@gmail.com
Abstract
Post-traumatic stress disorder (PTSD) is a mental distress that occurs after participation in traumatic event such as the experience of natural disaster, car accident, terrorist attack or armed conflict, being a victim of sexual assault, tortured, physically abused, traumatized or being in any other life-threatening situation. The trauma victim does not always have to be in the position of the o directly threatened with physical harm. The disorder may be developed also as a result of an acute reaction to stress caused by participation in situation in which another person suffer so unimaginable that the further normal life of witness becomes impossible. Patients are often convinced that they lose previous ability to exist irretrievably. Globally PTSD is an increasingly recognized disorder. It can be predicted that in Europe, due to the ongoing war in Ukraine and the migration crisis, the frequency of severe disorders related to traumatic stress will systematically increase. In recent years, there has been a significant progress in knowledge and the development of methods for counteracting PTSD. The empirically confirmed forms of treatment include psychotherapeutic and pharmacotherapeutic interactions. The presented recommendations were developed by a team of experts in the field of psychiatry, clinical psychology, psychotherapy and primary care in order to proposed guidelines for therapeutic procedures in medical and psychological practice. The position statement of the working group have been developed in line with evidence-based practice as a part of three-stage procedure including: literature review, the issue discussion and development of the unified expert position.
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Lang, A. J., Hamblen, J. L., Holtzheimer, P., Kelly, U., Norman, S. B., Riggs, D., Schnurr, P. P., & Wiechers, I. (2024). A clinician’s guide to the 2023 VA/DoD Clinical Practice Guideline for Management of Posttraumatic Stress Disorder and Acute Stress Disorder. J Trauma Stress. https://doi.org/10.1002/jts.23013
URL: https://doi.org/10.1002/jts.23013
Ariel Lang, VA San Diego Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA. E-mail: ajlang@health.ucsd.edu
Abstract
A clinical practice guideline (CPG) is a rigorously established set of recommendations based on currently available evidence about the efficacy, safety, acceptability, and feasibility of interventions to assist with clinical decision-making. The 2023 Department of Veterans Affairs /Department of Defense Clinical Practice Guideline for Management of Posttraumatic Stress Disorder and Acute Stress Disorder is described herein. The CPG recommendations are accompanied by a clinical algorithm, which incorporates principles of evidence-based practice, shared decision-making, and functional and contextual assessments of goals and outcomes. An overview of the CPG recommendations is combined with a discussion of questions that clinicians and patients may face in implementing the CPG and suggestions for how to effectively work with the CPG.
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Laugharne, R., Farid, M., James, C., Dutta, A., Mould, C., Molten, N., Laugharne, J., & Shankar, R. (2023). Neurotechnological solutions for post-traumatic stress disorder: A perspective review and concept proposal. Healthc Technol Lett, 10(6), 133-138. https://doi.org/10.1049/htl2.12055
Open Access: https://doi.org/10.1049/htl2.12055
Rohit Shankar, Cornwall Intellectual Disability Equitable Research, University of Plymouth, Health and Wellbeing Innovation Centre, Treliske, Truro, Cornwall TR1 3FF, UK. E-mail: rohit.shankar@plymouth.ac.uk
Abstract
Post-traumatic stress disorder (PTSD) is an anxiety condition caused by exposure to severe trauma. It is characterised by nightmares, flashbacks, hyper-vigilance and avoidance behaviour. These all lead to impaired functioning reducing quality of life. PTSD affects 2-5% of the population globally. Most sufferers cannot access effective treatment, leading to impaired psychological functioning reducing quality of life. Eye movement desensitisation and reprocessing (EMDR) is a non-invasive brain stimulation treatment that has shown significant clinical effectiveness in PTSD. Another treatment modality, that is, trauma-focused cognitive behavioural therapy is also an effective intervention. However, both evidence-based treatments are significantly resource intensive as they need trained therapists to deliver them. A concept of a neuro-digital tool for development is proposed to put to clinical practice of delivering EMDR to improve availability, efficiency and effectiveness of treatment. The evidence in using new technologies to measure sleep, geolocation and conversational analysis of social media to report objective outcome measures is explored. If achieved, this can be fed back to users with data anonymously collated to evaluate and improve the tool. Coproduction would be at the heart of product development so that the tool is acceptable and accessible to people with the condition.
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Magne, H. (2023). Is there a place for EMDR in neurology. Rev Neurol (Paris), S0035-3787(23)01151. https://doi.org/10.1016/j.neurol.2023.10.016
URL: https://doi.org/10.1016/j.neurol.2023.10.016
Hugues Magne, Cabinet medical, 2 bis, avenue de Royat, 63400 Chamalieres, France
E-mail: dr.hugues.magne@gmail.com
Abstract
[The concluding paragraph is listed as there is no abstract.]
In summary, all reviews on this topic agree that EMDR is a safe and effective treatment for psychiatric and non-psychiatric disorders. Although further randomized, controlled and well-designed trials are needed, EMDR therapy is a complementary or alternative treatment that can be proposed in the field of neurology, especially for the treatment of CP and for the treatment of FND.
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Manfield, P. E., Taylor, G., Dornbush, E., Engel, L., & Greenwald, R. (2023). Preliminary evidence for the acceptability, safety, and efficacy of the flash technique. Front Psychiatry, 14, 1273704. https://doi.org/10.3389/fpsyt.2023.1273704
Open Access: https://doi.org/10.3389/fpsyt.2023.1273704
Philip E. Manfield, Independent Practice, Albany, CA, United States. E-mail: PEM49@Columbia.edu
Abstract
OBJECTIVES: This study reports on four similar studies intended to explore the acceptability, safety, and efficacy of the flash technique (FT), a method of rapidly reducing the intensity of a disturbing memory or image, with minimal subjective disturbance for subjects during the process. Of the four studies, two were conducted during FT trainings in the United States, one in Australia, and one in Uganda.
METHODS: The studies involve pre-, post-, and follow-up repeated-measures design to determine the effectiveness of a 15-min FT intervention. A total of 654 subjects were asked to think of a disturbing memory and then participate in a structured experience of an FT. The purpose of this investigation was to determine whether a brief application of an FT would be safe and effective in significantly reducing their disturbance. In each study, subjects rated their disturbing memories on a 0-to-10 scale, with zero representing no disturbance at all and 10 representing the worst they could imagine. Then, they took part in a 15-min group practicum where they were guided in a self-administering FT with no individual supervision or support.
RESULTS: In all four studies, the mean reduction in disturbance exceeded two-thirds, the results were significant (p < 0.001), and the effect size was very large. Of the 813 sessions (654 subjects) represented in these studies, only two subjects reported slight increases in disturbances, and both of these subjects reported reductions in disturbance in their second FT experiences 2 h later. At a 4-week follow-up, mean disturbance levels in all four studies indicated maintenance of benefit or slightly further reduction of mean disturbance levels. An 18-month follow-up study with a subgroup of subjects who initially reported a high level of memory-related distress found similar maintenance of gains as well as symptom reduction.
CONCLUSION: These findings provide preliminary evidence of acceptability, safety, and efficacy of FT; therefore, further study is warranted.
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Marlow, S., Laugharne, R., Allard, J., Bassett, P., Priebe, S., Ledger, J., Kerr, J., Priest, D., Vanhoorn, A., Boland, C., & Shankar, R. (2024). A pragmatic randomized controlled exploratory trial of the effectiveness of Eye Movement Desensitization and Reprocessing therapy for psychotic disorder. Journal of Psychiatric Research, 169, 257-263. https://doi.org/10.1016/j.jpsychires.2023.11.024
Open Access: https://doi.org/10.1016/j.jpsychires.2023.11.024
Rohit Shankar, Threemilestone Industrial Estate, Truro, TR 4 9LD, UK. E-mail address: rohit.shankar@plymouth.ac.uk
Abstract
Background: People with severe mental illness are often excluded from trials related to Eye Movement Desensitization and Reprocessing (EMDR) therapy. Principal concerns are that they may not tolerate treatment, might risk relapse or that psychotic symptoms may worsen. There is however building evidence of a traumatogenicetiology of psychotic disorder that may benefit therapeutically from EMDR. However, EMDR in this role is done mainly in specialist tertiary settings.
Aim: To conduct a randomized exploratory trial of prospective treatment of EMDR for people with psychotic disorder and a history of trauma in an adult community mental health service.
Methods: A randomized exploratory trial with a controlled pilot design was employed to conduct a prospective treatment and six-month follow-up study with an interim 10-week analysis in a rural county in the UK (population 538,000). We recruited participants with psychotic disorder who had a reported history of trauma and were interested in receiving trauma therapy. They were then randomized to either receive EMDR or treatment as usual (TAU). The primary instrument used was the Impact of Events Scale (IES) with secondary instruments of Positive and Negative Symptoms of Psychotic Disorder (PANSS), PTSD Checklist (PCL-C), and subjective Quality
of Life (MANSA).
Results: IES scores showed significant improvements in the EMDR group (n =24, age 42.0 SD (14.5), 42% male) compared to the TAU group (n =12, age 34.4 SD (11.3), 50% male) at 10 weeks and at six months (p <0.05). There were significant improvements in PCL-C and PANSS negative symptoms scores associated with treatment (p < 0.05). All other scales showed positive trends.
Conclusions: This study demonstrates that EMDR can reduce the impact of traumatic events for patients with a psychotic disorder in a clinical setting in the UK. The improvements in psychotic disorder persisted for six months after treatment.
Trial registration: ISRCTN43816889.
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Miles, L. W., Valentine, J. L., Mabey, L. J., Hopkins, E. S., Stodtmeister, P. J., Rockwood, R. B., & Moxley, A. N. H. (2023). A systematic review of evidence-based treatments for adolescent and adult sexual assault victims. Journal of the American Psychiatric Nurses Association, 10783903231216138.
Open Access: https://journals.sagepub.com/doi/10.1177/10783903231216138
Leslie W. Miles, Teaching Professor, Brigham Young University College of Nursing, 430 Kimball Tower, Provo, UT 84601, USA. E-mail: leslie-miles@byu.edu
Abstract
BACKGROUND: Sexual assault (SA) is a serious crime that is a prevalent mental and public health problem.
AIMS: Addressing the needs of SA victims and providing appropriate treatment are essential to reduce potential adverse short- and long-term outcomes.
METHODS: Our team undertook an extensive systematic literature review (published between January 2006 and July 2021) to provide evidence-based mental health intervention recommendations for adolescent and adult victims of SA. Where SA-specific research was limited, the literature and clinical practice guidelines on treatments for trauma-induced post-traumatic stress disorder (PTSD) were reviewed to provide additional information to formulate recommendations.
RESULTS: Findings strongly support several primary psychotherapy treatments: cognitive behavioral therapy, cognitive processing therapy, eye movement desensitization and reprocessing, narrative exposure therapy, and prolonged exposure therapy. Complementary (aerobic exercise, art, drama, and music therapy) and pharmacological treatments were explored.
CONCLUSIONS: Mental health nurses who provide services for victims of SA can utilize this overview to guide recommendations for treatment of SA trauma and related PTSD symptoms to mitigate the short- and long-term negative impacts after a traumatic event. When victims of SA receive optimal mental health treatments, our communities benefit as victims heal and recover.
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Modlin, N. L., Creed, M., Sarang, M., Maggio, C., Rucker, J. J., & Williamson, V. (2024). Trauma-Informed Care in Psychedelic Therapy Research: A Qualitative Literature Review of Evidence-Based Psychotherapy Interventions in PTSD and Psychedelic Therapy Across Conditions. Neuropsychiatr Dis Treat, 20, 109-135. https://doi.org/10.2147/NDT.S432537
Open Access: https://doi.org/10.2147/NDT.S432537
Nadav Liam Modlin, The Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF, UK, E-mail: nadav.modlin@kcl.ac.uk
Abstract
INTRODUCTION: Post-traumatic stress disorder (PTSD) is associated with significant patient burden. While pharmacotherapies and evidence-based psychotherapy interventions (EBPI) are effective, studies consistently highlight inadequate outcomes and high treatment dropout. Psychedelic therapy (PT) has shown preliminary promise across difficult-to-treat conditions, including MDMA-assisted therapy for PTSD, however trials of classical psychedelics in PTSD are lacking. Understanding patients' experiences of EBPI could help promote safety in PT. AIM: To systematically review qualitative research on patients' subjective experience of EBPI for PTSD, and of PT, and examine areas of overlap and divergence between them.
METHODS: Systematic literature searches for studies published between 2010 and 2023 were conducted on OVID, PubMed, Web of Science, and PsycInfo. Included were original studies in English that presented qualitative data of patient experiences of EBPI in PTSD, or PT for any indication. Extracted data from included studies were analysed using thematic synthesis. Syntheses were completed separately for EBPI and PT, before similarities and differences between the therapies were identified.
RESULTS: 40 research articles were included for review: 26 studies on EBPI for PTSD, and 14 studies on PT. EBPI studied were CBT, EMDR, CPT and PE. Psychedelic compounds studied were psilocybin, ibogaine, LSD, MDMA and ketamine, for treatment of substance use disorders, anxiety relating to physical illness, depression, and PTSD. Core themes from patient experiences of EBPI: 1) patient burden in PTSD treatment; 2) readiness; 3) key mechanisms of change; 4) psychological safety and trust. Themes identified in the review of PT: 1) indirect trauma processing; 2) reorganisation of self-narratives via processes of relatedness and identification; 3) key treatment characteristics.
CONCLUSION: This study suggests overlap between patients' experience of EBPI and PT in terms of key mechanisms of change, the importance of psychological safety and readiness to engage in treatment. Trauma-informed care paradigms and practices may improve safety and acceptability of PT research.
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Ozgur, G., Ozgur, E., & Karabulut, M. (2024). End-point nyustagmus and EMDR. Marmara Medical Journal, 37(1), 103-105. https://doi.org/10.5472/marumj.1379890
Open Access: https://dergipark.org.tr/en/download/article-file/3498831
Borte Gurbuz Ozgur, E-mail: borte.gurbuz@adu.edu.tr
Abstract
Eye movement desensitization and reprocessing (EMDR) is a psychotherapy that helps people to heal from trauma or other disturbing life experiences. In this article, the appearance of nystagmus in the eye during the application of the EMDR method was discussed while treating a 16-year-old adolescent girl who presented with a complaint of not eating meat following a traumatic event. Although, eye movements are used in EMDR, nystagmus can impede the patient’s ability to maintain eye movements. After excluding additional pathologies related to the eye, alternative bilateral stimulations can be used in EMDR.
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Ross, J., Navarro, F., Mainthow, N., Givaudan, J., & Jarero, I. (2024). Breast And Cervical Cancer-Related PTSD: Randomized Controlled Trial on the ASSYST Treatment Intervention. Cancer Therapy & Oncology, 25(5). https://doi.org/10.19080/CTOIJ.2024.25.556175
Open Access: https://tinyurl.com/yokbgphw
Ross Jessica, Ágape, Desarrollo Integral, AC, Puebla México.
Abstract
The aim of this randomized controlled trial with an intention-to-treat analysis was to evaluate the effectiveness, efficiency, and safety of the Acute Stress Syndrome Stabilization Individual (ASSYST-I) treatment intervention in reducing posttraumatic stress disorder (PTSD), anxiety, and depression symptoms in adult females with breast or cervical cancer. A total of 30 adult females met the inclusion criteria and participated in the study. Participants’ ages ranged from 37 to 62 years old (M =48.63 years old). A two-arm randomized controlled trial (RCT) design was applied. PTSD, anxiety, and depression symptoms were measured in three time points for all participants in the study. Repeated-measures ANOVA showed that the intervention had a significant effect for time with a large effect size (F (2,56) = 76.68 p <.000, η² = .738), and a significant interaction with a large effect size between time and group, (F (2, 56) = 101.21, p <.000, η² = .738), on PTSD. For anxiety, results differed significantly across time points (F (2,56) = 3.16, p= .05, η² =. 102). Mean scores on depression showed a significant interaction between time and group (F (2, 56) =5.94, p =.000, η² =. 317).
Results on the Reliable Change Index (RCI) and the Clinically Significant Change (CSC) Margin showed that the ASSYST-I treatment intervention exhibited reliable change in PTSD symptom reduction and clinically significant change, indicating that the treatment group participants are more likely to belong to the non-PTSD population after the intervention. Conversely, the control group participants are more likely to belong to the PTSD population. All this data supports the effectiveness, efficiency, and safety of the ASSYST-I treatment intervention in reducing PTSD, anxiety, and depression symptoms in adult females with breast or cervical cancer. No adverse effects or events were reported by the participants during the treatment procedure administration or at follow-up. None of the participants showed clinically significant worsening/exacerbation of symptoms after treatment. Participants in the control group were invited to receive the intervention treatment after the follow-up assessment, fulfilling our ethical criteria.
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Smith, S., Aelita, S., & Martha, G. (2024). Clinical Control Trial on the Healing Drawing Procedure (HDP) Trauma Treatment Intervention Provided by Non-Specialist Mental Health Providers to Vulnerable Children Living in Taraz, Republic of Kazakhstan. Psychology and Behavioral Science International Journal, 21(3). https://doi.org/10.19080/pbsij.2024.21.556065
Open Access: https://doi.org/10.19080/pbsij.2024.21.556065
Sadie Smith, Department of Research, Breakout, Denver, Colorado, United States of America.
Abstract
This clinical controlled trial had two objectives: 1) to evaluate the effectiveness, efficiency, and safety of the Healing Drawing Procedure (HDP) group trauma treatment intervention in reducing posttraumatic stress disorder (PTSD) symptoms among vulnerable children living in Taraz, Kazakhstan and 2) to explore the effectiveness and safety of non-specialist mental health providers (MHPs) being trained in and delivering the HDP group trauma treatment intervention as part of the task-sharing focused Trauma Healing Training Program (THTP), which is being developed to safely bring effective mental health treatment interventions to high-need, low-resource contexts, specifically in low-and-middle-income countries (LMICs).
A total of 22 children between the ages of 7-14 (M = 10.09 years old) met the inclusion criteria and participated in the study. To evaluate the effectiveness, efficiency, and safety of the HDP treatment intervention in reducing PTSD symptoms in vulnerable children, repeated-measures ANOVA was applied, comparing the Treatment Group (TG) and the Control Group (CG). Results showed that the HDP treatment intervention had a significant effect for time, with a medium effect size (F (2,40) = 17.72 p <.000, η² = 470), and a significant effect for group with a lower effect size (F (1, 20 = 76.66, p<.001, η² = .404). Intragroup comparisons of means showed significant differences for the Treatment Group (TG) between Time 1. Pre-test assessment and Time 2. Post-treatment assessment with a large effect, t (14) = 5.42, p=.00, d = .955. These data confirm the effectiveness, efficacy, and safety of the HDP group trauma treatment intervention in reducing posttraumatic stress disorder (PTSD) symptoms in children. Results also show the Trauma Healing Training Program’s success in safely bringing an effective mental health treatment intervention provided by specially trained non-specialist mental health providers in a low-resource country.
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Schipper-Eindhoven, S. M., de Knegt, N. C., Mevissen, L., van Loon, J., de Vries, R., Zhuniq, M., & Bekker, M. H. J. (2023). EMDR treatment for people with intellectual disabilities: a systematic review about difficulties and adaptations. Front Psychiatry, 14, 1328310. https://doi.org/10.3389/fpsyt.2023.1328310
Open Access: https://doi.org/10.3389/fpsyt.2023.1328310
Simone M. Schipper-Eindhoven, Zodiak, Prinsenstichting, Purmerend, Netherlands. E-mail: si.schipper@prinsenstichting.nl
Abstract
INTRODUCTION: People with intellectual disabilities (ID) are at increased risk for developing Post Traumatic Stress Disorder (PTSD). Emerging evidence indicates that Eye Movement Desensitization and Reprocessing (EMDR) therapy is feasible and potentially effective for this group. However, communication, cognition, stress regulation, and attachment difficulties may interfere with the EMDR process. Adaptation of the EMDR protocol seems therefore required for this population. AIM: This review aims to systematically identify and categorize the difficulties in applying EMDR to people with ID and the adaptations made by therapists to overcome these challenges.
METHODS: A literature search was performed in May 2023. Article selection was based on inclusion and exclusion criteria and quality appraisal.
RESULTS: After screening, 13 articles remained for further review. The identified difficulties and adaptations were categorized into the three domains of adaptive functioning (i.e., conceptual, social, and practical functioning). Considerable difficulties in applying the EMDR protocol for this group were reported. The adaptations made by therapists to overcome these difficulties were highly variable. They could be divided into three main categories: adaptions in EMDR delivery (e.g., tuning to the developmental level of the client, simplifying language, decreasing pace), involvement of others (e.g., involving family or support staff during or in between sessions), and the therapeutic relationship (e.g., taking more time, supportive attitude).
DISCUSSION: The variability of the number of mentioned difficulties and adaptations per study seems to be partly related to the specific EMDR protocol that was used. In particular, when the Shapiro adult protocol was administered, relatively more detailed difficulties and adaptations were described than in publications based on derived existing versions of an EMDR protocol for children and adolescents. A probable explanation is that already embedded modifications in these protocols facilitate the needed attunement to the client's level of functioning.
PRACTICAL IMPLICATIONS: The authors of this review suggest that EMDR protocols for children and adolescents could be adapted for people with an intellectual disability. Further research should focus on the involvement of trusted others in EMDR therapy for people with ID and the therapeutic relationship from an attachment and relational-based perspective.
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Thunnissen, M. R., de Jong, P. J., Rijkeboer, M. M., Voncken, M. J., Rapee, R. M., & Nauta, M. H. (2023). Targeting negative flashforward imagery in speech anxiety with a visuospatial dual-task: Do attenuated flashforwards lead to less anxiety and avoidance. J Behav Ther Exp Psychiatry, 83, 101940. https://doi.org/10.1016/j.jbtep.2023.101940
Open Access: https://doi.org/10.1016/j.jbtep.2023.101940
M.R. Thunnissen, Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands.E-mail address: m.r.thunnissen@rug.nl
Abstract
BACKGROUND AND OBJECTIVES: It has been proposed that negative mental imagery plays an important role in the persistence of social fears. Experiencing vivid and distressing 'flashforward' images of a potential social catastrophe appears to be of relevance in speech anxiety. To clarify the role of these images, the current experimental study tested if reducing the vividness and distressing properties of recurring negative flashforward images subsequently reduces anxiety and avoidance tendencies regarding a speech.
METHODS: Participants were female undergraduates high in speech anxiety (N = 134) who joined our study online. In the experimental condition, we used a visuospatial dual-task to reduce the vividness and distress of flashforward imagery. Primary outcomes were participants' self-reported anxiety and avoidance ratings in anticipation of and during an actual speech. As a secondary outcome, we used observer ratings of participants' anxiety during the speech.
RESULTS: Participants reported moderate to high frequency and interference of their vivid and distressing flashforward images in daily life. The dual-task resulted in reductions in image vividness and distress. However, we found no differences between conditions in anxiety and avoidance ratings before and during the speech.
LIMITATIONS: The imagery manipulation effect was moderate to small. Moreover, we included a subclinical sample.
CONCLUSIONS: Reducing negative flashforward imagery vividness and distress with a visuospatial dual-task did not directly lead to less anxiety and avoidance tendencies related to a later speech. Thus, findings provided no support for the hypothesis that experiencing highly vivid and distressing flashforward images causally contributes to social fears.
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van Vliet, N. I., Huntjens, R. J. C., van Dijk, M. K., Huisman, M., Bachrach, N., Meewisse, M. L., van Haren, S., & de Jongh, A. (2023). Predictors and moderators of treatment outcomes in phase-based treatment and trauma-focused treatments in patients with childhood abuse-related post-traumatic stress disorder. Eur J Psychotraumatol, 15(1), 2300589. https://doi.org/10.1080/20008066.2023.2300589
Open Access: https://doi.org/10.1080/20008066.2023.2300589
Noortje I. van Vlieta Dimence, Mental Health Group, Deventer, the Netherlands
E-mail: n.vanvliet@dimence.nl
Abstract
Background: Knowledge of treatment predictors and moderators is important for improving the effectiveness of treatment for PTSD due to childhood abuse.
Objective: The first aim of this study was to test the potential predictive value of variables commonly associated with PTSD resulting from a history of repeated childhood abuse, in relation to treatment outcomes. The second aim was to examine if complex PTSD symptoms act as potential moderators between treatment conditions and outcomes.
Method: Data were obtained from a randomized controlled trial comparing a phase-based treatment (Skills Training in Affect and Interpersonal Regulation [STAIR] followed by Eye Movement Desensitization and Reprocessing [EMDR] therapy; n = 57) with a direct trauma-focused treatment (EMDR therapy only; n = 64) in people with PTSD due to childhood abuse. The possible predictive effects of the presence of borderline personality disorder, dissociative symptoms, and suicidal and self-injurious behaviours were examined. In addition, it was determined whether symptoms of emotion regulation difficulties, self-esteem, and interpersonal problems moderated the relation between the treatment condition and PTSD post-treatment, corrected for pre-treatment PTSD severity.
Results: Pre-treatment PTSD severity proved to be a significant predictor of less profitable PTSD treatment outcomes. The same was true for the severity of dissociative symptoms, but only post-treatment, and not when corrected for false positives. Complex PTSD symptoms did not moderate the relationship between the treatment conditions and PTSD treatment outcomes.
Conclusions: The current findings suggest that regardless of the common comorbid symptoms studied, immediate trauma-focused treatment is a safe and effective option for individuals with childhood-related PTSD. However, individuals experiencing severe symptoms of PTSD may benefit from additional treatment sessions or the addition of other evidence-based PTSD treatment approaches. The predictive influence of dissociative sequelae needs further research.
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Wright, S. L., Karyotaki, E., Cuijpers, P., Bisson, J., Papola, D., Witteveen, A., Suliman, S., Spies, G., Ahmadi, K., Capezzani, L., Carletto, S., Karatzias, T., Kullack, C., Laugharne, J., Lee, C. W., Nijdam, M. J., Olff, M., Ostacoli, L., Seedat, S., . . . Sijbrandij, M. (2024). EMDR v. other psychological therapies for PTSD: a systematic review and individual participant data meta-analysis. Psychol Med, 1-9. https://doi.org/10.1017/S0033291723003446
URL: https://doi.org/10.1017/S0033291723003446
Simonne Lesley Wright, Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. E-mail: s.l.wright@vu.nl
Abstract
BACKGROUND: This systematic review and individual participant data meta-analysis (IPDMA) examined the overall effectiveness of eye movement desensitization and reprocessing (EMDR) in reducing posttraumatic stress disorder (PTSD) symptoms, achieving response and remission, and reducing treatment dropout among adults with PTSD compared to other psychological treatments. Additionally, we examined available participant-level moderators of the efficacy of EMDR.
METHODS: This study included randomized controlled trials. Eligible studies were identified by a systematic search in PubMed, Embase, PsyclNFO, PTSDpubs, and CENTRAL. The target population was adults with above-threshold baseline PTSD symptoms. Trials were eligible if at least 70% of study participants had been diagnosed with PTSD using a structured clinical interview. Primary outcomes included PTSD symptom severity, treatment response, and PTSD remission. Treatment dropout was a secondary outcome. The systematic search retrieved 15 eligible randomized controlled trials (RCTs); 8 of these 15 were able to be included in this IPDMA (346 patients). Comparator treatments included relaxation therapy, emotional freedom technique, trauma-focused cognitive behavioral psychotherapies, and REM-desensitization.
RESULTS: One-stage IPDMA found no significant difference between EMDR and other psychological treatments in reducing PTSD symptom severity (β = -0.24), achieving response (β = 0.86), attaining remission (β = 1.05), or reducing treatment dropout rates (β = -0.25). Moderator analyses found unemployed participants receiving EMDR had higher PTSD symptom severity at the post-test, and males were more likely to drop out of EMDR treatment than females.
CONCLUSION: The current study found no significant difference between EMDR and other psychological treatments. We found some indication of the moderating effects of gender and employment status.
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