EMDR Research News July 2021
With each reference below, you will find the citation, abstract and author contact information (when available). Previous posting to this blog can be viewed by year in the sidebar below right (visible on computer and tablet - landscape). Summary listings by topic are available at EMDR Research. A comprehensive listing of all EMDR-related research is available at the Francine Shapiro Library. EMDRIA members can access recent Journal of EMDR Practice and Research articles in the member’s area on the EMDRIA website. JEMDR issues older than 12 months are available open access on Connect - Springer Publishing Company.
Cardazzone, E., Gallucci, M., Callerame, C., Cussino, M., Gelo, O., Pasca, P., & Zaccagnino, M. (2021). Linguistic changes during EMDR sessions: A preliminary single‐case study. Counselling and Psychotherapy Research, 21(2), 422-432. doi:10.1002/capr.12394
Elisa Cardazzone, EMDR Center for Eating Disorders, Via Pergolesi 14, 20124 Milan, Italy. Email: firstname.lastname@example.org
Several studies have used text analysis software such as Linguistic Inquiry and Word Count (LIWC) to study how language modification reflects improvements in individuals’ psychophysical health. The aim of this preliminary single-case study was to evaluate the linguistic changes occurring during EMDR sessions in a patient suffering from anorexia nervosa. Each weekly session (N = 73) of an entire one-and-a-half- year treatment was divided into three different stages (pre-stimulation, stimulation and post-stimulation phase): the patient's speech was analysed at each phase. Results showed significant changes in the examined linguistic categories: affective processes, cognitive processes, biological processes and non-fluency words. These changes were observed before, during and after the bilateral stimulations. These results are discussed in the light of previous studies concerning the linguistic changes occurring in traumatic event disclosure. They suggest access and reprocessing of painful events during each session, especially when the clinician uses bilateral stimulation. It is possible to suppose the patient's progressive processing of the traumatic experience, followed by its integration into more adaptive mnemonic networks at the end of the therapeutic session. In conclusion, the observed linguistic changes could be representative of an adaptive resolution of adverse life experiences, allowing the patient to create new connections between thoughts, images and bodily sensations linked to the target memories. The clinical implications and limits of this single-case study are also discussed.
Grubaugh, A. L., Brown, W. J., Wojtalik, J. A., Myers, U. S., & Eack, S. M. (2021). Meta-Analysis of the Treatment of Posttraumatic Stress Disorder in Adults With Comorbid Severe Mental Illness. The Journal of Clinical Psychiatry, 82(3). doi:10.4088/jcp.20r13584
Anouk L. Grubaugh, PhD, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, PO Box 250861, Charleston, SC 29425. E-mail: email@example.com
Objective: To evaluate the efficacy of psychosocial treatments for posttraumatic stress disorder (PTSD) among individuals with a comorbid severe mental illness (SMI; i.e., schizophrenia, bipolar disorder, major depressive disorder).
Data Sources: PubMed, PsycINFO, CINAHL, and Cochrane Library were searched from January 1998 to March 2020 using keywords related to PTSD, treatment, and severe mental illness.
Study Selection: All clinical trials for PTSD psychotherapy among individuals with SMI were included. From 38 potentially eligible studies, a total of 14 clinical trials across 684 individuals with comorbid SMI and PTSD were identified and included in the analysis.
Data Extraction: Data on demographic, SMI diagnosis, symptom severity, sample attrition, and treatment protocol received were extracted. Effect size calculations and subsequent meta-analyses were conducted using the Meta-Analysis Package for R (metafor) version 2.1–0 in R (3.6.0).
Results: PTSD treatments had a large effect on PTSD outcomes among individuals with SMI, with patients experiencing a standard deviation reduction in PTSD symptomatology pre- to post-treatment (g = −1.009, P < .001, k = 34). Prolonged exposure (g = −1.464; P < .001; SE = 0.276; k = 5), eye movement desensitization and reprocessing (g = −1.351; P < .001; SE = 0.276; k = 5), and brief treatment program
(g = −1.009; P < .001; SE = 0.284; k = 5) had the largest effects on PTSD symptoms.
Conclusions: Although underrepresented in the PTSD literature, PTSD psychotherapies are effective for individuals with SMI. Treatments with an exposure-based component may have greater efficacy in this clinical population.
Han, H. R., Miller, H. N., Nkimbeng, M., Budhathoki, C., Mikhael, T., Rivers, E., . . . Wilson, P. (2021). Trauma informed interventions: A systematic review. PLoS One, 16(6), e0252747. doi:10.1371/journal.pone.0252747
Open access: https://pubmed.ncbi.nlm.nih.gov/34157025
Hae-Ra Han, School of Nursing, The Johns Hopkins University, Baltimore, Maryland, United States of America. E-mail: firstname.lastname@example.org
BACKGROUND: Health inequities remain a public health concern. Chronic adversity such as discrimination or racism as trauma may perpetuate health inequities in marginalized populations. There is a growing body of the literature on trauma informed and culturally competent care as essential elements of promoting health equity, yet no prior review has systematically addressed trauma informed interventions. The purpose of this study was to appraise the types, setting, scope, and delivery of trauma informed interventions and associated outcomes.
METHODS: We performed database searches- PubMed, Embase, CINAHL, SCOPUS and PsycINFO-to identify quantitative studies published in English before June 2019. Thirty-two unique studies with one companion article met the eligibility criteria.
RESULTS: More than half of the 32 studies were randomized controlled trials (n = 19). Thirteen studies were conducted in the United States. Child abuse, domestic violence, or sexual assault were the most common types of trauma addressed (n = 16). While the interventions were largely focused on reducing symptoms of post-traumatic stress disorder (PTSD) (n = 23), depression (n = 16), or anxiety (n = 10), trauma informed interventions were mostly delivered in an outpatient setting (n = 20) by medical professionals (n = 21). Two most frequently used interventions were eye movement desensitization and reprocessing (n = 6) and cognitive behavioral therapy (n = 5). Intervention fidelity was addressed in 16 studies. Trauma informed interventions significantly reduced PTSD symptoms in 11 of 23 studies. Fifteen studies found improvements in three main psychological outcomes including PTSD symptoms (11 of 23), depression (9 of 16), and anxiety (5 of 10). Cognitive behavioral therapy consistently improved a wide range of outcomes including depression, anxiety, emotional dysregulation, interpersonal problems, and risky behaviors (n = 5). CONCLUSIONS: There is inconsistent evidence to support trauma informed interventions as an effective approach for psychological outcomes. Future trauma informed intervention should be expanded in scope to address a wide range of trauma types such as racism and discrimination. Additionally, a wider range of trauma outcomes should be studied.
Hase, M. (2021). Instant Resource Installation and Extensive Resource Installation - Two Novel Techniques for Resource Installation in EMDR therapy - Theory, Description and Case Report. European Journal of Trauma & Dissociation, 5(4), 100224. doi:10.1016/j.ejtd.2021.100224
Open access: http://dx.doi.org/10.1016/j.ejtd.2021.100224
Dr. Michael Hase, Lu€neburger Zentrum fu€r Stressmedizin. Im Kamp 9, D-21335 Lu€neburg Germany. E-mail address: email@example.com
In recent years, resource installation has turned into an important procedure in Eye Movement Desensitization and Reprocessing Therapy (EMDR). Research has provided preliminary evidence regarding the neurophysiological signature of EMDR therapy resource installation. Even if a variety of resource installation procedures have been described, there is a variety of clients with different needs. Especially clients with attachment deficits or attachment disorder and in general complex client could profit from innovation in resource installation. Additional strategies for the enhancement of resource memory networks could enrich the EMDR therapy procedural toolbox. Two novel resource installation procedures, Instant Resource Installation (IRI) and Extensive Resource Installation (xtRI) are introduced and discussed. Two case examples document the clinical use of these novel EMDR resource enhancement procedures.
Hase, M. (2021). The Structure of EMDR Therapy: A Guide for the Therapist. Front Psychol, 12, 660753. doi:10.3389/fpsyg.2021.660753
Open access: https://www.frontiersin.org/articles/10.3389/fpsyg.2021.660753/full
Michael Hase, Lüneburger Zentrum für Stressmedizin, Lüneburg, Germany. E-mail: firstname.lastname@example.org
Since the introduction of EMD by Dr. Shapiro in 1987, which led to the development of EMDR Therapy, clinical experiences and research contributed to a variety of protocols and procedures. While this dynamic evolution within EMDR Therapy is offering more options to treat a variety of patients suffering from various disorders, there is a greater risk of deviations from the core framework of this approach that would no longer be understood as EMDR Therapy. While research shows that following Shapiro's standard protocols and procedural steps is important to achieve positive treatment effects, it seems prudent to define the core elements in EMDR Therapy beyond adherence to the standard protocol given the complexity of clinical demands in a variety of treatment contexts. The author proposes that best practices requires not only an adherence to the fidelity of the model, but a willingness to adapt the model in order to best meet the needs of our clients in a variety of clinical contexts. Defining the core elements that constitute EMDR Therapy offers both a structure that has been well established and offers a foundation from which clinical adaptations can be made that are within the realm of what is widely accepted as EMDR Therapy. Such a structure could also be used to define research as well as clinical applications. Additionally EMDR Therapy as a comprehensive psychotherapy approach implies that the therapeutic relationship is an important component and should be considered a core element of this methodology.
Kim, H.-J., Kim, J. E., & Lee, S.-H. (2021). Early Trauma Is Associated With Suicidal Ideation in Patients With Panic Disorder. Journal of Nervous & Mental Disease, Publish Ahead of Print. doi:10.1097/nmd.0000000000001368
Sang-Hyuk Lee, MD, PhD, Department of Psychiatry, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-712, Republic of Korea. E‐mail: email@example.com
There are several predictors of suicidality in patients with panic disorder (PD). Being a woman, younger age, low education level, unmarried status, and symptom severity have been suggested. This study aimed to examine whether early trauma is associated with suicidal ideation in patients with PD. Our study included 267 patients with PD and 105 controls. Data on sociodemographic variables and data from the Early Trauma Inventory Self Report–Short Form, Beck Depression Inventory, Panic Disorder Severity Scale, Anxiety Sensitivity Inventory–Revised, Coping Scales, and Scale for Suicide Ideation were collected, and correlation and regression analyses were performed. This study suggests that clinicians should consider early trauma when assessing suicidal ideation in patients with PD. Clinicians could consider alternative treatments, such as trauma-focused cognitive- behavioral therapy, eye movement desensitization, reprocessing approaches, and classical pharmacological and psychological treatments for patients with PD who have a history of early trauma and are expected to be at high risk for suicide.
Kjærum, A. (2021). Response to EMDR European and international associations letter. Torture Journal, 30(3), 117-119. doi:10.7146/torture.v30i3.122782
Open access: http://dx.doi.org/10.7146/torture.v30i3.122782
Asger Kjærum, Director of Advocacy, IRCT. E-mail: firstname.lastname@example.org
The following is a response by the International Rehabilitation Council for Torture Victims (IRCT) to the criticism expressed by EMDR International Association and EMDR Europe Association in relation to our report and the Statement issued by the Independent Forensic Group (IFEG), which describe how the use of conversion therapy can be prohibited under the global ban on torture and ill-treatment.
Karadag, M., Topal, Z., Ezer, R. N., & Gokcen, C. (2021). Use of EMDR-Derived Self-Help Intervention in Children in the Period of COVID-19: A Randomized-Controlled Study. Journal of EMDR Practice and Research, 15(2), 114-126. doi:10.1891/emdr-d-20-00054
Dr. Mehmet Karadag, Gaziantep University Medical School Child and Adolescent Psychiatry Department, Gaziantep, Turkey, 27310. E-mail: email@example.com
Self-help treatments are an important intervention tool, with high accessibility and ease of application. To our knowledge, no research has previously been conducted on any self-help intervention derived from eye movement desensitization and reprocessing (EMDR) therapy. In this study, we evaluated the mental health status of children not directly affected by the pandemic and investigated the effects of using an EMDR-derived self-help intervention in children as a low-intensity treatment. The mental health status of 178 children was evaluated online via the State-Trait Anxiety Inventory for Children (STAIC) and Childhood Posttraumatic Stress Reaction Index (CPTS-RI). Then, children were randomly assigned to intervention and waitlist. A booklet containing EMDR-derived techniques was sent via the school online portal and the intervention was conducted. Posttests were administered 4 weeks later. The attrition rate was 45.5%, with 97 children completing the trial (intervention: 52; waitlist: 45). At baseline, 76.4% of children showed posttraumatic stress symptoms (PTSS) above threshold. Results showed a statistically significant decrease in the posttest PTSS scores for the intervention group compared to waitlist. The intervention group had significant pre–post improvement on all but one subscale, while the waitlist group showed a significant increase in state anxiety on the STAIC. In conclusion, posttraumatic stress was found to be high in children during the COVID-19 outbreak period, and EMDR-derived self-help intervention appeared to be an effective psychosocial intervention tool.
Maddock, A., Blair, C., Ean, N., & Best, P. (2021). Psychological and social interventions for mental health issues and disorders in Southeast Asia: a systematic review. Int J Ment Health Syst, 15(1), 56. doi:10.1186/s13033-021-00482-y
Open access: https://pubmed.ncbi.nlm.nih.gov/34090491
Alan Maddock, School of Social Sciences, Education and Social Work, Queen's University Belfast, Northern Ireland, Belfast, UK. E-mail: firstname.lastname@example.org
BACKGROUND: Mental health issues and disorders are major public health challenges, particularly in low- and middle-income countries in Southeast Asia, where chronic shortages in mental health services and human resources exist. The development of effective and accessible mental health systems in Southeast Asia will require evidence based psychological and social interventions. This systematic review provides a narrative synthesis of the evidence on the effectiveness of such interventions for mental health issues and disorders in Southeast Asia.
METHODS: A comprehensive literature search of 7 electronic databases (PsycINFO, Medline (Ovid), Cochrane library, EMBASE, SCOPUS, APA PsycArticles, and Social Care Online) was undertaken.
RESULTS: Thirty two studies employing RCT designs to evaluate the effectiveness of a range of psychological and social mental health interventions on a number of different mental health outcomes were included in this review. The disparate intervention programmes reviewed were categorised as: lay delivered, yoga, aerobic and/or meditation based, cognitive behavioural therapy oriented, eye movement desensitization and reprocessing based (EMDR), health worker delivered, and hybrid programmes. The majority of the studies included in this review were of low to moderate quality due to the variability in the quality of the study design. The highest quality, and most promising evidence came from the evaluations of lay delivered interventions. This evidence demonstrates the feasibility and potential sustainability of implementing such interventions in resource constrained contexts.
CONCLUSIONS: The review findings indicate that a disparate array of mental health interventions can be implemented effectively in a range of Southeast Asian mental health and health settings. There is a clear need for significantly more research however, through higher quality and larger scale RCTs before it will be known more definitively, if these interventions are effective, and for whom they are most effective in different Southeast Asian contexts.
Manfield, P. E., Engel, L., Greenwald, R., & Bullard, D. G. (2021). Flash Technique in a Scalable Low-Intensity Group Intervention for COVID-19-Related Stress in Healthcare Providers. Journal of EMDR Practice and Research, 15(2), 127-139. doi:10.1891/emdr-d-20-00053
Philip Manfield, 1205 Brighton Avenue, Albany, CA 94706– 1309. E-mail: email@example.com
The flash technique (FT) is a low-intensity individual or group intervention that appears to rapidly lessen the distress of disturbing and traumatic memories. This paper reports on the safety and effectiveness of group FT with 77 healthcare providers and 98 psychotherapists impacted by working with COVID- 19 patients. One-hour webinars included 30 minutes of psychoeducation and two guided 15-minute FT interventions, focused on participants’ most distressing pandemic-related memory. Before and after each 15-minute FT intervention, they rated that memory using the 11-point 0-to-10 subjective units of disturbance (SUD) scale. Results from both interventions were highly significant with large effect sizes (p < .001, Hedges’ g = 2.01, Hedges’ g = 2.39). No adverse reactions were reported. For 35 participants who processed the same memory in both interventions, the pre–post SUD scores from the beginning of intervention #1 to the end of intervention #2 showed a significant reduction with a large effect size (p < .001, Hedges’ g = 3.80). For this group, both intervention #1 and intervention #2 showed significant reductions with large effect sizes (p < .001, Hedges’ g = 2.00) (p < .001, Hedges’ g = 1.18). Follow-up SUD scores were obtained from 58 participants, with the mean disturbance level showing a significant further decrease. These findings provide preliminary evidence that group FT appears to safely provide rapid relief from disturbing memories. FT merits further research.
Maxfield, L. (2021). Low-Intensity Interventions and EMDR Therapy. Journal of EMDR Practice and Research, 15(2), 86-98. doi:10.1891/emdr-d-21-00009
Louise Maxfield, PO Box 1165, Ridgetown, ON, Canada, N0P 2C0. E-mail: Dr.Maxfield@outlook.com
Unlike high-intensity treatment, in which clients have face-to-face contact with a mental health specialist, clients in low-intensity treatment have limited or no contact with a specialist. Instead, their treatment is usually provided through self-help procedures, which are delivered via (guided) computer programs, books, or “mHealth” apps. Other treatments sometimes considered low-intensity are brief treatments, group therapy, and interventions delivered by nonspecialists. Advantages include effectiveness, accessibility, efficiency, and affordability. Concerns related to safety, engagement, and adherence to self-help programs may be addressed by (asynchronous) therapist guidance. This article describes low-intensity treatments and their relevance for eye movement desensitization and reprocessing (EMDR) therapy. Hundreds of randomized controlled trials (RCTs) have found self-help interventions to be efficacious, with many producing the same level of results as the traditional face-to-face procedure. Guided self-help cog- nitive behavioral therapy is recommended for the treatment of posttraumatic stress disorder in the guide- lines of both the National Institute for Health and Care Excellence and International Society of Traumatic Stress Studies. Only three self-help-EMDR RCTs have been conducted. This author advocates for reconceptualizing EMDR group therapy as “guided self-help-EMDR therapy,” because it is a highly manualized, heavily scripted treatment in which the client works independently on their own material. In this respect, it offers an excellent template for the future development of efficacious low-intensity EMDR interventions. Developing safe, easy-to-use, affordable, and readily available low-intensity interventions will make effective EMDR treatment available to many millions of people around the world.
Mertens, G., van Schie, K., Lammertink, S., Littel, M., & Engelhard, I. M. (2021). Verbal suggestions fail to modulate expectations about the effectiveness of a laboratory model of EMDR therapy: Results of two preregistered studies. J Behav Ther Exp Psychiatry, 73, 101673. doi:10.1016/j.jbtep.2021.101673
Open access: https://pubmed.ncbi.nlm.nih.gov/34198055
Gaëtan Mertens, Department of Medical and Clinical Psychology, Tiburg University, Warandelaan 2, room T526, 5037, AB Tilburg, the Netherlands. E-mail: firstname.lastname@example.org
BACKGROUND AND OBJECTIVES: For many psychotherapies, like Eye Movement and Desensitization Reprocessing (EMDR) therapy, there is an ongoing discussion about the role of specific versus non-specific mechanisms in their effectiveness However, experimental research directly examining the potential role of non-specific mechanisms is scarce. Here, we address the role of a non-specific factor that is often put forward for EMDR, namely treatment effectiveness expectations, within a laboratory model of EMDR therapy.
METHODS: In a lab-based (N = 96) and an online experiment (N = 173), we gave participants verbal instructions to manipulate their treatment expectations. Instructions emphasized EMDR's effectiveness or ineffectiveness. Then, participants were asked to recollect an unpleasant autobiographical memory with or without making eye-movements.
RESULTS: In line with previous studies, we found significant reductions of reported vividness and emotionality of negative autobiographical memories in the eye-movements condition. These reductions did not differ between the verbal suggestions conditions in both experiments, suggesting a limited effect of treatment effectiveness suggestions.
LIMITATIONS: Treatment effectiveness expectations were not successfully manipulated by the suggestions manipulation. This suggests that treatment expectations may be more difficult to influence than anticipated, thus limiting the interpretation of our findings.
CONCLUSIONS: These findings tentatively corroborate the results of two earlier reports, suggesting that the effects of verbal suggestions about treatment effectiveness in a laboratory model of EMDR therapy may be limited.
Miguel-Alvaro, A., Guillén, A. I., Contractor, A. A., & Crespo, M. (2021). Positive memory intervention techniques: a scoping review. Memory, 1-18. doi:10.1080/09658211.2021.1937655
Open access: https://pubmed.ncbi.nlm.nih.gov/34110270
María Crespo, Facultad de Psicología, Universidad Complutense de Madrid, Campus de Somosaguas, s/n, 28223, Madrid, Spain. E-mail: email@example.com
The scoping review examines and summarises the available knowledge base on intervention techniques focused on positive memories. An iterative series of PsycInfo and Medline searches was conducted up to April 2021 following PRISMA-ScR guidelines. Thirty-nine studies, spanning 12 intervention techniques, were selected and described including: (1) theoretical basis; (2) type of study, sample, and measures; (3) intervention protocol; and (4) results of empirical studies if applicable. Results indicated that most techniques have only been tested in one-two studies with modest sample sizes and, when follow-ups are conducted, they are typically short. Results indicate that working with positive memories has the greatest impact on improving positive affect and reducing depressive symptoms, and that these effects are often temporary. This review serves as a quick reference guide to help professionals' access to descriptions and information on empirical evidence of positive memory techniques, improving their therapeutic arsenal to enhance well-being and therapeutic outcomes in their patients.
Moench, J., & Billsten, O. (2021). Randomized Controlled Trial: Self-Care Traumatic Episode Protocol, Computerized EMDR Treatment of COVID-19-Related Stress. Journal of EMDR Practice and Research, 15(2), 99-113. doi:10.1891/emdr-d-20-00047
Judy Moench, Dr. Judy Moench Psychological Services Ltd., #260, 10230 142 Street, NW Edmonton, AB, T5N 3Y6, Canada. E-mail: firstname.lastname@example.org
Healthcare workers and mental health clinicians are at heightened risk for mental health issues while they support their communities during the COVID-19 pandemic, and early psychological intervention is crucial to protect them. The Self-Care Traumatic Episode Protocol (STEP) is a computerized intervention adapted from the Eye Movement Desensitization and Reprocessing Group Traumatic Episode Protocol (EMDR G-TEP). This study evaluated the effectiveness of STEP for mental health clinicians in the context of COVID-19. Thirty-four mental health clinicians were randomly allocated to treatment (n = 17) or waitlist (n = 17). The Generalized Self-Efficacy Scale (GSE) and Depression and Anxiety Stress Scale (DASS-21) were completed by the treatment group at baseline and 1-week follow-up postintervention and by the waitlist group at baseline, preintervention, and 1-week follow-up postintervention. Pre–post comparisons showed a significant decrease in depression, anxiety, and stress for Immediate Treatment, t(15) = −3.64, p < .01, d = .73, and for Delayed Treatment, t(15) = −3.53, p < .01, d = .68, There was also a significant increase in general self-efficacy for Immediate Treatment, t(15) = 2.87, p < .05, d = .46, and Delayed Treatment, t(15) = 3.72, p < .01, d = .56. The randomized controlled trial (RCT) indicated that STEP may be effective in increasing general self-efficacy and reducing symptoms of depression, anxiety, and stress among mental health clinicians in the context of COVID-19. Further research investigating the potential of utilizing the STEP intervention on a larger scale and with other populations is needed.
Piedfort Marin, O., Fernandez, I., & Miles, C. (2021). EMDR as an evidence-based therapy for trauma – A reply to the Independent Forensic Expert Group’s statement on con- version therapy. Torture Journal. Retrieved from https://tidsskrift.dk/torture-journal/article/view/122782
Open access: https://tidsskrift.dk/torture-journal/article/view/122782
Correspondence: email@example.com; firstname.lastname@example.org; email@example.com
In the Volume 30 of the Torture Journal, the Independent Forensic Expert Group (IFEG, 2020a) made a “Statement on Conversion Therapy,” based on Josina Bothe’s very detailed report “It’s torture, not therapy” (Bothe, 2020). In the US the common terminology now is Sexual Orientation Change Efforts (SOCE) since the terminology should not give the impression that it is a therapy. The authors of this paper have included Eye Movement Desensitization and Reprocessing (EMDR) therapy (Shapiro, 2018) among the practices performed “to create change in an individual’s sexual orientation.”
Sigal, N., & Rob. (2021). Dual perspectives on art therapy and EMDR for the treatment of complex childhood trauma. International Journal of Art Therapy, 26(1-2), 37-46. doi:10.1080/17454832.2021.1906288
Video URL: https://vimeo.com/548797797
Nili Sigal, Devon Partnership NHS Trust, UK.
This article explores art therapy and EMDR for the treatment of complex PTSD caused by childhood sexual abuse, from the point of view of both client and therapist. It was co-written with a former client who wishes to remain anonymous.
The therapeutic work took place in an NHS community setting. The idea of writing together – emerged organically as therapy came to an end, with both client and therapist feeling they have learnt from the process and that sharing these ideas could be beneficial for other practitioners.
While psychodynamically informed, much of the intervention followed the main principles of a trauma-focused approach with an emphasis on embodied processes – both in art therapy and EMDR.
The client made a great deal of progress during therapy and both writers explore the changes and insights that were gained as part of the article, with a particular emphasis on using interoceptive skills to enhance emotional processing.
When working with clients who have complex PTSD it is important to be aware of trauma-informed approaches and the role of grounding, stabilisation, embodied experiences and trauma processing. At times, this might be essential in order to help clients manage high levels of emotional arousal in the room, learn to contain their distress and improve their symptoms.
Implications for Research
More research is required to establish ways in which trauma-informed thinking can be incorporated into art therapy, the link between visual and emotional processing, and whether art therapy can improve interoceptive ability.
This article contains the summary of three years of art therapy and Eye Movement Desensitisation and Reprocessing (EMDR). It was co-written with ‘Rob’ (pseudonym), a male client in his mid-thirties who has a history of childhood sexual abuse and who wishes to remain anonymous. In the paper, Rob provides his account of the intervention while I explain my process as a therapist. I had limited experience of complex trauma work before I met him, and in many ways the journey was transformative for both of us.
In my writing, I briefly outline the theoretical basis of my thoughts and choices within our art therapy sessions. I reflect on the way my practice has expanded and changed, in order to incorporate an understanding of the way trauma affects the body and how we can work with the body in art therapy. As an EMDR therapist, I often combine EMDR and art therapy with clients who have complex trauma and believe that these two approaches can complement each other.
Therapy with Rob was often difficult to contain and there were times where his risk – of self-harm, substance misuse and suicidal urges – had to be carefully considered and managed. The principles of trauma-informed interventions were crucial for our work together. This includes explaining the current research about trauma to the client, so that the client understands his/her experiences better. It also involves helping clients to feel as calm and safe in the room and in their own bodies as possible, and maintaining an emphasis on body sensations in the here-and-now.
The article considers the idea of ‘interoceptive imagery’ as a way of working with the body in art therapy with traumatised clients. Some of Rob's images are explored and a link is provided for a video we co-produced, where he discusses more of his journey and his artwork.
Smyth-Dent, K., Becker, Y., Burns, E., & Givaudan, M. (2021). The Acute Stress Syndrome Stabilization Remote Individual (ASSYST-RI) for TeleMental Health Counseling After Adverse Experiences. Psychology and Behavioral Science International Journal, 16(2). doi:10.19080/PBSIJ.2021.16.555932
Open access: https://juniperpublishers.com/pbsij/PBSIJ.MS.ID.555932.php
Smyth-Dent Kelly, Department of Research, Scaling Up, Reno, Nevada, United States.
The aim objective of this field trial was to evaluate the feasibility and effectiveness of the Acute Stress Syndrome Stabilization Remote Individual (ASSYST-RI) procedure in decreasing the levels of subjective perceived disturbance produced by the psychological distress or physiological reactivity of recent adverse experiences (e.g., kidnappings, COVID-19-related distress, interpersonal violence). A total of 48 participants (39 females and 9 males) ranging in ages from 18 to 67 years old (M=37.1 years) received one-single ASSYST-RI session of 50 minutes average duration. Participation was voluntary with the participants’ verbal informed consent in accordance with the Mental Capacity Act 2005. The telemental health counseling was in compliance with the American Psychological Association (APA) Guidelines for the Practice of Telepsychology. A pre-post design was applied comparing the subjective units of disturbance (SUD) means using a within t-test analysis. Results showed significant differences with a large effect size. Pre-test (M = 8.27, SD = 1.69) and post-test (M = 1.45, SD = 1.66), Cohen’s d = 3.32. This field trial provides preliminary evidence on the ASSYST-RI feasibility and effectiveness in decreasing the levels of subjective perceived disturbance produced by the psychological distress or physiological reactivity of recent adverse experiences.
Turrini, G., Tedeschi, F., Cuijpers, P., Del Giovane, C., Kip, A., Morina, N., . . . Barbui, C. (2021). A network meta-analysis of psychosocial interventions for refugees and asylum seekers with PTSD. BMJ Glob Health, 6, e005029. doi:10.1136/bmjgh-2021-005029
Open access: https://pubmed.ncbi.nlm.nih.gov/34088735
Dr Giulia Turrini, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy. E-mail: firstname.lastname@example.org
INTRODUCTION: Refugees and asylum seekers are vulnerable to common mental disorders, including post-traumatic stress disorder (PTSD). Using a network meta-analysis (NMA) approach, the present systematic review compared and ranked psychosocial interventions for the treatment of PTSD in adult refugees and asylum seekers.
METHODS: Randomised studies of psychosocial interventions for adult refugees and asylum seekers with PTSD were systematically identified. PTSD symptoms at postintervention was the primary outcome. Standardised mean differences (SMDs) and ORs were pooled using pairwise and NMA. Study quality was assessed with the Cochrane Risk of Bias (RoB) tool, and certainty of evidence was assessed through the Confidence in Network Meta-Analysis application.
RESULTS: A total of 23 studies with 2308 participants were included. Sixteen studies were conducted in high-income countries, and seven in low-income or middle-income countries. Most studies were at low risk of bias according to the Cochrane RoB tool. NMA on PTSD symptoms showed that cognitive behavioural therapy (CBT) (SMD=-1.41; 95% CI -2.43 to -0.38) and eye movement desensitisation and reprocessing (EMDR) (SMD=-1.30; 95% CI -2.40 to -0.20) were significantly more effective than waitlist (WL). CBT was also associated with a higher decrease in PTSD symptoms than treatment as usual (TAU) (SMD -1.51; 95% CI -2.67 to -0.36). For all other interventions, the difference with WL and TAU was not significant. CBT and EMDR ranked best according to the mean surface under the cumulative ranking. Regarding acceptability, no intervention had less dropouts than inactive interventions.
CONCLUSION: CBT and EMDR appeared to have the greatest effects in reducing PTSD symptoms in asylum seekers and refugees. This evidence should be considered in guidelines and implementation packages to facilitate dissemination and uptake in refugee settings.
van Pelt, Y., Fokkema, P., de Roos, C., & de Jongh, A. (2021). Effectiveness of an intensive treatment programme combining prolonged exposure and EMDR therapy for adolescents suffering from severe post-traumatic stress disorder. Eur J Psychotraumatol, 12(1), 1917876. doi:10.1080/20008198.2021.1917876
Open access: https://pubmed.ncbi.nlm.nih.gov/34025927
Ytje van Pelt, Zernikepark 12, Groningen 9747 AN, The Netherlands. E-mail: email@example.com
Background: Following promising effects of an intensive trauma treatment for adults, the question arises whether adolescents who suffer from severe post-traumatic stress disorder (PTSD) can also profit from a similar treatment programme.
Objective: To assess the effectiveness of an intensive trauma-focused treatment programme combining two evidence-based trauma-focused therapies and physical activities for adoles- cents suffering from severe PTSD.
Method: Treatment consisted of daily sessions of prolonged exposure (PE) therapy and eye movement desensitization and reprocessing (EMDR) therapy supplemented with physical activity (13 days on average). All patients (N = 27; 96.3% women, mean age = 16.1 years; SD = 1.3) had been exposed to one or more (interpersonal) traumatic events. Twenty-two of them (81.5%) also fulfilled the diagnostic criteria of a comorbid psychiatric disorder (mean number of comorbid disorders = 2.22). The majority of patients were referred because previous treatment was difficult or complications were expected to occur. Severity of PTSD symptoms and presence of a PTSD diagnostic status were assessed using the Dutch version of the CAPS- CA IV at baseline, post-treatment and at 3-month follow-up.
Results: CAPS-CA IV scores decreased significantly from pre- to post-treatment (Cohen’s d = 1.39). Of all patients 81.5% (n = 22) showed a clinically meaningful response, of whom 63% (n = 17) no longer fulfilled the diagnostic criteria of PTSD at post-treatment as established with the CAPS-CA IV. The results were maintained at 3-month follow-up. During treatment, neither adverse events nor dropout occurred.
Conclusions: The results suggest that an intensive trauma-focused treatment programme combining prolonged exposure, EMDR therapy, and physical activity can be an effective and safe treatment for adolescents suffering from severe PTSD and multiple comorbid psychiatric disorders.
Weber, M., Schumacher, S., Hannig, W., Barth, J., Lotzin, A., Schäfer, I., . . . Kleim, B. (2021). Long-term outcomes of psychological treatment for posttraumatic stress disorder: a systematic review and meta-analysis. Psychol Med, 1-11. doi:10.1017/S003329172100163X
Open access: https://pubmed.ncbi.nlm.nih.gov/34176532
Birgit Kleim, Department of Psychology, University of Zurich, Zurich, Switzerland.
Several types of psychological treatment for posttraumatic stress disorder (PTSD) are considered well established and effective, but evidence of their long-term efficacy is limited. This systematic review and meta-analysis aimed to investigate the long-term outcomes across psychological treatments for PTSD. MEDLINE, Cochrane Library, PTSDpubs, PsycINFO, PSYNDEX, and related articles were searched for randomized controlled trials with at least 12 months of follow-up. Twenty-two studies (N = 2638) met inclusion criteria, and 43 comparisons of cognitive behavioral therapy (CBT) were available at follow-up. Active treatments for PTSD yielded large effect sizes from pretest to follow-up and a small controlled effect size compared with non-directive control groups at follow-up. Trauma-focused treatment (TFT) and non-TFT showed large improvements from pretest to follow-up, and effect sizes did not significantly differ from each other. Active treatments for comorbid depressive symptoms revealed small to medium effect sizes at follow-up, and improved PTSD and depressive symptoms remained stable from treatment end to follow-up. Military personnel, low proportion of female patients, and self-rated PTSD measures were associated with decreased effect sizes for PTSD at follow-up. The findings suggest that CBT for PTSD is efficacious in the long term. Future studies are needed to determine the lasting efficacy of other psychological treatments and to confirm benefits beyond 12-month follow-up.
Yael, B., Elena, E. M., Cristina, P. M., Amalia, O., Ignacio, J., & Martha, G. (2021). Longitudinal multisite randomized controlled trial on the provision of the acute stress syndrome stabilization remote for groups to general population in lockdown during the COVID-19 pandemic. Psychology and Behavioral Science International Journal, 16(2). doi:10.19080/PBSIJ.2021.16.555931
Open access: https://juniperpublishers.com/pbsij/PBSIJ.MS.ID.555931.php
Ignacio Jarero, Department of Research, Mexican Association for Mental Health Support in Crisis, Mexico City, Mexico
The aim of this longitudinal multisite randomized controlled trial (RCT), using a treatment as usual (TAU) control group design, was to evaluate the effectiveness of the Acute Stress Syndrome Stabilization Remote for Groups (ASSYST-RG) procedure in reducing posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in the general population during the COVID-19 pandemic lockdown in Mexico. A total of 63 adults (60 females and 3 males) met the inclusion criteria. Participants’ ages ranged from 21 to 73 years old (M =43.09 years). Significant differences between groups were found in all variables. Differences between groups were maintained at follow up assessment. ANOVA for repeated-measures (pre-treatment, post-treatment and follow-up) showed that the ASSYST-RG had a significant effect to reduce Posttraumatic Stress Disorder (F (2, 122) = 22.40 p <.000, ηP2 = .269). Anxiety and depression showed a significant interaction effect for time and group (F (1, 61) = 8.89, p <.00, ηP2= .127) and (F (2, 122) = 35.04, p <.001, ηP2 = .365) respectively. No adverse effects or events were reported by the participants during the procedure administration or at three months follow-up while all participants were still in lockdown. None of the participants showed clinically significant worsening/exacerbation of symptoms after the procedure. This randomized controlled trial provides evidence for the effectiveness, efficacy, feasibility, and safety of the ASSYST-RG in reducing posttraumatic stress, anxiety, and depression symptoms in the general population during the COVID-19 pandemic lockdown.
Zeifman, R. J., Landy, M. S. H., Liebman, R. E., Fitzpatrick, S., & Monson, C. M. (2021). Optimizing treatment for comorbid borderline personality disorder and posttraumatic stress disorder: A systematic review of psychotherapeutic approaches and treatment efficacy. Clin Psychol Rev, 86, 102030. doi:10.1016/j.cpr.2021.102030
Richard J. Zeifman, Department of Psychology, Ryerson University, Toronto, Canada. E-mail: firstname.lastname@example.org.
Comorbid borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) is a severe and complicated clinical presentation characterized by especially high rates of suicide, healthcare utilization, and psychosocial impairment. Although guidelines exist for treating each of these disorders alone, there remains limited guidance on the optimal treatment in cases where BPD and PTSD co-occur. Therefore, this systematic review synthesizes the existing research on the treatment of BPD-PTSD with the aim of optimizing treatment for this population. First, the prevalence and clinical severity of comorbid BPD-PTSD is reviewed. Next, we describe the results of our systematic review, which identified 21 articles that examined treatment outcomes in the context of BPD-PTSD or subclinical BPD-PTSD. Based on our results, we describe existing psychotherapeutic approaches, including BPD-specific treatments, trauma-focused and non-trauma-focused treatments for PTSD, and stage-based treatments for BPD-PTSD. We also summarize BPD-PTSD treatment outcomes, including whether each disorder interferes with treatment and recovery of the other. Results related to treatment safety and concerns regarding conducting trauma-focused treatment for BPD-PTSD are addressed. We end by highlighting important gaps in the literature and provide recommendations for further research.