EMDR Research News July 2022
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 Treating Depression with EMDR Therapy from the international research team who developed the EMDR DeprEnd protocol for treating depression.
The book of the month is Treating Depression with EMDR Therapy.
"This groundbreaking book introduces EMDR-DeprEnd, a pathogenic memory-based EMDR therapy approach. DeprEnd has been demonstrated in a number of studies and meta-analyses to be at least as effective―and often more effective―than other guideline-based therapies in treating depression, including cognitive behavioral therapy (CBT)."
"EMDR-DeprEnd is particularly helpful with chronic and recurrent depression that does not respond well to other treatments. Written by the international research team who developed this quick-acting and efficient therapy, the text provides clinicians with the evidence-based tools they need to integrate EMDR-DeprEnd into their practices.
This text explains in depth a step-by-step approach to processing the pathogenic memory structures that are the basis of most depressive disorders and ways to address both depressive and suicidal states. Real-world case studies incorporate the often-co-occurring trauma-based disorders found in depressive patients.
Abundant illustrations enhance understanding of stress and trauma-based depressive disorders and the successful interventions that improve client outcomes. Protocol scripts for therapist and client also help prepare readers to provide optimal treatment to their clients."
Azimisefat, P., Rajabi, S., de Jongh, A., Kanske, P., & Jamshidi, F.-. (2022). Comparison of the Effectiveness of Virtual Reality Exposure Therapy with Eye Movement Desensitization and Reprocessing Therapy on Symptoms of Acrophobia and Anxiety Sensitivity in Adolescent Girls: A Randomized Controlled Trial. Preprint.
Soran Rajabi, Department of Psychology, Persian Gulf University, Iran. E-mail: email@example.com
Acrophobia is a specific phobia characterized by a severe fear of heights. The purpose of the present study was to compare two therapies to and virtual reality exposure therapy (VRET) and eye movement desensitization and reprocessing (EMDR) therapy We applied a design with 45 female adolescent students. Students who met the for acrophobia were to either VRET (N=15; M M or a Waiting List (N=15; Mage=17.50; SD=1.26). The study groups were tested in the first and last treatment sessions regarding symptoms of acrophobia (Acrophobia Questionnaire) and anxiety sensitivity (Anxiety Sensitivty Index). The data showed that both the application VRET and EMDR were associated with significantly reduced symptoms of acrophobia (d = 1.03 for VRET and d = 1.08 for EMDR) and (d = 1.15 for VRET and d = 1.13 for EMDR) in comparison to the Waiting List. Negligible differences were found between both intervention groups after treatment (d = 0.13 for and d = 0.03 for anxiety sensitivity). The results suggest that both VRET and EMDR are interventions that can significantly improve symptoms of acrophobia and anxiety sensitivity.
Banoğlu, K., & Korkmazlar, Ü. (2022). Efficacy of the eye movement desensitization and reprocessing group protocol with children in reducing posttraumatic stress disorder in refugee children. European Journal of Trauma & Dissociation, 6(1), 100241. doi:10.1016/j.ejtd.2021.100241
Köksal Banoğlu, Foreign Affairs and Public Project Office, Maltepe District Governorship of Istanbul City, Altaycesme M. Oba Cikmazi S. No:8 K:7 Maltepe, Istanbul, Turkey. E-mail: firstname.lastname@example.org
The prevalence of posttraumatic stress disorder (PTSD) is high among Syrian refugee children. Depression is another pathology whose symptoms are often seen associated with vulnerability to PTSD and decreasing life satisfaction in refugee children. The Eye Movement Desensitization and Reprocessing (EMDR) psychotherapy method is a well-known intervention for the treatment of PTSD. Despite its treatment efficacy shown in clinical trials, individual EMDR applications fall short of the cost and time effectiveness targets in mass casualty incidents, such as war victimizations. In response to this need, a group treatment protocol developed especially for children (EMDR-GP/C) was tested by a randomized controlled trial study with Syrian refugee children (n = 61, 6-15 years old). After the treatment, EMDR group had significantly lower trauma scores compared to the waiting-list (F(1,58) = 4.72, p = .03, ηp² = .08). Depression scores significantly diminished (F(1, 17) = 8.67, p = .01, ηp² = .34) and well-being levels increased (F(1,58) = 6.58, p = .01, ηp² = .10). The curative effect of time by itself (F(1, 59) = 29.91, p < .001, ηp² = .34) and time-by-group interaction (F(1, 59) = 4.61, p = .04, ηp² = .07) were significant on PTSD symptoms, but non-significant on depression and well-being levels. Results suggest that EMDR-GP/C interventions may reduce PTSD and depression symptoms, as well as improving the well-being of Syrian refugee children with PTSD. It also appears that the content of the EMDR-GP/C helps children to integrate the whole experience, reconstructing an adaptive meaning for the traumatic event.
Bursnall, M., Thomas, B. D., Berntsson, H., Strong, E., Brayne, M., & Hind, D. (2022). Clinician and Patient Experience of Internet-Mediated Eye Movement Desensitisation and Reprocessing Therapy. J Psychosoc Rehabil Ment Health, 1-12. doi:10.1007/s40737-022-00260-0
Open Access: https://pubmed.ncbi.nlm.nih.gov/35136713
Matthew Bursnall, School of Health and Related Research (ScHARR), University of Sheffield. Regent Court, 30 Regent Street, Sheffield S1 4DA, UK. E-mail: email@example.com
Many eye movement desensitization and reprocessing (EMDR) therapists moved their practice online during COVID-19. We conducted surveys and interviews to understand the implementation and acceptability of online EMDR therapy. From 17 June to 2nd August 2021 an online survey was open to EMDR therapists from the EMDR Association UK & Ireland and EMDR International Association email lists, and, through them, their clients. Questions related to determinants of implementation (for therapists) and acceptability (for clients) of online EMDR. Semi-structured interviews were conducted with a sample of therapist respondents to provide a deeper understanding of survey responses. Survey responses were received from therapists (n = 562) from five continents, and their clients (n = 148). 88% of clients responded as being extremely or very comfortable receiving EMDR therapy online. At the initial point of 'social distancing', 54% of therapists indicated strong or partial reluctance to deliver online EMDR therapy compared to 11% just over one year later. Four fifths of therapists intended to continue offering online therapy after restrictions were lifted. Free-text responses and interview data showed that deprivation and clinical severity could lead to exclusion from online EMDR. Internet connectivity could disrupt sessions, lead to cancellations, or affect the therapy process. Therapists benefited from training in online working. Online EMDR is generally acceptable to therapists and clients, with reservations about digital exclusion, case severity, poor internet connectivity and the need for training. Further research is needed to confirm that online EMDR is clinically non-inferior to in-person working. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40737-022-00260-0.
Cotraccia, A. J. (2022). Trauma as Absence: A Biopsychosocial-AIP Definition of Trauma and Its Treatment in EMDR. Journal of EMDR Practice and Research, EMDR-2022. doi:10.1891/emdr-2022-0011
Anthony Cotraccia, 4372 River Road, New Hope, PA 18938. E-mail: firstname.lastname@example.org
This paper advances the biopsychosocial adaptive information processing model (BPS-AIP) and theory (Cotraccia, 2012) by adding consciousness as a mechanism of action activated via social behavior in EMDR. An attention schema is conceptualized as content integrated with dynamic self-models that maintain subjective mental states of biopsychosocial connectivity or disconnectivity. These implicit self-models are portrayed as determining 1) the disposition of the BPS-AIP system of clients presenting for EMDR as more or less connected or disconnected prior to, at the time of, and following, a stressful event; and 2) whether or not stressful events become traumatizing over time. Attention schema theory (Graziano, 2021) is integrated to further describe how establishing and enhancing attentional agency when addressing simple and complex-PTSD facilitates consolidation of autobiographical memory. Self-integration in the context of an attuned therapeutic relationship is described in terms of patterns of tracking attention to promote heightened states of self/other consciousness and activate the innate healing system. Attention schema theory, as a prominent theory of consciousness, adds to BPS-AIP’s compelling description of how an innate neurophysiological system can be integrated with psychosocial components that explain how both subjective and intersubjective experiences are causally relevant to the processing of autobiographical memory.
Hamblen, J. L., Grubbs, K. M., Cole, B., Schnurr, P. P., & Harik, J. M. (2022). “Will it work for me?” Developing patient-friendly graphical displays of posttraumatic stress disorder treatment effectiveness. J Trauma Stress, 35(3), 999-1010. doi:10.1002/jts.22808
Open Access: https://pubmed.ncbi.nlm.nih.gov/35261090
Jessica Hamblen, National Center for PTSD, VA Medical Center (116D), 215 North Main Street, White River Junction, Vermont 05009, USA.
E-mail: Jessica.L.Hamblen@dartmouth. edu
The goal of this study was to create simple visual displays to help patients understand the benefits of evidence-based treatment for posttraumatic stress disorder (PTSD). We reviewed randomized trials of the most effective individual, trauma-focused psychotherapies and first-line antidepressants for adults with PTSD. The analytic sample included 65 treatment arms from 41 trials. We used binomial logistic regression to estimate the proportion of participants who lost their PTSD diagnosis at posttreatment and created a sample icon array to display these estimates. We provide a range of estimates (0-100) based on varying the percentage of the sample with a military affiliation. The percentage of participants who no longer met the diagnostic criteria for PTSD among civilian populations was 64.3% for trauma-focused treatment, 56.9% for SSRI/SNRI, and 16.7% for waitlist/minimal attention. For military populations, the proportions of participants who no longer met the diagnostic criteria were 44.2%, 36.7%, and 8.1%, respectively. We present icon arrays for 0%, 7%, 50%, and 100% military affiliation displaying 100 icons, a portion of which were shaded to indicate the number of participants that no longer met the PTSD criteria following treatment. After evidence-based treatment, between one third and two thirds of participants no longer met the PTSD criteria. Providers can use the icon array developed in this study with patients to facilitate communication regarding PTSD treatment effectiveness.
Hase, M., & Brisch, K. H. (2022). The Therapeutic Relationship in EMDR Therapy. Front Psychol, 13, 835470. doi:10.3389/fpsyg.2022.835470
Open Access: https://pubmed.ncbi.nlm.nih.gov/35712194
Michael Hase, EMDR Center, Lüneburg, Germany. E-mail: email@example.com
The history of EMDR Therapy goes back to 1987, when it was introduced as EMD, a novel treatment for PTSD by Francine Shapiro. Over the course of time EMD developed into the comprehensive therapy approach named EMDR Therapy. The development of the "Adaptive Information Processing (AIP) Model", the model of pathogenesis and change of EMDR Therapy, was a milestone in this development from technique to psychotherapy approach. Up to date EMDR Therapy offers not only a model of pathogenesis and change, but also a variety of treatment plans and techniques to treat patients of various diagnosis far beyond PTSD. What seems to be missing is a specific description of the therapeutic relationship in EMDR Therapy. The therapeutic relationship should be described as a core element of EMDR Therapy, and seems be related to the structure of EMDR Therapy. As attachment theory offers a view on the development of interpersonal relationships in general, an attachment theory based perspective of the therapeutic relationship seems advisable. A description of the therapeutic relationship in EMDR Therapy is necessary at this point of the development of EMDR Therapy to a psychotherapeutic approach and therefore we try to describe the therapeutic relationship in this article and point out parallels between the therapeutic relationship and the development and core features of an attachment based relationship. We propose to describe EMDR Therapy as a sensitive psychotherapy. Implications for treatment, training and research will be discussed.
Hutchinson, R., King, N., & Majumder, P. (2022). How effective is group intervention in the treatment for unaccompanied and accompanied refugee minors with mental health difficulties: A systematic review. International Journal of Social Psychiatry, 68(3), 484-499. doi:10.1177/00207640211057727
Pallab Majumder, University of Nottingham; Bulwell Children’s Centre, Steadfold Close, Bulwell, Nottingham NG6 8AX, UK.
Background: Unaccompanied refugee minors (URM) are at significantly higher risk of trauma exposure and mental illness. Research examining the most effective treatments for this population is limited.
Aims: To study the available research evidence on outcomes from various group interventions in this population. The objective is to investigate if these can be used clinically in future interventions.
Methods: Systematic review was carried out for patient outcomes where group therapy was used as treatment in URM. Studies with ARM (Accompanied refugee minors) were included because of similarities between these groups and because many studies were mixed population.
Results: Seventeen papers met eligibility criteria with a total of N=1,119 participants. About 80% studies with a quantitative component reported improvements, and 69% of the studies that carried out statistical analyses reported statistically significant improvements in mental health symptoms. Every qualitative measure reported positive outcome for the participants. Studies with URM tended to show improved outcomes more often than studies exclusively with ARM.
Conclusions: The evidence demonstrates the efficacy of group therapy in improving mental health outcomes, although the number of studies with robust methodology is small. Group intervention has potential to improve engagement and outcomes of URM with mental illness. Future direction for research is discussed.
Javinsky, T.-R., Udo, I., & Awani, T. (2022). Eye movement desensitisation and reprocessing: part 2 – wider use in stress and trauma conditions. BJPsych Advances, 1-10. doi:10.1192/bja.2022.31
Itoro Udo. E-mail: firstname.lastname@example.org
Eye Movement Desensitisation and Reprocessing (EMDR) is an established psychotherapy that utilises repetitive, bilateral stimulation, such as saccadic eye movements, to treat the symptoms associated with traumatic experiences. Much of the attention EMDR has received has focused on its use in treating post-traumatic stress disorder (PTSD), which has resulted in its inclusion in several treatment guidelines. There is, however, emerging evidence that suggests a promising role for EMDR in managing a wide range of other mental and physical health conditions. High-quality studies demonstrate the efficacy of EMDR in managing conditions such as anxiety disorders, obsessive–compulsive disorder, major depressive disorder and chronic pain. Preliminary studies have also investigated its use in conditions such as bipolar disorder, eating disorders, substance misuse, psychotic disorders and sleep disturbances. The major studies exploring these applications of EMDR, outside of PTSD, are reviewed in this article.
Johansson, R., Nyström, M., Dewhurst, R., & Johansson, M. (2022). Eye-movement replay supports episodic remembering. Proc Biol Sci, 289(1976), 20220964. doi:10.1098/rspb.2022.0964
Open Access: https://pubmed.ncbi.nlm.nih.gov/35703049
Roger Johansson, Department of Psychology, Lund University, Lund, Sweden. Humanities Lab, Lund University, Lund, Sweden. E-mail: email@example.com
When we bring to mind something we have seen before, our eyes spontaneously unfold in a sequential pattern strikingly similar to that made during the original encounter, even in the absence of supporting visual input. Oculomotor movements of the eye may then serve the opposite purpose of acquiring new visual information; they may serve as self-generated cues, pointing to stored memories. Over 50 years ago Donald Hebb, the forefather of cognitive neuroscience, posited that such a sequential replay of eye movements supports our ability to mentally recreate visuospatial relations during episodic remembering. However, direct evidence for this influential claim is lacking. Here we isolate the sequential properties of spontaneous eye movements during encoding and retrieval in a pure recall memory task and capture their encoding-retrieval overlap. Critically, we show that the fidelity with which a series of consecutive eye movements from initial encoding is sequentially retained during subsequent retrieval predicts the quality of the recalled memory. Our findings provide direct evidence that such scanpaths are replayed to assemble and reconstruct spatio-temporal relations as we remember and further suggest that distinct scanpath properties differentially contribute depending on the nature of the goal-relevant memory.
Kratzer, L., Schiepek, G., Heinz, P., Schöller, H., Knefel, M., Haselgruber, A., & Karatzias, T. (2022). What makes inpatient treatment for PTSD effective? Investigating daily therapy process factors. Psychother Res, 1-13. doi:10.1080/10503307.2022.2050830
Leonhard Kratzer, Department of Psychotraumatology, Clinic St. Irmingard, Osternacher Strasse 103, Prien am Chiemsee, Bavaria 83209, Germany.
OBJECTIVE: Therapeutic process factors including alliance and motivation are considered to play a key role in the treatment of post-traumatic stress disorder (PTSD). Yet, our understanding of change processes in therapy is mostly based on theoretical considerations with limited empirical evidence. In order to identify process characteristics of successful inpatient treatments of PTSD, we investigated the intraindividual, interindividual, and temporal associations of daily assessments of therapy process factors like motivation, alliance, and insight. METHOD: Therapy process questionnaire (TPQ) assessments were collected from 101 inpatients with PTSD over 50 days, resulting in 5050 assessments. Multilevel vector autoregressive (mlVAR) modelling was applied to investigate the networks of the TPQ factors in a subgroup with good outcome regarding PTSD symptomatology and a subgroup with less favourable outcome. RESULTS: The two subgroups differed markedly in their network models, suggesting that therapy processes might be different for those with good and those with poor treatment outcomes. CONCLUSIONS: Our results suggest that good treatment outcome is linked to a specific therapy process dynamic where mindfulness and insight lead to the kind of temporary well-being required to effectively engage with problems and negative emotions, while motivation to change ensures the continuity of confronting negative emotions and problems.
Lakin, D. P., García-Moreno, C., & Roesch, E. (2022). Psychological Interventions for Survivors of Intimate Partner Violence in Humanitarian Settings: An Overview of the Evidence and Implementation Considerations. Int J Environ Res Public Health, 19(5), 2916. doi:10.3390/ijerph19052916
Open Access: https://pubmed.ncbi.nlm.nih.gov/35270610
Daniel P. Lakin, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA. E-mail: firstname.lastname@example.org
This paper provides an analytical overview of different types of psychological interventions that have demonstrated efficacy in low-income and/or humanitarian settings and points to special considerations that may be needed if used with women who have been subjected to gender-based violence (GBV). This paper reviews diverse therapeutic modalities and contrasts them across several domains, including their conventional use and principles; their documented use and efficacy in humanitarian settings; any special considerations or modifications necessary for GBV-affected clients; and any additional resources or implementation concerns when working in low-income contexts. By examining the evidence base of multiple interventions, we hope to provide clinicians and GBV-prevention advocates with an overview of tools/approaches to provide survivor-centered, trauma-informed responses to GBV survivors. This analysis responds to the growing recognition that gender-based violence, in particular intimate partner violence and sexual violence, is strongly associated with mental health problems, including anxiety, depression, and post-traumatic stress. This is likely to be exacerbated in humanitarian contexts, where people often experience multiple and intersecting traumatic experiences. The need for mental health services in these settings is increasingly recognized, and a growing number of psychological interventions have been shown to be effective when delivered by lay providers and in humanitarian settings.
Lempertz, D., Vasileva, M., Brandstetter, L., Bering, R., & Metzner, F. (2022). Short-term eye movement desensitization and reprocessing (EMDR) therapy to treat children with posttraumatic stress symptoms after single trauma: A case series. Clin Child Psychol Psychiatry, 13591045221082395. doi:10.1177/13591045221082395
Daniela Lempertz, Private Practice for Child and Youth Psychotherapy, Lühlingsgasse 3, Unkel 53572, Germany. E-mail: email@example.com
BACKGROUND: Traumatic experiences can lead to posttraumatic stress disorder (PTSD). For young children, even minor, inconspicuous looking events can lead to posttraumatic stress symptoms. Trauma-focused treatment with Eye Movement Desensitization and Reprocessing (EMDR) offers children an age-adapted intervention to help them successfully process traumatic experiences. So far, there has been a lack of well evaluated trauma-focused treatments for young children. METHODS: These case series examine the effectiveness of a short-term treatment with EMDR therapy for children showing PTSD symptoms after experiencing a single incident induced trauma. Five children between 5 and 10 years of age who developed PTSD after a single incident trauma received a manualized EMDR treatment for 6 weeks (mean number of sessions: seven including a mean number of EMDR sessions: 3.4). Posttraumatic stress symptoms were assessed prior to treatment, following treatment and at a 3-month follow-up with standardized instruments for caregivers and children. RESULTS: PTSD symptoms decreased for all children after completing the treatment from clinical to non-clinical level. Reductions in vegetative hyperarousal, fears and clinging behaviour were achieved. Furthermore, reductions in the parental stress levels, as well as a recovery of everyday routine and everyday stability were observed. CONCLUSION: Short-term EMDR treatment appears to be a promising treatment for single incident trauma in young children providing a potentially successful quick and safe psychological treatment for children. Results contribute to the knowledge of feasibility and acceptability of short-term, trauma-focused treatments of children with EMDR. Replication of the results of these case series in larger samples using a randomized controlled design is warranted.
Lipinski, S., Boegl, K., Blanke, E. S., Suenkel, U., & Dziobek, I. (2021). A blind spot in mental healthcare? Psychotherapists lack education and expertise for the support of adults on the autism spectrum. Autism, 13623613211057973. doi:10.1177/13623613211057973
Open Access: https://pubmed.ncbi.nlm.nih.gov/34825580
Debbie Spain, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, de Crespigny Park, PO Box 80, Denmark Hill, London SE5 8AF, UK.
Autistic individuals are at greater risk of experiencing adverse and traumatic life events. Eye Movement Desensitisation and Reprocessing (EMDR), a psychological therapy, is potentially effective for treating the constellation of difficulties arising from traumatic experiences, as well as mental health conditions. Yet minimal research has focused on how EMDR may require adaptation to improve its accessibility, acceptability and effectiveness for autistic individuals. In a three- round Delphi survey, 103 EMDR therapists were asked about barriers to EMDR for autistic individuals and adaptations employed to enhance therapy, so as to generate consensus about important or essential components of adaptations to EMDR. Four types of barriers were highlighted: client-related characteristics, therapist-related characteristics, differences in the therapeutic relationship and systemic issues. One hundred and twenty-four adaptations were identified, including 35 general adaptations (i.e. relevant across EMDR phases), 81 relating to specific EMDR phases and 8 about EMDR clinical supervision. Of these, 27 adaptations were used often or always by at least 80% of participants; a further 61 were sometimes incorporated within therapy, depending on the client. Study findings highlight the need for EMDR therapists to have training about autism and the potential ways of tailoring EMDR, and that individual case conceptualisation is key.
Lumley, M. A., Yamin, J. B., Pester, B. D., Krohner, S., & Urbanik, C. P. (2022). Trauma matters: psychological interventions for comorbid psychosocial trauma and chronic pain. Pain, 163(4), 599-603. doi:10.1097/j.pain.0000000000002425
Mark A. Lumley, Department of Psychology, Wayne State University, Detroit, MI, United States. E-mail: firstname.lastname@example.org
There is growing interest in psychosocial trauma and chronic pain (CP). Numerous retrospective studies link trauma or posttraumatic stress disorder (PTSD) to CP and prospective studies indicate that earlier trauma is a risk factor for later CP. Some scholars have offered explanations of this link, focusing on the commonalities of trauma and CP or their bidirectional relationships, such as the shared vulnerability, mutual maintenance and perpetual avoidance models. Others have proposed how trauma might cause, exacerbate, or maintain CP by disrupting physiological, cognitive, emotional, or interpersonal processes. Unfortunately, these models have rarely informed treatment initiatives, leaving key questions unanswered: How does one define trauma in populations with CP? Is it beneficial to treat comorbid trauma or CP? What interventions effectively do so? This topical review addresses these questions.
Meneguzzo, P., Garolla, A., Bonello, E., & Todisco, P. (2022). Alexithymia, dissociation and emotional regulation in eating disorders: Evidence of improvement through specialized inpatient treatment. Clin Psychol Psychother, 29(2), 718-724. doi:10.1002/cpp.2665
Open Access: https://pubmed.ncbi.nlm.nih.gov/34432335
Paolo Meneguzzo, Department of Neuroscience, University of Padova, via Giustiniani 2, Padova 35128, Italy. E-mail: email@example.com
The research into emotional regulation in eating disorders (EDs) has shown specific impairments and maladaptive coping strategies in patients, and there is an increasing interest in the role of the emotional domain in the treatment outcome. This study aims to evaluate the effect of a specialized inpatient treatment characterized by both an intensive and comprehensive standardized multidisciplinary programme based on cognitive-behavioural therapy and a flexible and personalized component implemented by third-wave interventions. A cohort of 67 female ED patients (anorexia nervosa = 28, bulimia nervosa = 28 and binge eating disorder = 11) underwent an evaluation of emotional regulation difficulties, alexithymia and dissociative symptomatology at admission to a specialized ED ward. The psychological modifications were subsequently re-evaluated upon discharge, after an inpatients treatment of 60 days, examining specific changes in the specific psychopathology. A significant improvement after specialized ED treatment was shown in alexithymia, emotional regulation difficulties and dissociation symptoms, with higher effect sizes in patients with higher alexithymia scores. As regards the specific effect of the psychological improvement, changes into alexithymia scores have shown specific correlations with ED psychopathology (p < 0.010) and with difficulties in emotional regulation (p < 0.010) in patients with higher alexithymia levels at admission. Emotional regulation and dissociation should therefore be evaluated in ED patients and may be improved with specific therapeutic approaches, while alexithymia remains a clinical trait, even with a significant reduction.
Papanikolopoulos, P., Prattos, T., & Foundoulakis, E. (2022). Pandemic Times and the Experience of Online EMDR Practice in Greece: A Qualitative Study on Obstacles and Perspectives. Journal of EMDR Practice and Research, EMDR-2021. doi:10.1891/emdr-2021-0033
Penny Papanikolopoulos PhD, ΕMDR Europe Trainer, Consultant and Practitioner, Hellenic American University: 436 Amherst St, Nashua, NH 03063 USA. E-mail: firstname.lastname@example.org
Covid-19 Pandemic has had a biopsychosocial impact on the Greek mental health system by worsening symptoms of depression and stress in the general population. As the need for mental health services increased, the Pandemic strongly affected EMDR practice, and training which was mainly online, during 2020. In a small sample consisting of 40 EMDR practitioners, a brief online questionnaire was administered concerning the obstacles that professionals believe they face doing online EMDR therapy in Greece during the Pandemic. A conventional qualitative analysis was conducted on the respondents’ feedback by coding the content. Among others, the results showed two categories of practical and psychosocial defects in the efficient application of online EMDR practice. Lack of physical contact, poor application of bilateral stimulation based on technical difficulties, poor computer skills, and physical exhaustion due to continuous lockdown were some of the content subcategories. The results are discussed concerning the current context of the Pandemic and local characteristics. Moreover, practical implications for online EMDR practice are discussed.
Rew, G., Clark, L., & Rogers, G. (2022). Making Sense of Offence Related Trauma: Exploring Two Patients Lived Experience. Journal of EMDR Practice and Research, EMDR-2022. doi:10.1891/emdr-2022-0004
Gemma Rogers, E-mail: email@example.com
Offence related trauma refers to a trauma reaction following the perpetration of a violent offence. This research explores the lived experience of offence related trauma, in two forensic patients. The meaning and understanding these individuals make of their own coping strategies, triggers and treatment and how this contributes to their behaviour was explored using a semi-structured interview and analysed using Interpretative Phenomenological Analysis. Two super-ordinate themes emerged from the data: ‘Journey to Forgiveness’ and ‘Living with the Whole Me.’ These themes and their subthemes highlight the nuances of offence related trauma and raise the question of how processes such as complicated grief and associated shame can impact on recovery and rehabilitation. The implications of the findings for professionals providing treatment in forensic settings are considered.
Semmlinger, V., Takano, K., Schumm, H., & Ehring, T. (2021). Dropout from psychological interventions for refugees and asylum seekers: A meta-analysis. J Consult Clin Psychol, 89(9), 717-730. doi:10.1037/ccp0000681
Open Access: https://pubmed.ncbi.nlm.nih.gov/34591546
Verena Semmlinger, Department of Psychology, Ludwig-Maximilians-University Munich, Munich 80802, Germany. E-mail: firstname.lastname@example.org
BACKGROUND: Refugees and asylum seekers often suffer from migration stressors and related psychopathology. However, providing this population with psychological treatment has a number of barriers (e.g., culture and language differences), which are widely thought to hinder the success and continuation of treatment. OBJECTIVE: The current systematic review and meta-analysis aims to provide first comprehensive evidence on the prevalence and predictors of dropout in treatment provided for refugees and asylum seekers. METHOD: We synthesized the existing evidence on dropout from psychological and psychosocial interventions provided to adult refugees and asylum seekers resettled in high-income countries. Specifically, we meta-analyzed the prevalence of dropout from treatment and explored the factors that predict dropout. Our database search in Pubmed, PsycINFO, Web of Science, and PTSDpubs identified 28 eligible randomized controlled trials (RCTs; 2,691 participants; 39 active treatment conditions), published up to January 31, 2021. RESULTS: Results showed a weighted average dropout rate of 19.14%, 95% confidence interval [14.66, 24.60] across studies and treatment conditions. Subgroup analyses and meta-regressions revealed no statistically significant predictors for dropout. However, several refugee-specific variables (e.g., longer mean duration in country of resettlement, lower rate of insecure asylum status) may merit closer attention in future research. CONCLUSIONS: These findings suggest that, in contrast to widespread assumption, the estimated average dropout rate is comparable to those reported in nonrefugee populations. However, more research is needed to establish the underlying mechanisms of dropout, which may differ across populations.
Susanty, E., Sijbrandij, M., Srisayekti, W., Suparman, Y., & Huizink, A. C. (2022). The Effectiveness of Eye Movement Desensitization for Post-traumatic Stress Disorder in Indonesia: A Randomized Controlled Trial. Front Psychol, 13, 845520. doi:10.3389/fpsyg.2022.845520
Open Access: https://pubmed.ncbi.nlm.nih.gov/35548495
Anja C. Huizink, Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands. E-mail: email@example.com
Objective: Post-traumatic stress disorder (PTSD) may affect individuals exposed to adversity. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based trauma-focused psychotherapy for PTSD. There is still some debate whether the eye movements (EMs) are an effective component of EMDR. The primary aim of this study was to investigate the effectiveness of Eye Movement Desensitization (EMD) treatment in reducing PTSD symptoms compared to a retrieval-only active control condition. We also investigated whether PTSD symptom reduction was associated with reductions in depression and anxiety, and improvements in quality of life. Methodology: Adult PTSD patients (n = 91) were recruited at public psychological services in Jakarta, Bandung and Cimahi, Indonesia. PTSD was diagnosed with the Structured Clinical Interview for DSM-5 disorders (SCID-5). Participants were randomized into: EMD (n = 47) or retrieval-only (n = 44). EMD consisted of clinical history and treatment planning, preparation, assessment, EMs, closure, whereas retrieval-only consisted of the same elements except EMs. Data were collected at baseline (T0), 1-week post-treatment (T1), 1-month follow-up (T2), and 3-months follow-up (T3). Outcome measures included the PTSD Checklist for DSM-5 (PCL-5), Hopkins Symptoms Checklist-25 (HSCL-25), and the World Health Organization Quality of Life-BREF (WHOQoL-BREF). Data were analyzed with linear mixed model analysis in R Statistics. Results: Although there were main effects of time indicating reductions for both EMD and retrieval-only in PCL-5 and HSCL-25 scores, and improvements in WHOQoL-BREF scores at T1, T2, and T3, no significant differences in PCL-5, HSCL-25, and WHOQoL-BREF total scores between the EMD and retrieval-only groups at T1, T2, and T3 were found (all group x time interaction p's > 0.005). Conclusion: Within a clinical sample of PTSD patients in Indonesia, both EMD and retrieval-only was associated with reductions in symptoms of PTSD, anxiety and depression, and improvements in quality of life, although EMs did not add to the efficacy of the treatments. Further research to examine the underlying mechanisms of EMDR's effective treatment elements in clinical samples is needed. Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [ISRCTN55239132].
Thoresen, I. H., Auren, T. J. B., Langvik, E. O., Engesæth, C., Jensen, A. G., & Klæth, J. R. (2022). Intensive outpatient treatment for post-traumatic stress disorder: a thematic analysis of patient experience. Eur J Psychotraumatol, 13(1), 2043639. doi:10.1080/20008198.2022.2043639
Open Access: https://pubmed.ncbi.nlm.nih.gov/35479299
Trude Julie Brynhildsvoll Auren, Regional Unit for Treatment of Severe Posttraumatic Stress Disorder, Nidaros. DPS, St. Olavs Hospital, Trondheim, Norway
Background: Intensive treatments have shown encouraging results in the treatment of several psychological disorders, including post-traumatic stress disorder (PTSD). However, qualitative studies on patient experiences with intensive treatment for PTSD remain scarce. Objective: The aim of this study was to explore patient experiences with an intensive, outpatient treatment for PTSD and to discover important factors behind treatment feasibility. Method: Eight participants were recruited from two groups of patients having completed the intensive treatment programme. Semi-structured qualitative interviews were conducted, and data sets were analysed using thematic analysis. Results: The main result indicated that patients experienced the treatment as very demanding, but still worth the effort in terms of reducing symptoms. The intensity was valued as useful. Participants emphasized the sense of unity with other participants as well as physical activity as important factors for completion of the treatment programme. The rotation of therapists was also highlighted as important for treatment efficacy. Conclusions: This study provides insights into what the patients experienced and emphasized as important aspects of treatment and essential factors for completing treatment. The main conclusions were that all of the patients evaluated the treatment as demanding, but the reward of reduced symptoms made it worthwhile. The high frequency of therapy sessions and the therapist rotation were reported to counteract avoidance and increase the patients' commitment to therapy. Physical activity and unity in the group were highlighted as essential for treatment feasibility. HIGHLIGHTS: • High treatment intensity enabled increased focus and adherence, and reduced avoidance. Therapist rotation led to heightened intensity and new learning experiences. • Physical activity and sense of unity through group elements were reported as important factors for treatment feasibility.
Todisco, P., Meneguzzo, P., Garolla, A., Antoniades, A., Vogazianos, P., & Tozzi, F. (2021). Impulsive behaviors and clinical outcomes following a flexible intensive inpatient treatment for eating disorders: findings from an observational study. Eat Weight Disord, 26(3), 869-877. doi:10.1007/s40519-020-00916-5
Patrizia Todisco, Eating Disorders Unit, Casa di Cura "Villa Margherita", via Costacolonna 20, Arcugnano, VI, Italy. E-mail: firstname.lastname@example.org
PURPOSE: The aim of the study was to assess the differences between impulsive and non-impulsive patients in response to a multidisciplinary intensive inpatient treatment for eating disorders (EDs). METHODS: 320 patients with EDs were consecutively recruited in an eating disorders unit (EDU). They were assessed by clinical interviews and self-reported questionnaires. The treatment was characterized by a patient-centric approach and included both an intensive and comprehensive standardized multidisciplinary program based on cognitive-behavioral therapy and a flexible and personalized component according to the needs and the history of each patient. RESULTS: Impulsive ED patients showed greater improvement in specific psychopathological areas, in particular: interpersonal sensitivity of Symptom Checklist-90 (SCL-90) (p = 0.007); Eating Disorder Examination Questionnaire (EDE-Q) Global Score (p = 0.009), EDE-Q eating concern (p < 0.001) and EDE-Q shape concern (p = 0.025). The two groups also showed a different pattern on the Body Uneasiness Test, with impulsive patients uniquely showing improvement on Global Severity Index (p = 0.006), body image concern (p = 0.008), compulsive self monitoring (p = 0.002), and weight phobia (p = 0.037). DISCUSSION: Results support the hypothesis that patients with impulsive behaviors might benefit from treatments characterized by a standardized cognitive behavioral therapy implemented by third-wave interventions according to each patient's clinical profile. Personalized treatment approaches could be an answer to the complexity of ED, addressing individual psychopathology. Further studies are needed to confirm these preliminary findings. LEVEL OF EVIDENCE: III, cohort or case-control analytic studies.
Udo, I., Javinsky, T.-R., & Awani, T. (2022). Eye movement desensitisation and reprocessing: part 1 – theory, procedure and use in PTSD. BJPsych Advances, 1-10. doi:10.1192/bja.2022.32
Itoro Udo. Email: email@example.com
Eye movement desensitisation and reprocessing (EMDR) is an established psychotherapy developed in the late 1980s to treat post-traumatic stress disorder (PTSD). It involves the use of repetitive eye movements or other bilateral stimulation to aid in the reprocessing of traumatic memories. It is unique in that it does not require extended exposure to or discussion of distressing memories and may result in symptom resolution in fewer sessions than other psychotherapies. In the decades since its initial development, a wealth of high-quality evidence has suggested that EMDR is a safe and effective treatment for trauma- and stress-based conditions, resulting in its inclusion in various treatment guidelines. This article reviews the theory behind how EMDR works, how it is conducted, the evidence supporting its use in the treatment of PTSD and its approved indications and contraindications.
Vanderschoot, T., & Dessel, P. V. (2022). EMDR Therapy and PTSD: A Goal-Directed Predictive Processing Perspective. Journal of EMDR Practice and Research, EMDR-2022. doi:10.1891/emdr-2022-0009
Pieter Van Dessel, Department of Experimental-Clinical and Health Psychology, Ghent University, Gent, 9000, Belgium. E-mail: Pieter.VanDessel@UGent.be
Eye movement desensitization and reprocessing (EMDR) therapy is a widely used evidence-based treatment for posttraumatic stress disorder (PTSD). The mental processes underlying both PTSD and EMDR treatment effects are often explained by drawing on processes that involve the automatic formation and change of mental associations. Recent evidence that contrasts with these explanations is discussed and a new perspective to PTSD and EMDR treatment effects is proposed that draws on automatic inferential processes and can be readily integrated with the dominant (Adaptive Information Processing) model. This new perspective incorporates insights from cognitive theories that draw on predictive processing and goal-directed processes to elucidate (changes in) automatic inferences that underlie PTSD symptoms and EMDR treatment effects. Recommendations for clinical practice are provided based on this new perspective.
Velu, M. E., Martens, I., Shahab, M., de Roos, C., Jongedijk, R. A., Schok, M., & Mooren, T. (2022). Trauma-focused treatments for refugee children: study protocol for a randomized controlled trial of the effectiveness of KIDNET versus EMDR therapy versus a waitlist control group (KIEM). Trials, 23(1), 347. doi:10.1186/s13063-022-06178-z
Open Access: https://pubmed.ncbi.nlm.nih.gov/35461281
Merel E. Velu, Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands. E-mail: firstname.lastname@example.org
BACKGROUND: Prevalence of posttraumatic stress disorder (PTSD) in refugees is reportedly higher in comparison to the general population. Refugee children specifically are often coping with trauma and loss and are at risk for mental health difficulties. With staggering numbers of people seeking refuge around the world and 50% being 18 years or younger, research examining the effects of trauma-focused therapies for refugee children with PTSD is highly needed. Both Eye Movement Desensitization and Reprocessing (EMDR) therapy and the child version of Narrative Exposure Therapy (KIDNET) have been used for refugees, although these treatment methods have not been systematically compared. The aim of the current study is to investigate the effectiveness of EMDR and KIDNET, compared to a waitlist control group and with each other, offered to refugee children. METHODS: A randomized controlled three-arm trial has been designed. The primary outcome is PTSD diagnosis and symptom severity assessed with the Clinician-Administered PTSD Scale for Children DSM5 (CAPS-CA-5) at baseline (T1), 1 month post-treatment, or after 8 weeks of waiting (T2) and 3 months follow-up (T3). Additionally, instruments to assess posttraumatic stress symptoms, behavioral and emotional problems, and quality of life perception in children aged 8-18 are conducted at T1, T2, and T3. DISCUSSION: This is the first RCT that examines the effectiveness of EMDR and KIDNET in refugee children aged 8-18 years specifically, compared to a waitlist control group intended to reduce PTSD diagnosis and severity of posttraumatic stress symptoms and comorbid complaints in a growing and challenging population. TRIAL REGISTRATION: Dutch Trial Register NL40769 . Retrospectively registered on June 16, 2021.
Wolitzky-Taylor, K. B., Horowitz, J. D., Powers, M. B., & Telch, M. J. (2008). Psychological approaches in the treatment of specific phobias: a meta-analysis. Clin Psychol Rev, 28(6), 1021-1037. doi:10.1016/j.cpr.2008.02.007
M. Alexandra Kredlow, Department of Psychology, Tufts University. E-mail: email@example.com
Data from 33 randomized treatment studies were subjected to a meta-analysis to address questions surrounding the efficacy of psychological approaches in the treatment of specific phobia. As expected, exposure-based treatment produced large effects sizes relative to no treatment. They also outperformed placebo conditions and alternative active psychotherapeutic approaches. Treatments involving in vivo contact with the phobic target also outperformed alternative modes of exposure (e.g., imaginal exposure, virtual reality, etc.) at post-treatment but not at follow-up. Placebo treatments were significantly more effective than no treatment suggesting that specific phobia sufferers are moderately responsive to placebo interventions. Multi-session treatments marginally outperformed single-session treatments on domain-specific questionnaire measures of phobic dysfunction, and moderator analyses revealed that more sessions predicted more favorable outcomes. Contrary to expectation, effect sizes for the major comparisons of interest were not moderated by type of specific phobia. These findings provide the first quantitative summary evidence supporting the superiority of exposure-based treatments over alternative treatment approaches for those presenting with specific phobia. Recommendations for future research are also discussed.
Yaşar, A. B., Konuk, E., Kavakçı, Ö., Uygun, E., Gündoğmuş, İ., Taygar, A. S., & Uludağ, E. (2022). A Randomized-Controlled Trial of EMDR Flash Technique on Traumatic Symptoms, Depression, Anxiety, Stress, and Life of Quality With Individuals Who Have Experienced a Traffic Accident. Front Psychol, 13, 845481. doi:10.3389/fpsyg.2022.845481
Open Access: https://pubmed.ncbi.nlm.nih.gov/35401305
Iḃrahim Gündoğmus, Department of Psychiatry, Kırıkkale Yüksek Iḣ tisas Hospital, Kırıkkale, Turkey. E-mail: firstname.lastname@example.org
The Flash Technique of Eye Movement Desensitization and Reprocessing (EMDR) is widely recognized for its effectiveness in reducing the effects of emotional responses associated with traumatic memories. Using a randomized-controlled trial methodology, this study attempts to establish the efficacy of the EMDR Flash Technique. This study's sample includes volunteers who were involved in traffic accidents and were given the randomized EMDR Flash Technique and Improving Mental Health Training for Primary Care Residents (mhGAP) Stress management module. The participants were given a socio-demographic data form, the Depression-Anxiety-Stress 21 scale (DASS-21), the Impact of Event Scale-Revised (IES-R), and the WHOQOL Quality of Life scale. Participants were evaluated using measurements taken before and after the application, as well as a one-month follow-up. The mean age of the participants was 36.20 (11.41) years and 82.1% (n = 32) were female. The DASS-21 Anxiety (η^2^ = 0.085), IES-R Intrusion (η^2^ = 0.101), Avoidance (η^2^ = 0.124), Total (η^2^ = 0.147), and WHOQOL-BREF Psychological (η^2^ = 0.106) score improvements of the EMDR Flash Technique group were shown to be statistically significant when compared to the mhGAP group. However, no statistically significant difference in the DASS-21 Depression, Stress, Impact of Event Scale-Revised Hyperarousal WHOQOL-BREF General Health, Physical, Social Relationships, and Environment component scores was reported between the two groups. The present study's findings clearly demonstrate that the EMDR Flash technique, when applied to persons involved in traffic accidents, is successful in improving anxiety, intrusion, avoidance, total traumatic stress, and mental quality of life symptoms for at least 1 month. We believe that these findings will improve the reliability and applicability of the EMDR Flash Technique, which was tested for the first time in a clinical randomized-controlled trial (RCT).