Video of the month

Each month I also feature an EMDR video. This month we showcase a clinical video from a series by Linda Curran. In this video Linda interviews Babette Rothschild on “Dual Awareness for treating PTSD” and shows client vignettes in which she demonstrates methods for stabilization through building self-regulation and presentification skills. Other videos in this series include interviews with EMDR luminaries discussing their views on EMDR.

Journal Articles

Arnone, R., Orrico, A., D'aquino, G., & Di Munzio, W. (2012). [EMDR and psychopharmacological therapy in the treatment of the post-traumatic stress disorder]. Rivista Di Psichiatria, 47(2), 0. doi:10.1708/1071.11732

Raffaele Arnone, ASL Salerno 1 Nocera Inferiore (SA), E-mail: raffaele_arnone@libero.it

Abstract

Aim. This study evaluates the efficacy of two different treatment for post-traumatic stress disorder (PTSD): the psychopharmacological therapy, with a SSRI drug, and EMDR.

Method. Two independent groups have been administered two different treatments: the treatment with sertraline to the group for psychopharmacological therapy; the treatment with one-week sessions of EMDR to the other group. For the evaluation of the symptoms of PTSD has been used the Clinician-Administered PTSD Scale (CAPS). The inclusion of the subjects in the two groups has been absolutely random.

Results. The results confirm previous studies available in literature, pointing out the efficacy of EMDR and of sertraline in improving the post-traumatic symptomatology and the levels of subjective sufference. But the number of subjects which at the end of the study didn't satisfy any more the criteria for PTSD has been absolutely greater in the group treated with EMDR.

Conclusions. The study confirms the hypothesis of EMDR as a more efficacious treatment for PTSD compared to psychopharmacological therapy. This result could be a stimulus for further research with greater groups to investigate also the long term efficacy

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Bae, H., & Kim, D. (2012). Desensitization of triggers and urge reprocessing for an adolescent with internet addiction disorder. Journal of EMDR Practice and Research, 6(2), 73-81. doi:10.1891/1933-3196.6.2.73

Daeho Kim, Department of Psychiatry, Hanyang Univer-sity Guri Hospital, Guri, Gyeonggi, 471-701 South Korea. E-mail: dkim9289@hanyang.ac.kr

Abstract

This case study reports the successful treatment of Internet addiction in a 13- year-old male using four 45-minute sessions of the desensitization of triggers and urge reprocessing (DeTUR) protocol—an addiction protocol of eye movement desensitization and reprocessing (EMDR; Popky, 2005). This protocol uses EMDR procedures to process current triggers and positive future templates, but it does not identify or directly address any past trauma. At baseline, the participant showed a moderate level of Internet addiction (scoring 75 on Young's Internet Addiction Test [IAT]) and moderate depression (26 on the Beck Depression Inventory [BDI]). During assessment, he identified 7 triggers for Internet gaming and rated the associated urge to engage in the activity with scores of 3-9 on the level of urge scale (0 = lowest, 10 = strongest). Using the DeTUR protocol, the level of urge for each trigger was reduced to 2, which the participants defined as “not being able to think about or crave for the game.“ After treatment, his symptoms had declined to nonclinical levels (38 on IAT and 6 on BDI) and he was able to restrict his time on the Internet to an hour per day. These therapeutic gains were maintained at 6- and 12-month follow-up. The DeTUR may be a good treatment option for Internet addiction and further controlled studies are needed.

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Bossini, L., Casolaro, I., Santarnecchi, E., Caterini, C., Koukouna, D., Fernandez, I., & Fagiolini, A. (2012). [Evaluation study of clinical and neurobiological efficacy of EMDR in patients suffering from post-traumatic stress disorder]. Rivista Di Psichiatria, 47(2), 12-5. doi:10.1708/1071.11733

Letizia Bossini, Dipartimento di Neuroscience, Sezione di Psichiatria, Università di Siena, E-mail: letizia.bossini@gmail.com

Abstract

Strong evidences support use of EMDR in patients suffering from post-traumatic stress disorder (PTSD).

Aim. To evaluate clinical and neurobiological-structural efficacy of EMDR on drug-naïve PTSD without comorbidity.

Materials and methods. We made clinical evaluation and hippocampal volume measurement by MRI on 29 subjects suffering from PTSD and on 30 healthy control-subjects. Then, patients were treated with EMDR and after three months of psychotherapy the clinical evaluation and the MRI exam were replied.
Results and discussion. Our results demonstrated that the diagnosis of PTSD was no more possible on all the patients who terminated the psychotherapy (n=18). At the same time, all the patients showed an average increase of 6% in hippocampal volumes.

Conclusions. Our research suggests that EMDR treatment correlates not only with a significant improvement of symptoms of PTSD, but also with a significant increase of hippocampal volumes.

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Cook-Vienot, R., & Taylor, R. J. (2012). Comparison of eye movement desensitization and reprocessing and biofeedback/stress inoculation training in treating test anxiety. Journal of EMDR Practice and Research, 6(2), 62-72. doi:10.1891/1933-3196.6.2.62

Raymond J. Taylor, Counseling Services of Houston, Texas, P.O. Box 9023, Pueblo, CO 81008. E-mail: rtmtrt@ aol.com

Abstract

Eye movement desensitization and reprocessing (EMDR) and Biofeedback/Stress Inoculation Training (B/SIT) treatment and no treatment (NT) were compared in reducing test anxiety. Thirty college students with high test anxiety were randomly assigned to each condition. Pre-post assessments were conducted using the Test Anxiety Inventory (TAI), State-Trait Anxiety Inventory (STAI), Rational Behavior Inventory (RBI), and Autonomic Perception Questionnaire (APQ). Treatment therapists were licensed professionals with at least 2 years experience in their respective modality. Statistical analysis using a two-way analysis of variance with repeated measures found significant interactions between time (pre-post) and treatment conditions for all measures except the RBI. Post hoc Newman-Keuls analyses were conducted on the change scores, indicating that both EMDR and B/SIT significantly reduced test anxiety. EMDR generally outperformed B/SIT.

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Faretta, E. (2012). [EMDR and cognitive-behavioural therapy in the treatment of panic disorder: A comparison]. Rivista Di Psichiatria, 47(2), 19-25. doi:10.1708/1071.11735

Elisa Faretta, Psicologa, Psicoterapeuta, Responsabile Centro Psicoterapia Integrata Immaginativa ad Espressione Corporea, E-mail: e.faretta@piiec.com

Abstract

Aim. A comparison between two treatments used in the Panic Disorder: EMDR, an evidence-based method for PTSD, and Cognitive Behavioural Therapy (CBT), which is nowadays considered the most effective psychotherapeutic approach for this disorder.

Method. In order to evaluate any improvement obtained from the adopted treatment, a descriptive analysis through the use of the SPSS software has been carried out, on a sample of 20 subjects, divided in two groups (EMDR and CBT).

Results. From the data obtained, a tendency to improve is already clear from the first evaluation (after 12 sessions), in all the proposed tests. The symptomatic progress turned out to be quite similar in the two compared groups. EMDR treatment however seems to have a faster progress in symptom reduction which is maintained over time, as evidenced at follow-up.

Conclusion. From the showed results, it is possible to confirm that both treatments are effective for the resolution of a Panic Disorder, even if some differences between the two therapies are clear, both from a symptomatic and a timing point of view. So, it is suggested to carry on the research in this area of interest.

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Fernandez, I., & Giovannozzi, G. (2012). [EMDR and adaptive information processing. Psychotherapy as a stimulation of the self-reparative psychological processes]. Rivista Di Psichiatria, 47(2), 4-7. doi:10.1708/1071.11731

Isabel Fernandez, Psicologo, Psicoterapeuta, Presidente della Associazione per l’EMDR in Italia, Centro Ricerca e Studi in Psicotraumatologia, Milano, E-mail: isabelf@tin.it

Abstract

Based on the concept of traumatic event, the model of the adaptive information processing is described to illustrate how EMDR is applied to reprocess the trauma and resolve post-traumatic psychopathology. The eight phases of the EMDR treatment are presented together with the way an EMDR session is conducted and the contribution and innovation that EMDR represents in the field of therapy of post-traumatic states and its applicability in other symptomatic conditions.

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Haugen, P. T., Evces, M., & Weiss, D. S. (2012). Treating posttraumatic stress disorder in first responders: A systematic review. Clinical Psychology Review, 32(5), 370-380. doi: 10.1016/j.cpr.2012.04.001

Peter T. Haugen, World Trade Center Health Program NYU School of Medicine Clinical Center of Excellence at Bellevue Hospital Center, Bellevue Hospital Center, Room A720, 462 First Ave., New York, NY 10016, USA. Tel.: + 1 212 562 6148. E-mail: peter.haugen@nyumc.org

Abstract

First responders are generally considered to be at greater risk for full or partial posttraumatic stress disorder (PTSD) than most other occupations because their duties routinely entail confrontation with traumatic stressors. These critical incidents typically involve exposure to life threat, either directly or as a witness. There is a substantial literature that has examined the risk factors, symptom presentation, course, and comorbidities of PTSD in this population. However, to our knowledge, there are no systematic reviews of treatment studies for first responders. We conducted a systematic review of the PTSD treatment literature (English and non-English) in order to evaluate such treatment proposals based on what is known about treating PTSD in first responders. We especially sought to identify randomized controlled trials (RCTs) whose primary outcome was PTSD. Our search identified 845 peer-reviewed articles of which 0.002% (n = 2) were bona fide RCTs of PTSD treatment in first responders. Both studies tested a psychosocial treatment. We did not locate a single psychopharmacologic RCT for PTSD in first responders. An additional 2 psychosocial studies and 13 case or observational studies comprised the remaining extant literature. Though both RCTs showed significant large treatment effects (d = 1.37; h = 0.92), the literature is startlingly sparse and is not sufficient for evidence-based recommendations for first responders.

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Jarero, I., & Uribe, S. (2012). The EMDR protocol for recent critical incidents: Follow-Up report of an application in a human massacre situation. Journal of EMDR Practice and Research, 6(2), 50-61. doi:10.1891/1933-3196.6.2.50

Igancio Jarero and Susana Uribe, Boulevar de la Luz 771, Jardines del Pedregal, l Álvaro Obregón, Mexico City, 01900. E-mail: nacho@amamecrisis.com.mx

Abstract

This article reports the follow-up results of our field study (Jarero & Uribe, 2011) that investigated the application of the eye movement desensitization and reprocessing (EMDR) Protocol for Recent Critical Incidents (EMDR-PRECI) in a human massacre situation. A single individual session was provided to 32 forensic personnel of the State Attorney General in the Mexican state of Durango who were working with 258 bodies recovered from clandestine graves. Pre-post results showed significant improvement for both immediate treatment and waitlist/delayed treatment groups on the Impact of Event Scale (IES) and Short PTSD Rating Interview (SPRINT). In this study, we report the follow-up assessment, which was conducted, at 3 and 5 months posttreatment. Follow-up scores showed that the original treatment results were maintained, with a further significant reduction of self-reported symptoms of posttraumatic stress and PTSD between posttreatment and follow-up. During the follow-up period, the employees continued to work with the recovered corpses and were continually exposed to horrific emotional stressors, with ongoing threats to their own safety. This suggests that EMDR-PRECI was an effective early intervention, reducing traumatic stress for a group of traumatized adults continuing to work under extreme stressors in a human massacre situation. It appears that the treatment may have helped to prevent the development of chronic PTSD and to increase psychological and emotional resilience.

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Lipke, H. (2012). Comment on Dunne and Farrell (2011). Journal of EMDR Practice and Research, 6(2), 82-82. doi:10.1891/1933-3196.6.2.82

Howard Lipke, Rosalind Franklin University of Health Sciences, 1078 Pear Tree Lane, Wheeling, IL 60090. E-mail: HLipke@aol.com

Abstract

I was quite pleased to see Dunne and Farrell (2011) intelligently and usefully address clinician experience incorporating eye movement desensitization and reprocessing (EMDR) into practice. I was also pleased that they could find some use for the data I accumulated in 1992 from the 443 responders to the questionnaires sent to the first 1,295 EMDR Institute trainees for whom I was able to obtain current addresses (Lipke, 1995).

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Mevissen, L., Lievegoed, R., Seubert, A., & De Jongh, A. (2012). Treatment of PTSD in people with severe intellectual disabilities: A case series. Developmental Neurorehabilitation, 15(3), 223-32. doi:10.3109/17518423.2011.654283

Liesbeth Mevissen, Clinical Psychologist, Accare, Centre for Child and Adolescent Psychiatry, Diepenveenseweg 169, 7413 AP, Deventer, the Netherlands. E-mail: l.mevissen@accare.nl

Abstract

Objective: There is a dearth of information regarding the treatment of PTSD in people with severe intellectual disabilities (ID). The purpose of the present case studies was to assess the applicability and effects of an evidence-based treatment method for psychological trauma with this population.

Methods: The treatment of four single cases with Eye Movement Desensitization and Reprocessing (EMDR) was evaluated. Participants included adults and children with a variety of symptoms, as well as different histories of negative life events.

Results: In all cases PTSD symptoms decreased. In all but one case, the gains were maintained at 15.5 months to 2.5 years following treatment. Depressive symptoms and physical complaints diminished and social and adaptive skills improved.

Conclusion: EMDR seems to be an applicable treatment method for clients with severe ID. Reduction and maintenance of PTSD symptoms in individuals with severe ID appears to be both desirable and obtainable.

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Mosquera, D., & González-Vázquez, A. (2012). [Borderline personality disorder, trauma and EMDR]. Rivista Di Psichiatria, 47(2), 26-32. doi:10.1708/1071.11736

Dolores Mosquera, Psicologo, Esperto in Disturbi della Personalità, Direttore Centro OGPSIC, Coruña, Spagna, E-mail: doloresmosquera@gmail.com

Abstract
The authors step by the diagnostic criteria for Borderline Personality Disorder, viewing them from the perspective of the Adaptive Information Processing and pointing them as a guide for exploration and search of traumatic interpersonal events connected to attachment story and which can be addressed by the therapeutic work with EMDR.

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Onofri, A. (2012). [EMDR in psychiatry. Introduction to the supplement]. Rivista Di Psichiatria, 47(2), 1-3. doi:10.1708/1071.11730

Antonio Onofri, Psichiatra, Vicepresidente della Associazione per l’EMDR in Italia, E-mail: dottoronofri@gmail.com

Abstract

The Author, after having summarized what EMDR is, remembers the international acknowledgements it has received and points out the main hypothesis of functioning and the studies of neurophysiology. He specifies how EMDR, from an initial step of therapeutic technique and clinical method, has become a global approach useful from many fields of the psychopathology, till to the most complex post-traumatic situations.

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Pagani, M., Lorenzo, G. d., Verardo, A., Nicolais, G., Monaco, L., Niolu, C., . . . Siracusano, A. (2012). [Neurobiological correlates of EMDR therapy]. Rivista Di Psichiatria, 47(2), 16-8. doi:10.1708/1071.11734

Marco Pagani, Istituto di Scienze e Tecnologie della Cognizione, CNR, Roma, E-mail: marcopagani2@yahoo.it

Abstract

The EEGs in a group of ten subjects with major psychological trauma treated with EMDR and in ten controls have been registered both during the listening of the autobiographical narrative of the index trauma (script) and during a whole EMDR session. The EEGs have been performed again during the last EMDR session when patients were free of symptoms. During script listening a prevalent activation of the limbic regions corresponding to prefrontal and orbitofrontal cortex has been registered, being explained as the emotional arousal during trauma reliving at the symptomatic phase. The significant decrease of such activations during the late asymptomatic phase represents the neurobiological correlate of recovery. Moreover, the evidence of significant cortical activation in the parietal-temporo-occipital areas, during the last session, suggests a switch of the dominant electrical signal towards cortical areas with a prevalent cognitive function.

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Panko, T. R., & George, B. P. (2012). Child sex tourism: Exploring the issues. Criminal Justice Studies: A Critical Journal of Crime, Law & Society. doi:10.1080/1478601X.2012.657904

Thomas R. Panko, School of Criminal Justice, The University of Southern Mississippi, 118 College Drive, #5127, Hattiesburg, MS, 39406, USA.

Abstract
Child sex tourism (CST) refers to a particular kind of tourism organized to satisfy the need among certain customer segments for establishing commercial sexual relationships with children. It is an expression of contemporary slavery and a major human rights challenge facing our generation. In this paper, the trauma experienced by child victims of commercial sexual abuse in the touristic setting is discussed. An overview of treatment modalities for the victims such as trauma-focused cognitive behavioral therapy and eye movement desensitization and reprocessing are presented. The efforts of outstanding movements around the world in eradicating CST are highlighted. The paper also considers the complex web of relationships that constitutes the CST distribution system.

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Smeets, M. A., Dijs, M. W., Pervan, I., Engelhard, I. M., & van den Hout, M. A. (2012). Time-course of eye movement-related decrease in vividness and emotionality of unpleasant autobiographical memories. Memory, 20(4), 346-57. doi:10.1080/09658211.2012.665462

Monique A. M. Smeets, Clinical & Health Psychology, Utrecht University, Utrecht, The Netherlands.

Abstract

The time-course of changes in vividness and emotionality of unpleasant autobiographical memories associated with making eye movements (eye movement desensitisation and reprocessing, EMDR) was investigated. Participants retrieved unpleasant autobiographical memories and rated their vividness and emotionality prior to and following 96 seconds of making eye movements (EM) or keeping eyes stationary (ES); at 2, 4, 6, and 10 seconds into the intervention; then followed by regular larger intervals throughout the 96-second intervention. Results revealed a significant drop compared to the ES group in emotionality after 74 seconds compared to a significant drop in vividness at only 2 seconds into the intervention. These results support that emotionality becomes reduced only after vividness has dropped. The results are discussed in light of working memory theory and visual imagery theory, following which the regular refreshment of the visual memory needed to maintain it in working memory is interfered with by eye movements that also tax working memory, which affects vividness first.

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van den Berg, D. P., & van der Gaag, M. (2012). Treating trauma in psychosis with EMDR: A pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 43(1), 664-671. doi:10.1016/j.jbtep.2011.09.011

David PG van den Berg, Parnassia Psychiatric Institute, Prinsegracht 63, 2512 EX Den Haag, The Netherlands. E-mail: d.vandenberg@parnassia.nl

Abstract

BACKGROUND: Initial studies have shown that posttraumatic stress disorder (PTSD) can be effectively treated in patients with a psychotic disorder. These studies however used adapted treatment protocols, avoided direct exposure to trauma related stimuli or preceded treatment with stabilizing techniques making treatment considerably longer in duration.

METHOD: An open trial in which adult subjects with a psychotic disorder and a comorbid PTSD (n = 27) received a maximum of six Eye Movement Desensitization and Reprocessing (EMDR) therapy sessions. PTSD symptoms, psychotic symptoms and additional symptoms were assessed at baseline and end-of-treatment.

RESULTS: The dropout rate was 18.5 percent (five subjects). Only five of the twenty-two completers (22.7%) still met criteria for PTSD after treatment. PTSD symptoms, auditory verbal hallucinations, delusions, anxiety, depression, and self-esteem all improved significantly. Paranoid ideation and feelings of hopelessness did not improve significantly. Treatment did not lead to symptom exacerbation in subjects. There were no adverse events, such as suicide attempts, self-mutilation, aggressive behavior or admission to a general or psychiatric hospital.

CONCLUSIONS: This pilot study shows that a short EMDR therapy is effective and safe in the treatment of PTSD in subjects with a psychotic disorder. Treatment of PTSD has a positive effect on auditory verbal hallucinations, delusions, anxiety symptoms, depression symptoms, and self-esteem. EMDR can be applied to this group of patients without adapting the treatment protocol or delaying treatment by preceding it with stabilizing interventions.

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Van Der Vleugel, B. M., Van Den Berg, D. P., & Staring, A. B. (2012). [Trauma, psychosis, post-traumatic stress disorder and the application of EMDR]. Rivista Di Psichiatria, 47(2), 33-8. doi:10.1708/1071.11737

Berber M Van Der Vleugel, Mental Health Care Service GGZ Noord-Holland Noord, Alkmaar, The Netherlands, E-mail: b.vandervleugel@ggz-nhn.nl

Abstract

SUMMARY. In this article we describe three interactions between trauma, post-traumatic stress disorder (PTSD) and psychosis: 1. many patients with psychotic disorders suffered from traumatic life experiences that play an important role in the onset and content of their psychosis; 2. the experience of psychosis as well as its psychiatric treatment may result in post-traumatic stress symptoms; 3. if psychosis and PTSD occur simultaneously, there is a substantial risk for reciprocal negative reinforcement of both symptom groups as well as for potentially ongoing traumatization. Although these interactions are highly relevant from a clinical perspective, they usually remain unattended in routine care. The three interactions will be illustrated by a case history as well as an impression of the psychological treatment including EMDR. We recommend to pay attention to traumatization and comorbid PTSD in routine care for people with psychosis, as well as to offer them treatment.

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van Rens, L. W., de Weert-van Oene, G. H., van Oosteren, A. A., & Rutten, C. (2012). [Clinical treatment of posttraumatic stress disorder in patients with serious dual diagnosis problems]. Tijdschrift Voor Psychiatrie, 54(4), 383-8.

L. Van Rens, IrisZong, Dubbele Diagnose Klinikek Wolfheze Klinische Behandeling Arnhem. E-mail: l.rens@iriszorg.nl

Abstract

Three patients with severe addiction problems, early sexual trauma, posttraumatic stress disorder PTSD comorbid psychotic vulnerability and personality problems received integrated treatment following admission to a clinic specialising in the care of patients with a dual diagnosis. Treatment was administered in accordance with current guidelines and involved either imaginal exposure or eye movement desensitization and reprocessing EMDR, integrated with relapse management of addiction problems. It is concluded that the current evidence-based guidelines regarding PTSD and addiction can also be applied successfully and effectively to an extremely vulnerable patient population.