EMDR Research News June 2018
1 is a Randomized Controlled Trials
- Early EMDR intervention following intense rocket attacks on a town
5 are Quasi-experimental Studies
- Individual treatment selection for patients with posttraumatic stress disorder
- A Non-randomized Controlled Trial of EMDR on Affective Symptoms in Patients With Glioblastoma Multiforme
- Treating addiction with schema therapy and EMDR in women with co-occurring SUD and PTSD: A pilot study
- A five-day inpatient EMDR treatment programme for PTSD: pilot study
- Presence of the dissociative subtype of PTSD does not moderate the outcome of intensive trauma-focused treatment for PTSD
1 is a Case Series report
- Betrayal of the Body: Group Approaches to Hypo-Sexuality for Adult Female Sufferers of Childhood Sexual Abuse
1 is a general survey
- Patterns of practice in community mental health treatment of adult depression
2 are individual case reports
- EMDR in a forensic patient withPTSD resulting from homicide: a case study
- Treatment of a Patient with Borderline Personality Disorder Based on Phase-Oriented Model of EMDR: A Case Report
5 are Review or Meta-analysis articles
- EMDR for Bipolar Disorder: A systematic review of the existing literature
- Do trauma-focused psychological interventions have an effect on psychotic symptoms? A systematic review and meta-analysis
- The Efficacy of EMDR in Children and Adults Who Have Experienced Complex Childhood Trauma: A Systematic Review of Randomized Controlled Trials
- EMDR in psychonocology
- Some considerations about EMDR and psychosis
1 is a Guideline
- Position Paper for the Treatment of Nightmare Disorder in Adults: An American Academy of Sleep Medicine Position Paper
2 are Theoretical Papers
- Treating personality disorders with EMDR therapy
- EMDR Treatment of Grief and Mourning
3 are neurological studies
- Hippocampal gray matter increases following multimodal psychological treatment for combat-related post-traumatic stress disorder
- Neurocognitive functioning over the course of trauma-focused psychotherapy for PTSD: Changes in verbal memory and executive functioning
- Metabolic and Electrophysiological Changes Associated to Clinical Improvement in Two Severely Traumatized Subjects Treated With EMDR-A Pilot Study
With each reference below, you will find the citation, abstract and author contact information (when available). Prior quarterly summaries of journal articles can be found on the EMDRIA website and a comprehensive listing of all EMDR-related research is available at the Francine Shapiro Library. EMDRIA members can access recent Journal of EMDR Practice and Research articles in the member’s area on the EMDRIA website. JEMDR issues older than 12 months are available open access on IngentaConnect.
Bedeschi, L. (2018). EMDR for Bipolar Disorder: A systematic review of the existing literature. Clinical Neuropsychiatry, 15(3), 222-225.
Open access: http://www.clinicalneuropsychiatry.org/pdf/06_Paper_Clinical-18-3.pdf
Ludovica Bedeschi, E-mail: email@example.com
Objective: Bipolar disorder, also known as manic-depressive illness, is a mental disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Up to 60% of patient with bipolar disorder (BD) present a history of traumatic events which is associated with greater episode severity, higher risk of comorbidity and higher relapse rates. growing evidence suggests that incidences of childhood trauma are quite frequent in bipolar disorder and probably affect the clinical expression of the disease. the relationships between childhood trauma and bipolar disorder suggest several interpretations, mainly a causal link, a neurodevelopmental consequence, or the intergenerational transmission of traumatic experiences. then is no surprising to diagnose in comorbidity with BD, also a PTSD for which the EMDR has been elected among the more appropriate treatment by the who (world health organization 2013). The purpose of this work is to examine the existing literature about Bipolar Disorder and EMDR treatment, and to point out its strengths and limits for a further and more efficient application of the EMDR on this severe disease.
Method: a literature search was undertaken using all the available resources, on the web (PubMed) and on the Journals that treated such topic, including contacting directly the authors of the studies and the Francine Shapiro library.
Results: Due to the few materials available, it has been not possible to do a meta-analysis. The review is based on all the available sources (four articles) and study results.
Conclusions: although the available studies regarding EMDR application on bipolar disorders are at the moment really few, the outcome of each presented study seem to agree about some points: EMDR seems to be a promising treatment in terms of related trauma affective symptoms, and in terms of relapse prevention; EMDR, in fact, seems to elicit some positive effects in bipolar patients, including the treatment compliance and the disease awareness, so relevant in the therapeutic process of this psychopathological condition.
Brand, R. M., McEnery, C., Rossell, S., Bendall, S., & Thomas, N. (2018). Do trauma-focused psychological interventions have an effect on psychotic symptoms? A systematic review and meta-analysis. Schizophr Res, 195, 13-22.
Rachael M. Brand, Centre for Mental Health, Swinburne University, PO Box 218, Hawthorn, VIC 3122, Australia. E-mail address: firstname.lastname@example.org
There is growing recognition of the relationship between trauma, posttraumatic stress disorder (PTSD) and psychosis. There may be overlaps in causal mechanisms involved in the development of PTSD and psychosis following traumatic or adverse events. Trauma-focused treatments found to be effective in treating PTSD may therefore represent a new direction in the psychological treatment of psychosis. This systematic review examined the literature on trauma-focused treatments conducted with people with schizophrenia spectrum or psychotic disorders to determine effects on psychotic symptoms. Secondary outcomes were symptoms of PTSD, depression and anxiety. Twenty-five studies were included in the review, with 12 being included in the meta-analysis. Trauma-focused treatments had a small, significant effect (g=0.31, CI [0.55, 0.06]) on positive symptoms immediately post-treatment, but the significance and magnitude of this effect was not maintained at follow-up (g=0.18, CI [0.42, -0.06]). Trauma-focused treatments also had a small effect on delusions at both post-treatment (g=0.37, CI [0.87, -0.12]) and follow-up (g=0.38, CI [0.67, 0.10]), but this only reached significance at follow-up. Effects on hallucinations and negative symptoms were small and non-significant. Effects on PTSD symptoms were also small (post-treatment g=0.21, CI [0.70, -0.27], follow up g=0.31, CI [0.62, 0.00]) and only met significance at follow-up. No significant effects were found on symptoms of depression and anxiety. Results show promising effects of trauma-focused treatments for the positive symptoms of psychosis, however further studies developing and evaluating trauma-focused treatments for trauma-related psychotic symptoms are needed.
Butler, O., Willmund, G., Gleich, T., Gallinat, J., Kühn, S., & Zimmermann, P. (2018). Hippocampal gray matter increases following multimodal psychological treatment for combat-related post-traumatic stress disorder. Brain Behav, 8(5), e00956.
Oisin Butler, Max Planck Institute for Human Development, Center for Lifespan Psychology, Berlin, Germany. Email: email@example.com
Introduction: Smaller hippocampal volumes are one of the most consistent findings in neuroimaging studies of post-traumatic stress disorder (PTSD). However, very few prospective studies have assessed changes in hippocampal gray matter prior to and following therapy for PTSD, and no neuroimaging studies to date have longitudinally assessed military populations.
Methods: A pilot study was conducted, assessing patients with combat-related PTSD with structural MRI. Participants were then assigned either to a treatment group or waiting-list control group. After the treatment group received multimodal psychological therapy for approximately 6 weeks, both groups completed a second neuroimaging assessment.
Results: Region-of-interest analysis was used to measure gray matter volume in the hippocampus and amygdala. There was a group by time interaction; the therapy group (n = 6) showed a significant increase in hippocampal volume and a nonsignificant trend toward an increase in amygdala volume following therapy, while no change was observed in the waiting-list group (n = 9).
Conclusions: This study provides initial evidence for increases in gray matter volume in the hippocampus in response to therapy for combat-related PTSD.
Chen, R., Gillespie, A., Zhao, Y., Xi, Y., Ren, Y., & McLean, L. (2018). The Efficacy of Eye Movement Desensitization and Reprocessing in Children and Adults Who Have Experienced Complex Childhood Trauma: A Systematic Review of Randomized Controlled Trials. Front Psychol, 9, 534.
Open access: https://www.frontiersin.org/articles/10.3389/fpsyg.2018.00534/full
Yanping Ren, firstname.lastname@example.org
Background: Survivors of complex childhood trauma (CT) such as sexual abuse show poorer outcomes compared to single event trauma survivors. A growing number of studies investigate Eye Movement Desensitization and Reprocessing (EMDR) treatment for posttraumatic stress disorder (PTSD), but no systematic reviews have focused on EMDR treatment for CT as an intervention for both adults and children. This study therefore systematically reviewed all randomized controlled trials (RCTs) evaluating the effect of EMDR on PTSD symptoms in adults and children exposed to CT.
Methods: Databases including PubMed, Web of Science, and PsycINFO were searched in October 2017. Randomized controlled trials which recruited adult and children with experience of CT, which compared EMDR to alternative treatments or control conditions, and which measured PTSD symptoms were included. Study methodology quality was evaluated with Platinum Standard scale.
Results: Six eligible RCTs of 251 participants were included in this systematic review. The results indicated that EMDR was associated with reductions in PTSD symptoms, depression and/or anxiety both post-treatment and at follow-up compared with all other alternative therapies (cognitive behavior therapy, individual/group therapy and fluoxetine) and control treatment (pill placebo, active listening, EMDR delayed treatment, and treatment as usual). However, studies suffered from significant heterogeneity in study populations, length of EMDR treatment, length of follow-up, comparison groups, and outcome measures. One study had a high risk of bias.
Discussion: This systematic review suggests that there is growing evidence to support the clinical efficacy of EMDR in treating CT in both children and adults. However, conclusions are limited by the small number of heterogenous trials. Further RCTs with standardized methodologies, as well as studies addressing real world challenges in treating CT are required.
Deisenhofer, A. K., Delgadillo, J., Rubel, J. A., Böhnke, J. R., Zimmermann, D., Schwartz, B. et al. (2018). Individual treatment selection for patients with posttraumatic stress disorder. Depress Anxiety.
Anne-Katharina Deisenhofer, Clinical Psychology and Psychotherapy, Department
of Psychology, University of Trier, D-54296 Trier, Germany. Email: email@example.com
BACKGROUND: Trauma-focused cognitive behavioral therapy (Tf-CBT) and eye movement desensitization and reprocessing (EMDR) are two highly effective treatment options for posttraumatic stress disorder (PTSD). Yet, on an individual level, PTSD patients vary substantially in treatment response. The aim of the paper is to test the application of a treatment selection method based on a personalized advantage index (PAI).
METHOD: The study used clinical data for patients accessing treatment for PTSD in a primary care mental health service in the north of England. PTSD patients received either EMDR (N = 75) or Tf-CBT (N = 242). The Patient Health Questionnaire (PHQ-9) was used as an outcome measure for depressive symptoms associated with PTSD. Variables predicting differential treatment response were identified using an automated variable selection approach (genetic algorithm) and afterwards included in regression models, allowing the calculation of each patient's PAI.
RESULTS: Age, employment status, gender, and functional impairment were identified as relevant variables for Tf-CBT. For EMDR, baseline depressive symptoms as well as prescribed antidepressant medication were selected as predictor variables. Fifty-six percent of the patients (n = 125) had a PAI equal or higher than one standard deviation. From those patients, 62 (50%) did not receive their model-predicted treatment and could have benefited from a treatment assignment based on the PAI.
CONCLUSIONS: Using a PAI-based algorithm has the potential to improve clinical decision making and to enhance individual patient outcomes, although further replication is necessary before such an approach can be implemented in prospective studies.
Faretta, E. (2018). EMDR in psychonocology. Clinical Neuropsychiatry, 15(3), 206-221.
Open access: http://www.clinicalneuropsychiatry.org/pdf/05_Paper_Clinical-18-3.pdf
Elisa Faretta, Via Settembrini n°56 – 20124 Milan (Mi) – Italy. E-mail: firstname.lastname@example.org
Objective: the article describes the state of the research on psychoncology with a focus on EMDR approach to this area of expertise.
Method: Qualitative analysis of the existing literature.
Results: Epidemiological data, together with ACEs studies, and the research on the psychological effects of cancer highlight the relevance of a supportive and/or therapeutical intervention for oncological patients. The field of psychoncology is defined as understanding and treating the traumatic effects of the oncological disease, whose symptomatology can be consistent with a diagnosis of clinical, or subclinical, PTSD. Evidence-based psychotherapies for oncological patients are CBT and EMDR. Four experimental studies on EMDR in psychoncology (Faretta 2013, Capezzani et al. 2013, Jarero et al. 2015, Faretta et al. 2016) support the aptness of AIP model in the conceptualization of cancer as a highly specific, traumatic event.
Conclusions: The review of the existing literature points out the efficacy of trauma-focused treatments in psychoncology and suggests crucial preliminary cues on EMDR application, even though further researches are needed to validate these results.
Fleurkens, P., Hendriks, L., & van Minnen, A. (2018). Eye Movement Desensitization and Reprocessing (EMDR) in a forensic patient with Posttraumatic Stress Disorder (PTSD) resulting from homicide: a case study. The Journal of Forensic Psychiatry & Psychology, 1-13.
Pascal Fleurkens, E-mail: email@example.com
Posttraumatic Stress Disorder (PTSD) resulting from perpetration, is highly prevalent in forensic populations and has been associated with future risk of anger, aggressive behavior, and criminal recidivism. Since forensic psychiatry aims at reducing violence and recidivism, treatment of PTSD in this population is of great importance. Controlled studies to the feasibility and effectiveness of PTSD treatment within forensic populations are lacking. In five case studies, however, feasibility of EMDR is demonstrated in offenders with PTSD and comorbid disorders like psychosis or depression. The present case study aimed to expand this knowledge by describing the application of EMDR to a forensic psychiatric patient with a narcissistic personality disorder with antisocial and borderline features, and PTSD resulting from a murder he committed. Over the course of EMDR, PTSD symptoms (both established by clinical interview and self-report) decreased. Posttreatment, the patient did not meet the criteria for PTSD anymore. Importantly, results were maintained during eight months follow-up and no adverse events took place. The results of this case study offer strong support for a randomized controlled study.
Lewis, C. C., Marti, C. N., Marriott, B. R., Scott, K., & Ayer, D. (2017). Patterns of practice in community mental health treatment of adult depression. Psychother Res, 1-8.
Erin P. Finley, PhD MPH, South Texas Veterans Health Care System, 7400 Merton Minter Blvd., San Antonio, TX 78229-4404, USA.
OBJECTIVE: Community mental health therapists often endorse an eclectic orientation, but few studies reveal how therapists utilize elements of evidence-based psychotherapies. This study aimed to characterize treatment as usual patterns of practice among therapists treating depressed adults in community mental health settings.
METHOD: Therapists (N = 165) from the USA's largest not-for-profit provider of community-based mental health services completed surveys assessing their demographics and practice element use with depressed adult clients. Specifically, therapists indicated whether they utilized each of 45 unique practice elements from the following evidence-based psychotherapies: Acceptance and Commitment Therapy, Behavioral Activation, Brief Psychodynamic Therapy, Cognitive Behavioral Therapy (CBT), Interpersonal Therapy, Mindfulness-Based CBT, Problem-Solving Therapy, and Self-Control Therapy. Principal component analysis was employed to identify practice patterns.
RESULTS: The principal component analysis included 31 practice elements and revealed a three-factor model with distinct patterns of practice that did not align with traditional evidence-based practice approaches, including: (i) Planning, Practice, and Monitoring; (ii) Cognitive, Didactic, and Interpersonal; and (iii) Between Session Activities.
CONCLUSIONS: Therapist-reported practice patterns confirmed an eclectic approach that brought together elements from theoretically distinct evidence-based psychotherapies. Future research is needed to explore how these patterns of practice relate to client outcomes to inform focused training and/or de-implementation efforts. Clinical or methodological significance of this article: This study confirmed previous reports that community mental health therapists adopt an eclectic approach, combining elements from disparate theoretical orientations.
Marconi, M., & Polidoro, A. (2018). Some considerations about EMDR and psychosis. Clinical Neuropsychiatry, 15(3), 226-229.
Open access: http://www.clinicalneuropsychiatry.org/pdf/07_Paper_Clinical-18-3.pdf
Dr. Michele Marconi, firstname.lastname@example.org
The aim of this paper is to outline some considerations about the efficacy and applicability of Eye Movement Desensibilization and Reprocessing (EMDR) approach on psychotic patients. EMDR is receiving great attention from different scholars and across different approaches. Several meta-analyses have shown the effectiveness of EMDR therapy in treating Post-Traumatic Stress Disorder (see Jonas et al. 2013; Chen et al. 2014, 2015). According to contemporary scientific literature it is have been noticed that a diagnosis of psychotic disorder does not always represent an exclusion criterion for applying an EMDR intervention (van der Vleugen et al. 2015). A comorbidity exists between psychosis and Post-traumatic Stress Disorder (PTSD), and this could mean that a common landscape between these two dimensions may be explored (Kim and Lee 2016, Millan et al. 2017). PTSD patients that later develop psychotic symptoms have often a story of early abuse and they could probably benefit of an EMDR approach. The authors of the present paper evaluate the existing scientific literature about the use of EMDR for psychotic patients, showing how the available data seem to indicate it as part of a more complex intervention, able not only to reduce the impact of explicit symptoms, but also to make a change of a pervasive imagery and core negative believes that maintain a kind distortion in the inner and external world of the patient. Also if no real evidence is still available about the use of EMDR in psychosis, there are a few promising studies regarding its applicability for the post-traumatic aspects often existing in psychotic disorders (Hardy and van den Berg 2017).
Morgenthaler, T. I., Auerbach, S., Casey, K. R., Kristo, D., Maganti, R., Ramar, K. et al. (2018). Position Paper for the Treatment of Nightmare Disorder in Adults: An American Academy of Sleep Medicine Position Paper. J Clin Sleep Med.
INTRODUCTION: Nightmare disorder affects approximately 4% of adults, occurring in isolation or as part of other disorders such as posttraumatic stress disorder (PTSD), and can significantly impair quality of life. This paper provides the American Academy of Sleep Medicine (AASM) position regarding various treatments of nightmare disorder in adults.
METHODS: A literature search was performed based upon the keywords and MeSH terms from the Best Practice Guide for the Treatment of Nightmare Disorder in Adults that was published in 2010 by the AASM. The search used the date range March 2009 to August of 2017, and sought to find available evidence pertaining to the use of behavioral, psychological, and pharmacologic therapies for the treatment of nightmares. A task force developed position statements based on a thorough review of these studies and their clinical expertise. The AASM Board of Directors approved the final position statements.
DETERMINATION OF POSITION: Positions of "recommended" and "not recommended" indicate that a treatment option is determined to be clearly useful or ineffective/harmful for most patients, respectively, based on a qualitative assessment of the available evidence and clinical judgement of the task force. Positions of "may be used" indicate that the evidence or expert consensus is less clear, either in favor or against the use of a treatment option. The interventions listed below are in alphabetical order within the position statements rather than clinical preference: this is not meant to be instructive of the order in which interventions should be used.
POSITION STATEMENTS: • The following therapies are recommended for the treatment of PTSD-associated nightmares and nightmare disorder: image rehearsal therapy. • The following therapies may be used for the treatment of PTSD-associated nightmares: cognitive behavioral therapy; cognitive behavioral therapy for insomnia; eye movement desensitization and reprocessing; exposure, relaxation, and rescripting therapy; the atypical antipsychotics olanzapine, risperidone and aripiprazole; clonidine; cyproheptadine; fluvoxamine; gabapentin; nabilone; phenelzine; prazosin; topiramate; trazodone; and tricyclic antidepressants. • The following therapies may be used for the treatment of nightmare disorder: cognitive behavioral therapy; exposure, relaxation, and rescripting therapy; hypnosis; lucid dreaming therapy; progressive deep muscle relaxation; sleep dynamic therapy; self-exposure therapy; systematic desensitization; testimony method; nitrazepam; prazosin; and triazolam. • The following are not recommended for the treatment of nightmare disorder: clonazepam and venlafaxine. • The ultimate judgment regarding propriety of any specific care must be made by the clinician, in light of the individual circumstances presented by the patient, accessible treatment options, and resources.
Mosquera, D. (2018). Treating personality disorders with EMDR therapy. Clinical Neuropsychiatry, 15(3), 187-193.
Open access: http://www.clinicalneuropsychiatry.org/pdf/03_Paper_Clinical-18-3.pdf
Dolores Mosquera, Institute for the Study of Trauma and Personality Disorders (INTRA-TP), A Coruña (Spain). E-mail: email@example.com
Eye Movement Desensitization and Reprocessing (EMDR) Therapy has been shown to be an effective, efficient, and well-tolerated treatment for posttraumatic stress disorder (PTSD) and useful for both adult and childhood onset PTSD. Since there is ample evidence of the contributions of early, chronic, severe interpersonal trauma, early attachment disturbances and negative life experiences in the development of Personality Disorders (PD), the indications for EMDR treatment of individuals with personality disorders seem clear. This article focuses on understanding the relevance of adaptive information in individuals with personality disorders. Specific adaptations for borderline, narcissistic and antisocial presentations during the different phases of EMDR will also be addressed.
Nijdam, M. J., Martens, I. J. M., Reitsma, J. B., Gersons, B. P. R., & Olff, M. (2018). Neurocognitive functioning over the course of trauma-focused psychotherapy for PTSD: Changes in verbal memory and executive functioning. Br J Clin Psychol.
Mirjam J. Nijdam, Centre for Psychological Trauma, Department of Psychiatry, Academic Medical Centre at the University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands (email: M.J.Nijdam@amc.uva.nl).
OBJECTIVES: Individuals with post-traumatic stress disorder (PTSD) have neurocognitive deficits in verbal memory and executive functioning. In this study, we examined whether memory and executive functioning changed over the course of treatment and which clinical variables were associated with change.
DESIGN: Neuropsychological assessments were administered at baseline and endpoint of a randomized controlled trial as secondary outcome.
METHODS: Trauma survivors (n = 88) diagnosed with PTSD received trauma-focused psychotherapy within a 17-week randomized controlled trial. Neuropsychological tests were the California Verbal Learning Test, Rivermead Behavioural Memory Test, Stroop Color Word Test, and Trail Making Test.
RESULTS: Significant, small- to medium-sized improvements in verbal memory, information processing speed, and executive functioning were found after trauma-focused psychotherapy (Cohen's d 0.16-0.68). Greater PTSD symptom decrease was significantly related to better post-treatment neurocognitive performance (all p < .005). Patients with comorbid depression improved more than patients with PTSD alone on interference tasks (p < .01). No differences emerged between treatment conditions and between patients on serotonergic antidepressants and those who were not.
CONCLUSIONS: This study suggests that neurocognitive deficits in PTSD can improve over the course of trauma-focused psychotherapy and are therefore at least partly reversible. Improvements over treatment are in line with previous neuropsychological and neuroimaging studies and effect sizes exceed those of practice effects. Future research should determine whether these changes translate into improved functioning in the daily lives of the patients.
PRACTITIONER POINTS: Patients with PTSD have difficulties performing verbal memory tasks (e.g., remembering a grocery list, recall of a story) and executive functioning tasks (e.g., shifting attention between two tasks, ignoring irrelevant information to complete a task). Verbal memory, information processing speed, and executive functioning significantly improved in patients with post-traumatic stress disorder over the course of trauma-focused psychotherapy. Improvements were equal in size for two different trauma-focused psychotherapies (Eye movement desensitization and reprocessing therapy and brief eclectic psychotherapy for PTSD). Medium-sized effects were found for recall of a story, whereas effects in other aspects of verbal memory, information processing speed, and executive functioning were small-sized. No causal attributions can be made because we could not include a control group without treatment for ethical reasons. Findings may be more reflective of patients who completed treatment than patients who prematurely dropped out as completers were overrepresented in our sample.
Pagani, M., Castelnuovo, G., Daverio, A., La Porta, P., Monaco, L., Ferrentino, F. et al. (2018). Metabolic and Electrophysiological Changes Associated to Clinical Improvement in Two Severely Traumatized Subjects Treated With EMDR-A Pilot Study. Front Psychol, 9, 475.
Open access: https://www.frontiersin.org/articles/10.3389/fpsyg.2018.00475/full
Marco Pagani, firstname.lastname@example.org
Neuroimaging represents a powerful tool to investigate the neurobiological correlates of Eye Movements Desensitization and Reprocessing (EMDR). The impact of EMDR on cortical and sub-cortical brain regions has been proven by several investigations demonstrating a clear association between symptoms disappearance and changes in cortical structure and functionality. The aim of this study was to assess by electroencephalography (EEG) and for the first time by positron emission tomography (PET) the changes occurring after EMDR therapy in two cases of psychological trauma following brain concussion and comatose state due to traffic accident. A 28 and a 29 years old men underwent extensive neuropsychological examination, which investigated: (i) categorical and phonological verbal fluency; (ii) episodic verbal memory; (iii) executive functions; (iv) visuospatial abilities; (v) attention and working memory as well as clinical assessment by means of psychopathological tests (CAPS, IES, BDI, SCL90R, and DES). They were then treated by eight sessions of EMDR. During the first session EEG monitoring was continuously performed and ^18^F-FDG PET scans, depicting brain metabolism, were acquired at rest within a week (T0). After the last session, in which the two clients were considered to be symptoms-free, neuropsychological, clinical, and PET assessment were repeated (T1). PET data were semi-quantitatively compared to a group of 18 normal controls, as for EEG the preferential cortical activations were disclosed by thresholding the individual z-score to a p < 0.05. There was a significant improvement in clinical condition for both clients associated with a significant decrease in CAPS scores. IES and BDI were found to be pathological at T0 and improved at T1 in only one subject. Visuo-constructive abilities and abstract reasoning improved after EMDR in both subjects. As for EEG, the most striking changes occurred in fronto-temporal-parietal cortex in subject 1 while subject 2 showed only minor changes. PET showed more pronounced metabolism in orbito-frontal and prefrontal cortex at T1 as compared to T0 in both subjects. In conclusion both clients had a clear clinical improvement in PTSD symptoms associated with metabolic and electrophysiological changes in limbic and associative cortex, respectively, highlighting the value of EMDR also in such extreme pathological conditions.
Safarabad, N. M., Farid, A.-A. A., Gharraee, B., & Habibi, M. (2018). Treatment of a Patient with Borderline Personality Disorder Based on Phase-Oriented Model of Eye Movement Desensitization and Reprocessing (EMDR): A Case Report. Iranian Journal of Psychiatry, 13(1), 80-83.
Open access: http://ijps.tums.ac.ir/index.php/ijps/article/viewFile/926/675
Ali-Asghar Asgharnejad Farid, Tehran Institute of Psychiatry, School of Behavioral Sciences and Mental Health, NiayeshSt, Sattarkhan Ave., PO Box: 14565- 441, Tehran, Iran. Email: Asgharnejadfarid.email@example.com
Objective: This study aimed at reporting the effect of the 3-phase model of eye movement desensitization and reprocessing in the treatment of a patient with borderline personality disorder.
Method: A 33-year-old female, who met the DSM-IV-TR criteria for borderline personality disorder, received a 20- session therapy based on the 3-phase model of eye movement desensitization and reprocessing. Borderline Personality Disorder Checklist (BPD-Checklist), Dissociative Experience Scale (DES-II), Beck Depression Inventory-II-second edition (BDI-II), and Anxiety Inventory (BAI) were filled out by the patient at all treatment phases and at the 3- month follow- up. Results: According to the obtained results, the patient’s pretest scores in all research tools were 161, 44, 37, and 38 for BPD-Checklist, DES-II, BDI-II, and BAI, respectively. After treatment, these scores decreased significantly (69, 14, 6 and 10 respectively). So, the patient exhibited improvement in borderline personality disorder, dissociative, depression and anxiety symptoms, which were maintained after the 3-month follow-up.
Conclusion: The results supported the positive effect of phasic model of eye movement desensitization and reprocessing on borderline personality disorder.
Shapiro, E., Laub, B., & Rosenblat, O. (2018). Early EMDR intervention following intense rocket attacks on a town: A randomised clinical trial. Clinical Neuropsychiatry, 15(3), 194-205.
Open access: http://www.clinicalneuropsychiatry.org/pdf/04_Paper_Clinical-18-3.pdf
Elan Shapiro, PO Box 187, Ramat Yishay, 30095, Israel. E-mail: firstname.lastname@example.org
Objective: The aim of the study is to investigate the efficacy of EMDR R-TEP interventions with residents suffering from post-traumatic symptoms.
Method: The study employed a waitlist/delayed treatment control group design and participants were randomly allocated to either immediate or waitlist/delayed treatment conditions. The measures used included the PCL-5 posttrauma checklist for DSM-5; the PHQ-9 depression scale; the Subjective Unit of Disturbance (SUD) scale and the Brief Resilience Coping Scale (BRCS). The clinical staff of the Resilience Center (HOSEN) offered EMDR therapy treatment using the Recent Traumatic Episode Protocol (R-TEP) for 25 trauma-stricken residents referred to their center. The study began within three months after the 2014 round of hostilities. Three 90 minute sessions were given first to the intervention group and a month later to the delayed treatment control group. The follow-up measures were taken six months later.
Results: The immediate treatment group had significantly improved scores on post-trauma and depression measures compared to the waitlist/delayed treatment group, who showed no improvement prior to their treatment. There were significant interactions between group and time for PCL-5, PHQ-9 and SUD. Post hoc testing of the interaction revealed that within group A, participants exhibited a significant decrease in PCL-5, PHQ-9 and SUD scores (one-tailed p: <0.001, 0.006, 0.03). The results in resilience scores over time showed an increasing trend in group A that failed to reach significance. Repeated measures analysis of group B revealed a borderline statistically significant difference in resilience scores over time.
Conclusions: This study provides further evidence, supporting the efficacy of Early EMDR Intervention for reducing post-traumatic stress and depression symptoms among civilian victims of hostility. The evidence for resilience was indecisive and requires further research.
Solomon, R. M. (2018). EMDR Treatment of Grief and Mourning. Clinical Neuropsychiatry, 15(3), 173-186.
Open access: http://www.clinicalneuropsychiatry.org/pdf/02_Paper_Clinical-18-3.pdf
Roger M. Solomon, Critical incident Recovery Resources 4001 9th Street north, #404 Arlington, Virginia 22203, USA. E-mail: email@example.com
Objective: To discuss how Eye Movement Desensitization and Reprocessing (EMDR) therapy can be utilized in the treatment of grief and mourning.
Method: Several frameworks of grief and mourning that can inform EMDR therapy are discussed. Rando’s “R” processes provides a framework for understanding the psychological processes necessary for the assimilation and
accommodation of loss. Attachment theory provides a framework for understanding grief and mourning given that loss can trigger the same reactions experienced as a child to loss of an attachment figure. Dual Process theory posits that healthy grief involve the oscillation between coping with emotional aspects of the loss (Loss Orientation) and coping with the daily life tasks (Restoration Orientation). Continuing Bonds theory describes how grief does not resolve from detaching from the deceased loved one, but rather in developing a new relationship, a continuing bond that endures through one’s life.
Results and Conclusions: EMDR therapy, utilizing an eight phase, three pronged (past, present, future) approach can be utilized in the treatment of grief and mourning. Different theoretical frameworks inform case conceptualization and selection of memories for EMDR processing to facilitate assimilation and accommodation of the loss.
Szpringer, M., Oledzka, M., & Amann, B. L. (2018). A Non-randomized Controlled Trial of EMDR on Affective Symptoms in Patients With Glioblastoma Multiforme. Frontiers in Psychology, 9.
Open access: https://www.frontiersin.org/articles/10.3389/fpsyg.2018.00785/full
Monika Szpringer, firstname.lastname@example.org
Glioblastoma multiforme (GBM) is a highly aggressive brain cancer and its survival after diagnosis is less than 2 years. Therefore, GBM patients are especially prone to co-occurring psychological conditions such as anxiety and depressive disorders. Furthermore, aggressive medical therapies affect patients’ lives, undermining their sense of meaning and coherence. The main aim of this study was to determine the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) therapy on anxiety, depression and sense of coherence in patients with GBM. Thirty-seven GBM- diagnosed women were included in this trial and received standard medical care. Of those, 18 patients were treated during 4 months with 10–12 individual EMDR sessions (60–90 minutes each). Nineteen GBM patients were used as a non-randomized control group as they consented to psychological evaluations but not to a psychotherapeutic intervention. The groups were homogeneous in terms of gender, age, educational level and treatment, but not in anxiety and depressive levels at baseline. All patients were evaluated at baseline, after treatment (4 months) and at follow-up (further 4 months) by the Hospital Anxiety and Depression Scale (HADS-M) and the Sense of Coherence Scale (SOC-29). Caregivers in both groups were interviewed by the Patient Caregiver Questionnaire after 4 months follow-up. Statistical analyses were conducted using ANOVA statistics, correlation and regression analysis. Results showed a statistically significant decrease in the EMDR group in anxiety, depression and anger, when compared to the experimental group. EMDR therapy also had a positive impact upon the sense of coherence level in the experimental group, whereas in the control group this declined. Finally, the caregivers reported beneficial outcomes of the EMDR therapy with less anxiety- and anger-related behaviors in patients in the experimental group compared to the control group. This study is the first to show beneficial effects of EMDR therapy in alleviating affective symptoms and improving coherence in a severe medically ill population with GBM.
Tapia, G., Perez-Dandieu, B., Lenoir, H., Othily, E., Gray, M., & Delile, J.-M. (2018). Treating addiction with schema therapy and EMDR in women with co-occurring SUD and PTSD: A pilot study. Journal of Substance Use, 23(2), 199-205.
Geraldine Tapia, email@example.com
Background: This study aimed to examine whether the combined use of schema therapy (ST) and Eye Movement Desensitization and Reprocessing (EMDR) can improve substance use disorder (SUD) out- comes in a sample of women with co-occurring SUD and posttraumatic stress disorder (PTSD). To our knowledge, no research has examined this question in a SUD-PTSD clinical sample.
Methods: We proposed to 15 women with SUD/PTSD comorbidity a two-phase-protocol therapy: eight ST sessions associated with EMDR focused on reprocessing traumatic memory (phase A) and eight ST sessions associated with EMDR focused on reprocessing addictive memory (phase B). We evaluated addiction severity, alcohol craving, cannabis craving, PTSD symptoms, early maladaptive schemas (EMS) intensity and depressive symptoms before and after treatment.
Results: Findings indicated that eight sessions of ST combined with EMDR focused on traumatic memories (phase A) reduced PTSD symptoms and the number of EMS. Findings on phase B showed a statistically significant decrease for addiction severity and depressive symptoms.
Conclusions. This study supports the importance of providing integrative therapies for improving SUD outcomes. Overall, this study indicates that ST plus EMDR is an effective, rapid, thorough and enduring treatment for SUD-PTSD women.
Wohl, A., & Kirschen, G. W. (2018). Betrayal of the Body: Group Approaches to Hypo-Sexuality for Adult Female Sufferers of Childhood Sexual Abuse. J Child Sex Abus, 27(2), 154-160.
Hypo-sexuality, self-reported hypoactive sexual desire and/or sexual aversion, is a common symptom experienced by women who were victims of childhood sexual abuse. This symptom may be distressing to the patient herself, and may place strain on her romantic relationships in adulthood. Unfortunately, this problem often remains undiscussed between patient and provider, in part due to the provider's lack of comfort or knowledge regarding how best to address this issue. In this article, we explore several strategies that providers may employ in a group setting in order to help women realize their sexuality while minimizing untoward side effects such as feelings of guilt or shame, or flashbacks. We highlight the merits of each technique, and provide insights from clinical experience to guide practitioners to help their patients facing this difficult issue.
Zepeda Méndez, M., Nijdam, M. J., ter Heide, F. J. J., van der Aa, N., & Olff, M. (2018). A five-day inpatient EMDR treatment programme for PTSD: pilot study. European Journal of Psychotraumatology, 9(1), 1425575.
Open access: https://www.tandfonline.com/doi/abs/10.1080/20008198.2018.1425575
Mayaris Zepeda Méndez. firstname.lastname@example.org
Background: Trauma-focused psychotherapies for posttraumatic stress disorder (PTSD) have been demonstrated to be efficacious, but also have considerable non-response and dropout rates. Intensive treatment may lead to faster symptom reduction, which may contribute to treatment motivation and thereby to reduction of dropout.
Objective: The aim of the current study was to investigate the feasibility and preliminary effectiveness of an intensive five-day inpatient treatment with Eye Movement Desensitization and Reprocessing (EMDR) and trauma-informed yoga for patients with PTSD. Method: A non-controlled pilot study with 12 adult patients with PTSD was conducted. At baseline the PTSD diagnosis was assessed with the Clinician-Administered PTSD Scale (CAPS-5) and comorbid disorders with the Mini International Neuropsychiatric Interview (MINI). Primary outcome was self-reported PTSD symptom severity (PTSD Check List for DSM-5; PCL-5) measured at the beginning of day 1 (T1), at the end of day 5 (T2) and at follow-up on day 21 (T3). Reliable change indexes (RCI) and clinically significant changes were calculated.
Results: From T1 to T3, PTSD symptoms significantly improved with a large effect size (Cohen’s d = 0.91). Nine of the 11 patients who completed treatment showed reliable changes in terms of self-reported PTSD. At T3, two of the patients no longer met criteria for PTSD as measured with the PCL-5. One patient dropped out after the first day. No serious adverse events occurred.
Conclusions: The majority of patients in our pilot study experienced symptom reduction consistent with reliable changes in this five-day inpatient treatment with EMDR and yoga. Randomized controlled trials – with longer follow up periods – are needed to properly determine efficacy and efficiency of intensive clinical treatments for PTSD compared to regular treatment. This is one of the first studies to show that intensive EMDR treatment is feasible and is indicative of reliable improvement in PTSD symptoms in a very short time frame.
Zoet, H. A., Wagenmans, A., van Minnen, A., & de Jongh, A. (2018). Presence of the dissociative subtype of PTSD does not moderate the outcome of intensive trauma-focused treatment for PTSD. Eur J Psychotraumatol, 9(1), 1468707.
Open access: https://www.ncbi.nlm.nih.gov/pubmed/29805779
Ad de Jongh. E-mail: email@example.com
Background: There is a widely-held belief in the trauma field that the presence of dissociative symptoms is associated with poor treatment response. However, previous research on the effect of dissociation in treatment outcomes pertained to specific patients and trauma populations.
Objective: To test the hypothesis that the presence of the dissociative subtype of PTSD (DS) would have a detrimental effect on the outcome of an intensive trauma-focused treatment programme.
Methods: PTSD symptom scores (Clinician Administered PTSD Scale [CAPS] and PTSD Symptom Scale Self-Report [PSS-SR]) were analysed using the data of 168 consecutive patients (70.6% female) who had been exposed to a wide variety of multiple traumas, including childhood sexual abuse, and of whom 98.2% were diagnosed with severe PTSD (CAPS > 65). Most of them suffered from multiple comorbidities and 38 (22.6%) met the criteria for DS. They took part in an intensive trauma-focused treatment programme for PTSD. Pre- and post-treatment differences were compared between patients with and without DS.
Results: Large effect sizes were achieved for PTSD symptom reduction on CAPS and the PSS-SR, both for patients with DS and those without. Although patients with DS showed a significantly greater PTSD symptom severity at the beginning, and throughout, treatment, both groups showed equal reductions in PTSD symptoms. Of those who met the criteria for DS, 26 (68.4%) no longer fulfilled the criteria for this classification after treatment.
Conclusion: The results provide no support for the notion that the presence of DS negatively impacts trauma-focused treatment outcomes. Accordingly, PTSD patients with DS should not be denied effective trauma-focused treatments.