EMDR Research News June 2020
3 Randomized Controlled Trials
- Trauma, treatment and Tetris: video gaming increases hippocampal volume in male patients with combat-related PTSD
- Cognitive therapy and EMDR for reducing psychopathology in bereaved people after the MH17 plane crash
- The Effectiveness of EMDR on Fear of Negative Evaluation and Social Adjustment in Female Students with Social Phobia
- Impact of dissociation on the effectiveness of psychotherapy for PTSD
- The association between study quality and effect sizes of psychological interventions for pediatric PTSD
- Cost-effectiveness of psychological treatments for post-traumatic stress disorder in adults
- Positive Internal Experiences in PTSD Interventions
- Treating implicit trauma: comparing the EMDR Therapy Standard Protocol with a ‘Blind 2 Therapist’ version in Northern Iraq
- Sequence matters: Combining Prolonged Exposure and EMDR therapy for PTSD
- Intensive trauma-focused therapy with victims of crime
2 Case Series
- EMDR as an Adjunctive Psychological Therapy for Patients With Functional Neurological Disorder
- Combining psychotherapy with craniosacral therapy for severe traumatized patients
2 Individual Case Reports
- Prenatal and Perinatal EMDR Therapy: Early Family Intervention
- EMDR Treatment of Childhood Sexual Abuse for a Child Molester: Self-Reported Changes in Sexual Arousal
- Adaptive Information Processing Theory: Origins, Principles, Applications, and Evidence
- Recruitment of sensory, memory and emotional networks during bilateral alternating auditory stimulation
- Post-traumatic growth in the twenty-first century: how current trends may threaten our ability to grow after trauma
- Consultation for EMDRIA Certification in EMDR: Best Practices and Challenges
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.
Butler, O., Herr, K., Willmund, G., Gallinat, J., Kühn, S., & Zimmermann, P. (2020). Trauma, treatment and Tetris: video gaming increases hippocampal volume in male patients with combat-related posttraumatic stress disorder. J Psychiatry Neurosci, 45(3), 190027. doi:10.1503/jpn.190027
Open access: https://www.ncbi.nlm.nih.gov/pubmed/32293830
Oisin Butler, the Max Planck Institute for Human Development, Center for Lifespan Psychology, Berlin, Germany. E-mail: email@example.com
Background: Tetris has been proposed as a preventative intervention to reduce intrusive memories of a traumatic event. However, no neuroimaging study has assessed Tetris in patients with existing posttraumatic stress disorder (PTSD) or explored how playing Tetris may affect brain structure. Methods: We recruited patients with combat-related PTSD before psychotherapy and randomly assigned them to an experimental Tetris and therapy group (n = 20) or to a therapy-only control group (n = 20). In the control group, participants completed therapy as usual: eye movement desensitization and reprocessing (EMDR) psychotherapy. In the Tetris group, in addition to EMDR, participants also played 60 minutes of Tetris every day from onset to completion of therapy, approximately 6 weeks later. Participants completed structural MRI and psychological questionnaires before and after therapy, and we collected psychological questionnaire data at follow-up, approximately 6 months later. We hypothesized that the Tetris group would show increases in hippocampal volume and reductions in symptoms, both directly after completion of therapy and at follow-up. Results: Following therapy, hippocampal volume increased in the Tetris group, but not the control group. As well, hippocampal increases were correlated with reductions in symptoms of PTSD, depression and anxiety between completion of therapy and follow-up in the Tetris group, but not the control group. Limitations: Playing Tetris may act as a cognitive interference task and as a brain-training intervention, but it was not possible to distinguish between these 2 potential mechanisms. Conclusion: Tetris may be useful as an adjunct therapeutic intervention for PTSD. Tetris-related increases in hippocampal volume may ensure that therapeutic gains are maintained after completion of therapy.
Contractor, A. A., Weiss, N. H., Forkus, S. R., & Keegan, F. (2020). Positive Internal Experiences in PTSD Interventions: A Critical Review. Trauma, Violence, & Abuse, 152483802092578. doi:10.1177/1524838020925784
Ateka A. Contractor, Department of Psychology, University of North Texas, 369 Terrill Hall, Denton, TX 76203, USA. Email: firstname.lastname@example.org
Evidence suggests that individuals with post-traumatic stress disorder (PTSD) symptoms exhibit deficits in positive internal experiences. This study critically reviewed empirically validated PTSD interventions to determine (1) whether positive memories, cognitions, and emotions were explicitly addressed and (2) the goals of focusing on these positive internal experiences. We selected 11 empirically validated PTSD interventions listed as “recommended/strongly recommended” in recently published reviews, reviewed existing literature for studies using these interventions (N 1⁄4 1,070), short-listed randomized controlled trial studies meeting predetermined inclusion criteria for the selected interventions (in English, developed for adults, individual therapy modality, in-person administration, tailored to PTSD; N 1⁄4 47), and emailed authors (N 1⁄4 41) to obtain the unique intervention manuals. Hereby, we reviewed 13 unique empirically validated PTSD intervention manuals. Findings indicated 53.85%, 69.23%, and 69.23% of reviewed manuals explicitly discussed positive memories, emotions, and cognitions, respectively. Primarily, positive memories were integral to mechanisms underlying PTSD, a precursor to targeting negative experiences, an indicator of treatment progress, or a way to identify client problems; positive emotions were discussed when providing psychoeducation on PTSD/ trauma reactions; and positive cognitions were addressed in reference to coping with negative experiences or as targets to enhance self-concept. This review demonstrates that comparatively, positive memories are infrequently elicited in the reviewed interventions; positive emotions and cognitions are explicitly referenced in two-thirds of the reviewed interventions but are included as a primary focus for therapeutic processing only in a few interventions; and eye movement desensitization and reprocessing has the most comprehensive focus on positive internal experiences.
Cope, S. R. (2020). EMDR as an Adjunctive Psychological Therapy for Patients With Functional Neurological Disorder: Illustrative Case Examples. Journal of EMDR Practice and Research, 14(2), 76-89. doi:10.1891/emdr-d-20-00008
Sarah R. Cope, South West London and St. George’s Mental Health NHS Trust, Neuropsychiatry Service, St. George’s Hospital, Blackshaw Road, London, SW17 0QT, United Kingdom. E-mail: Sarah.Cope@swlstg.nhs.uk
Functional neurological disorder (FND) is a common diagnosis in neurology clinics, and there is some evidence psychological therapy can be of benefit. Eye movement desensitization and reprocessing therapy (EMDR) is a well-evidenced treatment for posttraumatic stress disorder (PTSD), and there is increasing evidence that it is beneficial for other conditions. EMDR is a therapy designed to focus on distressing memories, and therefore can be used for non-PTSD presentations where distressing memories are relevant. There is a small amount of case study evidence that EMDR can be used successfully with FND presentations and comorbid PTSD. This article describes two illustrative case examples of people diagnosed with FND who have distressing memories relevant to their presentation. Presenting functional symptoms included functional non-epileptic attacks and functional sensory symptoms. Psychological treatment-as-usual plus EMDR resulted in improvements for both cases and demonstrated that EMDR is a promising additional treatment option for FND presentations, appropriately selected. Recommendations regarding further research are made.
Cortizo, R. (2020). Prenatal and Perinatal EMDR Therapy: Early Family Intervention. Journal of EMDR Practice and Research, 14(2), 104-115. doi:10.1891/emdr-d-19-00046
Rosita Cortizo, Psy.D, LMFT, MA, North County Health Services, San Marcos, California. E-mail: recortizo@ gmail.com
This article discusses the integration of eye movement desensitization and reprocessing (EMDR) therapy with a family therapy treatment, which was designed for treating mothers and their babies from conception through the first year of life. The Calming Womb Family Therapy Model (CWFTM) is a multidisciplinary, Integrative, early intervention approach. Its foundations originate from Murray Bowen's family model of understanding the individual in the context of their families as emotional interactive systems; Selma Fraiberg's psychodynamic work and psychoeducational interventions with mothers and infants to resolve maternal trauma and transference reactions to their babies followed by educational guidance in infant development through the first year of their lives; and EMDR therapy. EMDR therapy can improve internal resources for expectant mothers; monitor their levels of psychological distress; and enable them to access and process traumatic memories, other adverse life experiences, recent stressors, and pre-perinatal concerns and bring them to adaptive resolution. EMDR therapy can also help pregnant mothers develop imaginal templates of future events that incorporate in utero developmental prenatal education and deepen their bonds with their babies. The pre-perinatal psychotherapist's knowledge of infant development and capacity for interpersonal warmth, affect tolerance, somatic resourcing, reflective stance, and relational attunement can provide a fertile ground for the expectant mother and womb baby relationship and enriching life together. The ultimate goal is to conceive and rear healthy children.
Dickinson, S. (2020). Post-traumatic growth in the twenty-first century: how current trends may threaten our ability to grow after trauma. The Journal of Positive Psychology, 1-9. doi:10.1080/17439760.2020.1752782
Samuel Dickinson, Public Health Programs, Weill Cornell Public Medical College, New York, NY. E-mail: email@example.com
Victims of trauma who experience post-traumatic stress disorder are often able to reframe the tragedies that they have been through in a way that gives them new-found purpose in life and a sense of empowerment. When they do so, they are enacting the phenomenon of post-traumatic growth. There are several empirically supported predictors of post-traumatic growth, including a person’s level of optimism and extroversion, the amount they socialize with friends and others who have experienced similar traumas, and their level of self-confidence and ability to be open to new ideas. These predictors of PTG may be at a disadvantage of being realized in light of modern-day trends of isolation, depression, low self-esteem, and inactivity. In order for trauma clinicians to be maximally effective with the clients that they treat in today’s social and cultural climate, these trends must be accounted for in treatment plans for individuals with PTSD. This article recommends a combination of activating one’s social network, utilizing modalities that specifically target depression and trauma-processing such as Behavioral Activation and EMDR, participation in team sports, and widespread psychoeducation regarding trauma symptoms in an effort to normalize presentation and fight against stigma.
Farrell, D., Kiernan, M. D., de Jongh, A., Miller, P. W., Bumke, P., Ahmad, S., . . . Mattheß, H. (2020). Treating implicit trauma: a quasi-experimental study comparing the EMDR Therapy Standard Protocol with a ‘Blind 2 Therapist’ version within a trauma capacity building project in Northern Iraq. Journal of International Humanitarian Action, 5(1). doi:10.1186/s41018-020-00070-8
Open access: http://dx.doi.org/10.1186/s41018-020-00070-8
Derek Farrell, University of Worcester (UK), Worcester, UK. E-mail: firstname.lastname@example.org
Psychological trauma is a silent epidemic which presents as a global public health issue, often in the form of post- traumatic stress disorder (PTSD). Eye Movement Desensitisation and Reprocessing (EMDR) Therapy is an empirically supported treatment intervention for PTSD and has been used as part of trauma-capacity building, particularly in low- and middle-income countries (LMIC). For some survivor’s, their trauma experiences cannot be spoken of: they may be alluded to, suggested and though not directly expressed. There are several factors as to why these implicit trauma experiences are ‘unspoken’, for example, when the trauma involves a deep-rooted sense of shame or guilt, a distorted sense of over-responsibility or when to speak of the trauma engenders fear of retribution, reprisal and consequence. This paper will explore the effectiveness of using two protocol variations of EMDR Therapy—standard versus a ‘Blind 2 Therapist’ protocol version as part of a quasi-experimental study which took place in Northern Iraq. The study contains two projects and subsequently tested several hypotheses regarding safety, effectiveness, efficiency and relevance of the ‘Blind 2 Therapist’ protocol within EMDR Therapy. Results indicated support for the B2T protocol intervention with various trauma populations including Yezidi survivors of Islamic State of Iraq and the Levant (ISIL)—also known as Daesh.
Greenwald, R., Camden, A. A., Gamache, N., Lasser, K. A., Chapman, R., & Rattner, B. (2020). Intensive trauma-focused therapy with victims of crime. European Journal of Trauma & Dissociation, 100146. doi:10.1016/j.ejtd.2020.100146
Ricky Greenwald, E-mail: email@example.com
Intensive trauma-focused psychotherapy is a relatively recent clinical practice innovation that has the potential to reduce treatment time, risk, and dropout rate while improving treatment efficiency. We conducted an open trial of trauma-focused intensive therapy featuring progressive counting (PC) and eye movement desensitization and reprocessing (EMDR) for 61 multiply-traumatized treatment-seeking victims of crime. Results showed strong participant retention as well as significant improvement at two weeks and 12 weeks post-treatment, with large to very large effect sizes on all outcomes, including posttraumatic stress and related symptoms, severity of primary presenting problems, quality of life, and overall stability and level of functioning. Outcomes were similar for PC and EMDR. The mean treatment time was 30.73 hours, or a little less than a week, enabling participants to quickly move on with their lives. Intensive trauma-focused psychotherapy may represent an important advance in the delivery of psychotherapy.
Hill, M. D. (2020). Adaptive Information Processing Theory: Origins, Principles, Applications, and Evidence. J Evid Based Soc Work (2019), 17(3), 317-331. doi:10.1080/26408066.2020.1748155
Margaret Duval Hill, DSW Program, Tulane School of Social Work—8906, 127 Elk Place, New Orleans, LA, 70112. E-mail: firstname.lastname@example.org
This paper describes the origins, principles, applications, and evidence related to Adaptive Information Processing (AIP) theory. AIP theory provides the theoretical underpinning of Eye Movement Desensitization and Reprocessing (EMDR) therapy. AIP theory was developed to explain the observed results of EMDR therapy delivered to individuals experiencing trauma and PTSD. The AIP model hypothesizes that maladaptively stored memories of trauma create obstacles to rational processing of information, which occurs in the prefrontal cortex area of the brain. Bilateral stimulation, through eye movements or other mechanisms, is hypothesized to remove the obstacles and permit complete processing of the memory, leading to a reduction in trauma symptoms. EMDR therapy, with the AIP model as rationale, has been effectively used in the treatment of PTSD. Evidence in support of AIP theory is emerging as some promising results have been shown in studies that rely on measuring various types of physiological changes that occur during EMDR therapy.
Hoeboer, C. M., De Kleine, R. A., Molendijk, M. L., Schoorl, M., Oprel, D. A. C., Mouthaan, J., . . . Van Minnen, A. (2020). Impact of dissociation on the effectiveness of psychotherapy for post-traumatic stress disorder: meta-analysis. BJPsych Open, 6(3). doi:10.1192/bjo.2020.30
Open access: http://dx.doi.org/10.1192/bjo.2020.30
C. M. Hoeboer. Email: C.email@example.com
Background: Many patients with post-traumatic stress disorder (PTSD) experience dissociative symptoms. The question of whether these dissociative symptoms negatively influence the effective- ness of psychotherapy for PTSD is unresolved.
Aims: To determine the influence of dissociative symptoms on psychotherapy outcome in PTSD.
Method: We conducted a systematic search in Cochrane, Embase, PILOTS, PsycINFO, PubMed and Web of Science for relevant clinical trials. A random-effects meta-analysis examined the impact of dissociation on psychotherapy outcome in PTSD (pre- registered at Prospero CRD42018086575).
Results: Twenty-one trials (of which nine were randomised controlled trials) with 1714 patients were included. Pre-treatment dissociation was not related to treatment effectiveness in patients with PTSD (Pearson’s correlation coefficient 0.04, 95% CI −0.04 to 0.13). Between-study heterogeneity was high but was not explained by moderators such as trauma focus of the psychotherapy or risk of bias score. There was no indication for publication bias.
Conclusions: We found no evidence that dissociation moderates the effectiveness of psychotherapy for PTSD. The quality of some of the included studies was relatively low, emphasising the need for high-quality clinical trials in patients with PTSD. The results suggest that pre-treatment dissociation does not determine psychotherapy outcome in PTSD.
Hoppen, T. H., & Morina, N. (2020). Is high-quality of trials associated with lower treatment efficacy? A meta-analysis on the association between study quality and effect sizes of psychological interventions for pediatric PTSD. Clin Psychol Rev, 78, 101855. doi:10.1016/j.cpr.2020.101855
Nexhmedin Morina, University of Münster, Institute of Psychology, Fliednerstr. 21, 48149 Münster, Germany. E-mail: firstname.lastname@example.org
This meta-analysis aimed at providing an up-to-date estimate on the efficacy of psychological interventions for pediatric PTSD and to analyze the association between treatment efficacy and study quality. We systematically searched PsycINFO, Medline and recent meta-analyses for randomized controlled trials (RCTs). RCTs were eligible if a) they included at least 10 participants per group, b) compared a psychological intervention to a control condition or another psychological intervention and c) mean age was below 19 years. Study quality was assessed independently by both authors on the basis of eight quality criteria. We explored the potential associations between study quality and effect sizes in three ways. Firstly, we compared effect-sizes of high-quality vs. lower-quality studies. Secondly, we analyzed study quality as a continuous predictor of effect sizes. And thirdly, we examined the relationship between the eight individual quality criteria and effect sizes. A total of 46 eligible RCTs were included in the meta-analysis. Psychological interventions produced a large effect size when compared to waitlist (g = 1.07, k = 23, NNT = 1.81) and a medium effect size when compared to active control conditions (g = 0.60, k = 15, NNT = 3.03) at post-treatment. Overall, study quality was moderate. Comparisons of high-quality trials (k = 16) with lower-quality trials (k = 30) produced only non-significant findings in main-analyses as well as moderator sub-analyses. Study quality as a continuous variable was also not found to be related to effect sizes in any of the main analyses, nor was any of the eight individual quality criteria. The summary of the available literature strongly suggests that psychological interventions are effective in treating PTSD in children and adolescents. No significant associations between study quality and treatment efficacy were observed.
Lenferink, L. I. M., de Keijser, J., Smid, G. E., & Boelen, P. A. (2020). Cognitive therapy and EMDR for reducing psychopathology in bereaved people after the MH17 plane crash: Findings from a randomized controlled trial. Traumatology. doi:10.1037/trm0000253
Lonneke I. M. Lenferink, Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands. E-mail: email@example.com
Experiencing a sudden/violent loss of a significant other is a risk factor for developing persistent complex bereavement disorder (PCBD), depression, and/or posttraumatic stress disorder (PTSD). Cognitive therapy (CT) combined with eye movement desensitization and reprocessing (EMDR) might be an effective treatment for bereaved people with PCBD, depression, and/or PTSD symptoms after sudden/ violent loss. We tested the effects of CT + EMDR versus waitlist controls in disaster-bereaved people. In a multicenter randomized controlled trial, changes in self-rated PCBD, depression, and PTSD levels were compared between an immediate treatment and waitlist control group in 39 Dutch people who experienced loss(es) in the disaster with flight MH17, using multilevel modeling. Associations between reductions in symptom levels and reductions in maladaptive cognitive–behavioral variables were examined using regression analyses. The immediate treatment group showed a significantly stronger decline in depression (Hedges’ g = 0.61) compared with waitlist controls (Hedges’ g = 0.15). No significant between-groups differences were found in PCBD and PTSD levels. Symptom reductions were correlated with reductions in maladaptive cognitive–behavioral variables. Although CT + EMDR coincided with symptom reductions associated with reductions in negative cognitions and avoidance behaviors, more research with larger samples is needed to further examine the effectiveness of CT + EMDR in bereaved people after sudden/violent loss.
Madere, J., Leeds, A., Sells, C., Sperling, C., & Browning, M. (2020). Consultation for EMDRIA Certification in EMDR: Best Practices and Challenges. Journal of EMDR Practice and Research, 14(2), 62-75. doi:10.1891/emdr-d-19-00052
Jennifer Madere, Intuitus Group Independent Professionals, 1464 E. Whitestone Blvd. Ste. 2001, Cedar Park, TX 78613. E-mail: firstname.lastname@example.org
Post-graduate credentials in specific therapeutic models have become more common in recent decades and offer assurance of certain levels of expertise amid increased globalization. Since 1999, the Eye Movement Desensitization and Reprocessing International Association (EMDRIA) and the international EMDR community have worked to establish guidelines and standards for advanced designations in the provision of EMDR therapy. This article focuses on the consultation processes that are outlined in the requirements for clinicians seeking to apply for advanced designations in EMDR therapy. Within the individual and group consultation hours required, consultants operate in several roles, including educator and evaluator, toward addressing the needs of consultees and the requirements put forth by credentialing bodies. The needs of consultees pursuing advanced designations in EMDR therapy include education, documentation of consultation hours and skills attained, and recommendation for the advanced designation. This article provides recommendations and best practices for EMDRIA Approved Consultants who are challenged by the current EMDRIA Certification credentialing process. Challenges with implementation of EMDR Europe's Accredited Practitioner program are also addressed. Strategies are offered to reduce identified ethical concerns surrounding consultation for advanced designations, and to support the integrity of EMDR therapy as an evidence-based treatment model. Building upon the history of the advanced designations within EMDRIA and EMDR Europe, current requirements and the need for research to inform requirements, explicit guidelines, and objective standards are discussed.
Mavranezouli, I., Megnin-Viggars, O., Grey, N., Ghutani, G., Leach, J., Daly, C., . . . Pilling, S. (2020). Cost-effectiveness of psychological treatments for post-traumatic stress disorder in adults. Plos One. doi:10.1371/journal. pone.0232245
Open access: https://doi.org/10.1371/journal. pone.0232245
Ifigeneia Mavranezouli, Centre for Reviews and Dissemination, University of York, York, United Kingdom. E-mail: email@example.com
Background: Post-traumatic stress disorder (PTSD) is a severe and disabling condition that may lead to functional impairment and reduced productivity. Psychological interventions have been shown to be effective in its management. The objective of this study was to assess the cost- effectiveness of a range of interventions for adults with PTSD.
Methods: A decision-analytic model was constructed to compare costs and quality-adjusted life-years (QALYs) of 10 interventions and no treatment for adults with PTSD, from the perspective of the National Health Service and personal social services in England. Effectiveness data were derived from a systematic review and network meta-analysis. Other model input parameters were based on published sources, supplemented by expert opinion.
Results: Eye movement desensitisation and reprocessing (EMDR) appeared to be the most cost- effective intervention for adults with PTSD (with a probability of 0.34 amongst the 11 evaluated options at a cost-effectiveness threshold of £20,000/QALY), followed by combined somatic/cognitive therapies, self-help with support, psychoeducation, selective serotonin reuptake inhibitors (SSRIs), trauma-focused cognitive behavioural therapy (TF-CBT), self-help without support, non-TF-CBT and combined TF-CBT/SSRIs. Counselling appeared to be less cost-effective than no treatment. TF-CBT had the largest evidence base.
Conclusions: A number of interventions appear to be cost-effective for the management of PTSD in adults. EMDR appears to be the most cost-effective amongst them. TF-CBT has the largest evidence base. There remains a need for well-conducted studies that examine the long- term clinical and cost-effectiveness of a range of treatments for adults with PTSD.
Qorbanpoor Lafmejani, A., Samady Biniaz, D., & Rezaei, S. (2020). The Effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) on Fear of Negative Evaluation (FNE) and Social Adjustment in Female Students with Social Phobia. International Journal of Psychology (IPA). doi:10.24200/IJPB.2020.170331.1086
Amir Qorbanpoor lafmejani, Department of Counseling and Educational Sciences, Faculty of Literature and Humanities, University of Guilan, Rasht, Iran. E-mail: firstname.lastname@example.org
The present study aimed at determining the effect of eye movement desensitization and reprocessing (EMDR) on fear of negative evaluation (FNE) and social adjustment in female students with social phobia. The population of the study consisted of all female students of Mashhad Higher Education Institute of Engineers (Northeastern Iran). Thirty students were selected randomly from among those whose had high scores in the social phobia questionnaire. They responded to the FNE and social adjustment scales. The research was quasi-experimental following a pretest-posttest control group design. The experimental group received an intervention protocol, while the control group received no intervention. The data were analyzed using Univariate/Multivariate covariance analysis (ANCOVA & MANCOVA) through SPSS v.21. The findings indicated that the EMDR leads to reduced FNE (F = 35.20, p < 0.0001, ή = 0.773) and increased social adjustment (F = 41.07, p < 0.0001, ή = 0.699). Having participated in the EMDR therapy, students with social phobia reported reduced symptoms of social phobia, such as FNE and greater social adjustment. The EMDR is an effective therapeutic approach to reducing anxiety disorders, including social phobia and enhancing social adjustment.
Rousseau, P. F., Boukezzi, S., Garcia, R., Chaminade, T., & Khalfa, S. (2020). Cracking the EMDR code: Recruitment of sensory, memory and emotional networks during bilateral alternating auditory stimulation. Aust N Z J Psychiatry, 4867420913623. doi:10.1177/0004867420913623
Pierre-François Rousseau, Laboratoire de Neurosciences Sensorielles et Cognitives, UMR 7260, Aix-Marseille Université, CNRS, 3, place Victor Hugo Case 32, 13331 Marseille Cedex 3, France. Email: email@example.com
INTRODUCTION: The inability to extinguish a conditioned fear is thought to be at the core of post-traumatic stress disorder. Eye movement desensitization and reprocessing therapy has been efficacious for post-traumatic stress disorder, but the brain mechanisms underlying the effect are still unknown. The core effect of eye movement desensitization and reprocessing therapy seems to rely on the simultaneous association of bilateral alternating stimulation and the recall of the traumatic memory. To shed light on how eye movement desensitization and reprocessing therapy functions, we aimed to highlight the structures activated by bilateral alternating stimulation during fear extinction and its recall.
METHODS: We included 38 healthy participants in this study. Participants were examined twice in functional magnetic resonance imaging, over 2 consecutive days. On the first day, they performed two fear conditioning and extinction procedures, one with and one without the bilateral alternating stimulation during the fear extinction learning phase in a counter-balanced order across the participants. On the second day, participants completed the fear extinction recall procedure, in the same order as the previous day. Statistical significance of maps was set at p < 0.05 after correction for family-wise error at the cluster level.
RESULTS: The analysis revealed significant activation with versus without bilateral alternating stimulation at the early extinction in the bilateral auditory areas, the right precuneus, and the left medial frontal gyrus. The same pattern was found in the early recall on the second day. The connectivity analysis found a significant increase in connectivity during bilateral alternating stimulation versus without bilateral alternating stimulation in the early extinction and recall between the two superior temporal gyri, the precuneus, the middle frontal gyrus and a set of structures involved in multisensory integration, executive control, emotional processing, salience and memory.
CONCLUSION: We show for the first time that in the eye movement desensitization and reprocessing therapy the bilateral alternating stimulation is not a simple sensory signal and can activate large emotional neural networks.
Stub, T., Kiil, M. A., Lie, B., Kristoffersen, A. E., Weiss, T., Hervik, J. B., & Musial, F. (2020). Combining psychotherapy with craniosacral therapy for severe traumatized patients: A qualitative study from an outpatient clinic in Norway. Complement Ther Med, 49, 102320. doi:10.1016/j.ctim.2020.102320
Trine Stub, The National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, UiT The Artic University of Norway, Norway. E-Mail: firstname.lastname@example.org
BACKGROUND: Craniosacral therapy (CST) is an established complementary modality for several health complaints. A clinic for psychosomatics in Norway has included CST into a multimodal treatment approach for severely traumatized patients. The aim of this study was to investigate and describe the indications for the use of craniosacral therapy within trauma therapy. Specifically, to explore treatment philosophy, criteria for improvement, treatment aims, and the evaluation of the risk profile of the multimodal treatment approach.
METHODS: Semi-structured individual interviews (n = 8) and one focus group interview were conducted with the therapists at the Clinic for Psychosomatics, Hospital of Southern Norway, Kristiansand, Norway. The text data were transcribed verbatim, and the analysis of the material was conducted according to conventional and direct content analysis.
RESULTS: The therapists at the clinic applied a holistic treatment approach, based on their understanding of mind and body as one entity. To access emotions and traumata, they used a mixture of different treatment techniques. The therapists experienced patients with severe bodily symptoms as being less cognitively present and attributed this to the symptoms craving most mental resources. The craniosacral therapists' specific aims and task within the multimodal trauma therapy was to ease these physical complaints, so that cognitive and emotional resources could be utilized for therapy. The psychotherapists found that emotions and traumata were more accessible after CST. The general treatment goals were to increase symptom tolerance levels and to enable better self-care. Furthermore, the ability to transform negative behaviors and develop positive alternatives were considered to be signs of improvement.
CONCLUSION: The study participants considered that patients with complex traumas, including post-traumatic stress disorder, seemed to benefit from this multimodal treatment approach and appreciated its' holistic treatment philosophy, including craniosacral therapy. With regard to patient safety, the study participants recommended that craniosacral therapy for severely traumatized patients should only be provided in cooperation with psychotherapists, or other highly qualified health personnel working in specialized institutions.
Van Minnen, A., Voorendonk, E. M., Rozendaal, L., & de Jongh, A. (2020). Sequence matters: Combining Prolonged Exposure and EMDR therapy for PTSD. Psychiatry Res, 290, 113032. doi:10.1016/j.psychres.2020.113032
Open access: https://www.ncbi.nlm.nih.gov/pubmed/32454314
A. Van Minnen. E-mail: email@example.com
OBJECTIVE: Investigating the influence of the sequence in which two evidence-based trauma-focused treatments are offered to PTSD-patients.
METHODS: PTSD-patients were treated using an intensive eight-day treatment program, combining Prolonged Exposure (PE) and EMDR therapy. Forty-four patients received a PE session in the morning and an EMDR session in the afternoon, while 62 patients received the reversed sequence (EMDR followed by PE). Outcome measures were PTSD symptom severity and subjective experiences.
RESULTS: Patients who received PE first and EMDR second showed a significantly greater reduction in PTSD symptoms. Patients preferred this sequence and valued the treatment sessions as significantly more helpful compared to patients in the EMDR-first condition.
CONCLUSION: The results of this explorative study are supportive of the notion that PE and EMDR therapy can be successfully combined, and that sequence matters. First applying PE sessions before EMDR sessions resulted in better treatment outcome, and better subjective patient's evaluations in terms of treatment helpfulness and preference.
Wright, L. C., & Warner, A. (2020). EMDR Treatment of Childhood Sexual Abuse for a Child Molester: Self-Reported Changes in Sexual Arousal. Journal of EMDR Practice and Research, 14(2), 90-103. doi:10.1891/emdr-d-19-00060
Lisa Catherine Wright, V7, Mersey Care NHS Foundation Trust, Merseyside, Kings Business Park, Prescot, Mersey- side, L34 1PJ, UK. E-mail: firstname.lastname@example.org
Expanding on previous findings that eye movement desensitization and reprocessing (EMDR) therapy may alter deviant sexual arousal in adult child molesters with a history of childhood sexual abuse (CSA), this article describes the changes reported following the application of EMDR therapy to the memories of CSA in an adult male who had sexually offended against prepubescent children. The client had previously completed a cognitive behavioral intervention to address his offending behavior. EMDR therapy took place over 11 months and consisted of 32 sessions, including preparation and review phases. The aim of the therapy was to alleviate current reported distress and symptoms of posttraumatic stress disorder (PTSD) related to his memories of CSA. The client reported positive changes in emotional, cognitive, and physiological functioning, consistent with reductions on a range of subscales of the Trauma Symptom Inventory 2 and the Inventory of Altered Self-Capacities. However, on completion of therapy, he also reported a reduction in the frequency and strength of sexual arousal to children, which was maintained at a 3-year follow-up, although this was not a target for treatment. The experiences described during the EMDR process by this client are discussed and related to the adaptive information processing (AIP) model and previous findings on reported changes in sexual arousal in this client group.