EMDR Research News March 2023
Among the 5 articles listed from Issue 1 of the Journal of EMDR Practice and Research, you will find a pilot study on change in attachment security, a review of reports on EMDR for pregnant clients with substance use disorders, and a meta-analysis on EMDR treatment of substance user disorders.
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.
Allen, A., McKillop, N., Katsikitis, M., & Millear, P. (2023). The effects of bilateral stimulation using eye movements on sexual fantasies with follow-up. J Behav Ther Exp Psychiatry, 79, 101826. https://doi.org/10.1016/j.jbtep.2022.101826
Andrew Allen, Sunshine Coast Mind & Neuroscience - Thompson Institute, University of the Sunshine Coast, 12 Innovation Parkway, Birtinya, Queensland, 4575, Australia. E-mail address: firstname.lastname@example.org
BACKGROUND AND OBJECTIVES: Sexual fantasies represent a common aspect of human sexuality that can support sexual well-being but also contribute to psychopathology. The latter warrants intervention and bilateral stimulation with eye movements (EMs) may be a suitable intervention for impairing mental imagery of sexual fantasies. This study aimed to evaluate the effect of multiple rounds of EMs on sexual fantasies, gauge the effect over time with a one-week follow-up, and assess how impaired sexual imagery may influence behaviour and behavioural intention.
METHODS: Twenty-eight participants (14 male, Mage = 44.10, SDage = 9.77) selected a favoured sexual fantasy and engaged in five repeated rounds of an EM task, either face-to-face or via telehealth. Baseline phenomenological characteristics of sexual fantasies were compared against repeated measures after each round of EMs and at one-week follow-up, as well as hypothetical behavioural intention and frequency of fantasy masturbation.
RESULTS: All sexual fantasy characteristics (e.g., vividness, sensations, arousal, believability) diminished progressively between each round of EMs. These characteristics increased from round five to follow-up. However, they remained significantly reduced compared to baseline. Participants' hypothetical behavioural intention and frequency of masturbation associated with their sexual fantasies also reduced post-EM task.
LIMITATIONS: Use of self-report measures; participants' mental imagery could not be measured directly; and no comparison groups were included.
CONCLUSIONS: As an imagery impairing task, bilateral stimulation with EMs is effective for diminishing the phenomenological properties of sexual fantasies, extending upon extant literature. Collectively, the progressive research regarding EMs and sexual fantasies encourages replication in specific populations (e.g., individuals with problematic or harmful sexual fantasies).
Almehdar, A. S. (2023). A systematic review of studies of eye movement desensitization and reprocessing (EMDR) therapy for post-traumatic stress disorder from 2017 to 2021 documented in the Saudi digital library. Journal of Educational and Psychological Sciences, 7(5), 108-132. https://doi.org/10.26389/ AJSRP.R111222
Open Access: https://doi.org/10.26389/ AJSRP.R111222
Dr. Areej Salem Almehdar, College of Social Sciences, University of Jeddah. E-mail: email@example.com
The results from scientific research over the past three decades have proven that Eye Movement desensitization and reprocessing EMDR, is an effective treatment in cases of post-traumatic stress disorder and is also effective in relieving the symptoms of many other psychological disorders. Due to the scarcity of published studies on the effectiveness of this treatment in Arabic, the current study came to fill this research gap, and to conduct a systematic review that reveals the most prominent features of research in trauma treatment with eye movement and desensitization and reprocessing (EMDR) as reflected in the Saudi Digital Library in the period from 2017 to 2021 AD. The research relied on using the method of systematic literature review. This review concluded with 17 papers written in English and two papers written in Arabic. These studies are varied in their methods and the target groups. The systematic review reached a clear understanding of the most prominent current and future trends and topics that are being dealt with in EMDR trauma treatment studies. The recommendations indicated the urgent need for more studies and research in Arabic culture that prove the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy for post-traumatic stress disorder with different clinical groups in Arabic culture.
Barazzone, N. A., Santos, I., McGowan, J. F., Crowley, M., Chamberlain, A. R., & Donaghay-Spire, E. G. (2023). Eye Movement Desensitization and Reprocessing Therapy and Change in Attachment Security: A Pilot Study. Journal of EMDR Practice and Research, EMDR-2022. https://doi.org/10.1891/emdr-2022-0053
Natalie A. Barazzone, Salomons Institute for Applied Psychology, 1 Meadow Road, Tunbridge Wells, TN1 2YG, UK. E-mail: firstname.lastname@example.org
Eye movement desensitization and reprocessing (EMDR) therapy has a rapidly growing evidence base; however, research into its changes in attachment security during EMDR therapy is limited. This pilot study aimed to explore changes in attachment security in a clinical sample of adults who received EMDR therapy for symptoms of posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD). It also explored the quality of the therapeutic alliance in relation to changes in attachment security. A within-subject, repeated-measures design was used. Eighteen participants received fifteen EMDR sessions on average and completed self-report measures of attachment, PTSD, CPTSD, and therapeutic alliance. A decrease in attachment insecurity was observed. Changes in attachment security were partially associated with the quality of the therapeutic alliance and changes in symptomatology. This study contributes to the emerging literature on change in attachment and EMDR therapy.
Burger, S. R., Hardy, A., van der Linden, T., van Zelst, C., de Bont, P. A. J., van der Vleugel, B., Staring, A. B. P., de Roos, C., de Jongh, A., Marcelis, M., van Minnen, A., van der Gaag, M., & van den Berg, D. P. G. (2023). The bumpy road of trauma-focused treatment: Posttraumatic stress disorder symptom exacerbation in people with psychosis. J Trauma Stress. https://doi.org/10.1002/jts.22907
Open Access: https://pubmed.ncbi.nlm.nih.gov/36719408
Simone R. Burger, Room MF-B543, Van der Boechorstraat 7 1081 BT Amsterdam, the Netherlands. E-mail: email@example.com
Concern for symptom exacerbation and treatment drop-out is an important barrier to the implementation of trauma-focused therapy (TFT), especially in people with a psychotic disorder. This study, which was part of a multicenter randomized controlled trial, investigated posttraumatic stress disorder (PTSD) symptom exacerbation during eye movement desensitization reprocessing (EMDR) therapy and prolonged exposure (PE) in a sample of 99 participants with PTSD and psychosis. Symptom exacerbations during the first four sessions (early exacerbation) and between-session exacerbations over the course of therapy were monitored using the PTSD Symptom Scale-Self Report. Analyses of covariance and chi-square tests were conducted to investigate exacerbation rates and their associations with treatment response and drop-out. Both early exacerbation and between-session exacerbation were relatively common (32.3% and 46.5%, respectively) but were unrelated to poor treatment response or an increased likelihood of treatment drop-out. Both clinicians and patients need to be aware that symptom exacerbation during TFT is common and not related to poor outcomes. Symptom exacerbation can be part of the therapeutic process, should be acknowledged and guided, and should not be a barrier to the implementation of TFT in people with psychosis.
Caille, A., Allemang-Trivalle, A., Blanchin, M., Rebion, A., Sauvaget, A., Gohier, B., Birmes, P., Bui, E., Fakra, E., Krebs, M.-O., Lemogne, C., Prieto, N., Jalenques, I., Vidailhet, P., Aouizerate, B., Hingray, C., & El-Hage, W. (2023). EMDR for symptoms of depression, stress and burnout in health care workers exposed to COVID-19 (HARD): A study protocol for a trial within a cohort study. European Journal of Psychotraumatology, 14(1). https://doi.org/10.1080/20008066.2023.2179569
Open Access: http://dx.doi.org/10.1080/20008066.2023.2179569
Wissam El-Hage, UMR 1253, iBrain, Université de Tours, Inserm, 37000 Tours, France; Centre Régional de Psychotraumatologie CVL, CHRU de Tours, 37000 Tours, France. E-mail: firstname.lastname@example.org
Background: Stressful events during a pandemic are a major cause of serious health problems, such as burnout, depression and posttraumatic stress disorder (PTSD) among health care workers (HCWs). During three years, HCWs, on the frontline to fight the COVID-19 pandemic, have been at an increased risk of high levels of stress, anxiety, depression, burnout and PTSD. Regarding potential psychological interventions, Eye Movement Desensitization & Reprocessing (EMDR) is a structured, strongly recommended therapy based on its well- known efficacy in reducing PTSD symptoms and anxiety.
Objectives: This study, designed as a trial within a cohort (TwiC), aims to 1) estimate the prevalence of depression, burnout and PTSD in a sample of HCWs after experiencing the COVID-19 emergency (cohort part) and 2) assess the efficacy and acceptability of ‘EMDR + usual care’ for HCWs from the cohort who report significant psychological symptoms (trial part). Methods: The study, designed as a TwiC, consists of a prospective cohort study (n = 3000) with an embedded, pragmatic, randomized open-label superiority trial with two groups (n = 900). Participants included in the trial part are HCWs recruited for the cohort with significant symptoms on at least one psychological dimension (depression, burnout, PTSD) at baseline, 3 months or 6 months, determined by using the Patient Health Questionnaire (PHQ-9), Professional Quality of Life (ProQOL) scale, and PTSD Checklist for the DSM-5 (PCL-5). The intervention consists of 12 separate EMDR sessions with a certified therapist. The control group receives usual care. The trial has three primary outcomes: changes in depression, burnout and PTSD scores from randomization to 6 months. All participants are followed up for 12 months.
Conclusions: This study provides empirical evidence about the impact of the COVID-19 pandemic and the mental health burden it places on HCWs and assesses the effectiveness of EMDR as a psychological intervention.
Trial registration NCT04570202
Carvalho, E. R., & Hoersting, R. C. (2023). The TraumaClinic Model of EMDR Basic Training in Brazil: A Country Case Study for In-Person and Online Training. Journal of EMDR Practice and Research, EMDR-2022. https://doi.org/10.1891/emdr-2022-0052
Esly Regina Carvalho, PhD, TEP, Training and Clinical Director, TraumaClinic. E-mail: email@example.com
This article utilizes a country case study design to describe the implementation of eye movement desensitization and reprocessing (EMDR) therapy training in Brazil. The primary focus is on the methodology, adaptations, adjustments, and cultural considerations necessary to incorporate in-person and virtual training in this country. Additionally, the article will explore the impact of the Covid-19 pandemic to address National Government Guidance related to social distancing. This guidance required adjustments to training delivery, clinical and self-practice, clinical supervision, and consultation. Finally, the article outlines the advantages and disadvantages of implementing EMDR therapy training in Brazil, expanding to how models of good practice could be implemented in other countries, such as Angola and Mozambique, to include cultural adaptation, sensitivity, and replication.
Cassidy, G. P., McQuaid, J., Heatherington, L., & Su, C. J. (2023). Asylee perspectives on psychotherapies for posttraumatic stress. J Trauma Stress. https://doi.org/10.1002/jts.22917
Galen Cassidy, Department of Psychology, University of Texas, Austin, 108 E. Dean Keaton A8000, Austin, TX, 78712, USA. E-mail: firstname.lastname@example.org
Asylees (i.e., asylum seekers) have a higher prevalence of mental health concerns, particularly posttraumatic distress, than the general population due to both their exposure to traumatic experiences and prolonged uncertain status in a new country. Meta-analyses of randomized controlled trials with asylees have found that culturally adapted cognitive behavioral therapy (CA-CBT), eye movement desensitization and reprocessing (EMDR), and narrative exposure therapy (NET) are efficacious in treating trauma-related symptoms and posttraumatic stress disorder (PTSD); however, treatment utilization remains low. Thus, it is imperative to determine what PTSD interventions are effective, credible, and acceptable for asylees. We employed structured virtual interviews with 40 U.S. asylees from diverse countries living with one or more symptoms of PTSD. Participants were asked about treatment engagement, perceived barriers to treatment, goals for psychotherapy, and perceptions of the effectiveness and difficulty of engaging in CA-CBT, EMDR, NET, and (non-exposure-based) interpersonal therapy (IPT) for PTSD. Participants perceived IPT to be significantly less difficult than all exposure-based treatments, with medium effect sizes, ds = 0.55-0.71. A qualitative analysis of asylees' comments provided valuable insights into how they think about these treatments. Ways in which these results can be considered when informing recommendations for improving interventions for asylees are discussed.
Cowling, M. M., & Anderson, J. R. (2023). The effectiveness of therapeutic interventions on psychological distress in refugee children: A systematic review. J Clin Psychol. https://doi.org/10.1002/jclp.23479
Open Access: https://pubmed.ncbi.nlm.nih.gov/36634291
Joel R. Anderson, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne Campus (St Patrick), Locked Bag 4115, Melbourne, Victoria 3065, Australia. E-mail: Joel.Anderson@acu.edu.au
OBJECTIVE: To systematically review existing research exploring the effectiveness of psychological interventions in reducing symptoms of distress amongst refugee and asylum-seeker children. METHOD: Six databases were searched to identify English studies presenting original empirical quantitative data (published before September 2022) testing the efficacy of psychological interventions for children from refugee and asylum-seeking backgrounds. Quality of studies were assessed through the Appraisal Tool for Cross-Sectional Studies as well as the Cochrane Risk of Bias Tool. Relevant data were extracted to facilitate a narrative synthesis.
RESULTS: Seventy-one eligible articles were identified (n > 10,000). A number of cognitive-behavioral, psychosocial, and trauma-focused interventions that catered specifically to children and their families were identified. A synthesis of these results suggest that interventions may assist in the reduction of various psychopathologies, although the effects were mixed across intervention types.
CONCLUSIONS: While the review yielded promising findings, most findings were derived from small pilot and empirical studies, leading to difficulties with drawing conclusions. There remains a need for studies using more rigorous research methodologies to expand and ratify this valuable knowledge base.
CLINICAL SIGNIFICANCE: Forced displacement is at an all-time high. Many children are being forced to seek asylum and refuge, and they become vulnerable to the development of poor mental health, with limited understanding surrounding how to appropriately intervene. This review aims to equip clinicians with increased knowledge and confidence in working therapeutically alongside clients from refugee or asylum-seeking background, with the goal of fostering positive mental health and wellbeing.
Edwards, K. E., & Wills-Rinaldi, K. A. (2023). Integrating Eye Movement Desensitization and Reprocessing (EMDR) into a Bereavement Program for Complicated Grief and Bereavement (FR221B). Journal of Pain and Symptom Management, 65(3), e288. https://doi.org/10.1016/j.jpainsymman.2022.12.099
Outcomes: 1. Name two trauma related factors that can complicate grief 2. Describe how to integrate eye movement desensitization and reprocessing therapy into a treatment framework for complicated grief and loss Eye movement desensitization and reprocessing (EMDR), initially founded by Dr. Francine Shapiro, is an interactional, standardized treatment approach. Its use has been empirically validated in over 40 randomized controlled studies with trauma patients. EMDR is a comprehensive psychotherapy model that accelerates the treatment of a wide range of patient difficulties related to disturbing past events and present life conditions. Because the bereavement period can be associated with disturbing past events, EMDR can be integrated into the treatment of grief to process distressing memories and present triggers. Through EMDR, the bereaved can assimilate and accommodate the loss more readily. Yale New Haven Health—Bridgeport Hospital developed a pilot bereavement screening program in 2017 and a sustained program in 2019 for the families of those patients not enrolled in hospice at the time of the patient's death. In November of 2021, the palliative care social worker obtained training in EMDR, and has been integrating this modality in bereavement work. Since her training, almost 400 families have been referred to our bereavement screening program. Of those, a smaller percentage have gone on to individual therapy, but EMDR has been applicable in almost 50% of those in individual therapy for complicated grief. Using case examples, the EMDR treatment protocol will be highlighted with the Adaptive Information Processing model, which addresses the unprocessed memories that appear to set the basis for a wide range of current dysfunction. Two cases will be discussed in depth, outlining the eight phases of EMDR therapy for each patient that was seen. Referral criteria, presenting issues, treatment, and outcomes will be discussed, with particular attention to the applicability of this model for marginalized groups. The case presentations will highlight the rapid post-treatment EMDR effects, which are particularly potent and speak to its efficacious treatment.
Endhoven, B., De Cort, K., Matthijssen, S. J. M. A., de Jongh, A., van Minnen, A., Duits, P., Schruers, K. R. J., van Dis, E. A. M., Krypotos, A. M., Gerritsen, L., & Engelhard, I. M. (2023). Eye movement desensitization and reprocessing (EMDR) therapy or supportive counseling prior to exposure therapy in patients with panic disorder: study protocol for a multicenter randomized controlled trial (IMPROVE). BMC Psychiatry, 23(1), 157. https://doi.org/10.1186/s12888-022-04320-4
Open Access: https://pubmed.ncbi.nlm.nih.gov/36918861
Bart Endhoven, Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508, TC Utrecht, The Netherlands. E-mail: email@example.com
BACKGROUND: Exposure-based therapy is the treatment of choice for anxiety disorders, but many patients do not benefit sufficiently from it. Distressing images of threat related to the future or past may maintain the anxiety symptomatology or impede exposure therapy. An intervention that targets threat-related imagery is eye movement desensitization and reprocessing (EMDR) therapy. The main goal of this multicenter randomized controlled trial is to investigate whether EMDR therapy plus exposure therapy, relative to supportive counseling plus exposure therapy, improves treatment efficacy, tolerability, and adherence in patients with panic disorder. In addition, we will examine potential predictors of optimal treatment allocation, mechanisms of change as well as the long term effects of treatment. Finally, we will assess cost-effectiveness. METHODS: A multicenter randomized controlled trial mixed design will be conducted. Participants will be 50 patients, aged ≥ 18, diagnosed with a panic disorder. They will be randomly assigned to one of two conditions: EMDR therapy (i.e., flashforward strategy) or supportive counseling (each consisting of four weekly sessions of 90 min each) prior to exposure therapy (consisting of eight weekly sessions of 90 min each). Assessments will be made pre-treatment (T1), between-treatments (T2), post-treatment (T3), one month post-treatment (FU1) and six months post-treatment (FU2) by an assessor blind to treatment condition. The primary outcome measure is severity of panic-related symptoms. Secondary outcome measures are: tolerability of exposure therapy (initial avoidance, willingness to start exposure therapy, considered drop-out; no-show and drop-out), related symptomatology (generalized anxiety, depression), and functional impairment. DISCUSSION: The primary goals of this research are to compare the efficacy, tolerability, and adherence of EMDR therapy plus exposure therapy and supportive counseling plus exposure therapy and to identify predictors, moderators, and mediators for treatment success. This multi-center research aims to make a significant contribution to our understanding as to how treatment for patients with anxiety disorders can be optimized, and elucidate who can benefit most from this novel approach. TRIAL REGISTRATION: ISRCTN-ISRCTN29668369: Improving anxiety treatment by modifying emotional memories before real-life exposure. Registered 27 June 2022-retrospectively registered. ISRCTN-ISRCTN29668369.
Gathier, A. W., Verhoeven, J. E., van Oppen, P. C., Penninx, B. W. J. H., Merkx, M. J. M., Dingemanse, P., Stehouwer, K. M. K. S., van den Bulck, C. M. M., & Vinkers, C. H. (2023). Design and rationale of the REStoring mood after early life trauma with psychotherapy (RESET-psychotherapy) study: a multicenter randomized controlled trial on the efficacy of adjunctive trauma-focused therapy (TFT) versus treatment as usual (TAU) for adult patients with major depressive disorder (MDD) and childhood trauma. BMC Psychiatry, 23(1), 41. https://doi.org/10.1186/s12888-023-04518-0
Open Access: https://pubmed.ncbi.nlm.nih.gov/36650502
Anouk W. Gathier. E-mail: firstname.lastname@example.org
BACKGROUND: Major depressive disorder (MDD) is a common, recurrent mental disorder and a leading cause of disability worldwide. A large part of adult MDD patients report a history of childhood trauma (CT). Patients with MDD and CT are assumed to represent a clinically and neurobiologically distinct MDD subtype with an earlier onset, unfavorable disease course, stress systems' dysregulations and brain alterations. Currently, there is no evidence-based treatment strategy for MDD that specifically targets CT. Given the central role of trauma in MDD patients with CT, trauma-focused therapy (TFT), adjunctive to treatment as usual (TAU), may be efficacious to alleviate depressive symptoms in this patient population. METHODS: The RESET-psychotherapy study is a 12-week, single-blind, randomized controlled trial testing the efficacy of TFT in 158 adults with moderate to severe MDD, as a 'stand-alone' depression diagnosis or superimposed on a persistent depressive disorder (PDD), and CT. TFT (6-10 sessions of Eye Movement Desensitization and Reprocessing and/or imagery rescripting) + TAU is compared to TAU only. Assessments, including a wide range of psychological/psychiatric and biological characteristics, take place before randomization (T0), during treatment (T1), at post-treatment (T2) and at 6-month follow-up (T3). Pre-post treatment stress-related biomarkers in hair (cortisol) and blood (epigenetics and inflammation) will be assessed to better understand working mechanisms of TFT. A subgroup of 60 participants will undergo structural and functional Magnetic Resonance Imaging (MRI) assessments to determine pre-post treatment brain activity. The primary outcome is self-reported depression symptom severity at post-treatment, measured with the 30-item Inventory of Depressive Symptomatology - Self Report (IDS-SR). DISCUSSION: If adjunctive TFT efficaciously alleviates depressive symptoms in MDD patients with CT, this novel treatment strategy could pave the way for a more personalized and targeted MDD treatment. TRIAL REGISTRATION: ClinicalTrials.gov, registered at 08-12-2021, number of identification: NCT05149352.
Gindt, M., Fernandez, A., Zeghari, R., Ménard, M. L., Nachon, O., Richez, A., Auby, P., Battista, M., & Askenazy, F. (2022). A 3-year retrospective study of 866 children and adolescent outpatients followed in the Nice Pediatric Psychotrauma Center created after the 2016 mass terror attack. Front Psychiatry, 13, 1010957. https://doi.org/10.3389/fpsyt.2022.1010957
Open Access: https://pubmed.ncbi.nlm.nih.gov/36569628
Morgane Gindt. E-mail: email@example.com
BACKGROUND: The mass terrorist attack in Nice, France, in July 2016 caused deaths and injuries in a local population, including children and adolescents. The Nice Pediatric Psychotrauma Center (NPPC) was opened to provide mental health care to the pediatric population (0-18 years) who experienced traumatic events. OBJECTIVES: This study describes the specificity of the care pathway for young trauma victims, with an explanation of how the NPPC works during the first three years. METHODS: In this retrospective study, we conducted quantitative and qualitative data collection about new and follow-up consultations, primary and comorbid diagnoses, and the kind of trauma (terrorist attack versus other kinds of trauma). Ethics approval was obtained from the local Ethics committee. RESULTS: 866 children and adolescents were followed in the NPPC. We found a high rate of Post-Traumatic Stress Disorder (PTSD; 71%) in this population with a high rate of comorbidities (67%), mainly sleep disorders (34.7%) and mood and anxiety disorders (16.2%). A high number of children and adolescents impacted by the terrorist attack required follow-up consultations after exposure to the mass terrorist attack, the first care-seeking requests continued to occur three years later, although at a slower rate than in the first and second years. New consultations for other kinds of trauma were observed over time. DISCUSSION: This study supports previous findings on the significant impact of mass trauma in the pediatric population showing even a higher level of PTSD and a high rate of comorbidities. This may be explained by the brutality of the traumatic event, particularly for this age group. The findings of this study have implications for early interventions and long-term care for children and adolescents to prevent the development of chronic PTSD into adulthood.
Guidetti, C., Brogna, P., Chieffo, D. P. R., Turrini, I., Arcangeli, V., Rausa, A., Bianchetti, M., Rolleri, E., Santomassimo, C., Di Cesare, G., Ducci, G., Romeo, D. M., & Brogna, C. (2023). Eye Movement Desensitization and Reprocessing (EMDR) as a Possible Evidence-Based Rehabilitation Treatment Option for a Patient with ADHD and History of Adverse Childhood Experiences: A Case Report Study. J Pers Med, 13(2), 200. https://doi.org/10.3390/jpm13020200
Open Access: https://pubmed.ncbi.nlm.nih.gov/36836434
firstname.lastname@example.org or email@example.com
BACKGROUND: Children with Attention Deficit Hyperactivity Disorder (ADHD) having a history of adverse childhood experiences (ACEs) could be very difficult to treat with standard psychotherapeutic approaches. Some children diagnosed with ADHD may have Post-Traumatic Stress Disorder (PTSD) or have had experienced a significant traumatic event. Trauma and PTSD could exacerbate ADHD core symptoms and be a risk factor of poor outcome response.
OBJECTIVE: to report for the first time the history of a patient with ADHD and ACE successfully treated with an EMDR approach. CONCLUSION: EMDR could be a promising treatment for ADHD children with a history of traumatic experiences in addition to pharmacological treatments.
Hoppen, T. H., Meiser-Stedman, R., Jensen, T. K., Birkeland, M. S., & Morina, N. (2023). Efficacy of psychological interventions for post-traumatic stress disorder in children and adolescents exposed to single versus multiple traumas: meta-analysis of randomised controlled trials. Br J Psychiatry, 1-8. https://doi.org/10.1192/bjp.2023.24
Open Access: https://pubmed.ncbi.nlm.nih.gov/36855922
Thole Hoppen. E-mail: firstname.lastname@example.org
BACKGROUND: Previous meta-analyses of psychotherapies for children and adolescents with post-traumatic stress disorder (PTSD) did not investigate whether treatment efficacy is diminished when patients report multiple (versus single) traumas.
AIMS: To examine whether efficacy of psychological interventions for paediatric PTSD is diminished when patients report multiple (versus single) traumas.
METHOD: We systematically searched PsycInfo, MEDLINE, Web of Science and PTSDpubs on 21 April 2022 and included randomised controlled trials (RCTs) meeting the following criteria: (a) random allocation; (b) all participants presented with partial or full PTSD; (c) PTSD is the primary treatment focus; (d) sample mean age <19 years; (e) sample size n ≥ 20. Trauma frequency was analysed as a dichotomous (single versus ≥2 traumas) and continuous (mean number of exposures) potential moderator of efficacy.
RESULTS: Of the 57 eligible RCTs (n = 4295), 51 RCTs were included in quantitative analyses. Relative to passive control conditions, interventions were found effective for single-trauma-related PTSD (Hedges' g = 1.09; 95% CI 0.70-1.48; k = 8 trials) and multiple-trauma-related PTSD (g = 1.11; 95% CI 0.74-1.47; k = 12). Psychotherapies were also more effective than active control conditions in reducing multiple-trauma-related PTSD. Comparison with active control conditions regarding single-event PTSD was not possible owing to scarcity (k = 1) of available trials. Efficacy did not differ with trauma exposure frequency irrespective of its operationalisation and subgroup analyses (e.g. trauma-focused cognitive-behavioural therapy only).
CONCLUSIONS: The current evidence base suggests that psychological interventions for paediatric PTSD can effectively treat PTSD in populations reporting single and multiple traumas. Future trials for PTSD following single-event trauma need to involve active control conditions.
Kaptan, S. K., Yilmaz, B., Varese, F., Andriopoulou, P., & Husain, N. (2023). What works? Lessons from a pretrial qualitative study to inform a multi-component intervention for refugees and asylum seekers: Learning Through Play and EMDR Group Traumatic Episode Protocol. J Community Psychol, 51(1), 361-381. https://doi.org/10.1002/jcop.22908
Open Access: https://doi.org/10.1002/jcop.22908
Safa Kemal Kaptan, School of Health Sciences, Manchester Academic Health Science Centre, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
Almost half of the trials failed to recruit their targeted sample size of which 89% could be preventable. Successful implementation of mental health trials in a context of forcibly displaced individuals can be even more challenging. Mental health difficulties have the potential to impact parenting skills, which are linked to poor development in children, while parenting interventions can improve parents' mental health and parenting behaviors. However, the evidence on parenting interventions for refugees is limited. A parenting intervention, Learning Through Play Plus Eye Movement Desensitization and Reprocessing Group Treatment Protocol, has been designed to address parental mental health. This pretrial qualitative study, conducted with refugees, asylum seekers and professionals, aimed to explore their perceptions of the intervention and to identify barriers and recommendations for better engagement, recruitment, and delivery. Three themes were generated from thematic analysis: the content of the intervention, suggestions for improvement and implementation, and understanding the role of the facilitator. These themes provided insights into the issues that might predict the barriers for delivery of the intervention and offered several changes, including destigmatization strategies to improve engagement.
Kip, A., Iseke, L. N., Papola, D., Gastaldon, C., Barbui, C., & Morina, N. (2022). Efficacy of psychological interventions for PTSD in distinct populations - An evidence map of meta-analyses using the umbrella review methodology. Clin Psychol Rev, 100, 102239. https://doi.org/10.1016/j.cpr.2022.102239
Nexhmedin Morina. Institute of Psychology, University of Münster, Fliednerstr. 21, 48149 Münster, Germany. E-mail address: email@example.com
We aimed at mapping the meta-analytic evidence base on the efficacy of psychological treatments for posttraumatic stress disorder (PTSD) in specific populations. We conducted a systematic search until January 2022 in MEDLINE, PsycINFO, PTSDpubs, Web of Science, and the Cochrane Database of Systematic Reviews for meta-analyses of randomized controlled trials. We contrasted all eligible meta-analyses irrespective of overlapping datasets to present a comprehensive overview of the state of research. Reporting quality was assessed using the AMSTAR 2 tool and certainty of evidence was assessed using established umbrella review criteria. Nine meta-analyses with distinct adult populations (51 unique trials) and four with children and adolescents (24 unique trials) were included. Reporting quality of meta-analyses was heterogeneous with risk of bias assessment being rated lowest. The certainty of evidence on the efficacy of psychological interventions for adult populations was thoroughly weak because of small samples and large heterogeneity. In war- and conflict-affected youth, the certainty of evidence was suggestive. Our review highlights the need to improve quality of meta-analyses on treatment efficacy for PTSD. More importantly, however, the findings demonstrate the need for new large-scale trials on the efficacy of treatments for PTSD in distinct populations in order to increase certainty of evidence and to identify potential differences in treatment responses.
Kranenburg, L., Lambregtse-van den Berg, M., & Stramrood, C. (2023). Traumatic Childbirth Experience and Childbirth-Related Post-Traumatic Stress Disorder (PTSD): A Contemporary Overview. Int J Environ Res Public Health, 20(4), 2775. https://doi.org/10.3390/ijerph20042775
Open Access: https://doi.org/10.3390/ijerph20042775
Leonieke Kranenburg, Department of Psychiatry, Section Medical Psychology, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail: Leonieke Kranenburg
With this manuscript we provide an overview of the prevalence, symptoms, risk factors, screening, support, and treatment for women with a traumatic childbirth experience or childbirth-related PTSD. This overview is based on both recent literature and the authors' clinical experiences from the fields of obstetrics, psychiatry and medical psychology to provide up-to-date knowledge about recognizing, preventing and treating CB-PTSD from a clinical perspective. We pay substantial attention to prevention as there are many things health care professionals can do or not do to contribute to a positive childbirth experience, and save women, their infants and families from a sub-optimal start due to childbirth-related trauma.
Leuning, E. M., van den Berk-Smeekens, I., van Dongen-Boomsma, M., & Staal, W. G. (2023). Eye Movement Desensitization and Reprocessing in adolescents with autism; Efficacy on ASD symptoms and stress. Front Psychiatry, 14, 981975. https://doi.org/10.3389/fpsyt.2023.981975
Open Access: https://doi.org/10.3389/fpsyt.2023.981975
Esther Marion Leuning E-mail: firstname.lastname@example.org
INTRODUCTION: Eye Movement Desensitization and Reprocessing (EMDR) is a well-established and thoroughly researched treatment method for posttraumatic stress symptoms. When patients with an autism spectrum disorder (ASD) are treated with EMDR for their Posttraumatic Stress Disorder (PTSD), they sometimes report a decrease in the core symptoms of ASD. This explorative pre-post-follow up design study is designed to investigate whether EMDR with a focus on daily experienced stress, is effective in reducing ASD symptoms and stress in adolescents with ASD.
METHODS: Twenty-one adolescents with ASD (age 12 to 19) were treated with ten sessions EMDR, focusing on events of daily experienced stress.
RESULTS: No significant decrease of ASD symptoms was found on the total score of the Social Responsiveness Scale (SRS) as reported by caregivers from baseline to end measurement. However, there was a significant decrease on total caregivers SRS score comparing the baseline to the follow-up measurement. On two subscales, Social Awareness and Social Communication, a significant decrease was found from baseline to follow-up. On the subscales Social Motivation and Restricted Interests and Repetitive Behavior, no significant effects were found. On pre- and posttest scores of total ASD symptoms measured by the Autism Diagnostic Observation Schedule (ADOS-2), no significant effects were found. On the contrary, scores on self-reported Perceived Stress Scale (PSS) showed a significant decrease from baseline to follow-up. Also, 52% of adolescents showed a significant improvement of global clinical functioning at endpoint measurement on the Clinical Global Impression Improvement, rated by an independent child psychiatrist.
DISCUSSION: In sum, these results of this uncontrolled study suggest a partial effect of EMDR in adolescents with ASD on ASD symptoms, rated by their caregivers. In addition, the results of this study show that EMDR treatment on daily experienced stress significantly reduce perceived stress as reported by the participants, and improves global clinical functioning. The results also suggest a 'sleeper effect', since no significant effects were found between baseline- and post- treatment measurements, but only between baseline- and follow up three months after the treatment. This finding is in line with other studies investigating psychotherapeutic effects in ASD. Implications for clinical practice and suggestions for future research are discussed.
Logsdon, E., Cornelius-White, J. H. D., & Kanamori, Y. (2023). The Effectiveness of EMDR With Individuals Experiencing Substance Use Disorder: A Meta-Analysis. Journal of EMDR Practice and Research, EMDR-2022. https://doi.org/10.1891/emdr-2022-0046
Jeffrey H. D. Cornelius-White, Missouri State University, Counseling Leadership and Special Ed, 901 S. National Ave., Springfield, MO 65897. E-mail: jcornelius-white@ missouristate.edu
The current meta-analysis aims to synthesize existing studies on the effectiveness of both trauma-focused and addiction-focused eye movement desensitization and reprocessing (EMDR) for people with substance use disorder (SUD). Search and selection procedures involved screening 1,733 references, yielding 10 studies published between 2008 and 2021 from 8 countries with 561 participants. After the removal of one outlier study, the results showed EMDR to be effective on a variety of outcomes for people with SUD (n= 9,d= .654, 95% CI [.332, .985],p< .001). Regarding the effects on SUD outcomes, meta-analysis also showed EMDR to be effective (n= 7,d= .580, 95% CI [.209, .951],p= .002). Specifically, EMDR was effective with SUD treatment engagement and severity, but not necessarily the reduction of cravings, and also effective for reducing comorbid posttraumatic and depressive symptoms. This meta-analysis is limited by the number of studies and participants, heterogeneity in methods of included studies, the quality of studies, and other factors.
Magalhães, S. S., Toralles, M. B. P., & Jarero, I. (2022). The ASSYST protocol reduces stress in health care workers in the pandemic. Revista de Ciências Médicas e Biológicas, 21(3), 637-643. https://doi.org/10.9771/cmbio.v21i3.52004
Open Access: http://dx.doi.org/10.9771/cmbio.v21i3.52004
Samildes Magalhães, E-mail: email@example.com.
Introduction: the emergence of cases of COVID-19 led to the emergence of acute stress in the general population, especially in health professionals and, among them, in mental health, who began to have a high demand for care for people suffering from disorders. related to trauma and stressors as a result of: social isolation, hospitalization, deaths, worsening of the financial situation with loss of job, among others.
Objective: this work with the Protocol for the Stabilization of Acute Remote Stress Syndrome in Group Format aims to provide the first psychological care to reduce disturbances and improve adaptive functioning, avoiding the evolution to more dysfunctional psychological conditions such as Post Stress Disorder -Traumatic (PTSD).
Methodology: twenty- three (23) participants (psychologists) were selected and all responded to psychometric assessment scales (HADS and PCL-5) before and after 2 (two) online therapy sessions (videoconference) with application of the protocol.
Results: the regression model shows a mean reduction in the anxiety score of -2.3 (ep 0.9), with p-value = 0.0010; significant; in the depression score, mean of 1.13 (p=0.125); and in the PTSD score, a mean reduction of –9.5 (3.3), with p-value=0.006.
Discussion: the statistical Results revealed an approximation with the Results of the research carried out by Becker et al (2021). According to these authors, no adverse effects were reported by the participants during the intervention, confirming the efficacy, feasibility and safety of ASSYST-RG.
Conclusion: The Results show that ASSYST-RG was effective in reducing anxiety, depression and PTSD.
Mazzoni, G. P., Miglietta, E., Ciulli, T., Rotundo, L., Pozza, A., Gonzalez, A., & Fernandez, I. (2022). Group Eye Movement Desensitization Reprocessing (EMDR) Psychotherapy and Recurrent Interpersonal Traumatic Episodes: A Pilot Follow-Up Study. Clinical Neuropsychiatry, 19(6), 379-389. https://doi.org/10.36131/ cnfioritieditore20220605
Open Access: doi.org/10.36131/cnfioritieditore20220605
Dr Elisabetta Miglietta, PhD, Studi Cognitivi, Cognitive Psychotherapy and Research Center, Florence, Italy. E-mail: firstname.lastname@example.org
Objective: To explore the acceptability and the effectiveness of an Eye Movement Desensitization Reprocessing Integrative Group Treatment Protocol (EMDR-IGTP) for patients with a history of recurrent traumatic episodes of interpersonal nature.
Method: Seven women were recruited from a Trauma Centre and were offered EMDR-IGTP, consisting of 10 semi-structured group sessions. Participants were assessed through a set of standardised clinical measures before the treatment, at the end of it, and after 1 and 3 months since its conclusion.
Results: EMDR-IGTP was well accepted by all participants. After the intervention and at 1 and 3 months follow-up, patients showed a significant reduction of dissociative symptoms, traumatic symptoms and improved emotional regulation.
Conclusions: This study suggests that GITM-EMDR therapy can be a helpful treatment for people who experienced traumatic episodes of interpersonal nature and supports more extensive research in this direction.
Melegkovits, E., Blumberg, J., Dixon, E., Ehntholt, K., Gillard, J., Kayal, H., Kember, T., Ottisova, L., Walsh, E., Wood, M., Gafoor, R., Brewin, C., Billings, J., Robertson, M., & Bloomfield, M. (2022). The effectiveness of trauma-focused psychotherapy for complex post-traumatic stress disorder: A retrospective study. Eur Psychiatry, 66(1), e4. https://doi.org/10.1192/j.eurpsy.2022.2346
Open Access: https://doi.org/10.1192/j.eurpsy.2022.2346
Michael Bloomfield, E-mail: email@example.com
OBJECTIVE: We retrospectively evaluated the effectiveness of trauma-focused psychotherapy (TF-P) versus stabilization and waiting in a civilian cohort of patients with an 11th version of the international classification of disease (ICD-11) diagnosis of complex post-traumatic stress disorder (CPTSD).
METHODS: We identified patients with CPTSD treated at a specialist trauma service over a 3-year period by triangulating evidence from self-report questionnaires, file review, and expert-clinician opinion. Patients completed a phase-based treatment: stabilization consisting of symptom management and establishing safety, followed by waiting for treatment (phase 1); individual TF-P in the form of trauma-focused cognitive behavioral therapy (TF-CBT), or eye movement desensitization and reprocessing (EMDR) or TF-CBT plus EMDR (phase 2). Our primary outcome was PTSD symptoms during phase 2 versus phase 1. Secondary outcomes included depressive symptoms, functional impairment, and a proxy CPTSD measure. Exploratory analysis compared outcomes between treatments. Adverse outcomes were recorded.
RESULTS: Fifty-nine patients were included. Compared to receiving only phase 1, patients completing TF-P showed statistically significant reductions in PTSD [t(58) = -3.99, p < 0.001], depressive symptoms [t(58) = -4.41, p < 0.001], functional impairment [t(58) = -2.26, p = 0.028], and proxy scores for CPTSD [t(58) = 4.69, p < 0.001]. There were no significant differences in outcomes between different treatments offered during phase 2. Baseline depressive symptoms were associated with higher PTSD symptoms and functional impairment.
CONCLUSIONS: This study suggests that TF-P effectively improves symptoms of CPTSD. However, prospective research with validated measurements is necessary to evaluate current and new treatments and identify personal markers of treatment effectiveness for CPTSD.
Morris, H., Hatzikiriakidis, K., Dwyer, J., Lewis, C., Halfpenny, N., Miller, R., & Skouteris, H. (2022). Early intervention for residential out-of-home care staff using eye movement desensitization and reprocessing (EMDR). Psychol Trauma. https://doi.org/10.1037/tra0001418
Heather Morris, Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia. E-mail: firstname.lastname@example.org
OBJECTIVE: Residential out-of-home care (OoHC) staff regularly experience workplace-related trauma. This may contribute to the future development of a trauma- or stressor-related disorder. Eye movement desensitization and reprocessing (EMDR) is an effective treatment for stress disorders but is largely unstudied in OoHC staff. The objective of the current study was to determine if EMDR, provided early within 3 months of an incident, reduced trauma symptom severity in OoHC staff.
METHOD: During a 3-year pilot study (2018-2020), a trained clinician delivered the Recent Traumatic Episode Protocol (R-TEP) and Group Traumatic Episode Protocol (G-TEP) EMDR to OoHC staff from one community service organization in Victoria, Australia. Retrospective data from the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) were deidentified and analyzed using descriptive statistics and analysis of variance. Due to the COVID-19 pandemic, individual EMDR (R-TEP) was provided via telehealth in 2020 in comparison with face-to-face sessions during 2018-2019.
RESULTS: Overall, a significant decrease in PCL-5 scores was seen from baseline to follow up, and staff who received R-TEP or G-TEP experienced reductions in symptoms. Both face-to-face and online modalities showed significant reductions in PCL-5 scores. No significant differences were found between the online or face-to-face modes of delivery, suggesting both options are effective. No adverse reactions were reported among the 144 staff who participated.
CONCLUSION: This study provides evidence for the efficacy of EMDR in reducing traumatic stress symptom severity for residential OoHC staff. A larger, prospective research study is needed.
Palmisano, A. N., Meshberg-Cohen, S., Petrakis, I. L., & Sofuoglu, M. (2023). A systematic review evaluating PTSD treatment effects on intermediate phenotypes of PTSD. Psychol Trauma. https://doi.org/10.1037/tra0001410
Correspondence concerning this article should be addressed to Alexandra N. Palmisano, Yale University, National Center for PTSD, Errera Community Care Center, 200 Edison Road, Room 1319, Orange, CT 06516, United States. E-mail: alexandra.palmisano@ yale.edu
Objective: Although the efficacy of evidence-based treatments for posttraumatic stress disorder (PTSD) has been well established, high rates of treatment dropout and/or nonresponse or under-response to treatment suggest a need to explore novel treatment approaches. Most current research has focused on DSM-based categorical outcomes as primary indicators of treatment response, which may obscure the phenotypic heterogeneity of PTSD and limit the ability to map symptoms to underlying neurobiology. This systematic review aimed to identify intermediate phenotypes (IPs) of PTSD and evaluate IP sensitivity to PTSD treatments.
Method: Five databases were searched for empirical studies published in English between January 1, 2010 and August 1, 2022 examining behavioral and pharmacological PTSD treatment effects on biobehavioral PTSD outcomes.
Results: Twenty-two studies met the inclusion criteria. Most studies evaluated behavioral treatment outcomes (n = 20), while only two studies evaluated pharmacological interventions. Five PTSD IPs were identified, including “impairments in working memory,” “alterations in cognitive control,” “unstable threat processing,” “heightened fear or startle response,” and “disturbances in sleep and wakefulness.” This review offers preliminary support to suggest the utility of IP measures in assessing treatment efficacy; however, risk of bias and methodological limitations constrain the validity and generalizability of the results.
Conclusions: The paucity of research combined with the heterogeneity of study methodologies and significant study limitations makes it difficult to draw strong conclusions regarding IP sensitivity to treatment. However, the existing body of research incorporating this framework shows potential for the IP approach to improve the translation of treatment efficacy from clinical trials to clinical settings.
Pierce, Z. P., Johnson, E. R., Kim, I. A., Lear, B. E., Mast, A. M., & Black, J. M. (2023). Therapeutic interventions impact brain function and promote post-traumatic growth in adults living with post-traumatic stress disorder: A systematic review and meta-analysis of functional magnetic resonance imaging studies. Frontiers in Psychology, 14. https://doi.org/10.3389/fpsyg.2023.1074972
Open Access: https://doi.org/10.3389/fpsyg.2023.1074972
Zachary P. Pierce, E-mail: email@example.com
Introduction: The present systematic review and meta-analysis explores the impacts of cognitive processing therapy (CPT), eye movement desensitization and reprocessing (EMDR), and prolonged exposure (PE) therapy on neural activity underlying the phenomenon of post-traumatic growth for adult trauma survivors.
Methods: We utilized the following databases to conduct our systematic search: Boston College Libraries, PubMed, MEDLINE, and PsycINFO. Our initial search yielded 834 studies for initial screening. We implemented seven eligibility criteria to vet articles for full-text review. Twenty-nine studies remained for full-text review after our systematic review process was completed. Studies were subjected to several levels of analysis. First, pre-and post- test post-traumatic growth inventory (PTGI) scores were collected from all studies and analyzed through a forest plot using Hedges’ g. Next, Montreal Neurological Institute (MNI) coordinates and t-scores were collected and analyzed using an Activation Likelihood Estimation (ALE) to measure brain function. T-scores and Hedges’ g values were then analyzed using Pearson correlations to determine if there were any relationships between brain function and post-traumatic growth for each modality. Lastly, all studies were subjected to a bubble plot and Egger’s test to assess risk of publication bias across the review sample.
Results: Forest plot results indicated that all three interventions had a robust effect on PTGI scores. ALE meta-analysis results indicated that EMDR exhibited the largest effect on brain function, with the R thalamus (t=4.23, p<0.001) showing robust activation, followed closely by the R precuneus (t=4.19, p<0.001). Pearson correlation results showed that EMDR demonstrated the strongest correlation between increased brain function and PTGI scores (r=0.910, p<0.001). Qualitative review of the bubble plot indicated no obvious traces of publication bias, which was corroborated by the results of the Egger’s test (p=0.127).
Discussion: Our systematic review and meta-analysis showed that CPT, EMDR, and PE each exhibited a robust effect on PTG impacts across the course of treatment. However, when looking closer at comparative analyses of neural activity (ALE) and PTGI scores (Pearson correlation), EMDR exhibited a more robust effect on PTG impacts and brain function than CPT and PE.
Porter, J. L. B. (2022). EMDR therapy with people who have intellectual disabilities: process, adaptations and outcomes. Advances in Mental Health and Intellectual Disabilities, 16(1), 32-43. https://doi.org/10.1108/amhid-07-2021-0033
Joanne L.B. Porter. E-mail: firstname.lastname@example.org
Purpose Emerging evidence indicates that adapted eye movement desensitisation and reprocessing (EMDR) can be useful for people with intellectual disabilities in treating post-traumatic stress disorder (PTSD). However, the required adaptations are not described in enough detail across the literature, making it difficult for therapists to easily adapt EMDR for people with intellectual disabilities. This paper aims to address this by describing 14 clinical cases, along with outcome data for six people, and the views of five people with intellectual disabilities about EMDR.
Design/methodology/approach A total of 14 people with mild or moderate intellectual disabilities and varied experiences of trauma were offered EMDR by one clinical psychologist in a UK NHS setting; nine people completed EMDR therapy, six people provided outcome data with pre-post measures and five people were asked two questions about EMDR therapy.
Findings Adaptations are described. The outcome data indicate reductions in symptoms of PTSD following EMDR intervention. EMDR was liked and perceived as useful.
Originality/value This paper provides details about adaptations that can be made to the standard EMDR protocol, reports the views of service users about EMDR and adds evidence that EMDR reduces symptoms of PTSD in people who have intellectual disabilities.
Rousseau, P. F., Malbos, E., Verger, A., Nicolas, F., Lançon, C., Khalfa, S., & Guedj, E. (2019). Increase of precuneus metabolism correlates with reduction of PTSD symptoms after EMDR therapy in military veterans: an 18F-FDG PET study during virtual reality exposure to war. Eur J Nucl Med Mol Imaging, 46(9), 1817-1821. https://doi.org/10.1007/s00259-019-04360-1
Areej Salem Almehdar, College of Social Sciences, University of Jeddah, KSA. E-mail: email@example.com
PURPOSE: The prevalence of posttraumatic stress disorder (PTSD) is higher among veterans, and can lead to disastrous consequences such as suicide. Eye movement desensitization and reprocessing (EMDR) is recommended in first-line psychotherapies for PTSD. Virtual reality exposure (VRE) coupled with 18F-FDG PET imaging can highlight the activated brain regions during stress exposure. The objective of this study is to identify, after EMDR therapy, the regions of brain metabolism that evolve during the stress exposure of a war scene with symptomatic remission in a group of military veterans suffering from PTSD, and to secondarily search for predictive metabolic features.
METHODS: We recruited 15 military veterans suffering from PTSD who performed an ^18^F-FDG PET sensitized by the exposure to a virtual war scene, before (T0) and after (T1) EMDR therapy. Statistical parametric mapping was used to compare brain metabolism before and after treatment and to study correlations between metabolism and evolution scores on PTSD clinical scales (PTSD Checklist Scale, PCLS; Clinician-Administered PTSD Scale, CAPS).
RESULTS: The metabolic activity of the precuneus was increased after EMDR therapy (p < 0.005 uncorrected, k > 180) and correlated with clinical improvement with the CAPS scale (r = -0.73 and p < 0.001). Moreover, the precuneus metabolic value before therapy predicted the clinical improvement on the PCLS scale (T1-T0) after EMDR (r = -0.667 and p < 0.006).
CONCLUSION: The clinical improvement in military patients with PTSD after EMDR is related to increased precuneus metabolism upon VR stress exposure.
Ruisch, J. E., Nederstigt, A. H. M., van der Vorst, A., Boersma, S. N., Vink, M. T., Hoeboer, C. M., Olff, M., & Sobczak, S. (2023). Treatment of post-traumatic stress disorder in people with dementia: a structured literature review. Psychogeriatrics. https://doi.org/10.1111/psyg.12951
Open Access: https://doi.org/10.1111/psyg.12951
Dr. J.E. Ruisch, MD, School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology Maastricht, The Netherlands. E-mail: firstname.lastname@example.org
Post-traumatic stress disorder (PTSD) is associated with cognitive dysfunctions and is an independent risk factor for dementia. A recent study has found the prevalence of PTSD in people with dementia is 4.7%-7.8%. However, little is known about the effectiveness of PTSD treatment for people with dementia. The primary aim of the current study is to review previous studies on the treatment of PTSD in people with dementia. A structured literature review was performed using a 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' analysis in PubMed, Embase, PsycINFO and CINAHL. Two independent researchers screened titles and abstracts. The inclusion criteria were: PTSD symptoms present, diagnosis of dementia, PTSD treatment form described and effects of the treatment mentioned. Articles that matched these criteria were included and content and quality were analyzed. We included nine articles, all case reports, with a total of 11 cases. The discussed treatment options are eye movement desensitisation and reprocessing (EMDR) (n = 3), prolonged exposure (n = 1), cognitive behavioural therapy (n = 1) and pharmacological treatment (n = 4). All articles reported a positive effect of the intervention on several monitored symptoms. Evidence for positive effects and feasibility of EMDR were most reliable, and it was applied in two articles of sufficient quality published in 2018 and 2019. EMDR 'on-the-spot' was described with positive effect in one article in which three cases were discussed. The quality of included papers ranged from insufficient to sufficient. This review shows that people with PTSD and dementia can benefit from PTSD treatment. EMDR, prolonged exposure, acceptance and commitment therapy and pharmacological treatment are applicable in this population. EMDR treatment is most described in this population (n = 5) and shows positive results, and the studies are of sufficient quality (n = 3). Further research in the form of a randomised controlled trial is required to study the effectivity of different treatment interventions in this population.
Sgualdini, E., Favaro, N., Dal Lago, D., Cibin, M., & Chiamulera, C. (2023). A randomized study to compare the effects of EMDR added to TAU on substance memory in a residential addiction setting. Journal of Substance Use, 1-8. https://doi.org/10.1080/14659891.2023.2166611
Cristiano Chiamulera, Department Diagnostic & Public Health, Università degli Studi di Verona, Policlinico ‘GB Rossi’, P. le Scuro 10, Verona 37135, Italy. E-mail: email@example.com
Background: The “Eye Movement Desensitisation and Reprocessing” (EMDR) is a therapy targeting traumatic memories. Although memories from their substance use memory may increase the risk of relapse, only a few studies investigated the effects of EMDR in addiction.
Methods: Individuals with substance use disorders (SUD) receiving TAU in a residential setting were randomized for EMDR in conjunction with TAU (EMDR + TAU) and TAU groups. Craving for the substance, substance target memory features, relapse rates and other measures of EMDR efficacy were assessed after intervention at 6 weeks (T1) and 6-month follow-up (T2).
Results: EMDR + TAU significantly suppressed substance craving, pleasantness, and target memory vividness at T1, but increased substance unpleasant scores. EMDR effects were also significantly observed at T2 for pleasantness and vividness. EMDR + TAU group showed high scores and reported benefits from EMDR, but not significant differences in relapse rate, vs. TAU group.
Conclusion: Our study suggests that EMDR + TAU in SUD inpatient in a residential setting may reduce substance craving, and in the meantime, provides proof-of-concept on targeting substance memory.
Srikosai, S., Khamfou, C., Thakham, A., Wongmueang, J., Thippunya, K., Wongpothi, U., & Tailangkha, P. (2003). A Pilot Study of Therapeutic Benefits From Eye Movement Desensitization and Reprocessing Psychotherapy in Major Depressive Disorder Associated with Post-Traumatic Stress Disorder. International Journal of Scientific Research, 12(1). https://doi.org/10.36106/ijsr
Open Access: https://doi.org/10.36106/ijsr
Objective: To investigate the therapeutic benefits of EMDR psychotherapy in treating MDD associated with PTSD.
Methods: A pilot study was performed by using standardized EMDR psychotherapy in subjects with MDD associated with PTSD. The inclusion criteria were the followings; (1) Adults aged 18 years old or older, (2) Subjects being treated with antidepressants for at least two months assumably stable blood levels, (3) Subjects with depressive symptoms based upon the Patient Health Questionnaire (PHQ-9) depressive scale, (4) Subjects with positive score for traumatic events based upon the Children's Revised Impact of Events Scale-13 (CERIES-13, Thai version). The subjects were eligible if they fulfilled all four criteria. The subjects were treated with 60-90 minutes of EMDR psychotherapy twice a week for three weeks. The changes in PHQ-9 depressive scale, CERIES-13 scale, and Rosenberg self-esteem scale were obtained before the treatment, at the end of the treatment, and 3 months after treatment. The collective data was analyzed with a Paired t-test.
Results: Eighteen subjects with a mean age of 28 years were enrolled in the study. The subjects had significantly decreased PHQ-9 scale and CERIES-13 scale (mean difference [MD] = -11.47, p<0.001; MD = - 36.47, p<0.001, respectively), and had significantly increased self-esteem scale (MD = 9.13, p<0.001) at 3 months after treatment when compared to prior results.
Conclusion: The study demonstrated the therapeutic benefits of adding EMDR psychotherapy in MDD associated with PTSD patients who were currently treated with antidepressants. The benefits of adding EMDR psychotherapy may possibly reduce depressive symptoms, PTSD symptoms and improve self-esteem in subjects. Further evaluation of the effectiveness of EMDR psychotherapy is in a guaranteed randomized controlled trial method.
Swerdlow, B. A., Baker, S. N., Leifker, F. R., Straud, C. L., Rozek, D. C., & Sippel, L. M. (2023). The impact of trauma-focused psychotherapy for posttraumatic stress disorder on interpersonal functioning: A systematic review and meta-analysis of randomized clinical trials. J Trauma Stress. https://doi.org/10.1002/jts.22906
Lauren M. Sippel, 215 North Main St., White River Junction, VT, USA, 05009. E-mail: firstname.lastname@example.org
Interpersonal functioning is a common concern for people with postttraumatic stress disorder (PTSD) but is not a key target of most trauma-focused psychotherapies (TFPs). We preregistered and undertook a systematic review and meta-analysis of randomized clinical trials (RCTs) examining the efficacy of TFPs for improving interpersonal functioning. Studies were identified through the PTSD Trials Standardized Data Repository, scholarly databases, and the solicitation of unpublished data from the PTSD research community following current PRISMA guidelines. We used random effects meta-analysis to estimate within-group change (i.e., pre- to posttreatment) in interpersonal functioning. Meta-analytic findings yielded a medium total effect of TFP on interpersonal functioning, g = 0.54, 95% CI [0.37, 0.72], with high between-study heterogeneity. Sensitivity analyses yielded substantively equivalent point estimates when outliers were excluded, g = 0.55, and when only the most well-established individual TFPs were included, g = 0.57. In contrast, allocation to a control condition was associated with little average change in interpersonal functioning, g = 0.04 [-0.12, 0.21]. Formal tests did not yield clear evidence of publication bias. Bias-corrected estimates varied but centered around a medium effect, gs = 0.41-1.11. There was a medium-to-large association between change in interpersonal functioning and change in PTSD symptoms, rs = -.35--.44. The extant literature on TFPs and interpersonal functioning is small and heterogeneous, indicating the need for more focused attention on this outcome. Results suggest that, on average, TFPs are moderately efficacious for improving interpersonal functioning; however, additional treatment may be needed to meet the desired level of improvement.
Szeska, C., Mohrmann, H., & Hamm, A. O. (2023). Facilitated extinction but impaired extinction recall by eye movement manipulation in humans - Indications for action mechanisms and the applicability of eye movement desensitization. Int J Psychophysiol, 184, 64-75. https://doi.org/10.1016/j.ijpsycho.2022.12.009
Christoph Szeska. E-mail: email@example.com
Eye movement desensitization and reprocessing (EMDR) therapy utilizes the manipulation of eye movements to reduce affective distress during fear-exposure. Animal research recently suggested a potential neural mechanism underlying these effects, by which increased activity of the superior colliculus (SC), mediating visual attention, increases the inhibition of the basolateral amygdala (BLA), mediating defensive plasticity. We tested such mechanism in forty healthy humans using a multiple-day single-cue fear conditioning and extinction paradigm. The activity of the SC during extinction was experimentally manipulated by eye movements, as half of the participants executed saccadic eye movements (n = 20; major SC involvement), while the other half executed smooth eye pursuits (n = 20; minor SC involvement). Amygdala-mediated fear-potentiated startle responses and fear bradycardia, as well as threat expectancy was analyzed. Saccadic eye movements facilitated the extinction of fear bradycardia and fear-potentiated startle responses. Higher saccadic accuracy and range correlated with reduced fear-potentiated startle. However, during extinction recall, fear-potentiated startle and fear bradycardia resurged and partly reached levels obtained after fear acquisition. Threat expectancy was not affected by different eye movements and was not elevated during extinction recall. Within limitations, results support an inhibitory SC-BLA pathway in humans by which eye movements may reduce low-level defensive responding, but not threat expectancy. Yet, manipulating eye movements during extinction learning seems to impair extinction recall for behavioral and physiological defensive response indices. Thus, increasing SC activity might enhance initial efficacy of exposure treatment, but additional strategies seem necessary for sustained fear attenuation.
Tapp, K., Vereenooghe, L., Hewitt, O., Scripps, E., Gray, K. M., & Langdon, P. E. (2023). Psychological therapies for people with intellectual disabilities: An updated systematic review and meta-analysis. Compr Psychiatry, 122, 152372. https://doi.org/10.1016/j.comppsych.2023.152372
Open Access: https://doi.org/10.1016/j.comppsych.2023.152372
Peter E. Langdon, Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry CV4 7AL, United Kingdom. E-mail address: Peter.Langdon@warwick.ac.uk
Objective: The aim of this systematic review and meta-analysis (PROSPERO 2020 CRD42020169323) was to evaluate the efficacy of psychological therapy for people with intellectual disabilities.
Method: A comprehensive literature search yielded 22,444 studies which were screened for eligibility. Studies were eligible for inclusion if a psychological therapy was delivered to people with intellectual disabilities compared to a group who did not receive the therapy. Thirty-three controlled trials were eligible for inclusion in the review, with 19 included within a DerSimonian-Laird random effects meta-analysis. Subgroup analysis was completed by clinical presentation, and by comparing randomised trials to non-randomised trials, and group- based to individually delivered psychotherapy.
Results: Following the removal of outliers, psychological therapy for a range of mental health problems was associated with a small and significant effect size, g = 0.43, 95% CI [0.20, 0.67], N = 698. There was evidence of heterogeneity and bias due to studies with small sample sizes and a lack of randomisation. Non-randomised studies were associated with a large effect size, g = 0.90, 95% CI [0.47, 1.32], N = 174, while randomised studies were associated with a small effect size, g = 0.36, 95% CI [0.17, 0.55], N = 438, excluding outliers. Individually delivered psychological therapy was associated with a small and non-significant effect size, g = 0.32, 95% CI [− 0.01, 0.65], N = 146, while group-based interventions were associated with a small and significant effect size, g = 0.37, 95% CI [0.05, 0.68], N = 361, again, excluding outliers. Psychological therapy for anger was associated with a moderate effect size, g = 0.60, 95% CI [0.26, 0.93], N = 324, while treatment for depression and anxiety was associated with a small and non-significant effect size, g = 0.38, 95% CI [− 0.10, 0.85], N = 216, after outliers were removed.
Conclusions: Studies are fraught with methodological weaknesses limiting the ability to make firm conclusions about the effectiveness of psychological therapy for people with intellectual disabilities. Improved reporting standards, appropriately powered and well-designed trials, and greater consideration of the nature and degree of adaptations to therapy are needed to minimise bias and increase the certainty of conclusions.
Tcheshmedjiev, I., & Farrell, D. (2023). The Effects of EMDR Therapy on Pregnant Clients With Substance Use Disorders: A Narrative, Scoping Literature Review. Journal of EMDR Practice and Research, EMDR-2022. https://doi.org/10.1891/emdr-2022-0049
Derek Farrell, University of Worcester, Worcester. E-mail: firstname.lastname@example.org
This narrative scoping literature review explores a significant clinical population, pregnant women with co-occurring substance misuse, through the lens of adaptive information processing and the potential for eye movement desensitization and reprocessing (EMDR) therapy intervention. A data search in PubMed, PsychINFO, Web of Knowledge, Science Direct, Cochran, and Scopus databases focusing on literature published within the last 10 years. Due to the distinctiveness of the issue, 10 research articles met the required inclusion criteria. The results confirm that EMDR can deliver effective outcomes for women with co-occurring substance use disorder during pregnancy. However, the rationale for using EMDR as a “sole-treatment” intervention appears insufficient. Instead, there is an argument supporting the utilization of integrative approaches. This review highlights the limited research available for this essential population and discusses the need for further study and investigation.
Ter Heide, F. J. J., de Goede, M. L., van Dam, S., & Ekkers, S. (2022). Development of an online supportive treatment module for moral injury in military veterans and police officers. Front Psychiatry, 13, 890858. https://doi.org/10.3389/fpsyt.2022.890858
Open Access: https://doi.org/10.3389/fpsyt.2022.890858
F. Jackie June ter Heide. E-mail: email@example.com
BACKGROUND: Military members and police officers often operate in high stakes situations and under high levels of physical and psychological stress. Consequently, they may be confronted with morally injurious experiences and develop moral injury. Most treatments for moral injury are cognitive-behavioral, face-to-face treatments, which may be supported by online interventions. Online interventions have shown promise in the treatment of trauma-related psychopathology, but few such interventions for moral injury yet exist.
OBJECTIVE: To develop and conduct a preliminary evaluation of an online treatment module for moral injury in treatment-seeking military veterans and police officers, to be used in conjunction with regular face-to-face treatment.
METHOD: An online module was developed based on the moral injury literature, using elements from seven existing treatments. A preliminary evaluation was conducted using both quantitative and qualitative methods, and focusing on perceived feasibility, acceptability and engagement of the module, as well as potential benefits and harms. The concept module was evaluated by 15 assessors, including patient representatives, multidisciplinary caregivers and experts.
RESULTS: The module was rated favorably, with mean evaluation scores ranging from 7.9 to 8.8 on a 10-point scale. Several suggestions for improvement were made, especially concerning privacy issues, safety instructions, patient-therapist collaborations, and role plays, and the module was adapted accordingly.
CONCLUSION: Using input from literature, patient representatives and experts, we developed an online treatment module for moral injury in military veterans and police officers, to be used in conjunction with face-to-face therapy. Acceptability and feasibility will be further examined in a future pilot study.
Torres, P. B., Ignacio, D. A., & Gottlieb, M. (2023). Reducing the Cost of Caring: Indirect Trauma Exposure on Mental Health Providers. Journal of EMDR Practice and Research, EMDR-2022. https://doi.org/10.1891/emdr-2022-0044
Patricia Bianca Torres. Fielding Graduate University, E-mail: firstname.lastname@example.org
Most mental health clinicians treating trauma survivors are exposed to repeated details of clients’ traumatic experiences, and some of these clinicians may experience symptoms of indirect trauma through vicarious traumatization (VT), which has the potential of negatively impacting professional quality of life (ProQOL). The ProQOL Scale was developed to measure both negative and positive effects of working with those who have experienced traumatic stress. The purpose of this study was to determine if clinicians who are trained in eye movement desensitization and reprocessing (EMDR) therapy, as compared to trauma-focused cognitive behavioral therapy (TF-CBT) and prolonged exposure (PE), would relate to aspects of their ProQOL differently. Second, it was hypothesized that the ProQOL model would predict VT in TF-CBT and PE clinicians, but not in EMDR therapy clinicians. Fifty-four trauma clinicians who reported their primary modality of treatment as EMDR, PE, and TF-CBT were studied. Participants completed a survey that included demographic information, the ProQOL Scale, and the Vicarious Trauma Scale (VTS). Hierarchical ordinary least squared regression revealed that the empirical ProQOL model did not predict VT scores in EMDR therapy clinicians as it did for non-EMDR therapy clinicians. This study implies that there could be aspects of the EMDR therapy methodology that may support a clinician’s healthy worldview when empathetically bonding with traumatized clients, thereby fostering longevity for both clients and clinicians.
Uccellini, O., Benlodi, A., Caroppo, E., Cena, L., Esposito, G., Fernandez, I., Ghazanfar, M., Imbasciati, A., Longo, F., Mazza, M., Marano, G., Nacinovich, R., Pignatto, A., Rolnick, A., Trivelli, M., Spada, E., & Vanzini, C. (2022). 1000 Days: The “WeCare Generation” Program-The Ultimate Model for Improving Human Mental Health and Economics: The Study Protocol. Int J Environ Res Public Health, 19(24), 16741. https://doi.org/10.3390/ijerph192416741
Open Access: https://doi.org/10.3390/ijerph192416741
Emanuele Caroppo. E-mail: email@example.com
INTRODUCTION: The COVID-19 pandemic stressed the necessity of a new resilience of the human population and health system. The program is a new proposal of territorial intervention, with a new paradigm, on the diseases of the human body and mind.
BACKGROUND: In recent decades, the independent strands of investigation on brain plasticity and early trauma consequences have demonstrated that traumatic experiences in the period from pregnancy to the age of 3 years have an enormous impact on an individual's future development, and both physical and mental health. Research shows that adverse child experiences (ACEs) are associated with a strong risk of conditions such as: harmful alcohol use, smoking, illicit drug use, high body-mass index, depression, anxiety, interpersonal violence, cancer, type 2 diabetes, cardiovascular diseases, stroke respiratory diseases and, as a consequence, to a high financial cost in Italy and also across Europe (1-9% GDP) and the USA (total annual costs estimated to be USD 581 billion in Europe and USD 748 billion in North America). All this suggests that an early intervention on that traumatized-slice of population leads to multiplied savings.
METHODS: A multi-center, randomized, controlled trial was designed. The parents of the future neonatal population (from pregnancy to delivery) with trauma will be enrolled, and randomized to treatment, or control arm. The article describes in detail how the primary outpoint (cost to the national health system), and some secondary outpoints, will be collected.
DISCUSSION: An overall rate of return on investment (ROI) statistically significant 13.0% per annum with an associated benefit/cost ratio (BCR) of 6.3 is expected as the primary outcome of the program. Our proposed model predicts a new medical paradigm aiming to empower new generations, with a strong return on economy and health.
van Schie, K., & van Veen, S. C. (2023). Omitting continuous memory recall from dual-task interventions does not reduce intervention effectiveness. Behav Res Ther, 164, 104291. https://doi.org/10.1016/j.brat.2023.104291
Open Access: https://doi.org/10.1016/j.brat.2023.104291
Kevin van Schie. E-mail: firstname.lastname@example.org
In Eye Movement Desensitization and Reprocessing a patient recalls a traumatic memory, while simultaneously performing a dual-task (e.g., making horizontal eye movements, tapping a pattern). Earlier lab studies show that increasing the load of a dual-task -and leaving fewer resources for memory recall-results in larger decreases in memory vividness and emotionality compared to control conditions. Therefore, we investigated whether it is necessary to continuously and deliberately recall the memory next to performing high taxing dual-tasks. In two online experiments, participants (N = 172, N = 198) recalled a negative autobiographical memory and were randomly assigned to (1) Memory Recall + Dual-Tasks, (2) Dual-Tasks Only, or (3) No Intervention Control. The dual-tasks were complex pattern tapping and spelling out loud. Before and after the intervention the memory was rated on vividness, emotionality, and accessibility. High taxing dual-tasks, regardless of whether there was continuous memory recall, resulted in the largest reductions in all dependent variables compared to control. Unexpectedly, there was no evidence that the addition of continuous memory recall added to these reductions. These results suggest that continuous memory recall might not, or only minimally be needed for the beneficial effects of the dual-task procedure in EMDR might not be beneficial per se. We discuss the necessity of memory (re)activation, alternative explanations, and implications for practice.
Wilhelmus, B., Marissen, M. A. E., van den Berg, D., Driessen, A., Deen, M. L., & Slotema, K. (2023). Adding EMDR for PTSD at the onset of treatment of borderline personality disorder: A pilot study. J Behav Ther Exp Psychiatry, 79, 101834. https://doi.org/10.1016/j.jbtep.2023.101834
Bobbie Wilhelmus. E-mail: email@example.com
Background and objectives: Eye movement desensitization and reprocessing (EMDR) is an effective treatment for individuals suffering from posttraumatic stress disorder (PTSD). However, EMDR is not typically offered to people with PTSD who also meet the criteria for borderline personality disorder (BPD). This study examines the feasibility and clinical benefits of EMDR for PTSD delivered in addition to the onset of treatment as usual (TAU) for BPD.
Methods: In a non-concurrent, multiple baseline design, 12 patients with BPD and PTSD received fifteen weekly 45-min sessions of TAU. During this period, eight weekly 90-min EMDR sessions were added. Outcome measures were obtained weekly for self-reported PTSD symptoms (PTSD checklist for DSM-5), levels of psychopathology (Brief Symptom Checklist), and the effect of psychopathology on different areas of life (Sheehan Disability Scale). Results: 9 participants completed the treatment protocol. In the EMDR phase, PTSD severity scores decreased significantly between sessions, while no between-session drop in scores occurred during the TAU only phase. Similar results were obtained for general symptoms and disability. No adverse events were reported. Limitations: Results on the efficacy and safety of EMDR in patients with BPD and PTSD need to be replicated in larger samples and in RCTs before they can be generalized to the entire population.
Conclusions: The results of our study suggest that EMDR may be feasible and effective in reducing PTSD symptoms in patients concurrently receiving BPD treatment. EMDR appears to be a promising intervention for patients with BPD and comorbid PTSD.
Willis, N., Dowling, A. P. C., Deehan, T., & O’Reilly, P. G. (2023). Exploring the Impact of Trauma and the Role of Compassion Before and After a Phase-orientated Intervention for Complex Trauma. European Journal of Trauma & Dissociation, 7(1), 100308. https://doi.org/10.1016/j.ejtd.2022.100308
Niamh Willis, E-mail: firstname.lastname@example.org
This study aimed to explore the impact of trauma exposure in childhood on participants lives before and after having completed a phase-orientated intervention for complex trauma. The symptoms of complex trauma encompass three core features: re-experiencing of the traumatic event in the present, avoidance of traumatic reminders and a sense of current threat as well as three additional elements called disturbances in self-organisation (WHO, 2018). These disturbances include emotion regulation difficulties, negative self-concept and interpersonal difficulties (WHO, 2018). The second aim of this study was to explore the role of a compassion-based approach in responding to these trauma-related difficulties at pre and post intervention stages. Qualitative content analysis was used to develop themes that summarize key findings. 20 semi-structured interviews were conducted at pre and post intervention stages with 10 participants who were presenting with symptoms of complex trauma. The pre-intervention data gave rise to 4 themes. These were 1) impact of trauma understood through comorbid diagnoses and suicidality 2) multifaceted trauma survival strategies 3) difficult relationship with self and 4) complexity of compassionate relating to trauma. The post-intervention data also gave rise to 5 themes which were 5) positive impact on psychological functioning 6) understanding and coping with trauma through compassion focused therapy (CFT) mechanisms 7) group process 8) phase-orientated approach required and 9) further work required. The pre-intervention data indicated that trauma had a widespread negative impact on participant's psychological functioning. The post-intervention data endorsed the trauma intervention as being helpful in alleviating the emotional distress associated with trauma. The combination and sequencing of both CFT and trauma-focused therapy was central to reported improvements in trauma symptoms.
Willis, N., Dowling, A. P. C., & O’Reilly, P. G. (2023). Stabilisation and Phase-Orientated Psychological Treatment for Posttraumatic Stress Disorder: A Systematic Review and Meta-analysis. European Journal of Trauma & Dissociation, 7(1), 100311. https://doi.org/10.1016/j.ejtd.2022.100311
Niamh Willis, E-mail: email@example.com
Background: Severe posttraumatic stress disorder (PTSD) symptoms and the emergence of a complex posttraumatic stress disorder diagnosis (CPTSD), has contributed to clinical practice that is different in format than what is recommended by treatment guidelines for PTSD in adults. Phase-orientated approaches are commonly used with this population with the aim of stabilising trauma symptoms prior to engaging with exposure based trauma-focused treatment.
Objective: This review aimed to synthesise data on standalone stabilisation interventions and stabilisation followed by trauma-focused therapy (i.e. phase-orientated approach), to provide some clarity on the efficacy of these interventions.
Method: A systematic search of the qualitative and quantitative literature found 6,400 articles, of which 31 met predefined criteria. A narrative synthesis approach was used to collate qualitative data. To analyse effect sizes in quantitative studies, a random effects meta-analysis was conducted.
Results: The primary finding from the qualitative studies indicated that group stabilisation interventions are helpful for reducing trauma symptoms and in preparing for trauma-focused therapy. The themes supporting this finding were Group Process, Specific Skills and Psychoeducation, and Motivation and Readiness for Change. A secondary qualitative finding related to the challenges associated with implementing a stabilisation intervention. The themes giving rise to this finding are Stabilisation; A Demanding Process and the Structure of Stabilisation Interventions. A meta-analysis showed a medium effect size for PTSD symptom reduction using stabilisation interventions (d = 0.59 with 95% confidence intervals [CI] ranging from 0.14 to 1.04 (z = 2.58; p < .05). This effect size was reduced to a small effect when utilizing only randomised controlled trial (RCT) stabilisation data (d = 0.42, CI = 0.23 to 0.61, z = 4.37; p > .001).
There were no qualitative studies on phase-orientated treatment approaches found using review search criteria. A large effect size was found for phase-orientated quantitative studies (d = 1.32, CI = 0.88 to 1.76, z = 5.89; p < .001) and this large effect size was maintained using RCT data (d = 1.47, CI = 1.00 to 1.95, z = 6.05; p < 001). There was tentative evidence that phase-orientated treatment is more effective than standalone stabilisation, with a small effect size (d = 0.45, CI = 0.17 to 0.72, z = 3.19; p < .01).
Conclusion: The results of this review are consistent with previous literature supporting the effectiveness of stabilisation and phase-orientated models for reducing PTSD symptoms. Limitations pertaining to the heterogeneity of included studies and the difficulty in identifying which specific psychological models should be utilised in clinical practice as well as the generalisability of the findings to relevant populations are discussed.
Winkler, O., Burback, L., Greenshaw, A. J., & Jin, J. (2023). Shifting to Trauma-Informed Care in Inpatient Psychiatry: A Case Study of an Individual with Dissociative PTSD Undergoing EMDR Therapy. Case Rep Psychiatry, 2023, 8161010. https://doi.org/10.1155/2023/8161010
Open Access: https://doi.org/10.1155/2023/8161010
Caring for patients with personality disorders can be challenging due to risks associated with suicidal ideation, homicidal threats, splitting, and acting out with problematic behavior in psychiatric inpatient units. Limited resources on inpatient units further add to the stress and burden on staff. This case summarizes how trauma-informed care was implemented in an inpatient setting to produce marked improvement in a patient's treatment outcomes as well as better staff engagement and satisfaction. This culture change in the approach to care was not an easy process, as effortful planning and resources were required for key elements such as ongoing coaching, education, and regular staff debriefings. This case report signals the need for service providers to enable health systems to examine rules and exceptions from a cultural perspective of considering equity, diversity, and inclusion (EDI)-to allow openness to rational exceptions, even if they are unconventional.
Wippich, A., Howatson, G., Allen-Baker, G., Farrell, D., Kiernan, M., & Scott-Bell, A. (2023). Eye movement desensitization reprocessing as a treatment for PTSD in conflict-affected areas. Psychol Trauma. https://doi.org/10.1037/tra0001430
Andrea Scott-Bell, Faculty of Health and Life Sciences, Department of Sport, Exercise and Rehabilitation, Northumberland Building 240, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK. E-mail: firstname.lastname@example.org
OBJECTIVE: One recommended psychological intervention for trauma treatment in Western countries, including posttraumatic stress disorder (PTSD), is eye movement desensitization reprocessing (EMDR). However, there is a paucity of data regarding treatment interventions in low- and middle-income countries. This study examined the efficacy of EMDR for treating posttraumatic stress (PTS), anxiety, and depression among a cohort of individuals with low socioeconomic status in a conflict-affected middle-income country as well as a smaller refugee cohort.
METHODS: Two hundred and sixty-eight adults residing in Lebanon (male = 65, female = 203, SD|gender| = 0.43; µ|age| = 30.5, SD|age| = 10.49; 85% Lebanese, 15% refugees [9.3% from Syria, and 5.7% from Iraq, Palestine, the Philippines, and Other]) received EMDR therapy. Measures of PTS, anxiety, and depression were taken at three time points: before treatment (T0), posttreatment (T1), and 6-month follow-up (T2).
RESULTS: Reduction in PTS symptoms from T0 to T1, F|(1, 208)| = 412.3, p < .01, and T1 to T2, F|(1, 46)| = 136.1, p < .01. Reduction in anxiety symptoms from T0 to T1, F|(1, 208)| = 387.0, p < .01, and T1 to T2, F|(1, 46)| = 153.7, p < .01. Similarly, for depression, a reduction of symptoms from T0 to T1, F|(1, 207)| = 309.5, p < .01, and T0 to T2, F|(1, 46)| = 96.0, p < .01.
CONCLUSION: This research supports the use of EMDR for the treatment of PTS, depression, and anxiety symptoms in individuals with low socioeconomic status and refugees, thus contributing to the research base for populations that are under-researched. Mental health services, especially in conflict-affected settings, would benefit from using EMDR therapy to target these pathologies in these populations.
Yakeline, M. A., Fernandez-Gonzalo, S., & Merce, J. V. (2023). Eye movement desensitization and reprocessing (EMDR): Efficacy in improving clinical, neuropsychological, and quality of life in women victims of violence. Journal of Population Therapeutics and Clinical Pharmacology, 30(3), 595-609. https://doi.org/10.47750/jptcp.2023.30.03.062
Open Access: https://doi.org/10.47750/jptcp.2023.30.03.062
Mohammed J.M.Hrwsh, Bio Department, College of Education, Samarra University, E-mail: Nuhaali922@gmail.com
The number of women victims of violence has increased considerably in recent years, causing physical, mental and social damage. In this study, the efficacy of the psychotherapeutic model of Eye Movement Desensitization and Reprocessing (EMDR) was evaluated and compared with narrative exposure therapy (NET) as approaches for improving clinical and neuropsychological aspects and quality of life in abused women. A randomized experimental study was carried out in which 120 women exposed to physical, psychological and sexual violence participated and were assigned to an EMDR or NET group. An extensive battery of clinical, neuropsychological and quality of life tests were used pre- and posttreatment for 10 therapeutic sessions. The results indicated that the group of women exposed to physical and psychological violence who received EMDR therapy achieved a greater decrease in anxiety, depression and posttraumatic symptoms as well as an increase in quality of life, working memory, attentional capacity and processing speed. Compared with that of NET, the efficacy of EMDR was greater, mediated by sociodemographic factors. It is necessary to include protocols for comprehensive health care and psychological first aid for women who are victims of violence.
Yunitri, N., Chu, H., Kang, X. L., Wiratama, B. S., Lee, T. Y., Chang, L. F., Liu, D., Kustanti, C. Y., Chiang, K. J., Chen, R., Tseng, P., & Chou, K. R. (2023). Comparative effectiveness of psychotherapies in adults with posttraumatic stress disorder: a network meta-analysis of randomised controlled trials. Psychol Med, 1-13. https://doi.org/10.1017/S0033291722003737
Open Access: https://doi.org/10.1017/S0033291722003737
Kuei-Ru Chou, E-mail: email@example.com
BACKGROUND: Evidence on the long-term comparative effectiveness of posttraumatic stress disorder (PTSD) psychotherapies in adults remains unknown. Therefore, we performed an extensive network meta-analysis of randomised controlled trials (RCTs) to determine the comparative effectiveness of psychotherapies for people diagnosed with PTSD.
METHODS: A comprehensive search was conducted in Cochrane library, Embase, Medline-OVID, PubMed, Scopus, and Psych-Info until March 2021. Studies on the effectiveness of cognitive processing therapy (CPT), cognitive therapy (CT), eye movement desensitisation reprocessing (EMDR), narrative exposure therapy (NET), prolonged exposure (PE), cognitive behavioural therapy (CBT), present-centred therapy (PCT), brief eclectic psychotherapies (BEP), psychodynamic therapy (PDT) or combination therapies compared to no treatment (NT) or treatment as usual (TAU) in adults with PTSD were included. Frequentist and Bayesian approaches were used for analysis in R-software.
RESULTS: We included 98 RCTs with 5567 participants from 18 897 studies. CPT, EMDR, CT, NET, PE, CBT, and PCT were significant to reduce PTSD symptoms (SMD range: -1.53 to -0.75; Certainty: very low to high) at immediate post-treatment and ranked accordingly. Longitudinal analysis found EMDR (1.02) and CPT (0.85) as the significant therapies with large effect size in short-term and long-term follow-up, respectively. NET and CPT showed higher proportion of loss of PTSD diagnosis (RR range: 5.51-3.45) while there were no significant psychotherapies for retention rate compared to NT.
CONCLUSIONS: Our findings provide evidence for improving current guidelines and informing clinical decision-making for PTSD management. However, the best PTSD treatment plan should be tailored to patients' needs, characteristics, and clinician expertise. REGISTRATION: PROSPERO CRD42020162143.