Video of the month

Andrew M. Leeds, Ph.D. speaking on “Guidelines for clinicians in recommending EMDR for an addict in treatment”. This is one of eight question and answer segments available on the ONE80CENTER YouTube channel.

Bonus free book chapters from Marilyn Luber and Springer Publishing Company

“To better serve the Boston community in the wake of the April 15 events, Springer Publishing Company offers HAP and its EMDR volunteer clinicians free access to three [actually five] chapters.” I do not know how long these PDFs will remain available, so follow the link below quickly if you want to download these helpful chapters (listed below).

Implementing EMDR Early Mental Health Interventions for Man-made and Natural Disasters

Adler-Tapia, R. (In press). Early mental health intervention for first responders/ protective service workers including firefighters and emergency medical services (EMS) professionals.

Alter-Reid, K. (In press). Community trauma: A blueprint for support and treatment for trauma recovery network (TRN) responders from the Newtown, CT tragedy.

Artigas, L., Jarero, I., Alcalá, N., & López Cano, T. (n.d.). (In press). The EMDR integrative group treatment protocol for children (IGTP).

Jarero, I., & Artigas, L. (In press). The EMDR protocol for recent critical incidents (EMDR-PRECI).

Shapiro, E., & Laub, B. (In press). The recent traumatic episode protocol (R-TEP): An integrative protocol for early EMDR intervention (EEI).

Journal Articles

---

Bellecci-St. Romain, L. (2013). EMDR with recurrent flash-forwards: Reflections on Engelhard et al.'s 2011 study. Journal of EMDR Practice and Research, 7(2), 106-111. doi:10.1891/1933-3196.7.2.106

Lisa Bellecci-St. Romain, 221 S. Broadway, Suite 608, Wichita, KS 67202. E-mail: maptlisa@gmail.com

Abstract

“Translating Research Into Practice” is a new regular journal feature in which clinicians share clinical case examples that support, elaborate, or illustrate the results of a specific research study. Each column begins with the abstract of the study, followed by the clinician's description of their own application of standard eye movement desensitization and reprocessing (EMDR) procedures with the population or problem treated in the study. The column is edited by the EMDR Research Foundation with the goal of providing a link between research and practice and making research findings relevant in therapists’ day-to-day practices. In this issue’s column, Lisa Bellecci-St. Romain references Engelhard et al.'s (2011) study examining the impact of eye movements on recurrent, intrusive visual images about potential future catastrophes-“flash-forwards.” Illustrating the findings by Engelhard et al., Bellecci-St. Romain describes the successful use of the EMDR standard protocol in two cases-a woman fearful of returning to work even after past memories are cleared and a young man in early sobriety whose reprocessing of the past is interrupted by concerns of an imminent court appearance. The case examples are followed with a discussion of the importance of recognizing and targeting flash-forwards as present triggers in the three-pronged EMDR standard protocol.

---

Blore, D. C., Holmshaw, E. M., Swift, A., Standart, S., & Fish, D. M. (2013). The development and uses of the blind to therapist EMDR protocol. Journal of EMDR Practice and Research, 7(2), 95-105. doi:10.1891/1933-3196.7.2.95

David Blore, Suite 303, Clifford House, 7-9 Clifford Street, York, YO1 9RA, United Kingdom. E-mail: david.blore@btinternet.com

Abstract

The blind to therapist (B2T) protocol (Blore & Holmshaw, 2009a, 2009b) was devised to circumvent client unwillingness to describe traumatic memory content during eye movement desensitization and reprocessing (EMDR). It has been used with at least six clinical presentations:

• Reassertion of control among “executive decision makers”
• Shame and embarrassment
• Minimizing potential for vicarious traumatization
• Cultural issues: avoiding distress being witnessed by a fellow countryman
• Need for the presence of a translator versus prevention of information “leakage”
• Reducing potential stalling in processing: client with severe stammer

This article details the history, development, and current status of the protocol, and provides case vignettes to illustrate each use. Clinical issues encountered when using the protocol and “dovetailing” the B2T protocol back into the standard protocol are also addressed.

---

Jonas DE, Cusack K, Forneris CA, Wilkins TM, Sonis J, Middleton JC, Feltner C, Meredith D, Cavanaugh J, Brownley KA, Olmsted KR, Greenblatt A, Weil A, Gaynes BN. (2013) Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder (PTSD). Comparative Effectiveness Review No. 92. (Prepared by the RTI International-University of North Carolina Evidence-based Practice Center under Contract No. 290-2007-10056-I.) AHRQ Publication No. 13-EHC011-EF. Rockville, MD: Agency for Healthcare Research and Quality; April 2013.

Free full text available: http://www.ncbi.nlm.nih.gov/books/n/cer92/pdf/

Abstract

Objectives. To assess efficacy, comparative effectiveness, and harms of psychological and pharmacological treatments for adults with posttraumatic stress disorder (PTSD).

Data sources. MEDLINE®, Cochrane Library, PILOTS, International Pharmaceutical Abstracts, CINAHL®, PsycINFO®, Web of Science, Embase, U.S. Food and Drug Administration Web site, and reference lists of published literature (January 1980-May 2012).

Review methods. Two investigators independently selected, extracted data from, and rated risk of bias of relevant trials. We conducted quantitative analyses using random-effects models to estimate pooled effects. To estimate medications’ comparative effectiveness, we conducted a network meta-analysis using Bayesian methods. We graded strength of evidence (SOE) based on established guidance.

Results. We included 92 trials of patients, generally with severe PTSD and mean age of 30s to 40s. High SOE supports efficacy of exposure therapy for improving PTSD symptoms (Cohen’s d -1.27; 95% confidence interval, -1.54 to -1.00); number needed to treat (NNT) to achieve loss of diagnosis was 2 (moderate SOE). Evidence also supports efficacy of cognitive processing therapy (CPT), cognitive therapy (CT), cognitive behavioral therapy (CBT)-mixed therapies, eye movement desensitization and reprocessing (EMDR), and narrative exposure therapy for improving PTSD symptoms and/or achieving loss of diagnosis (moderate SOE). Effect sizes for reducing PTSD symptoms were large (e.g., 28.9- to 32.2-point reduction in Clinician-Administered PTSD Scale [CAPS]; Cohen’s d ~ -1.0 or more compared with controls); NNTs were ≤ 4 to achieve loss of diagnosis for CPT, CT, CBT-mixed, and EMDR.

Evidence supports the efficacy of fluoxetine, paroxetine, sertraline, topiramate, and venlafaxine for improving PTSD symptoms (moderate SOE); effect sizes were small or medium (e.g., 4.9- to 15.5-point reduction in CAPS compared with placebo). Evidence for paroxetine and venlafaxine also supports their efficacy for inducing remission (NNTs ~8; moderate SOE). Evidence supports paroxetine’s efficacy for improving depression symptoms and functional impairment (moderate SOE) and venlafaxine’s efficacy for improving depression symptoms, quality of life, and functional impairment (moderate SOE). Risperidone may help PTSD symptoms (low SOE). Network meta-analysis of 28 trials (4,817 subjects) found paroxetine and topiramate to be more effective than most medications for reducing PTSD symptoms, but analysis was based largely on indirect evidence and limited to one outcome measure (low SOE).

We found insufficient head-to-head evidence comparing efficacious treatments; insufficient evidence to verify whether any treatment approaches were more effective for victims of particular trauma types or to determine comparative risks of adverse effects.

---

Jarero, I., Amaya, C., Givaudan, M., & Miranda, A. (2013). EMDR individual protocol for paraprofessional use: A randomized controlled trial with first responders. Journal of EMDR Practice and Research, 7(2), 55-64. doi:10.1891/1933-3196.7.2.55

Ignacio Jarero, PhD, EdD, Boulevard de la Luz 771, Jardines del Pedregal, Álvaro Obregón, México City 01900. E-mail: nacho@amamecrisis.com.mx

Abstract

The eye movement desensitization and reprocessing (EMDR) individual protocol for paraprofessional use in acute trauma situations (EMDR-PROPARA) is part of a project developed at the initiative of Dr. Francine Shapiro. This randomized clinical trial examined the effectiveness of the protocol administered by experienced EMDR therapists. There were 39 traumatized first responders on active duty randomly assigned to receive two 90-min sessions of either EMDR-PROPARA or of supportive counseling. Participants in the EMDR-PROPARA group showed benefits immediately after treatment, with their scores on the Short PTSD Rating Interview (SPRINT) showing further decreases at 3-month follow-up. In comparison, supportive counseling participants experienced a nonsignificant decrease after treatment and an increase in the SPRINT scores at the second follow-up. The significant difference between the two treatments provides preliminary support for EMDR-PROPARA’s effectiveness in reducing severity of posttraumatic symptoms and subjective global improvement. More controlled research is recommended to evaluate further the efficacy of this intervention.

---

Lobenstine, F., & Courtney, D. (2013). A case study: The integration of intensive EMDR and ego state therapy to treat comorbid posttraumatic stress disorder, depression, and anxiety. Journal of EMDR Practice and Research, 7(2), 65-80. doi:201310.1891/1933-3196.7.2.65

Farnsworth E. Lobenstine, LICSW, 1164 South East St. Amherst, MA 01002. E-mail: farnsloben@gmail.com

Abstract

This study used a quantitative, single-case study design to examine the effectiveness of the integration of intensive eye movement desensitization and reprocessing (EMDR) and ego state therapy for the treatment of an individual diagnosed with comorbid posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD). The participant received 25.5 hr of treatment in a 3-week period, followed with 12 hr of primarily supportive therapy over the next 6-week period. Clinical symptoms decreased as evidenced by reduction in scores from baseline to 6-week follow-up on the following scales: Beck Depression Inventory (BDI) from 46 (severe depression) to 15 (mild mood disorder), Beck Anxiety Inventory (BAI) from 37 (severe anxiety) to 25 (moderate anxiety), and Impact of Events Scale from 50 (severe PTSD symptoms) to 12 (below PTSD cutoff). Scores showed further reductions at 6-month follow-up. Results show the apparent effectiveness of the integration of intensive EMDR and ego state work.

---

van der Hart, O., Groenendijk, M., Gonzalez, A., Mosquera, D., & Solomon, R. (2013). Dissociation of the personality and EMDR therapy in complex trauma-related disorders: Applications in the stabilization phase. Journal of EMDR Practice and Research, 7(2), 81-94. doi:10.1891/1933-3196.7.2.81

Onno van der Hart, PhD, Department of Clinical and Health Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands. E-mail: o.vanderhart@uu.nl

Abstract

As proposed in a previous article in this journal, eye movement desensitization and reprocessing (EMDR) clinicians treating clients with complex trauma-related disorders may benefit from knowing and applying the theory of structural dissociation of the personality (TSDP) and its accompanying psychology of action. TSDP postulates that dissociation of the personality is the main feature of traumatization and a wide range of trauma-related disorders from simple posttraumatic stress disorder (PTSD) to dissociative identity disorder (DID). The theory may help EMDR therapists to develop a comprehensive map for understanding the problems of clients with complex trauma-related disorders and to formulate and carry out a treatment plan. The expert consensus model in complex trauma is phase-oriented treatment in which a stabilization and preparation phase precedes the treatment of traumatic memories. This article focuses on the initial stabilization and preparatory phase, which is very important to safely and effectively use EMDR in treating complex trauma. Central themes are (a) working with maladaptive beliefs, (b) overcoming dissociative phobias, and (c) an extended application of resourcing.

---