EMDR Research News May 2021
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.
Aarts, I., Vriend, C., Snoek, A., van den End, A., Blankers, M., Beekman, A. T. F., . . . Thomaes, K. (2021). Neural correlates of treatment effect and prediction of treatment outcome in patients with PTSD and comorbid personality disorder: study design. Borderline Personal Disord Emot Dysregul, 8(1), 13. doi:10.1186/s40479-021-00156-8
Open access: https://pubmed.ncbi.nlm.nih.gov/33947471
Inga Aarts, Sinai Centrum, Amstelveen, The Netherlands. E-mail: firstname.lastname@example.org
BACKGROUND: Neural alterations related to treatment outcome in patients with both post-traumatic stress disorder (PTSD) and comorbid personality disorder are unknown. Here we describe the protocol for a neuroimaging study of treatment of patients with PTSD and comorbid borderline (BPD) or cluster C (CPD) personality disorder traits. Our specific aims are to 1) investigate treatment-induced neural alterations, 2) predict treatment outcome using structural and functional magnetic resonance imaging (MRI) and 3) study neural alterations associated with BPD and CPD in PTSD patients. We hypothesize that 1) all treatment conditions are associated with normalization of limbic and prefrontal brain activity and hyperconnectivity in resting-state brain networks, with additional normalization of task-related activation in emotion regulation brain areas in the patients who receive trauma-focused therapy and personality disorder treatment; 2) Baseline task-related activation, together with structural brain measures and clinical variables predict treatment outcome; 3) dysfunction in task-related activation and resting-state connectivity of emotion regulation areas is comparable in PTSD patients with BPD or CPD, with a hypoconnected central executive network in patients with PTSD+BPD. METHODS: We aim to include pre- and post-treatment 3 T-MRI scans in 40 patients with PTSD and (sub) clinical comorbid BPD or CPD. With an expected attrition rate of 50%, at least 80 patients will be scanned before treatment. MRI scans for 30 matched healthy controls will additionally be acquired. Patients with PTSD and BPD were randomized to either EMDR-only or EMDR combined with Dialectical Behaviour Therapy. Patients with PTSD and CPD were randomized to Imaginary Rescripting (ImRs) or to ImRs combined with Schema Focused Therapy. The scan protocol consists of a T1-weighted structural scan, resting state fMRI, task-based fMRI during an emotional face task and multi-shell diffusion weighted images. For data analysis, multivariate mixed-models, regression analyses and machine learning models will be used. DISCUSSION: This study is one of the first to use neuroimaging measures to predict and better understand treatment response in patients with PTSD and comorbid personality disorders. A heterogeneous, naturalistic sample will be included, ensuring generalizability to a broad group of treatment seeking PTSD patients. TRIAL REGISTRATION: Clinical Trials, NCT03833453 & NCT03833531 . Retrospectively registered, February 2019.
Bisson, J. I., Wright, L. A., Jones, K. A., Lewis, C., Phelps, A. J., Sijbrandij, M., . . . Roberts, N. P. (2021). Preventing the onset of post traumatic stress disorder. Clin Psychol Rev, 86, 102004. doi:10.1016/j.cpr.2021.102004
Open access: https://pubmed.ncbi.nlm.nih.gov/33857763
Jonathan I. Bisson, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, United Kingdom. E-mail: email@example.com
Post-traumatic stress disorder (PTSD) is a common mental health condition that requires exposure to a traumatic event. This provides unique opportunities for prevention that are not available for other disorders. The aim of this review was to undertake a systematic review and evaluation of randomized controlled trials (RCTs) of interventions designed to prevent PTSD in adults. Searches involving Cochrane, Embase, Medline, PsycINFO, PILOTS and Pubmed databases were undertaken to identify RCTs of pre-incident preparedness and post-incident interventions until May 2019. Six pre-incident and 69 post-incident trials were identified that could be included in meta-analyses. The overall quality of the evidence was low. There was emerging evidence that some interventions may be helpful but an absence of evidence for any intervention that can be strongly recommended for universal, selected or indicated prevention before or within the first three months of a traumatic event. The strongest results were found for cognitive-behavioural therapy with a trauma focus (CBT-T) in individuals with a diagnosis of acute stress disorder which supports calls to detect and treat individuals with significant symptoms rather than providing blanket preventative interventions. Further research is required to optimally configure existing interventions with some evidence of effect and to develop novel interventions to address this major public health issue.
Boterhoven de Haan, K. L., Lee, C. W., Correia, H., Menninga, S., Fassbinder, E., Köehne, S., & Arntz, A. (2021). Patient and Therapist Perspectives on Treatment for Adults with PTSD from Childhood Trauma. J Clin Med, 10(5), 954. doi:10.3390/jcm10050954
Open access: https://pubmed.ncbi.nlm.nih.gov/33804440
Katrina L. Boterhoven de Haan, Faculty of Health and Medical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia. E-mail: firstname.lastname@example.org
This study aimed to explore patients' and therapists' experiences with trauma-focused treatments in patients with posttraumatic stress disorder from childhood trauma (Ch-PTSD). Semi-structured interviews were conducted with patients (n = 44) and therapists (n = 16) from an international multicentre randomised clinical trial comparing two trauma-focused treatments (IREM), imagery rescripting and eye movement and desensitisation (EMDR). Thematic analysis was used to identify key themes within the data. Patients and therapists commented about the process of therapy. The themes that emerged from these comments included the importance of the patients' willingness to engage and commit to the treatment process; the importance and difficulty of the trauma work, observations of how the trauma focused therapy produced changes in insight, and sense of self and empowerment for the future. In addition, therapists made suggestions for optimising the therapist role in the trauma-focused treatment. This included the importance of having confidence in their own ability, confronting their own and their client's avoidance and the necessity and difficulties of adhering to the treatment protocols. These reported experiences add further support to the idea that trauma-focused treatments, without a stabilisation phase, can be tolerated and deepens our understanding of how to make this palatable for individuals with Ch-PTSD.
Brincat, S. L., Donoghue, J. A., Mahnke, M. K., Kornblith, S., Lundqvist, M., & Miller, E. K. (2021). Interhemispheric transfer of working memories. Neuron, 109(6), 1055-1066.e4. doi:10.1016/j.neuron.2021.01.016
Open access: https://pubmed.ncbi.nlm.nih.gov/33561399
Earl K. Miller, The Picower Institute for Learning and Memory and Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139 USA. E-mail: email@example.com
Visual working memory (WM) storage is largely independent between the left and right visual hemifields/cerebral hemispheres, yet somehow WM feels seamless. We studied how WM is integrated across hemifields by recording neural activity bilaterally from lateral prefrontal cortex. An instructed saccade during the WM delay shifted the remembered location from one hemifield to the other. Before the shift, spike rates and oscillatory power showed clear signatures of memory laterality. After the shift, the lateralization inverted, consistent with transfer of the memory trace from one hemisphere to the other. Transferred traces initially used different neural ensembles from feedforward-induced ones, but they converged at the end of the delay. Around the time of transfer, synchrony between the two prefrontal hemispheres peaked in theta and beta frequencies, with a directionality consistent with memory trace transfer. This illustrates how dynamics between the two cortical hemispheres can stitch together WM traces across visual hemifields.
Carletto, S., Malandrone, F., Berchialla, P., Oliva, F., Colombi, N., Hase, M., . Ostacoli, L. (2021). Eye movement desensitization and reprocessing for depression: a systematic review and meta-analysis. European Journal of Psychotraumatology, 12(1), 1894736. doi:10.1080/20008198.2021.1894736
Open access: http://dx.doi.org/10.1080/20008198.2021.1894736
Luca Ostacoli, Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, Orbassano, Turin 10043, Italy. E-mail: firstname.lastname@example.org
Background: In recent years, eye movement desensitization and reprocessing (EMDR) has been applied to different psychiatric conditions beyond post-traumatic stress disorder (PTSD), and an increasing number of studies have evaluated its effect on depression. To date, no quantitative synthesis of the efficacy of EMDR on depression has been conducted. Objective: To meta-analytically review the studies on EMDR for depression as the primary target for treatment.
Method: Studies with a controlled design evaluating the effect of EMDR on depression were searched on six electronic databases (PubMed, Embase, CINAHL, PsycINFO, Cochrane data- base, and Francine Shapiro Library) and then selected by two independent reviewers. A systematic review and meta-analysis was conducted.
Results: Eleven studies were included for qualitative synthesis. Nine studies were included in the meta-analysis, involving 373 participants. The overall effect size of EMDR for depres- sive symptoms is large (n = 9, Hedges’ g = – 1.07; 95%CI [–1.66; – 0.48]), with high heterogeneity (I2 = 84%), and corresponds to a ‘number needed to treat’ of 1.8. At follow- up (range 3–6 months), the effect remains significant but moderate (n = 3, Hedges’ g = – 0.62; 95%CI [–0.97; – 0.28]; I2 = 0%). The effect of EMDR compared with active controls is also moderate (n = 7, g = – 0.68; 95%CI [–0.92; – 0.43]; I2 = 0%). No publication bias was found, although the results are limited by the small number and poor methodological quality of the included studies.
Conclusions: Review findings suggest that EMDR may be considered an effective treatment for improving symptoms of depression, with effects comparable to other active treatments. However, findings need to be interpreted in light of the limited number of the studies and their quality. Further research is required to understand the longer-term of effects EMDR in treating depression and preventing depression relapse.
Protocol registration: PROSPERO (CRD42018090086).
Fávero, M., Moreira, D., Abreu, B., Del Campo, A., Moreira, D. S., & Sousa-Gomes, V. (2021). Psychological intervention with adult victims of sexual abuse: A comprehensive review. Clin Psychol Psychother. doi:10.1002/cpp.2598
Marisalva Fávero, University Institute of Maia, Av. Carlos de Oliveira Campos, 4475-690, Maia, Portugal. E-mail: email@example.com.
Child sexual abuse (CSA) is a phenomenon that is ubiquitous to all cultures and social classes. It has short- and long-term consequences, with specific treatment models that have been developed and adapted from psychological intervention models. A wide variety of studies have sought to evaluate the results of treatments with adult CSA survivors. This study presents an overview of research on the treatment of adult victims of CSA, by reviewing the existing literature on the types of treatment and the most studied psychotherapeutic avenues, and reports the findings related to the efficacy of these treatments. It is possible to conclude that psychological intervention exhibits benefits in the reduction of symptoms resulting from the experience of CSA and demonstrates the need to conduct further research on the effectiveness of intervention.
Fonseka, T. M., & Smith, C. (2021). The treatment of trauma-induced sexual pain among women: Clinical considerations for the use of adjunctive EMDR. The Canadian Journal of Human Sexuality, 30(1), 114-124. doi:10.3138/cjhs.2020-0035
Trehani Fonseka, MSc, MSW, RSW, School of Social Work, King’s University College at Western University, 266 Epworth Avenue, London, Ontario N6A 2M3 Canada. E-mail: firstname.lastname@example.org
Almost half of all women experience a sexual pain disorder in their lifetime, including dyspareunia, vaginismus, vulvodynia, and provoked vestibulodynia. Despite significant negative consequences across quality of life indices, few women seek treatment for sexual pain, and among those who do access support, more than half report that currently available strategies are ineffective or even harmful in some cases. This outcome may partly result from a standard of care that prioritizes pharmacotherapy and/or physiotherapy within pain management protocols rather than psychological interventions despite their demonstrated ability to yield comparatively better treatment outcomes. In considering that some women experience sexual pain in the aftermath of a sexually traumatic event, Eye Movement Desensitization and Reprocessing (EMDR), a type of evidence-based trauma therapy, may be a suitable adjunctive treatment to mitigate symptoms by targeting psychological risk factors. In this report, the authors first review the impact of sexual trauma on sexual pain, particularly the biopsychosocial effects of trauma within the body and its hypothesized mechanisms of action on sexual functioning, and then provide an overview of EMDR therapy, including how it promotes the resolution of trauma symptoms and its effects on sexual pain. By presenting this evidence, the authors will explore how EMDR therapy may have utility as a novel adjunctive treatment to address sexual trauma-induced sexual pain disorders and optimize the provision of care among this clinical population.
Hasanovi, M., Morgan, S., Oakley, S., Richman, S., Omeragi, I., Sirui, N., . . . Oakley, Z. (2021). Development of EMDR Therapy in Bosnia And Herzegovina - Education By Supervision to Accreditation. Psychiatria Danubina, 33(1), 4-12.
Open access: http://www.psychiatria-danubina.com/UserDocsImages/pdf/dnb_vol33_sup1/dnb_vol33_sup1_4.pdf
Professor Mevludin Hasanovi, MD, PhD, Department of Psychiatry, University Clinical Center Tuzla Ul. Rate Dugonjia bb, 75 000 Tuzla, Bosnia and Herzegovina E-mail: email@example.com
Introduction: Due to the increased needs of the citizens of Bosnia and Herzegovina (B&H) affected by the 1992-1995 war, after five basic EMDR (Eye Movement Desensitisation and Reprocessing) trainings and one EMDR training workshop for children and adolescents, Trauma Aid UK (former Humanitarian Aid Program UK and Ireland) continually provides supervision to mental health professionals in B&H, working towards European EMDR Association accreditation for the clinicians. To describe the experiences of education, clinical practice, and supervision of EMDR psychotherapy in the process of obtaining European accreditation of EMDR trainees from Bosnia and Herzegovina.
Subjects and methods: In order to understand how EMDR trainees perceive the process of supervision up to accreditation, nine questions were sent by email to 95 EMDR trainees about practicing EMDR, the number of patients with whom they use EMDR on a monthly basis, about their supervisors, and the number of completed supervisions, blocks to treatment while practicing EMDR, as well as positive experiences with EMDR practice and working with supervisors. 36 EMDR trainees answered these questions. The answers were analyzed using quantitative and qualitative methods.
Results: Of the 36 participants in this short study, 30 (83.3%) are women. Most of them are from Sarajevo 14 (38.9%), Tuzla 8 (22.2%) and Mostar 3 (8.3%), 2 (5.6%) from Biha, Brko, Gradaac, one from Banovii, Jajce, Prnjavor, Pale and Zenica. Psycho- logists make up the highest number of participants 25 (72.3%), followed by 5 (13.9) neuropsychiatric specialists. 31 currently have a supervisor (86.1%), 6 have changed their supervisor, and these 31 do not want to change their existing supervisor. Of them, 5 (13.9%) asked to be assigned a new supervisor. A qualitative analysis of the respondents revealed that the greatest problem in practicing EMDR therapy is the lack of space and time in the institutions where they work, the inability to reach patients seeking EMDR treatment, the parallel use of psycho- therapeutic guidelines that they have previously adopted, and insufficient determination to use EMDR. They are mostly satisfied with the experience they have gained in supervision which they deem very important in the process of accreditation. They highly appre- ciate the expertise and accessibility of the supervisors, to whom they are grateful for the help and support they received while presenting their cases from EMDR practice.
Conclusions: Findings from this study can serve as a basis for improving the supervisory process during the acquisition of European accreditation for EMDR practitioners in B&H. The findings can also aid in understanding the difficulties mental health professionals in BiH face practicing EMDR therapy while working towards the accreditation as practitioners of this very effective and necessary psychotherapeutic method.
Hase, M. (2021). Instant Resource Installation and Extensive Resource Installation - Two Novel Techniques for Resource Installation in EMDR therapy - Theory, Description and Case Report. European Journal of Trauma & Dissociation, 100224. doi:10.1016/j.ejtd.2021.100224
Michael Hase MD, Lüneburger Zentrum für Stressmedizin Dorette-von-Stern-Str. 14 21337 Lüneburg Germany. firstname.lastname@example.org
In recent years, resource installation has turned into an important procedure in Eye Movement Desensitization and Reprocessing Therapy (EMDR). Research has provided preliminary evidence regarding the neurophysiological signature of EMDR therapy resource installation. Even if a variety of resource installation procedures have been described, there is a variety of clients with different needs. Especially clients with attachment deficits or attachment disorder and in general complex client could profit from innovation in resource installation. Additional strategies for the enhancement of resource memory networks could enrich the EMDR therapy procedural toolbox. Two novel resource installation procedures, Instant Resource Installation (IRI) and Extensive Resource Installation (xtRI) are introduced and discussed. Two case examples document the clinical use of these novel EMDR resource enhancement procedures.
Hendrix, Y. M. G. A., Dongen, K. S. M. V., Jongh, A. D., & Pampus, M. G. V. (2021). Postpartum Early EMDR Therapy Intervention (PERCEIVE) Study for Women After a Traumatic Birth Experience: Study Protocol for a Randomized Controlled Trial. Trials. doi:10.21203/rs.3.rs-414386/v1
Open access: http://dx.doi.org/10.21203/rs.3.rs-414386/v1
Yvette M.G.A. Hendrix. E-mail: email@example.com
Background. Up to 43% of women perceive giving birth as traumatic which may result in the development of posttraumatic stress disorder (PTSD) or related symptoms. Negative and traumatic childbirth experiences can also lead to fear of childbirth, avoiding or negatively in uencing a subsequent pregnancy, mother-infant bonding problems, problems with breastfeeding, depression and reduced quality of life. For PTSD in general, eye movement desensitization and reprocessing (EMDR) therapy has proven to be effective. However, little is known about the preventive effects of early intervention EMDR therapy in women after a traumatic birth experience. The purpose of this study is to determine the effectiveness of early intervention EMDR therapy in preventing PTSD and reducing PTSD symptoms in women with a traumatic birth experience.
Methods. The PERCEIVE-study is a randomized controlled trial. Women suffering from the consequences of a traumatic birth experience will be randomly allocated at maximum 14 days postpartum to either EMDR therapy or “care-as-usual”. Patients in the EMDR condition receive two sessions of therapy between fourteen (T0) and thirty- ve days postpartum. All participants will be assessed at T0, and at nine weeks postpartum (T1). At T1 all participants will undergo a CAPS-interview about the presence and severity of PTSD symptoms. The primary outcome measure is severity of PTSD symptoms, whereas the secondary outcomes pertain to fear of childbirth, mother-infant bonding, breastfeeding, depression and quality of life. The study will be conducted at a large city hospital and at several midwifery practices in Amsterdam, the Netherlands.
Discussion. It is to be expected that the results of this study will provide more insight about the safety and effectiveness of early intervention EMDR therapy in the prevention and reduction of PTSD (symptoms) in women with a traumatic birth experience.
Trial registration. Trial register. NL73231.000.20. Registered on August 21, 2020. https://www.trialregister.nl/trial/8843
Hoogsteder, L. M., Ten Thije, L., Schippers, E. E., & Stams, G. J. J. M. (2021). A Meta-Analysis of the Effectiveness of EMDR and TF-CBT in Reducing Trauma Symptoms and Externalizing Behavior Problems in Adolescents. Int J Offender Ther Comp Criminol, 306624X211010290. doi:10.1177/0306624X211010290
Larissa M Hoogsteder, Forensic Care Specialists, Utrecht, The Netherlands.
This multi-level meta-analysis tested if evidence-based trauma treatment was effective in reducing trauma symptoms and externalizing behavior problems in adolescents. Based on eight independent samples and 75 effect sizes, results indicated that Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization Reprocessing (EMDR) had a large and significant overall effect (d = 0.909) on reducing trauma symptoms and externalizing behavior problems. Trauma treatment significantly decreased trauma symptoms (large effect) and externalizing behavior problems (medium effect). Age and type of control group moderated treatment effects. Treatment was more effective in older adolescents. Trauma treatment for adolescents with externalizing behavior problems had a larger effect compared to no treatment, but not compared to treatment as usual. It seems important to provide a broad treatment offer for adolescents with severe externalizing behavior problems, in which, besides trauma treatment, attention is paid to reducing relevant individual risk factors for behavior problems.
Jellestad, L., Zeffiro, T., Piccirelli, M., Malamud, J., Klimke, B., Rauen, K., . . . Mueller-Pfeiffer, C. (2021). Interfering with fear memories by eye movement desensitization and reprocessing. Int J Psychophysiol, S0167-8760(21)00152. doi:10.1016/j.ijpsycho.2021.04.006
Open access: https://pubmed.ncbi.nlm.nih.gov/33901511
Correspondence: Christoph Mueller-Pfeiffer, University Hospital of Zurich, Department of Psychiatry and Psychotherapy, Culmannstrasse 8, 8091 Zurich. E-mail: firstname.lastname@example.org
OBJECTIVE: Pharmacologic and behavioral interventions that block reconsolidation of reactivated fear memory have demonstrated only limited success in modifying stronger and long-standing fear memories. Given the efficacy of Eye Movement Desensitization and Reprocessing (EMDR) in treating PTSD, pursuit eye movements are a promising and novel intervention for studies of human memory reconsolidation. Here, we examined the efficacy of pursuit eye movements in interfering with reconsolidation of conditioned fear memories.
METHODS: We conducted a 3-day differential Pavlovian fear conditioning procedure in healthy adults, using videos of biologically prepared stimuli (tarantulas), partly reinforced with electrical shocks while recording skin conductance response (SCR) as a measure of autonomic conditioned responses. Fear conditioning was performed on Day 1. On Day 2, 38 participants were randomized into groups performing pursuit eye movements either immediately after fear memory reactivation, when the fear memory was stable, or 10 min later, when the fear memory was assumed to be more labile. On Day 3, fear memory strength was assessed by SCR to both reactivated and nonreactivated fear memories.
RESULTS: Strong differential conditioning to the spider stimuli were observed during both fear acquisition and fear memory reactivation. Reactivated fear memory conditioned responses of participants performing pursuit eye movements after a 10-min delay were significantly smaller in the reinstatement phase (0.16 μS; 95% CI [0.02, 0.31]).
CONCLUSIONS: Pursuit eye movements were effective in reducing fear-conditioned SCR in reinstatement. This result supports the theoretical proposition that EMDR can interfere with reactivated fear memory reconsolidation.
Karadag, M., Department of Child and Adolescent Psychiatry, G. U. S. O. M., Gaziantep, Turkey, Gunel Karadeniz, P., & Department of Biostatistics, S. U. S. O. M., Gaziantep, Turkey. (2021). Comparison of Group Eye Movement Desensitization and Reprocessing with Cognitive and Behavioral Therapy Protocol after the 2020 Earthquake in Turkey: A Field Study in Children and Adolescents. European Journal of Therapeutics, 27(1), 40-44. doi:10.5152/eurjther.2021.20056
Open access: http://dx.doi.org/10.5152/eurjther.2021.20056
Mehmet Karadağ, Department of Child and Adolescent Psychiatry, Gaziantep University School of Medicine, Gaziantep, Turkey. E-mail: email@example.com
Objective: We aimed at comparing the efficiency of “Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol (EMDR-IGTP)” with “Cognitive and Behavioral Therapy Based Crisis Prevention Program for Children and Adolescents (CIPCA)” in children who survived the 2020 earthquake in Turkey.
Methods: We randomly divided 56 children and adolescents who were earthquake victims between the ages of 8 and 14 into two groups. Half of the participants underwent EMDR-IGTP, while the other underwent CIPCA. Outcomes were obtained using clinical global impression (CGI) and the subjective units of distress (SUDS) scales before and after therapy.
Results: The median age of the participants was 10 years (range: 8–14) and 53.6% of them were male. The median CGI scores of the EMDR-IGTP group before and after therapy were 7 (3–7) and 1 (1–7), while that of the CIPCA group before and after therapy were 7 (3–7) and 4 (2–7), respectively (p<0.001). The median SUDS scores of the EMDR-IGTP group before and after therapy were 10 (5–10) and 1 (0–10), while that of the CIPCA group before and after therapy were 9 (5–10) and 5.5 (3–9), respectively (p<0.001).
Conclusion: Both EMDR-IGTP and CIPCA are effective in reducing the acute traumatic stress following the earthquake; however, EMDR-IGTP is relatively more effective. Thus, both methods can be used as a psychosocial intervention in post-earthquake traumatic events.
Matthijssen, S. J. M. A., Brouwers, T. C., van den Hout, M. A., Klugkist, I. G., & de Jongh, A. (2021). A randomized controlled dismantling study of Visual Schema Displacement Therapy (VSDT) vs an abbreviated EMDR protocol vs a non-active control condition in individuals with disturbing memories. European Journal of Psychotraumatology, 12(1), 1883924. doi:10.1080/20008198.2021.1883924
Open access: http://dx.doi.org/10.1080/20008198.2021.1883924
Suzy J. M. A. Matthijssen, Altrecht Academic Anxiety Centre, Altrecht GGz, Nieuwe Houtenseweg 12, 3524 SH Utrecht, The Netherlands. E-mail: firstname.lastname@example.org
Background: Visual Schema Displacement Therapy (VSDT) is a novel therapy for the treatment of fears and trauma-related mental health problems including PTSD. VSDT proved to be effective in reducing emotionality of aversive memories in healthy individuals in two previous randomized controlled trials and outperformed both a non-active control condition (CC) and an abbreviated version of EMDR therapy, a well-established first-line treatment for posttraumatic stress disorder.
Objectives: In an effort to enhance the understanding concerning the efficacy of VSDT, and to determine its active components, a dismantling study was conducted in individuals with disturbing memories in which the effects of VSDT were tested against EMDR therapy, a non-active CC and three different VSDT-protocols, each excluding or altering a hypothesized active component.
Method: Participants (N = 144) were asked to recall an emotional aversive event and were randomly assigned to one of these six interventions, each lasting 8 minutes. Emotional disturbance and vividness of participants’ memories were rated before and after the intervention and at one and four-week follow-up.
Results: Replicatory Bayesian analyses supported hypotheses in which VSDT was superior to the CC and the EMDR condition in reducing emotionality, both directly after the intervention and at one week follow-up. However, at four-week follow-up, VSDT proved equal to EMDR while both treatments were superior to the CC. Concerning vividness the data also showed support for hypotheses predicting VSDT being equal to EMDR and both being superior to the CC in vividness reduction. Further analyses specifying differences between the abbreviated VSDT protocols detected no differences between these conditions.
Conclusion: It remains unclear how VSDT yields its positive effects. Because VSDT appears to be unique and effective in decreasing emotionality of aversive memories, replication of the results in clinical samples is needed.
Perri, R. L., Castelli, P., La Rosa, C., Zucchi, T., & Onofri, A. (2021). COVID-19, Isolation, Quarantine: On the Efficacy of Internet-Based Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive-Behavioral Therapy (CBT) for Ongoing Trauma. Brain Sci, 11(5), 579. doi:10.3390/brainsci11050579
Open access: https://pubmed.ncbi.nlm.nih.gov/33946179
Rinaldo Livio Perri, Faculty of Psychology, University Niccolò Cusano, Via Don Carlo Gnocchi 3, 00166 Rome, Italy. E-mail: email@example.com
Literature points to cognitive-behavioural therapy (CBT) and eye movement desensitization and reprocessing (EMDR) as evidence-based therapies for trauma-related disorders. Treatments are typically administered in a vis-à-vis setting with patients reporting symptoms of a previously experienced trauma. Conversely, online-therapies and ongoing trauma have not received adequate attention. This study aimed to compare the efficacy of two brief treatments for health professionals and individuals suffering from the circumstances imposed by the coronavirus disease 2019 (COVID-19) pandemic. The EMDR and the trauma focused-CBT were administered online during the earliest stage of distress to manage the ongoing trauma associated to quarantine or disease. Thirty-eight patients satisfying the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for acute stress disorder were randomly assigned to the EMDR or CBT treatment. Both groups received a 7-session therapy, and psychometric tests were administered before, after the treatment and at one-month follow-up to assess traumatic symptoms, depression and anxiety. Results revealed that both treatments reduced anxiety by 30%, and traumatic and depressive symptoms by 55%. Present findings indicate the internet-based EMDR and CBT as equally effective brief treatments, also suggesting a maintenance of the effects as indicated by the follow-up evaluation. The EMDR and CBT might be considered as first line therapies to treat the ongoing trauma and to prevent the sensitization and accumulation of trauma memories.
Peters, L., & McIlvennan, C. (2021). Trauma after the Gift of Life: Identification and Treatment of Post-Traumatic Stress Disorders in Heart Transplant Recipients. The Journal of Heart and Lung Transplantation, 40(4), S488. Retrieved from https://www.sciencedirect.com/science/article/pii/S1053249821020350
Open access: https://www.sciencedirect.com/science/article/pii/S1053249821020350
L. Peters, University of Colorado, Aurora, CO.
Orthotopic heart transplantation (OHT) recipients have rates of post-traumatic stress disorder (PTSD) over double that of the general population. PTSD after OHT is associated with increased mortality. Use of eye movement desensitization and reprocessing (EMDR) therapy is a novel treatment strategy for PTSD and recently shown to be more effective than cognitive behavioral therapy (CBT). EMDR after OHT has not been reported in the literature. We present two cases that highlight successful use of EMDR therapy post-OHT with improvement of PTSD symptoms.
A 31-year-old female with non-compaction cardiomyopathy occurring during the post-partum period underwent OHT 6 weeks after delivery. Post-OHT course was uncomplicated with no episodes of rejection. Patient treated for depression with sertraline during first year post-OHT. Patient reported symptoms of PTSD with decreased functional capacity. Patient referred for consideration of EMDR therapy, found to be appropriate candidate by psychologist and underwent EMDR. Psychologist reported that patient experienced complete reduction in distress for targets. Patient reported resolution of PTSD symptoms and improved functional capacity.
A 52-year-old male with hypertrophic cardiomyopathy underwent OHT, then required second OHT 5 years later due to graft dysfunction from progressive coronary vasculopathy. Course after re-OHT was notable for persistent, moderate cellular rejection requiring treatment with thymoglobulin, increase in baseline oral immunosuppression, and eventual addition of methotrexate. Patient treated for chronic, stable depression with sertraline and CBT. Patient reported symptoms of PTSD, specifically noting fear of needing a third transplant. Patient referred for consideration of EMDR therapy, found to be appropriate candidate by psychologist and underwent EMDR. Psychologist reported patient experienced significant but incomplete reductions in distress for targets and did not complete all sessions of EMDR therapy due to difficulties in the therapy. Patient reported improvement, but not resolution, of his PTSD symptoms.
Increased mortality is associated with PTSD after OHT. Therefore, OHT recipients experiencing PTSD symptoms should be referred for further evaluation. Additionally, the use of EMDR therapy could be considered.
Rousseau, P. F., Vallat, R., Coste, O., Cadis, H., Nicolas, F., Trousselard, M., . . . Khalfa, S. (2021). Sleep parameters improvement in PTSD soldiers after symptoms remission. Sci Rep, 11(1), 8873. doi:10.1038/s41598-021-88337-x
Open access: https://pubmed.ncbi.nlm.nih.gov/33893376
Pierre Francois Rousseau, Laboratoire de Neurosciences Cognitives UMR 7291, Aix Marseille Université CNRS, Marseille, France. E-mail: firstname.lastname@example.org
Eye movement desensitization and reprocessing (EMDR) is a psychotherapy for the treatment of posttraumatic stress disorder (PTSD). It is still unclear whether symptoms remission through EMDR therapy is associated with a beneficial effect on one of the PTSD symptoms, sleep disturbance. Our objective was therefore to study sleep parameters before and after symptom remission in soldiers with PTSD. The control group consisted of 20 healthy active duty military men who slept in a sleep lab with standard polysomnography (PSG) on two sessions separated by one month. The patient group consisted of 17 active duty military with PTSD who underwent EMDR therapy. PSG-recorded sleep was assessed 1 week before the EMDR therapy began and 1 week after PTSD remission. We found that the increased REMs density after remission was positively correlated with a greater decrease of symptoms. Also, the number of EMDR sessions required to reach remission was correlated with intra-sleep awakenings before treatment. These results confirm the improvement of some sleep parameters in PTSD after symptoms remission in a soldier's population and provide a possible predictor of treatment success. Further experiments will be required to establish whether this effect is specific to the EMDR therapy.
van der Put, C. E., Asscher, J. J., Stams, G. J., van der Laan, P. H., Breuk, R., Jongman, E., & Doreleijers, T. (2013). Recidivism after treatment in a forensic youth-psychiatric setting: the effect of treatment characteristics. Int J Offender Ther Comp Criminol, 57(9), 1120-1139. doi:10.1177/0306624X12452389
E. E. Schippers, Forensic outpatient treatment center de Waag, Forensic Care Specialists, Postbus 1362, Utrecht 3500 BJ, The Netherlands. E-mail: ESchippers@dfzs.nl
The aim of this study was to examine the effect of treatment characteristics on recidivism in a forensic youth-psychiatric outpatient clinic. The treatment offered comprised functional family therapy (FFT), individual cognitive behavioural therapy (CBT), or CBT in combination with parent training. Some of the youth additionally participated in aggression replacement training (ART). FFT and ART were implemented as a trial version, meaning that most therapists had not received formal training yet. Treatment characteristics related to recidivism were length of treatment, type of treatment, number of sessions, and the therapist. The longer the period of treatment and the greater the number of sessions, the higher the recidivism, even after controlling for risk of recidivism based on static risk factors. Juveniles who participated in ART reoffended more often than juveniles who had not participated in such training. Given the fact that FFT and ART were not well-implemented trial versions, it can be concluded that poorly implemented treatment leads to poor outcomes.
Zoet, H. A., de Jongh, A., & van Minnen, A. (2021). Somatoform Dissociative Symptoms Have No Impact on the Outcome of Trauma-Focused Treatment for Severe PTSD. Journal of Clinical Medicine, 10(8), 1553. doi:10.3390/jcm10081553
Open access: http://dx.doi.org/10.3390/jcm10081553
Harmen A. Zoet, PSYTREC, 3723 MB Bilthoven, The Netherlands. E-mail: email@example.com
For patients with complex or other severe forms of PTSD, particularly in cases with dis- sociative symptoms, different treatment approaches have been suggested. However, the influence of somatoform dissociation on the effectiveness of trauma-focused treatment has hardly ever been studied. This study aims to test the hypotheses that (1) PTSD patients reporting a low level and those reporting a high level of somatoform dissociative symptoms would both benefit from an intensive trauma-focused treatment, and that (2) somatoform dissociative symptoms would alleviate. Participants were 220 patients with severe PTSD, enrolled in an intensive treatment program combining EMDR therapy and prolonged exposure therapy, without a preceding stabilization phase. Trauma history was diversified, and comorbidity was high. PTSD symptoms (CAPS-5 and PCL-5) and somatoform dissociative symptoms (SDQ-5 and SDQ-20) were assessed at pre-treatment, post- treatment and at six months after completion of treatment. The course of both PTSD and somatoform dissociative symptoms was compared for individuals reporting low and for those reporting high levels of somatoform dissociative symptoms. Large effect sizes were observed regarding PTSD symptoms reduction for patients with both low and high levels of somatoform dissociation. Somatoform dissociation did not impact improvement in terms of PTSD symptom reduction. The severity of somatoform dissociative symptoms decreased significantly in both groups. This decrease was greater for those with a positive screen for a dissociative disorder. These results add further support to the notion that the presence of strong somatoform dissociative symptoms in patients with PTSD does not necessarily call for a different treatment approach. Clinical implications are discussed.