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Babaei, N., Kerry, C., Goode, K., Dang, K., Mirzadeh, P., Pirbaglou, M., Kirk, M. A., & Ritvo, P. (2023). Clinical Assessment of Eye Movement Desensitization and Reprocessing in Memory Distress: Protocol for a Double-Blinded Randomized Controlled Trial. JMIR Res Protoc, 12, e38552. https://doi.org/10.2196/38552

Open Access: https://pubmed.ncbi.nlm.nih.gov/37171869

Paul Ritvo, School of Kinesiology and Health Science York University, 4700 Keele St, Toronto, ON, M3J1P3, Canada. E-mail: pritvo@yorku.ca

Abstract

BACKGROUND: Exposures to events are widespread and can cause posttraumatic stress disorder (PTSD). Cognitive behavioral therapy and eye movement desensitization and reprocessing (EMDR) are frequently used and validated behavioral PTSD treatments. Despite demonstrated effectiveness, highly upsetting memory reactions can be evoked, resulting in extensive distress and, sometimes, treatment dropout. In recent years, multiple treatment approaches have aimed at reducing such upsetting memory reactions to traumatic memories while therapeutic progress proceeds. One of these methods, the flash technique (FT), a modification of standard EMDR (S-EMDR), appears effective in distressing memory reduction. This study will examine FT-EMDR and S-EMDR efficacies when both methods are delivered via web-based video.
OBJECTIVE: This study aims to assess the relative efficacy of (web-based) FT-EMDR versus S-EMDR in reducing the PTSD symptoms, anxieties, and depression associated with traumatic memories at postintervention and 1-month follow-up.
METHODS: This double-blinded, web-based, 2-arm randomized controlled trial will employ self-report outcomes. A total of 90 participants will be identified from the web-based CloudResearch platform and randomly allocated to the experimental or comparison group. Inclusion criteria are as follows: (1) approved for engagement by the CloudResearch platform; (2) 25-60 years of age; (3) residing in Canada or the United States; (4) a recalled disturbing memory of an event >2 years ago that has not repeated and was moderately or more upsetting during occurrence; (5) memory moderately or more upsetting at baseline and not linked to an earlier memory that is equally or more than equally disturbing. Exclusion criteria are bipolar disorder, borderline personality disorder, obsessive-compulsive disorder, schizophrenia, substance abuse or addiction in the past 3 months, suicidal ideation, and suicide attempt in the past 6 months. Interventions include guided video instruction of full FT or guided video of EMDR. Outcome measures are as follows: Primary outcome is PTSD symptoms that are measured by the PTSD Checklist for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders-5) at 1-month follow-up. Secondary outcomes are State Anxiety subscale of State-Trait Anxiety Inventory at baseline, postintervention, and 1-month follow-up; Trait Anxiety subscale of State-Trait Anxiety Inventory; depression (Patient Health Questionnaire-9); and Positive and Negative Affect Schedule measured at 1-month follow-up.
RESULTS: If, at 1-month follow-up, the web-based FT-EMDR intervention is more effective in reducing PTSD symptoms (as measured by the PTSD Checklist for DSM-5) than EMDR, it may help reduce traumatic memory distress in multiple contexts.
CONCLUSIONS: This randomized controlled trial will advance current understandings of PTSD symptoms and interventions that target traumatic memory-related distress. TRIAL REGISTRATION: ClinicalTrials.gov NCT05262127; https://clinicaltrials.gov/ct2/show/NCT05262127.

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Bonano-Broussard, D., Simmons, R., & Ager, R. (2023). The effects of trauma-informed yoga as an enhancement to the practice of EMDR for posttraumatic stress disorder: an exploratory pilot study. Social Work in Mental Health, 1-20. https://doi.org/10.1080/15332985.2023.2201366

URL: https://www.tandfonline.com/doi/abs/10.1080/15332985.2023.2201366

Deslie Bonano-Broussarda, School of Social Work, Tulane University, New Orleans, LA, USA. E-mail: dbonanobroussard@tulane.edu

Abstract

This novel pilot study assesses if Trauma-Informed Yoga (TIY) provides a platform for promoting the preparatory and regulatory skills necessary for EMDR when treating PTSD. Nine clients completed two EMDR sessions per week for three weeks. One EMDR session was preceded by TIY. Surveys and exit interviews were administered to therapists and clients following each EMDR session. We found that practicing TIY prior to EMDR encouraged interoception, mind-body connectedness, tolerance, and relaxation, thus suggesting it is beneficial to EMDR.

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Bruin, J., van Rood, Y. R., Peeters, K. C. M. J., de Roos, C., Tanious, R., Portielje, J. E. A., Gelderblom, H., & Hinnen, S. C. H. (2023). Efficacy of eye movement desensitization and reprocessing therapy for fear of cancer recurrence among cancer survivors: a randomized single-case experimental design. Eur J Psychotraumatol, 14(2), 2203427. https://doi.org/10.1080/20008066.2023.2203427

Open Access: https://pubmed.ncbi.nlm.nih.gov/37144665

J. Bruin, Department of Psycho Oncology, Leiden University Medical Center (LUMC), RC Leiden, the Netherlands. E-mail: j.bruin@lumc.nl

Abstract

Background: Fear of cancer recurrence (FCR) is one of the greatest problems with which cancer survivors have to deal. High levels of FCR are characterized by intrusive thoughts about cancer-related events and re-experiencing these events, avoidance of reminders of cancer, and hypervigilance, similar to post-traumatic stress disorder (PTSD). Eye movement desensitization and reprocessing (EMDR) therapy focuses on these images and memories. It is effective in reducing PTSD and may be effective in reducing high levels of FCR.
Objective: The aim of the present study is to investigate the effectiveness of EMDR for severe FCR in breast and colorectal cancer survivors.
Method: A multiple-baseline single-case experimental design (n = 8) was used. Daily repeated measurements for FCR were taken during the baseline phase and treatment phase, post-treatment, and at the 3 month follow-up. Participants answered the Cancer Worry Scale (CWS) and the Fear of Cancer Recurrence Inventory, Dutch version (FCRI-NL) five times, i.e. at the start and at the end of each phase (baseline, treatment, post-treatment, and follow-up). The study was prospectively registered at clinicaltrials.gov (NL8223).
Results: Visual analysis and effect size calculation by Tau-U were executed for the daily questionnaire on FCR. The weighted average Tau-U score was .63 (p < .01) for baseline versus post-treatment, indicating large change, and .53 (p < .01) between baseline and follow-up, indicating moderate change. The scores on the CWS and FCRI-NL-SF decreased significantly from baseline to follow-up.
Conclusion: The results seem promising for EMDR therapy as a potentially effective treatment for FCR. Further research is recommended. Patients who experience high fear of cancer recurrence (FCR) often have intrusive memories and images about (future) cancer-related events. Eye movement desensitization and reprocessing (EMDR) therapy can focus on these intrusions. EMDR therapy is found to be a promising therapy for patients experiencing high FCR.

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Burback, L., Dhaliwal, R., Reeson, M., Erick, T., Hartle, K., Chow, E., Vouronikos, G., Antunes, N., Marshall, T., Kennedy, M., Dennett, L., Greenshaw, A., Smith-MacDonald, L., & Winkler, O. (2023). Trauma focused psychotherapy in patients with suicidal ideation: A scoping review. Current Research in Behavioral Sciences, 4, 100102. https://doi.org/10.1016/j.crbeha.2023.100102

Open Access: http://dx.doi.org/10.1016/j.crbeha.2023.100102

Olga Winkler, 1E1 Walter Mackenzie Health Sciences centre (WMC), 8440 112 St NW, Edmonton, AB, T6G 2B7. E-mail address: ow@ualberta.ca

Abstract

This scoping review focused on the use of trauma focused therapy (TFT) with participants who have suicidal ideation. Methods: Following the PRISMA extension for Scoping Reviews guidelines, MEDLINE, EMBASE, APA PsycINFO, and CINAHL databases were searched on March 18, 2021. Peer-reviewed studies in English reporting on the use of TFT with patients with suicidal ideation or Borderline Personality Disorder (BPD) were included. Results: From 3,272 publications, 43 studies were included. Most studies utilized Prolonged Exposure, Eye Movement Desensitization and Reprocessing, Cognitive Processing Therapy, and other exposure-based interventions, alone or in combination with another intervention. Approximately 50% of studies used intensive (two sessions or more per week) delivery of the intervention. Studies mainly focused on clinical improvement of symptoms, rather than suicidality. Overall, studies reported symptom improvements in Posttraumatic Stress Disorder, depression, and BPD symptoms, suicidal ideation and non-suicidal self-injury, with few critical adverse events on record. Conclusion: Despite increased research interest in this area, knowledge gaps remain. Greater attention to mixed methods studies may increase our understanding of the lived experience of those with suicidal ideation undergoing TFT. There is a need for studies to explore the effect of TFT on symptoms associated with psychiatric diagnoses other than PTSD, and for studies reporting on the significance of both sex and gender of patients. Prospective interventional studies that focus on participants with suicidal ideation, and consensus on standardized suicidal ideation outcome measures, are also needed. There is a need to compare intensive vs. non-intensive TFT, and to examine whether inclusion of emotion regulation skills is a significant determinant of suicidal risk outcomes in this context. In contrast to common apparent clinical practice decisions restricting TFT to patients without suicidal symptoms, limited evidence indicates that TFT, including intensive delivery, may not increase suicide risk. Due to methodological issues, further studies are needed to confirm this observation and to determine any increased risk for specific patient subgroups and TFT interventions.

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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. Eur J Psychotraumatol, 14(1), 2179569. https://doi.org/10.1080/20008066.2023.2179569

Open Access: https://pubmed.ncbi.nlm.nih.gov/37052108


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: wissam.elhage@univ-tours.fr

Abstract

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.

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Cope, S. R., G., S. J., El-Leithy, S., Vanzan, S., Pentland, C., Pick, S., Golder, D., Hogwood, P. T., K. J., Billings, J., & Edwards, M. J. (In press). MODIFI: Protocol for randomised feasibility study of eye movement desensitisation and reprocessing therapy (EMDR) for functional neurological disorder (FND). British Medical Journal Open.

Open Access: https://kclpure.kcl.ac.uk/portal/files/207031390/MODIFI_protocol_paper_submission_to_BMJOpen_21042023.pdf


Sarah R. Cope, Neuropsychiatry Service, South West London & St. George’s Mental Health Trust, St. George’s Hospital, Blackshaw Road, SW17 0QT, UK. E-mail: sarah.cope@swlstg.nhs.uk

Abstract

Introduction:
Functional neurological disorder (FND) refers to an involuntary loss of control over and/or aberrant perception of the body. Common presenting symptoms are functional (non-epileptic) seizures, and functional motor disorder, e.g. walking difficulties, weakness, or tremor. Greater access to effective treatments would lead to reduced distress and disability; and reduce unnecessary healthcare costs.
This study will examine eye-movement desensitisation and reprocessing therapy (EMDR) as a treatment for FND. EMDR is an evidence-based treatment for post-traumatic stress disorder (PTSD), but its use for other conditions is growing. An FND-specific EMDR protocol will be tested, and if the intervention proves feasible with promising clinical outcomes, progression to a substantive study could take place.
Methods and Analysis:
Fifty adult patients diagnosed with FND will be recruited. It will be a single-blind randomised controlled trial with two arms: EMDR (plus standard neuropsychiatric care; NPC) and standard NPC. The two groups will be compared at baseline (T0), 3 months (T1), 6 months (T2), and 9 months (T3). Measures of feasibility include safety, recruitment, retention, treatment adherence and acceptability. Clinical outcome measures will assess health-related functioning/quality of life, ratings of FND symptoms and severity, depression, anxiety, PTSD, dissociation, service-utilisation and other costs. Improvement and satisfaction ratings will also be assessed. Feasibility outcomes will be summarised using descriptive statistics. Exploratory analyses using (linear/logistic) mixed effect models will examine the rate of change in the groups’ clinical outcome measures across the four time-points.
After the intervention period, a sample of participants, and clinicians, will be invited to attend semi-structured interviews. The interviews will be analysed using reflexive thematic analysis.

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De Jongh, A., & Hafkemeijer, L. C. S. (2023). Trauma-focused treatment of a client with Complex PTSD and comorbid pathology using EMDR therapy. J Clin Psychol. https://doi.org/10.1002/jclp.23521

URL: https://pubmed.ncbi.nlm.nih.gov/37058521


Ad De Jongh, Psychotrauma Expertise Centre (PSYTREC), Bilthoven, The Netherlands. E-mail: a.de.jongh@acta.nl

Abstract

OBJECTIVE: Complex post-traumatic stress disorder (CPTSD) is a classification within the International Classification of Diseases, 11th Revision (ICD-11) that, besides the DSM-5 symptom clusters of post-post-traumatic stress disorder (PTSD), includes the presence of negative self-concept, difficulties in regulating emotions and relationship skills. The purpose of the present study was to provide guidance on how to deliver Eye Movement Desensitization and Reprocessing (EMDR) therapy in the context of CPTSD, based on current clinical knowledge and the latest scientific research findings.
METHOD: This paper describes the treatment of a 52-year-old woman with CPTSD and borderline personality disorder for which immediate trauma-focused EMDR therapy was used.
RESULTS: First, a description of what EMDR therapy entails and some important treatment strategies that the therapist may employ to assist in trauma-focused treatment of clients with CPTSD using EMDR therapy are outlined.
CONCLUSION: The treatment results are in line with mounting evidence supporting the notion that EMDR therapy is a safe and potentially effective treatment alternative for individuals with CPTSD or personality problems.

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de Veer, M. R., Waalboer-Spuij, R., Hijnen, D. J., Doeksen, D., Busschbach, J. J., & Kranenburg, L. W. (2023). Reducing scratching behavior in atopic dermatitis patients using the EMDR treatment protocol for urge: A pilot study. Front Med (Lausanne), 10, 1101935. https://doi.org/10.3389/fmed.2023.1101935

Open Access: https://pubmed.ncbi.nlm.nih.gov/37081840

Mathijs R. de Veer, Department of Psychiatry, Section Medical Psychology, Erasmus University Medical Centre, Rotterdam, Netherlands. E-mail: m.deveer@erasmusmc.nl

Abstract

BACKGROUND: Itch, and thereby the scratching behavior, is a common complaint in atopic dermatitis. Scratching damages the skin, which in turn worsens the itch. This itch-scratch cycle perpetuates the skin condition and has a major impact on the patient's quality of life. In addition to pharmacological treatment, psychological interventions show promising results in reducing scratching behavior.
OBJECTIVES: To investigate the effect of treatment according the EMDR treatment protocol for urge on scratching behavior of atopic dermatitis patients in a controlled study.
METHODS: This study applies a multiple baseline across subjects design. Six patients were randomly allocated to different baseline lengths and all of them started registration of scratching behavior at the same day, using a mobile phone application. Nocturnal scratching was registered by a smart watch application. The total study duration was 46 days and was equal for all patients. Treatment consisted of two sessions using the EMDR treatment protocol for urge. Furthermore, standardized measures were used to assess disease activity, quality of life, and self-control. The nonoverlap of all pairs effect size was calculated for the daily measure data.
RESULTS: One patient dropped out. Visual inspection suggests that the scratching behavior decreased over time in all patients. Furthermore, a moderate effect size of the treatment is found. During the baseline phase, scratching behavior fluctuated considerably and showed a slight negative trend. Outcomes of disease activity decreased over time and patients' self-control and quality of life improved after treatment. Nocturnal scratching behavior did not change after the intervention.
CONCLUSION: The results of the visual analysis of day time scratching behavior, disease activity, quality of life, and self-control seem promising. These findings pave the way for future research into the effect of the new intervention on other skin conditions suffering from scratching behavior, such as prurigo nodularis.

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Farrell, D., Moran, J., Zat, Z., Miller, P. W., Knibbs, L., Papanikolopoulos, P., Prattos, T., McGowan, I., McLaughlin, D., Barron, I., Mattheß, C., & Kiernan, M. D. (2023). Group early intervention eye movement desensitization and reprocessing therapy as a video-conference psychotherapy with frontline/emergency workers in response to the COVID-19 pandemic in the treatment of post-traumatic stress disorder and moral injury-An RCT study. Front Psychol, 14, 1129912. https://doi.org/10.3389/fpsyg.2023.1129912

Open Access: https://pubmed.ncbi.nlm.nih.gov/37063579

Derek Farrell, School of Psychology, University of Worcester, Worcester, United Kingdom, E-mail: d.farrell@worc.ac.uk

Abstract

OBJECTIVE: Frontline mental health, emergency, law enforcement, and social workers have faced unprecedented psychological distress in responding to the COVID-19 pandemic. The purpose of the RCT (Randomized Controls Trial) study was to investigate the effectiveness of a Group EMDR (Eye Movement Desensitization and Reprocessing) therapy (Group Traumatic Episode Protocol-GTEP) in the treatment of Post-Traumatic Stress Disorder (PTSD) and Moral Injury. The treatment focus is an early intervention, group trauma treatment, delivered remotely as video-conference psychotherapy (VCP). This early intervention used an intensive treatment delivery of 4x2h sessions over 1-week. Additionally, the group EMDR intervention utilized therapist rotation in treatment delivery. METHODS: The study's design comprised a delayed (1-month) treatment intervention (control) versus an active group. Measurements included the International Trauma Questionnaire (ITQ), Generalized Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire (PHQ-9), Moral Injury Events Scale (MIES), and a Quality-of-Life psychometric (EQ-5D), tested at T0, T1: pre-treatment, T2: post-treatment, T3: 1-month follow-up (FU), T4: 3-month FU, and T5: 6-month FU. The Adverse Childhood Experiences - International version (ACEs), Benevolent Childhood Experience (BCEs) was ascertained at pre-treatment only. N = 85 completed the study. RESULTS: Results highlight a significant treatment effect within both active and control groups. Post Hoc comparisons of the ITQ demonstrated a significant difference between T1 pre (mean 36.8, SD 14.8) and T2 post (21.2, 15.1) (t11.58) = 15.68, p < 0.001). Further changes were also seen related to co-morbid factors. Post Hoc comparisons of the GAD-7 demonstrated significant difference between T1 pre (11.2, 4.91) and T2 post (6.49, 4.73) (t = 6.22) = 4.41, p < 0.001; with significant difference also with the PHQ-9 between T1 pre (11.7, 5.68) and T2 post (6.64, 5.79) (t = 6.30) = 3.95, p < 0.001, d = 0.71. The treatment effect occurred irrespective of either ACEs/BCEs during childhood. However, regarding Moral Injury, the MIES demonstrated no treatment effect between T1 pre and T5 6-month FU. The study's findings discuss the impact of Group EMDR therapy delivered remotely as video-conference psychotherapy (VCP) and the benefits of including a therapist/rotation model as a means of treatment delivery. However, despite promising results suggesting a large treatment effect in the treatment of trauma and adverse memories, including co-morbid symptoms, research results yielded no treatment effect in frontline/emergency workers in addressing moral injury related to the COVID-19 pandemic. CONCLUSION: The NICE (2018) guidance on PTSD highlighted the paucity of EMDR therapy research used as an early intervention. The primary rationale for this study was to address this critical issue. In summary, treatment results for group EMDR, delivered virtually, intensively, using therapist rotation are tentatively promising, however, the moral dimensions of trauma need consideration for future research, intervention development, and potential for further scalability. The data contributes to the emerging literature on early trauma interventions.

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Gill, P., Fraser, E., Tran, T. T. D., De Sena Collier, G., Jago, A., Losinno, J., & Ganci, M. (2023). Psychosocial treatments for nightmares in adults and children: a systematic review. BMC Psychiatry, 23(1), 283. https://doi.org/10.1186/s12888-023-04703-1

Open Access: https://pubmed.ncbi.nlm.nih.gov/37085821

Peter Gill, Institute for Health and Sport, Victoria University Australia, Footscray Park, Ballarat Rd, Melbourne, VIC, Australia. E-mail: Peter.Gill@vu.edu.au

Abstract

BACKGROUND: As nightmares may be a risk factor for, or symptom of, multiple psychological disorders, some researchers suggest that nightmares should be screened, diagnosed, and treated. Treatments for nightmares include trauma-focused Cognitive Behavioural Therapy and Image Rehearsal Therapy, and pharmacological interventions such as prazosin and nitrazepam. As recent research has put into question our current understanding of treatment efficacy, there is a need to systematically review findings related to the effectiveness of nightmare treatments to inform best practice. The current review assessed the efficacy of psychosocial treatments of nightmare in all cohorts.
METHODS: A systematic search of four databases for peer reviewed journal articles from 2000 onwards produced 69 (35 RCTs, 34 non-RCTs) eligible articles that underwent narrative synthesis.
RESULTS: The results provide strong evidence for exposure and image rehearsal treatments for the reduction of nightmare frequency, severity, and distress, in civilian, military, idiopathic, and posttraumatic stress disorder (PTSD) cohorts. There is emerging evidence that self-guided and brief treatment modalities offer efficient and effective treatment options. There is an urgent need for clinical trials of treatment effectiveness in children.
CONCLUSIONS: The results suggest that treatments for nightmares are most effective when they facilitate a sense of control or mastery by directly targeting the nightmare content and/or the client's emotional responses to the nightmare content.

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Hoppen, T. H., Kip, A., & Morina, N. (2023). Are psychological interventions for adult PTSD more efficacious and acceptable when treatment is delivered in higher frequency? A meta-analysis of randomized controlled trials. J Anxiety Disord, 95, 102684. https://doi.org/10.1016/j.janxdis.2023.102684

URL: https://pubmed.ncbi.nlm.nih.gov/36827748

T.H. Hoppen, Institute of Psychology University of Münster, Fliednerstr. 21, 48149 Münster, Germany. E-mail address: thoppen@uni-muenster.de

Abstract

BACKGROUND: Two systematic reviews indicated that higher treatment frequency of psychological interventions for adult PTSD may lead to higher efficacy and less dropout. Yet, a quantitative review is missing. METHODS: We conducted a thorough systematic literature search and included trials meeting the following criteria: a) random allocation, 2) PTSD was primary treatment focus, 3) ≥ 70% interview-based PTSD rate 4) mean age ≥ 18 years, and 5) N ≥ 20. Treatment session frequency was analyzed dichotomously (< 1.5 vs. ≥ 1.5 sessions/week) and continuously (sessions per week & minutes per week). RESULTS: A total of 160 RCTs with data from 10,556 patients were included. Analyses yielded similar treatment efficacy irrespective of treatment frequency definitions and whether differential efficacy was estimated directly via head-to-head trials or indirectly via comparisons to the same comparison group. Intense (≥ 1.5 sessions/week) vs. standard (< 1.5 sessions/week) delivery was, however, associated with significantly lower dropout rates (as a proxy for acceptability) for trauma-focused interventions (18.64% vs 11.54%, respectively, p = .024), but not for non-trauma-focused interventions. CONCLUSIONS: We found no evidence for differential treatment efficacy of intense vs. standard psychotherapies for adult PTSD. Evidence for increased acceptability was found for intense vs. standard trauma-focused interventions.

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Hoppen, T. H., Jehn, M., Holling, H., Mutz, J., Kip, A., & Morina, N. (2023). The efficacy and acceptability of psychological interventions for adult PTSD: A network and pairwise meta-analysis of randomized controlled trials. J Consult Clin Psychol. https://doi.org/10.1037/ccp0000809

URL: https://pubmed.ncbi.nlm.nih.gov/37141033

Thole H. Hoppen, Institute of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany. E-mail: thoppen@uni-muenster.de

Abstract

OBJECTIVE: A comprehensive quantitative summary of the efficacy and acceptability of psychological interventions (PIs) for adult posttraumatic stress disorder (PTSD) is lacking.
METHOD: We conducted a systematic literature search to identify randomized controlled trials (RCTs) examining the efficacy and acceptability (all-cause dropout) of psychological interventions (i.e., trauma-focused cognitive behavior therapy [TF-CBT], eye movement desensitization and reprocessing [EMDR], other trauma-focused interventions and non-trauma-focused interventions).
RESULTS: One hundred fifty-seven RCTs were included comprising 11,565 patients. Most research (64% of RCTs) accumulated for TF-CBT. In network meta-analyses, all therapies were effective when compared to control conditions. Interventions did not differ significantly in their efficacy. Yet, TF-CBT yielded higher short- (g = 0.17, 95% CI [0.03-0.31], number of comparisons kes = 190), mid- (i.e., ≤5 months posttreatment, g = 0.23, 95% CI [0.06-0.40], kes = 73) and long-term efficacy (i.e., >5 months posttreatment, g = 0.20, 95% CI [0.04-0.35], kes = 41) than non-trauma-focused interventions. There was some evidence of network inconsistencies, and heterogeneity in outcomes was large. In pairwise meta-analysis, slightly more patients dropped out from TF-CBT than non-trauma-focused interventions (RR = 1.36; 95% CI [1.08-1.70], kes = 22). Other than that, interventions did not differ in their acceptability.
CONCLUSIONS: Interventions with and without trauma focus are effective and acceptable in the treatment of PTSD. While TF-CBT yields the highest efficacy, slightly more patients discontinued TF-CBT than non-trauma-focused interventions. Altogether, the present results align with results of most previous quantitative reviews. Yet, results need to be interpreted with caution in light of some network inconsistencies and high heterogeneity in outcomes.

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Hughes, G., Sutterfield, B., Anderson, R., Streck, S., Hillman, C., Shepard, S., Wise, A., Ottwell, R., Hartwell, M., & Vassar, M. (2023). Assessment of Reporting of Patient-Reported Outcomes in Randomized Controlled Trials for Interventions of Post-Traumatic Stress Disorder. Psychiatr Q. https://doi.org/10.1007/s11126-023-10017-y

URL: https://pubmed.ncbi.nlm.nih.gov/36976434

Griffin Hughes, Office of Medical Student Research, Oklahoma State University Center for Health Sciences, 1111 W 17th St, 74107, Tulsa, OK, USA. E-mail: griffinhughesresearch@okstate.edu

Abstract

BACKGROUND: Post-traumatic stress disorder (PTSD) has debilitating effects on quality of life. Patient-reported outcomes (PROs) assess changes in quality of life and serve as subjective measurements of patient experience. The aim of this study is to assess the completeness of PRO reporting within randomized controlled trials with interventions pertaining to PTSD.
METHODS: This cross-sectional, meta-epidemiological study assessed the completeness of PRO reporting in RCTs investigating PTSD interventions. We searched multiple databases for published RCTs of PTSD interventions that used PROs as a primary or secondary outcome. We assessed PRO completeness using the PRO adaptation of the Consolidated Standards of Reporting Trial (CONSORT). We used a bivariate regression model to determine the association between trial characteristics and the completeness of reporting.
RESULTS: After an initial screening of 5906 articles, our final sample of RCTs for inclusion was 43. The mean completeness of reporting of PROs was 58.4% (SD = 14.50). We found no significant associations between trial characteristics and completeness of the CONSORT-PRO adaptation.
CONCLUSION: Reporting of PROs was often incomplete among RCTs focused on PTSD. We believe that adherence to CONSORT-PRO will improve both PRO reporting and implementation into clinical practice to improve assessment of quality of life.

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IJdema, T., Laceulle, O. M., Thomaes, K., & Korrelboom, K. (2023). Valenced dual tasking in patients with posttraumatic stress disorder. Psychol Trauma. https://doi.org/10.1037/tra0001470

URL: https://pubmed.ncbi.nlm.nih.gov/36996246

Tom IJdema, Department of Medical and Clinical Psychology, Centre of Research on Psychological Disorders and Somatic Diseases, Tilburg University, Postbus 90153, 5000 LE Tilburg, The Netherlands. E-mail: t.ijdema@tilburguniversity.edu

Abstract

OBJECTIVE: Dual-tasking studies show that emotionality and vividness of aversive memory decrease by engaging in a working memory task and simultaneous recall of that memory. Adding positive valence to a dual task might be a promising innovation in the amelioration of lab-induced memory. However, studies aiming to translate these findings into autobiographical memory of a posttraumatic stress disorder (PTSD) population find conflicting results or show methodological flaws. The current study assesses the benefit of adding positive valence to a dual-tasking procedure in PTSD patients.
METHOD: In a cross-over design PTSD patients (N = 33) recalled their traumatic memory and received the following three conditions in randomized order: rating positive pictures + exposure, rating neutral pictures + exposure, and exposure only. Each of the three conditions consisted of four sets of 1 min. In the first cycle, participants were exposed to each condition in a randomized order, which was then repeated in a second cycle. Before and after each condition, emotionality and vividness were rated on a visual analog scale (VAS), resulting in seven measurement timepoints in total.
RESULTS: Firstly, repeated measures ANOVAs showed a time effect: memories were less emotional and vivid after our summed (three) interventions. Secondly, repeated measures ANCOVAs indicated no evidence for differences between the conditions.
CONCLUSIONS: We did not find evidence for a benefit of adding positive valence to a dual-task procedure in PTSD patients.

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Klatte, R., Strauss, B., Flückiger, C., Färber, F., & Rosendahl, J. (2023). Defining and assessing adverse events and harmful effects in psychotherapy study protocols: A systematic review. Psychotherapy (Chic), 60(1), 130-148. https://doi.org/10.1037/pst0000359

URL: https://pubmed.ncbi.nlm.nih.gov/35049321

Jenny Rosendahl, Institute of Psychosocial Medicine, Psychotherapy and Psycho- oncology, Jena University Hospital, Friedrich Schiller University Jena, Stoystraße 3, D-07740 Jena, Germany. E-mail: jenny.rosendahl@med.uni -jena.de

Abstract

The assessment of safety data has become a standard across many clinical interventions. The aim of this systematic review is to investigate the extent to which harm is addressed within psychotherapy study protocols. The review includes study protocols of randomized controlled trials published between 2004 and 2017 investigating the effects of psychotherapy in adult patients with affective disorders, phobia, anxiety, obsessive-compulsive disorder, posttraumatic stress disorder, and/or personality disorders. We conducted a systematic search in the CENTRAL, Medline, PsycINFO, and Web of Science databases as well as in relevant journals. In total, 115 study protocols were included, examining 168 psychotherapy and 85 control conditions. These protocols differed considerably in the way they conceptualized harm: 77 explicitly addressed harm, 62 considered serious adverse events, and 39 considered adverse events. Although serious adverse events were defined somewhat consistently, adverse events were not. Our results imply that clinical researchers do not apply standardized approaches with regard to harm concepts, assessment, and management. To gather data on frequencies of harmful effects, we argue a higher degree of standardization would be useful. Feasible recommendations are provided based on examples of good practice from the reviewed study protocols.

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Kowalski, J., Elżanowski, A., & Śliwerski, A. (2023). A review of selected psychotherapies for PTSD, their efficacy and treatment guidelines in adults. Psychiatr Pol, 1-11. https://doi.org/10.12740/PP/OnlineFirst/157105

Open Access: https://pubmed.ncbi.nlm.nih.gov/37074864

Joachim Kowalski, Institute of Psychology PAN 00-183 Warszawa, Stefana Jaracza St. 1 E-mail: jkowalski@psych.pan.pl

Abstract

AIM: Around 2.5% of Poles will develop post-traumatic stress disorder (PTSD) during their lifetime. Recent events, i.e. the pandemic and the war in Ukraine, are the factors that will increase the number of people dealing with PTSD. Owing to that, this paper aims to review and familiarise readers with the available scientific evidence on psychotherapies of PTSD provided in Poland.
MATERIAL AND METHODS: A review of meta-analyses of randomised controlled trials and a review of the most recent treatment guidelines concerning PTSD. RESULTS: The best available evidence points to high efficacy of cognitive-behavioural therapy (CBT) with prolonged exposure and Eye Movement Desensitization and Reprocessing (EMDR). Humanistic therapy also proves effective to a certain degree, but not as effective as therapies that use exposure to stimuli and memories associated with trauma. There is no evidence of the efficacy of psychodynamic therapy and methods based on polyvagal theory. Organisations preparing guidelines recommend primarily CBT and EMDR.
CONCLUSIONS: Efficacious treatment of PTSD should include a protocol with a component of exposure to trauma-related memories and stimuli. It is recommended to use such therapies in the psychotherapeutic treatment of PTSD.

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Kuck, S., Arntz, A., Rameckers, S. A., Lee, C. W., Boterhoven de Haan, K. L., Fassbinder, E., & Morina, N. (2023). Intraindividual variability and emotional change as predictors of sudden gains in imagery rescripting and EMDR for PTSD in adult survivors of childhood abuse. Clin Psychol Psychother. https://doi.org/10.1002/cpp.2855

Open Access: https://pubmed.ncbi.nlm.nih.gov/37078854

Nexhmedin Morina, Institute of Psychology, University of Münster, Münster, Germany. E-mail: morina@uni-muenster.de

Abstract

Sudden gains, defined as large and stable improvements in symptom severity during psychological treatment, have consistently been found to be associated with better outcomes across treatments and diagnoses. Yet, insights on coherent predictors of sudden gains and on emotional changes around sudden gains in post-traumatic stress disorder (PTSD) are lacking. We aimed at replicating a measure of intraindividual variability as a predictor for sudden gains and testing its independence from change during treatment. Furthermore, we expected changes in emotions of guilt, shame and disgust prior to sudden gains to predict sudden gains. Data from a pre-registered randomized controlled trial (RCT) of eye-movement desensitization and reprocessing (emdr) and Imagery Rescripting (ImRs) for PTSD in 155 adult survivors of childhood abuse were used. Intraindividual variability of PTSD symptoms in both treatments did not predict sudden gains status and was not independent of change during treatment. In the EMDR condition, levels of shame during treatment predicted sudden gains and shame decreased shortly before a sudden gain in both treatments. Reductions in all emotions during sudden gains were significantly higher for participants with sudden gains than for comparable intervals in non-sudden gainers. Our findings do not support the predictive validity of intraindividual variability for sudden gains. The decrease of guilt, shame and disgust during sudden gains warrants further research on their role as a mechanism of treatment change for PTSD.

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Leung, K. C., McCarthy, C., & Mclean, L. M. (2023). Post-traumatic stress disorder in doctors: Origins, approach and Eye Movement Desensitisation and Reprocessing therapy. Australas Psychiatry, 31(2), 136-138. https://doi.org/10.1177/10398562231166293

URL: https://pubmed.ncbi.nlm.nih.gov/36950855

Kelvin CY Leung, Research and Education Network, WSLHD, Westmead, NSW 2145, Australia. E-mail: kelvin.leung1@health.nsw.gov.au

Abstract

OBJECTIVES: Navigating a high-stakes clinical environment, medical doctors tend to consider trauma and adverse workplace events as 'part of their job'. This often leads to delays in help-seeking in doctors who develop acute traumatic stress symptoms (ATSS), post-traumatic stress disorder (PTSD) and their comorbidities. This article outlines the prevalence of acute traumatic stress and PTSD in this population and summarises the emerging evidence base for Eye Movement Desensitisation and Reprocessing (EMDR) early-intervention protocols of this population.
CONCLUSION: Doctors have higher prevalence rates of ATSS and PTSD than the general public. Eye Movement Desensitisation and Reprocessing therapy's early-intervention protocols for recent, prolonged and ongoing traumatic stress have the potential to be a widely acceptable, timely and cost-effective intervention for doctors and other healthcare workers (HCWs), as highlighted in the emerging evidence base, which has grown considerably in response to the impact of the COVID pandemic on HCWs' mental health. These evidence-based interventions could potentially be routinely offered to doctors and other HCWs within 1 month of an adverse workplace experience to reduce ATSS, PTSD and other comorbidities.

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Lotzin, A., Franc de Pommereau, A., & Laskowsky, I. (2023). Promoting Recovery from Disasters, Pandemics, and Trauma: A Systematic Review of Brief Psychological Interventions to Reduce Distress in Adults, Children, and Adolescents. Int J Environ Res Public Health, 20(7), 5339. https://doi.org/10.3390/ijerph20075339

Open Access: https://pubmed.ncbi.nlm.nih.gov/37047954

Annett Lotzin, Institute for Clinical Psychology and Psychotherapy, Department of Psychology, MSH Medical School Hamburg, 20457 Hamburg, Germany. E-mail: annett.lotzin@medicalschool-hamburg.de

Abstract

A substantial number of survivors of disasters, pandemics, and other severe stressors develop persistent distress that impairs mental health and well-being. However, only a few brief psychological interventions target distress or subclinical symptoms. This systematic review aimed to identify and describe brief psychological interventions to reduce distress or subclinical symptoms in survivors of disasters, pandemics, and other severe stressors. Based on a systematic literature search (MEDLINE, PsycINFO, PSYNDEX, PTSDpubs, and Web of Science), we reviewed published studies and study protocols on self-help, psychosocial support, or brief psychotherapeutic interventions to reduce distress and/or subclinical symptoms following natural hazards and man-made disasters, pandemics, or other traumatic events. We included 27 published studies or study protocols (n = 15 RCTs, n = 3 controlled pre-post studies, and n = 9 uncontrolled pre-post studies) describing 22 interventions. We found evidence for reducing psychological distress and/or subclinical symptoms in 9 out of 15 RCTs, 2 out of 3 controlled pre-post studies, and 9 out of 9 uncontrolled pre-post studies. One RCT provided evidence of increasing well-being. Innovative brief interventions have been developed to reduce distress and/or subclinical symptoms that have an emerging evidence base.

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Mainthow, N., Zapien, R., Givaudan, M., & Jarero, I. (2023). Longitudinal Multicenter Randomized Controlled Trial on the ASSYST Individual Treatment Intervention Provided to Adult Females with Adverse Childhood Experiences. Psychology and Behavioral Science International Journal, 20(3).

Open Access: https://juniperpublishers.com/pbsij/volume20-issue3-pbsij.php

Nicolle Mainthow, Department of Research, Mexican Association for Mental Health Support in Crisis, Mexico.

Abstract

The aim of this longitudinal multicenter randomized controlled trial with intention-to-treat analysis was to evaluate the effectiveness, efficacy, and safety of the Acute Stress Syndrome Stabilization Individual (ASSYST-I) treatment intervention in reducing posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in adult females with adverse childhood experiences. A total of 43 adult females met the inclusion criteria and participated in the study. Participants’ ages ranged from 18 to 80 years old (M =33.74 years). A two-arm randomized controlled trial (RCT) design was applied. PTSD, anxiety, and depression symptoms were measured in four-time points for all participants in the study. Results showed that the ASSYST-I treatment intervention had a significant effect in the different comparisons carried out through ANOVA for repeated measurements for these variables.
In regard to posttraumatic stress disorder (PTSD), results showed that the intervention had a significant effect for time on this variable with a large effect size (F (3,123) = 196.07 p <.000, η2 = .827), and a significant interaction between time and group, (F (3, 123) = 25.67, p <.000, η2 = .385). A significant effect for group was also found (F (1, 41 = 9.17, p<.005, η2 = .183). The significant differences of the means over time and comparing the groups are presented, including the size effect.
The statistical analysis and the clinical reports confirmed that the ASSYST-I is an effective, safe, and efficient treatment intervention to reduce PTSD, anxiety, and depression symptoms caused by pathogenic memories produced by adverse childhood experiences in the adult female general population. No adverse effects or events were reported by the participants during the treatment procedure administration or at sixty-day follow-up. None of the participants showed clinically significant worsening/exacerbation of symptoms after treatment. All participants received the intervention treatment according to the research design, fulfilling our ethical criteria.

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Paauw, C. C., de Roos, C., Koornneef, M. G. T., Elzinga, B. M., Boorsma, T. M., Verheij, M. A., & Dingemans, A. E. (2023). Eye movement desensitization and processing for adolescents with major depressive disorder: study protocol for a multi-site randomized controlled trial. Trials, 24(1), 206. https://doi.org/10.1186/s13063-023-07226-y

Open Access: https://pubmed.ncbi.nlm.nih.gov/36941688

C. C. Paauw, Department Youth, GGZ Rivierduinen, Sandifortdreef 19, 2333 ZZ Leiden, the Netherlands. E-mail: c.paauw@rivierduinen.nl

Abstract

BACKGROUND: Major depressive disorder (MDD) is one of the most common mental disorders in adolescence carrying a serious risk of adverse development later in life. Extant treatments are limited in effectiveness and have high drop-out and relapse rates. A body of literature has been published on the association between distressing/ traumatic experiences and development and maintenance of MDD, but the effectiveness of a trauma-focused treatment approach for MDD has hardly been studied. This study aims to determine the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy as stand-alone intervention in adolescents diagnosed with MDD.
METHODS: This study will be a randomized controlled trial with two conditions: (1) EMDR treatment (6 sessions) and (2) waiting list condition (WL: 6 weeks, followed by EMDR treatment). First, participants receive a baseline measure after which they will be randomized. Participants will be assessed post-intervention after which the WL participants will also receive six EMDR sessions. Follow-up assessments will be conducted at 3 and 6 months follow-up.
STUDY POPULATION: In total, 64 adolescents (aged 12-18) diagnosed with a major depressive disorder (DSM-5) and identified memories of at least one distressing or traumatic event related to the depressive symptomatology will be included. Main study parameters/endpoints: Primary outcome variables will be the percentage of patients meeting criteria for MDD classification, and level of depressive symptoms. Secondary outcome measures include symptoms of PTSD, anxiety, and general social-emotional problems. At baseline, family functioning and having experienced emotional abuse or neglect will be assessed to explore whether these factors predict post-treatment outcome.
DISCUSSION: With the present study, we aim to investigate whether EMDR as a trauma-focussed brief intervention may be effective for adolescents with a primary diagnosis of MDD. EMDR has been proven an effective treatment for traumatic memories in other disorders. It is hypothesized that traumatic memories play a role in the onset and maintenance of depressive disorders. Particularly in adolescence, early treatment of these traumatic memories is warranted to prevent a more chronic or recurrent course of the disorder. TRIAL REGISTRATION: International Clinical Trial Registry Platform (ICTRP): NL9008 (30-10-2020).

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Potik, D. (2022). Depth Psychology Conceptualization of Trauma-Focused Treatment for Patients with Combat-Related PTSD: Joining the Therapeutic Quest and Alchemy. Psychological Perspectives, 65(3-4), 446-460. https://doi.org/10.1080/00332925.2022.2153524

URL: http://dx.doi.org/10.1080/00332925.2022.2153524

Abstract

Evidence-based psychological treatments of combat posttraumatic stress disorder (PTSD) focus on well-organized protocols whose aim is symptom resolution. However, these protocols do not address either the patient’s subjective experience or to the therapist’s role during such treatments. According to the depth psychology perspective presented herein, combat PTSD patients are heroes whose quest was to serve their country, but their encounter with the dragon left them with psychic and spiritual deadness. During the treatment of such patients, the therapist the therapist embodies, or personifies, the ancient Greek god, Hermes, who helps the patient to acquire the necessary skills for the therapeutic quest. In this quest, the therapist symbolizes aliveness and is the generator of an alchemical change.

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Sappok, T., Bayer, M., Helmes, A., Gabriel, A., Wagner, J., Styp von Rekowski, A., & Tergeist, M. (2023). [Psychotherapy in disorders of intellectual development-Current evidence and practical implementation]. Nervenarzt, 94(5), 446-455. https://doi.org/10.1007/s00115-023-01472-w

URL: https://pubmed.ncbi.nlm.nih.gov/37129621

Tanja Sappok, Medizin für Menschen mit Behinderungen, Medizinische Fakultät, Universität Bielefeld, Bielefeld, Deutschland. E-mail: tanja.sappok@mara.de.

Abstract

People with a disorder of intellectual development (German draft of the ICD-11, which came into force on 1 January 2022) suffer more frequently from mental illnesses. According to the international treatment guidelines multimodal approaches should include not only psychopharmacological treatment, but also disorder-specific psychotherapeutic methods. These psychotherapeutic interventions have to be adapted to the communicative and cognitive abilities (performance diagnostics with IQ tests) as well as the emotional developmental stage (developmental diagnostics, e.g., with the scale of emotional development, short version, SED-S 2; [1]). To ensure this, the rules of simple language should be observed and when appropriate relatives or caregivers should be involved in the therapeutic process. The effectiveness of cognitive behavioral therapy has received most scientific attention, especially for affective disorders. Posttraumatic stress disorders can be validly treated with eye movement desensitization and reprocessing (EMDR). There is also good evidence for exposure therapy with reinforcement in the treatment of anxiety disorders.

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Smith, S., Mark, T., & Givaudan, M. (2023). Clinical Trial on the ASSYST for Groups Treatment Intervention Provided to Syrian Refugees Living in Lebanon. Psychology and Behavioral Science International Journal, 20(2). https://doi.org/10.19080/PBSIJ.2023.20.556033

Open Access: https://juniperpublishers.com/pbsij/volume20-issue2-pbsij.php

Sadie Smith, Department of Research, Breakout, Denver, Colorado, USA.

Abstract

The aim of this clinical trial was to evaluate the effectiveness and safety of the Acute Stress Syndrome Stabilization for Groups (ASSYST-G) treatment intervention, provided by formally trained frontline workers, in reducing posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in adult refugees from Syria living in Lebanon. A total of 41 adult females met the inclusion criteria and participated in the study. Participants’ ages ranged from 18 to 64 years old (M = 38.09 years).
After the treatment intervention, results showed a large effect size in reducing PTSD symptoms associated with the identified worst memory of their experience as refugees. A statistical significance of the one-sample t-test, comparing pre- and post-treatments assessments, t (40) =7.54, p=.000; d= .98 is reported. Cohen ́s effect size for this comparison was considered as large effect (d=.80). Anxiety analysis showed a statistical significance of the one-sample t-test, t (40) = 3.20, p=.003; d= .44, with a decrease in the post-treatment assessment. Mean score for depression was not high in the pretest, and no significant effect was found for this variable after the intervention.
No adverse effects or events were reported by the participants during the treatment procedure administration or at one-month post-treatment assessment. None of the participants showed clinically significant worsening/exacerbation of PTSD, anxiety, or depression symptoms after treatment.

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Venturo-Conerly, K. E., Eisenman, D., Wasil, A. R., Singla, D. R., & Weisz, J. R. (2022). Meta-analysis: The Effectiveness of Youth Psychotherapy Interventions in Low- and Middle-Income Countries. J Am Acad Child Adolesc Psychiatry, S0890-8567(22)01980. https://doi.org/10.1016/j.jaac.2022.12.005

URL: https://www.sciencedirect.com/science/article/abs/pii/S0890856722019803

Katherine Venturo-Conerly, AB, 33 Kirkland Street, Cambridge, MA 02138. E-mail: kventuroconerly@g.harvard.edu

Abstract

OBJECTIVE: Because most youth psychotherapies are developed and tested in high-income countries, relatively little is known about their effectiveness or moderators in low- and middle-income countries (LMICs). To address this gap, we conducted a meta-analysis of randomized controlled trials (RCTs) testing psychotherapies for youth with multiple psychiatric conditions in LMICs, and we tested candidate moderators.
METHOD: We searched 9 international databases for RCTs of youth psychotherapies in LMICs published through January 2021. The RCTs targeted elevated symptoms of youth anxiety (including post-traumatic stress disorder [PTSD] and obsessive-compulsive disorder), depression, conduct problems, and attention problems. Using robust variance estimation, we estimated the pooled effect sizes (Hedges g) at post treatment and follow-up for intervention vs control conditions.
RESULTS: Of 5,145 articles identified, 34 articles (with 43 treatment-control comparisons and 4,176 participants) met methodological standards and were included. The overall pooled g with winsorized outliers was 1.01 (95% CI = 0.72-1.29, p < .001) at post treatment and 0.68 (95% CI = 0.29-1.07, p = .003) at follow-up. Interventions delivered by professional clinicians significantly outperformed those delivered by lay providers (g = 1.59 vs 0.53), but all interventions for conduct problems were delivered by professionals, and the difference for interventions targeting internalizing problems (g = 1.33 vs .53) was not significant. Interventions developed non-locally were more effective if they were not adapted to local contexts than if they were adapted locally (g = 2.31 vs 0.66), highlighting a need for further research on effective adaptations. Significant risk of bias was identified.
CONCLUSION: Overall, pooled effects of youth psychotherapies in LMICs were markedly larger than those in recent comparable non-LMIC meta-analyses, which have shown small-to-medium effects for youth psychotherapies. Findings highlight the potential benefits of youth psychotherapies in LMICs, as well as a need for more RCTs and improved study quality.

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Vignaud, P., Chauliac, N., Contamin, E., Richer, S., Vuillermoz, C., Brunelin, J., & Prieto, N. (2023). Relevance and Feasibility of Group Traumatic Episode Protocol Delivered to Migrants: A Pilot Field Study. Int J Environ Res Public Health, 20(7), 5419. https://doi.org/10.3390/ijerph20075419

Open Access: https://pubmed.ncbi.nlm.nih.gov/37048033

Philippe Vignaud, INSERM U1028, CNRS UMR5292, PSYR2 Team, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, F-69500 Bron, France. E-mail: philippe.vignaud@chu-lyon.fr

Abstract

INTRODUCTION: Post-Traumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) are commonly observed in migrants. Although Eye Movement Desensitization and Reprocessing (EMDR) can be helpful to treat these diseases, it remains difficult to propose EMDR as an individual intervention in help-seeking migrants. Group EMDR, like Group Traumatic Episode Protocol (G-TEP), which was built around the 8 phases of the original EMDR protocol, could offer an effective treatment to a large number of people. It may also be more resource-efficient to provide psychiatric care to migrants.
METHODS: In this open-label trial, the feasibility and the effectiveness of a 6-session G-TEP intervention was investigated in a group of 10 migrants. RESULTS: The intervention was well tolerated by participants. The final attrition rate was 10%. After the intervention, there was a 28.2% significant decrease in PTSD and complex PTSD symptoms, as measured by the International Trauma Questionnaires (total_ITQ) scores (p = 0.013) and a trend towards a significant decrease in MDD symptoms, as measured with the Patient Health Questionnaire (PHQ-9) (p = 0.057).
CONCLUSIONS: G-TEP may be effective in decreasing PTSD symptoms in migrants. The accessibility, low-cost, and very structured features of G-TEP may make its implementation sustainable in the field of psychiatric care for migrants.

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Xu, Z., Hu, J., & Wang, Y. (2023). Bilateral eye movements disrupt the involuntary perceptual representation of trauma-related memories. Behav Res Ther, 165, 104311. https://doi.org/10.1016/j.brat.2023.104311

URL: https://pubmed.ncbi.nlm.nih.gov/37037182

Yingying Wang, Zhejiang University, Department of Psychology and Behavioral Sciences, China. E-mail address: ywang15@zju.edu.cn

Abstract

Bilateral eye movement (EM) is a critical component in eye movement desensitization and reprocessing (EMDR), an effective treatment for post-traumatic stress disorder. However, the role of bilateral EM in alleviating trauma-related symptoms is unclear. Here we hypothesize that bilateral EM selectively disrupts the perceptual representation of traumatic memories. We used the trauma film paradigm as an analog for trauma experience. Nonclinical participants viewed trauma films followed by a bilateral EM intervention or a static Fixation period as a control. Perceptual and semantic memories for the film were assessed with different measures. Results showed a significant decrease in perceptual memory recognition shortly after the EM intervention and subsequently in the frequency and vividness of film-related memory intrusions across one week, relative to the Fixation condition. The EM intervention did not affect the explicit recognition of semantic memories, suggesting a dissociation between perceptual and semantic memory disruption. Furthermore, the EM intervention effectively reduced psychophysiological affective responses, including the skin conductance response and pupil size, to film scenes and subjective affective ratings of film-related intrusions. Together, bilateral EMs effectively reduce the perceptual representation and affective response of trauma-related memories. Further theoretical developments are needed to elucidate the mechanism of bilateral EMs in trauma treatment.

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Zhao, J., Chen, D. Y., Li, X. B., Xi, Y. J., Verma, S., Zhou, F. C., & Wang, C. Y. (2023). EMDR versus waiting list in individuals at clinical high risk for psychosis with post-traumatic stress symptoms: A randomized controlled trial. Schizophr Res, 256, 1-7. https://doi.org/10.1016/j.schres.2023.04.003

URL: https://pubmed.ncbi.nlm.nih.gov/37116264

Fu-Chun Zhou, Beijing Anding Hospital, Capital Medical University, No. 5 Ankang Hutong, Xicheng District, Beijing 100088, China. E-mail: frankchow@ccmu.edu.cn

Abstract

BACKGROUND: Post-traumatic stress disorder (PTSD) is highly prevalent in the individuals at clinical-high risk for psychosis (CHR). The aim of this study was to examine the efficacy and safety of Eye Movement Desensitization and Reprocessing (EMDR) in individuals at CHR with comorbid PTSD or subthreshold PTSD in a randomized controlled trial.
METHODS: Fifty-seven individuals at CHR with PTSD or subthreshold PTSD formed the study sample. The eligible participants were randomly assigned to a 12 weeks EMDR treatment (N = 28) or a waiting list condition (WL, N = 29). The structured interview for psychosis risk syndrome (SIPS), the clinician administered post-traumatic stress disorder scale (CAPS) and a battery of self-rating inventories covering depressive, anxiety and suicidal symptoms were administered.
RESULTS: Twenty-six participants in the EMDR group and all the participants in the WL group completed the study. The analyses of covariance revealed greater reduction of the mean scores on CAPS (F = 23.2, Partial η^2^ = 0.3, P < 0.001), SIPS positive scales (F = 17.8, Partial η^2^ = 0.25, P < 0.001) and all the self-rating inventories in the EMDR group than in the WL group. Participants in the EMDR group were more likely to achieve remission of CHR compared to those in the WL group at endpoint (60.7 % vs. 31 %, P = 0.025).
CONCLUSIONS: EMDR treatment not only effectively improved traumatic symptoms, but also significantly reduced the attenuated psychotic symptoms and resulted in a higher remission rate of CHR. This study highlighted the necessity of adding a trauma-focused component to the present approach of early intervention in psychosis.

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