EMDR Research News November 2020
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.
Bennett, R. S., Denne, M., McGuire, R., & Hiller, R. M. (2020). A Systematic Review of Controlled-Trials for PTSD in Maltreated Children and Adolescents. Child Maltreat, 1077559520961176. doi:10.1177/1077559520961176
Rachel M. Hiller, Department of Psychology, University of Bath, United Kingdom.
Email: E. R.Hiller@bath.ac.uk
Child maltreatment is associated with elevated risk of post-traumatic stress disorder (PTSD), which can often present alongside comorbidities. While evidence-based treatments for PTSD in young people already exist, there remains ongoing clinical and academic debate about the suitability of these approaches, particularly cognitive-behavioral approaches, for young people who have been exposed to more complex traumatic experiences, such as maltreatment. We conducted an updated systematic review of the evidence-base for psychological treatments for PTSD, specifically for maltreated young people. Fifteen randomized controlled trials and five non-randomized controlled clinical trials satisfied the inclusion criteria. Trials included treatments ranging from trauma-focused CBT to creative-based therapies. Trauma-focused CBT remained the best supported treatment for children and adolescents following child maltreatment, with new evidence that symptom improvements are maintained at longer-term follow up. The evidence for other therapies remained limited, and there were concerns regarding methodological quality. Implications for treatment decision-making are discussed.
Boterhoven de Haan, K. L., Lee, C. W., Fassbinder, E., van Es, S. M., Menninga, S., Meewisse, M. L., . . . Arntz, A. (2020). Imagery rescripting and eye movement desensitisation and reprocessing as treatment for adults with post-traumatic stress disorder from childhood trauma: randomised clinical trial. Br J Psychiatry, 1-7. doi:10.1192/bjp.2020.158
Katrina L. Boterhoven de Haan, Faculty of Health and Medical Sciences, University of Western Australia, Australia. Email: email@example.com
BACKGROUND: Investigation of treatments that effectively treat adults with post-traumatic stress disorder from childhood experiences (Ch-PTSD) and are well tolerated by patients is needed to improve outcomes for this population.
AIMS: The purpose of this study was to compare the effectiveness of two trauma-focused treatments, imagery rescripting (ImRs) and eye movement desensitisation and reprocessing (EMDR), for treating Ch-PTSD.
METHOD: We conducted an international, multicentre, randomised clinical trial, recruiting adults with Ch-PTSD from childhood trauma before 16 years of age. Participants were randomised to treatment condition and assessed by blind raters at multiple time points. Participants received up to 12 90-min sessions of either ImRs or EMDR, biweekly.
RESULTS: A total of 155 participants were included in the final intent-to-treat analysis. Drop-out rates were low, at 7.7%. A generalised linear mixed model of repeated measures showed that observer-rated post-traumatic stress disorder (PTSD) symptoms significantly decreased for both ImRs (d = 1.72) and EMDR (d = 1.73) at the 8-week post-treatment assessment. Similar results were seen with secondary outcome measures and self-reported PTSD symptoms. There were no significant differences between the two treatments on any standardised measure at post-treatment and follow-up.
CONCLUSIONS: ImRs and EMDR treatments were found to be effective in treating PTSD symptoms arising from childhood trauma, and in reducing other symptoms such as depression, dissociation and trauma-related cognitions. The low drop-out rates suggest that the treatments were well tolerated by participants. The results from this study provide evidence for the use of trauma-focused treatments for Ch-PTSD.
Byrne, G. (2020). A Systematic Review of Treatment Interventions for Individuals With Intellectual Disability and Trauma Symptoms: A Review of the Recent Literature. Trauma Violence Abuse, 1524838020960219. doi:10.1177/1524838020960219
Gary Byrne, Primary Care Psychology Department, Churchtown, Health Service Executive, Dublin 14, Ireland. Email: firstname.lastname@example.org
Individuals with intellectual disabilities (IDs) are at increased susceptibility to adverse life experiences and trauma sequelae. There is a disparate range of therapeutic interventions for post-traumatic stress disorder (PTSD) and associated symptoms. This systematic review aimed to appraise the effectiveness of both cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) for PTSD and associated symptoms for both adults and children with mild, moderate, or severe intellectual delay. A systematic search, in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, of the PsychInfo, PubMed, Cochrane Database of Systematic Reviews, and MEDLINE databases were performed, and all relevant articles published between 2010 and March 2020 were included. A total of 11 articles were included, eight that focused on EMDR and three on CBT. The methodological quality of many of these articles was generally weak. Tentative findings suggest that EMDR and CBT are both acceptable and feasible treatment options among adults and children with varying levels of intellectual delay, but no firm conclusions can be drawn regarding effectiveness due to small sample sizes, lack of standardized assessment, and a paucity of methodological rigorous treatment designs. This review highlights the continued use of therapeutic approaches with clients presenting with IDs and PTSD. It adds to the extant literature by providing an expansive and broad overview of the current effectiveness of both EMDR and CBT. Further high-quality research is needed to provide more conclusive findings regarding treatment effectiveness and modifications to treatment needed with this population.
Coventry, P. A., Meader, N., Melton, H., Temple, M., Dale, H., Wright, K., . . . Roberts, N. P. (2020). Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis. PLoS medicine, 17(8), e1003262.
Open access: https://doi.org/10.1371/journal.pmed.1003262
Peter A. Coventry, Centre for Reviews and Dissemination, University of York, York, United Kingdom. E-mail: email@example.com
Why was the study done?
• Complex traumatic events are of a multiple or prolonged nature and are increasingly prevalent owing to unprecedented levels of population displacement, armed conflict, and increased recognition of childhood sexual abuse and domestic violence.
• People exposed to complex traumatic events are at risk of not only posttraumatic stress disorder (PTSD) but also other mental health problems.
• There are evidence-based psychological and pharmacological treatments for single-event PTSD, but it is not known if people who have experienced complex traumatic events can benefit and tolerate commonly available treatments.
• To inform treatment guidelines and future research, a broad evidence synthesis is needed that goes beyond existing knowledge to identify candidate interventions for mental health problems associated with complex trauma.
What did the researchers do and find?
• We undertook a systematic review and meta-analysis of the effectiveness and acceptability of psychological and pharmacological treatments for mental health problems in veterans, refugees, victims of childhood sexual abuse and domestic violence, and war-affected populations.
• We used network meta-analysis to disentangle the relative contribution of different components of psychological treatments.
• The meta-analysis showed that psychological treatments are effective for treating PTSD, anxiety, and depression and improving sleep in people with a history of complex traumatic events.
• Pharmacological interventions were less effective than psychological interventions for treating PTSD symptoms and improving sleep.
• Trauma-focused treatments were the most effective approaches, but these treatments tended to be less effective in veterans and war-affected populations.
• Multicomponent interventions that included two or more components were the most effective for treating PTSD symptoms, and these approaches were promising for the management of disturbances of self-organisation.
What do these findings mean?
• Existing evidence-based trauma-focused psychological treatments can be effectively used as first-line therapy for PTSD and mental health comorbidities in people exposed to complex trauma.
• Because phasing of treatment was categorised as a constituent part of multicomponent interventions, there is a case to move beyond binary distinctions of phase-based versus non-phase-based interventions, which has hampered progress in PTSD research.
• Future studies could test the most effective means to deliver patient-centred and multicomponent interventions for people exposed to complex trauma, especially in those with higher levels of mental health comorbidity.
Draper, A., Marcellino, E., & Ogbonnaya, C. (2020). Fast Feet Forward: Sports training and running practice to reduce stress and increase positive cognitions in unaccompanied asylum‐seeking minors. Counselling and Psychotherapy Research. doi:10.1002/capr.12330
Miss Comfort Ogbonnaya, Coram 41 Brunswick Square, London, WC1N 1AZ, UK. Email: firstname.lastname@example.org
Unaccompanied asylum‐seeking children (UASC) are a vulnerable group who are exposed to multiple traumatic events such as persecution, sexual maltreatment, imprisonment, torture, and losses in their home country (Bean, Derluyn, Eurelings‐Bontekoe, Broekaert, & Spinhoven, 2007; Wiese and Burhorst, 2007). They are also subjected to continuous transitions throughout their migration trajectory (Bhugra, 2004). Although many studies have investigated the efficacy of bilateral movement in treatment of one single traumatic event (e.g. Fernandez, 2007), there is limited literature around bilateral movements interventions being used with perpetuated and multiple traumas within this cohort. This paper looks at the evidence for early intervention trauma work based on EMDR principles, the benefits of using running as a form of bilateral movement and the findings of a UASC sport trauma group with children in Kent, UK. It also gives recommendations for future research into early intervention trauma work with unaccompanied asylum‐seeking children. The data showed a significant rise in the Validity of Cognition scores with a reduction in Subjective Units of Disturbance scores of those participating in the programme. This highlights the validity of this protocol and shows promising results for future enquiry.
Houben, S. T. L., Otgaar, H., Roelofs, J., Merckelbach, H., & Muris, P. (2020). The effects of eye movements and alternative dual tasks on the vividness and emotionality of negative autobiographical memories: A meta-analysis of laboratory studies. Journal of Experimental Psychopathology, 11(1), 204380872090774. doi:10.1177/2043808720907744
Open access: http://dx.doi.org/10.1177/2043808720907744
Sanne T. L. Houben, Department of Clinical Psychological Science, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands. E-mail: email@example.com
Performing eye movements during memory retrieval is considered to be important for the therapeutic effect of eye movement desensitization and reprocessing (EMDR). We conducted a meta-analysis of laboratory studies that compared the effects of eye movements and/or alternative dual tasks (e.g., counting) on the vividness and emotionality of negative autobiographical memories with recall only (control) conditions. The databases PsycINFO and Web of Science were queried. Fifteen studies that involved 942 participants were included. Eye movements and alternative dual tasks produced similar vividness and emotionality decreases, with the impact on vividness being strong than that on emotionality. However, eye movements yielded a stronger overall vividness reduction than alternative dual tasks, although the associated effect size was small (Cohen’s d 1⁄4 .29). Because eye movements and alternative dual tasks produced comparable effects, one might conclude that both tasks are therapeutic equivalents. However, it should be acknowledged that only a limited number of laboratory studies were included in our meta-analysis, and the degree to which both procedures tax working memory was not independently established. Although our conclusion cannot be generalized to clinical practice, it does raise questions about the mode of action of EMDR.
Irish, A. J. (2020). Using Recent Traumatic Episode Protocol in College Counseling Centers. Journal of College Counseling, 23(2), 180-192. doi:10.1002/jocc.12158
Allen J. Irish, Counseling Center, North Dakota State University. Correspondence concerning this article should be addressed to Allen J. Irish, Counseling Center, North Dakota State University, Department 2841, PO Box 6050, Fargo, ND 58108-6050 E-mail: firstname.lastname@example.org
Experiencing a traumatic event as a college student can have significant social, emotional, and academic consequences. This article discusses the use of an alternative protocol of eye‐movement desensitization and reprocessing, called Recent Traumatic Episode Protocol (E. Shapiro & Laub, 2008), and its use to reduce significant psychological distress of a college student who lived through a mass casualty shooting in the United States.
Jamshidi, F., Rajabi, S., & Dehghani, Y. (2020). How to heal their psychological wounds? Effectiveness of EMDR therapy on post‐traumatic stress symptoms, mind‐wandering and suicidal ideation in Iranian child abuse victims. Counselling and Psychotherapy Research, 1-10.
Soran Rajabi, Persian Gulf University, Bushehr, Iran. E-mail: email@example.com
Child abuse is increasingly known to be a risk factor for health in children across any nationality worldwide. Studies in this area have shown that child abuse, as a traumatic event, can lead to symptoms of PTSD, mind-wandering and also suicidal ideation in adulthood. Although studies have shown significant effects of EMDR on a reduction in psychological symptoms in individuals with a history of trauma, further studies are needed regarding the specific effect of this treatment on reducing PTSD symptoms, suicidal ideations and mind-wandering in female victims of child abuse. The current study aimed to investigate the effectiveness of EMDR therapy on reducing PTSD symptoms, suicidal ideations and mind-wandering in female victims of child abuse. Thirty female victims were assigned to either EMDR or waiting list control in a randomised, double-blind trial. The participants in the EMDR group attended eight twice-weekly sessions. The participants were examined in pre-test and post-test with Civilian Mississippi Scale for PTSD (CMS), Child Abuse and Self-Report Scale (CASRS), Mind-Wandering Questionnaire (MWQ), Beck Scale for suicidal ideation (BSSI) and Brief Dissociative Experiences Scale (DES-B). Results of multivariate analysis of covariance showed that EMDR had a significant effect on reducing PTSD symptoms with an effect size of 0.72, suicidal ideations with an effect size of 0.53, and mind-wandering with an effect size of 0.19. It can be concluded that this treatment is effective in improving PTSD, suicidal ideations and mind-wandering in female victims of child abuse.
Perez, M. C., Estevez, M. E., Becker, Y., Osorio, A., Jarero, I., & Givaudan, M. (2020). Multisite Randomized Controlled Trial on the Provision of the EMDR Integrative Group Treatment Protocol for Ongoing Traumatic Stress Remote to Healthcare Professionals Working in Hospitals During the Covid-19 Pandemic. Psychology and Behavioral Science International Journal, 15(4), 1-12.
Open access: https://juniperpublishers.com/pbsij/pdf/PBSIJ.MS.ID.555920.pdf
Ignacio Jarero, Department of Research, Mexican Association for Mental Health Support in Crisis, Mexico City, Mexico.
The aim of this longitudinal multisite randomized controlled trial (RCT), using a waitlist/delayed treatment control group design, was to evaluate the effectiveness of the Eye Movement Desensitization and Reprocessing-Integrative Group Treatment Protocol for Ongoing Traumatic Stress Remote (EMDR-IGTP-OTS-R) in reducing posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in healthcare professionals working in hospitals during the Covid-19 pandemic in Puebla, Mexico. The study was conducted in 2020 in the city of Puebla, Mexico with healthcare professionals (nurses and medical doctors) working in ten hospitals who received Covid-19 patients. A total of 80 healthcare professionals met the inclusion criteria. Participants’ ages ranged from 21 to 51 years old (M =33.24 years). In this study, the early EMDR online group therapy intervention was initiated seven weeks after the first Covid-19 patients died in the hospitals. Intensive EMDR group treatment was provided. Data analysis by repeated measures ANOVA, showed that the EMDR-IGTP-OT-R had a significant effect on the explored variables (PTSD, Anxiety, and Depression) in time, group, and interaction time by group. Comparisons within means of the different pairs of longitudinal measurements were also useful to observe the consistency of the data. Results showed a large effect size (Cohen ́s d, from 1.93 to 1.25) between the pretest and the first posttreatment assessment, being able to attribute these effects to the EMDR-IGTP-OTS-R treatment. Results were confirmed with the between-group mean comparisons since the waitlist/delayed treatment act as a control group. In this case, the effect size (Cohen ́s d) varied from 3.95 to 1.92 showing a large effect of the difference between groups, attributed to the start time of the treatment. Results also showed an overall subjective global improvement in the study participants.
No adverse effects (e.g., symptoms of dissociation, fear, panic, freeze, shut down, collapse, fainting), or events (e.g., suicide ideation, suicide attempts, self-harm, homicidal ideation) were reported by the participants during treatment or at three months post-treatment follow-up while all participants were still working in their hospitals receiving COVID-19 patients. None of the participants showed clinically significant worsening/exacerbation of symptoms on the PCL-5 or HADS after treatment. To the best of our knowledge, this is the first RCT on early intervention with an evidence-based trauma-focus (TF) therapy (e.g., EMDR, TF-CBT) provided online in a group format and intensive treatment modality to healthcare professionals working in hospitals during the COVID-19 pandemic.
This randomized controlled trial provides evidence for the effectiveness, efficacy, feasibility, and safety of the EMDR-IGTP-OTS-R in reducing posttraumatic stress, anxiety, and depression symptoms for healthcare professionals working in hospitals during the Covid-19 pandemic, expanding the EMDR therapy frontiers.
Karatzias, T., Shevlin, M., Fyvie, C., Grandison, G., Garozi, M., Latham, E., . . . Hyland, P. (2020). Adverse and benevolent childhood experiences in Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD): implications for trauma-focused therapies. Eur J Psychotraumatol, 11(1), 1793599. doi:10.1080/20008198.2020.1793599
Open access: https://pubmed.ncbi.nlm.nih.gov/33029328/
Thanos Karatzias, School of Health & Social Care, Edinburgh Napier University, Edinburgh EH11 4BN, Scotland UK. E-mail: firstname.lastname@example.org
Background: There is very little work on the role of positive or benevolent childhood experiences and how such events might offer protection from the insidious effects of adverse experiences in childhood or later in life.
Objectives: We set out to test, using latent variable modelling, whether adverse and benevolent childhood experiences could be best described as a single continuum or two correlated constructs. We also modelled the relationship between adverse and benevolent childhood experiences and ICD-11 PTSD and Complex PTSD (CPTSD) symptoms and explored if these associations were indirect via psychological trauma.
Methods: Data were collected from a trauma-exposed sample (N = 275) attending a specialist trauma care centre in the UK. Participants completed measures of childhood adverse and benevolent experiences, traumatic exposure, and PTSD and CPTSD symptoms.
Results: Findings suggested that adverse childhood experiences operate only indirectly on PTSD and CPTSD symptoms through lifetime trauma exposure, and with a stronger effect for PTSD. Benevolent childhood experiences directly predicted only CPTSD symptoms.
Conclusions: Benevolent and traumatic experiences seem to form unique associations with PTSD and CPTSD symptoms. Future research is needed to explore how benevolent experiences can be integrated within existing psychological interventions to maximise recovery from traumatic stress.
Lenferink, L. I. M., Meyerbröker, K., & Boelen, P. A. (2020). PTSD treatment in times of COVID-19: A systematic review of the effects of online EMDR. Psychiatry research, 293, 113438.
Open access: https://doi.org/10.1016/j.psychres.2020.113438
L.I.M. Lenferink, Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands and Department of Clinical Psychology & Experimental Psychopathology, University of Groningen; Groningen, the Netherlands. E-mail address: email@example.com
COVID-19 affects many societies by measures as “social distancing”, forcing mental health care professionals to deliver treatments online or via telephone. In this context, online Eye Movement Desensitization and Reprocessing (EMDR) is an emerging treatment for patients with Posttraumatic Stress Disorder (PTSD). We performed a systematic review of studies investigating online EMDR for PTSD. Only one trial was identified. That uncontrolled open trial showed promising results. There is an urgent need to further examine the effects of online EMDR for PTSD, before its wider dissemination is warranted. Remotely delivered cognitive behavioural therapy seems the preferred PTSD-treatment in times of COVID-19.
Melton, H., Meader, N., Dale, H., Wright, K., Jones-Diette, J., Temple, M., . . . Coventry, P. (2020). Interventions for adults with a history of complex traumatic events: the INCiTE mixed-methods systematic review. Health Technol Assess, 24(43), 1-312. doi:10.3310/hta24430
Open access: https://pubmed.ncbi.nlm.nih.gov/32924926
Peter Coventry, Centre for Reviews and Dissemination, University of York, York, UK.
Traumatic events that happen often and that are difficult to escape from, such as childhood abuse, are sometimes known as complex traumatic events. People who have a history of complex traumatic events can develop post-traumatic stress disorder and can also suffer from other mental health problems. It is not known if people who experience complex traumatic events can benefit from existing psychological treatments or medications, or if these treatments are acceptable. This review aimed to find out which treatments are most effective and acceptable for mental health problems in people with complex trauma histories, and to identify the frontrunners for future research. We searched electronic databases for evidence about treatment effectiveness and acceptability in adults with a history of complex traumatic events. We found 104 randomised controlled trials and nine non-randomised controlled trials that tested the effectiveness of psychological and/or medications, as well as nine studies that used interviews and focus groups to describe the acceptability of psychological treatments. The studies were split across different populations that included veterans, refugees, people who had experienced childhood sexual abuse and domestic violence, and civilians affected by war. We found that psychological treatments that focused on improving symptoms associated with trauma were effective for reducing post-traumatic stress disorder symptoms and depression across all populations and fewer people dropped out of these treatments, suggesting that they are acceptable. However, trauma-focused treatments were less effective among veterans than among other groups and less effective for reducing other psychological symptoms commonly experienced by people with complex trauma histories. Phased treatments that first start with helping people to feel safe before focusing on trauma symptoms might be beneficial for both post-traumatic stress disorder and additional psychological symptoms. There was little evidence that medications, other than antipsychotics, were effective for post-traumatic stress disorder symptoms. Future work should test if phased treatments are more effective than non-phased treatments over the long term.
Short, N. A., Morabito, D. M., & Gilmore, A. K. (2020). Secondary prevention for posttraumatic stress and related symptoms among women who have experienced a recent sexual assault: A systematic review and meta-analysis. Depress Anxiety. doi:10.1002/da.23030
Nicole A. Short, Department of Anesthesiology, University of North Carolina, 211B W Cameron Ave, Chapel Hill, NC 27516. E-mail: Nicole_Short@med.unc.edu
BACKGROUND: Women who have experienced a recent sexual assault (SA) are at high risk for posttraumatic stress disorder (PTSD) and related conditions, with approximately half of women experiencing SA meeting criteria for PTSD. There are no guidelines for the prevention of PTSD and other common mental health disorders after SA. Thus, the purpose of this systematic review and meta-analysis is to synthesize research on secondary preventions for PTSD after SA, determine efficacy whether any intervention seems promising, and ascertain when, how, and to whom interventions should be delivered.
METHODS: After searching electronic databases for secondary preventions for PTSD and related conditions among women who have experienced a recent SA, 17 studies were reviewed, their quality was rated on the clinical trial assessment measure, and 10 studies were meta-analyzed (7 were excluded, as they were not randomized controlled trials or due to the absence of heterogeneity).
RESULTS: Results suggested a small-to-moderate effect of prevention on reducing PTSD and related symptoms. There was no moderating effect of medication versus psychosocial interventions, timing, treatment modality, or targeted versus universal prevention. Half of the studies were of high quality.
CONCLUSION: Cognitive-behavioral secondary preventions for PTSD appear to be safe and effective among women who have experienced a recent SA. Future research should identify best practices and mechanisms of treatment, and once identified, it should move toward implementation science.
Stingl, M., Hanewald, B., Kruse, J., & Sack, M. (2020). Positive side effects in trauma-focusing PTSD treatment: Reduction of attendant symptoms and enhancement of affective and structural regulation. Psychol Trauma. doi:10.1037/tra0000700
Markus Stingl, Center of Psychiatry and Psychotherapy, Justus-Liebig-University Giessen, Klinikstrasse 36, Giessen 35392, Germany. E-mail: firstname.lastname@example.org
OBJECTIVE: Trauma-focusing treatments such as eye movement desensitization and reprocessing (EMDR) are highly effective in reducing the core symptoms of posttraumatic stress disorder (PTSD), for example, intrusive memories and flashbacks, hyperarousal, and avoidance. Additionally, suffering from PTSD is often accompanied by a broader set of mental comorbidities and complaints such as depression, anxiety disorders or somatization, and disturbed self-regulation abilities. According to the Adaptive Information Processing model (Shapiro, 2001), the processing of pathogenic memories can help not only to reduce the PTSD symptoms but also accompanying complaints additionally.
METHOD: In an eye movement desensitization and reprocessing treatment study of 116 patients suffering from PTSD, we targeted the course of additional symptoms and structural skills using the Symptom Checklist-90 SCL-90, Beck Depression Inventory, Toronto Alexithymia Scale-20, and Hannover Selbstregulationsinventar in a pre-post design.
RESULTS: The results showed that apart from alleviating the PTSD symptoms, exposure-based treatment of pathogenic memories led to a significant decrease in accompanying symptoms such as depression, anxiety, and somatization. Furthermore, patients improved their structural abilities with regard to emotional perception and differentiation, controlling impulses, tolerating frustration, and regulating self-esteem.
CONCLUSION: PTSD core symptoms and comorbid complaints are closely interlinked and can be seen as a traumatic-stress cluster, which is accompanied by significant impairments in self- and emotion regulation. Therefore, treatment concepts should explicitly foster emotional processing and structural abilities to target the posttraumatic stress responses entirely.
Clinical Impact Statement
Given the high prevalence of comorbidities (e.g., affective disorders, somatization, anxiety) in patients suffering from posttraumatic stress disorder (PTSD), the study observed the interconnections and the course of accompanying symptoms following confrontation therapy. Results showed that the alleviation of the PTSD symptomatology is accompanied by reduced comorbid complaints correlating with improvements in self- and emotion regulation. Therefore, we hypothesize the existence of a comprehensive posttraumatic stress cluster comprising significant impairments in self-regulation, which may cause the broader pattern of symptoms beyond PTSD core symptoms. As a consequence, established treatment concepts should explicitly foster emotional processing and structural abilities to reduce posttraumatic distress and to target the distress from emotional dysregulation entirely.
Strelchuk, D., Wiles, N., Turner, K. M., Derrick, C., & Zammit, S. (2020). Feasibility study of eye movement desensitisation and reprocessing (EMDR) in people with an at-risk mental state (ARMS) for psychosis: study protocol. BMJ open, 10, e038620.
Open access: https://bmjopen.bmj.com/content/10/10/e038620.abstract
Ms. Daniela Strelchuk, Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. email@example.com
Introduction Trauma can play an important role in the development of psychosis, yet no studies have investigated whether a trauma-focused psychological therapy could prevent the onset of psychosis in people at high risk of developing this condition. This study aims to establish whether it would be feasible to conduct a multicentre randomised controlled trial (RCT) to investigate the clinical and cost-effectiveness of eye movement desensitisation and reprocessing (EMDR) therapy to prevent the onset of psychosis in people with an at-risk mental state (ARMS).
Methods/analysis This is a single-arm trial with a nested qualitative study where all participants (target n=20) will be offered EMDR. Eligible participants are those who meet criteria for ARMS; have experienced a traumatic event before the onset of ARMS symptomatology; and have at least one symptom of post-traumatic stress disorder (PTSD). Participants will be followed up at 4, 8 and 12 months after the baseline assessment. The primary outcome measure is transition to psychosis, and secondary outcome measures include severity of psychotic symptoms, PTSD, depression, anxiety, impaired functioning, health status and resource use. The analysis will aim to establish the rates of recruitment and retention for a large-scale RCT. Interviews with therapists and patients will explore their views of the study and their experiences of delivering or receiving EMDR.
Ethics and dissemination This protocol has been approved by the South West-Cornwall and Plymouth Research Ethics Committee (Reference 18/SW/0037). Findings will be disseminated through journal publications, conference presentations and meetings with service users, their families, mental health professionals and commissioners.
Trial registration number ISRCTN31976295.
Tarquinio, C., Brennstuhl, M. J., Rydberg, J. A., Bassan, F., Peter, L., Tarquinio, C. L., . . . Tarquinio, P. (2020). EMDR in Telemental Health Counseling for Healthcare Workers Caring for COVID-19 Patients: A Pilot Study. Issues Ment Health Nurs, 1-12. doi:10.1080/01612840.2020.1818014
Open access: https://pubmed.ncbi.nlm.nih.gov/33052727
Camille Louise Tarquinio, UFR Sciences Humaines et Sociales, EPSAM/APEMAC, University of Lorraine, Ile du Saulcy, BP 30309, Metz Cedex 1 57045, France. E-mail: firstname.lastname@example.org
BACKGROUND: The COVID-19 pandemic is putting a strain on health systems around the world. Healthcare workers, on the front lines of the epidemic, are facing major and potentially traumatic stressful events, overwhelming their ability to cope and their resources.
OBJECTIVE: The objective of this article will be to show how the use of the URG-EMDR protocol in a telemental health setting has proven to be feasible and effective in the treatment of a group of healthcare professionals working in nursing homes or hospital services that were highly mobilized during the acute phase of COVID-19.
METHOD: 17 participants, registered nurses (N = 7) and licensed practical nurses (N = 10), were remotely treated using the URG-EMDR protocol in a single session. The assessment focused on anxiety and depressive symptoms (HAD scale) and the level of perceived disturbance (SUD). An additional evaluation of the satisfaction with the remote psychotherapy intervention was conducted.
RESULTS: As the URG-EMDR protocol has already proven itself during emergency interventions, it is interesting to note that its remote use in the treatment of healthcare providers caring for COVID-19 patients allows for an improvement in the emotional state and a decrease in perceived disturbance, in a single session. This result is maintained 1 week after the intervention, despite the continued professional activities of the participants and the continuity of the event. Moreover, the remote therapy setting was judged satisfactory by the patients, even if it required adjustments and certain recommendations for practice.
DISCUSSION: The remote use of the URG-EMDR protocol opens up innovative perspectives for early interventions and the prevention of the development of psychological disorders in the long term following a situation of acute stress.
Torricelli, L., Poletti, M., & Raballo, A. (2020). Managing COVID-19 related psychological distress in health workers: field experience in northern Italy. Psychiatry Clin Neurosci. doi:10.1111/pcn.13165
Dr. Michele Poletti, Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy. E-mail: email@example.com
Uphoff, E., Robertson, L., Cabieses, B., Villalón, F. J., Purgato, M., Churchill, R., & Barbui, C. (2020). An overview of systematic reviews on mental health promotion, prevention, and treatment of common mental disorders for refugees, asylum seekers, and internally displaced persons. Cochrane Database Syst Rev, 9, CD013458. doi:10.1002/14651858.CD013458.pub2
Open access: https://pubmed.ncbi.nlm.nih.gov/32885850
BACKGROUND: Migrants who have been forced to leave their home, such as refugees, asylum seekers, and internally displaced persons (IDP), are likely to experience stressors which may lead to mental health problems. The efficacy of interventions for mental health promotion, prevention, and treatment may differ in this population.
OBJECTIVES: With this overview of systematic reviews, we will map the characteristics and methodological quality of existing systematic reviews and registered systematic review protocols on the promotion of mental health and prevention and treatment of common mental disorders among refugees, asylum seekers, and IDPs. The findings from this overview will be used to prioritise and inform future Cochrane reviews on the mental health of involuntary migrants.
METHODS: We searched Ovid MEDLINE (1945 onwards), Ovid Embase (1974 onwards), Ovid PsycINFO, ProQuest PTSDpubs, Web of Science Core Collection, Cochrane Database of Systematic Reviews, NIHR Journals Library, CRD databases (archived), DoPHER, Epistemonikos, Health Evidence, 3ie International Initiative for Impact Evaluation, and PROSPERO, to identify systematic reviews of mental health interventions for involuntary migrants. We did not apply any restrictions on date, language, or publication status to the searches. We included systematic reviews or protocols for systematic reviews of interventions aimed at refugees, asylum seekers, and internally displaced persons. Interventions must have been aimed at mental health promotion (for example, classroom-based well-being interventions for children), prevention of mental health problems (for example, trauma-focussed Cognitive Behavioural Therapy to prevent post-traumatic stress disorder), or treatment of common mental disorders and symptoms (for example, narrative exposure therapy to treat symptoms of trauma). After screening abstracts and full-text manuscripts in duplicate, we extracted data on the characteristics of the reviews, the interventions examined in reviews, and the number of primary studies included in each review. Methodological quality of the included systematic reviews was assessed using AMSTAR 2.
MAIN RESULTS: The overview includes 23 systematic reviews and 15 registered systematic review protocols. Of the 23 published systematic reviews, meta-analyses were conducted in eight reviews. It was more common for the search strategy or inclusion criteria of the reviews to state that studies involving refugees were eligible for inclusion (23/23), than for asylum seekers (14/23) or IDPs (7/23) to be explicitly mentioned. In most reviews, study eligiblity was either not restricted by participant age (9/23), or restricted to adults (10/23). Reviews commonly reported on studies of diagnosis or symptoms of post-traumatic stress disorder or trauma (11/23) and were less likely to report on depression or anxiety (6/23). In 15 reviews the intervention of interest was focused on/ specific to psychological therapy. Across all 23 reviews, the interventions most commonly identified from primary studies were general Cognitive Behavioural Therapy, Narrative Exposure Therapy, and a range of different integrative and interpersonal therapies. Even though many reviews included studies of participants without a diagnosis of a mental health problem, they often assessed mental health treatments and did not usually distinguish between promotion, prevention, and treatment in the review aims. Together the 23 systematic reviews included 336 references, of which 175 were unique primary studies. Limitations to the methodological quality of reviews most commonly related to reporting of selection criteria (21/23), absence of a protocol (19/23), reporting of study design (20/23), search strategy (22/23), and funding sources of primary studies (19/23).
AUTHORS' CONCLUSIONS: Gaps exist in the evidence on mental health interventions for refugees, asylum seekers, and internally displaced persons. Most reviews do not specify that internally displaced persons are included in the selection criteria, even though they make up the majority of involuntary migrants worldwide. Reviews specific to mental health promotion and prevention of common mental disorders are missing, and there is more evidence available for adults or mixed populations than for children. The literature is focused on post-traumatic stress disorder and trauma-related symptoms, with less attention for depression and anxiety disorders. Better quality systematic reviews and better report of review design and methods would help those who may use these reviews to inform implementation of mental health interventions.
van Gelderen, M. J., Nijdam, M. J., de Vries, F., Meijer, O. C., & Vermetten, E. (2020). Exposure-related cortisol predicts outcome of psychotherapy in veterans with treatment-resistant posttraumatic stress disorder. J Psychiatr Res, 130, 387-393. doi:10.1016/j.jpsychires.2020.08.011
Open access: https://www.sciencedirect.com/science/article/pii/S0022395620309225?via%3Dihub
Marieke J. van Gelderen, ARQ Centrum’45, Nienoord 5, 1112 XE, Diemen, the Netherlands. E-mail: firstname.lastname@example.org
BACKGROUND: Hypothalamic-pituitary-adrenal axis functioning has been related to treatment outcome in posttraumatic stress disorder (PTSD). Previous studies have primarily focused on cortisol levels before and after a course of therapy and findings have not been fully consistent. This study investigated session-related cortisol levels in veterans with treatment-resistant PTSD over the course of a novel motion-assisted virtual reality exposure therapy and aimed to determine whether cortisol levels were related to changes in PTSD symptom severity.
METHODS: Veterans (N = 22) received six exposure sessions during which salivary cortisol samples were collected pre-session, post-session and in the late afternoon following sessions. PTSD symptom severity was assessed by structured clinical interviews at pre- and post-treatment. Average cortisol levels were compared between responders and non-responders. Linear regression analyses were conducted with PTSD symptom change as criterion variable, average cortisol levels as predictor, and timing of sampling and baseline PTSD symptoms as covariates.
RESULTS: Responders to treatment tended to have higher average cortisol levels at pre-session (p = 0.064) and post-session (p = 0.050) compared to non-responders. Higher average pre-session and post-session cortisol levels predicted greater PTSD symptom improvement (pre: b = -1.83, p = 0.009; post: b = -3.57, p = 0.004).
CONCLUSION: This study provides preliminary evidence for session-related cortisol as biomarker of response to exposure-based therapies for PTSD. Higher cortisol levels may have facilitated fear extinction and reconsolidation, and may indicate increased physiological stress activation necessary for appropriate treatment engagement. Further work involving comparable methodology is encouraged to establish session-related cortisol as biomarker and to determine the mechanisms through which it interacts with treatment outcome.
Waterman, L. Z., & Cooper, M. (2020). Self-administered EMDR therapy: potential solution for expanding the availability of psychotherapy for PTSD or unregulated recipe for disaster. BJPsych Open, 6, e115. doi:10.1192/bjo.2020.92
Open access: https://pubmed.ncbi.nlm.nih.gov/33004107
Lauren Waterman. E-mail: email@example.com
BACKGROUND: Post-traumatic stress disorder (PTSD) carries a high disease burden worldwide, yet significant barriers exist to providing and accessing treatment for PTSD, particularly in refugee populations and in low- and middle-income countries. There is emerging evidence that self-administered psychological therapies, such as those accessed via online and mobile applications, are efficacious for many mental illnesses and increase access to treatment. Online and mobile applications offering self-help tools for eye movement desensitisation reprocessing (EMDR) therapy, an internationally recommended treatment for PTSD, are already widely distributed to the public.
AIMS: To present a commentary evaluating the potential benefits and risks of self-administered EMDR therapy: first, by conducting a search for existing peer-reviewed evidence relating to self-administered EMDR therapy; second, by presenting existing evidence for other self-help psychotherapies and evaluating what additional insight this could provide into the potential efficacy, safety, tolerability and accessibility of self-administered EMDR therapy; and, third, by describing the conflicting views of EMDR experts on the topic.
METHOD: A search was conducted for articles related to internet, mobile, book or computerised self-help EMDR therapy. The following databases were searched systematically: Medline, PsycInfo, EMBASE, AMED, CINAHL, Psychology and Behavioural Sciences, Cochrane Database and the EMDR Library.
RESULTS: Only one small primary research study was found relating to self-administered EMDR therapy. The results indicated significantly reduced symptoms of PTSD, depression, anxiety, distress and disability between pre-treatment and 3 month follow-up. No serious adverse events were reported. However, substantial methodological issues were discovered.
CONCLUSIONS: There is evidence that self-administered psychotherapies, in general, can be safe, effective and highly accessible. However, controversies persist regarding the safety and potential efficacy of self-administered EMDR therapy, and more robust research is needed. It is vital that methods are found to improve worldwide access to effective PTSD treatment, particularly given the current scale of migration to flee civil unrest.