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Video of the month

This month, I am bringing you the invited closing plenary which I delivered June 13, 2010 at the EMDR Europe Conference in Hamburg on “The Future of EMDR.” This video is just over one hour long.

The Future of EMDR 2010 from Hexagon Lark on Vimeo.

Footnote to the plenary: Viewers of the plenary will notice that Prediction 1 was: “Chris Lee’s meta-analysis of the contribution of eye movements in processing emotional memories will be published in a respected peer-reviewed journal in 2011.” This turned out to be somewhat optimistic. The Journal of Consulting and Clinical Psychology rejected the meta-analysis twice, delaying its appearance. Lee and Cuijpers subsequently submitted the meta-analysis to the Journal of Behavior Therapy and Experimental Psychiatry in March 2011. After peer review it was revised and resubmitted in October 2012. It was accepted for publication in November 2012, appeared first online in December 2012 when it was indexed here, and was finally published in June 2013, 18 months later than I predicted. The next of the predictions will be due in 2014.

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Journal Articles

de Bont, P. A., van Minnen, A., & de Jongh, A. (2013). Treating PTSD in patients with psychosis: A within-group controlled feasibility study examining the efficacy and safety of evidence-based PE and EMDR protocols. Behavior Therapy, 44(4), 717-730. doi:10.1016/j.beth.2013.07.002

Paul A. J. M. de Bont, Mental Health Centre Land van Cuijken Noord Limburg, PO Box 103, 5830 AC Boxmeer, The Netherlands; e-mail: paj.de.bont@ggzoostbrabant.nl; pajmdebont@gmail.com.

Abstract

The present study uses a within-group controlled design to examine the efficacy and safety of two psychological approaches to posttraumatic stress disorder (PTSD) in 10 patients with a concurrent psychotic disorder. Patients were randomly assigned either to prolonged exposure (PE; N=5) or eye movement desensitization and reprocessing (EMDR; N=5). Before, during, and after treatment, a total of 20 weekly assessments of PTSD symptoms, hallucinations, and delusions were carried out. Twelve weekly assessments of adverse events took place during the treatment phase. PTSD diagnosis, level of social functioning, psychosis-prone thinking, and general psychopathology were assessed pretreatment, posttreatment, and at three-month follow-up. Throughout the treatment, adverse events were monitored at each session. An intention-to-treat analysis of the 10 patients starting treatment showed that the PTSD treatment protocols of PE and EMDR significantly reduced PTSD symptom severity; PE and EMDR were equally effective and safe. Eight of the 10 patients completed the full intervention period. Seven of the 10 patients (70%) no longer met the diagnostic criteria for PTSD at follow-up. No serious adverse events occurred, nor did patients show any worsening of hallucinations, delusions, psychosis proneness, general psychopathology, or social functioning. The results of this feasibility trial suggest that PTSD patients with comorbid psychotic disorders benefit from trauma-focused treatment approaches such as PE and EMDR.

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Dijkstra, A., & van Asten, R. (2013). The eye movement desensitization and reprocessing procedure prevents defensive processing in health persuasion. Health Communication. doi:10.1080/10410236.2013.779558

Arie Dijkstra, Department of Social Psychology, University of Groningen. E-mail: arie.dijkstra@rug.nl

Abstract

In the present study, the method of eye movement desensitization and reprocessing (EMDR) is studied to understand and prevent defensive reactions with regard to a negatively framed message advocating fruit and vegetable consumption. EMDR has been shown to tax the working memory. Participants from a university sample (n = 124) listened to the persuasive message in a randomized laboratory experiment. In the EMDR condition, they were also instructed to follow with their eyes a dot on the computer screen. The dot constantly moved from one side of the screen to the other in 2 seconds. In addition, a self-affirmation procedure was applied in half of the participants. EMDR led to a significant increase in persuasion, only in recipients in whom the persuasive message could be expected to activate defensive self-regulation (in participants with a moderate health value and in participants with low self-esteem). In those with a moderate health value, EMDR increased persuasion, but only when recipients were not affirmed. In addition, EMDR increased persuasion only in recipients with low self-esteem, not in those with high self-esteem. These results showed that EMDR influenced persuasion and in some way lowered defensive reactions. The similarities and differences in effects of EMDR and self-affirmation further increased our insight into the psychology of defensiveness.

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Doering, S., Ohlmeier, M. -C., de Jongh, A., Hofmann, A., & Bisping, V. (2013). Efficacy of a trauma-focused treatment approach for dental phobia: A randomized clinical trial. European Journal of Oral Sciences, 1-10. doi:10.1111/eos.12090

Prof. Stephan Doering, Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria E-mail: stephan.doering@meduniwien.ac.at

Abstract

It has been hypothesized that treatment specifically focused on resolving memories of negative dental events might be efficacious for the alleviation of anxiety in patients with dental phobia. Thirty-one medication-free patients who met the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria of dental phobia were randomly assigned to either Eye Movement Desensitization and Reprocessing (EMDR) or a waitlist control condition. Dental anxiety was assessed using the Dental Anxiety Questionnaire (DAS), the Dental Fear Survey (DFS), a behavior test, and dental attendance at 1-yr of follow up. Eye Movement Desensitization and Reprocessing was associated with significant reductions of dental anxiety and avoidance behavior as well as in symptoms of post-traumatic stress disorder (PTSD). The effect sizes for the primary outcome measures were d = 2.52 (DAS) and d = 1.87 (DFS). These effects were still significant 3 months (d = 3.28 and d = 2.28, respectively) and 12 months (d = 3.75 and d = 1.79, respectively) after treatment. After 1 yr, 83.3% of the patients were in regular dental treatment (d = 3.20). The findings suggest that therapy aimed at processing memories of past dental events can be helpful for patients with dental phobia.

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Hašto, J., & Vojtová, H. (2013). Posttraumatic stress disorder: Bio-psycho-social aspects, eye movement desensitization and reprocessing and autogenic training in persistent stress: Case study, part 1. European Journal of Mental Health, 8(1), 81-101.

Full text available at: http://www.ejmh.eu/mellekletek/2013_1_81_Hasto_Vojtova.pdf

Jozef Hašto, Psychiatric Clinic Pro mente sana, Palackeho 21, SK-91101 Trenčin, Slovakia, E-mail: j.hasto.tn@gmail.com

Abstract

The inclusion of the diagnostic category Posttraumatic Stress Disorder (PTSD) in both the American and the international diagnostic systems, and the definition of the ‘exceptional stressor’ has probably contributed to the recent boom in psychotraumatology research. The bio-psycho-social model seems to be the most adequate account with regard to the multiple layers of the problem. The authors provide an overview of recent research findings. Numerous scientific studies have focused on finding effective treatment methods for trauma-related disorders. Both pharmacological and psychotherapeutic approaches have been found effective. Nowadays, the authors consider psychotherapy to be more essential in the treatment approach for traumatogenic disorders.

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Konitzer, M., & Jaeger, B. (2013). Stellt shapiros EMDR einen paradigmenwechsel in der psychotherapie dar? Versuch einer konzeptionellen analyse. [Does Shapiro's EMDR make a paradigm shift in psychotherapy? Trying to assess EMDR by conceptual analysis.]. Psyche: Zeitschrift Für Psychoanalyse Und Ihre Anwendungen, 67(5), 458-482.

Abstract

Despite of Francine Shapiro's self-explanation EMDR is no paradigm shift in psychotherapy but an eclecticism of Freudian thought, behaviorism, mesmerism and esoterics. The particular metaphorical blend of mechanics and optics is an offspring from early modern times' memorial arts. While this ancient “ars memorativa” tried to enhance memory by mechanical techniques its modern second coming tries to erase traumatic memory by mechanical means. Such an “ars oblivationis” is lesser based scientifically but in cultural tradition. Moreover Shapiro's concept shows cultural signs of an “Imitatio Freudi” (Bloom), confirming instead of abolishing the old paradigm.

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Novo Navarro, P., Maiche Marini, A., Scott, J., Landin-Romero, R., & Amann, B. L. (2013). No effects of eye movements on the encoding of the visuospatial sketchpad and the phonological loop in healthy participants: Possible implications for eye movement desensitization and reprocessing therapy. Personality and Individual Differences, 55(8), 983-988. doi:10.1016/j.paid.2013.08.005

FIDMAG Germanes Hospitalàries Research Foundation, Benito Menni CASM, CIBERSAM, Dr. Antoni Pujadas 38, 08830 Sant Boi de Llobregat, Spain. E-mail: benedikt.amann@gmail.com

Abstract

Horizontal eye movement is an essential component of the psychological intervention “eye movement desensitization and reprocessing” (EMDR) used in posttraumatic stress disorder. A hypothesized mechanism of action is an overload of the visuospatial sketchpad and/or the phonological loop of the working memory. The aim is to explore how eye movements affect the information encoding of the visuospatial sketchpad and the phonological loop. Fifty healthy young adults performed two immediate recall tasks from the Wechsler Memory Scale: “Corsi Cubes” and “Digits”. Using a within-participants design, up to 16 repetitions of eight seconds of eye-movement and an eye-rest condition were performed. There were no statistically significant differences between the eye movement and eye rest conditions for either recall task. In our sample of healthy participants, eye movements did not improve the immediate auditory and visual consolidation memory, undermining this hypothesized mechanism of action of EMDR. However, these findings might also be explained by our exclusion of tests that would stimulate autobiographical memory and our use of a non-clinical sample.

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ten Hoor, N. M. (2013). Treating cognitive distortions with EMDR: A case study of a sex offender. The International Journal of Forensic Mental Health, 12(2), 139-148. doi:10.1080/14999013.2013.791350

Nina M. ten Hoor, De Waag, Outpatient Centre for Forensic Psychiatry, Leiden, the Netherlands.

Abstract

This single-case study illustrates how eye movement desensitization and reprocessing (EMDR) can be of use in the treatment of cognitive distortions in sex offenders who themselves have been victimized in their childhood. A 56-year-old man did not perceive his childhood sexual experiences as negative. As a consequence, he could not see any harm in his own offending in later life. He spent one year in cognitive-behavioral group therapy barely making any progress. After nine EMDR sessions, most cognitive distortions appeared to be resolved. He was able to attend his group sessions in a more open and involved manner.

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Zarghi, A., Zali, A., & Tehranidost, M. (2013). Methodological aspects of cognitive rehabilitation with eye movement desensitization and reprocessing (EMDR). Basic and Clinical Neuroscience, 4(1), 97-103.

Abstract

A variety of nervous system components such as medulla, pons, midbrain, cerebellum, basal ganglia, parietal, frontal and occipital lobes have role in Eye Movement Desensitization and Reprocessing (EMDR) processes. The eye movement is done simultaneously for attracting client's attention to an external stimulus while concentrating on a certain internal subject. Eye movement guided by therapist is the most common attention stimulus. The role of eye movement has been documented previously in relation with cognitive processing mechanisms. A series of systemic experiments have shown that the eyes’ spontaneous movement is associated with emotional and cognitive changes and results in decreased excitement, flexibility in attention, memory processing, and enhanced semantic recalling. Eye movement also decreases the memory's image clarity and the accompanying excitement. By using EMDR, we can reach some parts of memory which were inaccessible before and also emotionally intolerable. Various researches emphasize on the effectiveness of EMDR in treating and curing phobias, pains, and dependent personality disorders. Consequently, due to the involvement of multiple neural system components, this palliative method of treatment can also help to rehabilitate the neuro-cognitive system.