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Journal Articles
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Antos, Z., Zackiewicz, K., Tomaszek, N., Modzelewski, S., & Waszkiewicz, N. (2024). Beyond Pharmacology: A Narrative Review of Alternative Therapies for Anxiety Disorders. Diseases, 12(9), 216. https://doi.org/10.3390/diseases12090216

Open Access: https://pubmed.ncbi.nlm.nih.gov/39329885

Zuzanna Antos, Department of Psychiatry, Medical University of Bialystok, pl. Wołodyjowskiego 2, 15-272 Białystok, Poland. E-mail: 38738@student.umb.edu.pl

Abstract

BACKGROUND: Anxiety disorders significantly reduce patients' quality of life. Current pharmacological treatments, primarily benzodiazepines and antidepressants, are associated with numerous side effects. Consequently, there is a continual search for alternative methods to traditional therapies that are less burdensome for patients and broaden their therapeutic options. Our objective was to determine the role of selected alternative methods in the treatment of anxiety disorders.
METHODS: In this review, we examined recent evidence on alternative treatments for anxiety disorders, including physical activity, mindfulness, virtual reality (VR) technology, biofeedback, herbal remedies, transcranial magnetic stimulation (TMS), cryotherapy, hyperbaric therapy, vagus nerve stimulation (VNS), 3,4-methylenedioxymethamphetamine (MDMA), electroconvulsive therapy (ECT), and eye movement desensitization and reprocessing (EMDR) therapy. For this purpose we reviewed PubMed and after initial search, we excluded works unrelated to our aim, non-original data and animal studies. We conducted second search to cover all minor methods.
RESULTS: We included 116 studies, which data is presented in Tables. We have investigated which methods can support treatment and which can be used as a stand-alone treatment. We assessed the risks to benefits of using alternative treatments.
CONCLUSION: Alternative treatments significantly expand the options available to patients and clinicians, with many serving as adjuncts to traditional therapies. Among the methods presented, mindfulness has the most significant therapeutic potential.

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Assmann, N., Rameckers, S. A., Schaich, A., Lee, C. W., Boterhoven de Haan, K., Rijkeboer, M. M., Arntz, A., & Fassbinder, E. (2024). Childhood-related PTSD: the role of cognitions in EMDR and imagery rescripting. Eur J Psychotraumatol, 15(1), 2397890. https://doi.org/10.1080/20008066.2024.2397890

Open Access: https://doi.org/10.1080/20008066.2024.2397890

Nele Assmann, Department of Psychiatry, Psychosomatic and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany. E-mail: Nele.Assmann@uksh.de

Abstract

Background: The relationship between trauma-related negative cognitions and post-traumatic stress disorder (PTSD) symptoms has been studied frequently. Several studies found a mediating effect of trauma-related negative cognitions on symptom reduction in studies on different psychotherapeutic treatments, however, this relationship has never been studied in imagery rescripting (ImRs) or eye movement desensitization and reprocessing (EMDR).
Objective: To analyse the role of trauma-related negative cognitions in the treatment of PTSD due to childhood trauma with EMDR and ImRs.
Method:N = 155 patients with PTSD due to childhood trauma aged between 18 and 65 (M = 38.54) participated in a randomized clinical trial and were treated with either EMDR or ImRs in Australia, Germany, and the Netherlands between October 2014 and June 2019. We analysed the relationship between PTSD symptoms (Clinician-administered PTSD Scale for DSM-5, CAPS-5 and Impact of Event Scale revised; IES-R, completed twice for index trauma and for all other traumas) and trauma-related negative cognitions (Post-Traumatic Cognitions Inventory, PTCI) using Granger Causality analyses with linear mixed models on person-centered variables. Assessments were conducted pre-treatment, post-treatment (12 sessions in 6 weeks), eight weeks post-treatment, and one year after the pre-treatment assessment.
Results: Changes in negative cognitions (PTCI) preceded changes in PTSD symptoms (unidirectional) as measured by the CAPS and the IES-R for index trauma. For the IES-R related to all other traumas, a unidirectional relationship was found in which changes in PTSD symptoms preceded changes in negative cognitions. No moderating effect of treatment was found. On the level of PTCI subscales only changes in cognitions about oneself preceeded changes in PTSD symptoms.
Conclusions: The results support the idea of a general role of trauma-related negative cognitions in the treatment of PTSD. The analyses should be replicated with a higher frequency of assessments. We studied the role of trauma-related negative cognitions in the treatment of post-traumatic stress disorder (PTSD) with either EMDR or ImRs. Within-person changes in trauma-related negative cognitions preceded changes in PTSD symptoms, except for self-reported PTSD symptoms of all other trauma’s than the index trauma, where the opposite relationship was found. We found no moderation by treatment condition, this supports the idea of a general role of trauma-related negative cognitions in the treatment of post-traumatic stress disorder.

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Carbajal, J., Horne, T. L., Ponder, W. N., Sieja, L. I., & Collins, C. R. (2024). Preliminary Efficacy of the Transdiagnostic EMDR-Negative Affect Protocol. Journal of EMDR Practice and Research, EMDR-2024. https://doi.org/10.1891/emdr-2024-0014

URL: http://dx.doi.org/10.1891/emdr-2024-0014

Jose Carbajal, Stephen F. Austin State University, PO Box 6104, SFA Station, Nacogdoches, TX 75962, USA. E-mail: carbajalji@sfasu.edu

Abstract

First responders and their dependents must cope with the stress from their occupational duties. Those who present for treatment can be overwhelmed by their affective display. In this study, we used a mixed methods design with two first responders and the widow of a first responder. We used the Positive and Negative Affect Schedule measure to identify the negative affect and tested the Eye Movement Desensitization and Reprocessing-Negative Affect protocol, which directly targets the negative affect. From baseline to the end of treatment, all three clients had a clinically significant reduction in negative affect, and at 3-month follow-up, the two first responders had a significant reduction in negative affect. There was also a decrease in scores on attachment, depression, generalized anxiety, suicidality, and posttraumatic stress symptoms, as well as an increase in scores on resilience. The findings show promising results; however, the protocol needs randomized controlled trials with first responders and veteran populations in larger sample sizes to prove its efficacy.

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Dellorco, M., Lynch, O., Ziegelmeyer, E., Roeske, M., Winston-Lindeboom, P., & Diamond, G. (2024). Bolstering family therapy: Assimilating EMDR into ABFT in youth residential treatment. Fam Process. https://doi.org/10.1111/famp.13050

URL: https://pubmed.ncbi.nlm.nih.gov/39148283

Payne Winston-Lindeboom, Newport Healthcare (Center for Research and Innovation), Nashville, TN, USA. E-mail: payne.winston@newporthealthcare. com

Abstract

The psychotherapy field has a long history of integration to improve treatment effectiveness. One type, assimilative integration, offers innovative opportunities to family therapy to incorporate the clinical and research contributions of different approaches. This paper contributes to the literature on integration by exploring how Eye Movement Desensitization and Reprocessing (EMDR) can be assimilated into Attachment-Based Family Therapy (ABFT) for youth in residential psychiatric treatment. ABFT seeks to improve attachment security to parental figures by asking adolescents and young adults to discuss attachment ruptures. This process, specially designed for patients with internalizing disorders, can provoke anxiety, particularly for a patient population that commonly has a history of trauma and adverse life experiences. EMDR is a first-line therapy for post-traumatic stress disorder and has the potential to be effective in treating various other mental health conditions. When patient emotional withdrawal or dysregulation due to breaches in trust between child and parent emerges in ABFT, EMDR may help desensitize associated memories and bolster the family therapy process. The authors provide an overview of both models, and a detailed case study as an example. The paper concludes with a discussion on implications, integration efforts, and limitations.

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Gardoki-Souto, I., Torre, O. M. D. L., Hogg, B., Redolar-Ripoll, D., Sadurní, L. M., McNally, M. F., Blanch, J. M., Lupo, W., Pérez, V., Radua, J., Amann, B. L., Valiente-Gómez, A., & Moreno-Alcázar, A. (2024). ºCorrigendum: Augmentation of EMDR with Multifocal transcranial Current Stimulation (MtCS) in the treatment of fibromyalgia: study protocol of a double blind randomized controlled exploratory and pragmatic trial. Research Square. https://doi.org/10.21203/rs.3.rs-4363105/v1

Open Access: http://dx.doi.org/10.21203/rs.3.rs-4363105/v1

Benedikt.Amann@gmail.com

Abstract

Background: Fibromyalgia (FM) is a generalized, widespread chronic pain disorder affecting 2.7% of the general population. In recent years, different studies have observed a strong association between FM and psychological trauma. Therefore, a trauma-focused psychotherapy, such as Eye Movement Desensitization and Reprocessing (EMDR), combined with a non-invasive brain stimulation technique, such as Multifocal transcranial Current Stimulation (MtCS), could be an innovative adjunctive treatment option. This double blind Randomized Controlled Trial (RCT) analyzes if EMDR therapy is effective in the reduction of pain symptoms in FM patients, and if its potential is boosted with the addition of MtCS.
Methods:96 patients with FM and a history of traumatic events will be randomly allocated to Waiting List, EMDR + active-MtCS or EMDR + sham-MtCS. Therapists and patients will be kept blind to MtCS conditions, and raters will be kept blind to both EMDR and MtCS. All patients will be evaluated at baseline, post-treatment, and follow-up at 6 months after post-treatment. Evaluations will assess the following variables: sociodemographic data, pain, psychological trauma, sleep disturbance, anxiety and affective symptoms, wellbeing, self-care, emotional regulation, self-esteem, and cognitive functioning.
Discussion: This study will provide evidence of whether EMDR therapy is effective in reducing pain symptoms in FM patients, and whether the effect of EMDR can be enhanced by MtCS.
Trial registration number: This trial was registered at ClinicalTrials.gov on 2 August 2019, identifier: NCT04084795

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Hendrix, Y. M. G. A., van Pampus, M. G., Hofman, A., Henrichs, J., van der Horst, H. E., & de Jongh, A. (2024). Postpartum Early EMDR Therapy Intervention (PERCEIVE) Study for Women after a Traumatic Birth Experience: A Randomised Controlled Trial. Available at SSRN 4898491. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4898491

Open Access: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4898491

Yvette Maria Gertruda Annemar Hendrix. E-mail: y.m.g.a.hendrix@olvg.nl

Abstract

Background: Post-traumatic stress disorder (PTSD) following a traumatic childbirth experience (TBE) is a significant yet under-recognized condition. We investigated the effectiveness and safety of early trauma-focused (i.e. EMDR) therapy in reducing or preventing PTSD symptoms at nine weeks postpartum after a TBE compared with care as usual (CAU).
Methods: We conducted a randomised controlled trial in a hospital and 25 midwifery practices in Amsterdam, the Netherlands, enrolling women within fourteen days postpartum who reported a TBE. Women were randomly assigned (1:1) to the EMDR or CAU group using an independent web-based system. The participants and researchers were not masked to group assignment. The clinical interviewer conducting the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) was masked, and statistical analyses were performed masked to group assignment. The women received two EMDR therapy sessions (60 min) or two telephone calls (CAU) between three and five weeks postpartum. The primary outcome was PTSD symptoms at nine weeks postpartum measured by the PTSD Checklist for DSM-5 (PCL-5) continuously and dichotomously (PCL-5 ≥31, indicative of PTSD) and CAPS-5 scores at nine weeks postpartum. Analyses were performed according to intention-to-treat (ITT) and per-protocol analyses. The trial was pre-registered in the Netherlands Trial Register (NL73231.000.20).
Findings: Between September 10, 2020, and November 7, 2023, 861 (7.9%) out of 10,963 women screened, reported a TBE and 151 women were randomly assigned to the EMDR therapy (n=76) or CAU group (n=75). Seven patients withdrew informed consent and one was inaccessible after randomisation, leaving 74 women in the EMDR group and 69 in the CAU group for ITT analyses. The EMDR group showed a significantly larger reduction in PCL-5 scores than the CAU group (adjusted mean difference on square root scale = -0.82, 95% CI -1.24 to -4.04; p<0.001), translating to a raw adjusted mean difference of -8.73 points. The EMDR group had a significantly larger reduction in probable PTSD incidence (EMDR 33·8% (n=25) to 11·1% (n=8); CAU 43·5% (n=30) to 27·3% (n=18)); adjusted odds ratio = 0·39, 95% CI 0·18 -0·88; p=0·023. Square root transformed CAPS-5 symptom severity scores were significantly lower in the EMDR group (β=-0ˑ73, 95% CI -1ˑ23 to -0.23, p=0ˑ004), indicating a raw mean difference of 3ˑ8 points on average between groups. PTSD diagnosis rates according to the CAPS-5 were not significantly different between groups: three participants (4ˑ2%) in EMDR versus six participants (9ˑ1%) in the CAU group, p=0ˑ310. Serious adverse events were not observed.
Interpretation: EMDR therapy proved effective and safe in reducing PTSD symptoms and related psychological distress in postpartum women with a TBE compared to CAU. Its integration into postnatal care protocols may greatly benefit patients with TBEs.
Trial Registration: The trial was pre-registered in the Netherlands Trial Register (NL73231.000.20).

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Hutchins, J., & Simblett, S. (2024). A Cognitive Strategy Approach to EMDR for Trauma Post Severe Traumatic Brain Injury: A Single-Case Feasibility and Acceptability Study. Journal of EMDR Practice and Research, 18(3), 118-128. https://doi.org/10.1891/emdr-2024-0028

URL: https://doi.org/10.1891/emdr-2024-0028

Jonathan Hutchins, Hutchins Psychology Services Ltd, London, UK.
E-mail: jonathan@hutchinspsychology.co.uk

Abstract

Cognitive strategy approach eye movement desensitization and reprocessing (EMDR) is a new approach to adapting the standard eight-phase EMDR protocol to the needs of clients with a traumatic brain injury (TBI). This is a single case study of a 23-year-old female with severe TBI following a road traffic accident with posttraumatic stress disorder (PTSD). On neuropsychological assessment, she scored below the average range across subtests of immediate and delayed memory, language, attention, and visuospatial perception, and on clinical observation, she had significant difficulties with executive functioning including emotional lability and poor planning and problem solving, suggesting significant cognitive impairment. Cognitive strategy approach EMDR was used as a key intervention to reprocess the trauma memory within one 40-minute session. She was assessed, pre- and postintervention as well as at 3-month follow-up, on measures of depression and anxiety (Hospital Anxiety and Depression Scale) and PTSD (Clinician-Administered PTSD Scale and Impact of Events Scale-Revised), which all showed a significant immediate reduction on reliable change indices for symptoms of PTSD and anxiety that either improved or was maintained at 3-month follow-up. This case study represents a first in terms of the evidence base for the benefits of cognitive strategy approach EMDR to treat emotional difficulties, including PTSD, experienced by a person with marked cognitive deficits as a result of a severe TBI.

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Martínez Cáceres, G., & Premuda-Conti, P. (2024). ASSYST-Individual Adapted for the Treatment of Obsessive-Compulsive Disorder. Journal of EMDR Practice and Research, EMDR-2024. https://doi.org/10.1891/emdr-2024-0026

URL: https://doi.org/10.1891/emdr-2024-0026

Paola Premuda-Conti, Division of Counseling, Rehabilitation and Interpreter Training, Troy University, 5201 W. Kennedy Blvd, Ste. 110, Tampa, FL, 33609, USA. E-mail: ppremudaconti@troy.edu

Abstract

Clients with obsessive-compulsive disorder (OCD) symptoms pose a challenge for psychotherapists. Current evidence-based treatments have limitations in efficacy and client retention. This article reports on 17 cases treated with the Acute Stress Syndrome Stabilization Individual (ASSYST-I) Adapted for OCD in an outpatient mental health clinic in Uruguay. The average number of sessions was 16. Clients completed the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) to assess OCD symptom severity before and after treatment. Wilcoxon signed-rank tests found significant differences between pre- and posttreatment on the Y-BOCS total scores (z= −3.624, p< .001), obsessions subtotal scores (z= −3.627, p< .001), and compulsions subtotal scores (z= −3.624, p< .001). This study describes the ASSYST-I Adapted for OCD and discusses its preliminary safety, feasibility, and acceptability.

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Molendijk, M., Baart, C., Schaffeld, J., Akçakaya, Z., Rönnau, C., Kooistra, M., de Kleine, R., Strater, C., & Mooshammer, L. (2024). Psychological Interventions for PTSD, Depression, and Anxiety in Child, Adolescent and Adult Forced Migrants: A Systematic Review and Frequentist and Bayesian Meta-Analyses. Clin Psychol Psychother, 31(4), e3042. https://doi.org/10.1002/cpp.3042

Open Access: https://doi.org/10.1002/cpp.3042

Marc Molendijk, Institute of Psychology, Department of Clinical Psychology, Leiden University, Leiden, The Netherlands. E-mail: molendijkml@fsw.leidenuniv.nl

Abstract

OBJECTIVE: The number of forced migrants has been rising for years. Many forced migrants suffer from post-traumatic stress disorder (PTSD), depression, and/or anxiety and need treatment. Here, we evaluate the effectiveness of psychological interventions (CBT, EMDR, expressive/art, mindfulness, mixed elements, NET and psychoeducation) in reducing symptoms of PTSD, depression, and anxiety in forced migrants.
DESIGN AND DATA SOURCES: Systematic searches in PubMed and Web of Science and searches of preprint servers and grey literature were performed (final search date: 1 September 2023). Random-effects frequentist and Bayesian meta-analyses were used for data synthesis.
RESULTS: We included 84 studies on treatment effects in adults (pooled N = 6302) and 32 on children and adolescents (pooled N = 1097). Our data show a reduction in symptoms of PTSD, depression and anxiety symptoms in both adults and child/adolescent forced migrants. Pooled pre- to post-treatment effects (effect size Cohen's d) ranged from -1.03 to -0.26 for PTSD, from -0.91 to -0.11 for depression and from -0.91 to -0.60 for anxiety, without there being differences in outcome per study design (i.e., RCT comparison vs. non-RCT comparison vs. single arm treatment study). Treatment effects remained evident over follow-up, and not a single type of treatment stood out as being superior to other treatment types. Structural differences in populations (e.g., regarding country of origin) over studies, however, could have hampered the validity of the comparisons between study characteristics such as treatment type. CONCLUSION: Our findings support the effectiveness of psychological treatment in adult and child/adolescent forced migrants.

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Perez-Strumolo, L. (2024). The Effectiveness of the Flash Technique Is Explained by the Broaden-and-Build Theory of Positive Emotion. Journal of EMDR Practice and Research, EMDR-2024. https://doi.org/10.1891/emdr-2024-0015

URL: https://doi.org/10.1891/emdr-2024-0015

Lysandra Perez-Strumolo, School of Social Science and Human Services, Ramapo College, 505 Ramapo Valley Road, Mahwah, NJ 07430, USA. E-mails: lperezst@ram- apo.edu; lysandra.perez.strumolo@gmail.com

Abstract

The Flash Technique (FT) appears to significantly reduce distress and sympathetic arousal in the preparation phase of eye movement desensitization and reprocessing, making the therapeutic process more manageable, and in some cases resulting in spontaneous resolution of symptoms. The broaden-and-build theory of positive emotion is proposed as an explanation for the effectiveness of FT, which requires sustained attention to a positive engaging focus producing a sensation of pleasure or positive feeling. The positive emotion experienced in FT, following retrieval of a traumatic memory at a distance, produces a broadening effect on cognitive function, leading to increased cognitive flexibility and an enhanced ability to integrate diverse information, allowing adaptive reprocessing of traumatic material, reduction in distress, and spontaneous development of adaptive responses.

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Poandl, M. M., & Gutierrez, D. (2024). Strengths-based and trauma-informed: Using eye movement desensitization and reprocessing to promote posttraumatic growth. Traumatology, 0. https://doi.org/10.1037/trm0000527

URL: https://doi.org/10.1037/trm0000527


Margaret M. Poandl, School of Education, Virginia Commonwealth University, 1015 West Main Street, Box 842020, Richmond, VA 23284-2020, United States. E-mail: poandlmm@vcu.edu

Abstract

Over the past 25 years, there has been a shift from a singularly deficit-oriented view of trauma reactions to one that is more inclusive and includes a focus on posttraumatic growth (PTG). Consistent with a strengths- based approach, mental health professionals must attend to the positive reactions that trauma survivors can experience. Research is clear on the importance of PTG, though there is a gap in the literature regarding how to incorporate PTG in therapeutic settings. This article aims to combine a strengths-based perspective with trauma-informed practice. Therefore, the purpose of this article is to provide a conceptual framework of how to apply a trauma-informed treatment protocol in a clinical setting to facilitate PTG. The authors describe eye movement desensitization and reprocessing based on its protocols that uniquely support the growth process. We believe that clinicians must understand the potential benefits that individuals may experience and apply that knowledge to existing trauma-informed treatments to fully encapsulate the spectrum of posttrauma reactions to most effectively guide individuals in their trauma recovery.

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Purnell, L., Chiu, K., Bhutani, G. E., Grey, N., El-Leithy, S., & Meiser-Stedman, R. (2024). Clinicians’ perspectives on retraumatisation during trauma-focused interventions for post-traumatic stress disorder: A survey of UK mental health professionals. J Anxiety Disord, 106, 102913. https://doi.org/10.1016/j.janxdis.2024.102913

Open Access: https://doi.org/10.1016/j.janxdis.2024.102913

Richard Meiser-Stedman, Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, NR4 7TJ, United Kingdom. E-mail: r.meiser-stedman@uea.ac.uk

Abstract

Concerns regarding retraumatisation have been identified as a barrier to delivering trauma-focused therapy for post-traumatic stress disorder (PTSD). We explored clinicians' understanding of what constitutes potential signs of retraumatisation (PSoR), reported incidences of witnessing retraumatisation, use of (and confidence in) therapies for PTSD, fear of retraumatisation during therapy for PTSD, and whether having witnessed retraumatisation was associated with these variables. We surveyed 348 clinicians. There was variation in what clinicians viewed as PSoR. Retraumatisation was reported by clinicians in 3.4 % of patients undergoing trauma-focused therapy for PTSD. A variety of trauma-focused and non-trauma-focused therapies were routinely used, yet 14.4 % reported not using trauma-focused therapy. There was a significant negative correlation between participants' highest reported confidence in trauma-focused therapy and endorsement of PSoR (r = -.25) and fear of retraumatisation (r = -.28). Mean fear of retraumatisation was 30.3 (SD=23.4; a score we derived from asking participants out of 100 how much they worry about trauma-focused therapy being harmful in its own right/leading to a worsening of PTSD symptoms). Participants who had witnessed retraumatisation reported significantly greater endorsement of PSoR (d=.69 [95 % CI .37, 1.02]) and fear of retraumatisation (d=.94 [95 % CI .61, 1.26]). Confidence in using therapies for PTSD was varied and related to how clinicians understood retraumatisation. Retraumatisation is uncommon, but there is variability in clinicians' interpretation of what retraumatisation is, and its utility warrants research.

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Ramallo-Machín, A., Gómez-Salas, F. J., Burgos-Julián, F., Santed-Germán, M. A., & Gonzalez-Vazquez, A. I. (2024). Factors influencing quality of processing in EMDR therapy. Front Psychol, 15, 1432886. https://doi.org/10.3389/fpsyg.2024.1432886

Open Access: https://doi.org/10.3389/fpsyg.2024.1432886

M. A. Santed-Germán, Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain. E-mail: msanted@psi.uned.es

Abstract

This study presents a preliminary analysis of a new instrument oriented at the analysis of processes in EMDR trauma therapy, the Processing Difficulties Scale (PDS). This scale includes 17 items described by experienced EMDR consultants and practitioners as indicative of problems during memory reprocessing. The proposed factorial solution based on four factors explains a total variance explained of 55% and an adequate goodness of fit, based on the proposed indices: RMSEA = 0.07; TLI = 0.91; CFI = 0.95. Table 1 shows the factorial loads for each of the items. The first factor includes 5 items (7, 8, 9, 10, 11), the second factor includes 6 items (13, 14, 25, 27, 28, 31), the third factor includes 3 items (3, 16, 22) and the fourth factor includes 3 items (19, 23, 24). Confirmatory analysis confirms the factorial solution proposed in the exploratory analysis factor and based on four factors with 17 items. The analysis of internal consistency from Cronbach's alpha and the Omega index shows good internal consistency: Factor 1 (good processing; α = 0.92; ω = 0.94), Factor 2 (lack of generalization and/or absence of changes; α = 0.87; ω = 0.90), Factor 3 (poor emotional processing; α = 0.83; ω = 0.85) an Factor 4 (loss of dual attention; α = 0.82; ω = 0.83). In the case of the total scale, both coefficients exceeded 0.90, with an alpha of 0.92 and an Omega of 0.94. The convergent and discriminant validity criteria were estimated by calculating correlations, exploring the relationship between the factors resulting from the final result, the global severity index (GSI) of the SCL-90 and the level of improvement (NGS). These statistical analyses showed good levels of convergent and discriminant validity for all final factors. The PDS may offer a different perspective to analyze the controversy between clinicians and researchers about the need of a preparation phase in patients with complex early traumatization, dissociative symptoms and/or emotion dysregulation, and the different results in specific research around this topic. Exploring the problems in processing in a transdiagnostic way, in a preliminary analysis, we found that the number of early traumatic events measured with the ACE correlates positively with indicators of a loss of dual attention, while emotional dysregulation measured with the DERS does not predict poor processing. Finally, the dissociation measured with the DES seems to correlate positively with the indicators of a loss of dual attention during processing, not seeming to predict poor processing but did show a negative correlation with the indicators of good general processing. These results partially support the findings of some authors on the involvement of certain variables in the processing of traumatic memories, and it may be interesting to evaluate processing styles and their relationship with various indicators, to develop specific interventions in phase 2 of EMDR therapy, thus improving clinical interventions.

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Semmlinger, V., Leithner, C., Klöck, L. M., Ranftl, L., Ehring, T., & Schreckenbach, M. (2024). Prevalence and Predictors of Nonresponse to Psychological Treatment for PTSD: A Meta‐Analysis. Depression and Anxiety, 2024(1), 0. https://doi.org/10.1155/2024/9899034

Open Access: https://doi.org/10.1155/2024/9899034

Verena Semmlinger, Department of Psychology, Ludwig-Maximilians-University Munich, Munich 80802, Germany. E-mail: verena.semmlinger@psy.lmu.de

Abstract

Background. Although highly efficacious psychological treatments for posttraumatic stress disorder (PTSD) exist, there is evidence that first‐line psychological treatment approaches leave a substantial subgroup of patients still suffering from clinically relevant PTSD symptoms posttreatment.
Aims. We aimed to meta‐analytically establish the prevalence and predictors of nonresponse to first‐line guideline‐recommended psychological treatments for PTSD.
Materials and Methods. This meta‐analysis was preregistered (CRD42023368766). We searched the PTSD Trials Standardized Data Repository, Embase, Medline, PsychINFO, and PTSDpubs. We included randomized controlled trials (RCT), reporting data on nonresponse operationalized by (lack of) symptom reduction in PTSD symptoms at posttreatment of first‐line guideline‐recommended PTSD treatments for adult patients meeting criteria for a PTSD diagnosis. All studies published by October 10, 2023, were included. Data were extracted by two independent reviewers. We estimated the pooled average nonresponse rates and ORs. Subgroup and metaregression analyses targeting the nonresponse rates served to identify significant predictors. All analyses were conducted using three‐level multilevel models. Study quality was assessed using Cochrane’s RoB 2 tool.
Results. Eighty six studies with 117 active treatment conditions and 7,894 participants were included in the meta‐analysis. The weighted average nonresponse rate was 39.23%, 95% CI (35.08%, 43.53%). Nonresponse was less frequent in the treatment condition compared to the control condition (OR = 0.22). Subgroup analyses and metaregression revealed the type of analysis, population, type of intervention, treatment format, year of publication, age, sex, PTSD symptom severity, comorbid depression, and baseline depression score as significant predictors. The heterogeneity between studies was substantial to considerable (I2 = 83.12%). Half of the studies had a high risk of bias.
Conclusions. This meta‐analysis found that a substantial subgroup of patients suffering from PTSD still showed clinically significant symptoms after having received treatment. Treatment modifications should be considered for specific subgroups of PTSD patients based on predictors found to be associated with nonresponse.

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Seok, J.-W., & Kim, J. I. (2024). The Efficacy of Eye Movement Desensitization and Reprocessing Treatment for Depression: A Meta-Analysis and Meta-Regression of Randomized Controlled Trials. J Clin Med, 13(18), 5633. https://doi.org/10.3390/jcm13185633

Open Access: https://doi.org/10.3390/jcm13185633

Joong Il Kim, Digital Health Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea. E-mail: jikim@kiom.re.kr

Abstract

Background: Eye Movement Desensitization and Reprocessing (EMDR) therapy has gained attention for its potential effectiveness in treating depression beyond its initial use for PTSD. This systematic review and meta-analysis aims to evaluate the efficacy of EMDR in treating depression and to identify the variables influencing its effectiveness.
Methods: A comprehensive search was conducted across databases, including MEDLINE, PubMed, and EMBASE, covering studies up to January 2023. A total of 521 studies were screened, and 25 studies with 1042 participants (522 EMDR, 520 control) met the inclusion criteria and were included in the meta-analysis. The inclusion criteria involved randomized controlled trials (RCTs) comparing EMDR to control conditions such as usual care or waitlist groups, with outcomes focused on changes in depression symptoms.
Results: The results show that EMDR had a significant effect on reducing depression symptoms (Hedges' g = 0.75), with moderate heterogeneity being observed. The meta-regression indicated that the severity of depression was a significant predictor of EMDR's effectiveness, with greater effects in severe cases. Additionally, the systematic review analyzed and evaluated various theoretical models and related studies that explain how EMDR works for the treatment of depression, reporting on neurobiological models proposed in previous research.
Conclusions: This study confirms that EMDR is effective in treating depression, particularly in severe cases, and highlights its potential as a non-pharmacological intervention. However, this study highlights the need for more standardized research and long-term evaluations to assess EMDR's lasting impact. Integrating EMDR into multimodal treatment plans and primary care, especially for treatment-resistant depression, could significantly improve patient outcomes.

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Smith, C., Ford, C., Baldwin, G., Jensen, T. K., Karatzias, T., Birkeland, M. S., & Meiser-Stedman, R. (2024). Do psychological treatments for PTSD in children and young people reduce trauma-related appraisals? A systematic review and meta-analysis. Behav Res Ther, 182, 104621. https://doi.org/10.1016/j.brat.2024.104621

Open Access: https://doi.org/10.1016/j.brat.2024.104621

Richard Meiser-Stedman, Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK. E-mail: r.meiser-stedman@uea.ac.uk

Abstract

Research is increasingly highlighting the role of negative trauma-related appraisals in child and adolescent post-traumatic stress disorder (PTSD). The cognitive model of PTSD claims that an essential mechanism of treatment is a reduction in these appraisals. The current systematic review with meta-analysis investigated the extent to which psychological treatments for PTSD reduce negative trauma-related appraisals in children and adolescents. Four databases (PsycINFO, Medline Complete, CINAHL Complete and PTSDpubs) were searched on the 11-12th December 2022. The Risk of Bias 2 (ROB-2) tool was used to assess for risk of bias. Thirteen studies were included in this review, comprising 937 child and adolescent participants. Using a random effects model to perform the meta-analysis, a medium pooled effect size for the effect of current treatments on trauma-related appraisals was found (g = -.67, 95% CI [-.86, -.48]). There was only a moderate level of heterogeneity between studies (I^2^ = 44.4%), increasing the confidence with which these findings can be interpreted. These results indicate that psychological treatments for child and adolescent PTSD significantly reduce negative trauma-related appraisals. However, it is important to note that no trial included in the review was categorised as having low risk of bias.

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van Heemstra, H., van der Aa, N., Mooren, T., Medema, D., Vink, G., Knipscheer, J., Moradi, A., Kleber, R., & Ter Heide, J. J. (2024). Coping styles in refugees with PTSD: Results from a randomized trial comparing EMDR therapy and stabilization. PLoS One, 19(9), e0310093. https://doi.org/10.1371/journal.pone.0310093

Open Access: https://doi.org/10.1371/journal.pone.0310093

Henriette van Heemstra, ARQ Centrum’45, Diemen, The Netherlands.
E-mail: j.van.heemstra@arq.org

Abstract

BACKGROUND: While treatment of posttraumatic stress disorder (PTSD) in refugees is generally effective, many refugees remain symptomatic after treatment. Coping styles could be relevant to PTSD treatment response and as such may be a potential focus of PTSD treatment.
AIMS: The study aims to examine 1) if baseline coping styles are related to treatment response after EMDR therapy or stabilization, and 2) if coping styles change during these treatments.
METHOD: Seventy-two refugees with PTSD were randomly allocated to 12 hours of EMDR therapy or stabilization. A coping questionnaire (COPE-easy) and clinical interview for PTSD (CAPS-IV) were administered before and after treatment and at three-month follow-up. The association between baseline coping styles and PTSD symptom change was examined using regression analysis and a t-test. Changes in coping styles were analyzed using mixed design ANOVA.
RESULTS: No significant relations between baseline coping style levels and PTSD symptom changes were found. Additionally, coping style levels did not change significantly after either treatment.
CONCLUSION: Contrary to the hypothesis, we did not find any evidence that treatment was related to (changes in) coping style. Addressing pre-treatment coping styles among refugees receiving short-term therapy, may not be required for reducing PTSD. Changing coping styles may need a longer or different type of treatment.

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Yu, Y., Zhang, X., Xue, Y., & Ni, S. (2024). Reducing intrusive memories and promoting posttraumatic growth with Traveler: A randomized controlled study. Appl Psychol Health Well Being. https://doi.org/10.1111/aphw.12591

URL: https://doi.org/10.1111/aphw.12591

Shiguang Ni, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, Guangdong, China. E-mail: ni.shiguang@sz.tsinghua.edu.cn

Abstract

Over recent decades, serious games have become a promising intervention approach for addressing psychological problems by providing users with computerized, engaging, and interactive experiences. An innovative serious game, Traveler, has been developed specifically as an intervention tool for managing posttraumatic responses immediately after trauma. The game incorporates the principle of visuospatial interference, the core elements of Tetris, such as spatial displacement and mental rotation, and the critical phases of eye movement desensitization and reprocessing. To test the intervention efficacy and feasibility of Traveler, we conducted a randomized controlled trial involving 105 young adults. Participants were randomly assigned into three groups: a wait-list control group, a group undergoing five-session written exposure therapy, or a group engaging in one session of Traveler gameplay. Outcome measures included intrusive memories (i.e. vividness of traumatic images, disgust at traumatic images, flashback frequency, and flashback impact) and posttraumatic growth measured by the Posttraumatic Growth Inventory. Traveler significantly outperformed the control and written exposure therapy groups in reducing intrusive memories and enhancing posttraumatic growth, with effects persisting at a 30-day follow-up. Thus, Traveler offers a promising brief and early intervention technique for addressing posttraumatic responses. Yet, its clinical applicability requires further investigation.

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Zepeda Méndez, M., Nijdam, M. J., Ter Heide, F. J. J., van der Aa, N., & Olff, M. (2024). Response of patients with complex forms of PTSD to highly intensive trauma treatment: A clinical cohort study. Psychol Trauma, Advance online publication. https://doi.org/10.1037/tra0001747

URL: https://doi.org/10.1037/tra0001747

Mayaris Zepeda Méndez, ARQ Centrum’45, ARQ National Psychotrauma Center, Rijnzichtweg 35, 2342 AX Oegstgeest, Noord-Holland, The Netherlands. E-mail: m.zepeda.mendez@centrum45.nl

Abstract

OBJECTIVE: Although highly intensive trauma treatment programs show promising results in the treatment of patients with posttraumatic stress disorder (PTSD), it remains uncertain if patients with complex forms of PTSD can benefit equally from these intensive programs. To investigate whether patients with the dissociative subtype of PTSD (PTSD + DS) and patients with probable complex PTSD (CPTSD) draw equal benefits from a highly intensive trauma treatment program as patients with PTSD.
METHOD: In this clinical cohort study, patients were included who attended a 5-day intensive program consisting of eye movement desensitisation reprocessing, exposure in vivo and trauma-sensitive yoga components. PTSD with DS was assessed with the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (CAPS-5), and a provisional diagnosis of CPTSD was assessed with the International Trauma Questionnaire. Primary outcome measure was self-reported PTSD-symptom severity measured by PTSD Checklist for DSM-5 at the start of the program (T1) and a week after the program (T2).
RESULTS: Both groups, PTSD + DS (d = 0.85) and probable CPTSD (d = 0.85) benefitted significantly in terms of PTSD-symptom severity reduction and the size of the decrease was not significantly different from that of patients with PTSD.
CONCLUSIONS: Patients with both forms of PTSD complexity can benefit even from a very brief intensive treatment program, which extends previous studies. The diagnoses of PTSD + DS and CPTSD seem helpful to assess the initial severity of the symptoms, but do not imply contra-indications to benefit from intensive treatment. Highly intensive treatment programs are promising interventions to effectively treat complex forms of PTSD and should be studied further in randomized clinical trials.

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