EMDR Research News September 2014
There is a randomized controlled study of EMDR therapy for treating PTSD in those with chemical dependency. There is a wonderful first report from The European Depression EMDR Network study [EDEN] with a non-randomized exploratory study of EMDR therapy as an adjunct for Cognitive Behavioral Therapy for those with major depressive disorder.
There are two meta-analyses: the first analyzed studies of EMDR therapy for adults with PTSD, the other examined EMDR therapy for child victims of natural and manmade disasters.
There are two new review articles: one reviews reports of EMDR therapy for traumatized refugees, the other reviews EMDR therapy for victims of natural disasters. There also is a quality of care article examining subjective patient reports of responses to therapy for PTSD.
There are three neurological reports. One is an fMRI study of healthy subjects responses of monaural versus bilateral auditory stimulation. A second examines EEG responses in a case series of subjects with PTSD. The third is an EEG study of the inter hemispheric coherence hypothesis of EMDR therapy that reports on the effects of bilateral eye movements on positive memories in non-clinical subjects.
There are three clinical case reports. One from Korea examines two cases of patients with bipolar disorder treated for PTSD with EMDR therapy. A second reports on a single case of nightmares treatment with EMDR therapy. The third explores the use of compassion focused interweaves in EMDR therapy.
The book of the month features a just recently released book from Dolores Mosquera and Anabel Gonzalez on Borderline Personality Disorder and EMDR Therapy.
With each reference below, you will find the citation, abstract and author contact information (when available). Prior quarterly summaries of journal articles can be found on the EMDRIA website and 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 IngentaConnect.
Book of the month
The book of the month features a just recently released book from Dolores Mosquera and Anabel Gonzalez on Borderline Personality Disorder and EMDR Therapy.
From the forward by Andrew M. Leeds, Ph.D.:
“Before receiving initial training in EMDR therapy, both Dolores Mosquera and Anabel Gonzalez were working with highly challenging clinical populations… Both were challenged from the beginning of their work with EMDR therapy to find ways of using EMDR therapy with these most challenging of patients. Both are committed to fidelity in application of the standard EMDR procedures where that is possible. Both have also been quick to glean essential adaptations needed to fit EMDR to the needs of patients with BPD.
Having watched countless hours of video recordings of their work with these patients, I can affirm that their work reveals that they have encountered difficulties along the way. This is to be expected. But they have made a careful study of their successes and their blunders, and from their moments of confusion and uncertainty, they have strengthened both their conceptual grasp of how to understand what is happening within the clinical encounter, as well as the subtle simplicity of how to help their patients move forward into their full humanity. I say “simplicity”, but that is of course misleading. The best work, when it is done elegantly, in the most challenging moment, nearly always looks simple; but underneath that simplicity lies a great deal of perception, thought and choice. In this book they illuminate the interiority of their work and reveal the many lessons they have gained from their work with their patients.”
Chen, Y. R., Hung, K. W., Tsai, J. C., Chu, H., Chung, M. H., Chen, S. R., . . . Chou, K. R. (2014). Efficacy of eye-movement desensitization and reprocessing for patients with posttraumatic-stress disorder: A meta-analysis of randomized controlled trials. PLoS ONE, 9(8), e103676. doi:10.1371/journal.pone.0103676
Ying-Ren Chen, Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, and Taoyuan Armed Forces General Hospital, Longtan, Taiwan. E-mail: wt.ude.umt@urieuk
Full text online: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4125321/
BACKGROUND: We performed the first meta-analysis of clinical studies by investigating the effects of eye-movement desensitization and reprocessing (EMDR) therapy on the symptoms of posttraumatic stress disorder (PTSD), depression, anxiety, and subjective distress in PTSD patients treated during the past 2 decades.
METHODS: We performed a quantitative meta-analysis on the findings of 26 randomized controlled trials of EMDR therapy for PTSD published between 1991 and 2013, which were identified through the ISI Web of Science, Embase, Cochrane Library, MEDLINE, PubMed, Scopus, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature electronic databases, among which 22, 20, 16, and 11 of the studies assessed the effects of EMDR on the symptoms of PTSD, depression, anxiety, and subjective distress, respectively, as the primary clinical outcome.
RESULTS: The meta-analysis revealed that the EMDR treatments significantly reduced the symptoms of PTSD (g = -0.662; 95% confidence interval (CI): -0.887 to -0.436), depression (g = -0.643; 95% CI: -0.864 to -0.422), anxiety (g = -0.640; 95% CI: -0.890 to -0.390), and subjective distress (g = -0.956; 95% CI: -1.388 to -0.525) in PTSD patients.
CONCLUSION: This study confirmed that EMDR therapy significantly reduces the symptoms of PTSD, depression, anxiety, and subjective distress in PTSD patients. The subgroup analysis indicated that a treatment duration of more than 60 min per session was a major contributing factor in the amelioration of anxiety and depression, and that a therapist with experience in conducting PTSD group therapy was a major contributing factor in the reduction of PTSD symptoms.
d'Ardenne, P., & Heke, S. (2014). Patient-reported outcomes in post-traumatic stress disorder part I: Focus on psychological treatment. Dialogues in Clinical Neuroscience, 16(2), 213-26.
Sarah Heke, Director, Institute for Psychotrauma, 86 Old Montague Street, London E1 5NN, UK. E-mail firstname.lastname@example.org
Full text available online: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4140514/
Since 2000, patient reports have contributed significantly to the widening diagnostic criteria for post-traumatic stress disorder, notably with the inclusion of complex, repeated, and indirect threat to people who develop symptoms. This paper describes and explains why patient reports matter, through worldwide mental health users' movements and the human rights movement. It looks at 46 recent patient-reported outcomes of preferred psychological treatments in clinical research and practice, and compares them with clinician-reported outcomes, using rating scales that diagnose and measure therapeutic gains. Attention is given to one qualitative study of survivors of the London bombings as an example of patients' personal traumatic experiences. Understanding patients' views and their limitations can help increase success in trauma-focused therapy outcomes, particularly where patients fail to engage with or complete treatment, where they doubt the validity of the treatment, or do not see it as culturally appropriate, or fear of revisiting the past. Specific recommendations are made for a more collaborative approach with patients in psychiatric and community care and clinical research.
Herkt, D., Tumani, V., Grön, G., Kammer, T., Hofmann, A., & Abler, B. (2014). Facilitating access to emotions: Neural signature of EMDR stimulation. PLoS ONE, 9(8), e106350. doi:10.1371/journal.pone.0106350
Birgit Abler, Department of Psychiatry, Ulm University, Ulm, Germany. Email: email@example.com
Free full text online: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0106350
BACKGROUND: Eye Movement Desensitisation and Reprocessing (EMDR) is a method in psychotherapy effective in treating symptoms of posttraumatic stress disorder. The client attends to alternating bilateral visual, auditory or sensory stimulation while confronted with emotionally disturbing material. It is thought that the bilateral stimulation as a specific element of EMDR facilitates accessing and processing of negative material while presumably creating new associative links. We hypothesized that the putatively facilitated access should be reflected in increased activation of the amygdala upon bilateral EMDR stimulation even in healthy subjects.
METHODS: We investigated 22 healthy female university students (mean 23.5 years) with fMRI. Subjects were scanned while confronted with blocks of disgusting and neutral picture stimuli. One third of the blocks was presented without any additional stimulation, one third with bilateral simultaneous auditory stimulation, and one third with bilateral alternating auditory stimulation as used in EMDR.
RESULTS: Contrasting disgusting vs. neutral picture stimuli confirmed the expected robust effect of amygdala activation for all auditory stimulation conditions. The interaction analysis with the type of auditory stimulation revealed a specific increase in activation of the right amygdala for the bilateral alternating auditory stimulation. Activation of the left dorsolateral prefrontal cortex showed the opposite effect with decreased activation.
CONCLUSIONS: We demonstrate first time evidence for a putative neurobiological basis of the bilateral alternating stimulation as used in the EMDR method. The increase in limbic processing along with decreased frontal activation is in line with theoretical models of how bilateral alternating stimulation could help with therapeutic reintegration of information, and present findings may pave the way for future research on EMDR in the context of posttraumatic stress disorder
Hofmann, A., Hilgers, A., Lehnung, M., Liebermann, P., Ostacoli, L., Schneider, W., & Hase, M. (2014). Eye movement desensitization and reprocessing as an adjunctive treatment of unipolar depression: A controlled study. Journal of EMDR Practice and Research, 8(3), 103-112. doi:10.1891/1933-318.104.22.168
Dr. Arne Hofmann, EMDR Institute Germany, Dolmanstrasse 86b, 51427 Bergisch Gladbach. E-mail: Arne-Hofmann@t-online.de
Depression is a severe mental disorder that challenges mental health systems worldwide. About 30% of treated patients do not experience a full remission after treatment, and more than 75% of patients suffer from recurrent depressive episodes. Although psychotherapy and medication can improve remission rates, the success rates of current treatments are limited. In this nonrandomized controlled exploratory study, 21 patients with unipolar primary depression were treated with a mean of 44.5 sessions of Cognitive Behavioural Therapy (CBT) including an average 6.9 adjunctive sessions of Eye Movement Desensitization and Reprocessing (EMDR). A control group (n = 21) was treated with an average of 47.1 sessions of CBT sessions alone. The main outcome measure was the Beck Depression Inventory II (BDI-II). The treatment groups did not differ in their BDI-II scores before treatment, and both treatments resulted in significant improvement. There was an additional benefit for patients treated with adjunctive EMDR (p = .029). Also the number of remissions at post treatment, as measured by a symptom level below a BDI-II score of 12, was significantly better in the adjunctive EMDR group, the group showing more remissions (n = 18) than the control group ( n = 8; p < .001). This potential effect of EMDR in patients with primary depression should be examined further in larger randomized controlled studies.
Farina, B., Imperatori, C., Quintiliani, M. I., Castelli Gattinara, P., Onofri, A., Lepore, M., . . . Della Marca, G. (2014). Neurophysiological correlates of eye movement desensitization and reprocessing sessions: Preliminary evidence for traumatic memories integration. Clinical Physiology and Functional Imaging. doi:10.1111/cpf.12184
Claudio Imperatori, Department of Human Science, European University of Rome, ItalyVia degli Aldobrandeschi 190, 00163 Roma. E-mail: firstname.lastname@example.org
We have investigated the potential role of eye movement desensitization and reprocessing (EMDR) in enhancing the integration of traumatic memories by measuring EEG coherence, power spectra and autonomic variables before (pre-EMDR) and after (post-EMDR) EMDR sessions during the recall of patient's traumatic memory. Thirteen EMDR sessions of six patients with post-traumatic stress disorder were recorded. EEG analyses were conducted by means of the standardized Low Resolution Electric Tomography (sLORETA) software. Power spectra, EEG coherence and heart rate variability (HRV) were compared between pre- and post-EMDR sessions. After EMDR, we observed a significant increase of alpha power in the left inferior temporal gyrus (T = 3·879; P = 0·41) and an increased EEG coherence in beta band between C3 and T5 electrodes (T = 6·358; P<0·001). Furthermore, a significant increase of HRV in the post-EMDR sessions was also observed (pre-EMDR: 6·38 ± 6·83; post-EMDR: 2·46 ± 2·95; U-Test= 45, P = 0·043). Finally, the values of lagged coherence were negatively associated with subjective units of disturbance (r(24) = -0·44, P<0·05) and positively associated with parasympathetic activity (r(24)=0·40, P<0·05). Our results suggest that EMDR leads to an integration of dissociated aspects of traumatic memories and, consequently, a decrease of hyperarousal symptoms.
June ter Heide, F. J., Mooren, T. T. M., Knipscheer, J. W., & Kleber, R. J. (2014). EMDR with traumatized refugees: From experience-based to evidence-based practice. Journal of EMDR Practice and Research, 8(3), 147-156. doi:10.1891/1933-322.214.171.124
Jackie June ter Heide, MA, MPhil (Cantab), Foundation Centrum ‘45, Nienoord 5, 1112 XE Diemen, the Netherlands. E-mail: email@example.com
Many refugees resettled in Western countries suffer from an accumulation of traumatic and current stressors that contribute to mental health problems and may complicate trauma-focused treatment. Consequently, the acceptability, safety, and efficacy of trauma-focused treatment with refugees have been a matter of clinical and scientific interest. In recent years, the evidence has accumulated for narrative exposure therapy and culturally adapted cognitive behavioral therapy. Although eye movement desensitization and reprocessing (EMDR) is practiced with resettled refugees, only five small studies of limited quality have been conducted on EMDR with this population. In the absence of strong evidence, therapists practising EMDR with refugees may be aided by transcultural psychiatric principles, especially matching of explanatory models. In addition, high-quality research is needed to reliably determine acceptability, safety, and efficacy of EMDR with traumatized refugees.
Keller, B., Stevens, L., Lui, C., Murray, J., & Yaggie, M. (2014). The effects of bilateral eye movements on EEG coherence when recalling a pleasant memory. Journal of EMDR Practice and Research, 8(3), 113-128. doi:10.1891/1933-3126.96.36.199
Dr. Larry Stevens, Northern Arizona University, Depart-ment of Psychological Sciences, Box 15106, Flagstaff, AZ 86011. E-mail: Larry.Stevens@nau.edu
In an investigation of the interhemispheric coherence (IhC) model for eye movement desensitization and reprocessing (EMDR) bilateral eye movement (BEM) effects, 30 participants were exposed to a stationary dot, a blinking red/green dot, or saccadic BEMs during the contemplation of a positive emotional memory. Electroencephalographies (EEGs) were measured afterward during an eyes-closed processing stage. Analyses revealed no significant IhC enhancement for the BEM condition but significant increases in Delta and Low Beta EEG intrahemispheric BEM coherence in the right and left frontal areas, respectively, and a trend increase in Right Frontal Low Beta BEM coherence. LORETA neuroimaging was employed to visually present significant amplitude changes corresponding to observed coherence effects. The functional significance of these intrahemispheric coherence effects is presented and a cortical coherence extension of the IhC model is suggested.
Kennedy, A. (2014). Compassion-Focused EMDR. Journal of EMDR Practice and Research, 8(3), 135-146. doi:10.1891/1933-3188.8.131.52
Dr. Angela Kennedy, Tertiary Psychosis Service, Tees, Esk and Wear Valleys NHS Foundation Trust, Sniperley House, Lanchester Road Hospital, Durham, DH1 5RD, England. E-mail: Angela.firstname.lastname@example.org
Compassion-focused therapy was developed to enhance physiological systems related to well-being, safeness, and connectedness in people where shame and self-criticism inhibited progress in therapy (Gilbert, 2000; Gilbert & Irons, 2005). This system links attachment experiences with emotion regulation capacities, with integrative capacities of the mind and also with the interplay between different motivational systems, which are played out in multiple self-states (Cortina & Liotti, 2010; Cozolino, 2010; Gilbert, 2009; Liotti & Gilbert, 2011). Hence, a compassionate focus could potentially prove valuable in eye movement desensitization and reprocessing (EMDR), particularly where shame or attachment trauma is involved or for those traumas that have impacted on the structure of the self, for example, dissociation. A structured compassion-focused EMDR (CF-EMDR) seems likely to be particularly useful for therapists wishing to pay positive attention to strengths and well-being. The primary task of the CF-EMDR therapist would therefore be to facilitate a warm and wise relationship to the problems that brought the person to EMDR. This article outlines the potential benefit of a compassionate focus in the processing phases of EMDR to address self-critical blocks, giving clinical examples in tables to illustrate the process and language.
Natha, F., & Daiches, A. (2014). The effectiveness of EMDR in reducing psychological distress in survivors of natural disasters: A review. Journal of EMDR Practice and Research, 8(3), 157-170. doi:10.1891/1933-3184.108.40.206
Fehmida Natha, Doctorate in Clinical Psychology, Lancaster University, Furness College, Faculty of Health and Medicine, Lancaster, LA1 4YG, United Kingdom. E-mail: email@example.com
Natural disasters affect whole communities both at an individual level as well as economically and socially. However, the impact of natural disasters on an individual's mental health is substantial; yet, the response to one's mental health needs after a disaster is underdeveloped. Nevertheless, the Humanitarian Assistance Programme has attempted to address these needs by providing eye movement desensitization and reprocessing (EMDR) to natural disaster survivors. This systematic review provides evidence for the effectiveness and efficacy of EMDR in the treatment of psychological distress in survivors of natural disasters. Of the 8 studies reviewed, 4 were controlled trials and 1 study part-controlled. All the studies demonstrated statistical and clinical significance in reducing posttraumatic stress disorder (PTSD) symptoms, anxiety, depression, and other distress experienced by survivors of natural disasters. In addition, 4 of the 8 studies demonstrated clinical significance after just 1 session, presenting EMDR as resource-, time-, and cost-efficient intervention. Theoretical framework, adaptation in intervention, methodological issues, and quality assessment of studies are discussed. Implications for future research and clinical practice are also discussed.
Newman, E., Pfefferbaum, B., Kirlic, N., Tett, R., Nelson, S., & Liles, B. (2014). Meta-analytic review of psychological interventions for children survivors of natural and man-made disasters. Current Psychiatry Reports, 16(9), 462. doi:10.1007/s11920-014-0462-z
Elana Newman, The University of Tulsa Institute of Trauma, Adversity, and Injustice, Department of Psychology, 800 South Tucker Drive, Tulsa, OK, 74103, USA. E-mail: firstname.lastname@example.org
Although many post-disaster interventions for children and adolescent survivors of disaster and terrorism have been created, little is known about the effectiveness of such interventions. Therefore, this meta-analysis assessed PTSD outcomes among children and adolescent survivors of natural and man-made disasters receiving psychological interventions. Aggregating results from 24 studies (total N = 2630) indicates that children and adolescents receiving psychological intervention fared significantly better than those in control or waitlist groups with respect to PTSD symptoms. Moderator effects were also observed for intervention package, treatment modality (group vs. individual), providers' level of training, intervention setting, parental involvement, participant age, length of treatment, intervention delivery timing, and methodological rigor. Findings are discussed in detail with suggestions for practice and future research.
Oh, D., & Kim, D. (2014). Eye movement desensitization and reprocessing for posttraumatic stress disorder in bipolar disorder. Psychiatry Investigation, 11(3), 340-1. doi:10.4306/pi.2014.11.3.340
Daeho Kim, MD, PhD Department of Psychiatry, Hanyang University Medical School, 222 Wangsim-ni-ro, Seongdong-gu, Seoul 133-791, Republic of Korea Tel: +82-2-2290-8430, Fax: +82-2-2298-2055 E-mail: email@example.com
Free full text online:
There is evidence that posttraumatic stress disorder (PTSD) is more prevalent in patients with bipolar disorder. According to a review, the mean prevalence of PTSD in bipolar patients is 16.0%, which is double the lifetime prevalence of PTSD in the general population. Also bipolar patients with comorbid PTSD exhibit more severe bipolar illness and multiple Axis I disorders, and they disengage more frequently from treatment, suggesting poorer outcome and course of the disorder. Trauma-focused cognitive-behavior therapy and eye movement desensization and reprocessing (EMDR) are considered first-line treatments for PTSD. Nonetheless, evidence for the efficacy of PTSD treatment in bipolar disorder is lacking. This is an unsatisfactory situation given the fact that anti-depressant pharmacotherapy, often suggested as a second-line treatment for PTSD, has limited application for bipolar patients because of the possibility of manic switch and adverse long-term outcomes. We report here the successful administration of EMDR to two cases of PTSD in patients with bi-polar disorder.
Perez-Dandieu, B., & Tapia, G. (2014). Treating trauma in addiction with EMDR: A pilot study. Journal of Psychoactive Drugs, 46(4), 303-9. doi:10.1080/02791072.2014.921744
Béatrice Perez-Dandieu M.S.W. Clinical Psychologist, Centre d’Etude et d’Information sur les Drogues (CEID), Bordeaux, France; Institut Michel Montaigne, Centre de Thérapies Familiales et de Traumatismes, Cenon, France.
Objective: This study investigated the effects of standard eye movement desensitization and reprocessing (EMDR) protocol in chronically dependent patients. We propose that reprocessing traumatic memories with EMDR would lead to measurable changes of addiction symptoms.
Method: Twelve patients with alcohol and/or drug dependency were randomly assigned to one of two treatment conditions: treatment as usual (TAU) or TAU plus eight sessions of EMDR (TAU+EMDR). Measures of PTSD symptoms, addiction symptoms, depression, anxiety, self-esteem, and alexithymia were included in this study.
Results: The TAU+EMDR group showed a significant reduction in PTSD symptoms but not in addiction symptoms. EMDR treatment was also associated with a significant decrease in depressive symptoms, while patients receiving TAU showed no improvement in this area. The TAU+EMDR group also showed significant changes in self-esteem and alexithymia post-treatment.
Conclusions: This study suggests that PTSD symptoms can be successfully treated with standard EMDR protocol in substance abuse patients
Woo, M. (2014). Eye movement desensitization and reprocessing treatment of nightmares: A case report. Journal of EMDR Practice and Research, 8(3), 129-134. doi:10.1891/1933-3220.127.116.11
Dr. Matthew Woo, The Resilienz Clinic, 10 Sinaran Drive #10-30, Novena Medical Center, Singapore 307506. E-mail: firstname.lastname@example.org
A single client with depression and chronic nightmares was treated with 4 sessions of eye movement desensitization and reprocessing (EMDR) and showed a decrease in nightmares and improvement in general well-being. The client's 2 nightmare images were resolved following Luber's (2010) protocol for nightmare processing. Treatment effects were measured with the Outcome Rating Scale and showed a shift from the clinical range at pretreatment to the nonclinical range at the third session. The ready improvement and gains of this patient have served to highlight various aspects of the EMDR procedures which have worked well for the client, which included targeting the negative cognitions surrounding the theme of helplessness as well as adapting the positive cognition with a collectivistic orientation.