---

Assmann, N., Fassbinder, E., Schaich, A., Lee, C. W., Boterhoven de Haan, K., Rijkeboer, M., & Arntz, A. (2021). Differential Effects of Comorbid Psychiatric Disorders on Treatment Outcome in Posttraumatic Stress Disorder from Childhood Trauma. J Clin Med, 10(16), 3708. doi:10.3390/jcm10163708

Open access: https://pubmed.ncbi.nlm.nih.gov/34442005

Nele Assmann, Department of Psychiatry and Psychotherapy, Lübeck University, 23538 Lübeck, Germany. E-mail: nele.assmann@uksh.de

Abstract

Patients with posttraumatic stress disorder (PTSD) frequently have comorbid diagnoses such as major depressive disorder (MDD) and anxiety disorders (AD). Studies into the impact of these comorbidities on the outcome of PTSD treatment have yielded mixed results. The different treatments investigated in these studies might explain the varied outcome. The purpose of this study was to examine the impact of these comorbidities on the outcome of two specific PTSD treatments. MDD and AD were analyzed as predictors and moderators in a trial comparing 12 sessions of either eye movement desensitization and reprocessing (EMDR) or imagery rescripting (IR) in 155 adult patients with PTSD from childhood trauma. The primary outcome was reduction of PTSD symptoms (clinician-administered PTSD Scale for DSM-5, CAPS-5) assessed at eight-week follow-up and a secondary outcome was self-report PTSD symptoms (Impact of Event Scale, IES-R). MDD was not a predictor of treatment outcome but did have a significant moderator effect. Patients with MDD showed a better outcome if they were treated with IR, whereas patients without MDD improved more in the EMDR condition. No impact of AD emerged. It seems essential to consider comorbid MDD when planning PTSD treatment to improve treatment outcomes. More research is needed to replicate our findings and focus on different kinds of PTSD treatments and other comorbidities.

---

Biggs, C., Tehrani, N., & Billings, J. (2021). Brief trauma therapy for occupational trauma-related PTSD/CPTSD in UK police. Occup Med (Lond), 71(4-5), 180-188. doi:10.1093/occmed/kqab075

Open access: https://pubmed.ncbi.nlm.nih.gov/34273165

Jo Billings, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK. E-mail: j.billings@ucl.ac.uk

Abstract

Background: Police are frequently exposed to occupational trauma, making them vulnerable to post-traumatic stress disorder (PTSD) and other mental health conditions. Through personal and occupational trauma police are also at risk of developing Complex PTSD (CPTSD), associated with prolonged and repetitive trauma. Police Occupational Health Services require effective interventions to treat officers experiencing mental health conditions, including CPTSD. However, there is a lack of guidance for the treatment of occupational trauma.
Aims: To explore differences in demographics and trauma exposure between police with CPTSD and PTSD and compare the effectiveness of brief trauma-focused therapy between these diagnostic groups. METHODS: Observational cohort study using clinical data from the Trauma Support Service, providing brief trauma-focused therapy for PTSD (cognitive behavioural therapy/eye movement desensitization and reprocessing) to UK police officers. Demographics, trauma exposure, baseline symptom severity and treatment effectiveness were compared between police with PTSD and CPTSD. Changes in PTSD, depression and anxiety symptoms were used to measure treatment effectiveness.
Results: Brief trauma therapy reduced symptoms of PTSD, depression and anxiety. Treatment effectiveness did not differ between CPTSD and PTSD groups. Police with CPTSD exposed to both primary and secondary occupational trauma had poorer treatment outcomes than those exposed to a single occupational trauma type.
Conclusions: Brief trauma-focused interventions are potentially effective in reducing symptoms of PTSD, depression and anxiety in police with CPTSD and PTSD. Further research is needed to establish whether additional CPTSD symptoms (affect dysregulation, self-perception and relational difficulties) are also reduced.

---

Bozkurt Bayhan, D., Tarquinio, C., Rydberg, J., & Korkmazlar, Ü. (2021). The study of the group intervention containing EMDR therapy for children and mothers in the field of trauma after a mine explosion in Turkey. European Journal of Trauma & Dissociation, 6(1). doi:10.1016/j.ejtd.2021.100248

URL: https://doi.org/10.1016/j.ejtd.2021.100248

Berfin Bozkurt Bayhan, Université de Lorraine France APEMAC, F-57000 Metz, France. E-mail: berfinbozkurt@gmail.com

Abstract

Background
On the 13th of May 2014, 301 miners lost their lives in a coal mine explosion in Soma, Turkey. A field study was conducted by volunteers under the roof of the EMDR Humanitarian Assistance Programs: Trauma Recovery (EMDR-HAP-TR) organization.
Objective
All the interventions in this study were aimed to help victims of the disaster. Furthermore, the study aimed to assess the effectiveness of the intervention, specifically the EMDR Group Protocol (EMDR-GP) with Children and Caregivers, which was administered to children and mothers who lost their fathers and husbands in the Soma mine disaster.
Methods
Participants in the study were 25 children and 16 mothers in the intervention group and 25 children and 16 mothers in the control group. The Child's Reaction to Traumatic Events Scale (CROPS) was administered to the children and the Impact of Event Scale-Revised (IES-R) was administered to the mothers. In the intervention groupe, the Subjective Units of Disturbance scale (SUD) was administered both to children and to mothers at different times during the intervention, including before and after desensitization, and at the end of the intervention. CROPS and IES-R were administered before the intervention and 1-year post-intervention. In the control group, CROPS was administered to 25 children and IES-R was administered to 16 mothers. As there was no initial inclusion for a control group due to the field intervention, pre-test measures are not available for the control group.
Results
The SUD ratings and one-year follow-up results on CROPS and IES-R showed that the EMDR-GP reduced all scores for both children and mothers. Compared to the control group, the decrease of CROPS scores in children was found to be significant, while the decrease of IES-R scores in mothers was not. It can be suggested that the EMDR-GP with Children and Caregivers is an effective treatment.
Conclusion
These preliminary findings need to be verified by further studies with a larger number of participants and other populations. Future studies should also include a grief-based scale in situations where there is a risk of traumatic bereavement.

---

Brynhildsvoll Auren, T. J., Gjerde Jensen, A., Rendum Klæth, J., Maksic, E., & Solem, S. (2021). Intensive outpatient treatment for PTSD: a pilot feasibility study combining prolonged exposure therapy, EMDR, physical activity, and psychoeducation. Eur J Psychotraumatol, 12(1), 1917878. doi:10.1080/20008198.2021.1917878

Open access: https://pubmed.ncbi.nlm.nih.gov/34025928

Stian Solem, Department of Psychology, Norwegian University of Science and Technology, Trondheim 7491, Norway. E-mail: stian.solem@ntnu.no

Abstract

Background: Intensive treatment could be effective for patients with post-traumatic stress disorder (PTSD).
Objective: The aim of the study was to test the feasibility of an 8-day (2-week) intensive outpatient treatment for PTSD.
Method: Treatment each day consisted of individual Prolonged Exposure (PE), Eye Movement Desensitization and Reprocessing (EMDR), and psychoeducation and physical activity in groups. Patients met different therapists from session to session.
Results: Six patients started and completed treatment. Levels of attendance of sessions was high. Patients reported that they were satisfied with the treatment, describing it as emotionally taxing, but meaningful. Therapists also described several positive aspects of the treatment format. There were large reductions in PTSD symptoms.
Conclusions: Given these promising, but preliminary findings on the programme’s feasibility, future research should investigate this treatment format using larger samples and controlled designs.

---

Civilotti, C., Margola, D., Zaccagnino, M., Cussino, M., Callerame, C., Vicini, A., & Fernandez, I. (2021). Eye Movement Desensitization and Reprocessing in Child and Adolescent Psychology: a Narrative Review. Current Treatment Options in Psychiatry, 8(3), 95-109. doi:10.1007/s40501-021-00244-0

Open access: http://dx.doi.org/10.1007/s40501-021-00244-0

Cristina Civilotti, Department of Psychology, University of Turin, Turin, Italy. Email: cristina.civilotti@unito.it

Abstract

Purpose of review: Eye movement desensitization and reprocessing (EMDR) therapy is recognized as an excellent approach to the treatment of trauma in clinical and academic contexts by several national and international organizations. The purpose of this work is to summarize the results of research on EMDR therapy with children and adolescents in various contexts through a narrative review of the scientific literature.
Recent findings: Selected studies were clustered in several clinical domains: (1) EMDR and trauma (T), (2) EMDR and violence, (3) EMDR and physical illnesses, and (4) EMDR and psychological problems. Our research indicates how the effectiveness of EMDR therapy within the context of child and adolescent psychology has been widely established in literature. One of the advantages of the use of EMDR therapy with children and adolescents is its flexibility, which allows it to be adapted for various age ranges, situations, and cultures.
Summary: EMDR therapy is a structured psychotherapeutic method that facilitates the treatment of several psychopathologies and problems related to both traumatic events and more common experiences that are emotionally stressful for children and adolescents, although new studies are necessary to increase its validity.

---

Daniel Estrada, B., de Jesús Angulo, B., Elena Navarro, M., Jarero, I., & Sánchez-Armass, O. (2019). PTSD, Immunoglobulins, and Cortisol Changes after the Provision of the EMDR - PRECI to Females Patients with Cancer-Related PTSD Diagnosis. American Journal of Applied Psychology, 8(3), 64. doi:10.11648/j.ajap.20190803.12

Open access: http://dx.doi.org/10.11648/j.ajap.20190803.12

Benito Daniel Estrada, Department of Research, San Luis Potosí Autonomous University, San Luis Potosí, Mexico. E-mail: benito.estrada@uaslp.mx

Abstract

EMDR therapy administered to patients with cancer has proven to be effective in the reduction of posttraumatic stress disorder (PTSD) symptoms and PTSD diagnosis remission. The main objective of this study was to measure the PTSD scores and diagnosis changes before and after the provision of the EMDR-Protocol for Recent Critical Incidents and Ongoing Traumatic Stress (EMDR-PRECI) to female patients with cancer-related PTSD diagnosis. A secondary objective was to observe the immunoglobulins and the cortisol changes pre and post-treatment. Seven female patients with different types of cancer (5 breast, 1 colon, and 1 lymphatic cancer), different cancer treatments (radiation, chemotherapy, radiation, and chemotherapy), and PTSD diagnosis related to their diagnosis and cancer treatment met the inclusion criteria. Participants’ age ranged from 40 to 57 years old (M = 52.28 years old). For PTSD diagnosis and total scores, we used the Global Assessment of Posttraumatic Stress Questionnaire validated for the Mexican population. Biomarkers (cortisol and immunoglobulins) were measured before and after EMDR treatment. For the neuroendocrine measure, we used the cortisol levels in the participant’s blood. For the immunological measure, we used the Nephelometry technique. We measured the changes in the following types of antibodies (immunoglobulins): a) Immunoglobulin A (IgA), b) Immunoglobulin G (IgG), and c) Immunoglobulin M (IgM). EMDR-PRECI was provided by three licensed EMDR clinicians formally trained in the protocol administration. Each EMDR- PRECI session lasted 50-60 minutes. The minimum number of sessions was three and the maximum ten with an average of five. Treatment focused only on the distressing memories related to diagnosis and cancer treatment. No adverse effects were reported during treatment or at six months post-treatment assessment. Results showed a full PTSD diagnosis remission in all participants with significant differences for PTSD scores, t (6) = 2.44, p < .05. These results are in concordance with Carletto et al., study in which all patients treated with EMDR no longer met criteria for PTSD [12]. No significant differences were found for immunoglobulins or cortisol. We believe that the administration of the EMDR-PRECI could be an efficient and effective component of a psychosocial approach to reduce or eliminate cancer-related PTSD symptoms and diagnosis.

---

Demirci, O. O., & Sagaltici, E. (2021). Eye movement desensitization and reprocessing treatment in functional neurological symptom disorder with psychogenic nonepileptic seizures: A study of two cases. Clin Child Psychol Psychiatry, 13591045211037276. doi:10.1177/13591045211037276

URL: https://pubmed.ncbi.nlm.nih.gov/34353136

Eser Sagaltici, Department of Psychiatry, Bagcilar Training and Research Hospital, 134200, Bagcilar, Istanbul 34200, Turkey. Email: dresersagaltici@yahoo.com

Abstract

Patients with functional neurological symptom disorder (FND) have many diverse symptoms including psychogenic nonepileptic seizures (PNES), positive movements such as tremor, dystonia, or gait abnormalities, loss of motor function such as leg or arm paresis, and loss of sensory functions, such as blindness, deafness, or loss of feeling in the limbs. Eye movement desensitization and reprocessing (EMDR) is a therapy method that includes some techniques arising from psychodynamic, cognitive, and behavioral approaches. EMDR is known as a proven psychotherapeutic approach in post-traumatic stress disorder, but there are also numerous studies reporting its efficacy in other psychiatric disorders and trauma-associated symptoms, in patients with comorbid psychiatric disorders. This article presents the outcome of EMDR treatment of two patients' cases, a 13-year-old female and a 16-year-old male, who were diagnosed as FND with PNES, according to the DSM-5 diagnostic criteria. In both cases, there was a significant decrease in Adolescent Dissociative Experiences Scale scores and no pseudo seizures were found, even at the sixth-month follow-up visits. These case studies suggest that EMDR can be an effective method in the long-term treatment of FND with PNES and a useful alternative to other treatment methods.

---

Dominguez, S. K., Matthijssen, S. J. M. A., & Lee, C. W. (2021). Trauma-focused treatments for depression. A systematic review and meta-analysis. PLoS One, 16(7), e0254778. doi:10.1371/journal.pone.0254778

Open access: https://pubmed.ncbi.nlm.nih.gov/34292978

Christopher William Lee, School of Psychology and Exercise Science, Murdoch University, Murdoch, WA, Australia. E-mail: chris.lee@uwa.edu.au

Abstract

Background: Trauma-focused treatments (TFTs) have demonstrated efficacy at decreasing depressive symptoms in individuals with PTSD. This systematic review and meta-analysis evaluated the effectiveness of TFTs for individuals with depression as their primary concern.
Methods: A systematic search was conducted for RCTs published before October 2019 in Cochrane CENTRAL, Pubmed, EMBASE, PsycInfo, and additional sources. Trials examining the impact of TFTs on participants with depression were included. Trials focusing on individuals with PTSD or another mental health condition were excluded. The primary outcome was the effect size for depression diagnosis or depressive symptoms. Heterogeneity, study quality, and publication bias were also explored.
Results: Eleven RCTs were included (n = 567) with ten of these using EMDR as the TFT and one using imagery rescripting. Analysis suggested these TFTs were effective in reducing depressive symptoms post-treatment with a large effect size [d = 1.17 (95% CI: 0.58~ 1.75)]. Removal of an outlier saw the effect size remain large [d = 0.83 (95% CI: 0.48~ 1.17)], while the heterogeneity decreased (I2 = 66%). Analysis of the 10 studies that used EMDR also showed a large effect [d = 1.30 (95% CI: 0.67~1.91)]. EMDR was superior to non trauma-focused CBT [d = 0.66 (95% CI: 0.31~1.02)] and analysis of EMDR and imagery rescripting studies suggest superiority over inactive control conditions [d = 1.19 (95% CI: 0.53~ 1.86)]. Analysis of follow-up data also supported the use of EMDR with this population [d = 0.71 (95% CI: 1.04~0.38)]. No publication bias was identified.
Conclusions: Current evidence suggests that EMDR can be an effective treatment for depression. There were insufficient RCTs on other trauma-focused interventions to conclude whether TFTs in general were effective for treating depression. Larger studies with robust methodology using EMDR and other trauma-focused interventions are needed to build on these findings.

---

El Haj, M., Boutoleau-Bretonnière, C., & Janssen, S. M. J. (2021). Eye movements of recent and remote autobiographical memories: fewer and longer lasting fixations during the retrieval of childhood memories. Psychol Res, 85(6), 2466-2473. doi:10.1007/s00426-020-01403-3

URL: https://pubmed.ncbi.nlm.nih.gov/32862309


Mohamad El Haj, Faculté de Psychologie, Laboratoire de Psychologie Des Pays de La Loire (LPPL - EA 4638), Université de Nantes, Chemin de La Censive du Tertre, Univ Angers, BP 81227, 44312 Nantes, France. E-mail: mohamad.elhaj@univ-nantes.fr

Abstract

There is an increased interest in the study of eye movements during the retrieval of autobiographical memories. Following this trend, the aim of the current study was to evaluate eye movements during the retrieval of remote and recent autobiographical memories. We instructed 71 participants to retrieve memories of personal events from early childhood (6-10 years), late childhood/early adolescence (11-14 years), late adolescence (15-18 years), and the last month. During the retrieval of these memories, participants wore eye-tracking glasses. Analyses showed that early childhood memories triggered fewer fixations and fixations with longer durations than memories from the last month. However, no significant differences were observed for the number of saccades, saccade durations, or total amplitude of the saccades. The fewer and longer lasting fixations during the retrieval of early childhood memories can be attributed either to the visual system reconstructing remote memories from an observer perspective or to difficulties when reconstructing remote memories.

---

Jericho, B., Luo, A., & Berle, D. (2021). Trauma-focused psychotherapies for post-traumatic stress disorder: A systematic review and network meta-analysis. Acta Psychiatr Scand. doi:10.1111/acps.13366

Open access: https://doi.org/10.1111/acps.13366

David Berle, Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia. Email: david.berle@uts.edu.au

Abstract

Introduction: Meta-analytic reviews suggest similar outcomes across trauma-focused psychotherapies for adults with post-traumatic stress disorder (PTSD). However, this conclusion may be premature due to suboptimal statistical-review methodologies. Network meta-analysis (NMA) allows a detailed rank-ordering of the efficacy of established psychotherapy interventions derived from indirect evidence as well as results from direct head-to-head comparisons.
Objective: We sought to determine the efficacy and attrition rates of psychotherapy interventions for PTSD by applying NMA.
Methods: We searched EMBASE, PsychINFO, PTSDPubs and PubMed for randomised controlled trials that compared psychotherapies either head-to-head or against controls for adults with PTSD. A frequentist NMA was used to compare direct and indirect effects to determine the efficacy and attrition rates of psychotherapy interventions.
Results: Of the 5649 papers identified, 82 trials comprising of 5838 patients were included. The network comprised 17 psychotherapies and four control conditions. Network estimates indicated superior efficacy of meta-cognitive therapy and cognitive processing therapy over other psychotherapies (ESs between = 0.26 and 2.32). Written exposure therapy and narrative exposure therapy were associated with lower risk of drop out when considered alongside other psychotherapies. Confidence in the network meta-analytic estimates was considered moderate for both outcomes.
Conclusions: In broad terms, therapeutic commensurability was evident. Nevertheless, with additional studies and larger sample sizes, meta-cognitive and written exposure therapies could indeed differentiate themselves from other approaches as having favourable efficacy and acceptability respectively. These findings may inform clinical decision-making, as well as guide future research for PTSD.

---

Lazzaroni, E., Invernizzi, R., Fogliato, E., Pagani, M., & Maslovaric, G. (2021). Coronavirus Disease 2019 Emergency and Remote Eye Movement Desensitization and Reprocessing Group Therapy With Adolescents and Young Adults: Overcoming Lockdown With the Butterfly Hug. Front Psychol, 12, 701381. doi:10.3389/fpsyg.2021.701381

Open access: https://pubmed.ncbi.nlm.nih.gov/34512458

Elisa Lazzaroni. E-mail: e.lazzaroni@asst-lecco.it

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has represented an individual and collective trauma with an impact on mental health. Restrictive measures such as lockdowns have increased risk factors for the development or triggering of various psychopathologies. Timely psychological intervention has constituted a protective factor that has been indicated as a form of prevention. The main objective of this study was to measure changes in the levels of traumatic stress and anxiety in a clinical population of adolescents and young adults aged 13 to 24 years - already assisted by the local primary and specialty care services before the pandemic - following a trauma-focused psychotherapeutic group intervention according to the eye movement desensitization and reprocessing protocol, conducted remotely before the end of the first lockdown. The Impact of Event Scale-Revised (IES-R), State-Trait Anxiety Inventory (STAI) scales, and the Emotion Thermometer were administered pre- and post-treatment. At the end of the treatment, the Post-Traumatic Growth Inventory (PTGI) questionnaire was administered. The results show that there was a significant improvement pre- and post-intervention in the scores of the scales STAI, IES-R, and Emotion Thermometer with a reduction in post-traumatic symptoms related in particular to the domains of intrusiveness and hyperarousal. The domain of avoidance was less significantly modified by therapy. This overall clinical improvement did not correlate with any of the demographic variables of the sample. In addition, the results show a significant positive global perceived change (PTGI) that did not correlate with the reduction of anxiety or post-traumatic symptoms measured by the other self-report scales. The explored use of telemedicine has revealed a valuable clinical opportunity.

---

Maglione, M. A., Chen, C., Bialas, A., Motala, A., Chang, J., Akinniranye, O., & Hempel, S. (2021). Combat and Operational Stress Control Interventions and PTSD: A Systematic Review and Meta-Analysis. Mil Med, usab310. doi:10.1093/milmed/usab310

URL: https://pubmed.ncbi.nlm.nih.gov/34318331

Abstract

Introduction: Military personnel must prepare for and respond to life-threatening crises on a daily basis. This lifestyle places stress on personnel, and particularly so on deployed service members who are isolated from support systems and other resources. As part of a larger systematic review on the acceptability, efficacy, and comparative effectiveness of interventions designed to prevent, identify, and manage stress reactions, we assessed posttraumatic stress disorder (PTSD) outcomes.
Materials and methods: We searched the electronic databases PsycINFO, PubMed, PTSDPubs, the Defense Technical Information Center, and Cochrane Central, as well as bibliographies of existing systematic reviews, to identify English-language studies evaluating the efficacy or comparative effectiveness of stress control interventions published since 1990. Controlled trials and cohort comparisons of interventions with military, law enforcement, and first responders were included. Two independent reviewers screened literature using predetermined eligibility criteria. Researchers individually abstracted study-level information and outcome data and assessed the risk of bias of included studies; data were reviewed for accuracy by the project leader. Changes in PTSD symptom scores from baseline to post-intervention were converted to standardized mean differences for comparison across studies. Risk ratios were calculated for PTSD case rates post-deployment. When several studies that compared an intervention group with a similar control/comparator reported the same outcome category and measure type, we conducted meta-analysis. We conducted meta-regression by adding a categorical variable, representing setting (i.e., in theater) or population (military vs. law enforcement or first responders) to the meta-analysis model to assess whether this variable was associated with the outcome across studies. The quality of the body of evidence (QoE) was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, which considers study limitations (risk of bias), directness, consistency, precision, and publication bias.
Results: Sixteen controlled trials and 13 cohort comparisons reporting PTSD outcomes met inclusion criteria. Eight controlled trials and two cohort studies had high risk of bias, primarily due to poor, differential, or unknown response rate at follow-up. Twenty-four of the 29 studies included military personnel. Interventions included Acceptance-based Skills training, Attention Bias Modification training, stress inoculation with biofeedback, Critical Incident Stress Debriefing, group psychological debriefing, Eye Movement Desensitization and Reprocessing for sub-clinical stress, embedding mental health providers in theater, Third Location Decompression, reintegration programs, and a 3-week post-deployment residential program for psychological resource strengthening. Meta-analyses of studies comparing a group that received a stress control intervention to a group that did not receive an intervention found no significant difference in reduction in PTSD symptom scores (moderate QoE) or PTSD case rate post-deployment (low QoE). A meta-analysis of studies comparing a specific stress control intervention to an active comparator (usually standard stress management education) found no significant effect on PTSD symptom scores (moderate QoE).
Conclusion: Although combat and operational stress control (COSC) interventions may play a valuable role in decreasing stress, decreasing absenteeism, and enabling return to duty, a systematic review of 29 studies that included a control/comparison group found little evidence that COSC is effective in preventing PTSD or decreasing PTSD symptom scores in military personnel.

---

Manthey, A., Sierk, A., Brakemeier, E. L., Walter, H., & Daniels, J. K. (2021). Does trauma-focused psychotherapy change the brain? A systematic review of neural correlates of therapeutic gains in PTSD. Eur J Psychotraumatol, 12(1), 1929025. doi:10.1080/20008198.2021.1929025

Open access: https://pubmed.ncbi.nlm.nih.gov/34394855

Judith K. Daniels, Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2, 9712 TS Groningen, The Netherlands. E-mail: J.K.Daniels@rug.nl

Abstract

Background: Meta-analytic results indicate that posttraumatic stress disorder (PTSD) is associated with hypoactivation of the medial prefrontal cortex (mPFC), hyperactivation of the amygdala, and volume reductions of the hippocampus. Effective psychotherapeutic treatments were hypothesized to normalize these neural patterns via upregulation of prefrontal structures, which in turn downregulate limbic regions.
Objective: To gain a sound understanding of the effects of successful psychotherapy on the brain, neural changes from pre- to post-treatment in PTSD patients will be aggregated.
Method: A systematic literature search identified 24 original studies employing structural or functional MRI measurements both before and after treatment of patients diagnosed with PTSD.
Results: In conjunction, the review returned little evidence of an activation increase in the mPFC/rostral anterior cingulate cortex (rACC) following successful treatment. Five out of 12 studies observed such an increase (especially during emotion processing tasks), albeit in partially non-overlapping brain regions. Conversely, neither the putative related activation decrease in the amygdala nor volumetric changes or altered activation during the resting state could be convincingly established.
Conclusion: Successful psychological treatments might potentially work via upregulation of the mPFC, which thus may be involved in symptom reduction. However, the role of the amygdala in recovery from PTSD remains unclear. There is currently no indication that the various PTSD treatment approaches employed by the reviewed studies differ regarding their action mechanisms, but further research on this topic is needed.

---

Mattheß, C., Farrell, D., Mattheß, M., Bumke, P., Sodemann, U., & Mattheß, H. (2020). Trauma stabilization as an effective treatment for children with post-traumatic stress problems in South-East Asia. Int J Ment Health Nurs, 29(4), 725-735. doi:10.1111/inm.12707

URL: https://pubmed.ncbi.nlm.nih.gov/32124561

Cordula Mattheß, Sanddornstr. 49, 47269 Duisburg, Germany. Email: Cordula.eichfeld@web.de

Abstract

High numbers of children and adolescents in South-East Asia are traumatized by either natural disasters or human-made violence. Addressing traumatic sequelae in local populations with empirically based trauma treatments is challenged by the insufficiency inappropriately trained mental health provision. To meet this need for qualified therapists, the humanitarian/trauma capacity-building organization, Trauma Aid Germany, trained 37 therapists in psychotraumatology, including trauma stabilization. This study analyses the impact of trauma stabilization as a sole treatment intervention for post-traumatic stress (PTS) problems in children and adolescents. Each client was screened for PTS problems pre- and post-treatment using the Child Behaviour Checklist. Trauma stabilization (including psychoeducation) was the focus for subsequent data analysis. Those excluded were clients in receipt of trauma confrontation interventions. Trauma stabilization, as a sole treatment intervention, appeared to be sufficiently effective in reducing the PTS problems. The data set suggests that trauma stabilization has the potential to be effective, efficient, and sufficient treatment intervention for PTS problems in children and adolescents. Trauma stabilization techniques have the advantage of being relatively straightforward to teach and easy to integrate into practice. They are clinically safe, flexible, adaptable to the development stage and age of the client, and culturally and spiritually sensitive. A further advantage of trauma stabilization interventions is that they are bespoke - adjusted and adapted to the specific needs of the client. The discussion considers the implications for the potential utilization of mental health nurses and paraprofessionals in low- and middle-income countries in trauma stabilization interventions.

---

Matthijssen, S. J. M. A., Brouwers, T., van Roozendaal, C., Vuister, T., & de Jongh, A. (2021). The effect of EMDR versus EMDR 2.0 on emotionality and vividness of aversive memories in a non-clinical sample. European Journal of Psychotraumatology, 12(1). doi:10.1080/20008198.2021.1956793

Open access: http://dx.doi.org/10.1080/20008198.2021.1956793

Suzy J.M.A. Matthijssen, Altrecht Academic Anxiety Centre, Altrecht GGZ, Nieuwe Houtenseweg 12, Utrecht, SH 3524, The Netherlands. E-mail: s.matthijssen@altrecht.nl

Abstract

Background: Eye movement desensitization and reprocessing (EMDR) therapy is a treatment meant to reduce vividness and emotionality of distressing memories. There is accumulating evidence that working memory taxation is the core of the working mechanism of EMDR therapy and that EMDR derives its effect by taxing the working memory (WM) with a dual task while actively keeping a disturbing memory in mind. From a theoretical stance, based upon assumptions derived from the WM theory, the effectiveness of EMDR therapy could be improved by several adaptations.
Objectives: To test the assumption that integrating these elements into the standard EMDR protocol would enhance EMDR therapy, this adapted version of EMDR (i.e. EMDR 2.0), was compared to standard EMDR in a laboratory setting. It was hypothesized that EMDR 2.0 would be more efficacious than standard EMDR, and show a greater decrease in emotionality and vividness than standard EMDR therapy. Our second hypothesis was that EMDR 2.0 would be more efficient than standard EMDR in that this variant needs less session time and a smaller number of sets (i.e. approximately 30 seconds of WM taxation).
Method: Non-clinical participants (N = 62, 79% female, mean age = 35.21) with a disturbing autobiographical memory were randomly allocated to receive either EMDR or EMDR 2.0. Emotionality and vividness of the memory were measured pre- and post-intervention, and at 1- and 4-week follow-up.
Results: The results showed no difference between EMDR and EMDR 2.0 in decreasing emotionality and vividness, and no difference in session time. However, participants in the EMDR 2.0 condition needed fewer sets than those in the standard EMDR condition. Conclusion: The notion that EMDR 2.0 is more efficient is partially supported by the results showing participants needed less sets than in standard EMDR to reach the same results. Future research with clinical samples is warranted.

---

Moore, P. S. (2021). EMDR Treatment for Persistent Post-Concussion Symptoms Following Mild Traumatic Brain Injury: A Case Study. Journal of EMDR Practice and Research, 15(3), 157-166. doi:10.1891/emdr-d-21-00015

URL: http://dx.doi.org/10.1891/emdr-d-21-00015

Phil S. Moore, Consultant Neuropsychologist & Clinical Psychologist Medicolegal-Psychology-Neuropsychology ltd., The Old Sweet Shop, 68 Mil St, Torrington, Devon, EX38 8AN, UK. email: psychologyassessment@ yahoo.co.uk

Abstract

The majority of people who experience mild traumatic brain injury (mTBI) have a healthy recovery, where initial somatic, cognitive, psychological, and behavioral mTBI-related symptoms resolve naturally within hours or days. Unfortunately, a significant minority of people develop persistent post-concussion symp- toms, sometimes referred to as persistent post-concussion syndrome (pPCS), often causing severe long- term reduction in well-being and daily function. Psychological and neuropsychological treatments are typically limited to antidepressants, psychoeducation on mTBI and pPCS, basic neurorehabilitative cognitive compensatory strategies, traditional cognitive behavioral therapy, or no treatment at all. This paper discusses a single case study which demonstrates how eye movement desensitization and reprocessing (EMDR) therapy might provide psychological improvement in clients who sustain mTBI and develop pPCS. The case example describes a 57-year-old man who sustained a mTBI from a serious road traffic collision as a pedestrian and who developed pPCS. Treatment included nine 1.5-hour EMDR sessions across a 5-month period (the first being an assessment). Measures of psychological symptom change and client feedback were taken at pretreatment, midtreatment, posttreatment, and aftertreatment had ceased to gauge long-term status. Measures were taken at 18-month follow-up and 4-year review (which followed litigation settlement). The novel viability for the application of EMDR for this client group is discussed.

---

Nascimento, J. C. P., Santos, K. V. G. D., Dantas, J. K. D. S., Dantas, D. V., & Dantas, R. A. N. (2021). Non-pharmacological therapies for the treatment of post-traumatic stress disorder among emergency responders: a scoping review. Rev Esc Enferm USP, 55, e03724. doi:10.1590/S1980-220X2020011603724

Open access: https://pubmed.ncbi.nlm.nih.gov/34161443

Jessica Cristhyane Peixoto Nascimento BR 101, s/n - Lagoa Nova, CEP 59070-405 – Natal, RN, Brazil. E-mail: jessicacristhy@gmail.com

Abstract

Objective: Identify non-pharmacological therapies for the treatment of post-traumatic stress disorder in emergency responders.
Method: Scope review according to the guidelines of the Joanna Briggs Institute and the PRISMA-ScR protocol. A search was conducted in nine databases, portals of theses and dissertations, and using an electronic search engine.
Results: In total, 23 studies were selected and analyzed, and then categorized into six thematic fields - therapy with omega 3 food supplement, art therapy, physical exercise therapy, mindfulness-based therapy, therapy with elements of nature, and psychotherapy - which were considered non-pharmacological treatments for this psychopathology among emergency responders, as well as the use of psychotherapy via telehealth as an option for treatment.
Conclusion: More evidence supporting diet therapy is required, while the other therapeutic options presented positive results, finding support in national and international recommendations of treatment and clinical practice.

---

Olivier, E., de Roos, C., & Bexkens, A. (2021). Eye Movement Desensitization and Reprocessing in Young Children (Ages 4-8) with Posttraumatic Stress Disorder: A Multiple-Baseline Evaluation. Child Psychiatry Hum Dev. doi:10.1007/s10578-021-01237-z

URL: https://pubmed.ncbi.nlm.nih.gov/34487289

Eline Olivier, Psymens, Korenmolenlaan 1D, 3447 GG Woerden, The Netherlands. E-mail: elineolivier@icloud.com

Abstract

To reduce the acute and long-term effects of trauma, early and effective treatment is necessary. Eye movement desensitization and reprocessing (EMDR) therapy is a brief treatment for posttraumatic stress disorder (PTSD), with a substantial evidence base for children and adolescents aged 8 to 18 years. In the present study we aimed to provide preliminary evidence of EMDR as a trauma treatment for young children. We studied 9 children, aged 4 to 8 years old with a DSM-5 diagnosis of PTSD. A non-concurrent multiple baseline experimental design was used combined with standardized measures. Participants received six 1-h sessions of EMDR. Results post-treatment showed that EMDR was effective in reaching diagnostic remission of PTSD (85.7%), and decreasing severity of PTSD symptoms and emotional and behavioral problems. All gains were maintained at follow-up 3 months after treatment. EMDR appears an effective treatment for PTSD in young children aged 4 to 8 years. Further research is warranted.

---

Ooms-Evers, M., van der Graaf-Loman, S., van Duijvenbode, N., Mevissen, L., & Didden, R. (2021). Intensive clinical trauma treatment for children and adolescents with mild intellectual disability or borderline intellectual functioning: A pilot study. Res Dev Disabil, 117, 104030. doi:10.1016/j.ridd.2021.104030

Open access: https://pubmed.ncbi.nlm.nih.gov/34314951

Marjolein Ooms-Evers, Ambiq, Postbus 820, 7550 AV Hengelo, the Netherlands. E-mail address: m.evers@ambiq.nl

Abstract

Background: Children and adolescents with mild intellectual disability (MID) or borderline intellectual functioning (BIF) are at increased risk for posttraumatic stress disorder (PTSD) or trauma-related symptoms due to adverse childhood experiences (ACEs). Weekly provided treatment sessions and/or outpatient treatment may not be effective enough. AIMS: Investigate feasibility, safety and potential effectiveness of an intensive clinical trauma treatment in children and adolescents with MID-BIF and trauma-related symptoms as a result of ACEs or PTSD.
Methods and procedures: Thirty-three participants between 6 and 17 years of age received intensive clinical treatment after experiencing multiple ACEs (most commonly physical abuse, emotional neglect or abuse, sexual abuse, domestic violence and bullying). Treatment lasted 8.4 days on average and consisted of a daily program of prolonged exposure, eye movement desensitisation and reprocessing and physical activation, embedded in a trauma-sensitive environment. Data were collected at intake, first day of treatment, last day of treatment and at follow-up.
Outcomes and results: There was a significant reduction of trauma-related symptoms and emotional and behavioral problems after treatment. In addition, the number of participants fulfilling the DSM-5 criteria of PTSD decreased from 24 at intake to 8 at the end of treatment. There was no drop out and no adverse events were seen.
Conclusions and implications: The results of this pilot study suggest that an intensive clinical trauma treatment is a potentially effective and safe option for children and adolescents with MID-BIF.

---

Otgaar, H., Houben, S. T. L., Rassin, E., & Merckelbach, H. (2021). Memory and eye movement desensitization and reprocessing therapy: a potentially risky combination in the courtroom. Memory, 1-9. doi:10.1080/09658211.2021.1966043

Open access: https://pubmed.ncbi.nlm.nih.gov/34404311

Henry Otgaar, Universiteitssingel 40, 6220 MD, Maastricht, The Netherlands. E-mail: Henry.Otgaar@maastrichtuniversity.nl

Abstract

Does Eye Movement and Desensitization and Reprocessing (EMDR) therapy affect the accuracy of memories? This recurrent issue in recent memory research bears relevance to expert witness work in the courtroom. In this review, we will argue that several crucial aspects of EMDR may be detrimental to memory. First, research has shown that eye movements undermine the quality and quantity of memory. Specifically, eye movements have been shown to decrease the vividness and emotionality of autobiographical experiences and amplify spontaneous false memory levels. Second, a sizeable proportion of EMDR practitioners endorse the controversial idea of repressed memories and discuss the topic of repressed memory in therapy. Third, in the Dutch EMDR protocol, patients are instructed to select the target image by using flawed metaphors of memory (e.g., memory works as a video). Such instructions may create demand characteristics to the effect that people over-interpret imagery during therapy as veridical memories. Collectively, the corpus of research suggests that several components of EMDR therapy (i.e., performing eye movements, therapist beliefs and therapeutic instructions) may undermine the accuracy of memory, which can be risky if patients, later on, serve as witnesses in legal proceedings.

---

Penninx Quevedo, R., de Jongh, A., Bouwmeester, S., & Didden, R. (2021). EMDR therapy for PTSD symptoms in patients with mild intellectual disability or borderline intellectual functioning and comorbid psychotic disorder: A case series. Res Dev Disabil, 117, 104044. doi:10.1016/j.ridd.2021.104044

URL: https://pubmed.ncbi.nlm.nih.gov/34438220

R. Penninx Quevedo, GGZ Oost Brabant, Care Program Trauma, Wesselmanlaan 25A, 5707 HA, Helmond, the Netherlands. E-mail address: RC.PenninxQuevedo@ggzoostbrabant.nl

Abstract

Background: Little is known about the effectiveness of EMDR therapy for PTSD symptoms in persons with mild intellectual disability or borderline intellectual functioning (MID-BIF, IQ 50-85) and psychosis. AIMS: To examine effectiveness, feasibility, and safety of eye movement desensitization and reprocessing (EMDR) therapy in six patients with MID-BIF, PTSD and psychotic disorder.
Methods and procedures: Data were collected in a multiple baseline across-subjects design. Before, during and after treatment, weekly assessments on PTSD symptoms and adverse events were carried out. PTSD classification was assessed, and severity of hallucinations, delusions, and general psychopathology were measured at pretreatment, posttreatment and three-month follow-up.
Outcomes and results: There were no dropouts and five of the six participants completed treatment early. They showed a decrease in PTSD symptom severity and did no longer meet DSM-5 PTSD criteria at posttreatment. Results were maintained at follow-up. Symptoms did not exacerbate as indicated by a significant decrease in general psychopathology (in five participants) and an improvement in general functioning. In five participants severity of psychotic symptoms decreased.
Conclusions and implications: EMDR therapy is safe and feasible and the results suggest that it can be an effective treatment for PTSD in patients with triple mental health problems in a tertiary mental health treatment setting.

---

Phelps, A. J., Lethbridge, R., & Brennan…, S. (2021). Australian guidelines for the prevention and treatment of posttraumatic stress disorder: Updates in the third edition. Australian & New Zealand Journal of Psychiatry. doi:10.1177/00048674211041917

URL: https://doi.org/10.1177/00048674211041917

Andrea J Phelps, Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, 161 Barry Street, Carlton, VIC 3152, Australia. Email: ajphelps@unimelb.edu.au

Abstract

Objective: This paper describes the development of the third edition of the National Health and Medical Research Australian Guidelines for the Prevention and Treatment of Acute Stress Disorder, posttraumatic stress disorder and Complex posttraumatic stress disorder, highlighting key changes in scope, methodology, format and treatment recom- mendations from the previous 2013 edition of the Guidelines.
Method: Systematic review of the international research was undertaken, with GRADE methodology used to assess the certainty of the evidence, and evidence to decision frameworks used to generate recommendations. The Guidelines are presented in an online format using MAGICApp.
Results: Key changes since the publication of the 2013 Guidelines include a new conditional recommendation for Child and Family Traumatic Stress Intervention for children and adolescents with symptoms within the first 3 months of trauma, and a strong recommendation for trauma-focused cognitive behaviour therapy for the child alone or with a caregiver, for those with diagnosed posttraumatic stress disorder. For adults with posttraumatic stress disorder, strong recommendations are made for specific types of trauma-focused cognitive behaviour therapy and conditional recommendations are made for five additional psychological interventions. Where medication is indicated for adults with posttraumatic stress disorder, venlafaxine is now conditionally recommended alongside sertraline, paroxetine or fluoxetine.
Conclusion: These Guidelines, based on systematic review of the international literature, are intended to guide decision making for practitioners, service planners, funders and those seeking treatment for trauma related mental health concerns. For an Australian Guideline, a critical limitation is the absence of research on the treatment of Australian Aboriginal and Torres Strait Islander peoples. The new online format of the Australian posttraumatic stress disorder Guidelines means that they can be updated as sufficient new evidence becomes available.

---

Phillips, R., McSherry, P., Pinto, C., & Maguire, T. (2021). Exploring Therapists’ Experiences of Applying EMDR Therapy With Clients Experiencing Psychosis. Journal of EMDR Practice and Research, 15(3), 142-156. doi:10.1891/emdr-d-21-00018

URL: http://dx.doi.org/10.1891/emdr-d-21-00018

Rebecca Phillips, Trainee Clinical Psychologist, Shackleton Building (Building 44), University of Southampton, Faculty of Environmental and Life Sciences, Highfield Campus, Southampton, Hants, England SO17 1BJ. E-mail: rep1u18@ soton.ac.uk

Abstract

Little is known of the usability of eye movement desensitization and reprocessing (EMDR) as an intervention for those experiencing psychosis. This study aimed to explore therapists’ experience of using EMDR with this population. A qualitative design was employed using an inductive approach and a thematic analysis. Twenty therapists, who had used EMDR with this client group, took part in a semi-structured interview to explore their experiences of the intervention. Key themes were generated from the data: (a) familiarity with psychosis and EMDR, (b) acceptability of EMDR, (c) the importance of systemic factors, and (d) keeping key therapy principles in mind. Findings highlighted the importance of supervision to build therapist confidence, the value of the multidisciplinary team, and the need for a shift in beliefs surrounding the usefulness of EMDR to the wider system. Recommendations for individuals and services are provided.

---

Sambucini, D., Aceto, P., Begotaraj, E., & Lai, C. (2020). Efficacy of Psychological Interventions on Depression Anxiety and Somatization in Migrants: A Meta-analysis. J Immigr Minor Health, 22(6), 1320-1346. doi:10.1007/s10903-020-01055-w

Open access: https://pubmed.ncbi.nlm.nih.gov/32712851

Carlo Lai, Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185 Rome, Italy. E-mail: carlo.lai@uniroma1.it

Abstract

Many studies reveal the effectiveness of different psychological interventions on the adult refugees reporting mental health distress. Aim of this metanalysis was to test the efficacy of different psychological treatments on the depressive, anxiety and somatization symptoms on refugees and asylum seekers. Fifty-two studies, since 1997 to 2019, were included in the systematic review and 27 of those were included in the metanalysis. Studies providing a pre and post treatment methodological design were included. All treatments reported significant effects on the three outcomes. Qualitative observations showed a probability to have a significant pre-post treatment effects on trials with outcome of depression (56%), anxiety (44%), and somatization (42%). Cognitive behavioral treatment resulted the most effective treatment. The status of refugee compared to the status of asylum seeker seems to have a great effect on the effectiveness of the treatment.

---

Scelles, C., & Bulnes, L. C. (2021). EMDR as Treatment Option for Conditions Other Than PTSD: A Systematic Review. Frontiers in Psychology, 12. doi:10.3389/fpsyg.2021.644369

Open access: http://dx.doi.org/10.3389/fpsyg.2021.644369

Charles Scelles, Adult Psychiatry Department, Université Catholique de Louvain – Saint Luc University Hospital, Brussels, Belgium. E-mail: cscelles@lametairie.ch
Luis Carlo Bulnes, Brain, Body and Cognition Research Group, Vrije Universiteit Brussel, Brussels, Belgium. E-mail: luis.carlo.bulnes@vub.be

Abstract

Eye Movement Desensitisation and Reprocessing (EMDR) is a treatment for post-traumatic stress disorder (PTSD). The technique is known to facilitate reprocessing of maladaptive memories that are thought to be central to this pathology. Here we investigate if EMDR therapy can be used in other conditions. We conducted a systematic literature search on PubMed, ScienceDirect, Scopus, and Web of Science. We searched for published empirical findings on EMDR, excluding those centred on trauma and PTSD, published up to 2020. The results were classified by psychiatric categories. Ninety articles met our research criteria. A positive effect was reported in numerous pathological situations, namely in addictions, somatoform disorders, sexual dysfunction, eating disorders, disorders of adult personality, mood disorders, reaction to severe stress, anxiety disorders, performance anxiety, Obsessive-Compulsive Disorder (OCD), pain, neurodegenerative disorders, mental disorders of childhood and adolescence, and sleep. Some studies reported that EMDR was successful in usually uncooperative (e.g., Dementia) or unproductive cases (e.g., aphasia). Moreover, in some severe medical conditions, when psychological distress was an obstacle, EMDR allowed the continuation of treatment-as-usual. Furthermore, the effects observed in non-pathological situations invite for translational research. Despite a generally positive outlook of EMDR as an alternative treatment option, more methodologically rigorous studies are needed. We discuss the advantages and limitations and possible implications for the hypothesised mechanisms of action.

---

Schwartzkopff, L., Gutermann, J., Steil, R., & Müller-Engelmann, M. (2021). Which Trauma Treatment Suits me? Identification of Patients’ Treatment Preferences for Posttraumatic Stress Disorder (PTSD). Front Psychol, 12, 694038. doi:10.3389/fpsyg.2021.694038

Open access: https://pubmed.ncbi.nlm.nih.gov/34456808


Laura Schwartzkopff, Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany. E-mail: schwartzkopff@psych.uni-frankfurt.de

Abstract

Several psychotherapy treatments exist for posttraumatic stress disorder. This study examines the treatment preferences of treatment-seeking traumatized adults in Germany and investigates the reasons for their treatment choices. Preferences for prolonged exposure, cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), psychodynamic psychotherapy and stabilization were assessed via an online survey. Reasons for preferences were analyzed by means of thematic coding by two independent rates. 104 traumatized adults completed the survey. Prolonged exposure and CBT were each preferred by nearly 30%, and EMDR and psychodynamic psychotherapy were preferred by nearly 20%. Stabilization was significantly less preferred than all other options, by only 4%. Significantly higher proportions of patients were disinclined to choose EMDR and stabilization. Patients who preferred psychodynamic psychotherapy were significantly older than those who preferred CBT. Reasons underlying preferences included the perceived treatment mechanisms and treatment efficacy. Traumatized patients vary in their treatment preferences. Preference assessments may help clinicians comprehensively address patients' individual needs and thus improve therapy outcomes.

---

Simmons, C., Meiser-Stedman, R., Baily, H., & Beazley, P. (2021). A meta-analysis of dropout from evidence-based psychological treatment for post-traumatic stress disorder (PTSD) in children and young people. Eur J Psychotraumatol, 12(1), 1947570. doi:10.1080/20008198.2021.1947570

Open access: https://pubmed.ncbi.nlm.nih.gov/34377359

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

Abstract

Background: Despite the established evidence base of psychological interventions in treating PTSD in children and young people, concern that these trauma-focused treatments may 'retraumatise' patients or exacerbate symptoms and cause dropout has been identified as a barrier to their implementation. Dropout from treatment is indicative of its relative acceptability in this population. Objective: Estimate the prevalence of dropout in children and young people receiving a psychological therapy for PTSD as part of a randomized controlled trial (RCT). Methods: A systematic search of the literature was conducted to identify RCTs of evidence-based treatment of PTSD in children and young people. Proportion meta-analyses estimated the prevalence of dropout. Odds ratios compared the relative likelihood of dropout between different treatments and controls. Subgroup analysis assessed the impact of potential moderating variables. Results: Forty RCTs were identified. Dropout from all treatment or active control arms was estimated to be 11.7%, 95% CI [9.0, 14.6]. Dropout from evidence-based treatment (TFCBTs and EMDR) was 11.2%, 95% CI [8.2, 14.6]. Dropout from non-trauma focused treatments or controls was 12.8%, 95% CI [7.6, 19.1]. There was no significant difference in the odds of dropout when comparing different modalities. Group rather than individual delivery, and lay versus professional delivery, were associated with less dropout. Conclusions: Evidence-based treatments for children and young people with PTSD do not result in higher prevalence of dropout than non-trauma focused treatment or waiting list conditions. Trauma-focused therapies appear to be well tolerated in children and young people.

---

Talbot, D. (2021). Examination of Initial Evidence for EMDR as a Treatment for Obsessive-Compulsive Disorder. Journal of EMDR Practice and Research, 15(3), 167-173. doi:10.1891/emdr-d-21-00004

URL: http://dx.doi.org/10.1891/emdr-d-21-00004

Daniel Talbot, University of Notre Dame, 128-140 Broadway, Chippendale, NSW 2007, Australia. E-mail: daniel.talbot@nd.edu.au

Abstract

Obsessive-compulsive disorder (OCD) is a debilitating psychological condition that impacts millions of people globally. The front-line psychological intervention for OCD is exposure/response prevention (ERP), however, many individuals do not respond to this treatment approach. Eye movement desensitization and reprocessing (EMDR) is a new therapeutic option which could be effective in treating OCD. This review examined the initial evidence for the effectiveness of EMDR in reducing OCD symptoms. Nine studies were included in the review, including six case studies and three group studies. Results indicate that EMDR is a promising candidate for treating OCD, with all studies showing EMDR therapy resulted in reduced symptoms from baseline. Results also indicated that EMDR may be as effective as ERP, and more effective than selective serotonin reuptake inhibitors (SSRIs) in treating OCD.

---

van Deursen, R., Jones, K., Kitchiner, N., Hannigan, B., Barawi, K., & Bisson, J. I. (2021). The psychophysiological response during post-traumatic stress disorder treatment with modular motion-assisted memory desensitisation and reconsolidation (3MDR). Eur J Psychotraumatol, 12(1), 1929027. doi:10.1080/20008198.2021.1929027

Open access: https://pubmed.ncbi.nlm.nih.gov/34221251

Robert van Deursen, School of Healthcare Sciences, Cardiff University, Ty Dewi Sant, Heath Park, Cardiff, UK. E-mail: vandeursenr@cardiff.ac.uk
CF14 4XN, UK

Abstract

Background: Psychophysiological changes are part of post-traumatic stress disorder (PTSD) symptomatology and can signal emotional engagement during psychological treatment. Objectives: The aim of this study was to explore psychophysiological responses during multi-modular motion-assisted memory desensitization and reconsolidation (3MDR) therapy. Increased self-reported distress, substantially increased heart rate (HR) and breathing rate (BR) were expected at the start of therapy and predicted to improve over time. Since physical exercise demands during therapy were low, any large HR or BR responses were considered part of the psychophysiological response.
Methods: This study used pooled data collected during a randomized controlled trial of 3MDR, which demonstrated significant improvement as measured by the Clinician Administered PTSD Scale. Whilst attending therapy, HR and BR data, subjective units of distress (SUD) score and phrases to describe feelings whilst exposed to trauma-related images were collected continuously from 37 UK male military veterans with PTSD.
Results: HR and BR were significantly increased throughout all sessions (p < .01 for both). Whilst HR was raised slightly remaining on average below 100 beats/minute, BR was increased substantially with average values between 40 and 50 breaths/minute. SUD scores were very high during therapy which concurred with the many negative feelings experienced during therapy sessions. Across the course of the treatment, SUD scores (p < .01) and negative feelings were reduced (p < .001), and positive feelings have increased (p < .01) significantly, reflecting improvements in clinicians assessed PTSD symptoms. Across therapy sessions, HR (p = .888) and BR (p = .466) responses did not change.
Conclusions: The strong psychophysiological response alongside high levels of self-reported distress and negative feelings is interpreted as high emotional engagement during therapy. A novel finding was the very significant BR increase throughout recorded sessions. Future PTSD research should include BR response to therapy and explore breathing control as a treatment target.

---

Wong, S.-L. (2021). A Model for the Flash Technique Based on Working Memory and Neuroscience Research. Journal of EMDR Practice and Research, 15(3), 174-184. doi:10.1891/emdr-d-21-00048

URL: http://dx.doi.org/10.1891/emdr-d-21-00048

Sik-Lam Wong, 917 The Alameda, Berkeley, CA 94707. E-mail: slwmft@gmail.com

Abstract

Research has shown that the Flash Technique (FT) appears to reduce memory-related disturbance and may reduce symptoms of posttraumatic stress disorder. This paper discusses the connections between FT and eye movement desensitization and reprocessing (EMDR) therapy. In FT, clients remind themselves of a traumatic memory without dwelling on it and focus instead on a positive engaging focus and then blink their eyes when prompted. This paper summarizes numerous models describing how the brain processes traumatic material and presents a model for how FT may work in the brain. It proposes that during the blinking, the patient’s periaqueductal gray (PAG) may take over, sensing the reminder of the traumatic memory and reflexively triggering the amygdala. In Porges’s neuroception model, the PAG assesses danger without going through the conscious brain. Recent fMRI data show that for patients with posttraumatic stress disorder, there is enhanced connectivity from the amygdala to the left hippocampus. Thus, triggering the amygdala may, in turn, activate the left hippocampus, which may then provide a brief access to the traumatic memory. Given the brief access, there is insufficient time for the amygdala to go into overactivation. The client remains calm while accessing the traumatic memory, thus setting up the prediction error necessary for possible memory reconsolidation. This process is repeated during blinking in FT allowing memory reconsolidation to proceed. This model requires experimental confirmation.

---

Yan, S., Shan, Y., Zhong, S., Miao, H., Luo, Y., Ran, H., & Jia, Y. (2021). The Effectiveness of Eye Movement Desensitization and Reprocessing Toward Adults with Major Depressive Disorder: A Meta-Analysis of Randomized Controlled Trials. Front Psychiatry, 12, 700458. doi:10.3389/fpsyt.2021.700458

Open access: https://pubmed.ncbi.nlm.nih.gov/34421681

Yanbin Jia, Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, China. E-mail: yanbinjia2006@163.com

Abstract

The practice-based evidence suggests that it is possible to use eye movement desensitization and reprocessing (EMDR) to treat major depressive disorder (MDD), but its specific efficacy is unknown. A systematic search was carried out for randomized controlled trials comparing EMDR with a control condition group in MDD patients. Two meta-analyses were conducted, with symptom reduction as primary outcome and remission as exploratory outcome. Eight studies with 320 participants were included in this meta-analysis. The first meta-analysis showed that EMDR outperformed "No Intervention" in decreasing depressive symptoms (standardized mean difference [SMD] = -0.81, 95% CI = -1.22 to -0.39, p < 0.001, low certainty), but statistically significant differences were not observed in improving remission (risk ratio = 1.20, 95% CI = 0.87-1.66, p = 0.25, very low certainty). The second showed the superiority of EMDR over CBT in reducing depressive symptoms (mean difference [MD] = -7.33, 95% CI = -8.26 to -6.39, p < 0.001, low certainty), and improving remission (risk ratio = 1.95, 95% CI = 1.24-3.06, p = 0.004, very low certainty). Besides, anxiety symptoms and level of functioning could not be included as secondary outcome due to the lack of data. The present meta-analysis suggests that EMDR is more effective in treating MDD than "No Intervention" and CBT, particularly in individuals who have traumatic experience. However, this result should be considered with caution due to small sample size and low quality of trails.

---