Eye movement desensitization and reprocessing (EMDR): a meta-analysis

Psychotherapies at a Glance: Consensus Guideline-Recommended Psychotherapies for Adults With Psychiatric Disorders

Clinical decision making by psychiatrists and informed consent by patients require knowledge of evidence-based psychotherapies (EBPs) and their indications. However, many mental health professionals are not versed in the empirical literature on EBPs or the consensus guideline recommendations derived from this literature. The authors compared rigorous national consensus guidelines for EBP treatment of DSM-defined adult psychiatric disorders-derived from well-conducted randomized controlled trials and meta-analyses and from expert opinions from the United States, United Kingdom, and Canada-to create the Psychotherapies-at-a-Glance tool. Recommended EBPs are cognitive-behavioral therapy, family therapy, contingency management, dialectical behavior therapy, eye movement desensitization reprocessing, interpersonal psychotherapy, mentalization-based treatment, motivational interviewing, peer support, problem-solving therapy, psychoeducation, short-term psychodynamic psychotherapy, and 12-step facilitation. The Psychotherapies-at-a-Glance tool summarizes the indications, rationales, and therapeutic tasks that characterize these differing psychotherapies and psychosocial treatments. The tool is intended for use in clinical teaching, treatment planning, and patient communications.

Psychological intervention in women victims of childhood sexual abuse: a randomized controlled clinical trial comparing EMDR psychotherapy and trauma-focused cognitive behavioral therapy

Introduction

Childhood sexual abuse persists as a painful societal reality, necessitating responses from institutions and healthcare professionals to prevent and address its severe long-term consequences in victims. This study implements an intervention comprising two psychotherapeutic approaches recommended by the WHO and international clinical guidelines for addressing short-, medium-, and long-term posttraumatic symptomatology: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR). Both approaches are adapted from group formats for implementation in small online groups via Zoom.

Methods

The impact of both therapeutic approaches on trauma improvement was assessed in a sample of 19 women who were victims of childhood sexual abuse through a Randomized Clinical Trial comparing EMDR Psychotherapy and Trauma-Focused Cognitive Behavioral Therapy after a baseline period. Intra and inter comparison were made using statistics appropriate to the sample.

Results

Both therapeutic approaches significantly reduced symptomatology across various evaluated variables, suggesting their efficacy in improving the quality of life for these individuals. Following CBT-FT treatment, patients exhibited enhanced emotional regulation, reduced reexperiencing, and avoidance. The EMDR group, utilizing the G-TEP group protocol, significantly improved dissociation, along with other crucial clinical variables and the perception of quality of life.

Discussion

Although the limitations of this study must be taken into account due to the size of the sample and the lack of long-term follow-up, the results align with existing scientific literature, underscoring the benefits of trauma-focused psychological treatments. The online group format appears promising for enhancing the accessibility of psychological treatment for these women. Furthermore, the differential outcomes of each treatment support recent research advocating for the inclusion of both approaches for individuals with trauma-related symptomatology.

Ethics and dissemination

The study has been approved by the Ethics Committee of the Valencian International University (VIU) (Valencia, Spain) (Ref. CEID2021_07). The results will be submitted for publication in peer-reviewed journals and disseminated to the scientific community.

Clinical trial registration

https://clinicaltrials.gov/ct2/show/NCT04813224, identifier NCT04813224.

Exploration driven by a medial preoptic circuit facilitates fear extinction in mice

Repetitive exposure to fear-associated targets is a typical treatment for patients with panic or post-traumatic stress disorder (PTSD). The success of exposure therapy depends on the active exploration of a fear-eliciting target despite an innate drive to avoid it. Here, we found that a circuit running from CaMKIIα-positive neurons of the medial preoptic area to the ventral periaqueductal gray (MPA-vPAG) facilitates the exploration of a fear-conditioned zone and subsequent fear extinction in mice. Activation or inhibition of this circuit did not induce preference/avoidance of a specific zone. Repeated entries into the fear-conditioned zone, induced by the motivation to chase a head-mounted object due to MPA-vPAG circuit photostimulation, facilitated fear extinction. Our results show how the brain forms extinction memory against avoidance of a fearful target and suggest a circuit-based mechanism of exposure therapy.

Eye Movement Desensitization and Reprocessing versus Cognitive Behavior Therapy for Treating Post-Traumatic Stress Disorder: A Systematic Review and Meta-Analysis

This meta-analysis review compared eye movement desensitization and reprocessing and cognitive behavior therapy efficacy in reducing post-traumatic stress disorder (PTSD), anxiety, and depression symptoms. A systematic search for articles published between 2010 and 2020 was conducted using five databases. The RevMan software version 5 was used. Out of 671 studies, 8 fulfilled the inclusion criteria and were included in this meta-analysis. Three studies reported that eye movement desensitization and reprocessing reduced depression symptoms better than cognitive behavior therapy in both children, adolescents, and adults (SDM (95% CI) = -2.43 (-3.93--0.94), p = 0.001). In three other studies, eye movement desensitization and reprocessing were shown to reduce anxiety in children and adolescents better than cognitive behavior therapy (SDM (95% CI) = -3.99 (-5.47--2.52), p < 0.001). In terms of reducing PTSD symptoms, eye movement desensitization and reprocessing and cognitive behavior therapy did not demonstrate any statistically significant differences (SDM (95% CI) = -0.14 (-0.48-0.21), p = 0.44). There was no statistically significant difference at the three-month follow-up and at the six-month follow-up for depression (p = 0.31), anxiety (p = 0.59), and PTSD (p = 0.55). We recommend randomized trials with larger samples and longer follow-up times in the future.

Eye movement desensitization and reprocessing for the treatment and early intervention of trauma among first responders: A systematic review

First responders are exposed to repetitive work-related trauma and, thus, are at risk of developing posttraumatic stress disorder (PTSD). Eye-movement desensitization and reprocessing (EMDR) is a psychotherapy intervention designed to treat symptoms of posttraumatic stress. We conducted a systematic review to examine the viability of EMDR among first responders. The primary aim of this review was to identify studies that have trialed EMDR among first responders and evaluate its effectiveness in reducing trauma-related symptoms; a secondary aim was to identify whether EMDR has been used as an early intervention for this cohort and determine its effectiveness as such. Four databases were searched. Studies were included if they evaluated the extent to which EMDR was effective in alleviating symptoms stemming from work-related trauma exposure among first responders. The findings from each study were reported descriptively, and eight studies that evaluated the efficacy of EMDR in this population were included. There was substantial variation in how EMDR was implemented, particularly in the type, duration, frequency, and timing. The findings suggest that EMDR can alleviate symptoms of work-related trauma exposure among first responders; however, findings regarding early intervention were inconclusive, and a methodological quality assessment revealed that all studies were classified as being of either weak or medium quality. Although this review provides preliminary insights into the effectiveness of EMDR for first responders, the conclusions that can be drawn from the literature are limited, and the findings highlight several gaps in the literature.

Eye Movement Desensitization and Reprocessing in a Primary Care Setting: Assessing Utility and Comparing Efficacy of Virtual Versus In-Person Methods

Introduction: Eye movement desensitization and reprocessing (EMDR) is an evidence-based psychotherapy method designed to treat distress associated with traumatic memories. The COVID-19 pandemic has challenged providers to shift EMDR to telehealth platforms. Objectives: This research had to aims. (1) To compare EMDR in conjunction with cognitive behavioral therapy (CBT) with CBT alone for treatment of a patient population with prevalent anxiety and (2) to compare the efficacy of virtual EMDR with that of in-person EMDR in the primary care setting. Methods: Retrospective chart review of all adult patients seen by a single therapist at a primary care center was conducted from January 2018 to December 2020. Charts were reviewed for demographics, psychiatric diagnoses, number of visits, number and type of EMDR treatments, and patient health questionnaire (PHQ)-9 and general anxiety disorder (GAD-7) scores pre- and post-treatment. Results: Patients who underwent EMDR with CBT demonstrated greater decreases in PHQ-9 and GAD-7 scores than patients who had only CBT (2.4, 2.5 vs. 0.9, 1.1). However, after adjusting for total number of sessions, post-traumatic stress disorder, grief, and pain, the adjusted mean differences of change in PHQ-9 and GAD-7 scores between those who underwent EMDR with CBT and CBT-exclusive patients were not statistically significant. Similarly, the adjusted mean differences of change in PHQ-9 and GAD-7 scores between those who underwent virtual EMDR and those who had in-person EMDR were not statistically significant. Conclusions: To our knowledge, this is the first study describing the use of virtual EMDR in a primary care setting. Although our data did not provide evidence for the superiority of EMDR with CBT over CBT alone, we demonstrate that both in-person and virtual EMDR led to significantly improved GAD-7 scores.

The effectiveness of dual-task interventions for modulating emotional memories in the laboratory: A meta-analysis

Dual-tasks (e.g., making horizontal eye-movements) while recollecting a memory are often used both in the lab and the clinic (such as in EMDR therapy) to attenuate emotional memories and intrusive mental images. According to working memory theory, dual-task interventions are effective because they limit cognitive resources available for the processing of emotional memories. However, there is still ongoing debate about the extent to which and under what conditions dual-task interventions are effective to interfere with emotional memories. In this meta-analysis, we assessed k = 53 laboratory studies investigating the effects of dual-task interventions on negative and positive memories. The effects were measured with the raw mean reduction in vividness and emotionality self-report ratings of emotional memories before compared to after the intervention on 100-point rating scales. Results showed that the dual-task interventions made both negative and positive memories less vivid (mean reduction negative images = 9.18, 95% CI [7.06, 11.29]; mean reduction positive images = 11.73, 95% CI [8.59, 14.86]) and less emotional (mean reduction negative images = 6.22, 95% CI [4.50, 7.94]; mean reduction positive images = 6.71, 95% CI [2.21, 11.20]). Several moderators were tested and are discussed in the light of working memory theory.

EMDR as Treatment Option for Conditions Other Than PTSD: A Systematic Review

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.

Lost in Transition? Evidence-Based Treatments for Adolescents and Young Adults with Posttraumatic Stress Disorder and Results of an Uncontrolled Feasibility Trial Evaluating Cognitive Processing Therapy

Posttraumatic stress disorder (PTSD) is not uncommon among adolescents and young adults (AYAs). Left untreated, transition to adulthood might be especially challenging and/or prolonged for AYAs. However, it is unclear whether AYAs are adequately represented in current PTSD treatment research and whether they benefit to the same degree as younger or older individuals. In the first part of the paper, we reflect on developmental considerations in the treatment of AYAs and give an overview of current age-specific results in PTSD treatment research. Furthermore, we review individual trauma-focused evidence-based treatments that were examined in AYAs over the last 10 years. In the second part, we present data from an uncontrolled feasibility trial evaluating cognitive processing therapy (CPT) with some age-adapted modifications and an exposure component (written accounts). We treated 17 AYAs (aged 14 to 21) suffering from posttraumatic stress symptoms (PTSS). At posttreatment, participants had improved significantly with respect to clinician-rated PTSS severity (d = 1.32). Treatment gains were maintained throughout the 6-week and 6-month follow-ups. Results indicated that CPT, with only minor adaptations, was feasible and safe in AYAs. The recommendations for future research focus on the inclusion of young adults in trials with adolescents, more refined age reporting in clinical trials, and the encouragement of dismantling studies in youth. To conclude, clinical recommendations for caregiver involvement and the addressing of developmental tasks, motivational issues and emotion regulation problems are discussed.

COVID-19, Isolation, Quarantine: On the Efficacy of Internet-Based Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive-Behavioral Therapy (CBT) for Ongoing Trauma

Literature points to cognitive-behavioural therapy (CBT) and eye movement desensitization and reprocessing (EMDR) as evidence-based therapies for trauma-related disorders. Treatments are typically administered in a vis-à-vis setting with patients reporting symptoms of a previously experienced trauma. Conversely, online-therapies and ongoing trauma have not received adequate attention. This study aimed to compare the efficacy of two brief treatments for health professionals and individuals suffering from the circumstances imposed by the coronavirus disease 2019 (COVID-19) pandemic. The EMDR and the trauma focused-CBT were administered online during the earliest stage of distress to manage the ongoing trauma associated to quarantine or disease. Thirty-eight patients satisfying the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for acute stress disorder were randomly assigned to the EMDR or CBT treatment. Both groups received a 7-session therapy, and psychometric tests were administered before, after the treatment and at one-month follow-up to assess traumatic symptoms, depression and anxiety. Results revealed that both treatments reduced anxiety by 30%, and traumatic and depressive symptoms by 55%. Present findings indicate the internet-based EMDR and CBT as equally effective brief treatments, also suggesting a maintenance of the effects as indicated by the follow-up evaluation. The EMDR and CBT might be considered as first line therapies to treat the ongoing trauma and to prevent the sensitization and accumulation of trauma memories.

On being a client with posttraumatic stress disorder: Interactions with treatment providers and institutional barriers

Premature dropout from psychological treatment for posttraumatic stress disorder (PTSD) is common. Little research has sought to understand perceptions of treatment and barriers to treatment in this population. This study analyzed anonymous posts among an online community of individuals with PTSD (93 forum users comprising 158 posts regarding treatment providers and 40 forum users comprising 50 posts regarding institutional barriers). Results indicated that individuals with PTSD desire greater clarity about expectations for treatment, collaboration toward treatment goals, open discussion of client-therapist boundaries, and increased validation among therapists in response to trauma disclosure. Individuals with PTSD also reported multiple systemic issues that were barriers to treatment including a lack of available services in their area, being placed on a waitlist for long periods of time, the cost of treatment as a financial burden, and poor crisis response in emergency rooms. Findings indicated areas of growth for treatment providers which will help inform future treatment studies in improving care and treatment adherence among individuals with PTSD.

EMDR for Depression: A Meta-Analysis and Systematic Review

The literature on the efficacy of eye movement desensitization and reprocessing (EMDR) for treating depression is heterogeneous due to research design, quality issues, and trials methodology. The current meta-analysis seeks to examine EMDR for depression with the aim of answering the aforementioned limitations. Thirty-nine studies were included for analysis after a review of the relevant literature. Univariate meta-regressions were run to examine dose-response and the effect of moderating variables. Subanalysis for primary and secondary depression showed a large, significant, and heterogeneous effect-size estimates, where EMDR significantly improved symptoms of depression in contrast to all control types. At post hoc, data were reexamined and a significant and large, yet heterogeneous, effect-size estimate emerged between the EMDR and control arm after the removal of two outliers [Hedges' g = 0.70, 95% CI =0.50–0.89, p-value < .01, I2 = 70%, K = 37]. This is the first meta-analysis examining for the effect of EMDR comparing to various control modalities on depression with dose-response. We found (a) that studies were balanced at onset in terms of depression severity, and (b) a large and significant effect of EMDR on depression at the end of trials. Additionally, the significance of the aggregate effect-size estimate at the end of trials was unchanged by the intake of psychotropic medications, reported demographic variables, or EMDR methodology.

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

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

Forty-five 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, and wellbeing.

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

ClinicalTrials.gov NCT04084795 . Registered on 2 August 2019.

Detecting and Preventing Defensive Reactions Toward Persuasive Information on Fruit and Vegetable Consumption Using Induced Eye Movements

Objective: Persuasive messages regarding fruit and vegetable consumption often meet defensive reactions from recipients, which may lower message effectiveness. Individual differences in emotion regulation and gender are expected to predict these reactions. In the working memory account of persuasion, inducing voluntary eye movements during the processing of the auditory persuasive information might prevent defensiveness and thereby increase message effectiveness.

Methods: Participants in two independently recruited samples from the general population (n = 118 and n = 99) listened to a negatively framed auditory persuasive message advocating fruit and vegetable consumption. Half of them were asked to keep following a regularly moving stimulus on their screen with their eyes. At pretest, the individual differences of cognitive self-affirmation inclination (CSAI) and gender were assessed to predict defensive reactions.

Results: In Study 1, induced eye movements significantly increased self-reported consumption after 2 weeks when CSAI was low, but only in males, as indicated by a significant three-way interaction (p < 0.001). With negative self-evaluative emotions as dependent variable, this three-way interaction was also significant (p < 0.05), suggesting that induced eye movements prevented defensiveness in low CSAI males. Study 2 did not assess consumption but replicated the latter three-way interaction (p < 0.05).

Conclusion: The studies replicated our earlier findings regarding the moderating effects of individual differences in emotion regulation (i.e., CSAI) on persuasion, but they also revealed gender differences in persuasion that are related to the working memory. The working memory account of persuasion provides new theoretical as well as practical angles on persuasion to target individuals in persuasion to increase fruit and vegetable consumption.

The messy landscape of eye movements and false memories

Eye-Movement Desensitisation and Reprocessing (EMDR) therapy is a common treatment for PTSD. However, skeptics like James Ost question the theoretical underpinnings, highlight inconsistency of empirical findings surrounding the efficacy of such therapy, and warn against unknown drawbacks. Little is known about the impact of the eye movements, a critical component in EMDR, on susceptibility to false memories, and the existing literature is contradictory. We review the literature and present new findings to help tell the story of the effects of eye movements on memory. Taken as a whole, this small body of work suggests that eye movements do not reliably affect susceptibility to misinformation, nor do they appear to enhance memory, but they do seem to increase spontaneous false memories.

Identifying mental health status using deep neural network trained by visual metrics

Mental health is an integral part of the quality of life of cancer patients. It has been found that mental health issues, such as depression and anxiety, are more common in cancer patients. They may result in catastrophic consequences, including suicide. Therefore, monitoring mental health metrics (such as hope, anxiety, and mental well-being) is recommended. Currently, there is lack of objective method for mental health evaluation, and most of the available methods are limited to subjective face-to-face discussions between the patient and psychotherapist. In this study we introduced an objective method for mental health evaluation using a combination of convolutional neural network and long short-term memory (CNN-LSTM) algorithms learned and validated by visual metrics time-series. Data were recorded by the TobiiPro eyeglasses from 16 patients with cancer after major oncologic surgery and nine individuals without cancer while viewing18 artworks in an in-house art gallery. Pre-study and post-study questionnaires of Herth Hope Index (HHI; for evaluation of hope), anxiety State-Trait Anxiety Inventory for Adults (STAI; for evaluation of anxiety) and Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS; for evaluation of mental well-being) were completed by participants. Clinical psychotherapy and statistical suggestions for cutoff scores were used to assign an individual's mental health metrics level during each session into low (class 0), intermediate (class 1), and high (class 2) levels. Our proposed model was used to objectify evaluation and categorize HHI, STAI, and WEMWBS status of individuals. Classification accuracy of the model was 93.81%, 94.76%, and 95.00% for HHI, STAI, and WEMWBS metrics, respectively. The proposed model can be integrated into applications for home-based mental health monitoring to be used by patients after oncologic surgery to identify patients at risk.

EMDR Versus Treatment-as-Usual in Patients With Chronic Non-Malignant Pain: A Randomized Controlled Pilot Study

In recent years, different studies have observed a strong association between chronic pain (CP) and psychological trauma. Therefore, a trauma-focused psychotherapy, such as eye movement desensitization and reprocessing (EMDR), could be an innovative treatment option. The aim of this pilot study was to assess whether a specific EMDR protocol for CP leads to (a) a reduction in pain intensity, (b) an improvement in anxiety and depressive symptoms, and (c) an improvement in quality of life. 28 CP patients were randomly assigned to EMDR + treatment as usual (TAU; n = 14) or to TAU alone (n = 14). Patients in the EMDR group received 12 psychotherapeutic sessions of 90 minutes over 3 months. Pain intensity was measured using the Visual Analog Scale and the Pain Disability index, quality of life using the EQ-5D-5L, and anxiety and depressive symptoms using the Hamilton Anxiety and Depression Scale. Measures were taken for both conditions at pre- and post-treatment, and a follow-up in the EMDR condition was taken at 3 months post-treatment. Patients in the EMDR group showed significantly reduced pain intensity and improved quality of life and anxiety and depressive symptoms compared to TAU alone at post-treatment. Improvements were largely maintained at 3-month follow-up. This study suggests that EMDR may be an effective and safe psychological intervention to be used within the multidisciplinary treatment plan of patients with CP.

Attitudes, Self-Efficacy, and Feasibility: Exploring Social Work Students' Perceptions of Evidence-Based Practice

PURPOSE

The literature on evidence-based practice (EBP) in social work indicates a complex relationship between practitioners' attitudes, views on feasibility, and self-efficacy related to EBP implementation.

METHOD

Qualitative interviews and a self-report questionnaire were completed with 8 social work students. A conceptual framework of their perceptions was developed through thematic analysis.

RESULTS

Participants reported mixed EBP attitudes, as both a practice "ideal", but also oppressive, rigid, and dehumanizing. Low confidence regarding research skills affected participants' self-efficacy. Resource constraints impacted feasibility through organizational culture and available practice-relevant research.

DISCUSSION

EBP misconceptions critically impacted educational practices, organizational culture, and practitioners' attitudes. Comprehensive education mindful of professional identity may address misconceptions and enhance self-efficacy. EBP-enabling organizational change and practice-relevant research may alleviate resource constraints.

CONCLUSION

Research should expand on how EBP attitudes and social work identity intersect, the impact of research skills on self-efficacy, and EBP barriers and facilitators in education and organizations.

The effectiveness of eye movement desensitization and reprocessing toward anxiety disorder: A meta-analysis of randomized controlled trials

BACKGROUND

Eye Movement Desensitization and Reprocessing (EMDR) has been well established as an effective treatment for post-traumatic stress disorder (PTSD). However, PTSD has been re-categorized as part of trauma and stressor-related disorders instead of anxiety disorders. We conducted the first meta-analysis on Randomized Controlled Trials to evaluate the effectiveness of EMDR on reducing symptoms of anxiety disorders.

METHODS

A manual and systematic search using various databases and reference lists of systematic review articles published up to December 2018 was conducted. The symptoms of anxiety, phobia, panic, traumatic feelings and behaviors/somatic symptoms were examined. Hedges' g effect sizes were computed, and random effect models were used for all analyses.

RESULTS

A total of 17 trials with 647 participants were included in this meta-analysis. EMDR was associated with a significant reduction of anxiety (g = -0.71; 95% CI: -0.96 to -0.47), panic (g = -0.62; 95% CI: -1.10 to -0.14), phobia (g = -0.45; 95% CI: -0.81 to -0.08), behavioural/somatic symptoms (g = -0.40; 95% CI: -0.63 to -0.12), but not traumatic feelings (g = -0.48; 95% CI: -1.14 to -0.18). Subgroup analysis revealed greater effects of EMDR if compared to passive control. However, the effects were not significantly different based on the duration, number of therapy sessions, or the number of weekly sessions.

CONCLUSIONS

Our meta-analysis indicates that EMDR is efficacious for reducing symptoms of anxiety, panic, phobia, and behavioural/somatic symptoms. Further research is needed to explore EMDR's long term efficacy on anxiety disorders.

Is There an Ace Up Our Sleeve? A Review of Interventions and Strategies for Addressing Behavioral and Neurobiological Effects of Adverse Childhood Experiences in Youth

Exposure to early life adversity (ELA) is a major public health crisis posing as a significant risk of immediate and sustained mental and physical health consequences. While a remarkable body of knowledge has been amassed showing psychological, cognitive, social, developmental, and neurobiological consequences of ELA exposure, little has been done to improve the long-term mental and physical health outcomes for youth exposed to ELA. Furthermore, neurobiological processes underlying poor outcomes in this population have been largely left out of prevention and intervention target efforts. In this review, we first describe ELA-related alterations across psychological and neurobiological systems in children and adolescents. Next, we describe existing evidence-based interventions targeting ELA-related outcomes. We then turn to experimental studies examining individual differences in mechanistic functioning consequent to ELA exposure, and strategies that target these mechanisms and modulate disrupted functioning. Finally, we highlight areas of future research that may be promising in engaging behavioral and neurobiological targets through novel preventive interventions or augmentation of existing interventions, thereby reducing negative mental and physical health outcomes later in life.

The intersection between the oculomotor and hippocampal memory systems: empirical developments and clinical implications

Decades of cognitive neuroscience research has shown that where we look is intimately connected to what we remember. In this article, we review findings from human and nonhuman animals, using behavioral, neuropsychological, neuroimaging, and computational modeling methods, to show that the oculomotor and hippocampal memory systems interact in a reciprocal manner, on a moment-to-moment basis, mediated by a vast structural and functional network. Visual exploration serves to efficiently gather information from the environment for the purpose of creating new memories, updating existing memories, and reconstructing the rich, vivid details from memory. Conversely, memory increases the efficiency of visual exploration. We call for models of oculomotor control to consider the influence of the hippocampal memory system on the cognitive control of eye movements, and for models of hippocampal and broader medial temporal lobe function to consider the influence of the oculomotor system on the development and expression of memory. We describe eye movement-based applications for the detection of neurodegeneration and delivery of therapeutic interventions for mental health disorders for which the hippocampus is implicated and memory dysfunctions are at the forefront.

Interventions for posttraumatic stress disorder symptoms induced by medical events: A systematic review

OBJECTIVE

Medical events such as myocardial infarction and cancer diagnosis can induce symptoms of posttraumatic stress disorder (PTSD). The optimal treatment of PTSD symptoms in this context is unknown.

METHODS

A literature search of 6 biomedical electronic databases was conducted from database inception to November 2018. Studies were eligible if they used a randomized design and evaluated the effect of treatments on medical event-induced PTSD symptoms in adults. A random effects model was used to pool data when two or more comparable studies were available.

RESULTS

Six trials met full inclusion criteria. Studies ranged in size from 21 to 81 patients, and included patients with PTSD induced by cardiac events, cancer, HIV, multiple sclerosis, and stem cell transplantation. All trials assessed psychological interventions. Two trials comparing a form of exposure-based cognitive behavioral therapy (CBT) with assessment-only control found that CBT resulted in lower PTSD symptoms [Hedges's g = -0.47, (95% CI -0.82 - -0.12), p = .009]. A third trial compared imaginal exposure (another form of exposure-based CBT) with an attention control and found a trend toward reduced PTSD symptoms. Three trials compared eye movement desensitization and reprocessing (EMDR) with active psychological treatments (imaginal exposure, conventional CBT, and relaxation therapy), and found that EMDR was more effective.

CONCLUSION

CBT and EMDR may be promising approaches to reducing PTSD symptoms due to medical events. However, additional trials are needed in this patient population.

Childhood Trauma and Psychosis: An Updated Review

There is growing evidence to support the link between childhood trauma and psychosis. Childhood trauma increases the risk for psychosis and affects severity and type of psychotic symptoms, and frequency of comorbid conditions, including depression and substance use. Childhood trauma is linked to more severe functional impairment in individuals with psychosis. There is evidence to support gender differences in the influence of childhood trauma on the course of psychotic illnesses, appearing to be more profound in girls and women. Other biological markers that may explain the link between childhood trauma and psychosis include brain-derived neurotrophic factor and other inflammatory markers.

[Post-traumatic stress disorder and psychogenic pain]

Post-traumatic stress disorder is an adjustment disorder combining psychological and physical symptoms. Faced with the pain associated with post-traumatic stress disorder, it is important to know how to differentiate between the pain linked to the physical injury at the time of the traumatic event and the psychogenic pain. Identifying these pains and studying their aetiology, combined with an assessment of the patient's psychological state and life history, enables multi-disciplinary care to be put in place to improve the patient's prognosis and can help to improve recognition of these disorders.

On EMDR: Measuring the working memory taxation of various types of eye (non-)movement conditions

BACKGROUND AND OBJECTIVE

A recent, large randomized controlled trial employing different forms of eye (non-)movements in eye movement desensitization and reprocessing (EMDR) showed that fixating the eyes either on a therapist's moving or non-moving hand led to equal reductions in symptoms of post-traumatic stress disorder (PTSD). However, numerous EMDR lab analogue studies found that eye movements produce larger memory effects than eyes stationary. These beneficial effects are typically explained by differences in working memory (WM) taxation. We tested the degree of WM taxation of several eye (non-)movement conditions used in the clinical trial.

METHODS

All participants (N = 40) performed: (1) eyes moving by following the experimenter's moving finger, (2) eyes fixed on the experimenter's stationary finger, (3) eyes closed, or (4) looking unfocused into the room. Simultaneously they performed a simple reaction time task. Reaction times are an objective index of the extent to which different dual attention tasks tax WM.

RESULTS

Eyes moving is more taxing than eyes fixed, while eyes fixed did not differ from eyes unfocused. All conditions were more taxing than eyes closed.

LIMITATIONS

We studied WM taxation in a laboratory setting; no clinical interventions were applied.

CONCLUSIONS

In line with previous lab studies, making eye movements was more taxing than eyes fixed. We discuss why this effect was not observed for reductions in PTSD symptoms in the clinical trial (e.g., differences in dependent variables, sample population, and intervention duration). For more comprehensive future insights, we recommend integration of mechanistically focused lab analogue studies and patient-oriented clinical studies.

Fear not: recent advances in understanding the neural basis of fear memories and implications for treatment development

Fear is a highly adaptive emotion that has evolved to promote survival and reproductive fitness. However, maladaptive expression of fear can lead to debilitating stressor-related and anxiety disorders such as post-traumatic stress disorder. Although the neural basis of fear has been extensively researched for several decades, recent technological advances in pharmacogenetics and optogenetics have allowed greater resolution in understanding the neural circuits that underlie fear. Alongside conceptual advances in the understanding of fear memory, this increased knowledge has clarified mechanisms for some currently available therapies for post-traumatic stress disorder and has identified new potential treatment targets.

Eye movement desensitization and reprocessing for post-traumatic stress disorder from the perspective of three-dimensional model of the experiential selfhood

Eye Movement Desensitization and Reprocessing (EMDR) therapy is included in many international trauma treatment guidelines and is also shortlisted as an evidence-based practice for the treatment of psychological trauma and Post-Traumatic Stress Disorder (PTSD). However, its neurobiological mechanisms have not yet been fully understood. In this brief article we propose a hypothesis that a recently introduced neurophysiologically based three-dimensional construct model for experiential selfhood may help to fill this gap by providing the necessary neurobiological rationale of EMDR. In support of this proposal we briefly overview the neurophysiology of eye movements and the triad selfhood components, as well as EMDR therapy neuroimaging studies.

The placebo and its effects: A psychoneuroendocrinological perspective

Placebos are usually employed deceptively in clinical trials in order to control for non-specific effects. However, since placebos themselves have been found to cause clinically relevant changes and in some cases are indistinguishable from the verum they are tested against, this theoretically inert, but practically effective intervention has become a scientific discipline in its own right. In this review, it is argued that placebos are generic and genuine biopsychosocial interventions and as such are highly interesting candidates for a psychoneuroendocrinological perspective. Yet, despite a considerable conceptual proximity between explanatory models of placebos and their effects with psychoneuroendocrine models and findings, placebos have thus far not been subject to systematic psychoneuroendocrine examination. Consequently, it would be highly interesting and informative to make placebos the target of psychoneuroendocrine scrutiny.

Eye movement inductions influence health behaviour: the working memory account of persuasion

Objective: Because the working memory (WM) has a limited capacity, the cognitive reactions towards persuasive information in the WM might be disturbed by taxing it by other means, in this study, by inducing voluntary eye movements (EMi). This is expected to influence persuasion. Methods: Participants (N = 127) listened to an auditory persuasive message on fruit and vegetable consumption, that was either framed positively or negatively. Half of them was asked to keep following a regularly moving dot on their screen with their eyes. At pretest, cognitive self-affirmation inclination (CSAI) was assessed as individual difference to test possible moderation effects. Results: The EMi significantly lowered the quality of the mental images that participants reported to have of the persuasive outcomes. With regard to self-reported fruit and vegetable consumption after two weeks, EMi significantly lowered consumption when CSAI was high but it significantly increased consumption when CSAI was low. Conclusions: The results verify our earlier findings that induced EM can influence persuasion. Although it remains unclear whether the effects of EMi were caused by disturbing mental images of persuasive outcomes or self-regulative reactions to these images, or both, the WM account may provide new theoretical as well as practical angles on persuasion.

Apport de l’EMDR dans la pratique du psychologue à l’hôpital auprès de patients en situation palliative

L’EMDR (désensibilisation et retraitement par les mouvements oculaires) est une approche psychothérapeutique recommandée et validée par les grandes institutions de santé dans le monde, pour traiter les troubles de stress post-traumatique (TSPT). Auprès de patients gravement malades, l’approche EMDR permet de soulager les symptômes tels que l’anxiété en lien avec les traitements et les soins. Nous présenterons à travers des cas cliniques un retour d’expérience d’utilisation de cette approche auprès de patients en situation palliative.

Conceptualization, Assessment, and Treatment of Traumatic Stress in First Responders: A Review of Critical Issues

First responders are regularly confronted with exposure to traumatic events, including potentially life-threatening situations as well as the grave injuries and deaths of colleagues and civilians. Evidence indicates that the prevalence of posttraumatic stress disorder (PTSD) is substantially higher among first responders than the general population. This article provides information about the outpatient trauma services at McLean Hospital's LEADER (Law Enforcement, Active Duty, Emergency Responder) program to assist clinicians who encounter these first responders in their practices or who are specifically interested in working with this patient population. We begin by synthesizing the literature on the prevalence of PTSD in first responders following work-related exposure to traumatic stress, and by addressing the occupation-specific risk factors and the third-variable risk factors that may contribute to potentiated risk. We then discuss assessment strategies and treatment options used in our program, which is tailored for individuals who are dealing with mental health issues stemming from occupation-specific traumatic-stress exposure. We also address the unique challenges of treating traumatized first responders with more complex issues such as traumatic stress exposure across the lifespan and safety issues, including acute suicidality. We conclude by discussing notable gaps in the literature, including the need to investigate why and how women present with different PTSD symptoms than men and how these differences need to be taken into account in determining appropriate treatment for women.

Testing the leadership and organizational change for implementation (LOCI) intervention in Norwegian mental health clinics: a stepped-wedge cluster randomized design study protocol

BACKGROUND

Alignment across levels of leadership within an organization is needed for successful implementation of evidence-based practice. The leadership and organizational change for implementation (LOCI) intervention is a multi-faceted multilevel implementation strategy focusing on enhancing first-level general and implementation leadership while also engaging with organization upper management to develop an organizational climate for implementation. The aim of the project is to evaluate the effectiveness of LOCI in supporting the implementation of evidence-based treatment for PTSD in child- and adult-specialized mental health clinics in health trusts in Norway.

METHODS

The study design is a stepped-wedge cluster randomized trial with enrollment of clinics in three cohorts. Executives, clinic leaders, and therapists will be asked to complete surveys assessing leadership and implementation climate. Surveys will be completed at baseline, 4, 8, 12, 16, and 20 months. Results from surveys will be shared with executives and clinic leaders to inform the subsequent creation of tailored leadership and climate development plans for enhanced implementation. Patients will complete surveys measuring traumatic events and post-traumatic stress symptoms during the therapy process. Therapy sessions will be audio or video recorded and scored for fidelity as part of training.

DISCUSSION

This study aims to provide knowledge on how to improve leadership and organizational climate to enhance effective implementation of evidence-based treatments in mental health services.

TRIAL REGISTRATION

The study has been registrated in ClinicalTrials with ID NCT03719651 .

Psychological and Brain Connectivity Changes Following Trauma-Focused CBT and EMDR Treatment in Single-Episode PTSD Patients

Among the different therapeutic alternatives for post-traumatic stress disorder (PTSD), Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) Therapy have shown promising results in helping patients cope with PTSD symptoms. However, given the different theoretical and methodological substrate of TF-CBT and EMDR, a potentially different impact on the brain for the two interventions could be hypothesized, as well as an interaction between trauma-specific PTSD symptomatology and response to a given psychotherapy. In this study, we monitored psychological and spontaneous functional connectivity fMRI patterns in two groups of PTSD patients who suffered by the same traumatic event (i.e., natural disaster), before and after a cycle of psychotherapy sessions based on TF-CBT and EMDR. Thirty-seven (37) PTSD patients were enrolled from a larger sample of people exposed to a single, acute psychological stress (i.e., 2002 earthquake in San Giuliano di Puglia, Italy). Patients were randomly assigned to TF-CBT (n = 14) or EMDR (n = 17) psychotherapy. Clinical assessment was performed using the Clinician-Administered PTSD Scale (CAPS), the Davidson Trauma Scale (DTS) and the Work and Social Adjustment Scale (WSAS), both at baseline and after treatment. All patients underwent a fMRI data acquisition session before and after treatment, aimed at characterizing their functional connectivity (FC) profile at rest, as well as potential connectivity changes associated with the clinical impact of psychotherapy. Both EMDR and TF-CBT induced statistically significant changes in clinical scores, with no difference in the clinical impact of the two treatments. Specific changes in FC correlated with the improvement at the different clinical scores, and differently for EMDR and TF-CBT. However, a similarity in the connectivity changes associated with changes in CAPS in both groups was also observed. Specifically, changes at CAPS in the entire sample correlated with an (i) increase in connectivity between the bilateral superior medial frontal gyrus and right temporal pole, and a (ii) decrease in connectivity between left cuneus and left temporal pole. Results point to a similar, beneficial psychological impact of EMDR and TF-CBT for treatment of natural-disaster PTSD patients. Neuroimaging data suggest a similar neurophysiological substrate for clinical improvement following EMDR and TF-CBT, involving changes affecting bilateral temporal pole connectivity.

Comparing the Effectiveness of EMDR and TF-CBT for Children and Adolescents: a Meta-Analysis

Efficacy of EMDR and TF-CBT for posttraumatic stress symptoms (PTSS) was explored through meta-analysis. A comprehensive search yielded 494 studies of children and adolescents with PTSS who received treatment with these evidence-based therapeutic modalities. Thirty total studies were included in the meta-analysis. The overall Cohen's d was small (-0.359) and statistically significant (p < 0.05), indicating EMDR and TF-CBT are effective in treating PTSS. Major findings posit TF-CBT is marginally more effective than EMDR; those with sub-clinical PTSS responded more favorably in treatment than those with PTSD; and greater reductions in PTSS were observed with presence of comorbidity in diagnosis. Assessment of publication bias with Classic fail-safe N revealed it would take 457 nonsignificant studies to nullify these findings.

Paranoid beliefs and realistic expectations of victimization: Data from the survey of police-public encounters

BACKGROUND

The anticipation of threat or victimization is a core feature of paranoia. Cognitive theories of paranoia suggest that paranoid thoughts may arise as a psychological response to trauma exposure, which likewise may lead to greater anticipation of subsequent victimization. Little is known, however, about the relation between paranoid beliefs and anticipated victimization when accounting for past victimization experience. The present study aimed to address whether the experiences of past victimization contribute to the link between paranoid beliefs and the anticipation of threat or victimization, with a particular focus on exposure to police violence.

METHODS

Data were collected through the Survey of Police-Public Encounters (N=1615), a cross-sectional, general population survey study conducted in four Eastern U.S. cities. Associations between paranoia and anticipated victimization were assessed using linear regression models, with and without adjustment for past victimization exposure.

RESULTS

Paranoid beliefs were positively associated with police victimization expectations (β=0.19, p<0.001), but these associations were statistically better explained by past exposures to similar victimization such that paranoia was no longer associated with anticipated victimization in adjusted models (β=0.02, p=0.451). To assess for the specificity of past exposures to victimization, adjusting for past exposure to intimate partner violence (as a control condition) did not eliminate the association between paranoia and expected police victimization.

CONCLUSIONS

The overall findings are consistent with cognitive theories of paranoia in which paranoid beliefs may be a severe but normative reaction to past victimization exposures in some cases.

How Does Eye Movement Desensitization and Reprocessing Therapy Work? A Systematic Review on Suggested Mechanisms of Action

Background: Eye movement desensitization and reprocessing [EMDR] is an innovative, evidence-based and effective psychotherapy for post-traumatic stress disorder [PTSD]. As with other psychotherapies, the effectiveness of EMDR contrasts with a limited knowledge of its underlying mechanism of action. In its relatively short life as a therapeutic option, EMDR has not been without controversy, in particular regarding the role of the bilateral stimulation as an active component of the therapy. The high prevalence of EMDR in clinical practice and the dramatic increase in EMDR research in recent years, with more than 26 randomized controlled trials published to date, highlight the need for a better understanding of its mechanism of action.

Methods: We conducted a thorough systematic search of studies published until January 2018, using PubMed, ScienceDirect, Web of Knowledge and Scopus databases that examined the mechanism of action of EMDR or provided conclusions within the framework of current theoretical models of EMDR functioning.

Results: Eighty-seven studies were selected for review and classified into three overarching models; (i) psychological models (ii) psychophysiological models and (iii) neurobiological models. The evidence available from each study was analyzed and discussed. Results demonstrated a reasonable empirical support for the working memory hypothesis and for the physiological changes associated with successful EMDR therapy. Recently, more sophisticated structural and functional neuroimaging studies using high resolution structural and temporal techniques are starting to provide preliminary evidence into the neuronal correlates before, during and after EMDR therapy.

Discussion: Despite the increasing number of studies that published in recent years, the research into the mechanisms underlying EMDR therapy is still in its infancy. Studies in well-defined clinical and non-clinical populations, larger sample sizes and tighter methodological control are further needed in order to establish firm conclusions.

EMDR to Treat Functional Neurological Disorder: A Review

Eye movement desensitization and reprocessing (EMDR) therapy is an established treatment for posttraumatic stress disorder (PTSD), but there is increasing evidence for its use beyond PTSD. EMDR can be effective at treating distressing memories not associated with PTSD, as well as somatic symptoms (like chronic pain), and as such could potentially be used as a treatment for patients with functional neurological disorder (FND). Searches were conducted for published peer-reviewed articles on the use of EMDR for FND. The databases selected and searched were Medline, Embase, Cochrane Library, CINAHL Plus, Web of Science, PsychINFO, PubMed, and Francine Shapiro Library. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Three relevant articles were found. The studies included are one case series and two case studies. Of the five participants included in the studies, four experienced functional non-epileptic attacks; and one experienced functional movement disorder. Four out of the five patients were successfully treated with EMDR. EMDR is potentially a useful treatment of FND, but further research, including controlled trials, is required. The authors propose that EMDR could be useful in treating patients with FND and comorbid PTSD, as well as patients without comorbid PTSD. We discuss the clinical implications and propose how EMDR could fit into the FND treatment pathway.

A Non-randomized Controlled Trial of EMDR on Affective Symptoms in Patients With Glioblastoma Multiforme

Glioblastoma multiforme (GBM) is a highly aggressive brain cancer and its survival after diagnosis is less than 2 years. Therefore, GBM patients are especially prone to co-occurring psychological conditions such as anxiety and depressive disorders. Furthermore, aggressive medical therapies affect patients' lives, undermining their sense of meaning and coherence. The main aim of this study was to determine the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) therapy on anxiety, depression and sense of coherence in patients with GBM. Thirty-seven GBM-diagnosed women were included in this trial and received standard medical care. Of those, 18 patients were treated during 4 months with 10-12 individual EMDR sessions (60-90 minutes each). Nineteen GBM patients were used as a non-randomized control group as they consented to psychological evaluations but not to a psychotherapeutic intervention. The groups were homogeneous in terms of gender, age, educational level and treatment, but not in anxiety and depressive levels at baseline. All patients were evaluated at baseline, after treatment (4 months) and at follow-up (further 4 months) by the Hospital Anxiety and Depression Scale (HADS-M) and the Sense of Coherence Scale (SOC-29). Caregivers in both groups were interviewed by the Patient Caregiver Questionnaire after 4 months follow-up. Statistical analyses were conducted using ANOVA statistics, correlation and regression analysis. Results showed a statistically significant decrease in the EMDR group in anxiety, depression and anger, when compared to the experimental group. EMDR therapy also had a positive impact upon the sense of coherence level in the experimental group, whereas in the control group this declined. Finally, the caregivers reported beneficial outcomes of the EMDR therapy with less anxiety- and anger-related behaviors in patients in the experimental group compared to the control group. This study is the first to show beneficial effects of EMDR therapy in alleviating affective symptoms and improving coherence in a severe medically ill population with GBM.

Beyond Pathologizing Harm: Understanding PTSD in the Context of War Experience

An alternative to objectifying approaches to understanding Post-traumatic Stress Disorder (PTSD) grounded in hermeneutic phenomenology is presented. Nurses who provided care for soldiers injured in the Iraq and Afghanistan wars, and sixty-seven wounded male servicemen in the rehabilitation phase of their recovery were interviewed. PTSD is the one major psychiatric diagnosis where social causation is established, yet PTSD is predominantly viewed in terms of the usual neuro-physiological causal models with traumatic social events viewed as pathogens with dose related effects. Biologic models of causation are applied reductively to both predisposing personal vulnerabilities and strengths that prevent PTSD, such as resiliency. However, framing PTSD as an objective disease state separates it from narrative historical details of the trauma. Personal stories and cultural meanings of the traumatic events are seen as epiphenomenal, unrelated to the understanding of, and ultimately, the therapeutic treatment of PTSD. Most wounded service members described classic symptoms of PTSD: flashbacks, insomnia, anxiety etc. All experienced disturbance in their sense of time and place. Rather than see the occurrence of these symptoms as decontextualized mechanistic reverberations of war, we consider how these symptoms meaningfully reflect actual war experiences and sense of displacement experienced by service members.

EMDR as Add-On Treatment for Psychiatric and Traumatic Symptoms in Patients with Substance Use Disorder

Background: Substance use disorders (SUD) are patterns of substance use leading to severe impairment on social, working and economic levels. In vivo and clinical findings have enhanced the role of the brain's stress-related system in maintaining SUD behaviors. Several studies have also revealed a high prevalence of post-traumatic symptoms among SUD patients, suggesting that a trauma-informed treatment approach could lead to better treatment outcomes. However, only few studies have evaluated the use of eye movement desensitization and reprocessing (EMDR) in SUD without consistent results. The aim of the present pilot study was to assess the efficacy of a combined trauma-focused (TF) and addiction-focused (AF) EMDR intervention in treating post-traumatic and stress-related symptoms of patients with SUD.

Methods: Forty patients with different SUD were enrolled in the study. Twenty patients underwent treatment as usual (TAU), the other 20 patients were treated with TAU plus 24 weekly sessions of EMDR. All patients were assessed before and after intervention for several psychological dimensions using specific tools (i.e., BDI-II, DES, IES-R, STAI, and SCL-90-GSI). A repeated measure MANOVA was performed to evaluate both between groups (TAU + EMDR vs. TAU) and within group (pre- vs. post-intervention) effects and interactions. A secondary outcome was the dichotomous variable yielded by the urine drug testing immunoassay (yes/no).

Results: The RM-MANOVA revealed both a significant pre–post main effect (p < 0.001), and a significant group-by-time main effect (p < 0.001). Significant improvements on IES-R, DES, and SCL-90-GSI scales were shown in both groups according to time effects (p < 0.05). However, significant greater effects were found for TAU + EMDR group than TAU group. No differences were found between TAU and TAU + EMDR groups in terms of urine drug immunoassay results before and after the interventions.

Conclusions: The TAU + EMDR group showed a significant improvement of post-traumatic and dissociative symptoms, accompanied by a reduction in anxiety and overall psychopathology levels, whereas TAU group showed a significant reduction only in post-traumatic symptoms. Although our results can only be considered preliminary, this study suggests that a combined TF- and AF- EMDR protocol is an effective and well-accepted add-on treatment for patients with SUD.

Metacognitive therapy vs. eye movement desensitization and reprocessing for posttraumatic stress disorder: study protocol for a randomized superiority trial

BACKGROUND

The psychological treatment of choice for patients with severe posttraumatic stress disorder (PTSD) is cognitive behavioural exposure therapy or Eye Movement Desensitisation Reprocessing (EMDR). Whilst these are the most effective treatments, approximately 30-45% of the patients show no significant improvements and follow-up data are sparse. Furthermore, a proportion of patients with severe trauma does not benefit or avoid exposure therapy due to the potential to overwhelm them. Therefore, it is necessary to search for effective methods that do not require exposure. Metacognitive therapy (MCT), a recent treatment approach to PTSD that does not require exposure, has potential strong treatment effects but so far a comparison with EMDR has not been made.

METHODS/DESIGN

This study is a two-arm, parallel, randomized, superiority trial comparing the effectiveness of MCT with EMDR. One hundred patients with a primary diagnosis of chronic PTSD will be included and will receive 12 sessions of one of the treatments. The primary outcome is severity of PTSD symptoms assessed with the Posttraumatic Diagnostic Scale (PDS) measured post-treatment (3 months). Secondary outcomes include symptom severity (PDS) and measures of anxiety, depression, metacognitive beliefs at 3-month and 12-month follow up.

DISCUSSION

This randomized study is the first to compare MCT with EMDR with 12-month follow-up. The study will indicate the comparative effectiveness of MCT against EMDR and the stability of effects when delivered in an outpatient clinical setting.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT01955590 . Registered on 24 September 2013.

Eye movement desensitisation and reprocessing: an update

Eye movement desensitisation and reprocessing (EMDR) is a relatively recent therapeutic approach to the treatment of traumatic memories in the wake of psychological trauma such as those found in post-traumatic stress disorder (PTSD). It is based on the theory that bilateral stimulation, mostly in the form of eye movements, allows the processing of traumatic memories. While the patient focuses on specific images, negative sensations and associated cognitions, bilateral stimulation is applied to desensitise the individual to these memories and more positive sensations and cognitions are introduced. Although there is still uncertainty about the theoretical concepts underlying EMDR and the role of bilateral stimulation, it is an effective and proven treatment for PTSD and traumatic memories. It should form part of treatment approaches offered to individuals with PTSD.