[Childhood-onset versus acute, adult-onset traumatized patients in the light of amnestic tendencies and derealisation]

Facial mimicry, facial emotion recognition and alexithymia in post-traumatic stress disorder

Individuals with post-traumatic stress disorder (PTSD) show abnormalities in higher-order emotional processes, including emotion regulation and recognition. However, automatic facial responses to observed facial emotion (facial mimicry) has not yet been investigated in PTSD. Furthermore, whereas deficits in facial emotion recognition have been reported, little is known about contributing factors. We thus investigated facial mimicry and potential effects of alexithymia and expressive suppression on facial emotion recognition in PTSD. Thirty-eight PTSD participants, 43 traumatized and 33 non-traumatized healthy controls completed questionnaires assessing alexithymia and expressive suppression. Facial electromyography was measured from the muscles zygomaticus major and corrugator supercilii during a facial emotion recognition task. Corrugator activity was increased in response to negative emotional expressions compared to zygomaticus activity and vice versa for positive emotions, but no significant group differences emerged. Individuals with PTSD reported greater expressive suppression and alexithymia than controls, but only levels of alexithymia predicted lower recognition of negative facial expressions. While automatic facial responses to observed facial emotion seem to be intact in PTSD, alexithymia, but not expressive suppression, plays an important role in facial emotion recognition of negative emotions. If replicated, future research should evaluate whether successful interventions for alexithymia improve facial emotion recognition abilities.

Comparison of Eye Movement Desensitization Reprocessing and Cognitive Behavioral Therapy as Adjunctive Treatments for Recurrent Depression: The European Depression EMDR Network (EDEN) Randomized Controlled Trial

Background: Treatment of recurrent depressive disorders is currently only moderately successful. Increasing evidence suggests a significant relationship between adverse childhood experiences and recurrent depressive disorders, suggesting that trauma-based interventions could be useful for these patients.

Objectives: To investigate the efficacy of Eye Movement Desensitization and Reprocessing therapy (EMDR) in addition to antidepressant medication (ADM) in treating recurrent depression.

Design: A non-inferiority, single-blind, randomized clinical controlled trial comparing EMDR or CBT as adjunctive treatments to ADM. Randomization was carried out by a central computer system. Allocation was carried out by a study coordinator in each center.

Setting: Two psychiatric services, one in Italy and one in Spain.

Participants: Eighty-two patients were randomized with a 1:1 ratio to the EMDR group (n = 40) or CBT group (n = 42). Sixty-six patients, 31 in the EMDR group and 35 in the CBT group, were included in the completers analysis. Intervention: 15 ± 3 individual sessions of EMDR or CBT, both in addition to ADM. Participants were followed up at 6-months.

Main outcome measure: Rate of depressive symptoms remission in both groups, as measured by a BDI-II score <13.

Results: Sixty-six patients were analyzed as completers (31 EMDR vs. 35 CBT). No significant difference between the two groups was found either at the end of the interventions (71% EMDR vs. 48.7% CBT) or at the 6-month follow-up (54.8% EMDR vs. 42.9% CBT). A RM-ANOVA on BDI-II scores showed similar reductions over time in both groups [F(6,59) = 22.501, p < 0.001] and a significant interaction effect between time and group [F(6,59) = 3.357, p = 0.006], with lower BDI-II scores in the EMDR group at T1 [mean difference = –7.309 (95% CI [–12.811, –1.806]), p = 0.010]. The RM-ANOVA on secondary outcome measures showed similar improvement over time in both groups [F(14,51) = 8.202, p < 0.001], with no significant differences between groups [F(614,51) = 0.642, p = 0.817].

Conclusion: Although these results can be considered preliminary only, this study suggests that EMDR could be a viable and effective treatment for reducing depressive symptoms and improving the quality of life of patients with recurrent depression. Trial registration: ISRCTN09958202.