EMDR and Parenting: A Clinical Case

Interventions from pregnancy to two years after birth for parents experiencing complex post-traumatic stress disorder and/or with childhood experience of maltreatment

BACKGROUND

Acceptable, effective and feasible support strategies (interventions) for parents experiencing complex post-traumatic stress disorder (CPTSD) symptoms or with a history of childhood maltreatment may offer an opportunity to support parental recovery, reduce the risk of intergenerational transmission of trauma and improve life-course trajectories for children and future generations. However, evidence relating to the effect of interventions has not been synthesised to provide a comprehensive review of available support strategies. This evidence synthesis is critical to inform further research, practice and policy approaches in this emerging area.

OBJECTIVES

To assess the effects of interventions provided to support parents who were experiencing CPTSD symptoms or who had experienced childhood maltreatment (or both), on parenting capacity and parental psychological or socio-emotional wellbeing.

SEARCH METHODS

In October 2021 we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers, together with checking references and contacting experts to identify additional studies.

SELECTION CRITERIA

All variants of randomised controlled trials (RCTs) comparing any intervention delivered in the perinatal period designed to support parents experiencing CPTSD symptoms or with a history of childhood maltreatment (or both), to any active or inactive control. Primary outcomes were parental psychological or socio-emotional wellbeing and parenting capacity between pregnancy and up to two years postpartum.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed the eligibility of trials for inclusion, extracted data using a pre-designed data extraction form, and assessed risk of bias and certainty of evidence. We contacted study authors for additional information as required. We analysed continuous data using mean difference (MD) for outcomes using a single measure, and standardised mean difference (SMD) for outcomes using multiple measures, and risk ratios (RR) for dichotomous data. All data are presented with 95% confidence intervals (CIs). We undertook meta-analyses using random-effects models.

MAIN RESULTS

We included evidence from 1925 participants in 15 RCTs that investigated the effect of 17 interventions. All included studies were published after 2005. Interventions included seven parenting interventions, eight psychological interventions and two service system approaches. The studies were funded by major research councils, government departments and philanthropic/charitable organisations. All evidence was of low or very low certainty. Parenting interventions Evidence was very uncertain from a study (33 participants) assessing the effects of a parenting intervention compared to attention control on trauma-related symptoms, and psychological wellbeing symptoms (postpartum depression), in mothers who had experienced childhood maltreatment and were experiencing current parenting risk factors. Evidence suggested that parenting interventions may improve parent-child relationships slightly compared to usual service provision (SMD 0.45, 95% CI -0.06 to 0.96; I2 = 60%; 2 studies, 153 participants; low-certainty evidence). There may be little or no difference between parenting interventions and usual perinatal service in parenting skills including nurturance, supportive presence and reciprocity (SMD 0.25, 95% CI -0.07 to 0.58; I2 = 0%; 4 studies, 149 participants; low-certainty evidence). No studies assessed the effects of parenting interventions on parents' substance use, relationship quality or self-harm. Psychological interventions Psychological interventions may result in little or no difference in trauma-related symptoms compared to usual care (SMD -0.05, 95% CI -0.40 to 0.31; I2 = 39%; 4 studies, 247 participants; low-certainty evidence). Psychological interventions may make little or no difference compared to usual care to depression symptom severity (8 studies, 507 participants, low-certainty evidence, SMD -0.34, 95% CI -0.66 to -0.03; I2 = 63%). An interpersonally focused cognitive behavioural analysis system of psychotherapy may slightly increase the number of pregnant women who quit smoking compared to usual smoking cessation therapy and prenatal care (189 participants, low-certainty evidence). A psychological intervention may slightly improve parents' relationship quality compared to usual care (1 study, 67 participants, low-certainty evidence). Benefits for parent-child relationships were very uncertain (26 participants, very low-certainty evidence), while there may be a slight improvement in parenting skills compared to usual care (66 participants, low-certainty evidence). No studies assessed the effects of psychological interventions on parents' self-harm. Service system approaches One service system approach assessed the effect of a financial empowerment education programme, with and without trauma-informed peer support, compared to usual care for parents with low incomes. The interventions increased depression slightly (52 participants, low-certainty evidence). No studies assessed the effects of service system interventions on parents' trauma-related symptoms, substance use, relationship quality, self-harm, parent-child relationships or parenting skills.

AUTHORS' CONCLUSIONS

There is currently a lack of high-quality evidence regarding the effectiveness of interventions to improve parenting capacity or parental psychological or socio-emotional wellbeing in parents experiencing CPTSD symptoms or who have experienced childhood maltreatment (or both). This lack of methodological rigour and high risk of bias made it difficult to interpret the findings of this review. Overall, results suggest that parenting interventions may slightly improve parent-child relationships but have a small, unimportant effect on parenting skills. Psychological interventions may help some women stop smoking in pregnancy, and may have small benefits on parents' relationships and parenting skills. A financial empowerment programme may slightly worsen depression symptoms. While potential beneficial effects were small, the importance of a positive effect in a small number of parents must be considered when making treatment and care decisions. There is a need for further high-quality research into effective strategies for this population.

Changing the Adult State of Mind With Respect to Attachment: An Exploratory Study of the Role of EMDR Psychotherapy

We aimed to assess changes in the attachment internal working model and reflective function (RF) as mechanisms of change in eye movement desensitization and reprocessing (EMDR) treatment for patients with traumatic memories. Twenty adult female patients with parenting and relational problems participated in the study. Attachment organization was assessed with the Adult Attachment Interview (AAI) and the RF coding scale pre- and posttreatment. We found that EMDR therapy increased patients' narrative coherence and RF. We noted a significant decrease in the number of participants classified as unresolved following the course of EMDR treatment in which loss and/or trauma were resolved. This article summarizes the changes after EMDR therapy regarding attachment status and its efficacy to reprocess early traumatic memories in a more adaptive way. Finally, our results also support the usefulness of the AAI as a tool for understanding the changing processes during a therapeutic treatment.

EMDR Intervention for a 17-Month-Old Child to Treat Attachment Trauma: Clinical Case Presentation

This article explores the effectiveness of treating a 17-month-old male diagnosed with posttraumatic stress disorder (PTSD) and a disrupted secure attachment utilizing eye movement desensitization reprocessing (EMDR) and an integrative family therapy approach. The child experienced a life-threatening choking incident requiring hospitalization. Pretreatment, the child was inconsolable by his parents when distressed and could not tolerate anything touching his throat. Posttreatment, the child accepts comfort from his parents and allows his mother to kiss his throat. Results demonstrate a reduction or elimination of PTSD symptoms and a return to a secure attachment. This case study underscores Shapiro’s Adaptive Information Processing (AIP) model (2001). Application and customization of the eight phases of EMDR therapy are highlighted along with the Integrative Attachment Trauma Protocol for Children (IATP-C). Treatment consisted of five sessions. Customization included caregiver psychoeducation; EMDR resource development, focused on strengthening attachment and regulating emotion; and facilitating caregiver co-regulation throughout EMDR. The use of EMDR therapy with customization through the IATP-C protocol shows promise as an effective intervention for treating posttraumatic stress symptoms and repairing attachment in very young children.

Intervening in the Intergenerational Transmission of Trauma by Targeting Maternal Emotional Dysregulation With EMDR Therapy

Many studies have shown that the relationship between child and caregivers is critical for healthy development of the child’s brain function, and for intergenerational transmission of attachment. Here, we propose a useful eye movement desensitization and reprocessing (EMDR) target for treatment of maternal emotional dysregulation that can cause maltreatment of the child, with the goal of interrupting intergenerational transmission of attachment trauma. First, we use schematics to demonstrate a hypothetical model of the interaction between a child’s attachment behavior and a mother’s bonding behavior. This schematic shows that the child’s physiologic reaction activates or triggers the mother’s negative affect and somatic sensations in her limbic system and brain stem and that, in turn, evokes the mother’s maltreatment behavior. The negative affect and somatic sensation (maternal emotional dysregulation) are Dysfunctionally Stored Information (DSI) that was produced in the mother’s past experience. We propose that the mother’s negative affect and somatic sensations activated by the child’s behaviors can be useful targets for EMDR therapy based on this hypothetical model. Two Japanese case reports (mothers with 4-year-old daughters) are described to illustrate this application. Further discussion highlights the feature of Japanese cultural relationship and the dissociation, and the meaning and scope of targeting maternal emotional dysregulation with EMDR therapy.