EMDR Therapy Humanitarian Trauma Recovery Interventions in Latin America and the Caribbean

Intervention with EMDR on a sample of healthcare workers in the nephrology and dialysis service during the COVID-19 emergency: from immediate treatment effect to long-term maintenance

Background

During the COVID-19 pandemic, psychological support was provided to healthcare workers in Nephrology and Dialysis Operative Unit of the Azienda Ospedaliera Bassini using an EMDR group protocol to decrease posttraumatic stress symptoms in the medium and long term. The aim of this study was to demonstrate the effectiveness of EMDR treatment to reduce post-traumatic stress symptoms at the end of the first pandemic wave and its progress over time in the subsequent phases of the health emergency.

Methods

The sample of study consisted of 43 healthcare workers from the Nephrology and Dialysis Service who spontaneously decided to take part in the Brief EMDR treatment. Statistical analyses were carried out to compare the data collected with the IES-R, the Emotion Thermometer and the Post-Traumatic Growth Scale. The comparisons covered pre-treatment, post-treatment and follow-up.

Results

The results show a significant clinical improvement in reducing PTSD symptoms following the Brief EMDR group treatment. The comparison between PRE and POST treatment (DELTA1) regarding the scores from IES-R and Emotion Thermometer, highlighted the important statistically change that occurred in terms of symptomatology reduction (p < 0.001). By comparing POST and FU (DELTA2), it was observed that all variables except avoidance show a significant weakening of the effect with time (p < 0.001), but the magnitude of this effect is much smaller than the improvement found in DELTA1. DELTA 3 analysis finally made it possible to highlight how the treatment effect is maintained almost intact at follow-up. In fact, the maintenance of a better situation at follow-up was observed, in the course of re-traumatization linked to the new wave, compared to the initial data (p < 0.001).

Conclusion

The COVID-19 health emergency has significantly impacted hospital healthcare workers, leading to a high risk of developing PTSD symptoms. A psychological intervention aimed at the operators themselves is therefore of great importance.

"Efficacy of Cognitive Behavioral Therapy in Post-traumatic Stress Disorder Among Spinal Cord Injury Patients: A Randomized Controlled Pilot Study"

"Post-Traumatic Stress Disorder (PTSD) develops after exposure to or witnessing traumatic events. PTSD is very common among the Spinal Cord Injury (SCI) patients. PTSD can be successfully treated with the Cognitive Behavioral Therapy (CBT). However, CBT is mostly used in the western countries, so its efficacy in the eastern culture is still not fully known. Keeping this in view, the current study has determined the efficacy of CBT in the treatment of PTSD among the SCI patients in Pakistan. Using a Randomized Controlled Pilot Study design, data were collected through the Clinician-Administered PTSD Scale for DSM-5 from thirty patients admitted to the Paraplegic Center. Trauma-focused CBT(TF-CBT) protocol was applied through fourteen sessions. Data were analyzed by descriptive and multivariate statistics. Findings show that the level of PTSD symptoms gradually decreased from high at baseline (CAPS-5 Mean Scores μ= 3.6) to low during follow-up stage (CAPS-5 Mean Scores μ= 0.89). Results obtained from the present study on the efficacy of CBT are in concurrence with the research findings in other countries. This study supports the efficiency CBT intervention among Pakistani patients who had developed PTSD symptoms after suffering from SCI. Therefore, CBT can be widely used in the management of PTSD in Pakistan."

Cultural Adaptations of the Standard EMDR Protocol in Five African Countries

Since 2007, mental health workers in sub-Saharan Africa have been trained in eye movement desensitization and reprocessing (EMDR) therapy. This qualitative study used an Afrocentric design with thematic analysis to investigate adaptations to the EMDR standard protocol that make it culturally relevant for African clients. Participants were 25 EMDR therapists (three male, age range 32–60 years, x̄ = 44) from five African countries, who practiced EMDR for 1–11 years (x̄ = 7). All answered a survey questionnaire, eight participated in a focus group discussion, and two provided a supervision notes analysis. Participants found EMDR a useful and beneficial therapy and preferred it over other therapies because of its nonnarrative nature and quick results. We identified four areas in which African therapists consistently made adaptations to the standard protocol: wording of the protocol text, cultural expression of thoughts and emotions, stimulation choice, and simplification of quantitative scales. Based on the study results, we make numerous recommendations for cultural adaptions to the EMDR protocol. These include language changes to take into account the clients' “we oriented” communication; cultural interpretations of positive and negative thoughts and events; adding cultural activities such as dance, music, and religious practices as resourcing exercises; using hand gestures or the pictorial faces scale instead of ordinal scales; and using tapping for bilateral stimulation instead of eye movements, which were sometimes seen as “witchcraft.” The relevance of the findings for EMDR practice and training are discussed. We recommend that African researchers further study the acceptability, use, and effectiveness of EMDR in their countries.

Trauma Education and Stigma Reduction in Global Settings: An Evaluation of the Impact of a One-Day Trauma Psychoeducation Workshop with Community Stakeholders in the Caribbean Nation of Saint Lucia

The independent island nation of Saint Lucia and surrounding Caribbean countries have fairly well-documented high reported rates of trauma, but limited training infrastructure for trauma-related mental health support and treatment services. This study addresses this disparity between high trauma exposure and sparse trauma-related resources by studying how a one-day training workshop impacted self-rated knowledge about trauma and stigma towards trauma survivors. The training was provided by a licensed clinical psychologist in partnership with a local women's rights group. Participants (n = 41) included school counselors, nurses, psychiatric providers, health educators, and advocates on the island. Participants completed pre- and post-workshop measures examining the variables of interest. The one-day workshop provided training on trauma types, post-trauma reactions, options for treatment, and hands-on training for trauma crisis-management and short-term interventions. Following the workshop, participants reported increased knowledge of trauma, more accurate perceptions of its prevalence, better understanding of evidence-based treatments, and lower trauma survivor-related stigma. This is the first trauma-focused workshop tested in St. Lucia, where the need for such training is considerable given few treatment options for trauma survivors in this area. Work is underway to provide more expansive services for trauma across the Caribbean region, given these preliminary promising findings.

Pre-Post Study to Assess EMDR-Based Group Therapy for Traumatized Refugee Preschoolers

Cross-culturally effective, low-threshold therapies for refugees that can be carried out quickly are urgently required. Worldwide, therapies are lacking, particularly for preschool refugee children, which support coping and prevent chronification of posttraumatic stress. This pilot study examined eye movement desensitization and reprocessing (EMDR)-based group treatment for preschool refugee children in German daycare centers. Ten refugee preschool children aged 4–6 years (n = 5 female) with posttraumatic stress disorder (PTSD) symptoms took part in an EMDR-based group treatment (with 2–4 children per group). PTSD symptoms were rated by parents and preschool teachers using items from the Child Behavior Checklist (CBCL 1½–5), pre- and posttreatment, and at 3-month follow-up. After treatment children tended to display less fear of animals or situations than before treatment. According to preschool teachers' perspective, the total number of PTSD symptoms dropped significantly at posttreatment (d = .93) and at follow-up (d = .81). Before the intervention, preschool teachers rated the children as being more defiant than their parents did (p = .020). After the intervention, the PTSD symptoms of boys were significantly higher than those of girls (p = .036) according to preschool teachers. The results indicate that timely psychotherapeutic interventions can be conducted with refugee children displaying PTSD symptoms in daycare centers. The efficacy of this intervention needs to be studied in a larger sample under controlled randomized conditions.

Efficacy of eye movement desensitization & reprocessing versus cognitive behavioral therapy in Post-Traumatic Stress and Depressive Symptoms: Study protocol for a Randomized Controlled Trial

Post-Traumatic Stress Disorder(PTSD) develops after exposure to or witnessing traumatic events. PTSD is highly comorbid and individuals with PTSD usually report Depressive Symptoms(DS). Common treatment choices for PTSD and DS are either EMDR or CBT, however, little is known about their comparative efficacy, especially in Pakistan. Therefore, this Randomized Controlled Trial(RCT) aims at determining the comparative efficacy of EMDR vs CBT in Pakistan. This study will also examine the association between reduction in symptoms of PTSD and DS over course of treatment. In this regard, two arms Crossover Randomized Controlled Trial(RCT) with Repeated Measures Design will be selected. This study will be conducted at two rehabilitation centers and patients will be screened at Time:01, baseline; Time:02, during treatment; Time:03, post treatment and Time:04, 06 months follow-up. All analyses will be performed according to intention-to-treat principle. Variations in symptoms will be analysed by using descriptive statistics, χ 2 tests, t-tests, and one way ANOVA. To examine changes in PTSD and DS across time and to check efficacy of each treatment, a series of Linear Mixed Models will be run. Furthermore, a series of multi-level lagged mediation analysis will be performed to check bi-directional mediation between changes PTSD and DS over time. This protocol has outlined the rationale for determining efficacy of EMDR and CBT in Pakistan. It will help in answering a broad range of questions concerning efficacy of newly developed evidence-based treatments. Moreover, it may also guide future research on the treatment of PTSD and DS in the developing countries.

Future Research: Global Implications

Therapists trained to provide eye movement desensitization and reprocessing (EMDR) therapy have a global responsibility. This article summarizes the multiple impacts of high stress events, and their long-term effects on individuals, families, communities, and nations. While it is well documented that EMDR treatment will remediate the individual symptoms of posttraumatic stress, research is still needed to determine how far-reaching such outcomes are. Future studies should determine whether treatment reverses the neurobiological changes, cognitive deficits, and affective dysregulation, which are associated with exposure to traumatic events. Research should also investigate whether successful treatment decreases high-risk and/or perpetrator behavior, and whether these effects are translated into behavioral and attitudinal changes sufficient to bring an end to intergenerational trauma and ethnopolitical conflicts. It seems self-evident that the ideal way to address pressing societal needs, on both local and global levels, is by the integration of science and practice. The article also discusses the development of nonprofit EMDR humanitarian assistance programs, and their essential work in the alleviation of suffering around the world. In addition to recommending the examination of EMDR's efficacy in treating traumatization from direct, natural, structural, and cultural causes, this article advocates that research resources be dedicated for testing interventions in the areas of the world with the greatest needs. The alleviation of suffering is the duty of our profession.

Randomized Controlled Trial on the Provision of the EMDR Integrative Group Treatment Protocol Adapted for Ongoing Traumatic Stress to Female Patients With Cancer-Related Posttraumatic Stress Disorder Symptoms

This randomized controlled trial extended the investigation previously conducted by Jarero et al. (2015) which found that the eye movement desensitization and reprocessing Integrative Group Treatment Protocol adapted for ongoing traumatic stress (EMDR-IGTP-OTS) was effective in reducing posttraumatic stress disorder (PTSD) symptoms related to the diagnosis and treatment of different types of cancer in adult women. The current study sought to determine if the results could be replicated and if the treatment would also be effective in reducing symptoms of anxiety and depression. Participants in treatment (N = 35) and no-treatment control (N = 30) groups completed pre, post, and follow-up measurements using the Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) (PCL-5) and the Hospital Anxiety and Depression Scale (HADS). Data analysis by repeated measures analysis of variance (ANOVA) showed that the EMDR-IGTP-OTS was effective in significantly reducing symptoms of PTSD, anxiety, and depression, with symptoms maintained at 90-day follow-up and with large effect sizes (e.g., d = 1.80). A comparison of the treatment and no-treatment control groups showed significantly greater decreases for the treatment group on symptoms of PTSD, anxiety, and depression. No significant correlation was found when exploring the relationship between scores on the Adverse Life Experiences scale and scores indicating pretreatment severity of PTSD, anxiety, and depression. This study suggests that EMDR-IGTP-OTS may be an efficient and effective way to address cancer-related posttraumatic, depressive, and anxious symptoms.

EMDR-Based Divorce Recovery Group: A Case Study

This case study investigated the effects of an eye movement desensitization and reprocessing (EMDR)-based divorce recovery group, consisting of four modalities: (a) modified EMDR Integrative Group Treatment Protocol adapted for adolescents and adults living with ongoing traumatic stress (EMDR-IGTP-OTS) to deal with the trauma from the divorce, (b) modified Affect Circuit Reset protocol to reduce intensity of negative affects, (c) psychoeducation on affects and divorce-related issues, and (d) small group discussion. The divorce recovery program is an attempt to provide an affordable, trauma-focused intervention for divorce recovery for low-income populations. This report summarizes the outcomes in a divorce recovery group of six women, all Chinese immigrants. Aside from one person in the midst of divorce, the group consisted of individuals divorced for 7 years or more, for whom the distress had lasted more than the 2 to 3 years typical of divorce recovery. Short Post-Traumatic Stress Disorder (PTSD) Rating Interview (SPRINT) scores collected at the beginning of week 2, at the end of week 7, and at the beginning of week 8 showed PTSD symptoms dropping from severe to mild. The mean SPRINT scores at 6 weeks and 13 weeks after treatment continued to decrease, approaching the no/minimal symptom range. The SPRINT scores showed a 65.6% reduction between week 2 (18.0 [SD = 8.4]) and 13 weeks after treatment (6.2 [SD= 5.5]), with a large effect size of d = 1.40, and a significant decrease of t(4)=4.0, p = .016.

EMDR, Community Psychology, and Innovative Applications of a Trauma Recovery Network as a Tool for Social Change

This article discusses the need for and ways to implement novel applications of early eye movement desensitization and reprocessing (EMDR) interventions (EEIs) at the community level for marginalized groups. Trauma Recovery Networks (locally based groups of licensed EMDR clinicians volunteering to provide pro bono disaster services, also known as TRNs) are an underused and insufficiently tapped tool when it comes to addressing the sequelae of disasters in our communities. We propose expanding our concept of and work with disasters beyond the traditional, legally recognized definition of Disaster (big D) to include ongoing stressful and traumatic community events or “little d” disasters. By serving those affected by little d disasters, the field of disaster response can be broadened in powerful ways. Marginalized communities typically suffer more and receive fewer services in the wake of traditional Disasters, threatening their civil rights and increasing the allostatic load on their collective health. Attending to the ongoing little d disasters, in these communities can be an important tool for social change, and various proposals for local TRNs are discussed.

EMDR Therapy Program for Advanced Psychosocial Interventions Provided by Paraprofessionals

The aim of this preliminary study was to evaluate the effectiveness of specially trained and supervised paraprofessionals in administering the eye movement desensitization and reprocessing Integrative Group Treatment Protocol (EMDR-IGTP) to reduce work-related posttraumatic stress disorder (PTSD) symptoms. The 2 paraprofessionals in this study were specially selected and trained in the application of the EMDR-IGTP and then provided treatment in an uncontrolled clinical trial to 37 clients from 3 non-governmental organizations in Bolivia. The participants were adult staff members (protective services workers, caregivers, psychologist, lawyers, and social workers) who provided care to children and adolescents with severe interpersonal trauma. Four EMDR-IGTP sessions within a parallel 2-week period were administered for each randomly assigned group. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) was administered at pretreatment and 30 and 90 days’ posttreatment. A repeated measures analysis of variance (ANOVA) determined that PCL-5 score means differed statistically significantly between time points F(2, 72) = 574.53, p < .001, ηP2 = .94. The study presents preliminary evidence scaling up EMDR therapy in a low- and middle-income country, making it possible to reach larger numbers of people in a shorter time, thereby offering an operational advantage. The study has limitations specially related to the size of the sample, the use of only one measure, and the lack of comparison with a control group or treatment. Further studies are required to present large samples with more measures and comparison of results with another therapy or control group.

A Model of Clinical Intervention in the Maternity Ward: The Breastfeeding and Bonding EMDR Protocol

Breastfeeding is one of the main manifestations of the bond that a mother builds with her newborn baby. Literature on psychological support for mothers in the early stages of breastfeeding is limited and interventions often do not pinpoint the actual roots of the difficulties. Breastfeeding difficulties may cause emotional distress to women and this can impact significantly on bonding and the perinatal period may turn into a state of crisis. Therefore, it is essential for the clinical psychologist to intervene selectively and in a prompt, effective way, especially when working in a maternity ward. This article suggests a model of intervention: the Breastfeeding and Bonding EMDR Protocol. This protocol, created ad hoc for breastfeeding, combines the work with eye movement desensitization and reprocessing (EMDR) on recent events, the standard protocol and the installation of resources. The hospital case study presented here thoroughly illustrates the various stages of the protocol and the peculiarity and functionality of EMDR regarding breastfeeding and bonding issues in the immediate postpartum period. Prevention is the paramount subject of the model of clinical intervention on breastfeeding hereafter presented.

The EMDR Integrative Group Treatment Protocol for Patients With Cancer

Experiencing cancer is a peculiar stressor within the infrastructure of posttraumatic stress disorder (PTSD) because this debilitating disease involves ongoing stressors and is both acute and potentially chronic. The experience can include a wide range of associated adverse events, such as tumor detection, diagnosis, severity of disease, and prognosis; aggressive treatment; disfigurement and bodily dysfunction; side effects of treatment; impaired physical, social, and occupational functioning; and sometimes, recurrence and diagnosis of terminal illness. This article provides a detailed description of the clinical application of the Eye Movement Desensitization and Reprocessing (EMDR) Integrative Group Treatment Protocol (EMDR-IGTP) Adapted for Adolescents and Adults Living with Ongoing Traumatic Stress for the patients with cancer. This protocol administers the eight phases of EMDR individual treatment to a group of patients using an art therapy format (i.e., drawings) and the butterfly hug (a self-administered bilateral stimulation method to process traumatic material). A previous study (Jarero et al., 2015) showed that after 6 sessions of EMDR-IGTP, there was a significant decrease in PTSD symptoms related to the diagnosis and treatment of different types of cancer in adult women. Effects were maintained at 90-day follow-up. In this article, we discuss how this protocol can be used to effectively provide intensive EMDR treatment to large groups of patients, and we provide detailed instructions for its provision to address one of the major psychological dimensions of cancer: the ongoing traumatic stress responses experienced by patients with cancer. A clinical example illustrates the treatment process.

EMDR Group Therapy With Women Who Were Sexually Assaulted in the Congo

Every year, thousands of women are sexually assaulted in the Democratic Republic of the Congo. In 2008, the author was invited to the Democratic Republic of the Congo to assist in developing and evaluating a brief psychotherapeutic approach that could be used to effectively treat sexually assaulted women suffering from posttraumatic stress. In this field study, 37 women were assigned to receive either 2 sessions of individual therapy (n = 8) using eye movement desensitization and reprocessing (EMDR) or 2 sessions of group therapy (n = 29) using the EMDR Integrative Group Treatment Protocol (EMDR-IGTP). Results of the study showed significant improvement in scores on the Subjective Units of Disturbance (SUD) Scale. SUD scores of those receiving individual therapy showed a significantly larger decrease than scores of the group therapy participants. All women completed the Impact of Event Scale (IES) before treatment, with scores well higher than the cutoff for posttraumatic stress disorder. Women (n = 6) in the first of the 4 EMDR-IGTP groups also completed the IES measure 2 weeks after treatment completion, with a significant decrease in their scores. In addition, many of the women spontaneously reported elimination of painful body sensations after the therapy. This study suggests the value of further research and development.

EMDR Therapy Humanitarian Assistance Programs: Treating the Psychological, Physical, and Societal Effects of Adverse Experiences Worldwide

The negative effects of trauma and other adverse life experiences have been shown to interfere with individual, family, and societal functioning. Eye movement desensitization and reprocessing (EMDR) therapy is empirically supported and recommended as a frontline treatment for psychological trauma in numerous practice guidelines. It provides both effective and efficient treatment without the need for detailed descriptions of the disturbing event or homework. This allows field teams to provide culturally sensitive therapy on consecutive days for those in remote areas and in crisis situations. Humanitarian assistance organizations have conducted projects internationally to provide EMDR therapy after both natural and manmade disasters and have helped develop sustainable mental health resources worldwide. This brief introduction provides an overview of current programs, treatment rationale, and a call for future action.

Commemorating EMDR’s 25th Anniversary byHighlighting EMDR Humanitarian Projects

This editorial introduces the special issue of the Journal of EMDR Practice and Research that commemorates the 25th anniversary of eye movement desensitization and reprocessing (EMDR) therapy by highlighting EMDR humanitarian programs around the world—in North America, Europe, Africa, the Middle East, Asia, Latin America, and the Caribbean. EMDR therapy is a valuable and appropriate intervention in humanitarian crises, given its effectiveness as a brief individual treatment, consecutive-day application, and group therapy. There are many compelling clinical vignettes in this issue, including some from a refugee camp in Syria, a hurricane in South America, and earthquakes in India and Italy. The authors in this issue bring years of experience to their articles, and their commentary on the challenges, future needs, and concerns is illuminating and thought-provoking.