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

Group Therapy for Survivors of Adult Sexual Assault: A Scoping Review

Across the world, women experience significant rates of sexual assault and there is a need to strengthen support services offered to survivors. Group therapy could provide an important addition to services that support healing and growth; however, the effectiveness of group therapy interventions with survivors of adult sexual assault is not well understood and clearer insights into designing and running group therapy interventions require further exploration. This review synthesizes literature exploring group therapy for survivors of adult sexual assault to inform future interventions and research implementing group therapy. A systematic approach was used to gather literature describing and evaluating group therapy interventions with survivors of adult sexual assault. Of the initial 466 articles identified through a comprehensive search strategy including database and hand searches, 32 met the inclusion criteria by describing a group therapy intervention conducted with survivors of adult sexual assault. A thematic approach to analysis was conducted to synthesize and collate the literature. Findings explore potentially useful strategies and characteristics of group therapy with survivors of adult sexual assault and make recommendations for the design and evaluation of future interventions. Group therapy has potential as a valuable support service provided to survivors but further rigorous research and evaluations are required to better capture outcomes and understand how to design and implement effective interventions.

Eye movement desensitisation and reprocessing: part 1 – theory, procedure and use in PTSD

Eye movement desensitisation and reprocessing (EMDR) is an established psychotherapy developed in the late 1980s to treat post-traumatic stress disorder (PTSD). It involves the use of repetitive eye movements or other bilateral stimulation to aid in the reprocessing of traumatic memories. It is unique in that it does not require extended exposure to or discussion of distressing memories and may result in symptom resolution in fewer sessions than other psychotherapies. In the decades since its initial development, a wealth of high-quality evidence has suggested that EMDR is a safe and effective treatment for trauma- and stress-based conditions, resulting in its inclusion in various treatment guidelines. This article reviews the theory behind how EMDR works, how it is conducted, the evidence supporting its use in the treatment of PTSD and its approved indications and contraindications.

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.

Group eye movement desensitization and reprocessing interventions in adults and children: A systematic review of randomized and nonrandomized trials

This review systematically synthesized existing literature on group protocols of eye movement desensitization and reprocessing (EMDR) therapy for treating a range of mental health difficulties in adults and children. We conducted database searches on PsychINFO, EMBASE, MEDLINE, Web of Science, The Cochrane Library and Francine Shapiro Library up to May 2020, using PRISMA guidelines. Studies were included if they used at least one standardized outcome measure, if they present a quantitative data on the effect of group EMDR protocols on mental health difficulties and if they were published in English. Twenty-two studies with 1739 participants were included. Thirteen studies examined EMDR Integrative Group Treatment Protocol (IGTP), four studies examined EMDR Group Traumatic Episode Protocol (G-TEP), four studies EMDR Integrative Group Treatment Protocol for Ongoing Traumatic Stress and one study considered EMDR Group Protocol with Children. Of the 22 studies included, 12 were one-arm trials and 10 were two-arm trials. We assessed risk of bias using a revised Tool to Assess Risk of Bias in Randomized Trials (ROB 2) and Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I). Overall, the results suggested that Group EMDR protocols might be an effective tool in improving a wide range of mental health-related outcomes including posttraumatic stress disorder (PTSD), depression and anxiety. However, the included studies are limited to methodological challenges. The limitations and future directions are discussed.

Interventions for adults with a history of complex traumatic events: the INCiTE mixed-methods systematic review

BACKGROUND

People with a history of complex traumatic events typically experience trauma and stressor disorders and additional mental comorbidities. It is not known if existing evidence-based treatments are effective and acceptable for this group of people.

OBJECTIVE

To identify candidate psychological and non-pharmacological treatments for future research.

DESIGN

Mixed-methods systematic review.

PARTICIPANTS

Adults aged ≥ 18 years with a history of complex traumatic events.

INTERVENTIONS

Psychological interventions versus control or active control; pharmacological interventions versus placebo.

MAIN OUTCOME MEASURES

Post-traumatic stress disorder symptoms, common mental health problems and attrition.

DATA SOURCES

Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1937 onwards); Cochrane Central Register of Controlled Trials (CENTRAL) (from inception); EMBASE (1974 to 2017 week 16); International Pharmaceutical Abstracts (1970 onwards); MEDLINE and MEDLINE Epub Ahead of Print and In-Process & Other Non-Indexed Citations (1946 to present); Published International Literature on Traumatic Stress (PILOTS) (1987 onwards); PsycINFO (1806 to April week 2 2017); and Science Citation Index (1900 onwards). Searches were conducted between April and August 2017.

REVIEW METHODS

Eligible studies were singly screened and disagreements were resolved at consensus meetings. The risk of bias was assessed using the Cochrane risk-of-bias tool and a bespoke version of a quality appraisal checklist used by the National Institute for Health and Care Excellence. A meta-analysis was conducted across all populations for each intervention category and for population subgroups. Moderators of effectiveness were assessed using metaregression and a component network meta-analysis. A qualitative synthesis was undertaken to summarise the acceptability of interventions with the relevance of findings assessed by the GRADE-CERQual checklist.

RESULTS

One hundred and four randomised controlled trials and nine non-randomised controlled trials were included. For the qualitative acceptability review, 4324 records were identified and nine studies were included. The population subgroups were veterans, childhood sexual abuse victims, war affected, refugees and domestic violence victims. Psychological interventions were superior to the control post treatment for reducing post-traumatic stress disorder symptoms (standardised mean difference -0.90, 95% confidence interval -1.14 to -0.66; number of trials = 39) and also for associated symptoms of depression, but not anxiety. Trauma-focused therapies were the most effective interventions across all populations for post-traumatic stress disorder and depression. Multicomponent and trauma-focused interventions were effective for negative self-concept. Phase-based approaches were also superior to the control for post-traumatic stress disorder and depression and showed the most benefit for managing emotional dysregulation and interpersonal problems. Only antipsychotic medication was effective for reducing post-traumatic stress disorder symptoms; medications were not effective for mental comorbidities. Eight qualitative studies were included. Interventions were more acceptable if service users could identify benefits and if they were delivered in ways that accommodated their personal and social needs.

LIMITATIONS

Assessments about long-term effectiveness of interventions were not possible. Studies that included outcomes related to comorbid psychiatric states, such as borderline personality disorder, and populations from prisons and humanitarian crises were under-represented.

CONCLUSIONS

Evidence-based psychological interventions are effective and acceptable post treatment for reducing post-traumatic stress disorder symptoms and depression and anxiety in people with complex trauma. These interventions were less effective in veterans and had less of an impact on symptoms associated with complex post-traumatic stress disorder.

FUTURE WORK

Definitive trials of phase-based versus non-phase-based interventions with long-term follow-up for post-traumatic stress disorder and associated mental comorbidities.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42017055523.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 43. See the NIHR Journals Library website for further project information.

Male and LGBT survivors of sexual violence in conflict situations: a realist review of health interventions in low-and middle-income countries

Conflict-related sexual violence (CRSV) against women and girls has been the subject of increasing research and scholarship. Less is known about the health of men, boys and lesbian, gay, bisexual, transgender (LGBT) and other gender non-binary persons who survive CRSV. This paper is the first systematic realist review on medical, mental health and psychosocial support (MHPSS) interventions that focusses on male and LGBT survivors of CRSV. The review explores the gender differences in context, mechanisms and outcomes that underpin interventions addressing the health and psychosocial wellbeing of male and LGBT survivors. The aim is to contribute to the design and delivery of gender-sensitive and, when needed, gender-specific approaches for interventions that respond to specific needs of different groups of all survivors. We conducted a systematic search of academic and grey literature to identify medical and MHPSS interventions that included men, boys and LGBT survivors. We identified interventions specifically targeting women and girls that we used as comparators. We then purposively sampled studies from the fields of gender and health, and sexual abuse against men and LGBT people for theory building and testing. We identified 26 evaluations of interventions for survivors of CRSV. Nine studies included male survivors, twelve studies focussed exclusively on female survivors and one study targeted children and adolescents. No intervention evaluation focussed on LGBT survivors of CRSV. The interventions that included male survivors did not describe specific components for this population. Results of intervention evaluations that included male survivors were not disaggregated by gender, and some studies did not report the gender composition. Although some mental health and psychosocial consequences of sexual violence against men and boys may be similar among male and female survivors, the way each process trauma, display symptoms, seek help, adhere to treatment and improve their mental health differ by gender. Initiatives targeting male and LGBT survivors of CRSV need to be designed to actively address specific gender differences in access, adherence and response to MHPSS interventions. Models of care that are gender-sensitive and integrated to local resources are promising avenues to promote the health of male and LGBT survivors of CRSV.

An Eye Movement Desensitization and Reprocessing (EMDR) Group Intervention for Syrian Refugees With Post-traumatic Stress Symptoms: Results of a Randomized Controlled Trial

The number of refugees has increased significantly over the past few years. PTSD and depression are among the most common mental health problems among refugees. Eye Movement Desensitization and Reprocessing (EMDR), an effective treatment for PTSD, is usually administered individually. The availability of mental health resources would be greatly enhanced when EMDR can be delivered to groups. The EMDR G-TEP is a group protocol based on Early EMDR intervention protocols. There is clinical evidence and one field study published on the effect of EMDR G-TEP and there is only one RCT published on the treatment of PTSD and depression in a refugee camp. The aim of our study was to investigate the efficacy of EMDR G-TEP in treating post-trauma symptoms and depression and preventing the development of chronic PTSD among refugees living in a refugee camp. 47 adult participants with PTSD symptoms were randomly allocated to experimental (n = 18) and control (n = 29) groups. We measured Impact of Event Scale (IES-R), Beck Depression Inventory-II (BDI-II) and International Neuropsychiatric Interview (MINI) at pre-, post- and 4-week follow-up. Analysis of the results showed that the EMDR G-TEP group had significantly lower PTSD and depression symptoms after intervention. The percentage of PTSD diagnosis decreased from 100 to 38.9% in the EMDR G-TEP group and was unchanged in the control group. Following the EMDR G-TEP intervention 61.1% of the experimental group no longer had a PTSD diagnosis; this decrease was maintained at 4 weeks follow-up. In the control group the percentage of people who no longer met the diagnostic criteria for PTSD was 10.3% post-test and 6.9% at 4 weeks follow-up. A significant decrease in depression symptoms from pre-test levels was found in EMDR group but not in the control group follow up-test. This study indicated that EMDR G-TEP effectively reduced PTSD symptoms among refugees living in a camp, after two treatment sessions conducted over a period of 3 days. Further studies need to be performed using a larger number of participants, followed for a longer period of time and given more treatment sessions to strengthen our findings.

Effectiveness of secondary and tertiary prevention for violence against women in low and low-middle income countries: a systematic review

BACKGROUND

Violence against women (VAW) is a major problem worldwide, with one in three women experiencing violence in their lifetime. While interventions to prevent violence (primary prevention) are extremely important, they can take many years. This review focuses on secondary and tertiary prevention interventions that address the needs of survivors of violence and aim to prevent recurrence. This review also focuses on studies taking place in low and low-middle income countries, where rates of VAW are highest.

METHODS

Searches of peer-reviewed and grey literature took place from March-June 2016 through databases (Embase, CINAHL, WHO Global Index Medicus, Medline, PsychINFO, Web of Science, Cochrane Library, Applied Social Sciences Index and Abstracts and Sociological Abstracts) and by consulting experts in the field. Only primary research was eligible for inclusion and studies had to focus on secondary or tertiary prevention for survivors of VAW in low or low-middle income countries. All study designs were eligible, as long as the study examined client-related outcome measures (e.g., incidence of violence, health outcomes or client satisfaction). Data were extracted and quality of the studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies and a qualitative quality assessment tool developed by Mays and Pope. Due to the low number of results and heterogeneity of the study populations and outcomes, a narrative synthesis was conducted and evidence was summarized.

RESULTS

One thousand two hundred fifteen studies were identified through the search strategy and 22 of these met the eligibility criteria. Overall, the evidence for interventions is weak and study limitations prevent definitive conclusions on what works. There is some evidence that interventions targeting alcohol use, both among perpetrators and survivors, may be effective at reducing VAW through secondary prevention, and that psychotherapy might be effective for survivors of non-partner sexual violence through tertiary prevention. Finally, some evidence exists for crisis centres increasing survivors' access to services (through both secondary and tertiary prevention), however, assessment of their impact on future VAW are needed.

CONCLUSIONS

Though some interventions for survivors of VAW have shown evidence of effectiveness, further research is needed, especially high-quality studies with quantitative outcome data.

Treating Posttraumatic Stress Disorder in Diverse Settings: Recent Advances and Challenges for the Future

Racial and ethnic minorities are at high risk for developing posttraumatic stress disorder (PTSD) after experiencing a traumatic event and are less likely to receive evidence-based treatment for their symptoms. There is a growing body of literature showing that culturally appropriate interventions result in greater uptake, symptom reduction, and sustained treatment gains. This article review explores new findings in the cultural understanding of PTSD among racial and ethnic minorities. We first review recent advances in the understanding of PTSD symptomotology. Next, we provide overview of trials demonstrating efficacy and effectiveness of cognitive processing therapy (CPT), prolonged exposure (PE), and trauma-focused cognitive-behavioral therapy (TF-CBT) in diverse communities. Then, we discuss specific implementation strategies common across intervention trials used to increase feasibility, acceptability, adoption, and sustainability. Last, we discuss areas for future research and dissemination efforts.