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Fellman V, Heppell PJ, Rao S. Afraid and Awake: The Interaction Between Trauma and Sleep in Children and Adolescents. Psychiatr Clin North Am 2024; 47:229-253. [PMID: 38302209 DOI: 10.1016/j.psc.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Traumatic experiences and sleep disturbances are both common in children and adolescents. Because of the reciprocal relationship between sleep complaints and trauma, a mental health evaluation should include not only an assessment of posttraumatic stress disorder and other trauma symptoms but also a specific evaluation of sleep-related complaints. Similarly, if a history of both trauma and sleep complaints is identified, an effective trauma-informed intervention, whether psychological, psychopharmacologic, or a combination of the two, should directly address sleep issues.
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Affiliation(s)
- Veronica Fellman
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, Child Study Center, One Park Avenue, 7th Floor, New York City, NY 10016, USA.
| | - Patrick J Heppell
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, Child Study Center, One Park Avenue, 7th Floor, New York City, NY 10016, USA
| | - Suchet Rao
- Psychiatry and Behavioral Health, NYC Administration for Children's Services, 150 William Street, 11th Floor, New York City, NY 10038, USA
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2
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Meentken MG, van der Mheen M, van Beynum IM, Aendekerk EWC, Legerstee JS, van der Ende J, Del Canho R, Lindauer RJL, Hillegers MHJ, Helbing WA, Moll HA, Utens EMWJ. Long-term effectiveness of eye movement desensitization and reprocessing in children and adolescents with medically related subthreshold post-traumatic stress disorder: a randomized controlled trial. Eur J Cardiovasc Nurs 2021; 20:348-357. [PMID: 33709117 DOI: 10.1093/eurjcn/zvaa006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/09/2020] [Accepted: 10/03/2020] [Indexed: 11/12/2022]
Abstract
AIMS Medical procedures and hospitalizations can be experienced as traumatic and can lead to post-traumatic stress reactions. Eye movement desensitization and reprocessing (EMDR) shows promising results but very few long-term studies have been published. Therefore, our aim was to test the long-term (8 months post-treatment) effectiveness of EMDR in children and adolescents with medically related subthreshold post-traumatic stress disorder (PTSD). METHODS AND RESULTS Seventy-four children (including 39 with congenital or acquired heart disease) aged 4-15 (M = 9.6 years) with subthreshold PTSD after previous hospitalization were included into a parallel group randomized controlled trial. Participants were randomized to EMDR (n = 37) or care-as-usual (CAU) (n = 37; medical care only). The primary outcome was PTSD symptoms of the child. Secondary outcomes were symptoms of depression and blood-injection-injury (BII) phobia, sleep problems, and health-related quality of life (HrQoL) of the child. Assessments of all outcomes were planned at baseline and 8 weeks and 8 months after the start of EMDR/CAU. We hypothesized that the EMDR group would show significantly more improvements on all outcomes over time. Both groups showed improvements over time on child's symptoms of PTSD (only parent report), depression, BII phobia, sleep problems, and most HrQoL subscales. GEE analyses showed no significant differences between the EMDR group (nT2 = 33, nT3 = 30) and the CAU group (nT2 = 35, nT3 = 32) on the primary outcome. One superior effect of EMDR over time was found for reducing parent-reported BII phobia of the child. CONCLUSION EMDR did not perform better than CAU in reducing subthreshold PTSD up to 8 months post-treatment in previously hospitalized children. Possible explanations and clinical implications are discussed.
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Affiliation(s)
- Maya G Meentken
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Malindi van der Mheen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ingrid M van Beynum
- Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Elisabeth W C Aendekerk
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jeroen S Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jan van der Ende
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Riwka Del Canho
- Department of Pediatrics, Maasstad Hospital, Rotterdam, The Netherlands
| | - Ramón J L Lindauer
- Academic Centre for Child and Adolescent Psychiatry the Bascule, Amsterdam, the Netherlands.,Department of Child and Adolescent Psychiatry, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Willem A Helbing
- Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Division of Cardiology, Department of Pediatrics, Radboud UMC-Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Henriette A Moll
- Division of Pediatrics, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Academic Centre for Child and Adolescent Psychiatry the Bascule, Amsterdam, the Netherlands.,Department of Child and Adolescent Psychiatry, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
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3
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Sleep parameters improvement in PTSD soldiers after symptoms remission. Sci Rep 2021; 11:8873. [PMID: 33893376 PMCID: PMC8065125 DOI: 10.1038/s41598-021-88337-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 04/06/2021] [Indexed: 11/08/2022] Open
Abstract
Eye movement desensitization and reprocessing (EMDR) is a psychotherapy for the treatment of posttraumatic stress disorder (PTSD). It is still unclear whether symptoms remission through EMDR therapy is associated with a beneficial effect on one of the PTSD symptoms, sleep disturbance. Our objective was therefore to study sleep parameters before and after symptom remission in soldiers with PTSD. The control group consisted of 20 healthy active duty military men who slept in a sleep lab with standard polysomnography (PSG) on two sessions separated by one month. The patient group consisted of 17 active duty military with PTSD who underwent EMDR therapy. PSG-recorded sleep was assessed 1 week before the EMDR therapy began and 1 week after PTSD remission. We found that the increased REMs density after remission was positively correlated with a greater decrease of symptoms. Also, the number of EMDR sessions required to reach remission was correlated with intra-sleep awakenings before treatment. These results confirm the improvement of some sleep parameters in PTSD after symptoms remission in a soldier's population and provide a possible predictor of treatment success. Further experiments will be required to establish whether this effect is specific to the EMDR therapy.
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Fellman V, Heppell PJ, Rao S. Afraid and Awake: The Interaction Between Trauma and Sleep in Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2021; 30:225-249. [PMID: 33223064 DOI: 10.1016/j.chc.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Traumatic experiences and sleep disturbances are both common in children and adolescents. Because of the reciprocal relationship between sleep complaints and trauma, a mental health evaluation should include not only an assessment of posttraumatic stress disorder and other trauma symptoms but also a specific evaluation of sleep-related complaints. Similarly, if a history of both trauma and sleep complaints is identified, an effective trauma-informed intervention, whether psychological, psychopharmacologic, or a combination of the two, should directly address sleep issues.
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Affiliation(s)
- Veronica Fellman
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, Child Study Center, One Park Avenue, 7th Floor, New York City, NY 10016, USA.
| | - Patrick J Heppell
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, Child Study Center, One Park Avenue, 7th Floor, New York City, NY 10016, USA
| | - Suchet Rao
- Psychiatry and Behavioral Health, NYC Administration for Children's Services, 150 William Street, 11th Floor, New York City, NY 10038, USA
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Boeke EA, Holmes AJ, Phelps EA. Toward Robust Anxiety Biomarkers: A Machine Learning Approach in a Large-Scale Sample. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:799-807. [PMID: 31447329 PMCID: PMC6925354 DOI: 10.1016/j.bpsc.2019.05.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The field of psychiatry has long sought biomarkers that can objectively diagnose patients, predict treatment response, or identify individuals at risk of illness onset. However, reliable psychiatric biomarkers have yet to emerge. The recent application of machine learning techniques to develop neuroimaging-based biomarkers has yielded promising preliminary results. However, much of the work in this domain has not met best practice standards from the field of machine learning. This is especially true for studies of anxiety, creating uncertainty about the potential for anxiety biomarker development. METHODS We applied machine learning tools to predict trait anxiety from neuroimaging measurements in humans. Using publicly available data from the Brain Genomics Superstruct Project, we compared a suite of neuroimaging-based machine learning models predicting anxiety within a discovery sample (n = 531, 307 women) via k-fold cross-validation, and we tested the final model (a stacked model incorporating region-to-region functional connectivity, amygdala seed-to-voxel connectivity, and volumetric and cortical thickness data) in a held-out, unseen test sample (n = 348, 209 women). RESULTS Though the best model was able to predict anxiety within the discovery sample (cross-validated R2 of .06, permutation test p < .001), the generalization test within the holdout sample failed (R2 of -.04, permutation test p > .05). CONCLUSIONS In this study, we did not find evidence of a generalizable anxiety biomarker. However, we encourage other researchers to investigate this topic, utilizing large samples and proper methodology, to clarify the potential of neuroimaging-based anxiety biomarkers.
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Affiliation(s)
- Emily A Boeke
- Department of Psychology, New York University, New York, New York
| | - Avram J Holmes
- Department of Psychology, Yale University, New Haven, Connecticut; Department of Psychiatry, Yale University, New Haven, Connecticut
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Jahanfar A, Fereidouni Z, Behnammoghadam M, Dehghan A, Bashti S. Efficacy of Eye Movement Desensitization and Reprocessing on the Quality of Life in Patients with Major Depressive Disorder: A Randomized Clinical Trial. Psychol Res Behav Manag 2020; 13:11-17. [PMID: 32021505 PMCID: PMC6955614 DOI: 10.2147/prbm.s232589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/24/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction The present study was conducted with the aim of investigating the efficacy of eye movement desensitization and reprocessing (EMDR) on the quality of life (QOL) in patients with major depressive disorder (MDD). Methods This is a randomized clinical trial study that investigated the efficacy of EMDR on the QOL in patients with MDD. In this study, all patients suffered from psychological trauma were currently in a major depressive episode and had a history of depression. 70 patients with MDD were selected through convenience sampling. Patients were then assigned to two groups of intervention and control (35 patients in each group). The assignment was performed randomly. For the intervention group, EMDR were performed in eight 90 mins sessions over 3 weeks. For the control group, no intervention was considered. Data on the QOL were collected using the WHO Quality of Life-BREF instrument before and after the treatment, and analysed using descriptive tests, paired t-test, independent t-test, and chi-square with SPSS v19. Results This study showed that the QOL in all its domains (physical health, psychological health, social relationships and environments) was significantly improved in patients with MDD in the intervention group after 8 sessions of EMDR. The post-treatment effect for the EMDR condition was 2.11, with a confidence interval of 1.3 to 2.7. Another finding of this study was that there was a statistically significant difference in the QOL scores in patients in the control group before and after the treatment; however, the mean difference in the intervention group was more than the control. Conclusion The results of this study showed that EMDR were effective on the QOL in patients with major depressive disorder, and improved individuals' QOL and all its domains. Treatment team members may use this technique as an effective and supportive one to improve the QOL in patients.
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Affiliation(s)
- Abdolhadi Jahanfar
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Zhila Fereidouni
- Department of Medical Surgical Nursing, Nursing School, Fasa University of Medical Sciences, Fasa, Fars, Iran
| | - Mohammad Behnammoghadam
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Azizallah Dehghan
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Somayeh Bashti
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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Meentken MG, van der Mheen M, van Beynum IM, Aendekerk EWC, Legerstee JS, van der Ende J, Del Canho R, Lindauer RJL, Hillegers MHJ, Moll HA, Helbing WA, Utens EMWJ. EMDR for children with medically related subthreshold PTSD: short-term effects on PTSD, blood-injection-injury phobia, depression and sleep. Eur J Psychotraumatol 2020; 11:1705598. [PMID: 32002140 PMCID: PMC6968501 DOI: 10.1080/20008198.2019.1705598] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Paediatric illness, injury and medical procedures are potentially traumatic experiences with a range of possible negative psychosocial consequences. To prevent psychosocial impairment and improve medical adherence, evidence-based psychotherapy should be offered if indicated. Eye movement desensitization and reprocessing (EMDR) has been found to reduce symptoms of posttraumatic stress disorder (PTSD) in adults. The evidence for the use with children is promising. Furthermore, recent studies indicate its effectiveness for the treatment of other psychological symptomatology. However, the effectiveness of EMDR in children with subthreshold PTSD after medically related trauma has not yet been investigated. Objective: Investigating the short-term effectiveness of EMDR on posttraumatic stress, anxiety, depression and sleep problems in children with subthreshold PTSD after hospitalization through a randomized controlled trial (RCT). Method: Following baseline screening of 420 children from various Dutch hospitals, 74 children (4-15 years old) with medically related subthreshold PTSD were randomized to EMDR (n = 37) or care-as-usual (CAU; n = 37). Follow-up assessment took place after M = 9.7 weeks. Generalized Estimating Equation (GEE) analyses were performed to examine the effectiveness of EMDR compared to CAU. Results: Children in both groups improved significantly over time on all outcomes. However, the EMDR group improved significantly more as to child-reported symptoms of blood-injection-injury (BII) phobia and depression, and child-, and parent-reported sleep problems of the child. There was no superior effect of EMDR compared to CAU on subthreshold PTSD symptom reduction. Conclusions: EMDR did not perform better than CAU in reducing PTSD symptoms in a paediatric sample of children with subthreshold PTSD after hospitalization. However, the study results indicate that EMDR might be superior in reducing symptoms of blood-injection-injury phobia, depression and sleep problems.
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Affiliation(s)
- Maya G Meentken
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Malindi van der Mheen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ingrid M van Beynum
- Department of Pediatrics, division of Cardiology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Elisabeth W C Aendekerk
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jeroen S Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jan van der Ende
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Riwka Del Canho
- Department of Pediatrics, Maasstad hospital, Rotterdam, The Netherlands
| | - Ramón J L Lindauer
- De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands.,Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Henriette A Moll
- Department of Pediatrics, division of Pediatrics, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Wim A Helbing
- Department of Pediatrics, division of Cardiology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Pediatrics, division of Cardiology, Radboud UMC - Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.,De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands.,Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, The Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
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Ntafouli M, Galbiati A, Gazea M, Bassetti CLA, Bargiotas P. Update on nonpharmacological interventions in parasomnias. Postgrad Med 2019; 132:72-79. [PMID: 31760836 DOI: 10.1080/00325481.2019.1697119] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Parasomnias are abnormal behaviors that occur during sleep and can be associated, in particular during adulthood, with impaired sleep quality, daytime dysfunction, and occasionally with violent and harmful nocturnal behaviors. In these cases, therapies are often considered. Longterm pharmacological treatments are not always well tolerated and often have limited efficacy. Therefore, behavioral approaches remain an important treatment option for several types of parasomnias. However, the evidence-based approaches are limited. In the current review, we highlight results from various nonpharmacological techniques on different types of parasomnias and provide a glimpse into the future of nonpharmacological treatments in this field.
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Affiliation(s)
- Maria Ntafouli
- Sleep Wake Epilepsy Center and Department of Neurology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Andrea Galbiati
- Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy.,Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mary Gazea
- Centre for experimental Neurology, Dept. of Neurology, Inselspital University Hospital, University of Bern, Bern, Switzerland.,Department of Biomedical Research (DBMR), Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Claudio L A Bassetti
- Sleep Wake Epilepsy Center and Department of Neurology, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Panagiotis Bargiotas
- Sleep Wake Epilepsy Center and Department of Neurology, Inselspital University Hospital, University of Bern, Bern, Switzerland.,Department of Neurology, Medical School, University of Cyprus, Nicosia, Cyprus
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Sleep in posttraumatic stress disorder: A systematic review and meta-analysis of polysomnographic findings. Sleep Med Rev 2019; 48:101210. [PMID: 31518950 DOI: 10.1016/j.smrv.2019.08.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/22/2019] [Accepted: 08/16/2019] [Indexed: 02/05/2023]
Abstract
Polysomnographic studies have been performed to examine sleep abnormalities in posttraumatic stress disorder (PTSD), but clear associations between PTSD and sleep disturbances have not been established. A systematic review of the evidence examining the polysomnographic changes in PTSD patients compared with controls was conducted using MEDLINE, EMBASE, All EBM databases, PsycINFO, and CINAHL databases. Meta-analysis was undertaken where possible. The searches identified 34 studies, 31 of which were appropriate for meta-analysis. Pooled results indicated decreased total sleep time, slow wave sleep and sleep efficiency, and increased wake time after sleep onset in PTSD patients compared with healthy controls. PTSD severity was associated with decreased sleep efficiency and slow wave sleep percentage. Rapid eye movement (REM) sleep percentage was significantly decreased in PTSD patients compared with controls in studies including participants with mean age below 30 y, but not in studies with other mean age groups (30-40 y and >40 y). Our study shows that polysomnographic abnormalities are present in PTSD. Sex, age, PTSD severity, type of controls, medication status, adaptation night, polysomnographic scoring rules and study location are several of the demographic, clinical and methodological factors that contribute to heterogeneity between studies.
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10
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Rensen N, Steur LMH, Schepers SA, Merks JHM, Moll AC, Grootenhuis MA, Kaspers GJL, van Litsenburg RRL. Concurrence of sleep problems and distress: prevalence and determinants in parents of children with cancer. Eur J Psychotraumatol 2019; 10:1639312. [PMID: 31448065 PMCID: PMC6691919 DOI: 10.1080/20008198.2019.1639312] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/23/2019] [Accepted: 06/18/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Parents of children with cancer are at risk for sleep problems. If these problems persist, an important perpetuating factor might be ongoing parental distress. Objective: The aim of this study is to assess the prevalence of sleep problems and the concurrence with distress in parents of children treated for cancer, and to identify predictors of this symptom clustering. Method: Parents completed the Medical Outcomes Study (MOS) Sleep Scale and Distress Thermometer for Parents (DT-P). Clinically relevant sleep problems were defined as a score >1SD above the norm and clinical distress as a thermometer score above the established cut-off of 4. Four parent categories were constructed: neither sleep problems nor distress; no distress but sleep problems; no sleep problems but distress; both sleep problems and distress. Predictive determinants (sociodemographic, medical, psychosocial) for each category were assessed with multilevel multinomial logistic regression. Results: Parents (202 mothers and 150 fathers) of 231 children with different cancers participated. Mean time since diagnosis was 3.3 ± 1.4 years (90% off-treatment). The prevalence of sleep problems was 37%. Fifty percent of parents reported neither sleep problems nor distress, 9% had only sleep problems, 13% only distress, and 28% reported both. Compared to parents without sleep problems or distress, parents who reported both were more likely to report parenting problems (OR 4.4, [2.2-9.1]), chronic illness (OR 2.8, [1.2-6.5]), insufficient social support (OR 3.7, [1.5-9.1]), pre-existent sleep problems (OR 6.2, [2.0-18.6]) and be female (OR 1.8, [1.1-4.2]). Conclusions: Sleep problems are common in parents of children treated for cancer, and occur mostly in the presence of clinical distress. Future research must show which interventions are most effective in this group: mainly targeted at sleep improvement or with prominent roles for stress management or trauma processing.
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Affiliation(s)
- Niki Rensen
- Pediatric Oncology-Hematology, Cancer Center Amsterdam, Amsterdam UMC, Emma Children’s Hospital, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Lindsay M. H. Steur
- Pediatric Oncology-Hematology, Cancer Center Amsterdam, Amsterdam UMC, Emma Children’s Hospital, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Sasja A. Schepers
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Psychosocial Department, Amsterdam UMC, Emma Children’s Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Johannes H. M. Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Pediatric Oncology-Hematology, Amsterdam UMC, Emma Children’s Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Annette C. Moll
- Ophthalmology, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands
| | - Martha A. Grootenhuis
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Psychosocial Department, Amsterdam UMC, Emma Children’s Hospital, University of Amsterdam, Amsterdam, Netherlands
| | - Gertjan J. L. Kaspers
- Pediatric Oncology-Hematology, Cancer Center Amsterdam, Amsterdam UMC, Emma Children’s Hospital, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Raphaële R. L. van Litsenburg
- Pediatric Oncology-Hematology, Cancer Center Amsterdam, Amsterdam UMC, Emma Children’s Hospital, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
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11
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Landin-Romero R, Moreno-Alcazar A, Pagani M, Amann BL. How Does Eye Movement Desensitization and Reprocessing Therapy Work? A Systematic Review on Suggested Mechanisms of Action. Front Psychol 2018; 9:1395. [PMID: 30166975 PMCID: PMC6106867 DOI: 10.3389/fpsyg.2018.01395] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/18/2018] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Ramon Landin-Romero
- Brain and Mind Centre and School of Psychology, The University of Sydney, Sydney, NSW, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
| | - Ana Moreno-Alcazar
- Institut de Neuropsiquiatria i Addiccions, Centre Fòrum Research Unit, Parc de Salut Mar, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Centro de Investigación Biomedica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Marco Pagani
- Institute of Cognitive Sciences and Technologies, CNR, Rome, Italy
| | - Benedikt L Amann
- Institut de Neuropsiquiatria i Addiccions, Centre Fòrum Research Unit, Parc de Salut Mar, Barcelona, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Centro de Investigación Biomedica en Red de Salud Mental (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain
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12
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Calancie OG, Khalid-Khan S, Booij L, Munoz DP. Eye movement desensitization and reprocessing as a treatment for PTSD: current neurobiological theories and a new hypothesis. Ann N Y Acad Sci 2018; 1426:127-145. [PMID: 29931688 DOI: 10.1111/nyas.13882] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/16/2018] [Accepted: 05/24/2018] [Indexed: 12/25/2022]
Abstract
Eye movement desensitization and reprocessing (EMDR), a form of psychotherapy for individuals with post-traumatic stress disorder (PTSD), has long been a controversial topic, hampered in part by a lack of understanding of the neural mechanisms that contribute to its remedial effect. Here, we review current theories describing EMDR's potential neurobiological mechanisms of action involving working memory, interhemispheric communication, de-arousal, and memory reconsolidation. We then discuss recent studies describing the temporal and spatial aspects of smooth pursuit and predictive saccades, which resemble those made during EMDR, and their neural correlates within the default mode network (DMN) and cerebellum. We hypothesize that if the production of bilateral predictive eye movements is supportive of DMN and cerebellum activation, then therapies that shift the brain towards this state correspondingly would benefit the processes regulated by these structures (i.e., memory retrieval, relaxation, and associative learning), all of which are essential components for PTSD recovery. We propose that the timing of sensory stimulation may be relevant to treatment effect and could be adapted across different patients depending on their baseline saccade metrics. Empirical data in support of this model are reviewed and experimental predictions are discussed.
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Affiliation(s)
- Olivia G Calancie
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- Division of Child and Youth Mental Health, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Sarosh Khalid-Khan
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- Division of Child and Youth Mental Health, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Linda Booij
- Department of Psychology, Concordia University, Montréal, Quebec, Canada
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Douglas P Munoz
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
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13
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Lipinska G, Thomas KGF. Better Sleep in a Strange Bed? Sleep Quality in South African Women with Posttraumatic Stress Disorder. Front Psychol 2017; 8:1555. [PMID: 28955274 PMCID: PMC5601006 DOI: 10.3389/fpsyg.2017.01555] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/25/2017] [Indexed: 11/13/2022] Open
Abstract
Although individuals diagnosed with posttraumatic stress disorder (PTSD) regularly report subjective sleep disruption, many studies using objective measures (e.g., polysomnography) report no PTSD-related sleep disruption. To account for these inconsistencies, some authors hypothesize that PTSD-diagnosed individuals have sleep-state misperception; that is, they self-report experiencing poor sleep quality, but objectively sleep relatively normally. We tested this sleep-state misperception hypothesis, collecting data on subjectively-reported sleep quality (in the home, and in the laboratory) and on objectively-measured, laboratory-based, sleep quality in PTSD-diagnosed participants from low socioeconomic status South African communities. Women with PTSD (n = 21), with trauma exposure but no PTSD (TE; n = 19), and healthy controls (HC; n = 20) completed questionnaires on their average sleep quality in the past 30 days, and on their sleep quality after a night (8 h) of polysomnographic-monitored sleep in the laboratory. PTSD-diagnosed individuals reported poorer everyday subjective sleep quality than TE and HC individuals. In the laboratory, however, there were no between-group differences in subjective sleep quality, and few between-group differences in objective sleep quality (PTSD-diagnosed individuals only had decreased sleep depth). Furthermore, whereas measures of laboratory-based objective and subjective sleep quality correlated significantly, especially in PTSD-diagnosed individuals, there were few significant associations between objective sleep measures and everyday subjective sleep quality. Taken together, these findings suggest that PTSD-diagnosed individuals likely experienced better sleep quality in the laboratory than at home. Descriptive observations corroborated this interpretation, with almost half the sample rating their laboratory sleep (which they described as “safe” and “quiet”) as better than their home sleep (which was experienced in an atmosphere marked by high levels of violence and nighttime noise). These findings disconfirm the sleep-state misperception hypothesis as related to PTSD, and suggest that the laboratory environment may influence sleep quality positively in these individuals. Many investigations of sleep in PTSD do not consider the influence of the laboratory environment. Our findings suggest that future studies in this field should consider that sleep-state misperception may be an artifact of the laboratory setting, especially when samples are drawn from communities where violence and crime are an everyday reality.
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Affiliation(s)
- Gosia Lipinska
- UCT Sleep Sciences and Applied Cognitive Science and Experimental Neuroscience Team, Department of Psychology, University of Cape TownCape Town, South Africa
| | - Kevin G F Thomas
- UCT Sleep Sciences and Applied Cognitive Science and Experimental Neuroscience Team, Department of Psychology, University of Cape TownCape Town, South Africa
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14
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Cox RC, Tuck BM, Olatunji BO. Sleep Disturbance in Posttraumatic Stress Disorder: Epiphenomenon or Causal Factor? Curr Psychiatry Rep 2017; 19:22. [PMID: 28321643 DOI: 10.1007/s11920-017-0773-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW The goal of this review is to integrate recent findings on sleep disturbance and PTSD, examine sleep disturbance as a causal factor in the development of PTSD, and identify future directions for research, treatment, and prevention. RECENT FINDINGS Recent research highlights a relationship between both objective and subjective sleep disturbance and PTSD across diverse samples. Sleep disturbance also predicts PTSD over time. Finally, treatments targeting sleep disturbance lead to decreased PTSD symptoms, while standard PTSD treatments conclude with residual sleep disturbance. Sleep disturbance may be more than a mere epiphenomenon of PTSD. Future research examining the causal role of sleep disturbance in the development of PTSD, as well as the utility of targeting sleep disturbance in prevention and treatment, is necessary to fully understand the likely bidirectional relationship between sleep disturbance and PTSD.
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Affiliation(s)
- Rebecca C Cox
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA
| | - Breanna M Tuck
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA
| | - Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA.
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15
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Kelly MR, Killgore WDS, Haynes PL. Understanding Recent Insights in Sleep and Posttraumatic Stress Disorder from a Research Domain Criteria (RDoC) Framework. CURRENT SLEEP MEDICINE REPORTS 2016. [DOI: 10.1007/s40675-016-0056-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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16
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Baglioni C, Nanovska S, Regen W, Spiegelhalder K, Feige B, Nissen C, Reynolds CF, Riemann D. Sleep and mental disorders: A meta-analysis of polysomnographic research. Psychol Bull 2016; 142:969-990. [PMID: 27416139 PMCID: PMC5110386 DOI: 10.1037/bul0000053] [Citation(s) in RCA: 535] [Impact Index Per Article: 66.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Investigating sleep in mental disorders has the potential to reveal both disorder-specific and transdiagnostic psychophysiological mechanisms. This meta-analysis aimed at determining the polysomnographic (PSG) characteristics of several mental disorders. Relevant studies were searched through standard strategies. Controlled PSG studies evaluating sleep in affective, anxiety, eating, pervasive developmental, borderline and antisocial personality disorders, attention-deficit-hyperactivity disorder (ADHD), and schizophrenia were included. PSG variables of sleep continuity, depth, and architecture, as well as rapid-eye movement (REM) sleep were considered. Calculations were performed with the "Comprehensive Meta-Analysis" and "R" software. Using random effects modeling, for each disorder and each variable, a separate meta-analysis was conducted if at least 3 studies were available for calculation of effect sizes as standardized means (Hedges' g). Sources of variability, that is, sex, age, and mental disorders comorbidity, were evaluated in subgroup analyses. Sleep alterations were evidenced in all disorders, with the exception of ADHD and seasonal affective disorders. Sleep continuity problems were observed in most mental disorders. Sleep depth and REM pressure alterations were associated with affective, anxiety, autism and schizophrenia disorders. Comorbidity was associated with enhanced REM sleep pressure and more inhibition of sleep depth. No sleep parameter was exclusively altered in 1 condition; however, no 2 conditions shared the same PSG profile. Sleep continuity disturbances imply a transdiagnostic imbalance in the arousal system likely representing a basic dimension of mental health. Sleep depth and REM variables might play a key role in psychiatric comorbidity processes. Constellations of sleep alterations may define distinct disorders better than alterations in 1 single variable. (PsycINFO Database Record
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Affiliation(s)
- Chiara Baglioni
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Svetoslava Nanovska
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Wolfram Regen
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Kai Spiegelhalder
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Bernd Feige
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Christoph Nissen
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | | | - Dieter Riemann
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
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17
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Careaga MBL, Girardi CEN, Suchecki D. Understanding posttraumatic stress disorder through fear conditioning, extinction and reconsolidation. Neurosci Biobehav Rev 2016; 71:48-57. [PMID: 27590828 DOI: 10.1016/j.neubiorev.2016.08.023] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 07/20/2016] [Accepted: 08/16/2016] [Indexed: 11/25/2022]
Abstract
Careaga MBL, Girardi CEN, Suchecki D. Understanding posttraumatic stress disorder through fear conditioning, extinction and reconsolidation. NEUROSCI BIOBEHAV REV -Posttraumatic stress disorder (PTSD) is a psychopathology characterized by exacerbation of fear response. A dysregulated fear response may be explained by dysfunctional learning and memory, a hypothesis that was proposed decades ago. A key component of PTSD is fear conditioning and the study of this phenomenon in laboratory has expanded the understanding of the underlying neurobiological changes in PTSD. Furthermore, traumatic memories are strongly present even years after the trauma and maintenance of this memory is usually related to behavioral and physiological maladaptive responses. Persistence of traumatic memory may be explained by a dysregulation of two memory processes: extinction and reconsolidation. The former may explain the over-expression of fear responses as an imbalance between traumatic and extinction memory. The latter, in turn, explains the maintenance of fear responses as a result of enhancing trauma-related memories. Thus, this review will discuss the importance of fear conditioning for the establishment of PTSD and how failure in extinction or abnormal reconsolidation may contribute to the maintenance of fear response overtime.
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Affiliation(s)
| | - Carlos Eduardo Neves Girardi
- Departamento de Psicobiologia - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Deborah Suchecki
- Departamento de Psicobiologia - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
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18
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25 years of Eye Movement Desensitization and Reprocessing (EMDR): The EMDR therapy protocol, hypotheses of its mechanism of action and a systematic review of its efficacy in the treatment of post-traumatic stress disorder. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2016; 11:101-114. [PMID: 26877093 DOI: 10.1016/j.rpsm.2015.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/14/2015] [Accepted: 12/21/2015] [Indexed: 11/22/2022]
Abstract
Eye movement desensitization and reprocessing (EMDR) is a relatively new psychotherapy that has gradually gained popularity for the treatment of post-traumatic stress disorder. In the present work, the standardised EMDR protocol is introduced, along with current hypotheses of its mechanism of action, as well as a critical review of the available literature on its clinical effectiveness in adult post-traumatic stress disorder. A systematic review of the published literature was performed using PubMed and PsycINFO databases with the keywords «eye movement desensitization and reprocessing» and «post-traumatic stress disorder» and its abbreviations «EMDR» and «PTSD». Fifteen randomised controlled trials of good methodological quality were selected. These studies compared EMDR with unspecific interventions, waiting lists, or specific therapies. Overall, the results of these studies suggest that EMDR is a useful, evidence-based tool for the treatment of post-traumatic stress disorder, in line with recent recommendations from different international health organisations.
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Dueck A, Berger C, Wunsch K, Thome J, Cohrs S, Reis O, Haessler F. The role of sleep problems and circadian clock genes in attention-deficit hyperactivity disorder and mood disorders during childhood and adolescence: an update. J Neural Transm (Vienna) 2015; 124:127-138. [DOI: 10.1007/s00702-015-1455-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 09/02/2015] [Indexed: 12/13/2022]
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20
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Developing zebrafish models relevant to PTSD and other trauma- and stressor-related disorders. Prog Neuropsychopharmacol Biol Psychiatry 2014; 55:67-79. [PMID: 25138994 DOI: 10.1016/j.pnpbp.2014.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/01/2014] [Accepted: 08/07/2014] [Indexed: 11/20/2022]
Abstract
While post-traumatic stress disorder (PTSD) and other trauma- and stress-related disorders (TSRDs) represent a serious societal and public health concern, their pathogenesis is largely unknown. Given the clinical complexity of TSRD development and susceptibility, greater investigation into candidate biomarkers and specific genetic pathways implicated in both risk and resilience to trauma becomes critical. In line with this, numerous animal models have been extensively used to better understand the pathogenic mechanisms of PTSD and related TSRD. Here, we discuss the rapidly increasing potential of zebrafish as models of these disorders, and how their use may aid researchers in uncovering novel treatments and therapies in this field.
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