EMDR therapy for PTSD after motor vehicle accidents: meta-analytic evidence for specific treatment

Therapeutic interventions impact brain function and promote post-traumatic growth in adults living with post-traumatic stress disorder: A systematic review and meta-analysis of functional magnetic resonance imaging studies

Introduction

The present systematic review and meta-analysis explores the impacts of cognitive processing therapy (CPT), eye movement desensitization and reprocessing (EMDR), and prolonged exposure (PE) therapy on neural activity underlying the phenomenon of post-traumatic growth for adult trauma survivors.

Methods

We utilized the following databases to conduct our systematic search: Boston College Libraries, PubMed, MEDLINE, and PsycINFO. Our initial search yielded 834 studies for initial screening. We implemented seven eligibility criteria to vet articles for full-text review. Twenty-nine studies remained for full-text review after our systematic review process was completed. Studies were subjected to several levels of analysis. First, pre-and post- test post-traumatic growth inventory (PTGI) scores were collected from all studies and analyzed through a forest plot using Hedges' g. Next, Montreal Neurological Institute (MNI) coordinates and t-scores were collected and analyzed using an Activation Likelihood Estimation (ALE) to measure brain function. T-scores and Hedges' g values were then analyzed using Pearson correlations to determine if there were any relationships between brain function and post-traumatic growth for each modality. Lastly, all studies were subjected to a bubble plot and Egger's test to assess risk of publication bias across the review sample.

Results

Forest plot results indicated that all three interventions had a robust effect on PTGI scores. ALE meta-analysis results indicated that EMDR exhibited the largest effect on brain function, with the R thalamus (t = 4.23, p < 0.001) showing robust activation, followed closely by the R precuneus (t = 4.19, p < 0.001). Pearson correlation results showed that EMDR demonstrated the strongest correlation between increased brain function and PTGI scores (r = 0.910, p < 0.001). Qualitative review of the bubble plot indicated no obvious traces of publication bias, which was corroborated by the results of the Egger's test (p = 0.127).

Discussion

Our systematic review and meta-analysis showed that CPT, EMDR, and PE each exhibited a robust effect on PTG impacts across the course of treatment. However, when looking closer at comparative analyses of neural activity (ALE) and PTGI scores (Pearson correlation), EMDR exhibited a more robust effect on PTG impacts and brain function than CPT and PE.

Eye Movement Desensitization and Reprocessing (EMDR) as a Possible Evidence-Based Rehabilitation Treatment Option for a Patient with ADHD and History of Adverse Childhood Experiences: A Case Report Study

BACKGROUND

Children with Attention Deficit Hyperactivity Disorder (ADHD) having a history of adverse childhood experiences (ACEs) could be very difficult to treat with standard psychotherapeutic approaches. Some children diagnosed with ADHD may have Post-Traumatic Stress Disorder (PTSD) or have had experienced a significant traumatic event. Trauma and PTSD could exacerbate ADHD core symptoms and be a risk factor of poor outcome response.

OBJECTIVE

to report for the first time the history of a patient with ADHD and ACE successfully treated with an EMDR approach.

CONCLUSION

EMDR could be a promising treatment for ADHD children with a history of traumatic experiences in addition to pharmacological treatments.

Promoting Mental Health in Healthcare Workers in Hospitals Through Psychological Group Support With Eye Movement Desensitization and Reprocessing During COVID-19 Pandemic: An Observational Study

BACKGROUND

Psychological support was provided by the Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol (EMDR-IGTP) within the hospitals in the Northern Italy in favor of healthcare workers during the COVID-19 pandemic. This study aimed at evaluating the effectiveness of treatment in terms of (a) symptomatology reduction related to peri- and post-traumatic stress; (b) clinical improvement over time; and (c) the maintenance of the achieved outcome over time.

METHODS

The population was composed of healthcare workers who spontaneously requested psychological intervention in both the first and the second emergency waves. Statistical analyses were carried out to highlight the differences in Impact of Event-Revised (IES-R) and Post-Traumatic Growth Inventory (PTGI) before and after the group intervention.

RESULTS

In both the first and the second waves, pre-treatment values are higher than post-treatment values for all dimensions of the IES-R. The results show that there are no significant differences between the first and the second wave with regard to the treatment effect. Healthcare workers maintained positive changes over time despite their prolonged exposure to an emergency and the possibility of retraumatization at the onset of a new emergency phase, irrespective of their working place. Healthcare workers who were treated in the first wave showed at the beginning of the second emergency wave less vulnerability and more resilience than those who were treated only in the second wave.Pre-treatment scores of healthcare workers affected by COVID-19 are discussed.

CONCLUSION

COVID-19 had a significant impact on the well-being of healthcare workers who were working in hospitals. Psychological support in case of emergency is needed.

Clinical efficacy of EMDR in unipolar depression: Changes in theta cordance

Eye Movement Desensitization and Reprocessing (EMDR) has demonstrated efficacy in treating major depressive disorder. EMDR increases cerebral perfusion in the anterior cingulate cortex (ACC) and dorsolateral prefrontal cortex (dlPFC). Activity in the ACC and dlPFC can be measured by theta cordance (TC) but has not been examined in EMDR. Ten participants (3 men, 7 women, M age = 42.31 ± 15.03) received ten 75 ± 15 minute EMDR sessions over 6.5 ± .5 weeks. Results indicated that PHQ-9 depression scores reduced from T1 (M = 13.9 ± 3.31) to T11 (M = 6.30 ± 3.23) with EMDR (SMD = 2.30), and that fTC but not pfTC was significantly related to this change. Depression declined as fTC declined. EMDR may engage the dlPFC or ACC that modulates depression and aid in reducing fTC and thus depression levels.

Adaptive Information Processing Theory: Origins, Principles, Applications, and Evidence

This paper describes the origins, principles, applications, and evidence related to Adaptive Information Processing (AIP) theory. AIP theory provides the theoretical underpinning of Eye Movement Desensitization and Reprocessing (EMDR) therapy. AIP theory was developed to explain the observed results of EMDR therapy delivered to individuals experiencing trauma and PTSD. The AIP model hypothesizes that maladaptively stored memories of trauma create obstacles to rational processing of information, which occurs in the prefrontal cortex area of the brain. Bilateral stimulation, through eye movements or other mechanisms, is hypothesized to remove the obstacles and permit complete processing of the memory, leading to a reduction in trauma symptoms. EMDR therapy, with the AIP model as rationale, has been effectively used in the treatment of PTSD. Evidence in support of AIP theory is emerging as some promising results have been shown in studies that rely on measuring various types of physiological changes that occur during EMDR therapy.

Eye movement desensitization and reprocessing for mental health problems: a systematic review and meta-analysis

There is no comprehensive meta-analysis of randomised trials examining the effects of Eye Movement Desensitization and Reprocessing (EMDR) on post-traumatic stress disorder (PTSD) and no systematic review at all of the effects of EMDR on other mental health problems. We conducted a systematic review and meta-analysis of 76 trials. Most trials examined the effects on PTSD (62%). The effect size of EMDR compared to control conditions was g = 0.93 (95% CI: 0.67-.18), with high heterogeneity (I²= 72%). Only four of 27 studies had low risk of bias, and there were indications for publication bias. EMDR was more effective than other therapies (g = 0.36; 95% CI: 0.14-0.57), but not in studies with low risk of bias. Significant results were also found for EMDR in phobias and test anxiety, but the number of studies was small and risk of bias was high. EMDR was examined in several other mental health problems, but for none of these problems, sufficient studies were available to pool outcomes. EMDR may be effective in the treatment of PTSD in the short term, but the quality of studies is too low to draw definite conclusions. There is not enough evidence to advise it for the use in other mental health problems.

Fear extinction and memory reconsolidation as critical components in behavioral treatment for posttraumatic stress disorder and potential augmentation of these processes

Posttraumatic stress disorder (PTSD) is associated with alterations in critical brain regions such as the amygdala, hippocampus, and prefrontal cortex. This brief review has two objectives: (1) to discuss research examining extinction and reconsolidation processes as mechanisms in PTSD psychotherapy, and (2) present possibilities for augmenting extinction and reconsolidation within treatment through alterations to therapeutic interventions and novel approaches. A key component of many effective PTSD therapies is exposure, which involves intentional confrontation and processing of the traumatic memory. Our review suggests that extinction and reconsolidation processes underlie effective exposure-based treatment, but the neurobiological mechanisms of these processes in behavioral treatments for PTSD remains unclear. We argue that enhancing extinction and/or disrupting reconsolidation of a feared memory may improve the efficacy of existing treatments (e.g., increased change for limited/non-responders, faster/greater changes for responders), which can be done through multiple channels. Potential avenues for augmentation of the processes of extinction and reconsolidation in PTSD psychotherapies are reviewed, including behavioral modifications, pharmacotherapy agents, and the use of devices during therapy. We further suggest that investigations towards understanding the extent to which extinction and reconsolidation processes are necessary in effective PTSD psychotherapy is an important future direction for enhancing clinical care among PTSD populations.

Possible neural mechanisms of psychotherapy for trauma-related symptoms: cerebral responses to the neuropsychological treatment of post-traumatic stress disorder model individuals

Psychotherapy is often effective for treating psychogenic disorders, but the changes that occur in the brain during such treatments remain unknown. To investigate this, we monitored cerebral activity throughout an entire session using a psychotherapeutic technique in healthy subjects. Since post-traumatic stress disorder (PTSD) is a typical psychogenic psychiatric disorder, we used PTSD-model volunteers who had experienced a moderately traumatic event. The technique used as psychotherapy was eye movement desensitisation and reprocessing (EMDR), a standard method for treating PTSD. The oxygenated haemoglobin concentration ([oxy-Hb]), a sensitive index of brain activation, measured using multi-channel near-infrared spectroscopy, revealed changes in [oxy-Hb] in the superior temporal sulcus (STS) and orbitofrontal cortex (OFC). During a vital therapeutic stage, a significant reduction in the activation by forced eye movements was observed in the right STS, and a trend toward a reduction in the left OFC. The hyperactivation of the right STS on the recall of unpleasant memories, and its normalisation by eye movements, seem to reflect an important neural mechanism of the psychotherapy. These findings suggest that psychotherapy for traumatic symptoms involves brain regions related to memory representation and emotion, and possibly those that link memory and emotion, such as the amygdala.