The Efficacy of Eye Movement Desensitization and Reprocessing in Children and Adults Who Have Experienced Complex Childhood Trauma: A Systematic Review of Randomized Controlled Trials

Mental health and conflict: a pilot of an online eye movement desensitisation and reprocessing (EMDR) intervention for forcibly displaced Syrian women

Background

The Syrian conflict has been ongoing since 2011. Practical and scalable solutions are urgently needed to meet an increase in need for specialised psychological support for post-traumatic stress disorder given limited availability of clinicians. Training forcibly displaced Syrians with a mental health background to remotely deliver specialised interventions increases the availability of evidence based psychological support. Little is known about the effectiveness of online therapy for forcibly displaced Syrian women provided by forcibly displaced Syrian women therapists.

Purpose

To pilot an evidence-based trauma therapy, Eye Movement Desensitisation and Reprocessing (EMDR), carried out online by trained forcibly displaced Syrian women therapists for forcibly displaced Syrian women who require treatment for post-traumatic stress disorder (PTSD).

Methods

83 forcibly displaced Syrian women, living in Türkiye or inside Syria, with diagnosable PTSD, were offered up to 12 sessions of online EMDR over a period of 3 months. This was delivered by forcibly displaced Syrian women therapists who were trained in EMDR. Data were gathered, using Arabic versions, on PTSD symptoms using the Impact of Events Scale Revised, depression symptoms using the Patient Health Questionnaire-9 and anxiety symptoms using the Generalised Anxiety Disorder Assessment-7 at baseline, mid-point, and end of therapy.

Results

PTSD scores, depression scores and anxiety scores all significantly reduced over the course of treatment, with lower scores at midpoint than baseline and lower scores at end of treatment than at midpoint. Only one participant (1%) exceeded the cutoff point for PTSD, and 13 (16%) exceeded the cutoff points for anxiety and depression at the end of treatment.

Conclusion

In this pilot study up to 12 sessions of online EMDR were associated with reductions in PTSD, anxiety and depression symptoms in Syrian women affected by the Syrian conflict. The training of forcibly displaced Syrian mental health professionals to deliver online therapy is a relatively low cost, scalable, sustainable solution to ensure that those who are affected by the conflict can access specialised support. Further research is needed using a control group to confirm that the observed effects are due to EMDR treatment, as is research with post-treatment follow-up to ascertain that benefits are maintained.

Clinical Efficacy of Psychotherapeutic Interventions for Post-Traumatic Stress Disorder in Children and Adolescents: A Systematic Review and Analysis

Background: This systematic review aggregates research on psychotherapeutic interventions for Post-Traumatic Stress Disorder (PTSD) in children and adolescents. PTSD in this demographic presents differently from adults, necessitating tailored therapeutic approaches. In children and adolescents, PTSD arises from exposure to severe danger, interpersonal violence, or abuse, leading to significant behavioral and emotional disturbances that jeopardize long-term development. The review focuses on describing PTSD within two age groups, children (6 to 12 years) and adolescents (12 to 18 years), while evaluating the effectiveness of various clinical interventions aimed at this condition. Methods: Utilizing the PRISMA guidelines, this review systematically examines studies that assess clinical interventions for PTSD in the younger population. Results: Key symptoms of PTSD in children and adolescents include avoidance, overstimulation, flashbacks, depression, and anxiety. The review identifies several effective treatments, including Cognitive Behavioral Therapy (CBT), Trauma-Focused CBT (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), Systemic Therapy, Play Therapy, Exposure Therapy, Relaxation Techniques, and Psychodynamic Psychotherapy. Particularly, TF-CBT is highlighted as the most effective and commonly used method in treating childhood and adolescent PTSD, as supported by most of the studies reviewed. Conclusions: A significant outcome of this study is the short-term effectiveness of CBT in reducing PTSD symptoms in children and adolescents. The findings underline the importance of psychotherapeutic interventions and mark a substantial advancement in understanding PTSD in young populations. It is crucial for practitioners to integrate various psychotherapeutic strategies into their practice to improve patient outcomes and treatment efficacy.

Practitioner Review: Neurobiological consequences of childhood maltreatment - clinical and therapeutic implications for practitioners

BACKGROUND

Childhood maltreatment is one of the most important preventable risk factors for a wide variety of psychiatric disorders. Further, when psychiatric disorders emerge in maltreated individuals they typically do so at younger ages, with greater severity, more psychiatric comorbid conditions, and poorer response to established treatments, resulting in a more pernicious course with an increased risk for suicide. Practitioners treating children, adolescents, and young adults with psychiatric disorders will likely encounter the highest prevalence of clients with early-onset maltreatment-associated psychiatric disorders. These may be some of their most challenging cases.

METHOD

In this report, we explore key validated alterations in brain structure, function, and connectivity associated with exposure to childhood maltreatment as potential mechanisms behind their patients' clinical presentations.

RESULTS

We then summarize key behavioral presentations likely associated with neurobiological alterations and propose a toolkit of established trauma and skills-based strategies that may help diminish symptoms and foster recovery. We also discuss how some of these alterations may serve as latent vulnerability factors for the possible development of future psychopathology.

CONCLUSIONS

Research on the neurobiological consequences of childhood adversity provides a vastly enriched biopsychosocial understanding of the developmental origins of health and pathology that will hopefully lead to fundamental advances in clinical psychology and psychiatry.

Eye movement desensitisation and reprocessing as add-on treatment to enhanced cognitive behaviour therapy for patients with anorexia nervosa reporting childhood maltreatment: A quasi-experimental multicenter study

OBJECTIVE

This quasi-experimental study aimed to compare the outcome of patients with Anorexia Nervosa (AN) reporting moderate/severe childhood maltreatment (CM) treated exclusively with Enhanced Cognitive Behaviour Therapy (CBT-E) or with CBT-E plus Eye Movement Desensitisation and Reprocessing (EMDR).

METHOD

A total of 75 patients with AN reporting moderate/severe CM were initially assessed regarding body mass index (BMI), general and eating disorder (ED)-specific psychopathology, and dissociative symptoms, and re-evaluated after 40 CBT-E sessions (T1). Then, 18 patients received EMDR, whereas the others were placed on a waiting list and continued CBT-E. T2 assessment was performed after 20-25 sessions of EMDR or CBT-E. A control group of 67 patients without CM was also enroled and treated with CBT-E.

RESULTS

Contrary to patients without CM, neither of the traumatised groups improved in BMI, general and ED psychopathology, or dissociation at T1. However, at T2, both traumatised groups improved in BMI and ED-specific psychopathology, with the CBT + EMDR group demonstrating greater improvements. Moreover, only the CBT + EMDR group improved in general psychopathology and dissociative symptoms. The reduction of ED symptoms in traumatised patients was mediated by the amelioration of dissociation.

DISCUSSION

The addition of EMDR to CBT-E may benefit patients with AN reporting moderate/severe CM.

Effects of wingwave® on athletes' wellbeing and fluidity of gaze behavior

Introduction

The wingwave^® method combining a muscular test and elements of eye movement desensitization and reprocessing has been found to successfully reduce anxiety and improve relaxation in people. However, it is still unclear how exactly its application improves individual wellbeing (though it is assumed to be related to changes in gaze patterns) and if it works for team sport athletes.

Method

To test both, team sport athletes who had reported a problem with a team sport aspect were randomly assigned to an experimental group and a control group. The experimental group members were individually coached by a wingwave^® coach once while the other participants watched a tennis match instead.

Results

Results showed that athletes in the wingwave^® group benefited from the coaching as their individual perception of their problems improved. These improvements were associated with a decrease of catch-up saccades in a visual object-tracking task conducted before and immediately after coaching.

Discussion

This points to wingwave^® interventions affecting gaze behavior and consequently wellbeing of team sport athletes.

Group Eye Movement Desensitization Reprocessing (EMDR) Psychotherapy and Recurrent Interpersonal Traumatic Episodes: A Pilot Follow-Up Study

Objective

To explore the acceptability and the effectiveness of an Eye Movement Desensitization Reprocessing Integrative Group Treatment Protocol (EMDR-IGTP) for patients with a history of recurrent traumatic episodes of interpersonal nature.

Method

Seven women were recruited from a Trauma Centre and were offered EMDR-IGTP, consisting of 10 semi-structured group sessions. Participants were assessed through a set of standardised clinical measures before the treatment, at the end of it, and after 1 and 3 months since its conclusion.

Results

EMDR-IGTP was well accepted by all participants. After the intervention and at 1 and 3 months follow-up, patients showed a significant reduction of dissociative symptoms, traumatic symptoms and improved emotional regulation.

Conclusions

This study suggests that GITM-EMDR therapy can be a helpful treatment for people who experienced traumatic episodes of interpersonal nature and supports more extensive research in this direction.

EMDR Therapy for Posttraumatic Stress Disorder Symptoms in Adult Inpatient Mental Health Settings

Most research evaluating eye movement desensitization and reprocessing (EMDR) therapy has taken place in community settings, leaving the impact for service users within inpatient environments less clear. This systematic review sought to identify, summarize, and critically evaluate studies that investigated the impact of EMDR on symptoms of posttraumatic stress disorder (PTSD) within adult inpatient mental health settings. Seven databases were systematically searched to identify published and unpublished articles eligible for inclusion. Eleven studies, published between 1995 and 2020, were included within this review. All studies showed that EMDR improved PTSD symptoms, across a variety of study populations. However, these findings are limited by the (a) preponderance of case study designs (preventing causal attribution); (b) provision of synchronous treatments; (c) poor methodological quality; and (d) high heterogeneity across studies. Prior research has shown EMDR’s effectiveness and safety for vulnerable populations. While the evidence is beginning to support its use with those experiencing PTSD symptoms within adult inpatient settings, it is premature to strongly recommend it as a routine intervention. Future research within this area is recommended.

Anxiety Reduction and Improved Concentration in Schoolchildren through Wingwave® Coaching

(1) Background: For nearly 20 years, the wingwave^® method, which combines elements of eye movement desensitization and reprocessing (EMDR) and a muscular strength test, has been used to reduce anxiety and improve relaxation in subjects. Past studies have scientifically evaluated this method in various contexts and have found it to be effective. In this study, we investigated the effects of short-term wingwave^® coaching on specific anxiety parameters regarding school, concentration ability, and subjective feelings towards two self-chosen themes in schoolchildren. (2) Methods: A group of 53 schoolchildren aged 11 to 12 years were randomly divided between an experimental and a control group. The experimental group received an intervention of three wingwave^® coaching sessions (one hour each). In these sessions, past and present negative feelings towards school as well as psychological resources to face future tasks in school were focused on and utilized. (3) Results: The results showed that the overall text anxiety, manifested anxiety, and dislike of school decreased significantly in the experimental group after the three coaching sessions compared to the control group. Furthermore, both concentration ability and the subjective feeling towards self-chosen subjects improved significantly in the experimental group compared to the control group. (4) Conclusions: Our results indicate that the wingwave^® method is an appropriate and effective instrument to reduce school anxiety and to improve concentration performance in schoolchildren—at least in the short and medium term.

Cognitive-behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis

BACKGROUND

Cognitive-behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive-behavioural therapy systematic reviews suggested that cognitive-behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials.

OBJECTIVES

This project was undertaken to map the quality and gaps in the cognitive-behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive-behavioural therapy.

DATA SOURCES

The overview was designed with cognitive-behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of Abstracts of Reviews of Effects and OpenGrey databases were searched from 1992 to January 2019.

REVIEW METHODS

Study inclusion criteria were as follows: (1) fulfil the Centre for Reviews and Dissemination criteria; (2) intervention reported as cognitive-behavioural therapy or including one cognitive and one behavioural element; (3) include a synthesis of cognitive-behavioural therapy trials; (4) include either health-related quality of life, depression, anxiety or pain outcome; and (5) available in English. Review quality was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2. Reviews were quality assessed and data were extracted in duplicate by two independent researchers, and then mapped according to condition, population, context and quality. The effects from high-quality reviews were pooled within condition groups, using a random-effect panoramic meta-analysis. If the across-condition heterogeneity was I2 < 75%, we pooled across conditions. Subgroup analyses were conducted for age, delivery format, comparator type and length of follow-up, and a sensitivity analysis was performed for quality.

RESULTS

A total of 494 reviews were mapped, representing 68% (27/40) of the categories of the International Classification of Diseases, Eleventh Revision, Mortality and Morbidity Statistics. Most reviews (71%, 351/494) were of lower quality. Research on older adults, using cognitive-behavioural therapy preventatively, ethnic minorities and people living outside Europe, North America or Australasia was limited. Out of 494 reviews, 71 were included in the primary panoramic meta-analyses. A modest effect was found in favour of cognitive-behavioural therapy for health-related quality of life (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.05 to 0.50, I2 = 32%), anxiety (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval -0.28 to 0.88, I2 = 62%) and pain (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.28 to 0.74, I2 = 64%) outcomes. All condition, subgroup and sensitivity effect estimates remained consistent with the general effect. A statistically significant interaction effect was evident between the active and non-active comparator groups for the health-related quality-of-life outcome. A general effect for depression outcomes was not produced as a result of considerable heterogeneity across reviews and conditions.

LIMITATIONS

Data extraction and analysis were conducted at the review level, rather than returning to the individual trial data. This meant that the risk of bias of the individual trials could not be accounted for, but only the quality of the systematic reviews that synthesised them.

CONCLUSION

Owing to the consistency and homogeneity of the highest-quality evidence, it is proposed that cognitive-behavioural therapy can produce a modest general, across-condition benefit in health-related quality-of-life, anxiety and pain outcomes.

FUTURE WORK

Future research should focus on how the modest effect sizes seen with cognitive-behavioural therapy can be increased, for example identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42017078690.

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. 25, No. 9. See the NIHR Journals Library website for further project information.

Identifying Profiles of Anxiety in Late Childhood and Exploring Their Relationship with School-Based Distress

Failure in dealing with anxiety-provoking situations and stressors in the school setting may have negative consequences not only on children’s performance, but also on their well-being in the future. This research aimed to examine the relationship of forms of anxiety (anticipatory anxiety, school-based performance anxiety, and generalized anxiety) with sources (teacher interactions, academic stress, peer interactions, and academic self-concept) and manifestations (emotional, behavioral, and physiological) of school-based distress. Specifically, our objectives were to examine the correlations between anxiety and school-based distress and, using a person-centered approach, to verify whether different anxiety profiles differed in their levels of distress. The Visual Analogue Scale for Anxiety-Revised (VAA-R) and the School Situation Survey (SSS) were administered to 756 Spanish students (M_age = 9.6, SD = 1.12); 50.3% were girls. Pearson’s correlation coefficients revealed a positive and significant association between each form of anxiety and each source and manifestation of distress. The latent profile analysis identified three anxiety profiles: High Anxiety, High School-based performance Anxiety, and Low Anxiety. The High Anxiety profile scored significantly higher in all sources and manifestations of distress than the Low Anxiety profile. The High Anxiety profile showed significantly higher scores in peer interactions and emotional and behavioral manifestations of distress than the group High School-based performance Anxiety. Suggestions for intervention strategies according to the risk profile are discussed.

EMDR in Cancer Patients: A Systematic Review

Background: Psychological distress is common among patients with cancer, with severe consequences on their quality of life. Anxiety and depression are the most common clinical presentation of psychological distress in cancer patients, but in some cases cancer may represent a traumatic event resulting in posttraumatic stress disorder (PTSD). Currently, Eye Movement Desensitization and Reprocessing (EMDR) therapy is considered an evidence-based treatment for PTSD, but recent studies also showed its effectiveness for anxiety and depression. The aim of the present systematic review is to summarize the current literature on the effect of EMDR on cancer-related psychological distress. Methods: A literature search was conducted for peer-reviewed articles about "EMDR" and "cancer patients" in the following electronic databases: PubMed, MEDLINE, Science Direct, Google Scholar, and Cochrane library. Results: Our search identified 7 studies in which EMDR was used with a total of 140 cancer patients. The psychiatric diagnosis was PTSD in 3 studies. Otherwise, the diagnosis concerned the anxious and depressive disorder spectrum. Overall, EMDR treatment schedules used were highly heterogeneous, with a different number of sessions (from 2 to 12) and a different duration of therapy (up to 4 months). However, across all studies analyzed EMDR therapy was judged to be adequate in reducing symptoms of psychological distress in this population. Conclusions: According to the results of our analysis, the level of evidence regarding EMDR efficacy in cancer patients is limited by the scarcity of studies and their low methodological quality. Although better quality research is needed, available data suggest that EMDR could be a promising treatment for psychological distress in patients with cancer.

School-Based Mind–Body Interventions: A Research Review

This paper contains a narrative review of the literature in the field of school-based mind–body interventions (MBIs). The aim of the current review is to verify whether the school-based MBI programs implemented in primary and secondary schools over the past 5 years are effective in helping schoolchildren cope with stress-related, behavioral, and affective issues, as well as improve stress response and school performance. All articles were retrieved using a number of databases. Inclusion criteria comprised qualitative and quantitative, English language, and peer-reviewed studies among third graders (8–9 years old) to twelfth graders (17–18 years old), including special needs pupils. Qualitative studies were limited to pupils’ experience only. Ten studies meeting the criteria for this review were assessed. The school-based interventions included yoga-based programs and mindfulness training. Evidence was evaluated and summarized. Across the reviewed studies, we found support for MBIs as part of school curricula to reduce negative effects of stress and promote overall well-being with caveats to consider in choosing specific programs. The practical implications of the current review include considerations related to the incorporation of MBIs in school curricula, which would likely benefit schoolchildren.

The effect of eye movement desensitization and reprocessing on the fear of hypoglycemia in type 2 diabetic patients: a randomized clinical trial

Background

The fear of hypoglycemia leads to psychological symptoms in patients with diabetes type 2. In this research, the effects of EDMR on the fear of hypoglycemia in patients with diabetes type 2 were examined.

Methods

A clinical trial study was carried out with participation of 72 patients who had diabetes type 2 in Velayat Hospital. The participants were randomly assigned into control and intervention groups. The intervention group received EMDR. The required information was gleaned using a questionnaire of fear of hypoglycemia, intensity of hypoglycemia, and demographics filled out before the intervention, and 1 month and 3 months after it. The data were analyzed using descriptive statistics on SPSS Version 23. For comparison of fear of hypoglycemia in intervention and control groups, repeated measure ANOVA and Cohen d test were used.

Results

The mean age of the participants in the intervention group was 43.17 ± 10.55 and in the control group was 45.86 ± 13.6. In this study, without considering the potential disruptors in the incorrect model, the intervention caused a reduction of 15 points 1 month after the completion of the intervention and a reduction of 17 points 3 month after the completion of the intervention on the scale of fear of hypoglycemia; but post-correction of potential disruptors, intervention caused a reduction of 19.5 scores 1 month after the completion and a reduction of 20.3 scores 3 months after the intervention .

Conclusions

The EMDR can be used as a non-pharmaceutical treatment method to treat and alleviate the fear of hypoglycemia in type 2 diabetes patients.

Trial registration

Iranian Registry of Clinical Trials: IRCT20181201041813N1, 2019/11/13.

The relationship between childhood trauma and Internet gaming disorder among college students: A structural equation model

BACKGROUND

The aim of this study was to investigate the mechanisms of Internet gaming disorder (IGD) and the associated interaction effects of childhood trauma, depression and anxiety in college students.

METHODS

Participants were enrolled full-time as freshmen at a University in the Hunan province, China. All participants reported their socio-demographic characteristics and undertook a standardized assessment on childhood trauma, anxiety, depression and IGD. The effect of childhood trauma on university students' internet gaming behaviour mediated by anxiety and depression was analysed using structural equation modelling (SEM) using R 3.6.1.

RESULTS

In total, 922 freshmen participated in the study, with an approximately even male-to-female ratio. A mediation model with anxiety and depression as the mediators between childhood trauma and internet gaming behaviour allowing anxiety and depression to be correlated was tested using SEM. The SEM analysis revealed that a standardised total effect of childhood trauma on Internet gaming was 0.18, (Z = 5.60, 95% CI [0.02, 0.05], P < 0.001), with the direct effects of childhood trauma on Internet gaming being 0.11 (Z = 3.41, 95% CI [0.01, 0.03], P = 0.001), and the indirect effects being 0.02 (Z = 2.32, 95% CI [0.00, 0.01], P = 0.020) in the pathway of childhood trauma-depression-internet gaming; and 0.05 (Z = 3.67, 95% CI [0.00, 0.02], P < 0.001) in the pathway of childhood trauma-anxiety-Internet gaming. In addition, the two mediators anxiety and depression were significantly correlated (r = 0.50, Z = 13.54, 95% CI [3.50, 5.05], P < 0.001).

CONCLUSIONS

The study revealed that childhood trauma had a significant impact on adolescents' Internet gaming behaviours among college students. Anxiety and depression both significantly mediated the relationship between childhood trauma and internet gaming and augmented its negative influence. Discussion of the need to understand the subtypes of childhood traumatic experience in relationship to addictive behaviours is included.

EMDR therapy in children and adolescents who have post-traumatic stress disorder: a six-week follow-up study

Objectives: The purpose of this study is to explore whether eye movement desensitisation and reprocessing (EMDR) is an effective therapy and to investigate whether EMDR affects anxiety levels for children and adolescents.Methods: We conducted this study with 30 clients. The clients completed self-administered questionnaires Child Post-Traumatic Stress Reaction Index Scale and The State-Trait Anxiety Inventory. The questionnaires were conducted before the therapy and 6 weeks after the completion of the therapy.Results: Nineteen clients (63%) had only one traumatic event, but 11 clients (37%) had more than one traumatic event. While the mean score on the PTSD symptom scale was 60 (±8.7), this rate decreased to 24 (±10.1), whereas the mean STAI-T scale was 59 (±8.9) before treatment and 41 (±11.5) after treatment. We found a statistically significant difference between symptom scores as quantified by both questionnaires before and after EMDR therapy (p < .05).Conclusions: As a result, we have shown that EMDR is an effective method for children and adolescents with PTSD in terms of both post-traumatic and anxiety symptom levels; however, we recommend a larger sample size with a control group to further establish the effectiveness of EMDR therapy in children.KEY POINTSPTSD is a common disorder in children and adolescents.Additional psychiatric disorders such as anxiety and depression are common in children and adolescents with PTSD.In PTSD cases applying for psychiatric treatment, trauma associated with sexual abuse is more pronounced and complex.EMDR is an effective therapy in children and adolescents as well as in adults.There is a statistically significant decrease at anxiety and PTSD symptom scores as quantified by questionnaires in patients with PTSD after EMDR therapy.

Post-traumatic stress disorder and the role of resilience, social support, anxiety and depression after the Jiuzhaigou earthquake: A structural equation model

This is the first study to investigate the mechanism of Post traumatic stress disorder (PTSD) after the 2017 7.0 Ritcher scale Jiuzhaigou earthquake. In order to identify the mechanism underling interactions among different factors associated with PTSD symptoms. Three months after the earthquake, 607 participants from the heavy damaged areas were recruited in this survey. Demographic information and scale measurements on social support, resilience, anxiety, depression, and PTSD were collected using standardized questionnaire. The result showed that PTSD, anxiety symptoms, and depressive symptoms prevalence in the severely affected area were 52.7 %, 53.8 % and 69.6 %, respectively. Resilience and social support had direct effects on PTSD, as well as indirect effects on PTSD through anxiety and depression. The proposed mechanism on PTSD explained the paths among the measured variables, which explained the risk and protective factors related to PTSD. This current study has important practical implications for understanding mental health status of earthquake victims.

Interpersonal Trauma and Risk of Depression Among Adolescents: The Mediating and Moderating Effect of Interpersonal Relationship and Physical Exercise

Interpersonal trauma in adolescent is an important public health concern. Depression can be a main consequence of interpersonal trauma, which subsequently results in various negative mental health outcomes. Previous research has investigated the independent effects of interpersonal trauma, interpersonal relationships and physical exercise on the risk of depression. However, the interaction effect of the three factors on depression remains unclear. We aim to investigate the associations between these potential factors and depression in adolescents, and explore the interaction effect of the three aforementioned factors. A cross-sectional study was conducted in Shenzhen, China, in 2017. A total of 1,883 adolescents from 11 middle schools and high schools were recruited. Demographic information, depressive symptoms, physical exercise, interpersonal relationships, interpersonal trauma, and academic record were collected through the use of standardized questionnaires. A linear regression model was performed to explore the association between these variables and depression. Pathway analysis was used to explore the role of potential mediators and moderators. The results showed that interpersonal trauma and poorer interpersonal relationships were significantly associated with depression (p < 0.05). We identified a mediating role of interpersonal relationships in the relationship between interpersonal trauma and depression, and a moderating role of physical exercise between interpersonal trauma and interpersonal relationships. This is the first study to examine the interaction effects of interpersonal trauma, interpersonal relationships and physical exercise on depression in adolescents. The current study therefore provides insights into factors which impact the mental health of adolescents. Through examining these factors one can gain further insight into potential factors associated with depression and therefore then develop more tailored interventions in order to support adolescents' mental well-being.

Eye Movement Desensitization Reprocessing for Children and Adolescents With Posttraumatic Stress Disorder: A Systematic Narrative Review

There is currently a limited number of studies into the efficacy of eye movement desensitization reprocessing (EMDR) therapy with children and adolescents with posttraumatic stress disorder (PTSD). The current study utilizes a systematic narrative review of methodologies and findings of previous literature reviews and meta-analyses as well as analyzing randomized control trials (RCTs) conducted from 2002 to 2018. Following initial scoping of the extent of studies, two systematic literature searches were conducted, firstly for literature reviews and secondly for recent RCTs. Nine databases were utilized. Eight reviews and seven RCTs were identified and analyzed for quality of methodology and outcome as measured by impact on PTSD symptoms. EMDR was found to be efficacious in reducing children's PTSD symptoms compared to waitlist conditions, with similar outcomes to cognitive behavior therapy (CBT). EMDR was effective with both single-event trauma as well as cumulative trauma such as sexual abuse. EMDR was equally effective with girls and boys as well as children from different cultures. EMDR achieved medium to large effect sizes. Reductions in PTSD were maintained at 2-, 3-, 6-, and 12-month follow-up. In conclusion, EMDR was consistently found to be an efficacious treatment for children with PTSD. Recommendations are made for future practice and research.

A Brief Narrative Summary of Randomized Controlled Trials Investigating EMDR Treatment of Patients With Depression

Depression, one of the most common mental disorders, is characterized by enormous social costs and limited rates of treatment success, even though psychotherapeutic and pharmacological treatments currently contribute to an increase in the remission rate. In light of recent studies that have shown that traumas and adverse life experiences may represent risk factors for the onset of depression, the therapeutic approach of eye movement desensitization and reprocessing (EMDR) therapy has been seen as potentially effective in the treatment of depression. The purpose of the present brief narrative review is to summarize the current literature on the efficacy of EMDR in patients with depression, in particular by referring to randomized controlled clinical trials (RCTs) that examined depression as a primary outcome. The data examined are updated to March 2019 and count seven RCT studies covering the years from 2001 to 2019. They are heterogeneous by type of intervention and demographic characteristics of the sample. Although the selected studies are few and with different methodological critical issues, the findings reported by the different authors suggest in a preliminary way that EMDR can be a useful treatment for depression.

Addressing Loneliness in Complex PTSD

Loneliness impacts both physical and psychological health and is associated with increases of all-cause mortality and suicidal behavior. Because loneliness may result from a variety of developmental, interpersonal, and intrapersonal factors, distinguishing its components, origins, and sustaining factors as it manifests in various psychopathological states are important steps in formulating interventions to alleviate these conditions. To date, loneliness has not been widely studied in relation to complex posttraumatic stress disorder (PTSD), which is newly delineated in the International Classification of Diseases, characterized by PTSD symptoms in the context of significant early trauma, as well as "disturbances in self-organization" marked by affective dysregulation, negative self-concept, and disturbances in relationships. In this article, illustrating with case material, we suggest that loneliness plays a major role in the development of complex PTSD and in the preservation of its symptoms. Consequently, therapies for complex PTSD should include interventions that address loneliness.

Effectiveness of an intensive treatment programme combining prolonged exposure and eye movement desensitization and reprocessing for severe post-traumatic stress disorder

Background: There is room for improvement regarding the treatment of severe post-traumatic stress disorder (PTSD). Intensifying treatment to increase patient retention is a promising development. Objective: The aim of this study was to determine the effectiveness of an intensive trauma-focused treatment programme over 8 days for individuals suffering from severe PTSD. Method: Treatment was provided for 347 PTSD patients (70% women; mean age = 38.32 years, SD = 11.69) and consisted of daily sessions of prolonged exposure and eye movement desensitization and reprocessing (EMDR) therapy (16 sessions in total), physical activity, and psycho-education. All participants had experienced multiple traumas, including sexual abuse (74.4%), and suffered from multiple comorbidities (e.g. 87.5% had a mood disorder). Suicidal ideation was frequent (73.9%). PTSD symptom severity was assessed by both clinician-rated [Clinician Administered PTSD Scale (CAPS)] and self-report [PTSD Symptom Scale Self Report (PSS-SR) and Impact of Event Scale (IES)] inventories. For a subsample (n = 109), follow-up data at 6 months were available. Results: A significant decline in symptom severity was found (e.g. CAPS intention-to-treat sample Cohen's d = 1.64). At post-treatment, 82.9% showed a clinically meaningful response and 54.9% a loss of diagnosis. Dropout was very low (2.3%). Conclusions: Intensive trauma-focused treatment programmes including prolonged exposure, EMDR therapy, and physical activity can be effective for patients suffering from severe PTSD and are associated with low dropout rates.