The Effects of β-Adrenergic Blockade on the Degrading Effects of Eye Movements on Negative Autobiographical Memories

Targeting craving with EMDR therapy: Future directions

Eye movement desensitization and reprocessing (EMDR) therapy may be a promising approach when targeting addiction-related memory representations that trigger craving. We propose a link with cue-reactivity mechanisms targeted by both cognitive bias modification training and cue-exposure therapy, including increased cue-devaluation, reduction in cognitive biases, and violation of dysfunctional expectancies. In this commentary, we propose a framework explaining the effects of addiction-focused EMDR therapy based on insights from working memory and inferential processing accounts, empirical evidence of underlying EMDR mechanisms, and the broader cue-exposure literature. It points to new directions for future addiction-focused EMDR therapy, by optimizing procedures, by more strongly taxing working memory, better violate dysfunctional expectancies, inhibiting cue-reactive related memories and lowering craving and inhibiting addictive responses. We hope that this framework will inspire future research investigating the underlying mechanisms as well as potential boundary conditions (e.g., arousal) that may moderate these mechanisms across a wider set of addictive-like domains.

The effects of eye movements on the content and characteristics of unpleasant autobiographical memories: an extended replication study

Experimental studies show that vividness and emotionality of aversive memories decrease after recall with eye movements. We aimed at replicating this finding. Relatedly, consistent with Conway's view that memory retrieval is constructive, we examined changes in the content of the memories. If eye movements render a memory less aversive, it may be avoided less, stimulating recall and increasing the opportunity to infer (contextual) details. Two experiments (N = 97 and N = 250) examined whether eye movements affect the number of central and peripheral memory details and characteristics. Female undergraduate students were randomly allocated to either eye movements with recall (EM) or recall only (RO). Before and after the experimental task, participants rated the vividness and emotionality, provided a detailed description and evaluated other memory characteristics. We replicated earlier findings that vividness (both experiments) and emotionality (experiment 2) were reduced more after EM compared to RO. However, conditions did not statistically significantly differ with respect to content details and other memory characteristics. Overall, findings support the idea that eye movements decrease the experience of the memory as vivid and emotional. Results are inconclusive regarding the idea that eye movements alter the number of recalled central and peripheral memory details.

The effects of bilateral stimulation using eye movements on sexual fantasies with follow-up

BACKGROUND AND OBJECTIVES

Sexual fantasies represent a common aspect of human sexuality that can support sexual well-being but also contribute to psychopathology. The latter warrants intervention and bilateral stimulation with eye movements (EMs) may be a suitable intervention for impairing mental imagery of sexual fantasies. This study aimed to evaluate the effect of multiple rounds of EMs on sexual fantasies, gauge the effect over time with a one-week follow-up, and assess how impaired sexual imagery may influence behaviour and behavioural intention.

METHODS

Twenty-eight participants (14 male, Mage = 44.10, SDage = 9.77) selected a favoured sexual fantasy and engaged in five repeated rounds of an EM task, either face-to-face or via telehealth. Baseline phenomenological characteristics of sexual fantasies were compared against repeated measures after each round of EMs and at one-week follow-up, as well as hypothetical behavioural intention and frequency of fantasy masturbation.

RESULTS

All sexual fantasy characteristics (e.g., vividness, sensations, arousal, believability) diminished progressively between each round of EMs. These characteristics increased from round five to follow-up. However, they remained significantly reduced compared to baseline. Participants' hypothetical behavioural intention and frequency of masturbation associated with their sexual fantasies also reduced post-EM task.

LIMITATIONS

Use of self-report measures; participants' mental imagery could not be measured directly; and no comparison groups were included.

CONCLUSIONS

As an imagery impairing task, bilateral stimulation with EMs is effective for diminishing the phenomenological properties of sexual fantasies, extending upon extant literature. Collectively, the progressive research regarding EMs and sexual fantasies encourages replication in specific populations (e.g., individuals with problematic or harmful sexual fantasies).

Boosting long-term effects of degraded memories via acute stress

Combining recall of an emotional memory with simultaneous horizontal eye movements (i.e., Recall + EM) reduces memory aversiveness. However, the long-term persistence of this effect is inconsistent across studies. Given that stress may aid in the consolidation of memories, we examined whether acute stress can boost the long-term effects of degraded memories. To test this, participants recalled two negative memories, which were assigned to a Recall + EM or Recall Only condition. Before and after each intervention they rated memory aversiveness (i.e., immediate effects) followed by a stress-induction or control procedure. After a 24h-period, participants rated each memory again (i.e., long-term effects). We found that Recall + EM produces immediate effects but that these effects dissolve over time. Moreover, acute stress did not boost potential long-term effects of Recall + EM. Degraded memories were not retained better by applying stress. We discuss these results and how long-term effectiveness may still be achieved.

•

We examined whether stress boosts the long-term effects of degraded memories.

•

Dual-task interventions robustly produce immediate memory degrading effects.

•

Immediate memory degrading effects dissolve over time (24h later).

•

The stress manipulation increased cardiovascular/neuroendocrine stress responses.

•

Acute stress did not boost potential long-term effects of dual-task interventions.

The effectiveness of dual-task interventions for modulating emotional memories in the laboratory: A meta-analysis

Dual-tasks (e.g., making horizontal eye-movements) while recollecting a memory are often used both in the lab and the clinic (such as in EMDR therapy) to attenuate emotional memories and intrusive mental images. According to working memory theory, dual-task interventions are effective because they limit cognitive resources available for the processing of emotional memories. However, there is still ongoing debate about the extent to which and under what conditions dual-task interventions are effective to interfere with emotional memories. In this meta-analysis, we assessed k = 53 laboratory studies investigating the effects of dual-task interventions on negative and positive memories. The effects were measured with the raw mean reduction in vividness and emotionality self-report ratings of emotional memories before compared to after the intervention on 100-point rating scales. Results showed that the dual-task interventions made both negative and positive memories less vivid (mean reduction negative images = 9.18, 95% CI [7.06, 11.29]; mean reduction positive images = 11.73, 95% CI [8.59, 14.86]) and less emotional (mean reduction negative images = 6.22, 95% CI [4.50, 7.94]; mean reduction positive images = 6.71, 95% CI [2.21, 11.20]). Several moderators were tested and are discussed in the light of working memory theory.

A Model for the Flash Technique Based on Working Memory and Neuroscience Research

Research has shown that the Flash Technique (FT) appears to reduce memory-related disturbance and may reduce symptoms of posttraumatic stress disorder. This paper discusses the connections between FT and eye movement desensitization and reprocessing (EMDR) therapy. In FT, clients remind themselves of a traumatic memory without dwelling on it and focus instead on a positive engaging focus and then blink their eyes when prompted. This paper summarizes numerous models describing how the brain processes traumatic material and presents a model for how FT may work in the brain. It proposes that during the blinking, the patient's periaqueductal gray (PAG) may take over, sensing the reminder of the traumatic memory and reflexively triggering the amygdala. In Porges's neuroception model, the PAG assesses danger without going through the conscious brain. Recent fMRI data show that for patients with posttraumatic stress disorder, there is enhanced connectivity from the amygdala to the left hippocampus. Thus, triggering the amygdala may, in turn, activate the left hippocampus, which may then provide a brief access to the traumatic memory. Given the brief access, there is insufficient time for the amygdala to go into overactivation. The client remains calm while accessing the traumatic memory, thus setting up the prediction error necessary for possible memory reconsolidation. This process is repeated during blinking in FT allowing memory reconsolidation to proceed. This model requires experimental confirmation.

The Computational, Pharmacological, and Physiological Determinants of Sensory Learning under Uncertainty

The ability to represent and respond to uncertainty is fundamental to human cognition and decision-making. Noradrenaline (NA) is hypothesized to play a key role in coordinating the sensory, learning, and physiological states necessary to adapt to a changing world, but direct evidence for this is lacking in humans. Here, we tested the effects of attenuating noradrenergic neurotransmission on learning under uncertainty. We probed the effects of the β-adrenergic receptor antagonist propranolol (40 mg) using a between-subjects, double-blind, placebo-controlled design. Participants performed a probabilistic associative learning task, and we employed a hierarchical learning model to formally quantify prediction errors about cue-outcome contingencies and changes in these associations over time (volatility). Both unexpectedness and noise slowed down reaction times, but propranolol augmented the interaction between these main effects such that behavior was influenced more by prior expectations when uncertainty was high. Computationally, this was driven by a reduction in learning rates, with people slower to update their beliefs in the face of new information. Attenuating the global effects of NA also eliminated the phasic effects of prediction error and volatility on pupil size, consistent with slower belief updating. Finally, estimates of environmental volatility were predicted by baseline cardiac measures in all participants. Our results demonstrate that NA underpins behavioral and computational responses to uncertainty. These findings have important implications for understanding the impact of uncertainty on human biology and cognition.

Taxing working memory to modulate mental imagery of the 9/11 terrorist attacks following media exposure during childhood: a pilot study in young adult UK residents

BACKGROUND AND OBJECTIVES

Media trauma in civilians is linked to intrusive imagery-based memory symptoms. We investigated whether mental imagery of the 9/11 terrorist attacks following media exposure is dampened by taxing working memory (WM).

METHODS

Forty-five young adult UK residents, who were exposed to the 9/11 terrorist attacks as children via the media, identified a personally-relevant mental image of the attacks. They were then randomly allocated to: (1) recall + Tetris, (2) recall + eye movements (EMs), or (3) recall-only. Ratings on imagery vividness and emotionality were provided at three time points: pre-, post-manipulations, and at 24-hr follow-up.

RESULTS

Repeated measures ANOVAs revealed that recall + Tetris and recall + EMs (relative to recall-only) significantly reduced imagery vividness and emotionality from pre- to post-manipulations, but not to follow-up.

LIMITATIONS

A passive control group is needed to fully rule out the role of natural memory decay; the follow-up was exploratory and took place outside the laboratory with reduced experimental control.

CONCLUSIONS

Aversive memory imagery from media trauma in civilians can be dampened by taxing WM, at least temporarily, which could be therapeutically useful. The use of such cognitive techniques may also hold relevance for public health approaches to address the impact of collective trauma.

The effect of EMDR versus EMDR 2.0 on emotionality and vividness of aversive memories in a non-clinical sample

Background: Eye movement desensitization and reprocessing (EMDR) therapy is a treatment meant to reduce vividness and emotionality of distressing memories. There is accumulating evidence that working memory taxation is the core of the working mechanism of EMDR therapy and that EMDR derives its effect by taxing the working memory (WM) with a dual task while actively keeping a disturbing memory in mind. From a theoretical stance, based upon assumptions derived from the WM theory, the effectiveness of EMDR therapy could be improved by several adaptations. Objectives: To test the assumption that integrating these elements into the standard EMDR protocol would enhance EMDR therapy, this adapted version of EMDR (i.e. EMDR 2.0), was compared to standard EMDR in a laboratory setting. It was hypothesized that EMDR 2.0 would be more efficacious than standard EMDR, and show a greater decrease in emotionality and vividness than standard EMDR therapy. Our second hypothesis was that EMDR 2.0 would be more efficient than standard EMDR in that this variant needs less session time and a smaller number of sets (i.e. approximately 30 seconds of WM taxation). Method: Non-clinical participants (N = 62, 79% female, mean age = 35.21) with a disturbing autobiographical memory were randomly allocated to receive either EMDR or EMDR 2.0. Emotionality and vividness of the memory were measured pre- and post-intervention, and at 1- and 4-week follow-up. Results: The results showed no difference between EMDR and EMDR 2.0 in decreasing emotionality and vividness, and no difference in session time. However, participants in the EMDR 2.0 condition needed fewer sets than those in the standard EMDR condition. Conclusion: The notion that EMDR 2.0 is more efficient is partially supported by the results showing participants needed less sets than in standard EMDR to reach the same results. Future research with clinical samples is warranted.

Making eye movements during imaginal exposure leads to short-lived memory effects compared to imaginal exposure alone

BACKGROUND AND OBJECTIVES

A plethora of eye movement desensitization and reprocessing (EMDR) analogue studies has shown that, in the short term, making eye movements (EM) during brief imaginal exposure ("recall + EM") blurs memories more than just imaginal exposure ("recall only"). Yet, results of the few studies that included a follow-up test are inconsistent. We improved this paradigm's ecological validity by including an extended intervention phase and multiple assessments per phase. We hypothesized that recall + EM results in larger immediate and 24 h reductions in memory vividness, negative valence, and distress than recall alone. We explored the persistence of the effects, as well as the predictive value of memory characteristics and individual differences.

METHODS

Students (N = 100) selected a negative autobiographical memory and were randomized to recall + EM or recall alone; both interventions lasted 32 intervals of 24s. During the interventions they rated the memory after every four intervals.

RESULTS

After 4 × 24s intervention, recall + EM resulted in memory deflation, while recall only caused memory inflation. After the full intervention (i.e., 32 × 24s), both conditions resulted in immediate and 24 h reductions on all outcome measures. Crucially, memory effects in the recall + EM condition partially relapsed 24 h later, while the effects in the recall only condition persisted. Change patterns were hardly explained by predictive variables.

LIMITATIONS

We used a non-clinical sample; replication in clinical samples is warranted.

CONCLUSION

Making EM during imaginal exposure leads to short-lived effects compared to imaginal exposure alone. However, EM may offer a response aid for those who avoid imaginal exposure.

Addiction-Focused Eye Movement Desensitization and Reprocessing Therapy as an Adjunct to Regular Outpatient Treatment for Alcohol Use Disorder: Results From a Randomized Clinical Trial

BACKGROUND

This study examined the feasibility, safety, and efficacy of addiction-focused eye movement desensitization and reprocessing (AF-EMDR) treatment, as an add-on intervention to treatment as usual (TAU).

METHODS

Adult outpatients with alcohol use disorder (AUD) (N = 109) who already received or had just started with TAU (Community Reinforcement Approach) were recruited at 6 outpatient addiction care facilities. They were randomly assigned to either TAU + 7 weekly 90-minute sessions of AF-EMDR (N = 55) or TAU-only (N = 54). Assessments were made at baseline, after AF-EMDR therapy (+ 8 weeks in the TAU-only group), and at 1- and 6-month follow-up. The primary outcomes were changes in drinking behavior as reported by the participant and biomarker indices.

RESULTS

Data were analyzed as intent-to-treat with linear mixed models. Additionally, sensitivity analyses were performed. No group or interaction effects were found for any of the outcome variables. Only limited change over time was seen with regard to indices of personal and societal recovery and in some secondary indices of clinical recovery (craving, desire thinking, and rumination). Reliable Change Index calculations showed that more TAU-only participants showed clinical improvement with regard to alcohol consumption while a somewhat higher proportion of participants in the TAU + AF-EMDR group experienced less craving. The acceptability, safety, and feasibility of the treatments received in both groups were comparable.

CONCLUSIONS

There was no add-on effect of AF-EMDR on TAU with regard to drinking behavior in outpatients with an AUD. Possible explanations are discussed. Future studies should first establish proof of principle regarding the potential of AF-EMDR therapy to disrupt operant learning and habits relevant in addiction.

The effects of dual-tasks on intrusive memories following analogue trauma

Patients with post-traumatic stress disorder frequently and involuntarily experience intrusions, which are strongly linked to the trauma hotspot. Voluntary memory characteristics (i.e., vividness and unpleasantness) of this hotspot can be reduced by performing a dual-task, such as making horizontal eye movements, which is frequently used in Eye Movement Desensitization and Reprocessing. We tested whether such dual-task interventions would also reduce involuntary memory (i.e., intrusions). Moreover, we examined if changes in hotspot vividness and unpleasantness predicted intrusion frequency. Additionally, we examined whether the effects were dependent on dual-task modality. We tested this in three experiments. Participants watched a trauma film and performed one of the interventions 10-min post-film (1) Recall + Eye movements, (2) Recall + Counting, or (3) No-Task Control. Before and after the intervention, participants rated the hotspot vividness and unpleasantness. They recorded intrusive memories about the film in a diary for a week. Unexpectedly, we found that hotspot vividness and unpleasantness ratings were not affected by the intervention. However, the prolonged (experiment 2), but not standard (experiment 1), dual-task interventions resulted in a lower number of intrusions, regardless of modality. However, this effect was not replicated in experiment 3. We discuss potential explanations and present suggestions for future research.

Treatment of Alcohol Use Disorder With Adjunctive Addiction-Focused EMDR: A Feasibility Study

Alcohol use disorder (AUD) treatment presents a serious challenge. While there are evidence-based treatment options available, there is still a substantial group of treatment-seeking patients who do not complete regular AUD treatment. In addition, accomplished reductions in drinking behavior during treatment are often lost posttreatment. Therefore, both feasibility and effectiveness of AUD treatment are important. Innovative interventions, such as addiction-focused eye movement desensitization and reprocessing (AF-EMDR) therapy (Markus & Hornsveld, 2017), may hold promise as adjunctive treatments. Here the results of a feasibility study of adjunctive AF-EMDR therapy in outpatients with AUD and without comorbid posttraumatic stress disorder (PTSD) are described. A multiple baseline design across four participants was used. They received AF-EMDR alongside treatment as usual (TAU). The results suggest that, while challenging, AF-EMDR therapy in outpatients with AUD can be safe, acceptable, and feasible. Whether it is effective, under what conditions and for whom, requires further study however.

Effects of "Visual Schema Displacement Therapy" (VSDT), an abbreviated EMDR protocol and a control condition on emotionality and vividness of aversive memories: Two critical analogue studies

BACKGROUND AND OBJECTIVES

Visual Schema Displacement Therapy (VSDT) is a novel therapy which has been described as a treatment for stress and dysfunction caused by a traumatic event. Although its developers claim this therapy is quicker and more beneficial than other forms of trauma therapy, its effectiveness has not been tested.

METHODS

We compared the efficacy of VSDT to an abbreviated EMDR protocol and a non-active control condition (CC) in two studies. In Study 1 participants (N = 30) were asked to recall three negative emotional memories under three conditions: VSDT, EMDR, and a CC, each lasting 8 min. Emotional disturbance and vividness of the memories were rated before and after the (within group) conditions. The experiment was replicated using a between group study. In Study 2 participants (N = 75) were assigned to one of the three conditions, and a follow-up after 6-8 days was added.

RESULTS

In both studies VSDT and EMDR were superior to the CC in reducing emotional disturbance, and VSDT was superior to EMDR. VSDT and EMDR outperformed the CC in terms of reducing vividness.

LIMITATION

Results need to be replicated in clinical samples.

CONCLUSIONS

It is unclear how VSDT yields positive effects, but irrespective of its causal mechanisms, VSDT warrants clinical exploration.

A comparison of physical comorbidities in patients with posttraumatic stress disorder developed after a terrorist attack or other traumatic event

No study investigated whether the presence of specific medical comorbidities is associated with the type of traumatic event, in particular with terrorist attack (TA). In a group of subjects with posttraumatic stress disorder (PTSD), the current study investigated the association between the types of traumatic event (TA vs. other traumatic event [OTE]) and medical comorbidities, controlling for sex and PTSD duration. The Mini International Neuropsychiatric Interview, the Clinician-Administered PTSD Scale, and the Davidson Trauma Scale were administered to 84 subjects diagnosed with PTSD. Thirty-nine were victims of TA and 45 victims of OTE. TA was associated with higher prevalence of neoplasms (β = 2.60, p = 0.02). Females were more protected than males from circulatory system comorbidities (β = 1.47, p = 0.04), while PTSD duration was associated with higher prevalence of such comorbidities (β = 0.005, p = 0.01). Females showed a higher prevalence of neoplasms than males (β = 2.50, p = 0.02). Female sex was protective against metabolic syndrome (β = -1.79, p = 0.02). Patients with PTSD due to TA and female patients should be considered for their higher prevalence of neoplasms, while male patients and those with higher symptom duration should be monitored for circulatory disease and metabolic syndrome. Symptom duration might be associated with circulatory and metabolic disease. Implications for tailored and timely psychopharmacological and psychotherapeutic intervention for PTSD are discussed focusing on these specific medical comorbidities.

How Does Eye Movement Desensitization and Reprocessing Therapy Work? A Systematic Review on Suggested Mechanisms of Action

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.

Cognitive Behavioral Therapy vs. Eye Movement Desensitization and Reprocessing for Treating Panic Disorder: A Randomized Controlled Trial

Objective: Cognitive Behavioral Therapy (CBT) is an effective intervention for patients with panic disorder (PD). From a theoretical perspective, Eye Movement Desensitization and Reprocessing (EMDR) therapy could also be useful in the treatment of PD because: (1) panic attacks can be experienced as life threatening; (2) panic memories specific to PD resemble traumatic memories as seen in posttraumatic stress disorder (PTSD); and (3) PD often develops following a distressing life event. The primary objective of this Randomized Controlled Trial (RCT), was to compare EMDR therapy with CBT for PD and determine whether EMDR is not worse than CBT in reducing panic symptoms and improving Quality Of Life (QOL). Methods: Two-arm (CBT and EMDR) parallel RCT in patients with PD (N = 84). Patients were measured at baseline (T1), directly after the last therapy session (T2), and 3 months after ending therapy (T3). Non-inferiority testing (linear mixed model with intention-to-treat analysis) was applied. Patients were randomly assigned to 13 weekly 60-min sessions of CBT (N = 42) or EMDR therapy (N = 42). Standard protocols were used. The primary outcome measure was severity of PD at T3, as measured with the Agoraphobic Cognitions Questionnaire (ACQ), the Body Sensations Questionnaire (BSQ), and the Mobility Inventory (MI). The secondary outcome measure was QOL, as measured with the World Health Organization Quality of Life short version (WHOQOL-Bref), at T3. Results: The severity of PD variables ACQ and BSQ showed non-inferiority of EMDR to CBT, while MI was inconclusive (adjusted analyses). Overall QOL and general health, Psychological health, Social relationships, and Environment showed non-inferiority of EMDR to CBT, while Physical health was inconclusive. Conclusion: EMDR therapy proved to be as effective as CBT for treating PD patients. Trial Registration: Dutch Trial Register, Nr. 3134 http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3134.