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Melani MS, Paiva JM, Mendlowicz MV, Vilete L, Luz MP, Ventura PR, Passos RBF, Berger W. Are There Differences Among Evidence-Based Psychotherapies for Treating Different DSM-5 PTSD Symptom Clusters? A Systematic Review and Meta-analysis of Controlled Clinical Trials. J Nerv Ment Dis 2024; 212:332-343. [PMID: 38810096 DOI: 10.1097/nmd.0000000000001769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
ABSTRACT Posttraumatic stress disorder (PTSD) is a heterogeneous disease defined by four Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) symptom clusters: reexperiencing, avoidance, negative alterations in cognitions and mood, and hyperarousal. There are effective evidence-based psychotherapies (EBPs) for PTSD. However, given the variety of PTSD clinical presentations, we conducted the first meta-analysis investigating whether DSM-5 PTSD symptom clusters show different responses to EBPs. We systematically reviewed the literature for controlled clinical trials in five databases, performed a meta-analysis, and evaluated the methodological quality of the studies. We screened 633 studies and included seven. Three showed high risk, two showed some concerns, and one showed a low risk of bias. The symptom clusters do not seem to respond differently to EBPs (SMD cluster B: -0.40; 95% confidence interval [CI], -0.87 to 0.08; cluster C: -0.49; 95% CI, -0.90 to -0.08; cluster D: -0.44; 95% CI, -0.94 to 0.05; cluster E: -0.54; 95% CI, -1.07 to -0.0), even when analyzed by the therapeutic focuses. The findings dovetail nicely with the network theory of PTSD symptom, as although it is a heterogeneous disorder, the EBPs seem to promote a kind of cascade of symptom improvement.
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Affiliation(s)
- Marina S Melani
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro
| | - Jéssica M Paiva
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro
| | | | - Liliane Vilete
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro
| | - Mariana P Luz
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro
| | - Paula Rui Ventura
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro
| | | | - William Berger
- Department of Psychiatry and Legal Medicine, Institute of Psychiatry, Universidade Federal do Rio de Janeiro
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Thunnissen MR, de Jong PJ, Rijkeboer MM, Voncken MJ, Nauta MH. Interventions Targeting Negative Mental Imagery in Social Anxiety: A Systematic Review and Meta-Analysis of Characteristics and Outcomes. Clin Psychol Psychother 2024; 31:e2996. [PMID: 38769942 DOI: 10.1002/cpp.2996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/19/2024] [Accepted: 04/16/2024] [Indexed: 05/22/2024]
Abstract
Psychological treatment for social anxiety disorder (SAD) has been found to be less effective than for other anxiety disorders. Targeting the vivid and distressing negative mental images typically experienced by individuals with social anxiety could possibly enhance treatment effectiveness. To provide both clinicians and researchers with an overview of current applications, this systematic review and meta-analysis aimed to evaluate the possibilities and effects of imagery-based interventions that explicitly target negative images in (sub)clinical social anxiety. Based on a prespecified literature search, we included 21 studies, of which 12 studies included individuals with a clinical diagnosis of SAD. Imagery interventions (k = 28 intervention groups; only in adults) generally lasted one or two sessions and mostly used imagery rescripting with negative memories. Others used eye movement desensitization and reprocessing and imagery exposure with diverse intrusive images. Noncontrolled effects on social anxiety, imagery distress and imagery vividness were mostly large or medium. Meta-analyses with studies with control groups resulted in significant medium controlled effects on social anxiety (d = -0.50, k = 10) and imagery distress (d = -0.64, k = 8) and a nonsignificant effect on imagery vividness. Significant controlled effects were most evident in individuals with clinically diagnosed versus subclinical social anxiety. Overall, findings suggest promising effects of sessions targeting negative mental images. Limitations of the included studies and the analyses need to be considered. Future research should examine the addition to current SAD treatments and determine the relevance of specific imagery interventions. Studies involving children and adolescents are warranted.
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Affiliation(s)
- Marjolein R Thunnissen
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
- Child Study Center, Accare, Groningen, The Netherlands
| | - Peter J de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Marleen M Rijkeboer
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Marisol J Voncken
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Maaike H Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
- Child Study Center, Accare, Groningen, The Netherlands
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de Jongh A, de Roos C, El-Leithy S. State of the science: Eye movement desensitization and reprocessing (EMDR) therapy. J Trauma Stress 2024; 37:205-216. [PMID: 38282286 DOI: 10.1002/jts.23012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 01/30/2024]
Abstract
Eye movement desensitization and reprocessing (EMDR) therapy is an evidence-based psychotherapy for posttraumatic stress disorder (PTSD), with support from more than 30 published randomized controlled trials (RCTs) demonstrating its effectiveness in both adults and children. Most international clinical practice guidelines recommend EMDR therapy as a first-line treatment for PTSD. This paper describes the current state of the evidence for EMDR therapy. We begin with a brief description of EMDR therapy and its theoretical framework. Next, we summarize the scientific support for its efficacy, effectiveness, and safety and discuss its applicability across cultures and with diverse populations. We conclude with suggestions for future directions to develop the research base and applications of EMDR therapy.
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Affiliation(s)
- Ad de Jongh
- Research Department, PSYTREC, Bilthoven, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
| | - Carlijn de Roos
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, the Netherlands
| | - Sharif El-Leithy
- Traumatic Stress Service, Springfield University Hospital, London, UK
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4
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Rameckers SA, van Emmerik AAP, Boterhoven de Haan K, Kousemaker M, Fassbinder E, Lee CW, Meewisse M, Menninga S, Rijkeboer M, Schaich A, Arntz A. The working mechanisms of imagery rescripting and eye movement desensitization and reprocessing: Findings from a randomised controlled trial. Behav Res Ther 2024; 175:104492. [PMID: 38359658 DOI: 10.1016/j.brat.2024.104492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 10/10/2023] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
We studied the mechanisms of eye movement desensitization and reprocessing (EMDR) and imagery rescripting (ImRs). We hypothesized that EMDR works via changes in memory vividness, that ImRs works via changes in encapsulated beliefs (EB), and that both treatments work via changes in memory distress. Patients (N = 155) with childhood-related posttraumatic stress disorder (Ch-PTSD) received 12 sessions of EMDR or ImRs. The vividness, distress, and EB related to the index trauma were measured with the Imagery Interview. PTSD severity was assessed with the Impact of Events Scale-Revised and the Clinician-Administered PTSD Scale for DSM-5. We conducted mixed regressions and Granger causality analyses. EMDR led to initially stronger changes in all predictors, but only for distress this was retained until the last assessment. No evidence for vividness as a predictive variable was found. However, changes in distress and EB predicted changes in PTSD severity during ImRs. These findings partially support the hypothesized mechanisms of ImRs, while no support was found for the hypothesized mechanisms of EMDR. Differences in the timing of addressing the index trauma during treatment and the timing of assessments could have influenced the findings. This study provides insight into the relative effectiveness and working mechanisms of these treatments.
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Affiliation(s)
- Sophie A Rameckers
- Department of Clinical Psychology, University of Amsterdam, the Netherlands.
| | | | | | | | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, Kiel University, Germany
| | - Christopher W Lee
- Faculty of Health and Medical Sciences, University of Western Australia, Australia
| | | | | | - Marleen Rijkeboer
- Department of Clinical Psychology, University of Amsterdam, the Netherlands; Department of Clinical Psychological Science, Maastricht University, the Netherlands
| | - Anja Schaich
- Department of Psychiatry and Psychotherapy, Kiel University, Germany; Department of Psychiatry and Psychotherapy, Lübeck University, Germany
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, the Netherlands
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5
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Meckling HI, Nauta MH, van Hout WJPJ, Wessel I. The effects of eye movements on the content and characteristics of unpleasant autobiographical memories: an extended replication study. Memory 2024:1-19. [PMID: 38300721 DOI: 10.1080/09658211.2024.2307925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024]
Abstract
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.
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Affiliation(s)
- H I Meckling
- Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - M H Nauta
- Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - W J P J van Hout
- Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - I Wessel
- Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
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Tolin DF, McKay D, Olatunji BO, Abramowitz JS, Otto MW. On the importance of identifying mechanisms and active ingredients of psychological treatments. Behav Res Ther 2023; 170:104425. [PMID: 37913558 PMCID: PMC11034847 DOI: 10.1016/j.brat.2023.104425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
This commentary addresses the thought-provoking article by Lorenzo-Luaces (in press). We review areas of both agreement and disagreement with the author's points, noting that readers should not infer that research into active ingredients and mechanisms is pointless. We conclude with a call for more research into the mechanisms of therapeutic change and the active ingredients of therapeutic interventions, with the aim of disseminating treatments that are both effective and efficient.
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Affiliation(s)
- David F Tolin
- The Institute of Living, Yale University School of Medicine, United States.
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Jauch I, Kamm J, Benn L, Rettig L, Friederich HC, Tesarz J, Kuner T, Wieland S. 2MDR, a Microcomputer-Controlled Visual Stimulation Device for Psychotherapy-Like Treatments of Mice. eNeuro 2023; 10:10/6/ENEURO.0394-22.2023. [PMID: 37268421 DOI: 10.1523/eneuro.0394-22.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 06/04/2023] Open
Abstract
Post-traumatic stress disorder and other mental disorders can be treated by an established psychotherapy called Eye Movement Desensitization and Reprocessing (EMDR). In EMDR, patients are confronted with traumatic memories while they are stimulated with alternating bilateral stimuli (ABS). How ABS affects the brain and whether ABS could be adapted to different patients or mental disorders is unknown. Interestingly, ABS reduced conditioned fear in mice. Yet, an approach to systematically test complex visual stimuli and compare respective differences in emotional processing based on semiautomated/automated behavioral analysis is lacking. We developed 2MDR (MultiModal Visual Stimulation to Desensitize Rodents), a novel, open-source, low-cost, customizable device that can be integrated in and transistor-transistor logic (TTL) controlled by commercial rodent behavioral setups. 2MDR allows the design and precise steering of multimodal visual stimuli in the head direction of freely moving mice. Optimized videography allows semiautomatic analysis of rodent behavior during visual stimulation. Detailed building, integration, and treatment instructions along with open-source software provide easy access for inexperienced users. Using 2MDR, we confirmed that EMDR-like ABS persistently improves fear extinction in mice and showed for the first time that ABS-mediated anxiolytic effects strongly depend on physical stimulus properties such as ABS brightness. 2MDR not only enables researchers to interfere with mouse behavior in an EMDR-like setting, but also demonstrates that visual stimuli can be used as a noninvasive brain stimulation to differentially alter emotional processing in mice.
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Affiliation(s)
- Isa Jauch
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, 69120 Heidelberg, Germany
| | - Jan Kamm
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, 69120 Heidelberg, Germany
| | - Luca Benn
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, 69120 Heidelberg, Germany
| | - Lukas Rettig
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, 69120 Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal and Psychosomatic Medicine, Heidelberg University and Heidelberg University Hospital, 69115 Heidelberg, Germany
| | - Jonas Tesarz
- Department of General Internal and Psychosomatic Medicine, Heidelberg University and Heidelberg University Hospital, 69115 Heidelberg, Germany
| | - Thomas Kuner
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, 69120 Heidelberg, Germany
| | - Sebastian Wieland
- Department of Functional Neuroanatomy, Institute for Anatomy and Cell Biology, Heidelberg University, 69120 Heidelberg, Germany
- Department of General Internal and Psychosomatic Medicine, Heidelberg University and Heidelberg University Hospital, 69115 Heidelberg, Germany
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8
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Xu Z, Hu J, Wang Y. Bilateral eye movements disrupt the involuntary perceptual representation of trauma-related memories. Behav Res Ther 2023; 165:104311. [PMID: 37037182 DOI: 10.1016/j.brat.2023.104311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/29/2023] [Accepted: 04/07/2023] [Indexed: 04/12/2023]
Abstract
Bilateral eye movement (EM) is a critical component in eye movement desensitization and reprocessing (EMDR), an effective treatment for post-traumatic stress disorder. However, the role of bilateral EM in alleviating trauma-related symptoms is unclear. Here we hypothesize that bilateral EM selectively disrupts the perceptual representation of traumatic memories. We used the trauma film paradigm as an analog for trauma experience. Nonclinical participants viewed trauma films followed by a bilateral EM intervention or a static Fixation period as a control. Perceptual and semantic memories for the film were assessed with different measures. Results showed a significant decrease in perceptual memory recognition shortly after the EM intervention and subsequently in the frequency and vividness of film-related memory intrusions across one week, relative to the Fixation condition. The EM intervention did not affect the explicit recognition of semantic memories, suggesting a dissociation between perceptual and semantic memory disruption. Furthermore, the EM intervention effectively reduced psychophysiological affective responses, including the skin conductance response and pupil size, to film scenes and subjective affective ratings of film-related intrusions. Together, bilateral EMs effectively reduce the perceptual representation and affective response of trauma-related memories. Further theoretical developments are needed to elucidate the mechanism of bilateral EMs in trauma treatment.
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Affiliation(s)
- Zhenjie Xu
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310028, Zhejiang, China
| | - Jie Hu
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310028, Zhejiang, China
| | - Yingying Wang
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310028, Zhejiang, China.
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van Schie K, van Veen SC. Omitting continuous memory recall from dual-task interventions does not reduce intervention effectiveness. Behav Res Ther 2023; 164:104291. [PMID: 36933473 DOI: 10.1016/j.brat.2023.104291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/19/2023] [Accepted: 03/09/2023] [Indexed: 03/11/2023]
Abstract
In Eye Movement Desensitization and Reprocessing a patient recalls a traumatic memory, while simultaneously performing a dual-task (e.g., making horizontal eye movements, tapping a pattern). Earlier lab studies show that increasing the load of a dual-task -and leaving fewer resources for memory recall-results in larger decreases in memory vividness and emotionality compared to control conditions. Therefore, we investigated whether it is necessary to continuously and deliberately recall the memory next to performing high taxing dual-tasks. In two online experiments, participants (N = 172, N = 198) recalled a negative autobiographical memory and were randomly assigned to (1) Memory Recall + Dual-Tasks, (2) Dual-Tasks Only, or (3) No Intervention Control. The dual-tasks were complex pattern tapping and spelling out loud. Before and after the intervention the memory was rated on vividness, emotionality, and accessibility. High taxing dual-tasks, regardless of whether there was continuous memory recall, resulted in the largest reductions in all dependent variables compared to control. Unexpectedly, there was no evidence that the addition of continuous memory recall added to these reductions. These results suggest that continuous memory recall might not, or only minimally be needed for the beneficial effects of the dual-task procedure in EMDR might not be beneficial per se. We discuss the necessity of memory (re)activation, alternative explanations, and implications for practice.
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Affiliation(s)
- Kevin van Schie
- Department of Psychology, Education & Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom; Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
| | - Suzanne C van Veen
- Kenter Jeugdhulp, Hoofddorp, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
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Solomon RM. Francine Shapiro (1948-2019). EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2023. [DOI: 10.1016/j.ejtd.2022.100309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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[Resource-Oriented Narrative TraumaTherapy (Resonat): Treating Complex Trauma Disorders in Children and Adolescents Gently and Specifically]. Prax Kinderpsychol Kinderpsychiatr 2023; 72:96-112. [PMID: 36744502 DOI: 10.13109/prkk.2023.72.2.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Resource-oriented narrative trauma therapy (ResonaT; Hiller u. Hensel, 2019) is an innovative and creative approach within existing narrative trauma procedures. It is based on the three core elements of modern trauma therapy (actualisation, resource activation, dual attention) and invokes the neurobiological self-healing mechanism of memory reconsolidation. Due to its low demands on the children, its resourceful and gentle actualisation of the traumatic material, the distance-creating use of animal protagonists and a supportive therapeutic relationship, it is particularly suitable for children and adolescents with complex trauma sequelae. Through specific structuring (orientation to the leading symptoms, elaboration of central basic emotions, allocation of current triggers to earlier traumatic events), the narratives can be formulated precisely for each child.The workload for the therapists is made considerably easier by the availability of around 100 elaborated, topic-specific narratives.
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Wadji DL, Martin-Soelch C, Camos V. Can working memory account for EMDR efficacy in PTSD? BMC Psychol 2022; 10:245. [PMID: 36320044 PMCID: PMC9623920 DOI: 10.1186/s40359-022-00951-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/10/2022] [Accepted: 10/10/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Although eye movement desensitization and reprocessing (EMDR) has been shown to be effective in the treatment of PTSD for years, it remains controversial due to the lack of understanding of its mechanisms of action. We examined whether the working memory (WM) hypothesis -the competition for limited WM resources induced by the dual task attenuates the vividness and emotionality of the traumatic memory - would provide an explanation for the beneficial effect induced by bilateral stimulation. METHODS We followed the Prisma guidelines and identified 11 articles categorized in two types of designs: studies involving participants with current PTSD symptoms and participants without PTSD diagnosis. RESULTS Regardless of the types of studies, the results showed a reduction of vividness and emotionality in the recall of traumatic stimuli under a dual-task condition compared to a control condition, such as recall alone. However, two studies used a follow-up test to show that this effect does not seem to last long. CONCLUSION Our results provide evidence for the WM hypothesis and suggest that recalling a traumatic memory while performing a secondary task would shift the individual's attention away from the retrieval process and result in a reduction in vividness and emotionality, also associated with the reduction of symptoms.
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Affiliation(s)
- Dany Laure Wadji
- grid.8534.a0000 0004 0478 1713I-Reach Lab, Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland ,grid.8534.a0000 0004 0478 1713Department of Psychology, University of Fribourg, Rue P.-A.-de Faucigny 2, CH-1700 Fribourg, Switzerland
| | - C. Martin-Soelch
- grid.8534.a0000 0004 0478 1713I-Reach Lab, Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - V. Camos
- grid.8534.a0000 0004 0478 1713W-MOVE (Working meMOry deVElopment) lab, Department of Psychology, University of Fribourg, Fribourg, Switzerland CH-1700
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Stingl M, Sammer G, Hanewald B, Zinsser F, Tucha O, Pape VR. Constant installation of present orientation and safety (CIPOS) - subjective and physiological effects of an ultrashort-term intervention combining both stabilizing and confrontational elements. Front Psychol 2022; 13:1035371. [PMID: 36389546 PMCID: PMC9665111 DOI: 10.3389/fpsyg.2022.1035371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/11/2022] [Indexed: 09/19/2023] Open
Abstract
Objectives Constant Installation of Present Orientation and Safety (CIPOS) is a Eye Movements Desensitization and Reprocessing (EMDR)-derived technique, which is often used to prepare for the treatment of post-traumatic stress disorder (PTSD). It differs from the latter by involving cyclically recurring exercises in reorientation to the present, interspersed between brief periods of exposure to the traumatic material.While EMDR is well established as a therapeutic method, the efficacy and mechanisms of action of CIPOS have not been investigated so far. In this pilot study, an experimental setting was used to record the subjective and physiological effects of the CIPOS intervention compared to a control condition with pure mental exposition. Methods The study was performed on 30 healthy volunteers aged from 20 to 30 years. Distress was induced using audio files of subjectively stressful situations. Subjective distress was measured via the Subjective Units of Distress Scale (SUD), while physiological indicators (noise-induced startle reflex, skin conductance level) were used as measures for objective stress. For each condition, pre- and post-intervention comparisons were calculated. Results In both groups, startle reflex potentiation and mean skin conductance level significantly decreased. In the group with CIPOS intervention, but not in the control group, a significant decrease in the SUD value was found. Conclusion and significance The results show that the CIPOS technique is as effective as pure mental exposition in reducing physiological stress. In addition, a superiority in reducing subjective distress (indicating a simplified reassessment of the stressful material) was found compared to pure mental exposition. Possible explanations of these effects are discussed.
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Affiliation(s)
- Markus Stingl
- Center for Psychiatry and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Gebhard Sammer
- Center for Psychiatry and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Bernd Hanewald
- Center for Psychiatry and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Franziska Zinsser
- Center for Psychiatry and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Oliver Tucha
- Clinic and Policlinic for Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
| | - Valeska Reichel Pape
- Center for Psychiatry and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
- Clinic and Policlinic for Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
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Brennstuhl MJ, Pascale T, Ann RJ, Camille Louise T, Lydia P, Christine R, Cyril T. Treating COVID-19 patients with EMDR: A pilot study. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [PMID: 37521717 PMCID: PMC9065594 DOI: 10.1016/j.ejtd.2022.100276] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The threatening and unpredictable nature of the coronavirus disease (COVID-19) pandemic presents unprecedented mental-health challenges worldwide. For those directly affected by the disease, the stress of facing potential death and overcoming fear can overwhelm their personal coping resources and can lead to symptoms of posttraumatic stress disorder and anxiety and depression. The objective of our study was to investigate the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) therapy to reduce anxio-depressive symptoms, distress and fear of the unknown in COVID-19 patients hospitalized for intensive care. A pilot study was conducted with 21 participants hospitalized for COVID-19 (11 women and 10 men) who were treated with EMDR therapy and assessed for anxio-depressive symptoms (Hospital Anxiety and Depression Scale, HADS), intensity of distress (Subjective Units of Disturbance, SUD scale), and levels of experienced fear (i.e., fear of the unknown) (Multidimensional Assessment of COVID-19-Related Fears, MAC-RF). After the 4-session treatment, the EMDR therapy showed to be effective in reducing all of the evaluated symptoms in all patients and allowed for stabilization. All patients maintained improved psychological states for one week following the four sessions. EMDR therapy has been shown to be an effective strategy for helping patients process exposure to adverse events by relieving symptoms of acute stress and trauma. EMDR is a focused approach that with as few as 4 sessions can strengthen adaptive coping strategies for dealing with an ongoing situation, restore optimism and can rapidly prevent the onset of potentially long-lasting psychological disorders.
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Bursnall M, Thomas BD, Berntsson H, Strong E, Brayne M, Hind D. Clinician and Patient Experience of Internet-Mediated Eye Movement Desensitisation and Reprocessing Therapy. JOURNAL OF PSYCHOSOCIAL REHABILITATION AND MENTAL HEALTH 2022; 9:251-262. [PMID: 35136713 PMCID: PMC8812350 DOI: 10.1007/s40737-022-00260-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/14/2022] [Indexed: 11/26/2022]
Abstract
Many eye movement desensitization and reprocessing (EMDR) therapists moved their practice online during COVID-19. We conducted surveys and interviews to understand the implementation and acceptability of online EMDR therapy. From 17 June to 2nd August 2021 an online survey was open to EMDR therapists from the EMDR Association UK & Ireland and EMDR International Association email lists, and, through them, their clients. Questions related to determinants of implementation (for therapists) and acceptability (for clients) of online EMDR. Semi-structured interviews were conducted with a sample of therapist respondents to provide a deeper understanding of survey responses. Survey responses were received from therapists (n = 562) from five continents, and their clients (n = 148). 88% of clients responded as being extremely or very comfortable receiving EMDR therapy online. At the initial point of ‘social distancing’, 54% of therapists indicated strong or partial reluctance to deliver online EMDR therapy compared to 11% just over one year later. Four fifths of therapists intended to continue offering online therapy after restrictions were lifted. Free-text responses and interview data showed that deprivation and clinical severity could lead to exclusion from online EMDR. Internet connectivity could disrupt sessions, lead to cancellations, or affect the therapy process. Therapists benefited from training in online working. Online EMDR is generally acceptable to therapists and clients, with reservations about digital exclusion, case severity, poor internet connectivity and the need for training. Further research is needed to confirm that online EMDR is clinically non-inferior to in-person working.
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Affiliation(s)
- Matthew Bursnall
- School of Health and Related Research (ScHARR), University of Sheffield. Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Benjamin D. Thomas
- School of Health and Related Research (ScHARR), University of Sheffield. Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Hannah Berntsson
- School of Health and Related Research (ScHARR), University of Sheffield. Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | | | | | - Daniel Hind
- School of Health and Related Research (ScHARR), University of Sheffield. Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
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16
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van Schie K, Burghart M, Kang S, Mertens G, Smeets T. Boosting long-term effects of degraded memories via acute stress. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2022; 11:100154. [PMID: 35811786 PMCID: PMC9263399 DOI: 10.1016/j.cpnec.2022.100154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Kevin van Schie
- Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
- Corresponding author.
| | | | - Sahaj Kang
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
| | - Gaëtan Mertens
- Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
| | - Tom Smeets
- Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
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17
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Casteen EJ, Nielsen SR, Olson EA, Frederiks K, Rosso IM. Reexperiencing and anxious arousal symptoms in relation to volumes of thalamus nuclei in posttraumatic stress spectrum adults. Brain Behav 2022; 12:e2639. [PMID: 35676235 PMCID: PMC9304824 DOI: 10.1002/brb3.2639] [Citation(s) in RCA: 3] [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: 02/01/2022] [Revised: 04/24/2022] [Accepted: 05/06/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Trauma reexperiencing is dominated by recollection of sensory-perceptual elements of the trauma, pointing to involvement of the sensory thalamus. This study examined posttraumatic stress symptoms in relation to volumes of thalamic nuclei that were grouped based on their predominant functions. We hypothesized that reexperiencing, controlling for other symptom dimensions, would correlate with volumes of thalamic nuclei involved in primary and higher-order sensory processing. METHODS Seventy-two trauma-exposed adults were interviewed with the Clinician Administered PTSD Scale for DSM-IV and underwent 3T magnetic resonance imaging. Scores were derived for reexperiencing, anxious arousal, dysphoric arousal, emotional numbing, and avoidance symptoms. These were entered as simultaneous predictors in five separate regression analyses, with age, sex, and total thalamus volume as covariates, predicting volumesf of five thalamus nuclear groupings corrected for intracranial volume: Specific sensory, associative-sensory, associative-cognitive, intralaminar, and motor groupings. RESULTS Reexperiencing symptoms were significantly positively correlated with volumes of the motor thalamic grouping, which included the ventral anterior, ventral lateral, and ventromedial nuclei. Anxious arousal was significantly negatively correlated with volumes of all five thalamic groupings. CONCLUSIONS Reexperiencing symptoms were correlated with volumes of the motor thalamus, while anxious arousal symptoms were related to all thalamic subregion volumes. Thalamic nuclei involved in motor functions, including oculomotor control and motor planning, may be implicated in posttraumatic reexperiencing symptoms.
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Affiliation(s)
- Emily J Casteen
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Sienna R Nielsen
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Elizabeth A Olson
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kevin Frederiks
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA
| | - Isabelle M Rosso
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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18
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Udo I, Javinsky TR, Awani T. Eye movement desensitisation and reprocessing: part 1 – theory, procedure and use in PTSD. BJPSYCH ADVANCES 2022. [DOI: 10.1192/bja.2022.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
SUMMARY
Eye movement desensitisation and reprocessing (EMDR) is an established psychotherapy developed in the late 1980s to treat post-traumatic stress disorder (PTSD). It involves the use of repetitive eye movements or other bilateral stimulation to aid in the reprocessing of traumatic memories. It is unique in that it does not require extended exposure to or discussion of distressing memories and may result in symptom resolution in fewer sessions than other psychotherapies. In the decades since its initial development, a wealth of high-quality evidence has suggested that EMDR is a safe and effective treatment for trauma- and stress-based conditions, resulting in its inclusion in various treatment guidelines. This article reviews the theory behind how EMDR works, how it is conducted, the evidence supporting its use in the treatment of PTSD and its approved indications and contraindications.
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19
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Psychological Intervention in Women Victims of Childhood Sexual Abuse: An Open Study-Protocol of a Randomized Controlled Clinical Trial Comparing EMDR Psychotherapy and Trauma-Based Cognitive Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127468. [PMID: 35742717 PMCID: PMC9223360 DOI: 10.3390/ijerph19127468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/20/2022] [Accepted: 06/15/2022] [Indexed: 02/06/2023]
Abstract
Introduction: Most victims of sexual abuse have symptoms that may lead to post-traumatic stress disorder. This study aims to offer evidence-based psychological treatment to women who have been sexually abused earlier in life and currently have sequelae from that trauma. With this treatment, each of the women in the study will hopefully improve their overall quality of life and, more specifically, it is expected that post-traumatic stress symptoms will decrease, as found in recent studies, as well as strengthening their security, confidence, and coping with the situations they have experienced. Methods and analysis: The effect of two therapeutic approaches focused on the improvement of trauma will be evaluated in a sample of 30–50 women victims of childhood sexual abuse, with a randomized clinical trial comparing EMDR psychotherapy and trauma-focused cognitive behavioral therapy. According to the literature reviewed, both approaches will considerably improve self-esteem when the appropriate number of sessions are conducted, significantly reducing general psychiatric symptoms and depression. Furthermore, the effects are sustained over time. It should be noted that this study will be carried out comparing both therapies, analyzing both the differential benefit of each and the cumulative effect of receiving both treatments and in which order. It is also intended to demonstrate that implementing the protocols presented in this study will help improve the quality of life of the women who benefit from them, and after this study, it will be possible to replicate this program in other people with the same problems. Each of the therapeutic benefits of each of them will be analyzed, and clinical and logistical guidance will be provided to implement both, including a session-by-session protocol.
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20
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Foster NL, Harriman G. Instructions to shift eyes do not increase item-method directed forgetting. Memory 2022; 30:1118-1129. [PMID: 35689404 DOI: 10.1080/09658211.2022.2085302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Successful forgetting of recently-studied information has been shown to be positively correlated with eye movements [Lee, Y. (2018). Withdrawal of spatial overt attention following intentional forgetting: Evidence from eye movements. Memory (Hove, England), 26(4), 503-513. https://doi.org/10.1080/09658211.2017.1378360]. We tested whether eye movements caused forgetting by manipulating instructions to move eyes following forget and remember cues in item-method directed forgetting. In Experiment 1, participants were instructed to move eyes to the periphery after TBF trials or to focus on the centre where the TBF word and cue had been presented. In Experiment 2, we manipulated eye movement instructions within participants such that on half of the TBR and TBF trials participants shifted their eyes to the periphery, and on the other half of the trials, participants focused on the centre of the screen. Experiment 3 replicated Experiment 2 with an added probe task which ensured participants were moving their eyes as instructed. Results overall showed eye movements did not increase directed forgetting. Instructing participants to shift or focus eyes did not interact with the effectiveness of directed forgetting. Furthermore, metacognitive measures collected during study indicated that participants are sensitive to the significant effects of directed forgetting, but - like recall - judgments were not affected by eye movement instructions. From these findings, we concluded that eye movements do not promote intentional forgetting.
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Affiliation(s)
| | - Grace Harriman
- St. Mary's College of Maryland, St. Mary's City, MD, USA
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21
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Vanderschoot T, Dessel PV. EMDR Therapy and PTSD: A Goal-Directed Predictive Processing Perspective. JOURNAL OF EMDR PRACTICE AND RESEARCH 2022. [DOI: 10.1891/emdr-2022-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Eye movement desensitization and reprocessing (EMDR) therapy is a widely used evidence-based treatment for posttraumatic stress disorder (PTSD). The mental processes underlying both PTSD and EMDR treatment effects are often explained by drawing on processes that involve the automatic formation and change of mental associations. Recent evidence that contrasts with these explanations is discussed and a new perspective to PTSD and EMDR treatment effects is proposed that draws on automatic inferential processes and can be readily integrated with the dominant (Adaptive Information Processing) model. This new perspective incorporates insights from cognitive theories that draw on predictive processing and goal-directed processes to elucidate (changes in) automatic inferences that underlie PTSD symptoms and EMDR treatment effects. Recommendations for clinical practice are provided based on this new perspective.
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22
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Susanty E, Sijbrandij M, Srisayekti W, Suparman Y, Huizink AC. The Effectiveness of Eye Movement Desensitization for Post-traumatic Stress Disorder in Indonesia: A Randomized Controlled Trial. Front Psychol 2022; 13:845520. [PMID: 35548495 PMCID: PMC9081880 DOI: 10.3389/fpsyg.2022.845520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Post-traumatic stress disorder (PTSD) may affect individuals exposed to adversity. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based trauma-focused psychotherapy for PTSD. There is still some debate whether the eye movements (EMs) are an effective component of EMDR. The primary aim of this study was to investigate the effectiveness of Eye Movement Desensitization (EMD) treatment in reducing PTSD symptoms compared to a retrieval-only active control condition. We also investigated whether PTSD symptom reduction was associated with reductions in depression and anxiety, and improvements in quality of life. Methodology Adult PTSD patients (n = 91) were recruited at public psychological services in Jakarta, Bandung and Cimahi, Indonesia. PTSD was diagnosed with the Structured Clinical Interview for DSM-5 disorders (SCID-5). Participants were randomized into: EMD (n = 47) or retrieval-only (n = 44). EMD consisted of clinical history and treatment planning, preparation, assessment, EMs, closure, whereas retrieval-only consisted of the same elements except EMs. Data were collected at baseline (T0), 1-week post-treatment (T1), 1-month follow-up (T2), and 3-months follow-up (T3). Outcome measures included the PTSD Checklist for DSM-5 (PCL-5), Hopkins Symptoms Checklist-25 (HSCL-25), and the World Health Organization Quality of Life-BREF (WHOQoL-BREF). Data were analyzed with linear mixed model analysis in R Statistics. Results Although there were main effects of time indicating reductions for both EMD and retrieval-only in PCL-5 and HSCL-25 scores, and improvements in WHOQoL-BREF scores at T1, T2, and T3, no significant differences in PCL-5, HSCL-25, and WHOQoL-BREF total scores between the EMD and retrieval-only groups at T1, T2, and T3 were found (all group x time interaction p's > 0.005). Conclusion Within a clinical sample of PTSD patients in Indonesia, both EMD and retrieval-only was associated with reductions in symptoms of PTSD, anxiety and depression, and improvements in quality of life, although EMs did not add to the efficacy of the treatments. Further research to examine the underlying mechanisms of EMDR's effective treatment elements in clinical samples is needed. Clinical Trial Registration [www.ClinicalTrials.gov], identifier [ISRCTN55239132].
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Affiliation(s)
- Eka Susanty
- Faculty of Psychology, Universitas Jenderal Achmad Yani, Cimahi, Indonesia
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Wilis Srisayekti
- Department of General and Experimental Psychology, Faculty of Psychology, Universitas Padjadjaran, Bandung, Indonesia
| | - Yusep Suparman
- Department of Statistics, Faculty of Mathematic and Natural Sciences, Universitas Padjadjaran, Bandung, Indonesia
| | - Anja C. Huizink
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of General and Experimental Psychology, Faculty of Psychology, Universitas Padjadjaran, Bandung, Indonesia
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23
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Voogd LD, Hermans EJ. Meta‐analytic evidence for downregulation of the amygdala during working memory maintenance. Hum Brain Mapp 2022; 43:2951-2971. [PMID: 35349194 PMCID: PMC9120562 DOI: 10.1002/hbm.25828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 01/27/2022] [Accepted: 02/10/2022] [Indexed: 11/11/2022] Open
Abstract
The amygdala is a region critically implicated in affective processes. Downregulation of the amygdala is one of the hallmarks of successful emotion regulation. Top‐down inhibition of the amygdala is thought to involve activation of the executive control network. This reciprocal relationship, however, is not exclusive to explicit emotion regulation. It has been noted that any cognitively demanding task that activates executive control network may downregulate the amygdala, including a standard working memory task. Such downregulation is likely established in a load‐dependent fashion with more cognitive demand leading to stronger deactivation. Using a coordinate‐based meta‐analysis, we examined whether a standard working memory task downregulates the amygdala similarly to cognitive reappraisal. We found that a standard 2‐back working memory task indeed systematically downregulates the amygdala and that deactivated clusters strongly overlap with those observed during a cognitive reappraisal task. This finding may have consequences for the interpretation of the underlying mechanism of cognitive reappraisal: amygdala downregulation may be related to the cognitively demanding nature of reappraisal and not per se by the act of the reappraisal itself. Moreover, it raises the possibility of applying working memory tasks in clinical settings as an alternative emotion regulation strategy.
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Affiliation(s)
- Lycia D. Voogd
- Donders Institute for Brain, Cognition, and Behavior Radboud University and Radboud University Medical Center Nijmegen The Netherlands
| | - Erno J. Hermans
- Donders Institute for Brain, Cognition, and Behavior Radboud University and Radboud University Medical Center Nijmegen The Netherlands
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24
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Kredlow MA, de Voogd LD, Phelps EA. A Case for Translation From the Clinic to the Laboratory. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2022; 17:1120-1149. [PMID: 35245166 DOI: 10.1177/17456916211039852] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Laboratory procedures have been used for decades as analogues for clinical processes with the goal of improving our understanding of psychological treatments for emotional disorders and identifying strategies to make treatments more effective. This research has often focused on translation from the laboratory to the clinic. Although this approach has notable successes, it has not been seamless. There are many examples of strategies that work in the laboratory that fail to lead to improved outcomes when applied clinically. One possible reason for this gap between experimental and clinical research is a failure to focus on translation from the clinic to the laboratory. Here, we discuss potential benefits of translation from the clinic to the laboratory and provide examples of how this might be implemented. We first consider two well-established laboratory analogues (extinction and cognitive reappraisal), identify critical aspects of the related clinical procedures (exposure and cognitive restructuring) that are missing from these analogues, and propose variations to better capture the clinical process. Second, we discuss two clinical procedures that have more recently been brought into the laboratory (eye-movement desensitization and reprocessing and imagery rescripting). We conclude by highlighting potential implications of this proposed shift in focus for translational research.
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Affiliation(s)
- M Alexandra Kredlow
- Department of Psychology, Tufts University.,Department of Psychology, Harvard University
| | - Lycia D de Voogd
- Donders Institute for Brain, Cognition, and Behavior, Radboud University and Radboud University Medical Center
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25
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Reitmaier J, Schiller A, Mühlberger A, Pfaller M, Meyer M, Shiban Y. Effects of rhythmic eye movements during a virtual reality exposure paradigm for spider-phobic patients. Psychol Psychother 2022; 95:57-78. [PMID: 34490711 DOI: 10.1111/papt.12363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/09/2021] [Indexed: 11/28/2022]
Abstract
UNLABELLED Rhythmic eye movements performed during eye movement desensitization and reprocessing (EMDR) therapy have been shown to evoke a physiological de-arousal pattern. OBJECTIVES Here, we examined whether the efficacy of a virtual reality exposure therapy (VRET) paradigm for phobic patients could be improved by adding rhythmic eye movements. DESIGN Spider-phobic patients (N = 53) were randomly assigned to either a group performing rhythmic eye movements or a control group undergoing exposure without such eye movements. METHODS During the VRET session, heart rate, electrodermal activity, eye movements, and subjective fear ratings were recorded. Participants underwent behavioural avoidance tests before and after treatment as well as a follow-up 10-14 days later. Questionnaire data were assessed before exposure and at follow-up. RESULTS There were clear treatment effects in both groups with almost no group differences (i.e., the subjective fear ratings and the skin conductance response). CONCLUSIONS Contrary to our expectation, the implementation of rhythmic eye movements during virtual exposure did not enhance the effectiveness of the treatment. However, the eye movement group did show a significantly lower heart rate during exposure compared with the control group which might indicate a less stressful treatment. PRACTITIONER POINTS One-session Virtual Reality Exposure Therapy reduced fear of spiders effectively. Performing rhythmic eye movements during exposure did not enhance therapy effects. Rhythmic eye movements during exposure resulted in lower heart rate than standard exposure.
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Affiliation(s)
- Jessica Reitmaier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Regensburg, Germany
| | - Anika Schiller
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Regensburg, Germany
| | - Andreas Mühlberger
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Regensburg, Germany
| | - Michael Pfaller
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Regensburg, Germany
| | - Marie Meyer
- Department of Psychology, PFH - Private University of Applied Sciences, Göttingen, Germany
| | - Youssef Shiban
- Department of Psychology, PFH - Private University of Applied Sciences, Göttingen, Germany
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26
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Yang X, Xu Y, Tan R, Zhou X. Event centrality and post-traumatic stress symptoms among college students during the COVID-19 pandemic: the roles of attention to negative information, catastrophizing, and rumination. Eur J Psychotraumatol 2022; 13:2078563. [PMID: 35695844 PMCID: PMC9176333 DOI: 10.1080/20008198.2022.2078563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has affected college students' mental health and caused post-traumatic stress symptoms (PTSS). Event centrality is thought to play a key role in the development of PTSS, but it is not yet clear by what mechanism. Theoretically, event centrality may affect the retrieval of traumatic memories and further prompt post-traumatic cognitions to understand events, and so may in turn be associated with PTSS in college students. However, few empirical studies have examined the mediating role of post-traumatic cognitions in the relationship between event centrality and PTSS, especially among college students during the COVID-19 pandemic. OBJECTIVES The objective of this study was to examine the mediating roles of post-traumatic cognitive factors (e.g. attention to negative information, catastrophizing, and rumination) in the relationship between event centrality and PTSS among college students during the COVID-19 pandemic. METHODS We recruited 1153 college students who completed the pandemic experiences scale, the centrality of event scale, the attention to positive and negative information scale, the cognitive emotion regulation questionnaire, and the PTSD Checklist for DSM-5 during the COVID-19 pandemic in May 2020. RESULTS In this sample of college students, event centrality directly predicted PTSS, and PTSS was also indirectly predicted by event centrality through attention to negative information, catastrophizing, and rumination. CONCLUSIONS These findings support the existing literature on the relationship between event centrality, proposed cognitive variables, and PTSS, and shed light on the mechanisms underlying PTSS. Our findings also highlight the importance and applicability of targeted cognitive interventions for PTSS in college students during the COVID-19 pandemic. HIGHLIGHTS The COVID-19 pandemic has caused post-traumatic stress symptoms among college students.Event centrality is a risk factor of post-traumatic stress symptoms among college students during the COVID-19 pandemic.Attention to negative information, catastrophizing and rumination mediate the relationship between event centrality and post-traumatic stress symptoms.
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Affiliation(s)
- Xima Yang
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, People's Republic of China
| | - Yongyong Xu
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, People's Republic of China
| | - Ruyue Tan
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, People's Republic of China
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, People's Republic of China
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27
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McLean CP, Levy HC, Miller ML, Tolin DF. Exposure therapy for PTSD: A meta-analysis. Clin Psychol Rev 2021; 91:102115. [PMID: 34954460 DOI: 10.1016/j.cpr.2021.102115] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/26/2021] [Accepted: 12/16/2021] [Indexed: 11/03/2022]
Abstract
Posttraumatic stress disorder (PTSD) is associated with high morbidity and functional impairment in the absence of effective treatment. Exposure therapy for PTSD is a trauma-focused treatment that typically includes in vivo and/or imaginal exposure. The goal of this meta-analysis was to examine the overall efficacy of exposure therapy for PTSD compared to various control conditions. We also assessed the efficacy of individual exposure-based treatments and the potentially moderating impact of various demographic, clinical, and treatment-related factors. PsycINFO and Medline were searched for randomized controlled trials of exposure-based therapies for adult PTSD. A total of 934 abstracts were screened for initial eligibility; of these, 65 articles met inclusion criteria and were included in the meta-analysis (total N = 4929 patients). Exposure therapy showed large effects relative to waitlist and treatment-as-usual, a small effect relative to non-trauma-focused comparators and a negligible effect relative to other trauma-focused treatments or medication. At follow-up most effects sizes were stable, except for a medium effect favoring exposure over medication. The individual exposure-based therapies examined were similarly effective. Moderator analyses revealed larger effect sizes in studies with fewer sessions, younger samples, fewer participants diagnosed with substance use disorder, and fewer participants on psychiatric medication. Effect sizes were also larger in studies of refugees and civilians compared to military samples, studies of PTSD related to natural disasters and transportation accidents vs. other traumatic events, and studies of individual vs. group therapy. Findings support the overall efficacy of exposure therapy and highlight that there are a number of efficacious exposure-based therapies available.
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Affiliation(s)
- Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA; Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305-5717, USA.
| | - Hannah C Levy
- Anxiety Disorders Center, The Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06106, USA
| | - Madeleine L Miller
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA
| | - David F Tolin
- Anxiety Disorders Center, The Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06106, USA; Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510, USA
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28
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Weiland FPG, Rathschlag M, Klatt S. Anxiety Reduction and Improved Concentration in Schoolchildren through Wingwave® Coaching. CHILDREN 2021; 8:children8121102. [PMID: 34943298 PMCID: PMC8700058 DOI: 10.3390/children8121102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/17/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022]
Abstract
(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.
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Cussino M, Crespi C, Mineccia V, Molo M, Motta G, Veglia F. State of mind of attachment and reflective function in an Italian transsexual sample. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2021. [DOI: 10.1016/j.ejtd.2019.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kemal Kaptan S, Brayne M. A qualitative study on clinicians’ perceptions of Attachment‐Focused eye movement desensitisation and reprocessing therapy. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Safa Kemal Kaptan
- Division of Psychology and Mental Health Faculty of Biology, Medicine and Health School of Health Sciences Manchester Academic Health Science Centre The University of Manchester Manchester UK
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Mertens G, Lund M, Engelhard IM. The effectiveness of dual-task interventions for modulating emotional memories in the laboratory: A meta-analysis. Acta Psychol (Amst) 2021; 220:103424. [PMID: 34619553 DOI: 10.1016/j.actpsy.2021.103424] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/05/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022] Open
Abstract
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.
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Reichel V, Sammer G, Gruppe H, Hanewald B, Garder R, Bloß C, Stingl M. Good vibrations: Bilateral tactile stim1ulation decreases startle magnitude during negative imagination and increases skin conductance response for positive imagination in an affective startle reflex paradigm. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2021. [DOI: 10.1016/j.ejtd.2020.100197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Landkroon E, Salemink E, Engelhard IM. Threat memory devaluation by a dual-task intervention: Testing return of fear and intrusive memory over 48 hours. J Behav Ther Exp Psychiatry 2021; 72:101639. [PMID: 33639440 DOI: 10.1016/j.jbtep.2021.101639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 10/23/2020] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND OBJECTIVES In dual-tasking, individuals recall a threat-related memory while performing a demanding dual-task. This is a fruitful approach to reduce the unpleasantness and vividness of aversive memories and to reduce conditioned fear responses. Crucially, it remains unclear whether dual-tasking can also reduce conditioned fear responses and intrusive memories over time. In this pre-registered two-day fear conditioning paradigm, we examined whether a dual-task intervention reduces return of fear and the frequency of intrusive memories of an aversive film over time. METHODS On Day 1, 76 healthy participants underwent fear acquisition with aversive film clips. They were then randomly allocated to one of three conditions: dual-tasking, memory recall without a dual-task ('recall only'), or no task. Afterwards, they underwent an extinction phase and were asked to record intrusive film memories over 48 h. On Day 3, return of fear was assessed. RESULTS On Day 1, fear acquisition and extinction were successful. On Day 3, spontaneous recovery and renewal were evident, but, overall, participants reported few intrusions. The dual-task and recall only groups reported reduced unpleasantness of threat memory compared to the no task group, but they did not show reduced (return of) fear responses or fewer intrusions. LIMITATIONS Intrusion frequency was low in all three groups, which limits the detection of intervention effects. CONCLUSIONS Even though dual-tasking and recall only devalued threat memory temporarily compared to no task, these interventions did not reduce (return of) fear responses and intrusions. Future studies could focus on improving the potency of imagery-based interventions.
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Affiliation(s)
- Elze Landkroon
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.
| | - Elske Salemink
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Iris M Engelhard
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
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Differential Effects of Comorbid Psychiatric Disorders on Treatment Outcome in Posttraumatic Stress Disorder from Childhood Trauma. J Clin Med 2021; 10:jcm10163708. [PMID: 34442005 PMCID: PMC8397108 DOI: 10.3390/jcm10163708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/09/2021] [Accepted: 08/14/2021] [Indexed: 01/15/2023] Open
Abstract
Patients with posttraumatic stress disorder (PTSD) frequently have comorbid diagnoses such as major depressive disorder (MDD) and anxiety disorders (AD). Studies into the impact of these comorbidities on the outcome of PTSD treatment have yielded mixed results. The different treatments investigated in these studies might explain the varied outcome. The purpose of this study was to examine the impact of these comorbidities on the outcome of two specific PTSD treatments. MDD and AD were analyzed as predictors and moderators in a trial comparing 12 sessions of either eye movement desensitization and reprocessing (EMDR) or imagery rescripting (IR) in 155 adult patients with PTSD from childhood trauma. The primary outcome was reduction of PTSD symptoms (clinician-administered PTSD Scale for DSM-5, CAPS-5) assessed at eight-week follow-up and a secondary outcome was self-report PTSD symptoms (Impact of Event Scale, IES-R). MDD was not a predictor of treatment outcome but did have a significant moderator effect. Patients with MDD showed a better outcome if they were treated with IR, whereas patients without MDD improved more in the EMDR condition. No impact of AD emerged. It seems essential to consider comorbid MDD when planning PTSD treatment to improve treatment outcomes. More research is needed to replicate our findings and focus on different kinds of PTSD treatments and other comorbidities.
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Otgaar H, Houben STL, Rassin E, Merckelbach H. Memory and eye movement desensitization and reprocessing therapy: a potentially risky combination in the courtroom. Memory 2021; 29:1254-1262. [PMID: 34404311 DOI: 10.1080/09658211.2021.1966043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Does Eye Movement and Desensitization and Reprocessing (EMDR) therapy affect the accuracy of memories? This recurrent issue in recent memory research bears relevance to expert witness work in the courtroom. In this review, we will argue that several crucial aspects of EMDR may be detrimental to memory. First, research has shown that eye movements undermine the quality and quantity of memory. Specifically, eye movements have been shown to decrease the vividness and emotionality of autobiographical experiences and amplify spontaneous false memory levels. Second, a sizeable proportion of EMDR practitioners endorse the controversial idea of repressed memories and discuss the topic of repressed memory in therapy. Third, in the Dutch EMDR protocol, patients are instructed to select the target image by using flawed metaphors of memory (e.g., memory works as a video). Such instructions may create demand characteristics to the effect that people over-interpret imagery during therapy as veridical memories. Collectively, the corpus of research suggests that several components of EMDR therapy (i.e., performing eye movements, therapist beliefs and therapeutic instructions) may undermine the accuracy of memory, which can be risky if patients, later on, serve as witnesses in legal proceedings.
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Affiliation(s)
- Henry Otgaar
- Faculty of Law, Catholic University of Leuven, Leuven, Belgium.,Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Sanne T L Houben
- Faculty of Law, Catholic University of Leuven, Leuven, Belgium.,Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Eric Rassin
- Erasmus School of Social and Behavioural Sciences, Rotterdam, Netherlands
| | - Harald Merckelbach
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
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Phaf RH, Hermans ME, Krepel A, Lieuw-On RL, Mulder CB, Weijland S. Horizontal eye movements foster approach to negative pictures but do not change emotional valence: A dopaminergic regulation hypothesis. NEW IDEAS IN PSYCHOLOGY 2021. [DOI: 10.1016/j.newideapsych.2021.100872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Vogel A, Rosner R. Lost in Transition? Evidence-Based Treatments for Adolescents and Young Adults with Posttraumatic Stress Disorder and Results of an Uncontrolled Feasibility Trial Evaluating Cognitive Processing Therapy. Clin Child Fam Psychol Rev 2021; 23:122-152. [PMID: 31620891 DOI: 10.1007/s10567-019-00305-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Posttraumatic stress disorder (PTSD) is not uncommon among adolescents and young adults (AYAs). Left untreated, transition to adulthood might be especially challenging and/or prolonged for AYAs. However, it is unclear whether AYAs are adequately represented in current PTSD treatment research and whether they benefit to the same degree as younger or older individuals. In the first part of the paper, we reflect on developmental considerations in the treatment of AYAs and give an overview of current age-specific results in PTSD treatment research. Furthermore, we review individual trauma-focused evidence-based treatments that were examined in AYAs over the last 10 years. In the second part, we present data from an uncontrolled feasibility trial evaluating cognitive processing therapy (CPT) with some age-adapted modifications and an exposure component (written accounts). We treated 17 AYAs (aged 14 to 21) suffering from posttraumatic stress symptoms (PTSS). At posttreatment, participants had improved significantly with respect to clinician-rated PTSS severity (d = 1.32). Treatment gains were maintained throughout the 6-week and 6-month follow-ups. Results indicated that CPT, with only minor adaptations, was feasible and safe in AYAs. The recommendations for future research focus on the inclusion of young adults in trials with adolescents, more refined age reporting in clinical trials, and the encouragement of dismantling studies in youth. To conclude, clinical recommendations for caregiver involvement and the addressing of developmental tasks, motivational issues and emotion regulation problems are discussed.
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Affiliation(s)
- Anna Vogel
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 25, 85072, Eichstätt, Germany.
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 25, 85072, Eichstätt, Germany
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Schnitzer G, Holttum S, Huet V. A systematic literature review of the impact of art therapy upon post-traumatic stress disorder. INTERNATIONAL JOURNAL OF ART THERAPY 2021. [DOI: 10.1080/17454832.2021.1910719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Gabriel Schnitzer
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, UK
| | - Sue Holttum
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Tunbridge Wells, UK
- British Association of Art Therapists, London, UK
| | - Val Huet
- British Association of Art Therapists, London, UK
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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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Inoue J, Matsuo K, Iwabuchi T, Takehara Y, Yamasue H. How Memory Switches Brain Responses of Patients with Post-traumatic Stress Disorder. Cereb Cortex Commun 2021; 2:tgab021. [PMID: 34296166 PMCID: PMC8176146 DOI: 10.1093/texcom/tgab021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 11/12/2022] Open
Abstract
To characterize the brain responses to traumatic memories in post-traumatic stress disorder (PTSD), we conducted task-employed functional magnetic resonance imaging and, in the process, devised a simple but innovative approach-correlation computation between task conditions. A script-driven imagery task was used to compare the responses with a script of the patients' own traumatic memories and with that of tooth brushing as a daily activity and to evaluate how eye movement desensitization and reprocessing (EMDR), an established therapy for PTSD, resolved the alterations in patients. Nine patients with PTSD (seven females, aged 27-50 years) and nine age- and gender-matched healthy controls participated in this study. Six patients underwent the second scan under the same paradigm after EMDR. We discovered intense negative correlations between daily and traumatic memory conditions in broad areas, including the hippocampus; patients who had an intense suppression of activation during daily recognition showed an intense activation while remembering a traumatic memory, whereas patients who had a hyperarousal in daily recognition showed an intense suppression while remembering a traumatic memory as a form of "shut-down." Moreover, the magnitude of the discrepancy was reduced in patients who remitted after EMDR, which might predict an improved prognosis of PTSD.
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Affiliation(s)
- Jun Inoue
- Department of Child and Adolescent Psychiatry, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka 431-3192, Japan
| | - Kayako Matsuo
- Center for Preventive Medicine in Mental Health, Department of Psychiatry, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka 431-3192, Japan.,Center for Research Collaboration and Support, Dokkyo Medical University School of Medicine, Mibu-machi, Shimotsuga-gun, Tochigi 321-0293, Japan
| | - Toshiki Iwabuchi
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Hamamatsu City, Shizuoka 431-3192, Japan.,United Graduate School of Child Development, Hamamatsu University School of Medicine, Hamamatsu city, Shizuoka 431-3192, Japan
| | - Yasuo Takehara
- Department of Radiology, Hamamatsu University Hospital, Hamamatsu city, Shizuoka, Japan 431-3192.,Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Graduate School of Medicine, Nagoya University, Nagoya City, Aichi 464-8601, Japan
| | - Hidenori Yamasue
- United Graduate School of Child Development, Hamamatsu University School of Medicine, Hamamatsu city, Shizuoka 431-3192, Japan.,Department of Psychiatry, Hamamatsu University School of Medicine, Hamamatsu city, Shizuoka 431-3192, Japan
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Susanty E, Sijbrandij M, Srisayekti W, Huizink AC. Eye Movement Desensitization (EMD) to reduce posttraumatic stress disorder-related stress reactivity in Indonesia PTSD patients: a study protocol for a randomized controlled trial. Trials 2021; 22:181. [PMID: 33663549 PMCID: PMC7931595 DOI: 10.1186/s13063-021-05100-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 02/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background Posttraumatic stress disorder (PTSD) may develop after exposure to a traumatic event. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based psychological treatment for PTSD. It is yet unclear whether eye movements also reduce stress reactivity in PTSD patients. This study aims to test whether eye movements, as provided during Eye Movement Desensitization (EMD), are more effective in reducing stress reactivity in PTSD patients as compared to a retrieval-only control condition. Methods The study includes participants who meet criteria of PTSD of the public psychological services in Jakarta and Bandung, Indonesia. One hundred and ten participants are randomly assigned to either an (1) Eye Movement Desensitization group (n = 55) or (2) retrieval-only control group (n = 55). Participants are assessed at baseline (T0), post-treatment (T1), 1 month (T2), and at 3 months follow-up (T3). Participants are exposed to a script-driven imagery procedure at T0 and T1. The primary outcome is heart rate variability (HRV) stress reactivity during script-driven imagery. Secondary outcomes include heart rate (HR), pre-ejection period (PEP), saliva cortisol levels, PTSD symptoms, neurocognitive functioning, symptoms of anxiety and depression, perceived stress level, and quality of life. Discussion If the EMD intervention is effective in reducing stress reactivity outcomes, this would give us more insight into the underlying mechanisms of EMDR’s effectiveness in PTSD symptom reduction. Trial registration ISRCTN registry ISRCTN55239132. Registered on 19 December 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05100-3.
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Affiliation(s)
- Eka Susanty
- Faculty of Psychology, Universitas Jenderal Achmad Yani, Cimahi, Indonesia. .,Department of Clinical, Neuro and Developmental Psychology, Faculty Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, Faculty Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Wilis Srisayekti
- Department of General and Experimental Psychology, Faculty of Psychology, Universitas Padjadjaran, Bandung, Indonesia
| | - Anja C Huizink
- Department of Clinical, Neuro and Developmental Psychology, Faculty Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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Using EMDR to Address Social Anxiety With Clients Who Stutter: Treatment Considerations. JOURNAL OF EMDR PRACTICE AND RESEARCH 2021. [DOI: 10.1891/emdr-d-20-00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article describes the treatment considerations when providing eye movement desensitization and reprocessing (EMDR) therapy to treat clients who stutter. Since stuttering is often developed in childhood and persists into adulthood, it has long-term impacts on the educational, social, psychological, and professional development of those who stutter. While stuttering can present with physiological impairments not amendable to psychological interventions, EMDR therapy may effectively decrease the psychological stressors (such as social anxiety and shame) that can intensify stuttering. The authors present an extensive literature review on the traumatic experiences and adverse effects of stuttering. They also discuss essential treatment guidelines when using EMDR to work with people who stutter (PWS), including processing developmental trauma when stuttering, experiences of being bullied because of stuttering, shame and internalized negative self-statements, distrust of one's body due to inability to control one's speaking, and the social anxiety and avoidance in dealing with triggering situations. The clinical instructions are illustrated with a case example of a 40-year-old college professor who experienced anxiety and shame related to persistent developmental stuttering, and who sought treatment due to difficulties speaking in front of his classes. After completing 20 sessions of EMDR therapy, the client reported decreased social anxiety and shame and was able to teach courses comfortably. Further research considerations using EMDR treatment with PWS are recommended.
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Rackham LA, Lau-Zhu A. 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. ANXIETY STRESS AND COPING 2021; 34:423-436. [PMID: 33412932 DOI: 10.1080/10615806.2020.1870107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Libby A Rackham
- School of Psychology, Cognitive Institute, Plymouth University, Plymouth, UK
| | - Alex Lau-Zhu
- Oxford Institute of Clinical Psychology Training and Research, Medical Sciences Division, University of Oxford, Oxford, UK.,Centre for Psychiatry, Division of Brain Sciences, Imperial College London, London, UK
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Tarquinio C, Brennstuhl MJ, Rydberg JA, Bassan F, Peter L, Tarquinio CL, Auxéméry Y, Rotonda C, Tarquinio P. EMDR in Telemental Health Counseling for Healthcare Workers Caring for COVID-19 Patients: A Pilot Study. Issues Ment Health Nurs 2021; 42:3-14. [PMID: 33052727 DOI: 10.1080/01612840.2020.1818014] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The COVID-19 pandemic is putting a strain on health systems around the world. Healthcare workers, on the front lines of the epidemic, are facing major and potentially traumatic stressful events, overwhelming their ability to cope and their resources. OBJECTIVE The objective of this article will be to show how the use of the URG-EMDR protocol in a telemental health setting has proven to be feasible and effective in the treatment of a group of healthcare professionals working in nursing homes or hospital services that were highly mobilized during the acute phase of COVID-19. METHOD 17 participants, registered nurses (N = 7) and licensed practical nurses (N = 10), were remotely treated using the URG-EMDR protocol in a single session. The assessment focused on anxiety and depressive symptoms (HAD scale) and the level of perceived disturbance (SUD). An additional evaluation of the satisfaction with the remote psychotherapy intervention was conducted. RESULTS As the URG-EMDR protocol has already proven itself during emergency interventions, it is interesting to note that its remote use in the treatment of healthcare providers caring for COVID-19 patients allows for an improvement in the emotional state and a decrease in perceived disturbance, in a single session. This result is maintained 1 week after the intervention, despite the continued professional activities of the participants and the continuity of the event. Moreover, the remote therapy setting was judged satisfactory by the patients, even if it required adjustments and certain recommendations for practice. DISCUSSION The remote use of the URG-EMDR protocol opens up innovative perspectives for early interventions and the prevention of the development of psychological disorders in the long term following a situation of acute stress.
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Affiliation(s)
- Cyril Tarquinio
- APEMAC-EPSAM EA 4360, Centre Pierre Janet, Metz, France.,UFR Sciences Humaines et Sociales, EPSAM/APEMAC, University of Lorraine, Metz, France.,EMDR Europe Practitioner and Consultant, Metz, France
| | - Marie-Jo Brennstuhl
- APEMAC-EPSAM EA 4360, Centre Pierre Janet, Metz, France.,UFR Sciences Humaines et Sociales, EPSAM/APEMAC, University of Lorraine, Metz, France.,EMDR Europe Practitioner and Consultant, Metz, France
| | - Jenny Ann Rydberg
- APEMAC-EPSAM EA 4360, Centre Pierre Janet, Metz, France.,UFR Sciences Humaines et Sociales, EPSAM/APEMAC, University of Lorraine, Metz, France.,EMDR Europe Practitioner and Consultant, Metz, France
| | - Fanny Bassan
- APEMAC-EPSAM EA 4360, Centre Pierre Janet, Metz, France.,UFR Sciences Humaines et Sociales, EPSAM/APEMAC, University of Lorraine, Metz, France.,EMDR Europe Practitioner and Consultant, Metz, France
| | - Lydia Peter
- APEMAC-EPSAM EA 4360, Centre Pierre Janet, Metz, France.,UFR Sciences Humaines et Sociales Ile du Saulcy, University of Lorraine, Metz, France
| | - Camille Louise Tarquinio
- APEMAC-EPSAM EA 4360, Centre Pierre Janet, Metz, France.,UFR Sciences Humaines et Sociales, EPSAM/APEMAC, University of Lorraine, Metz, France
| | - Yann Auxéméry
- APEMAC-EPSAM EA 4360, Centre Pierre Janet, Metz, France.,UFR Sciences Humaines et Sociales, EPSAM/APEMAC, University of Lorraine, Metz, France
| | - Christine Rotonda
- APEMAC-EPSAM EA 4360, Centre Pierre Janet, Metz, France.,UFR Sciences Humaines et Sociales, EPSAM/APEMAC, University of Lorraine, Metz, France
| | - Pascale Tarquinio
- APEMAC-EPSAM EA 4360, Centre Pierre Janet, Metz, France.,UFR Sciences Humaines et Sociales, EPSAM/APEMAC, University of Lorraine, Metz, France.,EMDR Europe Practitioner and Consultant, Metz, France
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Kenchel JM, Domagalski K, Butler BJ, Loftus EF. The messy landscape of eye movements and false memories. Memory 2020; 30:678-685. [PMID: 33356911 DOI: 10.1080/09658211.2020.1862234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Eye-Movement Desensitisation and Reprocessing (EMDR) therapy is a common treatment for PTSD. However, skeptics like James Ost question the theoretical underpinnings, highlight inconsistency of empirical findings surrounding the efficacy of such therapy, and warn against unknown drawbacks. Little is known about the impact of the eye movements, a critical component in EMDR, on susceptibility to false memories, and the existing literature is contradictory. We review the literature and present new findings to help tell the story of the effects of eye movements on memory. Taken as a whole, this small body of work suggests that eye movements do not reliably affect susceptibility to misinformation, nor do they appear to enhance memory, but they do seem to increase spontaneous false memories.
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Affiliation(s)
- Jillian M Kenchel
- Department of Psychological Science, University of California, Irvine, CA, USA
| | - Kirsten Domagalski
- Department of Psychological Science, University of California, Irvine, CA, USA
| | | | - Elizabeth F Loftus
- Department of Psychological Science, University of California, Irvine, CA, USA
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46
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Kessler H, Dangellia L, Herpertz S, Kehyayan A. [Digital Media in Psychotherapy - New Approaches and Perspectives in the Treatment of Trauma-Related Disorders]. Psychother Psychosom Med Psychol 2020; 70:371-377. [PMID: 32252120 DOI: 10.1055/a-1120-8976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article provides an insight into novel approaches and perspectives using digital technologies in the treatment of trauma-related disorders. Therapy options for patients with trauma-related disorders are not easily available on a global scale and there is a search for new specific therapeutic strategies. In the first part of this article, examples of digital approaches are provided that are based on established analogue treatments and are designed mainly to increase availability and cost-effectiveness of these treatments. In the second part, the focus lies on digital treatments that employ novel approaches, which are e. g. informed by cognitive science, to specifically target particular symptoms in clinical populations after their development in lab studies. Examples given are visuospatial interventions used to reduce intrusive symptoms, or training programmes to increase levels of interference control (to control trauma-related stimuli), or to change automatic dysfunctional cognitions. These interventions will be presented with their respective theoretical frameworks, along with results from first (partially clinical) studies, which are promising concerning acceptance, applicability and effectiveness.
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Affiliation(s)
- Henrik Kessler
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum
| | - Luisa Dangellia
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum
| | - Stephan Herpertz
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum
| | - Aram Kehyayan
- Klinik für Psychosomatische Medizin und Psychotherapie, LWL-Universitätsklinikum Bochum der Ruhr-Universität Bochum
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47
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Integrative psychotherapy and psychotherapy integration: The case of EMDR. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2020. [DOI: 10.1016/j.ejtd.2020.100165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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48
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Gerge A. A multifaceted case-vignette integrating neurofeedback and EMDR in the treatment of complex PTSD. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2020. [DOI: 10.1016/j.ejtd.2020.100157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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49
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Leer A, Engelhard IM. Side effects of induced lateral eye movements during aversive ideation. J Behav Ther Exp Psychiatry 2020; 68:101566. [PMID: 32179237 DOI: 10.1016/j.jbtep.2020.101566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 01/31/2020] [Accepted: 03/01/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Eye Movement Desensitization and Reprocessing (EMDR) is a treatment for posttraumatic stress disorder. It uses a dual-task approach, in which patients recall an aversive memory while making lateral eye movements. Research has shown that this 'eye movements' intervention reduces subjective memory vividness and emotionality. This study examined whether it also reduces memory accuracy on a visual discrimination task. METHODS Participants (68 undergraduates) underwent an aversive conditioning phase, in which two pictures of male faces were followed by shock. Then they recalled one face with (experimental condition) and one without (control condition) making lateral eye movements. Finally, they completed a stimulus discrimination test with slightly different faces shortly after the intervention and one day later. RESULTS Results showed that the eye movements intervention led to increased false-positive rates one day later. LIMITATIONS Our intervention targeted newly formed memory rather than consolidated memory. CONCLUSIONS The results inform theory about EMDR's mechanisms of change and suggest that the treatment may have side effects regarding memory accuracy.
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Affiliation(s)
- Arne Leer
- Utrecht University, Utrecht, the Netherlands
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50
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Irish AJ. Using Recent Traumatic Episode Protocol in College Counseling Centers. JOURNAL OF COLLEGE COUNSELING 2020. [DOI: 10.1002/jocc.12158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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