Eye Movement Desensitization and Reprocessing: Innovative Clinical Applications

Neurologically-based therapies such as Eye Movement Desensitization and Reprocessing (EMDR) are being clinically implemented and researched in the field of psychotherapy. While EMDR has a theoretical base and some research support for its effectiveness with Posttraumatic Stress Disorder (PTSD) therapists are now developing and using EMDR for other clinical problems. This report illustrates some of the unique applications of EMDR with clinical problems such as: driving phobia, interpersonal arguments, dyspareunia, depression, anxiety, and eating problems.     

Psychotherapeutic Interventions for Symptom Reduction in Veterans With PTSD: An Observational Study in a Residential Clinical Setting

Cognitive processing therapy (CPT) and eye movement desensitization and reprocessing (EMDR) therapy were compared for veterans in a posttraumatic stress disorder (PTSD) residential program (N = 51) who received individual EMDR and group CPT, individual CPT and group CPT, or trauma group exposure (TGE) therapy. Analyses revealed an overall significant difference on posttest measures of the PTSD Checklist for individual EMDR/group CPT and individual CPT/group CPT when compared to TGE, with no significant difference found between EMDR and CPT. Depression scores were significantly decreased between pre- and posttest for patients who received individual EMDR/group CPT. Results support EMDR and CPT as clinically effective and complementary treatments in residential PTSD treatment programs.     

Cognitive behaviour therapy versus eye movement desensitization and reprocessing for post-traumatic disorder – is it all in the homework then?

IntroductionTreatment of choice for post-traumatic stress disorder (PTSD) is either eye movement desensitization and reprocessing (EMDR) or trauma-focused cognitive behaviour therapy (TFCBT).ObjectiveThe aim of the present meta-analysis was to determine whether there are any differences between these two treatments with respect to efficacy and efficiency in treating PTSD.MethodWe performed a comprehensive literature search using several electronic search engines as well as manual searches of other review papers. Eight original studies involving 227 participants were identified in this manner.ResultsThere were no differences between EMDR and TFCBT on measures of PTSD. However, there was a significant advantage for EMDR over TFCBT in reducing depression (Hedge's g = 0.63). The analysis also indicated a difference in the prescribed homework between the treatments. Meta-regression analyses were conducted to examine the relationship between hours of homework and gains in depression and PTSD symptoms.ConclusionThese findings are discussed in terms of efficacy and cost-effectiveness and the use of homework in therapy.     

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

ABSTRACT

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

The underlying dimensions of DSM-5 posttraumatic stress disorder (PTSD) and their relationships with mental and somatoform dissociation,depression and anxiety among jail inmates

ABSTRACT

In this study we examined the DSM-5 factor structure of scores on the Turkish version of the posttraumatic stress disorder (PTSD) Checklist for DSM–5 (PCL-5) and predictors of PTSD caseness in a sample of male prisoners. The 7-factor hybrid model was the optimal model relative to the alternatives. Consistent with the PTSD literature in prisoners, the majority of respondents had past traumatic experiences (96.7%), a probable PTSD diagnosis (68.4%), pathological dissociation (46.8%) and somatoform dissociation (52.3%). Probable PTSD caseness was significantly associated with dissociation and depression, as well as higher levels of education and being married. Re-experiencing was strongly associated with mental and somatic dissociation; whereas dysphoric arousal was related to depression and anxiety.     

Influence of adjuvant mindfulness-based cognitive therapy (MBCT) on symptoms of post-traumatic stress disorder (PTSD) in veterans – results from a randomized control study

Even 30 or more years after the end of a war, veterans can suffer from post-traumatic stress disorder (PTSD). In the present study, we explored the influence on symptoms of PTSD among Iranian veterans of the Iran–Iraq war of mindfulness-based cognitive therapy (MBCT) as add-on to a standard treatment with citalopram. Forty-eight male veterans with PTSD (mean age: 52.97 years) took part in this eight-week intervention study. Standard treatment for all patients consisted of citalopram (30–50 mg/day at therapeutic dosages). Patients were randomly assigned either to the treatment or to the control condition. Treatment involved MBCT delivered in group sessions once a week. Patients in the control condition met at the hospital with the same frequency and duration for socio-therapeutic events. At baseline and at study completion, patients completed questionnaires covering symptoms of PTSD, depression, anxiety, and stress. At study completion after eight weeks, scores for PTSD (re-experiencing events, avoidance, negative mood and cognition, hyperarousal), depression, anxiety, and stress were lower, but more so in the intervention than the control group. Data suggest that, as adjuvant to standard SSRI medication, MBCT is an effective intervention to significantly reduce symptoms of PTSD, depression, anxiety, and stress among veterans.     

A Pilot Randomized Clinical Trial of a Novel,Culturally Adapted,Trauma-Focused Cognitive-Behavioral Intervention for War-Related PTSD in Iraqi Women

Trauma-focused cognitive-behavioral therapy (TF-CBT), broadly, is one of the leading evidence-based treatments for youth with posttraumatic stress disorder (PTSD). Generally, few culturally adapted TF-CBT interventions have been examined among war trauma-affected populations in low- and middle-income countries. Using a randomized clinical trial design, a total of 48 war trauma-exposed women in Iraq, M_age (SD) = 32.91 (5.33), with PTSD were randomly assigned to either TF-CBT or wait-list control (WLC) conditions. The intervention group received 12 individual weekly sessions of a culturally adapted TF-CBT intervention. Significant reductions in PTSD symptom severity were reported by women in the TF-CBT condition from pre- to posttreatment. Women in the TF-CBT condition reported significantly greater reductions in PTSD symptoms compared to WLC at 1-month follow-up. Additionally, levels of depression, anxiety, stress, and use of maladaptive emotion regulation strategies were significantly lower in the TF-CBT condition at posttreatment and 1-month follow-up, compared to the WLC condition. Women in the TF-CBT condition also reported significant improvements in various domains of quality of life at posttreatment and 1-month follow-up. This clinical trial provides preliminary cross-cultural support for the feasibility and efficacy of TF-CBT for the treatment of PTSD symptoms among women in non-Western cultures. Future directions and study limitations are discussed.     

Spanish version of Super Skills for Life: short- and long-term impact of a transdiagnostic prevention protocol targeting childhood anxiety and depression

ABSTRACT

Background and Objectives: Super Skills for Life (SSL) is a transdiagnostic protocol based on cognitive–behavioral therapy designed for children with internalizing problems. The present study examined for the first time the impact of the Spanish-adapted version of SSL in reducing anxiety and depressive symptoms in Spanish-speaking children.

Design: A quasi-experimental design with one group, pre- and posttest, and 1-year follow-up was conducted. Analyses were performed on an intent-to-treat basis.

Methods: Participants were 119 children (42.9% female; 8–12 years) recruited from nine schools. Children completed assessments of anxiety, depression, emotional and behavioral difficulties, and the extent to which anxiety interfered with life before and after receiving the 8-session SSL, and 12-months post-intervention.

Results: Anxiety and depressive symptoms were significantly reduced at post-test and 12-month follow-up assessments. SSL also had positive impact on other symptoms assessed (e.g., interference of anxiety with children’s life, peer problems, conduct problems). Overall, the long-term benefits of SSL appeared to be greater than the short-term benefits.

Conclusions: The results of this study suggest that SSL may be useful in reducing symptoms of anxiety and depression, and a broad range of other issues, in Spanish children.     

Treating PTSD in Patients With Psychosis: A Within-Group Controlled Feasibility Study Examining the Efficacy and Safety of Evidence-Based PE and EMDR Protocols

The present study uses a within-group controlled design to examine the efficacy and safety of two psychological approaches to posttraumatic stress disorder (PTSD) in 10 patients with a concurrent psychotic disorder. Patients were randomly assigned either to prolonged exposure (PE; N = 5) or eye movement desensitization and reprocessing (EMDR; N = 5). Before, during, and after treatment, a total of 20 weekly assessments of PTSD symptoms, hallucinations, and delusions were carried out. Twelve weekly assessments of adverse events took place during the treatment phase. PTSD diagnosis, level of social functioning, psychosis-prone thinking, and general psychopathology were assessed pretreatment, posttreatment, and at three-month follow-up. Throughout the treatment, adverse events were monitored at each session. An intention-to-treat analysis of the 10 patients starting treatment showed that the PTSD treatment protocols of PE and EMDR significantly reduced PTSD symptom severity; PE and EMDR were equally effective and safe. Eight of the 10 patients completed the full intervention period. Seven of the 10 patients (70%) no longer met the diagnostic criteria for PTSD at follow-up. No serious adverse events occurred, nor did patients show any worsening of hallucinations, delusions, psychosis proneness, general psychopathology, or social functioning. The results of this feasibility trial suggest that PTSD patients with comorbid psychotic disorders benefit from trauma-focused treatment approaches such as PE and EMDR.     

The effectiveness of cognitive behavioral group intervention on depression and anxiety in patients with type II diabetes

IntroductionDepression and anxiety are important risk factors for diabetes and high blood pressure.ObjectiveThis study investigated the effectiveness of the Cognitive-Behavioral Group Intervention for Diabetes Disease (CBGI-DD) in reducing depression and anxiety in female patients with type 2 diabetes (T2D).MethodThe CBGI-DD program includes 12 weekly 2.5 h sessions, spread weekly over the course of 3 months. The present study was semi-experimental and controlled, with assessments at pre-test and post-test. It included diagnostic criteria for the diagnosis of T2D in the patient's medical records by a diabetes specialist. Participants (62 female volunteers aged 25 to 75 years) were randomly allocated to a control or test group. Both groups responded to the Second edition of the Beck Depression Inventory (BDI-II) and the Beck Anxiety Inventory (BAI) before (pretest) and immediately after the intervention (posttest). Participants in the test group received CBGI-DD (from April up to the end of September 2018) at Mashhad Diabetes Center. The control group received only medical care during this period.ResultsAn analysis of covariance showed that compared to the control group, the test group had a significant reduction in anxiety and depression from pre-test to post-test (p < 0.05). It was compared post-test scores between the two groups, controlling for pre-test scores.ConclusionThe CBGI-DD program seems to be effective in reducing anxiety and depression in female patients with T2D. However, further research exploring the potential for long-term improvements in depression and anxiety is needed.     

Prospective associations between changes in mental health symptoms and health-related quality of life in veterans seeking posttraumatic stress disorder residential treatment

Background and Objectives: This study examined prospective associations between changes in mental health symptoms (posttraumatic stress disorder [PTSD], depression) and health-related quality of life (physical health, psychological well-being) for veterans with PTSD. Design: This study focused on 139 patients who completed a residential treatment program for PTSD in the Veterans Health Administration. Methods: Patients completed the veteran-specific, 12-item Medical Outcomes Study Short Form, PTSD Checklist – Military version, and Beck Depression Inventory at pre-treatment, discharge, and a four-month follow-up. When accounting for demographic factors, combat exposure, and baseline scores on the respective outcome variables (e.g. mental health, physical health, PTSD, and depressive symptoms), a series of multivariate analyses were conducted for treatment-related changes in mental and physical health on the outcome measures. Results: Reductions in PTSD symptomatology during the treatment period were prospectively linked with better health-related outcomes at the four-month follow-up. In addition, improved physical health and psychological well-being during treatment were each similarly associated with better PTSD and depression outcomes in the months following treatment. Conclusions: Addressing concerns in mental and physical health might have synergistic effects across both domains, supporting the need for holistic models and integrated health care strategies for treating veterans with PTSD.     

Effect of the 5-HTTLPR polymorphism on posttraumatic stress disorder,depression, anxiety,and quality of life among Iraq and Afghanistan veterans

Background and Objectives: Posttraumatic stress disorder (PTSD), depression, anxiety, and stress are significant problems among returning veterans and are associated with reduced quality of life. Design: A correlational design was used to examine the impact of a polymorphism (5-HTTLPR) in the serotonin transporter promoter gene on post-deployment adjustment among returning veterans. Methods: A total of 186 returning Iraq and Afghanistan veterans were genotyped for the 5-HTTLPR polymorphism. Symptoms of PTSD, depression, general stress, and anxiety were assessed along with quality of life. Results: After controlling for combat exposure, age, sex of the participant, and race, 5-HTTLPR had a significant multivariate effect on post-deployment adjustment, such that S′ carriers reported more post-deployment adjustment problems and worse quality of life than veterans homozygous for the L′ allele. This effect was larger when the analyses were restricted to veterans of European ancestry. Conclusions: Our findings suggest that veterans who carry the S′ allele of the 5-HTTLPR polymorphism may be at increased risk for adjustment problems and reduced quality of life following deployments to war zones.     

Great Men: Psychoanalytic Studies by Edward Hitschmann. Foreword by Ernest Jones

Abstract

This study examined the effectiveness of an integrated model of brief group psychotherapy for treatment of fibromyalgia syndrome, using cognitive behavioral and supportive expressive techniques. In the context of an outpatient, multidisciplinary fibromyalgia treatment program, group psychotherapy was provided to 35 patients with 21 control patients. Pre–post treatment measures of depression, anxiety, fibromyalgia impact, pain, fatigue, and morning tiredness were obtained. Using a quasi–experimental design with validated psychometric instruments, the results showed a significant decrease in pre-versus post treatment measures of depression, fibromyalgia impact, fatigue, and pain for the treatment patients, suggesting that an integrated model of group psychotherapy may have beneficial psychological and functional effects for some patients with fibromyalgia.     

Age-related differences in the association between autistic sons’ challenging behaviour and maternal anxiety and depression: implications for counsellors

ABSTRACT

The associations between sons' challenging behaviour and mothers' anxiety and depression were investigated in four age-subgroups of boys with Autism Spectrum Disorder and their mothers (n?=?49). Significant correlations were found only for the 6-yr-old boys' irritability and their mothers' anxiety (r?=?.808) and depression (r?=?.762), and for the 7-yr-old boys' stereotypy and their mothers' depression (r?=?.745). MANOVA and ANOVA found no significant differences between the irritability of the 6-yr-old boys and that of the remaining boys, nor between the 7-yr-olds' stereotypy and the remaining boys, plus no significant difference in the mothers' anxiety and depression scores across age groups. Implications are drawn for counselling and psychotherapy.     

Exposure therapy for PTSD delivered to veterans via telehealth: predictors of treatment completion and outcome and comparison to treatment delivered in person

Recent research has focused on the effectiveness of evidence-based psychotherapy delivered via telehealth services. Unfortunately to date, the majority of studies employ very small samples and limited predictor and moderator variables. To address these concerns and further replicate and extend the literature on telehealth, the present study investigated the effectiveness of 12-session exposure therapy delivered either via telehealth (n = 62) or in person (n = 27) in veterans with posttraumatic stress disorder (PTSD). Findings demonstrated that although older veterans and Vietnam veterans were more likely to complete the telehealth treatment, telehealth findings were not influenced by patient age, sex, race, combat theater, or disability status. Exposure therapy delivered via telehealth was effective in reducing the symptoms of PTSD, anxiety, depression, stress, and general impairment with large effect sizes. Interestingly, exposure therapy via telehealth was less effective than exposure therapy delivered in person; however, lack of random assignment to condition limits conclusions of differential effectiveness. Overall, these findings support the utility of telehealth services to provide effective, evidence-based psychotherapies.     

Psychological Trauma

Abstract

Group-based interpersonal psychotherapy (IPT-G) was provided to nine male Vietnam veterans with posttraumatic stress disorder (PTSD) to reduce interpersonal difficulties. Standardized measures of posttraumatic stress, depression, interpersonal problems, and functioning were administered pre- and posttreatment and at 2- and 4-month follow-ups. Individual (reliable change indices) and group analyses (repeated measures ANOVAs) indicated improvements in interpersonal and global functioning (not maintained at follow-up), as well as for PTSD and depressive symptoms (maintained at follow-up). Qualitative feedback indicated reduced levels of anger and stress as well as improved relationships. IPT-G for Vietnam veterans shows promise in improving interpersonal functioning and reducing psychological distress. However, since not all improvements were maintained over time, future studies may need to explore relapse prevention strategies.     

Marked shifts in gut microbial structure and neurotransmitter metabolism in fresh inmates revealed a close link between gut microbiota and mental health: A case-controlled study

Background/ObjectiveThe gut microbiota plays a pivotal role in psychological health, but the mechanistic perspective between gut microbiome and mental health remains poorly understoodMethodThe present case-controlled study recruited 30 unimprisoned subjects and 31 inmates that had been detained in jail for no more than a month. The mental health status, gut microbiota and blood NH3, H2S, 5-hydroxy trptamine and dopamine levels were measured.ResultsCompared with unimprisoned controls, the fresh inmates exhibited significantly higher scores on anxiety and depression. Both phylogenetic structure and functional genes of the gut microbiota markedly shifted in inmates. Inmates was more Bacteroides-dominated, while unimprisoned subjects were more Prevotella-dominated. Short-chain fatty acids (SCFAs)-producing genera were largely decreased in inmates and were negatively related to mental disorder scores, while Bacteroidetes and Proteobacteria were positive to anxiety and depression scores. Simultaneously, the inmates possessed reduced genes that participate in amino acids, carbohydrates and vitamin cofactors metabolism, but enriched genes that involved in the neurotransmitter-producing Shikimate pathway. Correlation analysis revealed that Anaerotruncus and Prevotella were negative to depression score, and Enterococcus was negative to anxiety score.ConclusionsOur results revealed potential link between gut microbiota and mental health, leading further support to the microbiota–gut–brain axis theory.     

Motor vehicle accident trauma exposure: Personality profiles associated with posttraumatic diagnoses

Abstract

Personality profiles associated with diagnostically distinct posttraumatic responses were examined. Profiles were compared between three groups defined on the basis of posttraumatic diagnosis following motor vehicle accident (MVA) trauma exposure. The diagnostic groups were: Posttraumatic Stress Disorder (PTSD), Acute Stress Disorder (ASD) without progression to PTSD, and subclinical responses. Participants were male and female community volunteers aged 18 to 77 (N = 83) who had all been exposed to an MVA meeting the DSM-IV diagnostic criteria for a traumatic event. The Personality Assessment Inventory (Morey, 1991) was used to assess psychological variables in the framework of posttraumatic diagnostic groups. The PTSD group scored significantly higher than the ASD and subclinical groups on scales assessing somatic complaints, anxiety, anxiety related disorders, depression, non-psychotic symptoms of schizophrenia, and negative relationships. The profile of the ASD group was characterized by self report of greater interpersonal warmth and a trend for greater egocentricity than the PTSD group. There were no significant differences in the personality profiles of the ASD and subclinical groups. The role of personality factors in posttraumatic adjustment is discussed in the context of previous literature.     

Psychological Distress and Symptoms of Posttraumatic Stress Disorder in Jewish Adolescents Following a Brief Exposure to Concentration Camps

We investigated the psychological impact of an organized visit to Polish concentration camps on Jewish-American adolescents. Eighty-seven adolescents who participated in a B'nai B'rith memorial visit to concentration camps in Poland completed measures of general psychological adjustment and posttraumatic stress disorder (PTSD) at four time-points: pretest, posttest, 6-month follow-up and 12-month follow-up. Measures included the SCL-90-R, the Mississippi Scale for PTSD, and the Impact of Events Scale (IES) for PTSD. On the SCL-90-R, changes in somatization, interpersonal sensitivity, obsessive-compulsive tendencies, depression, anxiety, and phobic anxiety were observed over time, with peak symptom scores at posttest and 6-month follow-up. Scores on the Mississippi Scale for PTSD and the IES Intrusion subscale also increased at 6-months. Predictors of PTSD symptoms on the Mississippi Scale included previous psychiatric treatment and SCL-90-R symptoms of paranoia, depression, and psychosis. Elevated psychotic symptoms on the SCL-90-R predicted PTSD symptoms on the IES. Jewish adolescents with preexisting symptoms of generalized distress or psychoticism appeared at increased risk for PTSD symptoms following exposure to Holocaust stimuli. This study contributes a prospective, multi-measure assessment of trauma reactions in adolescents.