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 Processing Therapy for Incarcerated Adolescents with PTSD

Summary

Despite increased recognition of trauma's association with conduct disorders, trauma treatment for the conduct-disordered population has been neglected. This study evaluated the effect of short-term, cognitive processing therapy (CPT) treatment on self-reported symptoms of trauma, such as anxiety, depression, intrusion, avoidance, and numbing. After treatment, the CPT group showed significant declines in these symptoms, while the wait-list control group did not.     

The Role of Trauma in Conduct Disorder

Summary

Trauma is proposed as a key to understanding the development and persistence of conduct disorder, in conjunction with other contributing factors. Trauma history is ubiquitous in the conduct disordered population, and trauma effects can help to account for many features of conduct disorder, including lack of empathy, impulsivity, anger, acting-out, and resistance to treatment. The current standard of care fails to fully address trauma, which may partially explain the low success rate of extant treatment approaches. A trauma-informed perspective is introduced to current models of conduct disorder. Research, prevention, and treatment implications are discussed.     

EMDR as a treatment for improving attachment status in adults and children

IntroductionThe purpose of the article is to examine the current literature regarding evidence for positive change in attachment status following Eye Movement Desensitization and Reprocessing (EMDR) therapy and to describe how an integrative EMDR and family therapy team model was implemented to improve attachment and symptoms in a child with a history of relational loss and trauma.LiteratureThe EMDR method is briefly described along with the theoretical model that guides the EMDR approach. As well, an overview of attachment theory is provided and its implication for conceptualizing symptoms related to a history of relational trauma. Finally, a literature review is provided regarding current preliminary evidence that EMDR can improve attachment status in children and adults.Clinical findingsA case study is described in which an EMDR and family therapy integrative model improved attachment status and symptoms in a child with a history attachment trauma.ConclusionThe case study and literature review provide preliminary evidence that EMDR may be a promising therapy in the treatment of disorders related to attachment trauma.     

Vers une nouvelle appréhension des mathématiques par traitement EMDR : actualités et perspectives

ObjectiveEMDR for Eye Movement Desensitization and Reprocessing developed since 1989 by F. Shapiro has demonstrated its effectiveness in the treatment of Post Traumatic Stress Disorder (PTSD). In Science of Education, no study has been previously developed in the application of EMDR protocols. The purpose of this article is to demonstrate the relevance and effectiveness of EMDR in supporting cognitive and emotional remediation of students in Master 1, with respect to mathematics, preparing Schools Teacher contest. The first encounters with the students revealed, through their discourse, an aversion to mathematics linked to one or more particularly painful experiences in a learning situation. Mathematics may cause anguish, sometimes tinged beliefs such as “I’ll never be able to… I am very bad at math”. This represents even an insurmountable obstacle in the professional life of some.MethodsNearly 170 students in Master 1 “Professor of the Schools” registered on the ESPE (College of the Teaching profession and Education) were asked about their relation to mathematics, both in their emotions as their self-efficacy. Among those who suggested a traumatic memory in a learning situation in mathematics, forty were selected and divided into two groups. The control group received two hours of information about relaxation techniques that could be used before mathematics. The other group benefited of the EMDR treatment according to the standard protocol in eight phases.ResultsThe results showed that students who received EMDR treatment experienced after treatment and one month later, a significant decline in their negative emotions with mathematics and an increase in the strength of their self-efficacy, unlike the control group.DiscussionEMDR demonstrates its effectiveness in reprocessing beliefs and emotions of students with respect to mathematics and opens ways of research in Educational Sciences. So, it will be necessary, from the principle of alternated bilateral stimulation, to develop specific protocols for the struggling students, to measure the effects in the long term and develop them in a group situation.     

Integrating positive psychology applications into the EMDR Peak Performance protocol

IntroductionThis article describes an innovative Eye Movement Desensitization and Reprocessing (EMDR) protocol which applies the standard EMDR protocol, with modifications, to the reduction of performance anxiety and enhancement of skillful performance in higher functioning clients.ObjectiveThe intention was to compare a modified version of the standard EMDR protocol for the reduction of performance anxiety and the enhancement of performance.MethodThe method was applying the special EMDR protocol for peak performance with higher functioning clients. A further enhancement applied three empirically valid techniques drawn from the subfield of positive psychology.ResultsPublished case studies suggest that this special EMDR protocol aided an experienced commercial pilot in overcoming his avoidance and returning to the flight simulator following a failed proficiency check, and assisted an executive in managing his sense of failure following a significant business setback. Athletes preparing for competition have also found the protocol assists them in managing precompetition anxiety. A further enhancement is the application of three techniques drawn from positive psychology which the empirical research in this subfield of psychology suggests can further enhance the benefits of this protocol.ConclusionLimitations are discussed and recommendations for future research are outlined.     

EMDR and early psychological intervention following trauma

IntroductionThis article evaluates developments in the field of early psychological intervention (EPI) after trauma in general and the place of early eye movement desensitization and reprocessing (EMDR) intervention (EEI) in particular. The issues and dilemmas involved with EPI and EEI will be outlined; related research presented and the current status evaluated.Literature and clinical findingsReviewing the literature and drawing on findings from initial research and case studies, the rationale and contribution that EMDR therapy has to offer is discussed relative to current evidence and theory regarding post-traumatic stress syndromes and trauma memories. The relative advantages of EEI will be elaborated.Discussion and conclusionIt is proposed that EEI, while trauma memories have not yet been integrated, may be used not only to treat acute distress but may also provide a window of opportunity in which a brief intervention, possibly on successive days, could prevent complications and strengthen resilience. Through the rapid reduction of intrusive symptoms and de-arousal response as well as by identifying potential obstructions to adaptive information processing (AIP), EMDR therapy may reduce the sensitisation and accumulation of trauma memories.     

Internet-based parent management training: a randomized controlled study

ObjectiveThe current study evaluated the efficacy of an Internet-based parent-training program for children with conduct problems. Dose–response ratio and costs for the program were also considered.MethodParents of 104 children (aged 3–12 years) were randomly allocated to either parent training or a waitlist control condition. Diagnostic assessment was conducted at baseline and parent ratings of child externalizing behaviors and parent strategies were completed before and after treatment and at 6-month follow-up.ResultsAt post-treatment assessment, children whose parent(s) had received the intervention showed a greater reduction in conduct problems compared to the waitlist children. Between group intent-to-treat effect sizes (Cohen’s d) on the Eyberg Intensity and Problem scales were .42 and .72, respectively (study completers .66 and 1.08). In addition, parents in the intervention group reported less use of harsh and inconsistent discipline after the treatment, as well as more positive praise. Effects on behavior problems were maintained at 6-month follow-up.ConclusionsThe results support the efficacy of parent training, administered through Internet, with outcomes comparable to many of the group-based parent training programs. The efficacy, low cost, and higher accessibility make this intervention a fitting part in a stepped-care model.     

Analyse et comparaison de discours de patients douloureux chroniques durant une thérapie de soutien par opposition à l’utilisation de la thérapie Eye Movement Desensitization and Reprocessing (EMDR)

IntroductionThe use of EMDR – Eye Movement Desensitization and Reprocessing – being innovative in the area of chronic pain. If his efficiency as show in the specific litterature, the way its work it is really different than usual therapy.ObjectiveThe main objective of this work is to compare the speech of patients during the use of EMDR vs. supportive therapy in a supported unit of chronic pain to the hospital.MethodsForty-five patients divided into three groups received EMDR therapy (standard protocol), EMDR therapy (pain protocol) as well as supportive therapy. All interviews were transcribed and analyzed using the software Alceste.ResultsThe results show that the semantic classes differ between the three forms of therapy, as well as passive or active posture of the patient during the therapy.ConclusionThese results give us an additional insights into what happens in fine in different types of therapy.     

Eye movement desensitization and reprocessing (EMDR) therapy in the treatment of victims of domestic violence: A pilot study

IntroductionThe purpose of this study was to determine the effectiveness of EMDR in reducing PTSD symptoms, anxiety and depression.MethodThirty-six women participated in this study; 12 were treated with EMDR, 12 received eclectic psychotherapy, and 12 were assigned to the control group.ResultWomen in the EMDR condition showed significantly reduced PTSD and anxiety compared with those in the eclectic psychotherapy condition. The two psychotherapy approaches led to significantly reduced scores (PTSD, depression, anxiety) after treatment compared to the control group. These effects were maintained at the 6-month follow-up. Finally, effect sizes for the IES and STAI scores were greater for the subjects in the EMDR condition.ConclusionThis study met our expectations in the sense that our findings confirm the advantages and the potential of EMDR.     

Motivation-Adaptive Skills-Trauma Resolution (MASTR) Therapy for Adolescents with Conduct Problems

Summary

Trauma is proposed as a key to understanding the development and persistence of adolescent conduct problems, in conjunction with other contributing factors. A trauma-focused individual therapy approach is presented as one example of how this population might be more effectively treated. This approach features motivational interviewing, self-control training (cognitive-behavioral therapy), and trauma resolution (eye movement desensitization and reprocessing). This paper reports on an open trial of six adolescents with school and conduct problems who received school-based Motivation-Adaptive Skills-Trauma Resolution (MASTR) treatment. Reductions in post-traumatic stress, related symptoms, and problem behaviors, along with improved school performance, indicate the value of further study of this treatment approach.     

The EMDR integrative group treatment protocol: EMDR group treatment for early intervention following critical incidents

IntroductionThis paper presents an overview of the Eye Movement Desensitization and Reprocessing – Integrative Group Treatment Protocol (EMDR-IGTP) that has been used since 1998 with both children and adults in its original format or with adaptations to meet the circumstances in numerous settings around the world for thousands of survivors of natural or man-made disasters and during ongoing geopolitical crisis.MethodThe author's intention is to highlight and enlightened the reader of the existence of this protocol that combines the eight standard EMDR treatment phases with a group therapy model and an art therapy format and use the Butterfly Hug as a form of a self-administered bilateral stimulation, thus providing more extensive reach than the individual EMDR application.ConclusionRandomize Controlled Trial Research is suggested to establish the efficacy of this intervention.     

Gender and Age Differences in Social Skills Among Children with ADHD: Peer Problems and Prosocial Behavior

Abstract

Gender differences in peer problems and prosocial behavior among children with attention-deficit hyperactivity disorder (ADHD) were examined. Parents and teachers rated social functioning on the Strengths and Difficulties Questionnaire (SDQ) among 592 children (age 5–10?years) with ADHD and among 215 children (age 6–10?years) in a community sample. Results in the clinical group revealed significant interaction effects where older boys showed fewer peer problems than younger boys, but older girls had similar peer problems as younger girls. Teachers reported less prosocial behavior among younger girls than older girls. No gender differences in social problems emerged for the nonclinical comparison group.     

EMDR therapy: An overview of its development and mechanisms of action

IntroductionThis article examines the history and development of Eye Movement Desensitization and Reprocessing (EMDR), from Dr. Francine Shapiro's original discovery in 1987, to current findings and future directions for research and clinical practice.Elements of the literatureAn overview is provided of significant milestones in the evolution of EMDR over the first 20 years, including key events, research and scientific publications, and humanitarian efforts. The authors also describe the Adaptive Information Processing (AIP) model, which is the theoretical basis of the therapy; they address the question of mechanisms of action, and EMDR's specific contribution to the field of psychotherapy.DiscussionEMDR is an integrative psychotherapy, which sees dysfunctionally stored memories as the core element of the development of psychopathology. In its view of memory, it integrates information that is sensory, cognitive, emotional and somatic in nature. The EMDR protocol looks at past events that formed the presented problem, at the present situations where the problem is experienced, and at the way, the client would like to deal with future challenges.ConclusionEMDR is a 25-year-old therapy that has accumulated a substantial body of research proving its efficiency, and is now part of many professional treatment guidelines. The research is pointing to its potentially large positive impact in the fields of mental and physical health.     

Autism characteristics in children with fetal alcohol spectrum disorders

Background: Children with fetal alcohol spectrum disorders (FASD) exhibit difficulties in many cognitive and behavioral domains and also have high comorbidity with other disorders such as attention deficit/hyperactivity disorder (ADHD) and conduct disorder as well as autism. Although the FASD profile is shown to be distinct from ADHD and conduct disorder, far less is known about the commonalities with autism. The current study used a parent-rated questionnaire containing an autism subscale to explore the autistic-like features that children with FASD exhibit. Methods: Studied were 25 children with FASD (age: M = 10.3 years) and 17 normal controls (NCs; age: M = 10.2 years). As part of a larger study, all parents/caregivers completed the Social Skills Improvement System (SSIS; Gresham & Elliot, 2008), which in addition to evaluating social skills and behavior problems globally, includes an Autism subscale. Results: Between-group comparisons showed the FASD group not only scored significantly lower in social skills and significantly higher in behavior problems than the NC group but children with FASD also scored significantly higher on the Autism subscale. Item analysis revealed they showed the most difficulty in terms of social and communicative functioning and the least in repetitive and restrictive behaviors. Conclusion: Current findings signify that FASD and autism share similarities with regard to social and communicative functioning. These findings, which further our knowledge of the FASD phenotype, may be useful in specifying the particular interventions these children need.     

Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample

ObjectiveTrauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area.MethodA consecutive sample of 330 patients with PTSD (age 17–83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects.ResultsCT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience.ConclusionsThe results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas.     

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.     

Treatment of grief and mourning through EMDR: Conceptual considerations and clinical guidelines

IntroductionEye Movement Desensitization and Reprocessing (EMDR) is an empirically-supported psychotherapeutic approach for treating trauma, which is also applicable to a wide range of other experientially-based clinical complaints. It is particularly useful in treating grief and mourning.Literature findingsEMDR is guided by the Adaptive Information Processing Model (AIP), which conceptualizes the effects of traumatic experiences in terms of dysfunctional memory networks in a physiologically-based information processing system. Numerous empirical studies have demonstrated EMDR's efficacy.DiscussionThe death of a loved one can be very distressing, with memories and experiences associated with the loss becoming dysfunctionally stored and preventing access to adaptive information, including positive memories of the deceased. EMDR can be utilized to integrate these distressing experiences and facilitate the assimilation and accommodation of the loss and movement through the mourning processes.ConclusionApplying the eight phases of EMDR to grief and mourning can yield potent clinical results in the aftermath of loss.     

Intelligence, Callous-Unemotional Traits, and Antisocial Behavior

Research has consistently shown that children with severe conduct problems often exhibit intellectual deficits, especially in their verbal abilities. We investigated whether or not this finding only applies to certain subgroups of children with severe conduct problems. In a sample of 117 clinic-referred children between the ages of 6 and 13, we assessed for Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) symptoms using a structured diagnostic interview with each child's parent and teacher, callous and unemotional traits using parent and teacher ratings, and intellectual functioning using a standard individually administered intelligence test. Children with an ODD or CD diagnosis who did not show callous and unemotional traits showed a deficit on subtests measuring verbal reasoning ability relative to a clinic control group. Children with an ODD or CD diagnosis who also showed callous and unemotional traits did not show a verbal deficit and, in fact, showed a trend toward having weaker nonverbal abilities. These results highlight the importance of recognizing distinct subgroups of children with severe conduct problems when studying potential intellectual deficits in these children.