From the March 2009 EMDRIA Newsletter

Ginger, S. (2008). Enriching Gestalt therapy through EMDR. International Journal of Psychotherapy, 12(2), 13-20.

Serge Ginger, 183 rue Lecourbe, Paris, France, 75015, <ginger@noos.fr>.

Abstract  The objective of the study was to examine the efficacy of EMDR treatment for children with post-traumatic stress disorder (PTSD) compared with untreated children in a waiting list control group (WLC) participating in a randomized controlled superiority trial (RCT). Thirty-three 6-16-year-old children with a DSM-IV diagnosis of PTSD were randomly assigned to eight weekly EMDR sessions or the WLC group. The Posttraumatic Stress Symptom Scale for Children (PTSS-C scale) was used in interviews with children to evaluate their symptoms and outcome. Post-treatment scores of the EMDR group were significantly lower than the WLC indicating improvement in total PTSS-C scores, PTSD-related symptom scale, and the subscales re-experiencing and avoidance among subjects in the EMDR group, while untreated children improved in PTSD-non-related symptom scale. The improvement in re-experiencing symptoms proved to be the most significant between-group difference over time. The results of the present exploratory study including a limited number of children with PTSD are encouraging and warrant further controlled studies of larger samples of children suffering from PTSD.

  Hogberg, G., & Hallstrom, T. (2008). Active multimodal psychotherapy in children and adolescents with suicidality: Description, evaluation and clinical profile. Clin Child Psychol Psychiatry, 13(3), 435-448.

Karolinska Institute, Stockholm, Sweden. gor.hogberg@gmail.com

Abstract  The aim of this study was to describe and evaluate the clinical pattern of 14 youths with presenting suicidality, to describe an integrative treatment approach, and to estimate therapy effectiveness. Fourteen patients aged 10 to 18 years from a child and adolescent outpatient clinic in Stockholm were followed in a case series. The patients were treated with active multimodal psychotherapy. This consisted of mood charting by mood-maps, psycho-education, wellbeing practice and trauma resolution. Active techniques were psychodrama and body-mind focused techniques including eye movement desensitization and reprocessing. The patients were assessed before treatment, immediately after treatment and at 22 months post treatment with the Global Assessment of Functioning Scale. The clinical pattern of the group was observed. After treatment there was a significant change towards normality in the Global Assessment of Functioning scale both immediately post-treatment and at 22 months. A clinical pattern, post trauma suicidal reaction, was observed with a combination of suicidality, insomnia, bodily symptoms and disturbed mood regulation. We conclude that in the post trauma reaction suicidality might be a presenting symptom in young people. Despite the shortcomings of a case series the results of this study suggest that a mood-map-based multimodal treatment approach with active techniques might be of value in the treatment of children and youth with suicidality.

Kapfhammer, H. P. (2008). [Therapeutic possibilities after traumatic experiences]. Psychiatr Danub, 20(4), 532-545.

Klinik fur Psychiatrie, Medizinische Universitat Graz, Auenbruggerplatz 31, Graz, Austria. <Hans-peter.kapfhammer@klinikum-graz.at>

Abstract  Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are frequent, but not obligatory psychological sequelae following trauma. A major subgroup of patients face a chronic course of illness associated with an increased psychiatric comorbidity and significant impairments in psychosocial adaptation. The typical psychopathological symptoms of ASD and PTSD are best described within a multifactorial model integrating both neurobiological and psychosocial influences. The complex etiopathogenesis of acute and posttraumatic stress disorder favours multimodal approaches in the treatment. Differential psychotherapeutic and pharmacological strategies are available. In a critical survey on empirical studies, psychological debriefing cannot be considered as a positive approach to be recommended as general preventive measure during the immediate posttraumatic phase. Positive effects of cognitive-behavioral interventions can be established for ASD. Psychodynamic psychotherapy, cognitive-behavioral therapy and EMDR show promising results in the treatment of PTSD. Major clinical restrictions of patient sampling within special research facilities, however, do not allow an unconditional generalization of these data to psychiatric routine care. In an empirical analysis the SSRIs are the most and best studied medications for ASD and PTSD. In comparison to tricyclic antidepressants SSRIs demonstrate a broader spectrum of therapeutic effects and are better tolerated. The substance classes of SSNRI, DAS, SARI and NaSSA are to be considered as drugs of second choice. They promise a therapeutic efficacy equivalent to the SSRIs, being investigated so far only in open studies. MAO-inhibitors may dispose of a positive therapeutic potential, their profile of side effects must be respected, however. Mood stabilizers and atypical neuroleptics may be used first and foremost in add-on strategies. Benzodiazepines should be used only with increased caution for a short time in states of acute crisis. In early interventions, substances blocking the norepinephric hyperactivity seem to be promising alternatives. Stress doses of hydrocortisone may be considered as an experimental pharmacological strategy so far.

Lee, C. (2008). More Than Imaginal Exposure. Journal of EMDR Practice and Research, 2(4), 262-268.

Christopher W. Lee, Clinical Psychology Programme, School of Psychology, Murdoch University, Murdoch, Western Australia 6150. E-mail: <Chris.Lee@murdoch.edu.au>

Abstract  The processes that underlie the effectiveness of eye movement desensitization and reprocessing (EMDR) are examined by evaluating the procedural differences between it and exposure therapy. Major factors include the degree of emphasis placed on reliving versus distancing in the therapies and the degree to which clients are encouraged to focus on direct trauma experiences versus experiences associated with the trauma. Research results indicate that, unlike traditional imaginal exposure, reliving responses in EMDR did not correlate with symptom improvement. Instead, consistent with an information processing model, the degree of distancing in EMDR was significantly associated with improvement. A case study is described to highlight these methodological divergences in the respective therapies relating to reliving. Finally, the research regarding the possible sources of the distancing response within EMDR was examined. The results indicate that the distancing process was more likely to be an effect produced by eye movements than by any therapist instructions. Theoretical and research evaluations indicate that the mechanisms underlying EMDR and traditional exposure therapy are different.

Maxfield, L., Melnyk, W. T., & Hayman, C. A. G. (2008). A Working Memory Explanation for the Effects of Eye Movements in EMDR. Journal of EMDR Practice and Research, 2(4), 247-261.

Louise Maxfield, London Health Sciences Centre, Department of Psychiatry, University of Western Ontario, South Street Hospital, 370 South Street, NR-D111, London, ON, N6A 4G5 Canada. E-mail: <Louise.Maxfield@lhsc.on.ca>.

Abstract  Research has consistently demonstrated that performance is degraded when participants engage in two simultaneous tasks that require the same working memory resources. This study tested predictions from working memory theory to investigate the effects of eye movement (EM) on the components of auto-biographical memory. In two experiments, 24 and 36 participants, respectively, focused on negative memories while engaging in three dual-attention EM tasks of increasing complexity. Compared to No-EM, Slow-EM and Fast-EM produced significantly decreased ratings of image vividness, thought clarity, and emotional intensity, and the more difficult Fast-EM resulted in larger decreases than did Slow-EM. The effects on emotional intensity were not consistent, with some preliminary evidence that a focus on memory-related thought might maintain emotional intensity during simple dual-attention tasks (Slow-EM, No-EM). The findings of our experiments support a working memory explanation for the effects of EM dual-attention tasks on autobiographical memory. Implications for understanding the mechanisms of action in EMDR are discussed.

Mendes, D. D., Mello, M. F., Ventura, P., Passarela Cde, M., & Mari Jde, J. (2008). A systematic review on the effectiveness of cognitive behavioral therapy for posttraumatic stress disorder. Int J Psychiatry Med, 38(3), 241-259.

Universidade Federal de Sao Paulo, Departamento de Psiquiatria, Brazil. <deisedaniela@gmail.com>

Abstract  OBJECTIVE: Cognitive behavioral therapy (CBT) is the most common psychotherapy approach for the treatment of PTSD. Nevertheless, previous reviews on the efficacy of several types of psychotherapy were unable to detect differences between CBT and other psychotherapies. The purpose of this study was to conduct systematic review on the efficacy ofCBT in comparison with studies that used other psychotherapy techniques. METHOD: Databases were searched using the following terms: posttraumatic stress disorder/stress disorder, treatment/psychotherapy/behavior cognitive therapy, randomized trials, and adults. Randomized clinical trials published between 1980 and 2005 and that compared CBT with other treatments for PTSD was included. The main outcomes were remission, clinical improvement, dropout rates and changes in symptoms. RESULTS: The 23 clinical trials included in the review comprised 1923 patients: 898 in the treatment group and 1,025 in the control group. CBT had better remission rates than EMDR (RR = 0.35; 95% CI: 0.16; 0.79; p = 0.01) or supportive therapies (RR = 0.43; 95% CI: 0.25; 0.74; p = 0.002, completer analysis). CBT was comparable to Exposure Therapy (ET) (RR = 0.90; 95% CI: 0.58; 1.40; p = 0.64), and cognitive therapy (CT) (RR = 1.01; 95% CI: 0.67; 1.51; p = 0.98) in terms of efficacy and compliance. CONCLUSIONS: These findings suggest that specific therapies, such as CBT, exposure therapy and cognitive therapy are equally effective, and more effective than supportive techniques in the treatment of PTSD.

Stickgold, R. (2008). Sleep-Dependent Memory Processing and EMDR Action. Journal of EMDR Practice and Research, 2(4), 289-299.

Robert Stickgold, Center for Sleep and Cognition, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, FD-861, Boston, MA 02215. E-mail: <rstickgold@hms.harvard.edu>.

Abstract  The unique efficacy of eye movement desensitization and reprocessing (EMDR) in the treatment of posttraumatic stress disorder is thought to result from changes in the brain/mind state induced by bilateral sensory stimulation, but the nature and specific consequences of these changes remain unknown. The possibility that bilateral stimulation induces a brain/mind state similar to that of rapid eye movement sleep is supported by studies showing that sleep facilitates forms of memory processing arguably necessary for the resolution of trauma. Such studies, along with direct studies of the impact of bilateral stimulation on memory and emotional processing, and dismantling studies identifying the requisite features of such bilateral stimulation for effective trauma processing, will eventually lead to an understanding of the neurobiological basis of EMDR.