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Trauma-focused therapy in early psychosis: results of a feasibility randomized controlled trial of EMDR for psychosis (EMDRp) in early intervention settings
Trauma is prevalent amongst early psychosis patients and associated with adverse outcomes. Past trials of trauma-focused therapy have focused on chronic patients with psychosis/schizophrenia and comorbid Post-Traumatic Stress Disorder (PTSD). We aimed to determine the feasibility of a large-scale randomized controlled trial (RCT) of an Eye Movement Desensitization and Reprocessing for psychosis (EMDRp) intervention for early psychosis service users.
A single-blind RCT comparing 16 sessions of EMDRp + TAU
TAU only was conducted. Participants completed baseline, 6-month and 12-month post-randomization assessments. EMDRp and trial assessments were delivered both in-person and remotely due to COVID-19 restrictions. Feasibility outcomes were recruitment and retention, therapy attendance/engagement, adherence to EMDRp treatment protocol, and the 'promise of efficacy' of EMDRp on relevant clinical outcomes.
Sixty participants (100% of the recruitment target) received TAU or EMDR + TAU. 83% completed at least one follow-up assessment, with 74% at 6-month and 70% at 12-month. 74% of EMDRp + TAU participants received at least eight therapy sessions and 97% rated therapy sessions demonstrated good treatment fidelity. At 6-month, there were signals of promise of efficacy of EMDRp + TAU
TAU for total psychotic symptoms (PANSS), subjective recovery from psychosis, PTSD symptoms, depression, anxiety, and general health status. Signals of efficacy at 12-month were less pronounced but remained robust for PTSD symptoms and general health status.
The trial feasibility criteria were fully met, and EMDRp was associated with promising signals of efficacy on a range of valuable clinical outcomes. A larger-scale, multi-center trial of EMDRp is feasible and warranted.
Journal Article
Sensorimotor-focused EMDR : a new paradigm for psychotherapy and peak performance
\"Sensorimotor Focused EMDR (SF-EMDR) for Psychotherapy combines two hugely influential and effective therapies, EMDR therapy and sensorimotor psychotherapy, to provide a new approach. In doing so, the book supports the widely held view of psychotherapists that in trauma the primary store of neurological information is somatic rather than cognitive\"-- Provided by publisher.
Book
The effect of eye movement desensitization on neurocognitive functioning compared to retrieval-only in PTSD patients: a randomized controlled trial
Background
There is robust evidence that posttraumatic stress disorder (PTSD) is associated with neurocognitive deficits, such as executive dysfunction or memory dysfunction. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based treatment for PTSD, in which eye movements (EMs) are performed during traumatic memory retrieval. We examined whether Eye Movement Desensitization (EMD) improves neurocognitive functioning in PTSD patients, in comparison with a retrieval-only control condition without EMs.
Methods
Adult patients with PTSD (
N
= 91) were randomized into EMD (
N
= 47) or retrieval-only (
N
= 44). Data were collected at baseline (T0), one-week post-treatment (T1), one-month follow-up (T2), and at three-month follow-up (T3). Outcome measures were the California Verbal Learning Test (CVLT), the Trail Making Test (TMT), and the Digit Span Subtest of the Wechsler Adult Intelligence Scale fourth edition (WAIS-IV). We conducted linear mixed model to analyse the main outcomes.
Results
There was a main effect of time, indicating improvements for both the EMD and retrieval-only groups in CVLT scores, TMT A, TMT B and Digit Span score of WAIS-IV (Bonferroni-adjusted
p’s
< 0.001) from T0 to T3. There were no effects of group (
p
= .64) or group by time on CVLT total trial A (T3;
p = .
34), delay A (T3;
p =
.76), TMT A (T3;
p =
.61), TMT B (T3:
p =
.58), and Digit Span scores (T3;
p =
.78) of the WAIS-IV, indicating no significant differences between groups on any of the outcomes.
Conclusion
Comparing EMD and retrieval-only did not show evidence for additive effects of EMs on the treatment of PTSD in terms of improvements in neurocognitive functioning. Thus, treatments based on retrieval of traumatic memories may be used to improve neurocognitive functioning in patients with PTSD.
Clinical trial registration
The trial was registered 19/12/2017 at ClinicalTrials.gov, identifier [ISRCTN55239132].
Journal Article
EMDR : the breakthrough therapy for overcoming anxiety, stress, and trauma
\"When EMDR was first published in 1997, it was hailed as the most important method to emerge in psychotherapy in decades. In the twenty years since, Eye Movement Desensitization and Reprocessing (EMDR) therapy has successfully treated psychological problems for millions of sufferers worldwide. In this updated edition, Francine Shapiro offers a new introduction that presents the latest applications of this remarkable therapy, as well as new scientific data demonstrating its efficacy. Drawing on the experiences of thousands of clinicians as well as a vast research literature on depression, addiction, PTSD, and other disorders, she explains how life experiences are physically stored in our brains, making us feel and act in harmful ways, and how EMDR therapy can bring relief, often in a remarkably short period of time. Applicable to survivors of trauma as well as people suffering from phobias and other experience-based disorders, EMDR is essential reading for anyone who seeks to understand why we hurt, how we heal, and how we get better.\"--Publisher's description.
Book
The efficacy of eye movement desensitization and reprocessing for post-traumatic stress disorder and depression among Syrian refugees: results of a randomized controlled trial
Previous research indicates a high prevalence of post-traumatic stress disorder (PTSD) and depression among refugees. Eye movement desensitization and reprocessing (EMDR) is an effective treatment for PTSD for victims of natural disasters, car accidents or other traumatic events. The current study examined the effect of EMDR on symptoms of PTSD and depression by comparing the treatment with a wait-list control condition in Syrian refugees.
Adult refugees located in Kilis Refugee Camp at the Turkish-Syrian border with a PTSD diagnosis were randomly allocated to either EMDR (n = 37) or wait-list control (n = 33) conditions. All participants were assessed with the Mini-International Neuropsychiatric Interview Plus at pre-intervention, at 1 week after finishing the intervention and at 5 weeks after finishing the intervention. The main outcome measures were the Harvard Trauma Questionnaire (HTQ) and the Impact of Event Scale-Revised. The Beck Depression Inventory and the Hopkins Symptoms Checklist-25 were included as secondary outcome measures. The Trial Registration no. is NCT01847742.
Mixed-model analyses adjusted for the baseline scores indicated a significant effect of group at post-treatment indicating that the EMDR therapy group showed a significantly larger reduction of PTSD symptoms as assessed with the HTQ. Similar findings were found on the other outcome measures. There was no effect of time or group × time interaction on any measure, showing that the difference between the groups at the post-treatment was maintained to the 5-week follow-up.
EMDR may be effective in reducing PTSD and depression symptoms among Syrian refugees with PTSD located in a refugee camp.
Journal Article
Imagery rescripting and eye movement desensitisation and reprocessing as treatment for adults with post-traumatic stress disorder from childhood trauma: randomised clinical trial
Investigation of treatments that effectively treat adults with post-traumatic stress disorder from childhood experiences (Ch-PTSD) and are well tolerated by patients is needed to improve outcomes for this population.
The purpose of this study was to compare the effectiveness of two trauma-focused treatments, imagery rescripting (ImRs) and eye movement desensitisation and reprocessing (EMDR), for treating Ch-PTSD.
We conducted an international, multicentre, randomised clinical trial, recruiting adults with Ch-PTSD from childhood trauma before 16 years of age. Participants were randomised to treatment condition and assessed by blind raters at multiple time points. Participants received up to 12 90-min sessions of either ImRs or EMDR, biweekly.
A total of 155 participants were included in the final intent-to-treat analysis. Drop-out rates were low, at 7.7%. A generalised linear mixed model of repeated measures showed that observer-rated post-traumatic stress disorder (PTSD) symptoms significantly decreased for both ImRs (d = 1.72) and EMDR (d = 1.73) at the 8-week post-treatment assessment. Similar results were seen with secondary outcome measures and self-reported PTSD symptoms. There were no significant differences between the two treatments on any standardised measure at post-treatment and follow-up.
ImRs and EMDR treatments were found to be effective in treating PTSD symptoms arising from childhood trauma, and in reducing other symptoms such as depression, dissociation and trauma-related cognitions. The low drop-out rates suggest that the treatments were well tolerated by participants. The results from this study provide evidence for the use of trauma-focused treatments for Ch-PTSD.
Journal Article
Optimizing the ICA-based removal of ocular EEG artifacts from free viewing experiments
Combining EEG with eye-tracking is a promising approach to study neural correlates of natural vision, but the resulting recordings are also heavily contaminated by activity of the eye balls, eye lids, and extraocular muscles. While Independent Component Analysis (ICA) is commonly used to suppress these ocular artifacts, its performance under free viewing conditions has not been systematically evaluated and many published reports contain residual artifacts. Here I evaluated and optimized ICA-based correction for two tasks with unconstrained eye movements: visual search in images and sentence reading. In a first step, four parameters of the ICA pipeline were varied orthogonally: the (1) high-pass and (2) low-pass filter applied to the training data, (3) the proportion of training data containing myogenic saccadic spike potentials (SP), and (4) the threshold for eye tracker-based component rejection. In a second step, the eye-tracker was used to objectively quantify the correction quality of each ICA solution, both in terms of undercorrection (residual artifacts) and overcorrection (removal of neurogenic activity). As a benchmark, results were compared to those obtained with an alternative spatial filter, Multiple Source Eye Correction (MSEC). With commonly used settings, Infomax ICA not only left artifacts in the data, but also distorted neurogenic activity during eye movement-free intervals. However, correction results could be strongly improved by training the ICA on optimally filtered data in which SPs were massively overweighted. With optimized procedures, ICA removed virtually all artifacts, including the SP and its associated spectral broadband artifact from both viewing paradigms, with little distortion of neural activity. It also outperformed MSEC in terms of SP correction. Matlab code is provided.
Journal Article