It has only been in this last decade that trauma-focused treatments (TFT) have been studied in patients with psychotic disorders. Before, the paradigm stated that TFT was contraindicated in these patients because clinicians and researchers assumed the risk of exacerbation of symptoms was too high. The purpose of this article is to examine the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy in the treatment of psychosis. To this end, we will present a brief narrative review of the current state of research in this particular field. The results suggest that, contrary to the “no-TFT-in-psychosis” paradigm, TFTs such as EMDR therapy can successfully be used to reduce trauma-related symptoms in patients with psychosis. Moreover, there are now provisional indications that psychotic symptoms such as delusions and hallucinations can be targeted directly and indirectly using EMDR therapy.
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Based on the assumptions of Shapiro’s adaptive information-processing model, it could be argued that a large proportion of people suffering from an anxiety disorder would benefit from eye movement desensitization and reprocessing (EMDR). This article provides an overview of the current empirical evidence on the application of EMDR for the anxiety disorders spectrum other than posttraumatic stress disorder (PTSD). Reviewing the existing literature, it is disappointing to find that 20 years after its introduction, support for the efficacy of EMDR for other conditions than PTSD is still scarce. Randomized outcome research is limited to panic disorder with agoraphobia and spider phobia. The results suggest that EMDR is generally more effective than no-treatment control conditions or nonspecific interventions but less effective than existing evidence-based (i.e., exposure-based) interventions. However, since these studies were based on incomplete protocols and limited treatment courses, questions about the relative efficacy of EMDR for the treatment of anxiety disorders remain largely unanswered.
- Go to article: Intensive EMDR to Treat Patients With Complex Posttraumatic Stress Disorder: A Case Series
There is mounting evidence suggesting that by increasing the frequency of treatment sessions, posttraumatic stress disorder (PTSD) treatment outcomes significantly improve. As part of an ongoing research project, this study examined the safety and effectiveness of intensive eye movement desensitization and reprocessing (EMDR) therapy in a group of seven (four female) patients suffering from complex PTSD and multiple comorbidities resulting from childhood sexual abuse, physical abuse, and/or work and combat-related trauma. Treatment was not preceded by a preparation phase and consisted of 2 × 4 consecutive days of EMDR therapy administered in morning and afternoon sessions of 90 minutes each, interspersed with intensive physical activity and psychoeducation. Outcome measures were the Clinician-Administered PTSD Scale (CAPS) and the PTSD Symptom Scale Self-report questionnaire (PSS-SR). During treatment, neither personal adverse events nor dropout occurred. CAPS scores decreased significantly from pre- to posttreatment, and four of the seven patients lost their PTSD diagnosis as established with the CAPS. The results were maintained at 3-month follow-up. Effect sizes (Cohen’s d) on the CAPS and PSS-SR were large: 3.2, 1.7 (prepost) and 2.3, 2.1 (prefollow-up), respectively. The results of this case series suggest that an intensive program using EMDR therapy is a potentially safe and effective treatment alternative for complex PTSD. The application of massed, consecutive days of treatments using EMDR therapy for patients suffering from PTSD, particularly those with multiple comorbidities, merits more clinical and research attention.
This article outlines a comprehensive model that helps to identify crucial target memories for EMDR treatment. The “Two Method Approach” can be used for conceptualization and treatment implementation for a broad spectrum of symptoms and problems, other than those related to PTSD per se. The model consists of two types of case conceptualizations. The First Method deals with symptoms whereby memories of the etiological and/or aggravating events can be meaningfully specified on a time line. It is primarily aimed at the conceptualization and treatment of DSM-IV-TR Axis I disorders. The Second Method is used to identify memories that underlie patients’ so-called dysfunctional core beliefs. This method is primarily used to treat more severe forms of pathology, such as severe social phobia, complex PTSD, and/or personality disorders. The two methods of case conceptualization are explained step by step in detail and are illustrated by case examples.
- Go to article: L'EMDR dans la psychose : lignes directrices pour la conceptualisation et le traitement
Un grand nombre de patients présentant une psychose ont vécu des traumatismes infantiles et souffrent d'un état de stress post-traumatique comorbide. La recherche indique que l'exposition à des événements perturbants en début de vie joue un rôle considérable dans l'émergence et la persistance de symptômes psychotiques – directement ou indirectement. L'approche des deux méthodes pour la conceptualisation EMDR et les données récentes sur le retraitement d'imagerie psychotique répondent bien aux modèles cognitifs existants de la psychose. Cet article présente une série de lignes directrices préliminaires pour la conceptualisation du traitement EMDR dans la psychose, fondées à la fois sur la théorie et sur l'expérience clinique, et illustrées par des exemples de cas. Plusieurs obstacles et stratégies thérapeutiques associées concernant l'utilisation de l'EMDR dans la psychose sont décrits. L'EMDR dans la psychose peut très bien se combiner avec d'autres interventions standard telles que les psychotropes et la thérapie cognitive comportementale.
- Go to article: The Current Status of EMDR Therapy Involving the Treatment of Complex Posttraumatic Stress Disorder
Complex posttraumatic stress disorder (CPTSD) is a diagnostic entity that will be included in the forthcoming edition of the International Classification of Diseases, 11th Revision (ICD-11). It denotes a severe form of PTSD, comprising not only the symptom clusters of PTSD (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV-TR]), but also clusters reflecting difficulties in regulating emotions, disturbances in relational capacities, and adversely affected belief systems about oneself, others, or the world. Evidence is mounting suggesting that first-line trauma-focused treatments, including eye movement desensitization and reprocessing (EMDR) therapy, are effective not only for the treatment of PTSD, but also for the treatment of patients with a history of early childhood interpersonal trauma who are suffering from symptoms characteristic of CPTSD. However, controversy exists as to when EMDR therapy should be offered to people with CPTSD. This article reviews the evidence in support of EMDR therapy as a first-line treatment for CPTSD and addresses the fact that there appears to be little empirical evidence supporting the view that there should be a stabilization phase prior to trauma processing in working with CPTSD.
- Go to article: L'approche des deux méthodes: un modèle pour la conceptualisation de cas dans un contexte thérapeutique EMDR
- Go to article: Approche des deux méthodes : un modèle de conceptualisation de cas dans le contexte de l’EMDR
Cet article décrit un modèle complet qui permet d’identifier des souvenirs cibles essentiels pour le traitement EMDR. L’“Approche des deux méthodes” peut s’appliquer à la conceptualisation et à la réalisation du traitement pour une large gamme de symptômes et de problèmes autres que ceux qui sont directement en lien avec l’ESPT. Le modèle se compose de deux types de conceptualisation de cas. La Première méthode s’applique aux symptômes permettant de préciser de manière significative les événements étiologiques ou aggravants sur une ligne du temps. Elle est principalement destinée à la conceptualisation et au traitement de troubles de l’Axe I du DSM-IV-TR. La Seconde méthode est utilisée pour identifier les souvenirs qui sous-tendent les croyances fondamentales dysfonctionnelles. Cette méthode est principalement destinée à traiter les formes plus graves de psychopathologie, comme la phobie sociale sévère, l’ESPT complexe ou les troubles de la personnalité. Les deux méthodes de conceptualisation de cas sont expliquées point par point, en détail, et sont illustrées par des exemples de cas.
- Go to article: The Status of EMDR Therapy in the Treatment of Posttraumatic Stress Disorder 30 Years After Its Introduction
The Status of EMDR Therapy in the Treatment of Posttraumatic Stress Disorder 30 Years After Its Introduction
Given that 2019 marks the 30th anniversary of eye movement desensitization and reprocessing (EMDR) therapy, the purpose of this article is to summarize the current empirical evidence in support of EMDR therapy as an effective treatment intervention for posttraumatic stress disorder (PTSD). Currently, there are more than 30 randomized controlled trials (RCT) demonstrating the effectiveness in patients with this debilitating mental health condition, thus providing a robust evidence base for EMDR therapy as a first-choice treatment for PTSD. Results from several meta-analyses further suggest that EMDR therapy is equally effective as its most important trauma-focused comparator, that is, trauma-focused cognitive behavioral therapy, albeit there are indications from some studies that EMDR therapy might be more efficient and cost-effective. There is emerging evidence showing that EMDR treatment of patients with psychiatric disorders, such as psychosis, in which PTSD is comorbid, is also safe, effective, and efficacious. In addition to future well-crafted RCTs in areas such as combat-related PTSD and psychiatric disorders with comorbid PTSD, RCTs with PTSD as the primary diagnosis remain pivotal in further demonstrating EMDR therapy as a robust treatment intervention.
Given the limited number of reported cases in literature, it might be concluded that it is rare to develop a choking phobia in childhood. However, it appears as though confusion in terminology and the time lapse between the onset of the disorder and treatment often results in the diagnosis being missed. In this article, we discuss a review of the clinical symptoms, differential diagnosis, comorbidity, etiology, and treatment options for choking phobia. We present a case series, describing the successful EMDR treatment of choking phobia for 4 children and adolescents, with positive outcomes achieved in 1 or 2 sessions. In addition, a detailed transcript is presented of a 15-year-old girl with a choking phobia related to an incident that occurred 5 years previously. The rapid elimination of symptoms in all 4 cases indicates that EMDR can be an effective treatment for choking phobias resulting from previous disturbing events. Randomized research on this promising intervention is strongly suggested.