Eye movement desensitization and reprocessing (EMDR) therapy is a form of psychotherapy used for individuals who have experienced stress-related injuries. Having an unpleasant experience of previous childbirth can cause anxiety and fear of labor in women during the next childbirth. The aim of this study was investigating the effect of the EMDR therapy on childbirth anxiety among multiparous women in the next normal pregnancy, following a prior stillbirth. A randomized controlled clinical trial was conducted with 30 pregnant women after they were admitted for delivery in an urban hospital in Qazvin, Iran, in 2016. The participants were selected using a convenient sampling method and then were randomly assigned into two groups, EMDR intervention (n = 15) and usual treatment control (n = 15). The Van den Bergh Pregnancy-Related Anxiety questionnaire was used to collect data before treatment (on admission when recruited for study) and after treatment (within 24 hours after childbirth). The EMDR therapy for the intervention group was performed with a 90-minute session when participants were admitted in hospital for delivery. The control group received only routine care. Data were collected using descriptive and inferential statistics and p < .05 was considered statistically significant. A statistically significant reduction in the mean anxiety in the EMDR intervention group compared to the control group was reported. Also, a reduction in the scores of posttest compared with pretest was observed in the EMDR intervention group (p < .01). The EMDR therapy reduced childbirth anxiety in pregnant women during normal pregnancy, following previous stillbirth.
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Although treatment fidelity measures for eye movement desensitization and reprocessing (EMDR) have been cited in past research, none have been subject to any empirical investigation of reliability. This three-phase study aimed to quantify the interrater reliability of a measure of EMDR treatment fidelity. First, two raters refined the reprocessing section of the EMDR Fidelity Checklist (Leeds, 2016) by developing a descriptive item-by-item scoring system to improve interpretation and reliability. The resultant checklist was piloted on recordings of five EMDR session recordings from the Laugharne et al. (2016) study. The checklist was then revised. Next, the raters used the checklist to assess 15 other recorded EMDR sessions from the same study. The intraclass correlations (ICCs) were in the excellent range for all subscales and total session scores (i.e., >0.75), with an exception of the Desensitization subscale, ICC = 0.69 (0.08, 0.90). Finally, individual items in that subscale were evaluated, finding that five items did not contribute to the ICC. When these were removed/revised, the ICC for this subscale moved into the excellent range, ICC = 0.81(0.43, 0.94). The findings of this study indicate that this checklist may be a reliable measure of treatment fidelity for single reprocessing EMDR sessions with the possible exception of the Body Scan phase. Future research using the checklist with raters who were not involved in checklist development is needed to confirm the generalizability of these findings.
This article discusses strategies for working with patients who present with the specific psychological deficits associated with complex trauma. In order to maintain the patient's stability, safety, and capacity for adaptive information processing (AIP) during sessions, these treatments require an extremely active therapist who is able to help regulate the pace of therapy and the patient's participation in it. Attunement to both patient's and therapist's experience is a core therapeutic process that enables the treatment. Eye movement desensitization and reprocessing (EMDR) therapists must set the frame of the therapy, help to build and then utilize the capacity for AIP, and establish a relationship capable of coregulating the patient's state during both resource development and trauma processing. All of these functions can be enhanced using bilateral stimulation (BLS). They are accomplished via specific therapist actions during sessions: assessing and supporting the capacity for AIP, looking for opportunities to strengthen resources and competencies, and staying attuned to empathic resonances and countertransference. Decisions that shape the treatment process and affect its pacing evolve from an integration of multiple factors: the therapist's attunement to self, patient, and the therapy relationship; and an understanding of complex trauma, dissociation, therapeutic process, and EMDR. Examples of patient–therapist interaction during two EMDR sessions are provided to illustrate therapy process and the use of the treatment relationship in clinical decision-making and coregulation.
- Go to article: Flash Technique Group Protocol for Highly Dissociative Clients in a Homeless Shelter: A Clinical Report
Flash Technique Group Protocol for Highly Dissociative Clients in a Homeless Shelter: A Clinical Report
The Flash Technique is a new protocol for use in the preparation phase of eye movement desensitization and reprocessing (EMDR) to quickly reduce the emotional intensity of traumatic memories, prior to full processing with EMDR. This report presents results from a Flash Technique group for five highly dissociative, currently sober addicts in a men's shelter. This group was an attempt to provide an affordable, trauma-focused intervention for the homeless. As part of the intake, each client met individually with the therapist for 30 minutes, to learn to use the flash technique to process a traumatic memory. Three inventories were used to measure treatment outcome: the Short PTSD Rating Interview (SPRINT), the Dissociative Experience Survey (DES-II), and the Beck Depression Inventory-II (BDI-II). Clients filled out the surveys 3 weeks before the start of the group and had their individual sessions 2 weeks before the start of the group. The DES and BDI-II were repeated at the beginning of the eighth session of the group. Clients' surveys showed a decline in scores after seven sessions of therapy: the DES scores dropped from 39.07 (standard deviation [SD] = 23.01) to 20.48 (SD = 10.02) with d = 0.81 and the BDI-II scores dropped from 32.4 (SD = 11.01) to 13.2 (SD = 8.4) with d = 1.74. Pre- and 2-week posttreatment SPRINT surveys showed scores dropping from 28 [SD = 2.05] pretreatment to 15.75 [SD = 5.19] 2 weeks posttreatment, with d = 6.07.
Given the significant growth in the migration flow of refugees who are fleeing from persecution, terrorism, and war-torn countries to Europe, there is an urgent need for effective interventions for the treatment of this highly traumatized population. EMDR Integrative Group Treatment Protocol (EMDR-IGTP) was provided to 14 child refugees (7 females) in 2016 at a Turkey orphanage near the Syrian border which was housing adult and child Syrian refugees. Treatment was provided in three groups, one each for children aged 3–7 years, pre-adolescents aged 9–12, and adolescents aged 13–18 with three sessions provided to each group. Pre-treatment assessment with multiple measures was compromised by difficulties with translator availability and refugee mobility, resulting in high attrition. When the post-treatment assessment was conducted 45 days later, many refugees had already left the orphanage. The sparse character of the data matrix produced analyzable data for 8 children (mean age 11 ± 3; 4 females) on the Children's Revised Impact of Event Scale (CRIES). Statistical analysis showed a significant decrease in CRIES scores, reflecting a decrease in severity of posttraumatic symptoms.
- Go to article: Randomized Controlled Trial: EMDR Early Intervention With and Without Eye Movements for Learned Helplessness State
Randomized Controlled Trial: EMDR Early Intervention With and Without Eye Movements for Learned Helplessness State
Learned helplessness (LH) is considered a psychological trait, which occurs after repeated exposure to aversive and uncontrollable situations (Seligman, 1975). Such an exposure is found to lead motivational, cognitive, and emotional deficits. LH has also been linked to different psychological disorders such as depression, anxiety, posttraumatic stress disorder (PTSD), and trauma-related depression. Eye movement desensitization and reprocessing (EMDR) therapy has been accepted as an efficacious treatment for PTSD, but evidence for its effectiveness as an early intervention is still preliminary. Also, there is some uncertainty regarding the role of eye movements in EMDR. The current randomized controlled study investigated whether a single 15-minute session of EMDR's Recent Traumatic Episode Protocol (R-TEP) could reduce the effects of laboratory-induced LH. The study further investigated whether R-TEP without eye movements would have the same effect. Using established experimental tasks, an LH state was induced via unsolvable maze tasks with effects measured by the participants' performance in solving anagrams. Results revealed that an LH state was successfully induced by the unsolvable mazes. R-TEP effectively reversed the negative effects of the LH state and was significantly more effective than no treatment controls and the R-TEP condition without eye movements, which was essentially a narrative exposure intervention. Results suggest that R-TEP can be successfully administered immediately following a distressful event, and that eye movements appear to be a necessary component of EMDR in reversing the cognitive, motivational, and/or emotional deficits induced by LH.
- Go to article: The Network Balance Model of Trauma and Resolution—Level I: Large-Scale Neural Networks
There are three large-scale neural networks in the brain. The default mode network functions in autobiographical memory, self-oriented and social cognition, and imagining the future. The central executive network functions in engagement with the external world, goal-directed attention, and execution of actions. The salience network mediates interoception, emotional processing, and network switching. Flexible, balanced participation of all three networks is required for the processing of memory to its most adaptive form to support optimal behavior. The triple network model of psychopathology suggests that aberrant function of these networks may result in diverse clinical syndromes of psychopathology (Menon, 2011). Acute stress causes a shift in the balance of the large-scale networks, favoring the salience network and rapid, evolutionarily proven survival responses. This shift results in memory being processed by the amygdala and hippocampus, with limited participation of the prefrontal cortex. Typically following the resolution of stress, balance of the three networks is restored, and processing of memory with prefrontal cortex participation resumes spontaneously. The Network Balance Model of Trauma and Resolution posits that failure to restore network balance manifests clinically as posttraumatic stress disorder (PTSD), with inadequately processed and dysfunctionally stored memory (Chamberlin, 2014). Using eye movement desensitization and reprocessing (EMDR) therapy as an example, the model illustrates how the phases of the standard protocol activate specific networks, restoring network balance and the optimal processing of memory. The model offers a physiological mechanism of action for the resolution of psychological trauma in general, and EMDR therapy in particular.
This research study examined 56 eye movement desensitization and reprocessing (EMDR) clinician responses to a case vignette to explore the question of how a sample of EMDR clinicians integrated the role of culture in EMDR therapy. A combination of basic interpretive and discourse analysis qualitative research methods examined participant responses to an online survey posting the vignette and several open-ended response questions. Results found that EMDR clinicians generally view the EMDR standard procedures as being flexible enough to meet client needs independent of cultural considerations. However, when prompted, the respondents were able to provide concrete examples of culture's potential influence. Furthermore, some implicit patterns of English language use suggested that there may be areas where more intentional reflection of the intersection of culture and EMDR may be warranted. The study serves as a catalyst for future inquiry on cultural issues in EMDR and validation of qualitative analytic strategies for EMDR research. The participants' responses also allowed an evaluation of how they conceptualized EMDR therapy and how they discussed EMDR with their clients. Identified themes included reflections on universality, reflections on cultural influences on treatment, individual differences in cultural identity, clinician identity interacting with treatment, EMDR process, and implicit cultural aspects of treatment.
- Go to article: Idéalisation et émotions positives inadaptées : thérapie EMDR pour femmes ambivalentes à l'idée de quitter un partenaire violent
- Go to article: Randomized Controlled Trial: Provision of EMDR Protocol for Recent Critical Incidents and Ongoing Traumatic Stress to First Responders
Randomized Controlled Trial: Provision of EMDR Protocol for Recent Critical Incidents and Ongoing Traumatic Stress to First Responders
This randomized controlled trial aimed to evaluate the effectiveness of the Eye Movement Desensitization and Reprocessing Protocol for Recent Critical Incidents and Ongoing Traumatic Stress (EMDR-PRECI) in reducing posttraumatic stress disorder (PTSD), anxiety, and depression symptoms related to the work of first responders on active duty. Participants were randomly assigned to two 60-minute individual treatment sessions (N = 30) or to a no-treatment control condition (N = 30). They completed pre-, post-, and follow-up measurements using the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) (PCL-5) and the Hospital Anxiety and Depression Scale (HADS). Data analysis by repeated measures analysis of variance (ANOVA) showed clear effects of the EMDR-PRECI in reducing PTSD work-related symptoms in the treatment group with symptom reduction maintained at 90-day follow-up with a large effect size (d = 3.99), while participants continued to experience direct exposure to potentially traumatic work-related events during the follow-up period. Data analysis by repeated measures ANOVA revealed a significant interaction between time and group, F (2,116) = 153.83, p < .001, ηP2 = .726 for PTSD, and for anxiety F (1,58) = 37.40, p < .005, ηP2 = .090, but not for depression. A t-test showed a clear decrease for depression symptoms for the treatment group with statistically significant results. The study results suggest that the EMDR-PRECI could be an efficient and effective way to address first responders' work-related PTSD, anxiety and depression symptoms. Future research is recommended to replicate these results and to investigate if symptom improvement also results in the reduction of physical health symptoms and early retirement for PTSD-related reasons among first responders.