Psychotherapeutic and pharmacological agents for post-traumatic stress disorder with sleep disorder: network meta-analysis.

OBJECTIVE: The current guidelines and canonical norms of diagnosis or treatment for Post-traumatic stress disorder (PTSD) with sleep disorder are still conflicting and have not yet reached a consensus. This study aimed to unravel the most effective countermeasures between two categories (psychotherapy and pharmacotherapy) put forward by the National Institute for Health and Clinical Excellence (NICE) and World Federation of Societies of Biological Psychiatry (WFSBP) respectively to treat PTSD individuals co-exist with sleep disorders. METHODS: Four databases, including PubMed, EMBASE, Cochrane Library, and APA PsyNet, were searched from inception to February 02, 2023. RESULTS: Twenty articles with 24 Randomized controlled trials (RCTs) and a total number of 1,647 participants were included. As demonstrated in the network meta-analysis comparison results, CBT-I (standardized mean differences (SMD) = -1.51,95% confidence interval (CI):-2.55 to -0.47), CBT-I plus IRT (SMD = -1.71, 95%CI:-3.39, -0.03), prazosin (SMD = -0.87,95%CI:-1.59 to -0.16) and hydroxyzine (SMD = -1.06, 95%CI: -1.94 to -0.19) significantly reduced PTSD symptoms compared with placebo. In contrast to placebo, CBT-I (SMD = -5.61,95%CI:-8.82 to -2.40) significantly improved sleep quality. For nightmare severity, IRT (SMD =-0.65, 95%CI:-1.00 to -0.31), prazosin (SMD = -1.20,95%CI:-1.72 to -0.67) and hydroxyzine (SMD = -0.98,95%CI:-1.58 to -0.37) significantly reduced nightmare severity in comparison with placebo. CONCLUSIONS: This study suggested that under most circumstances, psychotherapy namely CBT-I had a favorable profile, but pharmacotherapy with prazosin was effective in managing nightmare severity. The sole avail of CBT-I was recommended to improving sleep quality while CBT-I and CBT-I plus IRT showed excellent management of PTSD symptom severity. Exposure to CBT-I isrecommended for depression. The relevant clinical guidelines for the management of individuals with PTSD and sleep disorders may regard this as a reference. PROSPERO: CRD42023415240.

Distinct saliva DNA methylation profiles in relation to treatment outcome in youth with posttraumatic stress disorder.

In youth with posttraumatic stress disorder (PTSD) non-response rates after treatment are often high. Epigenetic mechanisms such as DNA methylation (DNAm) have previously been linked to PTSD pathogenesis, additionally DNAm may affect response to (psychological) therapies. Besides investigating the direct link between DNAm and treatment response, it might be helpful to investigate the link between DNAm and previously associated biological mechanisms with treatment outcome. Thereby gaining a deeper molecular understanding of how psychotherapy (reflecting a change in the environment) relates to epigenetic changes and the adaptability of individuals. To date, limited research is done in clinical samples and no studies have been conducted in youth. Therefore we conducted a study in a Dutch cohort of youth with and without PTSD (n = 87, age 8-18 years). We examined the cross-sectional and longitudinal changes of saliva-based genome-wide DNA methylation (DNAm) levels, and salivary cortisol secretion. The last might reflect possible abbreviations on the hypothalamic-pituitary- adrenal (HPA) axis. The HPA-axis is previously linked to DNAm and the development and recovery of PTSD. Youth were treated with 8 sessions of either Eye Movement Reprocessing Therapy (EMDR) or Trauma Focused Cognitive behavioral Therapy (TF-CBT). Our epigenome wide approach showed distinct methylation between treatment responders and non-responders on C18orf63 gene post-treatment. This genomic region is related to the PAX5 gene, involved in neurodevelopment and inflammation response. Additionally, our targeted approach indicated that there were longitudinal DNAm changes in successfully treated youth at the CRHR2 gene. Methylation at this gene was further correlated with cortisol secretion pre- and post-treatment. Awaiting replication, findings of this first study in youth point to molecular pathways involved in stress response and neuroplasticity to be associated with treatment response.

Eye movement desensitisation and reprocessing for survivors of life-threatening medical events.

OBJECTIVES: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of eye movement desensitisation and reprocessing (EMDR), a psychological intervention programme, on symptoms related to traumatic stress in survivors of life-threatening medical events. SECONDARY OBJECTIVES: to evaluate whether the effects of EMDR differ according to the nature of the medical event (associated diagnosis or setting), measured outcome (post-traumatic stress disorder (PTSD), anxiety, depression, or quality of life), or intervention (online, face-to-face, group or individual sessions).

Neurobiological modulation with REAC technology: enhancing pain, depression, anxiety, stress, and quality of life in post-polio syndrome subjects.

Post-polio syndrome (PPS) brings new challenges for polio survivors, including muscle decline, pain, depression, and diminished quality of life. This study explored the potential of REAC neuromodulatory treatments to ease pain, improve mood, and enhance quality of life in PPS patients. 17 individuals with PPS (average age 54.8) received three REAC treatments: Neuro Postural Optimization, Neuro Psycho Physical Optimization, and Neuro Psycho Physical Optimization-Cervico Brachial. Pain, depression, anxiety, stress, and quality of life were assessed before and after using established scales. REAC treatments significantly reduced pain across various dimensions, along with depression, anxiety, and stress levels. Additionally, patients reported improved physical and psychological quality of life. This study suggests REAC neuromodulatory treatments as a promising non-invasive option to improve pain, emotional well-being, and quality of life in individuals with PPS.

Mental health and conflict: a pilot of an online eye movement desensitisation and reprocessing (EMDR) intervention for forcibly displaced Syrian women.

Background: The Syrian conflict has been ongoing since 2011. Practical and scalable solutions are urgently needed to meet an increase in need for specialised psychological support for post-traumatic stress disorder given limited availability of clinicians. Training forcibly displaced Syrians with a mental health background to remotely deliver specialised interventions increases the availability of evidence based psychological support. Little is known about the effectiveness of online therapy for forcibly displaced Syrian women provided by forcibly displaced Syrian women therapists. Purpose: To pilot an evidence-based trauma therapy, Eye Movement Desensitisation and Reprocessing (EMDR), carried out online by trained forcibly displaced Syrian women therapists for forcibly displaced Syrian women who require treatment for post-traumatic stress disorder (PTSD). Methods: 83 forcibly displaced Syrian women, living in Türkiye or inside Syria, with diagnosable PTSD, were offered up to 12 sessions of online EMDR over a period of 3 months. This was delivered by forcibly displaced Syrian women therapists who were trained in EMDR. Data were gathered, using Arabic versions, on PTSD symptoms using the Impact of Events Scale Revised, depression symptoms using the Patient Health Questionnaire-9 and anxiety symptoms using the Generalised Anxiety Disorder Assessment-7 at baseline, mid-point, and end of therapy. Results: PTSD scores, depression scores and anxiety scores all significantly reduced over the course of treatment, with lower scores at midpoint than baseline and lower scores at end of treatment than at midpoint. Only one participant (1%) exceeded the cutoff point for PTSD, and 13 (16%) exceeded the cutoff points for anxiety and depression at the end of treatment. Conclusion: In this pilot study up to 12 sessions of online EMDR were associated with reductions in PTSD, anxiety and depression symptoms in Syrian women affected by the Syrian conflict. The training of forcibly displaced Syrian mental health professionals to deliver online therapy is a relatively low cost, scalable, sustainable solution to ensure that those who are affected by the conflict can access specialised support. Further research is needed using a control group to confirm that the observed effects are due to EMDR treatment, as is research with post-treatment follow-up to ascertain that benefits are maintained.

A network meta-analysis of psychological interventions for children and adolescents after natural and man-made disasters.

INTRODUCTION: Children and adolescents, after natural and man-made disasters, often exhibit various psychological, emotional, and behavioral issues, showing a range of clinical symptoms related to post-traumatic stress disorder (PTSD) and depression. This review used a network meta-analysis (NMA) approach to compare and rank psychological interventions for PTSD and depression in children and adolescents after exposure to natural and man-made disasters. METHODS: Randomized studies of psychosocial interventions for PTSD and depression in children and adolescents exposed to natural and man-made disasters were identified. PTSD and depression symptoms at postintervention and 1-12 month follow-up are the outcomes. The standardized mean differences (SMDs) between pairs of interventions at postintervention and follow-up were pooled. Mean effect sizes with 95% credible intervals (CI) were calculated, and the ranking probabilities for all interventions were estimated using the surface under the cumulative ranking curve. Study quality was assessed with version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). RESULTS: In total, 26 studies with 4331 participants were included in this NMA. Eye movement desensitization and reprocessing therapy (EMDR) (SMD = - 0.67; 95% CI - 1.17 to - 0.17), exposure therapy (ET) (SMD = - 0.66; 95% CI - 1.11 to - 0.22), and cognitive behavioral therapy (CBT) (SMD = - 0.62; 95% CI - 0.90 to - 0.34) were significantly more effective for PTSD at postintervention than inactive intervention. EMDR (SMD = - 0.72; 95% CI - 1.11 to - 0.33) and ET (SMD = - 0.62; 95% CI - 0.97 to - 0.27) were associated with a higher reduction in PTSD symptoms at follow-up than inactive intervention. EMDR (SMD = - 0.40; 95% CI - 0.78 to - 0.03) and play therapy (PT) (SMD = - 0.37; 95% CI - 0.62 to - 0.12) were significantly more effective for depression at postintervention than inactive intervention. For all psychological interventions in reducing depression symptoms at follow-up compared with inactive intervention, the differences were not significant. CONCLUSION: EMDR appears to be most effective in reducing PTSD and depression in children and adolescents exposed to natural and man-made disasters. In addition, ET and CBT are potentially effective in reducing PTSD symptoms at postintervention, while PT is beneficial in managing depression symptoms at the treatment endpoint.

[Evidence-based psychotherapy of posttraumatic stress syndrome-An update]. / Evidenzbasierte Psychotherapie posttraumatischer Belastungsstörungen ­ ein Update.

BACKGROUND: The aim of this article is to summarize the current state of research on the effectiveness of psychotherapeutic treatment of posttraumatic stress disorder (PTSD). METHODS: The results of current meta-analyses and trend-setting individual studies are summarized and the most important forms of intervention are explained. RESULTS: The psychotherapeutic treatment methods for PTSD are very effective, the effect sizes are large and superior to those of pharmacotherapy. Trauma exposure and cognitive restructuring are most effective. Trauma-focused procedures are generally superior to other forms of psychotherapy. A range of different cognitive behavioral procedures as well as eye movement desensitization and reprocessing are recommended. The most recent initial findings confirm a very good effectiveness for imagery rescripting methods as protective interventions without a formal confrontation with trauma. Individual therapy works better than group psychotherapy. In the group setting cognitive processing therapy has proven to be the best intervention. Trauma-focused treatment should also be used when comorbid conditions such as schizophrenia, bipolar disorder or addiction are present. DISCUSSION: Trauma-focused psychotherapy in an individual setting is the treatment of choice for PTSD. A large selection of effective methods and well-reviewed manuals are available. The German language S3 guidelines are currently being updated.

Eye movement intervention facilitates concurrent perception and memory processing.

A widely used psychotherapeutic treatment for post-traumatic stress disorder (PTSD) involves performing bilateral eye movement (EM) during trauma memory retrieval. However, how this treatment-described as eye movement desensitization and reprocessing (EMDR)-alleviates trauma-related symptoms is unclear. While conventional theories suggest that bilateral EM interferes with concurrently retrieved trauma memories by taxing the limited working memory resources, here, we propose that bilateral EM actually facilitates information processing. In two EEG experiments, we replicated the bilateral EM procedure of EMDR, having participants engaging in continuous bilateral EM or receiving bilateral sensory stimulation (BS) as a control while retrieving short- or long-term memory. During EM or BS, we presented bystander images or memory cues to probe neural representations of perceptual and memory information. Multivariate pattern analysis of the EEG signals revealed that bilateral EM enhanced neural representations of simultaneously processed perceptual and memory information. This enhancement was accompanied by heightened visual responses and increased neural excitability in the occipital region. Furthermore, bilateral EM increased information transmission from the occipital to the frontoparietal region, indicating facilitated information transition from low-level perceptual representation to high-level memory representation. These findings argue for theories that emphasize information facilitation rather than disruption in the EMDR treatment.

Eye Movement Desensitization and Reprocessing (EMDR) treatment in the medical setting: a systematic review.

Background: Literature points towards the potential benefits of the application of Eye Movement and Desensitization Processing (EMDR)-therapy for patients in the medical setting, with cancer and pain being among the domains it is applied to. The field of applying EMDR-therapy for patients treated in the medical setting has evolved to such an extent that it may be challenging to get a comprehensive overview.Objective: This systematic literature review aims to evaluate the use and effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) therapy in patients treated in the medical setting.Methods: We performed a literature search following the PRISMA guidelines. Studies were included if the effectiveness of EMDR-therapy was assessed in adult patients treated in a medical setting. Excluded were patients exclusively suffering from a mental health disorder, without somatic comorbidity. A risk of bias analysis was performed. This review was registered on PROSPERO (CRD42022325238).Results: Eighty-seven studies, of which 26 (pilot)-RCTs were included and categorized in 14 medical domains. Additionally, three studies focusing on persistent physical complaints were included. Most evidence exists for its application in the fields of oncology, pain, and neurology. The overall appraisal of these studies showed at least moderate to high risks of bias. EMDR demonstrated effectiveness in reducing symptoms in 85 out of 87 studies. Notably, the occurrence of adverse events was rarely mentioned.Conclusions: Overall, outcomes seem to show beneficial effects of EMDR on reducing psychological and physical symptoms in patients treated in a medical setting. Due to the heterogeneity of reported outcomes, effect sizes could not be pooled. Due to the high risk of bias of the included studies, our results should be interpreted with caution and further controlled high-quality research is needed.

First overview on the use of EMDR for adult patients treated in the medical setting.EMDR seems beneficial in improving psychological and physical symptoms.Given the heterogeneity of studies and high risk of bias, further controlled studies are needed in this field.

Current Research on Matching Trauma-Focused Therapies to Veterans: A Scoping Review.

INTRODUCTION: Trauma-focused (psycho)therapies (TFTs) are often used to treat post-traumatic stress disorder (PTSD) of (military) veterans, including prolonged exposure (PE), cognitive processing therapy (CPT), and eye movement desensitization and reprocessing. However, research thus far has not conclusively determined predictors of TFTs' success in this population. This scoping review's objectives are 1) to explore whether it is possible, based on currently available evidence, to match TFTs to veterans to maximize their outcomes, (2) to identify possible contraindications and adaptations of TFTs for this population, and (3) to identify gaps in the literature to guide future research. MATERIALS AND METHODS: Standard scoping review methodology was used. "White" and "gray" literature searches resulted in 4963 unique items identified. Following title and abstract screening and full-text analysis, 187 sources were included in the review. After data extraction, a narrative summary was used to identify common themes, discrepancies between sources, and knowledge gaps. RESULTS: Included publications most often studied CPT and PE rather than eye movement desensitization and reprocessing. These TFTs were at least partly effective with mostly moderate effect sizes. Attrition rates were slightly higher for PE versus CPT. There was variance in the methodological quality of the included studies. CONCLUSION: The current literature on TFTs to treat PTSD in veterans contains several knowledge gaps, including regarding treatment matching. Future research should examine effectiveness of these treatments using multiple sources of outcomes, longer time periods, combination with other treatment, outcomes outside of PTSD symptoms (such as functioning), and resilience.

Efficacy of EMDR for early intervention after a traumatic event: A systematic review and meta-analysis.

BACKGROUND: Eye Movement Desensitization and Reprocessing (EMDR) is a well-established psychological therapy for the treatment of post-traumatic stress disorder, based on the recommendations of clinical practice guidelines. However, these guidelines are not as consistent in recommending EMDR interventions for the early treatment of post-traumatic symptoms. The main objective of this review is to evaluate the effectiveness of EMDR therapy for early intervention after a traumatic event. METHODS: A systematic search for randomized clinical trials has been carried out in the PUBMED, CINAHL, Psyc-INFO and Cochrane Library search engines. We included individuals exposed to a recent traumatic event (within 3 months of a traumatic incident). Outcomes on PTSD, depression and anxiety in post-treatment, and at follow-up at 3, 6 and 12 months, as well as on safety and tolerability were extracted. RESULTS: A total of 11 RCTs were found. Studies showed beneficial effects of early EMDR interventions on post-traumatic symptoms at post-treatment and at 3-month follow-up. No differences were found between EMDR and no intervention or another intervention in the remaining analyses. LIMITATIONS: The main limitations are the low quality of the studies, the small number of studies per outcome assessed, and the small sample sizes. CONCLUSIONS: There is evidence for the short-term beneficial effect of early EMDR interventions on post-traumatic symptoms. Although it appears to be a safe therapeutic choice, more studies are necessary that include safety data.

The effects of an intensive outpatient treatment for PTSD.

Introduction: Research has shown that combining different evidence-based PTSD treatments for patients with PTSD in an intensive inpatient format seems to be a promising approach to enhance efficiency and reduce generally high dropout rates.Objective: To assess the effectiveness of an intensive six-day outpatient trauma-focused treatment for patients with PTSD.Method: Data from 146 patients (89.7% female, mean age = 36.79, SD = 11.31) with PTSD due to multiple traumatization were included in the analyses. The treatment programme consisted of six days of treatment within two weeks, with two daily individual 90-minute trauma-focused sessions (prolonged exposure and eye movement desensitization and reprocessing), one hour of exercise, and one hour of psychoeducation. All participants experienced multiple traumas, and 85.6% reported one or more comorbid psychiatric disorders. PTSD symptoms and diagnoses were assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), and self-reported symptoms were assessed with the PTSD Checklist for DSM-5 (PCL-5).Results: A significant decline in PTSD symptoms (CAPS-5 and PCL-5) from pretreatment to one-month follow-up (Cohen's d = 1.13 and 1.59) was observed and retained at six-month follow-up (Cohen's d = 1.47 and 1.63). After one month, 52.4% of the patients no longer met the diagnostic criteria for PTSD (CAPS-5). The Reliable Change Index (RCI) shows that 73.9% of patients showed improvement on the CAPS-5 and 77.61% on the PCL-5. Additionally, 21.77% (CAPS-5) and 20.0% (PCL-5) showed no change, while 4.84% (CAPS-5) and 2.96% (PCL-5) showed symptom worsening.Discussion: The results show that an intensive outpatient trauma treatment programme, including two evidence-based trauma-focused treatments, exercise, and psychoeducation, is effective for patients suffering from PTSD as a result of multiple traumatization. Subsequent research should focus on more controlled studies comparing the treatment programme with other intensive trauma treatments and less frequent routine treatment.

Intensive outpatient trauma treatment is effective in treating PTSD.Six days of combining prolonged exposure, EMDR, exercise and psycho-education seems feasible and effective in treating PTSD.73.9% of the patients show improvement on the CAPS-5 and 77.61% show improvement on the PCL-5, symptom worsening was there in 4,84, respectively 2.96%.

When one tool is not enough: An integrative psychotherapeutic approach to treating complex PTSD.

Complex posttraumatic stress disorder (CPTSD) is a term representing the psychopathological implications of exposure to chronic, inter-personal trauma. These include the main symptoms of PTSD, as well as changes in identity, emotion regulation, and inter-personal relationships. Self-harm and dissociation (i.e., disintegration of mental processes) are also quite common in CPTSD. Considering this complex and often severe clinical picture, mental health professionals often find it difficult to effectively treat CPTSD. In this paper, we present an integrative approach to the treatment of CPTSD based on a combination of techniques from several psychotherapy approaches. The case described here illustrates the need for therapeutic flexibility and eclecticism when treating individuals exposed to chronic trauma. We show the advantages of flexible therapeutic attunement, which enables the therapist to respond to the changing need of the patient, as well as her fluid clinical picture and symptom manifestation. The case also illustrates how interventions taken from psychodynamic therapy, Dialectical behavior therapy, and Eye Movement Desensitization and Reprocessing may be applicable in various stages of treatment, alleviating the patient's distress in several psychological and physical domains.

EMDR Flash Technique in adolescents with depression: A twelve-week follow-up study.

This study aims to investigate the specific effects of the EMDR Flash Technique on adolescents with depression. This follow-up study consists of 32 adolescents, 12-17 years of age (M = 14.34, SD = 1.56), including 7 males and 25 females. They were evaluated with Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Present, the Beck Depression Inventory (BDI), and Children Revised Impact of Event Scale-8 (Cries-8). These were administered at baseline, at the end of the 4th and 12th weeks of treatment. The EMDR Flash Technique which can be utilized in the preparation phase of Eye Movement Desensitization and Reprocessing (EMDR) to reduce the intensity of highly distressing memories rapidly and relatively painlessly was applied for 12 weeks, one session per week as a free-standing intervention. Also, the EMDR Flash Technique can be effective in decreasing the rate of noncompliance and drop-outs of adolescents. The baseline means of total BDI scores decreased from 48.19 to 2.16 at the end of the 12th week of treatment. Also, the CRIES scores decreased from 31.78 to 0.44 at the end of the 12th week of treatment. In addition, the baseline means of SUD scores decreased from 9.53 to zero at the end of the 12th week of treatment. Overall, our results underscore the effectiveness of the EMDR-Flash Technique in adolescents with depression.

Depression is a significant mental health concern for adolescents due to its early onset and chronic nature. Depression can be observed in conjunction with PTSD, and sometimes, depressive symptoms may transform into traumatic experiences. EMDR is an 8-stage protocol that includes history taking, preparation, assessment, desensitization, installation, body scan, closure, and reevaluation, used to alleviate the effects of traumatic experiences. It is hypothesized that unpleasant and traumatic events are stored in a dysfunctional way, and it promotes an adaptive processing and resolution of the traumatic experience. The goal of EMDR is to achieve an adequate processing of negative experiences and to create new adaptive information. The EMDR Flash Technique (FT) is utilized in the preparation phase of EMDR to reduce the intensity of highly distressing memories rapidly and relatively painlessly. Although a few studies have shown that the FT is effective in adults, there is only one study to investigate the effectiveness of the FT in children and adolescents. This research, in determining the efficacy of the EMDR FT on adolescents with depression, particularly focused on depression symptoms and assessed the observed changes in these symptoms. It aims to evaluate the specific effects of EMDR-FT on adolescents with depression, providing a unique perspective compared to previous research that has mainly focused on broader mental health disorder indicators. It is hypothesized that EMDR-FT is an effective therapy for treating adolescents with Depression. In the present study, adolescents with depression showed significant improvements in symptom severity and their traumatic events impact levels decreased. As a result of our study, a 12-week EMDR-FT treatment was observed to be effective for adolescents with depression and in reducing and improving traumatic stress levels and depression. Our results underscore the effectiveness of the EMDR-FT in adolescents with depression.

Skills training followed by either EMDR or narrative therapy for posttraumatic stress disorder in adult survivors of childhood abuse: a randomized controlled trial.

Background: Individuals suffering from PTSD following childhood abuse represent a large subgroup of patients attending mental health services. The aim of phase-based treatment is to tailor treatment to the specific needs to childhood abuse survivors with PTSD with a Skills Training in Affective and Interpersonal Regulation (STAIR) phase, in which emotion dysregulation and interpersonal problems are targeted, and a trauma-focused phase.Objective: The purpose of this study was to compare STAIR + Eye Movement Desensitization and Reprocessing (EMDR) vs. STAIR + Narrative Therapy (NT) as treatments for PTSD following childhood-onset trauma in a routine clinical setting.Method: Sixty-eight adults were randomly assigned to STAIR/EMDR (8 STAIR-sessions followed by 12 EMDR-sessions) or STAIR/NT (8 STAIR-sessions followed by 12 NT-sessions). Assessments took place at pre-treatment, after each treatment phase and at 3 and 12 months post-intervention follow-up. Primary outcomes were interviewer-rated and self-reported symptom levels of PTSD. Secondary outcomes included symptom levels of depression and disturbances in emotion regulation and interpersonal skills.Results: Multilevel analyses in the intent-to-treat sample indicated that patients in both treatments improved substantially on PTSD symptom severity (CAPS: d = 0.81 to 1.29; PDS: d = 1.68 to 2.15), as well as on symptom levels of depression, anxiety, emotion regulation, dissociation and interpersonal skills. Effects increased or were maintained until 12-month follow-up. At mid-treatment, after STAIR, patients in both treatments improved moderately on PTSD symptom severity (PDS: d = 1.68 to 2.15), as well as on symptom levels of depression (BDI: d = .32 to .31). Symptoms of anxiety, emotion dysregulation, interpersonal problems and dissociation were not decreased after STAIR. There were no significant differences between the two conditions on any outcome.Conclusion: PTSD in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or NT in the trauma-processing phase.Trial registration: ClinicalTrials.gov identifier: NCT01443182..

The study directly compares Skills Training in Affective and Interpersonal Regulation (STAIR) followed by either EMDR or Narrative Therapy in the trauma-processing phase in routine clinical setting.The brief phase-based treatment was found to be effective in reducing both symptoms of PTSD as well as emotion regulation and interpersonal problems in survivors of childhood abuse.Posttraumatic Stress Disorder in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or Narrative Therapy in the trauma-processing phase.

12-month follow-up of intensive outpatient treatment for PTSD combining prolonged exposure therapy, EMDR and physical activity.

BACKGROUND: Preliminary evidence shows promising treatment outcomes at short-term follow-up for intensive posttraumatic stress disorder (PTSD) treatment, but long-term follow-up studies are sparse. This study is a sequel to a previous pilot study and open trial, set out to investigate treatment outcomes at 12-month follow-up for outpatients completing an 8-day intensive treatment for PTSD. METHODS: All patients were diagnosed with PTSD and had multiple previous psychotherapy attempts (M = 3.1). Patients were assessed at pre-treatment, post-treatment, 3- and 12-month follow-up. Of 35 treated patients, 32 (91.4%) attended the long-term follow-up assessment. The treatment programme combined prolonged exposure therapy, eye movement desensitization and reprocessing, and physical activity. RESULTS: The effect sizes indicated large reductions in symptoms of PTSD, depression, anxiety, interpersonal problems, and well-being. Changes in functioning showed a small-medium effect. Results were stable across the follow-up period. The treatment response rates showed that 46-60% of patients achieved recovery with respect to PTSD symptoms, and that 44-48% no longer met diagnostic criteria for PTSD. CONCLUSIONS: Time-limited and concentrated outpatient treatment for PTSD can yield large and enduring positive outcomes. Controlled trials are needed to establish relative efficacy. TRIAL REGISTRATION: The study was registered in Current Research Information System In Norway (Cristin). Cristin-project-ID: 654,790. Date of registration: 18.03.2019.

Non-fear emotions in changes in posttraumatic stress disorder symptoms during treatment.

BACKGROUND AND OBJECTIVES: Posttraumatic stress disorder (PTSD) is not only associated with fear but also with other emotions. The present study aimed to examine if changes in shame, guilt, anger, and disgust predicted changes in PTSD symptoms during treatment, while also testing if PTSD symptoms, in turn, predicted changes in these emotions. METHODS: Participants (N = 155) with childhood-related PTSD received a maximum of 12 sessions of eye movement desensitization and reprocessing or imagery rescripting. The data was analyzed using Granger causality models across 12 treatment sessions and 6 assessment sessions (up until one year after the start of treatment). Differences between the two treatments were explored. RESULTS: Across treatment sessions, shame, and disgust showed a reciprocal relationship with PTSD symptoms, while changes in guilt preceded PTSD symptoms. Across assessments, anger was reciprocally related to PTSD, suggesting that anger might play a more important role in the longer term. LIMITATIONS: The individual emotion items were not yet validated, and the CAPS was not administered at all assessments. CONCLUSIONS: These findings partly differ from earlier studies that suggested a unidirectional relationship in which changes in emotions preceded changes in PTSD symptoms during treatment. This is in line with the idea that non-fear emotions do play an important role in the treatment of PTSD and constitute an important focus of treatment and further research.

Posttraumatic stress disorder in people with dementia: study protocol.

Background: Posttraumatic stress disorder (PTSD) is considered an independent risk factor for dementia. Despite the (clinical) evidence that PTSD is associated with neuropsychiatric symptoms in people with dementia, studies on its prevalence and clinical manifestation are limited, and their quality is affected by the lack of a structured method to diagnose PTSD in this population. The primary aim of the current study is to validate the 'TRAuma and DEmentia' interview as a diagnostic tool for PTSD in people with dementia and to test feasibility of EMDR treatment for people with PTSD and dementia.Methods: This prospective multi-centre study is divided into two parts. In study A, 90 participants with dementia will be included to test the criterion validity, inter-rater reliability and feasibility of the 'TRAuma and DEmentia' interview. In study B, 29 participants with dementia and PTSD will receive eye movement desensitisation and reprocessing therapy by a trained psychologist, and 29 participants with dementia and PTSD will be placed on the waiting list control group.Conclusion: This study aims to improve the diagnostic process of PTSD and to assess the effects of eye movement desensitisation and reprocessing treatment in people with dementia living in Dutch care facilities.Trial registration: NL70479.068.20 / METC 20-063 / OSF registration: https://doi.org/10.17605/OSF.IO/AKW4F.

This study protocol describes a two-part study on posttraumatic stress disorder in people with dementia in Dutch care facilities.The primary aim of the study is to validate the 'TRAuma and DEmentia' interview as a diagnostic tool for posttraumatic stress disorder in people with dementia.This study aims to test the feasibility of an evidence-based treatment for people with dementia and posttraumatic stress disorder in the form of eye movement desensitisation and reprocessing therapy.

The working mechanisms of imagery rescripting and eye movement desensitization and reprocessing: Findings from a randomised controlled trial.

We studied the mechanisms of eye movement desensitization and reprocessing (EMDR) and imagery rescripting (ImRs). We hypothesized that EMDR works via changes in memory vividness, that ImRs works via changes in encapsulated beliefs (EB), and that both treatments work via changes in memory distress. Patients (N = 155) with childhood-related posttraumatic stress disorder (Ch-PTSD) received 12 sessions of EMDR or ImRs. The vividness, distress, and EB related to the index trauma were measured with the Imagery Interview. PTSD severity was assessed with the Impact of Events Scale-Revised and the Clinician-Administered PTSD Scale for DSM-5. We conducted mixed regressions and Granger causality analyses. EMDR led to initially stronger changes in all predictors, but only for distress this was retained until the last assessment. No evidence for vividness as a predictive variable was found. However, changes in distress and EB predicted changes in PTSD severity during ImRs. These findings partially support the hypothesized mechanisms of ImRs, while no support was found for the hypothesized mechanisms of EMDR. Differences in the timing of addressing the index trauma during treatment and the timing of assessments could have influenced the findings. This study provides insight into the relative effectiveness and working mechanisms of these treatments.

Eye movement desensitization and reprocessing for depressed individuals with multiple sclerosis: A pilot study.

BACKGROUND: Multiple studies have highlighted elevated rates of depression among individuals with Multiple Sclerosis (MS), with its associated symptoms posing a significant threat to overall well-being. Moreover, existing literature suggests a potential interconnection between depressive manifestations and the decline of physical functionalities in the context of MS. OBJECTIVE: to examine the viability of the Eye Movement Desensitization Reprocessing (EMDR) therapy protocol for the treatment of depressive disorders (DeprEND) for alleviating depression in individuals with MS. METHODS: We conducted a process-outcome study to examine the feasibilty and effectiveness DeprEND enrolling 13 individuals with MS and depressive symtpoms. Psychological and physical assessment pre-, post-intervention and 3-month follow-up were included. Pre- and post-magnetic resonance imaging (MRI) scans were conducted to analyze potential alterations in brain function. RESULTS: The EMDR DeprEND treatment showed a high level of adherence and feasibility. Significant reductions in depressive symptoms were found at post-intervention and at 3 months follow-up. No significant differences were observed in terms of physical symptoms. A significant modulation observed in parietal and premotor areas when examining negative valence stimuli post-treatment was found. CONCLUSION: for The EMDR DeprEND protocol may represent a feasible and cost-effective treatment for reducing depressive symptoms in MS patients and improving their mental well-being.