Trauma-focused treatment of a client with Complex PTSD and comorbid pathology using EMDR therapy.

OBJECTIVE: Complex post-traumatic stress disorder (CPTSD) is a classification within the International Classification of Diseases, 11th Revision (ICD-11) that, besides the DSM-5 symptom clusters of post-post-traumatic stress disorder (PTSD), includes the presence of negative self-concept, difficulties in regulating emotions and relationship skills. The purpose of the present study was to provide guidance on how to deliver Eye Movement Desensitization and Reprocessing (EMDR) therapy in the context of CPTSD, based on current clinical knowledge and the latest scientific research findings. METHOD: This paper describes the treatment of a 52-year-old woman with CPTSD and borderline personality disorder for which immediate trauma-focused EMDR therapy was used. RESULTS: First, a description of what EMDR therapy entails and some important treatment strategies that the therapist may employ to assist in trauma-focused treatment of clients with CPTSD using EMDR therapy are outlined. CONCLUSION: The treatment results are in line with mounting evidence supporting the notion that EMDR therapy is a safe and potentially effective treatment alternative for individuals with CPTSD or personality problems.

Augmenting PTSD treatment with physical activity: study protocol of the APPART study (Augmentation for PTSD with Physical Activity in a Randomized Trial).

Background: New intensive trauma-focused treatment (TFT) programmes that incorporate physical activity have been developed for people with post-traumatic stress disorder (PTSD). However, the unique contribution of physical activity within these intensive TFT programmes has never been investigated in a controlled manner. Objectives: This randomized controlled trial will investigate the effectiveness of physical activity added to an intensive TFT programme. In addition, the study aims to investigate the underlying mechanisms of the effects of physical activity on the change in PTSD symptoms. Methods: Individuals with PTSD (N = 120) will be randomly allocated to two conditions: a physical activity or a non-physical active control condition. All participants will receive the same intensive TFT lasting eight days within two consecutive weeks, in which daily prolonged exposure and EMDR therapy sessions, and psycho-education are combined. The amount of physical activity will differ per condition. While the physical activity condition induces daily physical activities with moderate intensity, in the non-physical active control condition no physical activity is prescribed; but instead, a controlled mixture of guided (creative) tasks is performed. The two primary outcome measures are change in PTSD symptoms from pre- to post-treatment and at six months follow-up, measured with the Clinician-Administered PTSD Scale (CAPS-5), and the PTSD Checklist for DSM-5 (PCL-5). Additionally, self-reported sleep problems, depressive symptoms, emotion regulation, dissociation symptoms and anxiety sensitivity will be measured as potential underlying mechanisms. Conclusions: This study will contribute to the research field of augmentation strategies for PTSD treatment by investigating the effectiveness of physical activity added to intensive TFT. Trial registration: This trial is registered in the Netherlands Trial Register (Trial NL9120).

Antecedentes: Se han desarrollado para personas con TEPT nuevos programas de tratamiento intensivos centrados en trauma (TFT por sus siglas en inglés) que incorporan actividad física. Sin embargo, la contribución única de la actividad física dentro de estos programas de TFT intensivos nunca se ha investigado de manera controlada.Objetivos: Este ensayo controlado aleatorizado investigará la efectividad de la actividad física agregada a un programa intensivo de TFT. Además, el estudio tiene como objetivo investigar los mecanismos subyacentes de los efectos de la actividad física sobre el cambio en los síntomas de TEPT.Métodos: Las personas con TEPT serán asignadas en forma aleatoria a dos condiciones: una actividad física o una condición de control activo no físico. Todos los participantes recibirán la misma TFT intensiva que durará 8 días dentro de dos semanas consecutivas, en las que se combinarán diariamente la exposición prolongada y las sesiones de terapia EMDR y psicoeducación. La cantidad de actividad física diferirá según la condición. Mientras que la condición de actividad física induce actividades físicas diarias de moderada intensidad, en la condición de control activo no físico no se prescribe actividad física, sino que se realiza una mezcla controlada de tareas guiadas (creativa). Las dos medidas de resultado primarias son el cambio en los síntomas de TEPT antes y después del tratamiento y a los seis meses de seguimiento, medidos con la Escala de TEPT administrada por el clínico (CAPS-5) y la Lista de verificación de TEPT del DSM-5 (PCL-5). Adicionalmente, los problemas del sueño autoinformados, los síntomas depresivos, la regulación de emociones, los síntomas disociativos y la sensibilidad a la ansiedad se medirán como potenciales mecanismos subyacentes.Conclusiones: Este estudio contribuirá al campo de la investigación de las estrategias de potenciación para el tratamiento del TEPT al investigar la efectividad de la actividad física agregada a la TFT intensiva.Registro de ensayo: este ensayo esta registrado en el Registro de ensayos de los Países Bajos (ensayo NL 9120).

Postpartum Early EMDR therapy Intervention (PERCEIVE) study for women after a traumatic birth experience: study protocol for a randomized controlled trial.

BACKGROUND: Up to 33% of women develop symptoms of posttraumatic stress disorder (PTSD) after a traumatic birth experience. Negative and traumatic childbirth experiences can also lead to fear of childbirth, avoiding or negatively influencing a subsequent pregnancy, mother-infant bonding problems, problems with breastfeeding, depression and reduced quality of life. For PTSD in general, eye movement desensitization and reprocessing (EMDR) therapy has proven to be effective. However, little is known about the preventive effects of early intervention EMDR therapy in women after a traumatic birth experience. The purpose of this study is to determine the effectiveness of early intervention EMDR therapy in preventing PTSD and reducing PTSD symptoms in women with a traumatic birth experience. METHODS: The PERCEIVE study is a randomized controlled trial. Women suffering from the consequences of a traumatic birth experience will be randomly allocated at maximum 14 days postpartum to either EMDR therapy or 'care-as-usual'. Patients in the EMDR group receive two sessions of therapy between 14 (T0) and 35 days postpartum. All participants will be assessed at T0 and at 9 weeks postpartum (T1). At T1, all participants will undergo a CAPS-5 interview about the presence and severity of PTSD symptoms. The primary outcome measure is the severity of PTSD symptoms, whereas the secondary outcomes pertain to fear of childbirth, mother-infant bonding, breastfeeding, depression and quality of life. The study will be conducted at a large city hospital and at multiple midwifery practices in Amsterdam, the Netherlands. DISCUSSION: It is to be expected that the results of this study will provide more insight about the safety and effectiveness of early intervention EMDR therapy in the prevention and reduction of PTSD (symptoms) in women with a traumatic birth experience. TRIAL REGISTRATION: Netherlands Trial Register NL73231.000.20 . Registered on 21 August 2020.

Treatment of Pregnant Women With Fear of Childbirth Using EMDR Therapy: Results of a Multi-Center Randomized Controlled Trial.

Fear of childbirth (FoC) occurs in 7. 5% of pregnant women and has been associated with adverse feto-maternal outcomes. Eye Movement Desensitization and Reprocessing (EMDR) therapy has proven to be effective in the treatment of posttraumatic stress disorder (PTSD) and anxiety; however, its effectiveness regarding FoC has not yet been established. The aim was to determine the safety and effectiveness of EMDR therapy for pregnant women with FoC. This single-blind RCT (the OptiMUM-study, www.trialregister.nl, NTR5122) was conducted in the Netherlands. FoC was defined as a score ≥85 on the Wijma Delivery Expectations Questionnaire (WDEQ-A). Pregnant women with FoC and a gestational age between 8 and 20 weeks were randomly assigned to EMDR therapy or care-as-usual (CAU). The severity of FoC was assessed using the WDEQ-A. Safety was indexed as worsening of FoC symptoms, dropout, serious adverse events, or increased suicide risk. We used linear mixed model analyses to compare groups. A total of 141 women were randomized (EMDR n = 70; CAU n = 71). No differences between groups were found regarding safety. Both groups showed a very large (EMDR d = 1.36) or large (CAU d = 0.89) reduction of FoC symptoms with a mean decrease of 25.6 (EMDR) and 17.4 (CAU) points in WDEQ-A sum score. No significant difference between both groups was found (p = 0.83). At posttreatment, 72.4% (EMDR) vs. 59.6% (CAU) no longer met the criteria for FoC. In conclusion, the results are supportive of EMDR therapy as a safe and effective treatment of FoC during pregnancy, albeit without significant beneficial effects of EMDR therapy over and above those of CAU. Therefore, the current study results do not justify implementation of EMDR therapy as an additional treatment in this particular setting.

The impact of brief intensive trauma-focused treatment for PTSD on symptoms of borderline personality disorder.

Background: It is generally recommended to exercise caution in applying trauma-focused treatment to individuals with posttraumatic stress disorder (PTSD) and comorbid borderline personality disorder (BPD). Objective: To investigate the effects of a brief, intensive, direct trauma-focused treatment programme for individuals with PTSD on BPD symptom severity. Methods: Individuals (n = 72) with severe PTSD (87.5% had one or more comorbidities; 52.8% fulfilled the criteria for the dissociative subtype of PTSD) due to multiple traumas (e.g. 90.3% sexual abuse) participated in an intensive eight-day trauma-focused treatment programme consisting of eye movement desensitization and reprocessing (EMDR) and prolonged exposure (PE) therapy, physical activity, and psychoeducation. Treatment did not include any form of stabilization (e.g. emotion regulation training) prior to trauma-focused therapy. Assessments took place at pre- and post-treatment (Borderline Symptom List, BSL-23; PTSD symptom severity, Clinician Administered PTSD Scale for DSM-5, CAPS-5), and across the eight treatment days (PTSD Checklist, PCL-5). Results: Treatment resulted in significant decreases of BPD symptoms (Cohen's d = 0.70). Of the 35 patients with a positive screen for BPD at pre-treatment, 32.7% lost their positive screen at post-treatment. No adverse events nor dropouts occurred during the study time frame, and none of the patients experienced symptom deterioration in response to treatment. Conclusion: The results suggest that an intensive trauma-focused treatment is a feasible and safe treatment for PTSD patients with clinically elevated symptoms of BPD, and that BPD symptoms decrease along with the PTSD symptoms.

Antecedentes: generalmente se recomienda tener precaución al aplicar un tratamiento centrado en el trauma a las personas con trastorno de estrés postraumático (TEPT) y trastorno de personalidad límite comórbido (TPL).Objetivo: Investigar los efectos de un programa de tratamiento breve, intensivo y directo centrado en el trauma para personas con TEPT sobre la gravedad de los síntomas de TPL.Métodos: los participantes (n = 72) con TEPT grave (87.5% tenían una o más comorbilidades; 52.8% cumplieron los criterios para el subtipo disociativo de TEPT) debido a múltiples traumas (por ejemplo, 90.3% abuso sexual) participaron en un programa intensivo de ocho días de tratamiento centrado en el trauma, consistente en EMDR, terapia de exposición prolongada (PE), actividad física y psicoeducación. El tratamiento no incluyó ninguna forma de estabilización (por ejemplo, entrenamiento de regulación emocional) antes de la terapia centrada en el trauma. Las evaluaciones se realizaron antes y después del tratamiento (Lista de síntomas límite, BSL-23; severidad de los síntomas de TEPT, Escala de TEPT administrada por clínicos para DSM-5, CAPS-5) y durante los ocho días de tratamiento (Lista de verificación de TEPT, PCL-5).Resultados: el tratamiento resultó en una disminución significativa de los síntomas de TPL (d de Cohen = 0.70). De los 35 pacientes con un tamizaje positivo de TPL en el pretratamiento, el 32,7% perdió su tamizaje positivo en el postratamiento. No ocurrieron eventos adversos ni abandonos durante el período de tiempo del estudio, y ninguno de los pacientes experimentó deterioro de los síntomas en respuesta al tratamiento.Conclusión: Los resultados sugieren que un tratamiento intensivo centrado en el trauma es un tratamiento factible y seguro para pacientes con TEPT con síntomas clínicamente elevados de TPL, y que los síntomas de TLP disminuyen junto con los síntomas de TEPT.

Effectiveness of an intensive treatment programme combining prolonged exposure and eye movement desensitization and reprocessing for severe post-traumatic stress disorder.

Background: There is room for improvement regarding the treatment of severe post-traumatic stress disorder (PTSD). Intensifying treatment to increase patient retention is a promising development. Objective: The aim of this study was to determine the effectiveness of an intensive trauma-focused treatment programme over 8 days for individuals suffering from severe PTSD. Method: Treatment was provided for 347 PTSD patients (70% women; mean age = 38.32 years, SD = 11.69) and consisted of daily sessions of prolonged exposure and eye movement desensitization and reprocessing (EMDR) therapy (16 sessions in total), physical activity, and psycho-education. All participants had experienced multiple traumas, including sexual abuse (74.4%), and suffered from multiple comorbidities (e.g. 87.5% had a mood disorder). Suicidal ideation was frequent (73.9%). PTSD symptom severity was assessed by both clinician-rated [Clinician Administered PTSD Scale (CAPS)] and self-report [PTSD Symptom Scale Self Report (PSS-SR) and Impact of Event Scale (IES)] inventories. For a subsample (n = 109), follow-up data at 6 months were available. Results: A significant decline in symptom severity was found (e.g. CAPS intention-to-treat sample Cohen's d = 1.64). At post-treatment, 82.9% showed a clinically meaningful response and 54.9% a loss of diagnosis. Dropout was very low (2.3%). Conclusions: Intensive trauma-focused treatment programmes including prolonged exposure, EMDR therapy, and physical activity can be effective for patients suffering from severe PTSD and are associated with low dropout rates.

Antecedentes: Hay un margen de mejora con respecto al tratamiento del trastorno de estrés postraumático severo (TEPT). Intensificar el tratamiento para aumentar la retención de paciente es un desarrollo prometedor.Objetivo: Determinar la efectividad de un programa de tratamiento intensivo centrado en trauma durante 8 días para personas que presentan TEPT severo.Método: Se proporcionó tratamiento a 347 pacientes con TEPT (70,0% mujeres, edad media = 38,32 años, DE = 11,69) y consistió en sesiones diarias de exposición prolongada y terapia EMDR (16 sesiones en total), actividad física, y psico-educación. Todos los participantes habían experimentado múltiples traumas, incluido abuso sexual (74,4%), y padecían múltiples comorbilidades (por ejemplo, 87,5% trastorno anímico). La ideación suicida fue frecuente (73,9%). La gravedad de los síntomas de TEPT fue evaluada tanto por el clínico con inventarios calificados (CAPS) como por auto-reporte (PSS-SR y IES). Para una submuestra (N=109) se dispuso de datos de seguimiento a los seis meses.Resultados: Se encontró una disminución significativa en la gravedad de los síntomas (por ejemplo, en la muestra CAPS ITT d = 1,64 de Cohen). En el post tratamiento, el 82,9% mostró una respuesta clínicamente significativa y el 54,9% una pérdida del diagnóstico. El abandono fue muy bajo (2,3%).Conclusiones: Los programas intensivos de tratamientos centrados en trauma, incluido la terapia de exposición prolongada, la terapia EMDR y la actividad física, pueden ser efectivos para los pacientes que sufren de trastorno de estrés postraumático severo y se asocian con bajas tasas de abandono.

The OptiMUM-study: EMDR therapy in pregnant women with posttraumatic stress disorder after previous childbirth and pregnant women with fear of childbirth: design of a multicentre randomized controlled trial.

Background: Approximately 3% of women develop posttraumatic stress disorder (PTSD) after giving birth, and 7.5% of pregnant women show a pathological fear of childbirth (FoC). FoC or childbirth-related PTSD during (a subsequent) pregnancy can lead to a request for an elective caesarean section as well as adverse obstetrical and neonatal outcomes. For PTSD in general, and several subtypes of specific phobia, eye movement desensitization and reprocessing (EMDR) therapy has been proven effective, but little is known about the effects of applying EMDR during pregnancy. Objective: To describe the protocol of the OptiMUM-study. The main aim of the study is to determine whether EMDR therapy is an effective and safe treatment for pregnant women with childbirth-related PTSD or FoC. In addition, the cost-effectiveness of this approach will be analysed. Method: The single-blind OptiMUM-study consists of two two-armed randomized controlled trials (RCTs) with overlapping design. In several hospitals and community midwifery practices in Amsterdam, the Netherlands, all eligible pregnant women with a gestational age between eight and 20 weeks will be administered the Wijma delivery expectations questionnaire (WDEQ) to asses FoC. Multiparous women will also receive the PTSD checklist for DSM-5 (PCL-5) to screen for possible PTSD. The clinician administered PTSD scale (CAPS-5) will be used for assessing PTSD according to DSM-5 in women scoring above the PCL-5 cut-off value. Fifty women with childbirth-related PTSD and 120 women with FoC will be randomly allocated to either EMDR therapy carried out by a psychologist or care-as-usual. Women currently undergoing psychological treatment or women younger than 18 years will not be included. Primary outcome measures are severity of childbirth-related PTSD or FoC symptoms. Secondary outcomes are percentage of PTSD diagnoses, percentage caesarean sections, subjective childbirth experience, obstetrical and neonatal complications, and health care costs. Results: The results are meant to provide more insight about the safety and possible effectiveness of EMDR therapy during pregnancy for women with PTSD or FoC. Conclusion: This study is the first RCT studying efficacy and safety of EMDR in pregnant women with PTSD after childbirth or Fear of Childbirth.

Effectiveness of trauma-focused treatment for patients with psychosis with and without the dissociative subtype of post-traumatic stress disorder.

This study presents secondary analyses of a recently published trial in which post-traumatic stress disorder (PTSD) patients with psychosis (n = 108) underwent 8 sessions of trauma-focused treatment, either prolonged exposure (PE) or eye movement desensitisation and reprocessing (EMDR) therapy. 24.1% fulfilled the criteria for the dissociative subtype, a newly introduced PTSD subtype in DSM-5. Treatment outcome was compared for patients with and without the dissociative subtype of PTSD. Patients with the dissociative subtype of PTSD showed large reductions in clinician-administered PTSD scale (CAPS) score, comparable with patients without the dissociative subtype of PTSD. It is concluded that even in a population with severe mental illness, patients with the dissociative subtype of PTSD do benefit from trauma-focused treatments without a pre-phase of emotion regulation skill training and should not be excluded from these treatments.

Prolonged exposure and EMDR for PTSD v. a PTSD waiting-list condition: effects on symptoms of psychosis, depression and social functioning in patients with chronic psychotic disorders.

BACKGROUND: In patients with psychotic disorders, the effects of psychological post-traumatic stress disorder (PTSD) treatment on symptoms of psychosis, depression and social functioning are largely unknown METHOD: In a single-blind randomized controlled trial (RCT) 155 outpatients in treatment for psychosis (61.3% schizophrenic disorder, 29% schizoaffective disorder) were randomized to eight sessions prolonged exposure (PE; n = 53) or eye movement desensitization and reprocessing (EMDR) (n = 55), or a waiting-list condition (WL, n = 47) for treatment of their co-morbid PTSD. Measures were performed on (1) psychosis: severity of delusions (PSYRATS-DRS), paranoid thoughts (GPTS), auditory verbal hallucinations (PSYRATS-AHRS), and remission from psychotic disorder (SCI-SR-PANSS); (2) depression (BDI-II); (3) social functioning (PSP). Outcomes were compared at baseline, post-treatment, 6-month follow-up and over all data points. RESULTS: Both PE and EMDR were significantly associated with less severe paranoid thoughts post-treatment and at 6-month follow-up, and with more patients remitting from schizophrenia, at post-treatment (PE and EMDR) and over time (PE). Moreover, PE was significantly associated with a greater reduction of depression at post-treatment and at 6-month follow-up. Auditory verbal hallucinations and social functioning remained unchanged. CONCLUSIONS: In patients with chronic psychotic disorders PE and EMDR not only reduced PTSD symptoms, but also paranoid thoughts. Importantly, in PE and EMDR more patients accomplished the status of their psychotic disorder in remission. Clinically, these effects are highly relevant and provide empirical support to the notion that delivering PTSD treatment to patients with psychotic disorders and PTSD deserves increasing recognition and acceptance among clinicians.

[Imagery in psychosis: EMDR as a new intervention in the treatment of delusions and auditory hallucinations]. / Mentale beelden bij psychose: EMDR als een nieuwe interventie bij het behandelen van stemmen en wanen.

BACKGROUND: Historically, psychotherapy has focused on the treatment of patients' verbal representations (thoughts) and has proved particularly successful in the cognitive behavioural treatment of psychosis. However, there is mounting evidence that visual representations (imagery) play an important role in the onset and maintenance of psychiatric disorders, including psychotic symptoms. There are indications that heightened emotionality and vividness of visual representations are associated with severity of psychotic experiences. This may imply that a reduction in the vividness and emotionality of the psychosis-related imagery can lessen the suffering and stress, caused by the the psychotic symptoms. AIM: To introduce EMDR as a possible type of psychological treatment for patients suffering from psychosis-related imagery. METHOD: Three outpatients who had a psychotic disorder and suffered from auditory hallucinations and delusions were treated with EMDR in an average of six sessions. Treatment was performed by three therapists in different psychiatric institutions. All three were experienced in administrating CBT and EMDR. RESULTS: Treatment with EMDR reduced patients' level of anxiety, depression and the severity of psychotic symptoms. In addition, patients reported less avoidant behaviour and greater cognitive insight. CONCLUSION: The results of the study suggest that EMDR reduces the vividness and emotionality of imagery in psychosis which in turn alleviates the patients' psychotic symptoms. Further research into other possible types of interventions for the treatment of imagery in psychosis is recommended.

Treatment of PTSD in people with severe intellectual disabilities: a case series.

OBJECTIVE: There is a dearth of information regarding the treatment of PTSD in people with severe intellectual disabilities (ID). The purpose of the present case studies was to assess the applicability and effects of an evidence-based treatment method for psychological trauma with this population. METHODS: The treatment of four single cases with Eye Movement Desensitization and Reprocessing (EMDR) was evaluated. Participants included adults and children with a variety of symptoms, as well as different histories of negative life events. RESULTS: In all cases PTSD symptoms decreased. In all but one case, the gains were maintained at 15.5 months to 2.5 years following treatment. Depressive symptoms and physical complaints diminished and social and adaptive skills improved. CONCLUSION: EMDR seems to be an applicable treatment method for clients with severe ID. Reduction and maintenance of PTSD symptoms in individuals with severe ID appears to be both desirable and obtainable.

EMDR treatment in people with mild ID and PTSD: 4 cases.

Although there is evidence to suggest that people with intellectual disabilities (ID) are likely to be more susceptible to the development of posttraumatic stress disorder (PTSD) than persons in the general population, until now only eight case reports on the treatment of people with ID suffering from PTSD symptoms have been published. In an effort to enrich the literature on this subject, the aim was to investigate the applicability of an evidence-based treatment for PTSD (i.e., EMDR) in four people with mild ID, suffering from PTSD following various kinds of trauma. In all cases PTSD symptoms decreased and the gains were maintained at 3 months to 2.5 year follow-up. In addition, depressive symptoms and physical complaints subsided, and social and adaptive skills improved. It is concluded that clients' improvements converge to suggest the applicability of EMDR in people with mild ID. Difficulties involved in arriving at an accurate PTSD diagnosis in ID clients are discussed.

Treatment of chronic phantom limb pain using a trauma-focused psychological approach.

BACKGROUND: Chronic phantom limb pain (PLP) is a disabling chronic pain syndrome for which regular pain treatment is seldom effective. Pain memories resulting from long-lasting preamputation pain or pain flashbacks, which are part of a traumatic memory, are reported to be powerful elicitors of PLP. OBJECTIVE: To investigate whether a psychological treatment directed at processing the emotional and somatosensory memories associated with amputation reduces PLP. METHODS: Ten consecutive participants (six men and four women) with chronic PLP after leg amputation were treated with eye movement desensitization and reprocessing (EMDR). Pain intensity was assessed during a two-week period before and after treatment (mean number of sessions = 5.9), and at short- (three months) and long-term (mean 2.8 years) follow-up. RESULTS: Multivariate ANOVA for repeated measures revealed an overall time effect (F[2, 8]=6.7; P<0.02) for pain intensity. Pairwise comparison showed a significant decrease in mean pain score before and after treatment (P=0.00), which was maintained three months later. All but two participants improved and four were considered to be completely pain free at three months follow-up. Of the six participants available at long-term follow-up (mean 2.8 years), three were pain free and two had reduced pain intensity. CONCLUSIONS: These preliminary results suggest that, following a psychological intervention focused on trauma or pain-related memories, substantial long-term reduction of chronic PLP can be achieved. However, larger outcome studies are required.

[Treatment of idiopathic facial pain following implant placement]. / Behandeling van idiopathische aangezichtspijn na plaatsing implantaat.

A 39-year-old woman suffered from chronic a-typicalfacial pain and complaints associated with Post Traumatic Stress Disorder. The pain originated from the surgical removal of a residual tooth root under an oral implant and the stress symptoms were the consequences of the pain. Eventually, these problems had led to dismissalfrom work and family problems. She was unable to attend her dentist for a periodic oral survey due to extreme fear. Pharmacologic treatment, acupuncture, homeopathy and hypnotherapy had not improved her condition. Treatment aimed at coping with the memories of the oral treatment using 'eye movement desensitization and reprocessing' ultimately led to decline of complaints. This case report demonstrates that an oral problem may disrupt a patient's life and how psychotherapy can complete medical treatment.

Clinical management of dental anxiety: what works for whom?

This paper aims to provide an overview of the current knowledge regarding the management of adult dentally anxious patients. Furthermore, an attempt is made to formulate a number of preliminary clinical guidelines, based on the available literature. The findings are discussed in the light of the following four problem areas or types of patients, those with: 1) a mild form of fear or anxiety, 2) a phobia of specific dental procedures or situations, 3) interfering psychiatric symptoms and/or 4) a high treatment need. The literature suggests that particularly the implementation of a high level of predictability during treatment, the training of patients in the use of coping skills, and the application of in vivo exposure to anxiety provoking stimuli are the most appropriate options for the management of anxious dental patients and the reduction of their anxiety level.

Efficacy of eye movement desensitization and reprocessing in the treatment of specific phobias: Four single-case studies on dental phobia.

A series of single-case experiments was used to evaluate the application of Eye Movement Desensitization and Reprocessing (EMDR) to traumatically induced dental phobia. Following two to three sessions of EMDR treatment, three of the four patients demonstrated substantially reduced self-reported and observer-rated anxiety, reduced credibility of dysfunctional beliefs concerning dental treatment, and significant behavior changes. These gains were maintained at six weeks follow-up. In all four cases, the clinical diagnosis present at pretreatment was not present at posttreatment at a clinical level. All patients actually underwent the dental treatment they feared most within three weeks following EMDR treatment. The findings support the notion that EMDR can be an effective treatment alternative for phobic conditions with a trauma-related etiology.

Treatment of specific phobias with Eye Movement Desensitization and Reprocessing (EMDR): protocol, empirical status, and conceptual issues.

This paper considers the current empirical status of Eye Movement Desensitization and Reprocessing (EMDR) as a treatment method for specific phobias, along with some conceptual and practical issues in relation to its use. Both uncontrolled and controlled studies on the application of EMDR with specific phobias demonstrate that EMDR can produce significant improvements within a limited number of sessions. With regard to the treatment of childhood spider phobia, EMDR has been found to be more effective than a placebo control condition, but less effective than exposure in vivo. The empirical support for EMDR with specific phobias is still meagre, therefore, one should remain cautious. However, given that there is insufficient research to validate any method for complex or trauma related phobias, that EMDR is a time-limited procedure, and that it can be used in cases for which an exposure in vivo approach is difficult to administer, the application of EMDR with specific phobias merits further clinical and research attention.

[A new development in the treatment of anxiety and trauma: "eye movement desensitization and reprocessing (EMDR)"]. / Eine neue Entwicklung in der Behandlung von Angst und Traumata: "Eye Movement Desensitization and Reprocessing (EMDR)".

This article presents a new development on the field of psychotherapy: Eye-Movement Desensitization and Reprocessing (EMDR). This recently developed procedure promises rapid and effective treatment of anxiety related complaints, including post-traumatic stress disorders (DSM-III-R). In essence the therapist induces a series of rapid and rhythmic eye-movements. EMDR facilitates cognitive changes and lasting decrease of anxiety. As indicated by research and illustrated by case histories, EMDR can be effective in one session. Until now there is no definitive explanation for the effectiveness of this method.