Visual Schema Displacement Therapy versus Eye Movement Desensitization and Reprocessing therapy versus waitlist in the treatment of post-traumatic stress disorder: results of a randomized clinical trial.

Introduction: Visual Schema Displacement Therapy (VSDT) is a novel approach showing promise in mitigating distressing memories, akin to Eye Movement Desensitization and Reprocessing (EMDR). Objectives: This study aimed to determine the safety, feasibility, and effectiveness of VSDT in individuals with post-traumatic stress disorder (PTSD), comparing it to EMDR therapy and a waitlist control condition (WLCC). It was hypothesized that the application of VSDT would be safe and PTSD symptoms significantly be reduced from both baseline to post-treatment and from baseline to follow-up in the VSDT and EMDR therapy conditions. Furthermore, we expected both treatments to be significantly more effective than the waitlist control. Moreover, we hypothesized that VSDT and EMDR therapy would be associated with significant improvements in symptoms of depression and general psychopathology. Method: Forty-six adults with PTSD were randomly assigned to VSDT, EMDR therapy, or WLCC, receiving six 90-minute sessions. Assessments included the Clinician Administered PTSD Scale for the Diagnostic Statistical Manual (DSM)-5 (CAPS-5), PTSD Checklist for DSM-5 (PCL-5), Beck Depression Inventory-II (BDI-II) and Brief Symptom Inventory (BSI) before, during, and 3 months post-treatment. Results: Bayesian analysis found no differences between VSDT and EMDR in PTSD symptom reduction but both outperformed WLCC. EMDR was superior to the WLCC in reducing symptoms of depression and general psychopathology. At 3-month follow-up, 58.3% of the participants in the VSDT condition no longer met the PTSD diagnostic criteria (41.2% EMDR therapy and 15.4% WLCC) with no difference between the two therapy conditions. Self-reported PTSD symptom reduction was significant in VSDT (d = 1.38) and EMDR (d = 1.40) but modest in WLCC (d = 0.39). Dropout rate was 19.3%, with no adverse events. Conclusion: This study supports VSDT's efficacy in treating PTSD, offering a valuable therapeutic option comparable to EMDR, with significant reductions in PTSD symptoms and no difference with EMDR or the control condition for depressive symptoms and general psychopathology, and no reported adverse events.

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%.

The effectiveness, efficiency, and acceptability of EMDR vs. EMDR 2.0 vs. the Flash technique in the treatment of patients with PTSD: study protocol for the ENHANCE randomized controlled trial.

Background: Several widely studied therapies have proven to be effective in the treatment of post-traumatic stress disorder (PTSD). However, there is still room for improvement because not all patients benefit from trauma-focused treatments. Improvements in the treatment of PTSD can be achieved by investigating ways to enhance existing therapies, such as eye movement desensitization and reprocessing (EMDR) therapy, as well as exploring novel treatments. The purpose of the current study is to determine the differential effectiveness, efficiency, and acceptability of EMDR therapy, an adaptation of EMDR therapy, referred to as EMDR 2.0, and a novel intervention for PTSD, the so-called Flash technique. The second aim is to identify the moderators of effectiveness for these interventions. This study will be conducted among individuals diagnosed with PTSD using a randomized controlled trial design. Methods: A total of 130 patients diagnosed with (complex) PTSD will be randomly allocated to either six sessions of EMDR therapy, EMDR 2.0, or the Flash technique. The primary outcomes used to determine treatment effectiveness include the presence of a PTSD diagnosis and the severity of PTSD symptoms. The secondary outcomes of effectiveness include symptoms of depression, symptoms of dissociation, general psychiatric symptoms, and experiential avoidance. All patients will be assessed at baseline, at 4-week post-treatment, and at 12-week follow-up. Questionnaires indexing symptoms of PTSD, depression, general psychopathology, and experiential avoidance will also be assessed weekly during treatment and bi-weekly after treatment, until the 12-week follow-up. Efficiency will be assessed by investigating the time it takes both to lose the diagnostic status of PTSD, and to achieve reliable change in PTSD symptoms. Treatment acceptability will be assessed after the first treatment session and after treatment termination. Discussion: This study is the first to investigate EMDR 2.0 therapy and the Flash technique in a sample of participants officially diagnosed with PTSD using a randomized controlled trial design. This study is expected to improve the available treatment options for PTSD and provide therapists with alternative ways to choose a therapy beyond its effectiveness by considering moderators, efficiency, and acceptability. Trial registration: The trial was retrospectively registered in the ISRCTN registry at 10th November 2022 under registration number ISRCTN13100019.

Eye movement desensitization and reprocessing (EMDR) therapy or supportive counseling prior to exposure therapy in patients with panic disorder: study protocol for a multicenter randomized controlled trial (IMPROVE).

BACKGROUND: Exposure-based therapy is the treatment of choice for anxiety disorders, but many patients do not benefit sufficiently from it. Distressing images of threat related to the future or past may maintain the anxiety symptomatology or impede exposure therapy. An intervention that targets threat-related imagery is eye movement desensitization and reprocessing (EMDR) therapy. The main goal of this multicenter randomized controlled trial is to investigate whether EMDR therapy plus exposure therapy, relative to supportive counseling plus exposure therapy, improves treatment efficacy, tolerability, and adherence in patients with panic disorder. In addition, we will examine potential predictors of optimal treatment allocation, mechanisms of change as well as the long term effects of treatment. Finally, we will assess cost-effectiveness. METHODS: A multicenter randomized controlled trial mixed design will be conducted. Participants will be 50 patients, aged ≥ 18, diagnosed with a panic disorder. They will be randomly assigned to one of two conditions: EMDR therapy (i.e., flashforward strategy) or supportive counseling (each consisting of four weekly sessions of 90 min each) prior to exposure therapy (consisting of eight weekly sessions of 90 min each). Assessments will be made pre-treatment (T1), between-treatments (T2), post-treatment (T3), one month post-treatment (FU1) and six months post-treatment (FU2) by an assessor blind to treatment condition. The primary outcome measure is severity of panic-related symptoms. Secondary outcome measures are: tolerability of exposure therapy (initial avoidance, willingness to start exposure therapy, considered drop-out; no-show and drop-out), related symptomatology (generalized anxiety, depression), and functional impairment. DISCUSSION: The primary goals of this research are to compare the efficacy, tolerability, and adherence of EMDR therapy plus exposure therapy and supportive counseling plus exposure therapy and to identify predictors, moderators, and mediators for treatment success. This multi-center research aims to make a significant contribution to our understanding as to how treatment for patients with anxiety disorders can be optimized, and elucidate who can benefit most from this novel approach. TRIAL REGISTRATION: ISRCTN-ISRCTN29668369: Improving anxiety treatment by modifying emotional memories before real-life exposure. Registered 27 June 2022-retrospectively registered. ISRCTN-ISRCTN29668369.

The effect of EMDR versus EMDR 2.0 on emotionality and vividness of aversive memories in a non-clinical sample.

Background: Eye movement desensitization and reprocessing (EMDR) therapy is a treatment meant to reduce vividness and emotionality of distressing memories. There is accumulating evidence that working memory taxation is the core of the working mechanism of EMDR therapy and that EMDR derives its effect by taxing the working memory (WM) with a dual task while actively keeping a disturbing memory in mind. From a theoretical stance, based upon assumptions derived from the WM theory, the effectiveness of EMDR therapy could be improved by several adaptations. Objectives: To test the assumption that integrating these elements into the standard EMDR protocol would enhance EMDR therapy, this adapted version of EMDR (i.e. EMDR 2.0), was compared to standard EMDR in a laboratory setting. It was hypothesized that EMDR 2.0 would be more efficacious than standard EMDR, and show a greater decrease in emotionality and vividness than standard EMDR therapy. Our second hypothesis was that EMDR 2.0 would be more efficient than standard EMDR in that this variant needs less session time and a smaller number of sets (i.e. approximately 30 seconds of WM taxation). Method: Non-clinical participants (N = 62, 79% female, mean age = 35.21) with a disturbing autobiographical memory were randomly allocated to receive either EMDR or EMDR 2.0. Emotionality and vividness of the memory were measured pre- and post-intervention, and at 1- and 4-week follow-up. Results: The results showed no difference between EMDR and EMDR 2.0 in decreasing emotionality and vividness, and no difference in session time. However, participants in the EMDR 2.0 condition needed fewer sets than those in the standard EMDR condition. Conclusion: The notion that EMDR 2.0 is more efficient is partially supported by the results showing participants needed less sets than in standard EMDR to reach the same results. Future research with clinical samples is warranted.

Introducción: La terapia de desensibilización y reprocesamiento por movimientos oculares (EMDR en su sigla en inglés) es un tratamiento pensado para reducir la vivacidad y emocionalidad de las memorias angustiantes. Existe un cúmulo de evidencia que muestra que la tasa de la memoria de trabajo es el centro del mecanismo de trabajo de la terapia EMDR y que el EMDR deriva su efecto desde las tasas de memoria de trabajo (MT) con una tarea dual mientras mantiene activamente una memoria perturbadora en mente. Desde una postura teórica, basada en las asunciones derivadas de la teoría de la MT, la efectividad de la terapia EMDR podría mejorarse por medio de varias adaptaciones.Objetivos: Para probar la asunción que integrando estos elementos en el protocolo estándar EMDR para potenciar la terapia EMDR, esta versión adaptada de EMDR (es decir, EMDR 2.0), fue comparada con el EMDR estándar en un contexto de laboratorio. Fue hipotetizado que EMDR 2.0 sería más eficaz que el EMDR estándar, y mostraría una mayor disminución en la emocionalidad y vivacidad de la terapia EMDR estándar. Nuestra segunda hipótesis fue que EMDR 2.0 sería más eficiente que EMDR en que esta variante necesita menos tiempo de sesión, un número menor de sets (es decir, aproximadamente 30 segundos de tasas de MT).Método: Participantes no clínicos (N = 62, 79% mujeres, edad promedio = 35.21) con una memoria autobiográfica perturbadora fueron asignadas aleatoriamente a recibir ya sea EMDR o EMDR 2.0. La emocionalidad y la vivacidad de la memoria fueron medidos antes y después de la intervención, y seguimiento a 1 y a 4 semanas.Resultados: Los resultados mostraron no diferencias entre EMDR y EMDR 2.0 en disminuir la emocionalidad y la vivacidad, y no diferencia en el tiempo de la sesión. Sin embargo, los participantes en la condición de EMDR 2.0 necesitaron menos sets que aquellos en la condición EMDR estándar.Conclusión: La noción de que EMDR 2.0 es más eficiente es parcialmente apoyada por los resultados mostrando que los participantes necesitaron menos sets que en EMDR estándar para alcanzar los mismos resultados. Se justifican investigaciones futuras con muestras clínicas.

Predicting Outcome in an Intensive Outpatient PTSD Treatment Program Using Daily Measures.

It is useful to investigate factors that could predict treatment outcomes for PTSD. The current study aims to investigate the relationship between daily measured PTSD symptoms during an intensive six-day treatment program and overall post-treatment outcomes. The treatment program combines eye movement desensitization with reprocessing and prolonged exposure, as well as physical activity and psychoeducation. It was expected that for the entire duration of treatment, as well as the first half of the treatment, a greater decline in daily PTSD symptoms would be a predictor for a greater decline in PTSD symptoms at a four-week follow-up. Data from 109 PTSD-patients (87.2% female, mean age = 36.9, SD = 11.5) were used. PTSD symptoms were measured with the CAPS-5 and the self-reported PTSD checklist for DSM-5 (PCL-5). Daily PTSD symptoms were measured with an abbreviated version of the PCL-5 (8-item PCL). Latent growth curve models were used to describe changes in daily PTSD symptoms and predict treatment outcome. Results show that a greater decline in daily PTSD symptoms measured by the 8-item PCL predicts better treatment outcome (CAPS-5 and PCL-5), but that a patient's PTSD symptoms on the first day of treatment has no predictive effect. A decline in PTSD symptoms only during the first half of treatment was also found to predict treatment outcomes. Future research should be focused on replicating the results of the current study.

Trauma-focused treatments for depression. A systematic review and meta-analysis.

BACKGROUND: Trauma-focused treatments (TFTs) have demonstrated efficacy at decreasing depressive symptoms in individuals with PTSD. This systematic review and meta-analysis evaluated the effectiveness of TFTs for individuals with depression as their primary concern. METHODS: A systematic search was conducted for RCTs published before October 2019 in Cochrane CENTRAL, Pubmed, EMBASE, PsycInfo, and additional sources. Trials examining the impact of TFTs on participants with depression were included. Trials focusing on individuals with PTSD or another mental health condition were excluded. The primary outcome was the effect size for depression diagnosis or depressive symptoms. Heterogeneity, study quality, and publication bias were also explored. RESULTS: Eleven RCTs were included (n = 567) with ten of these using EMDR as the TFT and one using imagery rescripting. Analysis suggested these TFTs were effective in reducing depressive symptoms post-treatment with a large effect size [d = 1.17 (95% CI: 0.58~ 1.75)]. Removal of an outlier saw the effect size remain large [d = 0.83 (95% CI: 0.48~ 1.17)], while the heterogeneity decreased (I2 = 66%). Analysis of the 10 studies that used EMDR also showed a large effect [d = 1.30 (95% CI: 0.67~1.91)]. EMDR was superior to non trauma-focused CBT [d = 0.66 (95% CI: 0.31~1.02)] and analysis of EMDR and imagery rescripting studies suggest superiority over inactive control conditions [d = 1.19 (95% CI: 0.53~ 1.86)]. Analysis of follow-up data also supported the use of EMDR with this population [d = 0.71 (95% CI: 1.04~0.38)]. No publication bias was identified. CONCLUSIONS: Current evidence suggests that EMDR can be an effective treatment for depression. There were insufficient RCTs on other trauma-focused interventions to conclude whether TFTs in general were effective for treating depression. Larger studies with robust methodology using EMDR and other trauma-focused interventions are needed to build on these findings.

The Effects of the Flash Technique Compared to Those of an Abbreviated Eye Movement Desensitization and Reprocessing Therapy Protocol on the Emotionality and Vividness of Aversive Memories.

Introduction: The Flash technique is a novel intervention aimed at rapidly decreasing the subjective disturbance of an aversive memory, thereby serving as a potential way of treating post-traumatic stress disorder (PTSD). The protocol is used to stimulate clients to engage in positive imagery while being discouraged to actively recollect the targeted disturbing memory. Previous research into the Flash technique's efficacy shows promising results, yet controlled studies are lacking. Objectives: To test the efficacy of the Flash technique, it was compared to an abbreviated eye movement desensitization and reprocessing (EMDR) therapy protocol in a controlled experimental setting. We hypothesized that the Flash technique would lead to a larger decrease in the emotionality and vividness of an aversive autobiographical memory when compared to EMDR therapy. Our second hypothesis was that the procedure of the Flash technique would be evaluated more pleasant by its receiver. Method: The sample consisted of 60 non-clinical participants (mean age = 25.28 years; 73.33% female) who were able to recall an aversive autobiographical memory. They were randomized to either the Flash technique or the EMDR therapy condition. Measurements consisted of emotionality and vividness-ratings pre and post intervention, and at 1-week follow-up. Results: Bayesian analyses showed no differences between Flash and EMDR to the extent to which the emotionality and vividness of their memory was reduced. Afterward, the Flash technique was rated more pleasant than EMDR. Conclusion: The results support the claim that the Flash technique might be used as a brief and efficacious intervention for individuals suffering from disturbing memories. Although the results suggest that its efficacy does not differ from EMDR, the Flash technique seems to yield similar outcomes in a more pleasant way. Further research into its working mechanisms and in a clinical sample is required.

Effects of "Visual Schema Displacement Therapy" (VSDT), an abbreviated EMDR protocol and a control condition on emotionality and vividness of aversive memories: Two critical analogue studies.

BACKGROUND AND OBJECTIVES: Visual Schema Displacement Therapy (VSDT) is a novel therapy which has been described as a treatment for stress and dysfunction caused by a traumatic event. Although its developers claim this therapy is quicker and more beneficial than other forms of trauma therapy, its effectiveness has not been tested. METHODS: We compared the efficacy of VSDT to an abbreviated EMDR protocol and a non-active control condition (CC) in two studies. In Study 1 participants (N = 30) were asked to recall three negative emotional memories under three conditions: VSDT, EMDR, and a CC, each lasting 8 min. Emotional disturbance and vividness of the memories were rated before and after the (within group) conditions. The experiment was replicated using a between group study. In Study 2 participants (N = 75) were assigned to one of the three conditions, and a follow-up after 6-8 days was added. RESULTS: In both studies VSDT and EMDR were superior to the CC in reducing emotional disturbance, and VSDT was superior to EMDR. VSDT and EMDR outperformed the CC in terms of reducing vividness. LIMITATION: Results need to be replicated in clinical samples. CONCLUSIONS: It is unclear how VSDT yields positive effects, but irrespective of its causal mechanisms, VSDT warrants clinical exploration.

Auditory and Visual Memories in PTSD Patients Targeted with Eye Movements and Counting: The Effect of Modality-Specific Loading of Working Memory.

Introduction: Eye movement desensitization and reprocessing (EMDR) therapy is an evidence-based treatment for post-traumatic stress disorder (PTSD). A key element of this therapy is simultaneously recalling an emotionally disturbing memory and performing a dual task that loads working memory. Memories targeted with this therapy are mainly visual, though there is some evidence that auditory memories can also be targeted. Objective: The present study tested whether auditory memories can be targeted with EMDR in PTSD patients. A second objective was to test whether taxing the patient (performing a dual task while recalling a memory) in a modality specific way (auditory demanding for auditory memories and visually demanding for visual memories) was more effective in reducing the emotionality experienced than taxing in cross-modality. Methods: Thirty-six patients diagnosed with PTSD were asked to recall two disturbing memories, one mainly visual, the other one mainly auditory. They rated the emotionality of the memories before being exposed to any condition. Both memories were then recalled under three alternating conditions [visual taxation, auditory taxation, and a control condition (CC), which comprised staring a non-moving dot] - counterbalanced in order - and patients rerated emotionality after each condition. Results: All three conditions were equally effective in reducing the emotionality of the auditory memory. Auditory loading was more effective in reducing the emotionality in the visual intrusion than the CC, but did not differ from the visual load. Conclusion: Auditory and visual aversive memories were less emotional after working memory taxation (WMT). This has some clinical implications for EMDR therapy, where mainly visual intrusions are targeted. In this study, there was no benefit of modality specificity. Further fundamental research should be conducted to specify the best protocol for WMT.