State of the science: Eye movement desensitization and reprocessing (EMDR) therapy.

Eye movement desensitization and reprocessing (EMDR) therapy is an evidence-based psychotherapy for posttraumatic stress disorder (PTSD), with support from more than 30 published randomized controlled trials (RCTs) demonstrating its effectiveness in both adults and children. Most international clinical practice guidelines recommend EMDR therapy as a first-line treatment for PTSD. This paper describes the current state of the evidence for EMDR therapy. We begin with a brief description of EMDR therapy and its theoretical framework. Next, we summarize the scientific support for its efficacy, effectiveness, and safety and discuss its applicability across cultures and with diverse populations. We conclude with suggestions for future directions to develop the research base and applications of EMDR therapy.

Efficacy and moderators of efficacy of cognitive behavioural therapies with a trauma focus in children and adolescents: an individual participant data meta-analysis of randomised trials.

BACKGROUND: Existing clinical trials of cognitive behavioural therapies with a trauma focus (CBTs-TF) are underpowered to examine key variables that might moderate treatment effects. We aimed to determine the efficacy of CBTs-TF for young people, relative to passive and active control conditions, and elucidate putative individual-level and treatment-level moderators. METHODS: This was an individual participant data meta-analysis of published and unpublished randomised studies in young people aged 6-18 years exposed to trauma. We included studies identified by the latest UK National Institute of Health and Care Excellence guidelines (completed on Jan 29, 2018) and updated their search. The search strategy included database searches restricted to publications between Jan 1, 2018, and Nov 12, 2019; grey literature search of trial registries ClinicalTrials.gov and ISRCTN; preprint archives PsyArXiv and bioRxiv; and use of social media and emails to key authors to identify any unpublished datasets. The primary outcome was post-traumatic stress symptoms after treatment (<1 month after the final session). Predominantly, one-stage random-effects models were fitted. This study is registered with PROSPERO, CRD42019151954. FINDINGS: We identified 38 studies; 25 studies provided individual participant data, comprising 1686 young people (mean age 13·65 years [SD 3·01]), with 802 receiving CBTs-TF and 884 a control condition. The risk-of-bias assessment indicated five studies as low risk and 20 studies with some concerns. Participants who received CBTs-TF had lower mean post-traumatic stress symptoms after treatment than those who received the control conditions, after adjusting for post-traumatic stress symptoms before treatment (b=-13·17, 95% CI -17·84 to -8·50, p<0·001, τ2=103·72). Moderation analysis indicated that this effect of CBTs-TF on post-traumatic stress symptoms post-treatment increased by 0·15 units (b=-0·15, 95% CI -0·29 to -0·01, p=0·041, τ2=0·03) for each unit increase in pre-treatment post-traumatic stress symptoms. INTERPRETATION: This is the first individual participant data meta-analysis of young people exposed to trauma. Our findings support CBTs-TF as the first-line treatment, irrespective of age, gender, trauma characteristics, or carer involvement in treatment, with particular benefits for those with higher initial distress. FUNDING: Swiss National Science Foundation.

The bumpy road of trauma-focused treatment: Posttraumatic stress disorder symptom exacerbation in people with psychosis.

Concern for symptom exacerbation and treatment drop-out is an important barrier to the implementation of trauma-focused therapy (TFT), especially in people with a psychotic disorder. This study, which was part of a multicenter randomized controlled trial, investigated posttraumatic stress disorder (PTSD) symptom exacerbation during eye movement desensitization reprocessing (EMDR) therapy and prolonged exposure (PE) in a sample of 99 participants with PTSD and psychosis. Symptom exacerbations during the first four sessions (early exacerbation) and between-session exacerbations over the course of therapy were monitored using the PTSD Symptom Scale-Self Report. Analyses of covariance and chi-square tests were conducted to investigate exacerbation rates and their associations with treatment response and drop-out. Both early exacerbation and between-session exacerbation were relatively common (32.3% and 46.5%, respectively) but were unrelated to poor treatment response or an increased likelihood of treatment drop-out. Both clinicians and patients need to be aware that symptom exacerbation during TFT is common and not related to poor outcomes. Symptom exacerbation can be part of the therapeutic process, should be acknowledged and guided, and should not be a barrier to the implementation of TFT in people with psychosis.

Testing an attachment- and trauma-informed intervention approach for parents and young children after interparental violence: protocol for a randomized controlled trial.

BACKGROUND: Interparental violence has persistent adverse effects on victimized parents and children. Young children, including infants and toddlers, are at particular risk to develop long-lasting negative outcomes, and yet specific evidence on effective intervention approaches for this vulnerable group is still lacking. This study will test the effectiveness of an attachment- and trauma-informed intervention approach in a sample of parent-child dyads who have experienced severe interparental violence. We test the individual and combined effects of two interventions: (1) "Nederlandse Interventie Kortdurend op Atypisch oudergedrag" (NIKA; Dutch, short-term intervention focused on atypical parenting behavior) aimed at improving the attachment relationship and (2) eye movement desensitization and reprocessing (EMDR) therapy aimed at reducing parental post-traumatic stress disorder (PTSD) symptoms. METHODS: This study uses a multicenter randomized controlled design across multiple domestic violence shelters in the Netherlands. We aim to recruit 150 parent-child dyads with children aged between 0.5 and 6 years old. The study design consists of two phases. During the first phase for testing the effect of NIKA only, eligible dyads are randomly allocated to either NIKA or a waitlist usual care group. A pre-test is conducted prior to the treatment period and a post-test takes place directly afterwards (6 weeks after the pre-test). Phase 2 follows directly for testing the effects of EMDR and the combination of NIKA and EMDR. Parents who report clinical PTSD symptoms are randomly allocated to either EMDR therapy or a waitlist usual care group. Parents who do not report clinical PTSD symptoms only receive care as usual. Six weeks later, a post-test of phase 2 is conducted for all participating dyads. Primary study outcomes are disrupted parenting behavior, sensitive parenting behavior, and parental PTSD symptoms. Secondary study outcomes include PTSD symptoms and behavioral and emotional problems of the child. DISCUSSION: This study will inform and enhance the clinical field by providing new insights regarding effective treatment combinations for traumatized parents and their young children after interparental violence. TRIAL REGISTRATION: Netherlands Trial Register (NTR) NL9179 . Registered 7 January 2021.

Trauma-focused therapies for post-traumatic stress in psychosis: study protocol for the RE.PROCESS randomized controlled trial.

INTRODUCTION: Many people with psychotic disorders experience symptoms of post-traumatic stress disorder (PTSD). In recent years, several trauma-focused therapies (TFTs), including cognitive restructuring (CR), prolonged exposure (PE), and eye movement desensitization and reprocessing (EMDR) have been studied and found to be safe and effective in reducing PTSD symptoms in individuals with psychosis. However, studies were conducted in different countries, with varying inclusion criteria, therapy duration, control groups, and trial outcomes. RE.PROCESS will be the first study to compare the impact of CR, PE, and EMDR with a waiting list control condition within the same context. METHODS AND ANALYSIS: This is the protocol of a pragmatic, single-blind, multicentre, superiority randomized controlled trial, in which CR, PE, and EMDR are compared to a waiting list control condition for TFT (WL) in a naturalistic treatment setting. Inclusion criteria are as follows: age ≥ 16 years; meeting full DSM-5 diagnostic criteria for PTSD on the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), with a total CAPS score ≥ 23; and a psychotic disorder in the schizophrenia spectrum confirmed by the Structured Clinical Interview for DSM-5 (SCID-5). Participants (N=200) will be randomly allocated to 16 sessions of one of the TFTs or WL, in addition to receiving treatment as usual (TAU) for psychosis. The primary objective is to compare the effects of CR, PE, and EMDR to WL on researcher-rated severity of PTSD symptoms over time from baseline to 6-month follow-up. Secondary objectives are to examine these effects at the separate time-points (i.e., mid-treatment, post-treatment, and at 6-month follow-up) and to test the effects for clinician-rated presence of PTSD diagnosis, and self-rated severity of (complex) PTSD symptoms. DISCUSSION: This is the first RCT to directly compare the effects of CR, PE, and EMDR within the same context to TAU on PTSD symptoms in individuals with psychosis and PTSD. Secondary effects on clinical and functional outcomes will be investigated both directly after therapy and long term. TRIAL REGISTRATION: ISRCTN ISRCTN56150327 . Registered 18 June 2019.

Trauma-focused treatments for refugee children: study protocol for a randomized controlled trial of the effectiveness of KIDNET versus EMDR therapy versus a waitlist control group (KIEM).

BACKGROUND: Prevalence of posttraumatic stress disorder (PTSD) in refugees is reportedly higher in comparison to the general population. Refugee children specifically are often coping with trauma and loss and are at risk for mental health difficulties. With staggering numbers of people seeking refuge around the world and 50% being 18 years or younger, research examining the effects of trauma-focused therapies for refugee children with PTSD is highly needed. Both Eye Movement Desensitization and Reprocessing (EMDR) therapy and the child version of Narrative Exposure Therapy (KIDNET) have been used for refugees, although these treatment methods have not been systematically compared. The aim of the current study is to investigate the effectiveness of EMDR and KIDNET, compared to a waitlist control group and with each other, offered to refugee children. METHODS: A randomized controlled three-arm trial has been designed. The primary outcome is PTSD diagnosis and symptom severity assessed with the Clinician-Administered PTSD Scale for Children DSM5 (CAPS-CA-5) at baseline (T1), 1 month post-treatment, or after 8 weeks of waiting (T2) and 3 months follow-up (T3). Additionally, instruments to assess posttraumatic stress symptoms, behavioral and emotional problems, and quality of life perception in children aged 8-18 are conducted at T1, T2, and T3. DISCUSSION: This is the first RCT that examines the effectiveness of EMDR and KIDNET in refugee children aged 8-18 years specifically, compared to a waitlist control group intended to reduce PTSD diagnosis and severity of posttraumatic stress symptoms and comorbid complaints in a growing and challenging population. TRIAL REGISTRATION: Dutch Trial Register NL40769 . Retrospectively registered on June 16, 2021.

Eye Movement Desensitization and Reprocessing in Young Children (Ages 4-8) with Posttraumatic Stress Disorder: A Multiple-Baseline Evaluation.

To reduce the acute and long-term effects of trauma, early and effective treatment is necessary. Eye movement desensitization and reprocessing (EMDR) therapy is a brief treatment for posttraumatic stress disorder (PTSD), with a substantial evidence base for children and adolescents aged 8 to 18 years. In the present study we aimed to provide preliminary evidence of EMDR as a trauma treatment for young children. We studied 9 children, aged 4 to 8 years old with a DSM-5 diagnosis of PTSD. A non-concurrent multiple baseline experimental design was used combined with standardized measures. Participants received six 1-h sessions of EMDR. Results post-treatment showed that EMDR was effective in reaching diagnostic remission of PTSD (85.7%), and decreasing severity of PTSD symptoms and emotional and behavioral problems. All gains were maintained at follow-up 3 months after treatment. EMDR appears an effective treatment for PTSD in young children aged 4 to 8 years. Further research is warranted.

Predictors and moderators of treatment outcome for single incident paediatric PTSD: a multi-centre randomized clinical trial.

Background: With few RCTs having compared active treatments for paediatric PTSD, little is known about whether or which baseline (i.e. pre-randomization) variables predict or moderate outcomes in the evaluated treatments. Objective: To identify predictors and moderators of paediatric PTSD outcomes for Eye Movement Desensitization and Reprocessing Therapy (EMDR) and Cognitive Behavioural Writing Therapy (CBWT). Method: Data were obtained as part of a multi-centre, randomized controlled trial of up to six sessions (up to 45 minutes each) of either EMDR therapy, CBWT, or wait-list, involving 101 youth (aged 8-18 years) with a PTSD diagnosis (full/subthreshold) tied to a single event. The predictive and moderating effects of the child's baseline sociodemographic and clinical characteristics, and parent's psychopathology were evaluated using linear mixed models (LMM) from pre- to post-treatment and from pre- to 3- and 12-month follow-ups. Results: At post-treatment and 3-month follow-up, youth with an index trauma of sexual abuse, severe symptoms of PTSD, anxiety, depression, more comorbid disorders, negative posttraumatic beliefs, and with a parent with more severe psychopathology fared worse in both treatments. For children with more severe self-reported PTSD symptoms at baseline, the (exploratory) moderator analysis showed that the EMDR group improved more than the CBWT group, with the opposite being true for children and parents with a less severe clinical profile. Conclusions: The most consistent finding from the predictor analyses was that parental symptomatology predicted poorer outcomes, suggesting that parents should be assessed, supported and referred for their own treatment where indicated. The effect of the significant moderator variables was time-limited, and given the large response rate (>90%) and brevity (<4 hours) of both treatments, the present findings suggest a focus on implementation and dissemination, rather than tailoring, of evidence-based trauma-focused treatments for paediatric PTSD tied to a single event.

Antecedentes: Dado que pocos ECA (ensayos controlados aleatorizados) han comparado tratamientos activos para el TEPT pediátrico, se sabe poco acerca de si las variables basales (es decir, pre-aleatorización) predicen o moderan los resultados en los tratamientos evaluados.Objetivo: Identificar predictores y moderadores de los resultados del TEPT pediátrico para la Terapia de Reprocesamiento y Desensibilización por Movimientos Oculares (EMDR) y la Terapia de Escritura Cognitiva Conductual (CBWT en sus siglas en ingles).Método: Los datos se obtuvieron como parte de un ensayo controlado aleatorizado multicéntrico de hasta seis sesiones (de hasta 45 minutos cada una) de terapia EMDR, CBWT o lista de espera, que incluyó a 101 jóvenes (de 8 a 18 años de edad) con un diagnóstico de TEPT (total/subumbral) vinculado a un solo evento. Los efectos predictivos y moderadores de las características sociodemográficas y clínicas basales del niño y la psicopatología de los padres se evaluaron mediante modelos lineales mixtos (MLM) desde antes y después del tratamiento y desde antes hasta los 3 y 12 meses de seguimiento.Resultados: En el post-tratamiento y en el seguimiento a los 3 meses, los jóvenes con un trauma índice de abuso sexual, síntomas severos de TEPT, ansiedad, depresión, más trastornos comórbidos, creencias postraumáticas negativas y con un padre con psicopatología más severa obtuvieron los peores resultados en ambos tratamientos. Para los niños con síntomas de TEPT auto-informados más graves al inicio del estudio, el análisis del moderador (exploratorio) mostró que el grupo EMDR mejoró más que el grupo CBWT, siendo lo opuesto para los niños y los padres con un perfil clínico menos grave.Conclusiones: El hallazgo más consistente de los análisis de predictores fue que la sintomatología de los padres predijo peores resultados, lo que sugiere que los padres deben ser evaluados, apoyados y referidos para su propio tratamiento cuando esté indicado. El efecto de las variables moderadoras significativas fue limitado en el tiempo, y dada la gran tasa de respuesta (> 90%) y la brevedad (<4 horas) de ambos tratamientos, los presentes hallazgos sugieren un enfoque en la implementación y diseminación, en lugar de la adaptación, de tratamientos centrados en el trauma basados en la evidencia para el TEPT pediátrico vinculados a un solo evento.

Early intervention with eye movement desensitization and reprocessing (EMDR) therapy to reduce the severity of post-traumatic stress symptoms in recent rape victims: a randomized controlled trial.

Background: About 40% of rape victims develop post-traumatic stress disorder (PTSD) within three months after the assault. Considering the high personal and societal impact of PTSD, there is an urgent need for early (i.e. within three months after the incident) interventions to reduce post-traumatic stress in victims of rape. Objective: To assess the effectiveness of early intervention with eye movement desensitization and reprocessing (EMDR) therapy to reduce symptoms of post-traumatic stress, feelings of guilt and shame, sexual dysfunction, and other psychological dysfunction (i.e. general psychopathology, anxiety, depression, and dissociative symptoms) in victims of rape. Method: This randomized controlled trial included 57 victims of rape, who were randomly allocated to either two sessions of EMDR therapy or treatment as usual ('watchful waiting') between 14 and 28 days post-rape. Psychological symptoms were assessed at pre-treatment, post-treatment, and 8 and 12 weeks post-rape. Linear mixed models and ANCOVAs were used to analyse differences between conditions over time. Results: Within-group effect sizes of the EMDR condition (d = 0.89 to 1.57) and control condition (d = 0.79 to 1.54) were large, indicating that both conditions were effective. However, EMDR therapy was not found to be more effective than watchful waiting in reducing post-traumatic stress symptoms, general psychopathology, depression, sexual dysfunction, and feelings of guilt and shame. Although EMDR therapy was found to be more effective than watchful waiting in reducing anxiety and dissociative symptoms in the post-treatment assessment, this effect disappeared over time. Conclusions: The findings do not support the notion that early intervention with EMDR therapy in victims of rape is more effective than watchful waiting for the reduction of psychological symptoms, including symptoms of post-traumatic stress. Further research on the effectiveness of early interventions, including watchful waiting, for this specific target group is needed.

Antecedentes: Aproximadamente el 40% de las víctimas de violación desarrollan trastorno de estrés postraumático (TEPT) dentro de los tres meses posteriores a la agresión. Teniendo en cuenta el alto impacto personal y social del TEPT, existe una necesidad urgente de intervenciones tempranas (es decir, dentro de los tres meses posteriores al incidente) para reducir el estrés postraumático en las víctimas de violación.Objetivo: Evaluar la efectividad de la intervención temprana con terapia de desensibilización y reprocesamiento por movimiento ocular (EMDR en su sigla en inglés) para reducir los síntomas de estrés postraumático, sentimientos de culpa y vergüenza, disfunción sexual, y otras disfunciones psicológicas (es decir, psicopatología general, ansiedad, depresión, y síntomas disociativos) en víctimas de violación.Método: Este ensayo controlado aleatorizado incluyó a 57 víctimas de violación, que fueron asignadas al azar a dos sesiones de terapia EMDR o al tratamiento habitual ("espera vigilante") entre 14 y 28 días después de la violación. Los síntomas psicológicos se evaluaron antes del tratamiento, después del tratamiento, y 8 y 12 semanas después de la violación. Se utilizaron modelos lineales mixtos y ANCOVAs para analizar las diferencias entre las condiciones a lo largo del tiempo.Resultados: Los tamaños del efecto dentro del grupo de la condición EMDR (d = 0.89 a 1.57) y la condición de control (d = 0.79 a 1.54) fueron grandes, lo que indica que ambas condiciones fueron efectivas. Sin embargo, no se encontró que la terapia EMDR fuera más efectiva que la espera vigilante para reducir los síntomas de estrés postraumático, la psicopatología general, la depresión, la disfunción sexual, y los sentimientos de culpa y vergüenza. Aunque se encontró que la terapia EMDR era más efectiva que la espera vigilante para reducir la ansiedad y los síntomas disociativos en la evaluación posterior al tratamiento, este efecto desapareció con el tiempo.Conclusiones: Los hallazgos no apoyan la noción de que la intervención temprana con terapia EMDR en víctimas de violación sea más efectiva que la espera vigilante para la reducción de los síntomas psicológicos, incluyendo los síntomas del estrés postraumático. Se necesitan más investigaciones sobre la efectividad de las intervenciones tempranas, incluida la espera vigilante, para este grupo objetivo específico.

EMDR therapy for misophonia: a pilot study of case series.

Background: Misophonia is a disorder in which patients suffer from anger or disgust when confronted with specific sounds such as loud chewing or breathing, causing avoidance of cue-related situations resulting in significant functional impairment. Though the first treatment studies with cognitive behavioural therapy (CBT) showed promising results, an average of 50% of the patients has not improved much clinically. Objective: The aim of this pilot study was to assess the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy as a trauma-focused approach in treating misophonia symptoms. Method: A sample of 10 adult participants with misophonia was studied at the outpatient clinic of the Academic Medical Center in Amsterdam. Participants were either on the waiting list for CBT or non-responders to CBT. EMDR was focused on misophonia-related emotionally disturbing memories and delivered in a mean of 2.6 sessions of 60-90 minutes. Pre- and post-treatment self-assessed ratings of misophonia symptoms (AMISOS-R, primary outcome), of general psychopathology (SCL-90-R) and of quality of life (SDS) were administered. The co-primary outcome was the Clinical Global Impression Improvement scale (CGI-I). Results: A paired t-test (n = 8) showed improvement on the primary outcome (-6.14 [MD], 5.34 [SD]) on the AMISOS-R (P = .023). Three of the eight patients showed clinically significant improvement measured with the CGI-I. No significant effect on secondary outcomes was found. Conclusions: These preliminary results suggest that EMDR therapy focused on emotionally disturbing misophonia-related memories can reduce misophonia symptoms. RCTs with sufficient sample sizes are required to firmly establish the value of EMDR therapy for misophonia.

Antecedentes: La misofonía es un trastorno en el que los pacientes sufren de rabia o desagrado cuando se enfrentan a sonidos específicos como la masticación o la respiración ruidosa, lo que provoca la evitación de las situaciones relacionadas con el estímulo y da lugar a un deterioro funcional significativo. Aunque los primeros estudios de tratamiento con terapia cognitivo-conductual (TCC) mostraron resultados prometedores, una media del 50% de los pacientes no ha mejorado mucho clínicamente.Objetivo: El objetivo de este estudio piloto fue evaluar la eficacia de la terapia de desensibilización y reprocesamiento por movimientos oculares (EMDR) como enfoque centrado en el trauma para tratar los síntomas de la misofonía.Método: Se estudió una muestra de 10 participantes adultos con misofonía en la clínica ambulatoria del Centro Médico Académico de Ámsterdam. Los participantes estaban en lista de espera para la TCC o no respondían a la TCC. La EMDR se centró en los recuerdos emocionalmente perturbadores relacionados con la misofonía y se aplicó en una media de 2,6 sesiones de 60­90 minutos. Se administraron calificaciones autoevaluadas antes y después del tratamiento de los síntomas de misofonía (AMISOS-R, resultado primario), de psicopatología general (SCL-90-R) y de calidad de vida (SDS). El resultado co-primario fue la escala de Mejora de la Impresión Clínica Global (CGI-I).Resultados: Una prueba t pareada (n=8) mostró una mejora en el resultado primario (−6,14 [DM]), 5,34 [DE] en la AMISOS-R (P= .023). Tres de los ocho pacientes mostraron una mejora clínicamente significativa medida con la CGI-I. No se encontró ningún efecto significativo en los resultados secundarios.EMDR para la misofonía Estos resultados preliminares sugieren que la terapia EMDR centrada en los recuerdos emocionalmente perturbadores relacionados con la misofonía puede reducir los síntomas de ésta. Se requieren ECAs con tamaños de muestra suficientes para establecer firmemente el valour de la terapia EMDR para la misofonía.

Effectiveness of an intensive treatment programme combining prolonged exposure and EMDR therapy for adolescents suffering from severe post-traumatic stress disorder.

Background: Following promising effects of an intensive trauma treatment for adults, the question arises whether adolescents who suffer from severe post-traumatic stress disorder (PTSD) can also profit from a similar treatment programme. Objective: To assess the effectiveness of an intensive trauma-focused treatment programme combining two evidence-based trauma-focused therapies and physical activities for adolescents suffering from severe PTSD. Method: Treatment consisted of daily sessions of prolonged exposure (PE) therapy and eye movement desensitization and reprocessing (EMDR) therapy supplemented with physical activity (13 days on average). All patients (N = 27; 96.3% women, mean age = 16.1 years; SD = 1.3) had been exposed to one or more (interpersonal) traumatic events. Twenty-two of them (81.5%) also fulfilled the diagnostic criteria of a comorbid psychiatric disorder (mean number of comorbid disorders = 2.22). The majority of patients were referred because previous treatment was difficult or complications were expected to occur. Severity of PTSD symptoms and presence of a PTSD diagnostic status were assessed using the Dutch version of the CAPS-CA IV at baseline, post-treatment and at 3-month follow-up. Results: CAPS-CA IV scores decreased significantly from pre- to post-treatment (Cohen's d = 1.39). Of all patients 81.5% (n = 22) showed a clinically meaningful response, of whom 63% (n = 17) no longer fulfilled the diagnostic criteria of PTSD at post-treatment as established with the CAPS-CA IV. The results were maintained at 3-month follow-up. During treatment, neither adverse events nor dropout occurred. Conclusions: The results suggest that an intensive trauma-focused treatment programme combining prolonged exposure, EMDR therapy, and physical activity can be an effective and safe treatment for adolescents suffering from severe PTSD and multiple comorbid psychiatric disorders.

Antecedentes: Después de los efectos prometedores de un tratamiento intensivo del trauma para adultos, surge la pregunta de si los adolescentes que padecen un trastorno de estrés postraumático severo (TEPT) también pueden beneficiarse de un programa de tratamiento similar.Objetivo: Evaluar la efectividad de un programa de tratamiento intensivo centrado en el trauma que combina dos terapias centradas en el trauma basadas en la evidencia y actividad física para adolescentes que sufren de TEPT grave.Método: El tratamiento consistió en sesiones diarias de terapia de exposición prolongada (PE) y terapia de desensibilización y reprocesamiento por movimientos oculares (EMDR) complementadas con actividad física (13 días en promedio). Todos los pacientes (N = 27; 96.3% mujeres, edad media = 16,1 años; DE = 1.3) habían estado expuestos a uno o más eventos traumáticos (interpersonales). Veintidós de ellos (81.5%) también cumplían los criterios diagnósticos de un trastorno psiquiátrico comórbido (número medio de trastornos comórbidos = 2.22). La mayoría de los pacientes fueron derivados porque el tratamiento previo fue difícil o se esperaba que ocurrieran complicaciones. La gravedad de los síntomas de TEPT y la presencia del diagnóstico de TEPT se evaluaron utilizando la versión holandesa del CAPS-CA IV al inicio, después del tratamiento y a los 3 meses de seguimiento.Resultados: Los puntajes de CAPS-CA IV disminuyeron significativamente pre a post tratamiento (d de Cohen = 1,39). De todos los pacientes, el 81,5% (n = 22) mostró una respuesta clínicamente significativa, de los cuales el 63% (n = 17) ya no cumplía con los criterios diagnósticos de TEPT en el postratamiento según lo establecido con el CAPS-CA IV. Los resultados se mantuvieron a los 3 meses de seguimiento. Durante el tratamiento, no se produjeron eventos adversos ni abandonos.Conclusiones: Los resultados sugieren que un programa de tratamiento intensivo centrado en el trauma que combine exposición prolongada, terapia EMDR y actividad física puede ser un tratamiento eficaz y seguro para los adolescentes que padecen TEPT severo y múltiples trastornos psiquiátricos comórbidos.

Reducing posttraumatic stress in parents of patients with a rare inherited metabolic disorder using eye movement desensitization and reprocessing therapy: a case study.

Parents of children with severe inborn errors of metabolism frequently face stressful events related to the disease of their child and are consequently at high risk for developing parental posttraumatic stress disorder (PTSD). Assessment and subsequent treatment of PTSD in these parents is however not common in clinical practice. PTSD can be effectively treated by Eye Movement Desensitization and Reprocessing (EMDR), however no studies have been conducted yet regarding the effect of EMDR for parental PTSD. EMDR is generally offered in multiple weekly sessions which may preclude participation of parents as they are generally overburdened by the ongoing and often intensive care for their child. Therefore, we offered time-limited EMDR with a maximum of four sessions over two subsequent days to two parents of mucopolysaccharidosis type III (MPS III) patients to explore its potential effects. Both qualitative and quantitative outcomes were used to evaluate treatment effects. Both parents felt more resilient and competent to face future difficulties related to the disease of their child, and no adverse effects were reported. Quantitative outcomes showed a clinically significant decrease in post traumatic stress symptoms and comorbid psychological distress from pre- to post treatment, and these beneficial effects were maintained at follow-up. In conclusion, time-limited EMDR may be a highly relevant treatment for traumatized parents of children with MPS III, and probably also for parents of children with other rare progressive disorders. Further research is needed to validate the efficacy of EMDR in this specific population.

The effect of parental emotional abuse on the severity and treatment of PTSD symptoms in children and adolescents.

BACKGROUND: Maltreatment by a primary caregiver is an important risk factor for the development of PTSD symptoms. Whereas meta-analyses indicate that parental emotional abuse is one of the most common forms of maltreatment, the impact of emotional abuse on PTSD symptoms and treatment effectiveness is still unclear, especially in children. OBJECTIVE: We aimed to investigate the impact of parental emotional abuse on PTSD symptom severity and effectiveness of trauma treatment in children and adolescents. METHOD: In an outpatient sample (N = 287, mean age = 15.5 years), emotional abuse, index traumatic event, and PTSD symptoms were assessed at baseline. Thereafter, patients received evidence-based treatment for trauma-related symptoms embedded in a broader (systemic) treatment package. In a subsample (n = 130, mean age = 15.3 years) PTSD symptoms were assessed again 6 and 12 months after baseline. RESULTS: Emotional abuse (rather than any other type of maltreatment) was associated with more severe PTSD symptoms in all symptom clusters. This was independent of whether emotional abuse was reported as index traumatic event or not. Moreover, PTSD symptoms were significantly reduced 6 months after the start of trauma-focused treatment, and emotional abuse was associated with more severe PTSD symptoms over the course of treatment. CONCLUSIONS: These findings underline the detrimental nature of emotional maltreatment in the context of PTSD symptomatology and treatment effectiveness. This calls for routine assessment of parental emotional abuse in the diagnostic phase, even when this is not the reason of referral.

Dysfunctional posttraumatic cognitions, posttraumatic stress and depression in children and adolescents exposed to trauma: a network analysis.

BACKGROUND: The latest version of the International Classification of Diseases (ICD-11) proposes a posttraumatic stress disorder (PTSD) diagnosis reduced to its core symptoms within the symptom clusters re-experiencing, avoidance and hyperarousal. Since children and adolescents often show a variety of internalizing and externalizing symptoms in the aftermath of traumatic events, the question arises whether such a conceptualization of the PTSD diagnosis is supported in children and adolescents. Furthermore, although dysfunctional posttraumatic cognitions (PTCs) appear to play an important role in the development and persistence of PTSD in children and adolescents, their function within diagnostic frameworks requires clarification. METHODS: We compiled a large international data set of 2,313 children and adolescents aged 6 to 18 years exposed to trauma and calculated a network model including dysfunctional PTCs, PTSD core symptoms and depression symptoms. Central items and relations between constructs were investigated. RESULTS: The PTSD re-experiencing symptoms strong or overwhelming emotions and strong physical sensations and the depression symptom difficulty concentrating emerged as most central. Items from the same construct were more strongly connected with each other than with items from the other constructs. Dysfunctional PTCs were not more strongly connected to core PTSD symptoms than to depression symptoms. CONCLUSIONS: Our findings provide support that a PTSD diagnosis reduced to its core symptoms could help to disentangle PTSD, depression and dysfunctional PTCs. Using longitudinal data and complementing between-subject with within-subject analyses might provide further insight into the relationship between dysfunctional PTCs, PTSD and depression.

Effectiveness of trauma-focused treatment for adolescents with major depressive disorder.

Background: Major Depressive Disorder (MDD) in adolescence has a high prevalence and risk of disability, but current treatments show limited effectiveness and high drop-out and relapse rates. Although the role of distressing experiences that relate to the development and maintenance of MDD has been recognized for decades, the efficacy of a trauma-focused treatment approach for MDD has hardly been studied. Objective: To determine the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy as a stand-alone intervention in adolescents diagnosed with MDD. We hypothesized that reprocessing core memories related to the onset and maintenance of MDD using EMDR therapy would be associated with a significant decrease in depressive and comorbid symptoms. Method: We recruited 32 adolescents (12-18 years) fulfilling DSM-IV criteria for mild to moderate-severe MDD from an outpatient youth mental health care unit. Treatment consisted of six weekly 60-min individual sessions. Presence or absence of MDD classification (ADIS-C), symptoms of depression (CDI), symptoms of posttraumatic stress (UCLA), anxiety (SCARED), somatic complaints (CSI), and overall social-emotional functioning (SDQ) were assessed pre and post-treatment and 3 months after treatment. Results: 60.9% of the adolescents completing treatment no longer met DSM-IV criteria for MDD after treatment anymore, and 69.8% at follow-up. Multilevel analyses demonstrated significant posttreatment reductions of depressive symptoms (CDI: Cohen's d = 0.72), comorbid posttraumatic stress, anxiety and somatic complaints, while overall social-emotional functioning improved. These gains were maintained at 3-month follow-up (Cohen's d = 1.11). Severity of posttraumatic stress reactions significantly predicted the posttreatment outcome; however, duration of MDD, number of comorbid disorders, or having a history of emotional abuse, emotional neglect or physical neglect were not predictive for outcome. Conclusions: This is the first study suggesting that EMDR therapy is associated with a significant reduction of depressive symptoms and comorbid psychiatric problems in adolescents with mild to moderate-severe MDD.

Antecedentes: El Trastorno Depresivo mayor (MDD por sus siglas en inglés) tiene una alta prevalencia y alto riesgo de discapacidad en población adolescente, sin embargo, los tratamientos con los que se cuentan actualmente muestran una efectividad limitada, además de altas tasas de abandono y recaída. Pese a que el rol que juegan las experiencias adversas tanto en el desarrollo como en la mantención del MDD ha sido reconocido por décadas, la eficacia de un tratamiento con enfoque centrado en el trauma para MDD ha sido apenas estudiado.Objetivo: Determinar la efectividad de la terapia de desensibilización y reprocesamiento por movimientos oculares (EMDR por sus siglas en inglés) como intervención única en adolescentes diagnosticados con MDD. Nuestra hipótesis es que el reprocesamiento de recuerdos esenciales relacionados con el inicio y la mantención del MDD usando terapia EMDR estaría asociado a un descenso significativo en síntomas depresivos y comórbidos.Método: Reclutamos a 32 adolescentes (de 12 a 18 años) que cumplían los criterios DSM-IV para un MDD leve a moderado-severo de un servicio de salud mental ambulatoria juvenil. El tratamiento consistió en seis sesiones individuales de 60 minutos con frecuencia semanal. Se evaluaron con la presencia o ausencia de la clasificación de MDD (ADIS-C), síntomas depresivos (CDI), síntomas de estrés postraumático (UCLA), síntomas ansiosos (SCARED), quejas somáticas (CSI) y funcionamiento socioemocional global (SDQ) tanto antes de iniciar el tratamiento, post tratamiento y a los tres meses de finalizar el tratamiento.Resultados: El 60.9% de los adolescentes que completó el tratamiento ya no cumplía los criterios del DSM-IV para MDD una vez finalizada la intervención, y en el seguimiento un 69.8% ya no cumplía los criterios. El análisis de multinivel demostró reducciones significativas de síntomas depresivos post-tratamiento (CDI: d de Cohen=0.72), comorbilidad de estrés postraumático, ansiedad y quejas somáticas, mejorando además el funcionamiento socioemocional global. Esta mejoría fue mantenida al seguimiento de 3 meses (d de Cohen=1.11). La severidad de las reacciones de estrés postraumático predijo significativamente el resultado post tratamiento, aunque la duración del MDD, el número de desórdenes comórbidos o el haber tenido una historia de abuso emocional, negligencia emocional o negligencia física no fueron factores predictores para el resultado.Conclusiones: este es el 6primer estudio que sugiere que la terapia EMDR está asociada con una reducción significativa de síntomas depresivos y problemas psiquiátricos comórbidos en adolescentes con MDD leve a moderado-severo.

Early intervention with eye movement desensitisation and reprocessing (EMDR) therapy to reduce the severity of posttraumatic stress symptoms in recent rape victims: study protocol for a randomised controlled trial.

Background: It is estimated that more than 40% of rape victims develops a posttraumatic stress disorder (PTSD), a statistic that is relatively high compared to other types of trauma. PTSD can affect the victims' psychological, sexual, and physical health. Therefore, there is an urgent need for early interventions to prevent the onset of PTSD in this target group. Objective: This randomised controlled trial (RCT) examines the efficacy of early Eye Movement Desensitisation and Reprocessing (EMDR) therapy aimed to reduce the severity of posttraumatic stress symptoms in victims of recent rape. Methods: Subjects (N = 34) are individuals of 16 years and older who present themselves within 7 days post-rape at one of the four participating Sexual Assault Centres in the Netherlands. The intervention consists of two sessions of EMDR therapy between day 14 and 28 post-rape, while the control group receives treatment as usual, consisting of careful monitoring of stress reactions by a case-manager across two contacts during 1-month post-rape. Baseline assessment, posttreatment assessment and follow-up assessments at 8 and 12-weeks post-rape will be used to assess the development of posttraumatic stress symptoms. In addition, the efficacy of the intervention on psychological and sexual functioning will be determined. Linear mixed model analysis will be used to explore the differences within and between the EMDR group and control group at the various time points. Conclusions: The results of this RCT may help the dissemination and application of evidence-based preventative treatments for PTSD after rape.

Antecedentes: Se ha estimado que más del 40% de las víctimas de violación desarrollan un trastorno de estrés postraumático (TEPT), una estadística que es relativamente alta en comparación a otros tipos de trauma. El TEPT puede afectar la salud psicológica, sexual, y física de las víctimas. Por lo tanto, existe una necesidad urgente por intervenciones tempranas para prevenir la aparición de TEPT en este grupo objetivo.Objetivo: Este ensayo controlado aleatorio (RCT en sus siglas en inglés) examina la eficacia de una terapia temprana de Desensibilización y Reprocesamiento por Movimiento Ocular (EMDR en sus siglas en inglés) orientada a reducir la severidad de los síntomas de estrés postraumáticos en las víctimas recientes de una violación.Método: Los sujetos (N=34) son individuos de 16 años y más, que se presentan en uno de los cuatro Centros de Agresión Sexual participantes en los Países Bajos dentro de los 7 días posteriores a la violación. La intervención consiste de dos sesiones de terapia EMDR entre el día 14 y 28 luego de la violación, mientras que el grupo control recibe tratamiento habitual, el que consiste en un monitoreo cuidadoso de las reacciones de estrés en dos contactos durante un mes posterior a la violación, a cargo de un encargado del caso. La evaluación inicial (línea base), de post-tratamiento, y de seguimiento a las 8 y 12 semanas posteriores a la violación serán usadas para medir el desarrollo de los síntomas de estrés postraumático. Además, la eficacia de la intervención en el funcionamiento psicológico y sexual será determinada. Los análisis de modelos mixtos lineales serán usados.Conclusión: Los resultados de este RCT ayudarían a la difusión y aplicación de los tratamientos preventivos basados en la evidencia para el TEPT luego de una violación.

Health-economic benefits of treating trauma in psychosis.

Background: Co-occurrence of posttraumatic stress disorder (PTSD) in psychosis (estimated as 12%) raises personal suffering and societal costs. Health-economic studies on PTSD treatments in patients with a diagnosis of a psychotic disorder have not yet been conducted, but are needed for guideline development and implementation. This study aims to analyse the cost-effectiveness of guideline PTSD therapies in patients with a psychotic disorder. Methods: This health-economic evaluation alongside a randomized controlled trial included 155 patients with a psychotic disorder in care as usual (CAU), with comorbid PTSD. Participants received eye movement desensitization and reprocessing (EMDR) (n = 55), prolonged exposure (PE) (n = 53) or waiting list (WL) (n = 47) with masked assessments at baseline (T0) and at the two-month (post-treatment, T2) and six-month follow-up (T6). Costs were calculated using the TiC-P interview for assessing healthcare consumption and productivity losses. Incremental cost-effectiveness ratios and economic acceptability were calculated for quality-adjusted life years (EQ-5D-3L-based QALYs) and PTSD 'Loss of diagnosis' (LoD, CAPS). Results: Compared to WL, costs were lower in EMDR (-€1410) and PE (-€501) per patient per six months. In addition, EMDR (robust SE 0.024, t = 2.14, p = .035) and PE (robust SE 0.024, t = 2.14, p = .035) yielded a 0.052 and 0.051 incremental QALY gain, respectively, as well as 26% greater probability for LoD following EMDR (robust SE = 0.096, z = 2.66, p = .008) and 22% following PE (robust SE 0.098, z = 2.28, p = .023). Acceptability curves indicate high probabilities of PTSD treatments being the better economic choice. Sensitivity analyses corroborated these outcomes. Conclusion: Adding PTSD treatment to CAU for individuals with psychosis and PTSD seem to yield better health and less PTSD at lower costs, which argues for implementation.

Antecedentes: La comorbilidad de TEPT en la psicosis (estimada en 12%) aumenta el sufrimiento personal y los costos para la sociedad. No se han realizado aún estudios de economía de la salud de los tratamientos de TEPT en pacientes con diagnóstico de un trastorno psicótico, pero son necesarios para el desarrollo e implementación de guías. Este estudio apunta a analizar la costo-efectividad de las terapias para TEPT con guías clínicas en pacientes con un trastorno psicótico.Métodos: Esta evaluación de economía de la salud asociada a un estudio randomizado controlado incluyó a 155 pacientes con un trastorno psicótico en cuidado habitual (CAU), con TEPT comórbido.Los pacientes recibieron terapia de reprocesamiento por movimientos oculares (EMDR, n=55), exposición prolongada (PE, n=53) o lista de espera (WL, n=47) con evaluaciones ciegas basal (T0), a los 2 meses (post-tratamiento, T2) y a los 6 meses de seguimiento (T6). Los costos fueron calculados usando la entrevista TiC-P para evaluar el consumo en los sistemas de salud y pérdidas de productividad. Las tasas incrementales de costo-efectividad y acepabilidad económica fueron calculadas por Años de Vida ajustados por calidad (QALY basado en EQ-5D-3L) y pérdida de diagnóstico de TEPT (LoD, CAPS)Resultados: En comparación a lista de espera, los costos fueron menores en EMDR (-€1410) y PE (-€501) por paciente por cada 6 meses. Además, EMDR (SE robusta 0.024, t=2.14, p=0.035) y PE (SE robusta 0.024, t=2.14, p=0.035) produjeron una ganancia incremental en QALY de 0.05 y una probabilidad 26% mayor de LoD luego de EMDR (SE robusta 0.096, z=2.66, p=0.008) y 22% luego de PE (SE robusta 0.098, z=2.28, p=0.023). Las curvas de aceptabilidad indican altas probabilidades de que los tratamientos para TEPT sean la mejor alternativa económica. Los análisis de sensibilidad corroboraron estos resultados.Conclusion: El agregar tratamiento para TEPT a los cuidados habituales en pacientes con psicosis y TEPT parece producir mejor salud y menos TEPT a menor costo, lo que aboga por su implementación.

A trauma-focused approach for patients with tinnitus: the effectiveness of eye movement desensitization and reprocessing - a multicentre pilot trial.

Background: While normal tinnitus is a short-term sensation of limited duration, in 10-15% of the general population it develops into a chronic condition. For 3-6% it seriously interferes with many aspects of life. Objective: The aim of this trial was to assess effectiveness of a trauma-focused approach, eye movement desensitization and reprocessing (EMDR), in reducing tinnitus distress. Methods: The sample consisted of 35 adults with high levels of chronic tinnitus distress from five general hospitals in the Netherlands. Participants served as their own controls. After pre-assessment (T1), participants waited for a period of 3 months, after which they were assessed again (T2) before they received six 90 min manualized EMDR treatment sessions in which tinnitus-related traumatic or stressful events were the focus of treatment. Standardized self-report measures, the Tinnitus Functional Index (TFI), Mini-Tinnitus Questionnaire (Mini-TQ), Symptom Checklist-90 (SCL-90) and the Self-Rating Inventory List for Post-traumatic Stress Disorder (SRIP), were completed again halfway through treatment (T3), post-treatment (T4) and at 3 months' follow-up (T5). Results: Repeated measures analysis of variance revealed significant improvement after EMDR treatment on the primary outcome, TFI. Compared to the waiting-list condition, scores significantly decreased in EMDR treatment [t(34) = -4.25, p < .001, Cohen's dz  = .72]. Secondary outcomes, Mini-TQ and SCL-90, also decreased significantly. The treatment effects remained stable at 3 months' follow-up. No adverse events or side effects were noted in this trial. Conclusions: This is the first study to suggest that EMDR is effective in reducing tinnitus distress. Randomized controlled trials are warranted.

Antecedentes: mientras que el tinnitus normal es una sensación a corto plazo de duración limitada, en el 10-15% de los pacientes se transforma en una condición crónica. Para el 3-6% de los pacientes interfiere seriamente con muchos aspectos de la vida. El objetivo de este estudio fue evaluar la efectividad de un enfoque centrado en el trauma, la Desensibilización y Reprocesamiento por Movimientos Oculares (EMDR), para reducir el estrés por tinnitus. Métodos: La muestra consistió en 35 adultos con altos niveles de estrés por tinnitus crónico de cinco hospitales generales en los Países Bajos. Los participantes sirvieron como sus propios controles. Después de la pre-evaluación (T1), los participantes esperaron por un período de 3 meses, después de lo cual fueron evaluados nuevamente (T2) antes de recibir seis sesiones de tratamiento EMDR manualizadas de 90 minutos en las que los eventos traumáticos o estresantes relacionados con el tinnitus fueron el foco del tratamiento. Las medidas de autorreporte estandarizadas, el Índice Funcional de Tinnitus (TFI, por su sigla en inglés), el Mini Cuestionario de Tinnitus (Mini-TQ), la Lista de Chequeo de Síntomas - 90 (SCL-90, por su sigla en inglés) y la Lista de Inventario de Autorreporte para el TEPT (SRIP, por su sigla en inglés) se completaron nuevamente durante el tratamiento (T3), postratamiento (T4) y a los 3 meses de seguimiento (T5). Resultados: el análisis de varianza de medidas repetidas (ANOVA) reveló una mejora significativa después del tratamiento con EMDR en el resultado primario TFI. Comparado con la condición de lista de espera, los puntajes disminuyeron significativamente en el tratamiento con EMDR, como mostraron las pruebas t de muestras relacionadas (t(34) = -4.25, p <0.001, Cohen's dz = 0.72). Los resultados secundarios Mini-TQ y SCL-90 también disminuyeron significativamente. Los efectos del tratamiento se mantuvieron estables a los 3 meses de seguimiento. No se observaron eventos adversos o efectos secundarios en este estudio. Conclusiones: Este es el primer estudio que sugiere que el EMDR es efectivo para reducir el estrés por tinnitus. Se requieren ensayos aleatorios controlados.