Feasibility of EMDR toward Personality Functioning in Older Adults with PTSD.

OBJECTIVES: Severe posttraumatic stress disorder (PTSD) in older adults (≥60 years) has been found to be associated with maladaptive personality functioning and personality disorders (PD). Emerging evidence in adults supports that reprocessing adverse events with Eye Movement Desensitization and Reprocessing (EMDR) could improve personality functioning and reduce full PDdiagnosis. METHODS: A multicenterfeasibilitystudy in 24 older PTSD-patients receiving weekly EMDR-sessions for either 3, 6 or 9 months. A linear-mixed-model was used with personality functioning (SIPP-SF) as dependent variable and time, PTSD-severity (CAPS-5), and "othertreatment" as predictor variables. Secondary, pre- and posttreatment percentages were calculated for the PDspresence. RESULTS: Symptom changes over time showed a significant influence of CAPS-5 on SIPP-SF (b = -1.40, 95% CI=[-2.48 to -0.33], p = .012), no significant effect of time for total SIPP-SF, and a significant improvement of SIPP-SF "identityintegration"-scale over time (b = 9.20, 95% CI=[0.97-17.42], p = .029). There was a marginal significant effect of "othertreatment" (b = 8.42, 95% CI=[-0.30-17.13], p = .058). There was 31% full PDs-decrease. CONCLUSIONS: Observed improvements in personality functioning from pre to post EMDRtreatment were explained by PTSD-severity. Identityintegration improved significantly over time. Results suggest that participants with "othertreatment" showed more severe baseline-pathology and thus lower personality functioning. CLINICAL IMPLICATIONS: EMDR, in addition to being a feasible treatment option for older adults with PTSD, improves personality functioning and reduces the presence of PDs over time.'

A First Exploration: Can Eye Movement Desensitization and Reprocessing Improve Cognition in Older Adults With Posttraumatic Stress Disorder?

OBJECTIVES: In older adults, PTSD is associated with decreased verbal learning and executive dysfunction. Therefore, feasibility of EMDR-treatment to improve cognitive performance in older adults with PTSD was examined. Additionally, we investigated pre-treatment correlation with often co-occurring risk factors for cognitive decline (sleep problems, depressive disorder, physical inactivity, childhood traumatic events). DESIGN: Multicenter design with pre-post measurements. SETTING: Psychiatric Dutch hospitals Mondriaan Mental Health Center and Altrecht. PARTICIPANTS: 22 treatment-seeking PTSD-outpatients (60-84 years). INTERVENTION: Weekly one-hour EMDR session during 3, 6, or 9 months. MEASUREMENTS: PTSD was assessed with Clinician-Administered PTSD-scale for DSM-5 (CAPS-5). Verbal learning memory was measured with Auditory Verbal Learning Test (RAVLT), interference with Stroop Colour-Word Test (SCWT) and working memory with Wechsler Adult Intelligence Scale-Digit Span (WAIS-IV-DS). RESULTS: A Linear mixed-model showed significant improvement on RAVLT immediate-recall (F (1, 21) = 15.928, P = .001, 95% CI -6.98-2.20), delayed-recall (F (1, 21) = 7.095, P = .015, 95% CI -2.43-.30), recognition (F (21) = 8.885, P = .007, 95% CI -1.70- -.30), and SCWT (F (1 ,21) = 5.504, P = .029, 95% CI 4.38-72.78) but not on WAIS-IV-DS (F (20) = -1.237, P = .230, 95% CI -3.07-.78). There was no significant influence of therapy duration and CAPS-5 pre-treatment scores. There were small-medium nonsignificant correlations between CAPS-5 and cognitive performance pre-post differences, and between most cognitive measures and sleep problems, depressive disorder, and physical inactivity. CONCLUSIONS: Cognitive functioning on memory and attention possible increased in older adults with PTSD after EMDR treatment. Further research is needed with a larger sample and a control condition to corroborate these findings and to identify the possible mediating role of modifiable risk factors.

The feasibility of eye movement desensitization and reprocessing (EMDR) for older adults with posttraumatic stress disorder (PTSD) and comorbid psychiatric and somatic disorders.

OBJECTIVE: The aim of this study is to investigate the feasibility of eye movement desensitization and reprocessing (EMDR) therapy in older adults with posttraumatic stress disorder (PTSD), and to explicitly include information about presence of the comorbid psychiatric and somatic disorders as well as a history of traumatic events at treatment start. METHOD: A nonrandomized feasibility study in a multicenter design was conducted with 25 older PTSD patients (60-84 years). Treatment consisted of weekly 1-hour EMDR sessions for PTSD during 3, 6, or maximum 9 months. PTSD diagnosis was assessed with Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and PTSD Symptom Scale-Self Report (PSS-SR). We also operationalized PTSD symptom change on CAPS-5 and PSS-SR in loss of diagnosis according to DSM-5 and remission. Remission was defined as loss of diagnosis and no longer having any PTSD symptoms according to minimum severity scores on CAPS-5 (< 12) and PSS-SR (≤ 10). Comorbid psychiatric disorders were assessed pre- (and post-)treatment and somatic disorders and presence of traumatic (childhood) events were assessed pretreatment. RESULTS: Comorbidity rates of depressive (64%), anxiety (56%), other psychiatric (32%), personality (60%), and somatic disorders (96%) were high in our sample of older adults. A linear mixed model approach showed a significant decrease in CAPS-5 scores from pre- to posttreatment for the total sample [F(1, 24) = 150.304, p < .001; Cohen's d = 2.59]. No significant main effects of therapy duration (3, 6, or 9 months), pretreatment intensity of psychopathology (BSI), or their interaction was found (all p > .05). Eighty percent lost their PTSD diagnosis and remission rate was 52% for CAPS-5 and 37.5% for PSS-SR. Remission (not loss of PTSD-diagnosis) showed a negative correlation with the number of experienced traumatic childhood events. CONCLUSION: EMDR therapy showed large treatment effect on PTSD symptom severity in older adults and this was unrelated to therapy duration and presence of comorbid psychiatric and somatic disorders pretreatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Feasibility of EMDR in Older Adults with PTSD to Reduce Frailty and Improve Quality of Life.

OBJECTIVES: Posttraumatic stress disorder (PTSD) after exposure to multiple (childhood) trauma's is strongly associated with accelerated aging and high psychiatric and somatic comorbidity, influencing frailty and Quality of Life (QoL) in older adults. Eye Movement Desensitization therapy (EMDR) addresses psychological and physiologic symptoms stemming from adverse life events and therefore could influence frailty and QoL in older adults. METHODS: We conducted a multi-center feasibility study (two psychiatric hospitals) in Dutch older outpatients (N = 24; ≥60 years) with PTSD. Participants received weekly EMDR-treatment during the course of the trial (3 months to a maximum of 9 months). Frailty (Groninger Frailty Indicator) and QoL (EuroQol 5D-3L), were assessed pre- and posttreatment. RESULTS: A linear mixed-model approach showed significant reduction of frailty (F(1,23) = 9.019, p = .006) and improvement of QoL (F(1,23) = 13.787, p = .001). For both frailty and QoL, there was no significant influence of Clinician-Administered PTSD Scale (CAPS-5) pre-treatment score, therapy duration, and neither an interaction effect of therapy duration x CAPS-5 pre-treatment score. CONCLUSIONS: EMDR with older adults with PTSD showed a significant reduction of frailty and improvement of QoL. Randomized controlled studies are needed to more precisely study the impact of trauma-focused treatment in older adults on frailty and QoL and the implications this might have for lessening disease burden. CLINICAL IMPLICATIONS: Screening for PTSD in older frail adults is important to treat PTSD as a possible way to reduce frailty and improve QoL.

Comparing Intensive Trauma-Focused Treatment Outcome on PTSD Symptom Severity in Older and Younger Adults.

OBJECTIVE: To examine the treatment outcome of an intensive trauma-focused treatment program for post-traumatic stress disorder (PTSD) in older and younger adults. METHODS: A non-randomized outcome study was conducted with 62 consecutively admitted older PTSD patients (60-78 years) and 62 younger PTSD patients (19-58 years), matched on gender and availability of follow-up data. Patients participated in an intensive eight-day trauma-focused treatment program consisting of eye movement desensitization and reprocessing (EMDR), prolonged exposure (PE), physical activity, and group psycho-education. PTSD symptom severity (Clinician-Administered PTSD Scale-5 (CAPS-5)) was assessed, at pre- and post-treatment, and for a subsample (n = 31 older; n = 31 younger patients) at six-month follow-up. RESULTS: A repeated-measures ANCOVA (centered CAPS pre-treatment score as covariate) indicated a significant decrease in CAPS-5-scores from pre- to post-treatment for the total sample (partial η2 = 0.808). The treatment outcome was not significantly different across age groups (partial η2 = 0.002). There were no significant differences in treatment response across age groups for the follow-up subsample (pre- to post-treatment partial η2 < 0.001; post-treatment to follow-up partial η2 = 0.006), and the large decrease in CAPS-5 scores from pre- to post-treatment (partial η2 = 0.76) was maintained at follow-up (partial η2 = 0.003). CONCLUSION: The results suggest that intensive trauma-focused treatment is applicable for older adults with PTSD with a large within-effect size comparable to younger participants. Further research on age-related features is needed to examine whether these results can be replicated in the oldest-old (>80).