Francine Shapiro Library ~ EMDR Bibliography

Francine Shapiro Library - EMDR Bibliography Links

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1. Whisman, M., Bruzzesi, D., Ogren, D., Korn, D., Moore, P., Murphy, J., Hoffman, S., & Rouanzoin, C. (2001, June). "Once upon a trauma in Austin". Skit presented at the annual meeting of the EMDR International Association, Austin, Texas.

Language: English

Format: Other

Abstract:
Cerebella, a gifted facilitators, is teaching a level I training in Austin when fire alarms in the hotel lobby suddenly create fear and panic in our heroine.
Unable to overcome her trauma on her own, she seeks the help of a renknown EMDR therapist, Dr. Bilatera, a senior associate in the Clinical and Research Mental Health Institute of Dewey, Treat Em and Howe.
Narrator - Marcia Whisman, Amy Glia - Donna Bruzzesi, Hipo Campia - David Ogren, Video Cortexa - Debbie Korn, Anterior Cingulata - Peggy Moore, Broca Aria - Jerry Murphy, Prefrona Lobia - Sue Hoffman, Dr. Bilatera - Curt Rouanzoin, and Imprimatur - His excellency, the most cerebral Mens Sana

Keywords: Skit

Accuracy Verified: Yes

2. Oh, D. H., & Park, Y. C. (2010, July). Bilateral eye movement: Changes brain default network functions in EMDR treatment. Poster presented at the 1st EMDR Asia Conference, Bali, Indonesia.

Language: English

Format: Conference

Abstract:
Introduction: The aim of this study was to clarify the effect of bilateral eye movement as one of the important therapeutic components through EEG analysis. We examined differences between pre-bilateral eye movement and post-bilateral eye movement of normal healthy volunteers in scalp recorded EEGs in two different ways. First, we used qEEG to examine differences in specific band frequencies after bilateral eye movement. Secondly, we utilized low-resolution electromagnetic tomography (LORETA) source imaging (Pascual-Marqui et al., 1994) to explore the underlying neural generators of changed EEG activity. Methods:32 college students participated in the study. EEG was recorded continuously during the experiment. All participants experienced 3 blocks: 1) pre-experiment, eye-closed EEG in resting state, 2) stimuli condition (either eye movement or fixation) and 3) post-experiment, eye-closed EEG in resting state. 32-channel, eyes-closed EEG (30 artifactfree s/subject) was analyzed (source localization using FFT approximation and LORETA). Results: We demonstrated different functional connectivity patterns of the precuneus/posterior cingulate cortex (Brodmann area 23, 31) between bilateral eye movement and eye fixation phase. Conclusion: These results provided evidence to support that the bilateral eye movements in EMDR procedure gives rise to the changes of ‘brain default network’, accompanied by the alteration of regional brain electrical activity.

Keywords: Eye Movements Poster

Accuracy Verified: Yes

3. Keller, B., Stevens, L. C., Boyce, K., Lui, C., & Murray, J. (2011). Bilateral eye movements and EEG coherence during positive memories: Implications for PTSD and EMDR. Presentation at the American Psychological Association Conference, Washington, DC.

Language: English

Format: Conference

Abstract:
The purpose of this study was to investigate the role of bilateral eye movements in the processing of long-term emotional memories, especially as it pertains to the treatment method for PTSD known as EMDR. EMDR utilizes methods similar to cognitive therapy and exposure but also employs saccadic eye movements to facilitate the treatment. The saccadic eye movements are theorized by Shapiro and others to decrease emotional valence and vividness of episodic memories allowing for easier reprocessing. There remains some disagreement as to the actual role and importance of the saccadic eye movements as well as to the neurological effects of EMDR. This study used EEG power-spectral analysis and measures of interhemispheric coherence on 30 individuals who underwent one of three conditions while recalling positive episodic memories. The 3 conditions were (1) a solid black dot with no eye movement (control), (2) a low frequency color changing dot with no eye movement, and (3) a bilateral eye movement condition simulating EMDR. After a 5’ eyes-open baseline, participants experienced one of the three conditions while recalling a positive memory for five 1’ episodes. After each episode, each participant had 19-channel EEGs recorded while they stared ahead eyes opened. EEG data were noise artifacted, power spectral analyzed, and statistically analyzed for interhemispheric coherence differences between conditions for clusters of frontal pole (Fp), frontal (F), central (C), parietal (P), and occipital (O) electrodes. ANCOVA analysis of post-treatment coherence values, with baseline values as the covariate, across conditions showed significantly increased Low Beta (12-20Hz) activity in the Frontal region of the brain during the saccadic eye movements condition compared to the low frequency dot condition (p=.012). Also found were significantly increased Low Theta (4-6Hz) coherence values in the Parietal region of the brain in the low frequency dot condition compared to both the eye fixation (p=.017) and saccadic eye movement (p=.022) conditions. Self reports of memory clarity and vividness indicated significantly increased measures across all conditions. LORETA cortical localization analyses revealed Low Beta (12-20Hz) activation during the saccadic eye movements condition occurring primarily in Brodmanns Area 11 (BA11) and Brodmann Area 25 (BA25) and Low Theta (4-6Hz) activation during the low frequency dot condition focused in BA35 and BA36. LORETA neuroimages are presented. Cortical localizations of increased Low Beta interhemispheric coherence in BA11 (VentroMedial Frontal Cortex) and BA25 (Subgenual Anterior Cingulate Cortex) following bilateral eye movements during the recall of positive memories suggest a synchronization of information processing activities in parts of the frontal cortex involved in planning, reasoning, and decision making (11) and in verbal episodic memory retrieval (25). These functions are consistent with the assigned tasks of review of positive episodic memories in this study. Coincident with this pattern of cortical activation was an obtained increase in memory clarity and vividness during episodic memory retrieval. It is possible that the obtained effects on beta activity were an artifact of eye movements; however, the lack of significantly increased signal coherence at the Fp region and the removal of eye movement artifacts prior to data analysis reduce this possibility. These results provide support for an Interhemispheric Coherence Model as an explanation for the positive effects of Eye Movement Desensitization and Reprocessing of retrieved memories. Additionally, these outcomes suggest that it is the saccadic eye movements, not a repetition of a rhythmic stimulus, that elicits the changes in interhemispheric coherence, and possibly in emotional valence and vividness, highlighting the importance of saccadic eye movements in EMDR.

Keywords: Bilateral Stimulation EEG Coherence Eye Movements: Positive Memories Posttraumatic Stress Disorder PTSD

Accuracy Verified: No

4. Browning, C. (1999). Flotar hacia atrás y flotar hacia delante: Técnicas para ligar el pasado, Presente y futuro [Floatback and Float Forward: Techniques for the Tie Past, Present and Future]. Presentation at EMDRIA Latinoamericana.

Language: Spanish

Format: Conference

Abstract:
El protocolo estándar de EMDR requiere enfocar los orígenes de la perturbación, los gatillos del presente y crear un patrón de conductas adecuadas para el futuro (Shapiro). Algunos pacientes, sin embargo pueden tener dificultades para conectar su problema actual con acontecimientos del pasado. Así también, otros pacientes pueden tener dificultades para crear patrones positivos para el futuro, especialmente si ensayar conductas nuevas los pone ansiosos. Para estos problemas las técnicas de "Flotar hacia atrás" y "Flotar hacia delante" desarrolladas por William Zangwill Ph. D., entrenador del Instituto EMDR, son métodos efectivos para ligar el pasado, presente y futuro en un ámbito terapéutico y proveen al terapeuta de instrumentos para abordar eficientemente ambos temas. LA TÉCNICA DE FLOTAR HACIA ATRÁS Abordar recuerdos tempranos asociados con el material perturbador es fundamental para EMDR. Shapiro dice que ayudar al paciente a encontrar un recuerdo temprano "debe ser una de las primeras opciones que debe considerar al terapeuta..." (Shapiro, 1995). La Técnica de Flotar hacia atrás es un camino eficiente y poderoso para llegar a esta meta, permitiendo al terapeuta asistir al paciente a llevar a cabo sus propias asociaciones con acontecimientos del pasado. Su uso es muy apropiado cuando el terapeuta sospecha que una perturbación que el paciente experimenta en el presente, tiene sus raíces en experiencias del pasado; especialmente cuando preguntas como "Cuál es su recuerdo más temprano en relación a lo que se siente ahora? no ha tenido éxito en ayudar al paciente a conectar con eventos del pasado. También cuando un paciente presenta un tema o experiencia recurrente, la Técnica de Flotar hacia Atrás es ideal para ayudar al paciente a identificar un target para el reprocesamiento. Muchos pacientes se ponen en contacto con los problemas actuales con relativa facilidad. Por ejemplo, una paciente que se queja que se siente abandonada cuando su marido se va de viaje de negocios, probablemente pueda recordar sus problemas actuales con facilidad. Entonces el terapeuta puede aplicar la Técnica de Flotar hacia Atrás para ayudarle a la paciente a recordar un acontecimiento del pasado con rapidez y eficiencia. Para usar la Técnica de Flotar hacia Atrás, arme el protocolo con el problema actual, utilizando los pasos que figuran en el Manual de Entrenamiento del Nivel I y del Nivel II (Shapiro, 1994) incluyendo la imagen, la cognición negativa (CN), la cognición positiva (CP), la validación de la cognición (VoC), emociones, Unidad Subjetiva de Perturbación (SUD) y sensación corporal. Sin embargo, no incide todavía el procesamiento (es decir, movimientos oculares u otra estimulación). En vez de eso, diga a su paciente: "Fíjese en la imagen de... y esas palabras (repita la imagen perturbadora del paciente y su cognición negativa), fíjese que emociones le vienen y donde las siente en el cuerpo. Ahora cierre los ojos y deje que su mente flote hacia atrás a un período anterior en su vida, no busque, simplemente deje que su mente flote a una época donde usted pensaba cosas similares... (repita las emociones que dijo el paciente) en ...(repita los lugares del cuerpo donde el paciente sintió las sensaciones). Cuando esté listo abra los ojos y dígame lo primero que le viene a la mente". Utilice esta experiencia más temprana como target, completando todos los items del protocolo: imagen, CN, CP, VoC, emociones, SUD y ubicación de las sensaciones corporales y comience a procesar con movimientos oculares u otro estímulo bilateral. Una vez que se ha procesado este material, vuelva al target original del material actual. Muy a menudo se generaliza el trabajo realizado sobre el material más temprano y ya no hace falta procesar el material actual. Es importante usar términos generales cuando se le dan al paciente las instrucciones de la Técnica de Flotar hacia Atrás, es decir, pedir un recuerdo temprano y no el más temprano. Hay varias razones que avalan esto. Primero, muchas veces es el peor recuerdo y no el primero que funciona como el mejor target para el reprocesamiento,. Además, usar términos generales es una ayuda para los pacientes más compulsivos y perfeccionistas que de otra manera estarían demasiado preocupados en no equivocarse y encontrar exactamente la primera asociación. Finalmente, la flexibilidad que permite la utilización de términos generales más que términos específicos aumenta la posibilidad de éxito del paciente de conectarse con el pasado que es la meta de esta técnica. El rasgo esencial de la Técnica de Flotar hacia Atrás es usar las preguntas del protocolo para conectar los problemas del presente con eventos del pasado. Pasar las preguntas como fueron desarrolladas por Shapiro es un potente método para ayudar a los pacientes a sintonizar con todos los aspectos de su experiencia del problema. El material perturbador se vuelve más vívido y actual para el paciente y posibilita recordar experiencias similares. Se supone, como hipótesis, que al haber desarrollado el protocolo con todas las preguntas sobre el problema actual, estimula la red neuronal de asociaciones y posibilita casi sin esfuerzo el "flotar hacia atrás" a asociaciones tempranas. Además, el vínculo paciente-terapeuta es realzado porque el terapeuta valida la experiencia del paciente (la perturbación actual) al empezar el trabajo desde el punto en el que se encuentra el paciente. Las asociaciones son del paciente, eliminando el tema de la resistencia a cualquier idea o interpretación introducida por el terapeuta. El paciente se da cuenta vivencialmente de la conexión del presente con el pasado usando la Técnica de Flotar hacia Atrás, pudiendo esquivar la evitación y otras defensas. LA TÉCNICA DE FLOTAR HACIA DELANTE Mientras que la Técnica de Flotar hacia Atrás posibilita muy a menudo que los pacientes vean y sientan la conexión entre el problema actual y los eventos pasados, la Técnica de Flotar hacia delante permite que el paciente identifique y reprocese la ansiedad anticipatoria y desarrolle patrones positivos para el futuro. Es un método que puede ser utilizado en cualquier momento del proceso terapéutico para solucionar bloqueos, renuencias y en algunos casos, resistencias o temas de beneficios secundarios o pérdidas. Es especialmente útil para trabajar con el miedo del paciente a hacer EMDR. Para ponerlo en práctica, primero pida al paciente que imagine lo peor que le puede pasar si hace "X" (por ej. probar una nueva conducta, testear una nueva habilidad, empezar una experiencia nueva). ¿Qué es lo peor que le puede pasar si hace EMDR? Que es lo peor que le puede pasar si soluciona este problema? ¿Qué es lo peor que le puede pasar si le pone límites a su jefe respecto a la cantidad de trabajo que espera que usted haga? El paciente puede necesitar ayuda para identificar la peor escena. Algunas sugerencias incluyen el miedo a perder el control de sus emociones, el miedo a perder el control de sus funciones corporales como el control de esfínteres, miedo a tener un ataque de pánico, y no poder manejar su vida emocional entre las sesiones. Una vez que el paciente ha identificado el incidente, pregunte por la peor parte de esa escena y utilícelo como el target de EMDR, armando el protocolo con las preguntas estándar, pero con una leve modificación: pregunte por la imagen que representa la peor parte del peor incidente, por ej. "Cuando usted ve una imagen de si mismo/a haciendo......, que es lo peor que puede pasar?" Después siga con el resto de las preguntas estándar, es decir, CN, CP, VoC, emociones, SUD, y ubicación de la sensación corporal. Estimule el procesamiento del paciente con movimientos oculares u otro estímulo bilateral. Si el desarrollo de la peor escena del paciente le provoca un miedo racional, puede que se tengan que tomar medidas prácticas para solucionar estas preocupaciones. Por ejemplo, usando la técnica de flotar hacia delante con un chico de 13 años que estaba en un hogar adoptivo transitorio, la peor escena evocada por él fue: "Me van a devolver al Hogar si esta adopción no resulta". Durante el procesamiento, el SUD se redujo de 8 a 3 con bastante rapidez pero de ahí no bajaba. El paciente comentó que no bajaba porque esta "peor escena" podría sucederle realmente y le había sucedido en el pasado. Paramos los movimientos oculares, charlamos un rato y elaboramos un plan para: a) una sesión con sus padres adoptivos para hablar sobre la permanencia de la adopción y b) una llamada en conferencia a su asesor legal para clarificar sus derechos y opciones. Volviendo al target después de esto, le fue posible reducir el SUD a 1 con unos pocos sets de movimientos oculares. Al utilizar la Técnica de Flotar hacia delante para reprocesar la peor escena, el paciente tiene una oportunidad para resolver la ansiedad anticipatoria. Durante la instalación de la cognición positiva, el paciente está creando patrones positivos para acciones en el futuro. Una mujer cuyo hermano fue verbalmente abusivo con ella en la infancia y en la actualidad la intimidaba, armó una "peor escena" con: "Va a ser igualmente abusivo cuando lo vea la próxima vez". La paciente había hecho mucho EMDR, reprocesando incidentes de la infancia relacionados con el abuso verbal del hermano. Sin embargo, sin un referente positivo vivencial, seguía ansiosa cada vez que interactuaba con él. Pidiéndole que "flote hacia delante" y usando EMDR sobre una de las peores escenas, alivió su ansiedad respecto a una fiesta familiar que tenía pendiente. Instalando una CP de "Ahora estoy más fuerte" le permitió crear una imagen de si misma manejando a su hermano con humor y sintiéndose segura. A aplicar las Técnicas de Flotar hacia Atrás y hacia Delante y ocuparse así del pasado, presente y futuro, el terapeuta de EMDR puede sanar mejor a su paciente. Es más, las Técnicas de Flotar hacia Atrás y hacia Delante están basadas en EMDR. Las dos incorporan las preguntas del protocolo standard y le dan al terapeuta y al paciente la oportunidad de manejarse más fluidamente con dicho protocolo.

EMDR standard protocol requires a focus of the origins of the disturbance, the triggers of this and create a pattern of behaviors appropriate to the future (Shapiro). Some patients, however, may have difficulty connecting the current problem with past events. Also, other patients may have difficulty creating positive patterns for the future, especially if you try new behaviors makes them anxious. For these problems the techniques of "float back" and "Float forward" developed by William Zangwill Ph.D., EMDR Institute trainer, are effective methods to link the past, present and future in a therapeutic area and provide the therapist tools to effectively address both issues. THE ART OF FLOATING BACK Addressing early memories associated with foreign material is essential to EMDR. Shapiro said that helping the patient to find early memory "must be one of the first options to consider when therapist ..." (Shapiro, 1995). Floating Technique back is a powerful and efficient way to reach this goal, allowing the therapist to assist the patient to carry out their own associations with past events. Its use is most appropriate when the clinician suspects that a disturbance that the patient is experiencing at present, is rooted in past experiences, especially when questions like "What is your earliest memory in relation to what you feel now? Not been successful in helping patients to connect with past events. Also when a patient has a recurrent theme or experience, the Backward Floating Technique is ideal for helping the patient to identify a target for reprocessing. Many patients come into contact with the current problems with relative ease. For example, a patient who complains that she feels abandoned when her husband goes on a business trip, you can probably recall their current problems with ease. Then the therapist can apply the technique Float Backwards to help the patient to remember a past event quickly and efficiently. To use the technique to back float, arm the protocol to the current problem, using the steps listed in the Training Manual Level I and Level II (Shapiro, 1994) including the image, negative cognition (NC) positive cognition (PC), validation of cognition (VoC), emotions, Subjective Unit of Disturbance (SUD) and bodily sensation. However, it still affects the processing (ie, eye movements or other stimulation). Instead, tell your patient: "Look at the picture ... and those words (repetition of the disturbing image of the patient and negative cognition), note that emotions come from and where you sit on the body. Now close eyes and let your mind float back to an earlier period in your life, look no further, just let your mind float to a time when you thought things like ... (repeat the emotions that said the patient) .. . (repeat parts of the body where the patient felt the sensation). When you are ready open your eyes and tell me the first thing that comes to mind. " Use this early experience as a target, completing all protocol items: image, CN, CP, VoC, emotions, SUD and location of bodily sensations and begin processing with eye movements or other bilateral stimulation. Once this material has been processed, return to the original target of the current material. Very often we generalize the work done on the earlier material and no longer have to render the current material. It is important to use general terms when the patient is given instructions Technique Float Backwards, ie a memory request early and not earlier. There are several reasons that support this. First, it is often the worst memory and not the first that works as the best target for reprocessing. In addition, using general terms is an aid for compulsive and perfectionistic patients who otherwise would be too concerned with avoiding failure and find exactly the first association. Finally, the flexibility that allows the use of general rather than specific terms increases the likelihood of success of the patient to connect with the past that is the goal of this technique. The essential feature of the technique is to use Float Backwards questions of protocol to connect the problems of the present with past events. Skip the questions and were developed by Shapiro is a powerful method to help patients to tune into all aspects of their experience of the problem. The foreign material becomes more vivid and present to the patient and possible recall similar experiences. It is assumed, arguendo, that having developed the protocol with all the questions about the current problem, the neural network encourages and facilitates partnerships almost effortlessly "float back" early associations. In addition, the patient-therapist relationship is enhanced because the therapist validates the patient's experience (current disruption) to start work from the point where the patient is. Partnerships are the patient, eliminating the issue of resistance to any idea or interpretation introduced by the therapist. The patient realizes experientially connecting the present with the past by using the technique Float Backwards, can avoid the avoidance and other defenses. THE ART OF FLOATING FORWARD While technology enables Float Backwards often patients to see and feel the connection between the current problem and past events, the forward float technique allows the patient to identify and reprocess anticipatory anxiety and develop positive patterns the future. It is a method that can be used at any time of the therapeutic process to troubleshoot crashes, reluctance and in some cases, resistance or topics of ancillary benefits or losses. It is especially useful for working with the patient's fear to do EMDR. To put this into practice, first ask the patient to imagine the worst that can happen if you "X" (eg. Try a new behavior, test a new skill, start a new experience.) What's the worst that can happen if you EMDR? That's the worst that can happen if you solve this problem? What's the worst that can happen if you put your head limits on the amount of work expected to do? The patient may need help to identify the worst scene. Some suggestions include fear of losing control of his emotions, fear of losing control of their bodily functions such as bowel and bladder control, fear of having a panic attack and can not manage their emotional life between sessions. Once the patient has identified the incident, ask for the worst part of that scene and use it as the target of EMDR, setting up the protocol with the standard questions, but with a slight modification: ask for the image that represents the worst of worst incident, eg. "When you see a picture of him / herself by ......, it's the worst that can happen?" Then follow with the rest of the standard questions, ie, CN, CP, VoC, emotions, SUD, and location of bodily sensation. Stimulate the processing of patients with eye movements or other bilateral stimulation. If the development of the patient's worst scene provokes a rational fear, you may have to take practical steps to address these concerns. For example, using the technique of floating forward with a boy of 13 who was in a temporary foster home, the worst scene evoked for him was: "I will return home if this adoption is not." During processing, the LDS was reduced from 8 to 3 fairly quickly but it does not down. The patient said he did not go down because the "worst scene" could really happen and had happened in the past. Eye movements stopped, we chatted a while and developed a plan for: a) a meeting with her adoptive parents to discuss the permanence of the adoption and b) a conference call to his legal adviser to clarify your rights and options. Returning to the target after that, it was possible to reduce the LDS-1 with a few sets of eye movements. Using Floating Technique forward to reprocess the worst scenario, the patient has an opportunity to resolve the anticipatory anxiety. During the installation of the positive cognition, the patient is creating positive patterns for future action. A woman whose brother was verbally abusive to her children and now intimidated, put together a "worst stage" with: "It will be equally unfair when I see him next time." The patient had done much EMDR reprocessing childhood incidents related to verbal abuse of his brother. However, without a positive reference experiential, still anxious every time I interacted with him. Asking him to "float forward" and using EMDR on one of the worst scenes, relieved her anxiety about a family party that was pending. Installing a CP of "I'm stronger now allowed him to create an image of herself driving her brother with humor and feeling safe. To apply the techniques to float back and forth and deal well past, present and future, the EMDR therapist can heal your patient better. Moreover, techniques to float back and forth are based on EMDR. Both incorporate the standard protocol questions and give the therapist and the patient the opportunity to be managed more smoothly with this protocol.

Keywords: Floatback Technique Float Foward Technique

Accuracy Verified: Yes

5. Fay, D., Corrigan, F. Fisher, J., Galloway, J., & Mcafee, F. (2010, April). An fMRI study of the integration of “Becoming safely embodied” and EMDR techniques for the de-activation of fear motor neurocircuitry. Symposium presented at the 2nd Bi-Annual International European Society for Trauma and Dissociation, Belfast, Northern Ireland.

Language: English

Format: Conference

Abstract:
An fMRI Study of the Integration of “Becoming Safely Embodied” and EMDR Techniques for the De-Activation of Fear Motor Neurocircuitry Frank Corrigan, Consulting Psychiatist, Argyll & Bute Hospital, Lochgilphead, Argyll This panel discussion explores brain imaging results using BSE skills activating left anterior insula intensified with alternating bilateral stimulation (ABS) from Eye Movement Desensitisation and Reprocessing (Shapiro 1992). It suggests positive feelings associated with brain activations deactivate areas involved in motor responses to threat.

Keywords: Fear Motor Neurocircuitry fMRI Study

Accuracy Verified: Yes

6. Bergmann, U. (2000, September). Further thoughts on the neurobiology of EMDR: The role of the cerebellum in accelerated information processing. Traumatology, 6(3), 175-200. doi:10.1177/153476560000600303 .

Language: English

Format: Journal

Abstract:
This discussion explores, briefly, the position that the repetitive redirecting of attention in EMDR is capable of turning on the brain's REM sleep system, leading to the activation of specific areas of the the anterior cortex of the cingulate gyrus, facilitating its function as a filter, thereby facilitating the integration of traumatic memory into general semantic networks. This integration is seen to lead to the subsequent reduction in both the strength of hippocampally mediated episodic memories of the traumatic event as well as the amygdaloid mediated negative affect of PTSD. The possibility is suggested that another underlying mechanisms of EMDR stimulation is the activation of the lateral cerebellum. The contribution of the cerebellum to cognitive and language functions is explored. The activation of the dentate nuclei in the lateral neocerebellum is shown to facilitate activation of the ventrolateral and central lateral thalamic nuclei. The activation of the ventrolateral nucleus is shown to lead to the activation of the left dorsolateral prefrontal cortex; further facilitating the integration of traumatic memory into general semantic and other neocortical networks. [Author Abstract]

Keywords: Cognitive Processes Neurobiology Posttraumatic Stress Disorder PTSD Sleep Behavior Stressors Survivors

Accuracy Verified: Yes

7. Pagani, M., Nardo, D., Höberg, G., & Larson, S. (2009, November). Gray matter changes in limbic cortex in PTSD are associated with trauma load and EMDR outcome. Presentation at the 25th annual meeting of the International Society for Traumatic Stress Studies, Atlanta, GA.

Language: English

Format: Conference

Abstract:
Psychophysiological Research
There is converging evidence of gray matter (GM) structural alterations in different limbic structures in Post-Traumatic Stress Disorder (PTSD) patients. The aim of this study was to evaluate GM reduction in PTSD in relation to trauma load, and to assess the volumetric differences between responders (R) and non-responders (NR) to EMDR therapy. Magnetic Resonance Imaging scans of 21 subjects exposed to occupational trauma, who developed PTSD (S), and of 22 who did not (NS), were compared by means of an optimized Voxel-Based Morphometry (VBM) analysis as implemented in SPM. Within S, further comparisons were made between 10 R and 5 NR. A regression analysis between GM density and the Traumatic Antecedents Questionnaire (TAQ) was also performed on all 43 subjects. Results showed a highly significant GM volume reduction in S as compared to NS, bilaterally in posterior cingulate and in the left hemisphere in precuneus, lingual and parahippocampal gyri. Moreover, NR showed a highly significant GM volume reduction as compared to R in bilateral posterior cingulate, as well as insula, parahippocampal gyrus and amygdala in the right hemisphere. Regression analysis showed that GM volume reductions positively correlated with trauma load in bilateral anterior and posterior cingulate and right parahippocampal gyrus. In conclusion, GM volume reductions in posterior cingulate and parahippocampal cortex were associated with PTSD diagnosis, trauma load, and EMDR treatment outcome.

Keywords: Limbic Cortex Posttraumatic Stress Disorder PTSD Outcome Trauma Load

Accuracy Verified: Yes

8. Nardo, D., Hogberg, G., Looi, J. C., Larsson, S., Hallstrom, T., & Pagani, M. (2010, May). Gray matter density in limbic and paralimbic cortices is associated with trauma load and EMDR outcome in PTSD patients. Journal of Psychiatric Research, 44(7), 477-485. doi:10.1016/j.jpsychires.2009.10.014.

Language: English

Format: Journal

Abstract:
There is converging evidence of gray matter (GM) structural alterations in different limbic structures in Post-Traumatic Stress Disorder (PTSD) patients. The aim of this study was to evaluate GM density in PTSD in relation to trauma load, and to assess the GM differences between responders (R) and non-responders (NR) to EMDR therapy. Magnetic Resonance Imaging (MRI) scans of 21 subjects exposed to occupational trauma, who developed PTSD (S), and of 22 who did not (NS), were compared by means of an optimized Voxel-Based Morphometry (VBM) analysis as implemented in SPM. Within S, further comparisons were made between 10 R and 5 NR. A regression analysis between GM density and the Traumatic Antecedents Questionnaire (TAQ) was also performed on all 43 subjects. Results showed a significantly lower GM density in S as compared to NS in the left posterior cingulate and the left posterior parahippocampal gyrus. Moreover, NR showed a significantly lower GM density as compared to R in bilateral posterior cingulate, as well as anterior insula, anterior parahippocampal gyrus and amygdala in the right hemisphere. Regression analysis showed that GM density negatively correlated with trauma load in bilateral posterior cingulate, left anterior insula, and right anterior parahippocampal gyrus. In conclusion, a GM lower density in limbic and paralimbic cortices were found to be associated with PTSD diagnosis, trauma load, and EMDR treatment outcome, suggesting a view of PTSD characterized by memory and dissociative disturbances.[Pubmed]

Keywords: Limbic Cortex Posterior Cingulate Posttraumatic Stress PTSD

Accuracy Verified: Yes

9. Pagani, M. (2010, June). Gray matter density is associated with EMDR outcome in PTSD patients. In Research. Symposium conducted at the annual meeting of the EMDR Europe Association, Hamburg, Germany.

Language: English

Format: Conference

Abstract:
There is converging evidence of gray matter (GM) structural alterations in different limbic structures in Post-Traumatic Stress Disorder patients. Eye Movement Desensitization Reprocessing (EMDR) is currently used to treat PTSD but its neurobiological implications are still unknown. The aim of this study was to evaluate GM density in PTSD relation to trauma load, and to assess the GM differences between responders (R) and non-responders (NR) to EMDR therapy. Structured clinical interviews for DSM-IV Axis I Disorders were carried out before and after EMDR treatment. Those who no longer fulfilled the DSM-IV criteria for PTSD were classified as R and those who still met the diagnostic criteria of PTSD after treatment were classified as NR. Two scales 0f self-related Trauma Antecedent Questionnaire (‘trauma and neglect’ TAQ-, and ‘resilience factors’ TAQ+), were administered to assess lifelong trauma load and resilience. Magnetic Resonance Imaging (MRI) scans 10 R and of 5 NR were compared before therapy by means of an optimized Voxel-Based Morphometry (VBM) analysis as implemented in SPM. For group analysis, a threshold of p<0.05 corrected for multiple comparisons at cluster level and an uncorrected threshold of p <0.001 at voxel-level were used. NR subjects showed no significant differences nor in TAQ- scores neither in TAQ+ as compared to R(t=0.140, p+0.891). The contract R>NR exhibited a significant GM lower density in NR as compared to R in three different cluster: the first bilaterally located over posterior cingulate (Brodmann Areas, Bas 23 and 31); the second centered over the left precentral (BA 4), middle and medial frontal gyri (BA 6); the third including anterior insula (BA 13), and the complex anterior parahippocampal gyrus/amygdala, over the right hemisphere. To our knowledge, this is the first study investigating GM alterations with a VBM approach in a sample of PTSD patients respond and non responding to EMDR therapy. Posterior cingulate, parahippocampal and insular lower GM concentrations have been found to relate to responsiveness to EMDR therapy suggesting a high vulnerability of these structures to the effects of stress and trauma. These regions are well known to be implicated in processes such as: integration, encoding and retrieval of autobiographical and episodic memories; emotional processing, interoceptive awareness and sefl-referential conscious experience. Thus, our study supports lower GM densities in limbic and paralimbic cortices as a potential structural basis for memory and dissociative dysfunction in PTSD. Using such methodological approach can contribute to better understand the neurostructural basis for traumatic responses and their treatment. The goals for the audience are: 1. To understand the methodological research principles; 2. To be updated on neurobiological research in EMDR; 3. to be informed on the neural basis of EMDR.

Keywords: Gray Matter Posttraumatic Stress Disorder PTSD Research Symposium

Accuracy Verified: Yes

10. Bergmann, U. (1999, November). How does EMDR work? An exploration of possible neurobiological mechanisms. Presentation at the annual meeting of the International Society for the Study of Dissociation Fall Conference, Miami, FL.

Language: English

Format: Conference

Abstract: This discussion explores, briefly, the position that the repetitive redirecting of attention in EMDR is capable of turning on the brain's REM sleep system, leading to the activation of specific areas of the the anterior cortex of the cingulate gyrus, facilitating its function as a filter, thereby facilitating the integration of traumatic memory into general semantic networks. This integration is seen to lead to the subsequent reduction in both the strength of hippocampally mediated episodic memories of the traumatic event as well as the amygdaloid mediated negative affect of PTSD. The possibility is suggested that another underlying mechanisms of EMDR stimulation is the activation of the lateral cerebellum. The contribution of the cerebellum to cognitive and language functions is explored. The activation of the dentate nuclei in the lateral neocerebellum is shown to facilitate activation of the ventrolateral and central lateral thalamic nuclei. The activation of the ventrolateral nucleus is shown to lead to the activation of the left dorsolateral prefrontal cortex; further facilitating the integration of traumatic memory into general semantic and other neocortical networks

Keywords: Cognitive Processes Neurobiology Posttraumatic Stress Disorder PTSD Sleep Behavior Stressors Survivors

Accuracy Verified: Yes

11. Kaye, B. (2006). Interactive cognitive motor interweaves during EMDR. Cary, NC: Allied Psychological Services.

Language: English

Format: Other

Abstract:
A new interweave technique is described for when patients are slow to desensitize or when they are emotionally overwhelmed during EMDR treatment. The interweave is comprised of two parallel components: a finger-touching go/no-go tracking task as well as a semantic priming task. The theoretical rationale for the finger-touching task is explained relative to neuroimaging studies of the anterior cingulate cortex and other areas. The rationale for the semantic priming task is explained relative to research about dopaminergic activation projecting from the ventral tegmentum as well as novelty generated orienting responses. A two-stage model is proposed for constructing effective EMDR stimulation techniques.

Keywords: Cognitive Interweave

Accuracy Verified: Yes

12. Gómez, A. M. (2011). Mecanismos neurobiologicos del trastorno por estrés postraumático y la Terapia EMDR[Neurobiological mechanisms of PTSD and EMDR therapy]. Revista Iberoamericana de Psicotraumatología y Disociación, 1(1). Retrieved from http://revibapst.com/ARTICULO%20ALAIDE%202011.pdf on 12/9/2012.

Language: Spanish

Format: Other

Abstract:
El trastorno por estrés postraumático (TEPT) se caracteriza por temor, desesperanza u horror intensos en personas que han sido expuestas a acontecimientos traumáticos. La terapia de Desensibilización y Reprocesamiento por Movimiento Ocular (EMDR), es reconocida como un tratamiento efectivo y eficiente para tratar el TEPT. Diversos estudios han demostrado alteraciones anatómico-fisiológicas y neurobiológicas en los pacientes que presentan este trastorno, ya que intervienen estructuras como la amígdala, tálamo y diferentes áreas de la corteza prefrontal. Debido a lo anterior, se han realizado estudios sobre los mecanismos neurales y la implicación neurobiológica de la terapia EMDR en el TEPT, así como alteraciones en la función cognitiva dentro de la sintomatología clínica que se observa en los pacientes con este trastorno.

Posttraumatic stress disorder (PTSD) is characterized by fear, helplessness or horror severe in people who have been exposed to traumatic events. Eye Movement Desensitization and Reprocessing (EMDR) is recognized as an effective and efficient in treating PTSD. Several studies have shown anatomical and physiological alterations in neurobiological patients with this disorder, and involved structures like the amygdala, thalamus and different areas of the prefrontal cortex. Because of this, there have been studies on the neural mechanisms and neurobiological implications of EMDR in PTSD, as well as alterations in cognitive function within the clinical symptoms observed in patients with this disorder.

Keywords: Cognitive Function Neurobiology Posttraumatic Stress Disorder PTSD

Accuracy Verified: Yes

13. Corrigan, F. (2002). Mindfullness, dissociation, EMDR and the anterior cingulate cortex: A hypothesis. Contemporary Hypnosis, 19(1), 8-17. doi:10.1002/ch.235.

Language: English

Format: Journal

Abstract:
Hypotheses on the neurobiology of a mindfulness-dissociation continuum are presented. Crucial to the hypotheses are the observations of a reciprocal interaction between the cognitive and affective subdivisions of the anterior cingulate cortex and the unilateral activation of right anterior cingulate in hypnotic dissociation and in post-traumatic syndromes. It is proposed that the unilateral activation can cause a loss of the reciprocal relationship between the subdivisions and that in the case of peri-traumatic dissociation the subsequent syndrome responds to eye movement desensitization and reprocessing (EMDR) through restoration of the bilateral activation and reinstatement of the reciprocal relationship between the subdivisions. Bilateral activation of the cognitive subdivisions is proposed to underlie the attentional state of concentration mindfulness in which affect is well regulated. Copyright © 2002 British Society of Experimental and Clinical Hypnosis

Keywords: Anterior Cingulate Cortex Bilateral Activation Dissociation Emotional Trauma Gyrus Cinguli Hypnosis Hypnotic Dissociation Mindfulness Posttraumatic Syndromes Reciprocal Interaction

Accuracy Verified: Yes

14. Pagani, M., Flumeri, F., Salmaso, D., Nardo, D., Sanchez-Crespo, A., Danielsson, A. M., Brolin, F., Jacobsson, H., Larsson, S. A., & Hogberg, G. (2008, October). Neurobiological changes in post traumatic stress disorder following treatment with eye movement desensitisation reprocessing. Presentation at the European Association of Nuclear Medicine Congress, Munich, Germany, European Journal of Nuclear Medical and Molecular Imaging, 35(Supp 2).

Language: English

Format: Conference

Abstract:
Background: Only few studies have reported functional or structural modifications in Post Traumatic Stress Disorder (PTSD) patients following pharmacological treatment or psychotherapy. Eye movement desensitization and reprocessing (EMDR) is a novel eclectic psychotherapy utilising, among other techniques, relaxation and safe place exercises, cognitive restructuring, future projections, and imaginal exposure of the trauma combined with sensory stimulation. The aim of the study was to analyse the differences in regional cerebral blood flow (rCBF) distribution and in brain volumetry before and after EMDR therapy. Subjects and Methods: Fifteen subjects with chronic PTSD following occupational health hazards were treated with five sessions of EMDR. They were assessed with psychometric scales and diagnostic interviews before and directly after treatment. SPECT, during administration of an individualised trauma script, was performed using 99mTc-HMPAO. After EMDR, the subjects were subdivided into responders (R, n=10) and non-responders (NS, n=5), based on the absence or presence, respectively, of full PTSD diagnosis. SPECT and volumetric data (MRI) analyses were carried out by Statistical Parametric Mapping (SPM2). SPECT and MRI data were covaried by age and by time elapsed from trauma to SPECT. SPECT data were further covaried by the amount of grey matter normalised by the total intracranial volume. Results: Immediate significant post-treatment changes towards normality in all scales measuring psychological status were found in responders. As compared to NR, R showed a significantly decreased tracer uptake in parieto-occipital (Brodmann Area, BA, 37, fusiform gyrus) and in primary visual cortex (BA17) and in the hippocampus (p<0.001). The opposite comparison highlighted an increased tracer uptake in left frontal cortex (BA 44; p<0.05). Structural grey matter modifications were found in visual, posterior cingulate and parieto-temporal cortex, paralleling the functional changes. Conclusion: The positive EMDR outcome corresponded to increased 99mTc-HMPAO uptake in the left dorsolateral frontal cortex, processing attention and self confidence and exerting an inhibitory effect on the amygdala whose firing is supposed to be responsible for PTSD. After successful treatment significant decreases were found in primary visual cortex, processing images of traumatic memories and flashbacks; in fusiform gyrus, processing the memories of faces, bodies and words and in the hippocampi, involved in episodic and autobiographical memories. Volumetric changes paralleled the ones in tracer uptake in all regions Taken as a whole these findings suggest that the positive clinical outcome following EMDR therapy causes functional and structural neurobiological changes towards normality.

Keywords: Brain Volumetry Neurobiological Changes Posttraumtic Stress Disorder PTSD rCBF Regional Cerebral Blood Flow

Accuracy Verified: Yes

15. Pagani, M., DiLorenzo, G., Verardo, A. R., Nicolais, G., Monaco, L., Lauretti, G., Russo, R., Niolu, C., Ammaniti, M. Fernandex, I., & Siracusano, A. (2012). Neurobiological correlates of EMDR monitoring - an EEG study. PLoS ONE, 7(9), 1-12. doi:10.1371/journal.pone.0045753.

Language: English

Format: Journal

Abstract:
Background: Eye Movement Desensitization and Reprocessing (EMDR) is a recognized first-line treatment for psychological trauma. However its neurobiological bases have yet to be fully disclosed. Methods: Electroencephalography (EEG) was used to fully monitor neuronal activation throughout EMDR sessions including the autobiographical script. Ten patients with major psychological trauma were investigated during their first EMDR session (T0) and during the last one performed after processing the index trauma (T1). Neuropsychological tests were administered at the same time. Comparisons were performed between EEGs of patients at T0 and T1 and between EEGs of patients and 10 controls who underwent the same EMDR procedure at T0. Connectivity analyses were carried out by lagged phase synchronization. RESULTS: During bilateral ocular stimulation (BS) of EMDR sessions EEG showed a significantly higher activity on the orbito-frontal, prefrontal and anterior cingulate cortex in patients at T0 shifting towards left temporo-occipital regions at T1. A similar trend was found for autobiographical script with a higher firing in fronto-temporal limbic regions at T0 moving to right temporo-occipital cortex at T1. The comparisons between patients and controls confirmed the maximal activation in the limbic cortex of patients occurring before trauma processing. Connectivity analysis showed decreased pair-wise interactions between prefrontal and cingulate cortex during BS in patients as compared to controls and between fusiform gyrus and visual cortex during script listening in patients at T1 as compared to T0. These changes correlated significantly with those occurring in neuropsychological tests. Conclusion: The ground-breaking methodology enabled our study to image for the first time the specific activations associated with the therapeutic actions typical of EMDR protocol. The findings suggest that traumatic events are processed at cognitive level following successful EMDR therapy, thus supporting the evidence of distinct neurobiological patterns of brain activations during BS associated with a significant relief from negative emotional experiences.

Keywords: EEG Study Neurobiological Correlates

Accuracy Verified: Yes

16. Pagani, M., Nardo, D., Flumeri, F., Salmaso, D., Looi, J., Sanchez-Crespo, A., Larsson, S.A., Sundin, Ö., Hogberg, G., & Bejerot, S. (2009, January). P03-58 volumetric changes in PTSD and in a subgroup of PTSD patients not responding to EMDR psychotherapy. European Psychiatry, 24(Supplement 1), S1057-S1057. doi:10.1016/S0924-9338(09)71290-8.

Language: English

Format: Journal

Abstract:
Background: Several studies have reported limbic structures volume decrease in Post-Traumatic Stress Disorder (PTSD). However, in PTSD the effect of therapy on brain structures has seldom been investigated. The aim of the study was to evaluate the grey matter (GM) loss in occupational related PTSD and to assess the volumetric differences between patients responding (R) and non-responding (NR) to psychotherapy. Methods: Pre-EMDR MRI data of 21 train drives who did develop PTSD (S) and 22 who did not develop PTSD (NS) after person-under-the-train accidents were compared. Within S further comparisons were made between 10 R to Eye Movement Desensitisation Reprocessing (EMDR) therapy and 5 NR. Data were analysed by optimised voxel-based morphometry as implemented in Statistical Parametric Mapping. Results: As compared to NS, S showed a significant GM volume reduction in precuneus, lingual gyrus, posterior cingulate and parahippocampal cortex. The R>NR comparison highlighted a significant GM reduction in NR in bilateral posterior cingulate, left middle frontal cortex and right parahippocampal, insular and temporal cortices. Conclusions: Comparing two large groups of subjects significant GM volumetric reductions were found in PTSD in posterior limbic structures. NR showed, as compared to R, volume reduction in cortical structures including posterior cingulate and parahippocampal cortex. These latter two structures seem to be the hallmark for both PTSD diagnosis and therapy outcome prediction.

Keywords: Posttraumatic Stress Disorder PTSD

Accuracy Verified: Yes

17. Park, S.-C. (2011, February). Plasma levels of neurotrophic factors predict responses to eye movement desensitization and reprocessing in complex posttraumatic stress disorder. Hanyang University, Graduate School, Seoul, Korea.

Language: English

Format: Dissertation/Thesis

Abstract:
Complex PTSD is a proposed diagnosis that describes psychological sequelae of survivors with prolonged, repeated, and interpersonal trauma, including childhood physical abuse, incest, and other forms of family violence (Herman, 1992). The diagnostic criteria for complex PTSD are composed of the functional alterations in six areas: (1) regulation of affect and impulses; (2) attention or consciousness; (3) self-perception; (4) relations with others; (5) somatization; and (6) system of meaning (Pelcovitz et al., 1997). Recently, a morphometric study showed that patients with childhood abuse-related complex PTSD had more extensive involvements of neural substrates (reduced anterior cingulate and orbitofrontal volumes) than those with classical PTSD (Thomaes et al., 2009). Changes in the neural substrates of patients with complex PTSD may reflect the relationship, established in critical developmental phases, between traumatic experiences and neurobiological factors. Eye movement desensitization and reprocessing (EMDR) is an integrative and comprehensive psychotherapy that contains various effective elements of psychodynamic, cognitive-behavioral, interpersonal, and body-centered therapies (Shapiro and Maxfield, 2002). It was originally developed to resolve symptoms of psychic trauma, and has been shown to be highly effective in reducing the symptoms of posttraumatic stress disorder (PTSD) (Bradely et al., 2005; van der Kolk et al., 2007). It has been also proposed as a rapid and effective application for treating the core symptoms of complex PTSD (Korn and Leeds, 2002; Kim and Choi, 2004; Kim, 2003). Thus, the investigation of the effects of treatment of complex PTSD by EMDR may reveal aspects of neurobehavioral plasticity dependent on neurotrophic factors.

Keywords: Complex Posttraumatic Stress Disorder Complex PTSD C-PTSD Neurotrophic Factors Plasma Levels

Accuracy Verified: Yes

18. Hopchet, M., & Detournay, F. (2012, June). Preliminary study on the effects of simultaneous application of two types of stimulations (eye movements and tactile stimuli) on psychophysiological autoreported symptoms in the treatment of negative autobiographical memories [Estudios preliminares sobre los efectos de la aplicación simultanea de dos tipos de estimulación (movimientos oculares y táctiles) en sintomatología psicofisiológica autoinformada en el tratamiento de recuerdos autobiográficos negativos]. Presentation at the annual meeting of the EMDR Europe Association, Madrid, Spain.

Language: English

Format: Conference

Abstract:
Negative autobiographical memories are effectively treated using EMDR with patients making eye movements during the recall of negative autobiographical memories. While several studies have measured the effects of different types of stimulations, we are not aware of any research assessing the combined effects of two different stimulations applied simultaneously during the recall of the event. For this preliminary study involving 15 adult patients from both sexes, 4 EMDR counselor therapists measure 17 symptoms of the list proposed by Weimann (1968)). Each patient is evaluated before, during and at the end of each session. We control the effect of the sequence of one versus two types of stimulations by assigning each patient to both conditions but in a random way: (a) first target first session with one type of stimulation following with a second target first session, including two types of stimulation; (b) the inversed sequence. We compare the mean level intensity of each symptom (within factor) between one type vs. two types of stimulations (between factor) using the Anova and the t- Student tests. We hypothesize that an attenuation of intensity of the stress symptoms occurs when the patient is treated simultaneously with two types of bilateral stimulation (eye movements and tactile stimuli), compared to one (eye movements). The paper presents preliminary data, as well as a discussion of the results in the light of the theory of the working memory (Andrade et al.1997) and the reassurance reflex model of EMDR proposed by MacCulloch and Feldman (1996).

Los recuerdos autobiográficos negativos son tratados con efectividad usando el EMDR con pacientes a través del movimiento ocular de ojos durante el acceso al recuerdo negativo autobiográfico. Mientras muchos estudios han medido dos tipos diferentes de estimulación, no estamos al corriente de ninguna otra investigación que informe de los efectos combinados de los dos tipos de estimulación aplicada simultáneamente durante este acceso al recuerdo del evento. En este estudio preliminar contamos con los datos de 15 pacientes adultos de ambos sexos, 4 consultores EMDR midieron 17 síntomas de la lista propuesta por Weimann (1968). Cada paciente era evaluado antes, durante, y al final de cada sesión. Controlamos los efectos de una secuencia en función de los 2 tipos de estimulación, asignando a cada paciente ambas condiciones pero de manera aleatorizada: (a) Primer recuerdo Diana, primera sesión con un tipo de estimulación seguido de un Segundo recuerdo de la primera sesión incluyendo dos tipos de estimulación; (b) invertimos la secuencia anterior. Comparamos la media del nivel de intensidad de cada síntoma (dentro del factor) entre un tipo y dos tipos de estimulación (entre factores) usando cálculos estadísticos de Anoia y una t-‐Student para los resultados. Nuestra hipótesis es que ocurrirá una atenuación de los síntomas de estrés cuando el paciente es tratado simultáneamente con dos tipos de estimulación bilateral (movimientos oculares y estímulos táctiles), comparados con la de un solo tipo (Movimientos oculares). Este artículo presenta el análisis preliminar de los datos, así como la discusión de los resultados en línea con la teoría de la memoria de trabajo (Andrade y cols 1997) y la reafirmación del modelo refractario del EMDR propuesto por MacCulloch y Feldman (1996).

Keywords: Autobiographical Memories Bilateral Stimulation Eye Movements Tactile Stimulation

Accuracy Verified: Yes

19. van der Kolk, B. A., Burbridge, J. A., & Suzuki, J. (1997, June). The psychobiology of traumatic memory: Clinical implications of neuro imaging studies. Annals of the New York Academy of Sciences, 821, 99-113. doi:10.1111/j.1749-6632.1997.tb48272.x .

Language: English

Format: Journal

Abstract:
Whereas most patients with PTSD construct a narrative of their trauma over time, it is a characteristic of PTSD that sensory elements of the trauma itself continue to intrude as flashbacks and nightmares, altered states of consciousness in which the trauma is relived, unintegrated with an overall sense of self. Because traumatic memories are so fragmented, it seems reasonable to postulate that extreme emotional arousal leads to failure of the central nervous system (CNS) to synthesize the sensations related to the trauma into an integrated whole. Earlier models for a biological substrate of these phenomena have become rapidly outdated with the availability of new information derived from neuroimaging studies of patients with PTSD. The emerging body of knowledge from these studies has stimulated a gradual shift in emphasis away from the neurochemicals involved in the organisms' response to overwhelming threat to a focus on the neuronal filters concerned in the interpretation of sensory information: the interactions between the various parts of the CNS that process and interpret the meaning of incoming information, such as the amygdala, hippocampus, corpus callosum, anterior cingulte, and prefrontal cortex. [Text, p. 99]
Review Article: 58 references. This volume of the Annals was published as "Psychobiology of posttraumatic stress disorder," edited by Rachel Yehuda and Alexander C. McFarlane (New York: New York Academy of Sciences, 1997; ISBN 1-57331-078-6). These papers are the result of a conference entitled "Psychobiology of Posttraumatic Stress Disorder" sponsored by the New York Academy of Sciences, New York, 1996 September 7-10.

Keywords: Brain Imaging Dissociative Amnesia Etiology Literature Review Neuroanatomy Neuroendocrinology Psychobiology PTSD Stressors Survivors Treatment Effectiveness

Accuracy Verified: Yes

20. Corrigan, F. M. (2004). Psychotherapy as assisted homeostasis: Activation of emotional processing mediated by the anterior cingulate cortex. Medical Hypotheses, 63(6), 968-973.

Language: English

Format: Journal

Abstract:
Although psychotherapy is successful in altering emotional distress, the biological mechanism by which it achieves this has not been the subject of intensive neurobiological investigation. Mindful processing of emotion has been proposed to be a key factor in prevention of relapse in depressive illness and here that hypothesis is developed and extended to include other conditions in which emotion processing may be obstructed or dysregulated. Cognitive therapy, interpersonal psychotherapy, psycho-dynamic psychotherapy, and dialectical behaviour therapy, each in a different way and with a distinct emphasis, encourage awareness of emotions and their associated cognitions and biographies, and their varying success may depend on the degree to which they achieve activation of internal healing processes. In eye movement desensitisation and reprocessing (EMDR), the selected target is formatted for endogenous processing which is facilitated and accelerated by eye movements or alternating bilateral auditory or tactile stimulation. The ability to sustain focussed attention on the affect and its visceral, cognitive, and biographical components is postulated to activate a homeostatic process of distress resolution, seen most clearly in treatment of PTSD with EMDR, in which resolution of distress can be intense and rapid while therapist input is non-directive, although supportive, empathic, and non-judgemental. Once the therapist has helped to frame the questions, the patient's brain will find the answers needed for the resolution of the distress and all the components of the traumatic event, whether visceral, cognitive, affective, or interpersonal. The anterior cingulate cortex, especially the dorsal and rostral components, is suggested to be the key neurobiological substrate for the efficacious psychotherapeutic relief of distress, and relevant functional neuroimaging studies are summarised. One limitation of some previous imaging studies of emotion is that they have tended to use mild stimuli to discrete emotions. An alternative approach would be to image the brain during reprocessing of an unpleasant event which has profoundly affected the person so that the associated intense emotions could be clearly labelled and correlated with changes in regional brain functioning. [Author Summary]

Keywords: Cognitive Processes Cognitive Therapy Neurobiology

Accuracy Verified: Yes

21. Pagani, M., Nardo, D., Flumeri, F., Salmaso. D., Looi, J., Sanchez-Crespo, A., Larsson, S. A., Sundin, Ö., Hogberg, G., Bejerot, S. (2009, January). PW04-01 Volumetric changes in PTSD and in a subgroup of PTSD patients not responding to EMDR psychotherapy. European Psychiatry, 24(Supplement 1), S355. doi:10.1016/S0924-9338(09)70588-7.

Language: English

Format: Journal

Abstract:
(1)Background: Several studies have reported limbic structures volume decrease in Post-Traumatic Stress Disorder (PTSD). However, in PTSD the effect of therapy on brain structures has seldom been investigated. The aim of the study was to evaluate the grey matter (GM) loss in occupational related PTSD and to assess the volumetric differences between patients responding (R) and non-responding (NR) to psychotherapy. (2)Methods: Pre-EMDR MRI data of 21 train drives who did develop PTSD (S) and 22 who did not develop PTSD (NS) after person-under-the-train accidents were compared. Within S further comparisons were made between 10 R to Eye Movement Desensitisation Reprocessing (EMDR) therapy and 5 NR. Data were analysed by optimised voxel-based morphometry as implemented in Statistical Parametric Mapping. (3)Results: As compared to NS, S showed a significant GM volume reduction in precuneus, lingual gyrus, posterior cingulate and parahippocampal cortex. The R>NR comparison highlighted a significant GM reduction in NR in bilateral posterior cingulate, left middle frontal cortex and right parahippocampal, insular and temporal cortices. (4)Conclusions: Comparing two large groups of subjects significant GM volumetric reductions were found in PTSD in posterior limbic structures. NR showed, as compared to R, volume reduction in cortical structures including posterior cingulate and parahippocampal cortex. These latter two structures seem to be the hallmark for both PTSD diagnosis and therapy outcome prediction.

Keywords: Posttraumatic Stress Disorder PSTD

Accuracy Verified: Yes

22. Kaye, B. (2008). Reversing reciprocal suppression in the anterior cingulated cortex: A hypothetical model to explain EMDR effectiveness. Journal of EMDR Practice and Research, 2(1), 88-99. doi:10.1891/1933-3196.1.2.88.

Language: English

Format: Journal

Abstract:
A theoretical model is proposed to explain desensitization during Eye Movement Desensitization and Reprocessing (EMDR) as resulting from the reversal of reciprocal suppression of cognitive processing in the anterior cingulate cortex (ACC). Dual-attention and error monitoring are known to activate dorsal regions of the ACC that mediate metacognitive processing. Neuroimaging research has produced evidence that cognitive areas in the upper ACC may reciprocally suppress affective processing in the lower areas and vice versa. It is therefore proposed that the original eye-to-finger tracking task of EMDR may achieve its therapeutic effect by using error monitoring to reverse suppression of the upper ACC by the lower ACC. Contributions to EMDR effectiveness from resource installation and novelty-driven orienting reflexes may also influence ACC functioning. A distraction effect is proposed to be a negative and potentially disruptive by-product of very interactive stimulation tasks. A semantic priming procedure is suggested to limit distraction effects during more interactive forms of stimulation. [Author Abstract]

Keywords: Anterior Cingulate Cognitive Processes Neurotransmitters Reciprocal Suppression Semantic Priming

Accuracy Verified: Yes

23. Grant, M. (2000). Speculations on how EMDR might work to alleviate pain. Autism Today. Retrieved from http://www.autismtoday.com/articles/Finger-flash-therapy-catches-on.htm on 1/8/2013.

Language: English

Format: Other

Abstract:
Some of the key players of the central nervous system in pain are the thalamus, the amygdala, the anterior cingulate cortex and the frontal cortex. The Central Nervous System is also not 'hard-wired' but kept in a stable state by elaborate control mechanisms. If these control mechanisms become unstable, as a result of say prolonged stress, neurological changes can occur, producing symptoms such as those found in trauma and chronic pain.

Keywords: Chronic Pain

Accuracy Verified: Yes

24. Pagani, M. (2008, Novembre). Sub-strato neurobiologico della sindrome da stress post-traumatico e relativo impatto funzionale e strutturale della terapia con EMDR [Neurobiological substrate of post-traumatic stress syndrome and impact on functional and structural therapy with EMDR]. Presentazione le Applicazioni Cliniche del EMDR Congresso Nazionale, Milano, Italia.

Language: Italian

Format: Conference

Abstract:
Recenti studi hanno dimostrato come la sindrome da stress post-traumatico (PTSD) possa causare nel cervello cambiamenti sia strutturali che funzionali. Studi di imaging funzionale tramite tomografia ad emissione di fotone singolo (SPECT) e ad emissione di positrone (PET) hanno evidenziato significative variazioni del flusso cerebrale in pazienti con PTSD durante la rivisitazione del trauma. A questo proposito sono stati riportati aumenti e diminuzioni di flusso nell’ippocampo, nell’amigdala, nella corteccia prefrontale mediale, nel cingolo anteriore e posteriore e nella corteccia temporale. Il modello prevalente collega i sintomi del PTSD ad una mancata inibizione dell’ amigdala, iperattivata dalla sensazione di incombente minaccia, da parte della corteccia prefrontale. E’ stato anche proposto che i cambiamenti strutturali dell’ippocampo e del cingolo anteriore rivelati dalla risonanza magnetica strutturale (RM) siano causati dalla risposta neuronale allo stress. L’obiettivo delle nostre ricerche e’ stato quello di analizzare la risposta funzionale e le variazioni strutturali in due gruppi di soggetti esposti a trauma occupazionale che hanno sviluppato (S=sintomatici, n=20) o no (NS=non sintomatici, n=27) il PTSD. Una parte dei S (n=16) è stata trattata con EMDR. La diagnosi di PTSD prima e dopo la terapia è stata basata sia sui criteri del DSM-IV sia su vari test neuropsicologici mirati. La SPECT (n=47) e la RM (n=33) sono state eseguite da 3 mesi a sei anni dal trauma e la prima è stata ripetuta dopo EMDR. I sintomi sono stati provocati da uno script individualizzato che ha riportato alla memoria il trauma e durante il quale è stato iniettato il tracciante di flusso cerebrale. Le analisi eseguite hanno mostrato differenze significative tra S e NS nella risposta del flusso cerebrale allo script. Nei 33 soggetti in cui sono state eseguite sia la SPECT che la RM sono state trovate differenze significative sia funzionali che strutturali nella corteccia temporo-parietale sinistra e nell’ippocampo, regioni nelle quali gli score dei test neuropsicologici correlano significativamente con il flusso cerebrale. Nei soggetti con remissione sintomatologica dopo EMDR (R; n=11) sono state trovate rispetto ai soggetti che non hanno risposto alla terapia (NR; n=5) significative differenze di flusso in 4 aree corticali che processano funzioni deteriorate in corso di PTSD. Diminuzioni di flusso dopo la terapia sono state registrate nei R rispetto ai NR nell’ippocampo, nel giro fusiforme (corteccia parieto-occipitale) e nella corteccia visiva primaria. L’ippocampo è sede della memoria episodica ed autobiografica; il giro fusiforme processa il riconoscimento di volti, dei corpi e delle parole; la corteccia visiva primaria custodisce la memoria visiva degli eventi. La mancata inibizione e/o l’iperattività di queste regioni nel PTSD sono responsabili della rivisitazione patologica figurata e somatica dell’evento traumatico e della presenza di flashback ed immagini allucinatorie. Viceversa la corteccia frontale dorsolaterale ha mostrato un aumento di flusso nei R. Questa regione oltre ad essere deputata ad inibire nel sistema limbico la risposta patologica a stimoli che ricordano l’evento traumatico è essenziale per i processi di attenzione e del “senso di sé”, diminuiti in corso di PTSD e recuperati in seguito alla remissione della malattia. In questi soggetti la RM ha inoltre messo in evidenza il valore predittivo delle dimensioni dell’ippocampo rispetto all’efficacia della terapia con EMDR. I nostri risultati confermano il coinvolgimento della corteccia temporo-parieto-occipitale nel PTSD e sottolineano il valore delle neuroimmagini sia nello svelare gli effetti neurobiologici dell’EMDR che determinare il valore delle indagini strutturali nel predirne l’efficacia.

Recent studies have shown that the post-traumatic stress syndrome (PTSD) may result in both structural and functional brain changes. Imaging studies using functional Single photon emission tomography (SPECT) and positron emission tomography (PET) shown significant changes in cerebral blood flow in patients with PTSD during revisiting the trauma. In this regard have been reported increases and decreases in flow hippocampus, amygdala, medial prefrontal cortex, the anterior cingulate and posterior and temporal cortex. The dominant model linking the symptoms of PTSD to a no inhibition of 'amygdala hyperactivity disorder by the sense of impending threat by the prefrontal cortex. E 'was also proposed that the structural changes of the hippocampus and anterior cingulate revealed by structural magnetic resonance imaging (MRI) are caused by the response neuronal stress. The aim of our research and 'was to analyze the response functional and structural variations in two groups of subjects exposed to occupational trauma that have developed (S = symptomatic, n = 20) or not (NS = non-symptomatic, n = 27) PTSD. Part of S (n = 16) was treated with EMDR. The diagnosis of PTSD before and after the therapy was based on both DSM-IV has on several neuropsychological tests targeting. SPECT (n = 47) and MRI (n = 33) are were performed from 3 months to six years from the trauma and the first was repeated after EMDR. Symptoms were caused by a script individual who reported to the memory of the trauma and during which were injected with a tracer of cerebral blood flow. The analysis performed showed significant differences between S and NS in the response of flow brain to the script. In the 33 subjects in which they were performed both SPECT and MRI were found significant differences in both functional and structural temporo-parietal cortex left hippocampus, regions in which the scores of neuropsychological tests correlate significantly with the flow in the brain. In subjects with symptomatic remission after EMDR (R; n = 11) were found compared with subjects who did not respond to therapy (NR, n = 5) significant differences in flow in 4 cortical areas that process functions deteriorated in the course of PTSD. Decreases in flow after treatment were recorded in R than NR hippocampus, within fusiform (parieto-occipital cortex) and in the primary visual cortex. The hippocampus is the seat of episodic memory and autobiographical, and the processes around the fusiform recognition of faces, bodies and words, the primary visual cortex preserves the memory visual events. The non-inhibition and / or 'hyperactivity of these regions in PTSD are responsible for pathological figured revisiting the traumatic event and physical and presence of flashbacks and hallucinatory images. Contrast, the dorsolateral frontal cortex has showed an increase of flow in R. This region in addition to being deputies to inhibit the system limbic response to pathological stimuli that recall the traumatic event is essential for processes of attention and the "sense of self, decreased in the course of PTSD and recovered following remission. In these subjects, MRI has also highlighted the predictive value the size of the hippocampus compared the efficacy of EMDR therapy. Our results confirm the involvement of the temporo-parietal-occipital cortex in PTSD and emphasize the value of neuroimaging in revealing both the neurobiological effects of EMDR that determine the value of the structural surveys in predicting effectiveness.

Keywords: Neurobiology Posttraumatic Stress Disorder PTSD

Accuracy Verified: Yes

25. Levin, P., Lazrove, S., & van der Kolk, B. (1999, January-April). What psychological testing and neuroimaging tell us about the treatment of posttraumatic stress disorder by eye movement desensitization and reprocessing. Journal of Anxiety Disorders, 13(1-2), 159-172. doi:10.1016/S0887-6185(98)00045-0.

Language: English

Format: Journal

Abstract:
To better understand the pathophysiology and treatment of Posttraumatic Stress Disorder (PTSD), standard psychological testing, Rorschach Ink Blot testing, and neuroimaging using Single Photon Emission Computed Tomography (SPECT) were administered to subjects with PTSD prior to and following three sessions of Eye Movement Desensitization and Reprocessing (EMDR). Using this within-subject design, data from one of six subjects in our series is presented as a case report. Following EMDR, the subject experienced improvement in his level of distress, which correlated with decrements in PTSD and depressive symptomatology on psychological testing. Analysis of the Rorschach data corroborated these changes. Among other findings, the Hypervigilance Index went from positive to negative, indicating that the subject was spending less time scanning the environment for threats, and available ego resources also increased, as measured by the Experience Actual variable. Upon recall of the traumatic memory during SPECT scanning, two areas of the brain were hyperactive post-EMDR treatment relative to pretreatment: the anterior cingulate gyrus and the left frontal lobe. These changes were consistent with summed data from four out of six subjects in the ongoing study. An important implication of these findings is that successful treatment of PTSD does not reduce arousal at the limbic level, but instead, enhances the ability to differentiate real from imagined threat. The psychology and neurophysiology of PTSD are discussed in greater detail. (ScienceDirect)

Keywords: Adults Americans Brain Imaging Empirical Study Posttraumatic Stress Disorder PTSD Treatment Effectiveness

Accuracy Verified: Yes