Francine Shapiro Library - EMDR Bibliography Links
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1. 新井 康祥 , 木村 宏之 [Yasuhiro Arai, and Hiroyuki Kimura]. (2007年1月). 4.痛みのflashbackにEMDRを利用した症例(第55回日本心身医学会中部地方会演題抄録,地方会抄録,学会報告) [4.'A case of using EMDR for patients with a flashback accompanied with pain (Abstract Title of the 55th Chubu regional Japanese Society of Psychosomatic Medicine)]. 心身医学、47の日本学会（1）、57から58 [Japanese Journal of Psychosomatic Medicine, 47(1), 57-58].
Language: Japanese
Format: Journal
Keywords: Flashbacks Pain
Accuracy Verified: Yes
2. Huber, M., Siol, T., Herholz, K., Lenz, O., Köhle, K., & Heiss, W. D. (2001, December). Activation of thalamo-cortical systems in post-traumatic flashbacks: A positron emission tomography study. Traumatology, 7(4), 131-141. doi:10.1177/153476560100700402.
Language: English
Format: Journal
Abstract:
Trauma victims with post-traumatic stress disorder (PTSD) often experience ‘flashbacks’ that are described as being different from memories of other fearful biographic situations. We used Positron Emission Tomography and Statistical Parametric Mapping to compare in the same subject brain activation patterns during induced flashbacks with recall of fearful non-traumatic situations. During fearful recall there were significant activations of right precuneus. When traumatic memories were compared to neutral, right lingual gyrus, right thalamus / mamillary bodies, and right cerebellum were significantly activated. When brain activation during flashbacks was compared to simple fear, right mediodorsal thalamus (MD), right precuneus, and right cerebellum were significantly more active. With respect to recent experimental evidence concerning the function of thalamo-cortical systems, we hypothesize that post-traumatic flashback experiences are based on hyperactive thalamo-cortical ‘closed loop’ networks.
Keywords: Flashbacks Mediodorsal Thalamus PET Positron Emission Tomography Post-Trauamtic Stress Disorder PTSD Statistical Parameter Mapping Thalamo-Cortical Systems Trauma Victims
Accuracy Verified: Yes
3. Holmes, E. A., James, E. L., Coode-Bate, T., & Deeprose, C. (2009). Can playing the computer game “Tetris” reduce the build-up of flashbacks for trauma? A proposal from cognitive science. PLoS ONE, 4(1): e4153. doi:10.1371/journal.pone.0004153 .
Language: English
Format: Journal
Abstract:
Background.
Flashbacks are the hallmark symptom of Posttraumatic Stress Disorder (PTSD). Although we have successful treatments for full-blown PTSD, early interventions are lacking. We propose the utility of developing a ‘cognitive vaccine’ to prevent PTSD flashback development following exposure to trauma. Our theory is based on two key findings: 1) Cognitive science suggests that the brain has selective resources with limited capacity; 2) The neurobiology of memory suggests a 6-hr window to disrupt memory consolidation. The rationale for a ‘cognitive vaccine’ approach is as follows: Trauma flashbacks are sensory-perceptual, visuospatial mental images. Visuospatial cognitive tasks selectively compete for resources required to generate mental images. Thus, a visuospatial computer game (e.g. “Tetris”) will interfere with flashbacks. Visuospatial tasks post-trauma, performed within the time window for memory consolidation, will reduce subsequent flashbacks. We predicted that playing “Tetris” half an hour after viewing trauma would reduce flashback frequency over 1-week.
Methodology/Principal Findings.
The Trauma Film paradigm was used as a well-established experimental analog for Post-traumatic Stress. All participants viewed a traumatic film consisting of scenes of real injury and death followed by a 30-min structured break. Participants were then randomly allocated to either a no-task or visuospatial (“Tetris”) condition which they undertook for 10-min. Flashbacks were monitored for 1-week. Results indicated that compared to the no-task condition, the “Tetris” condition produced a significant reduction in flashback frequency over 1-week. Convergent results were found on a clinical measure of PTSD symptomatology at 1-week. Recognition memory between groups did not differ significantly. Conclusions/Significance.
Playing “Tetris” after viewing traumatic material reduces unwanted, involuntary memory flashbacks to that traumatic film, leaving deliberate memory recall of the event intact. Pathological aspects of human memory in the aftermath of trauma may be malleable using non-invasive, cognitive interventions. This has implications for a novel avenue of preventative treatment development, much-needed as a crisis intervention for the aftermath of traumatic events.
Keywords: Flashbacks Tetris
Accuracy Verified: Yes
4. Hassard, A., Jeynes, C., Smith, K., & Chung, M. C. (2008, June). Dose response, cognitive change and the working memory limit in eye movement desensitisation. Presentation at the annual meeting of the EMDR Europe Association, London, England.
Language: English
Format: Conference
Abstract:
The natural history of treatment with Eye Movement Desensitization (EMD), was investigated. EMD is defined as
EMDR without the cognitive components, such as the positive cognition procedure or cognitive interleave. When
EMD treatment does not proceed, then the flashback or distressing image is decomposed in various ways, until it
does proceed. A retrospective audit showed that patients report an average of seven flashbacks, or images. We
attempted to confirm this prospectively. One hundred and thirty patients in the Genito-Urinary Medicine Clinic
were entered. Fifty-one completed treatment. Progress was assessed with questionnaires at all treatment
sessions. All previously reported flashbacks or images were reassessed at the beginning of each session. All
distressing images were treated, both to the initial presenting event and all other distressing life events or
anxieties reported. The number of flashbacks desensitized was recorded. There was a six-month postal followup.
We predicted there would be an average of seven flashbacks and that the questionnaires would reduce to
low levels at this point. The mode and median values were seven. The mean was 7.9. Evaluation questionnaires
reduced to good levels. An average of seven flashbacks or images was reported to completion of treatment.
This seven may indicate the working memory limit. If PTSD and psychological disorder in general are caused by
overloaded working memory capacity, maybe EMD works by unloading it. If WM bandwidth is liberated by
treatment, then this may enable the cognitive and emotional change observed in EMD treatment. Further
implications of this will be discussed.
Keywords: Cognitive Change Dose Response
Accuracy Verified: Yes
5. Connell-Jones, G. (2011). Drug modulated EMDR Treatment for borderline personality disorder. Presentation at the 12th European Conference on Traumatic Stress (ECOTS), Vienna, Austria.
Language: English
Format: Journal
Abstract:
From my clinical work over the past 4 years a case series of 15 women patients, all detained in a secure hospital for
periods of up to 30 years discharged after EMDR therapy. Some cases discussed in depth, others factor analysed as
case series. Drug modulation permitted intensive therapy. The factors of complex stress disorder are beeing
discussed and its simlarity to borderline personality disorder. The effects of long term instititutionalisation after
detention in security. The responsible clinician as ‘‘goaler and therapist’’ as well as therapeutic pitfalls are being
explored. The psychopathology of the flashback is contrasted with the psychpathology of the alter (dissociative
identity). Prognostic factors and outcomes are being presented. The implications for personality disorder as a
diagnosis contrasted with complex PTSD will be evaluated.
Keywords: Borderline Personality Disorder BPD Drug Modulation
Accuracy Verified: Yes
6. Tonetti, F. (2008, Novembre). EMDR e trauma complesso in adolescente [EMDR and trauma in adolescents complex]. Presentazione Le applicazioni cliniche del EMDR Congresso Nazionale, Milano, Italia.
Language: Italian
Format: Conference
Abstract:
N. è stata portata in Italia a 14 anni con l’illusione di lavorare come baby sitter, finisce invece vittima dello sfruttamento sessuale organizzato e per circa un anno subisce violenze sessuali, fisiche e psicologiche. Con forza e coraggio notevoli, riesce a fuggire, nuda, da un’auto dove stava subendo l’ennesima violenza. Ha gravi lesioni sul corpo, viene soccorsa e portata in ospedale, dove decide di denunciare i suoi vittimizzatori.
Il caso finisce alla Procura del Tribunale per i Minorenni e N. viene collocata, sotto falso nome, in una comunità.
Il mio primo contatto con la ragazza avviene quando ha 16 anni ed è in comunità da cinque mesi. Presenta ancora i sintomi invadenti del PTSD: flashback, incubi, panico, pensieri ossessivi, isolamento, distacco emotivo che a volte la fa apparire molto calma, sovreccitazione. Non sa controllare gli impulsi e regolare le emozioni: passa dalla rabbia, che sfoga picchiando pugni contro il muro fino a ferirsi o spaccando tutto ciò che le capita sotto mano, alla eccitazione, alla depressione con sentimenti di inutilità a vivere, di colpa e di vergogna (sintomi di PTSD Complesso). Propongo e spiego da subito l’EMDR ritenendo che sia l’unico approccio terapeutico utile; stabiliamo piano terapeutico e N. esprime il suo consenso al trattamento. Particolare attenzione, data la problematicità, alla fase di preparazione e stabilizzazione. Nell’anamnesi emerge primo trauma a 10 anni, prima ricorda di essersi sentita amata e protetta. Rafforzo queste esperienze positive che diventano risorse in suo possesso. Fondamentale si rivela la psicoeducazione sui disturbi: N. accoglie con sollievo l’idea che non è “pazza” o “indemoniata” ma solo traumatizzata. Immaginiamo comportamenti alternativi per esprimere le emozioni e strategie di coping.
Posto al Sicuro: servono due sedute per stabilizzare e installare il posto al sicuro.
Il protocollo EMDR sarà applicato fedelmente nelle sue fasi; i target del passato affrontati in ordine cronologico.
N. è sempre partita da 1 nella scala VoC e da 10 nella SUD; ha concluso tutte le sedute con SUD: 0 e VoC: 6 /7. Ha avuto abreazioni e una volta ha chiesto di fermarsi: la NC era”sto per morire”.
Sono stati raggiunti, dopo 10 mesi di terapia, gli obiettivi del piano terapeutico: la sintomatologia post-traumatica si è risolta dopo otto sedute.
No was taken to Italy 14 years with the illusion of working as a babysitter, instead ends up a victim of sexual exploitation and organized for about a year suffer sexual violence, physical and psychological. With remarkable courage and strength, manages to escape, naked, from where a car was undergoing yet another violence. He has serious injuries on the body, is rescued and taken to hospital, where he decides to denounce his victimization.
The event ends at the General Prosecutor of the Juvenile Court and N. is placed under a false name, in a community.
My first contact with the girl when she is 16 years and is shared by five months. Still has the intrusive symptoms of PTSD: flashbacks, nightmares, panic, obsessive thoughts, isolation, emotional detachment that sometimes makes it appear very calm, excitement. Can not control impulses and regulate emotions: anger passes, which unleashed banging his fists against the wall until injury or cracking everything that happens at hand, the excitement, depression with feelings of futility in life, guilt and shame (symptoms of complex PTSD). Propose and explain EMDR now believing it is the only therapeutic approach useful, we establish a treatment plan and N. expresses its consent to treatment. Particular attention, given the problematic, the preparation and stabilization. Nell'anamnesi apparent trauma to the first 10 years, first recalls that she felt loved and protected. Reinforces these positive experiences that become resources in their possession. Reveals the basic psychoeducation about the disorder: No welcomes with relief the idea that is not "mad" or "possessed" but traumatized. Imagine alternative behaviors to express emotions and coping strategies.
Safe place: it takes two sessions to stabilize and secure way to install.
The EMDR protocol is applied faithfully in its early stages, the targets of the past dealt with in chronological order.
No always started from a ladder in VOC and 10 in South, has completed all the sessions with SUD: 0 and VOC: 6 / 7. Abreactions and had once asked to stop: the NC was "I am going to die."
Were achieved after 10 months of therapy, the goals of treatment plan: post-traumatic symptoms resolved after eight sessions.
Keywords: Adolescents Complex Trauma
Accuracy Verified: Yes
7. Hofmann, A. (1996). EMDR: Eine neue methode zur behandlung posttraumatischer belastungsstoerungen [Eye movement desensitization and reprocessing: A new treatment method for post-traumatic stress disorder]. Psychotherapeut, 41(6), 368-372. doi:10.1007/s002780050045.
Language: German
Format: Journal
Abstract:
8 stationäre Patienten mit chronischen PTSD wurden mit einem Durchschnitt von 4 Sitzungen der Augenbewegung Desensibilisierung und Wiederaufbereitung (EMDR) behandelt, eine neue Behandlungsmethode. Konkordant mit anderen Fallberichten und Studien, 7 der Patienten berichteten eine deutliche Entlastung von 17 schmerzhaften Erinnerungen verarbeitet, das war in der signifikanten Abnahme der Suds (subjektive Einheiten des Unbehagens, einer Skala von 0-10 dargestellt) von durchschnittlich 6,5 bis 0,9 nach der Behandlung mit EMDR (P <0,001). Dies wurde durch einen Rückgang in anderen Symptome und eine Verbesserung der negativen Selbst-bezogene Denken einher. 1 Patient zeigte keine Besserung. In einem Drittel der Erinnerungen verarbeitet werden, einen starken Anstieg der Suds (Rückblende) aufgetreten war und aufbereitet werden. Die positiven therapeutischen Wirkungen waren stabil 3 und 6 Monate nach der Behandlung, in 2 Fällen, berichtet nach einem Jahr zeigten anhaltende positive Ergebnisse. Keine negativen Ergebnisse der Behandlung berichtet wurden. Es wird vorgeschlagen, dass EMDR könnte ein nützliches Instrument bei der Behandlung von Patienten mit chronischer PTBS werden. Das Verfahren passte gut in einer psychodynamisch orientierten stationären Bereich. Diese Kombination schien zu helfen, speziell bei der Behandlung von Trauma-Patienten mit eingeschränkter Ich-Stärke. [Autor Zusammenfassung]
8 inpatients with chronic PTSD were treated with an average of 4 sessions of eye movement desensitization and reprocessing (EMDR), a new treatment method. Concordant with other case reports and studies, 7 of the patients reported a significant relief of 17 processed painful memories; this was shown in the significant decrease of SUDs (subjective units of discomfort, a 0-10 scale) from an average of 6.5 to 0.9 after treatment with EMDR (P < 0.001). This was paralleled by a decrease in other symptoms and an improvement in negative self-related thinking. 1 patient showed no improvement. In one third of the memories processed, a strong increase in SUDs (flashback) occurred and was reprocessed. The positive therapeutic effects were stable 3 and 6 months after treatment, In 2 cases, reports after a year showed persistent positive results. No negative results of the treatment were reported. It is suggested that EMDR could be a useful instrument in the treatment of patients with chronic PTSD. The procedure fitted well in a psychodynamically oriented inpatient setting. This combination seemed to help specifically in the treatment of trauma patients with impaired ego strength. [Author Summary]
Keywords: Adults Empirical Study Longitudinal Study Psychiatric Inpatients PTSD Stressors Survivors Treatment Effectiveness
Accuracy Verified: Yes
8. Sandberg, A. (2010, March 26). Erasing memories: Next treatment for PTSD and other trauma-related disorders?. Psychiatric Times. Retrieved from http://www.bbc.co.uk/worldservice/news/2010/03/100325_erasing_memories_hs.shtml 4/10/2010.
Language: English
Format: Magazine
Abstract:
Neuroscientists are exploring ways to erase bad memories in patients who have
experienced traumatic events. But, is it ethical to erase a memory or flashback and the
feelings associated with that moment to alleviate suffering, or should clinicians focus on
therapies such as CBT and EMDR (Eye Movement Desensitization and Reprocessing) to
help patients cope with a trauma? Online article includes a link to a BBC Podcast.
Keywords: CBT Cognitive Behavioral Therapy Erasing Memories Flashbacks
Accuracy Verified: Yes
9. Staff. (2009). Getting it right. KCAL, Los Angeles, CA.
Language: English
Format: Video
Abstract:
Getting it Right
TV station KCAL in Los Angeles is a welcome exception
to the common practice of reporting combat PTSD as
untreatable. A video clip on their website reports how a
Desert Storm vet rushed to assist victims of a recent
automobile accident in Santa Monica and experienced a
combat-based flashback. The video recounts his subsequent
successful EMDR therapy with HAP supporter
Sarah Gilman after diagnosis at Dr. Daniel Amen’s
imaging research clinic.
Accuracy Verified: Yes
10. Flumeri, F., Salmaso, D., & Pagani, M. (2008, 26-28 Settembre). Impatto dell'EMDR sulle fuzioni e sulla neurobiologia cerebrali [Impact on EMDR and neurobiological brain functions]. In T. Farma (Chair), Simposio, Il modello psicotraumatologico: Un ponte tra indicatori neurobiologici e Psicoterapia. VII Congresso SPR Italia, Modena.
Language: Italian
Format: Conference
Abstract:
Introduzione:negli ultimi anni il numero di studi condotti nell’ambito dei disturbi causati da eventi traumatici ha subito una forte accelerazione rilevando l’esistenza di alterazioni fisiologiche e morfologiche in specifiche aree cerebrali associate sia alla risposta emotiva al trauma che alla insorgenza dei sintomi della sindrome da stress post-traumatico (PTSD).
L’impiego delle tecniche di neuroimmagine ha consentito di fare luce sui correlati neurali della psicoterapia, rivelando i suoi effetti neurobiologici sulla funzione cerebrale. Nell’ambito dei diversi approcci psicoterapeutici, l’EMDR (Eye Movement Desensitization and Reprocessing therapy) è emerso come promettente risorsa per il trattamento del trauma e di altri disturbi d’ansia, sebbene ancora non sia stata completamente chiarita la sua modalità di azione sui circuiti neurali. Molte ricerche sono state effettuate per valutare l’efficacia dell’EMDR, ma solo un numero esiguo di esse ha indagato il substrato neurobiologico di questa psicoterapia.
Le metodiche di neuroimmagini utilizzate finora per studi sull’EMDR sono la Single Photon Emission Computed Tomography (SPECT) e la Magnetic Resonance Imaging (MRI). La prima raccoglie dati sull’attivita’ cellulare cerebrale mentre la seconda riporta dati anatomici strutturali.
Gli studi funzionali condotti con SPECT consentono di identificare le variazioni del metabolismo e del flusso ematico cerebrale, suggerendo un ruolo specifico per ciascuna area cerebrale coinvolta nel complesso meccanismo che sottende il processamento delle emozioni; la MRI consente invece di rilevare la presenza di variazioni morfologiche e volumetriche di specifiche strutture cerebrali. Negli ultimi anni, studi SPECT e MRI, volti ad esaminare gli effetti dell’EMDR sulla fisiopatologia cerebrale in pazienti affetti da disturbi d’ansia, hanno riscontrato sostanziali variazioni del flusso ematico ed alterazioni strutturali di alcune regioni cerebrali in seguito a terapia.
L’efficacia dell’EMDR nel trattamento del PTSD è stata confermata da uno studio SPECT su sei soggetti ( Lansing et al.) (1) che ha evidenziato dopo terapia una diminuzione del flusso ematico nel lobo occipitale bilateralmente e nel lobo parietale sinistro e un aumento di flusso nel giro frontale inferiore sinistro. Sempre utilizzando la SPECT Oh e Choi (2) hanno riportato una significativa modificazione del flusso cerebrale in seguito ad EMDR, prevalentemente riscontrabile nell’area limbica e nella corteccia prefrontale. Un recente studio con utilizzo di MRI (3) ha inoltre messo in evidenza un aumento di volume dell’ippocampo in seguito a trattamento con EMDR, aumento invece non riportato in un lavoro di Lindauer et al. su 9 soggetti con PTSD, nonostante il successo clinico della psicoterapia eclettica eseguita (4).
Obiettivi: il nostro gruppo ha studiato gli effetti a breve e lungo termine dell’EMDR (5, 6) dimostrando la sua efficacia nel trattamento di soggetti traumatizzati sul lavoro, e una stabilità del miglioramento clinico ottenuto in risposta alla terapia, ancora presente a distanza di tre anni. Nell’ambito dello stesso progetto sono state anche studiate le variazioni del flusso ematico cerebrale e della volumetria di alcune strutture cerebrali in relazione alla terapia con EMDR. Un primo studio SPECT ha analizzato la variazione della distribuzione di flusso in 11 soggetti guariti clinicamente da PTSD in seguito a EMDR messi a confronto con 5 soggetti nei quali la terapia non ha avuto effetto (7). Risultati: è stato evidenziato nei soggetti con remissione sintomatologica significative differenze di flusso in 4 aree corticali, alla disfunzione delle quali sono ascrivibili alcuni sintomi presenti in corso di PTSD. Diminuzioni di flusso post-terapia sono state registrate nell’ippocampo, nella corteccia parieto-occipitale e nella corteccia visiva primaria. L’ippocampo e’ sede della memoria a breve termine; la corteccia parieto-occipitale 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’iperattivita’ di queste regioni nel PTSD sono responsabili della rivisitazione patologica dell’evento traumatico e della presenza di flashback ed immagini allucinatorie. Inoltre la corteccia frontale dorsolaterale ha dimostrato un aumento di flusso nei soggetti che hanno risposto positivamente alla terapia. Questa regione chiave oltre ad essere deputata ad inibire la risposta patologica a stimoli che ricordano l’evento traumatico e’ essenziale per i processi di attenzione e di autostima, diminuiti in corso di PTSD e recuperati in seguito alla remissione della malattia. In ulteriori studi che combinano indagini funzionali e strutturali utilizzando SPECT e MRI abbiamo messo in evidenza il valore predittivo delle dimensioni dell’ippocampo riguardo all’efficacia della terapia con EMDR (Pagani et al. sottomesso).
Conclusioni: gli effetti della terapia con EMDR sono risultati, unitamente ad un consistente miglioramento della sintomatologia e ad una riduzione della iperreattività a stimoli di carattere emotivo, in una normalizzazione funzionale di alcune aree specifiche e in un aumento del volume ippocampale probabilmente ascrivibile a neo-neurogenesi. Questi risultati sono in linea con la pregressa letteratura e con le attuali conoscenze sul PTSD e suggeriscono basi neurobiologiche dell’effetto terapeutico dell’EMDR confermandone l’impatto funzionale su strutture cerebrali coinvolte in patologie ansiogene.
Bibliografia:
1. Lansing et al. (2005). J Neuropsych Clin Neurosci;17(4):526-532.
2. Ho DH and Choi J. (2007). J EMDR Pract Res;1(1):24-30.
3. Bossini et al. (2007). J Neuropsych Clin Neurosci; 19(4):475-476.
4. Lindauer et al. (2005). Psychol Med ; 35 :1-11.
5. Hogberg et al. (2007). Nord J Psych; 61(1):54-61.
6. Hogberg et al. (2008). Psych Res; doi:10.1016/j.psychres.2007.10.019.
7. Pagani et al. (2007). Nuc Med Comm; 28(10):757-65. [Pagani abstract]
Introduction In recent years the number of studies in disorders caused by traumatic events has been greatly accelerated by detecting the existence of morphological and physiological changes in specific brain areas associated with both the emotional response to trauma to the onset of symptoms Post-traumatic stress syndrome (PTSD).
The use of neuroimaging techniques has allowed to shed light on the neural correlates of psychotherapy, revealing the neurobiological effects on brain function. Under the different psychotherapeutic approaches, EMDR (eye movement desensitization and reprocessing therapy) has emerged as a promising resource for the treatment of trauma and other anxiety disorders, although still not been fully elucidated its mode of action on neural circuits. Many studies have been carried out to assess the effectiveness EMDR, but only a small number of them have investigated the neurobiological substrate of this psychotherapy.
The methods used so far for neuroimaging studies on EMDR are Single Photon Emission Computed Tomography (SPECT) and Magnetic Resonance Imaging (MRI). The first collects data on 'brain cells while the second contains structural anatomical data.
The functional studies performed with SPECT to identify changes in metabolism and cerebral blood flow, suggesting a specific role for each brain area involved in the complex mechanism underlying the processing of emotions, instead of MRI allows detection of morphological changes and volume of specific brain structures. In recent years, MRI and SPECT studies, aimed to examine the effects of EMDR on brain pathophysiology in patients with anxiety disorders, have found substantial variations in blood flow and structural alterations of some brain regions after treatment.
The effectiveness of EMDR in the treatment of PTSD was confirmed by a SPECT study in six subjects (Lansing et al.) (1) showed that after treatment reduced blood flow in the occipital lobe bilaterally and in left parietal lobe and a increase of flow in left inferior frontal gyrus. Always using SPECT Oh and Choi (2) reported a significant change of cerebral blood flow after EMDR, mainly found in limbic and prefrontal cortex. A recent study using MRI (3) has also highlighted an increase in volume of the hippocampus after treatment with EMDR, but no increase in reported work of Lindauer et al. on 9 subjects with PTSD, despite the clinical success of eclectic psychotherapy performed (4).
Objectives: Our group has studied the effects of short and long term EMDR (5, 6) demonstrating its effectiveness in treating traumatized individuals at work, and stability of clinical improvement obtained in response to therapy, yet this distance three years. Within the same project were also studied changes in cerebral blood flow and volume of certain brain structures in relation to treatment with EMDR. A first SPECT study analyzed the change in flow distribution in 11 subjects clinically recovered from PTSD after EMDR compared with 5 subjects in whom treatment had no effect (7). Results: It was shown in patients with symptomatic remission, significant differences in flow in 4 cortical areas, which are attributable to dysfunction of some symptoms of PTSD being present. Flow decreases post-treatment were recorded in the hippocampus, cortex parietal-occipital and primary visual cortex. The hippocampus and 'seat of short-term memory, the parietal-occipital cortex processes the recognition of faces, bodies and words, the primary visual cortex preserves the visual memory of events. The lack of inhibition and / or 'hyperactivity' of PTSD in these regions are responsible for the pathological review of the traumatic event and the presence of flashbacks and hallucinatory images. Moreover, the dorsolateral frontal cortex showed an increase in flow in subjects who responded positively to therapy. This key region in addition to being appointed to inhibit the pathological response to stimuli that recall the traumatic event and 'essential for the processes of attention and self-esteem, decreased in the course of PTSD and recovered following the remission of the disease. In further studies that combine functional and structural investigations using SPECT and MRI have shown the predictive value of the size of the hippocampus on the effectiveness of EMDR therapy (Pagani et al. Submitted).
Conclusion: the effects of EMDR therapy were coupled with a significant improvement in symptoms and a reduction of hyperreactivity to stimuli, emotional, functional in a normalization of some specific areas and an increase in hippocampal volume probably due to neo- neurogenesis. These results are consistent with previous literature and with current knowledge about PTSD and suggest a neurobiological basis of therapeutic EMDR confirming the functional impact on brain structures involved in anxiety-disorders.
Bibliography:
1. Lansing et al. (2005). J Neuropsych Clin Neurosci, 17 (4) :526-532.
2. I DH and J. Choi (2007). J EMDR pract Res, 1 (1) :24-30.
3. Bossini et al. (2007). J Neuropsych Clin Neurosci, 19 (4) :475-476.
4. Lindauer et al. (2005). Psychol Med, 35 :1-11.
5. Högberg et al. (2007). Nord J Psych, 61 (1) :54-61.
6. Högberg et al. (2008). Psych Res, doi: 10.1016/j.psychres.2007.10.019.
7. Pagani et al. (2007). NUC Med Comm, 28 (10) :757-65. [Pagani abstract]
Keywords: Brain Functions Neurobiology
Accuracy Verified: Yes
11. Lanius, U. F. (2004, September). PTSD, information processing & thalamo-coritcal dialogue. Presentation at the annual meeting of the EMDR International Association, Montreal, Quebec Canada.
Language: English
Format: Conference
Abstract:
A neurobiological model of PTSD as a neuropsychiavlc disorder that can
be characterized by thalamocortical dysrhythmia is proposed. It is argued that PTSD is related to disruptions in thalamus-medicated temporal
cognitive binding. The resulting lack of corticothalamic dialogue may account for flashback experiences and primary dissociation, and the resulting inability to integrate the totality of what is happening into personal memory and identity. The presentation will discuss recent neuroscience research with regard to the effects of traumatic stress on brain functioning that is integrated with Shapiro's Adaptive Information Processing Model.
Keywords: Thalamo-Coritcal Dialogue
Accuracy Verified: Yes
12. 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
13. Zampieri, A. J., Zampieri, M. J., & Godoy, M. F. (2012, Novembro). Trauma: Estudo comparativo de sessão única entre psicoterapia da fala e EMDR [Trauma: A comparative study between single-session psychotherapy and EMDR speech]. In comunicações de pesquisa. Apresentação no II Congresso Brasileiro de EMDR, Brasília, Brasil.
Language: Portuguese
Format: Conference
Abstract:
Introdução: Flashback, sono e autoestima perturbados, reatividade e agressividade, são efeitos de traumas. Prejudicam a vida pessoal e social. Dilatam a demanda em psicoterapia desafiando a rede publica de saúde. Novas saídas fazem-se urgentes, que antecipem e melhorem efeitos curativos. Desde 87 na Califórnia, Francine Shapiro criou a Eye Movement Desensitization and Reprocessing, ou simplesmente Psicoterapia por Reprocessamento de Informações, inspirada nos movimentos oculares típicos do sono REM. Método: Estudo comparativo entre efeitos de psicoterapia com ou sem recursos do EMDR, aplicando as escalas Beck para ansiedade, depressão e desesperança, e uma escala de impacto de eventos, antes e após uma sessão. Aos sujeitos do grupo experimental foi aplicado o protocolo padrão de EMDR e para os do grupo controle, o método da psicoterapia da fala. Resultados: A análise estatística demonstrou que, embora o estado inicial dos sujeitos de ambos os grupos fosse o mesmo, houve diferença significante nos resultados, na comparação pós-intervenção, para todos os itens pesquisados. O grupo de sujeitos atendidos em psicoterapia por EMDR apresentou pontuação final muito abaixo da inicial para ansiedade (p < 0,0001), depressão (p < 0,0001), desesperança (p = 0,0001) e impacto de eventos (p = 0,0083), em relação àqueles atendidos pela terapia da fala. Conclusão: A psicoterapia com EMDR é adequada para tratamento de situações traumáticas, e apresenta resultados expressivos desde a primeira sessão sobre o impacto do evento e sintomas de ansiedade, depressão, desesperança. Pelos resultados e agilidade deve ser cogitada para grandes demandas tais como na rede pública de saúde.
Introduction: Flashback, disturbed sleep and self-esteem, aggression and reactivity, are effects of trauma. Affect the personal and social life. Dilate demand in psychotherapy defying public health network. New outlets are made urgent that anticipate and improve curative effects. From 87 in California, Francine Shapiro created the Eye Movement Desensitization and Reprocessing, or simply Psychotherapy for Reprocessing Information, inspired by the eye movements typical of REM sleep. Methods: Comparative study of effects of psychotherapy with or without features of EMDR, applying Beck scales for anxiety, depression and hopelessness, and a scale of impact of events before and after a session. The subjects in the experimental group was administered the standard protocol for EMDR and the control group, the method of psychotherapy speech. Results: Statistical analysis showed that although the initial state of the subjects in both groups were the same, there was a significant difference in results when comparing post-intervention for all items surveyed. The group of subjects treated with EMDR in psychotherapy presented final score far below the initial anxiety (p <0.0001), depression (p <0.0001), hopelessness (p = 0.0001) and impact of events (p = 0.0083), compared to those treated by speech therapy. Conclusion: Psychotherapy with EMDR is suitable for treatment of traumatic situations, and presents significant results from the first session on the impact of the event and symptoms of anxiety, depression, hopelessness. The results and agility should be considered for large demands such as in public health.
Keywords: Beck Depression Inventory Comparative Study Psychotherapy Speech Single Session Trauma
Accuracy Verified: Yes
14. Parnell, L. (1995, June). The use of imaginal and cognitive interweaves with sexual abuse survivors. Presentation at the EMDR Network Conference, Santa Monica, CA.
Language: English
Format: Conference
Abstract:
This hour and a half presentation addresses the use of cognitive and imaginal interweaves in the treatment of adult survivors of
sexual abuse. The overall course of treatment with EMDR is briefly outlined including a variety of interweave interventions for use
in the beginning, middle and end of EMDR sessions.
In working with sexual abuse survivors with EMDR it is important to understand the issues commonly encountered in their
treatment. These include issues of safety, trust, responsibility, choice/control, interpersonal relationships, body awareness and
image, sexuality and self esteem. A sexual abuse assessment can be taken which includes information on the perpetrator(s), severity
and frequency of abuse, type of abuse, age of onset of abuse, duration of abuse, disclosure and family response.
Sexual abuse survivors present themselves in treatment in different ways. Some clients come to treatment remembering abuse and
want to clear it with EMDR. Other clients come to treatment with no clear memories of incidents but have a "feeling" something
happened to them and have symptoms of abuse. There are clients who have no clear memories but something has triggered
flashbacks and nightmares of sexual abuse. Finally, there are clients who have no memory of abuse and come to therapy for another
reason but uncover what they believe to be sexual abuse memories with EMDR.
There are three phases of treatment in sexual abuse cases. In the beginning phase, a history is taken and there is the establishment
of a trusting relationship. The client is prepared for EMDR. In the middle phase, there is the reprocessing and working through of
traumatic memories and transference work. In the end phase of treatment there is integration of the information which has been
uncovered and preparation for life outside of therapy.
Interweaves can be utilized in the beginning, middle and end of EMDR sessions.
In the beginning of individual EMDR sessions there is a check-in with clients to see how they have been doing during the week.
What has come up for them in their dreams or daily life since the last session? Next there is the selection and development of targets
for EMDR (body sensation, memory, flashback, symptom, dream, feeling, vague sense, negative cognition or drawing).
A safe place is then established where the client can go at the beginning, middle or end of the session as needed. Along with the
safe place an inner advisor or other inner resources can be contacted and developed for use in sessions. A connection with the
client's inner child is important which can be done through the use of guided imagery, photographs and/or artwork.
Instructions on how EMDR will be used are given with attention paid to issues of safety and control (they are in control, they can
stop at any time, they can return to the safe place, they know the signal for stop). Negative and positive cognitions are established
along with the EMDR protocol.
In the middle of individual EMDR sessions there are commonly problems with looping or being "stuck." This seems to occur
frequently with sexual abuse survivors because of the intensity of the trauma and because the child self is often frozen in time
lacking access to the adult self's information. Ways to work with this include looking for the blocking beliefs (i.e., The perpetrator
can hurt me), look for blocking images, and talking to the child part (what does he/she need?).
Imaginal and cognitive interweaves can be used in a variety of different ways in the middle of EMDR sessions. Some of these
include: imagining the adult self helping the child self in the traumatic scene, bringing in inner and outer resources for help (i.e., a
powdl imaginary being, a strong loving fiend, the therapist, etc.), and reality check interweave where is the perpetrator now?, can
helshe hurt you now?) It is also important to educate the child part that his or her feelings are normal, sexual feelings are normal etc.
It can be helpful to ask the adult self to talk to the child self explaining things to the child. Another useful interweave is to have the
adult self hold the perpetrator and allow the child to beat him or her up or have the adult self beat up the perpetrator allowing anger
to be expressed safely. Asking clients if they would like to return to the safe place for a break can also be helpful if they are feeling
too overwhelmed.
There are a number of ways to end or close incomplete EMDR sessions. Often it will not be possible to completely clear a traumatic
memory in a session or the memory worked on is completed but connected to a whole network of other traumatic events. For these
cases there are a number of interweaves that can be used. Clients can be requested to have the adult self comfort the child self in the .
safe place. The client can imagine putting the scary unfinished disturbance that has been uncovered in a file folder, box, safe, leave
it in the therapist's office, etc. The client can return to the safe place where the child and adult selves can play together. The adult
can comfort the child or do whatever is needed to create safety and containment. Clients can imagine their child self being held by
protector figures repeating cognitions related to safety, responsibility and choice. They can also be asked what they learned from the
session, installing their response with eye movements.
It is helpful to give homework to clients such as journaling, artwork, walks in nature, meditation, stress reduction, group work,
exercise, nutritious diet, and restriction of drugs and alcohol. Loving Kindness or Metta Meditation is another very helpful tool for
teaching self soothihg to adult survivors of sexual abuse.
Keywords: Cognitive Interweave Imaginal Interweave Sexual Abuse Survivors
Accuracy Verified: Yes
15. Beer, R., Cde Roos, C., de Jongh, A., & ten Broeke, R. (2013, APril). Van flashback tot flash forward [From flashback to flashforward]. Keynote presented at the Congress EMDR Vereniging EMDR Nederland, Nijmegen, the Netherlands.
Language: English
Format: Conference
Abstract:
Keywords: Flashback Flashfoward
Accuracy Verified: Yes