Francine Shapiro Library ~ EMDR Bibliography

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1. 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

2. Haour, F. (2009, June). Brain source imaging of the alpha rhythm in PTSD patients using the MEG technique. In K. Zaal (Chair), Research). Symposium conducted at the annual meeting of the EMDR Europe Association, Amsterdam, the Netherlands.

Language: English

Format: Conference

Abstract:
In anxiety disorders, such as PTSD, brain imaging has demonstrated local modifications of functional activities using various techniques. In the present study the direct neuronal activities were measured in delta, theta and beta frequencies, using Magnetoencephalagraphy (MEG) which provides very fast temporal response. The technique is neither invasive nor stressful for the patients. Nineteen female volunteers with DSM-IV PTSD were included in the study. The protocol was a script-driven imagery provocation test, achieved with the patients sitting in the MEG apparatus. The scenarios, specific for ach patient, were composed of 4 active conditions: neutral image (N) traumatic memory (T), traumatic memory suppression (TS) and positive image (P) corresponding to 3 minutes where the patient had to imagine the corresponding sequence with eyes closed Measures of heat rate and subjective disturbance (SUD) were measured during the recoding. The MEG data were analysed in the source domain using a spatial filtering approach. Measurement of electrophysiological waves of various rhythms: delta: 1-4 Hetz (Hz), theta: 4.8-5.8 Hz, alpha: 8-12 Hz and beta: 12-25 Hz was obtained. Anatomical information was from MRI imaging. Signal of activation during trauma recall (T-N) were limited to the delta and theta waves and mainly found in the left hemisphere (visual, orbitofrontal and dorsolateral prefrontal and temporal gyrus (BA 8-9-10-11, 18-19, 22, 28) and in the right supra marginal gyrus (Wernicke BA 40). Signal of inhibition during trauma recall (T-N) were found mainly in the left hemisphere, in the delta, alpha and beta waves (visual, orbitofrontal, dorsolateral prefrontal and temporal gyrus (BA 8-9-10-11, 18-18, 22, 28), cingular cortex (BA 23-24, 31, 32), insula (BA 13) and Broca visual cortex (BA 18-19, 43-44). In conclusion trauma recall mainly induces a hypoactivation in the ventromedial prefrontal cortex and in the cingular cortices, structures linked to the experience and regulation of emotions.

Keywords: Alpha Rhythm Brain Imaging MEG Technique Posttraumatic Stress Disorder PTSD Research Symposium

Accuracy Verified: Yes

3. Haour, F. (2010, June). Brain source imaging using magnetoencephalography (MEG): Modifications in various rhythms during memory recall, in PTSD patients. In Research. Symposium conducted at the annual meeting of the EMDR Europe Association, Hamburg, Germany.

Language: English

Format: Conference

Keywords: Magnetoencephalography MEG Memory Recall Posttraumatic Stress Disorder PTSD Research Rhythms Symposium

Accuracy Verified: Yes

4. Langwig, K. E. (2008, December). A functional magnetic resonance imaging study of the effects of eye movement desensitization and reprocessing therapy on post-traumatic stress disorder car accident patients: A pilot study. Union College, Schenectady, N.Y.

Language: English

Format: Dissertation/Thesis

Abstract:
Eye movement desensitization and reprocessing (EMDR) therapy is a novel therapy that has been effective in treating post-traumatic stress disorder (PTSD). Few studies have explored the neurological underpinnings of EMDR effectiveness. Utilizing a symptom provocation study design, this study assessed non-PTSD car accident patients. These pilot participants were scanned for comparison to PTSD patients and to explore the task design effectiveness for the future study of PTSD patients. One pilot participant exhibited activation in the left precuneus, and left medial temporal gyrus, and also in the left medial frontal gyrus. In PTSD patients the medial prefrontal cortex is often hypoactive, and inversely correlated with a hyperactive amygdala. The robust activation of medial frontal gyrus in the pilot subject with a corresponding inactivation of the amygdala indicates the participant's normal processing of the car accident trauma tic memories, and that task design and study parameters are being effectively implemented.

Keywords: Automobile Accidents Car Accidents fMRI Pilot Study Posttraumatic Stress Disorder PTSD

Accuracy Verified: Yes

5. 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

6. 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

7. 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

8. 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

9. Lansing, K., Amen, D. G., Hanks, C., & Rudy, L. (2005, Fall). High-resolution brain SPECT imaging and eye movement desensitization and reprocessing in police officers with PTSD. Journal of Neuropsychiatry and Clinical Neuroscience, 17(4), 526-532. doi:10.1176/appi.neuropsych.17.4.526.

Language: English

Format: Journal

Abstract:
Eye movement desensitization and reprocessing (EMDR) has been shown to be an effective treatment for PTSD. In this study, the authors evaluated the effectiveness and physiological effects of EMDR in police officers involved with on-duty shootings and who had PTSD. 6 police officers involved with on-duty shootings and subsequent delayed-onset PTSD were evaluated with standard measures, the Posttraumatic Stress Diagnostic Scale (PDS), and high-resolution brain single photon emission computed tomography (SPECT) imaging before and after treatment. All police officers showed clinical improvement and marked reductions in the PDS score. In addition, there were decreases in the left and right occipital lobe, left parietal lobe, and right precentral frontal lobe as well as significant increased perfusion in the left inferior frontal gyrus. In our study EMDR was an effective treatment for PTSD in this police officer group, showing both clinical and brain imaging changes. [Author Abstract]

Keywords: Empirical Study Off-Duty Shootings Police Officers Posttraumatic Stress Disorder PTSD Quantitative Study SPECT

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. Lansing, K. (2004, November). Images of healing: SPECT images of PTSD and recovery in police officers. Preconference presentation at the 20th annual meeting of the International Society of Traumatic Stress Studies, New Orleans, LA.

Language: English

Format: Conference

Abstract:
The effects of “lethal contact” (i.e., close range firefights) in both the military and law enforcement populations can render long-standing psychological impairment. In this study we evaluated the effectiveness and physiological effects of EMDR in police officers involved with on-duty shootings who had delayed PTSD. Method: Six police officers involved with on-duty shootings and subsequent delayed-onset PTSD were evaluated with standard measures, the Posttraumatic Stress Diagnostic Scale and high-resolution brain SPECT imaging, before and after treatment. Results: All police officers showed clinical improvement and marked reductions in the PDS (mean reduction from scores of 43.2 pre EMDR to 5.2 post EMDR). In addition, there were decreases in the left and right occipital lobe, left parietal lobe and right precentral frontal lobe, as well as significant increased perfusion (>0.001) in the left inferior frontal gyrus. Conclusions: In our study EMDR was an effective treatment for PTSD in this police officer group, showing both clinical and brain imaging changes. This multimedia presentation integrates selected case reviews including the dispatch recordings of the officer’s actual shooting incident/s, follow-up “check-in” messages documenting the officer’s reactions upon return to duty as well as pre- and post-treatment brain images. Brief selections of video also are used to further illustrate key principals. Clinical methodologies that were used with this group of subjects also will be discussed. Participant Alert: EMDR is a stepwise protocol designed to facilitate the reexperiencing of “trauma based” memories in order to assist the client in reformatting them into a non-disturbing / more “normalized” memory. During this protocol highly charged/upsetting images, feelings or experiences can arise for the client.

Keywords: Police Officers SPECT

Accuracy Verified: Yes

12. 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

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. 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

18. 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