Francine Shapiro Library ~ EMDR Bibliography

Francine Shapiro Library - EMDR Bibliography Links

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1. Mueller-Schwefe, R. (2010, June). Back into life - EMDR with primary withdrawal after trauma. In Experimental use of EMDR. Symposium conducted at the annual meeting of the EMDR Europe Association, Hamburg, Germany.

Language: English

Format: Conference

Abstract:
“Where I am? I am somewhere between heaven and earth, but I don't know where exactly." "My therapist waited for my anger, but it just isn't there...nowhere” – “I can't imagine anything helpful when I feel bad, I just don't have the energy... it's all too much for me." – “I just want to give up...” Reaction to traumatic events can vary a lot. This is true even when a PTSD has been diagnosed. Contrary to the 'classical' hyper-arousal response to traumatic memories there is also a different pattern of response that is characterized by a lack of an increase in heart rate, and very different pattern of neural activations, despite having a severe case of acute and subsequent PTSD'[l] and may go along with (peri- and posttraumatic) dissociation, emotional numbness, exhaustion, withdrawal and depression. The above statements belong to people with this pattern of response who have experienced subsequent difficulties already in the stabilization phase of their trauma-therapy. First, I will present an understanding of this symptomatology, the hypothesis being a predominance of the dorsal vagal system (see: Polyvagal Theory [2] and activation of the early withdrawal reflex (or: fear-paralysis reflex). This goes along with particular cognitive and especially emotional and physical features. Second, I will present a way to work with this condition, taking into account that the completion of "interrupted action." In this case does not imply an outward (fight or fight response) but an inward orientation withdrawal). EMDR with an adjusted protocol and tactile bilateral stimulation provides the way to process and pull through this interrupted (or unsatisfied) organismic withdrawal and the fear mostly associated with this process. Returning from this deep and primary withdrawal from life brings back the energy and the patient turns back towards life; vagal predominance subsides and the stuck impulse to withdraw releases. 1. Ruth A. Lanius, James W. Hopper, Ravi 5. Menon, Individual Differences in a Husband and Wife Who Developed PTSD After a Motor Vehicle Accident: A Functional MRI Case Study. Am J Psychiatry 160:4. April 2003, p. 668. 2. Porges. S.W. (2001). The Polyvagal Theory: Phylogenetic substrates of a social nervous system. International Journal of Psychophysiology, 42, 123-146. Learning objectives: 1. Recognize dorsal vagal predominance and primary withdrawal after trauma, 2. Understand the different orientation of interrupted action/ trauma scheme, 3. Know how to help withdrawal-patients to stabilize and process with adjusted EMDR-protocol and tactile or auditory bilateral stimulation. New and unique: Identifying this withdrawal-type of traumatic reaction and scheme, understanding it with the help of Polyvagal Theory and development of EMDR- adjusted protocol and way to process this.

Keywords: Primary Withdrawal Symposium

Accuracy Verified: Yes

2. Pagani, M., Salmaso, D., Looi, J., & Hogberg, G. (2008, June). Brain functional and volumetric analyses post traumatic stress disorder treated by EMDR. Presentation at the annual meeting of the EMDR Europe Association, London, England.

Language: English

Format: Conference

Abstract:
Neuro-imaging investigations in PTSD have reported findings for either functional or structural modifications. Only two studies have investigated the changes in cerebral blood flow (CBF) following EMDR therapy and one single-patient study recently reported EMDR-related structural changes. The aim of this study was to analyse the structural and functional changes occurring in brain regions implicated in the patho-physiology of PTSD along with the impact on CBF and volumetric data after EMDR treatment. Thirty six train drivers having being exposed to traumatic experiences at work were assigned to different two groups: symptomatic (S, n=17) or nonsymptomatic (NS, n=19), according to PTSD diagnosis. SPECT, following administration of an individualised 35 trauma script, and MRI were performed and EMDR therapy was administered to S. According to EMDR outcome S were further subdivided in responders (R, n=11) and non-responders (NS, n=5). One patient was not treated. CBF and volumetric analyses were performed on temporal lobes, hippocampi and nuclei caudati. ANOVA showed a significantly higher CBF distribution in the left temporal lobe of S as compared to NS and the right nc.caudatus was significantly larger in S. The R group had larger hippocampi and nc.caudati as compared to NR and the size of hippocampi correctly identified 81% of R and NR. The increased left temporal lobe CBF distribution among symptomatic PTSD subjects may reflect the affective significance of higher effort in emotional episodic memory stimulation among symptomatic individuals. Hippocampi volume as measured before EMDR was shown to predict with high accuracy the therapy outcome.

Keywords: Posttraumatic Stress Disorder PSTD

Accuracy Verified: Yes

3. 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

4. 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

5. Emard, P. (1995, June). A brief look at MRI brief therapy. Presentation at the EMDR Network Conference, Santa Monica, CA.

Language: English

Format: Conference

Abstract:
The MRI approach to brief therapy originated out of the serendipitous coming together of several incredibly creative minds that resulted in a form of psychotherapy in which the major goal was to make psychotherapy more efficient and more effective. It evolved out of research project on communication begun by anthropologist Gregory Bateson that soon involved the work of hypnotherapist Milton H. Erickson and psychiatrist Don Jackson. John Weakland, Jay Haley, Paul Watzlawick and Richard Fisch began to publish the ideas that resulted fiom the early research findings and in doing so developed a particular set of assumptions about the formation and resolution of human problems that differed significantly from traditional treatment models of the time. Further refinements through the clinical application of these methods resulted in a model of treatment that was a pioneer of the brief psychotherapy movement. It is based on a non-normative and non-pathological way of viewing people with problems; it looks at people in the context of their living situations; it resists the idea of client resistance, it places great emphasis on the use of language; and it seeks to amplify client assets and resources and minimize client liabilities and shortcomings. Brief therapists assume a willingness to be an active change agent for the benefit of their clients. They accept responsibility for creating an atmosphere of respect, patience, and creativity in which clients can find alternative ways to think and behave. They believe they have a set of tasks to perform that will hopefully result in the resolution or, as a minimum, the diminishment of the problem situation for which the client originally sought help. These tasks consist of a combination of ways of thinking and acting that are designed to increase the likelihood that the client will experience relief from a painful problem. One of the main tasks for a brief therapist is to find ways to construe the problems presented by the client so that a solution can be found. Brief therapists inquire into the interactional systemic aspects of a problem, the context or environment in which the problem occurs, the people involved in the problematic situation, and the ways the client has attempted to resolve the problem thus far. Another very important task is to identify and gain access to the persons who are the most interested in and willing to work toward changing the problem situation. The idea here is to spend the bulk of the therapeutic time and effort working with the person who is most invested in the change process. Brief therapists find ways to appeal to this person's values and belief systems so that (s)he will engage in activities and/or alter her/his behavior in ways that are likely to change the problem situation. A third task on which brief therapists concentrate is the establishment of clear, concrete, and doable goals of treatment. They collaborate with the client to determine what the client hopes to gain from treatment and when the client will know she is ready to handle life on his/her own, this assumes an emphasis on the client's present and the possibilities for the client's future rather than his/her past. The fourth task brief therapists focus on is the development of ways of intervening in the way the presenting problem is being handled in the present time. This is based on the central assumption that one of the main goals of psychotherapy is to induce clients to change the way a problem is handled. Such intervening is the result of thoughtful and careful consideration of many factors surrounding the problem situation and involves the use of a variety of skills. A final task for the brief therapist is to find ways to remove him/herself from the client's life in such a way that the client has faith in her/his own ability to function effectively without the therapist. This treatment model offers clinicians an opportunity to work in positive, goal-directed ways that clients find helpful and therapists find challenging and satisfying. It calls upon clinicians to develop keen observation skills, the ability to see things fiom a variety of perspectives, and an appreciation for the vast resources clients bring with them to therapy. While it is a simple model of treatment, it is by no means an easy one to master. It requires clinicians to step outside their usual frames of reference in the pursuit of creative solutions to difficult human problems. It rewards them with a greater sense of accomplishment and increased client satisfaction. In the ever-changing world of mental health, this is no small achievement.

Keywords: MRI Brief Therapy

Accuracy Verified: Yes

6. Pagani, M., Högberg, G., Fernandez, I., & Siracusano, A. (2013). Correlates of EMDR therapy in functional and structural neuroimaging: A critical summary of recent findings. Journal of EMDR Practice and Research, 7(1), 29-38. doi:10.1891/1933-3196.7.1.29.

Language: English

Format: Journal

Abstract:
Neuroimaging investigations of the effects of psychotherapies treating posttraumatic stress disorder (PTSD), including eye movement desensitization and reprocessing (EMDR), have reported findings consistent with modifications in cerebral blood flow (CBF; single photon emission computed tomography [SPECT]), in neuronal volume and density (magnetic resonance imaging [MRI]), and more recently in brain electric signal (electroencephalography [EEG]). Additionally in the recent past, EMDR- related neurobiological changes were monitored by EEG during therapy itself and showed a shift of the maximal activation from emotional limbic to cortical cognitive brain regions. This was the first time in which neurobiological changes occurring during any psychotherapy session have been reported, making EMDR the first psychotherapy with a proven neurobiological effect. The purpose of this article was to review the results of functional and structural changes taking place at PTSD treatment and presented during the period of 1999–2012 by various research groups. The reported pathophysiological changes are presented by neuropsychological technique and implemented methodology and critically analyzed.

Keywords: EEG Limbic System MRI Neurobiology SPECT

Accuracy Verified: Yes

7. Jatzko, A., Ruf, M., & Schmitt, A. (2008, Mai). Durch EMDR normalisierte funktionelle verarbeitungsprozesse bei PTBS: Eine fMRT pilotstudie [EMDR normalized by functional processing in PTSD: An fMRI pilot study] . Poster präsentiert auf der 10. Jahrestagung der DeGPT Deutschsprachige Gesellschaft für Psychotraumatologie, Psychisches Trauma-korperliches Leiden, Basel, Schweiz.

Language: German

Format: Conference

Abstract:
Es existieren kaum Untersuchungen mittels funktioneller Bildgebung, die den Effekt psychotherapeutischer Verfahren und deren Auswirkungen auf das Gehirn eruieren. Eye-Movement-Desensitization and Reprocessing (EMDR) ist ein anerkanntes Verfahren zur Behandlung der posttraumatischen Belastungsstörung, jedoch wurde noch keine fMRT-Studie zu diesem Verfahren veröffentlicht. Diese fMRT-Studie soll erste Hinweise auf die Auswirkungen einer EMDR-Therapie auf die Informationsverarbeitung einer Patientin mit einer posttraumatischen Belastungsstörung (PTBS) zeigen.

The fMRI study was at the ZI in a SIEMENS VISION 1.5 Tesla MR scanner with a 2D/EPI-Sequence (3.43 mm x 3:43 in plane Resolution, 24 layers, 4 mm per layer, 1 mm gap) and a Repetition time of 2.94 s made. It was her description of her of the accident at the moment of impact in a block design alternating with a baseline condition (only MRI noise) presented. Each 8x block was presented for 19.8 sec. After this there is a EMDRBehandlung (2h), where there were violent reactions of the patient. After a 20th Break was repeated the fMRI procedure. The Analysis was performed by BrainVoyager QX 1.9, with a t-test (fixed effect) with a threshold of q <0.5 (corrected) as was assumed significant.

Keywords: fMRI Pilot Study Poster Posttraumatic Stress Disorder PTSD

Accuracy Verified: Yes

8. Goodwin, D., Banner, L., & Hayward, R. (1995, June). Effects of EMDR in treating erectile dysfunction measured by magnetic resonance imaging. Symposium conducted at the EMDR Network Conference, Santa Monica, CA.

Language: English

Format: Conference

Abstract:
The experimenters seek to determine whether the reported anxiety-relieving effects of (EMDR) can be effectively applied to patients reporting erectile dysfunction and whether the expected changes in levels of anxiety can be measured as a function of changes in brain function observed through MRI tracings. The MRI is well suited to reflect hypothesized changes in the lowering of sympathetic arousal and the increasing of parasympathetic arousal as a response to EMDR procedures. This investigation, using the MRI brain scanning procedures was followed in stages of (1) establishing criteria for the radiological determination of characteristics of brain function measured with the MRI that descriminate between levels of experimentally induced anxiety and (2) conducting an experimental investigation of the application of EMDR while patients are undergoing the MRI scanning protocol. Psychological measures include the Personality Assessment Inventory(PAI) to screen for psychotherapy of subjects, the Impact of Events Scale(IOE), and the State-Trait Anxiety Inventory(STAI). Correlations between these scales and ratings of physiological changes are reported.

Keywords: Erectile Dysfunction MRI Scanning Protocol Symposium

Accuracy Verified: Yes

9. Konuk, E., & Epozdemir, H. (2010, July). EMDR and strategic family therapy. Presentation at the 1st EMDR Asia Conference, Bali, Indonesia.

Language: English

Format: Conference

Abstract:
Strategic Family Therapy developed some 50 years ago by a handful of visionaries at MRI (Mental Research Institute) in Palo Alto, California. This is why sometimes it is known as the “Palo Alto Group”. The kind of therapy evolved at that time changed the therapy world radically. The major shift was that: • The theory was a theory of change. The emphasis was on change rather than to understand how and why problems exist. • The focus was relationships rather than the phenomena going on under the skin of an individual. This meant that the way the therapist approached the clients was Systemic or interactional. • Strategic map was large enough to allow the therapist work with almost any kind of problem, borrow and use different techniques that belong to other approaches without conflict and confusion. • At that time therapy meant globally 4-5 sessions a week for many years. This was reduced to an average of 7-10 sessions. So when a therapist learned one of the Family Therapies, he learned essentially how to do therapy briefly. One of the approaches that EMDR therapists may integrate efficiently into their practice is Family Therapy. It may speed up the therapy especially when both trauma and relationships are particularly having a role in the formation and maintenance of the problem. In this workshop, the participants will learn: • The basic principles and techniques of Strategic Family Therapy, • Why and how change occurs, • When Strategic Family Therapy is called upon for help, • How interventions are designed and implemented.

Keywords: Strategic Family Therapy

Accuracy Verified: Yes

10. Konuk, E. & Epozdemir, H. (2010, March). EMDR and strategic family therapy. Presentation at the XVIII World International Family Therapy (IFTA) Congress, Buenos Aires, Argentina.

Language: English

Format: Conference

Abstract: Strategic Family Therapy developed some 50 years ago by a handful of visionaries at MRI (Mental Research Institute) in Palo Alto, California. This is why sometimes it is known as the “Palo Alto Group”. The kind of therapy evolved at that time changed the therapy world radically. The major shift was that: • The theory was a theory of change. The emphasis was on change rather than to understand how and why problems exist. • The focus was relationships rather than the phenomena going on under the skin of an individual. This meant that the way the therapist approached the clients was Systemic or interactional. • Strategic map was large enough to allow the therapist work with almost any kind of problem, borrow and use different techniques that belong to other approaches without conflict and confusion. • At that time therapy meant globally 4-5 sessions a week for many years. This was reduced to an average of 7-10 sessions. So when a therapist learned one of the Family Therapies, he learned essentially how to do therapy briefly. One of the approaches that Family and Marriage Therapists integrate efficiently into their practice is EMDR. Though EMDR (Eye Movement Desensitization and Reprocessing) is relatively new in the therapy world, now it is credited by many professional and governmental organizations as either “treatment of choice” or a valid psychotherapy approach. Especially when trauma is particularly have a role in the formation of the problem, then EMDR is a “life saver” for the therapist. In this workshop, the participants will learn: • The basic principles and techniques of EMDR and Strategic Family Therapy • Why and how change occurs • When EMDR is called upon for help • How interventions are designed and implemented The cases will be presented by live video recordings of sessions.

Keywords: Strategic Family Therapy

Accuracy Verified: Yes

11. Corrigan, F. M. (2005, June). Emoting mindfullness drives reprocessing: Clinical and functional MRI observations. In Research issues. Symposium conducted at the annual meeting of the EMDR Europe Association, Brussels, Belgium.

Language: English

Format: Conference

Abstract:
It is proposed that enhanced mindfulness of emotions is a key factor in successful reprocessing of traumatic memories with EMDR. Clinical experience of utilising this focus will be presented. An attempt to study the hypothesis using functional magnetic resonance imaging will be described.

Keywords: MRI Research

Accuracy Verified: Yes

12. Thompson, M. M., Pasto, L., & McCreary, D. R. (2002, July). Empirical assessment of Lanius, et al.s’ “functional MRI of EMDR in peacekeepers,’ a review of the EMDR literature and an annotated bibiliography. Defence R&D Canada – Toronto, Technical Memorandum, DRDC Toronto.

Language: English

Format: Other

Abstract:
This report reviews a research proposal, the major objective of which is to assess the relation between PTSD (Post Traumatic Stress Disorder) and limbic, paralimbic, and prefrontal brain function as assessed with functional MRI (Magnetic Resonance Imaging), and to determine whether an Eye Movement Desensitization and Reprocessing (EMDR) intervention causes those structures to return to a normal mode of functioning. The proposed study secondarily explores the effectiveness of EMDR in reducing PTSD symptomatology. While the first and second objectives of the study may have scientific merit, the mandates of other funding agencies would appear to be more appropriate for investigations of basic neuroscience processes associated with brain functioning in PTSD (e.g., NSERC or CIHR). Importantly, a critical review of the EMDR research reveals that a great deal of controversy surrounds the effectiveness of this therapy. EMDR has not been shown to be more effective than presently validated PTSD exposure-based therapies, and the eye movement component of EMDR appears to provide no therapeutic benefit. Finally, there is a lack of clarity around specific items listed in the proposed budget. Given these concerns it is not recommended that this proposal be funded at this time.

Keywords: Bibliographies Canada Desensitizing' Magnetic Resonance Imaging Eye Movements Mental DIsorders MRI Medical Research Order Disorder Transofrmations Signs and Symptoms Stress (Physiology) Traumatic Shock

Accuracy Verified: Yes

13. Pagani, M. (2013, June). Functional and structural neuroimaging and EEG monitoring related to EMDR and CBT treatments for PTSD. Presentation at the 13th annual conference for the European Society for Traumatic Stress Studies (ESTSS), Bologna, Italy.

Language: English

Format: Conference

Abstract:
In the recent past several neuroimaging studies aimed at evaluating the neural correlates of PTSD-related psychotherapies revealing their neurobiological effects on brain function. Functional studies by single photon emission computed tomography (SPECT) and electroencephalography (EEG) detected changes in cerebral blood flow and neuronal activation patterns, identifying the brain areas implicated in the various components of emotional processing and/or affected by the disorder. Investigations by magnetic resonance imaging (MRI) have also revealed PTSD-related structural changes. The first part of the workshop will review the neuroimaging methodologies and findings in PTSD treatment-related research with an extensive review of previous literature on the neurobiological effects of the various psychotherapies. The second part will deal with the description and implementation in research and clinic of neuropsychological testing with brief comments and discussion about their use in recent studies published by our group. In the third part the EEG monitoring of a complete set of Eye Movement Desensitization and Reprocessing therapies in 30 patients suffering of major trauma as compared to 20 healthy controls will be presented. These findings will also be compared to the neurobiological effects of trauma-focussed Cognitive Behavioural Therapy in a second group of psychologically traumatized clients. The results are the first report ever on the neurobiological changes occurring before, during and after PTSD-related psychotherapies shedding light on the neuronal processes underlying their clinical efficacy. The description and the discussion about the contents of the workshop will provide the audience (1) the necessary information to understand the methodological principles behind neuroimaging techniques (SPECT, EEG and MRI) and their possible applications in research and clinic; (2) the up-dated critical knowledge of the published papers in the field of PTSD-related psychotherapies functional and anatomical studies; (3) the basic research principles and examples to be motivated to start, take part and/or collaborate to functional studies in order to better understand the neural basis of psychotherapeutic techniques. The presented material will represent the state-of-the-art of the current neuroscience PTSD-related research and of the neuroimaging methodologies available at the moment.

Accuracy Verified: Yes

14. Choi, J., Kim, D., Kim, S-H., Lee, J-H., & Park, D-W. (2004, September). Functional MRI findings of EMDR for PTSD: A case series using script-driven imagery procedure. Poster presented at the annual meeting of EMDR International Association, Montreal, Quebec CA.

Language: English

Format: Conference

Keywords: MRI Findings PSTD Script-Driven Imagery Procedure

Accuracy Verified: Yes

15. 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

16. 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

17. 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

18. Konuk, E., & Epozdemir, H. (2010, June). The integration of EMDR and brief strategic therapy. Presentation at the annual meeting of the EMDR Europe Association, Hamburg, Germany.

Language: English

Format: Conference

Abstract:
Directives and strategic interventions were used in therapy for the first time almost half a century ago by a small number of 'communication researchers' at MRI (Mental Research institute) in Palo Alto. California. First time in the history of therapy, the therapist was not alone with the dent in the therapy room. He began inviting to the sessions the family members. people who are contributing to the problem and people who will come up and help to find solutions. The radical difference was that; The Palo Alto Group was not preoccupied with searching the reasons why there is a problem. Their emphasis was to find a solution to the problems the individual or the family is having. Therefore they always asked how change is possible. Another major shift in therapy was that: they focused not on the "intra-psychic" phenomena but on the relationships. Hence the terms 'interactional' and 'systemic'. They assumed that, if you can manage to change the interaction (behavior) or the system (how the family gets organized around the problem) you can overcome the problem. Another contribution was that the new map or the new paradigm was large enough to allow the therapist to incorporate and use varieties of techniques that belong to other approaches without any confusion. In '50s and '60s therapy used to take couple of sessions a week for many years. The Interactional or the Systemic approach heaped reduce the number of sessions per client to an average of 7-15 sessions. They coined the term 'Brief' to described their approach. Traditionally the new approach took several names: Interactional Therapy, Family Therapy, Brief Strategic Family Therapy, Systemic Family Therapy, Solution Focus Therapy and some others. One of the approaches that Family and Marriage Therapists integrate efficiently into their practice is EMDR. Especially when trauma is particularly having a role in the formation of the problem, then EMDR 18 a "life saver" for the therapist. Our learning objectives are: 1. to describe basic principles and techniques of EMDR and Brief Strategic Family Therapy 2 to explain the rationale of integrating EMDR and BSFT 3 to demonstrate skills on designing and implementing an intervention. The innovative view which stands behind this workshop is that the BSFT and EMDR can be efficiently integrated, which has not been frequentiy addressed in previous literature. At times the therapist may need to intervene in the process by using interventions other than BSFT EMDR very nicely serves this purpose without causing any mental confusion on the part of the therapist and the client.

Keywords: Brief Strategic Therapy

Accuracy Verified: Yes

19. Luber, M., & Shapiro, F. (2009). Interview with Francine Shapiro: Historical overview, present issues, and future directions of EMDR. Journal of EMDR Practice and Research, 3(4), 217-231. doi:10.1891/1933-3196.3.4.217.

Language: English

Format: Journal

Abstract:
This interview with Dr. Francine Shapiro, originator and developer of Eye Movement Desensitization and Reprocessing (EMDR), provides an overview of the history and evolution of EMDR from its inception to current findings and utilization, as well as future directions in research and clinical development. Dr. Shapiro discusses the psychological traditions that informed the development of EMDR and the Adaptive Information model, as well as the implications for current treatment. The rationale for the application of EMDR to a wide range of disorders is discussed, as well as its integration with other therapeutic approaches. Topics include research on the role of eye movements, the use of EMDR with combat veterans, somatoform disorders, attachment issues, and the distinct features of EMDR that have allowed it to be used for crisis intervention worldwide. Dr. Francine Shapiro is the originator and developer of EMDR. She is a senior research fellow at the Mental Research Institute (MRI) in Palo Alto, California, executive director of the EMDR Institute in Watsonville, California, and the founder and president emeritus of the EMDR Humanitarian Assistance Program, a nonprofit organization that coordinates disaster response and supports low fee training worldwide. She has written the primary text on EMDR: Eye Movement Desensitization and Reprocessing: Basic Principles and Procedures (Guilford Press) and co-authored or edited four others: EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress and Trauma (Basic Books), EMDR as an Integrative Psychotherapy Approach: Experts of Diverse Orientations Explore the Paradigm Prism (American Psychological Association Books), Handbook of EMDR and Family Therapy Processes (Wiley), and Short-Term Therapy for Long-Term Change. She has written and co-authored more than 60 articles and chapters and is an invited speaker at psychology conferences all over the world. Dr. Shapiro is a recipient of the American Psychological Association Division 56 Award for Outstanding Contributions to Practice in Trauma Psychology, the Distinguished Scientific Achievement in Psychology Award presented by the California Psychological Association and the International Sigmund Freud Award for Psychotherapy presented by the City of Vienna in conjunction with the World Council of Psychotherapy. She was appointed one of the “Cadre of Experts” by the American Psychological Association and Canadian Psychological Association Joint Initiative on Ethno-political Warfare. She has served as an advisor to many trauma treatment and outreach organizations and journals. She has three awards bestowed in her honor. Those given by the EMDR International Association and the EMDR-Ibero-American Association celebrate members of the EMDR community who follow in her footsteps of creative thinking, service, and dedication to the standard of EMDR. The EMDR Europe Association presents the Francine Shapiro EMDR-Europe Research Award in order to encourage research in the field. In 2008, a comprehensive electronic resource for scholarly articles and other important references related to EMDR and adaptive information processing was introduced and was named The Francine Shapiro Library in honor of Dr. Shapiro (http://emdr.nku.edu/emdr_data.php).

Keywords: History Interview

Accuracy Verified: Yes

20. Pagani, M. (2010, June). Introduction to neuroimaging in EMDR research. Presentation at the annual meeting of the EMDR Europe Association, Hamburg, Germany.

Language: English

Format: Conference

Abstract:
In the recent years the number of neuroimaging studies evaluating neural correlates of psychotherapy has steadily increased revealing its clear neurobiological effects on brain function across a wide range of psychiatric disorders. Functional studies by single photon emission computed tomography (SPECT) and positron emission tomography (PET) detect changes in cerebral blood flow and metabolism patterns, identifying the brain areas processing the various components of emotional processing and/or affected by the disorders. investigations by magnetic resonance imaging (MRI) have also revealed psychiatry disease-related structural changes. The first part of the workshop (20 minutes) will describe the neuroimaging methodologies implemented in EMDR research and their possible clinical implementations will be discussed. In the second part (10 minutes) neuroimaging studies on the neurobiological effect of EMDR will be reviewed (1-5). The third part of the workshop (30 minutes) will deal with the last findings in EMDR research and will focus on a recent studies published by our group on the Journal of Psychiatry Research about the predictive value of MRI on the outcome of EMDR therapy (6).Moreover a collaborator of our group will describe and present the preliminary findings of an ongoing experiment aiming to identify the neurophysiological mechanisms active during EMDR therapy. The description and the discussion about the contents of the workshop will provide the audience 1 the necessary information to understand the methodological principles behind the neuroimaging techniques (PET and SPECT) and their possible applications in research and clinic; 2, the critical knowledge of the limited number of published papers in the field of EMDR-related functional and anatomical studies (1-6); 3. the basic research principles and examples to be motivated to begin, take part and/or collaborate to EMDR research in order to shed light on the neural basis of this fascinating psychotherapeutic technique. The presented material will represent the state-of-the-art of the current neuroscience EMDR-related research and of the neuroimaging methodologies available at the moment. in case more contributions will be included in this workshop the proposed presentation time schedule might change. References: Lansing et al. (2005). J Neuropsych Clin Neurosci; l7(4):526-532. Propper et al. (2007). J Nerv Met Dis; 195:785-788. Ho DH and Choi J. (2007). J EMDR Pract Res; l(l):24-30. Pagani et al. (2007). Nuc Med Comm: 28(10):757-65. Bossini et al (2007). J Neuropsych Clin Neurosci; 19(4):475-476. Nardo et al. (2010). J Psychiatry Res; D0110.1016/jjpsychires.2009.10.014

Keywords: Neuroimaging Research

Accuracy Verified: Yes

21. Bossini, L., Tavanti, M., Calossi, S., Marino, G., Pieraccini, F., Vatti, G., & Castrogiovanni, P. (2008, Novembre). Le modificazioni del volume hippocampale dopo una terapia con EMDR nel PTSD [EMDR treatment for PTSD: effect on hippocampal volume]. Plenaria presentato le applicazioni cliniche di EMDR Congresso Nazionale, Milano, Italia.

Language: Italian

Format: Conference

Abstract:
Molti studi di Risonanza Magnetica (RM) hanno mostrato che in pazienti con Disturbo Post-Traumatico da Stress (DPTS) è presente un volume ippocampale più piccolo se confrontato con i controlli sani. Allo stesso tempo altre indagini hanno mostrato che i farmaci psichiatrici bloccano gli effetti dello stress nell’ippocampo e promuovano la neurogenesi a livello ippocampale. Comunque il solo studio che ha investigato gli effetti di un tipo di psicoterapia non ha evidenziato modificazioni volumetriche significative (1). Scopo dello Studio: Scopo dello studio è indagare gli effetti del trattamento con EMDR (Eye Movement Desensitization and Reprocessing) sul volume ippocampale e sui sintomi clinici di un gruppo di pazienti con DPTS. Metodologia: Abbiamo paragonato gli ippocampi di 9 pazienti con DPTS cronico e mai sottoposti ad alcun tipo di terapia (farmacologica e/o psicoterapica) a 9 soggetti sani accoppiati per sesso, età e scolarità. La diagnosi e la severità del DPTS è stata misurata tramite la Clinician-Administered PTSD Scale (CAPS) (Fase 1). Successivamente tutti i soggetti con DPTS sono stati sottoposti a 12 sedute settimanali di EMDR della durata di 90 minuti ciascuna e nuovamente sottoposti a valutazione clinica e RM (Fase 2). Risultati: Fase 1 - E’ stata scelta una p inferiore di .05 per indicare la significatività statistica. L’analisi della covarianza (ANCOVA) con l’emisfero (ippocampo sinistro vs. ippocampo destro) come fattore ripetuto, il volume totale cerebrale come covariata ha mostrato che i soggetti con DPTS hanno il volume ippocampale più piccolo rispetto ai controlli (F=12.53, d.f=1,15, p=.003). La media del punteggio della CAPS nei soggetti con DPTS era 55.78 ± 21.74. Fase 2 - Il trattamento con EMDR è associate ad un incremento del volume ippocampale sia a destra (5.9 %) (t=-3.34, df=8, p=.010) sia a sinistra (6.1 %) (t=-3.27, df=8, p=.011). I risultati indicano anche che il trattamento con EMDR produce un significativo decremento del punteggio totale della CAPS (da 55.78±21.74 a 19.33±15.49; t=4.78, df=8, p=.001 Conclusioni: La prima parte dello studio conferma i dati che mostrano che i soggetti con DPTS hanno un ippocampo più piccolo dei controlli sani La seconda parte suggerisce che il trattamento con EMDR può essere associato ad un miglioramento sintomatologico e ad un incremento del volume degli ippocampi. Questi risultati suggeriscono l’opportunità di continuare ad indagare gli effetti biologici delle psicoterapie.

Many studies of Magnetic Resonance Imaging (MRI) showed that in patients with Post-Traumatic Stress Disorder (PTSD) is a smaller hippocampal volume compared with healthy controls. At the same time other studies have shown that psychiatric drugs block the effects of stress and promote hippocampus neurogenesis in the hippocampus. However, the only study that investigated the effects of a type of psychotherapy showed no significant volume changes (1). Objective: The purpose of this study is to investigate the effects of treatment with EMDR (eye movement desensitization and reprocessing) on hippocampal volume and clinical symptoms of a group of patients with PTSD. Methods: We compared the hippocampi of nine patients with chronic PTSD and never subjected to any kind of treatment (pharmacological and / or psychotherapy) in 9 healthy subjects matched for sex, age and education. The diagnosis and severity of PTSD was measured by the Clinician-Administered PTSD Scale (CAPS) (Phase 1). Then all subjects with PTSD were subjected to 12 weekly sessions of EMDR lasting 90 minutes each and again subjected to clinical evaluation and MRI (Phase 2). Results: Step 1 - E 'was chosen p less than .05 to indicate statistical significance. The analysis of covariance (ANCOVA) with hemisphere (left vs. hippocampus. Right hippocampus) as repeated factor, the total brain volume as covariate showed that individuals with PTSD have smaller hippocampal volume than controls (F = 12:53 , df = 1.15, p =. 003). The average score of the CAPS in subjects with PTSD was 55.78 ± 21.74. Step 2 - Treatment with EMDR is associated with an increase in both right hippocampal volume (5.9%) (t =- 3:34, df = 8, p =. 010) and left (6.1%) (t =- 3.27, df = 8, p =. 011). The results also indicate that treatment with EMDR produces a significant decrease in the CAPS total score (from 21.74 to 55.78 ± 19:33 15:49 ± t = 4.78, df = 8, p =. 001 Conclusion: The first part of the study confirms the data showing that individuals with PTSD have a smaller hippocampus of healthy controls The second part suggests that treatment with EMDR may be associated with symptomatic improvement and an increase in the volume of the hippocampus. These results suggest the desirability of continuing to investigate the biological effects of psychotherapy.

Keywords: Hippocampal Volume Plenary Posttraumatic Stress Disorder PTSD

Accuracy Verified: Yes

22. Fisch, R. (1994, March). MRI brief therapy. Presentation at the EMDR Network Conference, Sunnyvale, CA.

Language: English

Format: Conference

Keywords: Brief Therapy MRI

Accuracy Verified: Yes

23. Fisch, R. (1993, March). MRI brief therapy. Presentation at the EMDR Network Conference, Sunnyvale, CA.

Language: English

Format: Conference

Keywords: MRI Brief Therapy

Accuracy Verified: Yes

24. Pagani, M. (2010, Novembre). Neurobiologia e nuovi concetti fisiopatologici dell’EMDR [Neurobiology and new concepts pathophysiological EMDR]. Presentazione al "Convegno La psicotraumatologia Oncologica, Roma, Italia.

Language: Italian

Format: Conference

Abstract:
La sindrome da stress post-traumatico (PTSD) causa nel cervello cambiamenti sia anatomici sia funzionali in specifiche aree cerebrali associate alla risposta emotiva al trauma ed alla relativa insorgenza dei sintomi. Studi di immagini funzionali (tomografia ad emissione di fotone singolo, SPECT, e a emissione di positroni, PET) e strutturali (risonanza magnetica, RM) hanno evidenziato significative variazioni neuropatologiche in pazienti con PTSD durante la rivisitazione del trauma. L’impiego di queste tecniche ha consentito di fare luce sui correlati neurali della psicoterapia, rivelando i suoi effetti neurobiologici sulle funzioni cerebrali. Nell’ambito dei diversi approcci psicoterapeutici, l’EMDR (Desensibilizzazione e rielaborazione attraverso i movimenti oculari) 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. Tuttavia solo un numero esiguo di studi ha indagato il substrato neurobiologico di questa psicoterapia. Verranno discussi studi che il nostro gruppo ha recentemente pubblicato su riviste internazionali e che hanno dimostrato con la SPECT come l’EMDR normalizzi il flusso ematico cerebrale nelle aree limbiche implicate nel PTSD (1) e con la RM come nei pazienti che non rispondono a terapia molte di queste aree presentino una diminuzione rilevante della densità della sostanza grigia (2). Verranno inoltre presentati i risultati preliminari del primo studio che monitora completamente con EEG una seduta EMDR e dimostra le attivazioni che i cicli di desensibilizzazione per se provocano a livello corticale e subcorticale sia durante la prima seduta che durante l’ultima quando il soggetto ha elaborato il trauma. 1. Nardo D et al. J Psychiat Res 2010; 44:477-485 2. Pagani M et al. Nucl Med Commun 2007; 28: 757-765

The syndrome of post-traumatic stress disorder (PTSD) causes changes in the brain is anatomical and functional in specific brain areas associated with emotional response to trauma and the related onset of symptoms. Studies of the functional (single photon emission computed tomography, SPECT, and emission tomography, PET) and structural (magnetic resonance imaging, MRI) have shown significant neuropathological changes in patients with PTSD during revisiting the trauma. The use of these 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 (Desensitization and reprocessing through eye movements) 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 neural circuits. However, only a small number of studies have investigated the neurobiological substrate of this psychotherapy. They will discuss studies that our group has recently published in international journals and who have demonstrated with SPECT as EMDR normalize cerebral blood flow in the limbic areas implicated in PTSD (1) and with MRI as in patients who do not respond to therapy many of these areas present a significant decrease in the density of gray matter (2). We will also present the preliminary results of the first study that monitors completely with EEG and demonstrates an EMDR session activations and cycles of desensitization if they cause in the cortex and subcortical both during the first session that during the last when the subject has developed the trauma. 1. D Nardo et al. J Psychiat Res 2010; 44:477-485 2. Pagani M et al. Nucl Med Commun 2007; 28: 757-765

Keywords: Neurobiology

Accuracy Verified: Yes

25. 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

26. Pagani, M., Salmaso, D., Flumeri, F., & Hogberg, G. (2008, June). The neurobiological substrates of PTSD and EMDR therapy. Presentation at the annual meeting of the EMDR Europe Association, London, England UK.

Language: English

Format: Conference

Abstract:
In the recent years, the number of studies using neuro-imaging to evaluate neural correlates of psychotherapy has steadily increased revealing its clear neurobiological effects on brain function across a wide range of psychiatric disorders. Functional studies by single photon emission computed tomography (SPECT) and positron emission tomography (PET) can now reliably detect changes in cerebral blood flow (CBF) and metabolism patterns, suggesting a specific role for each of the brain areas in various components of emotional processing. Investigations by magnetic resonance imaging (MRI) have also revealed psychiatry disease-related structural changes. Some regions have been reported to be associated with emotional response to trauma, and with symptom formation in posttraumatic stress disorder (PTSD). Several studies have provided evidence for the efficacy of Eye Movement Desensitization and Reprocessing therapy (EMDR) in the treatment of PTSD. However a very limited number of studies have investigated the neurobiological substrate of such therapy in clinical practice. SPECT and MRI studies, performed to examine the effects of EMDR on brain patho-physiology have provided some preliminary evidence that changes in brain CBF and structure patterns may follow effective treatment. In general in PTSD and in anxiety disorders functional deactivations parallel symptoms relief and decreased hyperreactivity to emotional and memory disturbances. Functional neuro-imaging is a promising tool for the investigation of the physiological impact of psychotherapy in anxiety related disorders and may thus pave the road for a better detection of its effects in psychiatric treatment. The scientific literature reporting PTSD/EMRD related neuro-imaging studies will be extensively reviewed.

Keywords: Neurobiology Posttraumatic Stress Disorder PTSD

Accuracy Verified: Yes

27. Pagani, M. (2011, June). Neuroimaging and novel neurobiological findings in EMDR research [Neuroimaging und neuartige neurobiologische erkenntnisse in der EMDR forschung]. Presentation at the annual meeting of the EMDR Europe Association, Vienna, Austria.

Language: English

Format: Conference

Abstract:
In the recent years the number of neuroimaging studies evaluating neural correlates of psychotherapy has steadily increased revealing its clear neurobiological effects on brain function across a wide range of psychiatric disorders. Functional studies by single photon emission computed tomography (SPECT) and positron emission tomography (PET) detect changes in cerebral blood flow and metabolism patterns, identifying the brain areas processing the various components of emotional processing and/or affected by the disorders. Investigations by magnetic resonance imaging (MRI) have also revealed psychiatry disease-related structural changes. The first part of the workshop (20 minutes) will describe the neuroimaging methodologies and findings in PTSD/EMDR research with and extensive review of previous literature on the neurobiological effects of EMDR. The second part of the workshop (20 minutes) will deal with the description and implementation in research and clinic of neuropsychological testing with brief comments and discussion about their use in the recent experiments performed by our group. In the third part the EEG monitoring of a complete set of EMDR therapies in 10 patients suffering of major trauma will be presented. The relative results are the first report ever on the neurobiological changes occurring before, during and after EMDR therapy sheding light on the neuronal processes underlying its clinical efficacy. Learning objectives: The description and the discussion about the contents of the workshop will provide the audience (1) the necessary information to understand the methodological principles behind the neuroimaging techniques (PET, SPECT and MRI) and their possible applications in research and clinic; (2) the critical knowledge of the limited number of published papers in the field of EMDR-related functional and anatomical studies; (3) the basic research principles and examples to be motivated to begin, take part and/or collaborate to EMDR research in order to better understand the neural basis of this fascinating psychotherapeutic technique.

Keywords: Neurobiology Neuroimaging

Accuracy Verified: Yes

28. Bossini, L., Poliziotto, N., Tavanti, M., Calossi, S., Lombardelli, A., Vatti, G., & Castrogiovanni, P. (2006, Febbraio). Neuroimaging e PTSD: Dati morfovolumetrici e loro variazioni dopo trattamento [Neuroimaging and PTSD: Facts morfovolumetrici and their changes after treatment]. Presentazione al Congresso XI SOPSI (Società Italiana di Psicopatologia), Roma, Italia.

Language: Italian

Format: Conference

Abstract:
Introduzione: molti studi concordano sulla riduzione del volume ippocampale nei pazienti affetti da PTSD 1 e che tale alterazione anatomica è correlata con deficit cognitivi e con la gravità dei sintomi. Comunque ad oggi non è stato ancora chiarito se l’atrofia ippocampale rappresenta l’esito di un effetto neurotossico del trauma o, piuttosto, una condizione preesistente che predispone allo sviluppo di alcune patologie psichiatriche. Già da tempo studi su animali dimostrano come lo stress causi atrofia ippocampale e inibizione della neurogenesi, con meccanismi verosimilmente legati ai glucocorticoidi, all’increzione del fattore corticotropo, all’aumento degli aminoacidi eccitatori, all’inibizione fattore neurotrofico cerebrale con perdita della plasticità neuronale. Nell’uomo, tuttavia, i risultati non sono così lineari. Da un lato alcuni studi hanno individuato come fattore principale l’aumento dei glucocorticoidi 2, dall’altro tale teoria è stata fortemente criticata 3. Secondo Yehuda il meccanismo di atrofia ippocampale è dovuto ad un’alterazione dell’asse Ipotalamo-Ipofisi-Surrene (HPA), ma in termini di una bassa increzione di glucocorticoidi che determina un aumento del feedback negativo dell’asse stesso ed un’ipersensibilità recettoriale. Indipendentemente dal meccanismo d’azione, la perdita di neuroni a livello ippocampale nei soggetti che hanno subito eventi traumatici sembra sufficientemente dimostrata e, fino a poco tempo fa, era considerata irreversibile. In realtà l’ippocampo sembra presentare una inusuale e spontanea capacità rigenerativa. Questo dato è stato individuato in molte specie animali e, in un unico studio, anche nell’uomo 4. Inoltre recenti evidenze pre-cliniche e cliniche hanno indicato che gli SSRI (Selective Serotonin Reuptake Inhibitors) promuovono la neurogenesi e riducono l’atrofia ippocampale indotta dallo stress nell’animale 5 e nell’uomo sono in grado di ridurre i sintomi del PTSD, incrementare le dimensioni dell’ippocampo e ridurre i deficit mnesici tipici della patologia 6 7. Un altro fattore che sembra essere in grado di stimolare la neurogenesi negli animali sembra essere “l’ambiente arricchito” verosimilmente tramite i meccanismi molecolari dell’apprendimento che sembrano in grado di attivare la trascrizione dell’mRNA per il Brain Derived Neurotrophic Factor. Questo dato della letteratura supporta il razionale dell’efficacia della psicoterapia anche se l’unico studio che valuta le modificazioni morfostrutturali dopo psicoterapia non ha riportato risultati positivi 8. Gli scopi di questo studio sono: – valutare la presenza di atrofia ippocampale nei pazienti affetti da PTSD (T0-drug-free); – valutare l’effetto della terapia: farmacologica con SSRI e psicoterapica con EMDR (Eye Movement Desensitization and Reprocessing) sia sul piano clinico e neuropsicologico, che sul volume ippocampale, sia sulla memoria (T1). Metodologia: abbiamo analizzato un campione di 20 pazienti, di età compresa tra i 15 ed i 65 anni, reclutati nell’ambulatorio psichiatrico del Policlinico universitario di Siena affetti da PTSD e un gruppo di controllo di soggetti sani appaiati per sesso, età, peso e altezza. I soggetti di entrambi i gruppi sono stati sottoposti ad uno studio morfovolumetrico computerizzato dell’Ippocampo tramite RM (Risonanza Magnetica). Inoltre, i diciassette pazienti con PTSD sono stati valutati tramite la somministrazione di test neuropsicologici e scale psicometriche per approfondire il quadro psicopatologico e valutare l’eventuale presenza di deficit cognitivi. Nei soggetti affetti da PTSD dopo un periodo di sei mesi di terapia psicofarmacologica sono stati ripetuti i test neuropsicologici, le scale psicometriche e l’analisi morfovolumetrica dell’ippocampo tramite RM. Tre pazienti, dopo le valutazioni al T0, hanno effettuato un protocollo terapeutico con solo EMDR e sono stati rivalutati dopo 8 sedute (due mesi). Risultati: i risultati della prima parte sperimentale (T0-drug-free) evidenziano che le dimensioni dell’ippocampo di sinistra nei soggetti affetti da PTSD sono significativamente minori rispetto ai controlli sani. Dai risultati osservati al follow-up (T1-post-terapia) è possibile evincere che la terapia nei soggetti considerati è associata ad un miglioramento della sintomatologia e ad un aumento dei volumi ippocampali, pari al 9,87% per l’ippocampo di destra e dell’8,37% per l’ippocampo di sinistra. Questi dati sono concordi con i dati presenti in letteratura, anche se la percentuale di recupero su base neuroplastica nel nostro studio risulta sensibilmente superiore rispetto ai due studi presenti in letteratura incremento pari al 4,6% 6; pari al 5% 7. I tre pazienti che hanno effettuato terapia con EMDR hanno anch’essi mostrato al T1 un miglioramento sintomatologico (CAPS non più positiva per i criteri diagnostici) ed un aumento medio dei volumi ippocampali pari a 338,25 mm3 per l’ippocampo DX e 357,93 mm3 per l’ippocampo SN. Conclusioni: la terapia nei soggetti considerati si è associata ad un aumento dei volumi ippocampali (9,87%-8,37%). L’aumento dei volumi ippocampali appare rilevante, consistente con i dati in letteratura, sebbene quantitativamente superiore, sottolineando l’efficacia degli SSRI verosimilmente tramite il meccanismo di attivazione della neurogenesi; è ipotizzabile che l’aumento di volume non sia da imputare ad un aumento delle cellule gliali ma ad un aumento di neuroni ippocampali visto il contemporaneo miglioramento clinico. Particolarmente interessante ci sembra il dato relativo all’efficacia clinica e sulla plasticità neurale della EMDR. Questa osservazione su solo tre casi, necessita chiaramente di essere confermata su un campione più ampio ma rappresenta la prima evidenza in letteratura di un’azione della psicoterapia diretta alla struttura cerebrale.

Introduction: Many studies agree on the reduction of hippocampal volume in patients with PTSD and that an anatomical alteration is correlated with cognitive deficits and the severity of symptoms. However to date has not yet been clarified whether hippocampal atrophy is the result of a neurotoxic effect of trauma or, rather, an underlying condition that predisposes to the development of some psychiatric disorders. For some time animal studies show that stress causes hippocampal atrophy and inhibition of neurogenesis, by mechanisms probably related to glucocorticoids, all'increzione corticotropo factor, increased excitatory amino acid, inhibition of brain neurotrophic factor with loss of neuronal plasticity. In humans, however, the results are not so linear. On the one hand, some studies have identified as the main factor increasing glucocorticoid two other such theory was strongly criticized 3. According to Yehuda mechanism of hippocampal atrophy is due to an alteration of hypothalamic-pituitary-adrenal (HPA), but in terms of a low secretion of glucocorticoids leading to an increase of negative feedback axis and the same receptor hypersensitivity . Regardless of the mechanism of action, loss of neurons in hippocampus in people who have suffered traumatic events seems sufficiently established and, until recently, was considered irreversible. In fact, the hippocampus appears to be an unusual and spontaneous regenerative capacity. This figure has been identified in many animal species and in one study in humans 4. Moreover, recent evidence pre-clinical and clinical studies have shown that SSRIs (Selective Serotonin Reuptake Inhibitors) promote neurogenesis and reduce stress-induced hippocampal atrophy in animals 5 and humans are able to reduce symptoms of PTSD, increase the size of the hippocampus and reduce the deficit mnesic typical of the disease 6 7. Another factor that seems to be able to stimulate neurogenesis in animals seems to be "enriched environment" probably through molecular mechanisms of learning that seem able to activate the transcription of mRNA for Brain Derived Neurotrophic Factor. This finding supports the rationale of the literature of the effectiveness of psychotherapy, even if the only study that evaluates changes morphostructural after psychotherapy has shown positive results 8. The aims of this study are: - To evaluate the presence of hippocampal atrophy in patients with PTSD (T0-drug-free) - to assess the effect of therapy: pharmacological SSRI and psychotherapy with EMDR (eye movement desensitization and reprocessing) is a clinical and neuropsychological, and on hippocampal volume, and memory (T1). Methods: We analyzed a sample of 20 patients, aged between 15 and 65, recruited nell'ambulatorio Psychiatric University Hospital of Siena with PTSD and a control group of healthy subjects matched by sex, age, weight and height. Subjects in both groups were subjected to a computerized study morfovolumetrico dell'Ippocampo using MRI (Magnetic Resonance). In addition, seventeen patients with PTSD were assessed through administration of psychometric scales and neuropsychological tests to study the psychopathological picture and evaluate the possible presence of cognitive deficits. In subjects with PTSD after a period of six months of pharmacological therapy were repeated neuropsychological tests, scales psychometric analysis morfovolumetrica hippocampus by MRI. Three patients at T0 after assessments, carried out a treatment protocol with only EMDR and were reassessed after eight sessions (two months). Results: The results of the first experiment (T0-drug-free) show that the size of the left hippocampus in patients with PTSD are significantly lower compared to healthy controls. The results observed during the follow-up (T1-post-therapy) can be inferred that therapy in patients considered to be associated with improvement in symptoms and an increase in hippocampal volume, equal to 9.87% for the right hippocampus and 8, 37% for the left hippocampus. These data are consistent with the data in the literature, although the recovery rate based on neuroplastic in our study is significantly higher than in the two studies in the literature increase of 4.6% 6; 5% 7. The three patients who have treatment with EMDR have also shown an improvement in symptoms at T1 (CAPS no longer positive for the diagnostic criteria) and an average increase in hippocampal volume amounted to 338.25 mm3 for the hippocampus and DX 357, 93 mm3 for the hippocampus SN. Conclusions: Therapy in patients considered was associated with an increase in hippocampal volume (9.87% -8.37%). The increase in hippocampal volume appear to be relevant, consistent with the literature data, although quantitatively greater, stressing the effectiveness of SSRIs probably through the mechanism of activation of neurogenesis, it is conceivable that the increase in volume is attributable to an increase glial cells but an increase of hippocampal neurons seen the simultaneous clinical improvement. Seems particularly interesting given the relative clinical effectiveness of EMDR and neural plasticity. This observation on only three cases, clearly needs to be confirmed on a larger sample but represents the first evidence in the literature of action of psychotherapy directed at brain structure.

Keywords: Posttraumatic Stress Disorder PTSD

Accuracy Verified: Yes

29. Oxdale, R. (2008, June). Neurophysiological observations on impaired processing: some things we can learn about PSTD & EMDR from sleep disorder conditions such as sleep apnoea and limb movement of sleep disorder. Presentation at the annual meeting of the EMDR Europe Association, London, England.

Language: English

Format: Conference

Abstract:
EMDR has developed on a theoretical background of information processing. What do we know about the structure and functioning of the processing parts of the brain, or “the processor”? In this talk I will bring together information from the research studies of Harvard neurophysiologist Robert Stickgold, the MRI studies of Ruth Lanius, and my own co-morbidity studies of PTSD, which show a very high co-morbid sleep disorder association. EMDR practitioners in UK and Europe may be unfamiliar with sleep disorder medicine, and this presentation aims to introduce them to this realm of interest. I will explain why sleep disorders render people vulnerable to developing PTSD; and why EMDR will help resolve PTSD; and why sometimes the sleep disorder problem needs to be recognized and addressed in its own right. Instruction on how to screen for significant sleep disorders and how to recognize them and distinguish them from sleep disturbance will be given. I will discuss recent and ongoing studies of limb movement disorder of sleep, which often seems to contribute to vulnerability to adjustment disorder and PTS symptoms. The ecological neatness of EMDR will be apparent, and difficulties in achieving results in chronic PTSD will be understandable and seen as remediable. The direction of possible future research efforts in this area will be discussed.

Keywords: Neurobiology

Accuracy Verified: Yes

30. 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

31. Staff. (2000). Phobia: When an irrational fear takes control. Films for the Humanities & Sciences, Princeton, NJ.

Language: English

Format: Video

Abstract:
For a person with a phobia, overcoming the fear--or at least learning how to resist its debilitating effects--can open the door to a fuller, freer life. This riveting two-part series uses MRI scans, body imaging, EEG tracing, and thermal photography to take an unflinching look at the biological and psychological mechanics of terror, as courageous patients seek to master their fears through medication, behavioral therapy, hypnotherapy, desensitization, virtual reality exposure therapy, the controversial technique of flooding, and a new treatment called EMDR.

Keywords: Fear Phobias Psychosocial Factors Treatment

Accuracy Verified: No

32. 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

33. Bossini, L., Casolaro, I., Santarnecchi, E., Caterini, C., Koukouna, D., Fernandez, I., & Fagiolini, A. (2012, March-April). Studio di valutazione dell'efficacia clinica e neurobiologica dell'EMDR in pazienti affetti da disturbo da stress post-traumatico [Evaluation study of clinical and neurobiological efficacy of EMDR in patients suffering from post-traumatic stress disorder]. Rivista di Pschiatria, 47(Supplement 1), 12S-15S. doi:10.1078/1071.11733.

Language: Italian

Format: Journal

Abstract:
Un forte supporto all'uso prove di EMDR nei pazienti affetti da disturbo post-traumatico da stress (PTSD). Obiettivo. Per valutare l'efficacia clinica e neurobiologica-strutturale di EMDR alla droga naïve PTSD senza comorbidità. Materiali e metodi. Abbiamo fatto una valutazione clinica e la misurazione del volume ippocampale da MRI su 29 soggetti affetti da PTSD e su 30 soggetti sani di controllo. Quindi, i pazienti sono stati trattati con EMDR e dopo tre mesi di psicoterapia della valutazione clinica e l'esame di risonanza magnetica sono state risposto. Risultati e discussione. I nostri risultati hanno dimostrato che la diagnosi di PTSD non era più possibile su tutti i pazienti che hanno terminato la psicoterapia (n = 18). Allo stesso tempo, tutti i pazienti hanno mostrato un aumento medio del 6% dei volumi dell'ippocampo. Conclusioni. La reaserach suggerisce che il trattamento EMDR correla non solo con un miglioramento significativo dei sintomi di PTSD, ma anche con un significativo aumento del volume dell'ippocampo.

Strong evidence support use of EMDR in patients suffering from post-traumatic stress disorder (PTSD). Aim. To evaluate clinical and neurobiological-structural efficacy of EMDR on drug-naïve PTSD without comorbidity. Materials and methods. We made clinical evaluation and hippocampal volume measurement by MRI on 29 subjects suffering from PTSD and on 30 healthy control-subjects. Then, patients were treated with EMDR and after three months of psychotherapy the clinical evaluation and the MRI exam were replied. Results and discussion. Our results demonstrated that the diagnosis of PTSD was no more possible on all the patients who terminated the psychotherapy (n=18). At the same time, all the patients showed an average increase of 6% in hippocampal volumes. Conclusions. Our reaserach suggests that EMDR treatment correlates not only with a significant improvement of symptoms of PTSD, but also with a significant increase of hippocampal volumes.

Keywords: Neurobiology Posttraumatic Stress Disorder PTSD

Accuracy Verified: Yes

34. 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

35. Films for the Humanities (Firm). (2000). Treating phobias 1. Princeton, NJ: Films for the Humanities & Sciences.

Language: English

Format: Video

Abstract:
In this program, the treatment of John's claustrophobia, Judith's fear of flying, and David's fear of heights--phobias described by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) as Situational Type and Natural Environment Type--are documented. Applications of virtual reality, by Emory University's Barbara Rothbaum, and eye movement desensitization and reprocessing, by clinical psychologist Carl Nickeson, are profiled. The research of Jeffrey Gray, of the Institute of Psychiatry (London), into blood flow in the brain during moments of stress, panic, and terror is also examined. This program is part of the series "Phobia: When an Irrational Fear Takes Control." This two-part series uses MRI scans, body imaging, EEG tracing, and thermal photography to take an unflinching look at the biological and psychological mechanics of terror, as courageous patients seek to master their fears through various forms of treatment.

Keywords: Behavior Therapy Phobias

Accuracy Verified: No

36. Levin, C., Shapiro, F., & Weakland, J. (1996). When the past is present: A conversation about EMDR and the MRI interactional approach. In M. F. Hoyt (Ed.), Constructive therapies: Volume 2 (pp. 197-210). New York: Guilford Press.

Language: English

Format: Book Section

Abstract:
Presents a conversation between C. Levin, F. Shapiro and J. Weakland. [consider an interactional approach to the] possible common factors and connections between the ways in which "past" and "present" might be understood and approached therapeutically within each respective method [eye movement desensitization and reprocessing (EMDR) and MRI (Mental Research Institute) brief therapy] (PsycINFO Database Record (c) 2008 APA, all rights reserved)

Keywords: Brief Psychotherapy MRI Scientific Communication

Accuracy Verified: Yes