Francine Shapiro Library ~ EMDR Bibliography

Francine Shapiro Library - EMDR Bibliography Links

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1. 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

2. Lendl, J. (2001, June). Brain performance and possible EMDR intervention. Presentation at the annual meeting of the EMDR International Association, Austin, TX.

Language: English

Format: Conference

Abstract:
Participants will: 1) be able to identify functions and problems of several brain areas; 2) be able to identify sepcific targets for suggested EMDR interventions; and 3) learn when to refer for possible brain scan.

Keywords: Brain Performance Brain Scan SPECT

Accuracy Verified: Yes

3. Snyker, E. (2003, May). Brain SPECT imaging and EMDR. Symposium conducted at the annual meeting of the EMDR Europe Association, Rome, Italy.

Language: English

Format: Conference

Keywords: Brain SPECT Imaging Symposium

Accuracy Verified: Yes

4. Amen, D. G. (2003, September). Brain SPECT imaging in PTSD and EMDR. Preconference presentation at the annual meeting of the EMDR International Association, Denver, CO.

Language: English

Format: Conference

Abstract:
Brain SPECT provides a window into brain activity and helps us understand the underlying physiology of many neurological and psychiatric illnesses. Specific psychological and medical treatments enhance or change our brain function. In this lecture, Dr. Amen will describe his extensive clinical experience and research into postraumatic stress disorder and EMDR. He has been involved in performing before and after brain SPECT scans for PTSD patients for several years and recently completed a formal research project with Karen Lansing on PTSD and EMDR. The results of this study will also be discussed.

Keywords: SPECT Brain

Accuracy Verified: Yes

5. Amen, D. G. (1999, June). Change your brain, change your life (EMDR not the focus). Presentation at the annual meeting of the EMDR International Association, Las Vegas, NV.

Language: English

Format: Conference

Abstract:
Participants will: 1) learn the functions the problems associated with five different brain systems; 2) learn the impact of head injuries on psychological behavior; and 3) develop three psychological strategies for enhancing each different brain system.

Keywords: Brain Brain Systems Head Injuries SPECT

Accuracy Verified: Yes

6. Amen, D. G. (2003, September). Change your brain, change your life: Breakthrough information on seeing and healing the brain. Presentation at the annual meeting of the EMDR International Association, Denver, CO.

Language: English

Format: Conference

Abstract:
Utilizing the latest, most sophistcated brain imaging technology in medicine, physician and clinical neuroscientist Daniel Amen will give you an intimate look into a "working brain." Based on his brain imaging work with over 16,000 brain SPECT studies, Dr.Amen will teach you what specific parts of the brain do, and graphically show what happens when things go wrong, illustrated by many case stories and a number of the actual brain images. He will correlate different brain patterns with specific feelings and behaviors, such as moodiness, irritability, conflict avoidance, worrying and temper outbursts, along with certain common psychiatric disorders such as depression, attenton deficit disorder, anxiety, and substance abuse. In addition, there will be prescriptions for healing each part of the brain, including cognitive, behavioral, nutritional and medicinal strategies.

Keywords: Brain SPECT

Accuracy Verified: Yes

7. Oh, D., & Choi, J. (2004). Changes in the regional cerebral perfusion after EMDR: A SPECT study of two cases. Journal of the Korean Society of Biological Psychiatry, 11(2), 173-180.

Language: Korean

Format: Journal

Abstract:
Over the last decade, EMDR(Eye Movement Desensitization and Reprocessing) has emerged as a promising new treatment for trauma and other anxiety-based disorders. However, neurobiological mechanism of EMDR has not been well understood. Authors report SPECT findings of two patients of PTSD before and after EMDR.Brain 99mTc-ECD-SPECT was performed before and after EMDR treatment. To evaluate the significance of changes in the regional cerebral perfusion, t-test was conducted on the resulting images using SPM99 . In addition, clinical scales(CAPS, CGI, STAI) were employed to asses the changes in the clinical symptoms of the patients. After EMDR treatment, each showed significant improvement in clinical symptoms. The cerebral perfusion increased in bilateral dorsolateral prefrontal cortex, and decreased in the temporal association cortex. The differences in the cerebral perfusion between patients after treatment and normal controls decreased. These changes appeared mainly in the limbic area the and the prefrontal cortex.These results suggest that EMDR may show the therapeutic effect through 1) improvement in the emotional control by increased activity in the prefrontal cortex, 2) inhibited hyperstimuli on amygdala by deactivation of the association cortex, 3) inhibition on past trauma related memory, and 4) keeping the functional balance between the limbic area and the prefrontal cortex. This case report needs further replication from studies with larger sample. [Author Abstract]

Keywords: Brain Imagining Adults Females Koreans Motor Vehicle Accidents Neurophysiology Posttraumatic Stress Disorder Psychiatric Inpatients PTSD: Rape SPECT Survivors Treatment Effectiveness

Accuracy Verified: Yes

8. Oh, D. H., & Choi, J. (2007). Changes in the regional cerebral perfusion after eye movement desensitization and reprocessing: A SPECT study of two cases. Journal of EMDR Practice and Research, 1(1), 24-30. doi:10.1891/1933-3196.1.1.24.

Language: English

Format: Journal

Abstract:
Eye movement desensitization and reprocessing (EMDR) has emerged as a promising new treatment for trauma and other anxiety-based disorders. However, the neurobiological mechanism of EMDR has not been well understood. This study reports changes in the resting regional cerebral blood flow after successful EMDR treatment in 2 patients with PTSD. Brain 99mTc-ECD-SPECT (Technetium 99m-ethyl cysteinate dimmer-single photon emission computerized tomography) was performed before and after EMDR, and, in addition, a pre- and posttreatment comparison was made with 10 non-PTSD participants as a control group. After EMDR, cerebral perfusion increased in bilateral dorsolateral prefrontal cortex and decreased in the temporal association cortex. The differences between participants and normal controls also decreased. Changes appeared mainly in the limbic area and the prefrontal cortex. These results are in line with current understanding of neurobiology of PTSD. EMDR treatment appears to reverse the functional imbalance between the limbic area and the prefrontal cortex. [Author Abstract]

Keywords: Adults Brain Imaging Females Koreans Motor Traffic Accidents Neuroimaging Neurophysiology Posttraumatic Stress Disorder Psychiatric Inpatients PTSD Rape RCBF Regional Cerebral Blood Flow Single Photon Emission Computerized Tomography Survivors Treatment Effectiveness

Accuracy Verified: Yes

9. Oh, D. H., & Choi, J. (2004, October). Changes in the regional cerebral perfusion assessed with 99mTc-ECD-SPECT after eye movement desensitization and reprocessing treatment. Poster spresented at the annual meeting Korean Neuropsychiatric Association, Seoul, Korea.

Language: Korean

Format: Conference

Keywords: Poster Regional Cerebral Perfusion SPECT

Accuracy Verified: Yes

10. Amen, D. G. (1997, July). A clinician’s guide to understanding and treating ADD. Presentation at the annual meeting of the EMDR International Association, San Francisco, CA.

Language: English

Format: Conference

Abstract:
Focuses primarily on ADD not EMDR.

Keywords: ADD Attention Deficit Disorder Brain SPECT

Accuracy Verified: Yes

11. 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

12. Pagani, M., Hogberg, G., Salmaso, D, Tarnell, B., Nardo, D., Sundin, Ö., Jonsson, C., Soares, J., Aberg-Wistedt, A., Jacobsson, H., Larsson, S.A., Hällström, T. (2007, October). Effects of EMDR psychotherapy on 99mTc-HMPAO distribution in occupation-related post-traumatic stress disorder. Nuclear Medicine Communications, 28(10), 757-765. doi:10.1097/MNM.0b013e3282742035.

Language: English

Format: Journal

Abstract:
Background: Post-traumatic stress disorder (PTSD) is a derangement of mood control with involuntary, emotionally fraught recollections that may follow deep psychological trauma in susceptible individuals. This condition is treated with pharmacological and/or cognitive therapies as well as psychotherapy with eye movement desensitization and reprocessing (EMDR). However, only a very limited number of studies have been published dealing with work-related PTSD, and investigations on the effect of treatment on cerebral blood flow represent an even smaller number. Aim: To investigate the short-term outcome of occupation-related PTSD after EMDR therapy by 99mTc-HMPAO SPECT. Method: Fifteen patients, either train drivers suffering from PTSD after having been unintentionally responsible for a person-under-train accident or employees assaulted in the course of duty, were recruited for the study. 99mTc-HMPAO SPECT was performed on these patients both before and after EMDR therapy while they listened to a script portraying the traumatic event. Tracer distribution analysis was then carried out at volume of interest (VOI) level using a three-dimensional standardized brain atlas, and at voxel level by SPM. The CBF data of the 15 patients were compared before and after treatment as well as with those of a group of 27 controls who had been exposed to the same psychological traumas without developing PTSD. Results: At VOI analysis significant CBF distribution differences were found between controls and patients before and after treatment (P=0.023 and P=0.0039, respectively). Eleven of the 15 patients responded to treatment, i.e., following EMDR they no longer fulfilled the DSM-IV criteria for PTSD. When comparing only the eleven responders with the controls, the significant group difference found before EMDR (P=0.019) disappeared after treatment. Responders and non-responders showed after therapy significant regional differences in frontal, parieto-occipital and visual cortex and in hippocampus. SPM analysis showed significant uptake differences between patients and controls in the orbitofrontal cortex (Brodmann 11) and the temporal pole (Brodmann 38) both before and after treatment. A significant tracer distribution difference present before treatment in the uncus (Brodmann 36) disappeared after treatment, while a significant difference appeared in the lateral temporal lobe (Brodmann 21). Conclusion: Significant 99mTc-HMPAO uptake regional differences were found, mainly in the peri-limbic cortex, between PTSD patients and controls exposed to trauma but not developing PTSD. Tracer uptake differences between responders and patients not responding to EMDR were found after treatment suggesting a trend towards normalization of tracer distribution after successful therapy. These findings in occupational related PTSD are consistent with previously described effects of psychotherapy on anxiety disorders. [PubMed]

Keywords: 99mTc-HMPAO Posttraumatic Stress Disorder PTSD

Accuracy Verified: Yes

13. Pagani, M., Hogberg, G., Salmaso, D., Nardo, D., Jonsson, C., Danielsson, A.M., Engelin, L., Jacobsson, H., Larsson, S. A., Hallstrom, T., & Sundin, Ö. (2006, September). Effects of EMDR therapy on 99mTc-HMPAO distribution in Post-traumatic stress disorder. Presentation at the European Assocation of Nuclear Medicine Congress, Athens, Greece. European Journal of Nuclear Medical and Molecular Imaging, 33, S169.

Language: English

Format: Conference

Abstract:
Background Post-traumatic stress disorder (PTSD) is a derangement of mood control with emotional trauma recollections that may follow psychological trauma. It is treated with pharmacological and cognitive therapies as well as with eye movement desensitization and reprocessing (EMDR). However, a limited number of studies have been published dealing with job related PTSD, and an even smaller number have assessed the effects of treatment on CBF. The aim of this study was to investigate the short term outcome of occupation based PTSD after EMDR therapy by 99mTc-HMPAO SPECT. Methods Fifteen patients suffering PTSD after having experienced a person under train accident or having been assaulted at work were included into the study. 99mTc-HMPAO SPECT was performed before and after EMDR therapy while listening to a script portraying the traumatic event. Tracer distribution analysis was performed at VOI level using a 3D standardised brain atlas and at cluster of voxel level by SPM and was subjected to an analysis of treatment as well as contrasted to a group of 27 subjects exposed to the same psychological trauma and not developing PTSD. Results Eleven of 15 patients responded to treatment, i.e. they did no longer fulfil the DSM-IV criteria for PTSD after EMDR. Overall VOI analysis showed significant differences between, both before and after treatment conditions and controls (p<0.05) but no effect of period, i.e. treatment. However, when contrasting responders to controls the significant group difference present after treatment disappeared, indicating a normalization effect due to successful EMDR treatment. SPM analysis showed significant uptake differences in orbitofrontal cortex (Brodmann 11) and temporal pole (Brodmann 38) before as well as after treatment as compared to controls. A significant tracer uptake group difference present before treatment in uncus (Brodmann 36) disappeared after treatment while a significant difference appeared in lateral temporal lobe (Brodmann 21). No tracer uptake differences were found by SPM as an effect of treatment, nor between the 11 responders and controls. Conclusion Significant 99mTc-HMPAO uptake differences, mainly in peri-limbic cortex, between PTSD patients investigated before and after EMDR and subject exposed to trauma not developing PTSD were found. Differences between the tracer distribution in patients before and after therapy were not significant neither at SPM nor at VOI analyses but the latter showed at group level an effect of symptom remission on tracer distribution. The findings underscore the validity of psychotherapy in anxiety disorders and confirm the efficacy of SPECT in psychiatry. [EANM]

Keywords: 99mTc-HMPAO Distribution Posttraumatic Stress Disorder PTSD

Accuracy Verified: Yes

14. Pagani, M., Hogberg, G., Salmaso, D., Nardo, D., Jonsson, C., Danielsson, A. M., Engelin, L., Jacobsson, H., Larsson, S. A., Hallstrom, T., & Sundin, Ö. (2006, September-October). Effects of EMDR therapy on 99mTc-HMPAO distribution in Post-traumatic Stress Disorder. Presentation at the European Assocation of Nuclear Medicine Congress, Athens, Greece.

Language: English

Format: Conference

Keywords: 99mTc-HMPAO Distribution Posttraumatic Stress Disorder PTSD

Accuracy Verified: Yes

15. 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

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

Language: English

Format: Journal

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

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

Accuracy Verified: Yes

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

Language: English

Format: Conference

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

Keywords: Police Officers SPECT

Accuracy Verified: Yes

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. Lansing, K. (2013, September). The rite of return: Coming back from duty-induced PTSD. High Ground Press.

Language: English

Format: Book

Abstract:
The Rite of Return: Coming Back from Duty-Induced PTSD is written for men and women in law enforcement, first response, and the military who are struggling with duty-induced PTSD. In a field-guide format, it presents an overview of a proven treatment approach adapted specifically for this population. The book offers clear teaching on PTSD and its effects on the brain. It also provides practical training in containment techniques for increased control of symptoms and motivation for battling the tendency to isolate. The successful case outcomes described throughout the book give substantive hope for recovery from PTSD. The message throughout is that duty-induced PTSD cannot be resolved in isolation or by reading self-help books. The author’s depth of knowledge and scope of experience evident in every chapter draws the reader confidently into places where the clinical generalist cannot tread. Karen Lansing’s understanding of duty-induced PTSD goes beyond a simply clinical perspective. She has been trained in public order, ridden extensively on patrol, done 48-hour tours of duty with firefighters, and has resided and trained alongside special weapons teams on military bases. She has “kitted up” and been stuck into flashpoint sectors in “exotic places” with tactical advisors in troubled regions. The benefits emerging from that cross-pollination of disciplines are apparent in the author’s respect and understanding of the specific clinical needs of Warriors and Rescuers. It's seen in her identification of and clinical protocol for the treatment of a rare but deadly post-shooting symptom that she refers to as transitory shooter's apraxia. The benefits are also clearly seen in the clinical outcomes of those featured in this book. The Rite of Return presents a powerful argument that PTSD need not lead to an end of mission or tour of duty, or to a lifelong injury. Instead, case account after case account indicates that Lansing's treatment approach leads to quite the opposite: officers consistently emerging stronger. These outcomes are confirmed throughout the book by the testimony of SPECT brain images before and after treatment. Accompanying them are accounts of subjects after treatment responding successfully to incidents very similar to those that had culminated in their PTSD. These unsung heroes recovered, becoming more competent, more tactically skilled and more mentally resilient than they had been prior to its time-limited, but significant, intrusion into their lives. Reading between the lines of this book, it's apparent that careers and lives have been saved because of the author’s innovative approach. Her only regret is that so many have been lost to the devastation of untreated or ill-treated, duty-induced PTSD. The publication of The Rite of Return couldn’t be better timed.

Keywords: Containment Techniques Duty-Induced PTSD Military Posttraumatic Stress Disorder PTSD Transitory Shooter's Apraxia

Accuracy Verified: Yes

25. 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

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

Language: English

Format: Journal

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

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

Accuracy Verified: Yes