Francine Shapiro Library - EMDR Bibliography Links
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1. van Etten, M. L., & Taylor, S. (1998). Comparative efficacy of treatments for posttraumatic stress disorder: A meta-analysis. Clinical Psychology and Psychotherapy, 5(3), 126-144. doi:10.1002/(SICI)1099-0879(199809).
Language: English
Format: Journal
Abstract:
A meta-analysis was conducted on 61 treatment outcome trials for PTSD. Conditions included drug therapies (TCAs, carbamazepine, MAOIs, SSRIs, and BDZs), psychological therapies (behaviour therapy, Eye-Movement Desensitization and Reprocessing (EMDR), relaxation training, hypnotherapy, and dynamic therapy), and control conditions (pill placebo, wait-list controls, supportive psychotherapies, and non-saccade EMDR control). Psychological therapies had significantly lower drop-out rates than pharmacotherapies (14% versus 32%), with attrition being uniformly low across all psychological therapies. In terms of symptom reduction, psychological therapies were more effective than drug therapies, and both were more effective than controls. Among the drug therapies, the SSRIs and carbamazepine had the greatest effect sizes, although the latter was based upon a single trial. Among the psychological therapies, behaviour therapy and EMDR were most effective, and generally equally so. The most effective psychological therapies and drug therapies were generally equally effective. Differences across treatment conditions were generally evident across symptom domains, with little matching of symptom domain to treatment type. However, SSRIs had some advantage over psychological therapies in treating depression. Follow-up results were not available for most treatments, but available data indicates that treatment effects for behaviour therapy and EMDR are maintained at 15-week follow-up. [Author Abstract]
Keywords: Antimanic Drugs Benzodiazepine Derivatives Hypnotherapy Meta Analysis Monoamine Oxidase Inhibitors Posttraumatic Stress Disorder Psychoanalytic Psychotherapy PTSD Relaxation Therapy Selective Serotonin Reuptake Inhibitors Treatment Effectiveness Tricyclic Derivatives
Accuracy Verified: Yes
2. Frustaci, A., Pozzi, G., Aurigemma, C., La Rosa, C., Lanza, G., Fernandez, I., & Ruggeri, G. (2006, Febbraio). Indicatori di cambiamento in pazienti con disturbi da eventi stressanti: Impiego della heart rate variability [Indicators of change in patients with disorders of stressful events: Use of heart rate variability]. Poster presentato al XI Congresso SOPSI (Società Italiana di Psicopatologia), Roma, Italia.
Language: Italian
Format: Conference
Abstract:
Introduzione: i pazienti traumatizzati presentano alterazioni sintomatiche quali intrusività, evitamento ed aumentato arousal, che ostacolerebbe la possibilità di elaborazione/integrazione
delle tracce mnesiche, oltre ad esprimersi a livello periferico. Tecniche specifiche di trattamento sembrano promuovere
l’elaborazione/integrazione delle memorie traumatiche, tra cui la Eye Movement Desensitization and Reprocessing
(EMDR). Nella ricerca valutativa è quindi necessario affiancare alle scale psicologiche un appropriato indicatore
biologico di attivazione neurovegetativa. La variabilità della frequenza cardiaca (Heart Rate Variability – HRV) esprime
l’integrità funzionale del sistema neurovegetativo in risposta
allo stress e può essere misurata nei domini di tempo o di frequenza. Lo studio della HRV è stato applicato in psichiatria ai disturbi
d’ansia (panico, DOC, PTSD) e dell’umore (depressione unipolare) in ricerche trasversali (confronto con controlli sani) e longitudinali di trattamento farmacologico (triciclici,
SSRIs) ma in pochi casi a trattamenti psicoterapici. Gli AA. valutano l’impiego della HRV come indicatore biologico nel trattamento psicoterapeutico di pazienti con Disturbo dell’adattamento erdurante da oltre un mese dopo l’esposizione ad eventi vitali stressanti (EVS). Metodi: sono stati reclutati 6 soggetti (M/F = 1/5, età 40,5 ± 11,0) esposti ad EVS ed avviati a ciclo di trattamento psicoterapico
breve (4-6 sedute a cadenza settimanale) di tipo
specifico (EMDR) o generico (colloqui supportivi). Costituivano criteri di esclusione: età < 18 o > 65 anni; comorbilità psichiatrica, neurologica e cardiologica; uso di farmaci interferenti. Le valutazioni psicopatologiche sono state eseguite al reclutamento
(TBASE: colloquio anamnestico, MINI, Brief
COPE), a inizio e fine ciclo di trattamento (TINI, TFINE: IES, SCL-90-R), a uno e tre mesi di follow-up (T30, T90: IES, SCL-90-R, Brief COPE). Le registrazioni Holter sono state effettuate ad ogni intervallo valutativo coprendo: 60 min. attività libera, 10 min. tilt-test, 3-5 min. ascolto dell’evento traumatico, 30-45 min. seduta psicoterapica. Sono stati impiegati test statistici non parametrici per l’analisi
delle correlazioni (Spearman) e delle differenze
(Wilcoxon). Risultati preliminari: vengono valutate le correlazioni a TINI e le variazioni T90 vs. TINI. Sono significative le seguenti correlazioni: ansia fobica SCL e SDNN (dev. standard intervalli R-R) [r = + 0,9; p = ,037]; collera-ostilità
SCL e SDNN [r = -0,95; p =.014]; depressione SCL e
r-MSSD (radice media somma quadrati diff. R-R) [r = + 0,9; p = ,037]; sint. intrusivi IES e LF (basse frequenze) [r
= -0,9; p = ,037]. Sono risultate statisticamente significative le seguenti variazioni:
IES totale [Z = -1,99; p = ,046], sintomi intrusivi IES [Z = -2,21; p = ,027], sintomi di evitamento IES [Z = -1,99; p = ,046], ideazione paranoide SCL [Z = -2,21; p = ,027]; R-R, LF e LF/HF (rapporto basse/alte frequenze) durante ascolto evento [Z = -2,02; p = ,043].
Discussione: a livello basale gli indicatori HRV di distress vegetativo correlano positivamente con collera-ostilità e sintomi intrusivi, negativamente con ansia e depressione. Anche dopo tre mesi dalla fine del trattamento gli interventi psicoterapeutici tendono a ridurre i punteggi sintomatici, e migliorano il bilancio simpato-vagale durante il riascolto dell’evento traumatico.
Introduction: trauma patients have symptomatic changes such as intrusiveness, avoidance and increased arousal, which hampers the development / integration
of memory traces, as well as speak at the peripheral level. Specific techniques of treatment seem to promote
the formulation and integration of traumatic memories, including eye movement desensitization and reprocessing
(EMDR). In evaluation research is therefore necessary to combine psychological scales appropriate indicator
organic autonomic activation. The heart rate variability (Heart Rate Variability - HRV) expresses
functional integrity of the autonomic nervous system in response
stress and can be measured in time or frequency domains. The study of HRV has been applied in psychiatric disorders
anxiety (panic, DOC, PTSD) and mood (unipolar depression) in cross-disciplinary (compared with healthy controls) and longitudinal drug treatment (tricyclic
SSRIs), but in a few cases in psychotherapeutic treatment. The AA. evaluate the use of HRV as a biological indicator in the psychotherapeutic treatment of patients with adjustment disorder erdurante more than a month after exposure to stressful life events (EVS). Methods: 6 subjects were recruited (M / F = 1 / 5, age 40.5 ± 11.0) exposed to EVS and initiated treatment cycle psychotherapeutic
short (4-6 sessions weekly) type
specific (EMDR) or generic (hearing supported). Exclusion criteria were: age <18 or> 65 years, psychiatric comorbidity, neurological and cardiological, use of drugs interfering. Psychopathological assessments were performed at recruitment
(TBASE: anamnestic interview, MINI, Brief
COPE) at the beginning and end of treatment cycle (TINI, TFINE: IES, SCL-90-R) in a three-month follow-up (T30, T90: IES, SCL-90-R, Brief COPE). Holter recordings were made at each interval evaluation covering: 60 min. free activity, 10 min. tilt-test, 3-5 min. listening to the traumatic event, 30-45 minutes. psychotherapy session. Were used nonparametric statistical tests for analysis
correlations (Spearman) and differences
(Wilcoxon). Preliminary results: the correlations are evaluated and changes TINI vs. T90. TINI. Significant correlations are the following: SCL phobic anxiety and SDNN (standard dev. RR intervals) [r = + 0.9, p =, 037]; anger-hostility
SCL SDNN [r = -0.95, p =. 014]; SCL depression
r-mssd (root mean square sum diff. RR) [r = + 0.9, p =, 037]; sint. IES intrusive and LF (low frequency) [r
= -0.9, P =, 037]. Were statistically significant, the following changes:
IES total [Z = -1.99, p =, 046], IES intrusive symptoms [Z = -2.21, p =, 027], symptoms of avoidance IES [Z = -1.99, p =, 046] , SCL paranoid [Z = -2.21, p =, 027], RR, LF and LF / HF ratio (low / high frequencies) while listening event [Z = -2.02, p =, 043].
Discussion: At baseline HRV indicators of distress correlated positively with growing anger-hostility, and intrusive symptoms, negatively with anxiety and depression. Even after three months of the end of psychotherapeutic treatment interventions aimed at reducing symptom scores and enhance sympathetic vagal balance during the playback of the traumatic event.
Keywords: Heart Rate Variability Poster Stress Disorders
Accuracy Verified: Yes
3. Staff. (2007, June). The latest, greatest treatments for PTSD. Carlat Psychiatry Report, 5(6). Retrieved from http://www.thecarlatreport.com/index.asp?page=wp530200711859 12/8/2007.
Language: English
Format: Newsletter
Abstract:
At least in Britain, it’s official: psychotherapy works better than medication for PTSD. You shouldn’t be too surprised. The last time we covered PTSD (TCPR April 2004) we reviewed the SSRIs and found them to have evidence of only modest efficacy.
Now, according to the latest treatment guidelines from Britain's National Institute for Clinical Excellence (NICE), antidepressants are no longer recommended as a first-line treatment, but cognitive therapy is. You can check out these guidelines for free at http://guidance.nice.org.uk/CG26/guidance/pdf/English.
Accuracy Verified: Yes
4. Ehlers, A., Gene-Cos, N., & Perrin, S. (2009). Low recognition of post-traumatic stress disorder in primary care. London Journal of Primary Care, 2, 36–42.
Language: English
Format: Journal
Abstract:
Post-traumatic stress disorder (PTSD) is a common
and disabling disorder that develops as a consequence
of traumatic events and is characterised by
distressing re-experiencing of parts of the trauma,
avoidance of reminders, emotional numbing and
hyperarousal. The NICE guidelines for PTSD (2005)
recommend trauma-focused psychological therapy
as the first-line treatment. A survey of 129 GPs in
south London investigated the recognition and
treatment of PTSD in primary care. The majority
of GPs underestimated the prevalence of PTSD.
Most PTSD patients seen in GP surgeries currently
do not receive or are not referred for NICE recommended
psychological treatments. Medications,
especially SSRIs, appear to be more commonly
prescribed than recommended by NICE. Efforts to
disseminate information about PTSD and effective
treatments to both patients and GPs are needed to
increase recognition rates and prompter access to
treatment. The Improving Access to Psychological
Therapies (IAPT) programme will make the NICE
recommended treatments more widely available
and will allow self-referral by adults with PTSD to
trauma-focused psychological therapy.
Accuracy Verified: Yes
5. 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
6. Davidson, J. R. T., Stein, D. J., Shalev, A.Y., & Yehuda, R. (2004, Spring). Posttraumatic stress disorder: Acquisition, recognition, course, and treatment. Journal of Neuropsychiatry and Clinical Neuroscience, 16(2), 135-147. doi:10.1176/appi.neuropsych.16.2.135.
Language: English
Format: Journal
Abstract:
Following exposure to trauma, a large number of survivors will develop acute symptoms of posttraumatic stress disorder (PTSD), which mostly dissipate within a short time. In a minority, however, these symptoms will evolve into chronic and persistent PTSD. A number of factors increase the likelihood of this occurring, including characteristic autonomic and hypothalamic-pituitary-adrenal axis responses. PTSD often presents with comorbid depression, or in the form of somatization, both of which significantly reduce the possibilities of a correct diagnosis and appropriate treatment. Mainstay treatments include exposure-based psychosocial therapy and selective serotonin reuptake inhibitors, such as paroxetine and sertraline, both of which have been found to be effective in PTSD. This paper looks at the course of PTSD, its disabling effect, its recognition and treatment, and considers possible new research directions.
Keywords: Comorbidity Posttraumatic Stress Disorder PTSD Recognition and Treatment SSRIs
Accuracy Verified: Yes
7. Ferrie, R. K. (2004, September). Problems with SSRIs in the treatment of traumatic syndromes. Presentation at the annual meeting of the EMDR International Association, Montréal, Quebec Canada.
Language: English
Format: Conference
Abstract:
This workshop will focus on the biological and clinical evidence supporting
the notion that depression, dissociation, somatization, and PTSD may be
symptomatic responses to traumatic events which affect the brain. The safety of SSRls and their application for the treatment of PTSD will be
discussed as will the complications arising from their short and long lerm
use. Single system designated case studies, will be used to demonstrate how
treatment with EMDR allows one to arrive at successful outcomes in
trauma spectrum disorders, with or without psychopharmacology.
Keywords: SSRIs
Accuracy Verified: Yes
8. Freeman, C. (2006, July). Psychological and drug therapies for post-traumatic stress disorder. Psychiatry, 5(7), 231-237. doi:10.1016/j.mppsy.2009.06.001.
Language: English
Format: Journal
Abstract:
There is an impressive evidence base for the psychological treatment of post-traumatic stress disorder (PTSD). The strongest evidence is for trauma-focused cognitive therapy and eye movement desensitization and reprocessing (EMDR) but brief eclectic psychotherapy is a promising alternative. As well as this strong evidence for efficacy there is emerging evidence for effectiveness, using these treatments in routine clinical practice without highly trained specialized staff. The treatment of PTSD is more than the use of structured psychotherapy packages – it involves careful assessment and attention to safety, boundary and termination issues. We know much less about how to deal with treatment resistance or complex trauma. Drug treatment is well evaluated with large trials, and has statistical but not clinical efficacy.
Keywords: Cognitive Therapy Drug Treatment Exposure Posttraumatic Stress Disorder PTSD SSRIs Stress-related Disorders Trauma Trauma Psychotherapy
Accuracy Verified: Yes
9. van der Kolk, B. A., Spinazzola, J., Blaustein, M. E., Hopper, J. W., Hopper, E. K., Korn, D. L., & Simpson, W. B. (2007, January). A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: Treatment effects and long-term maintenance. Journal of Clinical Psychiatry, 68(1), 37-46.
Language: English
Format: Journal
Abstract:
Objective: The relative short-term efficacy and long-term benefits of pharmacologic versus psychotherapeutic interventions have not been studied for PTSD. This study compared the efficacy of a selective serotonin reuptake inhibitor (SSRI), fluoxetine, with a psychotherapeutic treatment, eye movement desensitization and reprocessing (EMDR), and pill placebo and measured maintenance of treatment gains at 6-month follow-up. Method: 88 PTSD subjects diagnosed according to DSM-IV criteria were randomly assigned to EMDR, fluoxetine, or pill placebo. They received 8 weeks of treatment and were assessed by blind raters posttreatment and at 6-month follow-up. The primary outcome measure was the Clinician-Administered PTSD Scale, DSM-IV version, and the secondary outcome measure was the Beck Depression Inventory-II. The study ran from July 2000 through July 2003. Results: The psychotherapy intervention was more successful than pharmacotherapy in achieving sustained reductions in PTSD and depression symptoms, but this benefit accrued primarily for adult-onset trauma survivors. At 6-month follow-up, 75.0% of adult-onset versus 33.3% of child-onset trauma subjects receiving EMDR achieved asymptomatic end-state functioning compared with none in the fluoxetine group. For most childhood-onset trauma patients, neither treatment produced complete symptom remission. Conclusions: This study supports the efficacy of brief EMDR treatment to produce substantial and sustained reduction of PTSD and depression in most victims of adult-onset trauma. It suggests a role for SSRIs as a reliable first-line intervention to achieve moderate symptom relief for adult victims of childhood-onset trauma. Future research should assess the impact of lengthier intervention, combination treatments, and treatment sequencing on the resolution of PTSD in adults with childhood-onset trauma. [Author Abstract]
Keywords: Adults Depressive Disorders Empirical Study Posttraumatic Stress Disorder PTSD Quantitative Study Random Clinical Trial RCT Selective Serotonin Reuptake Inhibitors Stressors Survivors Treatment Effectiveness
Accuracy Verified: Yes
10. Tavanti, M., Bossini, L., Calossi, S., Lombardelli, A., Polizzotto, N., Vatti, G., Galli, R., Pieraccini F., & Castrogiovanni, P. (2008, Febbraio). Sertralina vs EMDR: Effetti sul volume ippocampale [Sertraline vs. EMDR: Effects on hippocampal volume]. Poster presentato al XII Congresso SOPSI (Società Italiana di Psicopatologia), Roma, Italia.
Language: Italian
Format: Conference
Abstract:
Molti dati sperimentali hanno mostrato che la terapia farmacologica
con SSRI può incrementare il volume dell’ippocampo,
invece il solo studio che ha investigato gli effetti di un tipo
di psicoterapia (TEB, Terapia Eclettica Breve) non ha evidenziato
alcuna efficacia sul volume ippocampale 1. Scopo
del nostro studio è valutare gli effetti del trattamento con EMDR
(Eye Movement Desensitization and Reprocessing) sul
volume ippocampale, sui sintomi e sulle performances mnesiche
di pazienti con Disturbo Post-Traumatico da Stress
(DPTS). La EMDR è una terapia la cui efficacia nel DPTS è
stata dimostrata in numerosi studi sperimentali.
Sono stati selezionati 12 soggetti drug-free con diagnosi di
DPTS alla SCID-P, senza comorbidità psichiatrica.
Ogni soggetto reclutato è stato sottoposto alla prima visita
(Tempo 0, Drug-Free) ad una indagine psicometrica (tramite
DTS), ad una indagine neuropsicologica (tramite una batteria
di test) e alla misurazione dei volumi cerebrali tramite
Risonanza Magnetica.
Successivamente, i 12 soggetti sono stati attribuiti in maniera
random a due diversi protocolli terapeutici. Sei soggetti
hanno effettuato 12 sedute di EMDR della durata di 1,5
ore, mentre sei soggetti sono stati trattati con 100 mg di sertralina.
Dopo il trattamento (Tempo 1, Post-Terapia) i soggetti sono
stati nuovamente sottoposti alle indagini effettuate al Tempo
0.
La seconda valutazione al Tempo 1 è stata effettuata dopo
tre mesi nei soggetti trattati con EMDR e dopo 6 mesi nei
soggetti trattati con la sertralina, in base ai tempi medi necessari
per la remissione cilinica del DPTS riportati in letteratura
per i due presidi terapeutici.
In questo studio verranno presentati i dati relativi alle differenze
volumetriche, ai miglioramenti clinici e alla performance
mnesica nei due gruppi di soggetti (soggetti sottoposti
ad EMDR e soggetti trattati con sertralina) e un dettagliato
confronto dei risultati ottenuti.
Many experimental data have shown that drug therapy
with SSRIs may increase the volume of the hippocampus,
Instead the only study that has investigated the effects of a type
psychotherapy (TEB, Brief Therapy Eclectic) showed no
no effect on hippocampal volume 1. Purpose
of our study was to evaluate the effects of treatment with EMDR
(Eye movement desensitization and reprocessing) on
hippocampal volume, symptoms and performance mnesic
of patients with Post-Traumatic Stress Disorder
(PTSD). The EMDR is a therapy whose efficacy in PTSD is
been demonstrated in numerous experimental studies.
Were selected 12 subjects with a diagnosis of drug-free
PTSD in the SCID-P, without psychiatric comorbidity.
Each recruited subject was submitted to the first visit
(Time 0, Drug-Free) at a psychometric investigation (by
DTS), a neuropsychological investigation (using a battery
test) and measurement of brain volume through
Magnetic Resonance Imaging.
Subsequently, 12 subjects have been allocated
random to two different treatment protocols. Six subjects
have carried out 12 sessions of EMDR duration of 1.5
hours, while six patients were treated with 100 mg of sertraline.
After treatment (Time 1, Post-Therapy) subjects are
were again subjected to the investigations made at the time
0.
The second evaluation at Time 1 was made after
three months in subjects treated with EMDR and after 6 months in
subjects treated with sertraline, based on the average time needed
cylinder for the remission of PTSD reported in the literature
for the two therapeutic aids.
In this study will be presented data on differences
displacement, the clinical improvements and performance
mnesic in the two groups of subjects (subjects
EMDR for patients treated with sertraline) and a detailed
comparison of results.
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Keywords: Hippocampal Volume Poster Sertraline
Accuracy Verified: Yes
11. Kapfhammer, H.-P. (2008, December). Therapeutische möglichkeiten nach traumatischen erlebnissen [Therapeutic possibilities after traumatic experiences]. Psychiatria Danubina, 20(4), 532-545.
Language: German
Format: Journal
Abstract:
Acute Belastungsstörung (ASD) und Posttraumatische Belastungsstörung (PTSD) sind häufige, aber nicht zwingend psychologische Folgeerscheinungen nach einem Trauma. Eine wichtige Untergruppe der Patienten vor einer chronischen Verlauf der Erkrankung mit einem erhöhten psychiatrischen Komorbidität und erhebliche Beeinträchtigungen in psychosozialen Anpassung assoziiert. Der typische psychopathologische Symptome von ASD und PTSD werden am besten in einem multifaktoriellen Modell der Integration sowohl neurobiologische und psychosoziale Einflüsse beschrieben. Die komplexen Ätiopathogenese von akuten und posttraumatischen Belastungsstörung begünstigt multimodalen Ansätzen in der Behandlung. Differential psychotherapeutische und pharmakologische Strategien zur Verfügung stehen. In einer kritischen Studie über empirische Studien, können psychologische Debriefing nicht als einen positiven Ansatz betrachtet werden, als allgemeine vorbeugende Maßnahme in der unmittelbaren posttraumatischen Phase empfohlen werden. Positive Auswirkungen der kognitiv-verhaltenstherapeutischen Interventionen kann für ASD eingerichtet werden. Psychodynamische Psychotherapie, kognitive Verhaltenstherapie und EMDR zeigen viel versprechende Ergebnisse bei der Behandlung von PTSD. Wesentliche klinische Einschränkungen der Patienten innerhalb von speziellen Probenahmen Forschungseinrichtungen, jedoch nicht gestatten, eine bedingungslose Verallgemeinerung dieser Daten zu psychiatrischen Routineversorgung. In einer empirischen Analyse der SSRIs sind die meisten und am besten untersuchten Medikamente für ASD und PTSD. Im Vergleich zu trizyklischen Antidepressiva SSRIs zeigen ein breiteres Spektrum an therapeutischen Wirkungen und sind besser verträglich. Die Substanzklassen der SNRI, DAS, SARI und NaSSA sind als Medikamente der zweiten Wahl angesehen werden. Sie versprechen eine therapeutische Wirksamkeit der SSRI gleichwertig, wobei bisher nur in offenen Studien untersucht. MAO-Hemmer können eine positive therapeutische Potenzial verfügen, müssen ihr Profil der Nebenwirkungen geachtet, jedoch werden. Mood-Stabilisatoren und atypische Neuroleptika können in Anspruch genommen werden und vor allem im Add-On-Strategien. Benzodiazepine sollten nur mit Vorsicht erhöht für eine kurze Zeit in den Staaten der akuten Krise eingesetzt werden. In frühen Interventionen, die blockierende Substanzen norepinephric Hyperaktivität scheinen vielversprechende Alternativen. Stress Dosen von Hydrocortison kann als experimentelle pharmakologische Strategie betrachtet so weit sein. [PubMed]
Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are frequent, but not obligatory psychological sequelae following trauma. A major subgroup of patients face a chronic course of illness associated with an increased psychiatric comorbidity and significant impairments in psychosocial adaptation. The typical psychopathological symptoms of ASD and PTSD are best described within a multifactorial model integrating both neurobiological and psychosocial influences. The complex etiopathogenesis of acute and posttraumatic stress disorder favours multimodal approaches in the treatment. Differential psychotherapeutic and pharmacological strategies are available. In a critical survey on empirical studies, psychological debriefing cannot be considered as a positive approach to be recommended as general preventive measure during the immediate posttraumatic phase. Positive effects of cognitive-behavioral interventions can be established for ASD. Psychodynamic psychotherapy, cognitive-behavioral therapy and EMDR show promising results in the treatment of PTSD. Major clinical restrictions of patient sampling within special research facilities, however, do not allow an unconditional generalization of these data to psychiatric routine care. In an empirical analysis the SSRIs are the most and best studied medications for ASD and PTSD. In comparison to tricyclic antidepressants SSRIs demonstrate a broader spectrum of therapeutic effects and are better tolerated. The substance classes of SSNRI, DAS, SARI and NaSSA are to be considered as drugs of second choice. They promise a therapeutic efficacy equivalent to the SSRIs, being investigated so far only in open studies. MAO-inhibitors may dispose of a positive therapeutic potential, their profile of side effects must be respected, however. Mood stabilizers and atypical neuroleptics may be used first and foremost in add-on strategies. Benzodiazepines should be used only with increased caution for a short time in states of acute crisis. In early interventions, substances blocking the norepinephric hyperactivity seem to be promising alternatives. Stress doses of hydrocortisone may be considered as an experimental pharmacological strategy so far.[PUBMED]
Keywords: Acute Stress Disorder ASD Posttraumatic Stress Disorder PTSD
Accuracy Verified: Yes
12. Forbes, D., Creamer, M. C., Phelps, A. J., Couineau, A. L., Cooper, J. A., Bryant, R. A., McFarlane, A. C., Devilly, G. J., Matthews, L. R., & Raphael, B. (2007, July). Treating adults with acute stress disorder and post-traumatic stress disorder in general practice: A clinical update. Medical Journal of Australia, 187(2), 120-123.
Language: English
Format: Journal
Abstract:
General practitioners have an important role to play in helping patients after exposure to severe psychological trauma. In the immediate aftermath of trauma, GPs should offer "psychological first aid", which includes monitoring of the patient's mental state, providing general emotional support and information, and encouraging the active use of social support networks, and self-care strategies. Drug treatments should be avoided as a preventive intervention after traumatic exposure; they may be used cautiously in cases of extreme distress that persists. Adults with acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) should be provided with trauma-focused cognitive behaviour therapy (CBT). Eye movement desensitisation and reprocessing (EMDR) in addition to in-vivo exposure (confronting avoided situations, people or places in a graded and systematic manner) may also be provided for PTSD. Drug treatments should not normally replace trauma-focused psychological therapy as a first-line treatment for adults with PTSD. If medication is considered for treating PTSD in adults, selective serotonin reuptake inhibitor antidepressants are the first choice. Other new generation antidepressants and older tricyclic antidepressants should be considered as second-line pharmacological options. Monoamine oxidase inhibitors may be considered by mental health specialists for use in people with treatment-resistant symptoms.
Keywords: Acute Stress Disorder Anti-Depressants ASD MAO Inhibitors Posttraumatic Stress Disorder PSTD SSRIs
Accuracy Verified: Yes
13. Blowers, C., Pawelzik, M., Zangwill, W., Fetko, D., Bondy, N., Cable, S., Thomson, J., & Fairhead, D. & Harrowes, M. (2003). Treating phobias desensitization, virtual reality exposure therapy, and EMDR. Princeton, NJ: Films for the Humanities & Sciences.
Language: English
Format: Video
Abstract:
This DVD draws excerpts from two programs, Treating Phobias: Behavioral Therapy, Hypnosis, Flooding, and SSRIs and the program Treating Phobias: Desensitization, Virtual Reality Exposure Therapy, and EMDR. Both are issued as parts of the series Phobia: When an Irrational Fear takes control. Included from these two programs are the work of Dr. Colin Blowers who uses behavioral therapy to treat fear of dogs, Dr. Markus Pawelzik of the Christoph Dornier Centrum who uses flooding to treat the fear of heights and Dr. William Zangwill who uses EMDR (eye movement desensitization reprocessing) to treat the fear of driving. Also shown is a fear of flying course which combines behavioral therapy and flooding to combat this phobia. The work of animal behaviorist Dr. Dennis Fetko, "Dr. Dog" is also highlighted. (WorldCAT)
Keywords: Phobias Virtual Reality Exposure Therapy
Accuracy Verified: Yes
14. Blowers, C., Pawelzik, M., Zangwill, W., Fetko, D., Bondy, N., Cable, S., Thomson, J., Fairhead, D., & Harrowes, M. (2003). Treating phobias, behavioral therapy, hypnosis, flooding, and SSRIs. Princeton, NJ: Films for the Humanities & Sciences: Distributed under license from BBC Worldwide Americas.
Language: English
Format: Video
Abstract:
This DVD draws excerpts from two programs, Treating Phobias: Behavioral Therapy, Hypnoisis, Flooding, and SSRIs and the program Treating Phobias: Desensitization, Virtual Reality Exposure Therapy, and EMDR. Both are issued as parts of the series Phobia: When an Irrational Fear takes control. Included from these two programs are the work of Dr. Colin Blowers who uses behavioral therapy to treat fear of dogs, Dr. Markus Pawelzik of the Christoph Dornier Centrum who uses flooding to treat the fear of heights and Dr. William Zangwill who uses EMDR (eye movement desensitization reprocessing) to treat the fear of driving. Also shown is a fear of flying course which combines behavioral therapy and flooding to combat this phobia. The work of animal behaviorist Dr. Dennis Fetko, "Dr. Dog" is also highlighted. (WorldCAT)
Keywords: Phobias Virtual Reality Exposure Therapy
Accuracy Verified: Yes