Francine Shapiro Library: EMDR Bibliography

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1. 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  

2. Hull, A. M. (2002). Neuroimaging findings in post-traumatic stress disorder:  Systematic review. doi:10.1192/bjp.181.2.102. British Journal of Psychiatry, 181(2), 102-110.

Language: English

Format: Journal

Abstract:
Background Findings from neuroimaging studies complement our understanding of the wide-ranging neurobiological changes in trauma survivors who develop post-traumatic stress disorder (PTSD). Aims To determine whether neuroimaging studies had identified structural and functional changes specific to PTSD. Method A review of all functional and structural neuroimaging studies of subjects with PTSD was carried out. Studies were identified using general medical and specific traumatic stress databases and paper searches of current contents and other secondary sources. Results The most replicated structural finding is hippocampal volume reduction, which may limit the proper evaluation and categorisation of experience. Replicated localised functional changes include increased activation of the amygdala after symptom provocation (which may reflect its role in emotional memory) and decreased activity of Broca's area at the same time (which may explain the difficulty patients have in labelling their experiences). Conclusions Evidence from neuroimaging studies has suggested areas of the brain that may be damaged by psychological trauma. The clinical implications of these neuroimaging findings need to be investigated further because they challenge traditional therapeutic approaches.

Keywords: Posttraumatic Stress Disorder  PTSD  

3. 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  

4. 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  

5. 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  

6. 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  

7. 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.

8. 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