Aproximaciones psicoterapéuticas para el manejo del tinnitus crónico no pulsátil / Psychotherapy approaches for the management of non-pulsatile chronic tinnitus

Resumen La fisiopatología del tinnitus crónico no pulsátil es poco clara, pero se reconoce un componente psicológico relevante, por tanto, existen distintas aproximaciones psicoterapéuticas que han sido estudiadas. La terapia cognitivo conductual es la que cuenta con mayor evidencia. Ella contempla la reestructuración de las cogniciones disfuncionales que favorecen la presencia del tinnitus. Se ha verificado su eficacia en los niveles de distrés, calidad de vida, severidad, sintomatología depresiva e insomnio asociados. La desensibilización y reprocesamiento por movimientos oculares recoge algunos presupuestos de la terapia cognitivo conductual, pero considera técnicas como la estimulación bilateral. Sus resultados en patologías crónicas somáticas han sugerido la aplicación en tinnitus, corroborando su eficacia en calidad de vida, distrés y sintomatología depresiva. Dos psicoterapias basadas en mindfulness aplicadas en tinnitus son la reducción del estrés basado en el mindfulness y la terapia cognitiva basada en mindfulness. La primera ha demostrado eficacia en la calidad de vida y en la disminución y el refuerzo de cogniciones negativas y positivas, respectivamente. La segunda, es eficaz en la severidad, intensidad, distrés, ansiedad, depresión y discapacidad asociadas a tinnitus. Finalmente, la terapia de aceptación y compromiso promueve la aceptación como componente central del tratamiento de condiciones crónicas, considerando el control que ejerce el contexto sobre la vivencia de estas condiciones y el compromiso terapéutico. Esta terapia es eficaz en calidad de vida. Se promueve la investigación en aproximaciones psicoterapéuticas para el tinnitus, lo que posibilitará la aplicación de terapias más específicas y la clarificación de su fisiopatología.

Abstract The pathophysiology of non-pulsatile chronic tinnitus is unclear, but it is recognized a relevant psychological component. In this sense, different psychotherapeutic approaches have been studied. Cognitive behavioral therapy is the psychotherapy with the most evidence. It considers the restructuring of dysfunctional cognitions that favor the presence of tinnitus. Its efficacy has been verified on distress, quality of life, severity, associated depressive symptoms and insomnia. Eye movement desensitization and reprocessing includes some conceptions of cognitive behavioral therapy and considers techniques such as bilateral stimulation. Its results in chronic somatic pathologies have suggested its application in tinnitus, corroborating its efficacy in quality of life, distress, and depressive symptoms. Two mindfulness-based psychotherapies applied in tinnitus are mindfulness-based stress reduction and mindfulness-based cognitive therapy. The first has shown efficacy on quality of life and reduction and reinforcement of negative and positive cognitions, respectively. The second is effective on severity, loudness, distress, anxiety, depression and disability associated with tinnitus. Finally, acceptance and commitment therapy promote acceptance as a central component of the treatment of chronic conditions, considering the control exerted by the context over the experience of these conditions and the therapeutic commitment. This therapy is effective on quality of life. We foster the research on psychotherapeutic approaches to tinnitus, which will make it possible the application of more specific interventions and, at the same time, elucidate its pathophysiology.

Desensibilización y reprocesamiento por movimientos oculares (EMDR) para trastornos ansiosos y depresivos en niños y adolescentes: revisión de la evidencia disponible / Eye movement desensitization and reprocessing (EMDR) for anxiety and depressive disorders in children and adolescents: a review of the available literature

Resumen Introducción: la desensibilización y reprocesamiento por movimientos oculares (EMDR) tiene abundante evidencia de eficacia en desórdenes del espectro traumático. Su eficacia en trastornos ansiosos (TA) y depresivos (TD) en niños, niñas y adolescentes ha sido escasamente estudiada. Método: se realizó una revisión narrativa para describir la evidencia disponible sobre eficacia de EMDR en TA y TD en población infantojuvenil. Se buscaron artículos disponibles en PubMed/Medline, SciELO, PsycINFO y Cochrane Library. Se incluyeron todos los artículos primarios y secundarios que evaluaron el efecto de EMDR en TA y TD en población infantojuvenil. Se revisaron sus referencias como segundo método de inclusión. Resultados: se identificaron nueve estudios (cinco en TA y cuatro en TD); tres fueron observacionales y seis experimentales. Todos tuvieron tamaños muestrales reducidos. En TA, los estudios corroboraron la eficacia de EMDR sobre el temor fóbico en fobia a las arañas, pero no sobre la conducta evitativa, donde sería superior la exposición in vivo. Dos series de casos expusieron la utilidad de EMDR en fagogobia y en TA asociados a epilepsia. En TD, EMDR fue eficaz en la reducción de sintomatología depresiva en el contexto del trastorno depresivo mayor, trastorno de estrés agudo y trastornos conductuales. EMDR fue comparable a terapia cognitivo-conductual. Conclusiones: la evidencia corrobora la eficacia de EMDR en TA y TD en niños, niñas y adolescentes. Sin embargo, es muy escasa y cuenta con limitaciones metodológicas. Es necesario realizar estudios experimentales con protocolos estandarizados y especializados de EMDR para TA y TD en población infantojuvenil.

Introduction: Eye movement desensitization and reprocessing (EMDR) has abundant evidence of efficacy in traumatic spectrum disorders. Its efficacy in anxiety disorders (AD) and depressive disorders (DD) in children and adolescents has been scarcely studied. Methods: We conducted a narrative review to describe the available evidence on the efficacy of EMDR in AD and DD in children and adolescents. We searched for articles available in PubMed/Medline, SciELO, PsycInfo and the Cochrane Library. All primary and secondary studies evaluating the effect of EMDR on AD and DD in children and adolescents were included. Their references were reviewed as a second method of inclusion. Results: nine studies were identified (five in AD and four in DD); three were observational and six experimental. All had small sample sizes. In AD, studies corroborated the efficacy of EMDR on phobic fear in spider phobia, but not on avoidance behavior, where in vivo exposure would be superior. Two case series reported the efficacy of EMDR in choking phobia and AD associated with epilepsy. In DD, EMDR was effective in reducing depressive symptomatology in the context of major depressive disorder, acute stress disorder, and conduct disorders. EMDR was comparable to cognitive behavioral therapy. Conclusions: The evidence corroborates the efficacy of EMDR in AD and DD in children and adolescents. However, it is very scarce and has methodological limitations. It is necessary to carry out experimental studies with standardized and specialized EMDR protocols for AD and DD in the child and adolescent population.

An exploration of the processing of suppressed memories during Rebirthing-Breathwork / Uma exploração do processamento de memorias suprimidas durante Rebirthing-Breathwork / Una exploración del procesamiento de memorias suprimidas durante Rebirthing-Breathwork

Rebirthing-Breathwork is a technique that uses the breathing rhythm to activate a somatic-cognitive cycle. When allowed to unfold, this cycle activates suppressed and traumatic memories, brings them to consciousness and leads to their resolution. In this analytic and interpretative study we draw on first-person experiences and clinical observations to describe the phases of a typical Rebirthing Breathwork session. Changes in consciousness and in particular the phases related to the processing of suppressed or traumatic memories during Rebirthing Breathwork are described in detail, with the objective of developing a processing model. The findings are compared with the Adaptive Information Processing model developed by Shapiro to explain the processing of dysfunctional memories during Eye movement Desensitization and Reprocessing (EMDR). Shapiro's model is based on neurobiological theories and on the hypothesis that during EMDR traumatic memories form new connections and are assimilated in larger neural networks. Our findings suggest a different model, which involves the distillation and re-evaluation of subjective conceptual content. We sketch an alternative processing model ­ not based on information processing, but on consciousness and cognition ­ in which the subjective content of the memory is compared to an intuitively perceived higher self-image.(AU)

Rebirthing-Breathwork é uma técnica que utiliza o ritmo respiratório para ativar um ciclo cognitivo-somático. Quando permitido que se desenvolva, esse ciclo ativa memórias traumáticas reprimidas, trazendo-as à consciência e conduzindo-as à sua resolução. Neste estudo analítico e interpretativo utilizamos experiências pessoais e observações clínicas para descrever as fases de uma sessão típica de Rebirthing-Breathwork. Descrevemos em detalhes as mudanças de consciência e, particularmente, as fases relacionadas ao processamento de memórias reprimidas ou traumáticas durante a sessão. As evidências são comparadas ao Adaptive Information Processing model (AIP ­ modelo de processamento de informações adaptativas) desenvolvido por Shapiro para explicar a elaboração de memórias disfuncionais durante a terapia EMDR (Eye Movement Desensitization and Reprocessing, ou Dessensibilização e Reprocessamento por Movimentos Oculares). O modelo de Shapiro é baseado em teorias neurobiológicas e na hipótese de que, durante o EMDR,as memórias traumáticas formamnovas conexõese são assimiladas em redes neurais maiores. As nossas observações sugerem um modelo diferente, que envolve a destilação e reavaliação do conteúdo conceitual subjetivo. Esboçamos um modelo alternativo de processamento ­ não baseado no processamento de informação, mas emconsciência e cognição ­ no qual o conteúdo subjetivo da memória é comparado a uma autoimagem superior que é percebida intuitivamente.(AU)

Rebirthing-Breathwork es una técnica que utiliza el ritmo respiratorio para activar un ciclo cognitivosomático. Cuando permitido que se desarrolle, este ciclo activa memorias suprimidas y traumáticas, lleva las mismas a la conciencia y conduce hacia su resolución. En este estudio analítico e interpretativo aportamos experiencias personales y observaciones clínicas para describir las fases de una sesión típica de Rebirthing-Breathwork. Cambios en conciencia y en especial las fases relativas al procesamiento de memorias suprimidas y traumáticas durante el Rebirthing-Breathwork son descritos en detalles. Las evidencias son comparadas al Adaptive Information Processing model (AIP ­ modelo de procesamiento de informaciones adaptativas) desarrollado por Shapiro para explanación de la elaboración de memorias non-funcionales durante la terapia EMDR (Eye Movement Desensitization and Reprocessing, o Desensibilización y Reprocesamiento por Movimientos Oculares). El modelo de Shapiro es basado en teorías neurobiológicas y en la hipótesis de que, durante el EMDR, las memorias traumáticas forman nuevas conexiones y son asimiladas en redes neurales más grandes. Nuestras observaciones sugieren un modelo distinto, que abarca la destilación y revaluación del contenido conceptual subjetivo. Esbozamos un modelo alternativo de procesamiento ­ non basado en el procesamiento de información, pero en conciencia y cognición ­ en el cual el contenido subjetivo de la memoria es comparado a una autoimagen superior que es percibida intuitivamente.(AU)

Add-on Eye Movement Desensitization and Reprocessing (EMDR) Therapy for Adults with Post-traumatic Stress Disorder Who Failed to Respond to Initial Antidepressant Pharmacotherapy

This study examined the add-on efficacy of eye movement desensitization and reprocessing (EMDR) therapy among adult civilians with post-traumatic stress disorder (PTSD) who continued to be symptomatic after more than 12 weeks of initial antidepressant treatment. Scores for the Clinician Administered PTSD Scale (CAPS) were rated pre- and post-EMDR and at a 6-month follow-up. After an average of six sessions of EMDR treatment, seven of 14 patients (50%) showed more than a 30% decrease in CAPS score and eight (57%) no longer met the criteria for PTSD. Our results indicate that EMDR could be successfully added after failure of initial pharmacotherapy for PTSD.

Eye Movement Desensitization and Reprocessing to Facilitate Posttraumatic Growth: A Prospective Clinical Pilot Study on Ferry Disaster Survivors

OBJECTIVE: The purpose of this study was to investigate the therapeutic effects of eye movement desensitization and reprocessing (EMDR) on post-traumatic growth (PTG). METHODS: This study was conducted using a sample of ten survivors of a large-scale maritime disaster that occurred in the Yellow Sea, South Korea, in April 2014. A total of eight EMDR sessions were administered by a psychiatrist at two-week intervals over a period of five months, starting two or three months after the accident. Post-Traumatic Growth Inventory (PTGI), Stress-Related Growth Scale (SRGS), Clinician-Administered PTSD Scale (CAPS), and Connor-Davidson Resilience Scale (CD-RISC) were measured before treatment, after sessions 4 and 8, and at three months after treatment completion. RESULTS: After three months from treatment completion, significant increases were observed in PTG (PTGI: Z(8)=−2.380, p=0.017; SRGS: Z(8)=−2.380, p=0.017) and resilience (CD-RISC: Z(8)=−2.386, p=0.017). A decrease in post-traumatic stress disorder (PTSD) level was also significant (CAPS: Z(8)=−2.176, p=0.030). The reduction of CAPS scores was correlated with increases of PTGI (rho=0.78, p=0.023) and SRGS (rho=0.79, p=0.020) scores. The changes in CAPS, PTGI, and SRGS scores between time point of end 8-session and three months follow-up was not significant (all p>0.05). Subjects with higher pre-treatment CD-RISC scores showed more significant improvements in PTGI (rho=0.88, p=0.004) and SRGS (rho=0.83, p=0.010) scores after treatment than did those with lower pre-treatment CD-RISC scores. CONCLUSION: EMDR therapy using standard protocol for trauma processing helped facilitating PTG in disaster survivors. To generalize these findings, further controlled studies comparing with other treatment modalities for PTSD are needed.

Psychosocial Interventions for Children and Adolescents after a Disaster: A Systematic Literature Review (1991–2015)

OBJECTIVES: The aim of this systematic literature review is to analyze the psychosocial interventions for children and adolescents after disasters. METHODS: We conducted a review of the extant research literature from 1991 to 2015 via a comprehensive search of the MEDLINE, EMBASE, Cochrane CENTRAL, PubMed and PsyclNFO databases. The keywords employed in this research included: ‘child’, ‘adolescent’, ‘youth’, ‘disaster’, ‘posttraumatic’, ‘psychosocial’, ‘therapy’ and ‘intervention’. The researchers followed the PRISMA guidelines. A total of 850 articles were screened for their eligibility and fifty-nine were found to meet the study criteria. The final data analysis was performed based on the disaster type, study design, type of intervention, sample size, age, school grade, number of sessions, setting of intervention delivery, providers, approach and parent involvement. RESULTS: Countries worldwide have experienced various kinds of disasters, including earthquakes, hurricanes, vessel accidents, tornados, tsunamis, volcanic eruptions, war, fire, terrorism, and traffic accidents. The types of psychosocial intervention that were conducted after these disasters included: psychological first aid, psychological debriefing, psychoeducation, trauma focused cognitive behavior therapy, eye movement desensitization reprocessing, prolonged exposure therapy, group play therapy and arts therapy, project interventions, school-based interventions and web-based interventions. CONCLUSION: The findings of the systematic literature review suggest that an appropriate psychosocial intervention could be utilized as evidence-based mental health treatment for children and adolescents after disasters.

Treatment Response of Affect Regulation Group Therapy for Recently Traumatized School Children / 신경정신의학

OBJECTIVES: The aim of this study was to investigate the treatment effect and predictors of response of affect regulation group therapy (ARGT) delivered to a group of recently traumatized children. METHODS: A total of 464 school children, who had witnessed or confronted a tragic accident at school, were given a single-session of affect regulation group therapy, that which included psychoeducation and affect regulation elements from eye movement desensitization and reprocessing. Of 213 children whose with initial score of Subject Unit of Disturbance Scale (SUDS) score over 4, we compared pre- and post-treatment scores and performed conducted the responder vs. non-responder comparison. The pPost-traumatic disorder (PTSD) symptom scores measured by using Child Reaction to Traumatic Events Scale-Revised (CRTES-R), demographic variables, and clinical variables were considered. RESULTS: Affect regulation group therapy was effective for children who had experienced an acute traumatic event (t=16.3, p<0.001). Baseline SUDS score of for non-responder were was significantly higher (t=-2.89, p<0.001) and CRTES-R score approached a level of significance level (t=-1.72, p=0.09). However, results of logistic regression analysis identified showed that the pretreatment SUDS score was the only significant predictor of non-response. CONCLUSION: Affect regulation group therapy appeared to be effective for children who had undergone experienced an acute traumatic event. And in addition, the survivors' subjective distress was more important to treatment response than severity of PTSD symptoms severity.

The Psychological Characteristics and Functional Magnetic Resonance Imaging Findings in Firefighters with Partial Posttraumatic Stress Disorder and the Effect of Treatment by Using Eye Movement Desensitization and Reprocessing / 신경정신의학

OBJECTIVES: This study investigated the clinical characteristics and functional magnetic resonance imaging (fMRI) findings of firefighters suffering from partial posttraumatic stress disorder (partial PTSD). They were treated by eye movement desensitization and reprocessing (EMDR) and the treatment effect was evaluated. METHODS: A total of 116 firefighters were screened and 15 of them were diagnosed as partial PTSD. 1) We compared sociodemographic and psychological characteristics between the firefighter partial PTSD group and the firefighter control group. 2) Subjects in the firefighter partial PTSD group (n=10), firefighter control group (n=8), and general control group (n=12) underwent fMRI with traumatic, negative, positive, and neutral picture stimuli. We compared clinical characteristics and fMRI findings among these three groups. 3) Seven firefighters in the partial PTSD group were treated by EMDR and the treatment effect was evaluated according to psychological scales. RESULTS: In fMRI analysis, there was a left middle temporal/occipital activation in the order of the general control group, firefighter control group, than the firefighter partial PTSD group for the Traumatic-Baseline contrast. For the Negative-Baseline contrast, there was an increased left middle temporal/occipital activation in the general control group versus decreased activation in the firefighter control group and the firefighter partial PTSD group. All firefighters in the partial PTSD group treated by EMDR showed significant improvement of Clinician-Administered PTSD Scale scores. CONCLUSION: These results show high incidence rate of partial PTSD in firefighters. In addition, partial PTSD firefighters exhibited distinct clinical characteristics and fMRI findings and showed significant improvement by EMDR treatment.

[ effect of eye movement desensitization and reprocessing on anxiety in patients with myocardial infarction]

Coronary heart disease is the main cause of death and inability in all communities. Anxiety is the most common psychological response to myocardial infarction. Present study was conducted to indentify efficacy of eye movement desensitization and reprocessing on the anxiety of patients with myocardial infarction. This study is a clinical trial. Sixty patients with myocardial infarction hospitalized at the cardiac ward of a hospital in Qazvin between 2011-2012 were selected using sampling and were divided by random assignment into experimental and control groups. In order to collect data, demographic and anxiety questionnaires were used. Interventions were subsequently performed in two sessions every other day for 45 to 90 mi and anxiety level of the patients was measured before and after intervention. Data were analyzed using descriptive statistics, paired - t-test, t-test, Willcoxon and Chi square. Mean anxiety levels in experimental group were [48.87 +/- 4.28] and [7.37 +/- 2.42] before and after intervention, respectively; therefore it statistically showed a significant difference [P<0.001]. Mean anxiety level in control group was [49.10 +/- 5.13] before intervention and it was [48.40 +/- 5.31] after intervention, so it statistically showed a significant difference [P<0.001]. The eye movement desensitization and reprocessing is a newly effective, useful, efficient and non-invasive method for treatment and reducing anxiety in patients with myocardial infarction. Nurses, particularly those who are working in Critical Care Units can use this new and effective method for treatment of anxiety in patients

The Effect of Bilaterally Alternating Auditory Stimulations on the Episodic Memory Retrieval / 신경정신의학

OBJECTIVES: Previous research has shown that bilaterally alternating eye movements enhance episodic memory retrieval. This effect has been considered an important mechanism of the therapeutic effects of eye movement desensitization and reprocessing (EMDR) treatment. We conducted this study in order to test the hypothesis that bilaterally alternating auditory stimuli would also have similar effects on episodic memory retrieval. METHODS: Thirty eight right-handed subjects participated in this study. Subjects learned words, and then received bilaterally alternating auditory stimuli (as experimental stimuli) or unilateral auditory stimuli (as control stimuli). Subsequently, they performed recognition memory task. Recognition accuracy, response bias, and mean response to hits were used for evaluation of episodic memory retrieval. Repeated measures analysis of variance was performed for statistical analysis. RESULTS: There was no significant effect of experimental conditions in recognition accuracy, the response bias, and mean response time to hits. CONCLUSION: Unlike the previous positive results of bilaterally alternating eye movements, we did not observe an enhancing effect of bilaterally alternating auditory stimuli compared to unilateral auditory stimuli on episodic memory retrieval. This result suggests the possibility that the therapeutic mechanisms of EMDR might differ according to modalities of bilateral stimulation.

[Comparing the effectiveness of psychological debriefing, eye movement desensitization reprocessing, and imaginal exposure on treatment of chronic post-traumatic stress disorder]

Post-traumatic stress disorder [PTSD] is considered as one of the most prevalent disorder during the life time and can negatively influence the individual, family and social relationships of patients; so, prevention and treatment of this disorder is highly important. Eye movement desensitization and reprocessing [EMDR], psychological debriefing [PD], and imaginal exposure [IE] are some treatment but there is controversy about long effects of these treatments, especially among chronic patients. In a semi experimental study, a total of 54 adult male patients, based on Davidson scale and psychiatric diagnostic, were randomly selected, and then were divided into 3 equal therapy groups. All participants were evaluated before, after and 3 months after the treatment. Data were analyzed through the repeated variance and Duncan post-hoc tests. Psychological debriefing and eye movement desensitization and reprocessing were better than imaginal exposure in relief of chronic post-traumatic stress disorder signs and remaining the effectiveness in three months follow-up. It is concluded that all of the above methods are effective on chronic post-traumatic stress disorder and the efficacy of the therapeutic techniques would be still in force even after 3 months. Considering the importance of psychological interventions, it is necessary that such methods be taught to psychologists so that they can use them after traumatic accidents

Comparison of efficacy of eye movement, desensitization and reprocessing and cognitive behavioral therapy methods in the Treatment of stress disorder

According to symptom oriented of drug therapy in the treatment of post-traumatic stress disorder [PTSD], eye movement, desensitization and reprocessing [EMDR] and cognitive behavioral therapy [CBT] were increasingly used. The aim of this study was to compare effects of EMDR and CBT in acute stress. In this case-control study, 51 combatants with PTSD hospitalized in Isar Hospital of Ardabil province or were inhabited in Ardabil were randomly divided to three groups. The method was extended test method and study design was multi-group test-retest. Used tools included boring memories test, subjective units of distress or anxiety [SUD] scale, validity of cognitions [VOC] scale and hospital anxiety and depression scale. EMDR and CBT significantly decreased boring memories, mental distress, anxiety and depression, and also increased positive cognition. Although both EMDR and CBT caused significant reduction of anxiety and depression, EMDR was superior to CBT in reduction of PTSD symptoms of Iranian combatants. Regarding efficacy of EMDR and CBT in the treatment of PTSD, it is suggested to prevent and decrease symptoms of post traumatic stress disorder [PTSD]

A Pilot Study of Brief Eye Movement Desensitization and Reprocessing(EMDR) for Treatment of Acute Phase Schizophrenia

OBJECTIVES: Eye movement desensitization and reprocessing(EMDR) is a novel, time-limited psychotherapy originally developed for treatment of psychological trauma. The effectiveness of this therapy has been validated only for posttraumatic stress disorder; however, EMDR is often applied to other psychiatric illnesses, including other anxiety disorders and depression. This pilot study tested the efficacy of EMDR added to the routine treatment for individuals with acute stage schizophrenia. METHODS: This study was conducted in the acute psychiatric care unit of a university-affiliated training hospital. Inpatients diagnosed with schizophrenia were randomly assigned to either three sessions of EMDR, three sessions of progressive muscle relaxation(PMR) therapy, or only treatment as usual(TAU). All the participants received concurrent typical treatments(TAU), including psychotropic medication, individual supportive psychotherapy and group activities in the psychiatric ward. The Positive and Negative Syndrome Scale(PANSS), the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale were administered by a clinical psychologist who was blinded to the patients' group assignment. RESULTS: Forty-five patients enrolled and forty patients(89%) completed the post-treatment evaluation. There were no between-group differences in the withdrawal rates of patients during the treatment or at the three-month follow-up session. All three groups improved significantly across each of the symptomatic domains including schizophrenia, anxiety, and depressive symptoms. However, a repeated measures ANOVA revealed no significant differences among the groups over time. Effect size for change in total PANSS scores was also similar across treatment conditions, but effect size for negative symptoms was large for EMDR(0.60 for EMDR, 0.39 for PMR and 0.21 for TAU only). CONCLUSION: These findings supported the use of EMDR in treating the acute stage of schizophrenia but the results failed to confirm the effectiveness of the treatment over the two control conditions in three sessions. Further studies with longer courses of treatment, more focused target dimensions of treatment, and a sample of outpatients are necessary.

Eye Movement Desensitization and Reprocessing for Adolescent Depression

While cognitive behavior therapy is considered to be the first-line therapy for adolescent depression, there are limited data on whether other psychotherapeutic techniques are also effective in treating adolescents with depression. This report suggests the potential application of eye movement desensitization and reprocessing (EMDR) for treatment of depressive disorder related, not to trauma, but to stressful life events. At present, EMDR has only been empirically validated for only trauma-related disorders such as posttraumatic stress disorder. Two teenagers with major depressive disorder (MDD) underwent three and seven sessions of EMDR aimed at memories of stressful life events. After treatment, their depressive symptoms decreased to the level of full remission, and the therapeutic gains were maintained after two and three months of follow up. The effectiveness of EMDR for depression is explained by the model of adaptive information processing. Given the powerful effects observed within a brief period of time, the authors suggest that further investigation of EMDR for depressive disorders is warranted.

Treatment of Posttraumatic Stress Disorder / 신경정신의학

Posttraumatic stress disorder (PTSD) is a psychiatric disorder which cause is certain, and mechanism of PTSD has been studied actively for decades. The various kinds of therapy, based on the pathophysiology of PTSD, were applied and among them eye movement desensitization and reprocessing (EMDR), therapy for sleep, transcranial magnetic stimulation (TMS) and psychopharmacotherapy that showed considerable effect for patients with PTSD would be introduced.

Eye Movement Desensitization and Reprocessing(EMDR) for Post-traumatic Stress Disorder / 신경정신의학

This article reviews existing Eye Movement Desensitization and Reprocessing (EMDR) literature concerning its effectiveness, theory, mechanism, and procedural aspects in the treatment of post-traumatic stress disorder (PTSD). Evidence from randomized clinical trials and meta-analyses indicates that EMDR is as effective as well established treatments such as exposure and cognitive behavior therapy. And moreover, EMDR may be more efficient in terms of unnecessary homework assignment and fewer treatment sessions. The current status of EMDR occupies one of legitimate and standard psychotherapeutic approaches in adult PTSD treatment. Mechanism for treatment efficacy is poorly understood at present and putative at most, however, there is a growing body of literature on neurobiological change after successful EMDR treatment.

Changes in the Regional Cerebral Perfusion after Eye Movement Desensitization and Reprocessing: A SPECT Study of Two Cases

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.

A Case Series of Eye Movement Desensitization and Reprocessing (EMDR) in 30 Psychiatric Patients: Korean Experience / 신경정신의학

OBJECTIVES: Eye Movement Desensitization and Reprocessing (EMDR) is an emerging psychotherapeutic technique for posttraumatic stress disorder and other conditions associated with psychological trauma. The effectiveness of this technique has been reported among North American and European populations; however, research on it's effectiveness among other ethnocultural groups is sparse. This is the first clinical study of EMDR in Korea with 30 Korean psychiatric patients in two clinical settings. METHODS: Diagnostically heterogeneous group of 30 psychiatric patients underwent a mean of 3.13 (95%CI=2.54-3.73) sessions of EMDR. The Clinical Global Impression-Change scale (CGI-C) was administered one week and six months after the termination of treatment. RESULTS: Participants had a mean CGI-C score of 1.80 (95%CI=1.44-2.16). We designated as 'responders' those who were 'very much improved' or 'much improved' on the CGI-C, 23 (77%) After six months, 19/23 (83%) still characterized as remaimed responders. All the patients with posttraumatic stress disorder, phobia, and grief reaction were responders, and those with personality disorder nonresponders. Results for depressive and other disorders were mixed. CONCLUSION: Despite methodological limitations, results from this study suggest that the EMDR can be applied to Korean psychiatric patients.