The Therapeutic Relationship in EMDR Therapy.

The history of EMDR Therapy goes back to 1987, when it was introduced as EMD, a novel treatment for PTSD by Francine Shapiro. Over the course of time EMD developed into the comprehensive therapy approach named EMDR Therapy. The development of the "Adaptive Information Processing (AIP) Model", the model of pathogenesis and change of EMDR Therapy, was a milestone in this development from technique to psychotherapy approach. Up to date EMDR Therapy offers not only a model of pathogenesis and change, but also a variety of treatment plans and techniques to treat patients of various diagnosis far beyond PTSD. What seems to be missing is a specific description of the therapeutic relationship in EMDR Therapy. The therapeutic relationship should be described as a core element of EMDR Therapy, and seems be related to the structure of EMDR Therapy. As attachment theory offers a view on the development of interpersonal relationships in general, an attachment theory based perspective of the therapeutic relationship seems advisable. A description of the therapeutic relationship in EMDR Therapy is necessary at this point of the development of EMDR Therapy to a psychotherapeutic approach and therefore we try to describe the therapeutic relationship in this article and point out parallels between the therapeutic relationship and the development and core features of an attachment based relationship. We propose to describe EMDR Therapy as a sensitive psychotherapy. Implications for treatment, training and research will be discussed.

Trauma Psycho Social Support Plus and EMDR therapy for children and adolescents in a post-conflict setting: Mental health training in Kurdistan.

INTRODUCTION: This paper describes the implementation of a pilot project in Kurdistan / Northern Iraq on the use of EMDR in children in post-conflict settings. METHODS: A 4-field scheme aimed at patient stabilisation was taught to social workers for the application with children and adolescents in Northern Iraq. If possible, the stabilisation was followed by procedures aimed at memory reprocessing or modification within the eightphase EMDR protocol and (in all cases) with further care. RESULTS: An initial assessment of the children and adolescents themselves revealed significant traumatic burden. The subjective distress was reduced when the rescue and the present situation were reflected age-appropriately with the help of pictures and sketches. For six children and adolescents, a post-stabilisation treatment within EMDR therapy was offered. The first results in this very small sample were encouraging providing support for a fullscale controlled study.

The Structure of EMDR Therapy: A Guide for the Therapist.

Since the introduction of EMD by Dr. Shapiro in 1987, which led to the development of EMDR Therapy, clinical experiences and research contributed to a variety of protocols and procedures. While this dynamic evolution within EMDR Therapy is offering more options to treat a variety of patients suffering from various disorders, there is a greater risk of deviations from the core framework of this approach that would no longer be understood as EMDR Therapy. While research shows that following Shapiro's standard protocols and procedural steps is important to achieve positive treatment effects, it seems prudent to define the core elements in EMDR Therapy beyond adherence to the standard protocol given the complexity of clinical demands in a variety of treatment contexts. The author proposes that best practices requires not only an adherence to the fidelity of the model, but a willingness to adapt the model in order to best meet the needs of our clients in a variety of clinical contexts. Defining the core elements that constitute EMDR Therapy offers both a structure that has been well established and offers a foundation from which clinical adaptations can be made that are within the realm of what is widely accepted as EMDR Therapy. Such a structure could also be used to define research as well as clinical applications. Additionally EMDR Therapy as a comprehensive psychotherapy approach implies that the therapeutic relationship is an important component and should be considered a core element of this methodology.

Eye movement desensitization and reprocessing for depression: a systematic review and meta-analysis.

Background: In recent years, eye movement desensitization and reprocessing (EMDR) has been applied to different psychiatric conditions beyond post-traumatic stress disorder (PTSD), and an increasing number of studies have evaluated its effect on depression. To date, no quantitative synthesis of the efficacy of EMDR on depression has been conducted. Objective: To meta-analytically review the studies on EMDR for depression as the primary target for treatment. Method: Studies with a controlled design evaluating the effect of EMDR on depression were searched on six electronic databases (PubMed, Embase, CINAHL, PsycINFO, Cochrane database, and Francine Shapiro Library) and then selected by two independent reviewers. A systematic review and meta-analysis was conducted. Results: Eleven studies were included for qualitative synthesis. Nine studies were included in the meta-analysis, involving 373 participants. The overall effect size of EMDR for depressive symptoms is large (n = 9, Hedges' g = - 1.07; 95%CI [-1.66; - 0.48]), with high heterogeneity (I 2 = 84%), and corresponds to a 'number needed to treat' of 1.8. At follow-up (range 3-6 months), the effect remains significant but moderate (n = 3, Hedges' g = - 0.62; 95%CI [-0.97; - 0.28]; I 2 = 0%). The effect of EMDR compared with active controls is also moderate (n = 7, g = - 0.68; 95%CI [-0.92; - 0.43]; I 2 = 0%). No publication bias was found, although the results are limited by the small number and poor methodological quality of the included studies. Conclusions: Review findings suggest that EMDR may be considered an effective treatment for improving symptoms of depression, with effects comparable to other active treatments. However, findings need to be interpreted in light of the limited number of the studies and their quality. Further research is required to understand the longer-term of effects EMDR in treating depression and preventing depression relapse. Protocol registration: PROSPERO (CRD42018090086).

Antecedentes: En los últimos años, la desensibilización y reprocesamiento por movimientos oculares (EMDR) se ha aplicado a diferentes condiciones psiquiátricas más allá del trastorno de estrés postraumático (TEPT), y un número creciente de estudios ha evaluado su efecto en la depresión. Hasta la fecha, no se ha realizado ninguna síntesis cuantitativa de la eficacia de la EMDR en la depresión.Objetivo: Revisar meta-analíticamente los estudios de EMDR para la depresión como objetivo principal del tratamiento.Método: Se buscaron estudios con un diseño controlado que evaluaran el efecto de la EMDR en la depresión en seis bases de datos electrónicas (PubMed, Embase, CINAHL, PsycINFO, base de datos Cochrane y Francine Shapiro Library) y luego fueron seleccionados por dos revisores independientes. Se realizó una revisión sistemática y un metanálisis.Resultados: Se incluyeron once estudios para la síntesis cualitativa. Se incluyeron nueve estudios en el meta-análisis, con 373 participantes. El tamaño del efecto global de la EMDR para los síntomas depresivos es grande (n = 9, g de Hedges = −1,07; IC del 95% [−1,66; −0,48]), con alta heterogeneidad (I 2 = 84%), y corresponde a un 'número necesario a tratar' de 1,8. En el seguimiento (rango 3-6 meses), el efecto sigue siendo significativo pero moderado (n = 3, g de Hedges = −0,62; IC del 95% [−0,97;-0,28]; I 2 = 0%). El efecto del EMDR en comparación con los controles activos también es moderado (n = 7, g = −0,68; IC del 95% [−0,92;-0,43]; I 2 = 0%). No se encontró ningún sesgo de publicación, aunque los resultados están limitados por el pequeño número y la pobre calidad metodológica de los estudios incluidos.Conclusiones: Los resultados de la revisión sugieren que la EMDR puede considerarse un tratamiento eficaz para mejorar los síntomas de la depresión, con efectos comparables a los de otros tratamientos activos. Sin embargo, los hallazgos deben interpretarse a la luz del número limitado de los estudios y su calidad. Se requiere investigación adicional para comprender los efectos a largo plazo de la EMDR en el tratamiento de la depresión y la prevención de la recaída de la depresión.Registro del protocolo: PROSPERO (CRD42018090086).

Eye Movement Desensitization and Reprocessing Versus Treatment as Usual in the Treatment of Depression: A Randomized-Controlled Trial.

Eye movement desensitization and reprocessing (EMDR) is a well-established treatment for post-traumatic stress disorder. Recent research suggested that it may be effective in treating depressive disorders as well. The present study is part of a multicenter randomized-controlled trial, the EDEN study, in which a homogenous group of 30 patients was treated to test whether EMDR plus treatment as usual (TAU) would achieve superior results compared to TAU only in a psychosomatic-psychotherapeutic inpatient treatment setting. Both groups were assessed by the Beck Depression Inventory-II (BDI-II) and the Global Severity Index and depression subscale of the Symptom Checklist 90-Revised. The EMDR + TAU group improved significantly better than the TAU group on the BDI-II and Global Severity Index, while a marginally significant difference favoring the EMDR + TAU group over the TAU group was found on the depression subscale. In the EMDR + TAU group, seven out of 14 patients improved below nine points on the BDI-II, which is considered to be a full remission, while four out of 16 in the TAU group did so. These findings confirm earlier suggestions that EMDR therapy may provide additional benefit in the treatment of depression. The present study strengthens the previous literature on EMDR therapy in the treatment of depression due to the randomized-controlled design of the EDEN study.

Comparison of Eye Movement Desensitization Reprocessing and Cognitive Behavioral Therapy as Adjunctive Treatments for Recurrent Depression: The European Depression EMDR Network (EDEN) Randomized Controlled Trial.

Background: Treatment of recurrent depressive disorders is currently only moderately successful. Increasing evidence suggests a significant relationship between adverse childhood experiences and recurrent depressive disorders, suggesting that trauma-based interventions could be useful for these patients. Objectives: To investigate the efficacy of Eye Movement Desensitization and Reprocessing therapy (EMDR) in addition to antidepressant medication (ADM) in treating recurrent depression. Design: A non-inferiority, single-blind, randomized clinical controlled trial comparing EMDR or CBT as adjunctive treatments to ADM. Randomization was carried out by a central computer system. Allocation was carried out by a study coordinator in each center. Setting: Two psychiatric services, one in Italy and one in Spain. Participants: Eighty-two patients were randomized with a 1:1 ratio to the EMDR group (n = 40) or CBT group (n = 42). Sixty-six patients, 31 in the EMDR group and 35 in the CBT group, were included in the completers analysis. Intervention: 15 ± 3 individual sessions of EMDR or CBT, both in addition to ADM. Participants were followed up at 6-months. Main outcome measure: Rate of depressive symptoms remission in both groups, as measured by a BDI-II score <13. Results: Sixty-six patients were analyzed as completers (31 EMDR vs. 35 CBT). No significant difference between the two groups was found either at the end of the interventions (71% EMDR vs. 48.7% CBT) or at the 6-month follow-up (54.8% EMDR vs. 42.9% CBT). A RM-ANOVA on BDI-II scores showed similar reductions over time in both groups [F(6,59) = 22.501, p < 0.001] and a significant interaction effect between time and group [F(6,59) = 3.357, p = 0.006], with lower BDI-II scores in the EMDR group at T1 [mean difference = -7.309 (95% CI [-12.811, -1.806]), p = 0.010]. The RM-ANOVA on secondary outcome measures showed similar improvement over time in both groups [F(14,51) = 8.202, p < 0.001], with no significant differences between groups [F(614,51) = 0.642, p = 0.817]. Conclusion: Although these results can be considered preliminary only, this study suggests that EMDR could be a viable and effective treatment for reducing depressive symptoms and improving the quality of life of patients with recurrent depression. TRIAL REGISTRATION: ISRCTN09958202.

The AIP Model of EMDR Therapy and Pathogenic Memories.

Eye Movement Desensitization and Reprocessing (EMDR) therapy has been widely recognized as an efficacious treatment for post-traumatic stress disorder (PTSD). In the last years more insight has been gained regarding the efficacy of EMDR therapy in a broad field of mental disorders beyond PTSD. The cornerstone of EMDR therapy is its unique model of pathogenesis and change: the adaptive information processing (AIP) model. The AIP model developed by F. Shapiro has found support and differentiation in recent studies on the importance of memories in the pathogenesis of a range of mental disorders beside PTSD. However, theoretical publications or research on the application of the AIP model are still rare. The increasing acceptance of ideas that relate the origin of many mental disorders to the formation and consolidation of implicit dysfunctional memory lead to formation of the theory of pathogenic memories. Within the theory of pathogenic memories these implicit dysfunctional memories are considered to form basis of a variety of mental disorders. The theory of pathogenic memories seems compatible to the AIP model of EMDR therapy, which offers strategies to effectively access and transmute these memories leading to amelioration or resolution of symptoms. Merging the AIP model with the theory of pathogenic memories may initiate research. In consequence, patients suffering from such memory-based disorders may be earlier diagnosed and treated more effectively.

Eye movement desensitization and reprocessing (EMDR) therapy in the treatment of depression: a matched pairs study in an inpatient setting.

BACKGROUND: Depression is a severe mental disorder that challenges mental health systems worldwide as the success rates of all established treatments are limited. Eye Movement Desensitization and Reprocessing (EMDR) therapy is a scientifically acknowledged psychotherapeutic treatment for PTSD. Given the recent research indicating that trauma and other adverse life experiences can be the basis of depression, the aim of this study was to determine the effectiveness of EMDR therapy with this disorder. METHOD: In this study, we recruited a group of 16 patients with depressive episodes in an inpatient setting. These 16 patients were treated with EMDR therapy by reprocessing of memories related to stressful life events in addition to treatment as usual (TAU). They were compared to a group of 16 controls matched regarding diagnosis, degree of depression, sex, age and time of admission to hospital, which were receiving TAU only. RESULTS: Sixty-eight percent of the patients in the EMDR group showed full remission at end of treatment. The EMDR group showed a greater reduction in depressive symptoms as measured by the SCL-90-R depression subscale. This difference was significant even when adjusted for duration of treatment. In a follow-up period of more than 1 year the EMDR group reported less problems related to depression and less relapses than the control group. CONCLUSIONS: EMDR therapy shows promise as an effective treatment for depressive disorders. Larger controlled studies are necessary to replicate our findings.

Improved outcomes after alloplastic TMJ replacement: analysis of a multicenter study from Australia and New Zealand.

PURPOSE: The aim of the present study was to assess pain, function, diet, and quality of life (QOL) in subjects undergoing alloplastic temporomandibular joint (TMJ) reconstruction. MATERIALS AND METHODS: A total of 72 subjects were sent a questionnaire an average of 4 years after undergoing either unilateral or bilateral total joint replacement with a custom TMJ Concepts or stock Biomet total joint replacement device. The changes in pain, function, diet, and quality of life were assessed. RESULTS: Of the 72 subjects, 52 returned the questionnaire. Pain, function, diet, and QOL were all significantly improved at a mean follow-up of 46.3 months. The complications reported included an altered facial sensation and facial weakness. No implant failures were reported. CONCLUSIONS: The placement of an alloplastic TMJ total joint replacement can provide benefits for patients in the areas of pain, function, diet, and QOL. Additional research is required in this area.

Radiology operations: what you don't know could be costing you millions.

Rapid growth in advanced imaging procedures has left hospital radiology departments struggling to keep up with demand, resulting in loss of patients to facilities that can offer service more quickly. While the departments appear to be working at full capacity, an operational analysis of over 400 hospital radiology departments in the US by GE Healthcare has determined that, paradoxically, many departments are in fact underutilized and operating for below their potential capacity. While CT cycle time in hospitals that were studied averaged 35 minutes, top performing hospitals operated the same equipment at a cycle time of 15 minutes, yielding approximately double the throughput volume. Factors leading to suboptimal performance include accounting metrics that mask true performance, leadership focus on capital investment rather than operations, under staffing, under scheduling, poorly aligned incentives, a fragmented view of operations, lack of awareness of latent opportunities, and lack of sufficient skills and processes to implement improvements. The study showed how modest investments in radiology operations can dramatically improve access to services and profitability.