The effects of psychological interventions on neurocognitive functioning in posttraumatic stress disorder: a systematic review.

Background: Posttraumatic stress disorder (PTSD) is a serious mental disorder, which is associated with emotional and cognitive functioning problems. Psychological interventions, such as trauma-focused cognitive behavioural therapy (tf-CBT) and eye movement desensitization and reprocessing (EMDR) are effective in reducing PTSD symptoms. Despite evidence showing that PTSD is associated with neurocognitive deficits, there is no systematic overview available on neurocognitive outcomes following treatment for PTSD. The current systematic review examined whether psychological treatments for PTSD improve neurocognitive functioning outcomes related to memory, attention, information processing, and executive functioning. Method: A literature search in PubMed, PsycINFO, PTSDpubs, and Cochrane Library was performed up to March 7, 2022, in collaboration with a medical information specialist. Eligible PTSD treatment studies examining neurocognitive outcomes (memory, attention, information processing and executive function) in patients with a DSM-IV or ICD diagnosis of PTSD were included. Results: Of the 3023 titles and abstracts identified, 9 articles met inclusion criteria, of which 5 randomized controlled trials (RCTs) and 4 non-randomized studies. Treatments included were cognitive behavioural therapy (CBT), cognitive processing therapy (CPT), brief eclectic psychotherapy (BEP), eye movement desensitization and reprocessing (EMDR), virtual reality graded exposure therapy (VR-GET), and resilience-oriented treatment (ROT). Conclusions: This systematic review showed that psychological treatments for PTSD do not affect most neurocognitive functions, with exception of the memory outcomes. Future research, high-quality studies are needed to provide evidence of the effect of psychological treatment in improving neurocognitive functioning in PTSD. HIGHLIGHTS: This systematic review investigated the effects of psychological treatments on neurocognitive functioning in adults with PTSD.This review showed that most studies were very heterogeneous in design, method, and analysis.This review supports the evidence for psychological treatments for PTSD on improving memory outcomes.

Antecedentes: El trastorno de estrés postraumático (TEPT) es un trastorno mental serio, que está asociado con problemas emocionales y en el funcionamiento cognitivo. Las intervenciones psicológicas, tales como la terapia cognitivo conductual enfocada en el trauma (tf-CBT) y la terapia de Desensibilización y Reprocesamiento mediante Movimientos Oculares (EMDR) son efectivas en la reducción de los síntomas de TEPT. A pesar de que la evidencia ha mostrado que el TEPT está asociado con déficits neurocognitivos, no hay revisiones sistemáticas sobre los resultados neurocognitivos tras el tratamiento de TEPT. Esta revisión sistemática examinó si los tratamientos psicológicos para el TEPT mejoraron los resultados de funcionamiento neurocognitivo relacionados con la memoria, atención, procesamiento de información, y funcionamiento ejecutivo.Método: Se realizó una búsqueda de la literatura en PubMed, PsycINFO, PTSDpubs, y Cochrane Library hasta el 7 de marzo de 2022, en colaboración con un especialista en información médica. Fueron incluidos los estudios elegibles sobre tratamiento de TEPT que examinaban resultados neurocognitivos (memoria, atención, procesamiento de información y función ejecutiva) en pacientes con un diagnóstico de TEPT según DSM-IV o CIE.Resultados: De los 3023 títulos y resúmenes identificados, 9 artículos cumplieron los criterios de inclusión, de los cuales 5 eran ensayos clínicos aleatorizados (RCT) y 4 estudios no aleatorizados. Los tratamientos incluyeron terapia cognitivo conductual (CBT), terapia de procesamiento cognitivo (CPT), psicoterapia ecléctica breve (BEP), desensibilización y reprocesamiento mediante movimientos oculares (EMDR), terapia de exposición mediante realidad virtual graduada (VR-GET), y tratamiento orientado a la resiliencia (ROT).Conclusiones: Esta revisión sistemática mostró que los tratamientos psicológicos para el TEPT no afectan la mayoría de las funciones neurocognitivas, a excepción de los resultados en la memoria. Nuevas investigaciones, con estudios de alta calidad son necesarias para proveer de evidencia sobre el efecto del tratamiento psicológico en la mejoría del funcionamiento neurocognitivo en el TEPT.

The Effectiveness of Eye Movement Desensitization for Post-traumatic Stress Disorder in Indonesia: A Randomized Controlled Trial.

Objective: Post-traumatic stress disorder (PTSD) may affect individuals exposed to adversity. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based trauma-focused psychotherapy for PTSD. There is still some debate whether the eye movements (EMs) are an effective component of EMDR. The primary aim of this study was to investigate the effectiveness of Eye Movement Desensitization (EMD) treatment in reducing PTSD symptoms compared to a retrieval-only active control condition. We also investigated whether PTSD symptom reduction was associated with reductions in depression and anxiety, and improvements in quality of life. Methodology: Adult PTSD patients (n = 91) were recruited at public psychological services in Jakarta, Bandung and Cimahi, Indonesia. PTSD was diagnosed with the Structured Clinical Interview for DSM-5 disorders (SCID-5). Participants were randomized into: EMD (n = 47) or retrieval-only (n = 44). EMD consisted of clinical history and treatment planning, preparation, assessment, EMs, closure, whereas retrieval-only consisted of the same elements except EMs. Data were collected at baseline (T0), 1-week post-treatment (T1), 1-month follow-up (T2), and 3-months follow-up (T3). Outcome measures included the PTSD Checklist for DSM-5 (PCL-5), Hopkins Symptoms Checklist-25 (HSCL-25), and the World Health Organization Quality of Life-BREF (WHOQoL-BREF). Data were analyzed with linear mixed model analysis in R Statistics. Results: Although there were main effects of time indicating reductions for both EMD and retrieval-only in PCL-5 and HSCL-25 scores, and improvements in WHOQoL-BREF scores at T1, T2, and T3, no significant differences in PCL-5, HSCL-25, and WHOQoL-BREF total scores between the EMD and retrieval-only groups at T1, T2, and T3 were found (all group x time interaction p's > 0.005). Conclusion: Within a clinical sample of PTSD patients in Indonesia, both EMD and retrieval-only was associated with reductions in symptoms of PTSD, anxiety and depression, and improvements in quality of life, although EMs did not add to the efficacy of the treatments. Further research to examine the underlying mechanisms of EMDR's effective treatment elements in clinical samples is needed. Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [ISRCTN55239132].

Eye Movement Desensitization (EMD) to reduce posttraumatic stress disorder-related stress reactivity in Indonesia PTSD patients: a study protocol for a randomized controlled trial.

BACKGROUND: Posttraumatic stress disorder (PTSD) may develop after exposure to a traumatic event. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based psychological treatment for PTSD. It is yet unclear whether eye movements also reduce stress reactivity in PTSD patients. This study aims to test whether eye movements, as provided during Eye Movement Desensitization (EMD), are more effective in reducing stress reactivity in PTSD patients as compared to a retrieval-only control condition. METHODS: The study includes participants who meet criteria of PTSD of the public psychological services in Jakarta and Bandung, Indonesia. One hundred and ten participants are randomly assigned to either an (1) Eye Movement Desensitization group (n = 55) or (2) retrieval-only control group (n = 55). Participants are assessed at baseline (T0), post-treatment (T1), 1 month (T2), and at 3 months follow-up (T3). Participants are exposed to a script-driven imagery procedure at T0 and T1. The primary outcome is heart rate variability (HRV) stress reactivity during script-driven imagery. Secondary outcomes include heart rate (HR), pre-ejection period (PEP), saliva cortisol levels, PTSD symptoms, neurocognitive functioning, symptoms of anxiety and depression, perceived stress level, and quality of life. DISCUSSION: If the EMD intervention is effective in reducing stress reactivity outcomes, this would give us more insight into the underlying mechanisms of EMDR's effectiveness in PTSD symptom reduction. TRIAL REGISTRATION: ISRCTN registry ISRCTN55239132 . Registered on 19 December 2017.