This month’s newsletter has a particular focus on innovative uses of EMDR. My take: if you’re a therapist who works with trauma you should have trained already, and if you work with other anxiety conditions you should seriously consider it!
I recently attended some excellent training from Professor Ad de Jongh on the use of EMDR to treat Complex PTSD. The treatment protocol in his Netherlands clinic is quite radical, and they have published some fascinating data. I have linked to some of the research below, as well as some related videos. Some of the noteworthy innovations from their clinic included:
- Taxing working memory: Particular effort being made to tax working memory during trauma memory processing. This includes the combined use of very fast eye movements + audio stimulation + asking clients to tap complex rhythms. The theory is that clients with particularly good working memory capacity may need this simultaneous stimulation to adequately tax working memory to an extent that it acts as a sufficient distraction during trauma memory processing.
- Intensive treatments: Intensive CBT treatment has already been demonstrated to be an effective way of treating PTSD. The innovation at the Psytrec clinic is that their standard protocol was intensive – 2 sessions per day (exposure in morning, EMDR in afternoon) for 8 days. Their standard treatment is semi-inpatient (a sort of hotel-like accomodation, relatively unmonitored), but they have also demonstrated effective outpatient treatment using a similar model.
- No emotional regulation / stabilisation phase: Arguments for this included: lack of evidence for the necessity of a stabilization phase, evidence of safe treatment of trauma without stabilization (see research section below), and evidence that trauma memory processing leads to improvements in emotional regulation – so why not do the trauma memory work first?
- Therapist rotation: A big change in their model is that clients are seen by different therapists for every exposure/EMDR session – a client may see between 10 and 16 therapists in their 2 week treatment. The report from clients afterwards was that 92% preferred this mode of working.
PSYCHOLOGY ARTICLES AND VIDEO
- Animated video explaining the working memory hypothesis of EMDR
- Animated video explaining adverse childhood experiences
INTENSIVE EMDR TO TREAT COMPLEX PTSD
Early results from the intensive programme at Psytrec demonstrating effective treatment of Complex PTSD using EMDR in an intensive format.
- Bongaerts, H., Van Minnen, A., & de Jongh, A. (2017). Intensive EMDR to Treat Patients With Complex Posttraumatic Stress Disorder: A Case Series. Journal of EMDR Practice and Research, 11(2), 84-95.
Download paper at psycho-trauma.nl
EMDR FOR PTSD IN CLIENTS WITH PSYCHOSIS
A high proportion of clients with psychosis have experienced trauma and meet criteria for PTSD. However, many clients with psychosis are considered too unstable to be offered trauma-focused treatments. This RCT compared 8 sessions of prolonged exposure (PE) vs. 8 sessions of EMDR vs. waiting list. Both PE and EMDR led to significant reductions in PTSD symptoms. Contrary to common concerns, both trauma-focused treatments were associated with fewer adverse events than the waiting list condition.
- van den Berg, D. P., de Bont, P. A., van der Vleugel, B. M., de Roos, C., de Jongh, A., Van Minnen, A., & van der Gaag, M. (2015). Prolonged exposure vs eye movement desensitization and reprocessing vs waiting list for posttraumatic stress disorder in patients with a psychotic disorder: a randomized clinical trial. Jama Psychiatry, 72(3), 259-267.
Download paper at researchgate.net
RETHINKING THE NEEED FOR STABILISATION IN THE TREATMENT OF COMPLEX PTSD
This paper is essentially a rebuttal to the 2012 consensus guidelines for the treatment of complex PTSD. It challenges the lack of empirical evidence for the requirement to spend significant time offering stabilization.
- Jongh, A., Resick, P. A., Zoellner, L. A., Minnen, A., Lee, C. W., Monson, C. M., … & Rauch, S. A. (2016). Critical analysis of the current treatment guidelines for complex PTSD in adults. Depression and anxiety, 33(5), 359-369.
EMDR FLASHFORWARD PROTOCOL
I had read this paper when it came out, but the interesting twist was in seeing this protocol used in clients as a way of overcoming blocks in trauma memory processing. For example, some clients may present with fears of having a breakdown if they attempt to confront their trauma memories – in these cases the flashforward technique can be used to address the fear which is blocking trauma memory processing from taking place.
- Logie, R. D. J., & De Jongh, A. (2014). The “Flashforward procedure”: confronting the catastrophe. Journal of EMDR Practice and Research, 8(1), 25-32.
Download paper at ingentaconnect.com
COMPARING CBT AND EMDR FOR PANIC DISORDER
RCT for panic showing treatment equivalence. I would be surprised if they didn’t use the flashforward procedure.
- Horst, F., Den Oudsten, B., Zijlstra, W., de Jongh, A., Lobbestael, J., & De Vries, J. (2017). Cognitive behavioral therapy vs. eye movement desensitization and reprocessing for treating panic disorder: a randomized controlled trial. Frontiers in Psychology, 8, 1409.
Full paper at frontiersin.org
SAFETY OF TRAUMA MEMORY WORK IN UNSTABLE POPULATIONS
One traditional argument against attempting trauma memory work in certain population is that it might destabilize them. This study tested that hypothesis in a refugee population. No differences in safety were identified between and EMDR and stabilisation condition.
- Ter Heide, F. J. J., Mooren, T. M., van de Schoot, R., de Jongh, A., & Kleber, R. J. (2016). Eye movement desensitisation and reprocessing therapy v. stabilisation as usual for refugees: Randomised controlled trial. The British Journal of Psychiatry, bjp-bp.
Download paper at bjp.rcpsych.org
PSYCHOLOGICAL TREATMENTS FOR PSTD FOLLOWING CHILDHOOD SEXUAL ABUSE
This review gives effect sizes for treatments of PTSD in survivors of CSA. Spoiler: trauma-focused CBT = 1.7, non-trauma-focused-CBT = 1.11, EMDR = 2.0