Session 1:
EMDR Research on Special Populations

Chair: Isabel Fernandez
Language: English

Sunday, June 5th, 2011, 9.30 am – 10.45 am
Main Building of the University of Vienna, Room 33

Ina Dieffenbach (D)

Ina Dieffenbach

Long Term Evaluation of Specific Early Psychotherapeutical Interventions following Acute Strain among Children and Adolescents with Multiple Trauma Experience

Abstract: Title TAFO study II (Task-force)
Authors: I. Dieffenbach, B. Essen, T. Peters*, Prof. U. Willutzki*, R. Dieffenbach, Department for Children and Adolescent Psychiatry of the Vestische Children’s Clinic Datteln, University of Witten-Herdecke - *Faculty for Psychology, Department for Clinical Psychology and Psychotherapy, Ruhr-University, Bochum

Background: Early intervention is intended to prevent or at least reduce chronic manifestation of acute traumatic strain (Zehnder, Hornung & Lanolt, 2006) since tested strain has a negative impact on the child’s day-to-day quality of life and overall development, including the development and functioning of the brain (Cohen, Perel, DeBellis, Friedman & Putnam, 2002).
Studies of multiple trauma among adults and adolescents have shown that the severity of any impairment upon their psychological health must be seen in relation to the number of traumatic experiences that took place during childhood (Turner RJ, Lloyd DA 1995, Finkelhor D, Omrod RK, Turner HA 2007-I, Finkelhor D, Omrod RK, Turner HA 2007-II, Holt MK, Finkelhor D, Kantor GK 2007). In this process, interpersonal traumatic experiences such as accidents or severe illnesses can adversely affect development as much as traumatic exposure connected to elements of crime.

Objectives of the study:

  1. Interventions following acute traumatic strain will be examined with regard to the symptoms and the mental health of children and adolescents with multiple trauma experience in the long term. The study will examine whether early intervention has a positive effect on symptoms and whether such effects are of a short or long-term nature.
  2. The study should show whether gender specific and/or age specific correlation can be identified in the development of symptoms according to specific types of trauma, and whether risk groups can be identified as a result.
  3. The study will examine whether there exists an independent sub-group of children with multiple trauma under the age of 6, whose symptoms correspond to a developmental trauma disorder (van der Kolk 2005).


Methods:
The presented study is the retrospective part of our complete study. The retrospective part will contain an examination of the treatment results of 50 children and adolescents with multiple trauma experiences in the Vestische Children’s Clinic between 2002 and 2010. This will be followed by an evaluation of the treatment results by way of a newly developed telephone catamnesis, based on validated questionnaires (CRIES-13, ILK, Telekat) for measurement points T1-T3.

Results:
The results of the retrospective examination of children and adolescents with multiple trauma experience will be presented and compared to the results of our first evaluation of specific therapeutic early interventions following acute strain among children and adolescents with single trauma experience.

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Friederike Oppermann (D)

Friederike Oppermann

Experiences with EMDR in a General Practitioner Practice

Abstract: The study excellently describes results treating patients with PTSD after recent traumatic experiences. 200 patients with various stress reactions after recent traumatic stress like sexual dysfunction, eating disorders, somatic symptoms, conflicts in partnership and inability to work but no prior psychiatric disease in anamnesis were treated with EMDR. The number of active EMDR sessions needed to restore quality of life and capability of working varied from one to five active sessions. A three and six-month follow-up showed stable findings.

The study shows, that there is a great number of PTSD patients in general practice. Besides typical flashbacks, these patients show an enormous bandwidth of somatic and psychosomatic symptoms. General practitioners have an important position in making the correct diagnosis and EMDR is shown to be an effective, time saving and economic technique treating PTSD after recent trauma.

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Emiliano Santarnecchi (I) & Letizia Bossini (I)

Letizia Bossini

Emiliano Santarnecchi (I)

Cortical and Subcortical Volumetric Changes after EMDR Treatment in PTSD

Biographical Sketches: Letizia Bossini was born in 1971. She graduated summa cum laude from the University of Siena in 1998, discussing her thesis on Panic Disorders with an experimental design. She specialized in psychiatry with honors in 2002, with a thesis on Posttraumatic Stress Disorder. In the same year she obtained the license as an EMDR psychotherapist. In 2003 she was hired by the University of Siena to conduct research and teach medical students and residents, taking on a role as adjunct professor. She directs the center for the diagnosis and treatment of PTSD, National Observatory of victims of terrorism, and cooperates with the association EMDR Italy for research purposes. She is involved in clinical and neurobiological research over 15 years on various subjects with special reference to anxiety disorders and to sexual dysfunction. She is co-author of several scientific papers that have been published in international journals. She was speaker as well as moderator at more than 30 national and international conferences, and has been teaching numerous ECM courses for psychologists, physicians and psychiatrists.

Email: letizia.bossini@gmail.com

Abstract:
Objective: Only few studies have investigated the effects of EMDR therapy on global and regional cerebral volumes. Aim of the study is to assess the effects of Eye Movement Desensitization and Reprocessing (EMDR) treatment on Cortical and Subcortical structures and symptomatology in a group of patients with Post Traumatic Stress Disorder (PTSD), without comorbidity and drug naive. EMDR is a standardized, rapid, and effective psychotherapy for amelioration of traumatic sequelae, which incorporates aspects of cognitive therapy, behavioral techniques, and experiential and psychodynamic components.

Method: all the patients underwent an eight weeks treatment with EMDR monotherapy and a pre-post Magnetic Resonance Imaging (MRI) exam with a FreeSurfer software post-processing analyses. PTSD diagnosis and severity was established by the administration of the Clinician Administered PTSD Scale (CAPS DX) and the Davidson Trauma Scale (DTS). All the measurements were taken before and after EMDR treatment.
Our preliminary results suggest volumetric changes in subcortical structures, consistent with a reduction of PTSD symptoms.

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Session 2:
Research on EMDR mechanism of action and brain research

Chair: France Haour
Language: English

Sunday, June 5th, 2011, 9.30am – 10.45am
Main Building of the University of Vienna, Room 21

Hellen Hornsveld (NL) *

Hellen Hornsveld

More Support for the Working Memory Hypothesis: Results and Clinical Implications

Abstract: Eye movements (EMs) during retrieval of negative memories reduce the vividness and emotionality of these memories when they are being recalled later. This is a robust phenomenon and is the basis of the EMDR method. Of the many explanations that have been put forward to explain the benefits of EMs, the working memory (WM) explanation has – by far - the most empirical support.

The WM hypothesis will be explained and a new series of experiments will be presented that give additional support for the WM account and have some large clinical implications.

  1. In over 50% of the EMDR treatments eye movements are replaced by other bilateral stimulation like auditory tones or tapping. These ‘variants’ lack empirical support. Several studies (in healthy subjects and patients) strongly suggest that these alternatives are inferior to eye movements. This is in line with the working memory account.
  2. Eye movements are also used in (non-desensitization) procedures like the safe place and the RDI procedure. Again, there is no empirical support for the added value of eye movements. Our research indicates that – in line with the WM theory – EM’s seem counterproductive in RDI.
  3. EMs also reduce the vividness and emotionality of (disturbing) images of feared future events: "flashforwards". Research data in a non-clinical sample and some clinical cases will be presented.

* Hornsveld,H.K. & van de Hout, M.A.
Utrecht University, Dept of Clinical and Health Psychology, Utrecht, Netherlands
Marcel van den Hout, Iris Engelhard en Hellen Hornsveld received the 2010 EMDR Award for Outstanding Research.

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Martin Sack (D)

Martin Sack

Research-Update on EMDR Working Mechanism

Abstract: Eye Movement Desensitization and Reprocessing (EMDR) is a treatment approach based on adaptive information processing aiming to integrate maladaptive traumatic memories into functional explicit memory networks. While empirical research confirmed the clinical efficacy of EMDR there is still a controversial discussion on the need of bilateral stimulation in EMDR.

We will give an overview on supposed EMDR working mechanism and how they are supported by research findings. A special emphasis will be given on research investigating psychophysiological correlates of adaptive information processing. Data from our own research suggest that habituation occurring in the EMDR-treatment sessions is a consequence to successful processing of traumatic memory and that repetitive orienting responses together with other biologically determined working mechanisms may play a role in the efficacy of EMDR treatment.

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Marco Pagani (I)

Marco Pagani

Functional Changes and EEG Monitoring during EMDR Therapy

Abstract: A very limited number of studies investigated by SPECT and MRI the neurobiological substrate of EMDR therapy. These studies examined the effects of EMDR on brain pathophysiology and provided some preliminary evidence that changes in brain CBF patterns and grey matter density may be linked to effective treatment. In general in PTSD and in anxiety disorders functional deactivations parallel symptoms relief and decreased hyper-reactivity to emotional and memory disturbances. However, none of these functional studies has investigated on real-time the response of brain neurons to the external stimuli elicited by EMDR having been the related effects recorded only before and after therapy.

Electroencephalography (EEG), records the electrical activity resulting from neuronal activation with a time resolution of 1/8th of a second allowing continuous monitoring during psychotherapy.

The aim of the study was (1) to explore the technical feasibility of the on-line recording of whole EMDR sessions by means of advanced EEG unit and data analyses; (2) to identify the regions activated by either the administration of the traumatic script or by the bilateral brain stimulation during the EMDR session; (3) to compare these activations before and after having processed the index trauma and correlate them to the scores of self-administered neuropsychological tests.

Briefly, the patients recorded as digital file the autobiographical script of the traumatic experience and filled in 5 self-administered neuropsychological checklists. A 37 channel EEG cap was positioned and EEG recording was performed in sequence during resting state, listening to the script and during EMDR therapy.

The 8 phases of EMDR standard protocol were carefully followed and EEG recordings were analysed by eLORETA using Z score voxel values > 1.5. The procedure was performed during the first and the last EMDR session.

Preliminary analyses and results showed during the first EMDR session a preferential activation, particularly in the domain of theta and alpha bands, in the limbic prefrontal cortex. This can be tentatively explained by the emotional arousal during trauma reliving and by the attempt to inhibit both the elicited response and the activity of the amygdale. After the last EMDR session the maximal activation moved to regions more implicated in the direct control of the amygdala (medial prefrontal cortex), to the multimodal association area (fronto-temporal-parietal cortex) and to the left fusiform gyrus implicated in the explicit representation of faces, words and images and abstract thoughts. This was mainly due to the higher activity in the delta, beta and gamma bands representing brain activity related to attention tasks, active thinking, concentration and cross-modal processing.

Also the differences in activation during the scripts speak in favour of a better cognitive and sensitive (visual) elaboration of the traumatic event after EMDR therapy with a preferential activation moving from the fronto-limbic cortex towards the associative visual occipital cortex.

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Session 3:
Research on Clinical Application of EMDR other than PTSD

Chair: Ad de Jongh
Language: English

Sunday, June 5th, 2011, 11.15am – 12.30am
Main Building of the University of Vienna, Room 33

Michael Hase (D)

Michael Hase

EMDR to treat Substance Abuse and Addiction

Abstract: The comorbidity of PTSD and substance abuse gives sufficient reason to treat patients who are addicted with EMDR targeting the traumatic memories, which drive the comorbid PTSD. However, there are several pathways leading to addiction and PTSD is only one of them. Thirty years of addiction research have provided sufficient evidence for the crucial role of memory in drug dependency. The Addiction memory (AM) serves as a useful concept for "obsessive-compulsive craving" to be seen in drug addicted patients (Boening, 2001). The concept of an AM and its importance in relapse occurrence and maintenance of learned addictive behaviour has gained growing acceptance in the field of addiction research and treatment. The AM is interpreted as an individual-acquired memory following drug consumption in some individuals. The addiction memory is based on normal memory systems and systems of neuronal information processing. This neurobiological-based, imprinted, addictive behaviour seems to resist change under normal circumstances. The implicit nature of the addiction memory seems to qualify it as a target for EMDR treatment.

In a pilot-study group of 34 patients with chronic alcohol dependency in in-patient treatment for detoxification were randomly assigned to one of two treatment conditions: treatment as usual (TAU) or TAU+EMDR. In the TAU+EMDR group patients received two sessions of EMDR focusing on memories of intense craving or relapse in order to activate and reprocess the addiction memory. The craving for alcohol was measured by the Obsessive-Compulsive-Drinking-Scale (OCDS) pre, post, and 1 month after treatment. The TAU+EMDR group showed a significant reduction in craving post-treatment and 1 month after treatment whereas TAU did not. The TAU+EMDR group showed less relapse at the six-month follow-up. The results indicate that EMDR might be a useful approach for the treatment of addiction memory and associated symptoms of craving (Hase et al. 2008). Anecdotal report shows results with opiate and stimulant addicted patients.

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Arne Hofmann (D)

Arne Hofmann

EMDR in the Treatment of Depression

Abstract: Scientific studies of EMDR have shown that it is one of the most effective tools to treat posttraumatic stress disorder. One of the lesser known properties of EMDR is that it also seems to be an effective psychotherapy method in a number of disorders that may have part of their origins in stressful memories. One of these disorders is chronic depression. Severe depression is one of the most common mental disorders and affects between 5-15% of the general population in their lifetimes. Although many psychotherapeutic and pharmacologic interventions exist that are considered to be effective in depression, the treatment is less than satisfactory. High relapse rates (ranging at 50% after two years), unsatisfactory remissions and suicidal risks are among the major problems. Research shows that there may be a link between traumatic events (like abuse experience in childhood) and the later occurrence of a depressive disorder. However, there is no published systematic study that tries to explore the potential use of trauma-specific treatments like EMDR with depressive patients with trauma history. The presenter will report the status of research on the subject, a follow up study and current controlled studies underway to explore the use of EMDR in depressive patients.

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David van den Berg (NL)

David van den Berg (NL)

EMDR with Trauma in Psychosis: Preliminary Findings

Abstract: Posttraumatic stress disorder is one of the most common comorbid conditions in patients with psychotic disorders. A large proportion of this group indicate that they want to be treated for their PTSD symptoms. Conversely, a psychotic disorder is nearly always used as an exclusion criterion for effective psychotherapeutic treatments. The clinical experience and limited scientific research conducted in this area, however, indicate that these patients can be effectively treated with techniques directly aimed at processing the trauma. However, research in this area is lacking.

During this presentation the different interactions between trauma, psychosis and PTSD will briefly be discussed. In addition, the results of a feasibility trial of EMDR in patients with psychosis and comorbid PTSD will be presented. The main finding of this trial was that treatment did not result in any adverse effects. EMDR appeared to be very effective in alleviating PTSD symptoms. Even more surprisingly, other symptomatology, such as symptoms of psychosis and depression decreased significantly. Hence, treating PTSD in patients suffering from psychosis with EMDR appears to be feasible and safe.

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