EMDR therapy : crucial processes and effectiveness in a non-clinical and a post-war, cross-cultural context

The aim of this thesis was to clarify mechanisms that contributed to the treatment of adult posttraumatic stress disorder (PTSD) with eye movement desensitization and reprocessing therapy (EMDR). An initial review highlighted that: EMDR is efficacious for treatment of PTSD; the processes in EMDR differ from other PTSD treatments; controversy remained about the necessity and role of the eye movement (EM) component; and although the underlying mechanisms of EMDR remained unclear, evidence was emerging supporting orienting response, REM-sleep, and working memory theories of EMDR. The first study in this thesis investigated the necessity of EMs in EMDR, and the psychophysiological correlates of EM tasks used during therapy. Sixty-two non-clinical participants with negative autobiographical memories received a single EMDR session either without EMs, or with EMs of either varied or fixed rate of speed. EMDR-with-EMs led to greater reduction in distress than EMDR-without-EMs. Physiologically, when EMs began heart rate decreased significantly; skin conductance decreased during EM sets; heart rate variability and respiration rate increased significantly as EMs continued; and orienting responses were more frequent in the EM than no-EM condition at the start of exposure. Findings indicated that the eye movements in EMDR were beneficial, and were coupled with distinct psychophysiological changes that aid memory processing. A following study confirmed these findings by examining the effectiveness and physiological correlates of EMDR to treat trauma symptoms in a real world, post-war/conflict, developing nation, Timor Leste. Participants were 23 Timorese adults with symptoms consistent with PTSD, who served as their own waitlist control. EMDR was followed by significant and large reductions in PTSD symptoms, depression, and anxiety. Physiological responses associated with therapy confirmed changes seen previously in Western treatment sessions; physiological dearousal occurred within desensitisation sessions; heart rate decreased as EM sets began; skin conductance decreased within EM sets; and skin conductance responses that habituated in size and number in EM sets characteristic of an orienting response. Findings demonstrate EMDR can be effectively used cross-culturally, post-war/conflict, in Timor Leste, and this research adds to the body of theoretical knowledge as to how EMDR therapy works to facilitate processing of trauma memories

Influence of frequent nightmares on REM sleep-dependent emotional memory processing

La littérature suggère que le sommeil paradoxal joue un rôle dans l'intégration associative de la mémoire émotionnelle. De plus, les rêves en sommeil paradoxal, en particulier leur nature bizarre et émotionnelle, semblent refléter cette fonction associative et émotionnelle du sommeil paradoxal. La conséquence des cauchemars fréquents sur ce processus est inconnue, bien que le réveil provoqué par un cauchemar semble interférer avec les fonctions du sommeil paradoxal. Le premier objectif de cette thèse était de reproduire conceptuellement des recherches antérieures démontrant que le sommeil paradoxal permet un accès hyper-associatif à la mémoire. L'utilisation d'une sieste diurne nous a permis d'évaluer les effets du sommeil paradoxal, comparativement au sommeil lent et à l’éveil, sur la performance des participants à une tâche sémantique mesurant « associational breadth » (AB). Les résultats ont montré que seuls les sujets réveillés en sommeil paradoxal ont répondu avec des associations atypiques, ce qui suggère que le sommeil paradoxal est spécifique dans sa capacité à intégrer les traces de la mémoire émotionnelle (article 1). En outre, les rapports de rêve en sommeil paradoxal étaient plus bizarres que ceux en sommeil lent, et plus intenses émotionnellement ; ces attributs semblent refléter la nature associative et émotionnelle du sommeil paradoxal (article 2). Le deuxième objectif de la thèse était de préciser si et comment le traitement de la mémoire émotionnelle en sommeil paradoxal est altéré dans le Trouble de cauchemars fréquents (NM). En utilisant le même protocole, nos résultats ont montré que les participants NM avaient des résultats plus élevés avant une sieste, ce qui correspond aux observations antérieures voulant que les personnes souffrant de cauchemars soient plus créatives. Après le sommeil paradoxal, les deux groupes, NM et CTL, ont montré des changements similaires dans leur accès associatif, avec des résultats AB-négatif plus bas et AB-positif plus grands. Une semaine plus tard, seul les participants NM a maintenu ce changement dans leur réseau sémantique (article 3). Ces résultats suggèrent qu’au fil du temps, les cauchemars peuvent interférer avec l'intégration de la mémoire émotionnelle pendant le sommeil paradoxal. En ce qui concerne l'imagerie, les participants NM avaient plus de bizarrerie et plus d’émotion positive, mais pas négative, dans leurs rêveries (article 4). Ces attributs intensifiés suggèrent à nouveau que les participants NM sont plus imaginatifs et créatifs à l’éveil. Dans l'ensemble, les résultats confirment le rôle du sommeil paradoxal dans l'intégration associative de la mémoire émotionnelle. Cependant, nos résultats concernant le Trouble de cauchemars ne sont pas entièrement en accord avec les théories suggérant que les cauchemars sont dysfonctionnels. Le groupe NM a montré plus d’associativité émotionnelle, de même que plus d'imagerie positive et bizarre à l’éveil. Nous proposons donc une nouvelle théorie de sensibilité environnementale associée au Trouble de cauchemar, suggérant qu'une sensibilité accrue à une gamme de contextes environnementaux sous-tendrait les symptômes uniques et la richesse imaginative observés chez les personnes souffrant de cauchemars fréquents. Bien que davantage de recherches doivent être faites, il est possible que ces personnes puissent bénéficier e milieux favorables, et qu’elles puissent avoir un avantage adaptatif à l'égard de l'expression créative, ce qui est particulièrement pertinent lorsque l'on considère leur pronostic et les différents types de traitements.Existing literature suggests that REM sleep plays a role in the associative integration of emotional memory, and that attributes of dreams during REM sleep, particularly their bizarre and emotional nature, either reflect or even influence this associative and emotional function. The consequence of frequent nightmares on this process is unknown, although, the experience of a nightmare suggests an associative restriction imposed by intense negative emotion, consistent with research showing that negative affect tends to restrict cognitive flexibility in wake. This is consistent with existing theories of nightmare function, largely purporting that nightmares reflect temporary failures in emotion regulation. The first objective of the thesis was to conceptually replicate prior research portraying REM sleep as enabling increased associative access to emotional memory. The use of a daytime nap allowed us to assess the effects of REM sleep, compared to both NREM sleep and waking, on participant performance on a novel task measuring Associational Breadth (AB). Results showed that only those subjects awakened from REM sleep responded with atypical emotional word associations, suggesting that REM is specific in its capacity to broadly integrate emotional memory traces (article 1). Further, REM dream reports were more bizarre than both NREM dreams and waking daydreams, and more emotionally intense than NREM dreams; these attributes are thought to reflect the hyper-associative and emotional nature of REM sleep (article 2). The second objective was to clarify whether and how REM sleep-dependent emotional memory processing is altered in frequent nightmares sufferers. Using a similar nap protocol, our results showed that NM participants had higher baseline AB in response to emotional cue-words, contrary to predictions, but nonetheless corresponding with anecdotal reports of heightened creativity. Following REM sleep, both NM and CTL groups showed similar changes in associative access to emotional cue-words, with negative AB being restricted and positive AB being broadened; one week later, the NM group alone maintained this altered pattern of emotional semantic access (article 3). This finding suggests that, over time, nightmares may interfere with REM sleep-dependent emotional memory integration. Regarding imagery, the NM participants had heightened bizarreness, and positive, but not negative, imagery in their daydreams, but not their dreams (article 4), mirroring our AB finding that the NM group had significantly higher emotional associativity in wake, although patterns of associativity following a REM sleep nap did not differ between groups. Overall, findings support a role of REM sleep in the associative integration of emotional memory. However, our findings regarding nightmare sufferers are not entirely consistent with views that nightmares are associated with dysfunctional emotional memory processing. Although they did show a prolonged priming effect suggestive of inadequate emotion regulation, they also showed heightened semantic associativity and vivid positive imagery in wake. We therefore propose a novel Environmental Sensitivity framework for the study of nightmare sufferers, claiming that an increased sensitivity to a range of environmental contexts, not only negative contexts, underlies the unique symptoms and imaginative richness seen in frequent nightmare sufferers. Although further empirical research exploring potentially adaptive traits or sensitivity to positive contexts in nightmare sufferers is needed, the possibility that these individuals may benefit especially from supportive environments, and may have heightened creativity and semantic associativity, is particularly relevant when considering prognosis and treatment approaches

Investigating the perceived effectiveness of Eye Movement Desensitisation Reprocessing (EMDR) treatment in adult survivors of childhood sexual abuse and the impact on neuropsychological, emotional and behavioural functioning and quality of life : a case series analysis

Childhood sexual abuse (CSA) is an ongoing issue (WHO, 2017) with 1 in 20children annually reported as being abused in the UK (NSPCC, 2019; Radford et al,2011). Many child survivors are of adolescent or young adult age before they requesthelp from relevant services (HAVOCA, 2021; NSPCC, 2018; Noel, Dogaru, and Ellis,2015; Flatley, 2017). The aim of this study was to investigate the perceivedexperiences of six young adult female survivors of CSA of their EMDR treatment aswell as an assessment of the changes in the individual trauma stress response. Thiscase series analysis explored (a) neuropsychological, emotional (namely low selfesteem, anxiety and depression), behavioural functioning and quality of life issuesusing descriptive statistics via outcome measures conducted before, during and aftertreatment and (b) client perspectives through qualitative interviewing at one-monthfollow-up to ensure adequate time was allowed to monitor changes using ThematicAnalysis [TA]. The study setting was within the Improving Access to PsychologicalTherapies (IAPT) program framework, established to ensure service users accessingNHS treatment are presented with choice in their treatment.The triangulation of data in this study allowed for a deeper analysis of theexperiences of adult CSA survivors undergoing EMDR treatment beyond anexamination of differences in pre and post outcome measures. The descriptivestatistics suggested overall positive changes in participant functioning in allmeasured domains (three positive, two moderate outcome cases and one scepticalno-improvement case; based on independent research rater feedback) howevervariable differences in neuropsychological processing from pre- to post-treatment.The descriptive statistics were limited in their generalisability because of certainlimitations in data collection as inhibited by COVID-19 restrictions and because ofthe small sample size. Three key themes were identified in the qualitative analysiswhich contributed to the literature on treatment of adult CSA survivors by identifyingwhich factors the clients identified as helpful and unhelpful to their treatment. Thesethemes were identified as being an ‘Unhelpful’ process (service time restrictions, fearof the lack of confidentiality, fear of emotional reprocessing), ‘Helpful’ aspects oftherapy (client choice in treatment, therapist interpersonal and professional skills,psychological resourcing, idiosyncratic approaches) and ‘Mixed Responses’ due to COVID-19 (face-to-face vs remote working). Overall, this study contributed to theliterature about EMDR treatment for adult CSA survivors by shedding insight into theperceived experiences of clients and providing further evidence for the efficacy ofthis treatment.Importantly, further research could investigate a potentially larger sample, emphasison neuropsychological functioning, and within differing settings, to understanddeficits within the current study. A qualitative study of the perceptions andexperiences of childhood sexual abuse survivors who opt for CBT over EMDR mightlead to recommendations for changes in protocol that would make EMDR moreacceptable. There is scope to further investigate EMDR as a reliable and validtreatment option within NHS IAPT settings, alongside essential service developmentin therapist training programmes to support the growing need for treatment ofmultiple-trauma and/or Complex-PTSD (ICD-11, International Classification ofDiseases-11, 2018)

The embodied mind in sleep and dreaming : a theoretical framework and an empirical study of sleep, dreams and memory in meditators and controls

Les théories récentes de la conscience incarnée (embodiment) soulignent que l'esprit est un processus incarné, impliquant le cerveau, le corps et l'environnement. Plusieurs aspects de la cognition, de l’interaction sensorimotrice avec l’environnement à la pensée abstraite et métaphorique, ont été conceptualisés dans ce paradigme. Le sommeil et le rêve, cependant, ont rarement été abordés par des chercheurs dans le domaine de la conscience incarnée. Cette dissertation vise à montrer, en s’appuyant sur la phénoménologie, la philosophie énactive et des sciences cognitives du sommeil et des rêves, que le rêve est un processus incarné de formation de sens dans le monde onirique. Ce travail comporte trois objectifs principaux : 1) de démontrer que le rêve est incarné; 2) de clarifier les liens entre les expériences corporelles et la formation onirique; et 3) de préciser si la sensibilité corporelle accrue, en tant qu’une compétence entraînable, mène à des changements globaux dans la façon dont l'information est traitée en sommeil. Le premier objectif est une proposition inédite dans la science des rêves. Dans ce travail, j’analyse les études théoriques et empiriques sur le sujet afin de motiver la notion de l’incarnation corporelle du rêve. Je propose un cadre théorique et pratique pour la recherche en neurophénoménologie du sommeil (article I). Je montre que les rêves sont incarnés à plusieurs niveaux. Tout d'abord, de nombreux rêves contiennent des représentations du corps ou du mouvement corporel. Deuxièmement, les rêves sont vécus d’un à la première personne et ont une qualité spatiale. Troisièmement, les rêves sont structurés par l'émotion et l'affect, et sont ainsi enracinés dans le corps. Enfin, le corps du rêveur et le corps onirique ne sont pas indépendants l'un de l'autre : leur perméabilité est illustrée par les rêves intensifiés, les parasomnies (article II) et les études sur l'intégration des stimuli somato-sensoriels dans le contenu des rêves. Le deuxième objectif est d'étudier des exemples concrets dans lesquels les sensations somatiques, ou des altérations dans la perception habituelle du corps, affectent le contenu des rêves. Je procède par une revue de littérature sur l’état actuel des connaissances empiriques sur la paralysie du sommeil, en tant qu’un phénomène illustratif de l'altération dans l'expérience corporelle en sommeil (article II). Je conclus que les expériences corporelles dans le cadre de la paralysie du sommeil (pression sur la poitrine, sensations inhabituelles, et autres) nous informent sur la manière dont le sens altéré du corps modifie la perception de l'environnement, affecte les qualités de la relation intersubjective avec le monde, et illumine les caractéristiques subjectives fondamentales du sens de l'espace. En outre, les résultats de notre étude empirique démontrent que la stimulation somatosensorielle de la cheville en Stade 1 du sommeil et en sommeil paradoxal produit une variété de changements dans le contenu des rêves. Le troisième objectif était de tester si la formation contemplative, qui augmente la conscience corporelle, produit des changements dans l’apprentissage procédural, dans l'architecture du sommeil, dans la consolidation de la mémoire dépendante du sommeil et dans le contenu des rêves. Nous avons démontré (article III) que les méditants Vipassana et les sujets témoins avaient des patrons distincts de consolidation de la mémoire en sommeil : l'amélioration d'une tâche d’apprentissage procédural était associée à la densité des fuseaux du sommeil chez les méditants, tandis que les participants témoins avaient une relation forte entre l’amélioration de la tâche et durée du sommeil paradoxal. En outre, nous avons constaté une fréquence réduite des fuseaux du sommeil chez les méditants, ce qui suggère que la pratique de la méditation centrée sur le corps peut avoir un effet à long terme sur l’organisation et la fonction du sommeil. Dans l'ensemble, les résultats de cette enquête permettent de conclure que le rêve est un processus incarné de formation du sens, texturé par des souvenirs et des émotions, et que le rêveur n'est pas déconnecté de leur corps ou du monde extérieur. En outre, l’entrainement à la conscience corporelle peut produire des changements globaux dans l'architecture du sommeil et dans les processus cognitifs du sommeil, y compris les rêves et la consolidation de la mémoire. Ces résultats ont des implications théoriques et pratiques pour la recherche sur les fonctions du sommeil, des rêves et le rôle du corps dans l'expérience subjective.Recent theories of cognition have stressed that the mind is an embodied process, one involving brain, body, and environment. Many aspects of cognition, from waking sensorimotor coping with the world to other aspects of the mind, such as metaphor and abstract thought, have been explicated under this framework. Sleep and dreaming, however, have only rarely been approached by embodied mind theorists. In this dissertation, I draw on work in phenomenology, enactivism, and the cognitive science of sleep and dreaming, I aim to show that dreaming is an embodied process of sense-making in the dream world. This work has three main goals: 1) to argue that the dreaming mind is embodied; 2) to clarify the links between bodily experiences and oneiric mentation; and 3) to test whether increased bodily awareness as a trainable skill contributes to global changes in the way that the mind treats information in sleep. The first goal is a novel proposal in dream science. In this work, I review evidence for embodied dreaming and propose a theoretical and practical framework for neurophenomenological research (Article I). I propose that dreams are embodied in a number of different ways. First, many dreams contain representations of body or bodily movement. Second, dreams are experienced from a first-person point of view, and have a spatial quality. Third, dreams are structured by emotion and affect, and thus are rooted in the body. Finally, sleeping and dreaming bodies are not independent of each other; their permeability is exemplified by intensified dreams, parasomnias (Article II), and studies of somatosensory stimuli incorporation into dream content. The second goal is to investigate some of the concrete ways in which somatic sensations or alterations in habitual perception of the physical body affect dream content. I review the current state of knowledge on sleep paralysis as an illustration of sleep-dependent alteration in bodily experience (Article II), and conclude that bodily experiences in sleep paralysis (pressure on chest, unusual sensations, and others) provide information about the myriad ways an altered sense of the body changes one’s perception of the environment, affects qualities of one’s intersubjective relationship with the world, and provides insight into the fundamental subjective features of the sense of space. Additionally, results of our empirical study show that somatosensory ankle stimulation at sleep onset and during REM sleep produces a variety of changes in dream content. The third goal is to study whether contemplative training, which has been shown to increase bodily self-awareness, produces changes in procedural learning, sleep architecture, sleep-dependent memory consolidation and dream content. We showed (Article III) that Vipassana meditators and controls had distinct patterns of sleep-dependent memory consolidation: improvement on a procedural learning task was associated with sleep spindle density in meditators, while control participants had a strong relationship between improvement on the task and REM sleep duration. Additionally, we found a reduced sleep spindle frequency in meditators, suggesting that body-based meditation practice may have long-term effects on sleep organisation and function. Overall, the results of this inquiry point to the conclusion that dreaming is an embodied process of sense-making, textured by memories and affect, and that the dreamer is not disconnected from their body or the outside world. Furthermore, training in bodily awareness may produce global changes in sleep architecture and sleep cognition, including dreaming and memory consolidation. These results have theoretical and practical implications for research on functions of sleep, dreams and the role of the body in subjective experience

Dissociation and interpersonal autonomic physiology in psychotherapy research: an integrative view encompassing psychodynamic and neuroscience theoretical frameworks

Interpersonal autonomic physiology is an interdisciplinary research field, assessing the relational interdependence of two (or more) interacting individual both at the behavioral and psychophysiological levels. Despite its quite long tradition, only eight studies since 1955 have focused on the interaction of psychotherapy dyads, and none of them have focused on the shared processual level, assessing dynamic phenomena such as dissociation. We longitudinally observed two brief psychodynamic psychotherapies, entirely audio and video-recorded (16 sessions, weekly frequency, 45 min.). Autonomic nervous system measures were continuously collected during each session. Personality, empathy, dissociative features and clinical progress measures were collected prior and post therapy, and after each clinical session. Two-independent judges, trained psychotherapist, codified the interactions\u2019 micro-processes. Time-series based analyses were performed to assess interpersonal synchronization and de-synchronization in patient\u2019s and therapist\u2019s physiological activity. Psychophysiological synchrony revealed a clear association with empathic attunement, while desynchronization phases (range of length 30-150 sec.) showed a linkage with dissociative processes, usually associated to the patient\u2019s narrative core relational trauma. Our findings are discussed under the perspective of psychodynamic models of Stern (\u201cpresent moment\u201d), Sander, Beebe and Lachmann (dyad system model of interaction), Lanius (Trauma model), and the neuroscientific frameworks proposed by Thayer (neurovisceral integration model), and Porges (polyvagal theory). The collected data allows to attempt an integration of these theoretical approaches under the light of Complex Dynamic Systems. The rich theoretical work and the encouraging clinical results might represents a new fascinating frontier of research in psychotherapy

Attention and Social Cognition in Virtual Reality:The effect of engagement mode and character eye-gaze

Technical developments in virtual humans are manifest in modern character design. Specifically, eye gaze offers a significant aspect of such design. There is need to consider the contribution of participant control of engagement. In the current study, we manipulated participants’ engagement with an interactive virtual reality narrative called Coffee without Words. Participants sat over coffee opposite a character in a virtual café, where they waited for their bus to be repaired. We manipulated character eye-contact with the participant. For half the participants in each condition, the character made no eye-contact for the duration of the story. For the other half, the character responded to participant eye-gaze by making and holding eye contact in return. To explore how participant engagement interacted with this manipulation, half the participants in each condition were instructed to appraise their experience as an artefact (i.e., drawing attention to technical features), while the other half were introduced to the fictional character, the narrative, and the setting as though they were real. This study allowed us to explore the contributions of character features (interactivity through eye-gaze) and cognition (attention/engagement) to the participants’ perception of realism, feelings of presence, time duration, and the extent to which they engaged with the character and represented their mental states (Theory of Mind). Importantly it does so using a highly controlled yet ecologically valid virtual experience

Immunization and Autism of Children 3 to 16 Years Old in Rumah Autis Bekasi

Autism is defined as neurology disorder affecting brain functionalities so that resulting communication, social interaction, behavior difficulties and the symptom appears before age 3. This study is aimed at understanding the factors related to autism cases in Rumah Autis Bekasi. Methods: There variables in this study namely, independent variable was immunization and dependent variable was autism and confounding variable were genetic, parents’ age, maternal health history during pregnancy, and medication during pregnancy. Primary data collected through questionaire and interview to the families of autism. This is a case study on 60 samples divided into 30 samples of autism in Rumah Autis and 30 samples of normal people living nearby with the proportion 1:1. The data were analyzed using univariate, bivariate using chi square test, and multivariate statistical analysis using regresi logistic. The results show that there is no correlation between immunization history and the autism with p-value 0.774>0.05. There is a correlation between the father’s age and the autism with p-value 0.038<0.05 and OR 0.333,there is a significant relationship between maternal health history and autism with p-value 0.038<0.05 and OR 3.763 and multivariate analysis shows that the most dominant variable is maternal health history with p-value 0.019 and OR 13.496. This study suggests that the pregnant women should check up their condition if there are some health problems and taking medication without doctor’s prescription. Keyword: Immunization, Autism, Children 3 to 16 years ol

The theoretical relationship between stress and negative symptoms in first-onset psychosis

First-onset psychosis offers a unique window in which to observe the longitudinal interaction of the many semi-independent factors associated with the evolution of severe psychopathology. Research into these factors has been stimulated by the emergence of several vulnerability-stress models of psychosis. These models highlight interactions between biological and psychosocial precipitants, acute illness, and long-term outcome, and suggests that even if a biological vulnerability is present, this may not inevitably result in a functional 'disease'. It also has the potential to account for the significant heterogeneity and non­ specificity of symptomology in severe mental disorder. However, a comprehensive theory of the many co-occurring and multiplicative factors that mediate dysfunction has so far eluded the literature, with segregated theories that lacking in detailed observable and subjective factors typically being presented. In this study, an integrative approach is taken to research associated to stress and psychosis, and it is argued that models of trauma and posttraumatic stress disorder may provide a valuable framework for explaining a range of psychotic phenomena. Specifically, the theoretical overlap between the phenomenology of stress and the negative symptoms of psychosis is developed as a contribution to better understanding deficit psychopathologies. Case studies from clients in a first-onset psychosis intervention programme will be presented to illustrate a number of associations between adverse life events and negative symptoms. Implications are discussed for integrating multiple factors related to mental illness, the subjective experience, and the socio-cultural context, into theories of psychosis. The clinical implications of regarding components of negative symptomology as potentially modifiable are also discussed