Trauma-focused treatments for depression. A systematic review and meta-analysis

Background Trauma-focused treatments (TFTs) have demonstrated efficacy at decreasing depressive symptoms in individuals with PTSD. This systematic review and meta-analysis evaluated the effectiveness of TFTs for individuals with depression as their primary concern. Methods A systematic search was conducted for RCTs published before October 2019 in Cochrane CENTRAL, Pubmed, EMBASE, PsycInfo, and additional sources. Trials examining the impact of TFTs on participants with depression were included. Trials focusing on individuals with PTSD or another mental health condition were excluded. The primary outcome was the effect size for depression diagnosis or depressive symptoms. Heterogeneity, study quality, and publication bias were also explored. Results Eleven RCTs were included (n = 567) with ten of these using EMDR as the TFT and one using imagery rescripting. Analysis suggested these TFTs were effective in reducing depressive symptoms post-treatment with a large effect size [d = 1.17 (95% CI: 0.58~ 1.75)]. Removal of an outlier saw the effect size remain large [d = 0.83 (95% CI: 0.48~ 1.17)], while the heterogeneity decreased (I2 = 66%). Analysis of the 10 studies that used EMDR also showed a large effect [d = 1.30 (95% CI: 0.67~1.91)]. EMDR was superior to non trauma-focused CBT [d = 0.66 (95% CI: 0.31~1.02)] and analysis of EMDR and imagery rescripting studies suggest superiority over inactive control conditions [d = 1.19 (95% CI: 0.53~ 1.86)]. Analysis of follow-up data also supported the use of EMDR with this population [d = 0.71 (95% CI: 1.04~0.38)]. No publication bias was identified. Conclusions Current evidence suggests that EMDR can be an effective treatment for depression. There were insufficient RCTs on other trauma-focused interventions to conclude whether TFTs in general were effective for treating depression. Larger studies with robust methodology using EMDR and other trauma-focused interventions are needed to build on these findings

The Effects of the Flash Technique Compared to Those of an Abbreviated Eye Movement Desensitization and Reprocessing Therapy Protocol on the Emotionality and Vividness of Aversive Memories

Introduction: The Flash technique is a novel intervention aimed at rapidly decreasing the subjective disturbance of an aversive memory, thereby serving as a potential way of treating post-traumatic stress disorder (PTSD). The protocol is used to stimulate clients to engage in positive imagery while being discouraged to actively recollect the targeted disturbing memory. Previous research into the Flash technique’s efficacy shows promising results, yet controlled studies are lacking. Objectives: To test the efficacy of the Flash technique, it was compared to an abbreviated eye movement desensitization and reprocessing (EMDR) therapy protocol in a controlled experimental setting. We hypothesized that the Flash technique would lead to a larger decrease in the emotionality and vividness of an aversive autobiographical memory when compared to EMDR therapy. Our second hypothesis was that the procedure of the Flash technique would be evaluated more pleasant by its receiver. Method: The sample consisted of 60 non-clinical participants (mean age = 25.28 years; 73.33% female) who were able to recall an aversive autobiographical memory. They were randomized to either the Flash technique or the EMDR therapy condition. Measurements consisted of emotionality and vividness-ratings pre and post intervention, and at 1-week follow-up. Results: Bayesian analyses showed no differences between Flash and EMDR to the extent to which the emotionality and vividness of their memory was reduced. Afterward, the Flash technique was rated more pleasant than EMDR. Conclusion: The results support the claim that the Flash technique might be used as a brief and efficacious intervention for individuals suffering from disturbing memories. Although the results suggest that its efficacy does not differ from EMDR, the Flash technique seems to yield similar outcomes in a more pleasant way. Further research into its working mechanisms and in a clinical sample is required

Group schema therapy for cluster-C personality disorders:A multicentre open pilot study

BackgroundGroup schema therapy (GST) is increasingly popular as a treatment for personality disorders (PDs), including Cluster-C PDs. Individual ST has proven to be effective for Cluster-C PD patients, while the evidence for GST is limited. This study aimed to investigate the effectiveness of GST for Cluster-C PD. Moreover, differ- ences between the specific Cluster-C PDs (avoidant PD, dependent PD and obsessive-compulsive PD) were explored.MethodsA multicentre open trial was conducted, including 137 patients with a Cluster-C PD (avoidant PD: n = 107, dependent PD: n = 11 and obsessive- compulsive PD: n = 19). Patients received 30 weekly GST sessions with a maximum of 180 min of individual ST and five optional monthly booster sessions. Outcome measures including Cluster-C PD severity, general psychopathological symptoms, quality of life, functional impairment, happiness, PD-related beliefs, self-esteem, self- ideal discrepancy, schemas and schema modes were assessed at baseline until 2-year follow-up with semi-structured interviews and self-report measures. Change over time and differences between the specific Cluster-C PDs were analysed with mixed regression analyses.ResultsThe outcome measures showed significant improvements for all Cluster-C PDs, with medium to large effect sizes after 2 years. A treatment dropout rate of 11.7% was found. There were some indications for differences between the Cluster-C PDs in severity at baseline, change trajectories and effectiveness of GST. ConclusionsThis study demonstrated that GST is a promising treatment for Cluster-C PDs. The following step is a randomized controlled trial to further document the (cost-)effectiveness of GST. <br/

EMDR : oogbewegingen hebben geen invloed op positieve, verbale herinneringen

Onderzoek toont aan dat oogbewegingen, zoals die worden gemaakt in Eye Movement Desensitization and Reprocessing (EMDR) therapie, visuele herinneringsbeelden minder emotioneel beladen kunnen maken. Of oogbewegingen ook een effect hebben op (positief) verbaal materiaal is nog onbekend, maar ook daarop wordt deze interventie wel toegepast in behandelingen. In dit artikel beschrijven we twee studies waarin het effect wordt onderzocht

EMDR : oogbewegingen hebben geen invloed op positieve, verbale herinneringen

Onderzoek toont aan dat oogbewegingen, zoals die worden gemaakt in Eye Movement Desensitization and Reprocessing (EMDR) therapie, visuele herinneringsbeelden minder emotioneel beladen kunnen maken. Of oogbewegingen ook een effect hebben op (positief) verbaal materiaal is nog onbekend, maar ook daarop wordt deze interventie wel toegepast in behandelingen. In dit artikel beschrijven we twee studies waarin het effect wordt onderzocht

Enhancing trauma treatment : Exploring working mechanisms and testing a novel route

The thesis covers three parts. The first part is aimed at testing a specific component in a treatment protocol; the 'Positive Closure' procedure in the Dutch EMDR protocol. In this procedure, the activation of a positive verbal statement was combined with the making of eye movements, although it had never been investigated whether these eye movements actually had a positive effect on those verbal statements. In three studies, set out in the thesis, no positive nor a negative effect of the eye movements in the procedure was found. The second part of the thesis concerns research into EMDR's working mechanisms and the use of modality-specific taxation in EMDR treatment. EMDR usually aims at making visual aversive memories less emotional by recalling a visual memory and simultaneously perform a dual task. The two tasks - recall and the other dual task (most commonly making horizontal eye movements) - compete for working memory capacity and the aversive memory is affected by this. A recalled memory becomes labile and when dual tasking is performed during recall of an aversive memory this memory generally becomes less emotional. In two studies Suzy and colleagues show that not only visual but the emotionality of auditory aversive memories can also be made less aversive. This was investigated in PTSD patients, and also in psychotic patients in whom an aversive auditory hallucination memory was processed. A modality-specific effect (i.e., a greater effect on emotionality decrease of the memory by using taxation in the same modality [auditory/visual] as the content of the memory [auditory/visual]) was not found. However, experimental research with healthy participants shows that an auditory dual task during the retrieval of auditory memories and a visual dual task during retrieval of a visual memory is more taxing than performing these two tasks cross-modal (i.e., the opposite modality). Since larger dual task loads are more effective in degrading emotionality of memories it is therefore potentially more effective to use a dual task matched in modality than taxing in the opposite modality during recall. A cautious conclusion is that in addition to a large effect of general taxation during memory recall, there is a smaller modality-specific effect. The third part of the thesis investigated a new form of trauma treatment, Visual Schema Displacement Therapy (VSDT). This form of treatment was tested in two analogue studies in which VSDT was compared to an abbreviated EMDR protocol and a control condition. In both studies VSDT and EMDR were superior to the control condition in reducing emotional disturbance, and VSDT was superior to EMDR. Results were maintained at follow up. VSDT and EMDR outperformed the control condition in terms of reducing vividness

Enhancing trauma treatment: Exploring working mechanisms and testing a novel route

The thesis covers three parts. The first part is aimed at testing a specific component in a treatment protocol; the 'Positive Closure' procedure in the Dutch EMDR protocol. In this procedure, the activation of a positive verbal statement was combined with the making of eye movements, although it had never been investigated whether these eye movements actually had a positive effect on those verbal statements. In three studies, set out in the thesis, no positive nor a negative effect of the eye movements in the procedure was found. The second part of the thesis concerns research into EMDR's working mechanisms and the use of modality-specific taxation in EMDR treatment. EMDR usually aims at making visual aversive memories less emotional by recalling a visual memory and simultaneously perform a dual task. The two tasks - recall and the other dual task (most commonly making horizontal eye movements) - compete for working memory capacity and the aversive memory is affected by this. A recalled memory becomes labile and when dual tasking is performed during recall of an aversive memory this memory generally becomes less emotional. In two studies Suzy and colleagues show that not only visual but the emotionality of auditory aversive memories can also be made less aversive. This was investigated in PTSD patients, and also in psychotic patients in whom an aversive auditory hallucination memory was processed. A modality-specific effect (i.e., a greater effect on emotionality decrease of the memory by using taxation in the same modality [auditory/visual] as the content of the memory [auditory/visual]) was not found. However, experimental research with healthy participants shows that an auditory dual task during the retrieval of auditory memories and a visual dual task during retrieval of a visual memory is more taxing than performing these two tasks cross-modal (i.e., the opposite modality). Since larger dual task loads are more effective in degrading emotionality of memories it is therefore potentially more effective to use a dual task matched in modality than taxing in the opposite modality during recall. A cautious conclusion is that in addition to a large effect of general taxation during memory recall, there is a smaller modality-specific effect. The third part of the thesis investigated a new form of trauma treatment, Visual Schema Displacement Therapy (VSDT). This form of treatment was tested in two analogue studies in which VSDT was compared to an abbreviated EMDR protocol and a control condition. In both studies VSDT and EMDR were superior to the control condition in reducing emotional disturbance, and VSDT was superior to EMDR. Results were maintained at follow up. VSDT and EMDR outperformed the control condition in terms of reducing vividness

Fifteen to Twenty Seconds of Eye Movements Have No Effect on Believability of Positive Personal Verbal Statements : Results From a Working Memory Study

According to working memory theory, a task that taxes working memory during simultaneous focus on a memory will tend to reduce memory vividness and emotional intensity. Results have been found for both negative and positive memories. Some studies have shown the necessity of modality-specific tasks, with visual tasks producing greater deterioration of a visual memory, and auditory tasks reducing the quality of an auditory or verbal memory; other studies have reported cross-modality effects. Research has confirmed that eye movements similar to those in eye movement desensitization and reprocessing (EMDR) therapy produce these effects on visual imagery. However, the effects of eye movements on positive verbal imagery remain unclear. This study tested the effects of eye movements on positive verbal statements. In two experiments, undergraduates performed 15–20 seconds of eye movements or 15–20 seconds of keeping eyes stationary while focusing on a statement of a positive relevant personality trait (e.g., "I'm persistent"). Results showed that 15–20 seconds of eye movements did not enhance or diminish participant's belief in possessing the trait. Discussion focuses on methodological factors and calls for future research on the effect of eye movements on verbal material

The Effect of modality specific interference on working memory in recalling aversive auditory and visual memories*

Both auditory and visual emotional memories can be made less emotional by loading working memory (WM) during memory recall. Taxing WM during recall can be modality specific (giving an auditory [visuospatial] load during recall of an auditory [visual] memory) or cross modal (an auditory load during visual recall or vice versa). We tested whether modality specific loading taxes WM to a larger extent than cross modal loading. Ninety-six participants undertook a visual and auditory baseline Random Interval Repetition task (i.e. responding as fast as possible to a visual or auditory stimulus by pressing a button). Then, participants recalled a distressing visual and auditory memory, while performing the same visual and auditory Random Interval Repetition task. Increased reaction times (compared to baseline) were indicative of WM loading. Using Bayesian statistics, we compared five models in terms of general and modality specific taxation. There was support for the model describing the effect on WM of dual tasking in general, irrespective of modality specificity, and for the model describing the effect of modality specific loading. Both models combined gained the most support. The results suggest a general effect of dual tasking on taxing WM and a superimposed effect of taxing in matched modality