Abstract
Neuroimaging represents a powerful tool to investigate the neurobiological correlates of Eye Movements Desensitization and Reprocessing (EMDR). The impact of EMDR on cortical and sub-cortical brain regions has been proven by several investigations demonstrating a clear association between symptoms disappearance and changes in cortical structure and functionality. The aim of this study was to assess by electroencephalography (EEG) and for the first time by positron emission tomography (PET) the changes occurring after EMDR therapy in two cases of psychological trauma following brain concussion and comatose state due to traffic accident. A 28 and a 29 years old men underwent extensive neuropsychological examination, which investigated: (i) categorical and phonological verbal fluency; (ii) episodic verbal memory; (iii) executive functions; (iv) visuospatial abilities; (v) attention and working memory as well as clinical assessment by means of psychopathological tests (CAPS, IES, BDI, SCL90R, and DES). They were then treated by eight sessions of EMDR. During the first session EEG monitoring was continuously performed and 18F-FDG PET scans, depicting brain metabolism, were acquired at rest within a week (T0). After the last session, in which the two clients were considered to be symptoms-free, neuropsychological, clinical, and PET assessment were repeated (T1). PET data were semi-quantitatively compared to a group of 18 normal controls, as for EEG the preferential cortical activations were disclosed by thresholding the individual z-score to a p < 0.05. There was a significant improvement in clinical condition for both clients associated with a significant decrease in CAPS scores. IES and BDI were found to be pathological at T0 and improved at T1 in only one subject. Visuo-constructive abilities and abstract reasoning improved after EMDR in both subjects. As for EEG, the most striking changes occurred in fronto-temporal-parietal cortex in subject 1 while subject 2 showed only minor changes. PET showed more pronounced metabolism in orbito-frontal and prefrontal cortex at T1 as compared to T0 in both subjects. In conclusion both clients had a clear clinical improvement in PTSD symptoms associated with metabolic and electrophysiological changes in limbic and associative cortex, respectively, highlighting the value of EMDR also in such extreme pathological conditions.
Highlights
Post-traumatic stress disorder (PTSD) is a clinical condition that may affect victims of major psychological trauma and is one of the major contributors of mental suffering (Breslau et al, 1991; Kessler, 2000; Breslau, 2001; Darves-Bornoz et al, 2008)
The aim of this study was to assess by extensive neuropsychological and psychopathological test as well as by EEG and, for the first time, PET the changes occurring after Eye Movements Desensitization and Reprocessing (EMDR) therapy in two cases of psychological trauma following brain concussion due to traffic accident
The most striking improvement post-EMDR was in PTSD symptomatology as revealed by CAPS scores
Summary
Post-traumatic stress disorder (PTSD) is a clinical condition that may affect victims of major psychological trauma and is one of the major contributors of mental suffering (Breslau et al, 1991; Kessler, 2000; Breslau, 2001; Darves-Bornoz et al, 2008). The traumatic event is re-experienced in flashbacks with involuntary vivid replays, concomitant autonomic reactions, and negative feelings. Leading to avoidance of reminders, irritability, and social and emotional withdrawal (American Psychiatric Association, 1994). The recurring negative trauma memory acts as new trauma experience sensitizing the brain networks engaged in fear response and resulting into the emotional bodily reactions of autonomic arousal. In the last decades neuroimaging has represented a powerful tool to investigate the neurobiological correlates of PTSD. Consistent findings of modifications in cerebral blood flow (Single Photon Emission Computer Tomography, SPECT) (Zubieta et al, 1999; Bonne et al, 2003; Pagani et al, 2005a, 2007; Lindauer et al, 2008; Nardo et al, 2015), in metabolism (Positron Emission Tomography, PET) (Pissiota et al, 2002; Osuch et al, 2008; Molina et al, 2010; Kim et al, 2012; Zhu et al, 2016), in neuronal volume and density (Magnetic Resonance Imaging, MRI) (Lindauer et al, 2004; Looi et al, 2009; Nardo et al, 2010, 2013; O’doherty et al, 2015; Wrocklage et al, 2017), and more recently in brain electric signal (Electroencephalography, EEG) (Lee et al, 2014; Lobo et al, 2015) have been reported
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