Short-term interventions for overcoming emotional confusion: What to do when having many problems is yet another problem?

Introduction: Comorbidity between posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) is prevalent. Despite evidence-based therapies, high rates of nonresponse and dropout persist. This study therefore aimed to examine whether the concurrent application of eye movement desensitization and reprocessing (EMDR) for PTSD and dialectical behavior therapy (DBT) for BPD yields better results than EMDR alone. Methods: Patients with a PTSD diagnosis and at least four BPD symptoms were randomly assigned to EMDR (n = 63) or concurrent EMDR-DBT (n = 61). Over 1 year, changes in PTSD symptoms were measured using the Clinician-Administered PTSD Scale for DSM-5. Secondary outcomes included BPD symptoms, global functioning, and quality of life. Results: Both treatments led to large reductions in PTSD symptoms, without significant differences after 1 year (p = 0.312, d = −0.23, 95% CI = −0.6, 0.1). Both treatments also yielded large and comparable reductions in BPD symptoms and improved quality of life. Global functioning improved only in the EMDR condition according to one measure (World Health Organization Disability Assessment Schedule 2.0), while the other measure (Outcome Questionnaire 45) showed improvements in both groups. Additionally, patients in the EMDR-DBT condition were twice as likely to drop out from EMDR treatment compared to those in the EMDR-only condition. Conclusion: Stand-alone EMDR demonstrated safety and efficacy in alleviating PTSD and BPD symptoms, as well as enhancing quality of life. These findings support the use of EMDR as a strong therapeutic option for patients with PTSD and comorbid BPD symptoms. Further research is needed to assess longer-term outcomes beyond 1 year.

BackgroundComorbidity between Posttraumatic Stress Disorder (PTSD) and Borderline Personality Disorder (BPD) is high. There is growing motivation among clinicians to offer PTSD treatments – such as Eye Movement Desensitization and Reprocessing (EMDR) - to patients with PTSD and comorbid BPD. However, a large subgroup with comorbid BPD does not sufficiently respond to PTSD treatment and is more likely to be excluded or to dropout from treatment. Dialectical Behaviour Therapy (DBT) for BPD is well established and although there is some evidence that DBT combined with DBT Prolonged Exposure (DBT + DBT PE) is twice as effective in reducing PTSD symptoms than DBT alone, the comparative efficacy of integrated PTSD-DBT and PTSD-only treatment has not been investigated yet. The current study will therefore evaluate the comparative clinical efficacy and cost-effectiveness of EMDR-DBT and EMDR-only in patients with PTSD and comorbid (sub)clinical BPD. Moreover, it is not clear yet what treatment works best for which individual patient. The current study will therefore evaluate neurobiological predictors and mediators of the individual response to treatment.MethodA randomized controlled trial comparing the clinical efficacy and cost-effectiveness of integrated EMDR-DBT (n = 63) and EMDR-only (n = 63) in treatment-seeking adult patients with PTSD and comorbid (sub)clinical BPD. In addition, neurobiological predictors and mediators of treatment outcome, such as hair cortisol, FKBP5 and BDNF protein levels and FKBP5 and BDNF methylation status, are measured through hair and blood samples.DiscussionThis is the first study to compare the clinical efficacy and cost-effectiveness of integrated EMDR-DBT and EMDR-only in patients with PTSD and comorbid (sub)clinical BPD, while simultaneously identifying individual predictors and mediators of treatment response. Results will reveal which treatment works best for which individual patient, thereby guiding individual treatment choices and personalizing psychiatry.Trial registrationClinical Trials, NCT03833453. Retrospectively registered, 15 March 2019.

Borderline personality disorder (BPD) is a complex psychiatric condition marked by emotional dysregulation, unstable interpersonal relationships, and self-harming or suicidal behaviors. It is linked to a combination of biological vulnerabilities, maladaptive early environments, and invalidating caregiver responses, BPD has been addressed through various psychotherapeutic modalities such as Cognitive Behavioral Therapy, Dialectical Behavior Therapy, Schema-focused Therapy, Transference-Focused Psychotherapy, and Mentalization-based Therapy. As research increasingly recognizes the pivotal role of traumatic experiences, interest in trauma-focused interventions for BPD has grown. Therefore, Eye Movement Desensitization and Reprocessing (EMDR) therapy, rooted in the Adaptive Information Processing model, offers a structured approach to integrate and resolve trauma-related memories that may underlie BPD’s clinical presentation. Although initially developed and validated for Post-Traumatic Stress Disorder, EMDR’s application in BPD treatment shows promise, especially when tailored to address the unique challenges of this population. This review synthesizes the current literature on EMDR’s theoretical rationale, clinical adaptations, and preliminary empirical support for its efficacy in BPD. Integrating EMDR into multidisciplinary treatment protocols may advance individualized, effective strategies that improve outcomes and overall quality of life for individuals with BPD. Key Words: Borderline Personality Disorder, EMDR, Trauma Treatment

Background: Eye movement desensitization and reprocessing (EMDR) therapy is a treatment meant to reduce vividness and emotionality of distressing memories. There is accumulating evidence that working memory taxation is the core of the working mechanism of EMDR therapy and that EMDR derives its effect by taxing the working memory (WM) with a dual task while actively keeping a disturbing memory in mind. From a theoretical stance, based upon assumptions derived from the WM theory, the effectiveness of EMDR therapy could be improved by several adaptations. Objectives: To test the assumption that integrating these elements into the standard EMDR protocol would enhance EMDR therapy, this adapted version of EMDR (i.e. EMDR 2.0), was compared to standard EMDR in a laboratory setting. It was hypothesized that EMDR 2.0 would be more efficacious than standard EMDR, and show a greater decrease in emotionality and vividness than standard EMDR therapy. Our second hypothesis was that EMDR 2.0 would be more efficient than standard EMDR in that this variant needs less session time and a smaller number of sets (i.e. approximately 30 seconds of WM taxation). Method: Non-clinical participants (N = 62, 79% female, mean age = 35.21) with a disturbing autobiographical memory were randomly allocated to receive either EMDR or EMDR 2.0. Emotionality and vividness of the memory were measured pre- and post-intervention, and at 1- and 4-week follow-up. Results: The results showed no difference between EMDR and EMDR 2.0 in decreasing emotionality and vividness, and no difference in session time. However, participants in the EMDR 2.0 condition needed fewer sets than those in the standard EMDR condition. Conclusion: The notion that EMDR 2.0 is more efficient is partially supported by the results showing participants needed less sets than in standard EMDR to reach the same results. Future research with clinical samples is warranted.

EMDR training's for Bosnia and Herzegovina mental health workers resulted with seven European accredited EMDR psychotherapists and one European accredited EMDR consultant

IntroductionPosttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) often co-occur. There is growing motivation among clinicians to offer trauma-focused treatments, such as Eye Movement Desensitization and Reprocessing (EMDR), to patients with PTSD and comorbid BPD. However, a large subgroup of these patients does not sufficiently respond to trauma-focused treatment and is more likely to be excluded or dropout from treatment. Dialectical Behaviour Therapy (DBT) for BPD is well established and although there is some evidence that DBT combined with prolonged exposure is twice as effective in reducing PTSD symptoms than DBT alone, the comparative efficacy of trauma-focused treatment with and without concurrent PD treatment has not been investigated yet.ObjectivesThe current study will therefore evaluate the comparative clinical efficacy of EMDR with and without concurrent DBT in patients with PTSD and comorbid BPD.MethodsAdult patients were randomly assigned to EMDR with (n = 63) or without concurrent DBT (n = 63). A wide range of clinician-administered and self-report assessments were conducted before, during and up to six months after treatment. The longitudinal change in PTSD severity as the primary outcome was measured using multilevel mixed regression in SPSS. The present study is part of the overarching Prediction and Outcome Study in comorbid PTSD and Personality Disorders (PROSPER), which consists of a second RCT comparing trauma-focused treatment with and without concurrent PD treatment in patients with PTSD and cluster C PD.ResultsResults, available in January 2024, will reveal which treatment works best for this difficult-to-treat group of patients.ConclusionsThis is the first study to compare the clinical efficacy of EMDR with and without concurrent DBT in patients with PTSD and comorbid BPD. Results will reveal which treatment works best for this difficult-to-treat group of patients.Disclosure of InterestNone Declared

Eye Movement Desensitisation and Reprocessing (EMDR) is a psychological therapy that can help people process memories and distress about past events, so they have less impact on their daily lives. EMDR can be effective for treating symptoms of post-traumatic stress disorder, including nightmares and anxiety. Psychological therapies usually require adaptation so they are more accessible and effective for autistic people, but minimal research has focused on how best EMDR can be adapted. In this online survey study, we asked 103 EMDR therapists about barriers they think autistic people face when trying to have EMDR and what adaptations they use in their everyday practice. Four barriers were highlighted: client-related characteristics, therapist-related characteristics, differences in the therapeutic relationship and broader issues. Therapists identified a range of adaptations that can potentially be useful for autistic people, relating to being flexible, communicating clearly and having an awareness of individual differences. Many therapists emphasised the importance of not making assumptions about a person based on their autism diagnosis. Overall, the study findings suggest adaptations to EMDR are likely to be useful, but how relevant they are depends on each person.

This clinical practice article describes how to provide eye movement desensitization and reprocessing (EMDR) as an adjunctive treatment. It outlines the process used in developing an EMDR adjunctive therapy program in a nonprofit community agency that serves clients with chronic mental health and substance abuse disorders. The chronicity of clients’ mental health issues is complicated by life stressors that contribute to the lack of insight and accompanying poor decision making and helps to perpetuate the cycle of poverty and homelessness many experience. This article describes the initial pilot project in which EMDR was provided as a short-term intervention adjunctive to cognitive behavioral therapy, transactional analysis, and dialectical behavioral therapy. Preliminary results of this feasibility study supported the hypotheses that EMDR adjunctive therapy would reduce symptoms of traumatic stress and possibly enhance the effects of the primary therapy. This article makes multiple recommendations for program organization, including staff workshops and communication, and describes clinical strategies to ensure client readiness and to integrate EMDR with the other treatments. Recommendations are made for future research.

Being exposed to traumatic experiences is rather common in patients with schizophrenia. Adverse experiences may induce the onset of psychotic symptoms or trigger current symptoms to be exacerbated. Eye Movement Desensitization Reprocessing (EMDR) is an effective therapy in the treatment of incidences with underlying traumatic experiences, there by it can be conducted on various cases in addition to other treatments such as psycho-medication or another therapy method. It was developed by Shapiro in 1980s. Although desensitization is widely applied on patients with Post-Traumatic Stress Disorder, it is unusual for EMDR therapy to be safely and effectively performed in the treatment of psychotic disorder sor symptoms. In the present case study, EMDR treatment process and course of psychiatric state in a patient with history of child hood abuse and forced psychiatric residency will be discussed. The patient who had a diagnosis of schizophrenia for 8 years was treated with antipsychotic treatment as well as 2 sessions of EMDR, and as a result, a positive change was observed in her general clinical course. Our thoughts on this phenomenon are that EMDR treatment is an effective, safe and short-term intervention in the comorbidity of PTSD and psychotic disorders. However, the literature about the place of EMDR in the treatment of schizophrenia cases is rather limited and much more research is needed.

EPA-0604 - EMDR trainings for bosnia-herzegovina mental health workers in tuzla and sarajevo resulted with three european accrdedited emdr psychotherapists aftermath the 1992-1995 war

EMDR (eye movement desensitization and reprocessing): a different option in psychotherapy In recent years, there has been an interest in using the EMDR (Eye Movement Desensitization and Reprocessing) therapy. One of the reasons for this interest may be its effectiveness shown by numerous studies, especially, conducted with individuals who suffer from Post Traumatic Stress Disorder (PTSD). The EMDR is known to be an innovative approach that accelerates information processing and facilitates the integration of fragmented traumatic memories. This process is stated to allow better integration of the information that a person has to handle in the future. Recent practice guidelines and meta-analyses have designated the EMDR as a first-line treatment for trauma. Although the prevalences of trauma and trauma related disorders are high in Turkey, there has been a limited number of published studies highlighting treatment options. The EMDR’s mechanism of action has not yet been fully explained. Shapiro has proposed an adaptive information processing model. Later, based on laboratory and neuroimaging methods, a number of neurobiological models have been suggested. The present study explained the EMDR and its eight-phases. A case example with session records was provided to show the application and operation of the technique. After that, leading neurobiological models which attempt to explain the mechanisms of action of the EMDR were summarized. Finally, few studies conducted in Turkey using the EMDR were reviewed. Given the effectiveness of the EMDR regarding trauma and related disorders, the utilization of the technique by a broad number of mental health professionals may not only increase the professionals’ competency on psychiatric disorders, but also may provide patients suffering from these

BackgroundTraumatic and sudden loss can result in trauma symptoms such as nightmares, flashbacks and avoidance. These symptoms can disrupt natural grief processes (Murray. J EMDR Pract Res. 2012, 6(4):187–91). Eye...

Eye movement desensitization and reprocessing (EMDR) is a psychotherapeutic approach that has drew considerable attention and become controversial since its development. EMDR, which integrates various components of different psychotherapy schools, is a structured and short-term therapy approach. While it was initially used to reduce traumatic symptoms, recent studies indicate that EMDR may also be efficient in the treatment of various disorders. In this review, the long-term efficacy of EMDR in several disorders was investigated. For this purpose, the studies that examined the effectiveness of EMDR in common psychiatric problems such as post-traumatic stress disorder, anxiety disorders and depressive disorders with at least 3-months follow-up measurements were included. Numerous controlled studies show that EMDR is a reliable method for the treatment of PTSD and treatment gains have been maintained in the long term. Moreover, a limited number of studies recently conducted indicate that EMDR gives promising results in the treatment of unipolar depression, panic disorder, and obsessive-compulsive disorder. All in all, it can be concluded that EMDR is more effective than waiting lists and has an effect comparable with empirically supported therapies like cognitive behavioral therapy. However, the long-term follow-up studies with larger sample sizes are needed to reach reliable results. Keywords: Eye movement desensitization and reprocessing (EMDR), PTSD, depression, anxiety disorders, long term effects

BackgroundExisting recommended treatment options for personality disorders (PDs) are extensive and costly. There is emerging evidence indicating that trauma-focused treatment using eye movement desensitization and reprocessing (EMDR) therapy aimed at resolving memories of individuals’ adverse events can be beneficial for this target group within a relatively short time frame. The primary purpose of the present study is to determine the effectiveness of EMDR therapy versus waiting list in reducing PD symptom severity. Furthermore, the effects of EMDR therapy on trauma symptom severity, loss of diagnosis, personal functioning, quality of life, and mental health outcomes will be determined. In addition, the cost-effectiveness of EMDR therapy in the treatment of PDs is investigated. Moreover, predictors of treatment success, symptom deterioration and treatment discontinuation will be assessed. Lastly, experiences with EMDR therapy will be explored.MethodIn total, 159 patients with a PD will be included in a large multicentre single-blind randomized controlled trial. The Structured Clinical Interview for DSM-5 Personality Disorders will be used to determine the presence of a PD. Participants will be allocated to either a treatment condition with EMDR therapy (ten biweekly 90-min sessions) or a waiting list. Three months after potential treatment with EMDR therapy, patients can receive treatment as usual for their PD. All participants are subject to single-blinded baseline, post-intervention and 3-, 6- and 12-month follow-up assessments. The primary outcome measures are the Assessment of DSM-IV Personality Disorders and the Clinician-Administered PTSD Scale for DSM-5. For cost-effectiveness, the Treatment Inventory of Costs in Patients with psychiatric disorders, EuroQol-5D-3L, and the Mental Health Quality of Life Questionnaire will be administered. The PTSD Checklist for DSM-5, Brief State Paranoia Checklist and Difficulties in Emotion Regulation Scale will be used to further index trauma symptom severity. Type of trauma is identified at baseline with the Childhood Trauma Questionnaire-SF and Life Events Checklist for the DSM-5. Personal functioning and health outcome are assessed with the Level of Personality Functioning Scale-BF 2.0, Outcome Questionnaire-45 and Mental Health Quality of Life Questionnaire. Experiences with EMDR therapy of patients in the EMDR therapy condition are explored with a semi-structured interview at post-intervention.DiscussionIt is expected that the results of this study will contribute to knowledge about the effectiveness, and cost-effectiveness of trauma-focused treatment using EMDR therapy in individuals diagnosed with a PD. Follow-up data provide documentation of long-term effects of EMDR therapy on various outcome variables, most importantly the reduction of PD symptom severity and loss of diagnoses.Trial registrationNetherlands Trial Register NL9078. Registered on 31 November 2020

To investigate the efficacy of Eye Movement Desensitization and Reprocessing for postoperative pain management in adolescents. Eye Movement Desensitization and Reprocessing is an inexpensive, non-pharmacological intervention that has successfully been used to treat chronic pain. It holds promise in the treatment of acute, postsurgical pain based on its purported effects on the brain and nervous system. A randomized controlled trial was used. Fifty-six adolescent surgical patients aged between 12-18years were allocated to gender-balanced Eye Movement Desensitization and Reprocessing (treatment) or non-Eye Movement Desensitization and Reprocessing (control) groups. Pain was measured using the Wong-Baker FACES(®) Pain Rating Scale (WBFS) before and after the intervention (or non-intervention for the control group). A Wilcoxon signed-rank test demonstrated that the Eye Movement Desensitization and Reprocessing group experienced a significant reduction in pain intensity after treatment intervention, whereas the control group did not. Additionally, a Mann-Whitney U-test showed that, while there was no significant difference between the two groups at time 1, there was a significant difference in pain intensity between the two groups at time 2, with the Eye Movement Desensitization and Reprocessing group experiencing lower levels of pain. These results suggest that Eye Movement Desensitization and Reprocessing may be an effective treatment modality for postoperative pain.