RESUMEN
INTRODUCTION: Post-traumatic stress disorder (PTSD) is a chronic, disabling psychiatric disorder prevalent among U.S. service members and veterans. First-line treatments for PTSD endorsed in the 2017 Veterans Affairs (VA)/Department of Defense (DoD) Clinical Practice Guideline for PTSD emphasize individual, manualized trauma-focused psychotherapies that have a primary component of exposure and/or cognitive restructuring. These include prolonged exposure (PE) therapy, cognitive processing therapy (CPT), eye movement desensitization and reprocessing (EMDR), and others. Accelerated resolution therapy (ART) is an emerging trauma-focused therapy not specifically referenced in the guideline, but one that is consistent with the recommendations and is derived directly from EMDR. One randomized clinical trial and multiple observational studies have suggested that ART can be delivered in an average of just four treatment sessions. This commentary reviews the clinical, empirical, and theoretical rationale for use of ART as a potential first-line PTSD treatment modality in VA and DoD facilities. MATERIALS AND METHODS: The clinical protocol of ART is summarized into discrete procedural steps. The theoretical rationale as to how ART may help clients process traumatic memories and resolve symptoms of PTSD is also discussed, including how repeated sets of smooth pursuit horizontal eye movements may facilitate a relaxation response and assist with processing emotionally intrusive memories. Herein, we review primary treatment results from four published studies of ART, including mean symptom score reductions on the 17-item PCL (PTSD checklist) after treatment with ART, along with effect sizes and percentage of treatment responders. Finally, the ART protocol is compared directly against specific recommended elements of trauma-focused therapy described in the VA/DoD Clinical Practice Guideline. RESULTS: The four published studies of ART reviewed (n = 291) included adult civilians and service members/veterans; the mean age was 42.3 ± 12.3 yr and 28.9% were female. Among 237 treatment completers (81.4% of the combined cohort), the mean number of ART sessions received was 3.9 ± 1.1. Across the four studies, mean treatment-related reductions in PCL scores ranged from 15.6 ± 13.2 to 25.6 ± 11.3, with a pooled mean reduction on the PCL of 20.6 ± 15.0. Effect sizes were large and ranged from 1.18 to 2.26 (p< 0.0005) across studies, with a pooled effect size of 1.38 (95% confidence interval: 1.20-1.56, p < 0.0001). Using the clinical cutpoint of >10-point reduction on the PCL instrument, clinically significant change (response) ranged from 63.8% to 100.0% across the four studies, with a pooled treatment response rate of 74.7%. Results were nominally attenuated when conservatively assuming no treatment response for non-completers. CONCLUSION: The ART protocol contains the core therapeutic elements and aligns closely with the current VA/DoD Clinical Practice Guideline. It has a plausible theoretical rationale and an evolving empirical research base that includes four studies with peer-reviewed publications, one of which was a randomized controlled trial. These features, along with the brevity of the treatment protocol, no requirement for narration, and high provider satisfaction rates, provide a rationale for the potential use of ART as a first-line PTSD treatment modality for active duty and veteran military personnel.
Asunto(s)
Desensibilización y Reprocesamiento del Movimiento Ocular/normas , Trastornos por Estrés Postraumático/terapia , Resultado del Tratamiento , Adulto , Desensibilización y Reprocesamiento del Movimiento Ocular/métodos , Desensibilización y Reprocesamiento del Movimiento Ocular/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Personal Militar/psicología , Personal Militar/estadística & datos numéricos , Trastornos por Estrés Postraumático/psicología , Estados Unidos , United States Department of Defense/organización & administración , United States Department of Defense/estadística & datos numéricos , United States Department of Veterans Affairs/organización & administración , United States Department of Veterans Affairs/estadística & datos numéricos , Veteranos/psicología , Veteranos/estadística & datos numéricosRESUMEN
Eye movement desensitization and reprocessing (EMDR) is a relatively new psychotherapy that has gradually gained popularity for the treatment of post-traumatic stress disorder. In the present work, the standardised EMDR protocol is introduced, along with current hypotheses of its mechanism of action, as well as a critical review of the available literature on its clinical effectiveness in adult post-traumatic stress disorder. A systematic review of the published literature was performed using PubMed and PsycINFO databases with the keywords «eye movement desensitization and reprocessing¼ and «post-traumatic stress disorder¼ and its abbreviations «EMDR¼ and «PTSD¼. Fifteen randomised controlled trials of good methodological quality were selected. These studies compared EMDR with unspecific interventions, waiting lists, or specific therapies. Overall, the results of these studies suggest that EMDR is a useful, evidence-based tool for the treatment of post-traumatic stress disorder, in line with recent recommendations from different international health organisations.
Asunto(s)
Desensibilización y Reprocesamiento del Movimiento Ocular , Trastornos por Estrés Postraumático/terapia , Adulto , Desensibilización y Reprocesamiento del Movimiento Ocular/métodos , Desensibilización y Reprocesamiento del Movimiento Ocular/normas , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoRESUMEN
BACKGROUND: Post-traumatic stress disorder (PTSD) is one of the more commonly occurring mental disorders following potentially traumatizing events soldiers may encounter when deployed abroad. One of the first-line recommended treatment options is eye movement desensitization and reprocessing (EMDR). The number of studies assessing the effectiveness of EMDR in German soldiers under routine conditions is currently almost nil. METHODS: A retrospective, quasi-experimental effectiveness study on EMDR in an inpatient setting is presented using a prepost design. The study compares symptom reduction in soldiers (N = 78) with a wait-list (N = 18). Effect sizes of EMDR were measured for PTSD, symptoms of depression, and general mental health. RESULTS: Effect size for EMDR treatment of PTSD was d = 0.77; 95% confidence interval (CI): 0.51 to 1.36, for symptoms of depression d = 0.99; 95% CI: 0.31 to 1.36, and for general psychiatric symptoms d = 0.53; 95% CI: 0.17 to 1.21. The effects resulting from EMDR treatment were somewhat weaker than those reported in comparable studies in civilians. CONCLUSION: EMDR therapy is an effective treatment to reduce symptoms of PTSD and depression. However, in the military context it needs to be complemented by treatment options that specifically address further conditions perpetuating the disorders.
Asunto(s)
Desensibilización y Reprocesamiento del Movimiento Ocular/normas , Personal Militar/psicología , Trastornos por Estrés Postraumático/terapia , Resultado del Tratamiento , Adulto , Depresión/psicología , Depresión/terapia , Desensibilización y Reprocesamiento del Movimiento Ocular/métodos , Femenino , Alemania , Hospitalización/estadística & datos numéricos , Humanos , Pacientes Internos/psicología , Masculino , Persona de Mediana Edad , Personal Militar/estadística & datos numéricos , Psicometría/instrumentación , Psicometría/métodos , Estudios Retrospectivos , Trastornos por Estrés Postraumático/psicologíaRESUMEN
La desensibilización y el reprocesamiento por medio de movimientos oculares (EMDR) ha suscitado un gran número de estudios desde su aparición en 1989. El objetivo principal de este artículo es describir su desarrollo y evolución hasta la actualidad. Para ello se realizó una búsqueda bibliográfica en MEDLINE y PsycINFO con la entrada «eye movement desensitizacion». Tras la revisión de los 795 artículos resultantes, se eligieron aquellos que por su relevancia e interés mostraban mejor el desarrollo y evolución de la técnica. Además, se configuró una línea de vida que representó gráficamente su historia. Aunque en los primeros años el foco de investigación fue la validación de la técnica para el trastorno de estrés postraumático (TEPT), ésta comenzó muy rápidamente a aplicarse a otras problemáticas. Solo un 14% de los trabajos encontrados son estudios experimentales controlados. Actualmente, si bien se ha demostrado su eficacia como tratamiento del TEPT, se siguen barajando diversas hipótesis explicativas de su eficacia
Eye movement desensitization and reprocessing (EMDR) has led to a great number of studies since its appearance in 1989. The aim of this article is to describe EMDR development and evolution to the present day. With this purpose a search was carried out on MEDLINE and PsycINFO with the entry «eye movement desensitization». After revising the resulting 797 articles, those that because of their relevance explained best the development and evolution of the technique were chosen and shaped into a lifeline graphically representing the history of EMDR. Despite the fact that during the first years the focus of research was on the validation of the technique for post-traumatic disorder (PTSD), it was soon applied to other areas. Only 14% of the articles found account for controlled studies. Up to date, in spite of the effectiveness of EMDR for the treatment of PTSD that has been proven, many different explanatory hypotheses are still up for discussion
Asunto(s)
Humanos , Masculino , Femenino , Desensibilización y Reprocesamiento del Movimiento Ocular/instrumentación , Desensibilización y Reprocesamiento del Movimiento Ocular/métodos , Trastornos por Estrés Postraumático/complicaciones , Trastornos por Estrés Postraumático/diagnóstico , Desensibilización y Reprocesamiento del Movimiento Ocular/organización & administración , Desensibilización y Reprocesamiento del Movimiento Ocular/normas , Desensibilización y Reprocesamiento del Movimiento Ocular/tendencias , Trastornos por Estrés Postraumático/fisiopatología , Trastornos por Estrés Postraumático/psicologíaRESUMEN
This study aimed to critically review all studies that have set out to evaluate the use of eye movement desensitization and reprocessing (EMDR) for people diagnosed with both intellectual disability (ID) and post-traumatic stress disorder (PTSD). Searches of the online databases Psych Info, The Cochrane Database of Systematic Reviews, The Cochrane Database of Randomized Control Trials, CINAHL, ASSIA and Medline were conducted. Five studies are described and evaluated. Key positive points include the high clinical salience of the studies and their high external validity. Several common methodological criticisms are highlighted, however, including difficulty in the definition of the terms ID and PTSD, lack of control in design and a lack of consideration of ethical implications. Overall, the articles reviewed indicate cause for cautious optimism about the utility of EMDR with this population. The clinical and research implications of this review are discussed.