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EMDR Research News October 2016

This month there are 11 new articles related to EMDR therapy.

Of note are studies on:

  • The neurobiology of Resource Development and Installation
  • The neurobiology of EMDR Therapy for PTSD
  • An updated review of therapy for traumatized children and adolescents
  • A review of interventions after domestic violence
  • A review of neurobiology of EMDR and eye movements
  • Comparing eye movements versus changing visual input
  • Comparing eye movements vs. eye fixation vs. simple exposure in treating PTSD
  • Comparing EMDR vs. COMET (behavioral ego strengthening) for self-esteem in anxiety
  • Comparing EMDR vs Critical Incident Stress Debriefing for workplace violence
  • Developing credibility and positive expectancy for treatment of psychosis among trauma therapists
  • A controlled study of trauma focused treatment in those with psychosis with and without dissociative subtype PTSD

Two articles are available with open access for immediate download.

The book of the month is
EMDR and the Art of Psychotherapy with Children, Second Edition: Infants to Adolescents 2nd Edition and the companion Treatment Manual 2nd Edition by Robbie Adler-Tapia, Ph.D. and Carolyn Settle, MSW LCSW.

With each reference below, you will find the citation, abstract and author contact information (when available). Prior quarterly summaries of journal articles can be found on the
EMDRIA website and a comprehensive listing of all EMDR-related research is available at the Francine Shapiro Library. EMDRIA members can access recent Journal of EMDR Practice and Research articles in the member’s area on the EMDRIA website. JEMDR issues older than 12 months are available open access on IngentaConnect.

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Book of the Month

Art psychotherapy child
Art psychotherapy child manual
EMDR and the Art of Psychotherapy with Children, Second Edition: Infants to Adolescents 2nd Edition and the companion Treatment Manual 2nd Edition by Robbie Adler-Tapia, Ph.D. and Carolyn Settle, MSW LCSW.

This second edition teaches therapists to effectively use the entire EMDR therapy eight-phased treatment with children of all ages from infants to adolescents. The book details changes to the phases of EMDR therapy (history taking, case conceptualization, and treatment planning) along with alterations to case conceptualization for target identification and organization. It incorporates newly published research documenting current evidence-based support of EMDR therapy with children.

Basic skills for using EMDR therapy with children are explained, as well as transitions to more advanced skills for working with infants and toddlers, children with intellectual and developmental disabilities, and children in the welfare system. It integrates play therapy and other forms of expressive therapies. Specialty topics on using EMDR therapy include case conceptualization with diagnoses defined by the DSM-5 and ICD-10, newborn/neonate diagnoses, children with chemical dependency, and many more. Case studies woven throughout the text clearly demonstrate EMDR therapy applications, and summaries of published evidence support the efficacy of EMDR therapy, including studies from WHO and SAMHSA. Expanded to include all eight phases of EMDR therapy for infants and toddlers, preteens, and adolescents, this book continues to be the foundational EMDR text for therapists working with children.

New to the Second Edition:
  • Integrates developmental theory for use with children, adolescents, and teens
  • Includes breakthrough narrative therapeutic concepts with young children
  • Guides therapists in using EMDR therapy with specialty populations
  • Presents two new chapters--one on EMDR therapy with infants, toddlers, and preschoolers and a second on preteens and adolescents
Key Features:
  • Serves as the foundational EMDR therapy text for therapists working with children
  • Details the skills--from basic to advanced--needed for best practices
  • Includes the most current research on EMDR therapy

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Journal Articles

Amano, T., & Toichi, M. (2016). Possible neural mechanisms of psychotherapy for trauma-related symptoms: Cerebral responses to the neuropsychological treatment of post-traumatic stress disorder model individuals. Scientific Reports, 6, 34610. doi:10.1038/srep34610

Full text:
http://www.nature.com/articles/srep34610

Motomi Toichi, Graduate School of Medicine, Kyoto University, Kyoto, Japan. E-mail: yiu60432@nifty.com

Abstract


Psychotherapy is often effective for treating psychogenic disorders, but the changes that occur in the brain during such treatments remain unknown. To investigate this, we monitored cerebral activity throughout an entire session using a psychotherapeutic technique in healthy subjects. Since post-traumatic stress disorder (PTSD) is a typical psychogenic psychiatric disorder, we used PTSD-model volunteers who had experienced a moderately traumatic event. The technique used as psychotherapy was eye movement desensitisation and reprocessing (EMDR), a standard method for treating PTSD. The oxygenated haemoglobin concentration ([oxy-Hb]), a sensitive index of brain activation, measured using multi-channel near-infrared spectroscopy, revealed changes in [oxy-Hb] in the superior temporal sulcus (STS) and orbitofrontal cortex (OFC). During a vital therapeutic stage, a significant reduction in the activation by forced eye movements was observed in the right STS, and a trend toward a reduction in the left OFC. The hyperactivation of the right STS on the recall of unpleasant memories, and its normalisation by eye movements, seem to reflect an important neural mechanism of the psychotherapy. These findings suggest that psychotherapy for traumatic symptoms involves brain regions related to memory representation and emotion, and possibly those that link memory and emotion, such as the amygdala.

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Amano, T., & Toichi, M. (2016). The role of alternating bilateral stimulation in establishing positive cognition in EMDR therapy: A multi-channel near-infrared spectroscopy study.
PLoS ONE, 11(10), e0162735. doi:10.1371/journal.pone.0162735

Full text:
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0162735

Tamaki Amano. Graduate School of Medicine, Kyoto University, Kyoto, Japan. E-mail: yiu60432@nifty.com

Abstract


Eye movement desensitisation and reprocessing (EMDR) is a standard method for treating post-traumatic stress disorder. EMDR treatment consists of desensitisation and resource development and installation (RDI) stages. Both protocols provide a positive alternating bilateral stimulation (BLS). The effect of desensitisation with BLS has been elucidated. However, a role for BLS in RDI remains unknown. Therefore, it is important to measure feelings as subjective data and physiological indicators as objective data to clarify the role of BLS in RDI. RDI was administered to 15 healthy volunteer subjects who experienced pleasant memories. Their oxygenated haemoglobin concentration ([oxy-Hb]), a sensitive index of brain activity, was measured from the prefrontal cortex (PFC) to the temporal cortex using multi-channel near-infrared spectroscopy during recall of a pleasant memory with or without BLS. The BLS used was alternating bilateral tactile stimulation with a vibration machine. The psychological evaluation suggested that RDI was successful. The results showed that, compared with non-BLS conditions, accessibility was increased and subjects were more relaxed under BLS conditions. A significant increase in [oxy-Hb] was detected in the right superior temporal sulcus (STS), and a decrease in the wide bilateral areas of the PFC was observed in response to BLS. The significant BLS-induced activation observed in the right STS, which is closely related to memory representation, suggests that BLS may help the recall of more representative pleasant memories. Furthermore, the significant reduction in the PFC, which is related to emotion regulation, suggests that BLS induces relaxation and comfortable feelings. These results indicate an important neural mechanism of RDI that emotional processing occurred rather than higher cognitive processing during this stage. Considering the neuroscientific evidence to date, BLS in RDI may enhance comfortable feelings about pleasant memories. Based on the current findings, the use of BLS in RDI may be warranted in some clinical situations.

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Gillies, D., Maiocchi, L., Bhandari, A. P., Taylor, F., Gray, C., & O'Brien, L. (2016). Psychological therapies for children and adolescents exposed to trauma.
Cochrane Database of Systematic Reviews (Online), 10, CD012371. doi:10.1002/14651858.CD012371

Donna Gillies, Western Sydney Local Health District - Mental Health, Cumberland Hospital, Locked Bag 7118, Parramatta, NSW, 2124, Australia. donna.gillies1@health.nsw.gov.au.

Abstract


BACKGROUND: Children and adolescents who have experienced trauma are at high risk of developing post-traumatic stress disorder (PTSD) and other negative emotional, behavioural and mental health outcomes, all of which are associated with high personal and health costs. A wide range of psychological treatments are used to prevent negative outcomes associated with trauma in children and adolescents.

OBJECTIVES: To assess the effects of psychological therapies in preventing PTSD and associated negative emotional, behavioural and mental health outcomes in children and adolescents who have undergone a traumatic event.

SEARCH METHODS: We searched the Cochrane Common Mental Disorders Group's Specialised Register to 29 May 2015. This register contains reports of relevant randomised controlled trials from The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). We also checked reference lists of relevant studies and reviews. We did not restrict the searches by date, language or publication status.

SELECTION CRITERIA: All randomised controlled trials of psychological therapies compared with a control such as treatment as usual, waiting list or no treatment, pharmacological therapy or other treatments in children or adolescents who had undergone a traumatic event.

DATA COLLECTION AND ANALYSIS: Two members of the review group independently extracted data. We calculated odds ratios for binary outcomes and standardised mean differences for continuous outcomes using a random-effects model. We analysed data as short-term (up to and including one month after therapy), medium-term (one month to one year after therapy) and long-term (one year or longer).

MAIN RESULTS: Investigators included 6201 participants in the 51 included trials. Twenty studies included only children, two included only preschool children and ten only adolescents; all others included both children and adolescents. Participants were exposed to sexual abuse in 12 trials, to war or community violence in ten, to physical trauma and natural disaster in six each and to interpersonal violence in three; participants had suffered a life-threatening illness and had been physically abused or maltreated in one trial each. Participants in remaining trials were exposed to a range of traumas. Most trials compared a psychological therapy with a control such as treatment as usual, wait list or no treatment. Seventeen trials used cognitive-behavioural therapy (CBT); four used family therapy; three required debriefing; two trials each used eye movement desensitisation and reprocessing (EMDR), narrative therapy, psychoeducation and supportive therapy; and one trial each provided exposure and CBT plus narrative therapy. Eight trials compared CBT with supportive therapy, two compared CBT with EMDR and one trial each compared CBT with psychodynamic therapy, exposure plus supportive therapy with supportive therapy alone and narrative therapy plus CBT versus CBT alone. Four trials compared individual delivery of psychological therapy to a group model of the same therapy, and one compared CBT for children versus CBT for both mothers and children. The likelihood of being diagnosed with PTSD in children and adolescents who received a psychological therapy was significantly reduced compared to those who received no treatment, treatment as usual or were on a waiting list for up to a month following treatment (odds ratio (OR) 0.51, 95% confidence interval (CI) 0.34 to 0.77; number needed to treat for an additional beneficial outcome (NNTB) 6.25, 95% CI 3.70 to 16.67; five studies; 874 participants). However the overall quality of evidence for the diagnosis of PTSD was rated as very low. PTSD symptoms were also significantly reduced for a month after therapy (standardised mean difference (SMD) -0.42, 95% CI -0.61 to -0.24; 15 studies; 2051 participants) and the quality of evidence was rated as low. These effects of psychological therapies were not apparent over the longer term. CBT was found to be no more or less effective than EMDR and supportive therapy in reducing diagnosis of PTSD in the short term (OR 0.74, 95% CI 0.29 to 1.91; 2 studies; 160 participants), however this was considered very low quality evidence. For reduction of PTSD symptoms in the short term, there was a small effect favouring CBT over EMDR, play therapy and supportive therapies (SMD -0.24, 95% CI -0.42 to -0.05; 7 studies; 466 participants). The quality of evidence for this outcome was rated as moderate. We did not identify any studies that compared pharmacological therapies with psychological therapies.

AUTHORS' CONCLUSIONS: The meta-analyses in this review provide some evidence for the effectiveness of psychological therapies in prevention of PTSD and reduction of symptoms in children and adolescents exposed to trauma for up to a month. However, our confidence in these findings is limited by the quality of the included studies and by substantial heterogeneity between studies. Much more evidence is needed to demonstrate the relative effectiveness of different psychological therapies for children exposed to trauma, particularly over the longer term. High-quality studies should be conducted to compare these therapies.

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Hegarty, K., Tarzia, L., Hooker, L., & Taft, A. (2016). Interventions to support recovery after domestic and sexual violence in primary care.
International Review of Psychiatry (Abingdon, England), 28(5), 519-532. doi:10.1080/09540261.2016.1210103

Kelsey Hegarty. The University of Melbourne , Melbourne , Australia. E-mail: k.hegerty@unimelb.edu.au

Abstract


Experiences of domestic and sexual violence are common in patients attending primary care. Most often they are not identified due to barriers to asking by health practitioners and disclosure by patients. Women are more likely than men to experience such violence and present with mental and physical health symptoms to health practitioners. If identified through screening or case finding as experiencing violence they need to be supported to recover from these traumas. This paper draws on systematic reviews published in 2013-2015 and a further literature search undertaken to identify recent intervention studies relevant to recovery from domestic and sexual violence in primary care. There is limited evidence as to what interventions in primary care assist with recovery from domestic violence; however, they can be categorized into the following areas: first line response and referral, psychological treatments, safety planning and advocacy, including through home visitation and peer support programmes, and parenting and mother-child interventions. Sexual violence interventions usually include trauma informed care and models to support recovery. The most promising results have been from nurse home visiting advocacy programmes, mother-child psychotherapeutic interventions, and specific psychological treatments (Cognitive Behaviour Therapy, Trauma informed Cognitive Behaviour Therapy and, for sexual assault, Exposure and Eye Movement Desensitization and Reprocessing Interventions). Holistic healing models have not been formally tested by randomized controlled trials, but show some promise. Further research into what supports women and their children on their trajectory of recovery from domestic and sexual violence is urgently needed.

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Onderdonk, S. W., & van den Hout, M. A. (2016). Comparisons of eye movements and matched changing visual input.
Journal of Behavior Therapy and Experimental Psychiatry, 53, 34-40. doi:10.1016/j.jbtep.2015.10.010

Social and Health Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands. Electronic address: onderdonk.samuel@gmail.com.

Abstract


BACKGROUND AND OBJECTIVES: During EMDR trauma therapy, performing EM taxes WM, and simultaneously recalled memories become less vivid. It has been proposed that this WM occupation results from CVI which occurs during EM. This study sought to compare the effects of EM on memory to a task presenting identical visual stimulus to stationary eyes.

METHOD: In Study 1, participants recorded RT while performing two tasks: EM, and a task with visually identical images displayed on screen. In Study 2, these same tasks were performed while simultaneously recalling negative emotional memories.

RESULTS: Study 1 found RT was slowest in the EM condition, while RT in the CVI condition was still slower than in the control condition. Study 2 found decreases in memory vividness and emotionality after EM, while after CVI there was a small decrease in negativity which was not greater than in the control..

LIMITATIONS: Neither study included EM with no visual input; conclusions cannot be made about the effect of motor movement on WM taxation or recall. As neither study was conducted with trauma patients, it is unknown if the observed effects would be comparable in the population for which EMDR is intended.

CONCLUSIONS: Performing EM taxes more WM resources and has greater impact on both memory vividness and emotionality than matched CVI. This demonstrates that the effects observed in EMDR treatment are the result of more than occupying WM systems with visual stimuli alone.

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Sack, M., Zehl, S., Otti, A., Lahmann, C., Henningsen, P., Kruse, J., & Stingl, M. (2016). A comparison of dual attention, eye movements, and exposure only during eye movement desensitization and reprocessing for posttraumatic stress disorder: Results from a randomized clinical trial.
Psychotherapy and Psychosomatics, 85(6), 357-365. doi:10.1159/000447671

Prof. Dr. med. Martin Sack. Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technische Universität München, Munich, Germany. E-Mail m.sack@tum.de

Abstract


BACKGROUND: Currently, there is controversy on the possible benefits of dual-attention tasks during eye movement desensitization and reprocessing (EMDR) for patients with posttraumatic stress disorder (PTSD).

METHODS: A total of 139 consecutive patients (including 85 females) suffering from PTSD were allocated randomly among 3 different treatment conditions: exposure with eyes moving while fixating on the therapist's moving hand (EM), exposure with eyes fixating on the therapist's nonmoving hand (EF), and exposure without explicit visual focus of attention as control condition (EC). Except for the variation in stimulation, treatment strictly followed the standard EMDR manual. Symptom changes from pre- to posttreatment were measured with the Clinician-Administered PTSD Scale (CAPS) by an investigator blinded to treatment allocation.

RESULTS: In total, 116 patients completed the treatment, with an average of 4.6 sessions applied. Intention-to-treat analysis revealed a significant improvement in PTSD symptoms with a high overall effect size (Cohen's d = 1.96, 95% CI: 1.67-2.24) and a high remission rate of PTSD diagnosis (79.8%). In comparison to the control condition, EM and EF were associated with significantly larger pre-post symptom decrease (ΔCAPS: EM = 35.8, EF = 40.5, EC = 31.0) and significantly larger effect sizes (EM: d = 2.06, 95% CI: 1.55-2.57, EF: d = 2.58, 95% CI: 2.01-3.11, EC: d = 1.44, 95% CI: 0.97-1.91). No significant differences in symptom decrease and effect size were found between EM and EF.

CONCLUSIONS: Exposure in combination with an explicit external focus of attention leads to larger PTSD symptom reduction than exposure alone. Eye movements have no advantage compared to visually fixating on a nonmoving hand.

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Staring, A. B. P., van den Berg, D. P. G., Cath, D. C., Schoorl, M., Engelhard, I. M., & Korrelboom, C. W. (2016). Self-esteem treatment in anxiety: A randomized controlled crossover trial of eye movement desensitization and reprocessing (EMDR) versus competitive memory training (COMET) in patients with anxiety disorders.
Behaviour Research and Therapy, 82, 11-20. doi:10.1016/j.brat.2016.04.002

A.B.P. Staring. Wijde Doelen 23, 3512 XM, Utrecht, The Netherlands. E-mail: tonnie@backwash.org

Abstract


Background and purpose
Little is known about treating low self-esteem in anxiety disorders. This study evaluated two treatments targeting different mechanisms: (1) Eye Movement Desensitization and Reprocessing (EMDR), which aims to desensitize negative memory representations that are proposed to maintain low self-esteem; and (2) Competitive Memory Training (COMET), which aims to activate positive representations for enhancing self-esteem.

Methods
A Randomized Controlled Trial (RCT) was used with a crossover design. Group 1 received six sessions EMDR first and then six sessions COMET; group 2 vice versa. Assessments were made at baseline (T0), end of first treatment (T1), and end of second treatment (T2). Main outcome was self-esteem. We included 47 patients and performed Linear Mixed Models.

Results
COMET showed more improvements in self-esteem than EMDR: effect-sizes 1.25 versus 0.46 post-treatment. Unexpectedly, when EMDR was given first, subsequent effects of COMET were significantly reduced in comparison to COMET as the first intervention. For EMDR, sequence made no difference. Reductions in anxiety and depression were mediated by better self-esteem.

Conclusions
COMET was associated with significantly greater improvements in self-esteem than EMDR in patients with anxiety disorders. EMDR treatment reduced the effectiveness of subsequent COMET. Improved self-esteem mediated reductions in anxiety and depression symptoms.

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Strenge, H. (2016). Zur beziehung von EMDR und augenbewegungen – eine analyse der aktuellen neurobiologischen studienlage [on the relationship between EMDR and eye movements - an analysis of the current state of neurobiological research]. Psychotherapie, Psychosomatik,
Medizinische Psychologie, 66(08), 307-315. doi:10.1055/s-0042-110852

PD Dr. med. Hans Strenge Praxis für Psychotherapie Blücherplatz 16 24105 Kiel E-mail: hstrenge@gmx.de

Abstract


EMDR is an effective treatment for people diagnosed with posttraumatic stress disorder. The traditional technique of EMDR combines the activation of distressing reminders with guided rhythmic eye movements. The present article reviews the current state of research on the neu­robiological correlates of the eye movements occurring during EMDR. The distinction between saccades and smooth pursuit eye movements allows for detailed analyses of ocular motor connections with cerebral networks of attention, memory and emotion. Possible consequences for research and clinical practice with EMDR are discussed.

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Tarquinio, C., Rotonda, C., Houllé, W. A., Montel, S., Rydberg, J. A., Minary, L., . . . Alla, F. (2016). Early psychological preventive intervention for workplace violence: A randomized controlled explorative and comparative study between EMDR-recent event and critical incident stress debriefing.
Issues in Mental Health Nursing, 1-13. doi:10.1080/01612840.2016.1224282

Abstract


This randomized controlled trial study aims to investigate the efficacy of an early psychological intervention called EMDR-RE compared to Critical Incident Stress Debriefing on 60 victims of workplace violence, which were divided into three groups: 'EMDR-RE' (n = 19), 'CISD' (n = 23), and 'delayed EMDR-RE' (n = 18). EMDR-RE and CISD took place 48 hours after the event, whilst third intervention was delayed by an additional 48 hours. Results showed that after 3 months PCLS and SUDS scores were significantly lower with EMDR-RE and delayed EMDR-RE compared to CISD. After 48 hours and 3 months, none of the EMDR-RE-treated victims showed PTSD symptoms.

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van den Berg, D. P., van der Vleugel, B. M., de Bont, P. A., Thijssen, G., de Roos, C., de Kleine, R., . . . van der Gaag, M. (2016). Exposing therapists to trauma-focused treatment in psychosis: Effects on credibility, expected burden, and harm expectancies.
European Journal of Psychotraumatology, 7, 31712.

David P. G. van den Berg, Zoutkeetsingel 40, NL-2512 HN The Hague, The Netherlands, Email: d.vandenberg@parnassia.nl

Abstract


BACKGROUND: Despite robust empirical support for the efficacy of trauma-focused treatments, the dissemination proves difficult, especially in relation to patients with comorbid psychosis. Many therapists endorse negative beliefs about the credibility, burden, and harm of such treatment.
OBJECTIVE: This feasibility study explores the impact of specialized training on therapists' beliefs about trauma-focused treatment within a randomized controlled trial.
METHOD: Therapist-rated (n=16) credibility, expected burden, and harm expectancies of trauma-focused treatment were assessed at baseline, post-theoretical training, post-technical training, post-supervised practical training, and at 2-year follow-up. Credibility and burden beliefs of therapists concerning the treatment of every specific patient in the trial were also assessed.
RESULTS: Over time, therapist-rated credibility of trauma-focused treatment showed a significant increase, whereas therapists' expected burden and harm expectancies decreased significantly. In treating posttraumatic stress disorder (PTSD) in patients with psychotic disorders (n=79), pre-treatment symptom severity was not associated with therapist-rated credibility or expected burden of that specific treatment. Treatment outcome had no influence on patient-specific credibility or burden expectancies of therapists.
CONCLUSIONS: These findings support the notion that specialized training, including practical training with supervision, has long-term positive effects on therapists' credibility, burden, and harm beliefs concerning trauma-focused treatment.

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van Minnen, A., van der Vleugel, B., van den Berg, D., de Bont, P., de Roos, C., van der Gaag, M., & de Jongh, A. (2016). Effectiveness of trauma-focused treatment for patients with psychosis with and without the dissociative subtype of post-traumatic stress disorder.
The British Journal of Psychiatry : The Journal of Mental Science. doi:10.1192/bjp.bp.116.185579

Agnes van Minnen, Radboud University Nijmegen, Behavioural Science Institute, NijCare, PO Box 9104, 6500 HE Nijmegen, The Netherlands. Email: a.van.minnen@propersona.nl

Abstract


This study presents secondary analyses of a recently published trial in which post-traumatic stress disorder (PTSD) patients with psychosis (n = 108) underwent 8 sessions of trauma-focused treatment, either prolonged exposure (PE) or eye movement desensitisation and reprocessing (EMDR) therapy. 24.1% fulfilled the criteria for the dissociative subtype, a newly introduced PTSD subtype in DSM-5. Treatment outcome was compared for patients with and without the dissociative subtype of PTSD. Patients with the dissociative subtype of PTSD showed large reductions in clinician-administered PTSD scale (CAPS) score, comparable with patients without the dissociative subtype of PTSD. It is concluded that even in a population with severe mental illness, patients with the dissociative subtype of PTSD do benefit from trauma-focused treatments without a pre-phase of emotion regulation skill training and should not be excluded from these treatments.

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