A Pilot Study of the Therapeutic Benefit of Eye Movement Desensitization and Reprocessing Psychotherapy in Major Depressive Disorder Associated with Post-Traumatic Stress Disorder -
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Published:
Jun 29, 2021
Keywords:
MDD, EMDR, PTSD, pilot study, therapy
Main Article Content
Abstract
Objective : To investigate the therapeutic benefit of the EMDR psychotherapy in treating MDD associated with PTSD.
Methods : We performed a pilot study by using the standard EMDR psychotherapy in subjects with MDD associated with PTSD. The inclusion criteria were 1) adults with18-year-old of age or older; 2) subjects being treated with antidepressants for at least two months with stable blood levels; 3) subjects with depression based upon the Patient Health Questionnaire (PHQ-9) depressive scale; 4) subjects with positive score for traumatic events based upon the Children's Revised Impact of Events Scale-13 (CERIES-13, Thai version). The subjects were eligible if they fulfilled all four criteria. The studied subjects were treated with 60-90 minutes of EMDR psychotherapy twice a week for three weeks. The changing of the PHQ-9 depressive scale, CERIES-13 scale, and Rosenberg self-esteem scale were obtained before the treatment, at the end of the treatment, and a month later. The data were analyzed with Freidman's test and Dunn's method.
Results : Eighteen subjects with a mean age of 28 years were enrolled in the study. The subjects had significantly decreased PHQ-9 scale and CERIES-13 scale (mean difference [MD] = - 14, p = 0.004; MD = - 32, p<0.001, respectively), and had significantly increased self-esteem scale (MD = 8.58, p<0.001) at the end of the treatment, and a month later compared to the baseline (MD = - 16, p = 0.004; MD = - 37, p<0.001, MD = 8.29, p<0.001, respectively). Furthermore, there was no significant difference in the scales between the end of the treatment and one-month follow-up.
Conclusion : The study demonstrated the therapeutic benefit of adding EMDR psychotherapy in people with 18 years old or more who were treated with antidepressants for MDD associated with PTSD. The benefit of adding EMDR psychotherapy possibly reduces the depressive symptoms and PTSD symptoms and improves their self-esteem. Further evaluation of the effectiveness of EMDR psychotherapy in a randomized controlled trial method is warranted.
Article Details
How to Cite
Srikosai, S., Khamfou, C., Thakham, A., Wongmueang, J., Thippunya, K., Wongpothi, U., Tailangkha, P., & Methaanunkul, P. (2021). A Pilot Study of the Therapeutic Benefit of Eye Movement Desensitization and Reprocessing Psychotherapy in Major Depressive Disorder Associated with Post-Traumatic Stress Disorder: -. Journal of the Psychiatric Association of Thailand, 66(2), 173–188. Retrieved from https://he01.tci-thaijo.org/index.php/JPAT/article/view/246773
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Articles submitted for consideration must not have been previously published or accepted for publication in any other journal, and must not be under review by any other journal.
References
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the posttraumatic stress disorder-major depression connection. Biol. Psychiatry 2000; 48:902–9.
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findings from the National Comorbidity Survey. Am. J. Epidemiol. 1998; 147:353–61.
8. Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results
from the National Comorbidity Survey Replication (NCS-R). JAMA 2003; 289:3095–105.
[PubMed: 12813115].
9. Stander VA, Thomsen CJ, Highfill-McRoy RM. Etiology of depression comorbidity in combat-
related PTSD: A review of the literature. Clin. Psychol. Rev. 2014; 34:87-98.
10. Stein MB, Kennedy C. Major depressive and post-traumatic stress disorder comorbidity in female
victims of intimate partner violence. J. Affect. Disord. 2001; 66(2-3):133-8.
11. Gauhar YWM. The efficacy of EMDR in the treatment of depression. Journal of EMDR Practice and
Research 2016; 10(2):59-69.
12. Javidi H, Yadollahie M. Post-traumatic stress disorder. J. Occup. Environ. Med. 2012; 3(1):1-9.
13. Feeny NC, Foa EB, Treadwell KRH, March J. Post-traumatic stress disorder in youth: A critical
review of the cognitive and behavioral treatment outcome literature. Prof. Psychol res Pr 2004;
35:466-76.
14. Reid S, Barbui C. Long term treatment of depression with selective serotonin reuptake inhibitors
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15. Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, et al. Antidepressant
drug effects and depression severity: a patient-level meta-analysis. JAMA 2010; 303(1):47-53.
16. Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF. Adding psychotherapy
to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry
2014; 13:56-67.
17. Shapiro F. The role of eye movement desensitization & reprocessing (EMDR) therapy in medicine:
addressing the psychological and physical symptoms stemming from adverse life experiences. The
Permanente Journal 2014a; 18(1):71–7.
18. Shapiro F. EMDR therapy humanitarian assistance programs: treating the psychological, physical,
and societal effects of adverse experiences worldwide. Journal of EMDR Practice and Research
2014b; 8:181–6.
19. Shapiro F, Laliotis, D. EMDR and the adaptive information processing model: Integrative treatment
and case conceptualization. Clin. Soc. Work J. 2011; 39;191-200.
20. Shapiro F, Wesselmann D, Mevissen, L. Eye movement desensitization and reprocessing therapy
(EMDR). In MA Landolt M Cloitre U Schnyder (Eds.), Evidence-based treatments for trauma
related disorders in children and adolescents (p. 273–297); 2017. Springer International Publishing.
[Online]. Available from https://doi.org/10.1007/978-3-319-46138-0_13
21. Bae H, Kim D, Park YC. Eye movement desensitization and reprocessing for adolescent depression.
Psychiatric Invest 2008; 5:60-5.
22. Uribe MER, Ramírez EOL, Mena IJ. Effect of the EMDR psychotherapeutic approach on emotional
cognitive processing in patients with depression. Span. J. Psychol. 2010; 13(1):396–405.
23. Van der Kolk BA, Spinazzola J, Blaustein ME, Hopper JW, Hopper EK, Korn DL, Simpson WB.
A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine,
and pill placebo in the treatment of posttraumatic stress disorder: Treatment effects and long-term
maintenance. J. Clin. Psychiatry 2007; 68:37.
24. Hase M, Balmaceda UM, Hase A, Lehnung M, Tumani V, Huchzermeier C. Hofmann A. Eye
movement desensitization and reprocessing (EMDR) therapy in the treatment of depression: A
matched pairs study in an inpatient setting. Brain and Behavior 2015; 5(6):e00342. [Online].
Available from http://dx.doi.org/10.1002/brb3.342
25. Hofmann A, Hilgers A, Lehnung M, Liebermann P, Ostacoli L, Schneider W. Hase M. Eye movement
desensitization and reprocessing as an adjunctive treatment of unipolar depression: A controlled
study. Journal of EMDR Practice and Research 2014; 8(3):103–12.
26. Berg DPG, Gaag M. Treating trauma in psychosis with EMDR: A pilot study. J. Behav. Ther. Exp.
Psychiatry 2012; 43:664-71.
27. Ketumarn P, Piyasilpa V. Posttraumatic stress disorder in children and adolescents: lesson
learned from 5-year psychosocial intervention program for schools in Takuapa after Tsunami.
J Psychiatr Assoc Thailand 2009; 54(Supplement 1):81S-106 S.
28. Lotrakul M, Sumrithe S, Saipanish, R. Reliability and validity of the Thai version of the PHQ-9. BMC
Psychiatry 2008; 8:46-52.
29. Piyavhatkul N, Aroonpongpaisal S, Pstijanasoontorn N, Rongbutsri S, Maneeganondh S, Pimpanit
W. Validity and reliability of the Rosenberg self-esteem scale-Thai version as compared to the self-
esteem visual analog scale. J Med Assoc Thai 2011; 94(7):857-62.
30. Dominguez S, Drummond P, Gouldthorp B, Janson D, Lee CWA. randomized controlled trail
examining the impact of individual trauma-focused therapy for individuals receiving group
treatment for depression. Psychology and psychotherapy: theory, research and practice; 2020.
Published – 22 Jan 2020. [Online]. Available from https://doi.org/10.1111/papt.12268
31. Hase M, Plagge J, Hase A, Braas R, Ostacoli L, Hofmann A, Huchzermeier C. Eye movement
desensitization and reprocessing versus treatment as usual in the treatment of depression: A
randomized-controlled trail. Frontiers in Psychology 2018; 9:1384.
32. Minelli A, Zampieri E, Sacco C, Bazzanella R, Mezzetti N, Tessari E, et al. Clinical efficacy of trauma-
focused psychotherapies in treatment-resistant depression (TRD) inpatients: A randomized,
controlled pilot-study. Psychiatry Research 2019; 273:567-74. [Online]. Available from
https://doi.org/10.1016/j.psychres.2019.01.070.
33. Nijdam MJ, Gersons BPR, Reitsma JB, Jongh Ad de, Olff M. Brief eclectic psychotherapy V. eye
movement desensitization and reprocessing therapy for post-traumatic stress disorder:
ramdomised controlled trial. Br. J. Psychiatry 2012; 200:224-31. Doi: 10.1192/bjp.bp.111.099234
34. Schubert SJ, Lee CW, Araujo G, Butler SR, Taylor G, Drummond PD. The effectiveness of eye
movement desensitization and reprocessing therapy to treat symptoms following trauma in Timor
Leste. Journal of Traumatic Stress 2016; 29:141-8.
35. Valiente-Gomez A, Moreno-Alcazar A, Treen D, Cedron C, Colom F, Perez V, et al. EMDR beyond
PTSD: A systematic literature review. Frontiers in Psychology 2017; 8:1668. [Online]. Available from
https://doi.org/10.3389/fpsyg.2017.01668
36. Solomon RM, Shapiro F. EMDR and the adaptive information processing model. Journal of EMDR
Practice and Research 2008; 2(4):315-25.
37. Nutt D, Wilson S, Paterson L. Sleep disorders as core symptoms of depression. Dialogues Clin.
Neurosci 2008; 10(3):329-36.
38. Ahmad A, Larsson B, Sundelin-Wahlsten V. EMDR treatment for children with PTSD: Results of a
randomized controlled trial. Nord J. Psychiatry 2007; 61(5):349-54.
39. Benish SG, Imel ZE, Wampold BE. Corrigendum to “The relative efficacy of bona fide
psychotherapies for treating post-traumatic stress disorder: a meta-analysis of direct
comparisons.” Clin. Psychol. Rev. 2008; 28:766-75. Doi: 10.1016/j.cpr.2007.10.005
40. Chen YR, Hung KW, Tsai JC, Chung MH, Chen SR, et al. Efficacy of eye-movement
desensitization and reprocessing for patients with post-traumatic-stress disorders: a meta-
analysis of randomized controlled trails. PLoS ONE 2014; 9:e103676.
Doi: 10.1371/journal.pone.0103676
41. Chen L, Zang G, Hu M, Liang X. Eye-movement desensitization and reprocessing vs. cognitive-
behavioral therapy for adult post-traumatic-stress disorders: systematic review and meta-analysis.
J. Nerv. Ment. Dis. 2015; 203:443-51.
42. Cuijpers P, Veen SC, Sijbrandij M, Yoder W, Cristea LA. Eye movement desensitization and
reprocessing for mental health problems: a systematic review and meta-analysis. Cogn. Behav. Ther.
2020; 49(3):165-80.
43. Shapiro F. New notes on adaptive information processing with case formulation principles, forms,
scripts, and work-sheets. Hamden, CT: EMDR Humanitarian Assistance Programs; 2006. [Online].
Available from https://emdria.omeka.net/items/show/18486
44. Griffioen BT, Van der Vegt AA, de Groot IW, de Jongh A. The effect of EMDR and CBT on low self-
esteem in a general psychiatric population: A randomized controlled trial. Clinical Trial 2017;
8(Article 1919):1012. Doi: 10.3389/fpsyg.2017.01910
45. Wanders F, Serra M, De Jongh A. EMDR versus CBT for children with self-esteem and behavioral
problems: a randomized controlled trial. Journal of EMDR Practice and Research 2008; 2:180–9.
Doi: 10.1891/1933-3196.2.3.180
46. Shapiro F, Maxfield L. Eye movement desensitization and reprocessing. In F Shapiro (Ed.),
Encyclopedia of Psychotherapy Volum 1 (pp. 777-785). Elsvier Science (USA); 2002. [Online].
Available from https://doi.org/10.1037/10512-000
adolescent depression: a review of the past ten years. Part I. J. Am. Acad. Child Adolesc. Psychiatry 1996; 35:1427-39.
2. Le HN, Muñoz RF, Ippen CG, Stoddard JL. Treatment is not enough: We must prevent major
depression in women. Prevention & Treatment 2003; 6(1):Article 10. [Online]. Available from
https://doi.org/10.1037/1522-3736.6.1.610a
3. Stolberg RA, Clark DC, Bongar B. (2002). Epidemiology, assessment, and management of suicide
in depressed patients. In IH. Gotlib, CL. Hammen (Eds.), Handbook of depression (p. 581–601).
The Guilford Press; 2002.
4. Leahy RL. The cost of depression; 2019. [Online]. Available from
http://www.huffingtonpost.com/robert-leahy-phd/the-cost- ofdepression_b_770805.html
5. Suthamnirand A, Khongchub A, Chinajitpun N. Posttraumatic stress disorder in children. Journal
of Medicine and health Science 2014; 21(3):4-9.
6. Breslau N, Davis GC, Peterson EL, Schultz LR. A second look at comorbidity in victims of trauma:
the posttraumatic stress disorder-major depression connection. Biol. Psychiatry 2000; 48:902–9.
7. Bromet E, Sonnega A, Kessler RC. Risk factors for DSM-III-R posttraumatic stress disorder:
findings from the National Comorbidity Survey. Am. J. Epidemiol. 1998; 147:353–61.
8. Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results
from the National Comorbidity Survey Replication (NCS-R). JAMA 2003; 289:3095–105.
[PubMed: 12813115].
9. Stander VA, Thomsen CJ, Highfill-McRoy RM. Etiology of depression comorbidity in combat-
related PTSD: A review of the literature. Clin. Psychol. Rev. 2014; 34:87-98.
10. Stein MB, Kennedy C. Major depressive and post-traumatic stress disorder comorbidity in female
victims of intimate partner violence. J. Affect. Disord. 2001; 66(2-3):133-8.
11. Gauhar YWM. The efficacy of EMDR in the treatment of depression. Journal of EMDR Practice and
Research 2016; 10(2):59-69.
12. Javidi H, Yadollahie M. Post-traumatic stress disorder. J. Occup. Environ. Med. 2012; 3(1):1-9.
13. Feeny NC, Foa EB, Treadwell KRH, March J. Post-traumatic stress disorder in youth: A critical
review of the cognitive and behavioral treatment outcome literature. Prof. Psychol res Pr 2004;
35:466-76.
14. Reid S, Barbui C. Long term treatment of depression with selective serotonin reuptake inhibitors
and newer antidepressants. BMJ 2010; 340:c1468.
15. Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC, et al. Antidepressant
drug effects and depression severity: a patient-level meta-analysis. JAMA 2010; 303(1):47-53.
16. Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF. Adding psychotherapy
to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry
2014; 13:56-67.
17. Shapiro F. The role of eye movement desensitization & reprocessing (EMDR) therapy in medicine:
addressing the psychological and physical symptoms stemming from adverse life experiences. The
Permanente Journal 2014a; 18(1):71–7.
18. Shapiro F. EMDR therapy humanitarian assistance programs: treating the psychological, physical,
and societal effects of adverse experiences worldwide. Journal of EMDR Practice and Research
2014b; 8:181–6.
19. Shapiro F, Laliotis, D. EMDR and the adaptive information processing model: Integrative treatment
and case conceptualization. Clin. Soc. Work J. 2011; 39;191-200.
20. Shapiro F, Wesselmann D, Mevissen, L. Eye movement desensitization and reprocessing therapy
(EMDR). In MA Landolt M Cloitre U Schnyder (Eds.), Evidence-based treatments for trauma
related disorders in children and adolescents (p. 273–297); 2017. Springer International Publishing.
[Online]. Available from https://doi.org/10.1007/978-3-319-46138-0_13
21. Bae H, Kim D, Park YC. Eye movement desensitization and reprocessing for adolescent depression.
Psychiatric Invest 2008; 5:60-5.
22. Uribe MER, Ramírez EOL, Mena IJ. Effect of the EMDR psychotherapeutic approach on emotional
cognitive processing in patients with depression. Span. J. Psychol. 2010; 13(1):396–405.
23. Van der Kolk BA, Spinazzola J, Blaustein ME, Hopper JW, Hopper EK, Korn DL, Simpson WB.
A randomized clinical trial of eye movement desensitization and reprocessing (EMDR), fluoxetine,
and pill placebo in the treatment of posttraumatic stress disorder: Treatment effects and long-term
maintenance. J. Clin. Psychiatry 2007; 68:37.
24. Hase M, Balmaceda UM, Hase A, Lehnung M, Tumani V, Huchzermeier C. Hofmann A. Eye
movement desensitization and reprocessing (EMDR) therapy in the treatment of depression: A
matched pairs study in an inpatient setting. Brain and Behavior 2015; 5(6):e00342. [Online].
Available from http://dx.doi.org/10.1002/brb3.342
25. Hofmann A, Hilgers A, Lehnung M, Liebermann P, Ostacoli L, Schneider W. Hase M. Eye movement
desensitization and reprocessing as an adjunctive treatment of unipolar depression: A controlled
study. Journal of EMDR Practice and Research 2014; 8(3):103–12.
26. Berg DPG, Gaag M. Treating trauma in psychosis with EMDR: A pilot study. J. Behav. Ther. Exp.
Psychiatry 2012; 43:664-71.
27. Ketumarn P, Piyasilpa V. Posttraumatic stress disorder in children and adolescents: lesson
learned from 5-year psychosocial intervention program for schools in Takuapa after Tsunami.
J Psychiatr Assoc Thailand 2009; 54(Supplement 1):81S-106 S.
28. Lotrakul M, Sumrithe S, Saipanish, R. Reliability and validity of the Thai version of the PHQ-9. BMC
Psychiatry 2008; 8:46-52.
29. Piyavhatkul N, Aroonpongpaisal S, Pstijanasoontorn N, Rongbutsri S, Maneeganondh S, Pimpanit
W. Validity and reliability of the Rosenberg self-esteem scale-Thai version as compared to the self-
esteem visual analog scale. J Med Assoc Thai 2011; 94(7):857-62.
30. Dominguez S, Drummond P, Gouldthorp B, Janson D, Lee CWA. randomized controlled trail
examining the impact of individual trauma-focused therapy for individuals receiving group
treatment for depression. Psychology and psychotherapy: theory, research and practice; 2020.
Published – 22 Jan 2020. [Online]. Available from https://doi.org/10.1111/papt.12268
31. Hase M, Plagge J, Hase A, Braas R, Ostacoli L, Hofmann A, Huchzermeier C. Eye movement
desensitization and reprocessing versus treatment as usual in the treatment of depression: A
randomized-controlled trail. Frontiers in Psychology 2018; 9:1384.
32. Minelli A, Zampieri E, Sacco C, Bazzanella R, Mezzetti N, Tessari E, et al. Clinical efficacy of trauma-
focused psychotherapies in treatment-resistant depression (TRD) inpatients: A randomized,
controlled pilot-study. Psychiatry Research 2019; 273:567-74. [Online]. Available from
https://doi.org/10.1016/j.psychres.2019.01.070.
33. Nijdam MJ, Gersons BPR, Reitsma JB, Jongh Ad de, Olff M. Brief eclectic psychotherapy V. eye
movement desensitization and reprocessing therapy for post-traumatic stress disorder:
ramdomised controlled trial. Br. J. Psychiatry 2012; 200:224-31. Doi: 10.1192/bjp.bp.111.099234
34. Schubert SJ, Lee CW, Araujo G, Butler SR, Taylor G, Drummond PD. The effectiveness of eye
movement desensitization and reprocessing therapy to treat symptoms following trauma in Timor
Leste. Journal of Traumatic Stress 2016; 29:141-8.
35. Valiente-Gomez A, Moreno-Alcazar A, Treen D, Cedron C, Colom F, Perez V, et al. EMDR beyond
PTSD: A systematic literature review. Frontiers in Psychology 2017; 8:1668. [Online]. Available from
https://doi.org/10.3389/fpsyg.2017.01668
36. Solomon RM, Shapiro F. EMDR and the adaptive information processing model. Journal of EMDR
Practice and Research 2008; 2(4):315-25.
37. Nutt D, Wilson S, Paterson L. Sleep disorders as core symptoms of depression. Dialogues Clin.
Neurosci 2008; 10(3):329-36.
38. Ahmad A, Larsson B, Sundelin-Wahlsten V. EMDR treatment for children with PTSD: Results of a
randomized controlled trial. Nord J. Psychiatry 2007; 61(5):349-54.
39. Benish SG, Imel ZE, Wampold BE. Corrigendum to “The relative efficacy of bona fide
psychotherapies for treating post-traumatic stress disorder: a meta-analysis of direct
comparisons.” Clin. Psychol. Rev. 2008; 28:766-75. Doi: 10.1016/j.cpr.2007.10.005
40. Chen YR, Hung KW, Tsai JC, Chung MH, Chen SR, et al. Efficacy of eye-movement
desensitization and reprocessing for patients with post-traumatic-stress disorders: a meta-
analysis of randomized controlled trails. PLoS ONE 2014; 9:e103676.
Doi: 10.1371/journal.pone.0103676
41. Chen L, Zang G, Hu M, Liang X. Eye-movement desensitization and reprocessing vs. cognitive-
behavioral therapy for adult post-traumatic-stress disorders: systematic review and meta-analysis.
J. Nerv. Ment. Dis. 2015; 203:443-51.
42. Cuijpers P, Veen SC, Sijbrandij M, Yoder W, Cristea LA. Eye movement desensitization and
reprocessing for mental health problems: a systematic review and meta-analysis. Cogn. Behav. Ther.
2020; 49(3):165-80.
43. Shapiro F. New notes on adaptive information processing with case formulation principles, forms,
scripts, and work-sheets. Hamden, CT: EMDR Humanitarian Assistance Programs; 2006. [Online].
Available from https://emdria.omeka.net/items/show/18486
44. Griffioen BT, Van der Vegt AA, de Groot IW, de Jongh A. The effect of EMDR and CBT on low self-
esteem in a general psychiatric population: A randomized controlled trial. Clinical Trial 2017;
8(Article 1919):1012. Doi: 10.3389/fpsyg.2017.01910
45. Wanders F, Serra M, De Jongh A. EMDR versus CBT for children with self-esteem and behavioral
problems: a randomized controlled trial. Journal of EMDR Practice and Research 2008; 2:180–9.
Doi: 10.1891/1933-3196.2.3.180
46. Shapiro F, Maxfield L. Eye movement desensitization and reprocessing. In F Shapiro (Ed.),
Encyclopedia of Psychotherapy Volum 1 (pp. 777-785). Elsvier Science (USA); 2002. [Online].
Available from https://doi.org/10.1037/10512-000