This case study presents case conceptualization, therapeutic intervention, and the subjective and objective therapeutic progress of a 14-year-old adolescent hospitalized with posttraumatic stress disorder (PTSD) following emotional, physical, and sexual abuse by his father. The adaptive information processing (AIP) model that informs eye movement desensitization and reprocessing (EMDR) therapy and the theory of structural dissociation of the personality (TSDP) were used to conceptualize and guide the treatment. Stabilization and orientation to the present were essential to integrate his traumatic memories into a life narrative, and this became a major goal and an outcome of treatment. A single-case AB design was applied in assessing the impact of intervention. The UCLA PTSD Symptom Scale, Strengths and Difficulties Questionnaire—HEL (SDQ-HEL), State-Trait Anxiety Inventory (STAI), and Dissociative Experiences Scale II were administered at 5 different time points to assess changes in the youth’s subjective emotional state and indicated substantial improvement. In addition, objective behavior change (using O’Neill’s Behavior Checklist) was recorded on a daily basis for 7 months and showed a large decrease in the frequency of targeted maladaptive behaviors. The article describes the treatment process which helped the youth to regain a sense of time; establish a coherent sense of self; and maintain adaptive perceptions, emotions, attitudes, and behaviors.

ObjectiveFrontline mental health, emergency, law enforcement, and social workers have faced unprecedented psychological distress in responding to the COVID-19 pandemic. The purpose of the RCT (Randomized Controls Trial) study was to investigate the effectiveness of a Group EMDR (Eye Movement Desensitization and Reprocessing) therapy (Group Traumatic Episode Protocol—GTEP) in the treatment of Post-Traumatic Stress Disorder (PTSD) and Moral Injury. The treatment focus is an early intervention, group trauma treatment, delivered remotely as video-conference psychotherapy (VCP). This early intervention used an intensive treatment delivery of 42-h sessions over 1 week. Additionally, the group EMDR intervention utilized therapist rotation in treatment delivery.MethodsThe study’s design comprised a delayed (1-month) treatment intervention (control) versus an active group. Measurements included the International Trauma Questionnaire (ITQ), Generalized Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire (PHQ-9), Moral Injury Events Scale (MIES), and a Quality-of-Life psychometric (EQ-5D), tested at T0, T1: pre—treatment, T2: post-treatment, T3: 1-month follow-up (FU), T4: 3-month FU, and T5: 6-month FU. The Adverse Childhood Experiences – International version (ACEs), Benevolent Childhood Experience (BCEs) was ascertained at pre-treatment only. N = 85 completed the study.ResultsResults highlight a significant treatment effect within both active and control groups. Post Hoc comparisons of the ITQ demonstrated a significant difference between T1 pre (mean 36.8, SD 14.8) and T2 post (21.2, 15.1) (t11.58) = 15.68, p < 0.001). Further changes were also seen related to co-morbid factors. Post Hoc comparisons of the GAD-7 demonstrated significant difference between T1 pre (11.2, 4.91) and T2 post (6.49, 4.73) (t = 6.22) = 4.41, p < 0.001; with significant difference also with the PHQ-9 between T1 pre (11.7, 5.68) and T2 post (6.64, 5.79) (t = 6.30) = 3.95, p < 0.001, d = 0.71. The treatment effect occurred irrespective of either ACEs/BCEs during childhood. However, regarding Moral Injury, the MIES demonstrated no treatment effect between T1 pre and T5 6-month FU. The study’s findings discuss the impact of Group EMDR therapy delivered remotely as video-conference psychotherapy (VCP) and the benefits of including a therapist/rotation model as a means of treatment delivery. However, despite promising results suggesting a large treatment effect in the treatment of trauma and adverse memories, including co-morbid symptoms, research results yielded no treatment effect in frontline/emergency workers in addressing moral injury related to the COVID-19 pandemic.ConclusionThe NICE (2018) guidance on PTSD highlighted the paucity of EMDR therapy research used as an early intervention. The primary rationale for this study was to address this critical issue. In summary, treatment results for group EMDR, delivered virtually, intensively, using therapist rotation are tentatively promising, however, the moral dimensions of trauma need consideration for future research, intervention development, and potential for further scalability. The data contributes to the emerging literature on early trauma interventions.Clinical Trial Registration:Clinicaltrials.gov, ISRCTN16933691.

Covid-19 Pandemic has had a biopsychosocial impact on the Greek mental health system by worsening symptoms of depression and stress in the general population. As the need for mental health services increased, the Pandemic strongly affected EMDR practice, and training which was mainly online, during 2020. In a small sample consisting of 40 EMDR practitioners, a brief online questionnaire was administered concerning the obstacles that professionals believe they face doing online EMDR therapy in Greece during the Pandemic. A conventional qualitative analysis was conducted on the respondents’ feedback by coding the content. Among others, the results showed two categories of practical and psychosocial defects in the efficient application of online EMDR practice. Lack of physical contact, poor application of bilateral stimulation based on technical difficulties, poor computer skills, and physical exhaustion due to continuous lockdown were some of the content subcategories. The results are discussed concerning the current context of the Pandemic and local characteristics. Moreover, practical implications for online EMDR practice are discussed.

In this presentation we illustrate the effects of combining eye movement desensitization and reprocessing (E.M.D.R) therapy and theory of structural dissociation of the personality (T.S.D.P) on dissociative and post-traumatic stress disorder (P.T.S.D) symptoms. We first briefly describe both theories and conclude why combining them in the treatment of severely traumatized adolescents with PTSD may be beneficial.E.M.D.R therapy is an empirically valid treatment for P.T.S.D, based on numerous randomized controlled trials and several meta-analyses (e.g. Chen, Zhang, Hu, & Liang, 2015; Nijdam & Olff, 2016). The E.M.D.R Therapy Standard Protocol has eight specific phases.Phase 1: History taking and building the therapeutic alliance and creating a case conceptualization based on the past, the present and future.Phase 2: Client stabilization and preparation.Phase 3: Assessment activation of traumatic memory network.Phase 4: Desensitization of traumatic memory with the use of bi-lateral stimulation up to adaptive resolution while monitoring level of disturbance.Phase 5: Installation allows an increase of connections and generalizations to positive cognitive networks.Phase 6: Body scanning is used to monitor and clear any residual disturbing feelings in the body.Phase 7: Closure ensures client stability at the end of an EMDR session and between incomplete sessions.Phase 8: Reevaluation takes place at the beginning of the next session and it assesses treatment effects.According to T.S.D.P each human being has an integrative capacity to deal with traumatic experiences. The integrative capacity entails two major mental actions, namely synthesis and realization. Synthesis can be thought of as the way one perceives, compares, differentiates and/or categorizes internal and external experiences in the present and over time. Realization is a higher level mental action that entails awareness of reality, accepting it and adapting to it. It entails (1) personification or a sense of ownership and knowing ‘this is what happened to me’ and knowing feelings and thoughts about it and (2) presentification being grounded in the present while able to integrate the past and the possibilities of the future. Knowing that this has happened in the past and the present and future is no longer dictated by the traumatic past (van der Hart, Nijenhuis & Steele, 2006). Integration can be thought of as staying in the present while describing a past whole life narrative and owning experience. Thus, the person can express and feel his/her painful experience and memories without avoiding them and allowing phobias to keep memories at bay. According to T.S.D.P, the failure to integrate traumatic experiences basically yields a structural dissociation of the personality into two or more mental systems (van der Hart et al., 2006).The three-phase oriented treatment of T.S.D.P includes: (i) history, assessment, stabilization, symptom reduction and skills building; (ii) treatment of traumatic memories; and (iii) personality reintegration and rehabilitatio...