EMDR Therapy Modulates the Default Mode Network in a Subsyndromal, Traumatized Bipolar Patient

Landín-Romero, Ramón; Navarro, Patricia Novo; Viçens, Víctor; McKenna, Peter J.; Santed, Antonia; Pomarol‐Clotet, Edith; Salgado‐Pineda, Pilar; Shapiro, Francine; Amann, Benedikt L.

doi:10.1159/000346654

Cited by 30 publications

(23 citation statements)

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“…Interestingly, another study has also found alterations in the DMN in PTSD [52]. In our study [48] we found marked improvement after receiving EMDR for subsyndromal mood symptoms. Surprisingly, the patient also showed changes on functional magnetic resonance imaging (MRI) in the direction of normalization of the DMN.…”

Section: Discussionsupporting

confidence: 71%

“…But why do we believe that EMDR might have a mood-stabilizing effect on bipolar patients? This idea is based on a recent study which suggested that EMDR might modulate the Default Mode Network (DMN) in traumatized bipolar patients [48]. First identified in 2001, the DMN is an interconnected series of brain regions, including prominently the medial frontal cortex and also the posterior cingulate cortex/precuneus, which are highly active at rest but deactivate during the performance of attention-demanding tasks [49, 50].…”

Section: Discussionmentioning

confidence: 99%

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Eye movement desensitization and reprocessing therapy versus supportive therapy in affective relapse prevention in bipolar patients with a history of trauma: study protocol for a randomized controlled trial

Moreno‐Alcázar

Raduà

Landín-Romero

et al. 2017

Trials

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BackgroundUp to 60% of patients with bipolar disorder (BD) have a history of traumatic events, which is associated with greater episode severity, higher risk of comorbidity and higher relapse rates. Trauma-focused treatment strategies for BD are thus necessary but studies are currently scarce. The aim of this study is to examine whether Eye Movement Desensitization and Reprocessing (EMDR) therapy focusing on adherence, insight, de-idealisation of manic symptoms, prodromal symptoms and mood stabilization can reduce episode severity and relapse rates and increase cognitive performance and functioning in patients with BD.Methods/designThis is a single-blind, randomized controlled, multicentre trial in which 82 patients with BD and a history of traumatic events will be recruited and randomly allocated to one of two treatment arms: EMDR therapy or supportive therapy. Patients in both groups will receive 20 psychotherapeutic sessions, 60 min each, during 6 months. The primary outcome is a reduction of affective episodes after 12 and 24 months in favour of the EMDR group. As secondary outcome we postulate a greater reduction in affective symptoms in the EMDR group (as measured by the Bipolar Depression Rating Scale, the Young Mania Rating Scale and the Clinical Global Impression Scale modified for BD), and a better performance in cognitive state, social cognition and functioning (as measured by the Screen for Cognitive Impairment in Psychiatry, The Mayer-Salovey-Caruso Emotional Intelligence Test and the Functioning Assessment Short Test, respectively). Traumatic events will be evaluated by The Holmes-Rahe Life Stress Inventory, the Clinician-administered PTSD Scale and the Impact of Event Scale.DiscussionThe results of this study will provide evidence whether a specific EMDR protocol for patients with BD is effective in reducing affective episodes, affective symptoms and functional, cognitive and trauma symptoms.Trial registrationThe trial is registered at ClinicalTrials.gov, identifier: NCT02634372. Registered on 3 December 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1910-y) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Eye movement desensitization and reprocessing therapy versus supportive therapy in affective relapse prevention in bipolar patients with a history of trauma: study protocol for a randomized controlled trial

Moreno‐Alcázar

Raduà

Landín-Romero

et al. 2017

Trials

Self Cite

View full text Add to dashboard Cite

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“…Regions within the DMN have been shown to have their own specific roles with respect to internally directed cognition, such as episodic memory, theory of mind, self‐evaluation, envisioning the future, social and emotional judgment, and introspection . These areas are also involved in processing emotionally salient stimuli related to episodic memory . Below, we provide background of these neural circuits, how they relate to PTSD, and predictions regarding their role in treating PTSD through EMDR.…”

Section: Ptsd Neurophysiologymentioning

confidence: 99%

“…Eye movement desensitization and reprocessing (EMDR) is one of the evidence‐based treatments for post‐traumatic stress disorder (PTSD) and is recommended by multiple international guidelines . To date, EMDR has been used experimentally with some benefit, to treat phobias, mood, and personality disorders . EMDR is a structured psychotherapy developed by psychologist Francine Shapiro in 1987, and it became the first psychotherapy with a demonstrated neurobiological effect, specifically altered brain wave activity in response to treatment .…”

Section: Introductionmentioning

confidence: 99%

Eye movement desensitization and reprocessing as a treatment for PTSD: current neurobiological theories and a new hypothesis

Calancie

Khalid‐Khan

Booij

et al. 2018

Annals of the New York Academy of Sciences

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Eye movement desensitization and reprocessing (EMDR), a form of psychotherapy for individuals with post-traumatic stress disorder (PTSD), has long been a controversial topic, hampered in part by a lack of understanding of the neural mechanisms that contribute to its remedial effect. Here, we review current theories describing EMDR's potential neurobiological mechanisms of action involving working memory, interhemispheric communication, de-arousal, and memory reconsolidation. We then discuss recent studies describing the temporal and spatial aspects of smooth pursuit and predictive saccades, which resemble those made during EMDR, and their neural correlates within the default mode network (DMN) and cerebellum. We hypothesize that if the production of bilateral predictive eye movements is supportive of DMN and cerebellum activation, then therapies that shift the brain towards this state correspondingly would benefit the processes regulated by these structures (i.e., memory retrieval, relaxation, and associative learning), all of which are essential components for PTSD recovery. We propose that the timing of sensory stimulation may be relevant to treatment effect and could be adapted across different patients depending on their baseline saccade metrics. Empirical data in support of this model are reviewed and experimental predictions are discussed.

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“…It is hypothesized that the eye movements and tapping facilitates the brain's processing of prior trauma; one in which the negative associations are replaced by positive ones. While still speculative, initial fMRI studies 181 demonstrate that EMDR has the potential to restore normal DMN activity in traumatized patients. In each of these management schemas, reconditioning involves identifying triggering stimuli, graded reexposure, providing a means of regulating the subsequent behavioral responses, and finally the development of positive associations.…”

Section: Interventionmentioning

confidence: 99%

The role of associative learning and fear in the development of chronic pain – a comparison of chronic pain and post-traumatic stress disorder

Sueki

Dunleavy

Puentedura

et al. 2014

Physical Therapy Reviews

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Background: Associative learning is the theory that two stimuli can be paired to produce similar behavioral responses. In this model, a previously innocuous stimulus can become paired with a noxious stimulus to a point that this previously innocuous stimulus can result in the perception of pain. Objectives: This review discusses concepts related to neural activation and structural alterations in the presence of both chronic pain and post-traumatic stress disorder (PTSD). The role of associative learning and protective memory-based behavioral responses in the perception of pain is explored to provide a framework to inform clinical management of individuals with chronic pain and will be linked to the presence of actual or perceived threat or fear. Major Findings: Current research demonstrates that in individuals with chronic pain, cortical and subcortical processing of information shifts from normal nocioceptive processing areas to the medial prefrontal, anterior cingulate, and insular cortices, as well as the hippocampus (Hip) regions, all of which also show dysregulation, signs of gray matter atrophy, and changes in epigenetic coding. Because these regions are involved in memory, emotional processing, learning, and conditioning, it is reasonable to suggest that associative learning may be involved in the processing of both pain and PTSD. Conclusions: Clinically, rehabilitation paradigms that incorporate early intervention, positive expectation, therapeutic neuroscience education, visual imagery, movement retraining, and manual therapy all have the potential to change not only pain behavior but also the neural circuitry, epigenetic coding, and cortical morphology underlying chronic pain.

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EMDR Therapy Modulates the Default Mode Network in a Subsyndromal, Traumatized Bipolar Patient

Cited by 30 publications

References 31 publications

Eye movement desensitization and reprocessing therapy versus supportive therapy in affective relapse prevention in bipolar patients with a history of trauma: study protocol for a randomized controlled trial

Eye movement desensitization and reprocessing therapy versus supportive therapy in affective relapse prevention in bipolar patients with a history of trauma: study protocol for a randomized controlled trial

Eye movement desensitization and reprocessing as a treatment for PTSD: current neurobiological theories and a new hypothesis

The role of associative learning and fear in the development of chronic pain – a comparison of chronic pain and post-traumatic stress disorder

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