Eye movement desensitization and reprocessing (EMDR) in patients with a personality disorder

Abstract

Background: Little is known about the effects of targeting memories of adverse (childhood) events in people with a personality disorder (PD). Objective: Determining the effectiveness of brief EMDR therapy in individuals with PD. Method: In a randomized-controlled trial, 97 outpatients with a PD as main diagnosis were allocated to either five (90 minutes) sessions of EMDR therapy (n = 51) or a waiting list (WL) control condition (n = 46) followed by 3 months of treatment as usual for their PD. Individuals with posttraumatic stress disorder (PTSD) were excluded. Measurements were performed on psychological symptoms, psychological distress, and personality dysfunctioning. Outcomes were compared at baseline, post-treatment, and at 3-month follow up. Data were analysed as intent-to-treat with linear mixed models. Results: EMDR therapy yielded significant improvements with medium to large effect sizes for the primary outcomes after treatment, i.e. psychological symptoms (EMDR: d =.42; control group: d =.07), psychological distress (EMDR: d =.69; control group: d =.29), and personality functioning (EMDR: d =.41; control group: d = −.10) within groups. At 3-month follow-up, after 3 months of TAU, improvements were maintained. Significant differences were found between both groups regarding all outcome measures in favour of the EMDR group at post-treatment (ds between −.62 and −.65), and at follow-up, after 3 months of TAU (ds between −.45 and −.53). Conclusions: The results suggest that EMDR therapy can be beneficial in the treatment of patients with PDs. More rigorous outcome research examining long-term effects and using a longer treatment track is warranted. Desensibilización y reprocesamiento por movimiento ocular (EMDR) en pacientes con un trastorno de la personalidad. Antecedentes: Se sabe poco acerca del efecto que tiene la focalización de los recuerdos de los eventos adversos (de la infancia) en las personas con un trastorno de la personalidad (PD, por sus siglas en inglés). Objetivo: Determinar la eficacia de la terapia breve EMDR en individuos con PD. Método: En un ensayo controlado aleatorio, 97 pacientes ambulatorios con una PD como diagnóstico principal fueron asignados a cinco sesiones (de 90 minutos c/u) de terapia EMDR (n=51) o a una condición de control en lista de espera (WL, por sus siglas en inglés) (n=46) seguidas de tres meses de tratamiento habitual para su PD. Se excluyeron los individuos con trastorno de estrés postraumático. Se realizaron mediciones de los síntomas psicológicos, malestar psicológico, y disfunción de la personalidad. Los resultados se compararon al inicio, después del tratamiento y a los 3 meses de seguimiento. Los datos se analizaron como intención de tratar con modelos lineales mixtos. Resultados: La terapia EMDR produjo mejoras significativas con tamaños de efecto medianos a grandes para los resultados primarios después del tratamiento, es decir, síntomas psicológicos (EMDR: d =.42; grupo control: d =.07), malestar psicológico (EMDR: d =.69; grupo control: d =.29), y disfunció...

Does EMDR Therapy Have an Effect on Memories of Emotional Abuse, Neglect and Other Types of Adverse Events in Patients with a Personality Disorder? Preliminary Data

“…Several limitations of this study should be addressed. Firstly, because this is a sub-analysis of a treatment–outcome study [ 18 ], we did not conduct a power analysis. Therefore, it cannot be ruled out that a lack of statistical power explains why we were unable to detect significant differences among memory types.…”

“…The present study is based on the data of a randomized controlled trial (NL7470) in which the beneficial effects of EMDR therapy in patients with a PD without PTSD were investigated (https://www.trialregister.nl/trial/7470, accessed on 9 January 2019) [18]. All procedures involving the trial were approved by The Medical Ethics Committee, Southwest Holland, registered as NL61845.098.17.…”

“…Since adverse memories involving emotional abuse and neglect are highly prevalent in patients with a PD (with 73% reporting abuse and 82% reporting neglect) [ 17 ], it is important to explore the effects of EMDR therapy on these different memory types [ 18 , 19 ]. The results of a randomized controlled study of patients with a PD who did not fulfil the diagnostic criteria of PTSD showed that resolving memories of adverse childhood events using EMDR therapy led to a significant overall reduction in symptoms [ 18 ].…”

“…Since adverse memories involving emotional abuse and neglect are highly prevalent in patients with a PD (with 73% reporting abuse and 82% reporting neglect) [ 17 ], it is important to explore the effects of EMDR therapy on these different memory types [ 18 , 19 ]. The results of a randomized controlled study of patients with a PD who did not fulfil the diagnostic criteria of PTSD showed that resolving memories of adverse childhood events using EMDR therapy led to a significant overall reduction in symptoms [ 18 ]. Because the type of index memories experienced by patients involved not only physical and sexual abuse but also emotional neglect and emotional abuse, the purpose of the current study was to determine the differential effect of EMDR therapy on these memory types.…”

EMDR as Treatment Option for Conditions Other Than PTSD: A Systematic Review

“…*Note that during the review process it was possible to identify three recent studies, one by Hafkemeijer et al ( 2020 ) on EMDR and personality disorders, one by Matthijssen et al ( 2019 ) on psychosis, and one by Dominguez et al ( 2020 ) on EMDR and depression, not included in our literature search. In the RCT by Hafkemeijer et al ( 2020 ) randomised controlled trial, the intervention group received 5 90-min sessions of EMDR and was compared to a waiting list group. Results showed a significant improvement on psychological symptoms, psychological distress, and personality functioning in the EMDR group.…”