Feasibility of EMDR for posttraumatic stress disorder in patients with personality disorders: a pilot study

Abstract

Background: Trauma and posttraumatic stress disorder (PTSD) are prevalent in patients with personality disorders. Despite the established efficacy of eye movement desensitisation and reprocessing (EMDR) for PTSD, EMDR has barely been examined in patients with comorbid PTSD and personality disorders. Objective: The aim of this study was to explore what changes occur in symptom severity of PTSD, dissociative symptoms, insomnia, non-suicidal self-injurious behaviour and auditory verbal hallucinations in patients with personality disorders during treatment with EMDR. Method: This uncontrolled open feasibility study on EMDR for PTSD was an addition to treatment-as-usual for personality disorders. The outcome measures were the severity of PTSD symptoms, dissociation, insomnia, non-suicidal self-injury, and auditory verbal hallucinations. Results: Forty-seven participants (22 with a borderline personality disorder, 25 with other personality disorders) were included. A significant reduction in the severity of symptoms of PTSD, dissociation and insomnia was observed after EMDR treatment (median of four sessions), and 40% of the participants scored below the threshold for PTSD diagnosis. No differences in efficacy were found between patients with borderline personality disorder and other personality disorders. EMDR treatment was completed by 68% of the participants. Conclusions: The addition of EMDR techniques to treatment, as usual, may be beneficial in the treatment of PTSD in patients with personality disorders in order to reduce symptoms of PTSD, dissociation and insomnia. Although one-third of these patients did not complete the additional EMDR treatment, no severe complications (e.g. suicidal behaviour or hospitalisation) occurred. Controlled studies are needed to further investigate the validity of these findings.

Psychotherapy for posttraumatic stress disorder in patients with borderline personality disorder: a systematic review and meta-analysis of its efficacy and safety

“…Data regarding treatment, outcome measures, and population types are presented in Table 1 . In all 17 studies, psychotherapy was the intervention used to treat PTSD; in approximately half, the therapy was offered as an addition to other ongoing treatments unrelated to PTSD (Harned, Korslund, & Linehan, 2014 ; Kredlow et al, 2017 ; Pabst et al, 2014 ; Slotema, van den Berg, Driessen, Wilhelmus, & Franken, 2019 ; Steuwe et al, 2016 ; Walter, Bolte, Owens, & Chard, 2012 ). Fourteen of the 17 studies reviewed reported a statistically significant reduction in PTSD symptom severity.…”

“…Two studies assessed the effects of cognitive processing therapy (CPT)(Holder, Holliday, Pai, & Surís, 2017 ; Walter et al, 2012 ) and two the outcomes of narrative exposure therapy (NET)(Pabst et al, 2014 ; Steuwe et al, 2016 ). EMDR was studied by our group (Slotema et al, 2019 ) and interpersonal process group therapy also in a single study (Cloitre & Koenen, 2001 ). A combination of EMDR, PE with physical training and psycho-education was offered in one study (De Jongh et al, 2020 ).…”

“…The majority of studies included patients with BPD; only three studies explored the efficacy of PTSD treatments in personality disorders in general (Hembree et al, 2004 ; Slotema et al, 2019 ; Walter et al, 2012 ). Hembree and colleagues included 29 patients with the following personality disorders: avoidant – (28%), obsessive-compulsive – (24%), depressive – (24%), borderline – (10%), and negativistic -, schizoid -, antisocial – and narcissistic personality disorder (3% each).…”

A decennial review of psychotraumatology: what did we learn and where are we going?

“…Analyses of common ingredients of effective treatments have identified some common mechanisms such as change in negative personal meanings of the trauma and activation and change of trauma memories, which may help with making interventions more focused and possibly increasing their efficacy and efficiency further (Brown, Belli, Asnaani, & Foa, 2019;Olff et al, in press;Schnyder et al, 2015). In addition, research into innovative approaches such as pharmacological enhancers in exposure therapy (De Kleine, Rothbaum, & van Minnen, 2013) or neurofeedback (Lanius et al, 2015) There have been increased efforts to adapt and evaluate evidence-based interventions for children and adolescents (Kramer & Landolt, 2011;Nocon et al, 2017) and patients with multiple traumatic events and complex needs such as military veterans (Kitchiner, Roberts, Wilcox, & Bisson, 2012), refugees (see also section 7) (Lely et al, 2019;Nocon et al, 2017), survivors of childhood sexual abuse (Cloitre et al, 2010;Steil et al, 2018) and patients with comorbid personality disorders (Slotema, van Den Berg, Driessen, Wilhelmus, & Franken, 2019). Metaanalyses suggest that the same types of treatment, trauma-focused treatments, obtain the greatest effect sizes in most of these populations (Ehring et al, 2014;NICE, 2018).…”

The impact of brief intensive trauma-focused treatment for PTSD on symptoms of borderline personality disorder

“…For example, in an uncontrolled open pilot study with BPD patients and those with other personality disorders who also suffered from PTSD, the application of trauma-focused (i.e. EMDR) therapy appeared effective in terms of a significant reduction of PTSD symptoms (Slotema, van den Berg, Driessen, Wilhelmus, & Franken, 2019). No differences in outcome were found between the group with BPD (n = 16) and the group with other personality disorders (n = 16).…”