Efficacy of Eye Movement Desensitization and Reprocessing (EMDR) Therapy Compared to Treatment As Usual (TAU) in Psychiatric Inpatients With Severe Mental Disorder and a History of Psychological Trauma

Background

Severe mental disorders (SMD) are a group of diverse conditions which principally affect perception, cognition, emotion and behavioural control (Hyman et al. 2016). SMD has a significant health impact worldwide, both in economic terms as well as in mortality rate due to suicide or associated medical illnesses (Charlson et al. 2016), due to its high prevalence, frequent early age of onset, and its clinical course (usually chronic or with temporary improvements followed by relapse), and the cognitive deterioration of important mental capabilities.

The results of the different meta-analyses have shown that suffering adverse events in infancy significantly increases the risk of developing SMD in adult life (Bortolato et al., 2017; Palmier-Claus, Berry, Bucci, Mansell, & Varese, 2016). What is more, it is important to take into account that the presence of this comorbidity has important clinical implications, such as an increase in suicides, greater severity of symptoms, an increase in risky sexual behaviours, more hospital admissions, a worse disease course and a greater risk of being retraumatized (Rosenberg et al. 2007; Ford et al. 2007; Oquendo et al. 2005). However, at clinical level it is still an element which receives very little focus and may interfere in the correct evolution of the disease (Mauritz et al. 2013).

Two recently published studies in the severe psychiatric population have shown that the specific treatment of trauma improves in all cases the symptoms related to it in patients diagnoses with schizophrenia (van den Berg et al. 2015) and bipolar disorder (Novo et al. 2014), as well as showing an improvement in other clinical symptoms such as psychotic symptoms, paranoid ideation and hallucinations in the case of schizophrenia, and sub-syndromic symptoms in the case of bipolar disorder. In both studies, the intervention strategy used to treat traumatic events was EMDR (Eye Movement Desensitization and Reprocessing), a psychotherapeutic approach whose use in recent years has grown exponentially in clinical practice due to its great efficacy and safety, as well as being recommended by the World Health Organisation (WHO) and the American Psychiatric Association (APA) as a first line treatment for Post-traumatic Stress Disorder (PTSD) (Shapiro, 2014). It was developed at the beginning of the nineties by the North American psychologist Francine Shapiro to treat the consequences of psychological trauma. EMDR is an 8-phase psychological treatment composed of protocols and standardized procedures applicable to both adults and children. The eight phases (patient history, patient preparation, evaluation of the main aspects of the memory, desensitization of the traumatic memory, installation of the positive cognition, body scan, close and re-evaluation) and the protocol of the time line of past-present-future, allow a holistic evaluation of the image of the traumatic memory, and allow for the patient to be well-prepared before processing past events which underlie current pathology, current situations which cause perturbation, and challenges and possible future stimuli which might lead to the appearance of symptoms (Shapiro, 2014). The distinctive feature of this technique is the incorporation of bilateral stimulation, in the majority of cases through horizontal saccadic eye movements, into the combination of different theoretical and practical psychological orientations, in order to desensitize the suffering cause by traumatic memories and, as a consequence, achieve the reprocessing and the integration of these memories into the normalized biographic memories of the patient (Shapiro 2001). One of the main advantages of EMDR is that all protocols, both the standard and more specific ones, are standardized and scientifically validated both for clinical use and scientific scrutiny (Novo et al. 2016).

Evaluation & Diagnostic Protocol