Internet-delivered eye movement desensitization and reprocessing (iEMDR): an open trial

Recent research indicates internet-delivered cognitive behavioural therapy (iCBT) can reduce symptoms of post traumatic stress disorder (PTSD). This study examined the efficacy of an internet-delivered treatment protocol that combined iCBT and internet-delivered eye movement desensitization and reprocessing (iEMDR), in an uncontrolled trial. Eleven of the 15 participants completed post-treatment questionnaires. Large effect sizes were found from pre-treatment to 3-month follow-up (d = 1.03 – 1.61) on clinician-assessed and self-reported measures of PTSD, anxiety and distress, with moderate effect sizes (d = 0.59 – 0.70) found on measures of depression and disability. At post-treatment, 55% of the participants no longer met criteria for PTSD and this was sustained at follow-up. Symptom worsening occurred in 3 of 15 (20%) of the sample from pre- to post-treatment; however, these participants reported overall symptom improvement by follow-up. Future research directions for iEMDR are discussed.

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Internet-delivered eye movement desensitization and reprocessing (iEMDR): an open trial

F1000Research ◽

10.12688/f1000research.2-79.v1 ◽

2013 ◽

Vol 2 ◽

pp. 79

Author(s):

Jay Spence ◽

Nickolai Titov ◽

Luke Johnston ◽

Blake F Dear ◽

Bethany Wootton ◽

...

Keyword(s):

Eye Movement ◽

Treatment Protocol ◽

Behavioural Therapy ◽

Post Treatment ◽

Effect Sizes ◽

Future Research ◽

Symptom Improvement ◽

Post Traumatic Stress ◽

Pre Treatment

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Expectancies as predictors of symptom improvement after antimicrobial therapy for persistent symptoms attributed to Lyme disease

Clinical Rheumatology ◽

10.1007/s10067-021-05760-1 ◽

2021 ◽

Author(s):

Henriët van Middendorp ◽

Anneleen Berende ◽

Fidel J. Vos ◽

Hadewych H. M. ter Hofstede ◽

Bart Jan Kullberg ◽

...

Keyword(s):

Lyme Disease ◽

Treatment Success ◽

Symptomatic Improvement ◽

Post Treatment ◽

Symptom Improvement ◽

Persistent Symptoms ◽

Treatment Expectancies ◽

End Of Treatment ◽

Pre Treatment

Abstract Introduction/Objective Expectancies about symptom improvement or deterioration are reliable predictors of symptom progression and treatment outcomes (symptom resolution or symptomatic improvement) in many (non-)pharmacological studies and treatments. This study examined predictors of symptom improvement after antimicrobial therapy for persistent symptoms attributed to Lyme disease, hypothesizing particularly pre-treatment expectancies regarding symptom improvement to be predictive. Methods A predictive study was performed on pre-treatment and post-treatment individual characteristics, including expectancies, and physical and mental health–related quality of life (HRQoL) from the PLEASE-trial comparing randomized 12-weeks of doxycycline, clarithromycin-hydroxychloroquine, or placebo following 2 weeks of intravenous ceftriaxone. At end-of-treatment (14 weeks after trial start) and follow-up (52 weeks), complete data of 231 and 170 (of initial 280) patients with persistent symptoms temporally related to a history of erythema migrans or otherwise confirmed symptomatic Lyme disease, or accompanied by B. burgdorferi IgG or IgM antibodies, were examined through hierarchical regression analyses. Results In addition to pre-treatment HRQoL, pre-treatment expectancies regarding symptom improvement were consistently associated with stronger physical and mental HRQoL improvements at both end-of-treatment and follow-up (95% CI range: .09;.54, p < .01 to .27;.92, p < .001). Post-treatment expectancies regarding having received antibiotics vs. placebo was associated with more HRQoL improvement at end-of-treatment, but not at follow-up (95% CI-range 1.00;4.75, p = .003 to −7.34; −2.22, p < .001). Conclusions The present study shows that, next to pre-treatment functioning, patients’ pre-treatment and post-treatment expectancies regarding improvement of persistent symptoms attributed to Lyme disease relate to a more beneficial symptom course. Expectancies of patients may be relevant to explain and potentially improve patient outcomes (e.g., by optimized communication about treatment success). Trial registration ClinicalTrials.gov, NCT01207739 (Registration date: 23–09-2010) Key Points• As there is currently no sufficient symptom resolution or symptomatic improvement for many patients with persistent symptoms attributed to Lyme disease, it is relevant to know which factors determine symptom progression and predict heterogeneity in treatment response.• Next to pre-treatment functioning, expectancies regarding symptom improvement and having received antimicrobial study medication are associated with a more beneficial symptom course after both shorter-term and longer-term antimicrobial treatment.• Expectancies are relevant to consider in treatment studies and may be useful in clinical settings to improve symptom course and treatment outcome (e.g., by optimized communication about treatment success).

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Treatment of adult post-traumatic stress disorder using a future-oriented writing therapy approach

The Cognitive Behaviour Therapist ◽

10.1017/s1754470x09990171 ◽

2009 ◽

Vol 2 (4) ◽

pp. 243-255 ◽

Cited By ~ 4

Author(s):

Reginald D. V. Nixon ◽

Leonard W. Kling

Keyword(s):

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Expressive Writing ◽

Stress Disorder ◽

Post Treatment ◽

Future Research ◽

Post Traumatic Stress ◽

Post Traumatic ◽

Ptsd Severity

AbstractThe aim of this pilot study was to test whether a future-oriented expressive writing intervention is able to reduce post-traumatic stress disorder (PTSD) severity and associated symptoms such as depression and unhelpful trauma-related beliefs. In an uncontrolled pre-/ post-design participants attended 8 weeks of manualized therapy. Assessment was undertaken pre- and post-treatment, and participants also completed a 3-month follow-up assessment. Of the 17 participants who began therapy, 13 were treatment completers. Results indicated a significant decrease in PTSD severity, depression and unhelpful trauma-related cognitions from pre- to post-treatment and at 3-month follow-up. Clinically meaningful change was more modest; however, three participants reported PTSD remission at 3-month follow-up. It is concluded that expressive writing with a focus on achieving future goals and personal change may have some utility in reducing post-traumatic stress but future research will need to investigate this with greater methodological rigour before firm conclusions can be made.

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Interactions Between Self-Exposure and Alprazolam in the Treatment of Agoraphobia Without Current Panic: An Exploratory Study

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465800010481 ◽

1993 ◽

Vol 21 (3) ◽

pp. 219-238 ◽

Cited By ~ 13

Author(s):

Enrique Echeburúa ◽

Paz De Corral ◽

Elvira García Bajos ◽

Mercedes Borda

Keyword(s):

Repeated Measures ◽

Active Drug ◽

Post Treatment ◽

The Self ◽

Future Research ◽

Exposure Group ◽

Therapeutic Modalities ◽

Combined Action ◽

Pre Treatment

The aim of this work was to test the comparative efficacy of four therapeutic modalities (self-exposure, self-exposure + Alprazolam, Alprazolam, and self-exposure + placebo) and also to determine the combined effects of self-exposure with Alprazolam and self-exposure with placebo in the treatment of agoraphobia without current panic. The sample consisted of 31 patients selected according to DSM-III-R criteria. A multigroup experimental design with repeated measures of assessment (pre-treatment, post-treatment and 1, 3 and 6-month follow-up) was used. The results indicated that there was a similar therapeutic improvement (in about 75% of the cases) between pre- and post-treatment in all therapeutic modalities, except for the Alprazolam group, where improvement did not take place, was rather weak or tended to fade as time passed. This improvement increased at the follow-ups in the self-exposure + placebo group, remained stable in the self-exposure group, and was irregular or fairly unpredictable in the self-exposure + Alprazolam group. There was a positive combined action between self-exposure and placebo and a negative interaction between self-exposure and Alprazolam. The highest relapse rate appeared in the therapeutic modalities where the active drug was administered. The intratreatment evolution was faster in the self-exposure group than in the others, but it tended to remain stable in the second part of the therapy. It is therefore concluded that the efficacy of self-exposure therapy may be the same if reduced to half the number of sessions. Finally, several topics that may contribute to future research in this field are commented upon.

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Cognitive behavioural therapy for worry in young individuals with at-risk mental states: a preliminary investigation

The Cognitive Behaviour Therapist ◽

10.1017/s1754470x19000229 ◽

2019 ◽

Vol 12 ◽

Author(s):

Andrea Pozza ◽

Sandro Domenichetti ◽

Davide Dèttore

Keyword(s):

Mental Health ◽

At Risk ◽

Psychiatric Care ◽

Mental States ◽

Behavioural Therapy ◽

Post Treatment ◽

Future Research ◽

Cognitive Behavioural ◽

At Risk Mental States

Abstract Cognitive behavioural therapy (CBT) is a first-line strategy in reducing or delaying risk of transition to psychosis among young individuals with at-risk mental states (ARMS). However, there is little knowledge about its effects on other outcomes associated with ARMS. No study on CBT for ARMS has assessed worry, an important process associated with this condition. The present study investigated changes in worry at immediate post-treatment and 14-month follow-up after CBT for young individuals with ARMS seeking psychiatric care in mental health services. Thirty-seven young individuals (mean age = 26 years, SD = 6.07; 22.20% female) seeking psychiatric care in mental health services and classified as reporting ARMS through the Comprehensive Assessment of At-Risk Mental States were included. The Positive And Negative Syndrome Scales (PANSS) and Penn State Worry Questionnaire (PSWQ) were administered at baseline, post-treatment, and follow-up. CBT consisted of 30 weekly individual 1-hour sessions based on a validated CBT for ARMS manual enriched with components targeting worry [psychoeducation, problem-solving, (meta)cognitive restructuring, behavioural experiments]. Seven participants (18.91%) at follow-up had cumulatively made transition to psychosis. Repeated measures ANOVA with post-hoc pairwise comparisons showed significant changes in PSWQ scores from baseline to post-treatment and from baseline to follow-up; PSWQ scores remained stable from post-treatment to follow-up. This is the first study investigating changes in worry after CBT for ARMS, which appears to be a promising strategy also for this outcome. Future research with a larger sample size and control group may determine whether changes in worry are also associated with reduced transition risk. Key learning aims (1) To understand CBT evidence and procedures for young individuals with ARMS. (2) To reflect on the current limitations in the literature on CBT for ARMS. (3) To understand the importance and clinical implications of assessing worry in ARMS. (4) To focus on changes in worry as an outcome after CBT for ARMS. (5) To reflect on future research directions on the role of worry in CBT for ARMS.

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Metacognitive therapy versus cognitive–behavioural therapy in adults with generalised anxiety disorder

BJPsych Open ◽

10.1192/bjo.2018.54 ◽

2018 ◽

Vol 4 (5) ◽

pp. 393-400 ◽

Cited By ~ 15

Author(s):

Hans M. Nordahl ◽

Thomas D. Borkovec ◽

Roger Hagen ◽

Leif E. O. Kennair ◽

Odin Hjemdal ◽

...

Keyword(s):

Anxiety Disorder ◽

Cognitive Behavioural Therapy ◽

Treatment Protocol ◽

Behavioural Therapy ◽

Generalised Anxiety Disorder ◽

Metacognitive Therapy ◽

Recovery Rates ◽

Cognitive Behavioural ◽

Pre Treatment

BackgroundCognitive–behavioural therapy (CBT) is the treatment of choice for generalised anxiety disorder (GAD), yielding significant improvements in approximately 50% of patients. There is significant room for improvement in the outcomes of treatment, especially in recovery.AimsWe aimed to compare metacognitive therapy (MCT) with the gold standard treatment, CBT, in patients with GAD (clinicaltrials.gov identifier: NCT00426426).MethodA total of 246 patients with long-term GAD were assessed and 81 were randomised into three conditions: CBT (n = 28), MCT (n = 32) and a wait-list control (n = 21). Assessments were made at pre-treatment, post-treatment and at 2 year follow-up.ResultsBoth CBT and MCT were effective treatments, but MCT was more effective (mean difference 9.762, 95% CI 2.679–16.845, P = 0.004) and led to significantly higher recovery rates (65% v. 38%). These differences were maintained at 2 year follow-up.ConclusionsMCT seems to produce recovery rates that exceed those of CBT. These results demonstrate that the effects of treatment cannot be attributed to non-specific therapy factors.Declaration of interestA.W. wrote the treatment protocol in MCT and several books on CBT and MCT, and receives royalties from these. T.D.B. wrote the protocol in CBT and has published several articles and chapters on CBT and receives royalties from these. All other authors declare no competing interests.

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fNCI-directed treatment of sports related post-concussion syndrome ion syndrome

Neurology ◽

10.1212/01.wnl.0000550611.90268.73 ◽

2018 ◽

Vol 91 (23 Supplement 1) ◽

pp. S21.1-S21

Author(s):

Christiane Paney ◽

Marci Johnson ◽

Alina Fong ◽

Mark Allen

Keyword(s):

Reference Sample ◽

Treatment Protocol ◽

Severity Index ◽

Post Treatment ◽

Treatment Modalities ◽

Percent Reduction ◽

Symptom Scale ◽

Subjective Measurements ◽

Pre Treatment

PurposeWe propose that our individualized Enhanced Performance in Cognition (EPIC) Treatment can effectively address PCS in sports-related concussions by employing functional NeuroCognitive imaging (fNCI) in conjunction with post-concussion symptom scale measurements to inform and direct treatment modalities. fNCI is a specialized application of fMRI that utilizes a normative reference sample and biomarkers for concussion to provide sensitive and specific predictive diagnostic values. The fNCI addresses neurovascular coupling (NVC) dysregulation that commonly arises in PCS. These results inform individualized EPIC Treatment to restore normal NVC function with a treatment protocol that strategically integrates cardiovascular therapies with cognitive training.MethodsTwo hundred four sports concussion patients were assessed pre- and post-treatment using both objective (fNCI) and subjective Post-Concussion Symptom Scale (PCSS) measures, establishing pre-treatment benchmarks to measure therapeutic effectiveness. Patients underwent EPIC Treatment, which is a week-long, multiple treatments per day period consisting of cognitive, occupational, and neuromuscular therapy informed by fNCI and standardized PCSS findings.ResultsfNCI Severity Index Score (SIS) reported an average 80 percent reduction in objective measurements from the pre-treatment scan. Subjective measurements from the Post-Concussion Symptoms Scale (PCSS) reveal 59 percent reduction of symptoms as described by patient report. The SIS measurements are stable in follow-up scans 1-year post-treatment.ConclusionWe provide evidence that fNCI can be used in assessment and treatment of chronic PCS resulting from SRC. Furthermore, the results provide evidence that our fNCI-guided treatment has positive outcomes in both objective and subjective measurements. This supports the hypothesis that our treatment effectively addresses PCS symptoms resulting from SRC. Follow-up fNCI scans indicate that improvements are stable following treatment.SignificanceSRC patients suffering from chronic PCS who were assessed by fNCI and underwent EPIC treatment report immediate, sustainable, and longitudinal reduction in symptoms resulting in significant improvements to quality of life and functionality.

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Relationship between metamorphopsia and inner retinal microstructure following intravitreal ranibizumab injection for branch retinal vein occlusion

Scientific Reports ◽

10.1038/s41598-021-84038-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yoshimi Sugiura ◽

Fumiki Okamoto ◽

Tomoya Murakami ◽

Shohei Morikawa ◽

Takahiro Hiraoka ◽

...

Keyword(s):

Macular Edema ◽

Retinal Vein Occlusion ◽

Branch Retinal Vein Occlusion ◽

Post Treatment ◽

Intravitreal Ranibizumab ◽

Vein Occlusion ◽

Treatment Naïve ◽

Pre Treatment ◽

Number Of Injections

AbstractTo evaluate the effects of intravitreal ranibizumab injection (IVR) on metamorphopsia in patients with branch retinal vein occlusion (BRVO), and to assess the relationship between metamorphopsia and inner retinal microstructure and other factors. Thirty-three treatment-naïve eyes of 33 patients with macular edema caused by BRVO with at least 12 months of follow-up were included. The degree of metamorphopsia was quantified using the M-CHARTS. Retinal microstructure was assessed with spectral-domain optical coherence tomography. Disorganization of the retinal inner layers (DRIL) at the first month after resolution of the macular edema (early DRIL) and at 12 months after treatment (after DRIL) was studied. Central retinal thickness (CRT), and status of the external limiting membrane as well as ellipsoid zone were also evaluated. IVR treatment significantly improved best-corrected visual acuity (BCVA) and CRT, but the mean metamorphopsia score did not improve even after 12 months. Post-treatment metamorphopsia scores showed a significant correlation with pre-treatment metamorphopsia scores (P < 0.005), the extent of early DRIL (P < 0.05) and after DRIL (P < 0.05), and the number of injections (P < 0.05). Multivariate analysis revealed that the post-treatment mean metamorphopsia score was significantly correlated with the pre-treatment mean metamorphopsia score (P < 0.05). IVR treatment significantly improved BCVA and CRT, but not metamorphopsia. Post-treatment metamorphopsia scores were significantly associated with pre-treatment metamorphopsia scores, the extent of DRIL, and the number of injections. Prognostic factor of metamorphopsia was the degree of pre-treatment metamorphopsia.

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Outcomes of surgical and/or medical treatment in patients with prolactinomas during long-term follow-up: a retrospective single-centre study

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2020-0077 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Gamze Akkus ◽

Barış Karagun ◽

Hilal Nur Yaldız ◽

Mehtap Evran ◽

Murat Sert ◽

...

Keyword(s):

Medical Treatment ◽

Tumour Size ◽

Optic Chiasm ◽

Initial Therapy ◽

Post Treatment ◽

Surgical Removal ◽

Average Dose ◽

Single Centre Study ◽

Pre Treatment

AbstractObjectivesProlactinoma is the most common cause of pituitary tumours. Current medical guidelines recommend dopamine agonists (cabergoline or bromocriptine) as the initial therapy for prolactinoma. However, surgical removal can also be considered in selected cases, such as patients with macroadenomas with local complications (bleeding or optic chiasm pressure) or those not responding to medical treatment.MethodsThe present retrospective study included patients with prolactinomas (n=43; female, 24; male, 19) who were primarily managed with medical (n=32) or surgical (n=11) treatment.ResultsMacroadenoma (n=29.67%) was commonly detected in both genders (female, 54%; male, 84%). Moreover, the mean pre-treatment prolactin levels were similar in both genders (female, 683.3 ± 1347 ng/mL; male, 685.4 ± 805 ng/mL; p=0.226). Surgically treated patients had a greater reduction in tumour size (27.7 ± 17.9 mm pre-treatment vs. 8.72 ± 14.2 mm post-treatment) than non-surgically treated ones (12.5 ± 7.5 mm pre-treatment vs. 4.1 ± 4.2 mm post-treatment; p=0.00). However, the decrease in prolactin levels was similar between the two patient groups (p=0.108). During the follow-up period (10.6 ± 7.0 years), the average cabergoline dose of the patients was 1.42 ± 1.47 mcg/week.ConclusionsAlthough a surgical approach was considered for selected cases of prolactinoma, the average dose used for medical treatment was highly inadequate for the patients in the present study.

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Personalized attention control therapy for PTSD: effectiveness and moderators of outcome in a randomized controlled trial

Psychological Medicine ◽

10.1017/s0033291720004304 ◽

2020 ◽

pp. 1-11

Author(s):

Adva Segal ◽

Daniel S. Pine ◽

Yair Bar-Haim

Keyword(s):

Treatment Outcome ◽

Clinical Symptoms ◽

Controlled Trial ◽

Post Treatment ◽

Attention Control ◽

Randomized Controlled ◽

Control Therapy ◽

Pre Treatment ◽

Attentional Interference

Abstract Background Previous randomized controlled trials (RCTs) suggest that attention control therapy (ACT), targeting aberrant fluctuations of attention toward and away from threats in patients with PTSD, may be effective in reducing symptoms. The current RCT examined whether the use of personalized-trauma stimuli enhances ACT efficacy in patients with PTSD. Additional moderators of treatment outcome were tested on an exploratory basis. Methods Sixty patients with PTSD were randomly assigned to either personalized ACT, non-personalized ACT, or a control condition. Changes in symptoms were examined across pre-treatment, post-treatment, and a 3-month follow-up. Attentional interference was examined pre- and post-treatment. Baseline clinical and cognitive indices as well as the time elapsed since the trauma were tested as potential moderators of treatment outcome. Results A significant reduction in clinical symptoms was noted for all three conditions with no between-group differences. Attention bias variability decreased following ACT treatment. Personalized ACT was more effective relative to the control condition when less time had elapsed since the trauma. Baseline clinical and cognitive indices did not moderate treatment outcome. Conclusions In this RCT of patients with PTSD, ACT was no more effective in reducing PTSD symptoms than a control condition. The data also suggest a potential benefit of personalized ACT for patients who experienced their trauma more recently.

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