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EMDR and CBT for cancer patients: Comparative study of effects on PTSD, anxiety and depression
Journal of EMDR Practice & Research
Abstract and Figures
This pilot study examined the efficacy of eye movement desensitization and reprocessing (EMDR) treatment compared with cognitive behavioral therapy (CBT) in treating posttraumatic stress disorder (PTSD) in oncology patients in the follow-up phase of the disease. The secondary aim of this study was to assess whether EMDR treatment has a different impact on PTSD in the active treatment or during the follow-up stages of disease. Twenty-one patients in follow-up care were randomly assigned to EMDR or CBT groups, and 10 patients in the active treatment phase were assigned to EMDR group. The Impact of Event Scale—Revised (IES-R) and Clinician-Administered PTSD Scale (CAPS) were used to assess PTSD at pretreatment and 1 month posttreatment. Anxiety, depression, and psychophysiological symptoms were also evaluated. For cancer patients in the follow-up stage, the absence of PTSD after the treatment was associated with a significantly higher likelihood of receiving EMDR rather than CBT. EMDR was significantly more effective than CBT in reducing scores on the IES-R and the CAPS intrusive symptom subscale, whereas anxiety and depression improved equally in both treatment groups. Furthermore, EMDR showed the same efficacy both in the active cancer treatment and during the follow-up of the disease.
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... In addition to these successful interventions for adolescents cancer patients, some studies are highlighting the potential of an innovative approach that is the Eye Movement Desensitization and Reprocessing (EMDR). This type of intervention has significant effect on stress symptoms among other populations, such as oncological adult patients (Capezzani et al., 2013;Faretta, 2014Faretta, , 2018. To date, to the best of our knowledge, no studies have investigated the efficacy of EMDR therapy in the treatment of stress disorders symptoms experienced from cancer adolescent. ...
... In addition, our data are in line with the most recent literature on the application of EMDR in psycho-oncology in the reduction of intrusive symptoms and also, for a global well being in a long run. As the literature suggests early interventions to prevent and process traumatic emotional experiences can prevent the onset of long-term posttraumatic stress disorder (Capezzani et al., 2013;. Our research has not encountered any major limitations so far, with the only possible issues relating to conditions of patients (fever, nausea, fatigue, contact isolation), in particular during hospitalization and the hospital setting because often patients have to stay in their room during hospitalization due to chemotherapy treatment, and healthcare workers often enter this room, thus interrupting the session. ...
Introduction
Childhood cancer is rare, but it is the most frequent serious event with a high risk of traumatization for children, adolescents, parents and siblings. EMDR is widely studied as clinical intervention that addressed cancer-related stressors among cancer adult population, but to our knowledge, no researches have been conducted among children and adolescent with cancer.
Methods
The purpose of this case study is to describe for the first time the application of the EMDR protocol in a pediatric hospital setting with a 17-years-old Italian adolescent who received a diagnosis of leukemia. He accessed the psychological support service complaining of feelings of anxiety and general discomfort. EMDR protocol started after the diagnosis and ended after the usual eight phases. The Impact of Event Scale—Revised (IES-R) was used to assess stress disorders symptoms as outcome at the baseline (before the First Phase) and at the end of the EMDR protocol (after the Eight Phase).
Results
By using EMDR protocol the patient reported a decrease of emotional activation after a few EMDR sessions.
Conclusion
EMDR protocol may be effective for pediatric cancer patients in treating stress disorders symptoms and it can be proposed immediately after diagnosis as a standard care also in pediatric hospital setting.
... 80 Scientific evidence highlighted that the mechanisms of action of EMDR rely on modifications of neuroanatomical pathways 81,82 and the re-encoding of aversive traumatic memory 83 . Its rapid efficacy and adaptability make it a valuable option for those suffering from trauma-related conditions 84 , supporting the use of evidence-based treatments for PTSD in psychotherapy 85 . ...
Adverse life events (e.g., severe accidents, violence/abuse, organic disorders) can elicit traumatic responses characterized by intrusive thoughts, hyperarousal, and avoidance—highlighting the need for sound assessment tools. Also, these traumatic components could heighten anxiety and depression symptoms. This study aims included to: (1) assessing the psychometric properties of the Post-Traumatic Symptom Questionnaire (PTSQ) and delineating clinical cut-offs; (2) investigating how distinct trauma components contribute to anxiety and depression symptoms. Involving 761 participants who experienced a traumatic event, Part I tested the PTSQ psychometric properties, defining clinical cut-offs. Part II tested the impact of traumatic components on anxiety and depression symptoms, using a multiple multivariate latent regression model. PTSQ exhibited exemplary fit indices and robust psychometric properties. Clinically relevant cut-offs were identified. The differential contributions of intrusion, avoidance, and hyperarousal to anxiety and depression symptoms were evaluated, elucidating the strength and nature of these relationships. This study reaffirms the PTSQ as a psychometrically sound and reliable instrument. It underscores the effects of intrusion, avoidance, and hyperarousal on anxiety and depression symptoms in individuals with traumatic experiences. These insights advocate for evidence-based interventions aimed at alleviating the psychological suffering associated with trauma components, fostering adaptation and supporting psychological health.
... Additionally, EMDR has been reported to have effects similar to exposure therapy [59,[76][77][78]. Other studies have also found that when compared to cognitive behavioral therapy (CBT), EMDR has a similar effect on improving comorbid depression, with no significant differences between the two interventions [57,79,80]. ...
Background: Eye Movement Desensitization and Reprocessing (EMDR) therapy has gained attention for its potential effectiveness in treating depression beyond its initial use for PTSD. This systematic review and meta-analysis aims to evaluate the efficacy of EMDR in treating depression and to identify the variables influencing its effectiveness. Methods: A comprehensive search was conducted across databases, including MEDLINE, PubMed, and EMBASE, covering studies up to January 2023. A total of 521 studies were screened, and 25 studies with 1042 participants (522 EMDR, 520 control) met the inclusion criteria and were included in the meta-analysis. The inclusion criteria involved randomized controlled trials (RCTs) comparing EMDR to control conditions such as usual care or waitlist groups, with outcomes focused on changes in depression symptoms. Results: The results show that EMDR had a significant effect on reducing depression symptoms (Hedges’ g = 0.75), with moderate heterogeneity being observed. The meta-regression indicated that the severity of depression was a significant predictor of EMDR’s effectiveness, with greater effects in severe cases. Additionally, the systematic review analyzed and evaluated various theoretical models and related studies that explain how EMDR works for the treatment of depression, reporting on neurobiological models proposed in previous research. Conclusions: This study confirms that EMDR is effective in treating depression, particularly in severe cases, and highlights its potential as a non-pharmacological intervention. However, this study highlights the need for more standardized research and long-term evaluations to assess EMDR’s lasting impact. Integrating EMDR into multimodal treatment plans and primary care, especially for treatment-resistant depression, could significantly improve patient outcomes.
... 8 In fact, studies have shown that CBT use is effective in cancer patients when treating distress and pain. 9 Besides, CBT has also been shown to be effective in the context of insomnia, 10 PTSD, 11 fatigue, 12 fear, 13 anxiety and depression 14 in cancer patients. However, whether CBT is more effective than standard care in the treatment of combined MH and general wellness in cancer patients remains unanswered and is an investigation point of this project. ...
Objective
It has long been documented that cognitive behavioral therapy (CBT) has positive impacts on improving mental health (MH) and quality of life (QoL) in the general population, but investigations on its effect on cancer survivors remain limited, especially for QoL outcomes. The purpose of this meta‐analysis is to investigate the effects of CBT as compared to control on cancer patients' MH and QoL outcomes. Control is defined in this study as standard therapy, waitlist control, and active/alternative therapy.
Methods
In total, 154 clinical trials creating a sample size of 1627 individuals were collected. Analysis focusing on MH and QoL excluded 29 clinical trials resulting in a final analysis of 132 clinical trials (and 1030 effect sizes). R Statistical Software (version 4.2.2) and the robumeta package were utilized to complete analysis, which entailed robust variance estimation (RVE) in intercept‐only meta‐regression, and univariate meta‐regression (for moderator analysis).
Results
Across 132 clinical trials and 1030 effect size estimates, we identified that CBT moderately improves MH and QoL in cancer patients d = 0.388, 95% CI 0.294–0.483, p < 0.001. Additionally, age and delivery format can influence the efficacy of CBT in this patient population.
Conclusions
CBT statistically improves the MH and QoL psychosocial parameters in cancer patients with greater efficacy in younger patients. Important clinical and intervention‐related factors, that is, age and delivery, should be considered when oncologists consider CBT as a psychotherapeutic intervention for individuals with cancer.
... In terms of depression and anxiety levels, there was a clinically statistic difference between experimental group and control group [103]. Another comparison study showed that EMDR was as par with CBT in combatting depression and anxiety [104]. EMDR also reduced anxiety like symptoms in head and neck cancer patients taking radiotherapy [105]. ...
Purpose of Review
The current achievement of medical advancement is noteworthy; however, the occurrence of chronic diseases is increasing day by day, with a significant percentage of affected people are suffering from a mental health crisis. This article aims to present a thorough yet brief review of methods that can be employed to build the emotional wellness of chronic patients.
Recent Findings
The mental health care strategies include resilience-building, coping skills training, professional counseling, and lifestyle adaptations. Additionally, the article highlights the efficacy of several modern interventions, such as mindfulness-based therapies, cognitive behavioral therapy, eye movement desensitization, and recovery from stress therapy.
Summary
The global burden of chronic illness emphasizes the pressing need to mitigate mental health problems among chronic patients. By providing actionable insights, our study clears the path for targeted interventions and holistic approaches for chronic disease patients. Moreover, the article suggests to policymakers and clinicians the need for collaboration and multifaceted interventions.
People with an intellectual disability (PWID) are at far greater risk of experiencing adverse and traumatic events arising from a multitude of factors. The current chapter provides a broad overview of the risk factors, both general and specific, to PWID that leads to various psychological sequelae. Special consideration is given to the importance of engaging in a broad and encompassing assessment that draws from a range of sources in being able to differentiate and accurately identify post-traumatic stress disorder (PTSD) in addition to common comorbid difficulties that may overshadow accurate assessment. Recent literature is also summarized that provides promising, albeit tentative, evidence for the effectiveness of modified treatments that target trauma symptoms.
Introduction
This study examined the efficacy of eye movement desensitisation and reprocessing (EMDR) therapy compared with standard psychotherapy (SP) in treating post-traumatic stress disorder (PTSD) in paediatric oncology patients and their families in the early stage of cancer treatment. The secondary aim of this study was to assess whether EMDR therapy has a different impact on post-traumatic growth compared to SP.
Methods
Forty patients were randomly assigned to EMDR or SP groups. The Impact of Event Scale – Revised (IES-R) and the Distress Thermometer (DT) were used to assess PTSD symptoms at pre-treatment (at cancer diagnosis) and in the post-treatment stages (after 8 sessions). The Post-traumatic Growth Inventory-PTGI was administered in the post-treatment stage in order to evaluate positive changes.
Results
Both EMDR and SP are effective in reducing PTSD, but EMDR was significantly more effective than the SP in reducing scores on the IES-R, especially regarding the intrusive symptom subscale. Also, in the EMDR group there were higher scores of PTGI than in the standard group.
Conclusion
EMDR thus represents a promising treatment in the paediatric psycho-oncology setting.
Researchers who conduct studies comparing the efficacy of two treatments often find that their preferred treatment outperforms the comparison treatment. This finding has been labelled the allegiance association. Although this association is robust, it is unclear whether it reflects an allegiance bias on the part of the researchers or whether it is noncausal, with researchers being allied to the more effective treatments. This study applied a quasi‐experimental method proposed by a previous study to 19 pairs of treatment comparison studies. Each member of a pair had used the same two psychotherapies to treat clients with the same disorder, but the researchers in each of the two studies had opposing allegiances. If the authors of one study in the pair concluded that their preferred treatment was superior and the authors of the other study concluded that their preferred treatment was superior or that the two treatments were equivalent, these patterns would suggest allegiance bias. In 10 of the 19 pairs, the patterns were consistent with the operation of an allegiance bias, indicating that although allegiance biases are not inevitable, they are ubiquitous. Practitioners and other psychotherapy research consumers should use caution when interpreting the findings from treatment comparison studies.
Eye movement desensitization and reprocessing (EMDR) therapy is an evidence-based psychotherapy for posttraumatic stress disorder (PTSD), with support from more than 30 published randomized controlled trials (RCTs) demonstrating its effectiveness in both adults and children. Most international clinical practice guidelines recommend EMDR therapy as a first-line treatment for PTSD. This paper describes the current state of the evidence for EMDR therapy. We begin with a brief description of EMDR therapy and its theoretical framework. Next, we summarize the scientific support for its efficacy, effectiveness, and safety and discuss its applicability across cultures and with diverse populations. We conclude with suggestions for future directions to develop the research base and applications of EMDR therapy.
Identification of posttraumatic stress disorder (PTSD) symptoms and diagnoses in survivors of cancer is a growing area of research, but no published data exist regarding the symptom structure of PTSD in survivors of malignant disease. Findings from investigations of the PTSD symptom structure in other trauma populations have been inconsistent and have not been concordant with the reexperiencing, avoidance/numbing, and arousal symptom clusters specified in DSM‐IV. The present study employed confirmatory factor analysis to evaluate the extent to which the implied second‐order factor structure of PTSD was replicated in a sample of 142 breast cancer survivors. PTSD symptoms were measured using the PTSD Checklist—Civilian Version (PCL‐C). Fit indices reflected a moderate fit of the symptom structure implied by the DSM‐IV. These findings provide some tentative support for the DSM‐IV clustering of PTSD symptoms and for the validity of cancer‐related PTSD.
Little research substantiates long-term gains in the treatment of phantom limb pain. This report describes and evaluates an eye movement desensitization and reprocessing (EMDR) treatment with extensive follow-up.
A case series of phantom limb pain patients. Setting. In-patient hospitalization and out-patient private practice.
Case series of five patients with phantom limb pain ranging from 1 to 16 years. All patents were on extensive medication regimens prior to EMDR.
Three to 15 sessions of EMDR were used to treat the pain and the psychological ramifications.
Patients were measured for continued use of medications, pain intensity/frequency, psychological trauma, and depression.
EMDR resulted in a significant decrease or elimination of phantom pain, reduction in depression and posttraumatic stress disorder (PTSD) symptoms to subclinical levels, and significant reduction or elimination of medications related to the phantom pain and nociceptive pain at long-term follow-up.
The overview and long-term follow-up indicate that EMDR was successful in the treatment of both the phantom limb pain and the psychological consequences of amputation. The latter include issues of personal loss, grief, self-image, and social adjustment. These results suggest that (1) a significant aspect of phantom limb pain is the physiological memory storage of the nociceptive pain sensations experienced at the time of the event and (2) these memories can be successfully reprocessed. Further research is needed to explore the theoretical and treatment implications of this information-processing approach.
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ID - 47
RIASSUNTO Il presente studio indaga il concetto di "evento traumatico" allo scopo di compren-derne il significato ed il potenziale sviluppo, conseguente all'evento, di caratteristi-che psicopatologiche o di specifici disturbi psichiatrici, in modo particolare il Disturbo post-traumatico da stress. Sebbene la gravità dell'evento sia una caratteristica di primaria importanza, il suo potenziale traumatico è facilmente influenzato da caratteristiche individuali e sog-gettive: da qui l'importanza della valutazione della potenzialità traumatica dell'even-to e della modalità con cui l'evento si manifesta. Devono essere considerati due aspetti fondamentali: da un lato l'impatto dell'evento sull'individuo, dall'altro la preparazione della sua mente. Le conseguenze psicopatologiche del trauma dovreb-bero derivare primariamente dalle caratteristiche dell'evento di per sé e solo secon-dariamente dalla predisposizione individuale. Parole chiave: evento traumatico, memoria emotiva, dato sensoriale, tipologia dell'evento. SUMMARY The present study investigates the concept of "traumatic event" in order to investigate its meaning and the potential development, in reaction to it, of psychopathological features or specific clinical disorders, particularly Post-traumatic stress disorder. Although the event severity is a characteristic of primary importance its traumatic potential is greatly influenced by individual and subjective aspects: hence the impor-tance of the evaluation of the traumatic potentiality of the event and of the modality in which the event itself occurred. Within this perspective, two foundamental aspects are to be considered: on one hand the impact of the event on the individual, and on the other hand the preparation of his/her mind. The psychopathological conse-quences of trauma would primarily derive from the characteristics of the event per se, and only secondarily by individual predisposition.
The Clinician-Administered PTSD Scale (CAPS) is one of the most frequently used measures of posttraumatic stress disorder (PTSD). It has been shown to be a reliable and valid measure, although its psychometric properties in nonveteran populations are not well known. One problem with the CAPS is its long assessment time. The PTSD Symptom Scale–Interview Version (PSS-I) is an alternative measure of PTSD severity, requiring less assessment time than the CAPS. Preliminary studies indicate that the PSS-I is reliable and valid in civilian trauma survivors. In the present study we compared the psychometric properties of the CAPS and the PSS-I in a sample of 64 civilian trauma survivors with and without PTSD. Participants were administered the CAPS, the PSS-I, and the Structured Clinical Interview for DSM-IV (SCID) by separate interviewers, and their responses were videotaped and rated by independent clinicians. Results indicated that the CAPS and the PSS-I showed high internal consistency, with no differences between the two measures. Interrater reliability was also high for both measures, with the PSS-I yielding a slightly higher coefficient. The CAPS and the PSS-I correlated strongly with each other and with the SCID. Although the CAPS had slightly higher specificity and the PSS-I had slightly higher sensitivity to PTSD, overall the CAPS and the PSS-I performed about equally well. These results suggest that the PSS-I can be used instead of the CAPS in the assessment of PTSD, thus decreasing assessment time without sacrificing reliability or validity.