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Neurobiological response to EMDR therapy in clients with different psychological traumas

Regional cerebral blood flow in the amygdala and medial prefrontal cortex during traumatic imagery in male and female Vietnam veterans with PTSD. The key distinctions between groups were: i the lack of trauma-related symptoms in the controls; ii common experience of the Prostitutes Bovisio-Masciago disaster and the temporal and environmental Prostitutes Bovisio-Masciago of the SGP as compared to the more heterogeneous RM one.

All subjects had a concurrent traumatic memory related to the natural disaster by itself. Twenty age- and sex-matched healthy subjects free of any mental disorder Table 1 and aware of the study Prostitutes Bovisio-Masciago of their own free wills to participate as controls.

The key distinctions between groups were: i the lack of trauma-related symptoms in the controls; ii common experience of the natural disaster and the temporal and environmental homogeneity of the SGP as compared to the more heterogeneous RM one. Motivations for recruiting control subjects were the following: i to increase the robustness of the results adding a between-subjects analysis Prostitutes Bovisio-Masciago the comparison of patients at T0 first EMDR session and T1 last EMDR Prostitutes Bovisio-Masciago ; ii to cross-check that the cortical activation upon EMDR was not due to bilateral ocular stimulation by itself; iii to cross-check that the cortical activation upon EMDR was not merely due to exposure to traumatic memory, irrespectively of the pathological state.

The institutional ethics committee approved the study. Before implementing the study protocol all participants were given a description of the procedures and were asked to sign a written informed consent to participate in the study in accordance with Prostitutes Bovisio-Masciago Declaration of Helsinki. The study was performed in quiet Prostitutes Bovisio-Masciago, light and airy and a trained psychiatrist, not involved in EMDR therapy, performed clinical evaluation. During the assessment session clinicians evaluated the impact of the major psychological trauma Prostitutes Bovisio-Masciago persistence over time of the related symptoms.

The therapeutic process required two Prostitutes Bovisio-Masciago six once-weekly sessions to be successfully Prostitutes Bovisio-Masciago.

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The eight phases of the treatment have been described in details elsewhere Pagani et al. In brief, an EMDR session begins with the identification of the worst image of the traumatic memory, the negative belief, the disturbing emotion and the body location of the disturbance. Then, the client is asked to focus on these components Prostitutes Bovisio-Masciago memory and follow the fingers of the clinician performing for about 30 Prostitutes Bovisio-Masciago a bilateral stimulation BS guiding her eyes from right to left with sets of 30 s.

When the Prostitutes Bovisio-Masciago is completed, the client reports to be able to think of the traumatic experience with no disturbing emotions, with a positive self-belief and with the body tension free.

Five views of the brain lateral and medial left hemisphere, lateral and medial right hemisphere and ventral view are shown for each comparison.

Prostitutes Bovisio-Masciago includes working with the trauma memory and with anxiety provoking present situations linked Prostitutes Bovisio-Masciago the traumatic experience. The goal of EMDR is to address past, present and future issues related to traumatic events and reprocess them.

Once these issues are desensitized and reprocessed, post-traumatic symptoms show significant remission. Seventeen items describe the classical PTSD cluster symptoms: re-experiencing, avoidance and numbing, and hyperarousal as well as symptoms associated with PTSD features. IES regards Prostitutes Bovisio-Masciago response to stressful events during the past week tackling specifically areas of intrusion and avoidance.

Nonparametric permutation tests for functional neuroimaging: a primer with examples.

Total scores range from 0 Prostitutes Bovisio-Masciago Scores above 26 are considered to be clinically significant. Total scores range from 0 to 63, with scores above 18 indicating moderate to severe depressive symptoms. SCL R reports symptoms of psychological problems in the last 7 days allowing to assess their frequency. It has three global indexes measuring the Prostitutes Bovisio-Masciago or depth of individual's psychiatric disturbance; the total number of questions rated above one point and the intensity of symptoms.

RM vs. Post-hoc tests were performed with Bonferroni confidence interval adjustment for multiple comparisons to define which Prostitutes Bovisio-Masciago contributed to the major effects. The detailed EEG methodology and statistics has been described elsewhere Pagani et al.

We selected and exported only the epochs in which BS typically between 20 and 25 in each session and lasting about 30 Prostitutes Bovisio-Masciago were performed. A file lasting several min composed by concatenated BS periods was then created and analyzed. These merged epochs represented the period Prostitutes Bovisio-Masciago EMDR sessions in which clients were both focussed on the worst image of the index trauma and performing rhythmic bilateral ocular Prostitutes Bovisio-Masciago.

Intracerebral volume eLORETA inverse solution space was partitioned in cubic voxels of Prostitutes Bovisio-Masciago mm in which electric activity is represented for each voxel.

Images corresponded to the estimated neuronal generators of brain activity within each band Frei et al. Exceedence proportion tests evaluated the significance of activity based on its spatial extent, obtaining clusters of supra-threshold voxels. Socio-demographic and clinical data are shown in Table 1. Prostitutes Bovisio-Masciago 12 patients that used psychotropic drugs took Prostitutes Bovisio-Masciago or serotoninergic drugs.

Twenty patients had Axis I comorbidity. Among the 12 RM patients, seven had a major depressive disorder, one a bipolar I disorder, one a bipolar II disorder, five a panic disorder and two a generalized anxiety disorder. Among the eight SGP Prostitutes Bovisio-Masciago, six had a major depressive disorder, one a bipolar II disorder, four a panic disorder and one a generalized anxiety disorder. None of the clients showed any sign of dissociation.

Table 2. Descriptive and univariate pre-EMDR statistics of psychopathological scales are showed. None of the scores showed any significant group difference at T1 Table 3. Table 3. All other comparison did not result in any significant cortical electrical activation difference. Figure 1. SGP, C. Five views of the brain lateral and medial left hemisphere, lateral and medial right hemisphere and ventral view are shown for each comparison. Significant F -values Bonferroni corrected are reported. F -values colored scale is also shown for each comparison.

No differences were found in SGP clients in both comparisons. Figure 2. In A only the cluster depicted by yellow scale were found to be significant. Prostitutes Bovisio-Masciago the best of our knowledge this is the first study to show distinct neurobiological Prostitutes Bovisio-Masciago during the reliving of major psychological trauma in two groups of psychologically traumatized clients, differing for trauma type, social and territorial context and exposure across time.

In the symptomatic phase all 40 clients grouped together showed a significantly increased activity upon the guided recall of their traumatic experiences during bilateral ocular stimulation as compared Prostitutes Bovisio-Masciago controls in frontal and orbitofrontal cortex Figure 1A ; Table 4.

Also psychopathological evaluations confirmed at T0 this trend with lower scores for SGP as compared to the RM reaching in several comparisons significant difference Table 2. Table 4. Regions of significant activation differences and relative cluster extent.

The firing of prefrontal cortex upon traumatic memories represents the neurobiological correlate of the affective valence of the Prostitutes Bovisio-Masciago information Prostitutes Bovisio-Masciago and Lawrie, and probably occurs when trauma processing has not taken place yet. Moreover, prefrontal cortex is implicated in autobiographical Staniloiu et al.

In symptomatic clients these self-referential processes with high emotional contents may be overdone Prostitutes Bovisio-Masciago activation in prefrontal cortex larger than in normal individuals. In this respect EMDR has been proven to be effective in traumatized bipolar patients in whom it successfully modulated the changes Prostitutes Bovisio-Masciago in Default Mode Network Landin-Romero et al.

Consistently with previous studies, the relative psychotherapy-related activation decrease found in prefrontal cortex likely represents the successful down-regulation of emotional experiences. At T1, in all 40 Prostitutes Bovisio-Masciago grouped together relative neuronal deactivation in primary visual cortex and superior parietal lobe and significantly higher cortical activation in fusiform and lingual cortex were detected as compared to T0 Figure 2A.

This trend was consistent with the pre- and post-treatment comparison in RM clients in which cortical activation shifted from Anterior Pre Frontal Cortex at Prostitutes Bovisio-Masciago to fusiform and lingual cortex at T1 Figure 2B.

Moreover, post-treatment the differences in activation between Prostitutes Bovisio-Masciago clients and controls found at T0 disappeared. All these findings speak in favor of an EMDR-related response to reliving the traumatic event normalizing toward the one found in controls at T0, considered to be the gold standard for the neurophysiological response Prostitutes Bovisio-Masciago the exposure to past psychological traumas.

We can speculate Prostitutes Bovisio-Masciago during EMDR memory retention of the traumatic event moves from regions with implicit emotional valence to association areas in which the experience is integrated and consolidated.

In Prostitutes Bovisio-Masciago respect the deactivation post-treatment Figure 2A of the primary visual cortex along with the activation of fusiform cortex implicated in the explicit representation of faces, words and abstract thoughts Phillips et al.

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This suggest that EMDR therapy resulted in the SGP clients, as compared to RM ones, in a attenuated disappearance of pre-treatment frontal activation and in a limited post-treatment cognitivization of the traumatic event.

The post-treatment increase in ParaHippocampal Gyrus activation, mainly in theta band, in all 40 clients grouped together Prostitutes Bovisio-Masciago compared to T0 and to Prostitutes Bovisio-Masciago might be related to the normalization in retrieving their own past, especially episodes of crucial importance for Prostitutes Bovisio-Masciago affective-sensitive mnestic processing Fink et al.

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Theta rhythm is Prostitutes Bovisio-Masciago in episodic memory Hasselmo, Prostitutes Bovisio-Masciago memory formation and retrieval Rutishauser et al. Taken together the results indicate that, despite the severe psychological trauma suffered by single individuals, SGP clients showed a lower functional response to traumatic exposure during EMDR therapy.

Although symptom disappearance in SGP clients was associated to normalization of neuropsychiatric scores, functional activation in response to trauma reliving was not statistically different from that found in the symptomatic phase, also reflecting Prostitutes Bovisio-Masciago milder neurobiological impact of the index trauma. Having occurred in a small town the event did involve the whole community and was a recurrent topic openly discussed for the last 10 years.

Furthermore, images related to the event could not be avoided being part of the external environment. A possible explanation for the lack of significant neurobiological correlates of such strong emotional event lies in the Prostitutes Bovisio-Masciago that the recruited SGP clients as compared to the RM ones have been chronically exposed to the grief over time.

Sharing the traumatic memory with other members of the family and of the community also led Prostitutes Bovisio-Masciago experiencing components of social defeat and interpersonal distress Krabbendam et al. This implied an ongoing trauma processing which made the clients cope daily with Prostitutes Bovisio-Masciago losses and grief, and partially extinguish fear-inducing situations resulting in more structured traumatic memories with strong social implications and difficult to be accessed by psychotherapy, although EMDR Prostitutes Bovisio-Masciago relieve all clients from symptoms.

As a consequence, the activation of the prefrontal emotional cortex during the symptomatic phase was significantly Prostitutes Bovisio-Masciago in SGP clients than in RM ones and did not significantly differ from that of normal controls exposed to a traumatic event in which rationality overcame vivid emotions.

In this respect a recent investigation has shown upon retrieval of negative memories a lower amygdala activation Prostitutes Bovisio-Masciago older adults as compared to younger ones. This would speak in favor of a time-related adaptation to emotional events occurring during life in which longer exposure to emotional events might result in a successful regulation of Prostitutes Bovisio-Masciago responses to negative stimuli Ge et al.

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During the symptomatic phase the cortical activation in all 40 clients grouped together in Lateral Temporal Lobe and Fusiform and Lingual Cortex was significantly lower than in controls Table 4suggesting that in the latter group exposure to traumatic events resulted in a Prostitutes Bovisio-Masciago activation of brain cortex with cognitive relevance instead of brain areas associated with emotions and behavior.

Consistently, in response to negative emotions Cohen et al. The disappearance in all clients at T1 of the cortical hyperactivation Prostitutes Bovisio-Masciago prefrontal regions present at T0 is the most relevant functional correlate of EMDR, attenuating the negative emotional response to the index trauma and impacting on the neurobiology of Prostitutes Bovisio-Masciago regions implicated in fear processing.

Frontal cortex deactivation after successful psychotherapy is consistent with recent findings of efficacy of cognitive behavioral therapy in reducing the activation of the neural network of fear Prostitutes Bovisio-Masciago in panic disorder Kircher Prostitutes Bovisio-Masciago al.

Forebrain is a Prostitutes Bovisio-Masciago substrate of conscious experience with emotional valence monitoring information with affective consequences Dalgleish, and is also associated with the processing of self-generated thoughts Ramnani and Owen, The greater difference between clients and controls subjects was not due to the nature of traumas but to the lack of symptoms in the latter.

The shift of the prevalent cortical Prostitutes Bovisio-Masciago during trauma Prostitutes Bovisio-Masciago from prefrontal regions with limbic valence at T0 to regions with more cognitive valence at T1 is the second relevant neurobiological correlate of processing associated with EMDR, and it is Prostitutes Bovisio-Masciago confirmed by the highly significant decrease of all neuropsychological scores in RM clients and of the great majority of them in SGP clients.

The results confirmed the findings of a preliminary investigation reporting in real-time the cortical activation changes occurring during EMDR therapy Pagani et al. In the present study performed in a three times larger cohort of subjects the previous findings were indeed strengthened decreasing the likelihood of type II error since the sampling error decreases with the increase of the sample size.

The EEG recordings were carried out in client-friendly environments, avoiding possible biases due to physical and psychological discomfort to the clients caused by a non-natural noisy examination condition, resulting in unspecific activations Mazard et al. The dynamic representation of psychotherapy on the cerebral cortex Prostitutes Bovisio-Masciago functional imaging is by now an unicum in neuroimaging and paves the road to investigations implying longitudinal monitoring and therapeutic interventions during sessions.

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We also acknowledge some limitations of the study. Firstly, the spatial resolution of a channel EEG device is too low to allow a reliable detection of changes occurring in amygdala and central structures, limiting the analyses to the cortical regions. Secondly, the Prostitutes Bovisio-Masciago to subgroup SGP clients is prevented by a scarce numerosity not allowing further reliable statistical analyses and inferences about the neurobiological differences between clients having been exposed to the traumatic event in Prostitutes Bovisio-Masciago same social context and for the same number of years but with different types of trauma direct vs.

However, all of them were exposed to a major traumatic event, were Prostitutes Bovisio-Masciago and the scores of most of the psychopathological evaluations and clinical examination classified them as suffering moderate to extreme PTSD see Table 2. This sample can then be considered representative Prostitutes Bovisio-Masciago severely psychological traumatized individuals not differing from the majority of subjects recruited in the past investigations on PTSD.

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EEG monitoring enabled for the first time to disclose the neurobiological differences between groups of clients traumatized in different social and territorial context during the reliving of the traumatic event. The group chronically exposed to traumatic memories following a natural disaster showed moderate response to psychopathological evaluations and Prostitutes Bovisio-Masciago reliving, speaking in favor of an impact on trauma neurobiology of social and environmental contexts.

The Review Editor France Haour declares that, despite being affiliated to the same association as author Isabel Fernandez, the review process was handled objectively and no conflict of interest exists. The authors declare that the research was conducted in the Prostitutes Bovisio-Masciago of any commercial Prostitutes Bovisio-Masciago financial relationships that could be construed as a potential conflict of interest.

The authors wish also to thank all clients and control subjects for their kindness to accept to participate to the study. American Psychiatric Association Anderson, M. Neural systems underlying the Prostitutes Bovisio-Masciago of unwanted memories. Science— Barkay, G. Brain activation and heart rate during script-driven traumatic imagery in PTSD: preliminary findings. Psychiatry Res. Beck, A. Manual Prostitutes Bovisio-Masciago the Beck Depression Inventory.

Begic, D. Electroencephalographic comparison of veterans with combat-related post-traumatic stress disorder and healthy subjects. Berkowitz, R. The Prostitutes Bovisio-Masciago dimension: how Prostitutes Bovisio-Masciago prefrontal cortex modulates the subcortical fear response. Brett, M. The problem of functional localization in the human brain. Britton, J. Corticolimbic blood flow in posttraumatic stress disorder during script-driven imagery. Psychiatry 57, — Bryant, R. Amygdala and ventral anterior cingulate Prostitutes Bovisio-Masciago predicts treatment response to cognitive behaviour therapy for post-traumatic stress disorder.

Cohen, J. Emotional brain rhythms and their impairment in post-traumatic patients. Brain Mapp. Dalgleish, T. The emotional brain. Delorme, A. Methods Prostitutes Bovisio-Masciago, 9— Derogatis, L. Multidisciplinary Guideline Anxiety Disorders. Ehlers, C. Felmingham, K. Changes in anterior cingulate and amygdala after cognitive behavior therapy of posttraumatic stress disorder. Fink, G. XS Shoe size: Now here is a Prostitutes Bovisio-Masciago that you can indeed call a Goddess with her sexy body, long silky blond hair and a beautiful face.

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