EMDR treatment in patients with personality disorders. Should we fear symptom exacerbation?

Summary & key facts

Ninety-seven outpatients with personality disorders, but not posttraumatic stress disorder, were randomly assigned to either five sessions of EMDR trauma therapy or to a waitlist. Researchers tracked psychological distress and suicidal thoughts every week and again three months later. Overall, people tended to get better, short-term increases in distress or suicidal thinking happened in both groups, but these increases were less common with EMDR than with waiting, and most people got better again if therapy continued after a worse week. The study did not include people with an immediate high suicide risk, so the results apply to a more stable group.

Key facts:

• This was a randomized trial with 97 outpatients who had a personality disorder and did not have posttraumatic stress disorder.
• People were given five sessions of EMDR therapy or put on a waitlist, and researchers measured distress and suicidal thoughts every week and again three months later.
• No group of patients showed overall deterioration during the EMDR treatment period when patients were grouped by patterns of change.
• Short-term increases from one session to the next happened in both groups: about 10% of sessions in the EMDR group showed increased psychological distress compared with about 28% in the waitlist group.
• For suicidal thoughts, session-to-session increases happened in about 28% of sessions with EMDR and about 44% of sessions while waiting.
• When looking at overall change from before to after the treatment period, only about 2% of patients receiving EMDR had more psychological distress than at the start, compared with about 9% of patients on the waitlist.
• About 2% of patients in the EMDR group had more suicidal thoughts after treatment than at the start, compared with about 11% in the waitlist group.
• If a patient showed a short-term worsening, continuing therapy usually led to a reduction in distress and suicidal thoughts for most people.
• The study excluded people with acute suicidal risk, used only five EMDR sessions, and followed people for three months, so findings may not apply to people with very high suicide risk or to longer treatment plans.

Abstract

Background: Clinicians are often hesitant to use trauma-focused therapy for patients with personality disorders (PDs) because of concerns that the pathology may worsen.Objective: Exploring trajectories of change and individual exacerbations in psychological distress and suicidal thoughts in patients with a PD without comorbid posttraumatic stress disorder (PTSD) during EMDR therapy or waiting time.Method: In a randomized controlled trial, the effectiveness of five sessions of EMDR therapy was compared with a waitlist in 97 outpatients. Acute suicidal patients were not included in this study. Psychological distress and suicidality scores were measured on a weekly basis during the EMDR and waiting list (WL) periods and at 3-month follow-up. Data were analysed in a descriptive manner for individual patients, and hierarchical cluster analysis was used to identify patterns of change among clusters of patients. Mann–Whitney U and chi-squared tests were used to explore differences in specific patient characteristics between the found clusters of patients.Results: Patients generally improved, and no clusters of patients deteriorated during the EMDR therapy. Session-to-session exacerbations occurred in both the EMDR (psychological distress: 10.0%; suicidal thoughts: 28.0%) and WL group (psychological distress: 28.0%; suicidal thoughts: 43.5%). Two percent of patients in the EMDR group and 8.7% of patients in the WL condition showed an increase in psychological distress, whereas 2.0% of patients in the EMDR group and 10.9% of patients in the WL condition showed an increase in suicidal thoughts posttreatment compared to baseline.Conclusions: These results show that although individual exacerbations in psychological distress and suicidal thoughts occur, these were less likely to occur in response to EMDR therapy compared with no therapy. Continuation of therapy following exacerbation led to a decrease in psychological distress and suicidal thoughts in most patients.

Topics

Mental Health and Psychiatry Personality Disorders and Psychopathology Psychotherapy Techniques and Applications

Categories

Clinical Psychology Psychology Social Sciences

Tags

Clinical psychology Exacerbation Immunology Medicine Personality Personality disorders Psychiatry Psychology Psychotherapist Social psychology