Plasticity of memory in the etiology and   treatment of Post Traumatic Stress                Disorder.                    ...
Computer memory vs. human memoryPlasticity of human memory: a) Memory inflation
Imagination inflation1008060                                            Vividness4020 0       Recall     Recall           ...
Imagination inflation1008060                                            Vividness4020 0       Recall     Recall           ...
Imagination inflation1008060                                            Vividness4020 0       Recall     Recall           ...
Imagination inflation1008060                                            Vividness4020 0       Recall     Recall           ...
Computer memory vs. human memoryPlasticity of human memory: a) Memory inflation                            b) Memory defla...
Imagination deflation1008060                                        Vividness4020 0       Recall     Recall       Recall  ...
Imagination deflation1008060                                         Vividness4020 0       Recall      Recall       Recall...
Imagination deflation1008060                                        Vividness4020 0       Recall     Recall       Recall  ...
Imagination deflation1008060              Temporal ‘blurring’       Vividness4020 0       Recall     Recall       Recall  ...
Imagination deflation1008060                                        Vividness4020 0       Recall     Recall       Recall  ...
Application to PTSDMemory inflation in the etiology of PTSD:                  Dutch troops after IraqMemory deflation in t...
1) Memory inflation in the etiology of PTSD:       Traumatic event  PTSD      • Duration; distance; number of combat even...
Memory consistency study          Participants          •    Infantry troops deployed in 2004          Measures          •...
Before Iraq  Procedu  (N=214)    Iraq  5 months(N=171; 80%)  15 months(N=152; 71%)
Participants’ responses                                                      Change          Traumatic         YY      YN ...
Participants’ responses                                                       Change          Traumatic         YY     YN ...
Fig 1: nr. of potentially traumatic          Fig 2: nr. of negative traumatic        stressors recalled                   ...
• Accounts of trauma are plastic over time • More severe current PTSD symptoms    increased reporting of (major and minor...
Memory deflation in the treatment of PTSD        The curious case of EMDR
Historical notes:1) EMDR: technique, theory and claims extraordinary   and “extraordinary claims need exraordinary evidence”
Historical notes:1) EMDR: technique, theory and claims extraordinary   and “extraordinary claims need exraordinary evidenc...
Typical preparation of lab studies on EMDR1) Healthy volunteers retrieve aversive memories2) Pre-test: memories scored in ...
Three theories on EMDR effects considered here.EMDR works1) Via exposure (recall only, EM’sirrelevant)2) By promoting “int...
Exposure Theories: Recall only = Recall + EM’s (EM’s irrelevant)Januari 2011: at least 14 experimentsAuthor               ...
Data:Recall + EM’s > Recall onlyTherefore:Exposure theories fail to explain EMDR effects
Interhemispheric communication theoriesEMDR effects depend on Left-Right alternationof EM’s.Implication:Horizontal EM’s > ...
Eyes stationary              Eye Movements                                                           Horizontal           ...
Data:Recall + horizontal EM’s           =Recall + vertical EM’s.Therefore:“Interhemispheric communication” theoryfails to ...
Working Memory (WM) Theory: background.    1) WM: problem solving, planning, holding memory in mind etc.    2) WM acts on ...
Imagination deflation1008060                                        Vividness4020 0       Recall     Recall       Recall  ...
Critical tests WM explanation of EMDR effects1) Any technique that makes memory compete   for WM resources reduction of e...
Technique             Author                   Outcome                                           Recall   Recall +        ...
Critical tests WM explanation of EMDR effects1)Any technique that makes memory compete  for WM resources reduction of emo...
MoreVividLess        Positive   NegativeVivid        Memories   Memories
MorePositive Less           Positive   NegativePositive           Memories   Memories
Critical tests WM explanation of EMDR effects1) Any technique that makes memory compete   for WM resources reduction of e...
Change in “flash forwards” 1            80                                                  80            75              ...
Change in “flash forwards” 2(Engelhard, van den Hout et al., 2011)
Critical tests WM explanation of EMDR effects1) Any technique that makes memory compete   for WM resources reduction of e...
Van den Hout, Engelhard et al., 2011, Behav Res Ther,
Critical tests WM explanation of EMDR effects1) Any technique that makes memory compete   for WM resources reduction of e...
Correlations between WM span on prior testand reductions of vividness and emotionality during EM’s etc.                   ...
Critical tests WM explanation of EMDR effects1) Any technique that makes memory compete   for WM resources reduction of e...
Inverted U? Retrieval of memories about Queensday disaster(the Netherlands, 30 april 2009) under 4 conditions:1) no-dual t...
Engelhard, van den Hout & Smeets, J. Behav Ther. Expt Psychiat (2010)
Support for WM explanation of EMDR : 1) Other WM taxing dual tasks effective (counting, drawing etc) 2) Positive memories ...
Clinical Issues1) WM taxing during positive imagery/thoughts?
“Resource Development and Installation” (RDI)         according to EMDR protocol            Activation of “positive, funct...
Vividness                                                                                  Pleasantness                   ...
Implication: WM taxing during positive ideation,             counterproductive.
Clinical Issues (theoretically not irrelevant)1) WM taxing during positive imagery/thoughts?2) Memories for future events ...
Cf. earlier data:EM’s positive effects on vividness/emotionalityof flash forwards
Implication: theoretical and empirical basis for             treating “flash forwards”
Clinical Issues1) WM taxing during positive imagery/thoughts?2) Memories for future events and indication3) Using beeps in...
Replacing EM’s by bilateral beeps1) > 50% of actual EMDR sessions presently with beeps   instead of EM’s (Cf. interhemisph...
400                 350                                                        Eye Movements    Reaction    times    300  ...
400         350               Eye MovementsReactiontimes    300               Binaural(Msec)         stimulation         2...
400                  350    Reaction                                            Eye Movements    times    300             ...
400                  350    Reaction                                           Eye Movements    times    300              ...
Do beeps blur memory like EM’s do?
1,6                    1,2                                                        Eye movements          Drop          in ...
1,6                    1,2                                                        Eye movements          Drop          in ...
1,6                    1,2                                                        Eye movements        Drop        in     ...
1,6                    1,2                                                        Eye movements          Drop          in ...
Theory and data suggest: Beeps inferior to EM’s
Objection: Experimental model = clinical reality             1) Students had no PTSD             2) “Unpleasant memory” = ...
Clinical study; n= 12 PTSD(van den Hout et al., 2012. Behav Res Ther)(Rape (5 X), war + rape, years of sexual/physical abu...
2,5                     2                   1,5     Drop                                               EMs       in       ...
2,5                    2                  1,5     Drop                                              EMs       in          ...
2,5                    2                  1,5     Drop                                              EMs       in          ...
2,5                    2            ?                  1,5     Drop                                              EMs      ...
2,5                    2                  1,5     Drop                                              EMs       in          ...
2,5                    2                  1,5     Drop                                              EMs       in          ...
2,5           2         1,5Drop                                       EMs  in       1                               Beepss...
2,5           2                                   ?         1,5Drop                                       EMs  in       1 ...
2,5           2         1,5Drop                                       EMs  in       1                               Beepss...
What about patient’s opinions about1) Recall only?2) Recall+ beeps?3) Recall+ EM’s?        “How would you prefer to contin...
8765                         EMs4                         Beeps3                         Recall only210    Patients prefer...
8765                         EMs4                         Beeps3                         Recall only210    Patients prefer...
8765                         EMs4                         Beeps3                         Recall only210    Patients prefer...
8765                         EMs4                         Beeps3         ?                Recall only210    Patients prefe...
8                 7                 6                 5                                      EMs                 4        ...
8765                         EMs4                         Beeps3                         Recall only210    Patients prefer...
EM’s superior,But patients preferred beeps.      Clinicians may infer effectivity from patients’ preference.
Clinical Issues1) WM taxing during positive imagery/thoughts?     Implication: WM taxing during positive ideation is     c...
Summary1) General. Trauma memory is plastic:    a) Emergence of trauma memories after PTSD (inflation)     b) Blurring of ...
Thank you !
1    2            WM span    3        4            WM load of   WM load            dual task    provided                  ...
Plasticity of memory in the etiology and  treatment of Post Traumatic Stress Disorder.
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Plasticity of memory in the etiology and treatment of Post Traumatic Stress Disorder.

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Slides presented at the SITCC 2012 Congress in Rome. Prof. Marcel van den Hout, University of Utrecht

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Plasticity of memory in the etiology and treatment of Post Traumatic Stress Disorder.

  1. 1. Plasticity of memory in the etiology and treatment of Post Traumatic Stress Disorder. SITCC Roma, Oct. 2012 Marcel van den Hout
  2. 2. Computer memory vs. human memoryPlasticity of human memory: a) Memory inflation
  3. 3. Imagination inflation1008060 Vividness4020 0 Recall Recall Recall PRE Imag DURING POST Imag Imag
  4. 4. Imagination inflation1008060 Vividness4020 0 Recall Recall Recall PRE Imag DURING POST Imag Imag
  5. 5. Imagination inflation1008060 Vividness4020 0 Recall Recall Recall PRE Imag DURING POST Imag Imag
  6. 6. Imagination inflation1008060 Vividness4020 0 Recall Recall Recall PRE Imag DURING POST Imag Imag
  7. 7. Computer memory vs. human memoryPlasticity of human memory: a) Memory inflation b) Memory deflation
  8. 8. Imagination deflation1008060 Vividness4020 0 Recall Recall Recall PRE Imag DURING POST Imag Imag
  9. 9. Imagination deflation1008060 Vividness4020 0 Recall Recall Recall PRE Imag DURING POST Imag Imag
  10. 10. Imagination deflation1008060 Vividness4020 0 Recall Recall Recall PRE Imag DURING POST Imag Imag
  11. 11. Imagination deflation1008060 Temporal ‘blurring’ Vividness4020 0 Recall Recall Recall PRE Imag DURING POST Imag Imag
  12. 12. Imagination deflation1008060 Vividness4020 0 Recall Recall Recall PRE Imag DURING POST Imag Imag
  13. 13. Application to PTSDMemory inflation in the etiology of PTSD: Dutch troops after IraqMemory deflation in the treatment of PTSD: the curious case of EMDR
  14. 14. 1) Memory inflation in the etiology of PTSD: Traumatic event  PTSD • Duration; distance; number of combat events • non-traumatic stressors (daily difficulties; e.g., King et al., 1995; Bolton et al., 2003) • Often interpreted as “causal” impact • But: retrospective reports (e.g., Schwarz, Kowalski, & McNally, 1993; Southwick et al., 1997)  Methodological limitations
  15. 15. Memory consistency study Participants • Infantry troops deployed in 2004 Measures • PSS (Foa et al., 1993) • 22 war zone stressors 30 non-traumatic stressors  Experienced? Impact? (1-4 scale) (Maguen et al., 2004) (Engelhard, van den Hout, & McNally, 2008)
  16. 16. Before Iraq Procedu (N=214) Iraq 5 months(N=171; 80%) 15 months(N=152; 71%)
  17. 17. Participants’ responses Change Traumatic YY YN NY NN N % stressor Injured civilians due to 16 29 20 68 49 37 own action Seeing dead/injured NATO (non-Dutch) 16 22 16 79 38 29 soldiers Seeing human remains 21 16 18 78 34 26 Seeing dead/injured 48 7 25 53 32 24 civiliansHaving to aid in removalof unexploded ordnance 10 16 16 91 32 24
  18. 18. Participants’ responses Change Traumatic YY YN NY NN N % stressor Seeing dead/injured 52 13 13 55 26 20 Dutch soldiersHaving to aid in removal 3 15 11 104 26 20 of human remains Being shot at 75 6 19 33 25 19 Locating unexploded 12 9 15 97 24 18 land minesWitnessing an explosion 90 14 9 20 23 17Being injured because of 5 14 5 109 19 14 an assault/attack
  19. 19. Fig 1: nr. of potentially traumatic Fig 2: nr. of negative traumatic stressors recalled stressors recalled 13 4,5 4 12,5 3,5 12 3 11,5 2,5 PTSD PTSD No PTSD No PTSD 2 11 1,5 10,5 1 10 0,5 9,5 0 5 months 15 months 5 months 15 months (Engelhard, van den Hout, & McNally, 2008)
  20. 20. • Accounts of trauma are plastic over time • More severe current PTSD symptoms  increased reporting of (major and minor) stressor exposure
  21. 21. Memory deflation in the treatment of PTSD The curious case of EMDR
  22. 22. Historical notes:1) EMDR: technique, theory and claims extraordinary and “extraordinary claims need exraordinary evidence”
  23. 23. Historical notes:1) EMDR: technique, theory and claims extraordinary and “extraordinary claims need exraordinary evidence”2) Scientific community sceptical3) EMDR outcome studies and meta-analyses: EMDR as effective as CBT Bradley et al. (2005).A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162, 214-227. Seidler & Wagner (2006) Comparing the efficacy of EMDR and trauma focussed CBT in the treatment of PTSD. Psychological Medicine, 36, 1515-1522 Bisson and Ehlers, et al . (2007). Psychological treatments for chronic PTSD:A systematic review and meta-analysis. British Journal of Psychiatry, 190, 97-104.
  24. 24. Typical preparation of lab studies on EMDR1) Healthy volunteers retrieve aversive memories2) Pre-test: memories scored in terms of vividness/adversity3) Interventions: during recall a) Recall + Eye movements or b) Recall only4) Post test: recall and scored in terms of vividness/adversity
  25. 25. Three theories on EMDR effects considered here.EMDR works1) Via exposure (recall only, EM’sirrelevant)2) By promoting “interhemispheric communication” during recall3) Both EM’s and recall need ‘resources’ of working memory. Recall ‘looses competition” with EM’s
  26. 26. Exposure Theories: Recall only = Recall + EM’s (EM’s irrelevant)Januari 2011: at least 14 experimentsAuthor Outcome Recall Only Recall + EM’sAdrade et al., (1997) 0 +Van den Hout et al., (2001) 0 +Kavanagh et al., (2001) 0 +Kemps et al., (2007) 0 +Maxfield et al., (2008) Expt. 1 0 + Expt. 2 0 +Gunter & Bodner (2008) Expt. 1 0 + Expt. 2 0 + Expt. 3 0 +Lilley et al. (2009) 0 +Van den Hout et al. (2010) 0 +Engelhard et al. (2010 a-b) 0 +Hornsveld et al. (2010) 0 +Van den Hout et al. (2011) 0 +Van den Hout et al. (2011) Expt 1 0 + Expt 2 0 + Expt 3 0 +
  27. 27. Data:Recall + EM’s > Recall onlyTherefore:Exposure theories fail to explain EMDR effects
  28. 28. Interhemispheric communication theoriesEMDR effects depend on Left-Right alternationof EM’s.Implication:Horizontal EM’s > Vertical EM’s
  29. 29. Eyes stationary Eye Movements Horizontal Pre-to-post decreases Vertical Vividness Emotionality CompletenessFrom: Gunter & Bodner, 2008
  30. 30. Data:Recall + horizontal EM’s =Recall + vertical EM’s.Therefore:“Interhemispheric communication” theoryfails to explain EMDR effects.
  31. 31. Working Memory (WM) Theory: background. 1) WM: problem solving, planning, holding memory in mind etc. 2) WM acts on ‘limited resources’ 3) EMDR: retrieval and EM’s ‘compete for WM resources’: less resources available for retrieval4) Therefore: during recall less vivid/less emotional and reconsolidated as less vivid 5) Reconsolidation of memory affected by recall. Cf. Imagination inflation effect
  32. 32. Imagination deflation1008060 Vividness4020 0 Recall Recall Recall PRE Imag DURING POST Imag Imag
  33. 33. Critical tests WM explanation of EMDR effects1) Any technique that makes memory compete for WM resources reduction of emotionality
  34. 34. Technique Author Outcome Recall Recall + only WM taxing1) Vertical EM’s (Gunter & Bodner, 2008) 0 +2) Drawing ( idem) 0 +3) Shadowing (idem) 0 +4) Tetris (Engelhard et al, 2011) 0 +5) Counting (van den Hout et al., 2010) 0 + (Engelhard et al., 2010) 0 +7) Articulatory suppresion (Kemps et al., 2007) 0 +8) Attentional breathing (van den Hout et al., 2010) 0 +
  35. 35. Critical tests WM explanation of EMDR effects1)Any technique that makes memory compete for WM resources reduction of emotionality 2) EM’s during recall: Negative memories less negative. Positive memories less positive.
  36. 36. MoreVividLess Positive NegativeVivid Memories Memories
  37. 37. MorePositive Less Positive NegativePositive Memories Memories
  38. 38. Critical tests WM explanation of EMDR effects1) Any technique that makes memory compete for WM resources reduction of emotionality 2) EM’s during recall: Neg. memories less neg. Pos. Memories less pos. 3) Treatment of ‘flash forwards’ rather than “flash backs” should work also
  39. 39. Change in “flash forwards” 1 80 80 75 75 70 70 Emotionality 65 65Vividness 60 60 55 55 50 50 45 45 pre-test post-test pre-test post-test eye movement just retrieval eye movement just retrieval Engelhard, van den Hout, Janssen & van der Beek, 2010 ( Behav Res Ther)
  40. 40. Change in “flash forwards” 2(Engelhard, van den Hout et al., 2011)
  41. 41. Critical tests WM explanation of EMDR effects1) Any technique that makes memory compete for WM resources reduction of emotionality 2) EM’s during recall: Neg. memories less neg. Pos. Memories less pos. 3) Treatment ‘flash forwards’ rather than flash backs 4) Effective treatments really tax WM
  42. 42. Van den Hout, Engelhard et al., 2011, Behav Res Ther,
  43. 43. Critical tests WM explanation of EMDR effects1) Any technique that makes memory compete for WM resources reduction of emotionality 2) EM’s during recall: Neg. memories less neg. Pos. Memories less pos. 3) Treatment ‘flash forwards’ rather than flash backs 4) Effective treatments really tax WM 5) Bad at multi-tasking? Good effects EM’s!
  44. 44. Correlations between WM span on prior testand reductions of vividness and emotionality during EM’s etc. Vividness Emotionality (Gunter & Bodner, 2008) EM’s -0.44* -0.43* Shadowing -0.69* -0.59* Drawing -0.58* -0.49* Van den Hout et al., 2020, 2011 a) Counting -0.31* -0.18* EM’s -0.30* -0.29* Attentional breathing ns ns EM’s (Positive background) - ns EM’s (Neutral background) - ns EM’s (Negative background) - ns Engelhard et al, 2011 EM’s (Positive memories) ns -0.51* EM’s (Negative memories) ns -0.43* Tetris ns ns
  45. 45. Critical tests WM explanation of EMDR effects1) Any technique that makes memory compete for WM resources reduction of emotionality 2) EM’s during recall: Neg. memories less neg. Pos. Memories less pos. 3) Treatment ‘flash forwards’ rather than flash backs 4) Effective treatments really tax WM 5) Bad at multi-tasking? Good effects EM’s! 6) Dual task should not be TOO taxing (memory should be activated): inverted U predicted (Gunter & Bodner, 2008)
  46. 46. Inverted U? Retrieval of memories about Queensday disaster(the Netherlands, 30 april 2009) under 4 conditions:1) no-dual task (exposure only)2) Simple counting3) Intermediate complex counting4) Complex counting Engelhard, van den Hout & Smeets, J. Behav Ther. Expt Psychiat (2010)
  47. 47. Engelhard, van den Hout & Smeets, J. Behav Ther. Expt Psychiat (2010)
  48. 48. Support for WM explanation of EMDR : 1) Other WM taxing dual tasks effective (counting, drawing etc) 2) Positive memories after EM less positive 3) Flash forwards also affected4) WM taxing is evident from RT tasks5) Bad at multi-tasking Good response to EM, counting etc6) Dose response relationship: inverted U
  49. 49. Clinical Issues1) WM taxing during positive imagery/thoughts?
  50. 50. “Resource Development and Installation” (RDI) according to EMDR protocol Activation of “positive, functional and resourceful memories” and simultaneous EM’s Experiment: RDI (positive memories!!) under three conditions: a) Traditional (with horizontal EM’s) b) Alternative (with vertical EM’s) c) Crucial Alternative (without EM’s)
  51. 51. Vividness Pleasantness 0 Horizontal Vertical Recall-only 0 Horizontal Vertical Recall-only Mean Difference scores (in VAS Rating) -0,2 -0,2 -0,4 Mean Difference scores (in VAS Rating) -0,6 -0,4 -0,8 -0,6 -1 -1,2 -0,8 -1,4 -1 -1,6 -1,8 -1,2 Conditions ConditionsHornsveld et al, 2011
  52. 52. Implication: WM taxing during positive ideation, counterproductive.
  53. 53. Clinical Issues (theoretically not irrelevant)1) WM taxing during positive imagery/thoughts?2) Memories for future events and treatment indication
  54. 54. Cf. earlier data:EM’s positive effects on vividness/emotionalityof flash forwards
  55. 55. Implication: theoretical and empirical basis for treating “flash forwards”
  56. 56. Clinical Issues1) WM taxing during positive imagery/thoughts?2) Memories for future events and indication3) Using beeps instead of EM’s?
  57. 57. Replacing EM’s by bilateral beeps1) > 50% of actual EMDR sessions presently with beeps instead of EM’s (Cf. interhemisphere theory of EMDR) 2) No studies on clinical effects of beeps 3) Do bilateral beeps tax WM? 4) Beeps effective in blurring memory?
  58. 58. 400 350 Eye Movements Reaction times 300 Binaural (Msec) stimulation 250 No dual task 200 150Van den Hout, Engelhard et al., 2011, Behav Res Ther.
  59. 59. 400 350 Eye MovementsReactiontimes 300 Binaural(Msec) stimulation 250 No dual task 200 150
  60. 60. 400 350 Reaction Eye Movements times 300 Binaural (Msec) stimulation 250 ? No dual task 200 150Van den Hout, Engelhard et al., 2011, Behav Res Ther.
  61. 61. 400 350 Reaction Eye Movements times 300 Binaural (Msec) stimulation 250 No dual task 200 150Van den Hout, Engelhard et al., 2011, Behav Res Ther
  62. 62. Do beeps blur memory like EM’s do?
  63. 63. 1,6 1,2 Eye movements Drop in 0,8 Binaural scores stimulation No dual task 0,4 0 VividnessVan den Hout, Engelhard et al., 2011, Behav Res Ther.
  64. 64. 1,6 1,2 Eye movements Drop in 0,8 Binaural scores stimulation No dual task 0,4 0 VividnessVan den Hout, Engelhard et al., 2011, Behav Res Ther.
  65. 65. 1,6 1,2 Eye movements Drop in 0,8 Binaural scores stimulation No dual task 0,4 ? 0 VividnessVan den Hout, Engelhard et al., 2011, Behav Res Ther.
  66. 66. 1,6 1,2 Eye movements Drop in 0,8 Binaural scores stimulation No dual task 0,4 0 VividnessVan den Hout, Engelhard et al., 2011, Behav Res Ther.
  67. 67. Theory and data suggest: Beeps inferior to EM’s
  68. 68. Objection: Experimental model = clinical reality 1) Students had no PTSD 2) “Unpleasant memory” = trauma Question: How do real PTSD patients respond to beeps and EM’s?
  69. 69. Clinical study; n= 12 PTSD(van den Hout et al., 2012. Behav Res Ther)(Rape (5 X), war + rape, years of sexual/physical abuse etc) 6 recalls during session 1: 2 X EM’s 2 X Beeps 2 X Recall only Order of interventions: Balanced Dependant variables : Vividness Emotionality (SUDS)
  70. 70. 2,5 2 1,5 Drop EMs in 1 Beeps scores Recall only 0,5 0 -0,5 Emotionality VividnessVan den Hout et al, Behav Res Ther, 2012
  71. 71. 2,5 2 1,5 Drop EMs in 1 Beeps scores Recall only 0,5 0 -0,5 Emotionality VividnessVan den Hout et al, Behav Res Ther, 2012
  72. 72. 2,5 2 1,5 Drop EMs in 1 Beeps scores Recall only 0,5 0 -0,5 Emotionality VividnessVan den Hout et al, Behav Res Ther, 2012
  73. 73. 2,5 2 ? 1,5 Drop EMs in 1 Beeps scores Recall only 0,5 0 -0,5 Emotionality VividnessVan den Hout et al, Behav Res Ther, 2012
  74. 74. 2,5 2 1,5 Drop EMs in 1 Beeps scores Recall only 0,5 0 -0,5 Emotionality VividnessVan den Hout et al, Behav Res Ther, 2012
  75. 75. 2,5 2 1,5 Drop EMs in 1 Beeps scores Recall only 0,5 0 -0,5 Emotionality VividnessVan den Hout et al, Behav Res Ther, 2012
  76. 76. 2,5 2 1,5Drop EMs in 1 Beepsscores Recall only 0,5 0 -0,5 Emotionality Vividness
  77. 77. 2,5 2 ? 1,5Drop EMs in 1 Beepsscores Recall only 0,5 0 -0,5 Emotionality Vividness
  78. 78. 2,5 2 1,5Drop EMs in 1 Beepsscores Recall only 0,5 0 -0,5 Emotionality Vividness
  79. 79. What about patient’s opinions about1) Recall only?2) Recall+ beeps?3) Recall+ EM’s? “How would you prefer to continue?”
  80. 80. 8765 EMs4 Beeps3 Recall only210 Patients preference
  81. 81. 8765 EMs4 Beeps3 Recall only210 Patients preference
  82. 82. 8765 EMs4 Beeps3 Recall only210 Patients preference
  83. 83. 8765 EMs4 Beeps3 ? Recall only210 Patients preference
  84. 84. 8 7 6 5 EMs 4 Beeps 3 Recall only 2 1 0 Patients preferenceVan den Hout et al, Behav Res Ther, 2012
  85. 85. 8765 EMs4 Beeps3 Recall only210 Patients preference
  86. 86. EM’s superior,But patients preferred beeps. Clinicians may infer effectivity from patients’ preference.
  87. 87. Clinical Issues1) WM taxing during positive imagery/thoughts? Implication: WM taxing during positive ideation is counterproductive. 2) Memories for future events and indication Implication: theoretical and empirical basis for treating “flash forwards”3) Using beeps instead of EM’s? Implication: beeps inferior to EM’s
  88. 88. Summary1) General. Trauma memory is plastic: a) Emergence of trauma memories after PTSD (inflation) b) Blurring of trauma memories in EMDR (deflation) in EMDR 2) Regarding EMDR: a) Effects can be ‘modelled’ in lab. b) Explanation: Not merely exposure. Not interhemispheric communication. c) Robuste evidence: deflation due to WM taxing. during retrieval. d) Rational basis for EMDR with clinical implications: a) Dual tasking during positive imagery unfortunate b) Flash forwards rational indication c) Replacing EM’s by beeps bad idea
  89. 89. Thank you !
  90. 90. 1 2 WM span 3 4 WM load of WM load dual task provided by memory

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