EMDR Treatment Efficacy in Maltreated and Traumatized Children

Project location: ITALY, Rome
Project start date: December 2011 - Project end date: October 2013
Project number: 2011-36
Beneficiary: Cospexa


TIMELINE OF THE PRESENT ACTIVITY REPORT: From June 10, 2012 to June 30, 2013

Research on Post-Traumatic Stress Disorder (PTSD) has proved that the early traumatic experiences have a profound impact on children, who can express problems in affective regulatory abilities, dissociation, and difficulties in interpersonal relationship (van der Kolk, 2003). Furthermore, PTSD impacts negatively on cerebral maturation and also on neuroendocrinologic responses to stress, by altering the hypothalamic-pituitary-adrenal (HPA) axis and, subsequently, the production of cortisol.
The Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapeutic approach that has been proven effective for the treatment of PTSD. The key characteristic of EMDR is the use of alternating bilateral stimulation (such as, eye movements, tactile taps, or auditory tones) to facilitate memory retrieval, and to reduce negative emotions associated with memories.
In the treatment of the PTSD, EMDR practice is guided by the adaptive information processing (AIP) model (Shapiro, 2001), according to which a high level of disturbance related to traumatic experience causes the information processing system to fail to properly assimilate the experience into the normal neural memory networks. As a result, the unprocessed memory of the event can be stored in isolation, containing "the affects, thoughts, sensations, and behavioral responses that were encoded at the time of the event" (Shapiro, 2009, p. 13). The goal of EMDR is to access dysfunctionally stored experiences and to link them with other more adaptive information existing in the patient's neural networks.
Several studies have shown that EMDR can be applied successfully with children and adolescents. In the case of this population, the standard protocol can be modified. In fact, with children, the work tends to be more concrete and based on the production of images and pictures, and less on cognitions, emotions and feelings.

The aim of this research is to explore the efficacy of the EMDR treatment with traumatized children, aged between 8 and 11 years, by considering: the traumatic distress and emotional-adaptive functioning; the circadian rhythm of salivary cortisol; the cerebral mechanisms of emotion regulation. The study protocol include a comparison between two groups of children: children who are treated with EMDR treatment (EMDR group) and children who are addressed to a short psychodynamic psychotherapy (sPP group).
Along with a longitudinal perspective, children are examined in two steps - before (step 1) and within one month after the end of the therapy (step 2) -, by means of psychological, neuroendocrine and electrophysiological assessments.

Psychological assessment is carried out by means of the following instruments:
- CBCL/4-18 years (Achenbach, 1991, 2001; Italian validation by Frigerio et al., 2004): it allows to obtain caregiver reports of a child's emotional-adaptive functioning and behavior problems, on the basis of three broad syndrome scales: Internalizing Problems, Externalizing Problems and Total Problems.
- CAPS-P (Scheeringa, 2010)*: the CAPS provides a categorical diagnosis and a measure of the severity of PTSD symptoms. The CAPS-P version allows to obtain information about the child's post-traumatic distress from the parents, or - specifically for this study - from the legal guardians.
- TRF/4-18 years (Achenbach, 1991): it allows to obtain teacher's perception of child's academic performance, adaptive functioning and behavior problems. The TRF is a complement measure to the CBCL/4-18.
- CAPS-C (Scheeringa, 2010)*: this version of the CAPS allows to obtain information about the child's post-traumatic distress from the child or the adolescent directly.
- TSCC-A (Briere, 1996; Italian validation by Di Blasio et al., 2011): it's a self-report measure of post-traumatic distress and related psychological symptomatology in children, who have experienced traumatic events, including physical assault, victimization by peers, major losses, the witnessing of violence done to others and natural disasters.

Neuroendocrine assessment includes the measurement of circadian rhythm of salivary cortisol. Saliva samples for cortisol determination are obtained using cotton rolls and plastic containers. All the samples are collected at home, four times during one day (8.00 a.m.; 12.00 a.m.; 4.00 p.m., 8.00 p.m.), in the presence of the parents or of the legal guardians. Children are told to keep the cotton rolls in the mouth under their tongue or chew on it for about 60 sec. Saliva sample are stored in the freezer (for a maximum of 3 days) until the transport to the Centro Provinciale Giorgio Fregosi - Spazio Sicuro, by means of a cooler with dry ice. Saliva samples are analyzed by the Department of Cell Biology and Neuroscience, Istituto Superiore di Sanità, of Rome.

Electrophysiological examination employs visually evoked event-related potentials (ERPs) across emotional conditions, in order to assess patterns and individual differences in cortical mechanisms of emotion regulation in children.
During ERPs recording, angry, sad, happy and neutral faces (40 of each) are presented in randomized order. Pictures are frontal head shots of adult amateur actors (50% men and 50% women), taken from the Karolinska Directed Emotional Faces Series (KDEF, Lundqvist et al., 1998). Each picture is presented for 1500-ms, with an intertrial interval (ITI) of 1000 ms. EEG is recorded from scalp electrodes using the 256-channel Geodesic Sensor Net, owned by the Department of Dynamic and Clinical Psychology of "Sapienza" University of Rome.

Up to now, 10 children with a PTSD diagnosis have been recruited: 7 for the EMDR group (4 males and 3 females) and 3 for the sPP group (2 males and 1 female).
Children are sent to the Centro Provinciale Giorgio Fregosi - Spazio Sicuro by social services or directly by the Court.
The parents or the legal guardians received detailed information about the purposes of the study, as well as of the procedure, before signing the informed consent.
All the recruited children underwent the step 1 of the research, completing the psychological assessment, the detection of salivary cortisol and the EEG recording, before the beginning of the therapy. Furthermore, in the EMDR group 5 children have already completed the step 2 of the study.
In the next months, the number of the subjects of the two groups will be expanded and balanced, in order to proceed with the elaboration of the data.

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