Desensibilización y reprocesamiento por movimiento ocular; ensayo piloto en pacientes bipolares, hipótesis de funcionamiento y revisión sistemática

Abstract

There is a large gap between clinical and scientific observation of the role of post-traumatic stress disorder (PTSD) and traumatic events in the life of a patient diagnosed with bipolar disorder and the almost absence of treatment guidelines for this comorbidity. In clinical practice, classically, trauma has not been considered as a risk factor for bipolar patients with a significant lack of clinical trials of therapies focused on adverse events. Given the importance of PTSD, traumatic events, and vital events in prognosis and outcome in patients with bipolar disorder, evidence-based interventions for trauma in bipolar disorder should be investigated and provided._x000D_ The psychotherapeutic treatment "Eye movement desensitization and reprocessing" (EMDR) is a psychological treatment developed by Francine Shapiro and is currently indicated for the treatment of PTSD by different international organizations (American Psychological Association Presidential Task Force on Evidence-Based Practice, 2006, National Institute for Clinical Excellence, 2005, Ursano et al., 2004, World Health Organization, 2013). EMDR has been shown to be a safe, useful and effective tool, supported by scientific evidence for the treatment of PTSD._x000D_ The present thesis presents the benefits in affective and traumatic symptomatology of the first randomized, controlled trial of EMDR in a sample of bipolar I and II patients with subsyndromal symptoms and a history of traumatic events. This first positive sign results should encourage clinicians and researchers to conduct studies with larger samples in bipolar patients with a history of trauma to finally include a trauma focused therapy in a personalized care and intervention plan. In a functional neuroimaging study (fMRI) we presented the clinical improvement and the unexpected positive modulation of the Default Mode Network (DMN) after EMDR therapy of a patient with bipolar II disorder. The results of this case study possibly open an alternative way to study via fMRI the mechanism of action of EMDR, the modulation of the DMN in a larger sample. Both studies are pilot studies, whereas results are preliminary and should be interpreted with caution. In addition, we published another experimental work with respect to the mechanism of action of EMDR, which revealed that eye movements do not have a direct effect on working memory. Finally, the thesis is complemented by a global review about the clinical and scientific development of EMDR treatment. This article informs about the standard protocol of EMDR, the most important hypothesis of its mechanism of action and a systematic review on the efficacy in PTSD and other indications. One of the conclusions is that as in any other psychotherapy, further studies are needed to better understand its clinical efficacy, its mechanism of action and the underlying neurobiological basis for EMDR.

Date of Award	17 Mar 2017
Original language	Spanish
Awarding Institution	Hospital del Mar
Supervisor	Victor Pérez Solà (Tutor) & Benedikt Lorenz Amann . (Director)