Carletto Sara, Oliva Francesco, Barnato Micaela, Antonelli Teresa, Cardia Antonina, Mazzaferro Paolo, Raho Carolina, Ostacoli Luca, Fernandez Isabel, Pagani Marco
Clinical and Biological Sciences Department, University of Turin, Orbassano, Italy.
EMDR Italy Association, Bovisio Masciago, Italy.
Front Psychol. 2018 Jan 11;8:2333. doi: 10.3389/fpsyg.2017.02333. eCollection 2017.
Substance use disorders (SUD) are patterns of substance use leading to severe impairment on social, working and economic levels. and clinical findings have enhanced the role of the brain's stress-related system in maintaining SUD behaviors. Several studies have also revealed a high prevalence of post-traumatic symptoms among SUD patients, suggesting that a trauma-informed treatment approach could lead to better treatment outcomes. However, only few studies have evaluated the use of eye movement desensitization and reprocessing (EMDR) in SUD without consistent results. The aim of the present pilot study was to assess the efficacy of a combined trauma-focused (TF) and addiction-focused (AF) EMDR intervention in treating post-traumatic and stress-related symptoms of patients with SUD. Forty patients with different SUD were enrolled in the study. Twenty patients underwent treatment as usual (TAU), the other 20 patients were treated with TAU plus 24 weekly sessions of EMDR. All patients were assessed before and after intervention for several psychological dimensions using specific tools (i.e., BDI-II, DES, IES-R, STAI, and SCL-90-GSI). A repeated measure MANOVA was performed to evaluate both between groups (TAU + EMDR vs. TAU) and within group (pre- vs. post-intervention) effects and interactions. A secondary outcome was the dichotomous variable yielded by the urine drug testing immunoassay (yes/no). The RM-MANOVA revealed both a significant pre-post main effect ( < 0.001), and a significant group-by-time main effect ( < 0.001). Significant improvements on IES-R, DES, and SCL-90-GSI scales were shown in both groups according to time effects ( < 0.05). However, significant greater effects were found for TAU + EMDR group than TAU group. No differences were found between TAU and TAU + EMDR groups in terms of urine drug immunoassay results before and after the interventions. The TAU + EMDR group showed a significant improvement of post-traumatic and dissociative symptoms, accompanied by a reduction in anxiety and overall psychopathology levels, whereas TAU group showed a significant reduction only in post-traumatic symptoms. Although our results can only be considered preliminary, this study suggests that a combined TF- and AF- EMDR protocol is an effective and well-accepted add-on treatment for patients with SUD.
物质使用障碍（SUD）是指物质使用模式导致在社会、工作和经济层面出现严重损害。临床研究结果强化了大脑应激相关系统在维持物质使用障碍行为中的作用。多项研究还揭示，物质使用障碍患者中创伤后症状的患病率很高，这表明采用创伤知情治疗方法可能会带来更好的治疗效果。然而，只有少数研究评估了眼动脱敏再处理疗法（EMDR）在物质使用障碍治疗中的应用，且结果并不一致。本试点研究的目的是评估一种将聚焦创伤（TF）和聚焦成瘾（AF）的眼动脱敏再处理干预相结合的方法，对物质使用障碍患者创伤后及应激相关症状的治疗效果。40名患有不同物质使用障碍的患者参与了该研究。20名患者接受常规治疗（TAU），另外20名患者在接受常规治疗的基础上，每周进行24次眼动脱敏再处理治疗。所有患者在干预前后均使用特定工具（即贝克抑郁量表第二版、解离经验量表、创伤后应激障碍自评量表、状态特质焦虑量表和症状自评量表总症状指数）对多个心理维度进行评估。采用重复测量多变量方差分析来评估组间（TAU + EMDR组与TAU组）和组内（干预前与干预后）的效应及交互作用。次要结果是尿液药物检测免疫分析产生的二分变量（是/否）。重复测量多变量方差分析显示，干预前后的主效应显著（<0.001），组与时间的主效应也显著（<0.001）。根据时间效应，两组在创伤后应激障碍自评量表、解离经验量表和症状自评量表总症状指数上均有显著改善（<0.05）。然而，TAU + EMDR组的效果显著优于TAU组。在干预前后的尿液药物免疫分析结果方面，TAU组和TAU + EMDR组之间没有差异。TAU + EMDR组的创伤后及解离症状有显著改善，同时焦虑和整体精神病理学水平降低，而TAU组仅创伤后症状有显著减轻。尽管我们的结果只能被视为初步结果，但本研究表明，将聚焦创伤和聚焦成瘾的眼动脱敏再处理方案相结合，对物质使用障碍患者是一种有效且易于接受的附加治疗方法。
