Abstract Eye movement desensitization and reprocessing (EMDR) is an established treatment for post-traumatic stress disorder (PTSD). However, its working mechanism remains unclear. This study ...explored physiological correlates of eye movements during EMDR in relation to current hypotheses; distraction, conditioning, orienting response activation, and REM-like mechanisms. During EMDR therapy, fingertip temperature, heart rate, skin conductance, expiratory carbon dioxide level, and blood pulse oximeter oxygen saturation, were measured in male subjects with PTSD. The ratio between the low and high frequency components of the heart rate power spectrum (LF/HF) were computed as measures of autonomic balance. Respiratory rate was calculated from the carbon dioxide trace. Stimulation shifted the autonomic balance as indicated by decreases in heart rate, skin conductance and LF/HF-ratio, and an increased finger temperature. The breathing frequency and end-tidal carbon dioxide increased; oxygen saturation decreased during eye movements. In conclusion, eye movements during EMDR activate cholinergic and inhibit sympathetic systems. The reactivity has similarities with the pattern during REM-sleep.
In posttraumatic stress disorder (PTSD), physiological reactions during trauma scripts have been anchored to the diagnosis. According to the construct of research domain criteria, physiological ...reactions and self-rating scales could be used to evaluate treatment effects.
In the present study, self-rated PTSD symptoms combined with physiological reactions during trauma script were used as outcome measurements in the domain of arousal/regulatory systems in a controlled randomised study of Group Music and Imagery (GrpMI) treatment for females with PTSD or complex posttraumatic stress disorder (CPTSD) related to violence and/or sexual abuse.
45 traumatised women were randomised to 12 weeks of active treatment or waiting. Before and after the intervention, an assessment was done using physiological measurements during script-driven imagery (SDI) procedures. Subjective Units of Distress (SUD) were collected immediately after the trauma script (TS). Reactions during the SDI procedure were reported using the Responses to Script Driven Imagery (RSDI) scale, measuring re-experiencing, avoidance, and dissociation. Self-reported PTSD symptoms were accessed using the PTSD checklist for DSM-5 (PCL-5). Heart rate (HR), heart rate variability (HRV), and electrodermal activity were sampled during the baseline (BL) and TS conditions of the SDI procedure. As a measure of trauma-related reactivity, the difference between TS and BL was used for statistical calculations. HRV measures included high (HF; 0.15-0.4 Hz) and low (LF; 0.03-0.15 Hz) frequency band power, the LF/HF ratio, and the root mean square of successive inter-beat differences (RMSSD). Measures of electrodermal activity included skin conductance levels (SCL) and frequencies of non-specific skin conductance responses (NS-SCR). Further, correlations between self-rated PTSD symptoms and physiological reactivity measures were analysed.
During the TS, the absolute levels of HR, LF/HF-ratio, and NS-SCR, as well as the trauma-related reactivity of HR, RMSSD, HF, LF/HF-ratio, SCL, and NS-SCR, showed significant changes indicating decreased arousal during trauma script after treatment. Compared to the waitlist control, an interaction analysis showed significant treatment effects in the BL level of HR, the absolute TS level of HR and HF, and the trauma-related reactivity of RMSSD and HF, suggesting an improvement of vagal function in the treatment group. Significant treatment-related reductions were found in symptoms of PTSD, re-experiencing and avoidance, as well as SUD. The changes pre- to post-treatment in HR reactivity and self-rated PTSD symptoms correlated significantly. Furthermore, the initial HR reactivity predicted treatment outcome as measured with PCL-5.
In the evaluation of treatment methods for PTSD, a combination of self-report and physiological measures seems to be feasible. The physiological measures, in combination with a robust decrease in self-rated PTSD symptoms, indicate that trauma-focused GrpMI is a promising treatment for PTSD or CPTSD. More studies are needed to confirm the results, and further research comparing with other active treatments is necessary to establish the precise role of the treatment.
Women with a history of physical, sexual, and/or emotional abuse often suffer from post-traumatic stress disorder (PTSD) or complex posttraumatic stress disorder (CPTSD). Meta-analyses report that ...cognitive behavioural therapies (CBTs), followed by eye movement desensitization and reprocessing (EMDR) are the most studied psychotherapies for trauma treatment. Focus primarily lies on individual therapy – even though some studies on group therapy for trauma treatment also exist. Few studies exist regarding other alternative therapy forms, such as art-based psychotherapies or body-focused therapies.
This study investigated effects from the group music and imagery (GrpMI) method – a type of receptive music therapy – on trauma-related symptoms in women suffering from PTSD or CPTSD after physical, psychological, and/or sexual abuse.
Using a randomized controlled parallel-group design, a sample of 45 women were either assigned to a treatment group (T) who received 12 weekly treatment sessions of GrpMI or to a waiting list control group (WLC). Self-report scales were administered immediately before and after the intervention and at a three-month follow-up
A two-way mixed ANOVA showed a large group-by-time interaction effect on PTSD symptom severity (F(1, 42) = 8.68, p = .005 and Cohen's d = 0.94). A repeated-measures ANOVA showed a large effect within the T group (F(1, 20) = 16.6, p = .001, dav = 1.02), and the improvement remained at follow-up. The drop-out rate in the T group was as low as 4.5%.
The findings suggest that GrpMI may be efficacious for treating women with PTSD/CPTSD, but further controlled studies with larger samples are warranted. The study is registered at ClinicalTrials.gov (Registration number: NCT03503526)
IntroductionPerinatal complications, such as perinatal depression and preterm birth, are major causes of morbidity and mortality for the mother and the child. Prediction of high risk can allow for ...early delivery of existing interventions for prevention. This ongoing study aims to use digital phenotyping data from the Mom2B smartphone application to develop models to predict women at high risk for mental and somatic complications.Methods and analysisAll Swedish-speaking women over 18 years, who are either pregnant or within 3 months postpartum are eligible to participate by downloading the Mom2B smartphone app. We aim to recruit at least 5000 participants with completed outcome measures. Throughout the pregnancy and within the first year postpartum, both active and passive data are collected via the app in an effort to establish a participant’s digital phenotype. Active data collection consists of surveys related to participant background information, mental and physical health, lifestyle, and social circumstances, as well as voice recordings. Participants’ general smartphone activity, geographical movement patterns, social media activity and cognitive patterns can be estimated through passive data collection from smartphone sensors and activity logs. The outcomes will be measured using surveys, such as the Edinburgh Postnatal Depression Scale, and through linkage to national registers, from where information on registered clinical diagnoses and received care, including prescribed medication, can be obtained. Advanced machine learning and deep learning techniques will be applied to these multimodal data in order to develop accurate algorithms for the prediction of perinatal depression and preterm birth. In this way, earlier intervention may be possible.Ethics and disseminationEthical approval has been obtained from the Swedish Ethical Review Authority (dnr: 2019/01170, with amendments), and the project fully fulfils the General Data Protection Regulation (GDPR) requirements. All participants provide consent to participate and can withdraw their participation at any time. Results from this project will be disseminated in international peer-reviewed journals and presented in relevant conferences.
IntroductionThere has been a drastic increase in the reported number of people seeking help for gender dysphoria in many countries over the last two decades. Yet, our knowledge of gender dysphoria ...and related outcomes is restricted due to the lack of high-quality studies employing comprehensive approaches. This longitudinal study aims to enhance our knowledge of gender dysphoria; different aspects will be scrutinised, focusing primarily on the psychosocial and mental health outcomes, prognostic markers and, secondarily, on the underlying mechanisms for its origin.Methods and analysisThe Swedish Gender Dysphoria Study is an ongoing multicentre longitudinal cohort study with 501 registered participants with gender dysphoria who are 15 years old or older. Participants at different phases of their clinical evaluation process can enter the study, and the expected follow-up duration is three years. The study also includes a comparison group of 458 age- and county-matched individuals without gender dysphoria. Data on the core outcomes of the study, which are gender incongruence and experienced gender dysphoria, body satisfaction and satisfaction with gender-affirming treatments, as well as other relevant outcomes, including mental health, social functioning and life satisfaction, are collected via web surveys. Two different research visits, before and after starting on gender-affirming hormonal treatment (if applicable), are planned to collect respective biological and cognitive measures. Data analysis will be performed using appropriate biostatistical methods. A power analysis showed that the current sample size is big enough to analyse continuous and categorical outcomes, and participant recruitment will continue until December 2022.Ethics and disseminationThe ethical permission for this study was obtained from the Local Ethical Review Board in Uppsala, Sweden. Results of the study will be presented at national and international conferences and published in peer-reviewed journals. Dissemination will also be implemented through the Swedish Gender Dysphoria Study network in Sweden.
The populations of gonadotropin-releasing hormone (GnRH)-producing cells within the preoptic area (POA) and terminal nerve (TN) of the brain have been suggested as the neuronal systems mediating ...social control of sex and gonadogenesis in sequentially hermaphroditic teleosts. In the present study, the number and soma size of GnRH-immunoreactive (GnRH-ir) cells in the POA and TN were studied in male, female and juvenile individuals of the dusky anemonefish (Amphiprion melanopus), a species which displays both male to female sex change and socially controlled sexual maturation. The results showed that the number of POA (but not TN) GnRH-ir cells differ significantly between sexual phases, with males displaying higher cell numbers than both females and juveniles. Soma sizes of POA and TN GnRH-ir cells were larger in females than in males and juveniles. However, this relationship was fully explained by differences in body size. The results indicate that high POA GnRH cell numbers are part of a masculinizing mechanism and support the hypothesis that the POA GnRH cell population plays a central role in initiating or mediating the process of socially induced gonadal and/or behavioural transformations in sequential hermaphrodites.
Serotonin (5-hydroxytryptamine, 5-HT) and dopamine (DA) are two major monoamine neurotransmitters with a multitude of functions in the vertebrate brain. In fish, the 5-HT system has been shown to be ...sensitive to various forms of stress, but very few studies have examined the effects of toxic metals on these monoamine systems. Juvenile common carp were exposed to copper levels of 0.22, 0.34 and 0.84 μM during 1 week. In telencephalon, dose-dependent falls in 5-HT and DA levels were observed, with approximately 50% losses of these neurotransmitters at the highest copper concentration. Although less dramatic, falls were also seen in 5-HT and DA levels in hypothalamus and brain stem. No changes in 5-hydroxyindoleacetic acid (5-HIAA, the main 5-HT metabolite), AMP, ADP, ATP, adenylate energy charge or lactate levels were observed in brain. However, lactate levels in blood plasma increased with copper concentration. A significant copper accumulation only occurred in the liver, while no changes in brain or muscle were seen. It is concluded that copper exposure of common carp causes decreased brain 5-HT and DA levels, two neurotransmitters involved in, for example, feeding behaviour and locomotor control in fish. In fact, in telencephalon a fall in 5-HT levels was seen already at a copper concentration below that where food intake and movement were impaired.
