Aim: There is an extensive body of research examining the efficacy of Eye-Movement Desensitization Reprocessing (EMDR) therapy in treatment of Post-traumatic Stress Disorder (PTSD). This systematic narrative review aimed to systematically, and narratively, review robust evidence from Randomized-Controlled Trials examining the efficacy of EMDR therapy. Method: Eight databases were searched to identify studies relevant to the study aim. Two separate systematic searches of published, peer-reviewed evidence were carried out, considering relevant studies published prior to April 2017. After exclusion of all irrelevant, or non-robust, studies, a total of two meta-analyses and four Randomized-Controlled Trials were included for review. Results: Data from meta-analyses and Randomized-Controlled Trials included in this review evidence the efficacy of EMDR therapy as a treatment for PTSD. Specifically, EMDR therapy improved PTSD diagnosis, reduced PTSD symptoms, and reduced other trauma-related symptoms. EMDR therapy was evidenced as being more effective than other trauma treatments, and was shown to be an effective therapy when delivered with different cultures. However, limitations to the current evidence exist, and much current evidence relies on small sample sizes and provides limited follow-up data. Conclusions: This systematic narrative review contributes to the current evidence base, and provides recommendations for practice and future research. This review highlights the need for additional research to further examine the use of EMDR therapy for PTSD in a range of clinical populations and cultural contexts.

Eating disorders comorbid with depression are an established risk factor for suicide. In this study, we aimed to determine the effects of binge eating (BE) symptoms on suicidality and related clinical characteristics in major depressive disorder (MDD). A total of 817 community participants with MDD were included. We compared two groups (with and without lifetime BE symptoms). The MDD with BE group was subdivided into a frequent BE (FBE) subgroup (BE symptoms greater than twice weekly) and any BE (ABE) subgroup (BE symptoms greater than twice weekly). The MDD with BE group comprised 142 (17.38%) patients. The FBE and ABE subgroups comprised 75 (9.18%) and 67 (8.20%) patients, respectively. Comorbid alcohol use disorder, anxiety disorder, post-traumatic stress disorder (PTSD) and history of suicide attempt were significantly more frequent in the MDD with BE group than MDD without BE group. Sexual trauma was also reported more frequently in MDD with BE group. No significant differences were observed between the ABE and FBE subgroups. Multivariate logistic regression revealed an association of suicide attempt with BE symptoms and sexual trauma. Structural equation modeling showed that sexual trauma increased BE (β = 0.337, P <0.001) together with alcohol use (β = 0.185, P <0.001) and anxiety (β = 0.299, p<0.001), which in turn increased suicide attempt (β = 0.087, p = 0.011). BE symptoms were associated with suicide attempt in MDD after adjusting for other factors associated with suicidality. BE symptoms also moderated an association between suicide attempt and sexual trauma.

Non-pharmacological treatments of stress-induced disorders are promising, since they enhance endogenous stress defense systems and have few contraindications and side effects. This study tested a hypothesis that intermittent hypoxia conditioning (IHC) ameliorates behavioral, biochemical, and morphological signs of experimental PTSD induced in rats using a model of predator stress (10-day exposure to cat urine scent, 15 min daily followed by 14 days of stress-free rest). After the last day of stress exposure, rats were conditioned in an altitude chamber for 14 days at a 1,000 m simulated altitude for 30 min on day 1 with progressively increasing the altitude and duration to 4,000 m for 4 hours on day 5. PTSD was associated with decreased time spent in open arms and increased time spent in closed arms of the elevated X-maze, increased anxiety index, and increased rate of freezing responses. Functional and structural signs of adrenal cortex degeneration were also observed, including decreased plasma corticosterone and weight of adrenal glands, reduced thickness of the fasciculate zone, and hydropic degeneration of adrenal gland cells. The thickness of the adrenal fasciculate zone negatively correlated with the anxiety index. IHC alleviated both behavioral signs of PTSD and morphological evidence of adrenal cortex dystrophy. Also, IHC alone exerted an anti-stress effect, which was evident from the increased time spent in open arms of the elevated x-maze, and a fewer number of rats displaying freezing responses. Therefore, IHC of rats with experimental PTSD reduced behavioral signs of the condition and damage to the adrenal glands.

This paper tells the story of one man's experience of terrifying hallucinations and nightmares in an intensive care unit (ICU), drawing attention to the reality that intensive care treatment induces emotional suffering severe enough to be identified as post-traumatic stress disorder (PTSD). A body of international research, confirmed by South African studies, links life-saving critical care to symptoms which qualify for secondary psychiatric diagnosis including of post-traumatic stress. Risk factors include pre-ICU comorbid psychopathology. Early on in the clinical encounter with the patient in this paper it emerged that he bore the scars of another trauma. He had been a soldier. Recounting the terror he experienced when he was being weaned off mechanical ventilation evoked memories of his military history. Paradoxically, these shifted the focus away from the symptoms of PTSD, to make the helplessness and dependency of ICU patients more visible. This patient's clinical account and patient experiences in other studies reveal the relational vulnerability of ICU patients. In as much as experiences of ICU treatment can be terrifying, the non-response of carers distresses patients. This interplay of wounding and care provides a starting point from which to explore how we account for the neglect of relational care that is a recurring theme in medical contexts, without blaming the carers. These questions find resonance in a South African novel to which the paper refers. A novel about war and trauma movingly portrays the internal conflict of the central character, a nurse and her quest not to care, as a defence against vulnerability. In these ways writing about the relational vulnerability of patients opened up questions about the social and institutional context of carer vulnerability.

Cognitive-behavioural therapy is a first-line treatment for post-traumatic stress disorder (PTSD), but it is difficult to implement in disaster settings. We report the case of an 80-year-old Japanese woman, who was diagnosed with PTSD after the 2011 triple disaster (earthquake, tsunami and nuclear plant accident) in Fukushima. Her recovery was greatly enhanced by the social support she received while living in Idobata-Nagaya community housing, established by Soma city in Fukushima, where residents could naturally discuss their traumatic experiences. Habituation to traumatic memories and processing of cognitive aspects of the psychological trauma, which are therapeutic mechanisms of trauma-focused psychotherapies, spontaneously occurred in this setting. The details of this case support the effectiveness of Idobata Nagaya as a provider of psychological first aid, an evidence-informed approach to assist children, adolescents, adults and families in the aftermath of a disaster.