BPD and Psychosis Disorders: Two Emerging Fields for EMDR Research

Borderline personality disorder (BPD) is associated with significant levels of impairment, comorbidity with other disorders, and considerable need for health care resources. The symptoms of BPD range from instability of interpersonal relationships and self-image disturbances to impulsivity and suicidal tendencies. Individuals diagnosed with BPD can experience constant distress, as it is one of the most intrusive personality disorders. Due to neurobiological abnormalities affecting social cognition and attachment, individuals can have an underlying vulnerability to interpersonal and social stressors. Under challenging conditions, they are unable to regulate their feelings and return quickly to baseline emotional states.

Trauma experts have stated that BPD could be a complex variation of PTSD. Comorbidity between PTSD and BPD is very high and there is growing motivation among clinicians to provide PTSD treatments – such as Eye Movement Desensitisation and Reprocessing (EMDR) – to clients experiencing PTSD and comorbid BPD. Providing Online EMDR can be a successful treatment model to use with BPD. There is currently a high demand for EMDR in Melbourne.

The Adaptive Information Processing (AIP) model offers a conceptual basis for understanding how important biographical information regarding childhood experiences can be related to particular features of adult psychopathology, but it also provides an exceptional therapeutic framework for a disorder that is related to disturbing and traumatic early experiences.

A 2003 US prospective study analysed potential factors linked to the rapid remission observed in 10% of the subject’s experiencing BPD in a larger study on personality disorders (2000). The 2003 study showed that the reduction of symptoms and of the situational stress could be associated with the rapid improvements. Therefore, it is logical to expect that addressing these factors through psychotherapy could lead to positive effects. However, it is also true that the majority of individuals experiencing BPD find remission difficult.

In the past few years, the treatment of PTSD in individuals experiencing personality disorders was researched in the Netherlands (2019). The results are relevant, especially since the efficacy of the treatment did not differ between subjects with BPD and other personality disorders. After completing the therapy sessions, the participants reported a considerable alleviation of their PTSD, insomnia, and dissociation symptoms, with 40% no longer meeting the criteria for a PTSD diagnosis. However, the treatment was completed by 68% of the participants. Although these results can be regarded as encouraging, it is worth noting that the study was conducted on a few numbers of individuals.

We will further discuss a 2007 clinical case study whose subject was Linda, a woman who with BPD and major depressive disorder with severe anxiety. Over the course of 6 months in which she attended 20 EMDR therapy sessions, Linda’s main objective was the alleviation of raging outbursts, relationship conflicts, insecurities, depression, and panic and anxiety. The first phase of the EMDR treatment is particularly important, as it can provide affect management skills. In the beginning, the client was taught and encouraged to use diverse relaxation strategies, which can be particularly efficacious between sessions and at the end of incomplete sessions.

Linda identified 10 main painful events in her life which were targeted in chronological order, in accordance with the EMDR treatment protocol. As the focus shifted to the recent events, they were no longer regarded as disturbing by the client and didn’t have to be addressed directly. After reprocessing all the key events discussed during the sessions, the client’s overall functioning improved significantly. The EMDR therapy sessions lead to positive effects, such as the reduction of tension levels, improvements in self-awareness, the development of a more realistic perception of interpersonal relationships, and improved affect control. This clinical case study provides preliminary evidence for the efficacy of EMDR in treating BPD, and it proposes EMDR therapy as an adjunct to Dialectical Behavioural Therapy (DBT). Since DBT is the most effective form of therapy used in treating BPD patients, this concept might lead to the development of a more successful therapeutic approach. However, future research is needed in order to learn whether integrated EMDR-DBT would generate positive results or not. The case study was done in-person but there is a growing body of clinical evidence suggest the effectiveness of using EMDR online.

Besides the growing interest in BPD-focused EMDR therapy and its potential, great interest is also being taken in psychosis-focused EMDR. For instance, a 2014 study researched the effects of EMDR therapy as a potential psychological treatment for individuals experiencing psychosis-related imagery. Three psychotic outpatients from both auditory hallucinations and delusions subjected their negative imagery to 6 sessions (on average) of EMDR. This treatment seemed to reduce anxiety and depression levels, as well as the severity of psychotic symptoms. Additionally, the patients reported a reduction in avoidant behavior and improved cognitive awareness. The results of this study showed that EMDR could potentially reduce the emotionality and vividness of psychosis imagery, thus alleviating the psychotic symptoms of the patients. In order to confirm the accuracy of these findings, further RCTs have to be conducted.

A 2011 pilot study conducted in the Netherlands showed rewarding results in terms of EMDR-treated PTSD in individuals suffering from psychotic disorders. The approach led to positive effects related to anxiety symptoms, verbal hallucinations, delusions, self-esteem, and depression symptoms. It is worth mentioning that the EMDR treatment did not generate any adverse events, such as aggressive behavior, suicide attempts, or self-harm. On the other hand, the feelings of hopelessness and the paranoid ideation were not significantly alleviated. Even so, these open trial results showed that it is safe and effective to treat PTSD in individuals suffering from the schizophrenia spectrum disorder by using EMDR. There is also potential for delivering Online EMDR in this modality to those in Melbourne are other states.

Although extensive research on EMDR therapy in treating psychosis still needs to be conducted, the first studies show fruitful and promising results regarding the addition of trauma-focused treatments to the resources used in treating clients with psychotic disorders. Thus, EMDR therapy deserves to have a place in psychosis research and care. However, an essential precondition for producing beneficial effects is that mental healthcare professionals and researchers overcome their own hesitations and start evaluating and implementing empirically validated trauma-focused treatments for psychosis and trauma-based symptomatology.

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