Substance Use Disorders (SUD) are often comorbid with psychological trauma, however, the complex interaction between the two is not yet fully understood. Most addiction-specialized professionals do not engage in exploring past traumatic experiences of the patients due to personal, professional, and educational barriers. Therefore, psychological trauma remains highly undetected and its contribution to the development and maintenance of SUD is neglected. This compromises the therapeutic results of most interventions, with relapse rates in SUD still remaining impressively high. EMDR is one of the most effective interventions for Post-Traumatic Stress Disorder (PTSD), and has been applied to other disorders that are often comorbid with trauma, such as psychosis and depression, with promising results. Nevertheless, its application in SUD is still limited. Taken altogether, there is a need to clarify the efficacy of Eye Movement Desensitization and Reprocessing (EMDR) therapy in SUD, as well as the mechanisms of action that mediate its potential therapeutic effects. The aim of this study is to 1) determine the efficacy of EMDR therapy in patients with SUD comorbid with psychological trauma, as well as whether changes in these clinical variables correspond to changes in salivary cortisol levels- a robust marker of the Hypothalamic-Pituitary-Adrenal (HPA) axis; 2) investigate the mechanisms of action of EMDR therapy, paying special attention to the key role that the cerebellum might play in mediating its therapeutic effects.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
64
The first session consists of recording the patient's history. In the second session the therapist evaluates the presence of coping mechanisms of the patient and, if necessary, suggests extra coping techniques. The following sessions are devoted to the reprocessing process. During these sessions, a target memory is identified and processed using EMDR. After a total of 8-10 sessions, it is expected that the patient will have achieved physiological reconciliation, relieved distress, and the ability to reformulate negative beliefs.
treatment as usual for substance use disorders
Hospital Clínic de Barcelona
Barcelona, Barcelona, Spain
time to relapse
Relapse is defined as a return to the addictive behavior, different from a punctual consumption, which is considered as a lapse. This will bee measured by the Time Line Follow Back self-report (TLFB)
Time frame: 2 months
changes in functional connectivity
measured by resting-state fMRI
Time frame: 2 months
percentage of conditioned eyeblink responses (CR)
measured by the Eyeblink Conditioning System
Time frame: 2 months
CR latency, CR onset, and CR amplitude.
measured by the Eyeblink Conditioning System
Time frame: 2 months
Hair and salivary cortisol levels
Comparison of the Area Under the Curve pre and post treatment
Time frame: 2 months
Craving
Self-report measurement
Time frame: 2 months 3 months and 5 months
Total amount of substance consumed during the previous month
measured by the TLFB
Time frame: 2 months, 3 months and 5 months
Changes in depressive symptomatology
measured by Beck's Depression Inventory (BDI)
Time frame: 2 months, 3 months and 5 months
Changes in anxious symptomatology
measured by The State-Trait Anxiety Inventory (STAI)
Time frame: 2 months, 3 months and 5 months
Changes in posttraumatic symptomatology
measured by Clinician-Administered PTSD Scale (CAPS)
Time frame: 2 months, 3 months and 5 months
Changes in global functioning
measured by Functioning Assessment Short Test (FAST)
Time frame: 2 months, 3 months and 5 months
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