The Effect of Eye Movement Desensitization and Reprocessing (EMDR) on the severity of suicidal thoughts in patients with major depressive disorder: a randomized controlled trial

Zhila Fereidouni, Mohammad Behnammoghadam, Abdolhadi Jahanfar, Azizallah Dehghan, Zhila Fereidouni, Mohammad Behnammoghadam, Abdolhadi Jahanfar, Azizallah Dehghan

Abstract

Objective: Depression is a major risk factor for suicide and more than 90% of people who attempt suicide suffer from depression. The present study aimed to investigate the effect of eye movement desensitization and reprocessing (EMDR) therapy on the severity of suicidal thoughts in patients with major depressive disorder.

Study design: Randomized Clinical Trial.

Methods: This clinical trial was performed on 70 people with major depressive disorder who exhibited suicidal thoughts. The patients were selected via convenience sampling and were randomly divided into control (n=35) and experimental (n=35) groups. EMDR was performed individually in the experimental group for 45-90 min, 3 days per week, on alternate days, for 3 weeks (9 sessions in total), whereas the controls group received routine treatment without intervention. Both groups completed the Beck Scale for Suicide Ideation (BSSI) at pre- and post-test. The obtained data were analyzed with descriptive and inferential statistics using SPSS 22 (α=0.05).

Results: Mean BSSI score for the experimental group was reduced significantly at post-test (11.11±4.15) compared to pre-test (26.48±5.74) (p<0.001). Although the control group's mean BSSI score was also reduced at post-test (24.93±4.42) compared to pre-test (26.68±5.05), this difference was not statistically significant (p>0.05).

Conclusion: EMDR therapy has been shown in this study to reduce the severity of suicidal feelings. Therefore, it can be recommended as an alternative treatment method for reducing the severity of suicidal thoughts in patients with major depressive disorder.

Keywords: eye movement desensitization and reprocessing; major depressive disorder; suicidal thoughts.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2019 Fereidouni et al.

Figures

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Figure 1
Consort flow diagram.

References

    1. Health QO. Psychotherapy for major depressive disorder and generalized anxiety disorder. AHealth Technol Assess Ontario Health Technol Assess Ser. 2017;17(15):1.
    1. Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289(23):3095–3105. doi:10.1001/jama.289.23.3095
    1. Han C, Wang SM, Lee SJ, Jun TY, Pae CU. Optimizing the use of aripiprazole augmentation in the treatment of major depressive disorder: from clinical trials to clinical practice. Chonnam Med J. 2015;51(2):66–80. doi:10.4068/cmj.2015.51.2.66
    1. Bromet E, Andrade LH, Hwang I, et al. Cross-national epidemiology of DSM-IV major depressive episode. BMC Med. 2011;9(1):90. doi:10.1186/1741-7015-9-90
    1. Sadeghirad B, Haghdoost AA, Amin-Esmaeili M, et al. Epidemiology of major depressive disorder in Iran: a systematic review and meta-analysis. Int J Prev Med. 2010;1(2):81.
    1. Sajjadi H, Kamal SHM, Rafiey H, Vameghi M, Forouzan AS, Rezaei M. A systematic review of the prevalence and risk factors of depression among iranian adolescents. Glob J Health Sci. 2013;5(3):16. doi:10.5539/gjhs.v5n3p16
    1. Cassidy S, Bradley P, Robinson J, Allison C, McHugh M, Baron-Cohen S. Suicidal ideation and suicide plans or attempts in adults with Asperger’s syndrome attending a specialist diagnostic clinic: a clinical cohort study. Lancet Psychiatry. 2014;1(2):142–147. doi:10.1016/S2215-0366(14)70248-2
    1. Reynolds CF III, Cuijpers P, Patel V, et al. Early intervention to reduce the global health and economic burden of major depression in older adults. Annu Rev Public Health. 2012;33(1):123–135. doi:10.1146/annurev-publhealth-031811-124544
    1. Chesney E, Goodwin GM, Fazel S. Risks of all‐cause and suicide mortality in mental disorders: a meta‐review. World Psychiatry. 2014;13(2):153–160. doi:10.1002/wps.20128
    1. Ballard ED, Ionescu DF, Voort JLV, et al. Improvement in suicidal ideation after ketamine infusion: relationship to reductions in depression and anxiety. J Psychiatr Res. 2014;58:161–166. doi:10.1016/j.jpsychires.2014.07.027
    1. Tullis KF, Westscott CL, Winton TR. 2003. A theory on the use of cognitive behavioral therapy (CBT) plus eye movement desensitization and reprocessing (EMDR) to reduce suicidal thoughts in childhood trauma victims In: Tullis’s KF, editor. The Courage to Live Workbook. Memphis: KFT Press; Avalaible from:
    1. Lopez-Castroman J, Jaussent I, Beziat S, et al. Posttraumatic stress disorder following childhood abuse increases the severity of suicide attempts. J Affect Disord. 2015;170:7–14. doi:10.1016/j.jad.2014.08.010
    1. Johnston AK, Pirkis JE, Burgess PM. Suicidal thoughts and behaviours among Australian adults. findings from the 2007 National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry. 2009;43(7):635–643. doi:10.1177/1073191105274925
    1. Bentley KH, Franklin JC, Ribeiro JD, Kleiman EM, Fox KR, Nock MK. Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: a meta-analytic review. Clin Psychol Rev. 2016;43:30–46. doi:10.1016/j.cpr.2015.11.008
    1. Baker SP, Hu G, Wilcox HC, Baker TD. Increase in suicide by hanging/suffocation in the US, 2000–2010. Am J Prev Med. 2013;44(2):146–149. doi:10.1016/j.amepre.2012.10.010
    1. Karamouzian M, Rostami M. Suicide statistics in Iran: let’s get specific. Am J Men’s Health. 2019;13(1):1557988318807079. doi:10.1177/1557988318807079
    1. Park S-M, Cho S-i, Moon -S-S. Factors associated with suicidal ideation: role of emotional and instrumental support. J Psychosom Res. 2010;69(4):389–397. doi:10.1016/j.jpsychores.2010.03.002
    1. McAuliffe CM. Suicidal ideation as an articulation of intent: a focus for suicide prevention? Arch Suicide Res. 2002;6(4):325–338. doi:10.1080/13811110214524
    1. Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry. 1999;56(7):617–626. doi:10.1001/archpsyc.56.7.617
    1. Amick HR, Gartlehner G, Gaynes BN, et al. Comparative benefits and harms of second generation antidepressants and cognitive behavioral therapies in initial treatment of major depressive disorder: systematic review and meta-analysis. BMJ. 2015;351:h6019. doi:10.1136/bmj.h6019
    1. Hammad TA, Laughren T, Racoosin J. Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry. 2006;63(3):332–339. doi:10.1001/archpsyc.63.3.332
    1. McHugh RK, Whitton SW, Peckham AD, Welge JA, Otto MW. Patient preference for psychological vs. pharmacological treatment of psychiatric disorders: a meta-analytic review. J Clin Psychiatry. 2013;74(6):595. doi:10.4088/JCP.12r07757
    1. Merlis DT. Eye Movement Desensitization and Reprocessing (EMDR) Therapy: Basic Principles, Protocols, and Procedures. Springer; 2018:87–88. doi:10.1891/1933-3196.12.2.87
    1. Shapiro F. Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. J Trauma Stress. 1989;2(2):199–223. doi:10.1891/1933-3196.8.4.181
    1. Zeighami R, Behnammoghadam M, Moradi M, Bashti S. Comparison of the effect of eye movement desensitization reprocessing and cognitive behavioral therapy on anxiety in patients with myocardial infarction. Eur J Psychiatry 2018;32(2):72–76. doi:10.1016/j.ejpsy.2017.09.001
    1. Gao K, Su M, Sweet J, Calabrese JR. Correlation between depression/anxiety symptom severity and quality of life in patients with major depressive disorder or bipolar disorder. J Affect Disord. 2019;244(1):9–15. doi:10.1016/j.jad.2018.09.063
    1. van Spijker BA, van Straten A, Kerkhof AJ, Hoeymans N, Smit F. Disability weights for suicidal thoughts and non-fatal suicide attempts. J Affect Disord. 2011;134(1–3):341–347. doi:10.1016/j.jad.2011.05.020
    1. Gauhar YWM. The efficacy of EMDR in the treatment of depression. J EMDR Pract Res. 2016;10(2):59–69. doi:10.1891/1933-3196.10.2.59
    1. Solvason H, Husain M, Fitzgerald P, et al. Improvement in quality of life with left prefrontal transcranial magnetic stimulation in patients with pharmacoresistant major depression: acute and six month outcomes. Brain Stimul. 2014;7(2):219–225. doi:10.1016/j.brs.2013.10.008
    1. Beck AT, Kovacs M, Weissman A. Assessment of suicidal intention: the Scale for Suicide Ideation. J Consult Clin Psychol. 1979;47(2):343. doi:10.1037/0022-006X.47.2.343
    1. de Beurs DP, Fokkema M, de Groot MH, de Keijser J, Kerkhof AJ. Longitudinal measurement invariance of the Beck Scale for Suicide Ideation. Psychiatry Res. 2015;225(3):368–373. doi:10.1016/j.psychres.2014.11.075
    1. Healy DJ, Barry K, Blow F, Welsh D, Milner KK. Routine use of the Beck Scale for Suicide Ideation in a psychiatric emergency department. Gen Hosp Psychiatry. 2006;28(4):323–329. doi:10.1016/j.genhosppsych.2006.04.003
    1. Holden RR, DeLisle MM. Factor analysis of the Beck Scale for Suicide Ideation with female suicide attempters. Assessment. 2005;12(2):231–238. doi:10.1177/1073191105274925
    1. Esfahani M, Hashemi Y, Alavi K. Psychometric assessment of beck scale for suicidal ideation (BSSI) in general population in Tehran. Med J Islam Repub Iran. 2015;29:268.
    1. Solomon RM, Shapiro F. EMDR and the adaptive information processing modelpotential mechanisms of change. J EMDR Pract Res. 2008;2(4):315–325. doi:10.1891/1933-3196.2.4.315
    1. Shapiro F. EMDR therapy humanitarian assistance programs: treating the psychological, physical, and societal effects of adverse experiences worldwide. J EMDR Pract Res. 2014;8(4):181. doi:10.1891/1933-3196.8.4.181
    1. Rostaminejad A, Behnammoghadam M, Rostaminejad M, Behnammoghadam Z, Bashti S. Efficacy of eye movement desensitization and reprocessing on the phantom limb pain of patients with amputations within a 24-month follow-up. Int J Rehabil Res. 2017;40(3):209–214. doi:10.1097/MRR.0000000000000227
    1. Van der Kolk BA. The body keeps the score: memory and the evolving psychobiology of posttraumatic stress. Harv Rev Psychiatry. 1994;1(5):253–265.
    1. McLaughlin DF, McGowan IW, Paterson MC, Miller PW. Cessation of deliberate self harm following eye movement desensitisation and reprocessing: a case report. Cases J. 2008;1(1):177. doi:10.1186/1757-1626-1-177
    1. Spector J, Kremer S. Can I use EMDR with clients who report suicidal ideation? J EMDR Pract Res. 2009;3(2):107. doi:10.1891/1933-3196.3.2.107

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