EMDR Flash Forward as an intervention on the mental images of worst case scenarios in paranoid delusions

With psychosis there is a changed experience of reality, which influences
perception, thinking and emotions. One of the psychotic symptoms is the
presence of delusions. It is assumed that delusions are being developed to
explain strange experiences and striking signals within psychosis on the basis
of available knowledge and experience. The associated, intense emotions are a
determining factor for the development and persistence of the delusion.
Attention is often focused, the available information is perceived selectively
and as a result the fear is mainly reinforced. The danger that one fears, can
persist in imposing a worst case scenario on the patient in the form of a
terrifying image. Correction of false delusions does not occur because of the
persistence of avoidance behavior aimed at preventing this worst case scenario.
The intrusive image of the expected worst case scenario can be considered as a
mental representation. Disturbing mental representations are effectively
treated with Eye Movement Desensitisation and Reprocessing (EMDR), even in
people with psychosis, when it comes to traumatic experiences in the past
(flashbacks). The idea that mental representations that take place in the
future (flash forwards) can also be treated with this technique, is elaborated
in the EMDR Flash Forward protocol. Where is can be considered an effective
treatment method for various anxiety disorders. Logically one could assume that
the mental representations associated with paranoid delusions can therefore be
edited by the EMDR Flash Forward, in order to reduce the anxious disturbance
associated with the delusion. As a longer term consequence it can be assumed
that the patient is less preoccupied with the delusional belief, can let go of
safety behavior and be better able to organize his life more satisfactorily.

Primary Objective: Investigate whether EMDR Flash Forward is an effective
intervention to process the mental images of worst case scenarios that occur in
paranoid delusions, in order to decreases the preoccupation with the delusion.

Secondary Objective: Investigate whether the patient is less inclined to avoid
situations caused by the paranoid delusion in his/her daily life if he/she is
less preoccupied with the worst case scenario*s (after the intervention on the
mental images).

The present study is a 19-week pilot waiting list-control effect study. A
within-subject design is used, so the group of participants can serve as their
own control group, by using the waiting list time for this purpose. The
advantage of this design is that the N in this study with an effect size of 0.5
can be limited to 34. To compensate for an expected dropout of around 20%, a
total of 40 participants will be included.

Participants are treated for 6 weeks, once a week, with EMDR Flash Forward, a
variant of EMDR (Eye Movement Desensitization and Reprocessing), focused on the
worst case scenarios associated with the paranoid delusion.

In the case of treatment with EMDR, the test subjects may experience side
effects two to three days after a treatment session, for example physical
complaints such as headache, physical tension, mental tension complaints or a
temporary increase in psychotic symptoms. However, Van den Berg's research
(2017) shows that in patients with psychotic disorders such complaints do not
occur more or more frequently in EMDR treatment than in typical Cognitive
Behavioral Therapy proposed in the guidelines.