The influence of Eye Movement treatment on imagery in psychosis

Older and more recent studies have suggested that visual representations
(imagery) play an important role in causing and maintaining psychopathology,
and even psychotic symptoms such as hallucinations and delusions. The greater
the degree of emotionality and vividness of visual representations, the greater
the severity of psychotic experiences could be. It is plausible that blurring
the vividness and emotionality of imagery that maintain and induce psychotic
experiences, could have an effect on the extent and duration of the
preoccupation with psychotic symptoms, the extent and duration of the level of
distress and the severity of the impairments. It would be of clinical interest
to develop en research methods which could fade imagery found in psychotic
disorders. In this study, the intervention eye movement (part of an EMDR
treatment) is researched on its effect on imagery in psychotic disorders.

The objective of this study is to see wether the use of eye movement (EMDR)
reduces the emotionality en vividness of imagery (mental images) above 'recall
only'. This is a first study which may be the predecessor of a larger study, in
which the effect of an EMDR intervention on imagery in psychotic disorders will
be researched.

This is a randomized 'one session' cross over design

During the preparation phase of EMDR, various targets for treatment will be
identified, which involve crucial upsetting memories/images related to the
psychosis (see protocol for defined explanation and procedure). There are four
therapists in this study.Sessions will take up to one our and 30 minutes, due
to the capabilities of the clients. The speed of EMs is I Hz, and will be
presented by movement of the hand as described in the original protocol.
Two interventions will be applied: Recall only -a- (only retrieving the mental
image) and Recall + EMs -b- (retrieving the mental image while simultaniously
undergoing eye movement).

Before treatment the patiets are randomized in two conditions. Condition A
means that the session starts with EMs and followed by recall only. Condition B
means the opposite. Each given intervention will take up from 5 to 10 min. The
interventions will be repeated three times so that each patient has six recall
episodes: three recall only and three recall + EMs. Half of the patients will
receive a reverse condition order (either ab-ab-ab, or ba-ba-ba). Measurement
are taken before and right after a given intervention. Thus, every endpoint is
the starting point of the next initervention.
Before the first and after each following episode, patients will be asked to
recall the target, and to rate its emotional intensity and vividness (see
below). During each of the recall episodes, except for the first, the therapist
will ask the patient, after consecutive periods of 40 seconds: *what comes
up?*, *what is going through your mind?* or *what do you notice?* EMs will be
discontinued during these questions. The answers will not be discussed but are
followed with the suggestion: *concentrate on that, continue with that*, and de
EMs will be continued. After the last recall episode, patients will score their
evaluation of the two treatments.

All cliënts undergo a psychological treatment. This usually results in an
increase of psychological symptoms. The amount of stress that is induces by
this principle is deminished by eye movements. Hereafter starts a phase of
reprocessing, which van lead to new tension. In a EMDR treatment, these side
effect can last up to to or three days. This tension can cause mild physical
complaints like headache, muscular pain or other form of physical tensions or a
temporary increase of psychotic symptoms. Emotional distress like anxiety,
anger or sorrow can also be experienced. This phase is crucial to for the
decrease of burden caused by the intitial complaint. It is af great importance
that when the emotional distress increase to a high level, interventions are
administered accordingly to the distress. This can be in form of medication,
supporting counseling or other crisis interventions from the multidisciplinairy
team or offering admission possibilities. The chance is slightly that these
interventions will have to be initiated. Resuls from previous studies suggests
that patients are well equiped to undrgo an EMDR treatment.