HCPC registered psychologists with expertise and experience in neurorehabilitation. We offer services such as neuropsychological assessment NPsych

#NPsychPick of the Month: Applying EMDR therapy with clients who have impaired cognitive abilities, EMDR Therapy Quarterly, Summer 2023

Neuro EMDR: Applying EMDR therapy with clients who have impaired cognitive abilities

Author: Dr Jonathan Hutchins Simon Proudlock

EMDR therapy has been shown to be highly effective and time efficient in addressing trauma memories in both adults and children. However, there are questions about how EMDR can be effective with adults who have experienced a brain injury or are experiencing other cognitive difficulties. This article summarises some of the recent research within the area and proposes adaptations to the standard protocol that can be made to make best use of EMDR therapy in this population.


Within the UK in 2019-2020 there were 356,669 UK admissions to hospital with acquired brain injury (ABI), or any brain injury that has occurred after birth including traumatic brain injury (TBI), stroke or brain tumours, which is a 12% increase since 2005-2006 (Headway, 2023). In 2019, there were approximately 977 TBI admissions per day to UK hospitals, one every 90 seconds. The diagnostic criteria for TBI on the DSM V states that there must be an “impact to the head or other mechanisms of rapid movement or displacement of the brain within the skull with one or more of the following: loss of consciousness, posttraumatic amnesia, disorientation and confusion, neurological signs such as neuroimaging demonstrating injury or a worsening of a pre-existing seizure disorder” (American Psychiatric Association, 2013).

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Helmet use in preventing acute concussive symptoms in recreational vehicle related head trauma. Brain Injury, 2019

Helmet use in preventing acute concussive symptoms in recreational vehicle related head trauma

Marco Daverio, Franz E Babl, Ruth Barker, Dario Gregori, Liviana Da Dalt & Silvia Bressan

Pages 335-341, Brain Injury. Published online: 22 Jan 2018


Objectives: Helmets use has proved effective in reducing head trauma (HT) severity in children riding non-motorised recreational vehicles. Scant data are available on their role in reducing concussive symptoms in children with HT while riding non-motorised recreational vehicles such as bicycles, push scooters and skateboards (BSS). We aimed to investigate whether helmet use is associated with a reduction in acute concussive symptoms in children with BSS-related-HT.

Methods: Prospective study of children <18 years who presented with a BSS related-HT between April 2011 and January 2014 at a tertiary Paediatric Emergency Department (ED).

Results: We included 190 patients. Median age 9.4 years (IQR 4.8–13.8). 66% were riding a bicycle, 23% a push scooter, and 11% a skateboard. 62% were wearing a helmet and 62% had at least one concussive symptom. Multivariate logistic regression analysis adjusting for age, gender, and type of vehicle showed that patients without a helmet presented more likely with headache (adjusted odds-ratio (aOR) 2.54, 95% CI 1.27–5.06), vomiting (aOR 2.16, 95% CI 1.00–4.66), abnormal behaviour (aOR 2.34, 95% CI 1.08–5.06), or the presence of at least one concussive symptom (aOR 2.39, 95% CI 1.20–4.80).

Conclusions: In children presenting to the ED following a wheeled BSS-related HT helmet use was associated with less acute concussive symptoms.

ABBREVIATIONS: aOR, adjusted odds ratio; APHIRST, Australasian Paediatric Head Injury Rules Study; BSS, bicycles, push scooters and skateboards; CI, confidence interval; CT, computed tomography; ED, emergency department; HT, head trauma; IQR, interquartile range; OR, odds ratio; RCH, Royal Children’s Hospital; RV, recreational vehicle.


Neuroscience of Virtual Reality: From Virtual Exposure to Embodied Medicine. Cyberpsychol Behav Soc Netw, 2019

Neuroscience of Virtual Reality: From Virtual Exposure to Embodied Medicine.

Giuseppe Riva, Brenda K. Wiederhold, and Fabrizia Mantovani. Cyberpsychology, Behavior, and Social Networking, Vol. 22, No. 1 Closing Editorial. Published Online:16 Jan 2019



Is virtual reality (VR) already a reality in behavioral health? To answer this question, a meta-review was conducted to assess the meta-analyses and systematic and narrative reviews published in this field in the last twenty-two months. Twenty-five different articles demonstrated the clinical potential of this technology in both the diagnosis and the treatment of mental health disorders: VR compares favorably to existing treatments in anxiety disorders, eating and weight disorders, and pain management, with long-term effects that generalize to the real world. But why is VR so effective?

Here, the following answer is suggested: VR shares with the brain the same basic mechanism: embodied simulations. According to neuroscience, to regulate and control the body in the world effectively, the brain creates an embodied simulation of the body in the world used to represent and predict actions, concepts, and emotions. VR works in a similar way: the VR experience tries to predict the sensory consequences of an individual’s movements, providing to him/her the same scene he/she will see in the real world.

To achieve this, the VR system, like the brain, maintains a model (simulation) of the body and the space around it. If the presence in the body is the outcome of different embodied simulations, concepts are embodied simulations, and VR is an embodied technology, this suggests a new clinical approach discussed in this article: the possibility of altering the experience of the body and facilitating cognitive modeling/change by designing targeted virtual environments able to simulate both the external and the internal world/body.

Direct Electrical Stimulation of Lateral Orbitofrontal Cortex Acutely Improves Mood in Individuals with Symptoms of Depression

Direct Electrical Stimulation of Lateral Orbitofrontal Cortex Acutely Improves Mood in Individuals with Symptoms of Depression, Vikram R. Rao, Kristin K. Sellers, Deanna L. Wallace, Maryam M. Shanechi, Heather E. Dawes, Edward F. Chang. Current Biology. Published: November 29, 2018


Mood disorders cause significant morbidity and mortality, and existing therapies fail 20%–30% of patients. Deep brain stimulation (DBS) is an emerging treatment for refractory mood disorders, but its success depends critically on target selection. DBS focused on known targets within mood-related frontostriatal and limbic circuits has been variably efficacious.

Here, we examine the effects of stimulation in orbitofrontal cortex (OFC), a key hub for mood-related circuitry that has not been well characterized as a stimulation target. We studied 25 subjects with epilepsy who were implanted with intracranial electrodes for seizure localization. Baseline depression traits ranged from mild to severe. We serially assayed mood state over several days using a validated questionnaire. Continuous electrocorticography enabled investigation of neurophysiological correlates of mood-state changes. We used implanted electrodes to stimulate OFC and other brain regions while collecting verbal mood reports and questionnaire scores.

We found that unilateral stimulation of the lateral OFC produced acute, dose-dependent mood-state improvement in subjects with moderate-to-severe baseline depression. Stimulation suppressed low-frequency power in OFC, mirroring neurophysiological features that were associated with positive mood states during natural mood fluctuation. Stimulation potentiated single-pulse-evoked responses in OFC and modulated activity within distributed structures implicated in mood regulation. Behavioral responses to stimulation did not include hypomania and indicated an acute restoration to non-depressed mood state.

Together, these findings indicate that lateral OFC stimulation broadly modulates mood-related circuitry to improve mood state in depressed patients, revealing lateral OFC as a promising new target for therapeutic brain stimulation in mood disorders.


Perceived Post-traumatic Growth May Not Reflect Actual Positive Change: A Short-term Prospective Study of Relationship Dissolution

Perceived post-traumatic growth may not reflect actual positive change: A short-term prospective study of relationship dissolution, Meghan Owenz, Blaine J. Fowers. Journal of Social and Personal Relationships. Article first published online: November 19, 2018.


Romantic relationship breakups induce significant distress, which has prompted interest in the possibility of post-traumatic growth (PTG) following relationship dissolution. However, most studies have relied on retrospective self-reports of growth, raising questions about the actuality of growth following breakup. 

This prospective study assessed relationship quality prior to breakup, measured growth over time, included a comparison group that did not experience breakup, and tested rival hypotheses to assess PTG in comparison with positive reappraisal (PR). College students (N = 599) in romantic relationships were recruited as participants and assessed at two time points approximately 10 weeks apart. The primary sample includes participants who experienced a relationship breakup (N = 100).

Results indicated that, following a breakup, participants reported a high degree of breakup distress and perceived growth. The pattern of results suggests that reports of perceived PTG may reflect PR processes, as evidenced by the correlation between optimism at Time 1 and perceived, but not actual, PTG at Time 2. 

Consistent with previous prospective research, but differing from much of the retrospective research, a measure of “actual growth” was unrelated to distress, perceived growth, or whether the individual experienced a breakup. The results corroborate research suggesting that retrospective reports of PTG may not reflect actual personal growth measured before and after a traumatic event.

The Surprisingly Powerful Influence of Drawing on Memory

The Surprisingly Powerful Influence of Drawing on Memory by Myra A. Fernandes, Jeffrey D. Wammes, Melissa E. Meade. First Published August 30, 2018.

Abstract: The colloquialism “a picture is worth a thousand words” has reverberated through the decades, yet there is very little basic cognitive research assessing the merit of drawing as a mnemonic strategy. In our recent research, we explored whether drawing to-be-learned information enhanced memory and found it to be a reliable, replicable means of boosting performance. Specifically, we have shown this technique can be applied to enhance the learning of individual words and pictures as well as textbook definitions. In delineating the mechanism of action, we have shown that gains are greater from drawing than other known mnemonic techniques, such as semantic elaboration, visualization, writing, and even tracing to-be-remembered information. We propose that drawing improves memory by promoting the integration of elaborative, pictorial, and motor codes, facilitating the creation of a context-rich representation. Importantly, the simplicity of this strategy means it can be used by people with cognitive impairments to enhance memory, with preliminary findings suggesting measurable gains in performance in both normal aging individuals and patients with dementia.

Retrograde Personal Semantic Memory During Post-Traumatic Amnesia and Following Emergence

Retrograde Personal Semantic Memory During Post-Traumatic Amnesia and Following Emergence. Caroline M. Roberts, Gershon Spitz, Matthew Mundy and Jennie L. Ponsford. Journal of the International Neuropsychological Society. Volume 24, Issue 10 November 2018, pp. 1064-1072.

Objectives: Anecdotal reports suggest that following traumatic brain injury (TBI) retrograde memories are initially impaired and recover in order of remoteness. However, there has been limited empirical research investigating whether a negative gradient in retrograde amnesia—relative preservation of remote over recent memory—exists during post-traumatic amnesia (PTA) compared with the acute phase post-emergence. This study used a repeated-measures design to examine the pattern of personal semantic (PS) memory performance during PTA and within two weeks of emergence to improve understanding of the nature of the memory deficit during PTA and its relationship with recovery.

Methods: Twenty patients with moderate-severe TBI and 20 healthy controls (HCs) were administered the Personal Semantic Schedule of the Autobiographical Memory Interview. The TBI group was assessed once during PTA and post-emergence. Analysis of variance was used to compare the gradient across lifetime periods during PTA relative to post-emergence, and between groups.

Results: PS memory was significantly lower during PTA than post-emergence from PTA, with no relative preservation of remote memories. The TBI group was still impaired relative to HCs following emergence from PTA. Lower overall PS memory scores during PTA were associated with increased days to emerge from PTA post-interview.

Conclusions: These results suggest a global impairment in PS memory across lifetime periods particularly during PTA, but still present within 2 weeks of emergence from PTA. PS memory performance may be sensitive to the diffuse nature of TBI and may, therefore, function as a clinically valuable indicator of the likely time to emerge from PTA. (JINS, 2018, 24, 1064–1072).


Mental Health Mobile Phone App Usage, Concerns, and Benefits Among Psychiatric Outpatients: Comparative Survey Study

Torous J, Wisniewski H, Liu G, Keshavan M. (2018). Mental Health Mobile Phone App Usage, Concerns, and Benefits Among Psychiatric Outpatients: Comparative Survey Study. JMIR Ment Health 2018;5(4):e11715.

A total of 113 patients at the private insurance clinic and 73 at the state DMH clinic completed the survey. Those in the private insurance clinic were more likely to download a mental health app compared to the state DMH clinic, but actual rates of reported current app usage were comparable at each clinic, approximately 10%.

Conclusions: High interest in mental health apps does not automatically translate into high use. Patients may require continuous support in using relevant health apps.


Association of Concussion With the Risk of Suicide

Michael Fralick, Eric Sy, Adiba Hassan, et al. (2018). Association of Concussion With the Risk of Suicide. A Systematic Review and Meta-Analysis. JAMA Neurol. Published online November 12, 2018.

Systematic review and meta-analysis found a 2-fold higher risk of subsequent suicide among more than 700 000 patients diagnosed with concussion and/or mild TBI, compared with more than 6.2 million individuals who had not been so diagnosed. Experiencing concussion and/or mild TBI was also associated with a higher risk of suicide attempt and suicidal ideation.

These results suggest that experiencing concussion and/or mild TBI is associated with an increased risk of suicide.


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