An Efficient System for Eye Movement Desensitization and Reprocessing (EMDR) Therapy: A Pilot Study
Abstract
:1. Introduction
2. Related Work
3. Materials and Methods
3.1. Materials
- Video stimulus using a rendered ball on a graphical display;
- Audio stimulus simulating a moving sound source;
- Tactile stimulation using vibration motors placed on the user using bracelets—stimuli are synchronized to maximize the effectiveness;
- A chatbot for communicating with the user according to the EMDR protocol, allowing the system to function autonomously, i.e., in the absence of a therapist.
3.2. Recruitment
3.3. Procedure
3.4. Instruments
3.4.1. Primary Outcome Measures
3.4.2. Secondary Outcome Measures
4. Results
4.1. Primary Outcome Measures
4.2. Secondary Outcome Measures
5. Discussion
6. Conclusions
- The presence of an AI-driven chatbot, following the eight essential phases of EMDR [10], which can be further enhanced with new dialogue options and evaluation strategies;
- The ability to customize the interaction based on the patient’s characteristics. For example, using different stimulation methods (visual, audio, tactile) makes the EMDR procedure accessible for people with disabilities (severe visual impairment or even blindness, hearing loss);
- The possibility of applying EMDR treatments in a fully unsupervised manner, using the aforementioned chatbot, i.e., the assistance of a trained clinician is not required;
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
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Paper | Advantages | Disadvantages | Differences between Our System and Related Work |
---|---|---|---|
Aleluma Flores et al. [15] | Uses visual, tactile, and auditory therapy. Can be customized. | Implements only the desensitization phase in the EMDR protocol. Used only by psychotherapists/clinicians. The presence of a trained clinician is mandatory, cannot be used independently. | Presence of intelligent chatbot which implements the preparation, evaluation, and ending phases in the EMDR protocol. The system has the potential to be autonomous, the presence of a trained clinician not being mandatory. |
Jeffrey D. Eastman [17] | Visual stimulation can be dynamically adjusted based on feedback from the user. | Only visual and auditory stimuli. Audio is mostly used for playing relaxation sounds, very little information is given about bilateral audio stimulation. Only patent, not validated. | Presence of intelligent chatbot which implements the preparation, evaluation, and ending phases in the EMDR protocol. Audio, video, and tactile-based actuators that make the EMDR system more efficient. |
Gazit et al. [18] | Selection of the intensity of stimuli. | No intelligent chatbot. The system is designed to intermediate the relation between client and clinician and can be used remotely but requires the intervention of a therapist for setting the parameters. | The proposed system has the potential to be autonomous. |
Burgio et al. [19] | Opaque glasses that block light from reaching the eyes and thus prevent simultaneous exposure to other visual stimuli. Uses chemical stimulation. | The system is dependent on the presence of the therapist Different from the standardized EMDR procedure Only patent, not validated. | The proposed system includes an intelligent chatbot offering autonomy. Designed in relation to standardized EMDR procedures. |
Characteristics | Category | n | % |
---|---|---|---|
Age (years) | Mean ± standard deviation | 26.2 ± 4.21 | |
Gender | Male | 14 | 45.2 |
Female | 17 | 54.8 | |
Education | High school diploma | 4 | 12.9 |
College degree | 10 | 32.3 | |
Master’s degree | 15 | 28.4 | |
Doctorate (Ph.D) | 2 | 6.5 | |
Health condition | No treatment in the last 6 months | 23 | 74.2 |
Under treatment in the last 6 months | 8 | 25.8 | |
Months since the traumatic event | Less than 6 months | 1 | 3.2 |
Between 6 and 12 months | 13 | 41.9 | |
Between 12 and 24 months | 6 | 19.4 | |
Between 24 and 36 months | 7 | 22.6 | |
More than 36 months | 4 | 12.9 | |
Criteria for inclusion | (18–40 years of age; at least medium scores on IES-R and STAI) | 31 | 88.5 |
Criteria for exclusion | (Scored very high on both measures; suicidal; taking psychotropic medication; diagnosed psychological condition) | 4 | 11.6 |
The Phase of the Intervention | Description |
---|---|
1. Introduction | Participants were informed about EMDR therapy and how bilateral sensory stimulation helps process traumatic memories. It was mentioned that they could withdraw at any time if they were not comfortable with the procedure. At the same time, the participants went through an adjustment session with bilateral stimulations. |
2. Demographic info | The application requested demographic information (gender and age) and the agreement for participation. |
3. Preparation for accessing the traumatic event | Through intelligent chatbot guiding, the participant was led to access overwhelming emotions that sometimes interfere with their usual activity and primary events recorded in memory associated with overwhelming emotions. The participant was also guided to visualize that event mentally as a movie scene. Once the oldest memory associated with those emotions was identified, the participant was asked to describe it briefly. |
4. Body scanning | The participant was intelligently guided to identify the bodily sensations associated with that event (tension, tremor, cold, heat, pressure, or sounds). The information obtained was noted and recorded by the application. |
5. Identification of negative beliefs | Identification of negative beliefs (about oneself, others, the world, or life in general) caused by the traumatic event. |
6. Emotions and cognitions intensity assessment | Assessment of the intensity of negative cognitions/beliefs and emotions associated with that event (VOC and SUD scale) |
7. Treatment phase | Application of bilateral stimulation (audio, video, and sensory) in several sessions of four minutes each and assessment of the intensity of cognitions and emotions after each session of bilateral stimulation done through the guidance of the chatbot. |
8. Positive cognition identification and installing | Identifying and installing positive cognition through a new session of bilateral stimulation. |
9. Closure | The intelligent chatbot reminds the participant that they can benefit from psychological support. |
10. Feedback | The participant can share their impressions related to the experience of using the application. |
95% CI For Cohen’s D | ||||||
---|---|---|---|---|---|---|
t | df | p | Cohen’s d | Lower | Upper | |
IES-R Pre-, IES-R Post- | 10.521 | 30 | <0.001 | 1.890 | 1.292 | 2.476 |
STAI Pre-, STAI Post- | 11.759 | 30 | <0.001 | 2.112 | 1.469 | 2.744 |
N | Mean | SD | SE | |
---|---|---|---|---|
IES-R Pre- | 31 | 39.806 | 14.077 | 2.528 |
IES-R Post- | 31 | 13.742 | 5.785 | 1.039 |
STAI Pre- | 31 | 56.774 | 8.330 | 1.496 |
STAI Post- | 31 | 33.839 | 4.620 | 0.830 |
t | df | p | |
---|---|---|---|
VOC Pre-, VOC Post - | 14.471 | 30 | <0.001 |
SUD Pre-, SUD Post - | 75.904 | 30 | <0.001 |
N | Mean | SD | SE | |
---|---|---|---|---|
VOC Pre- | 31 | 2.968 | 0.657 | 0.118 |
VOC Post- | 31 | 6.097 | 0.887 | 0.156 |
SUD Pre- | 31 | 9.161 | 0.735 | 0.132 |
SUD Post- | 31 | 0.774 | 0.717 | 0.129 |
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Goga, N.; Boiangiu, C.-A.; Vasilateanu, A.; Popovici, A.-F.; Drăgoi, M.-V.; Popovici, R.; Gancea, I.O.; Pîrlog, M.C.; Popa, R.C.; Hadăr, A. An Efficient System for Eye Movement Desensitization and Reprocessing (EMDR) Therapy: A Pilot Study. Healthcare 2022, 10, 133. https://doi.org/10.3390/healthcare10010133
Goga N, Boiangiu C-A, Vasilateanu A, Popovici A-F, Drăgoi M-V, Popovici R, Gancea IO, Pîrlog MC, Popa RC, Hadăr A. An Efficient System for Eye Movement Desensitization and Reprocessing (EMDR) Therapy: A Pilot Study. Healthcare. 2022; 10(1):133. https://doi.org/10.3390/healthcare10010133
Chicago/Turabian StyleGoga, Nicolae, Costin-Anton Boiangiu, Andrei Vasilateanu, Alexandru-Filip Popovici, Marius-Valentin Drăgoi, Ramona Popovici, Ionatan Octavian Gancea, Mihail Cristian Pîrlog, Ramona Cristina Popa, and Anton Hadăr. 2022. "An Efficient System for Eye Movement Desensitization and Reprocessing (EMDR) Therapy: A Pilot Study" Healthcare 10, no. 1: 133. https://doi.org/10.3390/healthcare10010133