REM desensitisation

1. Introduction

Version followed: Ahmadi, Hazrati, Ahmadizadeh & Noohi (2015), Acta Medica Indonesiana 47(2):111–119, the only published description of a therapy by this name. This is a short outline, not a full implementation guide. The published procedure is a sleep-based cueing method that uses a sensor device; it is not an EMDR variant. The paper describes it only briefly, so it cannot be delivered as published (see section 3).

What is published. The only source for a therapy by this name is one trial: Khodabakhsh Ahmadi, Majid Hazrati, Mohammadjavad Ahmadizadeh and Sima Noohi (Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran), "REM Desensitization as a New Therapeutic Method for Post-Traumatic Stress Disorder: A Randomized Controlled Trial", Acta Medica Indonesiana 47(2):111–119 (2015). [source: journal article page and full text; Francine Shapiro Library record]
What the trial reports. The authors call it "a new therapeutic approach" for PTSD. Male military servicemen aged 25–50 with combat-related PTSD, recruited from hospitals in Bushehr, Iran, were randomised to REM desensitisation, EMDR or a no-therapy control; 33 completed. Outcomes were the Mississippi Scale for PTSD, the Pittsburgh Sleep Quality Index and a 37-item death-anxiety questionnaire. The authors report that REM desensitisation did better than EMDR on intrusive thoughts and on sleep quality, sleep duration and total sleep score; EMDR did better on depression; death anxiety did not differ between the two active arms. They name the small sample and a dropout rate above 31% as limitations. [source: Ahmadi et al. 2015, abstract and full text]
What the method is. "REM" refers to REM sleep. The authors' rationale is that REM sleep helps process and integrate traumatic memories. The method has two parts. First, a piece of light music is made into a calming cue by playing it in at least three waking desensitisation sessions, sometimes with soothing images the client has chosen. Then, during night sleep, the client wears glasses with infrared sensors, and REM eye movements trigger a short play of that music. If the client becomes aware of dreaming while the music plays, they are to carry on with the nightmare and face the scene without fear. [source: Ahmadi et al. 2015, full text] Still unknown [uncertain]: what the waking sessions contain, how many sessions and nights there are, the setting, the device (the paper cites no specification or supplier), therapist actions during treatment and safety monitoring. No manual, training course, follow-up study or replication has been published.
A name that can be confused with it. Tallis and Smith (1994) used "rapid eye movement desensitization (REMD)" for the eye-movement component of what became EMDR, not for a separate therapy. In their analogue study (a contrived trauma, not a clinical sample), REMD gave poorer emotional processing than slow eye movements or stationary imagery. [source: Francine Shapiro Library record of Tallis & Smith 1994] That older usage belongs to EMDR history: see guide 030.
What to use instead. For an established trauma treatment (EMDR, the trial's comparator), use guide 030 EMDR (standard, group and recent-event protocols). Do not present EMDR steps as REM desensitisation. [synthesis]

2. Framework

Rationale. REM sleep is proposed to support the processing and integration of traumatic memories. The method pairs a calming cue, conditioned in waking sessions, with REM periods of sleep, and asks the client to face the nightmare scene if they become aware of dreaming [source: Ahmadi et al. 2015]. Population in the trial: men aged 25–50 with PTSD from military incidents, diagnosis confirmed with the SCID and a Mississippi Scale score above 107, all on ongoing psychiatric medication. Exclusions were poor cooperation, other physical or psychological problems that interfered with the study, and prior ECT [source: Ahmadi et al. 2015]. Not reported: phases, session number or length, number of nights, or setting [uncertain].

3. Guiding principles

The paper states no guiding principles beyond its rationale. [synthesis] Two points follow from the evidence status:

Do not deliver it as a clinical treatment. The published outline lacks the device specification, the content of the waking sessions and the number of nights, so the method cannot be replicated. Treat it as a single unreplicated research procedure.
Do not relabel another method. Offering EMDR, or any improvised eye-movement or sleep-timed procedure, under this name would misinform clients.

4. Intervention inventory

The published trial describes two linked components [source: Ahmadi et al. 2015, full text]. Both are given below in outline only. Device specifications are left out, and nothing the paper does not state has been added. The method cannot be replicated from what is published (see section 3).

4.1 Conditioning a calming music cue (waking sessions)

Purpose and when to use: Before the sleep phase, a piece of light music is turned into a calming cue by playing it during waking desensitisation sessions [source: Ahmadi et al. 2015].
Steps:
1. Use one piece of light music as the cue, the same piece that will later be played during sleep [source: Ahmadi et al. 2015].
2. Play it in at least three desensitisation sessions, with or without soothing images that the client has chosen [source: Ahmadi et al. 2015].
3. The paper does not say what else happens in these sessions (relaxation, imagery or trauma exposure), how long they last or over what period they run [uncertain]. Do not fill these gaps in.
Example therapist language (illustrative): "We'll play this piece of music in our next few sessions while you hold the calm pictures you chose in mind. The idea is that it becomes a signal to your body that you can settle."
What to watch for: music that already has links to the trauma or to distress; a client who finds the music irritating rather than calming. Choose another piece or stop [synthesis].

4.2 Playing the cue during REM sleep

Purpose and when to use: The authors draw on the view that REM sleep helps process and integrate traumatic memories [source: Ahmadi et al. 2015, citing Stickgold 2002]. The method aims to deliver the conditioned calming cue during REM periods of night sleep [source: Ahmadi et al. 2015].
Steps:
1. During night sleep the client wears light, flexible glasses fitted with infrared sensors [source: Ahmadi et al. 2015].
2. When the sensors detect REM eye movements, they trigger a short play of the conditioned music [source: Ahmadi et al. 2015; device details omitted].
3. Beforehand, the client is told that if they become aware, while the music plays, that they are asleep and dreaming, they should try to carry on with the nightmare and face the scene without fear as far as they can [source: Ahmadi et al. 2015].
4. The paper does not report the setting (home or laboratory), the number of nights, any review of the nights with the therapist, or any safety monitoring [uncertain].
Example therapist language (illustrative): "If you hear the music and realise you're dreaming, try to stay with the dream and look at what is there. The music means you are safe in bed."
What to watch for: in the trial, 4 of 16 people in this arm could not tolerate wearing the glasses at night and 1 developed an allergy to them [source: Ahmadi et al. 2015]. Also watch for broken sleep, waking in distress and more fear of going to sleep [synthesis].

5. Handling problems

The paper gives no guidance on problems. It reports that 4 of 16 people in the REM arm could not tolerate the glasses at night and 1 developed an allergy to them [source: Ahmadi et al. 2015]. The rest is [synthesis].

A client asks for REM desensitisation after reading about the trial: explain that it rests on one small trial with a high dropout rate, that only a brief outline of the method and its device has been published, and that established PTSD treatments (including EMDR, the trial's comparator) are available. Do not promise the sleep or intrusion advantages the abstract reports.
Sleep problems or nightmares are the main complaint: use established sleep and nightmare treatments alongside trauma-focused therapy rather than this method.
Problems during eye-movement processing (overwhelm, dissociation, looping): see section 5 of guide 030.
A client cannot sleep with a worn device, or reports skin irritation: stop using it; do not press on with an intervention that disturbs sleep further [synthesis, prompted by the intolerance and allergy reported in the trial].

Sources

Web pages:

Cited:

Ahmadi K, Hazrati M, Ahmadizadeh M, Noohi S (2015). REM desensitization as a new therapeutic method for post-traumatic stress disorder: a randomized controlled trial. Acta Medica Indonesiana 47(2):111–119.
Tallis F, Smith E (1994). Does rapid eye movement desensitization facilitate emotional processing? Behaviour Research and Therapy 32(4):459–461.

← Previous · VI-058Observed and Experiential Integration (OEI)Next · VI-060 →Visuospatial game task after trauma (Tetris intervention)