EMDR therapy analysis

Abstract

Two subsequent fMRI images taken during or before and after an EMDR therapy treatment are compared. Changes in the trauma level measure in the relevant brain anatomy of the trauma-affected patient are determined and communicated, enabling a more objective assessment of the success of the EMDR therapy and / or this information can be used to customize the EMDR therapy during or after the treatment session.

Description

Technical Field

[0001] This invention generally relates to EMDR treatment analysis equipment and methods, as well as computer program products. Background Technology

[0002] Post-traumatic stress disorder (PTSD) is a serious mental health condition resulting from the brain's inability to adequately process extremely distressing events. Eye movement desensitization and reprocessing (EMDR) is a technique used to manage PTSD. EMDR is also applied to manage many other traumatic experiences. EMDR involves a unique process in which the therapist administers bilateral stimulation (BLS) to the patient, which elicits repetitive (horizontal) eye movements while the patient recalls the traumatic experience. The effort required for these eye movements helps the patient reprocess the experience and become less sensitive to it.

[0003] One problem with current EMDR treatment is that it uses a standard approach for all patients. Furthermore, this approach now relies on inconsistent and subjective criteria to evaluate recovery and treatment strategies. Moreover, the effectiveness of the treatment can often only be determined after the treatment is completed. Summary of the Invention

[0004] The purpose of this invention is to tailor EMDR strategies for patients with psychological or mental trauma to achieve optimal and personalized treatment outcomes.

[0005] Embodiments of the present invention relate to an eye movement desensitization and reprocessing (EMDR) therapy analysis device, a corresponding method, and a computer program for analyzing EMDR therapy for treating patients with psychological or psychiatric trauma. The device includes a computer-implemented system comprising a computer processor. The computer processor is configured to receive first functional magnetic resonance imaging (fMRI) data from a patient before or during EMDR therapy, wherein the first fMRI data includes fMRI data from regions of interest (ROIs) in the patient's brain or spinal cord known to be associated with the patient's level of trauma. The processor is also configured to receive second fMRI data from the patient during or after EMDR therapy, wherein the second fMRI data is obtained after the first fMRI data and includes fMRI data from the regions of interest in the patient's brain or spinal cord known to be associated with the patient's trauma. At least one of the first and second fMRI data is received during EMDR therapy. The processor is further configured to analyze the first fMRI data and the second fMRI data by identifying a trauma level metric that indicates the patient's trauma level, and to compare the second fMRI data with the trauma level metric of the first fMRI data to determine whether the patient's trauma level has changed. Furthermore, the computer processor is configured to communicate whether the trauma level has changed. Therefore, the device can analyze EMDR treatment procedures in real time, provide patient-specific indications of treatment effectiveness, and communicate the results to, for example, a therapist, and further to the processor or EMDR device.

[0006] In a preferred embodiment, the computer processor is further configured to: receive updated third fMRI data from a patient during or after EMDR treatment, wherein the third fMRI data is obtained after the second fMRI data and includes fMRI data from the region of interest in the patient's brain or spinal cord known to be associated with the patient's trauma; analyze the updated first fMRI data and the second fMRI data by identifying a trauma level metric indicative of the patient's trauma level; compare the third fMRI data with the trauma level metric of the second fMRI data and determine whether the patient's trauma level has changed. Therefore, the device is now able to provide indications of treatment effectiveness at three (or more) time points during or before and after treatment, and is able to provide more or more precise effectiveness information, for example, effectiveness information from before, during, and after the treatment.

[0007] In a preferred embodiment, the computer processor is further configured to: receive a sequence of at least two consecutively updated fMRI data from a patient during or after EMDR treatment, wherein the fMRI data includes fMRI data from the region of interest in the patient's brain or spinal cord known to be associated with the patient's trauma; analyze the at least two updated fMRI data by identifying a trauma level metric indicative of the patient's trauma level, wherein the at least two updated fMRI data include earlier acquired fMRI data and later acquired fMRI data, the later acquired fMRI data being acquired at a later stage than the earlier fMRI data, preferably, the later fMRI data being the last acquired fMRI data in the sequence of consecutive fMRI data; compare the trauma level metric of the later fMRI data with that of the earlier fMRI data and determine whether the patient's trauma level has changed. Therefore, treatment effectiveness can be determined and communicated at various time points and multiple moments (even later stages after treatment) during or before and after the treatment.

[0008] In a preferred embodiment, the first fMRI data is from the patient prior to undergoing the EMDR treatment. This allows for the acquisition of baseline values ​​of brain (region) activity.

[0009] In a preferred embodiment, the final fMRI data obtained is from the patient after undergoing the EMDR treatment. This allows for direct determination of treatment effectiveness or determination of treatment effectiveness at some point after the EMDR treatment course.

[0010] In a preferred embodiment, the measure of trauma of interest is the contrast of blood oxygen level correlation (BOLD). This is a particularly useful, well-studied, and frequently used measure in fMRI.

[0011] In a preferred embodiment, the trauma is post-traumatic stress disorder (PTSD), and the region of interest in the patient's brain preferably includes the patient's amygdala and / or the patient's prefrontal cortex, the amygdala preferably being the patient's left amygdala. EMDR has proven particularly useful for managing PTSD. Effective EMDR treatments can be determined particularly well based on fMRI images of the patient's amygdala and / or prefrontal cortex.

[0012] In a preferred embodiment, the level of trauma is further determined by combining the received EMDR data with other physiological or biometric data of the patient, such as skin conductance, brain electrical activity, heart rate, respiratory rate, blink rate, body temperature, or any other physical attribute of the patient that can serve as an indicator of effectiveness, and / or other fMRI or similar fMRI data, such as regional cerebral blood flow (CBF), cerebral blood volume (CBV), cerebral oxygen metabolic rate (CMRO2), or regional brain conductance, for example, regional brain conductance obtained by electrical property tomography. Therefore, by considering other data that may be measures of EMDR treatment with (temporary or persistent) effects, effectiveness parameters can be determined more precisely. The different data may be part of the communication from the claimed device or may be communicated separately. The therapist or (deep learning) algorithm may analyze the communicated data to cause adjustments to treatment or continuation of treatment.

[0013] In a preferred embodiment, the computer processor is configured to communicate with the EMDR therapist, via a communication device available during treatment, whether the level of trauma has changed, preferably during or shortly after the EMDR treatment session, for example, by displaying visual information or by conveying auditory or tactile signals to the communication device available to the EMDR therapist during treatment. This allows the therapist to be informed of the effectiveness of the treatment at the same time as it is administered or shortly after, thereby allowing for immediate adjustment of the treatment or a decision on whether further treatment is necessary.

[0014] In a preferred embodiment, the computer processor is configured to: communicate to a device capable of adjusting the EMDR treatment during an ongoing EMDR treatment session whether the level of trauma has changed, the device being capable of adjusting the EMDR treatment during an ongoing EMDR treatment session being, for example, a device for generating adaptive visual stimulation, such as an EMDR device including a light-emitting diode (23) and / or a pulse generator (231); and / or to provide suggestions or plans for future EMDR treatment sessions for the patient.

[0015] In a preferred embodiment, the processor is further configured to convert changes in a trauma level metric into an effectiveness parameter, such as a known value of the trauma level metric and / or a relative value compared to an initial value, for example, a relative value of the trauma level metric in the first fMRI data, such as a percentage; and wherein the communication device is further configured to communicate the effectiveness parameter. This is a particularly effective method for determining and optionally quantifying or standardizing the effectiveness of EMDR procedures.

[0016] Those skilled in the art will recognize further aspects and embodiments of the invention upon reading and understanding the following detailed description. Many additional advantages and benefits will become apparent to those skilled in the art upon reading the following detailed description of preferred embodiments. Attached Figure Description

[0017] The invention is illustrated in the accompanying drawings, in which:

[0018] Figure 1 A schematic cross-section of the human brain is shown, and the location of several brain anatomical structures mentioned in this article is illustrated.

[0019] Figure 2 illustrates how a therapist can perform EMDR therapy. Figure 2a , Figure 2b ) and how to use an exemplary EMDR device ( Figure 2c A schematic depiction of ).

[0020] Figure 3 An example of the BOLD response following neural activity is illustrated.

[0021] Figure 4 depicts a patient in an MR imaging setup. Figure 4a ) and the patient in the head coil inside the MR imaging device ( Figure 4b (Illustrative EMDR treatment procedure)

[0022] Figure 5 depicts a scene as shown in a ( Figure 5a ) or more ( Figure 5b An illustrative example of the construction of the output from the claimed invention’s device and method for treating a fictitious trauma patient during an EMDR treatment procedure.

[0023] This invention can take the form of various components and component arrangements, as well as various processing operations and processing operation arrangements. The accompanying drawings are for illustrative purposes only and should not be construed as limiting the invention. For better display, certain features may be omitted, or dimensions may not be proportional. Detailed Implementation

[0024] To provide context for the claimed invention, further details regarding PTSD and EMDR are provided.

[0025] PTSD can develop after exposure to a traumatic event (such as sexual assault, war, traffic collision, child abuse, or other life-threatening events). PTSD results from the brain's inability to adequately process the traumatic event. When the event is very intense, it can overwhelm the body's processing system, and a person may have difficulty coping with emotional distress for a period of time. As a result, disturbing thoughts and emotions surrounding the incident can persist for a long time after the trauma.

[0026] Symptoms may include disturbing thoughts, feelings, or dreams related to the event; mental or physical distress over trauma-related cues; attempts to avoid trauma-related cues; altered ways of thinking and feeling; and an increased fight-or-flight response. Other signs of PTSD may include reliving the initial incident through flashbacks or trauma; feelings of sadness or anger; feelings of loss of connection or alienation from people; and strong negative reactions to simple things, such as accidental touch or loud noise. These symptoms can persist for more than a month after the event and may last for years if left untreated, and can cause discomfort, reduced enjoyment of life, and / or even pose a danger to oneself or others.

[0027] People with PTSD show reduced brain activity in the dorsal and rostral anterior cingulate cortex 14 and the ventromedial prefrontal cortex 13-1, areas associated with the experience and regulation of emotions (see [link to relevant documentation]). Figure 1 The amygdala 11 is strongly involved in the formation of emotional memories, especially those related to fear. During periods of high stress, the hippocampus 12, which is associated with placing memories in their proper spatial and temporal context and with memory recall, is inhibited. This inhibition may be the reason why flashbacks can affect people with PTSD. When someone with PTSD experiences a similar traumatic event, the body perceives the event as recurring because the memory was never properly recorded in that person's memory. The amygdala model of PTSD proposes that the amygdala 11 is very strongly aroused and undercontrolled by the medial prefrontal cortex 13-2 and hippocampus 12, especially during extinction. This is consistent with the explanation that PTSD is a syndrome of inadequate extinction capacity. The basolateral nucleus (BLA) of the amygdala 11 is responsible for the comparison and development of associations between unconditioned and conditioned responses to stimuli, which gives rise to the fear conditioning present in PTSD.

[0028] Eye Movement Desensitization and Reprocessing (EMDR) is a well-researched treatment recommended by the World Health Organization (WHO) for managing trauma. EMDR is based on the idea that our brains naturally want to heal and achieve optimal mental health, but trauma can overwhelm our natural healing ability and "remain" in our memories. The associations surrounding the traumatic event remain negative and destructive, and patients may become sensitive to people, places, or things that remind them of the event. Because EMDR has proven to be a very effective treatment, psychotherapists primarily use it to treat patients with PTSD.

[0029] EMDR uses so-called adaptive solutions to transform trauma from its potentially distressing and triggering aspects into a form no longer associated with negative, emotional, physical, behavioral, and cognitive responses. This is part of EMDR's "desensitization and reprocessing." The key to adaptive solutions is relearning, which replaces the harmful and disturbing information associated with trauma (as well as thoughts, feelings, and behaviors) with new, more "adaptive" information and associations.

[0030] A standard EMDR protocol comprises two main phases: desensitization of traumatic memories and the development and installation of “resources” (e.g., safe ideas). The latter is known as Resource Development and Installation (RDI). In the standard protocol, both phases utilize alternating bilateral stimulation (BLS). BLS is performed concurrently with the recall of the worst-case scenario of the trauma and resource installation.

[0031] EMDR technique involves a unique procedure in which the therapist exposes the patient 20 to BLS, which involves alternating bilateral visual-eye movements. This stimulation can be their hand, finger, or stick 22 moving x, -x in front of the patient, and the patient 20 must follow the hand, finger, or stick 22 with their eyes 21 (see [link to EMDR technique]). Figure 2a , Figure 2b In a more modern setup, the EMDR instrument can be in the form of a device for providing visual stimulation, for example, using a device comprising a light-emitting diode 23 and a pulse generator 231, wherein the pulse generator 231 (e.g., an LED) is sequentially turned on and off to form a moving light path for the patient 20 to follow, see [link to relevant documentation]. Figure 2c Alternative versions of this EMDR device can utilize variations in brightness and color, or provide a grid of alternating elements or pulse generators instead of a row of pulse generators. Bilateral stimulation can also be auditory or other sensory stimulation, such as tactile stimulation.

[0032] Clinical observations during EMDR therapy have shown that a standardized EMDR procedure incorporating eye movements stimulates accelerated learning. When clients briefly focus on the traumatic memory while simultaneously experiencing BLS (Browsing and Linguistic Spectrum Disorder), both the vividness and emotional impact of the memory are reduced.

[0033] Traditionally, EMDR is performed manually, with the therapist guiding the patient's eye movement 21 using their fingers or hand 22. A limitation of EMDR is that even for experienced EMDR therapists, the manual control of the movement's rate and position is inaccurate and inconsistent, affecting the treatment's outcome. In some cases, the aforementioned EMDR instrument, with its adjustable light-emitting diode 23 and pulse generator 231, is used to provide EMDR treatment.

[0034] Another limitation of current EMDR treatment is that it uses a standardized, “one-size-fits-all” approach to treat PTSD for all patients and cannot be tailored to the specific characteristics of a patient (20).

[0035] Another limitation of traditional EMDR therapy is that it requires a highly trained and experienced EMDR therapist. During treatment, the therapist needs to check the treatment's effectiveness with the patient. This is done by asking questions about sensations in order to adjust finger movements or light movements within the EMDR device. This demands strong multitasking skills from the therapist and requires the patient to have a high level of attention to both auditory and visual information. This may lead to treatment outcomes that are not ideal in some cases.

[0036] An additional drawback of traditional EMDR therapy is that the progress of the treatment course and the number of subsequent courses required are based on the therapist's personal (subjective) assessment. That is, the therapist relies on the patient's answers, responses during the procedure, and the patient's descriptions of their symptoms before and after the EMDR procedure.

[0037] Moreover, it is not always easy to determine the cause of an unsuccessful treatment or the most effective part of a successful treatment afterward.

[0038] In conclusion, it is clear that there is a need for more specialized, objective, and effective customization of EMDR treatment and procedures to achieve optimal treatment outcomes and follow-up decisions for individual patients. Therefore, the objective of this invention is to provide a standardized yet personalized and controllable EMDR treatment.

[0039] A potential insight of the currently claimed invention is that eliminating or at least reducing the human variables introduced by real-time patient evaluation during the procedure and potentially having quantitative or qualitative data on the patient's brain responses to EMDR treatment is beneficial. Removing human intervention in treatments like EMDR seems counterintuitive (especially in the field of psychiatric treatment, where the therapist's personal interpretation of information has traditionally been highly valued). In particular, EMDR relies heavily on therapist-patient interaction, but the currently claimed invention does not replace human interaction; rather, it provides an additional tool to improve the treatment or its follow-up, which still requires auditory and / or visual guidance and monitoring of patient responses by a professional therapist. In a preferred embodiment of the invention, the therapist maintains control over decisions regarding maintaining or adjusting EMDR treatment.

[0040] A further insight is that functional magnetic resonance imaging (fMRI) is an imaging technique particularly well-suited for this purpose.

[0041] In fMRI, brain activity is measured by detecting changes associated with blood flow. This technique relies on the fact that cerebral blood flow and neuronal activation are coupled. When a region of the brain is used, blood flow to that region increases.

[0042] In fMRI, magnetic resonance images or their spatial or temporal series are obtained from the brain 10 or spinal cord 15 of a subject, thereby enabling the determination of brain activity, as blood flow in the brain is directly related to brain activity. When a region of the brain is active, blood flow to that region increases. A key property typically measured by fMRI is the contrast of blood oxygen level-dependent (BOLD) imaging, where neural activity is determined by imaging changes in blood flow (hemodynamic response) in specific areas of the brain or spinal cord. Figure 3 An exemplary graph is shown, in which the (normalized) amplitude Amp is tracked over time (t) for neural activity (NA) and (delayed) BOLD signal response (BOLD). N Other fMRI techniques are also available, but BOLD is the most common and well-studied fMRI method.

[0043] Figure 4a An exemplary drawing is shown of a trauma patient 20 undergoing EMDR treatment while being scanned in the chamber 33 of an MRI device 30. In this embodiment, the EMDR therapist stands beside the patient support table 32, and the patient's eyes 21 follow the gestures 22, as in a normal EMDR treatment procedure. Figure 4a It is an extremely simplified drawing. In reality, most of the patient's head is covered by the head coil (32) (see...). Figure 4b Furthermore, due to the loud noise generated by the MRI device 30, the patient will not be able to hear the therapist; therefore, sound can be provided via MR-compatible headphones 35. Because the patient's field of vision is greatly limited, the therapist must either be positioned so that his / her hands 22 are within the patient's field of vision, or must be positioned so that the patient can indirectly see the therapist through a mirror or an MR-compatible display system (not shown). Alternatively, a similar... Figure 2c The EMDR instrument shown is an (MR-compatible) EMDR instrument including a light-emitting diode (23) and a pulse generator (231). The EMDR instrument can be integrated with an MR device or can be located elsewhere and projected into the patient's field of vision (i.e., via a mirror, laser, etc.). The EMDR device can be (co-)controlled by a processor that communicates with a processor that analyzes fMRI data, which can directly or indirectly affect the operation of the EMDR device to adjust the BLA received by the patient.

[0044] For patients, fMRI (and MR imaging in general) is often a challenging experience due to the claustrophobic nature of the MR scanner and coil chamber, the loud noise, and the often lengthy scan time. This experience can be even worse for trauma patients, who may not respond optimally to EMDR procedures. Clearly, this must be taken into account when setting expectations for both patients and therapists. Many methods are known to reduce anxiety caused by scanning equipment and procedures, such as patient training and explanation, sound attenuation measures, and visual resources. These issues and measures will not be elaborated upon here unless it is considered that they can be combined with currently claimed inventions, provided they do not interfere with EMDR procedures (e.g., some visual aids may not be suitable in this case). On the other hand, visual and auditory information used to improve the patient experience can actually be used as part of EMDR therapy by combining or integrating auditory guidance and / or visual stimulation into the provided visual information.

[0045] In embodiments of the invention, first MRI data of patient 20 is obtained, particularly head MRI, using sequences of BOLD signals or other representative signals of regions of interest (hereinafter referred to as regions of interest, regardless of whether they are specific to one or more anatomical structures or regions) in the brain that can indicate susceptibility to (successful) EMDR treatment, such as fMRI data including BOLD signals of the patient's amygdala 11 and / or prefrontal cortex 13. As previously explained, PTSD patients often exhibit increased amygdala activation (caused by reduced activity in the prefrontal cortex, etc.), which will be identified as a high BOLD level in this anatomical structure. Therefore, successful treatment of PTSD will be indicated by a decrease in the BOLD level of the amygdala. Other brain or spinal cord cortical anatomical structures (e.g., dorsal and rostral anterior cingulate cortex, ventromedial prefrontal cortex, hippocampus) can also be used for PTSD trauma level determination and treatment analysis, or for various other psychological or mental trauma or neurological conditions, provided they are sufficient to indicate a successful EMDR treatment. The first fMRI data is preferably obtained before the start of the EMDR treatment, and for this reason, the first fMRI data can be used as a baseline value to determine the effectiveness of subsequent treatments.

[0046] Second fMRI data of the same region of interest are obtained during or after EMDR treatment, and preferably the same sequence is also used to obtain comparable signals of the region of interest.

[0047] Optionally, during or after EMDR treatment, third or even further (“late”) fMRI data of the same region of interest are obtained, and preferably the same sequence is also used to obtain comparable signals of the region of interest. This results in comparable fMRI data sequences of the same brain region. Preferably, the first fMRI data is obtained before the EMDR treatment course, and / or the later (preferably, final) fMRI data is obtained after the EMDR treatment course. One or more fMRI data obtained during the EMDR treatment course can be compared with fMRI data covering the same region of interest during the EMDR treatment course to obtain the temporal progression of the effect of EMDR treatment on the region of interest.

[0048] The acquired fMRI data is analyzed by identifying measures of the patient's level of trauma. When indications already exist about which region of interest is best suited for monitoring a specific trauma in a patient, this factor may have been considered when pre-setting the fMRI acquisition parameters. Alternatively, for example, a larger portion of the patient's brain could be imaged, and the most suitable region of interest could be determined by the therapist or through automated algorithms (e.g., machine learning). This can be done in real time (preferably using algorithms) because therapists may not be able to multitask while optimally focusing on the patient and performing treatment.

[0049] The use of (real-time) fMRI data provides a much better and more controlled treatment than currently known in the art, as therapists can advantageously use this information to inform decisions during or after treatment to optimize (individual-based and personalized) EMDR treatment by updating (readjusting) visual stimuli.

[0050] A particularly suitable measure of trauma of interest is BOLD, a well-studied fMRI measure that strongly indicates focal brain activity, as described above. For example, it is known from fMRI studies that PTSD patients have impaired extinction memories and elevated amygdala activity. Moreover, it is well known that PTSD patients experience significantly increased BOLD behavior in the left amygdala when performing pleasant emotion-inducing tasks. Therefore, it is known how and where fMRI can be used in the brains of PTSD patients to monitor potential changes in BOLD signaling and thus the potential effects of interventions. Increased skin conductance is also known in PTSD subjects.

[0051] Although BOLD is not easily calibrated and / or quantified in a general manner among patients, comparing various BOLD levels over time in the same patients under the same or similar conditions provides a suitable indication for detecting changes in BOLD levels over time.

[0052] A successful EMDR procedure results in altered (i.e., increased or decreased) brain activity in one or more relevant anatomical structures observed, presumably in the correct direction. Because real-time or near-real-time fMRI is possible, therapists can immediately detect the results (or absence) of the induced eye movements and can pursue the same results or modify the BLS.

[0053] In other examples, for a specific trauma, brain activity may actually be lower in certain anatomical structures, and in these cases, increased oxygenation in these anatomical structures can serve as an indicator of a successful EMDR procedure. It is even possible that multiple regions of interest are affected by increased and / or decreased oxygenation.

[0054] For example, obtaining the BOLD signal of the left amygdala before EMDR treatment of a patient with PTSD trauma, obtaining the BOLD signal of the left amygdala once or multiple times during EMDR treatment of a patient with PTSD trauma, obtaining the BOLD signal of the left amygdala directly after EMDR treatment of a patient with PTSD trauma, obtaining the BOLD signal of the left amygdala one or several days after EMDR treatment of a patient with PTSD trauma, for example, as the first fMRI data of the next EMDR treatment course.

[0055] Other suitable measures that can be obtained by using fMRI and that can be used as alternatives to or supplements to BOLD for certain types of regions of interest and / or certain types of trauma may be regional cerebral blood flow (CBF), cerebral blood volume (CBV), cerebral oxygen metabolic rate (CMRO2), or regional electroencephalogram (EEG), such as regional EEG obtained by changes in electrical property tomography (EPT) of fMRI.

[0056] In addition, fMRI data can be used in conjunction with known non-fMRI measures, such as skin conductance, brain electrical activity (EEG), heart rate (ECG), respiratory intensity, blink rate, body temperature, or any other physical attribute of the patient that can serve as an indicator of the effectiveness of EMDR treatment.

[0057] Once one or more appropriate trauma measures of interest are identified, the measure is quantified for each acquired fMRI data (i.e., the BOLD level is determined), and the oxygenation level of the region of interest is determined accordingly for each acquired fMRI data.

[0058] Next, one or more appropriate measures of interest for each acquired fMRI data point are compared to each other, and it is examined whether the measure has changed (i.e., increased, decreased, or remained substantially the same). Differences in the measure provide a measure (e.g., value) of the effectiveness of EMDR treatment. Large differences can indicate a large effect of treatment on the patient, and if the difference is in the desired direction (i.e., lower or higher oxygenation in the region of interest), then a large difference indicates a strong, positive response to treatment. If the effect is small, (almost) zero, or even a difference in the wrong direction, then this indicates that the treatment used or the parameters in the treatment are ineffective or even counterproductive.

[0059] For example, the reduction (or absence) of trauma levels can be communicated by providing actual values ​​of measurements (e.g., visually presented in tabular or graphical form). Furthermore, actual fMRI images can be provided with instructions for the therapist to review. This communication can also take the form of auditory or tactile signals, or any other way that will make the therapist aware of the effectiveness of EMDR therapy.

[0060] The level of trauma may be reduced (or absent) after treatment, allowing therapists to study the effectiveness in real time afterward or during EMDR sessions. This allows therapists to adjust treatment as needed or to understand which parts of the treatment were most effective and focus on those parts.

[0061] Alternatively, changes in trauma level can be communicated to another processor, which automatically modifies the automated EMDR device (e.g., one with features such as...). Figure 2c The pulse generator 231 shown is suitable for use in an MR environment or can be adapted for use in an MR environment.

[0062] In the example, differences in trauma measures are translated into effectiveness parameters for EMDR procedures that are preferably easy for therapists to interpret. Effectiveness parameters can be values ​​of trauma measures (e.g., BOLD value, blood oxygen level, etc.), or they can be relative values ​​(e.g., percentages) based on trauma measures at the first fMRI or from initial values ​​obtained from previous fMRIs (e.g., in relation to past EMDR procedures). Effectiveness parameters can be communicated in numerical, graphical, text or message, tabular, color-coded, or other formats.

[0063] In the example, differences in trauma measures can be communicated by providing actual (real-time) fMRI images (sequentially or adjacently), on which regions of interest are color-coded, and color changes indicate changes in effectiveness (e.g., green shading for increased effectiveness, and red shading for decreased effectiveness). A warning signal can be given when a change in the trauma level measure is detected as ineffective or detrimental. This may be the only information provided, at which point the therapist receives only feedback when treatment is unsuccessful, creating a low-stimulation environment for both patient and therapist, allowing them to optimally focus on the treatment itself.

[0064] When the latest or final (i.e., second or further) fMRI data is obtained after an EMDR treatment session, this may reveal the durable effects of the treatment. Second (or further) fMRI data can be obtained directly after the treatment or at a later stage for this purpose. This information can be used if it is necessary to request further treatment and / or whether the EMDR treatment should be adjusted for the next session (e.g., different auditory guidance and / or visual stimulation).

[0065] Therefore, it is possible to distinguish between two related tasks in the EMDR process (meaning the stimulus and / or traumatic memory received by the patient or other specific mental or physical tasks required of the patient): (1) the EMDR task during treatment when repetitive eye movements are present, and (2) the general neutral / fear / fright / anxiety task before or after treatment when repetitive eye movements are not present.

[0066] Brain activity measured during task (1) can indicate whether the treatment has any direct effect, and the therapist can (potentially in real time) adjust the BLA stimulation provided based on the brain activity measured during task (1).

[0067] Brain activity measured during task (2) can indicate whether EMDR therapy in previous or recently completed sessions has produced any lasting beneficial effects, and this information can also allow the therapist to adjust treatment settings(s) in subsequent sessions. The absolute level of brain activity during task (2) depends on the patient’s exact task: for example, if the patient is instructed to recall a traumatic event (as in EMDR, but without induced eye movements), the absolute level of brain activity may be similar to that during task (1). However, if the patient is instructed to remain still, the brain activity may be less when the patient is instructed to think about the trauma than measured during task (1). The absolute levels of brain activity may differ for tasks (1) and (2), even if they are performed rapidly one after the other. This can be used to determine baseline levels or quantify effects over time. In one example, the claimed EMDR analysis device may autonomously communicate (or even be planned or initialized) adjustments to current or subsequent treatments.

[0068] In one example, the claimed EMDR analysis device may alternatively or simultaneously provide an additional sensory modality different from visual stimulation, namely, auditory stimulation (headphones for providing auditory stimulation to the patient, adjusting auditory signals (type, loudness, timbre, alternation frequency, etc.)) or tactile stimulation (a stimulator with tactile stimulation). This additional stimulation can be tuned to be compatible with the patient experience enhancement of the imaging device through visual and / or auditory means, i.e., by providing stimulation in a rhythmic manner, preferably in a rhythmic manner compatible with the (undesired) stimulation of the MR device itself.

[0069] In one example, the claimed EMDR analysis device has a learning module based on data and information collected during previous treatment sessions: for example, providing automatic selection of light patterns or conditions (brightness, color, speed, and sequence).

[0070] When the latest or final (i.e., second or further) fMRI data is obtained during an EMDR treatment session, this can be used to inform the therapist of the effectiveness of the treatment during EMDR, allowing the therapist to adjust the treatment in real time. Alternatively, the second (or further) fMRI data can be used to adjust the settings of the EMDR instrument, similar to the information provided regarding... Figure 2c The description shows the content.

[0071] This is why only (real-time) data from the patient themselves is used to track the patient's response to EMDR and to make the continuation or adjustment of the protocol completely personalized.

[0072] Figure 5 depicts a simulated example of a treatment analysis output as a result of the device or method of the present invention.

[0073] exist Figure 5a The figure shows a graph illustrating the effectiveness parameter (E) over a period of time covering one EMDR treatment session. In this illustrative example, a hypothetical patient with PTSD was treated, and his left amygdala was imaged. The trauma level measure is the BOLD value derived from the fMRI data. The effectiveness parameter is plotted as a relative percentage compared to an initial baseline value, which here corresponds to the BOLD value determined before the start of EMDR treatment (t0). Five fMRI data points were acquired at different times during treatment (t1, t2, t3, t4, t5). One fMRI data point was acquired immediately after treatment (t6), and another fMRI data point was acquired some time later (e.g., hours or days later) (t7). It can be seen from the graph that EMDR was initially successful at t1 and t2, but it is clear that the patient responded poorly at t3, which was communicated to the therapist, for example, by means of the diagram showing... Figure 5a The graphic changes, color-coded messages, or color-enhanced "live" fMRI images are communicated to the therapist. Following this communication, the therapist adjusts the treatment, resulting in a further reduction in the effectiveness parameter E (a positive outcome indicating a reduction in the level of trauma). Alternatively, if an EMDR device for visual stimulation is used (e.g., similar to the one used for visual stimulation...), Figure 2c If the device shown and described is used to treat a fictitious patient, then the change in the wrong direction at t3 is communicated to the processor, which may be the same processor that analyzes the fMRI data, which translates the data into a (proposed) modified EMDR protocol (e.g., a modified light sequence), for which the therapist may or may not need to accept or reject an updated protocol.

[0074] Following treatment, BOLD levels decreased significantly, indicating that the treatment was largely successful. However, over time (at t7), the efficacy parameter increased (but did not reach the initial level, which indicates the durability of the treatment). Therapists may choose to schedule further sessions to further reduce trauma.

[0075] Figure 5b An example of an illustrative construction is shown, in which a fictional patient has undergone three EMDR treatment cycles (T1, T2, T3), with a time interval (e.g., days or weeks) between cycles. For each cycle, it is similar to... Figure 5aFor example, fMRI data are obtained directly before the treatment, during the treatment, and directly after the treatment. Clearly, each treatment reduces the effectiveness parameter (E), thereby reducing the level of trauma. Over time, the initial effectiveness parameter increases slightly, but each successive EMDR treatment reduces the level of trauma, and after each treatment, the therapist can decide whether the trauma has been adequately addressed or whether another treatment is needed.

[0076] The currently claimed invention refers to EMDR treatments; however, in the context of this invention, the very familiar term EMDR is considered to also cover a slightly broader range, including closely related and very similar BLS treatments, such as whole eye movement therapy (IEMT). The hand movements x, -x of the treatments described and illustrated can also cover non-horizontal movement directions, such as vertical or diagonal movement directions.

[0077] The invention currently claimed is primarily illustrated using fMRI of the amygdala and / or prefrontal cortex of PTSD patients. However, those skilled in the art can adapt the invention for other regions of interest and other neurological conditions and traumas. Those skilled in the art know which parts of the brain are the optimal indicators of trauma reduction and how that brain region should respond to successful treatment.

[0078] The term "data" may be used in the singular or plural form in the context of this invention and should be understood as all data acquired during a single imaging procedure or within a predetermined time in an extended procedure.

[0079] Although the invention has been illustrated and described in detail in the accompanying drawings and the foregoing description, such illustrations and descriptions should be considered illustrative or exemplary, and not restrictive; the invention is not limited to the disclosed embodiments.

[0080] Those skilled in the art, through studying the accompanying drawings, disclosure, and claims, will be able to understand and implement other variations of the disclosed embodiments when practicing the claimed invention. In the claims, the word "comprising" does not exclude other elements or steps, and the words "a" or "an" do not exclude multiple. A single processor or other unit can implement the functions of several items recited in the claims. Although certain measures are recited in dissimilar dependent claims, this does not imply that combinations of these measures cannot be advantageously used. Computer programs can be stored / distributed on suitable media, such as optical storage media or solid-state media supplied together with or as part of other hardware, but can also be distributed in other forms, such as via the Internet or other wired or wireless telecommunications systems. No reference numerals in the claims should be construed as limiting the scope.

Claims

1. An EMDR treatment analysis device for analyzing eye movement desensitization and reprocessing (EMDR) treatments for patients (20) with psychological or mental trauma, comprising: Computer-implemented systems, including: The computer processor is configured as follows: First functional magnetic resonance imaging (fMRI) data is received from a patient undergoing EMDR treatment, wherein the first fMRI data includes fMRI data from regions of interest known to be associated with the patient’s level of trauma in the patient’s brain (10) or spinal cord (15); Second functional magnetic resonance imaging (fMRI) data is received from the patient during EMDR treatment, wherein the second fMRI data is obtained after the first fMRI data and includes fMRI data from the patient’s brain (10) or spinal cord (15) of the patient’s known regions of interest associated with the patient’s trauma. The first fMRI data and the second fMRI data are analyzed by identifying a trauma level metric that indicates the level of trauma in the patient. The second fMRI data is compared with the trauma level measure of the first fMRI data to determine whether the patient’s trauma level has changed; Convey whether the level of trauma has changed; and The basolateral amygdala (BLA) stimulation may be adjusted based on the presence of eye movements during the EMDR procedure, or the EMDR procedure settings may be adjusted in subsequent treatments.

2. The EMDR treatment analysis device according to claim 1, wherein, The computer processor is also configured to: A third fMRI data is received from a patient (20) during or after EMDR treatment, wherein the third fMRI data is obtained after the second fMRI data and includes fMRI data from the patient’s brain (10) or spinal cord (15) of the patient’s known regions of interest associated with the patient’s trauma; The updated first fMRI data and the second fMRI data are analyzed by identifying a trauma level metric that indicates the level of trauma in the patient. The third fMRI data is compared with the trauma level measure of the second fMRI data to determine whether the patient's trauma level has changed.

3. The EMDR treatment analysis device according to claim 1 or 2, wherein, The computer processor is also configured to: A sequence of at least two consecutively updated fMRI data received from a patient (20) during or after EMDR treatment, wherein the fMRI data includes fMRI data from the region of interest known to be associated with the patient’s trauma in the patient’s brain (10) or spinal cord (15); The analysis involves identifying trauma level metrics that indicate the level of trauma in the patient, and includes at least two updated fMRI datasets, comprising earlier and later acquired fMRI datasets, wherein the later acquired fMRI dataset was acquired at a later stage than the earlier acquired fMRI dataset. Wherein, at least one of the at least two consecutively updated fMRI data is received during EMDR treatment; The trauma level measure of the later-obtained fMRI data is compared with that of the earlier-obtained fMRI data to determine whether the patient's trauma level has changed.

4. The EMDR treatment analysis device according to claim 3, wherein, The later-obtained fMRI data is the last fMRI data obtained in the sequence of continuous fMRI data.

5. The EMDR treatment analysis device according to claim 3, wherein, The later-obtained fMRI data were from the patient (20) after undergoing the EMDR treatment.

6. The EMDR treatment analysis device according to any one of claims 1, 2, 4 and 5, wherein, The measure of interest in trauma is the contrast of blood oxygen level-related BOLD.

7. The EMDR treatment analysis device according to any one of claims 1, 2, 4 and 5, wherein, The psychological or mental trauma mentioned is post-traumatic stress disorder (PTSD).

8. The EMDR treatment analysis device according to claim 7, wherein, The regions of interest in the patient’s brain include the patient’s amygdala (11) and / or the patient’s prefrontal cortex (13, 13-1, 13-2).

9. The EMDR treatment analysis device according to claim 8, wherein, The patient's amygdala is the patient's left amygdala.

10. The EMDR treatment analysis device according to any one of claims 1, 2, 4, 5, 8 and 9, wherein, The level of trauma is further determined by combining the received EMDR data with other physiological or bioassay data of the patient.

11. The EMDR treatment analysis device according to claim 10, wherein, The other physiological or biological data are skin conductance, brain electrical activity, heart rate, respiratory rate, blink rate, body temperature, or any other physical attribute of the patient that can serve as an indicator of effectiveness and / or other fMRI or similar fMRI data.

12. The EMDR treatment analysis device according to claim 11, wherein, Any other physical attribute and / or other fMRI or similar fMRI data of the patient that can serve as an indicator of effectiveness are regional cerebral blood flow (CBF), cerebral blood volume (CBV), cerebral oxygen metabolism rate (CMRO2), or regional brain conductance.

13. The EMDR treatment analysis device according to claim 12, wherein, The local electroencephalogram (EEG) conductivity was obtained through electrical property tomography.

14. The EMDR treatment analysis device according to any one of claims 1, 2, 4, 5, 8, 9, 11, 12, and 13, wherein, The computer processor is configured to communicate with the EMDR therapist, via communication devices available during therapy, whether the level of trauma has changed.

15. The EMDR treatment analysis device according to claim 14, wherein, The communication is performed by displaying visual information or by using auditory or tactile signals.

16. The EMDR treatment analysis device according to claim 14, wherein, The communication is performed during or shortly after the EMDR treatment course.

17. The EMDR treatment analysis device according to any one of claims 1, 2, 4, 5, 8, 9, 11, 12, 13, 15, and 16, wherein, The computer processor is configured to: communicate to a device capable of adjusting the EMDR treatment during an ongoing EMDR treatment session whether the level of trauma has changed; and / or provide suggestions or plans for the patient's future EMDR treatment sessions.

18. The EMDR treatment analysis device according to claim 17, wherein, The device that can adjust the EMDR treatment during an ongoing EMDR treatment session is a device for generating adaptive visual stimuli.

19. The EMDR treatment analysis device according to claim 18, wherein, The device for generating adaptive visual stimuli is an EMDR device comprising a light-emitting diode (23) and / or a pulse generator (231).

20. The EMDR treatment analysis device according to claim 14, wherein, The processor is further configured to convert changes in trauma level measurement into validity parameters; and the communication device is further configured to communicate the validity parameters.

21. The EMDR therapy analysis device of claim 20, wherein, The validity parameter is a known value of the trauma level measure and / or a relative value compared to an initial value.

22. The EMDR therapy analysis device of claim 21, wherein, The relative value is a relative value of the trauma level measure in the first fMRI data.

23. The EMDR treatment analysis device according to claim 22, wherein, The relative values ​​are percentages.

24. A computer program product configured to execute an EMDR treatment analysis method when running, the EMDR treatment analysis method comprising the following steps: First functional magnetic resonance imaging (fMRI) data were obtained from a patient (20) undergoing EMDR treatment, wherein the first fMRI data included fMRI data from regions of interest known to be associated with the patient’s level of trauma in the patient’s brain (10) or spinal cord (15); Second functional magnetic resonance imaging (fMRI) data is obtained from the patient (20) during EMDR treatment, wherein the second fMRI data is obtained after the first fMRI data and includes fMRI data from the patient’s brain (10) or spinal cord (15) of the patient’s known regions of interest associated with the patient’s trauma. The first fMRI data and the second fMRI data are analyzed by identifying a trauma level metric that indicates the level of trauma in the patient. Compare the second fMRI data with the trauma level measure of the first fMRI data; Determine whether the patient's trauma level measurement has changed; Convey whether the trauma level metric has changed; and The basolateral amygdala (BLA) stimulation may be adjusted based on the presence of eye movements during the EMDR procedure, or the EMDR procedure settings may be adjusted in subsequent treatments.

25. The computer program product according to claim 24, wherein, The EMDR treatment analysis method also includes the following steps: A sequence of continuously updated fMRI data received from a patient (20) during or after EMDR treatment, wherein the fMRI data includes fMRI data from the region of interest known to be associated with the patient’s trauma in the patient’s brain (10) or spinal cord (15); The analysis involves identifying trauma level metrics that indicate the level of trauma in the patient, and includes at least two updated fMRI datasets, comprising earlier and later acquired fMRI datasets, wherein the later acquired fMRI dataset was acquired at a later stage than the earlier acquired fMRI dataset. At least one of the continuously updated fMRI data was received during EMDR treatment; The trauma level measure of the later-obtained fMRI data is compared with that of the earlier-obtained fMRI data to determine whether the patient's trauma level has changed.

26. The computer program product according to claim 25, wherein, The later-obtained fMRI data is the last fMRI data obtained in the sequence of continuous fMRI data.

27. The computer program product according to any one of claims 24-26, wherein, The trauma is post-traumatic stress disorder (PTSD).

28. The computer program product according to claim 27, wherein, The regions of interest in the patient’s brain include the patient’s amygdala (11) and / or the patient’s prefrontal cortex (13, 13-1, 13-2).

29. The computer program product according to claim 28, wherein, The patient's amygdala is the patient's left amygdala.

30. The computer program product according to claim 27, wherein, The level of trauma is measured by the contrast of blood oxygen level-related BOLD.

31. A computer-readable storage medium storing a computer program product according to any one of claims 24-30.

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