Predictors and Process Moderators of EMDR Therapy for Depressive Symptoms

Monitoring depressive symptoms

The Patient Health Questionnaire-9 (PHQ-9) is a 9-item self-report tool used to measure depressive symptoms. Participants rate the frequency of symptoms over the previous 2-week period on a scale from 0 ("not at all") to 3 ("nearly every day"), with total scores indicating no symptoms (0-5 points), mild symptoms (6-10 points), moderate symptoms (11-15 points), or severe symptoms (greater than 15 points).

Depressive symptoms

The Beck Depression Inventory (BDI-II) is a 21-item self-report instrument that assesses the severity of depressive symptoms based on DSM-IV criteria. The total score ranges from 0 to 63, with higher scores indicating greater levels of depression. A score above 13 is considered the cut-off for depressive symptoms (14-19: mild depression; 20-28: moderate depression; ≥29: severe depression).

Personal beliefs

The Personal Beliefs Scale-Revised (PBS-R) is a 44-item self-report measure designed to evaluate maladaptive personal beliefs across domains such as self-worth, interpersonal relationships, and personal agency. Respondents first indicate whether each belief applies to them by selecting "yes" or "no". For beliefs marked as applicable, participants then rate the degree to which each belief is problematic or distressing on a 4-point Likert scale, ranging from 1 ("not at all") to 4 ("very problematic").

Personality domains

The Personality Inventory for DSM-5 - Brief Form (PID-5-BF) is a 25-item self-report measure designed to assess five personality trait domains: negative affect, detachment, antagonism, disinhibition, and psychoticism. Each domain consists of 5 items rated on a 4-point scale ranging from 0 ("very false or often false") to 3 ("very true or often true"). The total score ranges from 0 to 75, with higher scores indicating greater personality dysfunction, while individual domain scores range from 0 to 15. Consistently high scores in a particular domain may indicate significant and challenging areas for the patient that may warrant further assessment, treatment, or follow-up.

Anxiety symptoms

The Generalized Anxiety Disorder-7 (GAD-7) is a 7-item self-report instrument designed to measure the frequency of generalized anxiety symptoms over the previous 2-week period on a scale from 0 ("not at all") to 3 ("nearly every day"). Total scores indicate no symptoms (0-5 points), mild symptoms (6-10 points), moderate symptoms (11-15 points), or severe symptoms (greater than 15 points).

Dissociative symptoms

The Dissociative Experiences Scale (DES-II) is a 28-item, self-report assessment tool designed to measure dissociative experiences, including emotional involvement, depersonalization, derealization, compartmentalization, and amnesia. Each item on the scale evaluates the proportion of time an individual experiences the specific symptom. The overall score is calculated as the average of all item scores, ranging from 0% ("never") to 100% ("always").

Exposure to traumatic or stressful life events

The Life Stressor Checklist-Revised (LSC-R, Wolfe et al., 2012), is a self-report measure used to assess exposure to traumatic or stressful life events throughout the lifespan, such as natural disasters, interpersonal violence, and the sudden death of a loved one. Respondents use a dichotomous response format (yes/no) to indicate whether they have experienced each event. For endorsed events, participants provide additional details, including the age of occurrence, whether they felt in harm's way or helpless ("yes" or "no"), and rate the event's impact and associated emotional distress on a 5-point Likert scale (1 = "not at all" to 5 = "extremely"). Respondents are also asked to identify up to three events that currently have the greatest impact on their lives. The LSC-R is widely used in clinical and research contexts to evaluate the cumulative effects of life stressors and their psychological impact.

Compassion

The Compassionate Action and Engagement Scales (CAES) is a self-report instrument designed to assess three key dimensions of compassion: (1) the compassion one experiences for others, (2) the compassion one perceives from others, and (3) self-compassion. The scales are based on a standard definition of compassion as "a sensitivity to suffering in self and others, coupled with a commitment to alleviate and prevent it". The instructions for each scale define compassion and invite participants to reflect on their responses when confronted with their own suffering, the suffering of others, or the experience of compassion from others. Responses are recorded using a 10-point Likert scale ranging from "never" to "always". Higher scores reflect greater levels of sensitivity and commitment within each dimension of compassion.

Experience of Mindfulness

The Philadelphia Mindfulness Scale (PHLMS-I) is a 20-item self-report inventory designed to measure two core components of mindfulness: awareness (attentiveness to present-moment experiences) and acceptance (a non-judgmental attitude toward thoughts and emotions). Each subscale comprises 10 items rated on a 5-point Likert scale ranging from 1 ("never") to 5 ("very often"), reflecting the frequency of the subjective experiences. Subscale scores are calculated as the sum of their respective items, with higher scores indicating greater mindfulness abilities.

Evaluating adult attachment style

The Relationships Questionnaire (RQ), is a 4-item self-report tool used to assess an individual's adult attachment style. Respondents rate their agreement or disagreement with four statements on a 7-point Likert scale ranging from 1 ("strongly disagree") to 7 ("strongly agree"). The RQ identifies whether an individual has a secure, anxious, or avoidant attachment style and provides insights into how they approach and experience interpersonal relationships.