The results of our study demonstrate potential benefits of combining EMDR with BLAST wristbands to manage MTX intolerance in JIA patients. This tactile EMDR approach with the goal of continuation of therapy at home shows a significant further reduction in intolerance scores compared to EMDR alone, demonstrating added benefit of the BLAST wristbands in the patients’ ability to tolerate MTX therapy. Quality of life, which has already been proven to significantly improve with EMDR treatment, was enhanced even more with BLAST wristbands than without this additional treatment.

EMDR on its own has shown promise in various therapeutic settings, especially where trauma or adverse psychological reactions are involved [11, 12]. Its efficacy in PTSD treatment suggests the methodology’s ability to help patients reprocess distressing memories, making them less aversive. It is likely that a similar mechanism is at play with MTX intolerance. Children, after repeated experiences with MTX’s adverse effects, may associate the drug with a traumatic or aversive reaction, leading to an anticipatory response even before the drug is administered. EMDR, by addressing the initial experiences and the conditioned response, may attenuate the aversive nature of the memory or anticipation.

Instead of the traditional EMDR with bilateral eye movement stimulation, we implemented EMDR with tactile stimulation, using BLAST wristbands. The BLAST wristbands might provoke a greater effect and hold a higher appeal for further usage at home. Paulsen suggested that tactile bilateral stimulation might, in some cases, be more effective than visual or auditory bilateral stimulation, especially where dissociation or severe trauma is concerned [13]. Using BLAST wristbands, the exact same kind of stimulation is used in the EMDR therapy sessions, in the self-exercises at home and in the situation while taking the MTX.

Comparing our findings with existing literature, Bulatović et al. highlighted the high prevalence of MTX intolerance in JIA, with many patients developing an aversion to the drug over time [4]. While alternative therapeutic approaches and drugs are explored, our study presents a non-pharmacological approach to address the psychological aspect of the intolerance, which, as van Dijkhuizen et al. suggest, may play a significant role in the intolerance observed [14].

EMDR is based on the Adaptive Information Processing Method which states that, when experiences are processed in a healthy way, multiple elements of the experience such as thoughts, images, emotions and sensations are stored in our memory and helpful associations are forged with stored experiences and reactions in memory. In the case of a disturbing or traumatic event, dysfunctional coping mechanisms can negatively affect this information processing. This can possibly lead to flashback looks of negative experience memories which leads to an imbalance of emotions.

EMDR can be an effective treatment of traumatic stress disorder in adults and children [15,16,17] Benefits of this treatment have been demonstrated in the treatment of other kinds of dysfunctional memories and inefficient information processing of further adverse life experiences [18, 19]. We have already shown that EMDR is effective in treating MTX intolerance, strengthening the theory that MTX intolerance is based on dysfunctional or incomplete information processing evoked by e.g. strong negative feelings or adverse anticipation of side effects in line with taking MTX [9]. Patients have experienced MTX-related adverse effects or might have been told of the possibility of these occurring, and thus anticipate them in the future, with regular weekly re-enforcements and virtually no chance for escape [4, 20].

EMDR enables the processing of dysfunctional and traumatic memories, using an intensive recall combined with bilateral stimulation usually evoked by eye movement to dissolve the memories by reprocessing them (13). As a result, affective distress is relieved, negative beliefs are reformulated, and physiological arousal is reduced. Unprocessed memory content and dysfunctional experiences and memories are reprocessed several times in order to enable healthy information processing [21]. Bilateral stimulation by eye movement is supposed to counteract the ‚frozen information‘, enabling dissolution of traumatic memories, neutralization of the negative affect and reduction of physiological arousal [22].

Our results should be interpreted in light of several limitations. The sample size of our study, though significant, is still limited. Larger-scale studies may provide a more comprehensive understanding of the approach’s efficacy. In addition, the long-term effects of this combined intervention remain unknown. Follow-ups extending beyond 12 months might give insight into the sustained benefits or potential drawbacks of the approach. Considering individual variability, the mean intolerance score reduction was approx. 50%, but individual responses varied. Some participants might have benefited more from the intervention than others. Further analysis and possibly subgroup categorization might provide insights into which JIA patients stand to benefit the most from this combined approach. Another potential avenue for exploration is the role of other therapeutic interventions in conjunction with EMDR using BLAST. Cognitive Behavioral Therapy (CBT), for instance, has shown promise in managing chronic pain and could potentially offer an additional layer of support for these patients, addressing both the psychological aversion and the physical discomfort associated with MTX (8).