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Prillinger K, Goreis A, Macura S, Hajek Gross C, Lozar A, Fanninger S, Mayer A, Oppenauer C, Plener PL, Kothgassner OD. A systematic review and meta-analysis on the efficacy of dialectical behavior therapy variants for the treatment of post-traumatic stress disorder. Eur J Psychotraumatol 2024; 15:2406662. [PMID: 39351658 PMCID: PMC11445934 DOI: 10.1080/20008066.2024.2406662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 09/03/2024] [Accepted: 09/06/2024] [Indexed: 10/03/2024] Open
Abstract
Background: While there are well-established treatments for post-traumatic stress disorder (PTSD), these interventions appear to be less effective for individuals with comorbid borderline personality disorder (BPD) symptoms. Dialectical Behavior Therapy (DBT) for PTSD and DBT Prolonged Exposure (PE) are both effective interventions for treating these patients, but a comprehensive analysis evaluating the efficacy of these two interventions is lacking.Objective: To determine the effect sizes of PTSD-specific DBT treatments.Methods: We conducted a systematic review and pre-registered meta-analysis of the DBT literature for treating PTSD (osf.io/62rfq). Eligible trials and treatment evaluations published before September 2023 were searched in SCOPUS, PubMed, and the Cochrane Library databases. Thirteen articles were identified, and data were extracted for primary (PTSD symptoms) and secondary outcomes (BPD, depression, dissociation, non-suicidal self-injury [NSSI]). Treatment effects were calculated for randomised controlled trials, controlled clinical trials, and pre-post evaluations.Results: Overall, the studies involved 663 participants. Compared with control groups, PTSD-specific DBT treatments showed moderate effects in reducing PTSD symptom severity g = -0.69 (95% CI -1.03 to -0.34, p < .001) and depression g = -0.62 (95% CI -1.13 to -0.12, p = .016). Moreover, the pre-post changes showed an overall effect size for dissociative symptoms of g = -0.72 (95% CI -1.05 to -0.40, p < .001), for BPD-associated symptoms of g = -0.82 (95% CI -1.06 to -0.59, p < .001), and for NSSI frequency (g = -0.70, 95% CI -1.12 to -0.28, p = .001).Conclusions: Based on the results of our meta-analysis, DBT-PTSD and DBT PE were effective in reducing PTSD symptom severity and comorbid depressive symptoms. Further research on stage-based treatments should focus on systematically assessing NSSI, BPD symptoms, and suicidality.
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Affiliation(s)
- Karin Prillinger
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Vienna, Austria
| | - Andreas Goreis
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Vienna, Austria
| | - Sarah Macura
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Vienna, Austria
| | - Carola Hajek Gross
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Annika Lozar
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Selina Fanninger
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Anna Mayer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Claudia Oppenauer
- Division of Clinical Psychology, Department of Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Paul L. Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Vienna, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Oswald D. Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Vienna, Austria
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van Ee E, de Beijer D, Florisson D, Geuskens F. Making sense of change after Intensive Trauma Treatment: a mixed-methods study into adolescents' experience of efficacy. Child Adolesc Psychiatry Ment Health 2024; 18:92. [PMID: 39060919 PMCID: PMC11282781 DOI: 10.1186/s13034-024-00781-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND While evidence-based interventions are effective for children with post-traumatic stress disorder (PTSD), some adolescents may not respond sufficiently. Intensive trauma treatment (ITT) has shown promise for adults, but research on its efficacy for adolescents is limited. This study therefore aimed to explore the efficacy and subjective experience of change in adolescents participating in ITT. METHODS The present study employed a mixed-methods approach among a sample of adolescents with PTSD (N = 22; 90.1% female, age M = 17.0, SD = 1.72) who participated in an ITT program. Clinical data and narratives were combined to assess treatment efficacy and subjective experiences of change. RESULTS Quantitative analysis revealed a significant reduction in PTSD symptoms post-ITT, aligning with prior research. Qualitative analysis highlighted themes such as negative thoughts impacting treatment success, the importance of social support, and identity-related struggles. CONCLUSIONS The study contributes to understanding ITT efficacy and emphasizes the need for developmental sensitivity, systemic interventions, and continued research to enhance PTSD treatment for adolescents.
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Affiliation(s)
- Elisa van Ee
- Psychotraumacentrum Zuid-Nederland, Bethaniëstraat 10, Den Bosch, The Netherlands.
- Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, Nijmegen, The Netherlands.
| | - Dani de Beijer
- Psychotraumacentrum Zuid-Nederland, Bethaniëstraat 10, Den Bosch, The Netherlands
- Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, Nijmegen, The Netherlands
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Vaage-Kowalzik V, Engeset J, Jakobsen M, Andreassen W, Evensen JH. Exhausting, but necessary: the lived experience of participants in an intensive inpatient trauma treatment program. Front Psychol 2024; 15:1341716. [PMID: 38863672 PMCID: PMC11165995 DOI: 10.3389/fpsyg.2024.1341716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/09/2024] [Indexed: 06/13/2024] Open
Abstract
Background Intensive inpatient treatment programs have shown robust results in the treatment of post-traumatic stress disorder (PTSD). How patients experience this treatment program and what changes they experience as a result of the treatment have, however, only scarcely been explored through qualitative studies. Objective This study aimed to explore the lived experience of participants in an intensive inpatient trauma treatment program. Our research questions were as follows: how do patients experience intensive trauma-focused treatment? How do they experience possible changes related to participating in the treatment program? Methods Six patients diagnosed with PTSD with significant comorbidities, who recently participated in an intensive 2-week (4 + 4 days) inpatient trauma treatment program with prolonged exposure (PE), eye movement desensitization and reprocessing (EMDR), and therapist rotation (TR), were interviewed with a semi-structured qualitative interview. Transcripts were analyzed using a thematic analysis approach. Results Our analysis resulted in five main themes: (1) the need to feel safe; (2) the benefits of many and different therapeutic encounters; (3) variable experience with elements of treatment; (4) intensity; and (5) experienced change. Our results suggest that feeling safe within the framework of the treatment program facilitated the treatment process. Many and different therapeutic encounters, both through TR and with ward staff, contributed to experienced change. All participants described the intensity as facilitative to trauma processing. However, most participants also describe often feeling too overwhelmed to benefit from all elements of the treatment program. Conclusions Our findings suggest that participants experience the overall treatment program as beneficial and contributing to experienced change. Participants described the intensity of the program as exhausting, but necessary. Most did, however, report at times of being too overwhelmed to benefit from elements of the program. Consequently, our results prompt us to question the optimal level of intensity. Trial registration ClinicalTrials.gov identifier: NCT05342480. Date of registration: 2022-04-22.
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Affiliation(s)
| | - Jeanette Engeset
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Wenche Andreassen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Held P, Smith LJ, Parmar AM, Pridgen SA, Smith DL, Klassen B. Veterans' 12-month PTSD and depression outcomes following 2- and 3-week intensive cognitive processing therapy-based treatment. Eur J Psychotraumatol 2024; 15:2350908. [PMID: 38770596 PMCID: PMC11110869 DOI: 10.1080/20008066.2024.2350908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/24/2024] [Indexed: 05/22/2024] Open
Abstract
Background: Growing evidence indicates that daily delivery of evidence-based PTSD treatments (e.g. Cognitive Processing Therapy (CPT)), as part of intensive PTSD treatment programmes (ITPs), is feasible and effective. Research has demonstrated that a 2-week CPT-based ITP can produce equivalent outcomes to a 3-week ITP, suggesting shorter treatment can also be highly effective. However, the extent to which ITP length and composition impact longer-term outcomes needs further study.Objective: We examined whether PTSD and depression symptoms 3-, 6-, and 12-months following completion of a 2-week ITP could be considered non-inferior, or equivalent, to those of a 3-week ITP.Method: Data from 638 veterans who participated in a 2-week CPT-based ITP were evaluated against 496 veterans who participated in a 3-week CPT-based ITP. A Bayes factor approach was used to examine whether PTSD and depression severity outcomes of the 2-week ITP could be considered equivalent to the 3-week ITP.Results: Participants across both ITPs reported large PTSD (d = 0.98) and moderate to large depression symptom reductions (d = 0.69) from baseline to 12-month follow-up. The PTSD and depression symptom reductions seen in the 2-week ITP were determined to be equivalent to those of the 3-week ITP.Conclusions: Low follow-up completion was a limitation. Future research might replicate the present findings using samples with greater follow-up rates and explore whether adjunctive services impact other relevant constructs, such as quality of life and functioning.
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Affiliation(s)
- Philip Held
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Lia J. Smith
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Angelee M. Parmar
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sarah A. Pridgen
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Dale L. Smith
- Department of Psychiatry, University of Illinois – Chicago, Chicago, IL, USA
| | - Brian Klassen
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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Matthijssen SJMA, Menses SDF, Huisman-van Dijk HM. The effects of an intensive outpatient treatment for PTSD. Eur J Psychotraumatol 2024; 15:2341548. [PMID: 38665124 PMCID: PMC11057464 DOI: 10.1080/20008066.2024.2341548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/01/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction: Research has shown that combining different evidence-based PTSD treatments for patients with PTSD in an intensive inpatient format seems to be a promising approach to enhance efficiency and reduce generally high dropout rates.Objective: To assess the effectiveness of an intensive six-day outpatient trauma-focused treatment for patients with PTSD.Method: Data from 146 patients (89.7% female, mean age = 36.79, SD = 11.31) with PTSD due to multiple traumatization were included in the analyses. The treatment programme consisted of six days of treatment within two weeks, with two daily individual 90-minute trauma-focused sessions (prolonged exposure and eye movement desensitization and reprocessing), one hour of exercise, and one hour of psychoeducation. All participants experienced multiple traumas, and 85.6% reported one or more comorbid psychiatric disorders. PTSD symptoms and diagnoses were assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), and self-reported symptoms were assessed with the PTSD Checklist for DSM-5 (PCL-5).Results: A significant decline in PTSD symptoms (CAPS-5 and PCL-5) from pretreatment to one-month follow-up (Cohen's d = 1.13 and 1.59) was observed and retained at six-month follow-up (Cohen's d = 1.47 and 1.63). After one month, 52.4% of the patients no longer met the diagnostic criteria for PTSD (CAPS-5). The Reliable Change Index (RCI) shows that 73.9% of patients showed improvement on the CAPS-5 and 77.61% on the PCL-5. Additionally, 21.77% (CAPS-5) and 20.0% (PCL-5) showed no change, while 4.84% (CAPS-5) and 2.96% (PCL-5) showed symptom worsening.Discussion: The results show that an intensive outpatient trauma treatment programme, including two evidence-based trauma-focused treatments, exercise, and psychoeducation, is effective for patients suffering from PTSD as a result of multiple traumatization. Subsequent research should focus on more controlled studies comparing the treatment programme with other intensive trauma treatments and less frequent routine treatment.
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Wigard I, Meyerbröker K, Ehring T, Topper M, Arntz A, Emmelkamp P. Skills training followed by either EMDR or narrative therapy for posttraumatic stress disorder in adult survivors of childhood abuse: a randomized controlled trial. Eur J Psychotraumatol 2024; 15:2332104. [PMID: 38629403 PMCID: PMC11025408 DOI: 10.1080/20008066.2024.2332104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 03/06/2024] [Indexed: 04/19/2024] Open
Abstract
Background: Individuals suffering from PTSD following childhood abuse represent a large subgroup of patients attending mental health services. The aim of phase-based treatment is to tailor treatment to the specific needs to childhood abuse survivors with PTSD with a Skills Training in Affective and Interpersonal Regulation (STAIR) phase, in which emotion dysregulation and interpersonal problems are targeted, and a trauma-focused phase.Objective: The purpose of this study was to compare STAIR + Eye Movement Desensitization and Reprocessing (EMDR) vs. STAIR + Narrative Therapy (NT) as treatments for PTSD following childhood-onset trauma in a routine clinical setting.Method: Sixty-eight adults were randomly assigned to STAIR/EMDR (8 STAIR-sessions followed by 12 EMDR-sessions) or STAIR/NT (8 STAIR-sessions followed by 12 NT-sessions). Assessments took place at pre-treatment, after each treatment phase and at 3 and 12 months post-intervention follow-up. Primary outcomes were interviewer-rated and self-reported symptom levels of PTSD. Secondary outcomes included symptom levels of depression and disturbances in emotion regulation and interpersonal skills.Results: Multilevel analyses in the intent-to-treat sample indicated that patients in both treatments improved substantially on PTSD symptom severity (CAPS: d = 0.81 to 1.29; PDS: d = 1.68 to 2.15), as well as on symptom levels of depression, anxiety, emotion regulation, dissociation and interpersonal skills. Effects increased or were maintained until 12-month follow-up. At mid-treatment, after STAIR, patients in both treatments improved moderately on PTSD symptom severity (PDS: d = 1.68 to 2.15), as well as on symptom levels of depression (BDI: d = .32 to .31). Symptoms of anxiety, emotion dysregulation, interpersonal problems and dissociation were not decreased after STAIR. There were no significant differences between the two conditions on any outcome.Conclusion: PTSD in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or NT in the trauma-processing phase.Trial registration: ClinicalTrials.gov identifier: NCT01443182..
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Affiliation(s)
- I. Wigard
- Parnassiagroep, Amsterdam, the Netherlands
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - K. Meyerbröker
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
- Altrecht Academic Anxiety Centre, Utrecht, the Netherlands
| | - T. Ehring
- Department of Psychology, LMU Munich, Munich, Germany
| | - M. Topper
- GGZ-Noord-Holland-Noord, Alkmaar, the Netherlands
| | - A. Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - P. Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
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De Jongh A, Hafkemeijer LCS. Trauma-focused treatment of a client with Complex PTSD and comorbid pathology using EMDR therapy. J Clin Psychol 2024; 80:824-835. [PMID: 37058521 DOI: 10.1002/jclp.23521] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/20/2023] [Accepted: 03/25/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVE Complex post-traumatic stress disorder (CPTSD) is a classification within the International Classification of Diseases, 11th Revision (ICD-11) that, besides the DSM-5 symptom clusters of post-post-traumatic stress disorder (PTSD), includes the presence of negative self-concept, difficulties in regulating emotions and relationship skills. The purpose of the present study was to provide guidance on how to deliver Eye Movement Desensitization and Reprocessing (EMDR) therapy in the context of CPTSD, based on current clinical knowledge and the latest scientific research findings. METHOD This paper describes the treatment of a 52-year-old woman with CPTSD and borderline personality disorder for which immediate trauma-focused EMDR therapy was used. RESULTS First, a description of what EMDR therapy entails and some important treatment strategies that the therapist may employ to assist in trauma-focused treatment of clients with CPTSD using EMDR therapy are outlined. CONCLUSION The treatment results are in line with mounting evidence supporting the notion that EMDR therapy is a safe and potentially effective treatment alternative for individuals with CPTSD or personality problems.
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Affiliation(s)
- A De Jongh
- Psychotrauma Expertise Centre (PSYTREC), Bilthoven, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
- Research Department PSYTREC, Bilthoven, The Netherlands
- School of Health Sciences, Salford University, Manchester, UK
- Institute of Health and Society, University of Worcester, Worcester, UK
- School of Psychology, Queen's University, Belfast, Northern Ireland
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Klaeth JR, Jensen AG, Auren TJB, Solem S. 12-month follow-up of intensive outpatient treatment for PTSD combining prolonged exposure therapy, EMDR and physical activity. BMC Psychiatry 2024; 24:225. [PMID: 38532374 PMCID: PMC10964674 DOI: 10.1186/s12888-024-05656-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/04/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Preliminary evidence shows promising treatment outcomes at short-term follow-up for intensive posttraumatic stress disorder (PTSD) treatment, but long-term follow-up studies are sparse. This study is a sequel to a previous pilot study and open trial, set out to investigate treatment outcomes at 12-month follow-up for outpatients completing an 8-day intensive treatment for PTSD. METHODS All patients were diagnosed with PTSD and had multiple previous psychotherapy attempts (M = 3.1). Patients were assessed at pre-treatment, post-treatment, 3- and 12-month follow-up. Of 35 treated patients, 32 (91.4%) attended the long-term follow-up assessment. The treatment programme combined prolonged exposure therapy, eye movement desensitization and reprocessing, and physical activity. RESULTS The effect sizes indicated large reductions in symptoms of PTSD, depression, anxiety, interpersonal problems, and well-being. Changes in functioning showed a small-medium effect. Results were stable across the follow-up period. The treatment response rates showed that 46-60% of patients achieved recovery with respect to PTSD symptoms, and that 44-48% no longer met diagnostic criteria for PTSD. CONCLUSIONS Time-limited and concentrated outpatient treatment for PTSD can yield large and enduring positive outcomes. Controlled trials are needed to establish relative efficacy. TRIAL REGISTRATION The study was registered in Current Research Information System In Norway (Cristin). Cristin-project-ID: 654,790. Date of registration: 18.03.2019.
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Affiliation(s)
- Julie Rendum Klaeth
- Regional Unit for Treatment of Severe Posttraumatic Stress Disorder, Nidaros DPS, St. Olavs Hospital, Trondheim, 7040, Norway.
| | - Andreas Gjerde Jensen
- Regional Unit for Treatment of Severe Posttraumatic Stress Disorder, Nidaros DPS, St. Olavs Hospital, Trondheim, 7040, Norway
| | - Trude Julie Brynhildsvoll Auren
- Regional Unit for Treatment of Severe Posttraumatic Stress Disorder, Nidaros DPS, St. Olavs Hospital, Trondheim, 7040, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, 7491, Norway
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Ruisch JE, Havermans DCD, Gielkens EMJ, Olff M, Daamen MAMJ, van Alphen SPJ, van Kordenoordt M, Schols JMGA, Schruers KRJ, Sobczak S. Posttraumatic stress disorder in people with dementia: study protocol. Eur J Psychotraumatol 2024; 15:2320040. [PMID: 38488137 PMCID: PMC10946268 DOI: 10.1080/20008066.2024.2320040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/31/2024] [Indexed: 03/19/2024] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) is considered an independent risk factor for dementia. Despite the (clinical) evidence that PTSD is associated with neuropsychiatric symptoms in people with dementia, studies on its prevalence and clinical manifestation are limited, and their quality is affected by the lack of a structured method to diagnose PTSD in this population. The primary aim of the current study is to validate the 'TRAuma and DEmentia' interview as a diagnostic tool for PTSD in people with dementia and to test feasibility of EMDR treatment for people with PTSD and dementia.Methods: This prospective multi-centre study is divided into two parts. In study A, 90 participants with dementia will be included to test the criterion validity, inter-rater reliability and feasibility of the 'TRAuma and DEmentia' interview. In study B, 29 participants with dementia and PTSD will receive eye movement desensitisation and reprocessing therapy by a trained psychologist, and 29 participants with dementia and PTSD will be placed on the waiting list control group.Conclusion: This study aims to improve the diagnostic process of PTSD and to assess the effects of eye movement desensitisation and reprocessing treatment in people with dementia living in Dutch care facilities.Trial registration: NL70479.068.20 / METC 20-063 / OSF registration: https://doi.org/10.17605/OSF.IO/AKW4F.
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Affiliation(s)
- J. E. Ruisch
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht, the Netherlands
- Envida, Care for Older People, Department of Treatment and Support, Maastricht, the Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
| | - D. C. D. Havermans
- Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands
- TanteLouise, Bergen op Zoom, the Netherlands
| | - E. M. J. Gielkens
- Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Vrije Universiteit Brussel (VUB), Department of Psychology, Personality and Psychopathology Research Group (PEPS), Brussels, Belgium
| | - M. Olff
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands
- ARQ National Psychotrauma Centre, Diemen, the Netherlands
| | - M. A. M. J. Daamen
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Cicero, Department of Treatment and Guidance, Brunssum, the Netherlands
| | - S. P. J. van Alphen
- Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Vrije Universiteit Brussel (VUB), Department of Psychology, Personality and Psychopathology Research Group (PEPS), Brussels, Belgium
| | - M. van Kordenoordt
- Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Zuyderland Care, Sittard, the Netherlands
| | - J. M. G. A. Schols
- Envida, Care for Older People, Department of Treatment and Support, Maastricht, the Netherlands
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - K. R. J. Schruers
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht, the Netherlands
- Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
| | - S. Sobczak
- Mondriaan Mental Health Center, Heerlen-Maastricht, the Netherlands
- Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands
- Research Center Innovations in Care, Rotterdam University of Applied Science, Rotterdam, the Netherlands
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Vock S, Delker A, Rinderknecht J, Engel F, Wieland S, Beiner E, Friederich HC, Jarero IN, Seidler GH, Tesarz J. Group eye movement desensitization and reprocessing (EMDR) in chronic pain patients. Front Psychol 2024; 15:1264807. [PMID: 38455119 PMCID: PMC10919217 DOI: 10.3389/fpsyg.2024.1264807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/12/2024] [Indexed: 03/09/2024] Open
Abstract
The prevalence of chronic pain is increasing, and conventional pain therapies often have limited efficacy in individuals with high levels of psychological distress and a history of trauma. In this context, the use of Eye Movement Desensitization and Reprocessing (EMDR), an evidence-based psychotherapy approach for the treatment of posttraumatic stress disorder, is becoming increasingly important. EMDR shows promising results, particularly for patients with pain and high levels of emotional distress. Although group therapy is becoming increasingly popular in pain management, EMDR has mainly been studied as an individual treatment. However, a systematic review suggests that group therapy can be an effective tool for improving mental health outcomes, especially when trauma is addressed together. Based on these findings, an outpatient EMDR group program was developed for patients with chronic pain. The program consists of a total of four treatment days with 5-5.5 h therapy sessions each day and provides patients with a supportive environment in which they can learn effective pain management strategies and interact with other patients with similar experiences. Initial pilot evaluations indicate high efficacy and adequate safety for patients with chronic pain.
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Affiliation(s)
- Stephanie Vock
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Anna Delker
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Janna Rinderknecht
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Felicitas Engel
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Sebastian Wieland
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Eva Beiner
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | | | | | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
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Burback L, Brémault-Phillips S, Nijdam MJ, McFarlane A, Vermetten E. Treatment of Posttraumatic Stress Disorder: A State-of-the-art Review. Curr Neuropharmacol 2024; 22:557-635. [PMID: 37132142 PMCID: PMC10845104 DOI: 10.2174/1570159x21666230428091433] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 05/04/2023] Open
Abstract
This narrative state-of-the-art review paper describes the progress in the understanding and treatment of Posttraumatic Stress Disorder (PTSD). Over the last four decades, the scientific landscape has matured, with many interdisciplinary contributions to understanding its diagnosis, etiology, and epidemiology. Advances in genetics, neurobiology, stress pathophysiology, and brain imaging have made it apparent that chronic PTSD is a systemic disorder with high allostatic load. The current state of PTSD treatment includes a wide variety of pharmacological and psychotherapeutic approaches, of which many are evidence-based. However, the myriad challenges inherent in the disorder, such as individual and systemic barriers to good treatment outcome, comorbidity, emotional dysregulation, suicidality, dissociation, substance use, and trauma-related guilt and shame, often render treatment response suboptimal. These challenges are discussed as drivers for emerging novel treatment approaches, including early interventions in the Golden Hours, pharmacological and psychotherapeutic interventions, medication augmentation interventions, the use of psychedelics, as well as interventions targeting the brain and nervous system. All of this aims to improve symptom relief and clinical outcomes. Finally, a phase orientation to treatment is recognized as a tool to strategize treatment of the disorder, and position interventions in step with the progression of the pathophysiology. Revisions to guidelines and systems of care will be needed to incorporate innovative treatments as evidence emerges and they become mainstream. This generation is well-positioned to address the devastating and often chronic disabling impact of traumatic stress events through holistic, cutting-edge clinical efforts and interdisciplinary research.
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Affiliation(s)
- Lisa Burback
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | | | - Mirjam J. Nijdam
- ARQ National Psychotrauma Center, Diemen, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
- Department of Psychiatry, New York University Grossman School of Medicine, New York, USA
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12
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van der Linde RPA, Huntjens RJC, Bachrach N, Rijkeboer MM, de Jongh A, van Minnen A. The role of dissociation-related beliefs about memory in trauma-focused treatment. Eur J Psychotraumatol 2023; 14:2265182. [PMID: 37846662 PMCID: PMC10583636 DOI: 10.1080/20008066.2023.2265182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/16/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE Dysfunctional cognitions play a central role in the development of post-traumatic stress disorder (PTSD). However the role of specific dissociation-related beliefs about memory has not been previously investigated. This study aimed to investigate the role of dissociation-related beliefs about memory in trauma-focused treatment. It was hypothesized that patients with the dissociative subtype of PTSD would show higher levels of dissociation-related beliefs, dissociation-related beliefs about memory would decrease after trauma-focused treatment, and higher pre-treatment dissociation-related beliefs would be associated with fewer changes in PTSD symptoms. METHOD Post-traumatic symptoms, dissociative symptoms, and dissociation-related beliefs about memory were assessed in a sample of patients diagnosed with PTSD (n = 111) or the dissociative subtype of PTSD (n = 61). They underwent intensive trauma-focused treatment consisting of four or eight consecutive treatment days. On each treatment day, patients received 90 min of individual prolonged exposure (PE) in the morning and 90 min of individual eye movement desensitization and reprocessing (EMDR) therapy in the afternoon. The relationship between dissociation-related beliefs about memory and the effects of trauma-focused treatment was investigated. RESULTS Dissociation-related beliefs about memory were significantly associated with PTSD and its dissociative symptoms. In addition, consistent with our hypothesis, patients with the dissociative subtype of PTSD scored significantly higher on dissociation-related beliefs about memory pre-treatment than those without the dissociative subtype. Additionally, the severity of these beliefs decreased significantly after trauma-related treatment. Contrary to our hypothesis, elevated dissociation-related beliefs did not negatively influence treatment outcome. CONCLUSION The results of the current study suggest that dissociation-related beliefs do not influence the outcome of trauma-focused treatment, and that trauma-focused treatment does not need to be altered specifically for patients experiencing more dissociation-related beliefs about memory because these beliefs decrease in association with treatment.
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Affiliation(s)
- Robin P. A. van der Linde
- Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
- GGZ Oost Brabant, Boekel, the Netherlands
| | - Rafaële J. C. Huntjens
- Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Nathan Bachrach
- GGZ Oost Brabant, Boekel, the Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Marleen M. Rijkeboer
- Faculty of Psychology and Neurosciences, Maastricht University, Maastricht, the Netherlands
| | - Ad de Jongh
- Research Department, PSYTREC, Bilthoven, the Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands
- School of Psychology, Queen’s University, Belfast, Northern Ireland
- Institute of Health and Society, University of Worcester, Worcester, United Kingdom
- School of Health Sciences, Salford University, Manchester, United Kingdom
| | - Agnes van Minnen
- Research Department, PSYTREC, Bilthoven, the Netherlands
- Behavioural Science Institute (BSI), Radboud University, Nijmegen, the Netherlands
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13
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Paridaen P, Voorendonk EM, Gomon G, Hoogendoorn EA, van Minnen A, de Jongh A. Changes in comorbid depression following intensive trauma-focused treatment for PTSD and complex PTSD. Eur J Psychotraumatol 2023; 14:2258313. [PMID: 37796651 PMCID: PMC10557564 DOI: 10.1080/20008066.2023.2258313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/29/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The extent to which intensive trauma-focused treatment for individuals with post-traumatic stress disorder (PTSD) is also effective in treating comorbid major depressive disorder (MDD) remains unclear. OBJECTIVE The purpose of the present study was to test the hypothesis that brief intensive trauma-focused therapy for PTSD is associated with significant reductions in depressive symptoms and loss of diagnostic status of MDD. METHODS A total of 334 adult patients with PTSD (189 patients who were also diagnosed with MDD) underwent a brief intensive trauma-focused treatment programme consisting of EMDR therapy, prolonged exposure, physical activity, and psychoeducation. At pre-treatment, post-treatment and 6-month follow-up, severity and diagnostic status of PTSD and MDD were assessed. A linear mixed model was used to analyze changes in the severity of PTSD and depressive symptoms, whereas a generalized linear mixed model was used to determine changes in the MDD diagnostic status. RESULTS Treatment resulted in a significant and strong decrease of PTSD and MDD symptoms at post-treatment (d = 2.34 and 1.22, respectively), and at 6-month follow-up (d = 1.67 and 0.73, respectively). The proportion of patients fulfilling the diagnostic status of MDD changed from 57% at pre-treatment to 33% at the 6-month follow-up. Although the initial response to treatment did not differ between patients with and without comorbid MDD, for both groups a significant relapse in depressive symptoms was found after six months, which could be explained almost entirely by the presence of CPTSD at baseline. CONCLUSIONS The results support the notion that brief, intensive trauma-focused treatment is highly effective for individuals with PTSD and comorbid MDD. Because patients with CPTSD are vulnerable to relapse in depressive symptoms, this target group may require additional treatment.
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Affiliation(s)
- Paul Paridaen
- Research Department, PSYTREC, Bilthoven, the Netherlands
- Antes GGZ, Dordrecht
| | - Eline M. Voorendonk
- Research Department, PSYTREC, Bilthoven, the Netherlands
- Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Georgy Gomon
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Agnes van Minnen
- Research Department, PSYTREC, Bilthoven, the Netherlands
- Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Ad de Jongh
- Research Department, PSYTREC, Bilthoven, the Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands
- School of Psychology, Queen’s University, Belfast, Northern Ireland
- Institute of Health and Society, University of Worcester, Worcester, UK
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14
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van Woudenberg C, Voorendonk EM, Tunissen B, van Beek VHF, Rozendael L, Van Minnen A, De Jongh A. The impact of intensive trauma-focused treatment on sexual functioning in individuals with PTSD. Front Psychol 2023; 14:1191916. [PMID: 37614489 PMCID: PMC10442952 DOI: 10.3389/fpsyg.2023.1191916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/24/2023] [Indexed: 08/25/2023] Open
Abstract
Background Individuals with posttraumatic stress disorder (PTSD) often experience sexual disturbances. Objective To determine whether intensive trauma-focused treatment is associated with an improvement in sexual functioning (i.e., sexual satisfaction and sexual desire) in individuals with PTSD. Method In total, 227 patients with PTSD (68.7% women, mean age = 40.97) participated in an intensive eight-day trauma-focused treatment program consisting of prolonged exposure, eye movement and desensitization and reprocessing (EMDR) therapy, physical activity, and psychoeducation. Patients were assessed (i.e., Clinician Administered PTSD Scale and Sexual Functioning Questionnaire) pre- and post-treatment and at 6-months follow-up. Results Sexual satisfaction and sexual desire increased significantly associated with trauma-focused treatment from pre-treatment to 6-months follow-up, albeit the effect sizes were small (Cohen's d = 0.39 and 0.17, respectively). Although men reported greater overall sexual desire than women, sexual functioning improved after treatment in both men and women. Furthermore, those with remission of PTSD reported greater sexual functioning post-treatment and at 6-months follow-up, than those without remission. However, changes in PTSD symptoms associated with treatment were not predictive of the level of sexual satisfaction or sexual desire 6 months after treatment. Conclusion The results of this uncontrolled study suggest that intensive treatment for PTSD can have beneficial effects on sexual satisfaction and desire in both men and women; however, this may not necessarily be due to a decrease in PTSD symptoms.
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Affiliation(s)
| | - Eline M. Voorendonk
- Research Department, PSYTREC, Bilthoven, Netherlands
- Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, Netherlands
| | - Bo Tunissen
- Research Department, PSYTREC, Weert, Netherlands
| | | | | | - Agnes Van Minnen
- Research Department, PSYTREC, Bilthoven, Netherlands
- Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, Netherlands
| | - Ad De Jongh
- Research Department, PSYTREC, Bilthoven, Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands
- School of Psychology, Queen’s University, Belfast, United Kingdom
- Institute of Health and Society, University of Worcester, Worcester, United Kingdom
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15
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Bremer-Hoeve S, van Vliet NI, van Bronswijk SC, Huntjens RJ, de Jongh A, van Dijk MK. Predictors of treatment dropout in patients with posttraumatic stress disorder due to childhood abuse. Front Psychiatry 2023; 14:1194669. [PMID: 37599872 PMCID: PMC10436563 DOI: 10.3389/fpsyt.2023.1194669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Background Knowledge about patient characteristics predicting treatment dropout for post-traumatic stress disorder (PTSD) is scarce, whereas more understanding about this topic may give direction to address this important issue. Method Data were obtained from a randomized controlled trial in which a phase-based treatment condition (Eye Movement Desensitization and Reprocessing [EMDR] therapy preceded by Skills Training in Affect and Interpersonal Regulation [STAIR]; n = 57) was compared with a direct trauma-focused treatment (EMDR therapy only; n = 64) in people with a PTSD due to childhood abuse. All pre-treatment variables included in the trial were examined as possible predictors for dropout using machine learning techniques. Results For the dropout prediction, a model was developed using Elastic Net Regularization. The ENR model correctly predicted dropout in 81.6% of all individuals. Males, with a low education level, suicidal thoughts, problems in emotion regulation, high levels of general psychopathology and not using benzodiazepine medication at screening proved to have higher scores on dropout. Conclusion Our results provide directions for the development of future programs in addition to PTSD treatment or for the adaptation of current treatments, aiming to reduce treatment dropout among patients with PTSD due to childhood abuse.
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Affiliation(s)
| | | | - Suzanne C. van Bronswijk
- Department of Psychiatry and Neuropsychology, School for Mental health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Rafaele J.C. Huntjens
- Department of Experimental Psychotherapy and Psychopathology, University of Groningen, Groningen, Netherlands
| | - Ad de Jongh
- Department of Social Dentistry and Behavioral Sciences, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
- School of Health Sciences, Salford University, Manchester, United Kingdom
- Institute of Health and Society, University of Worcester, Worcester, United Kingdom
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16
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Gahnfelt H, Carlsson PFG, Blomdahl C. Is it safe enough? A pilot feasibility study of an 8-day intensive treatment for severe PTSD. Front Psychiatry 2023; 14:1200411. [PMID: 37547221 PMCID: PMC10397389 DOI: 10.3389/fpsyt.2023.1200411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
Intensive treatments for posttraumatic stress disorder (PTSD) are gaining increased research support. Treatment models targeting Complex PTSD and previously treatment-resistant PTSD have shown a good effect. A pilot study was performed to assess the feasibility of an 8-day intensive treatment program for severe PTSD in a Swedish public healthcare setting. Eleven participants completed treatment, and overall, the reduction in PTSD symptoms was considerable. Also, loss of diagnosis at 3-month follow-up was 100%. No adverse events occurred, and no elevation of suicidal intentions was reported. Symptom exacerbation could not be observed in the data and dropout due to the intensity of the treatment format did not occur. Based on these positive results, it is recommended that further research with larger samples is conducted. If found safe and effective, the 8-day treatment program could be an important addition to psychiatric healthcare.
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Affiliation(s)
- Hannes Gahnfelt
- Department of Research, Education and Innovation, Södra Älvsborg Hospital, Region Västra Götaland, Borås, Sweden
| | - Per F. G. Carlsson
- Department of Research, Education and Innovation, Södra Älvsborg Hospital, Region Västra Götaland, Borås, Sweden
| | - Christina Blomdahl
- R&D Centre Södra Älvsborg, Research, Education, Development & Innovation, Region Västra Götaland, Borås, Sweden
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17
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Voorendonk EM, Sanches SA, Tollenaar MS, Hoogendoorn EA, de Jongh A, van Minnen A. Adding physical activity to intensive trauma-focused treatment for post-traumatic stress disorder: results of a randomized controlled trial. Front Psychol 2023; 14:1215250. [PMID: 37546473 PMCID: PMC10400339 DOI: 10.3389/fpsyg.2023.1215250] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/15/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction This randomized controlled trial examined the effectiveness of physical activity added to an intensive trauma-focused treatment (TFT) for post-traumatic stress disorder (PTSD) in comparison to adding non-physical control activities. Methods A total of 119 patients with PTSD were randomly assigned to a physical activity condition (PA; n = 59) or a non-physical activity control condition (nPA; n = 60). The 8-day intensive TFT programme consisted of daily prolonged exposure, EMDR therapy, and psychoeducation, which was complemented with physical activities versus controlled mixtures of guided (creative) tasks. As a primary outcome, the change in clinician and self-reported PTSD symptoms from pre-to post-treatment and at 6 months follow-up were measured. Results Intent-to-treat linear mixed-effects models showed no significant differences between the PA and nPA conditions on change in PTSD severity. Clinician and self-reported PTSD symptoms significantly decreased for both conditions, with large effect sizes (e.g., CAPS-5 dpre-post = 2.28). At post-treatment, 80.0% in the PA, and 82.7% in the nPA condition no longer met the diagnostic criteria for PTSD. Regarding the loss of Complex PTSD diagnoses this was 92.5% and 95.0%, respectively. Conclusion Either with additional physical or non-physical activities, intensive TFT is very effective for the treatment of (Complex) PTSD, as reflected by large effect sizes and loss of diagnostic status in both groups. Clinical trial registration Trialregister.nl Identifier: Trial NL9120.
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Affiliation(s)
- Eline M. Voorendonk
- Research Department, PSYTREC, Bilthoven, Netherlands
- Behavioral Science Institute (BSI), Radboud University Nijmegen, Nijmegen, Netherlands
| | - Sarita A. Sanches
- Phrenos Centre of Expertise for Severe Mental Illness, Utrecht, Netherlands
- Altrecht Institute for Mental Health Care, Utrecht, Netherlands
| | - Marieke S. Tollenaar
- Institute of Psychology, Department of Clinical Psychology and the Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | | | - Ad de Jongh
- Research Department, PSYTREC, Bilthoven, Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands
- School of Psychology, Queen’s University, Belfast, United Kingdom
- Institute of Health and Society, University of Worcester, Worcester, United Kingdom
| | - Agnes van Minnen
- Research Department, PSYTREC, Bilthoven, Netherlands
- Behavioral Science Institute (BSI), Radboud University Nijmegen, Nijmegen, Netherlands
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18
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van Schie K, van Veen SC. Omitting continuous memory recall from dual-task interventions does not reduce intervention effectiveness. Behav Res Ther 2023; 164:104291. [PMID: 36933473 DOI: 10.1016/j.brat.2023.104291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/19/2023] [Accepted: 03/09/2023] [Indexed: 03/11/2023]
Abstract
In Eye Movement Desensitization and Reprocessing a patient recalls a traumatic memory, while simultaneously performing a dual-task (e.g., making horizontal eye movements, tapping a pattern). Earlier lab studies show that increasing the load of a dual-task -and leaving fewer resources for memory recall-results in larger decreases in memory vividness and emotionality compared to control conditions. Therefore, we investigated whether it is necessary to continuously and deliberately recall the memory next to performing high taxing dual-tasks. In two online experiments, participants (N = 172, N = 198) recalled a negative autobiographical memory and were randomly assigned to (1) Memory Recall + Dual-Tasks, (2) Dual-Tasks Only, or (3) No Intervention Control. The dual-tasks were complex pattern tapping and spelling out loud. Before and after the intervention the memory was rated on vividness, emotionality, and accessibility. High taxing dual-tasks, regardless of whether there was continuous memory recall, resulted in the largest reductions in all dependent variables compared to control. Unexpectedly, there was no evidence that the addition of continuous memory recall added to these reductions. These results suggest that continuous memory recall might not, or only minimally be needed for the beneficial effects of the dual-task procedure in EMDR might not be beneficial per se. We discuss the necessity of memory (re)activation, alternative explanations, and implications for practice.
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Affiliation(s)
- Kevin van Schie
- Department of Psychology, Education & Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands; MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom; Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
| | - Suzanne C van Veen
- Kenter Jeugdhulp, Hoofddorp, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
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Sciarrino NA, Myers US. If it's offered, will they come? Practical considerations when offering intensive PTSD treatment in an outpatient Veterans Affairs PTSD clinic. Bull Menninger Clin 2023; 87:46-62. [PMID: 36856477 DOI: 10.1521/bumc.2023.87.1.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) are efficacious; however, treatment dropout remains high. The delivery of intensive EBPs for PTSD (i.e., sessions three times per week or more) and telemental health may address barriers impacting dropout. Current evidence for intensive EBPs comes primarily from programs specifically designed for this level of care. Therefore, the feasibility of delivering intensive EBPs for PTSD in traditional outpatient clinics remains unclear. The aim of this pilot study was to identify veteran level of interest in intensive treatment and explore the feasibility of delivering intensive treatment via telemental health in an outpatient PTSD clinic at a Veterans Affairs (VA) hospital. One provider offered intensive treatment to 14 veterans. Three of the veterans initiated intensive treatment and completed with benefit. Veteranand system-level barriers, as well as veteran preferences for initiating intensive therapy and suggestions for implementing intensive EBPs in a routine outpatient clinic, are discussed.
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Affiliation(s)
- Nicole A Sciarrino
- The Ralph H. Johnson VA Medical Center, and in the Department of Psychiatry and Behavioral Sciences, Military Sciences Division, Medical University of South Carolina, Charleston, South Carolina. Dr
| | - Ursula S Myers
- The Ralph H. Johnson VA Medical Center, and in the Department of Psychiatry and Behavioral Sciences, Military Sciences Division, Medical University of South Carolina, Charleston, South Carolina. Dr.,The Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson VA Medical Center, Charleston, South Carolina
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20
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Burback L, Dhaliwal R, Reeson M, Erick T, Hartle K, Chow E, Vouronikos G, Antunes N, Marshall T, Kennedy M, Dennett L, Greenshaw A, Smith-MacDonald L, Winkler O. Trauma focused psychotherapy in patients with suicidal ideation: A scoping review. CURRENT RESEARCH IN BEHAVIORAL SCIENCES 2023. [DOI: 10.1016/j.crbeha.2023.100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
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Busser P, Guérin V, Coutance V, Blouet C, Bui E. A novel therapeutic fencing programme for female sexual assault victims. Eur J Psychotraumatol 2023; 14:2196907. [PMID: 37070615 PMCID: PMC10120562 DOI: 10.1080/20008066.2023.2196907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/26/2023] [Indexed: 04/19/2023] Open
Affiliation(s)
- Paul Busser
- Department of Psychiatry, Centre Hospitalier Universitaire Caen Normandie, Caen, France
| | | | - Véronique Coutance
- Department of Psychiatry, Centre Hospitalier Universitaire Caen Normandie, Caen, France
| | - Camille Blouet
- Department of Psychiatry, Centre Hospitalier Universitaire Caen Normandie, Caen, France
| | - Eric Bui
- Department of Psychiatry, Centre Hospitalier Universitaire Caen Normandie, Caen, France
- PhIND ‘Physiopathology and Imaging of Neurological Disorders’ (U1237), University of Caen Normandie & INSERM, Caen, France
- Massachusetts General Hospital, Boston, MA, USA
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22
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Kolthof KA, Voorendonk EM, Van Minnen A, De Jongh A. Effects of intensive trauma-focused treatment of individuals with both post-traumatic stress disorder and borderline personality disorder. Eur J Psychotraumatol 2022; 13:2143076. [PMID: 38872595 PMCID: PMC9704092 DOI: 10.1080/20008066.2022.2143076] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Research indicates that intensive trauma-focused therapy can be effective in alleviating symptoms of post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD). However, these studies have relied on self-report of BPD symptoms and follow-up data are scarce.Objective: The purpose of this feasibility study was to determine the effects of an intensive trauma-focused treatment programme on the severity of PTSD and BPD symptoms and the diagnostic status up to a 12-month follow-up.Methods: A total of 45 (60% female) individuals meeting the diagnostic criteria of both PTSD and BPD participated in an intensive eight-day trauma-focused treatment programme which combined prolonged exposure and EMDR therapy in an inpatient treatment setting. Severity of PTSD and BPD symptoms were assessed at pre-treatment, post-treatment, 6 months, and 12 months after treatment (CAPS-5, BPDSI-IV). Diagnostic status was determined using clinical interviews (CAPS-5 and SCID-5-P) at pre-treatment and 12-month follow-up.Results: Of all participants, 93.3% had been exposed to physical abuse, and 71.1% to sexual abuse prior to the age of 12 years. PTSD and BPD symptom severity significantly decreased from pre- to post-treatment (Cohen's ds: 1.58 and 0.98, respectively), and these results were maintained at 6- (ds: 1.20 and 1.01) and 12-month follow-up (ds: 1.53 and 1.36). Based upon CAPS-5, 69.2% no longer met the diagnostic criteria of PTSD at 12-month follow-up, while according to the SCID-5-P 73.1% no longer fulfilled the diagnostic criteria of BPD at that time. No significant worsening of symptoms occurred.Conclusion: The findings of this study, which is the first to examine the effects of psychotherapeutic treatment of PTSD on the presence of a borderline personality disorder one year after treatment, add support to the notion that a brief intensive trauma-focused treatment can be a valuable option for individuals suffering from both PTSD and BPD.
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Affiliation(s)
- K A Kolthof
- Psychotrauma Expertise Centre (PSYTREC), Bilthoven, Netherlands
- Sinai Centrum, Amersfoort, Netherlands
| | - E M Voorendonk
- Psychotrauma Expertise Centre (PSYTREC), Bilthoven, Netherlands
- Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, Netherlands
| | - A Van Minnen
- Psychotrauma Expertise Centre (PSYTREC), Bilthoven, Netherlands
- Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, Netherlands
| | - A De Jongh
- Psychotrauma Expertise Centre (PSYTREC), Bilthoven, Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands
- School of Health Sciences, Salford University, Manchester, UK
- Institute of Health and Society, University of Worcester, Worcester, UK
- School of Psychology, Queen's University, Belfast, UK
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23
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Bongaerts H, Voorendonk EM, Van Minnen A, Rozendaal L, Telkamp B, de Jongh A. Fully remote intensive trauma-focused treatment for PTSD and Complex PTSD. Eur J Psychotraumatol 2022; 13:2103287. [PMID: 36186161 PMCID: PMC9518290 DOI: 10.1080/20008066.2022.2103287] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 07/04/2022] [Indexed: 12/02/2022] Open
Abstract
Background: It is unknown whether remotely delivered intensive trauma-focused therapy not only is an effective treatment for PTSD, but also for Complex PTSD. Objective: Testing the hypothesis that a brief, fully remotely administered intensive trauma-focused treatment programme for individuals with PTSD and Complex PTSD would be safe, and associated with a significant decline of the corresponding symptoms and diagnostic status. Method: The treatment sample consisted of 73 consecutive patients diagnosed with PTSD according to the CAPS-5. According to the ITQ (n = 70) 33 (47.1%) patients also fulfilled the diagnostic criteria of Complex PTSD. The 4-day treatment programme contained a combination of prolonged exposure, EMDR therapy, physical activities and psycho-education. Treatment response was measured using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), the PTSD Checklist for DSM-5 (PCL-5), and the International Trauma Questionnaire (ITQ) for classifying Complex PTSD and indexing disturbances in self-organization (DSO). Results: Overall CAPS-5, PCL-5, and ITQ-DSO scores decreased significantly from pre- to post-treatment (Cohen's ds 2.12, 1.59, and 1.18, respectively), while the decrease was maintained to six months follow-up. At post-treatment, 60 patients (82.2%) no longer met the diagnostic criteria of PTSD, while the proportion of patients with Complex PTSD decreased from 47.1% to 10.1%. No drop out, and no personal adverse events occurred. Conclusions: The results support the notion that intensive, trauma-focused treatment is feasible, safe and associated with a large decrease in PTSD and Complex PTSD symptoms, even when it is brief, and applied fully remote. HIGHLIGHTS Second study to examine the effectiveness of a fully remote intensive trauma-focused treatment for PTSD and Complex PTSD.Significant decrease of DSO symptoms.Over 80 percent of the patients no longer met the diagnostic criteria of PTSD and Complex PTSD following treatment.
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Affiliation(s)
- H. Bongaerts
- Research Department PSYTREC, Bilthoven, The Netherlands
| | - E. M. Voorendonk
- Research Department PSYTREC, Bilthoven, The Netherlands
- Radboud University Nijmegen, Behavioural Science Institute (BSI), The Netherlands
| | - A. Van Minnen
- Research Department PSYTREC, Bilthoven, The Netherlands
- Radboud University Nijmegen, Behavioural Science Institute (BSI), The Netherlands
| | - L. Rozendaal
- Research Department PSYTREC, Bilthoven, The Netherlands
| | - B.S.D. Telkamp
- Wiskunde & Statistiek Inzichtelijk (WISI), Leiden, The Netherlands
| | - A. de Jongh
- Research Department PSYTREC, Bilthoven, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, The Netherlands
- School of Health Sciences, Salford University, Manchester, UK
- Institute of Health and Society, University of Worcester, UK
- School of Psychology, Queen’s University, Belfast, Northern Ireland
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24
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Watkins LE, Patton SC, Drexler K, A. M. Rauch S, Rothbaum BO. Clinical Effectiveness of an Intensive Outpatient Program for Integrated Treatment of Comorbid Substance Abuse and Mental Health Disorders. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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25
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Clinical and Administrative Insights From Delivering Massed Trauma-Focused Therapy to Service Members and Veterans. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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26
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Brown EM, Salat DH, Milberg WP, Fortier CB, McGlinchey RE. Accelerated longitudinal cortical atrophy in
OEF
/
OIF
/
OND
veterans with severe
PTSD
and the impact of comorbid
TBI. Hum Brain Mapp 2022; 43:3694-3705. [PMID: 35426972 PMCID: PMC9294300 DOI: 10.1002/hbm.25877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/04/2022] [Accepted: 04/05/2022] [Indexed: 12/02/2022] Open
Abstract
Veterans who deployed in support of Operation Enduring Freedom (OEF), Iraqi Freedom (OIF), and New Dawn (OND) commonly experience severe psychological trauma, often accompanied by physical brain trauma resulting in mild traumatic brain injury (mTBI). Prior studies of individuals with posttraumatic stress disorder (PTSD) have revealed alterations in brain structure, accelerated cellular aging, and impacts on cognition following exposure to severe psychological trauma and potential interactive effects of military‐related mTBI. To date, however, little is known how such deployment‐related trauma changes with time and age of injury of the affected veteran. In this study, we explored changes in cortical thickness, volume, and surface area after an average interval of approximately 2 years in a cohort of 254 OEF/OIF/OND Veterans ranging in age from 19 to 67 years. Whole‐brain vertex‐wise analyses revealed that veterans who met criteria for severe PTSD (Clinician‐Administered PTSD Scale ≥60) at baseline showed greater negative longitudinal changes in cortical thickness, volume, and area over time. Analyses also revealed a significant severe‐PTSD by age interaction on cortical measures with severe‐PTSD individuals exhibiting accelerated cortical degeneration with increasing age. Interaction effects of comorbid military‐related mTBI within the severe‐PTSD group were also observed in several cortical regions. These results suggest that those exhibiting severe PTSD symptomatology have accelerated atrophy that is exacerbated with increasing age and history of mTBI.
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Affiliation(s)
- Emma M. Brown
- Neuroimaging Research for Veterans (NeRVe) Center VA Boston Healthcare System Boston Massachusetts USA
- Translational Research Center for TBI and Stress Disorders (TRACTS) VA Boston Healthcare System Boston Massachusetts USA
| | - David H. Salat
- Neuroimaging Research for Veterans (NeRVe) Center VA Boston Healthcare System Boston Massachusetts USA
- Translational Research Center for TBI and Stress Disorders (TRACTS) VA Boston Healthcare System Boston Massachusetts USA
- Brain Aging and Dementia (BAnD) Laboratory, A. A. Martinos Center for Biomedical Imaging, Department of Radiology Massachusetts General Hospital Charlestown Massachusetts USA
| | - William P. Milberg
- Neuroimaging Research for Veterans (NeRVe) Center VA Boston Healthcare System Boston Massachusetts USA
- Translational Research Center for TBI and Stress Disorders (TRACTS) VA Boston Healthcare System Boston Massachusetts USA
- Department of Psychiatry Harvard Medical School Boston Massachusetts USA
- Geriatric Research, Education, and Clinical Center (GRECC) VA Boston Healthcare System Boston Massachusetts USA
| | - Catherine B. Fortier
- Translational Research Center for TBI and Stress Disorders (TRACTS) VA Boston Healthcare System Boston Massachusetts USA
- Department of Psychiatry Harvard Medical School Boston Massachusetts USA
- Geriatric Research, Education, and Clinical Center (GRECC) VA Boston Healthcare System Boston Massachusetts USA
| | - Regina E. McGlinchey
- Neuroimaging Research for Veterans (NeRVe) Center VA Boston Healthcare System Boston Massachusetts USA
- Translational Research Center for TBI and Stress Disorders (TRACTS) VA Boston Healthcare System Boston Massachusetts USA
- Department of Psychiatry Harvard Medical School Boston Massachusetts USA
- Geriatric Research, Education, and Clinical Center (GRECC) VA Boston Healthcare System Boston Massachusetts USA
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27
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Korkmaz B, Soygut G. The psychotherapeutic change process in women who have been sexually assaulted: An examination of the schema therapy model. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Burcu Korkmaz
- Department of Psychology Faculty of Arts & Science Bursa Uludag University Nilufer/Bursa Turkey
| | - Gonca Soygut
- Department of Psychology Hacettepe University Beytepe, Ankara Turkey
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28
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Jonkman C, Visser M, Vandenbosch M, Steketee M, Schuengel C, Fictorie V. Effectiveness of a high-intensive trauma-focused, family-based therapy for youth exposed to family violence: study protocol for a randomized controlled trial. Trials 2022; 23:46. [PMID: 35039059 PMCID: PMC8762952 DOI: 10.1186/s13063-021-05981-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/24/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Family violence is a common problem with direct adverse effects on children as well as indirect effects through disruption of parenting and parent-child relationships. The complex interrelationships between family violence, parenting, and relationships make recovery from psychological responses difficult. In more than half of the families referred to mental health care after family violence, the violence continues. Also, the effect sizes of "golden standard" treatments are generally lower for complex trauma compared to other forms of trauma. In the treatment of complex trauma, trauma-focused therapies including cognitive restructuring and imaginal exposure are most effective, and intensifying therapy results in faster symptom reduction. Furthermore, there is promising evidence that adding a parental component to individual trauma treatment increases treatment success. In family-based intensive trauma treatment (FITT), these factors are addressed on an individual and family level in a short period of time to establish long-term effects on the reduction of trauma symptoms and recovery of security in the family. This randomized controlled multicentre study tests if FITT is an effective treatment for concurrent reduction of trauma symptoms of children, improvement of parenting functioning, and increasing emotional and physical security in children, through the improvement of parent-child relationships. METHODS The effectiveness of FITT will be tested by a RCT design. A total of 120 adolescents with a history of family violence and PTS symptoms will be randomized to (a) an intensive trauma treatment with a parent and systemic component (FITT), (b) an intensive trauma treatment without these components (ITT), and (c) treatment as usual (TAU, low-frequency trauma treatment with parent therapy and family sessions). Changes in children's trauma symptoms, child and parent functioning, and emotional and physical security in the family will be monitored before, during, after, and at 3 months follow-up. DISCUSSION Comparing these interventions with and without a high intensive frequency and parenting and family components can help to understand if and how these interventions work and can contribute to the ambition to recover from the impact of family violence and restore emotional and physical security for children and young people. TRIAL REGISTRATION Netherlands Trial Register Trial NL8592 . Registered on 4 May 2020.
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Affiliation(s)
- Caroline Jonkman
- Children's Trauma Centre of Kenter Youthcare, Amsterdam, The Netherlands.,Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Margreet Visser
- Children's Trauma Centre of Kenter Youthcare, Amsterdam, The Netherlands
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29
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Voorendonk EM, Sanches SA, Tollenaar MS, De Jongh A, Van Minnen A. Augmenting PTSD treatment with physical activity: study protocol of the APPART study (Augmentation for PTSD with Physical Activity in a Randomized Trial). Eur J Psychotraumatol 2022; 13:2016219. [PMID: 35126881 PMCID: PMC8812732 DOI: 10.1080/20008198.2021.2016219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND New intensive trauma-focused treatment (TFT) programmes that incorporate physical activity have been developed for people with post-traumatic stress disorder (PTSD). However, the unique contribution of physical activity within these intensive TFT programmes has never been investigated in a controlled manner. OBJECTIVES This randomized controlled trial will investigate the effectiveness of physical activity added to an intensive TFT programme. In addition, the study aims to investigate the underlying mechanisms of the effects of physical activity on the change in PTSD symptoms. METHODS Individuals with PTSD (N = 120) will be randomly allocated to two conditions: a physical activity or a non-physical active control condition. All participants will receive the same intensive TFT lasting eight days within two consecutive weeks, in which daily prolonged exposure and EMDR therapy sessions, and psycho-education are combined. The amount of physical activity will differ per condition. While the physical activity condition induces daily physical activities with moderate intensity, in the non-physical active control condition no physical activity is prescribed; but instead, a controlled mixture of guided (creative) tasks is performed. The two primary outcome measures are change in PTSD symptoms from pre- to post-treatment and at six months follow-up, measured with the Clinician-Administered PTSD Scale (CAPS-5), and the PTSD Checklist for DSM-5 (PCL-5). Additionally, self-reported sleep problems, depressive symptoms, emotion regulation, dissociation symptoms and anxiety sensitivity will be measured as potential underlying mechanisms. CONCLUSIONS This study will contribute to the research field of augmentation strategies for PTSD treatment by investigating the effectiveness of physical activity added to intensive TFT. TRIAL REGISTRATION This trial is registered in the Netherlands Trial Register (Trial NL9120).
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Affiliation(s)
- E M Voorendonk
- Research Department, PSYTREC, Bilthoven, The Netherlands.,Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands
| | - S A Sanches
- Phrenos Centre of Expertise for Severe Mental Illness, Utrecht, The Netherlands
| | - M S Tollenaar
- Clinical Psychology and the Leiden Institute of Brain and Cognition, Leiden University, Leiden, The Netherlands
| | - A De Jongh
- Research Department, PSYTREC, Bilthoven, The Netherlands.,Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, The Netherlands.,School of Psychology, Queen's University, Belfast, Northern Ireland.,Institute of Health and Society, University of Worcester, Worcester, UK
| | - A Van Minnen
- Research Department, PSYTREC, Bilthoven, The Netherlands.,Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands
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30
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van Minnen A, Ter Heide FJJ, Koolstra T, de Jongh A, Karaoglu S, Gevers T. Initial development of perpetrator confrontation using deepfake technology in victims with sexual violence-related PTSD and moral injury. Front Psychiatry 2022; 13:882957. [PMID: 36061287 PMCID: PMC9435301 DOI: 10.3389/fpsyt.2022.882957] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/18/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Interventions aimed at easing negative moral (social) emotions and restoring social bonds - such as amend-making and forgiving-have a prominent role in the treatment of moral injury. As real-life contact between persons involved in prior morally injurious situations is not always possible or desirable, virtual reality may offer opportunities for such interventions in a safe and focused way. OBJECTIVE To explore the effects of the use of deepfake technology in the treatment of patients suffering from PTSD and moral injury as a result of being forced by persons in authority to undergo and commit sexual violence (so-called betrayal trauma). METHODS Two women who had experienced sexual violence underwent one session of confrontation with the perpetrator using deepfake technology. The women could talk via ZOOM with the perpetrator, whose picture was converted in moving images using deepfake technology. A therapist answered the questions of the women in the role of the perpetrator. Outcome measures were positive and negative emotions, dominance in relation to perpetrator, self-blame, self-forgiveness, and PTSD-symptom severity. RESULTS Both participants were positive about the intervention. Although they knew it was fake, the deepfaked perpetrator seemed very real to them. They both reported more positive and less negative emotions, dominance in relation to the perpetrator and self-forgiveness, and less self-blame and PTSD-symptoms after the intervention. CONCLUSION Victim-perpetrator confrontation using deepfake technology is a promising intervention to influence moral injury-related symptoms in victims of sexual violence. Deepfake technology may also show promise in simulating other interactions between persons involved in morally injurious events.
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Affiliation(s)
- Agnes van Minnen
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands.,Research Department PSYTREC, Bilthoven, Netherlands
| | | | | | - Ad de Jongh
- Research Department PSYTREC, Bilthoven, Netherlands.,Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands
| | - Sezer Karaoglu
- 3DUniversum, Amsterdam, Netherlands.,University of Amsterdam, Amsterdam, Netherlands
| | - Theo Gevers
- 3DUniversum, Amsterdam, Netherlands.,University of Amsterdam, Amsterdam, Netherlands
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31
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Auren TJB, Klæth JR, Jensen AG, Solem S. Intensive outpatient treatment for PTSD: an open trial combining prolonged exposure therapy, EMDR, and physical activity. Eur J Psychotraumatol 2022; 13:2128048. [PMID: 36237826 PMCID: PMC9553174 DOI: 10.1080/20008066.2022.2128048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Intensive outpatient treatment could be a promising option for patients with post-traumatic stress disorder (PTSD). Objective: The aim of the study was to test the effectiveness of an eight-day (two-week) intensive treatment for PTSD within a public health care setting (open trial design). Method: Eighty-nine patients were offered the choice between intensive treatment and spaced individual treatment, of which 34 (38.2%) chose the intensive format. Patients were assessed with self-report batteries and interviews at pre-treatment, start of treatment, post-treatment and three-month follow-up. Each day consisted of individual Prolonged Exposure therapy, Eye Movement Desensitization and Reprocessing therapy, group psychoeducation, and physical activity. Therapists rotated between patients. Results: Between 55 and 62% of the patients showed a clinically significant change (recovery) in symptoms of PTSD, and the effect sizes were large (d = 1.38-1.52). Patients also showed reduction in symptoms of depression and anxiety, along with improved well-being and interpersonal functioning. Changes in social and work functioning were more ambiguous. There were no dropouts, attendance was high, and patients were highly satisfied with the treatment. Conclusions: The intensive programme was an attractive and effective treatment option for patients with PTSD.
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Affiliation(s)
| | - Julie Rendum Klæth
- Regional Unit for Treatment of Severe Posttraumatic Stress Disorder, Nidaros DPS, St. Olavs Hospital, Trondheim, Norway
| | - Andreas Gjerde Jensen
- Regional Unit for Treatment of Severe Posttraumatic Stress Disorder, Nidaros DPS, St. Olavs Hospital, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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32
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Thoresen IH, Auren TJB, Langvik EO, Engesæth C, Jensen AG, Klæth JR. Intensive outpatient treatment for post-traumatic stress disorder: a thematic analysis of patient experience. Eur J Psychotraumatol 2022; 13:2043639. [PMID: 35479299 PMCID: PMC9037168 DOI: 10.1080/20008198.2022.2043639] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intensive treatments have shown encouraging results in the treatment of several psychological disorders, including post-traumatic stress disorder (PTSD). However, qualitative studies on patient experiences with intensive treatment for PTSD remain scarce. OBJECTIVE The aim of this study was to explore patient experiences with an intensive, outpatient treatment for PTSD and to discover important factors behind treatment feasibility. METHOD Eight participants were recruited from two groups of patients having completed the intensive treatment programme. Semi-structured qualitative interviews were conducted, and data sets were analysed using thematic analysis. RESULTS The main result indicated that patients experienced the treatment as very demanding, but still worth the effort in terms of reducing symptoms. The intensity was valued as useful. Participants emphasized the sense of unity with other participants as well as physical activity as important factors for completion of the treatment programme. The rotation of therapists was also highlighted as important for treatment efficacy. CONCLUSIONS This study provides insights into what the patients experienced and emphasized as important aspects of treatment and essential factors for completing treatment. The main conclusions were that all of the patients evaluated the treatment as demanding, but the reward of reduced symptoms made it worthwhile. The high frequency of therapy sessions and the therapist rotation were reported to counteract avoidance and increase the patients' commitment to therapy. Physical activity and unity in the group were highlighted as essential for treatment feasibility. HIGHLIGHTS • High treatment intensity enabled increased focus and adherence, and reduced avoidance. Therapist rotation led to heightened intensity and new learning experiences.• Physical activity and sense of unity through group elements were reported as important factors for treatment feasibility.
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Affiliation(s)
- Ida Haugland Thoresen
- Department of Psychology, Norwegian University of Science and Technology Trondheim, Norway
| | | | - Eva Oddrun Langvik
- Department of Psychology, Norwegian University of Science and Technology Trondheim, Norway
| | - Charlotte Engesæth
- Department of Psychology, Norwegian University of Science and Technology Trondheim, Norway
| | - Andreas Gjerde Jensen
- Regional Unit for Treatment of Severe Posttraumatic Stress Disorder, Nidaros DPS, St. Olavs Hospital, Trondheim, Norway
| | - Julie Rendum Klæth
- Regional Unit for Treatment of Severe Posttraumatic Stress Disorder, Nidaros DPS, St. Olavs Hospital, Trondheim, Norway
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33
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Winkler O, Dhaliwal R, Greenshaw A, O'Shea K, Abba-Aji A, Chima C, Purdon SE, Burback L. Web-Based Eye Movement Desensitization and Reprocessing for Adults With Suicidal Ideation: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e30711. [PMID: 34734835 PMCID: PMC8603176 DOI: 10.2196/30711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Adversity and traumatic experiences increase the likelihood of suicidal thoughts and behaviors. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based, trauma-focused psychotherapy that desensitizes painful memories, so that reminders in the present no longer provoke overwhelming emotional responses. Preliminary evidence suggests that EMDR can be used as an acute intervention in suicidal patients, including those with major depressive disorder. In addition, because of social distancing restrictions during the COVID-19 pandemic, clinicians have been using EMDR on the web and, in the absence of formal evaluations of web-based EMDR, informal reports indicate good results. OBJECTIVE The primary aim of this randomized controlled trial is to investigate whether remotely delivered EMDR (targeting experiences associated with suicidal thinking) reduces suicidal thoughts. Secondary aims include examining the impact of remotely delivered EMDR on symptoms of depression, anxiety, posttraumatic stress, emotional dysregulation, and dissociation. We will also report on adverse events in the EMDR group to explore whether targeting suicidal ideation with EMDR is safe. Finally, we will compare dropout rates between the treatment groups. METHODS In this randomized controlled trial, 80 adults who express suicidal ideation and meet the study criteria will receive either 12 sessions of twice weekly EMDR plus treatment as usual or treatment as usual alone. EMDR sessions will focus on the most distressing and intrusive memories associated with suicidal ideation. Data for primary and secondary objectives will be collected at baseline, 2 months, and 4 months after enrollment. A subsequent longer-term analysis, beyond the scope of this protocol, will examine differences between the groups with respect to the number of posttreatment emergency room visits, hospitalizations, and overall health care use in the year before and after therapy. RESULTS The protocol was approved by the University of Alberta Research Health Ethics Board (protocol ID Pro00090989). Funding for this study was provided by the Mental Health Foundation (grant RES0048906). Recruitment started in May 2021, with a projected completion date of March 2023. CONCLUSIONS The results of this trial will contribute to knowledge on whether web-based delivery of EMDR is a safe and effective treatment for reducing suicidal ideation and potentially reducing the incidence of suicide attempts in this patient population. TRIAL REGISTRATION ClinicalTrials.gov NCT04181047; https://clinicaltrials.gov/ct2/show/NCT04181047. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/30711.
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Affiliation(s)
- Olga Winkler
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Raman Dhaliwal
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Andrew Greenshaw
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Katie O'Shea
- Eye Movement Desensitization and Reprocessing International Association, Austin, TX, United States
| | - Adam Abba-Aji
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Chidi Chima
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Scot E Purdon
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Neuropsychology, Alberta Hospital Edmonton, Edmonton, AB, Canada
| | - Lisa Burback
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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34
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Ooms-Evers M, van der Graaf-Loman S, van Duijvenbode N, Mevissen L, Didden R. Intensive clinical trauma treatment for children and adolescents with mild intellectual disability or borderline intellectual functioning: A pilot study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 117:104030. [PMID: 34314951 DOI: 10.1016/j.ridd.2021.104030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/23/2021] [Accepted: 07/11/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Children and adolescents with mild intellectual disability (MID) or borderline intellectual functioning (BIF) are at increased risk for posttraumatic stress disorder (PTSD) or trauma-related symptoms due to adverse childhood experiences (ACEs). Weekly provided treatment sessions and/or outpatient treatment may not be effective enough. AIMS Investigate feasibility, safety and potential effectiveness of an intensive clinical trauma treatment in children and adolescents with MID-BIF and trauma-related symptoms as a result of ACEs or PTSD. METHODS AND PROCEDURES Thirty-three participants between 6 and 17 years of age received intensive clinical treatment after experiencing multiple ACEs (most commonly physical abuse, emotional neglect or abuse, sexual abuse, domestic violence and bullying). Treatment lasted 8.4 days on average and consisted of a daily program of prolonged exposure, eye movement desensitisation and reprocessing and physical activation, embedded in a trauma-sensitive environment. Data were collected at intake, first day of treatment, last day of treatment and at follow-up. OUTCOMES AND RESULTS There was a significant reduction of trauma-related symptoms and emotional and behavioral problems after treatment. In addition, the number of participants fulfilling the DSM-5 criteria of PTSD decreased from 24 at intake to 8 at the end of treatment. There was no drop out and no adverse events were seen. CONCLUSIONS AND IMPLICATIONS The results of this pilot study suggest that an intensive clinical trauma treatment is a potentially effective and safe option for children and adolescents with MID-BIF.
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Affiliation(s)
| | | | | | - Liesbeth Mevissen
- Trajectum, Zwolle, the Netherlands; Psychotrauma Practice, Rha, the Netherlands
| | - Robert Didden
- Trajectum, Zwolle, the Netherlands; Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
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35
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Alting van Geusau VVP, Mulder JD, Matthijssen SJMA. Predicting Outcome in an Intensive Outpatient PTSD Treatment Program Using Daily Measures. J Clin Med 2021; 10:jcm10184152. [PMID: 34575263 PMCID: PMC8468454 DOI: 10.3390/jcm10184152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
It is useful to investigate factors that could predict treatment outcomes for PTSD. The current study aims to investigate the relationship between daily measured PTSD symptoms during an intensive six-day treatment program and overall post-treatment outcomes. The treatment program combines eye movement desensitization with reprocessing and prolonged exposure, as well as physical activity and psychoeducation. It was expected that for the entire duration of treatment, as well as the first half of the treatment, a greater decline in daily PTSD symptoms would be a predictor for a greater decline in PTSD symptoms at a four-week follow-up. Data from 109 PTSD-patients (87.2% female, mean age = 36.9, SD = 11.5) were used. PTSD symptoms were measured with the CAPS-5 and the self-reported PTSD checklist for DSM-5 (PCL-5). Daily PTSD symptoms were measured with an abbreviated version of the PCL-5 (8-item PCL). Latent growth curve models were used to describe changes in daily PTSD symptoms and predict treatment outcome. Results show that a greater decline in daily PTSD symptoms measured by the 8-item PCL predicts better treatment outcome (CAPS-5 and PCL-5), but that a patient’s PTSD symptoms on the first day of treatment has no predictive effect. A decline in PTSD symptoms only during the first half of treatment was also found to predict treatment outcomes. Future research should be focused on replicating the results of the current study.
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Affiliation(s)
- Valentijn V. P. Alting van Geusau
- Altrecht Academic Anxiety Center, Altrecht GGz, 3524 SH Utrecht, The Netherlands;
- Department of Clinical Psychology, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Jeroen D. Mulder
- Department of Methodology and Statistcs, Faculty of Social and Behavioural Sciences, Utrecht University, 3584 CS Utrecht, The Netherlands;
| | - Suzy J. M. A. Matthijssen
- Altrecht Academic Anxiety Center, Altrecht GGz, 3524 SH Utrecht, The Netherlands;
- Department of Clinical Psychology, Utrecht University, 3584 CS Utrecht, The Netherlands
- Correspondence: ; Tel.: +31-302308790
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Greenwald R, Camden AA, Gamache N, Lasser KA, Chapman R, Rattner B. Intensive trauma-focused therapy with victims of crime. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2021. [DOI: 10.1016/j.ejtd.2020.100146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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van Minnen A, Tibben M. A brief cognitive-behavioural treatment approach for PTSD and Dissociative Identity Disorder, a case report. J Behav Ther Exp Psychiatry 2021; 72:101655. [PMID: 33848810 DOI: 10.1016/j.jbtep.2021.101655] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/18/2021] [Accepted: 03/30/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES We described a new treatment model for Posttraumatic Stress Disorder (PTSD) and Dissociative Identity Disorder (DID), based on cognitive-behavioural principles. In this model, dissociation is seen as a maladaptive avoidant coping strategy. In addition, we stress that patients have dysfunctional beliefs about dissociation. Both elements, avoidance behaviour and dysfunctional beliefs, are challenged during the brief, intensive trauma-focused treatment. When the PTSD-symptoms decrease, the patient is offered a fare-well ritual to say goodbye to their identities in one or more additional sessions. METHODS We illustrate this treatment approach with a case report of a woman with PTSD as a result of sexual abuse in her childhood, and DID with four identities. Treatment outcome was measured at intake, at pre-treatment, at post-treatment and at 3 and 6 months follow-up. RESULTS After the short treatment of only 2 weeks, she no longer fulfilled the DSM-5 diagnostic criteria for PTSD nor DID. These results were maintained at the follow-ups. LIMITATIONS Although we included a baseline-controlled time phase, it was not a controlled study, and only one patient was treated. CONCLUSIONS This new treatment model for DID-patients is promising but results should be interpreted cautiously since we described only one patient.
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Affiliation(s)
- Agnes van Minnen
- Radboud University Nijmegen, Behavioural Science Institute (BSI), the Netherlands; Research department PSYTREC, Bilthoven, the Netherlands.
| | - Marleen Tibben
- HSK Groep B.V., Centre of Expertise Functional Movement Disorders, Woerden, The Netherlands.
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Zhou YG, Shang ZL, Zhang F, Wu LL, Sun LN, Jia YP, Yu HB, Liu WZ. PTSD: Past, present and future implications for China. Chin J Traumatol 2021; 24:187-208. [PMID: 33994278 PMCID: PMC8343811 DOI: 10.1016/j.cjtee.2021.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/30/2021] [Accepted: 04/18/2021] [Indexed: 02/04/2023] Open
Abstract
There has been a long history since human beings began to realize the existence of post-traumatic symptoms. Posttraumatic stress disorder (PTSD), a diagnostic category adopted in 1980 in the Diagnostic and Statistical Manual of Mental Disorders-Ⅲ, described typical clusters of psychiatric symptoms occurring after traumatic events. Abundant researches have helped deepen the understanding of PTSD in terms of epidemiological features, biological mechanisms, and treatment options. The prevalence of PTSD in general population ranged from 6.4% to 7.8% and was significantly higher among groups who underwent major public traumatic events. There has been a long way in the studies of animal models and genetic characteristics of PTSD. However, the high comorbidity with other stress-related psychiatric disorders and complexity in the pathogenesis of PTSD hindered the effort to find specific biological targets for PTSD. Neuroimage was widely used to elucidate the underlying neurophysiological mechanisms of PTSD. Functional MRI studies have showed that PTSD was linked to medial prefrontal cortex, anterior cingulate cortex and sub-cortical structures like amygdala and hippocampus, and to explore the functional connectivity among these brain areas which might reveal the possible neurobiological mechanism related to PTSD symptoms. For now, cognitive behavior therapy-based psychotherapy, including combination with adjunctive medication, showed evident treatment effects on PTSD. The emergence of more effective PTSD pharmacotherapies awaits novel biomarkers from further fundamental research. Several natural disasters and emergencies have inevitably increased the possibility of suffering from PTSD in the last two decades, making it critical to strengthen PTSD research in China. To boost PTSD study in China, the following suggestions might be helpful: (1) establishing a national psychological trauma recover project, and (2) exploring the mechanisms of PTSD with joint effort and strengthening the indigenized treatment of PTSD.
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Affiliation(s)
- Yao-Guang Zhou
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Zhi-Lei Shang
- The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Fan Zhang
- Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Li-Li Wu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Lu-Na Sun
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Yan-Pu Jia
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China
| | - Hai-Bo Yu
- Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,Corresponding author.
| | - Wei-Zhi Liu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,The Emotion & Cognition Lab, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China,Corresponding author. Lab for Post-traumatic Stress Disorder, Faculty of Psychology and Mental Health, Naval Medical University, Shanghai, 200433, China.
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39
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van Pelt Y, Fokkema P, de Roos C, de Jongh A. Effectiveness of an intensive treatment programme combining prolonged exposure and EMDR therapy for adolescents suffering from severe post-traumatic stress disorder. Eur J Psychotraumatol 2021; 12:1917876. [PMID: 34025927 PMCID: PMC8128117 DOI: 10.1080/20008198.2021.1917876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Following promising effects of an intensive trauma treatment for adults, the question arises whether adolescents who suffer from severe post-traumatic stress disorder (PTSD) can also profit from a similar treatment programme. Objective: To assess the effectiveness of an intensive trauma-focused treatment programme combining two evidence-based trauma-focused therapies and physical activities for adolescents suffering from severe PTSD. Method: Treatment consisted of daily sessions of prolonged exposure (PE) therapy and eye movement desensitization and reprocessing (EMDR) therapy supplemented with physical activity (13 days on average). All patients (N = 27; 96.3% women, mean age = 16.1 years; SD = 1.3) had been exposed to one or more (interpersonal) traumatic events. Twenty-two of them (81.5%) also fulfilled the diagnostic criteria of a comorbid psychiatric disorder (mean number of comorbid disorders = 2.22). The majority of patients were referred because previous treatment was difficult or complications were expected to occur. Severity of PTSD symptoms and presence of a PTSD diagnostic status were assessed using the Dutch version of the CAPS-CA IV at baseline, post-treatment and at 3-month follow-up. Results: CAPS-CA IV scores decreased significantly from pre- to post-treatment (Cohen's d = 1.39). Of all patients 81.5% (n = 22) showed a clinically meaningful response, of whom 63% (n = 17) no longer fulfilled the diagnostic criteria of PTSD at post-treatment as established with the CAPS-CA IV. The results were maintained at 3-month follow-up. During treatment, neither adverse events nor dropout occurred. Conclusions: The results suggest that an intensive trauma-focused treatment programme combining prolonged exposure, EMDR therapy, and physical activity can be an effective and safe treatment for adolescents suffering from severe PTSD and multiple comorbid psychiatric disorders.
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Affiliation(s)
- Ytje van Pelt
- Psy-zo! Department of Specialized Mental Health Care and Department of Education, The Netherlands
| | - Petra Fokkema
- TrivioCare, Department Mental Health Care and Education Groningen, The Netherlands
| | - Carlijn de Roos
- Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ad de Jongh
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.,Research Department PSYTREC, Bilthoven, The Netherlands.,School of Health Sciences, Salford University, Manchester, UK.,Institute of Health and Society, University of Worcester, Worcester, UK.,School of Psychology, Queen's University, Belfast Northern, Ireland
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40
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Brynhildsvoll Auren TJ, Gjerde Jensen A, Rendum Klæth J, Maksic E, Solem S. Intensive outpatient treatment for PTSD: a pilot feasibility study combining prolonged exposure therapy, EMDR, physical activity, and psychoeducation. Eur J Psychotraumatol 2021; 12:1917878. [PMID: 34025928 PMCID: PMC8128113 DOI: 10.1080/20008198.2021.1917878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
Background: Intensive treatment could be effective for patients with post-traumatic stress disorder (PTSD). Objective: The aim of the study was to test the feasibility of an 8-day (2-week) intensive outpatient treatment for PTSD. Method: Treatment each day consisted of individual Prolonged Exposure (PE), Eye Movement Desensitization and Reprocessing (EMDR), and psychoeducation and physical activity in groups. Patients met different therapists from session to session. Results: Six patients started and completed treatment. Levels of attendance of sessions was high. Patients reported that they were satisfied with the treatment, describing it as emotionally taxing, but meaningful. Therapists also described several positive aspects of the treatment format. There were large reductions in PTSD symptoms. Conclusions: Given these promising, but preliminary findings on the programme's feasibility, future research should investigate this treatment format using larger samples and controlled designs.
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Affiliation(s)
| | - Andreas Gjerde Jensen
- Regional Unit for Treatment of Severe Posttraumatic Stress Disorder, Nidaros DPS, St. Olavs Hospital, Trondheim, Norway
| | - Julie Rendum Klæth
- Regional Unit for Treatment of Severe Posttraumatic Stress Disorder, Nidaros DPS, St. Olavs Hospital, Trondheim, Norway
| | - Elma Maksic
- Regional Unit for Treatment of Severe Posttraumatic Stress Disorder, Nidaros DPS, St. Olavs Hospital, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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41
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Somatoform Dissociative Symptoms Have No Impact on the Outcome of Trauma-Focused Treatment for Severe PTSD. J Clin Med 2021; 10:jcm10081553. [PMID: 33917166 PMCID: PMC8067818 DOI: 10.3390/jcm10081553] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 12/29/2022] Open
Abstract
For patients with complex or other severe forms of PTSD, particularly in cases with dissociative symptoms, different treatment approaches have been suggested. However, the influence of somatoform dissociation on the effectiveness of trauma-focused treatment has hardly ever been studied. This study aims to test the hypotheses that (1) PTSD patients reporting a low level and those reporting a high level of somatoform dissociative symptoms would both benefit from an intensive trauma-focused treatment, and that (2) somatoform dissociative symptoms would alleviate. Participants were 220 patients with severe PTSD, enrolled in an intensive treatment program combining EMDR therapy and prolonged exposure therapy, without a preceding stabilization phase. Trauma history was diversified, and comorbidity was high. PTSD symptoms (CAPS-5 and PCL-5) and somatoform dissociative symptoms (SDQ-5 and SDQ-20) were assessed at pre-treatment, post-treatment and at six months after completion of treatment. The course of both PTSD and somatoform dissociative symptoms was compared for individuals reporting low and for those reporting high levels of somatoform dissociative symptoms. Large effect sizes were observed regarding PTSD symptoms reduction for patients with both low and high levels of somatoform dissociation. Somatoform dissociation did not impact improvement in terms of PTSD symptom reduction. The severity of somatoform dissociative symptoms decreased significantly in both groups. This decrease was greater for those with a positive screen for a dissociative disorder. These results add further support to the notion that the presence of strong somatoform dissociative symptoms in patients with PTSD does not necessarily call for a different treatment approach. Clinical implications are discussed.
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42
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Gielkens EMJ, de Jongh A, Sobczak S, Rossi G, van Minnen A, Voorendonk EM, Rozendaal L, van Alphen SPJ. Comparing Intensive Trauma-Focused Treatment Outcome on PTSD Symptom Severity in Older and Younger Adults. J Clin Med 2021; 10:jcm10061246. [PMID: 33802898 PMCID: PMC8002665 DOI: 10.3390/jcm10061246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To examine the treatment outcome of an intensive trauma-focused treatment program for post-traumatic stress disorder (PTSD) in older and younger adults. Methods: A non-randomized outcome study was conducted with 62 consecutively admitted older PTSD patients (60–78 years) and 62 younger PTSD patients (19–58 years), matched on gender and availability of follow-up data. Patients participated in an intensive eight-day trauma-focused treatment program consisting of eye movement desensitization and reprocessing (EMDR), prolonged exposure (PE), physical activity, and group psycho-education. PTSD symptom severity (Clinician-Administered PTSD Scale-5 (CAPS-5)) was assessed, at pre- and post-treatment, and for a subsample (n = 31 older; n = 31 younger patients) at six-month follow-up. Results: A repeated-measures ANCOVA (centered CAPS pre-treatment score as covariate) indicated a significant decrease in CAPS-5-scores from pre- to post-treatment for the total sample (partial η2 = 0.808). The treatment outcome was not significantly different across age groups (partial η2 = 0.002). There were no significant differences in treatment response across age groups for the follow-up subsample (pre- to post-treatment partial η2 < 0.001; post-treatment to follow-up partial η2 = 0.006), and the large decrease in CAPS-5 scores from pre- to post-treatment (partial η2 = 0.76) was maintained at follow-up (partial η2 = 0.003). Conclusion: The results suggest that intensive trauma-focused treatment is applicable for older adults with PTSD with a large within-effect size comparable to younger participants. Further research on age-related features is needed to examine whether these results can be replicated in the oldest-old (>80).
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Affiliation(s)
- Ellen M. J. Gielkens
- Clinical Center of Excellence for Older Adults with Personality Disorders, Mondriaan, 6419 PJ Heerlen-Maastricht, The Netherlands; (S.S.); (S.P.J.v.A.)
- Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium;
- Correspondence:
| | - Ad de Jongh
- Psychotrauma Expertise Centre (PSYTREC), 3723 MB Bilthoven, The Netherlands; (A.d.J.); (A.v.M.); (E.M.V.); (L.R.)
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, 1081 LA Amsterdam, The Netherlands
- School of Health Sciences, Salford University, Manchester M6 6PU, UK
- Institute of Health and Society, University of Worcester, Worcester WR2 6AJ, UK
- School of Psychology, Queen’s University, 18-30 Malone Road, Belfast BT9 5 BN, UK
| | - Sjacko Sobczak
- Clinical Center of Excellence for Older Adults with Personality Disorders, Mondriaan, 6419 PJ Heerlen-Maastricht, The Netherlands; (S.S.); (S.P.J.v.A.)
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, 6226 NB Maastricht, The Netherlands
| | - Gina Rossi
- Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium;
| | - Agnes van Minnen
- Psychotrauma Expertise Centre (PSYTREC), 3723 MB Bilthoven, The Netherlands; (A.d.J.); (A.v.M.); (E.M.V.); (L.R.)
- Behavioural Science Institute (BSI), Radboud University Nijmegen, 6525 HR Nijmegen, The Netherlands
| | - Eline M. Voorendonk
- Psychotrauma Expertise Centre (PSYTREC), 3723 MB Bilthoven, The Netherlands; (A.d.J.); (A.v.M.); (E.M.V.); (L.R.)
- Behavioural Science Institute (BSI), Radboud University Nijmegen, 6525 HR Nijmegen, The Netherlands
| | - Linda Rozendaal
- Psychotrauma Expertise Centre (PSYTREC), 3723 MB Bilthoven, The Netherlands; (A.d.J.); (A.v.M.); (E.M.V.); (L.R.)
| | - Sebastiaan P. J. van Alphen
- Clinical Center of Excellence for Older Adults with Personality Disorders, Mondriaan, 6419 PJ Heerlen-Maastricht, The Netherlands; (S.S.); (S.P.J.v.A.)
- Personality and Psychopathology Research Group (PEPS), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium;
- Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, The Netherlands
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43
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Bongaerts H, Voorendonk EM, van Minnen A, de Jongh A. Safety and effectiveness of intensive treatment for complex PTSD delivered via home-based telehealth. Eur J Psychotraumatol 2021; 12:1860346. [PMID: 34025912 PMCID: PMC8128126 DOI: 10.1080/20008198.2020.1860346] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Home-based psychotherapy delivered via telehealth has not been investigated in the context of intensive trauma-focused treatment for individuals with severe or Complex posttraumatic stress disorder (PTSD). Objective: To examine the feasibility, safety and effectiveness of an intensive treatment programme containing prolonged exposure, EMDR therapy, physical activities and psycho-education, delivered via home-based telehealth. Method: The treatment was carried out within four consecutive days during the outbreak of the COVID-19 pandemic. The sample consisted of six (four female) patients suffering from severe or Complex PTSD resulting from exposure to multiple traumatic events, mostly during early childhood. Four of them fulfilled the diagnostic criteria of complex PTSD. Outcome measures were the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), the PTSD Checklist for DSM-5 (PCL-5), and the International Trauma Questionnaire (ITQ). Results: CAPS-5 and PCL-5 scores decreased significantly from pre- to post-treatment (Cohen's ds 1.04 and 0.93), and from post-treatment to follow-up (Cohen's ds 0.92 and 1.24). Four of the six patients lost their PTSD or Complex PTSD diagnostic status. No patient dropped out, no personal adverse events and no reliable symptom worsening occurred. Conclusions: The results suggest that intensive, trauma-focused treatment of severe or Complex PTSD delivered via home-based telehealth is feasible, safe and effective, and can be a viable alternative to face-to-face delivered intensive trauma-focused treatment.
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Affiliation(s)
| | - Eline M Voorendonk
- Research Department, PSYTREC, Bilthoven, The Netherlands.,Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Agnes van Minnen
- Research Department, PSYTREC, Bilthoven, The Netherlands.,Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Ad de Jongh
- Research Department, PSYTREC, Bilthoven, The Netherlands.,Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.,School of Health Sciences, Salford University, Manchester, UK.,Institute of Health and Society, University of Worcester, Worcester, UK.,School of Psychology, Queen's University, Belfast, Northern Ireland
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44
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Sun X, Huang D, Zeng F, Ye Q, Xiao H, Lv D, Zhao P, Cui X. Effect of intensive care unit diary on incidence of posttraumatic stress disorder, anxiety, and depression of adult intensive care unit survivors: A systematic review and meta-analysis. J Adv Nurs 2021; 77:2929-2941. [PMID: 33483993 DOI: 10.1111/jan.14706] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 01/11/2023]
Abstract
AIM To systematically evaluate the effect of intensive care unit diary psychotherapy on the incidence of posttraumatic stress disorder, anxiety, and depression after discharge from intensive care unit. BACKGROUND Many studies have reported the potential advantages and risks of intensive care unit diary psychotherapy in adult patients discharged from intensive care unit, but the results are divergent. DESIGN Systematic review and meta-analysis of prospective randomized controlled or case-controlled studies. DATA SOURCE Databases such as Cochran Library, Pubmed, Embase, CINAHL, and ProQuest databases, China national knowledge infrastructure (CNKI) were searched for literatures published from January 2000-March 2020. REVIEW METHODS We use the Cochrane Risk of Bias Tool for quality assessment and audit manager 5.3 software for meta-analysis. The main result is the incidence of posttraumatic stress disorder, anxiety, and depression. RESULTS Ten studies meeting the inclusion criteria were identified, including eight randomized controlled studies and two case-controlled studies, with a total of 1,210 patients. The pooled results of this meta-analysis indicated that the intensive care unit diary could reduce the incidence of posttraumatic stress disorder, anxiety, and depression. CONCLUSION This study showed that an intensive care unit diary could improve the psychological symptoms of adult intensive care unit patients after discharge. However, due to limitations such as publication bias and case sample size, the results should be carefully considered. Researchers need to further clarify the multidisciplinary collaborative process of intensive care unit diary therapy, the real beneficiaries, and its impact on family members' psychological status by conducting large, robust studies in the future. IMPACT This study's findings suggest that medical staff need to re-examine the role of intensive care unit diary therapy, its standardized implementation and provide effective intervention for reducing psychological stress-related symptoms of intensive care unit patients after discharge.
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Affiliation(s)
- Xihui Sun
- Department of Critical Care Medicine, Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai, China
| | - Debin Huang
- Department of Critical Care Medicine, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fan Zeng
- Department of Critical Care Medicine, Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai, China
| | - Qiao Ye
- Department of Critical Care Medicine, Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai, China
| | - Huineng Xiao
- Affiliated Hospital of North Sichuan Medical College, Nanchong Central Hospital, Nanchong City, China
| | - Deping Lv
- Affiliated Hospital of North Sichuan Medical College, Nanchong Central Hospital, Nanchong City, China
| | - Ping Zhao
- Department of Critical Care Medicine, Chongqing Bishan District People's Hospital (Bishan Hospital, First Affiliated Hospital of Chongqing Medical University), Bishan, China
| | - Xueting Cui
- Department of Critical Care Medicine, Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), Zhuhai, China
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45
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Boterhoven de Haan KL, Lee CW, Fassbinder E, van Es SM, Menninga S, Meewisse ML, Rijkeboer M, Kousemaker M, Arntz A. Imagery rescripting and eye movement desensitisation and reprocessing as treatment for adults with post-traumatic stress disorder from childhood trauma: randomised clinical trial. Br J Psychiatry 2020; 217:609-615. [PMID: 32892758 DOI: 10.1192/bjp.2020.158] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Investigation of treatments that effectively treat adults with post-traumatic stress disorder from childhood experiences (Ch-PTSD) and are well tolerated by patients is needed to improve outcomes for this population. AIMS The purpose of this study was to compare the effectiveness of two trauma-focused treatments, imagery rescripting (ImRs) and eye movement desensitisation and reprocessing (EMDR), for treating Ch-PTSD. METHOD We conducted an international, multicentre, randomised clinical trial, recruiting adults with Ch-PTSD from childhood trauma before 16 years of age. Participants were randomised to treatment condition and assessed by blind raters at multiple time points. Participants received up to 12 90-min sessions of either ImRs or EMDR, biweekly. RESULTS A total of 155 participants were included in the final intent-to-treat analysis. Drop-out rates were low, at 7.7%. A generalised linear mixed model of repeated measures showed that observer-rated post-traumatic stress disorder (PTSD) symptoms significantly decreased for both ImRs (d = 1.72) and EMDR (d = 1.73) at the 8-week post-treatment assessment. Similar results were seen with secondary outcome measures and self-reported PTSD symptoms. There were no significant differences between the two treatments on any standardised measure at post-treatment and follow-up. CONCLUSIONS ImRs and EMDR treatments were found to be effective in treating PTSD symptoms arising from childhood trauma, and in reducing other symptoms such as depression, dissociation and trauma-related cognitions. The low drop-out rates suggest that the treatments were well tolerated by participants. The results from this study provide evidence for the use of trauma-focused treatments for Ch-PTSD.
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Affiliation(s)
| | - Christopher W Lee
- Faculty of Health and Medical Sciences, University of Western Australia, Australia
| | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
| | | | | | | | - Marleen Rijkeboer
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands
| | | | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, the Netherlands
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46
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van Minnen A, van Dalen B, Voorendonk EM, Wagenmans A, de Jongh A. The effects of symptom overreporting on PTSD treatment outcome. Eur J Psychotraumatol 2020; 11:1794729. [PMID: 33029329 PMCID: PMC7473171 DOI: 10.1080/20008198.2020.1794729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND It is often assumed that individuals with posttraumatic stress disorder (PTSD) who overreport their symptoms should be excluded from trauma-focused treatments. OBJECTIVE To investigate the effects of a brief, intensive trauma-focused treatment programme for individuals with PTSD who are overreporting symptoms. METHODS Individuals (n = 205) with PTSD participated in an intensive trauma-focused treatment programme consisting of EMDR and prolonged exposure (PE) therapy, physical activity and psycho-education. Assessments took place at pre- and post-treatment (Structured Inventory of Malingered Symptomatology; SIMS, Clinician Administered PTSD Scale for DSM-5; CAPS-5). RESULTS Using a high SIMS cut-off of 24 or above, 14.1% (n = 29) had elevated SIMS scores (i.e. 'overreporters'). The group of overreporters showed significant decreases in PTSD-symptoms, and these treatment results did not differ significantly from other patients. Although some patients (35.5%) remained overreporters at post-treatment, SIMS scores decreased significantly during treatment. CONCLUSION The results suggest that an intensive trauma-focused treatment not only is a feasible and safe treatment for PTSD in general, but also for individuals who overreport their symptoms.
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Affiliation(s)
- Agnes van Minnen
- Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands.,Research Department, Research Department PSYTREC, Bilthoven, The Netherlands
| | - Birgit van Dalen
- Research Department, Research Department PSYTREC, Bilthoven, The Netherlands
| | - Eline M Voorendonk
- Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands.,Research Department, Research Department PSYTREC, Bilthoven, The Netherlands
| | - Anouk Wagenmans
- Research Department, Research Department PSYTREC, Bilthoven, The Netherlands
| | - Ad de Jongh
- Research Department, Research Department PSYTREC, Bilthoven, The Netherlands.,Academic Centre for Dentistry Amsterdam (ACTA, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.,School of Health Sciences, Salford University, Manchester, UK.,Institute of Health and Society, University of Worcester, Worcester, UK.,School of Psychology, Queen's University, Belfast, Northern Ireland
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47
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Sciarrino NA, Warnecke AJ, Teng EJ. A Systematic Review of Intensive Empirically Supported Treatments for Posttraumatic Stress Disorder. J Trauma Stress 2020; 33:443-454. [PMID: 32598561 DOI: 10.1002/jts.22556] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 03/23/2020] [Accepted: 04/12/2020] [Indexed: 01/03/2023]
Abstract
Various clinical practice guidelines for the treatment of posttraumatic stress disorder (PTSD) have consistently identified two frontline evidence-based psychotherapies (EBPs)-prolonged exposure (PE) and cognitive processing therapy (CPT)-as well as other empirically supported treatments (EST), such as eye movement desensitization and reprocessing (EMDR) and cognitive therapy for PTSD (CT for PTSD). However, researchers and clinicians continue to be concerned with rates of symptom improvement and patient dropout within these treatments. Recent attempts to address these issues have resulted in intensive, or "massed," treatments for PTSD. Due to variability among intensive treatments, including treatment delivery format, fidelity to the EST, and the population studied, we conducted a systematic review to summarize and integrate the literature on the impact of intensive treatments on PTSD symptoms. A review of four major databases, with no restrictions regarding publication date, yielded 11 studies that met all inclusion criteria. The individual study findings denoted a large impact of treatment on reduction of PTSD symptoms, ds = 1.15-2.93, and random-effects modeling revealed a large weighted mean effect of treatment, d = 1.57, 95% CI [1.24, 1.91]. Results from intensive treatments also noted high rates of treatment completion (i.e., 0%-13.6% dropout; 5.51% pooled dropout rate across studies). The findings suggest that intensive delivery of these treatments can be an effective alternative to standard delivery and contribute to improved treatment response and reduced treatment dropout.
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Affiliation(s)
| | | | - Ellen J Teng
- Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine, Houston, Texas, USA.,South Central Mental Illness Research, Education, and Clinical Center, Houston, Texas, USA
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Van Minnen A, Voorendonk EM, Rozendaal L, de Jongh A. Sequence matters: Combining Prolonged Exposure and EMDR therapy for PTSD. Psychiatry Res 2020; 290:113032. [PMID: 32454314 DOI: 10.1016/j.psychres.2020.113032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Investigating the influence of the sequence in which two evidence-based trauma-focused treatments are offered to PTSD-patients. METHODS PTSD-patients were treated using an intensive eight-day treatment program, combining Prolonged Exposure (PE) and EMDR therapy. Forty-four patients received a PE session in the morning and an EMDR session in the afternoon, while 62 patients received the reversed sequence (EMDR followed by PE). Outcome measures were PTSD symptom severity and subjective experiences. RESULTS Patients who received PE first and EMDR second showed a significantly greater reduction in PTSD symptoms. Patients preferred this sequence and valued the treatment sessions as significantly more helpful compared to patients in the EMDR-first condition. CONCLUSION The results of this explorative study are supportive of the notion that PE and EMDR therapy can be successfully combined, and that sequence matters. First applying PE sessions before EMDR sessions resulted in better treatment outcome, and better subjective patient's evaluations in terms of treatment helpfulness and preference.
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Affiliation(s)
- Agnes Van Minnen
- Radboud University Nijmegen, Behavioural Science Institute (BSI), The Netherlands; Research department PSYTREC, Bilthoven, The Netherlands.
| | - Eline M Voorendonk
- Radboud University Nijmegen, Behavioural Science Institute (BSI), The Netherlands; Research department PSYTREC, Bilthoven, The Netherlands.
| | | | - Ad de Jongh
- Research department PSYTREC, Bilthoven, The Netherlands; Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, The Netherlands; School of Health Sciences, Salford University, Manchester, United Kingdom; Institute of Health and Society, University of Worcester, United Kingdom; School of Psychology, Queen's University, Belfast Northern Ireland.
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49
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Voorendonk EM, De Jongh A, Rozendaal L, Van Minnen A. Trauma-focused treatment outcome for complex PTSD patients: results of an intensive treatment programme. Eur J Psychotraumatol 2020; 11:1783955. [PMID: 33029323 PMCID: PMC7473266 DOI: 10.1080/20008198.2020.1783955] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Complex PTSD (CPTSD) has been incorporated in the 11th edition of the International Classification of Diseases (ICD-11) as a mental health condition distinct from PTSD. OBJECTIVE The objective of the current study is to determine whether individuals classified as having CPTSD can benefit from an intensive trauma-focused treatment, resulting in decreased PTSD and CPTSD symptoms, and loss of diagnoses. METHOD Patients diagnosed with PTSD (N = 308) took part in an intensive 8-day treatment programme combining prolonged exposure, EMDR therapy, psycho-education, and physical activity. The treatment was not phase-based in that it did not contain a stabilization phase or skill training prior to therapy. CPTSD diagnosis was assessed by means of the International Trauma Questionnaire (ITQ) and PTSD diagnosis was assessed with both the ITQ and CAPS-5. Treatment response was measured with the CAPS-5, PCL-5, and ITQ. RESULTS Symptoms of both PTSD and CPTSD significantly decreased from pre- to post-treatment resulting in a significant loss of CAPS-5 based PTSD (74.0%) and ITQ-based PTSD and CPTSD diagnoses (85.0% and 87.7%, respectively). No adverse events occurred in terms of suicides, suicide attempts, or hospital admissions. CONCLUSIONS The results are supportive of the notion that the majority of patients classified as having CPTSD strongly benefit from an intensive trauma-focused treatment for their PTSD.
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Affiliation(s)
- Eline M. Voorendonk
- Research Department, PSYTREC, Bilthoven, The Netherlands
- Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Ad De Jongh
- Research Department, PSYTREC, Bilthoven, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
- School of Psychology, Queen’s University, Belfast, UK
- Institute of Health and Society, University of Worcester, Worcester, UK
| | | | - Agnes Van Minnen
- Research Department, PSYTREC, Bilthoven, The Netherlands
- Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands
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50
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Mevissen L, Ooms-Evers M, Serra M, de Jongh A, Didden R. Feasibility and potential effectiveness of an intensive trauma-focused treatment programme for families with PTSD and mild intellectual disability. Eur J Psychotraumatol 2020; 11:1777809. [PMID: 33029319 PMCID: PMC7473050 DOI: 10.1080/20008198.2020.1777809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Persons with mild intellectual disabilities or borderline intellectual functioning (MID-BIF; IQ 50-85) have a higher risk of being exposed to traumatic events and developing posttraumatic stress disorder (PTSD). EMDR therapy has shown to be applicable, safe and potentially effective for the treatment of PTSD in individuals with MID-BIF. However, in traumatized multi-problem families with MID-BIF and (impending) out of home placement of children, standard PTSD treatment in an outpatient setting may not be appropriate. OBJECTIVE To evaluate the feasibility and potential effectiveness of KINGS-ID, a six-week clinical trauma-focused treatment programme consisting of intensive EMDR therapy with parents and children, and parental skills training followed by two weeks of parent support at home. METHOD Six families (nine parents of whom six had MID-BIF) and 10 children (all having MID-BIF) participated in the KINGS-ID programme. Seven parents and seven children had PTSD. Data were collected within a single case study design. For each family member data were collected during baseline (three measurements), treatment (seven weekly measurements), posttreatment (three measurements) and at follow-up (three measurements). RESULTS None of the family members dropped out. Within the first two treatment weeks all but one child and one parent no longer met PTSD symptom criteria. In both children and parents, trauma-related symptoms and daily life impairment significantly decreased following treatment and in parents a significant decrease in symptoms of general psychopathology and parental stress was found. Results were maintained at six-month follow-up. CONCLUSIONS The findings of the current study are promising given that the treatment programme seems to offer new perspectives for traumatized multi-problem families with MID-BIF.
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Affiliation(s)
| | | | | | - Ad de Jongh
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.,Research Department, PSYTREC, Bilthoven, The Netherlands.,School of Health Sciences, Salford University, Manchester, UK.,Institute of Health and Society, University of Worcester, Worcester, UK.,School of Psychology, Queen's University, Belfast, Northern Ireland
| | - Robert Didden
- Trajectum, Zwolle, The Netherlands.,Behavioural Science Institute (BSI), Radboud University, Nijmegen, The Netherlands
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