Imagery rescripting and eye movement desensitisation and reprocessing for treatment of adults with childhood trauma-related post-traumatic stress disorder: IREM study design

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Abstract

Background

Post-traumatic stress disorder (PTSD) that originates from childhood trauma experiences can develop into a chronic condition that has lasting effects on an individual’s functioning and quality of life. While there are evidence-based guidelines for treating adult onset PTSD, treatments for adults with childhood trauma-related PTSD (Ch-PTSD) are varied and subject to ongoing debate. This study will test the effectiveness of two trauma-focused treatments, imagery rescripting (ImRs) and eye movement desensitisation and reprocessing (EMDR) in participants with Ch-PTSD. Both have been found effective in treatment of adult PTSD or mixed onset PTSD and previous research indicates they are well-tolerated treatments. However, we know less about their effectiveness for treating Ch-PTSD or their underlying working mechanisms.

Methods

IREM is an international multicentre randomised controlled trial involving seven sites across Australia, Germany and the Netherlands. We aim to recruit 142 participants (minimum of n = 20 per site), who will be randomly assigned to treatment condition. Assessments will be conducted before treatment until 1-year follow-up. Assessments before and after the waitlist will assess change in time only. The primary outcome measure is change in PTSD symptom severity from pre-treatment to 8-weeks post-treatment. Secondary outcome measures include change in severity of depression, anger, trauma-related cognitions, guilt, shame, dissociation and quality of life. Underlying mechanisms of treatment will be assessed on changes in vividness, valence and encapsulated belief of a worst trauma memory. Additional sub-studies will include qualitative investigation of treatment experiences from the participant and therapists’ perspective, changes in memory and the impact of treatment fidelity on outcome measures.

Discussion

The primary aims of this study are to compare the effectiveness of EMDR and ImRs in treating Ch-PTSD and to investigate the underlying working mechanisms of the two treatments. The large-scale international design will make a significant contribution to our understanding of how these treatments address the needs of individuals with Ch-PTSD and therefore, potentially improve their effectiveness.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12614000750684. Registered 16 July 2014.

Electronic supplementary material

The online version of this article (doi:10.1186/s12888-017-1330-2) contains supplementary material, which is available to authorized users.

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Most cited references 50

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Treatment for PTSD related to childhood abuse: a randomized controlled trial.

Patricia Jackson, K Chase Stovall-McClough, Eva Petkova … (2010)

Posttraumatic stress disorder (PTSD) related to childhood abuse is associated with features of affect regulation and interpersonal disturbances that substantially contribute to impairment. Existing treatments do not address these problems or the difficulties they may pose in the exploration of trauma memories, an efficacious and frequently recommended approach to resolving PTSD. The authors evaluated the benefits and risks of a treatment combining an initial preparatory phase of skills training in affect and interpersonal regulation (STAIR) followed by exposure by comparing it against two control conditions: Supportive Counseling followed by Exposure (Support/Exposure) and skills training followed by Supportive Counseling (STAIR/Support). Participants were women with PTSD related to childhood abuse (N=104) who were randomly assigned to the STAIR/Exposure condition, Support/Exposure condition (exposure comparator), or STAIR/Support condition (skills comparator) and assessed at posttreatment, 3 months, and 6 months. The STAIR/Exposure group was more likely to achieve sustained and full PTSD remission relative to the exposure comparator, while the skills comparator condition fell in the middle (27% versus 13% versus 0%). STAIR/Exposure produced greater improvements in emotion regulation than the exposure comparator and greater improvements in interpersonal problems than both conditions. The STAIR/Exposure dropout rate was lower than the rate for the exposure comparator and similar to the rate for the skills comparator. There were significantly lower session-to-session PTSD symptoms during the exposure phase in the STAIR/Exposure condition than in the Support/Exposure condition. STAIR/Exposure was associated with fewer cases of PTSD worsening relative to both of the other two conditions. For a PTSD population with chronic and early-life trauma, a phase-based skills-to-exposure treatment was associated with greater benefits and fewer adverse effects than treatments that excluded either skills training or exposure.

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Types of dissociation and dissociative types: A taxometric analysis of dissociative experiences.

Eve Carlson, Niels G. Waller, Frank Putnam (1996)

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Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: a meta-analytic study.

Günther Seidler, Allison F Wagner (2006)

Eye movement desensitization and reprocessing (EMDR) and trauma-focused cognitive-behavioral therapy (CBT) are both widely used in the treatment of post-traumatic stress disorder (PTSD). There has, however, been debate regarding the advantages of one approach over the other. This study sought to determine whether there was any evidence that one treatment was superior to the other. We performed a systematic review of the literature dating from 1989 to 2005 and identified eight publications describing treatment outcomes of EMDR and CBT in active-active comparisons. Seven of these studies were investigated meta-analytically. The superiority of one treatment over the other could not be demonstrated. Trauma-focused CBT and EMDR tend to be equally efficacious. Differences between the two forms of treatment are probably not of clinical significance. While the data indicate that moderator variables influence treatment efficacy, we argue that because of the small number of original studies, little benefit is to be gained from a closer examination of these variables. Further research is needed within the framework of randomized controlled trials. Our results suggest that in the treatment of PTSD, both therapy methods tend to be equally efficacious. We suggest that future research should not restrict its focus to the efficacy, effectiveness and efficiency of these therapy methods but should also attempt to establish which trauma patients are more likely to benefit from one method or the other. What remains unclear is the contribution of the eye movement component in EMDR to treatment outcome.

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Author and article information

Contributors

Katrina L. Boterhoven de Haan: katrina.boterhovendehaan@research.uwa.edu.au

Christopher W. Lee: chris.lee@uwa.edu.au

Eva Fassbinder: Eva.Fassbinder@uksh.de

Marisol J. Voncken: m.voncken@maastrichtuniversity.nl

Mariel Meewisse: M.Meewisse@ggz-nhn.nl

Saskia M. Van Es: saskia.vanes@psyq.nl

Simone Menninga: S.Menninga@psyq.nl

Margriet Kousemaker: m.kousemaker@sinaicentrum.nl

Arnoud Arntz: A.R.Arntz@uva.nl

Journal

Journal ID (nlm-ta): BMC Psychiatry

Journal ID (iso-abbrev): BMC Psychiatry

Title: BMC Psychiatry

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-244X

Publication date (Electronic): 4 May 2017

Publication date PMC-release: 4 May 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 165

Affiliations

[1 ]ISNI 0000 0004 1936 7910, GRID grid.1012.2, , Division of Psychiatry, UWA Medical School, Faculty of Health & Medical Sciences, University of Western Australia, ; 35 Stirling Highway, Crawley, WA 6009 Australia

[2 ]ISNI 0000 0001 0057 2672, GRID grid.4562.5, , Lübeck University, School of Psychiatry, ; Ratzeburger Allee 160, 23562 Lübeck, Germany

[3 ]ISNI 0000 0001 0481 6099, GRID grid.5012.6, , Maastricht University, Faculty of Psychology and Neuroscience, Department Clinical Psychological Science, ; P.O. Box 616, 6200 MD Maastricht, The Netherlands

[4 ]GGZ Noord-Holland Noord, Stationsplein 138, 1703 WC Heerhigowaard, Netherlands

[5 ]PsyQ Amsterdam, George Westinghousestraat 2, 1097 BA Amsterdam, Netherlands

[6 ]PsyQ Beverwijk, Leeghwaterweg 1A, 1951 NA Velsen-Noord, Netherlands

[7 ]Sinai Centrum, Laan van de Helende Meesters 2, Postbus 2063, 1180 EB Amstelveen, Netherlands

[8 ]ISNI 0000000084992262, GRID grid.7177.6, Department of Clinical Psychology, , University of Amsterdam, ; Weesperplein 4, 1018 XA Amsterdam, Netherlands

Article

Publisher ID: 1330

DOI: 10.1186/s12888-017-1330-2

PMC ID: 5418842

PubMed ID: 28472933

SO-VID: 6529e51b-de82-4d43-b871-2523d1856e61

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 27 February 2017

Date accepted : 24 April 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100009711, EMDR Research Foundation;

Custom metadata

ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: post-traumatic stress disorder,childhood,imagery rescripting,eye movement desensitisation and reprocessing,treatment

Data availability:

ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: post-traumatic stress disorder, childhood, imagery rescripting, eye movement desensitisation and reprocessing, treatment

Imagery rescripting and eye movement desensitisation and reprocessing for treatment of adults with childhood trauma-related post-traumatic stress disorder: IREM study design

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Abstract

Background

Methods

Discussion

Trial registration

Electronic supplementary material

Related collections

New Psychiatry

Most cited references 50

Treatment for PTSD related to childhood abuse: a randomized controlled trial.

Types of dissociation and dissociative types: A taxometric analysis of dissociative experiences.

Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: a meta-analytic study.

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