EMDR Research News August 2020
With each reference below, you will find the citation, abstract and author contact information (when available). Previous posting to this blog can be viewed by year in the sidebar below right (visible on computer and tablet - landscape). Summary listings by topic are available at EMDR Research. A comprehensive listing of all EMDR-related research is available at the Francine Shapiro Library. EMDRIA members can access recent Journal of EMDR Practice and Research articles in the member’s area on the EMDRIA website. JEMDR issues older than 12 months are available open access on Connect - Springer Publishing Company.
Alempijevic, D., Beriashvili, R., Beynon, J., Birmanns, B., Brasholt, M., Cohen, J., . . . Nuno Viera, D. (2020). Statement of the Independent Forensic Expert Group on Conversion Therapy. Torture Journal, 30(1), 66-78. doi:10.7146/torture.v30i1.119654
Open Access: https://irct.org/assets/uploads/10.%20Statement%20on%20CT.pdf
Conversion therapy is a set of practices that aim to change or alter an individual’s sexual orientation or gender identity. It is premised on a belief that an individual’s sexual orientation or gender identity can be changed and that doing so is a desirable outcome for the individual, family, or community. Other terms used to describe this practice include sexual orientation change effort (SOCE), reparative therapy, reintegrative therapy, reorientation therapy, ex-gay therapy, and gay cure.
Baas, M. A. M., van Pampus, M. G., Braam, L., Stramrood, C. A. I., & de Jongh, A. (2020). The effects of PTSD treatment during pregnancy: systematic review and case study. European Journal of Psychotraumatology, 11(1), 1762310. doi:10.1080/20008198.2020.1762310
Open Access: http://dx.doi.org/10.1080/20008198.2020.1762310
Maria G. van Pampus, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, PO box 95500, Amsterdam 1090 HM, The Netherlands. E-mail: M.G.vanPampus@olvg.nl
Background: PTSD in pregnant women is associated with adverse outcomes for mothers and their children. It is unknown whether pregnant women with PTSD, or symptoms of PTSD, can receive targeted treatment that is safe and effective.
Objective: The purpose of the present paper was to assess the effectiveness and safety of treatment for (symptoms of) PTSD in pregnant women.
Method: A systematic review was conducted in accordance with the PRISMA guidelines in Pubmed, Embase, PsychINFO, and Cochrane. In addition, a case is presented of a pregnant woman with PTSD who received eye-movement desensitization and reprocessing (EMDR) therapy aimed at processing the memories of a previous distressing childbirth.
Results: In total, 13 studies were included, involving eight types of interventions (i.e. trauma-focused cognitive behavioural therapy, exposure therapy, EMDR therapy, interpersonal psychotherapy, explorative therapy, self-hypnosis and relaxation, Survivor Moms Companion, and Seeking Safety Intervention). In three studies, the traumatic event pertained to a previous childbirth. Five studies reported obstetrical outcomes. After requesting additional information, authors of five studies indicated an absence of serious adverse events. PTSD symptoms improved in 10 studies. However, most studies carried a high risk of bias. In our case study, a pregnant woman with a PTSD diagnosis based on DSM-5 no longer fulfilled the criteria of PTSD after three sessions of EMDR therapy. She had an uncomplicated pregnancy and delivery.
Conclusion: Despite the fact that case studies as the one presented here report no adverse events, and treatment is likely safe, due to the poor methodological quality of most studies it is impossible to allow inferences on the effects of any particular treatment of PTSD (symptoms) during pregnancy. Yet, given the elevated maternal stress and cortisol levels in pregnant women with PTSD, and the fact that so far no adverse effects on the unborn child have been reported associated with the application of trauma-focused therapy, treatment of PTSD during pregnancy is most likely safe.
Barawi, K. S., Lewis, C., Simon, N., & Bisson, J. I. (2020). A systematic review of factors associated with outcome of psychological treatments for post-traumatic stress disorder. European Journal of Psychotraumatology, 11(01), 1774240. doi:10.1080/20008198.2020.1774240
Open Access: http://dx.doi.org/10.1080/20008198.2020.1774240
Kali S. Barawi, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Wales, UK. E-mail: BarawiK1@cardiff.ac.uk
Objective: Psychological interventions for post-traumatic stress disorder (PTSD) are not always effective and can leave some individuals with enduring symptoms. Little is known about factors that are associated with better or worse treatment outcome. Our objective was to address this gap.
Method: We undertook a systematic review following Cochrane Collaboration Guidelines. We included 126 randomized controlled trials (RCTs) of psychological interventions for PTSD and examined factors that were associated with treatment outcome, in terms of severity of PTSD symptoms post-treatment, and recovery or remission.
Results: Associations were neither consistent nor strong. Two factors were associated with smaller reductions in severity of PTSD symptoms post-treatment: comorbid diagnosis of depression, and higher PTSD symptom severity at baseline assessment. Higher education, adherence to homework and experience of a more recent trauma were associated with better treatment outcome.
Conclusion: Identifying and understanding why certain factors are associated with treatment outcome is vital to determine which individuals are most likely to benefit from particular treatments and to develop more effective treatments in the future. There is an urgent need for consistent and standardized reporting of factors associated with treatment outcome in all clinical trials.
Bisson, J. I., van Deursen, R., Hannigan, B., Kitchiner, N., Barawi, K., Jones, K., . . . Vermetten, E. (2020). Randomized controlled trial of multi-modular motion-assisted memory desensitization and reconsolidation (3MDR) for male military veterans with treatment-resistant post-traumatic stress disorder. Acta Psychiatr Scand. doi:10.1111/acps.13200
Open Access: https://pubmed.ncbi.nlm.nih.gov/32495381
Jonathan Bisson, School of Medicine, Cardiff University, Cardiff, UK. E-mail: email@example.com
Objective: To explore the potential efficacy of multi-modular motion- assisted memory desensitization and reprocessing (3MDR) in British military veterans with treatment-resistant service-related PTSD. Methods: Exploratory single-blind, randomized, parallel arm, cross- over controlled trial with nested process evaluation to assess fidelity, adherence and factors that influence outcome.
Results: A total of 42 participants (all male) were randomized with 83% retention at 12 weeks and 86% at 26 weeks. The difference in mean Clinician-Administered PTSD Scale for DSM-5 scores between the immediate and delayed 3MDR arms was 9.38 (95% CI 17.33 to 1.44, P = 0.021) at 12 weeks and 3.59 (14.39 to 7.20, P = 0.513) at 26 weeks when both groups had received 3MDR. The likely effect size of 3MDR was found to be 0.65. Improvements were maintained at 26-week follow-up. 3MDR was found to be acceptable to most, but not all, participants. Several factors that may impact efficacy and acceptability of 3MDR were identified.
Conclusion: 3MDR is a promising new intervention for treatment- resistant PTSD with emerging evidence of effect.
Brunault, P., Lebigre, K., Idbrik, F., Maugé, D., Adam, P., Barrault, S., . . . El-Hage, W. (2020). Childhood Trauma Predicts Less Remission from PTSD among Patients with Co-Occurring Alcohol Use Disorder and PTSD. J Clin Med, 9(7). doi:10.3390/jcm9072054
Open Access: https://www.mdpi.com/2077-0383/9/7/2054
Paul Brunault, CHRU de Tours, Service d'Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, 37044 Tours, France. E-mail: firstname.lastname@example.org
Post-traumatic stress disorder (PTSD) is highly prevalent among patients hospitalized for an alcohol use disorder (AUD). Hospitalization can improve PTSD and AUD outcomes in some but not all patients, but we lack data on the baseline predictors of PTSD non-remission. This study aimed to determine the baseline risk factors for non-remitted PTSD in patients hospitalized for an AUD. Of 298 AUD inpatients recruited in a rehabilitation center (Le Courbat, France), we included 91 AUD inpatients with a co-occurring PTSD and a longitudinal assessment at baseline (T1) and before discharge (T2: 8 weeks later). Patients were assessed for PTSD diagnosis/severity (PCL-5=PTSD Checklist for DSM-5), different types of trauma including childhood trauma (LEC-5=Life Events Checklist for DSM-5/CTQ-SF=Childhood Trauma Questionnaire, Short-Form), and AUD diagnosis/severity (clinical interview/AUDIT=Alcohol Use Disorders Identification Test). Rate of PTSD remission between T1 and T2 was 74.1%. Non-remitted PTSD at T2 was associated with a history of childhood trauma (physical, emotional or sexual abuse, physical negligence), but not with other types of trauma experienced, nor baseline PTSD or AUD severity. Among patients hospitalized for an AUD with co-occurring PTSD, PTSD remission was more strongly related to the existence of childhood trauma than to AUD or PTSD severity at admission. These patients should be systematically screened for childhood trauma in order to tailor evidence-based interventions.
Cowan, A., & Ashai, A. (2020). Psychotherapy with Survivors of Sexual Abuse and Assault. Innovations in Clinical Neuroscience, 17(1-3), 22-26. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239557/
Open Access: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239557/
Julie P. Gentile, MD; Email: email@example.com
Sexual assault and abuse can result in severe physical and emotional trauma to the victim. Deploying targeted psychotherapeutic treatment that is individualized for the survivor is important to achieving optimal patient outcomes. There are several valid and evidence-based treatments available
for posttraumatic stress disorder (PTSD) and interpersonal difficulties that can result from sexual abuse and assault. In this article, the authors discuss psychodynamic psychotherapy, trauma-focused cognitive behavioral therapy (TF-CBT), and eye movement desensitization and reprocessing therapy (EMDR) for the treatment of patients following sexual assault and abuse. The authors also provide practice points on common issues in the management of the treatment of sexual assault survivors, including transference, countertransference, and avoiding retraumatization. Composite case vignettes are used to illustrate treatment techniques.
Claudino, F. C. D. A., Gonçalves, L., Schuch, F. B., Martins, H. R. S., & Rocha, N. S. D. (2020). The Effects of Individual Psychotherapy in BDNF Levels of Patients With Mental Disorders: A Systematic Review. Frontiers in Psychiatry, 11, 1-9. doi:10.3389/fpsyt.2020.00445
Open Access: http://dx.doi.org/10.3389/fpsyt.2020.00445
Felipe Cesar de Almeida Claudino. E-mail: firstname.lastname@example.org
Background: Brain-derived Neurotrophic Factor (BDNF) is considered the main cerebral neurotrophin and is produced in the central neural system and peripherals. Its levels are reduced in patients with several psychiatric disorders, but it is unclear if the response to psychotherapy can alter its concentration.
Objective: To carry out a systematic review evaluating the effects of individual psychotherapy in BDNF levels in patients with mental disorders.
Methods: The databases PubMed, EMBASE, PsycArticles, SciELO, Web of Science, and CENTRAL; the last search was performed on October 2019 for trials evaluating the effects of individual psychotherapy in BDNF levels in adults with mental disorders. PROSPERO registration: CRD42018108144.
Results: Eight of 293 studies were included. A rise in BDNF levels was observed in depressive patients when psychotherapy was combined with medication. Patients with post-traumatic stress disorder (PTSD) who responded to therapy presented a raise in BDNF levels mostly when combined with physical activity. There was a rise in BDNF levels in those who responded to psychotherapy in patients with bulimia, in borderline patients, and in insomniacs.
Conclusions: The BDNF seems to present variations after psychotherapy especially in patients with bulimia, PTSD, insomnia, and borderline. These subjects also have symptom reduction. Thereby, BDNF could be a supplemental tool to analyze the success to psychotherapy. BDNF levels in patients with major depression after therapy are still controversial and the short follow-up of most studies is a limiting factor.
de Jongh, A., ten Broeke, E., Farrell, D., & Maxfield, L. (2020). Empirically Supported Psychological Treatments: EMDR Therapy. In J. G. Beck & D. M. Sloan (Eds.), The Oxford Handbook of Traumatic Stress Disorders, Second Edition. Oxford University Press. doi:10.1093/oxfordhb/9780190088224.013.33
Full text access to this chapter may be possible with subscription free trial.
This chapter provides an overview of the current empirical support for eye movement desensitization and reprocessing (EMDR) therapy for posttraumatic stress disorder (PTSD), which has been included in international treatment guidelines as an evidence-based and recommended treatment for this condition. It first provides a brief description of EMDR therapy, which is a standardized, eight-phase, trauma-focused therapy, involving the use of “bilateral” physical stimulation (eye movements, taps or tones). The scientific support for its efficacy is reviewed, particularly in comparison with its most crucial trauma-focused comparator (i.e., trauma-focused cognitive behavioral therapy). Finally, the chapter discusses research into the mechanism of action of EMDR therapy.
Draper, A., Marcellino, E., & Ogbonnaya, C. (2020). Fast Feet Forward: Sports training and running practice to reduce stress and increase positive cognitions in unaccompanied asylum‐seeking minors. Counselling and Psychotherapy Research. doi:10.1002/capr.12330
Miss Comfort Ogbonnaya, Coram 41 Brunswick Square, London, WC1N 1AZ, UK. E-mail: email@example.com
Unaccompanied asylum‐seeking children (UASC) are a vulnerable group who are exposed to multiple traumatic events such as persecution, sexual maltreatment, imprisonment, torture, and losses in their home country (Bean, Derluyn, Eurelings‐Bontekoe, Broekaert, & Spinhoven, 2007; Wiese and Burhorst, 2007). They are also subjected to continuous transitions throughout their migration trajectory (Bhugra, 2004). Although many studies have investigated the efficacy of bilateral movement in treatment of one single traumatic event (e.g. Fernandez, 2007), there is limited literature around bilateral movements interventions being used with perpetuated and multiple traumas within this cohort. This paper looks at the evidence for early intervention trauma work based on EMDR principles, the benefits of using running as a form of bilateral movement and the findings of a UASC sport trauma group with children in Kent, UK. It also gives recommendations for future research into early intervention trauma work with unaccompanied asylum‐seeking children. The data showed a significant rise in the Validity of Cognition scores with a reduction in Subjective Units of Disturbance scores of those participating in the programme. This highlights the validity of this protocol and shows promising results for future enquiry.
Ganslev, C. A., Storebø, O. J., Callesen, H. E., Ruddy, R., & Søgaard, U. (2020). Psychosocial interventions for conversion and dissociative disorders in adults. Cochrane Database Syst Rev, 7, CD005331. doi:10.1002/14651858.CD005331.pub3
Open Access: https://pubmed.ncbi.nlm.nih.gov/32681745
Christina A Ganslev, Clinic of Liaison Psychiatry, Region Zealand, Denmark.
Background: Conversion and dissociative disorders are conditions where people experience unusual neurological symptoms or changes in awareness or identity. However, symptoms and clinical signs cannot be explained by a neurological disease or other medical condition. Instead, a psychological stressor or trauma is often present. The symptoms are real and can cause significant distress or problems with functioning in everyday life for the people experiencing them.
Objectives: To assess the beneficial and harmful effects of psychosocial interventions of conversion and dissociative disorders in adults.
Search methods: We conducted database searches between 16 July and 16 August 2019. We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and eight other databases, together with reference checking, citation searching and contact with study authors to identify additional studies.
Selection criteria: We included all randomised controlled trials that compared psychosocial interventions for conversion and dissociative disorders with standard care, wait list or other interventions (pharmaceutical, somatic or psychosocial).
Data collection and analysis: We selected, quality assessed and extracted data from the identified studies. Two review authors independently performed all tasks. We used standard Cochrane methodology. For continuous data, we calculated mean differences (MD) and standardised mean differences (SMD) with 95% confidence interval (CI). For dichotomous outcomes, we calculated risk ratio (RR) with 95% CI. We assessed and downgraded the evidence according to the GRADE system for risk of bias, imprecision, indirectness, inconsistency and publication bias.
Main results: We included 17 studies (16 with parallel-group designs and one with a cross-over design), with 894 participants aged 18 to 80 years (female:male ratio 3:1). The data were separated into 12 comparisons based on the different interventions and comparators. Studies were pooled into the same comparison when identical interventions and comparisons were evaluated. The certainty of the evidence was downgraded as a consequence of potential risk of bias, as many of the studies had unclear or inadequate allocation concealment. Further downgrading was performed due to imprecision, few participants and inconsistency. There were 12 comparisons for the primary outcome of reduction in physical signs. Inpatient paradoxical intention therapy compared with outpatient diazepam: inpatient paradoxical intention therapy did not reduce conversive symptoms compared with outpatient diazepam at the end of treatment (RR 1.44, 95% CI 0.91 to 2.28; 1 study, 30 participants; P = 0.12; very low-quality evidence). Inpatient treatment programme plus hypnosis compared with inpatient treatment programme: inpatient treatment programme plus hypnosis did not reduce severity of impairment compared with inpatient treatment programme at the end of treatment (MD -0.49 (negative value better), 95% CI -1.28 to 0.30; 1 study, 45 participants; P = 0.23; very low-quality evidence). Outpatient hypnosis compared with wait list: outpatient hypnosis might reduce severity of impairment compared with wait list at the end of treatment (MD 2.10 (higher value better), 95% CI 1.34 to 2.86; 1 study, 49 participants; P < 0.00001; low-quality evidence). Behavioural therapy plus routine clinical care compared with routine clinical care: behavioural therapy plus routine clinical care might reduce the number of weekly seizures compared with routine clinical care alone at the end of treatment (MD -21.40 (negative value better), 95% CI -27.88 to -14.92; 1 study, 18 participants; P < 0.00001; very low-quality evidence). Cognitive behavioural therapy (CBT) compared with standard medical care: CBT did not reduce monthly seizure frequency compared to standard medical care at end of treatment (RR 1.56, 95% CI 0.39 to 6.19; 1 study, 16 participants; P = 0.53; very low-quality evidence). CBT did not reduce physical signs compared to standard medical care at the end of treatment (MD -4.75 (negative value better), 95% CI -18.73 to 9.23; 1 study, 61 participants; P = 0.51; low-quality evidence). CBT did not reduce seizure freedom compared to standard medical care at end of treatment (RR 2.33, 95% CI 0.30 to 17.88; 1 trial, 16 participants; P = 0.41; very low-quality evidence). Psychoeducational follow-up programmes compared with treatment as usual (TAU): no study measured reduction in physical signs at end of treatment. Specialised CBT-based physiotherapy inpatient programme compared with wait list: no study measured reduction in physical signs at end of treatment. Specialised CBT-based physiotherapy outpatient intervention compared with TAU: no study measured reduction in physical signs at end of treatment. Brief psychotherapeutic intervention (psychodynamic interpersonal treatment approach) compared with standard care: brief psychotherapeutic interventions did not reduce conversion symptoms compared to standard care at end of treatment (RR 0.12, 95% CI 0.01 to 2.00; 1 study, 19 participants; P = 0.14; very low-quality evidence). CBT plus adjunctive physical activity (APA) compared with CBT alone: CBT plus APA did not reduce overall physical impacts compared to CBT alone at end of treatment (MD 5.60 (negative value better), 95% CI -15.48 to 26.68; 1 study, 21 participants; P = 0.60; very low-quality evidence). Hypnosis compared to diazepam: hypnosis did not reduce symptoms compared to diazepam at end of treatment (RR 0.69, 95% CI 0.39 to 1.24; 1 study, 40 participants; P = 0.22; very low-quality evidence). Outpatient motivational interviewing (MI) and mindfulness-based psychotherapy compared with psychotherapy alone: psychotherapy preceded by MI might decrease seizure frequency compared with psychotherapy alone at end of treatment (MD 41.40 (negative value better), 95% CI 4.92 to 77.88; 1 study, 54 participants; P = 0.03; very low-quality evidence). The effect on the secondary outcomes was reported in 16/17 studies. None of the studies reported results on adverse effects. In the studies reporting on level of functioning and quality of life at end of treatment the effects ranged from small to no effect.
Authors' conclusions: The results of the meta-analysis and reporting of single studies suggest there is lack of evidence regarding the effects of any psychosocial intervention on conversion and dissociative disorders in adults. It is not possible to draw any conclusions about potential benefits or harms from the included studies.
Gerge, A. (2020). A multifaceted case-vignette integrating neurofeedback and EMDR in the treatment of complex PTSD. European Journal of Trauma & Dissociation, 100157. doi:10.1016/j.ejtd.2020.100157
Anna Gerge, Alborg Universitet Humanistiske Fakultet, 185 31 Vaxholm, Sweden. E-mail: firstname.lastname@example.org
The methods of neurofeedback (Kirk, 2016) and Eye Movement Desensitization and Reprocessing (Shapiro, 2018; Shapiro & Silk Forrest, 1997) will be reflected in relation to a short-time treatment of a patient with complex PTSD and an unspecified dissociative disorder. The aim is to inspire colleges to integrate therapy methods in their quest to help dysregulated patients to become stabile and regulated enough to endure trauma work. This is considered important, especially when working with patients with severe and complex posttraumatic conditions and dissociative disorders, where the evidence-based treatments often not fit for purpose (Corrigan & Hull, 2015). An alternative approach is presented with a single case-study of a patient treated with neurofeedback and EMDR in a psychodynamic short-time psychotherapy. The results of these interventions are presented together with the patient's drawings and reflections and finally discussed.
Giotakos, O. (2020). Neurobiology of emotional trauma. Psychiatriki, 31(2), 162-171.
Open Access: https://www.obrela.gr/wp-content/uploads/2020/07/Neurobiology-of-emotional-trauma.pdf
Orestis Giotakos, The Νon-Profit Organization "Obrela", Athens, Greece
An emotional trauma may induce a cascade of neurobiological events that have long-lasting consequences even altered gene expression. Early abuse and neglect can deregulate the child’s developing neurobiological system by reducing its resistance to stressful events, leading to later problems of emotional regulation. Children who have been subjected to physical or emotional abuse tend to pay more attention to signs that contain anger and are hypersensitive to threat. Scar hypothesis and the theories of behavioural sensitization or electrophysiological kindling suggest that emotional traumas may leave traces that persist even after remission of depression, and render individuals vulnerable to the onset of new episodes, even under the influence of only moderate psychosocial stress. Unfavorable early social experiences, such as emotional abuse or institutionalization can affect the structure and function of the prefrontal cortex. Exposure to repeated emotional stressors, even in the absence of post-traumatic stress disorder (PTSD) diagnoses, has been shown to produce increased synapse formation and dendritic growth in basolateral amygdala, dendritic retraction in the hippocampus, and anxiety-like behavior against specific triggers, such as phobia of open spaces. During the narration of an emotionally traumatic event, there is activation of the limbic system, the right amygdale, the orbitofrontal cortex and the anterior cingulate gyrus. In addition, there is an activation of the anterior insula, which records the physical impact of negative emotions, and the anterior and medial temporal cortex, which are involved in negative emotions. Neuroimaging studies in PTSD patients have found hypoactivity in the frontal lobe, anterior cingulate and thalamic areas, indicating the effects of PTSD on executive function, attention and cognitive, memorial, and affective and somatosensory integration. One of the most replicated findings in studies involving PTSD patients is the decreased activation of the dorsolateral prefrontal cortex. Studies have also found a negative correlation between the dorsolateral prefrontal cortex and amygdala activation. A recent meta-analysis revealed structural brain abnormalities associated with PTSD and emotional trauma and suggested that global brain volume reductions can distinguish PTSD from major depression. Neuroimaging studies of successful eye movement desensitization and reprocessing (EMDR) treatment have consistently shown that patients exhibited increased frontal lobe activation. Moving beyond diagnostic boundaries, focusing on the causal interplay between specific traumatic processes and using standardized measures, are useful directions for future research in memory, emotion and emotional trauma.
Harik, J. M., Grubbs, K. M., & Hamblen, J. L. (2020). The Impact of Treatment Description Format on Patient Preferences for Posttraumatic Stress Disorder Treatment. J Trauma Stress. doi:10.1002/jts.22528
Jessica Hamblen, PhD, National Center for PTSD (116D), VA Medical Center, 215 North Main Street, White River Junction, VT 05009. E-mail: Jessica.L.Hamblen@Dartmouth.edu
The present study examined how the format in which treatment information is presented impacts individuals' preferences for posttraumatic stress disorder (PTSD) treatments. Adults who screened positive for PTSD (N = 301) were randomized into groups to learn about five first-line treatments; participants either read sequential text descriptions or reviewed a comparison chart that presented side-by-side information. Participants rated treatment acceptability, rank ordered treatments from most to least preferred, and indicated their confidence in this ranking. Compared with participants in the text group, those in the chart group assigned more favorable acceptability ratings to prolonged exposure therapy (PE) and more moderate ratings to medications. Cognitive processing therapy was the most common first-choice treatment (43.6%). Forced-choice treatment rankings were similar across conditions, although participants in the chart group ranked PE more favorably than those in the text group, odds ratio (OR) = 0.54, 95% CI [0.35, 0.82], p = .004. Confidence in treatment rankings did not differ across conditions. The results suggest that perceptions of treatment acceptability can be influenced by the format in which treatment information is presented. In settings where the goal is to increase treatment acceptability, side-by-side formats may offer an advantage over sequential descriptions of each treatment.
Irish, A. J. (2020). Using Recent Traumatic Episode Protocol in College Counseling Centers. Journal of College Counseling, 23(2), 180-192. doi:10.1002/jocc.12158
Allen J. Irish, Counseling Center, North Dakota State University, Department 2841, PO Box 6050, Fargo, ND 58108‐6050. E-mail: email@example.com
Experiencing a traumatic event as a college student can have significant social, emotional, and academic consequences. This article discusses the use of an alternative protocol of eye‐movement desensitization and reprocessing, called Recent Traumatic Episode Protocol (E. Shapiro & Laub, 2008), and its use to reduce significant psychological distress of a college student who lived through a mass casualty shooting in the United States.
Ironson, G., Hylton, E., Gonzalez, B., Small, B., Freund, B., Gerstein, M., . . . Bira, L. (2020). Effectiveness of three brief treatments for recent traumatic events in a low-SES community setting. Psychological Trauma: Theory, Research, Practice, and Policy, 1-10. doi:10.1037/tra0000594
Gail Ironson, Department of Psychology, University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33124-0751. E-mail: firstname.lastname@example.org
Objective: To determine whether brief treatments provide psychological relief after traumatic events in low-resource communities.
Method: Participants (n = 105) who had experienced a traumatic event within the past 6 months were randomly assigned to 1 of 3 4-session treatments: individual eye movement desensitization and reprocessing (EMDR), group-administered stress management with a trauma focus (SMT), or group-administered psychological first aid (PFA). Measures administered pretreatment and at 1-, 3-, and 6-month posttreatment included posttraumatic stress disorder (PTSD) symptoms, posttraumatic cognitions (PTCI), and depressive symptoms (BDI).
Results: The 3 treatment groups all showed significant declines in PTSD, PTCI, and BDI symptoms over time with large prepost effect sizes (median 1-month: 0.96, 3-month: 1.38, 6-month: 1.10). However, the treatment groups showed significantly different rates of decline, with the EMDR group showing the fastest declines— interaction PTCI: F(1, 237) = 5.85, p = .016; depression:, F(1, 239) = 4.90, p = .028—followed by the SMT and then PFA group. While there were significant differences between the EMDR and PFA groups at the 1- and 3-month follow-ups, there were no significant differences in any of the 3 outcome measures at the 6-month follow-up, nor were there significant differences between groups on PTSD symptoms, F(1, 239) = 2.30, p = .131.
Conclusion: This study provides preliminary evidence that any of these 3 approaches may be useful in low-resource community settings. Because it gives the quickest relief, EMDR is the preferred approach, followed by SMT, due its ease of administration. PFA provides a reasonable alternative. Where possible, booster sessions should be planned.
Jacob, R., Li, T. Y., Martin, Z., Burren, A., Watson, P., Kant, R., . . . Wood, D. F. (2020). Taking care of our future doctors: a service evaluation of a medical student mental health service. BMC Med Educ, 20(1), 172. doi:10.1186/s12909-020-02075-8
Open Access: https://pubmed.ncbi.nlm.nih.gov/32471406
Rebeca Jacob, Dept of Liaison Psychiatry, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK. E-mail: Rebecca.Jacob@cpft.nhs.uk.
Background: Studies suggest medical students experience high levels of mental distress during training but are less likely, than other students, to access care due to stigma and concerns regarding career progression. In response, The School of Clinical Medicine, University of Cambridge supported the development of the 'Clinical Student Mental Health Service' to provide specialist input for this vulnerable group. This study evaluates the efficiency and effectiveness of this service.
Methods: Using mixed-methods, cross-sectional analysis of validated psychiatric rating scales and qualitative feedback, 89 responses were analysed from 143 clinical students referred, between 2015 and 2019. The care pathway included initial review by a psychiatrist, who triaged students to psychologists delivering therapies including: Cognitive Behavioural Therapy, Interpersonal Therapy, Eye Movement Desensitization Reprocessing Therapy or Cognitive Analytic Therapy. Efficiency was assessed by waiting times for psychiatry and psychology interventions, and number of sessions. Academic outcomes included school intermission and graduation. Clinical effectiveness was analysed by measuring global distress, depression, anxiety, functioning and suicidal risk. Pre/post intervention changes were captured using t-test and McNemar test with thematic analysis of qualitative feedback.
Results: Referral rates increased from 3.93% (22/560) in 2015 to 6.74% (45/668) in 2018. Median waiting times for initial psychiatric assessment and start of therapy was 26 and 33 days, respectively. All graduating students moved on to work as junior doctors. Levels of distress, (t = 7.73, p < 0.001, df = 31), depression (t = 7.26, p < 0.001, df = 34) anxiety (Z = - 4.63, p < 0.001) and suicide risk (Z = - 3.89, p < 0.001) were significantly reduced. Participant's functioning was significantly improved (p < 0.001, 99.5% CI 4.55 to 14.62). Feedback indicated high satisfaction with the rapid access and flexibility of the service and the team clinicians.
Conclusions: A significant proportion of medical students attending the service scored highly on validated rating scales measuring emotional distress, suicidality and mental illness. Reassuringly they benefitted from timely specialist mental health input, showing improvements in mental well-being and improved functioning. The development and design of this service might serve as an exemplar for medical schools developing similar support for their students.
Jamshidi, F., Rajabi, S., & Dehghani, Y. (2020). How to heal their psychological wounds? Effectiveness of EMDR therapy on post‐traumatic stress symptoms, mind‐wandering and suicidal ideation in Iranian child abuse victims. Counselling and Psychotherapy Research. doi:10.1002/capr.12339
Soran Rajabi, Soran Rajabi, Persian Gulf University, Bushehr, Iran. E-mail: email@example.com
Child abuse is increasingly known to be a risk factor for health in children across any nationality worldwide. Studies in this area have shown that child abuse, as a traumatic event, can lead to symptoms of PTSD, mind‐wandering and also suicidal ideation in adulthood. Although studies have shown significant effects of EMDR on a reduction in psychological symptoms in individuals with a history of trauma, further studies are needed regarding the specific effect of this treatment on reducing PTSD symptoms, suicidal ideations and mind‐wandering in female victims of child abuse. The current study aimed to investigate the effectiveness of EMDR therapy on reducing PTSD symptoms, suicidal ideations and mind‐wandering in female victims of child abuse. Thirty female victims were assigned to either EMDR or waiting list control in a randomised, double‐blind trial. The participants in the EMDR group attended eight twice‐weekly sessions. The participants were examined in pre‐test and post‐test with Civilian Mississippi Scale for PTSD (CMS), Child Abuse and Self‐Report Scale (CASRS), Mind‐Wandering Questionnaire (MWQ), Beck Scale for suicidal ideation (BSSI) and Brief Dissociative Experiences Scale (DES‐B). Results of multivariate analysis of covariance showed that EMDR had a significant effect on reducing PTSD symptoms with an effect size of 0.72, suicidal ideations with an effect size of 0.53, and mind‐wandering with an effect size of 0.19. It can be concluded that this treatment is effective in improving PTSD, suicidal ideations and mind‐wandering in female victims of child abuse.
John-Baptiste Bastien, R., Jongsma, H. E., Kabadayi, M., & Billings, J. (2020). The effectiveness of psychological interventions for post-traumatic stress disorder in children, adolescents and young adults: a systematic review and meta-analysis. Psychol Med, 50(10), 1598-1612. doi:10.1017/S0033291720002007
Rayanne John-Baptiste Bastien, Division of Psychiatry, UCL, London, England. E-mail: firstname.lastname@example.org
Background: Children and adolescents display different symptoms of post-traumatic stress disorder (PTSD) than adults. Whilst evidence for the effectiveness of psychological interventions has been synthesised for adults, this is not directly applicable to younger people. Therefore, this systematic review and meta-analysis synthesised studies investigating the effectiveness of psychological interventions for PTSD in children, adolescents and young adults. It provides an update to previous reviews investigating interventions in children and adolescents, whilst investigating young adults for the first time.
Methods: We searched published and grey literature to obtain randomised control trials assessing psychological interventions for PTSD in young people published between 2011 and 2019. Quality of studies was assessed using the Cochrane Risk of Bias tool. Data were analysed using univariate random-effects meta-analysis. RESULTS: From 15 373 records, 27 met criteria for inclusion, and 16 were eligible for meta-analysis. There was a medium pooled effect size for all psychological interventions (d = -0.44, 95% CI -0.68 to -0.20), as well as for Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) and Eye Movement Desensitisation and Reprocessing (EMDR) (d = -0.30, 95% CI -0.58 to -0.02); d = -0.46, 95% CI -0.81 to -0.12).
Conclusions: Some, but not all, psychological interventions commonly used to treat PTSD in adults were effective in children, adolescents and young adults. Interventions specifically adapted for younger people were also effective. Our results support the National Institute for Health and Care Excellence guidelines which suggest children and adolescents be offered TF-CBT as a first-line treatment because of a larger evidence base, despite EMDR being more effective.
Jones, C., Smith-MacDonald, L., Miguel-Cruz, A., Pike, A., van Gelderen, M., Lentz, L., . . . Greenshaw, A. (2020). Multi-Modal Virtual-Reality Based Treatment for Canadian Armed Forces Members with Combat-Related Posttraumatic Stress Disorder: A Computer-Assisted Rehabilitation Environment (CAREN) Waitlist Controlled Staggered Entry Study Protocol. JMIR Research Protocols. doi:10.2196/preprints.20620
Preprint Open Access: https://preprints.jmir.org/preprint/20620
Suzette Brémault-Phillips, Associate Professor, Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton Alberta T6G 2G4 Canada. E-mail: email@example.com
Background: Military members (MM) are at elevated risk of operational stress injuries (OSIs) including post-traumatic stress disorder (PTSD), and moral injury (MI). While psychotherapy can reduce symptoms, some MMs may experience treatment-resistant PTSD. Multi-modular Motion-Assisted Memory Desensitization and Reconsolidation (3MDR) has been introduced as a virtual reality (VR) intervention for individuals with PTSD related to military service. The 3MDR intervention incorporates exposure therapy, psychotherapy, Eye Movement Desensitization and Reconsolidation (EMDR), VR, supportive counselling, and treadmill-walking.
Objective: To investigate whether 3MDR reduces PTSD symptoms among individuals with combat-related treatment-resistant PTSD (TR-PTSD); examine technology acceptance and usability of the Computer Assisted Rehabilitation ENvironment (CAREN) and 3MDR by Canadian Armed Forces Service Members (CAF-SM), Veterans, 3MDR clinicians, and operators; and evaluate the impact on clinicians and operators of delivering 3MDR. Methods: This is a mixed-methods waitlist controlled crossover design pilot study. Participants include both CAF-SMs and Veterans (N=40) aged 18-60 years with combat-related TR-PTSD (unsuccessful experience of at least 2 evidence-based trauma treatments). Participants also include clinicians and operators (N=12) who have been trained in 3MDR and subsequently utilized this intervention with patients. CAF-SMs and Veterans will receive six weekly 90-minute 3MDR sessions. Quantitative and qualitative data will be collected at baseline and 1, 3 and 6 months post-intervention. Quantitative data collection will include multi-omic biomarkers (i.e., blood and salivary proteomic and genomic profiles of neuroendocrine, immune-inflammatory mediators, and microRNA), eye-tracking, electroencephalography (EEG), and physiological data. Data from outcome measures will capture self-reported symptoms of PTSD and moral injury, resilience, and technology acceptance and usability. Qualitative data will be collected from audiovisual recordings of 3MDR sessions and semi-structured interviews. Data analysis will include uni-and multivariate approaches and thematic analysis of treatment sessions and interviews. Machine learning analysis will be included to develop models for prediction of diagnosis, symptom severity, and treatment outcomes.
Results: This study commenced in April, 2019 and is planned to conclude in April, 2021. Study results will guide further evolution and utilization of 3MDR for MMs with TR-PTSD and have utility in treating other trauma-affected populations.
Conclusion: The goal of this study is to utilize qualitative and quantitative primary and secondary outcomes to provide evidence for effectiveness and feasibility of 3MDR for treating CAF-SMs and Veterans with TR-PTSD. The results will inform a full-scale clinical trial and stimulate development and adaptation of the protocol to mobile VR applications in supervised clinical settings. This study will add to knowledge of the clinical effectiveness of 3MDR and provide the first comprehensive analysis of biomarkers, technology acceptance and usability, moral injury, resilience, and the experience of clinician and operators delivering 3MDR.
Kozyra, M., Zimnicki, P., Kaczerska, J., Śmiech, N., Nowińska, M., & Milanowska, J. (2020). Veterans suffering from post-traumatic stress disorder–literature analyzing: symptoms, statistics and therapies. Journal of Education, Health and Sport, 10(8), 40-48.
Open Access: https://apcz.umk.pl/czasopisma/index.php/JEHS/article/download/JEHS.2020.10.08.005/26170
Magdalena Kozyra, Staffa 24, 20-454 Lublin, Poland. E-mail: firstname.lastname@example.org
Introduction: Post-traumatic stress disorder (PTSD) is a condition that affects 10-20% of people who will experience a serious mental injury in their lives. Soldiers are one of the most vulnerable social groups to develop PTSD as they reach several factors which may induce the PTSD.
The aim of the study: The purpose of this work was to find literature on PTSD among people in the military service. Material and method: Literature has been found and selected among articles found in the websites such as PubMed and Google Scholar.
Description of the state of knowledge: Literature describes both - factors predisposing to PTSD, and descriptions of numerous methods of therapy for soldiers such as cognitive behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), cognitive processing therapy (CPT) and Exposure Therapy. In addition, the literature provides many innovative methods to help combat the PTSD. It is important not only to inform the soldier about the therapy, but also to enable him to undergo it regularly. It is worth mentioning, for example, video to home - VTH, which is an extension of Exposure Therapy. Thanks to it, even if someone for some reason cannot participate in therapy in the place where it takes place, it can be done at home without fear of getting to the therapy.
Summary: There are many methods of PTSD therapy. In addition to pharmacological, psychotherapy is very important. Soldiers should undergo these therapies and should be encouraged to complete cycles so that they can feel the effects of the therapy.
Kredlow, M. A., de Voogd, L., & Phelps, E. A. (2020). Laboratory Analogues and Therapy Procedures: A Case for Translation from the Clinic to the Laboratory. PsyArXiv Preprints. doi:10.31234/osf.io/7r6p2
Open Access: http://dx.doi.org/10.31234/osf.io/7r6p2
M. Alexandra Kredlow, 52 Oxford Street, Cambridge, MA 02138. E-mail: email@example.com
Laboratory procedures have been used for decades as analogues for clinical processes with the goal of improving our understanding of psychological treatments and identifying strategies to make treatments more effective. The focus of this area of research has often been translation from the laboratory to the clinic. This process, however, has not been seamless; strategies that work in the laboratory do not always result in improved outcomes when applied clinically. One possible reason for this gap between experimental and clinical research is the failure to focus on translation from the clinic to the laboratory. In the current review, we will first discuss two well-established laboratory analogues (extinction and cognitive reappraisal), identify critical aspects of the related clinical procedures (exposure and cognitive restructuring) that we believe are missing from these analogues, and propose modifications to these analogues to better capture the clinical process. Second, we will further highlight the benefit of translation from the clinic to the laboratory by discussing two clinical procedures that have more recently been brought into the laboratory for examination (eye movement desensitization and reprocessing and imagery rescripting), discuss how we might improve translation from the clinic to the laboratory and future directions for this research.
Leer, A., & Engelhard, I. M. (2020). Side effects of induced lateral eye movements during aversive ideation. J Behav Ther Exp Psychiatry, 68, 101566. doi:10.1016/j.jbtep.2020.101566
Iris M. Engelhard, Department of Clinical Psychology, Utrecht University, P.O. Box 80140, Utrecht, Netherlands, 3508 TC. E-mail: I.M.Engelhard@uu.nl
Background and Objectives: Eye Movement Desensitization and Reprocessing (EMDR) is a treatment for posttraumatic stress disorder. It uses a dual-task approach, in which patients recall an aversive memory while making lateral eye movements. Research has shown that this 'eye movements' intervention reduces subjective memory vividness and emotionality. This study examined whether it also reduces memory accuracy on a visual discrimination task.
Methods: Participants (68 undergraduates) underwent an aversive conditioning phase, in which two pictures of male faces were followed by shock. Then they recalled one face with (experimental condition) and one without (control condition) making lateral eye movements. Finally, they completed a stimulus discrimination test with slightly different faces shortly after the intervention and one day later.
Results: Results showed that the eye movements intervention led to increased false-positive rates one day later.
Limitations: Our intervention targeted newly formed memory rather than consolidated memory.
Conclusions: The results inform theory about EMDR's mechanisms of change and suggest that the treatment may have side effects regarding memory accuracy.
Luteijn, I., VanDerNagel, J. E. L., van Duijvenbode, N., de Haan, H. A., Poelen, E. A. P., & Didden, R. (2020). Post-traumatic stress disorder and substance use disorder in individuals with mild intellectual disability or borderline intellectual functioning: A review of treatment studies. Research in Developmental Disabilities, 105, 103753. doi:10.1016/j.ridd.2020.103753
Ilse Luteijn, Tactus Verslavingszorg, P.O. Box 154, 7400 AD, Deventer, the Netherlands. E-mail: i.luteijn@Tactus.nl
Individuals with mild intellectual disability or borderline intellectual functioning (MID-BIF; IQ 50-85) are at high risk for developing post-traumatic stress disorder (PTSD) and substance use disorders (SUD). In individuals without MID-BIF, Seeking Safety (SeSa) is found to be effective in treating PTSD and SUD simultaneously. However, little is known about integrated treatment of PTSD and SUD in individuals with MID-BIF. This review aims to provide an overview of studies about this type of triple psychopathology, as well as PTSD or SUD in individuals with MID-BIF (i.e. dual diagnosis). No studies were found on integrated treatment of PTSD and SUD in individuals with MID-BIF. Thirty-two studies were found on treatment of either PTSD (mostly Eye Movement Desensitization and Reprocessing and cognitive behavior therapy) or SUD (mostly cognitive behavior therapy and mindfulness) in individuals with MID-BIF. Only 9.4 % of these studies mentioned the co-morbidity of PTSD and SUD. Suggestions for adapting treatment to individuals with MID-BIF were provided on communication, structure, non-verbal elements, network, coping skills, therapeutic relationship and use of suitable and reliable instruments to measure treatment progress. More research is needed on the effectivity of EMDR or Imaginary Exposure (IE) combined with SUD treatment (CBT and mindfulness), and on the adaption of SeSa tot individuals with MID-BIF, as well as on this type of triple psychopathology in general.
Matheson, C., & Weightman, E. (2020). A participatory study of patient views on psychotherapy for complex post-traumatic stress disorder, CPTSD. J Ment Health, 1-8. doi:10.1080/09638237.2020.1803229
Catherine Matheson, IAPT Lewisham, Lee Health Centre, 2 Handen Road, London, SE12 8NP, United Kingdom of Great Britain and Northern Ireland. E-mail: firstname.lastname@example.org
Background: A new diagnosis of Complex Post-traumatic Stress Disorder, CPTSD, is included in ICD-11 which was adopted in May 2019 by the World Health Organisation, WHO. In addition to the symptoms of PTSD, CPTSD includes emotional dysregulation, negative self-concept, and disturbances in relationships. It may be a helpful diagnosis for trauma survivors with experiences of human mistreatment such as torture and abuse.
Aims: This study explores the views of patients in the community on psychotherapy for the diagnosis of CPTSD, taking a qualitative, participatory approach.
Method: Twenty-four former patients from an NHS secondary mental health service in London interviewed each other about their treatment. Participants also collaborated in data analysis. All had a diagnosis of PTSD, with additional symptoms of CPTSD identified at assessment.
Results: The key factor in recovery was rebuilding relationships, beginning with the therapist. Groupwork was helpful in promoting relationships with others, as it may result in shame reduction. Involvement in the wider community through peer support groups was also valuable.
Conclusions: The rebuilding of relationships based on trust was an active mechanism of change and recovery from CPTSD. Participants felt that sufficient time, at least one year of psychotherapy with weekly sessions, was needed.
Mertens, G., van Schie, K., Lammertink, S., Littel, M., & Engelhard, I. (2020). Verbal suggestions about treatment effectiveness do not modulate the effectiveness of a laboratory model of EMDR therapy: Results of two preregistered studies. doi:10.31234/osf.io/zhcpn
Pre-print Open Access: http://dx.doi.org/10.31234/osf.io/zhcpn
Gaëtan Mertens, Department of Medical and Clinical Psychology, Warandelaan 2, room T526, Tiburg University, 5037 AB Tilburg, the Netherlands. E-mail: email@example.com
Background: As for many psychotherapies, there is ongoing discussion about the role of specific versus unspecific mechanisms in the effectiveness of Eye-Movement and Desensitization Reprocessing (EMDR) therapy for post-traumatic stress disorder. However, research directly examining the potential role of non-specific mechanisms in EMDR is scarce.
Objectives: Here, we address the role of one non-specific factor that is often put forward, namely treatment effectiveness expectations, in a laboratory model of EMDR therapy.
Method: In a lab-based study (N = 96) and an online study (N = 173), we gave participants verbal instructions to manipulate their treatment expectations. Instructions emphasized EMDR’s effectiveness or infectiveness. Then, participants were asked to recollect an unpleasant autobiographical memory with or without making eye-movements.
Results: In line with previous studies, we found significant reductions of reported vividness and emotionality of negative autobiographical memories. However, this effect was not modulated by manipulated treatment efficacy expectations. It must be noted that manipulation checks indicated that it was difficult to influence treatment effectiveness expectations using verbal suggestions.
Conclusions: These findings corroborate the results of two earlier reports, suggesting that the role of treatment expectations in EMDR therapy may be limited.
Mevissen, L., Ooms-Evers, M., Serra, M., de Jongh, A., & Didden, R. (2020). Feasibility and potential effectiveness of an intensive trauma-focused treatment programme for families with PTSD and mild intellectual disability. European Journal of Psychotraumatology, 11(1), 1777809. doi:10.1080/20008198.2020.1777809
Open Access: http://dx.doi.org/10.1080/20008198.2020.1777809
Liesbeth Mevissen, Trajectum, Zwolle, Zwolle 8017 KZ, The Netherlands. E-mail: firstname.lastname@example.org email@example.com
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.
National Institute for Health and Care Excellence. (2020). Tinnitus: assessment and management. [L] Evidence review for psychological therapies.
Open Access: https://www.nice.org.uk/guidance/ng155/chapter/Recommendations
While tinnitus is recognised as a physical symptom it is understood that it can have a profound emotional impact and that this is a major factor in the degree of suffering experienced.
There are a variety of different psychological therapies available currently within the NHS as interventions for a broad range of presentations. The following therapies have been applied either clinically or within a research context for people with tinnitus: cognitive behavioural therapy (CBT), mindfulness-based interventions e.g. mindfulness based cognitive therapy (MBCT) and mindfulness based stress reduction (MBSR), brief solution focused therapy, narrative therapy, acceptance and commitment therapy (ACT) and Eye Movement Desensitisation and Reprocessing (EMDR). These psychological therapies can be used with adults and can also be adapted for use with children and young people. Current practice includes psychological therapies within individual and group settings. When working with children, this often involves also working with their families and possibly schools.
CBT has been the main focus clinically and within research. Cognitive Behaviour Therapy (CBT) is based on the theory that an individual’s distress arises out of an interaction between their environment and past experiences, thoughts (cognitions), behaviour and physiological experiences.
The aim of this review is to determine the clinical and cost-effectiveness of psychological therapies including cognitive behavioural therapy and mindfulness based cognitive therapy in improving psychological outcomes and the impact of tinnitus on the person.
Potik, D., Moghrabi, F., & Schreiber, S. (2020). Case Report: Pharmacotherapy and EMDR Psychotherapy as an Effective Treatment for OCD Imagery in a Patient with a Psychotic Disorder. Isr J Psychiatry, 57(1), 47-54.
Open Access: https://www.researchgate.net/publication/343390813_Case_Report_Pharmacotherapy_and_EMDR_Psychotherapy_as_an_Effective_Treatment_for_OCD_Imagery_in_a_Patient_with_a_Psychotic_Disorder
David Potik, Department of Psychiatry, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. E-mail: firstname.lastname@example.org
Unlike compulsive symptoms, such as washing hands, or obsessive symptoms, such as recurring thoughts of contamination, the issue of obsessive compulsive disorder (OCD) imagery receives little attention in the literature. This article describes the case of a 28-year-old male who was referred to a psychiatric day care department following complaints of intrusive imagery which he had sustained for more than a decade. The symptoms started after watching a video clip of decapitation on the internet. He also complained of intrusive thoughts with both aggressive and sexual contents. The Yale-Brown Obsessive Compulsive Scale and the Impact of Event Scale-Revised were used to assess his mental distress. During his stay in the day care department, he was diagnosed with a schizoaffective disorder and OCD. The patient was treated successfully with an antipsychotic medication for the psychotic disorder and concomitantly with selective serotonin reuptake inhibitors (SSRIs) and eye movement desensitization and reprocessing (EMDR) therapy for the OCD. This clinical case report supports the body of knowledge on the efficacy of EMDR as an adjuvant treatment to pharmacotherapy for OCD and, specifically, for OCD imagery. In addition, it supports the growing body of evidence of the beneficial effect of EMDR therapy among patients with psychotic disorders.
Restauri, N., & Sheridan, A. D. (2020). Burnout and Posttraumatic Stress Disorder in the Coronavirus Disease 2019 (COVID-19) Pandemic: Intersection, Impact, and Interventions. Journal of the American College of Radiology, 17(7), 921-926. doi:10.1016/j.jacr.2020.05.021
Open Access: http://dx.doi.org/10.1016/j.jacr.2020.05.021
Nicole Restauri MD, Assistant Professor, University of Colorado, Department of Radiology, Thoracic Imaging, 12605 E. 16th Ave. Aurora, CO 80045, E-mail: email@example.com
Individual physicians and hospital administration should take proactive steps to minimize the compounding effects of high baseline burnout and the acute stressors of the COVID-19 pandemic in order to promote wellness among health-care providers.
Rydberg, J. A., & Machado, J. (2020). Integrative psychotherapy and psychotherapy integration: The case of EMDR. European Journal of Trauma & Dissociation, 100165. doi:10.1016/j.ejtd.2020.100165
J.A. Rydberg, Université de Lorraine, APEMAC, 57000 Metz, France. E-mail: firstname.lastname@example.org
EMDR therapy has received international recognition as a treatment of choice for posttraumatic stress disorder and is gaining increasing acknowledgment for other applications. This paper aims to explore whether EMDR therapy is best seen as set of techniques and procedures that may be flexibly integrated within an eclectic or otherwise focused therapy practice drawing upon several methods (EMDR as an integrable method), or as a comprehensive and distinct psychotherapy approach that must be used in its entirety to be optimally effective (EMDR as an integrative and comprehensive psychotherapy). To answer this question, the discussion is situated within the general movement toward psychotherapy integration and the main characteristics of EMDR are explored (the adaptive information processing [AIP] model, the eight-phased approach, the three-pronged protocol, the bilateral or dual attention stimulation) while considering its potential mediators, moderators, and mechanisms of action. These elements are examined to determine if they appear to be unique and idiosyncratic, and whether they may hinder or prevent the integration of EMDR procedures or techniques with other treatment modalities. In conclusion, it is argued that the individual therapist plays a central role in answering this paper’s question and that EMDR may be applied advantageously as a flexible, integrable method, as a comprehensive, stand-alone psychotherapy approach, and as an integrative psychotherapy approach that may successfully combine its theoretical and practical components with those of other forms of psychotherapy.
Sciarrino, N. A., Warnecke, A. J., & Teng, E. J. (2020). A Systematic Review of Intensive Empirically Supported Treatments for Posttraumatic Stress Disorder. Journal of Traumatic Stress. doi:10.1002/jts.22556
Open Access: https://onlinelibrary.wiley.com/doi/abs/10.1002/jts.22556
Nicole A. Sciarrino, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401. E-mail: email@example.com
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.
Sheikhi, M., Moradi, M., Shahsavary, S., Alimoradi, Z., & Salimi, H. R. (2020). The effect of eye movement desensitization and reprocessing on the fear of hypoglycemia in type 2 diabetic patients: a randomized clinical trial. BMC Psychol, 8(1), 82. doi:10.1186/s40359-020-00450-0
Open Access: https://pubmed.ncbi.nlm.nih.gov/32771061
Mohammadreza Sheikhi, Psychiatric Nursing Department, School of Nursing, Qazvin University of Medical Sciences (QUMS), Qazvin, Iran. E-mail: firstname.lastname@example.org
Background: The fear of hypoglycemia leads to psychological symptoms in patients with diabetes type 2. In this research, the effects of EDMR on the fear of hypoglycemia in patients with diabetes type 2 were examined.
Methods: A clinical trial study was carried out with participation of 72 patients who had diabetes type 2 in Velayat Hospital. The participants were randomly assigned into control and intervention groups. The intervention group received EMDR. The required information was gleaned using a questionnaire of fear of hypoglycemia, intensity of hypoglycemia, and demographics filled out before the intervention, and 1 month and 3 months after it. The data were analyzed using descriptive statistics on SPSS Version 23. For comparison of fear of hypoglycemia in intervention and control groups, repeated measure ANOVA and Cohen d test were used.
Results: The mean age of the participants in the intervention group was 43.17 ± 10.55 and in the control group was 45.86 ± 13.6. In this study, without considering the potential disruptors in the incorrect model, the intervention caused a reduction of 15 points 1 month after the completion of the intervention and a reduction of 17 points 3 month after the completion of the intervention on the scale of fear of hypoglycemia; but post-correction of potential disruptors, intervention caused a reduction of 19.5 scores 1 month after the completion and a reduction of 20.3 scores 3 months after the intervention.
Conclusions: The EMDR can be used as a non-pharmaceutical treatment method to treat and alleviate the fear of hypoglycemia in type 2 diabetes patients.
Trial Registration: Iranian Registry of Clinical Trials: IRCT20181201041813N1 , 2019/11/13.
Snoek, A., Beekman, A. T. F., Dekker, J., Aarts, I., van Grootheest, G., Blankers, M., . . . Thomaes, K. (2020). A randomized controlled trial comparing the clinical efficacy and cost-effectiveness of eye movement desensitization and reprocessing (EMDR) and integrated EMDR-Dialectical Behavioural Therapy (DBT) in the treatment of patients with post-traumatic stress disorder and comorbid (Sub)clinical borderline personality disorder: study design. BMC Psychiatry, 20(1). doi:10.1186/s12888-020-02713-x
Open Access: http://dx.doi.org/10.1186/s12888-020-02713-x
Aishah Snoek, Arkin Sinai Centrum, Amstelveen, The Netherlands. E-mail: email@example.com
Background: Comorbidity between Posttraumatic Stress Disorder (PTSD) and Borderline Personality Disorder (BPD) is high. There is growing motivation among clinicians to offer PTSD treatments – such as Eye Movement Desensitization and Reprocessing (EMDR) - to patients with PTSD and comorbid BPD. However, a large subgroup with comorbid BPD does not sufficiently respond to PTSD treatment and is more likely to be excluded or to dropout from treatment. Dialectical Behaviour Therapy (DBT) for BPD is well established and although there is some evidence that DBT combined with DBT Prolonged Exposure (DBT + DBT PE) is twice as effective in reducing PTSD symptoms than DBT alone, the comparative efficacy of integrated PTSD-DBT and PTSD-only treatment has not been investigated yet. The current study will therefore evaluate the comparative clinical efficacy and cost-effectiveness of EMDR-DBT and EMDR-only in patients with PTSD and comorbid (sub)clinical BPD. Moreover, it is not clear yet what treatment works best for which individual patient. The current study will therefore evaluate neurobiological predictors and mediators of the individual response to treatment.
Method: A randomized controlled trial comparing the clinical efficacy and cost-effectiveness of integrated EMDR- DBT (n = 63) and EMDR-only (n = 63) in treatment-seeking adult patients with PTSD and comorbid (sub)clinical BPD. In addition, neurobiological predictors and mediators of treatment outcome, such as hair cortisol, FKBP5 and BDNF protein levels and FKBP5 and BDNF methylation status, are measured through hair and blood samples.
Discussion: This is the first study to compare the clinical efficacy and cost-effectiveness of integrated EMDR-DBT and EMDR-only in patients with PTSD and comorbid (sub)clinical BPD, while simultaneously identifying individual predictors and mediators of treatment response. Results will reveal which treatment works best for which individual patient, thereby guiding individual treatment choices and personalizing psychiatry.
Trial registration: Clinical Trials, NCT03833453. Retrospectively registered, 15 March 2019.
Tehrani, N. (2019). Evaluation of a trauma therapy programme within emergency service organizations. Occup Med (Lond), 69(8-9), 559-565. doi:10.1093/occmed/kqz111
Noreen Tehrani Associates Limited, 12 Baronsfield Road, Twickenham TW1 2QU, UK. E-mail: firstname.lastname@example.org
Background: Occupational health practitioners working in emergency services, where employees are exposed to a higher level of physical or psychological trauma, need to be able to access trauma therapy programmes which are economically viable and effective in reducing post-traumatic stress disorder and associated symptoms of anxiety and depression. AIMS: The aim of this review is to provide evidence on benefits of a short-term organizational programme of trauma therapy using NICE (2018)  recommended interventions. Methods: The review examined the pre- and post-therapy clinical scores from 429 emergency service professionals (ESPs) who were employed in five police forces, two fire and two ambulance services. The ESPs in higher risk roles were in a psychological surveillance programme, with those found to be experiencing clinically significant levels of trauma-related symptoms being referred to a psychologist for an assessment which identified the ESPs requiring trauma therapy. At the end of the therapy, the symptoms of the ESPs were re-assessed, and the scores before and after the therapy were compared. Results: The results showed a significant improvement in the level of symptoms, with 81% of ESPs no longer exhibiting clinically significant trauma symptoms and 6% showing an increase in symptoms. In addition, the clinical results also showed improvements in ESPs' perceived work capacity and quality of social relationships. Conclusions: The findings indicate that there are clinical and personal benefits to using an organizationally based short-term model of trauma therapy in an emergency service setting.
van der Vleugel, B. M., Libedinsky, I., de Bont, P. A. J. M., de Roos, C., van Minnen, A., de Jongh, A., . . . van den Berg, D. (2020). Changes in posttraumatic cognitions mediate the effects of trauma-focused therapy on paranoia. Schizophrenia Bulletin Open. doi:10.1093/schizbullopen/sgaa036/33550606/sgaa036.pdf
Open Access: https://doi.org/10.1093/schizbullopen/sgaa036
Berber van der Vleugel Mailing Postbus 18, 1850 BA Heiloo, the Netherlands. E-mail: email@example.com
Background: Evidence suggests that in individuals with psychosis, paranoia is reduced after trauma-focused therapy (TFT) aimed at co-morbid posttraumatic stress disorder (PTSD).
Objective: To identify mediators of the effect of TFT on paranoia.
Method: In a multicenter single-blind randomized controlled trial 155 outpatients in treatment for psychosis were allocated to 8 sessions Prolonged Exposure (PE; n=53), 8 sessions Eye Movement Desensitization and Reprocessing (EMDR) therapy (n=55), or a waiting-list condition (WL; n=47) for treatment of co-morbid PTSD. Measures were performed on (1) paranoia (GPTS); (2) DSM-IV-TR PTSD symptom clusters (CAPS-IV; i.e., intrusions, avoidance, and hyperarousal); (3) negative posttraumatic cognitions (PTCI; i.e., negative self posttraumatic cognitions, negative world posttraumatic cognitions and self-blame); (4) depression (BDI-II); and (5) cognitive biases (i.e., jumping to conclusion, attention to threat, belief inflexibility and external attribution), cognitive limitations (i.e., social cognition problems and subjective cognitive problems), and safety behaviors (DACOBS). Outcome in terms of symptoms of paranoia (1) and potential mediators (2-5) were evaluated at post-treatment, controlling for baseline scores.
Results: The effects of TFT on paranoia were primarily mediated by negative self and negative world posttraumatic cognitions, representing almost 70% of the total indirect effect. Safety behaviors and social cognition problems were involved in the second step mediational pathway models.
Conclusions: Targeting the cognitive dimension of PTSD in TFT in psychosis could be an effective way to influence paranoia, whereas addressing safety behaviors and social cognition problems might enhance the impact of TFT on paranoia.
Van der Wal, A., Luyten, T., Cardon, E., Jacquemin, L., Vanderveken, O. M., Topsakal, V., . . . Gilles, A. (2020). Sex Differences in the Response to Different Tinnitus Treatment. Front Neurosci, 14, 422. doi:10.3389/fnins.2020.00422
Open Access: https://pubmed.ncbi.nlm.nih.gov/32477049/
Sarah Michiels E-mail: firstname.lastname@example.org
Annick Gilles E-mail: email@example.com
Introduction: Tinnitus is a complex symptom requiring a thorough multidisciplinary assessment to construct an individual's tinnitus profile. The Antwerp University Hospital hosts a tertiary tinnitus clinic providing intensive, multidisciplinary tinnitus care in the form of combinational psychological treatment with either Tinnitus Retraining Therapy (TRT)/Cognitive Behavioral Therapy (CBT) or TRT/eye movement desensitization and reprocessing therapy (EMDR), high-definition transcranial direct current stimulation (HD-tDCS), and physical therapy treatment (in cases of somatic influence of the neck or the temporomandibular area). Several factors may contribute to therapy effect of which the role of gender has recently gained more interest. As such, the current manuscript explores gender differences in the outcome of different tinnitus treatments.
Methods: Data on treatment outcome of four distinct tinnitus treatments (1. HD-tDCS; 2. orofacial physical therapy; 3. combination TRT + CBT; and 4. combination TRT + EMDR) were pooled and compared. Treatment outcome was assessed via the Tinnitus Functional Index (TFI). Participants completed the TFI at baseline, immediately after treatment and after 9 weeks (±3 weeks) follow-up. To explore the effect of gender on different treatment outcomes, a linear mixed model was designed including Time point, Gender, and Therapy Group as fixed factors as well as all interactions between these factors.
Results: TFI scores improved significantly over time regardless of therapy group (p < 0.0001). A mean TFI decrease of at least 13 points was obtained by all participants except by those in the HD-tDCS. Significant interactions between Gender and Time point were identified in all groups except for the TRT +EMDR group. Female subjects improved more extensively than males in the HD-tDCS (p = 0.0009) and orofacial therapy group (p = 0.0299). Contrarily, in the TRT +CBT group, male participants showed a significant improvement whereas the mean TFI scores of female subjects remained on baseline levels (p = 0.0138).
Conclusion: Our data suggest that male and female tinnitus patients seem to react differently to different therapy options. We strongly encourage further prospective studies to discern the relevance of gender in therapy outcome.
van Minnen, A., van Dalen, B., Voorendonk, E. M., Wagenmans, A., & de Jongh, A. (2020). The effects of symptom overreporting on PTSD treatment outcome. European Journal of Psychotraumatology, 11(1), 1794729. doi:10.1080/20008198.2020.1794729
Open Access: http://dx.doi.org/10.1080/20008198.2020.1794729
Agnes van Minnen, Behavioural Science Institute (BSI), Radboud University Nijmegen, Nijmegen, The Netherlands. E-mail: firstname.lastname@example.org
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 pro- gramme 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.
Verger, A., Rousseau, P. F., Malbos, E., Chawki, M. B., Nicolas, F., Lançon, C., . . . Guedj, E. (2020). Involvement of the cerebellum in EMDR efficiency: a metabolic connectivity PET study in PTSD. European Journal of Psychotraumatology, 11(1), 1767986. doi:10.1080/20008198.2020.1767986
Open Access: http://dx.doi.org/10.1080/20008198.2020.1767986
E. Guedj, Service Central de Biophysique et Médecine Nucléaire, Hôpital de la Timone, 264 Rue Saint Pierre, 13005 Marseille, France. E-mail: email@example.com
Background: We recently reported an improvement of precuneus PET metabolism after EMDR therapy in military participants suffering from PTSD.
Objective: The aim of the present study was to investigate the metabolic changes of precuneus connectivity in these participants after such treatment.
Method: Fifteen participants with PTSD performed a brain 18F-FDG-PET sensitized by virtual reality exposure to war scenes, before and after EMDR treatment. Inter-regional correlation analysis was performed to study metabolic changes of precuneus connectivity through SPMT maps at whole-brain level (p < 0.005 for the voxel, p < 0.05 for the cluster).
Results: A decrease of connectivity was observed after EMDR between the precuneus and two significant bilateral clusters of the cerebellum (bilateral Crus I and VI cerebellar lobules, Tmax voxel of 5.8 and 5.3, and cluster size of 343 and 314 voxels, respectively). Moreover, higher cerebellar metabolism before treatment was associated with reduced clinical PTSD scores after EMDR (p = 0.03). Conclusions: The posterior cerebellum and its metabolic connectivity with the precuneus are involved in the clinical efficiency of EMDR in PTSD.
von der Warth, R., Dams, J., Grochtdreis, T., & König, H.-H. (2020). Economic evaluations and cost analyses in posttraumatic stress disorder: a systematic review. European Journal of Psychotraumatology, 11(1), 1753940. doi:10.1080/20008198.2020.1753940
Open Access: http://dx.doi.org/10.1080/20008198.2020.1753940
Judith Dams, Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany. E-mail: firstname.lastname@example.org
Background: Posttraumatic stress disorder is associated with a high economic burden. Costs of treatment are known to be high, and cost-effectiveness has been analysed for several treatment options.
Objective: As no review on economic aspects of posttraumatic stress disorder exists, the aim of this study was to systematically review costs-of-illness studies and economic evaluations of therapeutic treatment for posttraumatic stress disorder, and to assess their quality. Method: A systematic literature search was performed in March 2017 and was last updated in February 2020 in the databases PubMed, PsychInfo and NHS Economic Evaluation Database. Cost-of-illness studies and economic evaluations of treatment for posttraumatic stress disorder were selected. Extracted cost data were categorized as direct costs and indirect costs and inflated to 2015 US-$ purchasing power parities (PPP). Quality was assessed using an adapted cost-of-illness studies quality checklist, the Consensus on Health Economic Criteria list, and the questionnaire to assess relevance and credibility of modelling studies by the International Society for Pharmacoeconomics and Outcome Research.
Results: In total, 13 cost-of-illness studies and 18 economic evaluations were included in the review. Annual direct excess costs ranged from 512 US-$ PPP to 19,435 US-$ PPP and annual indirect excess costs were 5,021 US-$ PPP per person. Trauma-focused cognitive-behavioural therapy (+selective serotonin re-uptake inhibitor) was found to be cost-effective compared with treatment as usual and no treatment. Overall, included studies were of low and moderate quality. Studies used inappropriate economic study designs and lacked information on the economic perspective used.
Conclusions: Posttraumatic stress disorder is a major public health problem that causes high healthcare costs. While trauma-focused cognitive-behavioural therapy was found to be cost-effective, further investigations regarding pharmacotherapy and other treatments are necessary.
Voorendonk, E. M., De Jongh, A., Rozendaal, L., & Van Minnen, A. (2020). Trauma-focused treatment outcome for complex PTSD patients: results of an intensive treatment programme. European Journal of Psychotraumatology, 11(1), 1783955. doi:10.1080/20008198.2020.1783955
Open Access: http://dx.doi.org/10.1080/20008198.2020.1783955
Eline M. Voorendonk, PSYTREC, Bilthoven 3723 MB, The Netherlands. E-mail: email@example.com
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.