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

Abstract

BackgroundPost-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.MethodsIREM 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.DiscussionThe 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 registrationAustralian New Zealand Clinical Trials Registry ACTRN12614000750684. Registered 16 July 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1330-2) contains supplementary material, which is available to authorized users.

The Efficacy of Eye Movement Desensitization and Reprocessing in Children and Adults Who Have Experienced Complex Childhood Trauma: A Systematic Review of Randomized Controlled Trials

“…One approach to treating CT-associated PTSD symptoms has been trauma-focused cognitive behavioral therapy (CBT), but high drop-out rates have been reported and some have suggested that prolonged exposure and a focus on trauma reprocessing is not appropriate (McDonagh et al, 2005 ; Cloitre et al, 2011 ; Boterhoven de Haan et al, 2017 ). This has led to exploration of alternative trauma-focused approaches for the treatment of CT.…”

Reescritura de Imágenes para el Tratamiento del Estrés Postraumático: Análisis y Revisión

“…Although there are no notable differences in effectiveness between IR and ET, several elements are proposed in order to make IR a therapeutic option of relevance for certain cases of PTSD. On the one hand, IR can break the patterns of victimization, impotence, and passivity of people who have suffered a trauma ; on the other hand, IR would be a treatment of choice because it is considered less aversive, invasive, and emotionally activating for the therapist and patients (e.g., de Haan et al, 2017) and the therapeutic alliance is less compromised than with the ET (Hoffart et al, 2013). In addition, according to Arntz et al (2012), IR may be especially indicated for patients resistant to cognitive behavioral therapy in whom cognitive restructuring or rational debate do not work.…”

“…No obstante, hacen falta más trabajos con buenos diseños de investigación para poder emitir conclusiones robustas acerca de las diferencias entre la RI y la exposición, así como para conocer sus mecanismos de acción. De hecho, hay autores que rebaten con argumentos empíricos la idea clásica acerca de que las técnicas de exposición son útiles únicamente para el abordaje del miedo y no para traumas en los que predominan emociones como la culpa, la ira o la vergüenza (de Haan et al, 2017).…”

“…De esta forma se podrá escoger el mejor tratamiento para el paciente y, en su caso, el mejor protocolo de RI (Brockman y Calvert, 2017). De hecho, algunos autores consideran que uno de los problemas a la hora de aplicar la RI es hacerlo siguiendo los protocolos originales, generados para traumas relacionados con los abusos en la infancia en los que necesariamente hay un perpetrador; su aplicación puede ser problemática en traumas en los que no lo hay o no está claramente identificado (de Haan et al, 2017).…”

Experiences of Patients With Borderline Personality Disorder With Imagery Rescripting in the Context of Schema Therapy—A Qualitative Study

“…Therapists can reduce time pressure by starting promptly with the IR or by scheduling longer sessions. For example, for treatments for PTSD with IR, the session length is up to 90 min to allow for enough time for emotional processing and debriefing ( 26 ). Also, therapists can allow for enough time for the patient to process each step during the IR and leave enough time for debriefing and stabilization after the IR.…”