Intensive EMDR to Treat Patients With Complex Posttraumatic Stress Disorder: A Case Series

Abstract

There is mounting support for the notion that also, individuals with severe, or "complex," forms of PTSD respond positively to TFTs and that neither trauma history, comorbidity, nor severe dissociative symptoms negatively affect clients' response to TFTs Foa, Zoellner, Feeny, Hembree, & Alvarez-Conrad, 2002;Hagenaars, van Minnen, & Hoogduin, 2010;Jerud, Pruitt, Zoellner, & Feeny, 2016;Olatunji, Cisler, & Tolin, 2010;van den Berg et al., 2015;van Minnen, Arntz, & Keijsers, 2002;van Minnen, Harned, Zoellner, & Mills, 2012; There is mounting evidence suggesting that by increasing the frequency of treatment sessions, posttraumatic stress disorder (PTSD) treatment outcomes significantly improve. As part of an ongoing research project, this study examined the safety and effectiveness of intensive eye movement desensitization and reprocessing (EMDR) therapy in a group of seven (four female) patients suffering from complex PTSD and multiple comorbidities resulting from childhood sexual abuse, physical abuse, and/or work and combatrelated trauma. Treatment was not preceded by a preparation phase and consisted of 2 3 4 consecutive days of EMDR therapy administered in morning and afternoon sessions of 90 minutes each, interspersed with intensive physical activity and psychoeducation. Outcome measures were the Clinician-Administered PTSD Scale (CAPS) and the PTSD Symptom Scale Self-report questionnaire (PSS-SR). During treatment, neither personal adverse events nor dropout occurred. CAPS scores decreased significantly from pre-to posttreatment, and four of the seven patients lost their PTSD diagnosis as established with the CAPS. The results were maintained at 3-month follow-up. Effect sizes (Cohen's d) on the CAPS and PSS-SR were large: 3.2, 1.7 (prepost) and 2.3, 2.1 (prefollow-up), respectively. The results of this case series suggest that an intensive program using EMDR therapy is a potentially safe and effective treatment alternative for complex PTSD. The application of massed, consecutive days of treatments using EMDR therapy for patients suffering from PTSD, particularly those with multiple comorbidities, merits more clinical and research attention.

Effectiveness of an intensive treatment programme combining prolonged exposure and eye movement desensitization and reprocessing for severe post-traumatic stress disorder

“…The purpose of the present study was to extend upon the case series of Bongaerts et al (2017) on massed EMDR therapy combined with physical activity and psycho-education. Two trauma-focused therapies, PE and EMDR, were combined with psycho-education and physical activity into a single programme and delivered en masse in a brief time period.…”

“…In a meta-analysis, EMDR was found to be effective for complex trauma (Chen et al, 2018) but little is known about the effects of intensive EMDR therapy. A pilot study by Bongaerts, Van Minnen, and De Jongh (2017) assessed the effectiveness of an intensive EMDR treatment programme for seven patients, consisting of 8 days of EMDR administered in morning and afternoon sessions of 90 minutes each, interspersed with physical activity and psycho-education. In this study, individuals meeting the criteria of the proposed diagnosis of complex PTSD (Maercker et al, 2013) showed a significant decrease in PTSD symptoms, while no adverse effects, symptom exacerbation, or dropout occurred.…”

The impact of childhood sexual abuse on the outcome of intensive trauma-focused treatment for PTSD

“…Bongaerts et al, 2017; Ehlers et al, 2014; Hendriks et al, 2010). Treatment results of these programmes are promising, as similar treatment outcomes have been found compared to regular trauma-focused therapies, while there are no reports of symptom exacerbation or increased drop-out rates.…”

“…In contrast to this line of reasoning, evidence has emerged showing that first-line trauma-focused treatments are effective in treating those with a history of CSA and symptoms of Complex PTSD without prior stabilization or training in emotion regulation (Bongaerts, Van Minnen, & De Jongh, 2017; Van Minnen, Harned, Zoellner, & Mills, 2012). For example, in a study among 110 female veterans with PTSD in a residential treatment setting, no differences in treatment response were found using trauma-focused treatment (i.e.…”

A five-day inpatient EMDR treatment programme for PTSD: pilot study

“…Specifically for veterans, Murphy et al (2015) tested a somewhat longer intensive treatment programme of six weeks with individual TF-CBT and found promising results. One pilot study is available in which the effects of an intensive eight-day EMDR programme were investigated in seven patients (Bongaerts, Van Minnen, & de Jongh, 2017), with large effects.…”