Phase-based treatment versus immediate trauma-focused treatment for post-traumatic stress disorder due to childhood abuse: randomised clinical trial

Abstract

Background It is unclear whether people with post-traumatic stress disorder (PTSD) and symptoms of complex PTSD due to childhood abuse need a treatment approach different from approaches in the PTSD treatment guidelines. Aims To determine whether a phase-based approach is more effective than an immediate trauma-focused approach in people with childhood-trauma related PTSD (Netherlands Trial Registry no.: NTR5991). Method Adults with PTSD following childhood abuse were randomly assigned to either a phase-based treatment condition (8 sessions of Skills Training in Affect and Interpersonal Regulation (STAIR), followed by 16 sessions of eye-movement desensitisation and reprocessing (EMDR) therapy; n = 57) or an immediately trauma-focused treatment condition (16 sessions of EMDR therapy; n = 64). Participants were assessed for symptoms of PTSD and complex PTSD, and other forms of psychopathology before, during and after treatment and at 3- and 6-month follow-ups. Results Data were analysed with linear mixed models. No significant differences between the two treatments on any variable at post-treatment or follow-up were found. Post-treatment, 68.8% no longer met PTSD diagnostic criteria. Self-reported PTSD symptoms significantly decreased for both STAIR–EMDR therapy (d = 0.93) and EMDR therapy (d = 1.54) from pre- to post-treatment assessment, without significant difference between the two conditions. No differences in drop-out rates between the conditions were found (STAIR–EMDR 22.8% v. EMDR 17.2%). No study-related adverse events occurred. Conclusions This study provides compelling support for the use of EMDR therapy alone for the treatment of PTSD due to childhood abuse as opposed to needing any preparatory intervention.

Fully remote intensive trauma-focused treatment for PTSD and Complex PTSD

“…What is more, the effect sizes in our study are at least not worse and, if anything, larger than those in our previous related studies with face-to-face intensive trauma-focused treatment in other samples consisting of a comparable patient group of patients with both PTSD and Complex PTSD (Van Toorenburg et al, 2020 ; Voorendonk et al, 2020 ). Interestingly, given that our intensive trauma-focused treatment online programme was found to be associated with a large symptom decline for most of the patients with elevated levels of ITQ-DSO severity, and that treatment resulted in a significant decrease in the ITQ-DSO symptom cluster, the present results do not support the notion that patients with Complex PTSD would need a phase-based approach to yield positive treatment outcomes (see also De Jongh et al, 2016 ; Oprel et al, 2021 ; Van Vliet et al, 2021 ). Conversely, a small percentage of patients continued to meet the criteria for PTSD (17.8%) ( n = 73) or Complex PTSD (11.7%) ( n = 60) at post-treatment.…”

“…Accordingly, it has been recommended that the treatment of these individuals should be phased, according to the so-called three-phase model (Cloitre et al, 2012 ). In recent years, however, evidence is mounting that an immediate trauma-focused approach in the treatment of symptoms of Complex PTSD, without a stabilization phase, is safe and effective (De Jongh et al, 2016 ; Karatzias et al, 2019 ; Oprel et al, 2021 ; Van Vliet, Huntjens, van Dijk, & De Jongh, 2021 ).…”

The effectiveness of trauma-focused psychotherapy for complex post-traumatic stress disorder: A retrospective study

“…Comparing this to phase 1, where a third of patients reliably improved on PTSD symptoms, we see that in most patients PTSD symptoms do not tend to spontaneously improve over time in the absence of active TF-P. As we compared treatment with stabilization plus waiting, we cannot infer whether stabilization alone is effective. In two recent studies [ 27 , 48 ], patients with CPTSD did not benefit more from the addition of affective and interpersonal skills training to prolonged exposure [ 27 ] and EMDR [ 48 ]. However, earlier research [ 49 ] had found additional skills training to improve outcomes for women with more severe difficulties in emotion regulation.…”

Imagery Rescripting as a stand-alone treatment for posttraumatic stress disorder related to childhood abuse: A randomized controlled trial

“…So far, direct comparisons between phase-based and immediate trauma-focused treatments are sparse and results are inconclusive. One dismantling study found larger symptom reductions for a combined treatment of STAIR followed by PE compared to the separate components (Cloitre et al, 2010), while two studies found no added value of sequential treatments for STAIR/PE compared to PE (Oprel et al, 2021) and STAIR/EMDR compared to EMDR (van Vliet et al, 2021) Therefore, as a second aim, we investigated whether a sequential treatment of STAIR/ImRs is more effective than ImRs alone. We hypothesized that (1) ImRs would be efficacious at immediate outcome when delivered to patients with CA-related PTSD compared to a waitlist control group, and (2) trauma-focused treatment (ImRs) with the addition of a skills training focusing on emotion regulation and interpersonal functioning (STAIR/ImRs) would be more effective in reducing PTSD-symptoms than trauma-focused treatment alone (ImRs) at immediate outcome and 12 weeks follow-up.…”