Psychological treatments for chronic post-traumatic stress disorder

Background: Vivid trauma-related intrusions are a hallmark symptom of posttraumatic stress disorder (PTSD), and may be involved in its onset. Effective interventions to reduce intrusions and to potentially prevent the onset of subsequent PTSD are scarce. Studies suggest that playing the videogame Tetris, shortly after watching aversive film clips, reduces subsequent intrusions. Other studies have shown that taxing working memory (WM) while retrieving an emotional memory reduces the memory’s vividness and emotionality. Objective: We developed TraumaGameplay (TGP), a gaming app designed to reduce intrusions. This paper describes two successive experiments to determine whether playing TGP without memory retrieval (regular TGP) or TGP with memory retrieval (dual-task TGP) reduces intrusion frequency at one week compared to a no-game control. Method: For both experiments, healthy university students were recruited. Experiment 1: 92 participants were exposed to a trauma film and randomized to (1) regular TGP1 (n = 31), (2) dual-task TGP1 (n = 31) or (3) control (n = 30). In experiment 2, 120 healthy students were exposed to a trauma film and randomized to (1) regular TGP2 (n = 30), (2) dual-task TGP2 (n = 29), (3) recall only (n = 31) or (4) control (n = 30). Results: We found no significant difference between conditions on the number of intrusions for either playing regular TGP or dual-task TGP in both experiment 1 and experiment 2. Conclusion: Our results could not replicate earlier promising findings from preceding experimental research. Several reasons may underpin this difference ranging from the visuospatial videogame used in our experiments to the method of the experiment to the difficulties of replicability in general.

Section: Introductionmentioning

confidence: 99%

Development and testing of TraumaGameplay: an iterative experimental approach using the trauma film paradigm

Asselbergs

Sijbrandij

Hoogendoorn³

et al. 2018

“…EMDR is an evidence-based psychological treatment that is frequently used and effective in post-traumatic stress disorder (PTSD) and its affiliated symptoms (Bisson et al, 2007; Bradley, Greene, Russ, Dutra, & Westen, 2005; Seidler & Wagner, 2006). Desensitization and reprocessing of memories and images that contribute to the symptoms, such as events in which the tinnitus acquired negative meaning, may reduce tinnitus distress.…”

Section: Introductionmentioning

confidence: 99%

A trauma-focused approach for patients with tinnitus: the effectiveness of eye movement desensitization and reprocessing – a multicentre pilot trial

Rikkert

Rood

Roos

et al. 2018

Background: While normal tinnitus is a short-term sensation of limited duration, in 10–15% of the general population it develops into a chronic condition. For 3–6% it seriously interferes with many aspects of life. Objective: The aim of this trial was to assess effectiveness of a trauma-focused approach, eye movement desensitization and reprocessing (EMDR), in reducing tinnitus distress. Methods: The sample consisted of 35 adults with high levels of chronic tinnitus distress from five general hospitals in the Netherlands. Participants served as their own controls. After pre-assessment (T1), participants waited for a period of 3 months, after which they were assessed again (T2) before they received six 90 min manualized EMDR treatment sessions in which tinnitus-related traumatic or stressful events were the focus of treatment. Standardized self-report measures, the Tinnitus Functional Index (TFI), Mini-Tinnitus Questionnaire (Mini-TQ), Symptom Checklist-90 (SCL-90) and the Self-Rating Inventory List for Post-traumatic Stress Disorder (SRIP), were completed again halfway through treatment (T3), post-treatment (T4) and at 3 months’ follow-up (T5). Results: Repeated measures analysis of variance revealed significant improvement after EMDR treatment on the primary outcome, TFI. Compared to the waiting-list condition, scores significantly decreased in EMDR treatment [t(34) = −4.25, p < .001, Cohen’s dz = .72]. Secondary outcomes, Mini-TQ and SCL-90, also decreased significantly. The treatment effects remained stable at 3 months’ follow-up. No adverse events or side effects were noted in this trial. Conclusions: This is the first study to suggest that EMDR is effective in reducing tinnitus distress. Randomized controlled trials are warranted.

“…Serious health problems often co-occur with PTSD, such as chronic pain and circulatory and musculoskeletal symptoms (Pacella, Hruska, & Delahanty, 2013). Consequently, PTSD has a large impact on the social and occupational functioning of patients (Bisson et al, 2007). …”

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confidence: 99%

“…Trauma-focused cognitive behavioural therapy (TF-CBT) and eye movement desensitization and reprocessing therapy (EMDR) are demonstrably the most efficacious treatment methods for PTSD to date and are recommended as treatments of choice in several guidelines (Bisson et al, 2007; National Institute of Clinical Excellence [NICE], 2015). However, several reviews and meta-analyses have shown that these treatments have large dropout and considerable non-response rates.…”

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confidence: 99%

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

Méndez

Nijdam

Heide

et al. 2018

Background: Trauma-focused psychotherapies for posttraumatic stress disorder (PTSD) have been demonstrated to be efficacious, but also have considerable non-response and dropout rates. Intensive treatment may lead to faster symptom reduction, which may contribute to treatment motivation and thereby to reduction of dropout. Objective: The aim of the current study was to investigate the feasibility and preliminary effectiveness of an intensive five-day inpatient treatment with Eye Movement Desensitization and Reprocessing (EMDR) and trauma-informed yoga for patients with PTSD. Method: A non-controlled pilot study with 12 adult patients with PTSD was conducted. At baseline the PTSD diagnosis was assessed with the Clinician-Administered PTSD Scale (CAPS-5) and comorbid disorders with the Mini International Neuropsychiatric Interview (MINI). Primary outcome was self-reported PTSD symptom severity (PTSD Check List for DSM-5; PCL-5) measured at the beginning of day 1 (T1), at the end of day 5 (T2) and at follow-up on day 21 (T3). Reliable change indexes (RCI) and clinically significant changes were calculated. Results: From T1 to T3, PTSD symptoms significantly improved with a large effect size (Cohen’s d = 0.91). Nine of the 11 patients who completed treatment showed reliable changes in terms of self-reported PTSD. At T3, two of the patients no longer met criteria for PTSD as measured with the PCL-5. One patient dropped out after the first day. No serious adverse events occurred. Conclusions: The majority of patients in our pilot study experienced symptom reduction consistent with reliable changes in this five-day inpatient treatment with EMDR and yoga. Randomized controlled trials – with longer follow up periods – are needed to properly determine efficacy and efficiency of intensive clinical treatments for PTSD compared to regular treatment. This is one of the first studies to show that intensive EMDR treatment is feasible and is indicative of reliable improvement in PTSD symptoms in a very short time frame.