Eye movement desensitization and reprocessing (EMDR) therapy is an evidence‐based psychotherapy for posttraumatic stress disorder (PTSD), with support from more than 30 published randomized ...controlled trials (RCTs) demonstrating its effectiveness in both adults and children. Most international clinical practice guidelines recommend EMDR therapy as a first‐line treatment for PTSD. This paper describes the current state of the evidence for EMDR therapy. We begin with a brief description of EMDR therapy and its theoretical framework. Next, we summarize the scientific support for its efficacy, effectiveness, and safety and discuss its applicability across cultures and with diverse populations. We conclude with suggestions for future directions to develop the research base and applications of EMDR therapy.
Background
Practice guidelines for childhood posttraumatic stress disorder (PTSD) recommend trauma‐focused psychotherapies, mainly cognitive behavioral therapy (CBT). Eye movement desensitization and ...reprocessing (EMDR) therapy is a brief trauma‐focused, evidence‐based treatment for PTSD in adults, but with few well‐designed trials involving children and adolescents.
Methods
We conducted a single‐blind, randomized trial with three arms (n = 103): EMDR (n = 43), Cognitive Behavior Writing Therapy (CBWT; n = 42), and wait‐list (WL; n = 18). WL participants were randomly reallocated to CBWT or EMDR after 6 weeks; follow‐ups were conducted at 3 and 12 months posttreatment. Participants were treatment‐seeking youth (aged 8–18 years) with a DSM‐IV diagnosis of PTSD (or subthreshold PTSD) tied to a single trauma, who received up to six sessions of EMDR or CBWT lasting maximally 45 min each.
Results
Both treatments were well‐tolerated and relative to WL yielded large, intent‐to‐treat effect sizes for the primary outcomes at posttreatment: PTSD symptoms (EMDR: d = 1.27; CBWT: d = 1.24). At posttreatment 92.5% of EMDR, and 90.2% of CBWT no longer met the diagnostic criteria for PTSD. All gains were maintained at follow‐up. Compared to WL, small to large (range d = 0.39–1.03) intent‐to‐treat effect sizes were obtained at posttreatment for negative trauma‐related appraisals, anxiety, depression, and behavior problems with these gains being maintained at follow‐up. Gains were attained with significantly less therapist contact time for EMDR than CBWT (mean = 4.1 sessions/140 min vs. 5.4 sessions/227 min).
Conclusions
EMDR and CBWT are brief, trauma‐focused treatments that yielded equally large remission rates for PTSD and reductions in the severity of PTSD and comorbid difficulties in children and adolescents seeking treatment for PTSD tied to a single event. Further trials of both treatments with PTSD tied to multiple traumas are warranted.
According to current treatment guidelines for Complex PTSD (cPTSD), psychotherapy for adults with cPTSD should start with a “stabilization phase.” This phase, focusing on teaching self‐regulation ...strategies, was designed to ensure that an individual would be better able to tolerate trauma‐focused treatment. The purpose of this paper is to critically evaluate the research underlying these treatment guidelines for cPTSD, and to specifically address the question as to whether a phase‐based approach is needed. As reviewed in this paper, the research supporting the need for phase‐based treatment for individuals with cPTSD is methodologically limited. Further, there is no rigorous research to support the views that: (1) a phase‐based approach is necessary for positive treatment outcomes for adults with cPTSD, (2) front‐line trauma‐focused treatments have unacceptable risks or that adults with cPTSD do not respond to them, and (3) adults with cPTSD profit significantly more from trauma‐focused treatments when preceded by a stabilization phase. The current treatment guidelines for cPTSD may therefore be too conservative, risking that patients are denied or delayed in receiving conventional evidence‐based treatments from which they might profit.
Post-traumatic stress disorder (PTSD) is highly prevalent in patients with a psychotic disorder. Because a PTSD diagnosis is often missed in patients with psychosis in routine care, a valid screening ...instrument could be helpful.
To determine the validity of the Trauma Screening Questionnaire (TSQ) as a screening tool for PTSD among individuals with psychotic disorders.
Among 2608 patients with a psychotic disorder, the rate of trauma exposure was determined and the TSQ was administered to screen for PTSD. PTSD status was verified in 455 patients using the Clinician-Administered PTSD Scale (trial registration: ISRCTN 79584912).
Trauma exposure was reported by 78.2% of the 2608 patients. PTSD prevalence was estimated at 16% (95% CI 14.6-17.4%) compared with 0.5% reported in the patients' clinical charts. A TSQ cut-off score of six predicted PTSD with 78.8% sensitivity, 75.6% specificity, 44.5% correct positives and 93.6% correct negatives.
The TSQ seems to be a valid screening tool for PTSD in patients with a psychotic disorder.
Concern for symptom exacerbation and treatment drop‐out is an important barrier to the implementation of trauma‐focused therapy (TFT), especially in people with a psychotic disorder. This study, ...which was part of a multicenter randomized controlled trial, investigated posttraumatic stress disorder (PTSD) symptom exacerbation during eye movement desensitization reprocessing (EMDR) therapy and prolonged exposure (PE) in a sample of 99 participants with PTSD and psychosis. Symptom exacerbations during the first four sessions (early exacerbation) and between‐session exacerbations over the course of therapy were monitored using the PTSD Symptom Scale–Self Report. Analyses of covariance and chi‐square tests were conducted to investigate exacerbation rates and their associations with treatment response and drop‐out. Both early exacerbation and between‐session exacerbation were relatively common (32.3% and 46.5%, respectively) but were unrelated to poor treatment response or an increased likelihood of treatment drop‐out. Both clinicians and patients need to be aware that symptom exacerbation during TFT is common and not related to poor outcomes. Symptom exacerbation can be part of the therapeutic process, should be acknowledged and guided, and should not be a barrier to the implementation of TFT in people with psychosis.
Early identification of posttraumatic stress disorder (PTSD) in children is important to offer them appropriate and timely treatment. The Children's Revised Impact of Event Scale (CRIES) is a brief ...self‐report measure designed to screen children for PTSD. Research regarding the diagnostic validity of the CRIES is still insufficient, has been restricted to specific populations, and sample sizes have often been small. This study evaluated the reliability and validity of the 8‐item (CRIES‐8) and 13‐item (CRIES‐13) versions of the CRIES in a large clinically referred sample. The measure was completed by 395 Dutch children (7–18 years) who had experienced a wide variety of traumatic events. PTSD was assessed using the Anxiety Disorders Interview Schedule for DSM‐IV: Child and Parent version. A cutoff score of 17 on the CRIES‐8 and 30 on the CRIES‐13 emerged as the best balance between sensitivity and specificity, and correctly classified 78%–81% of all children. The CRIES‐13 outperformed the CRIES‐8, in that the overall efficiency of the CRIES‐13 was slightly superior (.81 and .78, respectively). The CRIES appears to be a reliable and valid measure, which gives clinicians a brief and user‐friendly instrument to identify children who may have PTSD and offer them appropriate and timely treatment.
抽象
Traditional and Simplified Chinese s by AsianSTSS
標題：荷蘭臨床轉介樣本中兒童事件影響量表修訂版(CRIES)的特徵。
撮要：在兒童中及早發現創傷後壓力症(PTSD)便可提供迫切合適的治療。兒童事件影響量表修訂版(CRIES) 是篩選兒童PTSD的一個簡短自我報告量表。針對CRIES 診斷效力的研究並未足夠，大多局限於個別人群和只有小型樣本規模。本文在一大型臨床轉介樣本中評估CRIES 的8‐項目(CRIES‐8)和13‐項目(CRIES‐13)版本的信賴度和效力。共有395名曾經歷不同種類創傷事件的荷蘭兒童(7–18歲)完成測量。PTSD 是使用DSM‐IV焦慮症會見程序(兒童及家長版本)來評核。CRIES‐8 的17分和CRIES‐13的30分為分界點，能最佳平衡敏感度和特異性，亦正確地區分全部兒童的78%‐81%。而CRIES‐13比CRIES‐8優勝，因為CRIES‐13的全面效率略高(分別是.81和.78)。CRIES是一個可信賴和有效的量度，給臨床醫療人員一個簡短而易用的工具，以找出可能患上PTSD的兒童，並提供迫切合適治療。
标题：荷兰临床转介样本中儿童事件影响量表修订版(CRIES)的特征。
撮要：在儿童中及早发现创伤后压力症(PTSD)便可提供迫切合适的治疗。儿童事件影响量表修订版(CRIES) 是筛选儿童PTSD的一个简短自我报告量表。针对CRIES 诊断效力的研究并未足够，大多局限于个别人群和只有小型样本规模。本文在一大型临床转介样本中评估CRIES 的8‐项目(CRIES‐8)和13‐项目(CRIES‐13)版本的信赖度和效力。共有395名曾经历不同种类创伤事件的荷兰儿童(7–18岁)完成测量。PTSD 是使用DSM‐IV焦虑症会见程序(儿童及家长版本)来评核。CRIES‐8 的17分和CRIES‐13的30分为分界点，能最佳平衡敏感度和特异性，亦正确地区分全部儿童的78%‐81%。而CRIES‐13比CRIES‐8优胜，因为CRIES‐13的全面效率略高(分别是.81和.78)。CRIES是一个可信赖和有效的量度，给临床医疗人员一个简短而易用的工具，以找出可能患上PTSD的儿童，并提供迫切合适治疗。
The present study describes a Single-Case Experimental Design (SCED) research protocol. The outlined research is aimed at investigating the effectiveness and potential mechanisms of the Resolutions ...Approach (RA), a multidisciplinary intervention to stop child abuse and enhance safety in the families. Given the heterogeneity of the population and innovativeness of the topic, a SCED with a baseline period (A-phase) followed by a treatment period (B-phase) is designed. Participants will be fifteen families with children between 8 and 18 years in which specific signs of current child abuse are determined by more than one informant. The RA is a 20-session protocol implemented in an individual, family and social network context. Assessments of primary (incidents of child abuse) and secondary (child’s emotional and behavioral problems, parental stress, closeness of child-parent relationship) outcomes will take place at the start of the baseline period, at pre- and post-treatment, and at two follow-ups. Personalised, idiosyncratic, assessments of the main family problems will be administered on a weekly base. At post-treatment, a qualitative interview is administered in the families examining the most potent mechanisms of change and treatment components. During social network meetings, safety and openness of communication about child abuse is assessed. This study responds to a need for evidence-based interventions for mental health workers dealing with child abuse. Limitations such as bias in the parental reports of child abuse are discussed.
Trial registration:
Dutch Trial Register: NTR6757. Registered (retrospectively) 04 November 2017.
This study presents secondary analyses of a recently published trial in which post-traumatic stress disorder (PTSD) patients with psychosis (n = 108) underwent 8 sessions of trauma-focused treatment, ...either prolonged exposure (PE) or eye movement desensitisation and reprocessing (EMDR) therapy. 24.1% fulfilled the criteria for the dissociative subtype, a newly introduced PTSD subtype in DSM-5. Treatment outcome was compared for patients with and without the dissociative subtype of PTSD. Patients with the dissociative subtype of PTSD showed large reductions in clinician-administered PTSD scale (CAPS) score, comparable with patients without the dissociative subtype of PTSD. It is concluded that even in a population with severe mental illness, patients with the dissociative subtype of PTSD do benefit from trauma-focused treatments without a pre-phase of emotion regulation skill training and should not be excluded from these treatments.
Parents of children with severe inborn errors of metabolism frequently face stressful events related to the disease of their child and are consequently at high risk for developing parental ...posttraumatic stress disorder (PTSD). Assessment and subsequent treatment of PTSD in these parents is however not common in clinical practice. PTSD can be effectively treated by Eye Movement Desensitization and Reprocessing (EMDR), however no studies have been conducted yet regarding the effect of EMDR for parental PTSD. EMDR is generally offered in multiple weekly sessions which may preclude participation of parents as they are generally overburdened by the ongoing and often intensive care for their child. Therefore, we offered time-limited EMDR with a maximum of four sessions over two subsequent days to two parents of mucopolysaccharidosis type III (MPS III) patients to explore its potential effects. Both qualitative and quantitative outcomes were used to evaluate treatment effects. Both parents felt more resilient and competent to face future difficulties related to the disease of their child, and no adverse effects were reported. Quantitative outcomes showed a clinically significant decrease in post traumatic stress symptoms and comorbid psychological distress from pre- to post treatment, and these beneficial effects were maintained at follow-up. In conclusion, time-limited EMDR may be a highly relevant treatment for traumatized parents of children with MPS III, and probably also for parents of children with other rare progressive disorders. Further research is needed to validate the efficacy of EMDR in this specific population.
PDF
