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The efficacy of eye movement desensitization and reprocessing for post-traumatic stress disorder and depression among Syrian refugees: results of a randomized controlled trial

Published online by Cambridge University Press:  29 June 2016

C. Acarturk*
Affiliation:
Department of Psychology, Istanbul Şehir University, Istanbul, Turkey
E. Konuk
Affiliation:
Institute for Behavioral Studies, Istanbul, Turkey
M. Cetinkaya
Affiliation:
Department of Psychiatry, Istanbul University Medical School, Istanbul, Turkey
I. Senay
Affiliation:
Department of Psychology, Istanbul Şehir University, Istanbul, Turkey
M. Sijbrandij
Affiliation:
Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands
B. Gulen
Affiliation:
Kilis Refugee Camp, Kilis, Turkey
P. Cuijpers
Affiliation:
Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands
*
*Address for correspondence: C. Acarturk, Ph.D., Department of Psychology, Istanbul Şehir University, 34660 Uskudar, Istanbul, Turkey. (Email: cerenacarturk@sehir.edu.tr)

Abstract

Background

Previous research indicates a high prevalence of post-traumatic stress disorder (PTSD) and depression among refugees. Eye movement desensitization and reprocessing (EMDR) is an effective treatment for PTSD for victims of natural disasters, car accidents or other traumatic events. The current study examined the effect of EMDR on symptoms of PTSD and depression by comparing the treatment with a wait-list control condition in Syrian refugees.

Method

Adult refugees located in Kilis Refugee Camp at the Turkish–Syrian border with a PTSD diagnosis were randomly allocated to either EMDR (n = 37) or wait-list control (n = 33) conditions. All participants were assessed with the Mini-International Neuropsychiatric Interview Plus at pre-intervention, at 1 week after finishing the intervention and at 5 weeks after finishing the intervention. The main outcome measures were the Harvard Trauma Questionnaire (HTQ) and the Impact of Event Scale-Revised. The Beck Depression Inventory and the Hopkins Symptoms Checklist-25 were included as secondary outcome measures. The Trial Registration no. is NCT01847742.

Results

Mixed-model analyses adjusted for the baseline scores indicated a significant effect of group at post-treatment indicating that the EMDR therapy group showed a significantly larger reduction of PTSD symptoms as assessed with the HTQ. Similar findings were found on the other outcome measures. There was no effect of time or group × time interaction on any measure, showing that the difference between the groups at the post-treatment was maintained to the 5-week follow-up.

Conclusions

EMDR may be effective in reducing PTSD and depression symptoms among Syrian refugees with PTSD located in a refugee camp.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2016 

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References

Acarturk, C, Konuk, E, Cetinkaya, M, Senay, I, Sijbrandij, M, Cuijpers, P, Aker, T (2015). EMDR for Syrian refugees with posttraumatic stress disorder symptoms: results of a pilot randomized controlled trial. European Journal of Psychotraumatology 6, 27414.CrossRefGoogle ScholarPubMed
Alpak, G, Unal, A, Bulbul, F, Sagaltici, E, Bez, Y, Altindag, A, Dalkilic, A, Savas, HA (2014). Post-traumatic stress disorder among Syrian refugees in Turkey: a cross-sectional study. International Journal of Psychiatry in Clinical Practice 19, 4550.CrossRefGoogle ScholarPubMed
Bader, AM (2006). Internal consistency of an Arabic adaptation of the Beck Depression Inventory-II with college students in eighteen Arab countries. Social Behavior and Personality: An International Journal 34, 425430.Google Scholar
Beck, AT, Steer, RA, Brown, GK (1996). Manual for Beck Depression Inventory-II. Psychological Corporation: San Antonio, TX.Google Scholar
Bisson, JI, Roberts, NP, Andrew, M, Cooper, R, Lewis, C (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD003388. doi:10.1002/14651858.CD003388.pub4.CrossRefGoogle Scholar
Bradley, R, Greene, J, Russ, E, Dutra, L, Westen, D (2005). A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry 162, 214227.CrossRefGoogle ScholarPubMed
Engeler, A (2004). MINI Uluslararası Nöropsikiyatrik Görüşme Türkçe Uyarlama 5.0.0. Glaxo Smith Kline: Istanbul.Google Scholar
Engelhard, IM, van den Hout, MA, Janssen, WC, van der Beek, J (2010). Eye movements reduce vividness and emotionality of “flash-forwards”. Behaviour Research and Therapy 48, 442447.CrossRefGoogle Scholar
Fazel, M, Wheeler, J, Danesh, J (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet 365, 13091314.CrossRefGoogle ScholarPubMed
Furukawa, TA, Noma, H, Caldwell, DM, Honyashiki, M, Shinohara, K, Imai, H, Chen, P, Hunot, V, Churchill, R (2014). Waiting list may be a nocebo condition in psychotherapy trials: a contribution from network meta-analysis. Acta Psychiatrica Scandinavica 130, 181192.CrossRefGoogle ScholarPubMed
Ghareeb, AG (2000). Manual of the Arabic BDI-II. Angle Press: Cairo, Egypt.Google Scholar
Gunter, MA, Bodner, IM (2009). EMDR works…but how? Recent progress in the search for treatment mechanisms. Journal of EMDR Practice and Research 3, 161168.CrossRefGoogle Scholar
Herbert, JD, Mueser, KT (1992). Eye movement desensitization: a critique of the evidence. Journal of Behavior Therapy and Experimental Psychiatry 23, 169174.CrossRefGoogle ScholarPubMed
Ho, MSK, Lee, CW (2012). Cognitive behaviour therapy versus eye movement desensitization and reprocessing for post-traumatic disorder – is it all in the homework then? Revue Europėenne de Psychologie Appliquėe/European Review of Applied Psychology 62, 253260.CrossRefGoogle Scholar
IASC (Inter-Agency Standing Committee) (2007). IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. Inter-Agency Standing Committee: Geneva (http://www.who.int/mental_health/emergencies/guidelines_iasc_mental_health_psychosocial_june_2007.pdf). Accessed May 2015.Google Scholar
Kessler, RC (2000). Posttraumatic stress disorder: the burden to the individual and to the society. Journal of Clinical Psychiatry 5 (Suppl. 61), 412.Google Scholar
Kobeissi, L, Araya, R, El Kak, F, Ghantous, Z, Khawaja, M, Khoury, B, Mahfoud, Z, Nakkash, R, Peters, TJ, Ramia, S, Zurayk, H (2011). The Relaxation Exercise and Social Support Trial – RESST: study protocol for a randomized community based trial. BMC Psychiatry 11, 142.CrossRefGoogle ScholarPubMed
Lee, CW, Cuijpers, P (2013). A meta-analysis of the contribution of eye movements in processing emotional memories. Journal of Behavior Therapy Experimental Psychiatry 44, 231239.CrossRefGoogle ScholarPubMed
Leer, A, Engelhard, IM, van den Hout, MA (2014). How eye movements in EMDR work: changes in memory vividness and emotionality. Journal of Behavior Therapy and Experimental Psychiatry 45, 396401.CrossRefGoogle ScholarPubMed
McFarlane, AC, de Girolamo, G (2007). The nature of traumatic stressors and the epidemiology of posttraumatic reactions. In The Effects of Overwhelming Experience on the Mind, Body and Society (ed. van der Kolk, B.A., MacFarlane, A.C., Weisaeth, L.W.), pp. 129154. The Guilford Press: New York.Google Scholar
Mollica, R, McDonald, L, Massagli, M, Silove, D (2004). Measuring Trauma, Measuring: Instructions and Guidance on the Utilization of the Harvard Program in Refugee Versions of the Hopkins Symptom Checklist-25 (HSCL-25) and the Harvard Trauma Questionnaire (HTQ). Harvard Program in Refugee Trauma: Cambridge, MA.Google Scholar
Mollica, RF, Caspi-Yavin, Y, Bollini, P, Truong, T, Tor, S, Lavalle, J (1992). The Harvard Trauma Questionnaire: validating a cross-cultural instrument for measuring torture, trauma and posttraumatic stress disorder in Indochinese refugees. Journal of Nervous Mental Disease 180, 111116.CrossRefGoogle ScholarPubMed
Mollica, RF, Sarajlic, N, Chernoff, M, Lavella, J, Vukovic, IS, Massagli, MP (2001). Longitudinal study of psychiatric symptoms, disability, mortality, and emigration among Bosnian refugees. Journal of the American Medical Association 286, 546554.CrossRefGoogle ScholarPubMed
Morina, N, Maier, T, Bryant, R, Knaevelsrud, C, Wittman, L, Rufer, M, Schnyder, U, Müller, J (2012). Combining biofeedback and narrative exposure therapy for persistent pain and PTSD in refugees: a pilot study. European Journal of Psychotraumatology 3, 17660.CrossRefGoogle ScholarPubMed
Murray, KE, Davidson, GR, Schweitzer, RD (2010). Review of refugee mental health interventions following resettlement: best practices and recommendations. American Journal of Orthopsychiatry 80, 576585.Google Scholar
National Institute for Clinical Excellence (NICE) (2005). Post-traumatic stress disorder; the management of PTSD in adults and children in primary and secondary care. NICE Clinical Guidelines No. 26. Gaskell and the British Psychological Society: Leicester (http://www.nice.org.uk/guidance/CG26/chapter/key-priorities-for-implementation?print=true). Accessed June 2016.Google Scholar
Neuner, F, Onyut, PL, Ertl, V, Odenwald, M, Schauer, E, Elbert, T (2008). Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: a randomized controlled trial. Journal of Consulting and Clinical Psychology 76, 686694.CrossRefGoogle Scholar
Neuner, F, Schauer, M, Klaschik, C, Karunakara, U, Elbert, T (2004). A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an African refugee settlement. Journal of Consulting and Clinical Psychology 72, 579587.CrossRefGoogle Scholar
Nickerson, A, Bryant, RA, Silove, D, Steel, Z (2011). A critical review of psychological treatments of posttraumatic stress disorder in refugees. Clinical Psychology Review 31, 399417.CrossRefGoogle ScholarPubMed
Palic, S, Elklit, A (2010). Psychosocial treatment of posttraumatic stress disorder in adult refugees: a systematic review of prospective treatment outcome studies and a critique. Journal of Affective Disorders 131, 823.CrossRefGoogle Scholar
Panahi, Y, Moghaddam, BR, Sahebkar, A, Nazari, MA, Beiraghdar, F, Karami, G, Saadat, AR (2011). A randomized, double-blind, placebo controlled trial on the efficacy and tolerability of sertraline in Iranian veterans with post-traumatic stress disorder. Psychological Medicine 41, 21592166.CrossRefGoogle ScholarPubMed
Porter, M, Haslam, N (2005). Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. Journal of the American Medical Association 294, 602612.CrossRefGoogle ScholarPubMed
Rasmussen, A, Annan, J (2010). Predicting stress related to basic needs and safety in Darfur refugee camps: a structural and social ecological analysis. Journal of Refugee Studies 23, 2340.CrossRefGoogle ScholarPubMed
Seidler, GH, Wagner, FE (2006). Comparing the efficacy of EMDR and trauma-focused cognitive behavioral therapy in the treatment of PTSD: a meta-analytic study. Psychological Medicine 36, 15151522.CrossRefGoogle ScholarPubMed
Shapiro, E, Laub, B (2008). Early EMDR Intervention (EEI): a summary, a theoretical model, and the Recent Traumatic Episode Protocol (R-TEP). Journal of EMDR Practice and Research 2, 7996.CrossRefGoogle Scholar
Shapiro, E, Laub, B (2013). The Recent Traumatic Episode Protocol (R-TEP): an integrative protocol for early EMDR intervention (EEI). In Implementing EMDR Early Mental Health Interventions for Man-Made and Natural Disasters: Models, Scripted Protocols, and Summary Sheets (ed. Luber, M.), pp. 193207. Springer: New York.Google Scholar
Shapiro, F (1995). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures. Guilford Press: New York.Google Scholar
Shapiro, F (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures. Guilford Press: New York.Google Scholar
Sheehan, DV, Lecruiber, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59 (Suppl. 20), 2233; quiz 34–57.Google ScholarPubMed
Shoeb, M, Weinstein, H, Mollica, R (2007). The Harvard Trauma Questionnaire: adapting a cross- cultural instrument for measuring torture, trauma and posttraumatic stress disorder in Iraqi refugees. International Journal of Social Psychiatry 53, 447463.CrossRefGoogle ScholarPubMed
Stickgold, R (2002). EMDR: a putative neurobiological mechanism of action. Journal of Clinical Psychology 50, 6175.CrossRefGoogle Scholar
Ter Heide, FJJ, Mooren, TM, Kleijn, W, de Jong, A, Kleber, RJ (2011). EMDR versus stabilization in traumatized asylum seekers and refugees: results of a pilot study. European Journal of Psychotraumatology 2, 5881.CrossRefGoogle ScholarPubMed
Tol, WA, Barbui, C, Galappatti, A, Silove, D, Betancourt, TS, Souza, R, Golaz, A, van Ommeren, A (2011). Mental health and psychosocial support in humanitarian settings: linking practice and research. Lancet 378, 15811591.CrossRefGoogle ScholarPubMed
United Nations High Commissioner for Refugees (2013). Mental Health and Psychosocial Support for Persons of Concern (http://www.unhcr.org/51bec3359.html). Accessed June 2015.Google Scholar
United Nations High Commissioner for Refugees (2015). Syria Regional Refugee Response: Inter-agency Information Sharing Portal (http://data.unhcr.org/syrianrefugees/regional.php). Accessed February 2015.Google Scholar
Van der Hout, MA, Engelhard, M (2012). How does EMDR work? Journal of Experimental Psychopathology 3, 724738.CrossRefGoogle Scholar
Vuković, IS, Jovanović, N, Kolarić, B, Vidović, V, Mollica, RF (2014). Psychological and somatic health problems in Bosnian refugees: a three year follow up. Psychiatria Danubina 26, 442449.Google ScholarPubMed
Weiss, DS, Marmar, CR (1997). The Impact of Event Scale-Revised. In Assessing Psychological Trauma and PTSD: A Practitioner's Handbook (ed. Wilson, J. P. and Keane, T. M.), pp. 399411. Guilford Press: New York.Google Scholar
World Health Organization (2013). Guidelines for the Management of Conditions Specifically Related to Stress (http://apps.who.int/iris/bitstream/10665/85119/1/9789241505406_eng.pdf). Accessed June 2015.Google Scholar
Xu, R (2003). Measuring explained variation in linear mixed effects models. Statistics in Medicine 22, 35273541.CrossRefGoogle ScholarPubMed
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