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Brief eclectic psychotherapy v. eye movement desensitisation and reprocessing therapy for post-traumatic stress disorder: randomised controlled trial

  • Mirjam J. Nijdam (a1), Berthold P. R. Gersons (a2), Johannes B. Reitsma (a3), Ad de Jongh (a4) and Miranda Olff (a2)...
Abstract
Background

Trauma-focused cognitive–behavioural therapy (CBT) and eye movement desensitisation and reprocessing therapy (EMDR) are efficacious treatments for post-traumatic stress disorder (PTSD), but few studies have directly compared them using well-powered designs and few have investigated response patterns.

Aims

To compare the efficacy and response pattern of a trauma-focused CBT modality, brief eclectic psychotherapy for PTSD, with EMDR (trial registration: ISRCTN64872147).

Method

Out-patients with PTSD were randomly assigned to brief eclectic psychotherapy (n = 70) or EMDR (n = 70) and assessed at all sessions on self-reported PTSD (Impact of Event Scale – Revised). Other outcomes were clinician-rated PTSD, anxiety and depression.

Results

Both treatments were equally effective in reducing PTSD symptom severity, but the response pattern indicated that EMDR led to a significantly sharper decline in PTSD symptoms than brief eclectic psychotherapy, with similar drop-out rates (EMDR: n = 20 (29%), brief eclectic psychotherapy: n = 25 (36%)). Other outcome measures confirmed this pattern of results.

Conclusions

Although both treatments are effective, EMDR results in a faster recovery compared with the more gradual improvement with brief eclectic psychotherapy.

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Copyright
Corresponding author
Mirjam J. Nijdam, MSc, Centre for Psychological Trauma, Department of Psychiatry, Academic Medical Centre at the University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands. Email: m.j.nijdam@amc.uva.nl
Footnotes
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This study was supported by the Academic Medical Centre, Amsterdam, The Netherlands.

Declaration of interest

A.d.J. teaches and supervises clinical psychologists and psychiatrists in psychological trauma and its treatment by means of seminars, workshops and conferences, for which the participants pay a fee. He is also director and shareholder of a trauma treatment unit. For both activities he has the formal permission of the executive board of the University of Amsterdam to which he is affiliated.

Footnotes
References
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1 Breslau, N, Kessler, RC, Chilcoat, HD, Schultz, LR, Davis, GC, Andreski, P. Trauma and posttraumatic stress disorder in the community: the 1996 Detroit area survey of trauma. Arch Gen Psychiatry 1998; 55: 626–32.
2 Kessler, RC, Sonnega, A, Bromet, E, Hughes, M, Nelson, CB. Posttraumatic stress disorder in the national comorbidity survey. Arch Gen Psychiatry 1995; 52: 1048–60.
3 De Vries, GJ, Olff, M. The lifetime prevalence of traumatic events and posttraumatic stress disorder in the Netherlands. J Trauma Stress 2009; 22: 259–67.
4 National Collaborating Centre for Mental Health. Post–Traumatic Stress Disorder (PTSD): The Management of PTSD in Adults and Children in Primary and Secondary Care (CG 26). National Institute for Health and Clinical Excellence, 2005.
5 Foa, EB, Keane, TM, Friedman, MJ, Cohen, JA. Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies (2nd edn). Guilford Press, 2008.
6 Seidler, GH, Wagner, FE. Comparing the efficacy of EMDR and trauma–focused cognitive–behavioural therapy in the treatment of PTSD: a meta-analytic study. Psychol Med 2006; 36: 1515–22.
7 Ironson, G, Freund, B, Strauss, JL, Williams, J. Comparison of two treatments for traumatic stress: a community–based study of EMDR and prolonged exposure. J Clin Psychol 2002; 58: 113–28.
8 Schnurr, PP. The rocks and hard places in psychotherapy outcome research. J Trauma Stress 2007; 20: 779–92.
9 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM–IV). APA, 1994.
10 First, MB, Gibbon, M, Spitzer, RL, Williams, JBW, Benjamin, LS. Structured Clinical Interview for DSM–IV Axis II Personality Disorders Self–Report. American Psychiatric Association, 1997.
11 Lindauer, RJL, Gersons, BPR, Van Meijel, EPM, Blom, K, Carlier, IVE, Vrijlandt, I, et al. Effects of brief eclectic psychotherapy in outpatients with posttraumatic stress disorder: randomized clinical trial. J Trauma Stress 2005; 18: 205–12.
12 Olff, M, De Vries, GJ, Güzelcan, Y, Assies, J, Gersons, BPR. Changes in cortisol and DHEA plasma levels after psychotherapy for PTSD. Psychoneuroendocrinology 2007; 32: 619–26.
13 Bradley, R, Greene, J, Russ, E, Dutra, L, Westen, D. A multidimensional meta–analysis of psychotherapy for PTSD. Am J Psychiatry 2005; 162: 214–27.
14 Weiss, DS, Marmar, CR. The impact of event scale – revised. In Assessing Psychological Trauma and PTSD: A Handbook for Practitioners (eds Wilson, JP, Keane, RM): 399411. Guilford Press, 1997.
15 Korn, DL, Zangwill, W, Lipke, H, Smyth, NJ. EMDR Fidelity Scale. EMDRIA Research Committee, 2001.
16 De Jongh, A, Ten Broeke, E. Handboek EMDR: Een Geprotocolleerde Behandelmethode voor de Gevolgen van Psychotrauma [Handbook EMDR: A Manualized Treatment Method for the Consequences of Psychotrauma]. Harcourt Assessment, 2004.
17 Gersons, BPR, Carlier, IVE, Olff, M. Protocol Brief Eclectic Psychotherapy for Posttraumatic Stress Disorder. Academic Medical Center, University of Amsterdam, 2004.
18 Gersons, BPR, Carlier, IVE, Lamberts, RD, van der Kolk, BA. Randomized clinical trial of brief eclectic psychotherapy for police officers with posttraumatic stress disorder. J Trauma Stress 2000; 13: 333–47.
19 Davidson, JR, Malik, MA, Travers, J. Structured interview for PTSD (SIP): psychometric validation for DSM–IV criteria. Depress Anxiety 1997; 5: 127–9.
20 Spitzer, B, Gibbon, RL, Janet, M, Janet, W. Structured Clinical Interview for DSM–IV Axis I Disorders – Patient Edition (SCID I/P, version 2.0). American Psychiatric Press, 1996.
21 Van Groenestein, MAC, Akkerhuis, GW, Kupka, RW, Schneider, N, Nolen, WA. Gestructureerd Klinisch Interview voor de Vaststelling van DSM–IV As I Stoornissen [Structured Clinical Interview for the Diagnosis of DSM–IV Axis I Disorders]. Swets & Zeitlinger BV, 1999.
22 Zigmond, AS, Snaith, RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67: 361–70.
23 Creamer, M, Bell, R, Failla, S. Psychometric properties of the Impact of Event Scale – Revised. Behav Res Ther 2003; 41: 1489–96.
24 Carlier, IV, Lamberts, RD, Van Uchelen, AJ, Gersons, BP. Clinical utility of a brief diagnostic test for posttraumatic stress disorder. Psychosom Med 1998; 60: 42–7.
25 Zanarini, MC, Frankenburg, FR. Attainment and maintenance of reliability of Axis I and II disorders over the course of a longitudinal study. Compr Psychiatry 2001; 42: 369–74.
26 Spinhoven, P, Ormel, J, Sloekers, PP, Kempen, GI, Speckens, AE, Van Hemert, AM. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med 1997; 27: 363–70.
27 Schubert, S, Lee, CW. Adult PTSD and its treatment with EMDR: a review of controversies, evidence, and theoretical knowledge. J EMDR Pract Res 2009; 3: 117–32.
28 Vaughan, K, Armstrong, MS, Gold, R, O'Connor, N, Jenneke, W. A trial of eye movement desensitization compared to image habituation training and applied muscle relaxation in posttraumatic stress disorder. J Behav Ther Exp Psychiatry 1994; 25: 283–91.
29 Lee, C, Gavriel, H, Drummond, P, Richards, J, Greenwald, R. Treatment of PTSD: stress inoculation training with prolonged exposure compared to EMDR. J Clin Psychol 2002; 58: 1071–89.
30 Power, K, McGoldrick, T, Brown, K, Buchanan, R, Sharp, D, Swanson, V, et al. A controlled comparison of eye movement desensitization and reprocessing versus exposure plus cognitive restructuring versus waiting list in the treatment of post–traumatic stress disorder. Clin Psychol Psychother 2002; 9: 299318.
31 Taylor, S, Thordarson, DS, Maxfield, L, Fedoroff, IC, Lovell, K, Ogrodniczuk, J. Comparative efficacy, speed and adverse effects of three PTSD treatments: exposure therapy, EMDR, and relaxation training. J Consult Clin Psychol 2003; 71: 330–8.
32 Rothbaum, BO, Astin, MC, Marsteller, F. Prolonged exposure versus eye movement desensitization and reprocessing (EMDR) for PTSD rape victims. J Trauma Stress 2005; 18: 607–16.
33 Jones, B, Jarvis, P, Lewis, JA, Ebbutt, AF. Trials to assess equivalence: the importance of rigorous methods. BMJ 1996; 313: 36–9.
34 Bisson, JI, Ehlers, A, Matthews, R, Pilling, S, Richards, D, Turner, S. Psychological treatments for chronic post–traumatic stress disorders. Systematic review and meta–analysis. Br J Psychiatry 2007; 190: 97104.
35 Hembree, EA, Foa, EB, Dorfan, NM, Street, GP, Kowalski, J, Tu, X. Do patients drop out prematurely from exposure therapy for PTSD? J Trauma Stress 2003; 16: 555–62.
36 Schnurr, PP, Friedman, MJ, Engel, CC, Foa, EB, Shea, MT, Chow, BK, et al. Cognitive behavioural therapy for posttraumatic stress disorder in women: a randomized controlled trial. JAMA 2007; 297: 820–30.
37 Schottenbauer, MA, Glass, CR, Arnkoff, DB, Tendick, V, Gray, SH. Nonresponse and dropout rates in outcome studies on PTSD: review and methodological considerations. Psychiatry 2008; 71: 134–68.
38 Van Minnen, A, Hendriks, L, Olff, M. When do trauma experts choose exposure therapy for PTSD patients? A controlled study of therapist and patient factors. Behav Res Ther 2010; 48: 312–20.
39 Schnyder, U. Why new psychotherapies for posttraumatic stress disorder? Psychother Psychosom 2005; 74: 199201.
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Brief eclectic psychotherapy v. eye movement desensitisation and reprocessing therapy for post-traumatic stress disorder: randomised controlled trial

  • Mirjam J. Nijdam (a1), Berthold P. R. Gersons (a2), Johannes B. Reitsma (a3), Ad de Jongh (a4) and Miranda Olff (a2)...
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eLetters

Going Further on Post-Traumatic Stress Disorder

Itoro I. Udo, Specialty Registrar
20 April 2012

The study presented has been appraised with interest. (1) It is a well designed study that does what it sets out to do. This study incorporated clinical effectiveness data which makes it valuable to clinicians. I write to comment further as follows:

1.It would have been beneficial to have had further explanation of how mastery of Dutch language was determined in the study participants.

2.Trauma was characterised in the study as "complex" without a definition of what this subjective term is used to denote in the study.

3.It may have been beneficial to provide more information on the types of "comorbid psychiatric disorders" that participants had, for purposes of the readers' evaluation of clinical applicability of results. I am wondering whether any participant was diagnosed with Dissociative Identity Disorder (DID).(2) Knowing the spread of Personality Disorders and Bipolar Affective Disorder would have been particularly beneficial.

4.As to psychotropic medication use, one wonders what percentages ofparticipants were on mood stabilisers and its types which may have affected their trauma processing.

The bottom line results of this study substantiate what we do observeclinically. Further research needs to consider whether faster recovery does also occur with multiple trauma survivors. Increasingly, in liaison psychiatry settings, we are confronted with persons with Post-traumatic Stress Disorder and Bodily Distress (Medically Unexplained Symptoms); it would be worth investigating the place of Eye Movement Desensitisation Reprocessing (EMDR) versus Brief Eclectic Psychotherapy (BCP) or Trauma focused Cognitive Behavioural Therapy or Psychodynamic Interpersonal Therapy in such circumstances, (3) as faster recovery could have wider implications on health services. This may be by way of reduced use of acute/ emergency services, improved quality of life, increase sense of well being and reduction of risk.

References:

1. Nijdam MJ., Gersons BPR., Reitsma JB., Jongh A., Olff M. Brief Eclectic Psychotherapy v. Eye Movement Desensitisation and Reprocessing Therapy for Post-traumatic Stress Disorder: Randomised Controlled Trial. BJPsych 2012; 200 (3):224-231.

2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th edn) (DSM-IV). American Psychiatric Association; 1994.

3. Creed F., Feltz-Cornelius C., Guthrie E., Henningsen P., Rief W., Schroder A., White P. Identification, Assessment and Treatment of Individual Patients. In: Creed F., Henningsen P., Fink P. (eds.) MedicallyUnexplained Symptoms, Somatisation and Bodily Distress: Developing Better Clinical Services. Cambridge: Cambridge University Press; 2011. p175- 216.

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Conflict of interest: IIU is a member of EMDR Association UK & Ireland. The views expressed here are solely those of the author. IIU is trained in both CBT and EMDR.

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