Effectiveness of an intensive treatment programme combining prolonged exposure and eye movement desensitization and reprocessing for severe post-traumatic stress disorder

C Van Woudenberg, E M Voorendonk, H Bongaerts, H A Zoet, M Verhagen, C W Lee, A van Minnen, A De Jongh, C Van Woudenberg, E M Voorendonk, H Bongaerts, H A Zoet, M Verhagen, C W Lee, A van Minnen, A De Jongh

Abstract

Background: There is room for improvement regarding the treatment of severe post-traumatic stress disorder (PTSD). Intensifying treatment to increase patient retention is a promising development. Objective: The aim of this study was to determine the effectiveness of an intensive trauma-focused treatment programme over 8 days for individuals suffering from severe PTSD. Method: Treatment was provided for 347 PTSD patients (70% women; mean age = 38.32 years, SD = 11.69) and consisted of daily sessions of prolonged exposure and eye movement desensitization and reprocessing (EMDR) therapy (16 sessions in total), physical activity, and psycho-education. All participants had experienced multiple traumas, including sexual abuse (74.4%), and suffered from multiple comorbidities (e.g. 87.5% had a mood disorder). Suicidal ideation was frequent (73.9%). PTSD symptom severity was assessed by both clinician-rated [Clinician Administered PTSD Scale (CAPS)] and self-report [PTSD Symptom Scale Self Report (PSS-SR) and Impact of Event Scale (IES)] inventories. For a subsample (n = 109), follow-up data at 6 months were available. Results: A significant decline in symptom severity was found (e.g. CAPS intention-to-treat sample Cohen's d = 1.64). At post-treatment, 82.9% showed a clinically meaningful response and 54.9% a loss of diagnosis. Dropout was very low (2.3%). Conclusions: Intensive trauma-focused treatment programmes including prolonged exposure, EMDR therapy, and physical activity can be effective for patients suffering from severe PTSD and are associated with low dropout rates.

Keywords: EMDR therapy; Post-traumatic stress disorder; complex PTSD; intensive trauma-focused treatment; prolonged exposure; • Two trauma-focused guideline treatment protocols for PTSD were combined.• More than half of the patients lost their PTSD diagnosis following 8 days of treatment.• A very low dropout rate..

Figures

Figure 1.
Figure 1.
Flow diagram. CAPS, Clinician Administered PTSD Scale; PSS-SR, PTSD Symptom Scale Self Report; IES, Impact of Event Scale; ITT, intention-to-treat.
Figure 2.
Figure 2.
Overview of a day in the treatment programme. EMDR, eye movement desensitization and reprocessing; PE, prolonged exposure.
Figure 3.
Figure 3.
Mean Impact of Event Scale (IES) scores and standard errors during week 1 (days 1 and 4) and week 2 (days 5 and 8) of treatment.

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