Metacognitive therapy vs. eye movement desensitization and reprocessing for posttraumatic stress disorder: study protocol for a randomized superiority trial

Hans M Nordahl, Joar Øveraas Halvorsen, Odin Hjemdal, Mimoza Rrusta Ternava, Adrian Wells, Hans M Nordahl, Joar Øveraas Halvorsen, Odin Hjemdal, Mimoza Rrusta Ternava, Adrian Wells

Abstract

Background: The psychological treatment of choice for patients with severe posttraumatic stress disorder (PTSD) is cognitive behavioural exposure therapy or Eye Movement Desensitisation Reprocessing (EMDR). Whilst these are the most effective treatments, approximately 30-45% of the patients show no significant improvements and follow-up data are sparse. Furthermore, a proportion of patients with severe trauma does not benefit or avoid exposure therapy due to the potential to overwhelm them. Therefore, it is necessary to search for effective methods that do not require exposure. Metacognitive therapy (MCT), a recent treatment approach to PTSD that does not require exposure, has potential strong treatment effects but so far a comparison with EMDR has not been made.

Methods/design: This study is a two-arm, parallel, randomized, superiority trial comparing the effectiveness of MCT with EMDR. One hundred patients with a primary diagnosis of chronic PTSD will be included and will receive 12 sessions of one of the treatments. The primary outcome is severity of PTSD symptoms assessed with the Posttraumatic Diagnostic Scale (PDS) measured post-treatment (3 months). Secondary outcomes include symptom severity (PDS) and measures of anxiety, depression, metacognitive beliefs at 3-month and 12-month follow up.

Discussion: This randomized study is the first to compare MCT with EMDR with 12-month follow-up. The study will indicate the comparative effectiveness of MCT against EMDR and the stability of effects when delivered in an outpatient clinical setting.

Trial registration: ClinicalTrials.gov, NCT01955590 . Registered on 24 September 2013.

Keywords: EMDR; Metacognitive therapy; Posttraumatic stress disorder; Randomized controlled trial.

Conflict of interest statement

Ethics approval and consent to participate

The study will be conducted in accordance with the Ethical codes written in the Helsinki declaration (2000). The study has received ethical approved from the Regional committee for Medicine and Health Research Ethics in central Norway (2528/REK midt). We obtain informed, written consent from all participants in the study.

Consent for publication

Not applicable for the study protocol.

Competing interests

The authors declare that they have no competing interests

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Schedule of enrolment, interventions, and assessments. Abbreviations: ADIS-IV Anxiety and Depression Interview Scale-IV; BDI Beck Depression Inventory; BAI Beck Anxiety Inventory; IES-R Impact of Event Scale- revised; IIP-64 Inventory of Interpersonal Problems-64; PDS Posttraumatic Diagnostic Scale; MCQ-30 Metacognitive Questionnaire-30; PSS-I Posttraumatic Stress Disorder Scale-Interview; PTCI Post Traumatic Cognitions Inventory; SRS Session Rating Scale

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