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      A five-day inpatient EMDR treatment programme for PTSD: pilot study Translated title: 为期5天的住院病人的 用EMDR 治疗PTSD程序:一个试研究 Translated title: Un programa de tratamiento EMDR para el TEPT de 5 días para pacientes hospitalizados : estudio piloto

      , , , ,

      European Journal of Psychotraumatology

      Taylor & Francis

      Posttraumatic stress disorder, intensive treatment, trauma-focused psychotherapy, eye movement desensitization and reprocessing, feasibility, preliminary effect, yoga, 创伤后应激障碍,强化治疗,创伤中心心理治疗,眼动脱敏和再加工,可行性,早期效果,瑜伽, Trastorno de estrés postraumático, tratamiento intensivo, psicoterapia centrada en el trauma, desensibilización y reprocesamiento por movimientos oculares, viabilidad, efecto preliminar, yoga, • This pilot study investigated the potential benefits of a five-day inpatient treatment programme with EMDR and trauma-informed yoga for patients with PTSD. • After two weeks, nine out of 12 patients reported a reliable change in self-reported PTSD symptoms. • Although further research is needed to properly investigate the effects, the treatment programme was promising in showing a reduction in symptoms in a short time frame.

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          ABSTRACT

          Background: Trauma-focused psychotherapies for posttraumatic stress disorder (PTSD) have been demonstrated to be efficacious, but also have considerable non-response and dropout rates. Intensive treatment may lead to faster symptom reduction, which may contribute to treatment motivation and thereby to reduction of dropout.

          Objective: The aim of the current study was to investigate the feasibility and preliminary effectiveness of an intensive five-day inpatient treatment with Eye Movement Desensitization and Reprocessing (EMDR) and trauma-informed yoga for patients with PTSD.

          Method: A non-controlled pilot study with 12 adult patients with PTSD was conducted. At baseline the PTSD diagnosis was assessed with the Clinician-Administered PTSD Scale (CAPS-5) and comorbid disorders with the Mini International Neuropsychiatric Interview (MINI). Primary outcome was self-reported PTSD symptom severity (PTSD Check List for DSM-5; PCL-5) measured at the beginning of day 1 (T1), at the end of day 5 (T2) and at follow-up on day 21 (T3). Reliable change indexes (RCI) and clinically significant changes were calculated.

          Results: From T1 to T3, PTSD symptoms significantly improved with a large effect size (Cohen’s d = 0.91). Nine of the 11 patients who completed treatment showed reliable changes in terms of self-reported PTSD. At T3, two of the patients no longer met criteria for PTSD as measured with the PCL-5. One patient dropped out after the first day. No serious adverse events occurred.

          Conclusions: The majority of patients in our pilot study experienced symptom reduction consistent with reliable changes in this five-day inpatient treatment with EMDR and yoga. Randomized controlled trials – with longer follow up periods – are needed to properly determine efficacy and efficiency of intensive clinical treatments for PTSD compared to regular treatment. This is one of the first studies to show that intensive EMDR treatment is feasible and is indicative of reliable improvement in PTSD symptoms in a very short time frame.

           

          Planteamiento: Se ha demostrado que las psicoterapias centradas en el trauma para el TEPT son eficaces, pero también tienen tasas considerables de falta de respuesta y abandono. El tratamiento intensivo puede llevar a una reducción más rápida de los síntomas, lo que puede contribuir a la motivación para el tratamiento y, por lo tanto, a la reducción del abandono.

          Objetivo: El objetivo del presente estudio fue investigar la viabilidad y eficacia preliminar de un tratamiento intensivo de 5 días para pacientes hospitalizados con Desensibilización y Reprocesamiento por Movimientos Oculares (EMDR) y yoga basado en el trauma para pacientes con TEPT.

          Método: Se realizó un estudio piloto no controlado con 12 pacientes adultos con TEPT. Al inicio del estudio, se evaluó el diagnóstico de TEPT con el CAPS-5 y los trastornos comórbidos con el MINI. El resultado principal fue la gravedad de los síntomas de PTSD por medio de autoinforme (PCL-5) medida al comienzo del día 1 (T1), al final del día 5 (T2) y en el seguimiento el día 21 (T3). Se calcularon los índices de cambio fiable (RCI, por sus siglas en inglés) y los cambios clínicamente significativos.

          Resultados: De T1 a T3, los síntomas de TEPT mejoraron significativamente con un tamaño de efecto grande ( d de Cohen = 0,91) y 9 de los 11 pacientes que completaron el tratamiento mostraron cambios fiables en términos de auto-informes de TEPT. En T3, dos de los pacientes ya no cumplían los criterios para el trastorno de estrés postraumático medido con el PCL-5. Un paciente se retiró después del primer día. No se produjeron eventos adversos graves.

          Conclusiones: la mayoría de los pacientes en nuestro estudio piloto experimentaron una reducción de síntomas consistente con cambios fiables en este tratamiento de 5 días con EMDR y yoga. Se necesitan ensayos controlados aleatorios, con períodos de seguimiento más largos, para determinar adecuadamente la eficacia y la eficiencia de los tratamientos clínicos intensivos para el TEPT en comparación con el tratamiento habitual. Este es uno de los primeros estudios que demuestra que el tratamiento intensivo con EMDR es factible y es indicativo de una mejora fiable en los síntomas de TEPT después de un período de tiempo muy corto.

           

          背景:创伤中心的 PTSD心理治疗已被证实有效,但同时也有不容忽视的无效者和脱落率。

          目标:本研究的目的是考察用于治疗PTSD 的一个为期5天的住院病人强化治疗的可行性和早期有效性,治疗中使用眼动脱敏和再强化(EMDR)和创伤瑜伽。

          方法:在无控制组实验中使用12名成年PTSD病人。在基线期,使用 CAPS-5进行PTSD 诊断,使用 MINI 进行工病诊断。主要结果使用自评的 PTSD 症状严重度(PCL-5),在第一天开始(T1),第5天结束(T2)和第21天的追踪期(T3)。计算可靠改变指数(RCI)和临床显著改变。

          结果:从 T1到T3的 PTSD 症状显著改善,效应值较大(Cohen’s d = 0.91) 。11个完整完成治疗的病人中的9个显示了自评PTSD的可靠改变。在 T3,两个病人不再符合 PCL-5的PTSD 诊断标准。一个病人在第一天之后脱落。没有出现严重的负面事件。

          结论:大部分的病人在我们的试验研究中体验了症状减轻,并在使用 EMDR和瑜伽的5天

          住院病人治疗中得到保持。还需要(更长追踪期的)随机对照试验将这个 PTSD强化临床治疗和普通治疗进行对比,对其效果和效率进行适当的验证。这是展示强化 EMDR 治疗可行性的比较早的研究,在比较短的时间框架下显示了 PTSD 症状可靠的改善。

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          Most cited references 29

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          Psychometric properties of the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5) in veterans.

          This study examined the psychometric properties of the posttraumatic stress disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (PCL-5; Weathers, Litz, et al., 2013b) in 2 independent samples of veterans receiving care at a Veterans Affairs Medical Center (N = 468). A subsample of these participants (n = 140) was used to define a valid diagnostic cutoff score for the instrument using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5; Weathers, Blake, et al., 2013) as the reference standard. The PCL-5 test scores demonstrated good internal consistency (α = .96), test-retest reliability (r = .84), and convergent and discriminant validity. Consistent with previous studies (Armour et al., 2015; Liu et al., 2014), confirmatory factor analysis revealed that the data were best explained by a 6-factor anhedonia model and a 7-factor hybrid model. Signal detection analyses using the CAPS-5 revealed that PCL-5 scores of 31 to 33 were optimally efficient for diagnosing PTSD (κ(.5) = .58). Overall, the findings suggest that the PCL-5 is a psychometrically sound instrument that can be used effectively with veterans. Further, by determining a valid cutoff score using the CAPS-5, the PCL-5 can now be used to identify veterans with probable PTSD. However, findings also suggest the need for research to evaluate cluster structure of DSM-5. (PsycINFO Database Record
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            The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): Development and Initial Psychometric Evaluation in Military Veterans.

            The Clinician-Administered PTSD Scale (CAPS) is an extensively validated and widely used structured diagnostic interview for posttraumatic stress disorder (PTSD). The CAPS was recently revised to correspond with PTSD criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). This article describes the development of the CAPS for DSM-5 (CAPS-5) and presents the results of an initial psychometric evaluation of CAPS-5 scores in 2 samples of military veterans (Ns = 165 and 207). CAPS-5 diagnosis demonstrated strong interrater reliability (к = .78 to 1.00, depending on the scoring rule) and test-retest reliability (к = .83), as well as strong correspondence with a diagnosis based on the CAPS for DSM-IV (CAPS-IV; к = .84 when optimally calibrated). CAPS-5 total severity score demonstrated high internal consistency (α = .88) and interrater reliability (ICC = .91) and good test-retest reliability (ICC = .78). It also demonstrated good convergent validity with total severity score on the CAPS-IV (r = .83) and PTSD Checklist for DSM-5 (r = .66) and good discriminant validity with measures of anxiety, depression, somatization, functional impairment, psychopathy, and alcohol abuse (rs = .02 to .54). Overall, these results indicate that the CAPS-5 is a psychometrically sound measure of DSM-5 PTSD diagnosis and symptom severity. Importantly, the CAPS-5 strongly corresponds with the CAPS-IV, which suggests that backward compatibility with the CAPS-IV was maintained and that the CAPS-5 provides continuity in evidence-based assessment of PTSD in the transition from DSM-IV to DSM-5 criteria. (PsycINFO Database Record
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              The diagnostic accuracy of the PTSD checklist: a critical review.

              The PTSD Checklist (PCL) is the most frequently used self-report measure of PTSD symptoms. Although the PCL has been in use for nearly 20 years and over a dozen validation studies have been conducted, this paper provides the first comprehensive review of its diagnostic utility. Eighteen diagnostic accuracy studies of the PCL are presented, followed by an examination of the potential roles of spectrum effects, bias, and prevalence in understanding the variation in sensitivity, specificity, and other operating characteristics across these studies. Two related issues as to the interchangeability of the PCL's three versions (civilian, military, and specific) and various scoring methods are also discussed. Findings indicate that the PCL has several strengths as a PTSD screening test and suggest that it can be a useful tool when followed by a second-tier diagnostic test such as a standardized interview. However, the PCL's operating characteristics demonstrate significant variation across populations, settings, and research methods and few studies have examined such factors that may moderate the PCL's utility. Recommendations and cautions regarding the use of the PCL as a clinical screening test, a diagnostic tool in research, and as an estimator of PTSD population prevalence are provided. Published by Elsevier Ltd.
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                Author and article information

                Journal
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                ZEPT
                zept20
                European Journal of Psychotraumatology
                Taylor & Francis
                2000-8066
                2018
                05 February 2018
                : 9
                : 1
                Affiliations
                [ a ] Foundation Centrum ’45 | partner in Arq Psychotrauma Expert Group , Diemen, The Netherlands
                [ b ] Department of Psychiatry, Academic Medical Center at the University of Amsterdam , Amsterdam, The Netherlands
                [ c ] Arq Psychotrauma Expert Group , Diemen, The Netherlands
                Author notes
                CONTACT Mayaris Zepeda Méndez m.zepeda.mendez@ 123456centrum45.nl Foundation Centrum ’45 , Rijnzichtweg 35, 2342 AX Oegstgeest, The Netherlands
                [*]

                These authors contributed equally to this work.

                Article
                1425575
                10.1080/20008198.2018.1425575
                5804727
                © 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 1, Tables: 4, References: 46, Pages: 10
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