Case Report
Abstract
There is mounting evidence suggesting that by increasing the frequency of treatment sessions, posttraumatic stress disorder (PTSD) treatment outcomes significantly improve. As part of an ongoing research project, this study examined the safety and effectiveness of intensive eye movement desensitization and reprocessing (EMDR) therapy in a group of seven (four female) patients suffering from complex PTSD and multiple comorbidities resulting from childhood sexual abuse, physical abuse, and/or work and combat-related trauma. Treatment was not preceded by a preparation phase and consisted of 2 × 4 consecutive days of EMDR therapy administered in morning and afternoon sessions of 90 minutes each, interspersed with intensive physical activity and psychoeducation. Outcome measures were the Clinician-Administered PTSD Scale (CAPS) and the PTSD Symptom Scale Self-report questionnaire (PSS-SR). During treatment, neither personal adverse events nor dropout occurred. CAPS scores decreased significantly from pre- to posttreatment, and four of the seven patients lost their PTSD diagnosis as established with the CAPS. The results were maintained at 3-month follow-up. Effect sizes (Cohen’s d) on the CAPS and PSS-SR were large: 3.2, 1.7 (prepost) and 2.3, 2.1 (prefollow-up), respectively. The results of this case series suggest that an intensive program using EMDR therapy is a potentially safe and effective treatment alternative for complex PTSD. The application of massed, consecutive days of treatments using EMDR therapy for patients suffering from PTSD, particularly those with multiple comorbidities, merits more clinical and research attention.
Figures
Tables
Event | Assessment Instrument | Duration |
---|---|---|
Intake by phone | Intake questionnaire | 20 minutes |
Intake 1 | MINI | 2.5 hours |
PSS-SR | ||
Intake 2 | CAPS | 2.5 hours |
ITECa | ||
First 4 days of treatment | Day 1: PSS-SR | 4 days clinic |
Home | 3 days | |
Second 4 days of treatment | Day 1: PSS-SR | 4 days clinic |
Posttreatment | CAPS | 1 day |
10 days after treatment | PSS-SR | |
Follow-up: 1 and 2 months after posttreatment | PSS-SR | Sent by e-mail |
Follow-up: 3 months after posttreatment | CAPS | 2 hours |
PSS-SR |
Note. MINI = Mini-International Neuropsychiatric Interview; PSS-SR = PTSD Symptom Scale Self-report questionnaire; CAPS = Clinician-Administered PTSD Scale; ITEC = interview for traumatic events in childhood.
[i] aThe ITEC form will be provided to the patient to fill out at home and hand in at the second intake.
PSS-SR | CAPS | End-State CAPS | ||||||
---|---|---|---|---|---|---|---|---|
Pre | Post | Follow-Up | Pre | Post | Follow-Up | Post | Follow-Up | |
Harry | 23 | 11 | 27 | 99 | 45 | 70 | Response | Response |
Jenny | 30 | 14 | 20 | 86 | 47 | 47 | Response | Response |
Bob | 40 | 36 | NA | 77 | 22 | NA | Loss of diagnosis | NA |
Wilma | 29 | 25 | 10 | 57 | 44 | 43 | Loss of diagnosis | Loss of diagnosis |
Hilda | 41 | 1 | 0 | 104 | 2 | 0 | Remission | Remission |
James | 34 | 6 | 3 | 99 | 15 | 13 | Remission | Remission |
Ellen | 23 | NA | NA | 89 | NA | NA | NA | NA |
Total | 31.4 | 15.5 | 12 | 87.3 | 28.5 | 34.6 | ||
SD | (7.3) | (12.9) | (11.4) | (16.2) | (18.3) | (28.0) |
Note. Response is the reduction of 10 or more points of the CAPS score. Loss of diagnosis as Response plus no longer meeting either B, C, or D criteria and a score <45. Remission as Loss of diagnosis plus a score <20. PSS-SR = PTSD Symptom Scale Self-report questionnaire; CAPS = Clinician-Administered PTSD Scale; NA = not available.
Period | Abstract | Full | Total | |
---|---|---|---|---|
Apr 2024 | 81 | 99 | 33 | 213 |
Mar 2024 | 76 | 85 | 42 | 203 |
Feb 2024 | 22 | 79 | 45 | 146 |
Jan 2024 | 37 | 76 | 41 | 154 |
Dec 2023 | 32 | 73 | 34 | 139 |
Nov 2023 | 49 | 60 | 40 | 149 |
Oct 2023 | 37 | 42 | 28 | 107 |
Sep 2023 | 26 | 40 | 33 | 99 |
Aug 2023 | 23 | 38 | 25 | 86 |
Jul 2023 | 42 | 126 | 33 | 201 |
Jun 2023 | 27 | 61 | 46 | 134 |
May 2023 | 23 | 56 | 34 | 113 |
Apr 2023 | 27 | 77 | 50 | 154 |
Mar 2023 | 38 | 86 | 56 | 180 |
Feb 2023 | 34 | 69 | 41 | 144 |
Jan 2023 | 44 | 88 | 40 | 172 |
Dec 2022 | 7 | 43 | 33 | 83 |
Nov 2022 | 20 | 45 | 52 | 117 |
Oct 2022 | 40 | 63 | 33 | 136 |
Sep 2022 | 42 | 40 | 31 | 113 |
Aug 2022 | 33 | 34 | 19 | 86 |
Jul 2022 | 30 | 45 | 26 | 101 |
Jun 2022 | 30 | 91 | 21 | 142 |
May 2022 | 39 | 37 | 52 | 128 |
Apr 2022 | 25 | 40 | 33 | 98 |
Mar 2022 | 28 | 47 | 53 | 128 |
Feb 2022 | 16 | 43 | 30 | 89 |
Jan 2022 | 28 | 33 | 40 | 101 |
Dec 2021 | 28 | 59 | 52 | 139 |
Nov 2021 | 34 | 59 | 39 | 132 |
Oct 2021 | 32 | 64 | 36 | 132 |
Sep 2021 | 16 | 52 | 25 | 93 |
Aug 2021 | 15 | 50 | 25 | 90 |
Jul 2021 | 13 | 56 | 18 | 87 |
Jun 2021 | 56 | 176 | 24 | 256 |
May 2021 | 99 | 180 | 31 | 310 |
Apr 2021 | 105 | 233 | 39 | 377 |
Mar 2021 | 128 | 233 | 46 | 407 |
Feb 2021 | 68 | 197 | 27 | 292 |
Jan 2021 | 60 | 147 | 43 | 250 |
Dec 2020 | 34 | 69 | 24 | 127 |
Nov 2020 | 44 | 82 | 26 | 152 |
Oct 2020 | 45 | 101 | 35 | 181 |
Sep 2020 | 39 | 94 | 19 | 152 |
Aug 2020 | 48 | 95 | 17 | 160 |
Jul 2020 | 51 | 101 | 15 | 167 |
Jun 2020 | 33 | 131 | 26 | 190 |
May 2020 | 26 | 74 | 18 | 118 |
Apr 2020 | 44 | 73 | 25 | 142 |
Mar 2020 | 39 | 52 | 20 | 111 |
Feb 2020 | 48 | 73 | 20 | 141 |
Jan 2020 | 76 | 45 | 21 | 142 |
Dec 2019 | 27 | 34 | 14 | 75 |
Nov 2019 | 26 | 41 | 11 | 78 |
Oct 2019 | 22 | 38 | 15 | 75 |
Sep 2019 | 19 | 20 | 8 | 47 |
Aug 2019 | 3 | 12 | 11 | 26 |
Jul 2019 | 5 | 27 | 10 | 42 |
Jun 2019 | 29 | 37 | 14 | 80 |
May 2019 | 14 | 35 | 19 | 68 |
Apr 2019 | 16 | 43 | 18 | 77 |
Mar 2019 | 2 | 33 | 17 | 52 |
Feb 2019 | 12 | 25 | 15 | 52 |
Jan 2019 | 7 | 30 | 6 | 43 |
Dec 2018 | 32 | 21 | 5 | 58 |
Nov 2018 | 78 | 1 | 2 | 81 |
Oct 2018 | 67 | 3 | 4 | 74 |
Sep 2018 | 34 | 1 | 1 | 36 |
Aug 2018 | 16 | 3 | 7 | 26 |
Jul 2018 | 20 | 1 | 1 | 22 |
Jun 2018 | 4 | 0 | 2 | 6 |
May 2018 | 0 | 0 | 1 | 1 |