Case Report

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Intensive EMDR to Treat Patients With Complex Posttraumatic Stress Disorder: A Case Series

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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

FIGURE 1.
Example of a treatment day of the treatment program.
sgremdr_11_2_84_fig01View in Context
FIGURE 2.
Observed trajectory of the Clinician-Administered PTSD Scale (n = 6).
sgremdr_11_2_84_fig02View in Context
FIGURE 3.
Observed trajectory of the PTSD Symptom Scale Self-report questionnaire (n = 6).
sgremdr_11_2_84_fig03View in Context

Tables

TABLE 1.
General Overview of the Treatment Program, Assessment Instruments, and Their Duration
EventAssessment InstrumentDuration
Intake by phoneIntake questionnaire20 minutes
Intake 1MINI2.5 hours
PSS-SR
Intake 2CAPS2.5 hours
ITECa
First 4 days of treatmentDay 1: PSS-SR4 days clinic
Home3 days
Second 4 days of treatmentDay 1: PSS-SR4 days clinic
PosttreatmentCAPS1 day
10 days after treatmentPSS-SR
Follow-up: 1 and 2 months after posttreatmentPSS-SRSent by e-mail
Follow-up: 3 months after posttreatmentCAPS2 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.

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TABLE 2.
Posttraumatic Stress Disorder Symptom Change According to the Clinician-Administered PTSD Scale and PTSD Symptom Scale Self-Report Questionnaire
PSS-SRCAPSEnd-State CAPS
PrePostFollow-UpPrePostFollow-UpPostFollow-Up
Harry231127994570ResponseResponse
Jenny301420864747ResponseResponse
Bob4036NA7722NALoss of diagnosisNA
Wilma292510574443Loss of diagnosisLoss of diagnosis
Hilda411010420RemissionRemission
James3463991513RemissionRemission
Ellen23NANA89NANANANA
Total31.415.51287.328.534.6
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.

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