Trauma-focused treatments for refugee children: study protocol for a randomized controlled trial of the effectiveness of KIDNET versus EMDR therapy versus a waitlist control group (KIEM)
Merel E. VeluIrene J. M. MartensMona ShahabCarlijn de RoosRuud A. JongedijkMichaela SchokTrudy Mooren
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Abstract Background Prevalence of posttraumatic stress disorder (PTSD) in refugees is reportedly higher in comparison to the general population. Refugee children specifically are often coping with trauma and loss and are at risk for mental health difficulties. With staggering numbers of people seeking refuge around the world and 50% being 18 years or younger, research examining the effects of trauma-focused therapies for refugee children with PTSD is highly needed. Both Eye Movement Desensitization and Reprocessing (EMDR) therapy and the child version of Narrative Exposure Therapy (KIDNET) have been used for refugees, although these treatment methods have not been systematically compared. The aim of the current study is to investigate the effectiveness of EMDR and KIDNET, compared to a waitlist control group and with each other, offered to refugee children. Methods A randomized controlled three-arm trial has been designed. The primary outcome is PTSD diagnosis and symptom severity assessed with the Clinician-Administered PTSD Scale for Children DSM5 (CAPS-CA-5) at baseline (T1), 1 month post-treatment, or after 8 weeks of waiting (T2) and 3 months follow-up (T3). Additionally, instruments to assess posttraumatic stress symptoms, behavioral and emotional problems, and quality of life perception in children aged 8–18 are conducted at T1, T2, and T3. Discussion This is the first RCT that examines the effectiveness of EMDR and KIDNET in refugee children aged 8–18 years specifically, compared to a waitlist control group intended to reduce PTSD diagnosis and severity of posttraumatic stress symptoms and comorbid complaints in a growing and challenging population. Trial registration Dutch Trial Register NL40769 . Retrospectively registered on June 16, 2021.Keywords:
Exposure therapy
Traumatic stress
Psychological Trauma
Eye movement desensitization and reprocessing (EMDR) is a recently developed method for working through traumatic memories and related psychological problems. Recent literature reviews find strong support for EMDR's value in trauma therapy. The first studies using EMDR with children and adolescents yield similar findings. A case is presented to illustrate the procedure as used in clinical practice. EMDR appears to be a promising new resource for helping children and adolescents recover from trauma and loss.
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Methods Post-traumatic Stress Disorder (PTSD) is a disabling anxiety disorder that is highly prevalent among members of the Armed Services who have served in combat operations.1 Evidence-based cognitive behavioral therapies for PTSD include Cognitive Processing Therapy (CPT), Prolonged Exposure (PE) therapy, and Eye Movement Desensitization and Reprocessing (EMDR) which lead to clinically improved outcomes in ~50% of all treated cases2-4 and typically require between 8-15 treatment sessions. Pharmacological approaches to treating PTSD do not resolve the cause of PTSD and patients frequently experience side effects and withdrawal. Accelerated Resolution Therapy (ART) is a new exposure-based therapy that uses eye movements and is designed to be brief (i.e. 1-5 treatment sessions).
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The comparative treatment efficiency of eye movement desensitization and reprocessing (EMDR) therapy and prolonged exposure (PE) therapy for the treatment of posttraumatic stress disorder (PTSD) was tested for 20 participants diagnosed with PTSD. Efficiency was operationalized as the total exposure time to traumatic memories during and between sessions; the number of trauma memories processed over the course of therapy; how many sessions were required to resolve the primary trauma; and lower subjective units of disturbance (SUD) levels after the initial treatment session. Participants were randomized to each condition and received 12 90-minute sessions of therapy over 6 weeks. Symptoms were assessed by treatment-blind assessors at posttreatment, and at 3 and 6 months follow-up. Results demonstrated a significant decrease in symptoms posttreatment for PTSD ( d = .64), depression ( d = .46), anxiety ( d = .52) and stress ( d = .57) for both groups, which was maintained at 3 months. At 6 months there was a small increase in symptoms compared to the 3-month time point on the Clinician-Administered PTSD Scale (CAPS) but no significant change in any self-report symptoms EMDR was significantly more efficient than PE. EMDR participants had less total exposure time to traumatic memories when homework hours were included ( d = .66), reported lower SUD scores after the first session ( d = .45), required fewer sessions for the target memory to decrease to near zero distress levels ( d = .84), and processed more traumatic memories.
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Objective: To demonstrate the efficacy of EMDR in complex multiple psychological
trauma after failed drug treatment from selective serotonin reuptake inhibitor (SSRI) in a
diagnosed case of post traumatic stress disorder (PTSD).
Material and method: Single participant of this case study, a sitting session judge of
judicial governmental scaffold reported to this mental health tertiary care facility at his own
accord with features of intense anxiety, depression, maladjustment issues and posttraumatic
stress for a duration of several months. As a partial responder to full trial of SSRI
he was enrolled for EMDR therapy to address his symptoms of intense anxiety, panic
attacks, being overwhelmingly fearful, depressed, low self-esteem, inappropriate feelings
of guilt, flashbacks, avoidance, nightmares, hyper-arousal and inability to perform as a
judicial head in active war stricken area of northern Pakistan. Complete psychiatric
evaluation was carried out and after the discontinuation of SSRIs he was scored on Impact
of Event Scale (IES). He fulfilled the diagnostic criteria for PTSD as evaluated by the
English version of the PTSD module of the Structured Clinical Interview for DSM-IV
administered once before commencement of EMDR. Safe place of the client was
established and 8 staged protocol of EMDR was started with him. Multiple EMDR sessions
were conducted.
Result: The case presented in this paper had multiple psychological trauma forms and
failed drug treatment and yet it was observed that EMDR provided marked improvement in
all the domains of his deficits and this was at a prompt speed as compared to cognitive
behavioural therapy (CBT) which usually takes longer duration of therapy to achieve
similar results.
Conclusion: EMDR provides marked improvement in all domains of complex mental
trauma and traumatic memories. Improvement attained was prompt and enduring as
compared to other forms of established therapies and drug treatment indicating permanent
changes happening at neurobiological levels of brain.
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Post-traumatic stres disorder (PTSD) is a psychiatric disorder that is characterised with autonomic, dysphoric and cognitive signs together with affective numbing, distressed reexperiencing and avoidance from previous traumatic events at a person who has encountered, lived or heard an excessive traumatic event.
EMDR is a psychological method which has proven to be effective and it brings together elements of well-established approaches such as psychodynamic, cognitive, behavioral and client-centered approaches.
In this paper treatment process with Eye Movement Desensitization and Reprocessing (EMDR) of a case who shows signs of post-traumatic stress disorder after a car accident and the need for using this method by clinicians more frequent and widespread at post-traumatic stress disorder patients will be discussed.
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Traumatic experiences can lead to posttraumatic stress disorder (PTSD). For young children, even minor, inconspicuous looking events can lead to posttraumatic stress symptoms. Trauma-focused treatment with Eye Movement Desensitization and Reprocessing (EMDR) offers children an age-adapted intervention to help them successfully process traumatic experiences. So far, there has been a lack of well evaluated trauma-focused treatments for young children.These case series examine the effectiveness of a short-term treatment with EMDR therapy for children showing PTSD symptoms after experiencing a single incident induced trauma. Five children between 5 and 10 years of age who developed PTSD after a single incident trauma received a manualized EMDR treatment for 6 weeks (mean number of sessions: seven including a mean number of EMDR sessions: 3.4). Posttraumatic stress symptoms were assessed prior to treatment, following treatment and at a 3-month follow-up with standardized instruments for caregivers and children.PTSD symptoms decreased for all children after completing the treatment from clinical to non-clinical level. Reductions in vegetative hyperarousal, fears and clinging behaviour were achieved. Furthermore, reductions in the parental stress levels, as well as a recovery of everyday routine and everyday stability were observed.Short-term EMDR treatment appears to be a promising treatment for single incident trauma in young children providing a potentially successful quick and safe psychological treatment for children. Results contribute to the knowledge of feasibility and acceptability of short-term, trauma-focused treatments of children with EMDR. Replication of the results of these case series in larger samples using a randomized controlled design is warranted.
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Methods Posttraumatic Stress Disorder (PTSD) is a prevalent, disabling anxiety disorder.1 Psychotherapies used to treat PTSD, including cognitive behavioral therapies (CBT) and Eye Movement Desensitization and Reprocessing (EMDR), may require long-term treatment2 and provide only partial resolution of symptoms. Similarly, pharmacological approaches to treating PTSD do not resolve the cause of PTSD and clients frequently experience side effects and withdrawal. Accelerated Resolution Therapy (ART), a new eye movement, exposure-based therapy, is brief (i.e. 1-5 sessions) and does not require an established client/therapist relationship.
Exposure therapy
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