EMDR for children with medically related subthreshold PTSD: short-term effects on PTSD, blood-injection-injury phobia, depression and sleep

Background: Paediatric illness, injury and medical procedures are potentially traumatic experiences with a range of possible negative psychosocial consequences. To prevent psychosocial impairment and improve medical adherence, evidence-based psychotherapy should be offered if indicated. Eye movement desensitization and reprocessing (EMDR) has been found to reduce symptoms of posttraumatic stress disorder (PTSD) in adults. The evidence for the use with children is promising. Furthermore, recent studies indicate its effectiveness for the treatment of other psychological symptomatology. However, the effectiveness of EMDR in children with subthreshold PTSD after medically related trauma has not yet been investigated. Objective: Investigating the short-term effectiveness of EMDR on posttraumatic stress, anxiety, depression and sleep problems in children with subthreshold PTSD after hospitalization through a randomized controlled trial (RCT). Method: Following baseline screening of 420 children from various Dutch hospitals, 74 children (4–15 years old) with medically related subthreshold PTSD were randomized to EMDR (n = 37) or care-as-usual (CAU; n = 37). Follow-up assessment took place after M = 9.7 weeks. Generalized Estimating Equation (GEE) analyses were performed to examine the effectiveness of EMDR compared to CAU. Results: Children in both groups improved significantly over time on all outcomes. However, the EMDR group improved significantly more as to child-reported symptoms of blood-injection-injury (BII) phobia and depression, and child-, and parent-reported sleep problems of the child. There was no superior effect of EMDR compared to CAU on subthreshold PTSD symptom reduction. Conclusions: EMDR did not perform better than CAU in reducing PTSD symptoms in a paediatric sample of children with subthreshold PTSD after hospitalization. However, the study results indicate that EMDR might be superior in reducing symptoms of blood-injection-injury phobia, depression and sleep problems

Eye movement desensitization and reprocessing (EMDR) in children and adolescents with subthreshold PTSD after medically related trauma: design of a randomized controlled trial.

Background: Three in every 10 children and adolescents admitted to a hospital or undergoing medical treatment develop subthreshold symptoms of posttraumatic stress disorder (PTSD). When untreated, subthreshold PTSD can have a serious impact on psychosocial functioning, quality of life and long-term psychopathology. However, research investigating subthreshold PTSD and its treatment following paediatric medical interventions and/or hospitalization is scarce. Eye Movement Desensitization and Reprocessing (EMDR) is a fast and non-invasive psychosocial treatment for posttraumatic stress complaints. However, the effectiveness of EMDR in paediatric patients with subthreshold PTSD has not previously been systematically investigated. Objective: Describing the design of a randomized controlled trial (RCT) set up to evaluate the effectiveness of EMDR in children with subthreshold PTSD after hospitalization. Method: Children aged 4–15 years who have undergone a one-time (trauma type I) or repeated (trauma type II) hospitalization up to five years ago will be included. Participating children will be first screened with a standardized questionnaire for PTSD-symptoms. Subsequently, children with subthreshold PTSD will be randomly assigned to (1) approximately six sessions of standardized EMDR or (2) care as usual (CAU). Children with full diagnostic PTSD do not participate in the RCT, but are referred for direct treatment. Follow-up measurements will take place after eight weeks and eight months. Discussion: Considering the scarce evidence for the effectiveness of EMDR in children with medically related trauma, clinicans, researchers and children treated in hospitals can benefit from this study. Potential strengths and limitations of this study are discussed. Trial Registration: Netherlands Trial Register NTR580

Trauma treatment for children and adolescents: stabilizing or trauma-focused therapy?

Child abuse is widely prevalent in the Netherlands, and the strong social and political focus now put on the issue is fully warranted. Prevalence studies have estimated that around 3 % of all Dutch children experience some form of abuse or neglect (Alink et al., 2011; Lamers-Winkelman, Slot, Bijl, & Vijlbrief, 2007; Van IJzendoorn et al., 2007). The most common forms of maltreatment are neglect and domestic violence. Being a witness to domestic violence is a form of child maltreatment. In 2012, approximately 6,000 children under age 18 were accommodated in some kind of women’s or homeless facility in the Netherlands. Half of these were in women’s refuges after fleeing domestic violence. Research by Brilleslijper-Kater et al. (2010) found that such children had experienced an average of seven potentially distressing or traumatic events; most had directly experienced domestic violence by witnessing verbal or physical violence between their parents. A study in the Therapeutic Foster Care treatment program at De Bascule found that nearly a quarter of such children had experienced five or more different placements outside the parental home. Persistent relocations like these have an adverse impact on child development. Maltreatment leads to serious problems in children’s psychosocial functioning. Mental health problems may include posttraumatic stress disorder, other anxiety disorders, depressive disorder, attachment disorder, and conduct disorder. Such conditions are detrimental to a child’s development and may culminate in problems in the family, problems at school, and problems with other children (Jonkman, Verlinden, Bolle, Boer, & Lindauer, 2013; Lindauer & Boer, 2012). The negativ

Using neurobiological measures to predict and assess treatment outcome of psychotherapy in posttraumatic stress disorder: systematic review

Trauma-focused cognitive-behavioral therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) are effective treatments for posttraumatic stress disorder. However, little is known about their neurobiological effects. The usefulness of neurobiological measures to predict the treatment outcome of psychotherapy also has yet to be determined. Systematic review of randomized controlled trials (RCTs) focused on neurobiological treatment effects of TF-CBT or EMDR and trials with neurobiological measures as predictors of treatment response. We included 23 publications reporting on 16 separate trials. TF-CBT was compared with a waitlist in most trials. TF-CBT was associated with a decrease in heart rate and blood pressure and changes in activity but not in volume of frontal brain structures and the amygdala. Neurobiological changes correlated with changes in symptom severity. EMDR was only tested against other active treatments in included trials. We did not find a difference in neurobiological treatment effects between EMDR and other treatments. Publications on neurobiological predictors of treatment response showed ambiguous results. TF-CBT was associated with a reduction of physiological reactivity. There is some preliminary evidence that TF-CBT influences brain regions involved in fear conditioning, extinction learning and possibly working memory and attention regulation; however, these effects could be nonspecific psychotherapeutic effects. Future trials should use paradigms aimed specifically at these brain regions and physiological reactivity. There are concerns regarding the risk of bias in some of the RCTs, indicating that methodologically more rigorous trials are required. Trials with neurobiological measures as predictors of treatment outcome render insufficient results to be useful in clinical practic

A cross-cultural validation of the Clinician Administered PTSD Scale for Children and Adolescents in a Dutch population

Background: Trauma-focused interventions for children could be administered more efficiently and effectively if posttraumatic stress disorder (PTSD) and related symptoms were first investigated by a reliable and valid instrument. The Clinician Administered PTSD Scale for Children and Adolescents (CAPS-CA) is the gold standard for the assessment of PTSD. Until now no cross-cultural validation study has been published in an English peer-reviewed journal. Objective: This study aimed at the cross-cultural validation of the Dutch CAPS-CA. Method: A total of 112 children between the age of 8 and 18 were recruited at two trauma centers. Children were interviewed with the CAPS-CA and the Anxiety Disorders Interview Schedule Child (ADIS-C) version, and each filled out the Children's Revised Impact of Events Scale (CRIES-13), the Revised Child Anxiety and Depression Scale (RCADS), and the Strength and Difficulties Questionnaire (SDQ). One caretaker of each child was also interviewed by means of the ADIS Parent (ADIS-P) version and filled out the RCADS and SDQ. Results: The Dutch CAPS-CA showed as good internal consistency, inter-rater reliability, convergent and divergent validity, and concurrent validity as the original English version. Similar to the original version, we found better psychometric properties in terms of internal consistency and convergent validity for children 13 years and older than for children younger than 13 years. Conclusions: The Dutch CAPS-CA is as reliable and valid as the original English versio

Home-based parent–child interaction therapy to prevent child maltreatment: A randomized controlled trial

High treatment attrition and limited reach of mental health services for at-risk families remains an important problem in order to effectively address the global concern of child maltreatment and child disruptive behavior problems. This study evaluated the effectiveness of a home-based and time-limited adaptation of Parent–Child Interaction Therapy (PCIT). Twenty families with children (70% boys) aged between three and seven years were randomly assigned to an immediate treatment group (IT, n = 10) or a waitlist control group (WL, n = 10). After receiving treatment and compared to mothers in the WL group, mothers in the IT group reported fewer child behavior problems and more improved parenting skills. Although initial analyses revealed no significant differences, additional analyses showed a significant decrease in the primary outcome of the study, namely child abuse potential, between the baseline and follow-up assessment for the total treated sample. A low treatment attrition rate (15%) was found, indicating higher accessibility of treatment for families. Findings suggest that the brief home-based PCIT is a potentially effective intervention to prevent child maltreatment and disruptive behavior problems in at-risk families. Results also reinforce the importance of addressing the specific needs of these families to increase treatment effectiveness