PTSD Treatment and Childhood Trauma

What Is PTSD (Post-Traumatic Stress Disorder)?

Post-traumatic stress disorder (PTSD) is a psychological condition that develops as a result of trauma a person has experienced. Traumatic events profoundly affect a person both emotionally and psychologically. Trauma can occur at any age, not just in childhood.

The study entitled "TSSB tedavisi için Çocukluk Çağı Travmalarının ayrıntıları ile detaylı bir şekilde temas etmek şart değildir (Detailed Engagement with Childhood Trauma Memories Is Not Essential for PTSD Treatment)," published in The British Journal of Psychiatry, a leading journal in the field of psychology, addresses approaches to patients with a history of childhood trauma.

The same study was also published in JAMA Network under the title "Çocukluk travması sonrası travma sonrası stres bozukluğu olan yetişkinler için tedavi olarak Imagery Rescripting ve EMDR: Randomize Klinik Çalışma (Imagery Rescripting and EMDR as Treatments for Adults with Post-Traumatic Stress Disorder Following Childhood Trauma: A Randomized Clinical Trial)."

Study Background

This study was needed to improve outcomes for adults with post-traumatic stress disorder resulting from adverse childhood experiences (Ch-PTSD), by investigating effective treatments that are well tolerated by patients.

Study Aim

The primary aim of this study was to compare the effectiveness of two trauma-focused treatment methods—Imagery Rescripting (ImRs) and Eye Movement Desensitization and Reprocessing (EMDR)—for treating post-traumatic stress disorder (PTSD) associated with childhood trauma.

Study Methods 

An international, multicenter, randomized clinical trial was conducted with adults who had experienced childhood trauma before the age of 16 and had post-traumatic stress disorder (PTSD) associated with childhood trauma. Participants were randomized to treatment conditions and assessed at multiple time points by blinded assessors. Participants received twelve 90-minute sessions of ImRs or EMDR, twice a week.

Participants were allowed to end treatment before completing the 12 sessions if the coordinator agreed that further treatment was unnecessary. In such cases, assessments continued at the originally scheduled time points. All treatment sessions were audio- or video-recorded. The first session was intended to introduce the treatment model, and a list of trauma memories was compiled for processing. In the ImRs condition, participants practiced rescripting with a less negative (non-traumatic) memory. In the EMDR condition, no practice exercise was conducted because of time constraints. Trauma processing was required in every subsequent session.

The Treatment Process for Post-Traumatic Stress Disorder (PTSD)

For ImRs, therapists were required to have basic training in cognitive behavioral therapy, while EMDR required Level 1 basic training. For both treatments, an additional two days of training specifically focused on treating childhood trauma were required. Before beginning to treat participants enrolled in IREM, therapists had to demonstrate competence in at least two practice cases, which were video-recorded and assessed by the site coordinator. Therapists received ongoing peer supervision throughout the randomized controlled trial (RCT). Treatment integrity was assessed by raters using randomly selected recordings covering 60 participants from three countries. Each participant recording was rated using a modified EMDR Therapy Fidelity Rating Scale, with each item scored from 0 to 2. On the ImRs Adherence and Competence Scale, each item was scored from 0 to 4. Satisfactory adherence was demonstrated, with mean ratings of 1.34 for EMDR and 3.19 for ImRs. Analysis of the ratings for Dutch participants showed that the treatment conditions were statistically distinguishable.

The Treatment Process for Post-Traumatic Stress Disorder (PTSD): ImRs Therapy

The ImRs protocol developed by Arntz and Weertmen was followed. According to this protocol, in the first phase, the patient recalls a trauma memory from the perspective of their child self, including their thoughts, feelings, and needs. The patient is then guided to imagine a different ending, such as someone intervening to stop the abuse and attend to the child's other needs. During the first six treatment sessions, the therapist enters the imagery and intervenes. From the seventh session onward, the patient enters the imagery as their adult self and intervenes (the second phase). In the third phase, the patient re-experiences the event from the child's perspective, including the adult's intervention.

The Treatment Process for Post-Traumatic Stress Disorder (PTSD): EMDR Therapy

The eight-phase EMDR protocol developed by Shapiro was followed. The first session included an overall assessment, preparation, and identification of the core memory components of the first trauma to be processed (phases one, two, and three). The active trauma-processing phases, from phase three through phase eight, were repeated from the second session onward. In the 12th session, or earlier depending on the patient's progress, the focus was on current triggers and anticipatory anxiety about future events. The only deviation from the original EMDR protocol was to restrict strategies for overcoming blocks or imagery rescripting in order to prevent contamination between treatments.

Study Results

ImRs and EMDR were found to be effective in treating PTSD symptoms resulting from childhood trauma and in reducing other symptoms, such as depression, dissociation, and trauma-related cognitions. Low dropout rates indicated that the treatments were well tolerated by participants. The findings of this study provide evidence supporting the use of trauma-focused treatments for PTSD associated with childhood trauma.

In this study, two treatments that do not require prolonged recall of traumatic memories were found to be equally effective for adults with post-traumatic stress disorder (PTSD) resulting from childhood experiences.

Translation

Assistant Professor Alişan Burak Yaşar

Psychologist Kübra Nalçacı