Intensive Cognitive Therapy for PTSD: A Feasibility Study

Ehlers, Anke; Clark, David M.; Hackmann, Ann; Grey, Nick; Liness, Sheena; Wild, Jennifer; Manley, John; Waddington, Louise; McManus, Freda

doi:10.1017/s1352465810000214

Cited by 85 publications

(74 citation statements)

References 48 publications

(56 reference statements)

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“…The present results are largely in line with previous studies of similar intensive programs using PE or cognitive therapy (Blount et al, 2014;Ehlers et al, 2010Ehlers et al, , 2014Gantt & Tinnin, 2007;Hendriks et al, 2010;Lande et al, 2011). Although EMDR therapy has been administered intensively in previous studies, this case series was the first to evaluate an intensive treatment not only with EMDR therapy applied in a massed way of 3 hours per day but also in patients with complex presentations of PTSD.…”

Section: Resultssupporting

confidence: 89%

“…Therefore, to allow for a more rapid recovery of symptoms and negative effects of PTSD, several intensive ("massed") treatments for PTSD have been developed and tested in terms of applicability and effectiveness. For example, Ehlers and her group developed a consecutive days treatment consisting of 18 hours (90 minutes per day) of trauma-focused cognitive therapy over 5-7 working days (Ehlers et al, 2010). The efficacy of this intensive treatment program was determined among 121 patients suffering from chronic PTSD because of one or two discrete traumatic events in adulthood (Ehlers et al, 2014).…”

Section: Intensive Treatment For Posttraumatic Stress Disordermentioning

confidence: 99%

“…The results were also positive regarding dropout, varying from 0% (Blount et al, 2014;Ehlers et al, 2010;Hendriks et al, 2010;Lande et al, 2011) to 3% (Ehlers et al, 2014;Gantt & Tinnin, 2007). Although no adversities were reported (Ehlers et al, 2014;Gantt & Tinnin, 2007;Hendriks et al, 2010), it should be noted that these treatment programs did not contain a preparation phase prior to therapy aimed at improving emotion regulation and interpersonal skills (Ehlers et al, 2010;Gantt & Tinnin, 2007;Hendriks et al, 2010).…”

mentioning

confidence: 95%

“…Intensive EMDR Therapy to Treat Patients With Complex PTSD exposed to single and discrete traumatic events in adulthood (Ehlers et al, 2010;Ehlers, Clark, Hackmann, McManus, & Fennell, 2005;Ehlers et al, 2014) but also in individuals with (complex) PTSD as a result of childhood sexual abuse and in those suffering from severe comorbidities (Gantt & Tinnin, 2007;Hendriks, de Kleine, van Rees, Bult, & van Minnen, 2010). Several studies reported on intensive cognitive-behavioral treatment programs for chronic PTSD showing positive effects on PTSD symptoms (Ehlers et al, 2010(Ehlers et al, , 2005(Ehlers et al, , 2014Gantt & Tinnin, 2007;Hendriks et al, 2010), albeit length and dose of these treatment programs differed considerably, varying from 5 working days with 30 treatment hours in total (Hendriks et al, 2010), 5-7 consecutive days consisting of 18-20 treatment hours (Ehlers et al, 2010(Ehlers et al, , 2014, 5-10 days with 7 or 8 hours treatment per day (Blount, Cigrang, Foa, Ford, & Peterson, 2014;Gantt & Tinnin, 2007) to a program of 3 weeks containing more than 5 treatment hours per day (Lande, Banks Williams, Francis, Gragnani, & Morin, 2011).…”

mentioning

confidence: 99%

“…Several studies reported on intensive cognitive-behavioral treatment programs for chronic PTSD showing positive effects on PTSD symptoms (Ehlers et al, 2010(Ehlers et al, , 2005(Ehlers et al, , 2014Gantt & Tinnin, 2007;Hendriks et al, 2010), albeit length and dose of these treatment programs differed considerably, varying from 5 working days with 30 treatment hours in total (Hendriks et al, 2010), 5-7 consecutive days consisting of 18-20 treatment hours (Ehlers et al, 2010(Ehlers et al, , 2014, 5-10 days with 7 or 8 hours treatment per day (Blount, Cigrang, Foa, Ford, & Peterson, 2014;Gantt & Tinnin, 2007) to a program of 3 weeks containing more than 5 treatment hours per day (Lande, Banks Williams, Francis, Gragnani, & Morin, 2011). The results were also positive regarding dropout, varying from 0% (Blount et al, 2014;Ehlers et al, 2010;Hendriks et al, 2010;Lande et al, 2011) to 3% (Ehlers et al, 2014;Gantt & Tinnin, 2007). Although no adversities were reported (Ehlers et al, 2014;Gantt & Tinnin, 2007;Hendriks et al, 2010), it should be noted that these treatment programs did not contain a preparation phase prior to therapy aimed at improving emotion regulation and interpersonal skills (Ehlers et al, 2010;Gantt & Tinnin, 2007;Hendriks et al, 2010).…”

mentioning

confidence: 99%

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

Bongaerts¹,

Minnen

Jongh

2017

J EMDR Prac Res

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There is mounting support for the notion that also, individuals with severe, or "complex," forms of PTSD respond positively to TFTs and that neither trauma history, comorbidity, nor severe dissociative symptoms negatively affect clients' response to TFTs Foa, Zoellner, Feeny, Hembree, & Alvarez-Conrad, 2002;Hagenaars, van Minnen, & Hoogduin, 2010;Jerud, Pruitt, Zoellner, & Feeny, 2016;Olatunji, Cisler, & Tolin, 2010;van den Berg et al., 2015;van Minnen, Arntz, & Keijsers, 2002;van Minnen, Harned, Zoellner, & Mills, 2012; 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 combatrelated trauma. Treatment was not preceded by a preparation phase and consisted of 2 3 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.

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Section: Resultssupporting

confidence: 89%

Section: Intensive Treatment For Posttraumatic Stress Disordermentioning

confidence: 99%

mentioning

confidence: 95%

mentioning

confidence: 99%

mentioning

confidence: 99%

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

Bongaerts¹,

Minnen

Jongh

2017

J EMDR Prac Res

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Effect of Developmentally Adapted Cognitive Processing Therapy for Youth With Symptoms of Posttraumatic Stress Disorder After Childhood Sexual and Physical Abuse

et al. 2019

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IMPORTANCE Despite the high prevalence, evidence-based treatments for abuse-related posttraumatic stress disorder (PTSD) in adolescents have rarely been studied. OBJECTIVE To examine whether developmentally adapted cognitive processing therapy (D-CPT) is more effective than a wait-list condition with treatment advice (WL/TA) among adolescents with PTSD related to childhood abuse. DESIGN, SETTING, AND PARTICIPANTS This rater-blinded, multicenter, randomized clinical trial (stratified by center) enrolled treatment-seeking adolescents and young adults (aged 14-21 years) with childhood abuse-related PTSD at 3 university outpatient clinics in Germany from July 2013 to June 2015, with the last follow-up interview conducted by May 2016. Of 194 patients, 88 were eligible for randomization. INTERVENTIONS Participants received D-CPT or WL/TA. Cognitive processing therapy was enhanced by a motivational and alliance-building phase, by including emotion regulation and consideration of typical developmental tasks, and by higher session frequency in the trauma-focused core CPT phase. In WL/TA, participants received treatment advice with respective recommendations of clinicians and were offered D-CPT after 7 months. MAIN OUTCOMES AND MEASURES All outcomes were assessed before treatment (baseline), approximately 8 weeks after the start of treatment, after the end of treatment (posttreatment), and at the 3-month follow-up. The primary outcome, PTSD symptom severity, was assessed in clinical interview (Clinician-Administered PTSD Scale for Children and Adolescents for DSM-IV [CAPS-CA]). Secondary outcomes were self-reported PTSD severity, depression, borderline symptoms, behavior problems, and dissociation. RESULTS The 88 participants (75 [85%] female) had a mean age of 18.1 years (95% CI, 17.6-18.6 years). In the intention-to-treat analysis, the 44 participants receiving D-CPT (39 [89%] female) demonstrated greater improvement than the 44 WL/TA participants (36 [82%] female) in terms of PTSD severity (mean CAPS-CA scores, 24.7 [95% CI, 16.6-32.7] vs 47.5 [95% CI, 37.9-57.1]; Hedges g = 0.90). This difference was maintained through the follow-up (mean CAPS-CA scores, 25.9 [95% CI, 16.2-35.6] vs 47.3 [95% CI, 37.8-56.8]; Hedges g = 0.80). Treatment success was greatest during the trauma-focused core phase. The D-CPT participants also showed greater and stable improvement in all secondary outcomes, with between-groups effect sizes ranging from 0.65 to 1.08 at the posttreatment assessment (eg, for borderline symptoms, 14.1 [95% CI, 8.0-20.2] vs 32.0 [95% CI, 23.8-40.2]; Hedges g = 0.91). CONCLUSIONS AND RELEVANCE Adolescents and young adults with abuse-related PTSD benefited more from D-CPT than from WL/TA. Treatment success was stable at the follow-up and generalized to borderline symptoms and other comorbidities. TRIAL REGISTRATION German Clinical Trials Register identifier: DRKS00004787

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Cognitive Therapy

and

Ehring

2014

The Wiley Handbook of Anxiety Disorders

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Intensive Cognitive Therapy for PTSD: A Feasibility Study

Cited by 85 publications

References 48 publications

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

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

Effect of Developmentally Adapted Cognitive Processing Therapy for Youth With Symptoms of Posttraumatic Stress Disorder After Childhood Sexual and Physical Abuse

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