Treating PTSD with Imagery Rescripting in underweight eating disorder patients: a multiple baseline case series study

Abstract

Background Eating disorder patients with posttraumatic stress disorder have worse treatment results regarding their eating disorder than patients without posttraumatic stress disorder. Many eating disorder patients with co-morbid posttraumatic stress disorder symptoms are not treated for posttraumatic stress disorder symptoms during an underweight state. We propose that treatment of posttraumatic stress disorder is possible for underweight patients and that their trauma symptoms decrease with the use of Imagery Rescripting. We also investigated whether treatment of trauma influences eating disorder pathology in general and the process of weight gain specifically. Method Ten patients in clinical treatment (BMI 14–16.5) participated. A multiple baseline design was used, with baseline varying from 6 to 10 weeks, a 6-week treatment phase, a 3-week follow-up period and a 3-month follow-up measurement. Data were analysed with mixed regression. Results Evidence was found that Imagery Rescripting had strong positive effects on posttraumatic stress disorder symptoms without interfering with eating disorder treatment. Positive effects were also found on a range of secondary emotional and cognitive measures. Conclusion Imagery Rescripting of traumatic memories is a possible and safe intervention for underweight eating disorder patients. It also had positive clinical effects. Trial registration Netherlands trial register (NTR) Trial NL5906 (NTR6094). Date of registration 09/23/2016. https://www.trialregister.nl/trial/5906.

Perspectives of underweight people with eating disorders on receiving Imagery Rescripting trauma treatment: a qualitative study of their experiences

“…With regard to other effects, we found that the participants did not all experience decrease of anger, guilt, and PTSD symptoms two weeks after the end of ImRs treatment. This is in line with the multiple baseline study, which found a significant reduction in these variables only after three months [ 21 ]. As it is important to realize in this population that significant reductions in symptoms occur only after a few months, we recommend that participants in further research are interviewed after three months.…”

“…Four participants experienced physical assault, 5 participants experienced sexual assault, 2 participants had other unwanted or uncomfortable sexual experiences, 1 participant experienced combat or exposure to a war zone in the military and 1 participant experienced another very stressful event. One participant experienced 2 one-time traumatic experiences, the other participants experienced more complex trauma related to prolonged and severe traumatization at a younger age [ 21 ].…”

“…To seek a solution to the lack of evidence and the need for appropriate and helpful treatment, a broader study by ten Napel-Schutz et al [ 21 ] incorporated a quantitative multiple baseline case series study involving ten participants with PTSD, an ED, and a BMI of between 14 and 16.5. The results of the latter showed that people with PTSD could be treated effectively when underweight.…”

“…The following symptoms were all reduced: PTSD symptoms,emotional experiences of disgust, shame, guilt and anger; negative cognitions about the body, the self and the world; and difficulties with emotion regulation. The eating pathology also became less severe [ 21 ].…”

Eating disorder patients with and without PTSD treated in residential care: discharge and 6-month follow-up results

“…First, this is not a controlled trial but is rather an example of ongoing translational research that facilitates the connection between clinical science and its practical applications to people with EDs to improve health outcomes. There is a great need to develop integrated models to treat ED-PTSD, especially in higher levels of care [ 3 , 4 , 11 , 18 , 19 , 26 , 27 , 64 , 79 ].…”