Imagery rescripting and eye movement desensitisation and reprocessing for treatment of adults with childhood trauma-related post-traumatic stress disorder: IREM study design.
BACKGROUND
Post-traumatic stress disorder (PTSD) that originates from childhood trauma experiences can develop into a chronic condition that has lasting effects on an individual's functioning and quality of life. While there are evidence-based guidelines for treating adult onset PTSD, treatments for adults with childhood trauma-related PTSD (Ch-PTSD) are varied and subject to ongoing debate. This study will test the effectiveness of two trauma-focused treatments, imagery rescripting (ImRs) and eye movement desensitisation and reprocessing (EMDR) in participants with Ch-PTSD. Both have been found effective in treatment of adult PTSD or mixed onset PTSD and previous research indicates they are well-tolerated treatments. However, we know less about their effectiveness for treating Ch-PTSD or their underlying working mechanisms.


METHODS
IREM is an international multicentre randomised controlled trial involving seven sites across Australia, Germany and the Netherlands. We aim to recruit 142 participants (minimum of n = 20 per site), who will be randomly assigned to treatment condition. Assessments will be conducted before treatment until 1-year follow-up. Assessments before and after the waitlist will assess change in time only. The primary outcome measure is change in PTSD symptom severity from pre-treatment to 8-weeks post-treatment. Secondary outcome measures include change in severity of depression, anger, trauma-related cognitions, guilt, shame, dissociation and quality of life. Underlying mechanisms of treatment will be assessed on changes in vividness, valence and encapsulated belief of a worst trauma memory. Additional sub-studies will include qualitative investigation of treatment experiences from the participant and therapists' perspective, changes in memory and the impact of treatment fidelity on outcome measures.


DISCUSSION
The primary aims of this study are to compare the effectiveness of EMDR and ImRs in treating Ch-PTSD and to investigate the underlying working mechanisms of the two treatments. The large-scale international design will make a significant contribution to our understanding of how these treatments address the needs of individuals with Ch-PTSD and therefore, potentially improve their effectiveness.


TRIAL REGISTRATION
Australian New Zealand Clinical Trials Registry ACTRN12614000750684 . Registered 16 July 2014.
['Boterhoven de Haan|Katrina L|KL|', 'Lee|Christopher W|CW|', 'Fassbinder|Eva|E|', 'Voncken|Marisol J|MJ|', 'Meewisse|Mariel|M|', 'Van Es|Saskia M|SM|', 'Menninga|Simone|S|', 'Kousemaker|Margriet|M|', 'Arntz|Arnoud|A|']
D000293:Adolescent D000328:Adult D000368:Aged D001315:Australia D000069581:Exposure to Violence D057169:Eye Movement Desensitization Reprocessing D005133:Eye Movements D005260:Female D005858:Germany D006801:Humans D008297:Male D008875:Middle Aged D009426:Netherlands D011788:Quality of Life D012107:Research Design D013313:Stress Disorders, Post-Traumatic D055815:Young Adult
Imagery rescripting Eye movement desensitisation and reprocessing Treatment Childhood Post-traumatic stress disorder