EMDR and Imagery Rescripting as a Treatment for Trauma-Related Intrusive Images

Patients with post-traumatic stress disorder (PTSD) experience highly frequent
and distressing intrusive images depicting earlier aversive experiences. Not
only patients with PTSD experience these intrusions; they are also very common
in depression. Therefore, trauma treatments that target these intrusions may
also benefit patients with depression.
Additionally, comorbid depression in patients with PTSD reduces the effects of
trauma treatment. It is currently unknown which treatment for traumatic
intrusions is most effective for patients who meet criteria for PTSD,
depression, or both, and treatment selection is often a process of trial and
error. The mechanisms of action of trauma treatments may inform us how to
select the most appropriate treatment for a particular individual.

Our primary objective is to investigate whether EMDR and Imagery Rescripting
are effective for individual patients who experience intrusions: patients with
PTSD, patients with depression, and patients with PTSD and a comorbid
depression. To this end, we will examine the patterns of the reduction in the
severity of intrusions (i.e., frequency, uncontrollability, and degree of
interference with daily life) within each individual and within each of the six
groups (i.e., three patient groups and two interventions). In this way, we want
to gain more insight into the mechanisms of action of both treatments. We will
specifically investigate the potential mediating roles of self-compassion,
emotion regulation, positive affect, rumination, the vividness and distress of
intrusions, and intrusion-related beliefs about oneself.

Our second objective is to investigate the effect of EMDR and IR on quality of
life, PTSD and depression symptoms in each individual and within each group.
Our third objective is to explore the patients* and therapists* perspectives on
deciding factors in treatment selection, by asking them about preferences and
expectations concerning EMDR and IR.

The present study uses a single-case experimental design with a baseline phase,
an experimental or treatment phase, and a withdrawal of treatment phase, as
well as a 6-month follow-up.

Patients will be randomly assigned to EMDR or IR. In each condition, patients
will receive two 75-minute sessions of EMDR or IR each week, as well as an
additional coaching session each week. Treatment length depends on patients*
needs and varies between 2.5 and 6 weeks.

There is a regular procedure for patients who are referred to the *Kortdurende
Intensieve Trauma Traject* (KITT) of GGzE, which involves assessment as well as
treatment (EMDR or IR). Participation in the study requires completing
additional questionnaires for research purposes at baseline, post-treatment,
and follow-up (18 min each time), as well as daily measures during the
baseline, treatment, and withdrawal phases. There are two daily measures. Once
every week, questions about Outcome Expectancies will be added, which will take
an additional 2 minutes to complete. One of the daily measures indexes
intrusions only and will take 2 minutes to complete. The second daily measure
assesses intrusions as well as the potential mediators and will take 7 minutes
to complete. There are no known risks associated with the completion of the
questionnaires for the study. The total study duration (baseline up to and
including the withdrawal phase but excluding the 6-month follow-up) is a
minimum of 8.5 weeks and a maximum of 12 weeks, depending on the number of
intervention sessions patients receive. In addition to the time required for
the study, a potential burden for patients is the fact that they are randomized
to one of two interventions and, therefore, cannot choose their preferred
treatment. The benefits of the study include a better understanding of the
effectiveness of EMDR and IR for different patient groups, and the mechanisms
underlying the treatment effects. In addition, patients may benefit from
self-monitoring through completion of questionnaires throughout the study
period. Patients who have completed the study will be offered a feedback
session on their questionnaires and changes in scores after the 6-month
follow-up, which may help to guide any further treatment of the patients.
Patients will receive a financial compensation varying from ¤60 to ¤80 in
VVV-vouchers, depending on their time investment in the study.