PTSD as a result of chronic interpersonal violence in early childhood; Imaginal Exposure vs Imagery
Rescripting vs Body Focused Rescripting.

Meta-analyzes show that Trauma-Focused Cognitive Behavioral, Imaginary Exposure and Eye Movement
Desensitization-Reprocessing the most effective psychological treatments for posttraumatic stress disorder (PTSD) (Bisson et al, 2007; Bradley, Greene, Russ, Dutra & West, 2005; Cloitre, 2009; Seidler & Wagner, 2006). In 40-70% of the patients indicate that relatively short treatment (9-12 sessions of 90 minutes) to considerable reduction of PTSD symptoms. The vast majority of research has been conducted on PTSD following follwing a single traumatic event in childhood .
There is still little research on the application of this protocols to PTSD as a result of repeated and prolonged interpersonal
abuse in childhood (eg sexual and / or physical abuse) within the immediate environment. The question arises whether "new" forms of treatment such as Imaginary Rescripting and Body Focused Rescripting that more active intervention on key processes that play a role in the development of PTSD as dysfunctional based schedules and tonic immobility (TI) effective a proven effective form of treatment as imaginal exposure (IE). In this study, therefore the effectiveness of three treatments for chronic PTSD after interpersonal trauma in childhood investigated, namely (1) imaginal exposure, (2)
Imaginary Rescripting and (3) Body Focused Rescripting.

Objective of the study:

The research aims to 2 new forms of treatment for patients with comorbid PTSD as a result of multiple and repeated abuse in childhood to assess and compare Imaginary Exposure. The expectation is that these new forms of treatment will lead to a better end-state functioning, less dropout and a higher valuation for feasibility of therapists. The expectation is that Body Focused Rescripting superior to Imaginary Rescripting.



Hypotheses treatment study (1):

Effects 1. We expect treatment effects on the primary outcome measures in the ranking IE
A. In Rescripting therapies is influenced not only the fear but also anger, guilt, shame and sadness;

B. Because context dependence is less (UCS revaluation);

C. Because active intervention is essential processes in development of PTSD, such as TI;

D. Body Focused Rescripting better effects than ImRes because ImRes will initially focus on the explicit memory, while
patients with TI and dissociation possibly better results expected if one focuses on implicit memory. The context of the
UCS / UCR would be better represented if the traumatic event is not in vitro (imaginary) but in vivo depicts. The newly
learned response to the UCS representation is not directly aimed at expressing the blocked emotion (emotional
processing), but had to be aware of sensoromotor components (sensorimotor processing) such as perception of
sensory and physiological sensations of fixed action tendencies and defensive postures focus more on implicit than
explicit memory (Ogden, Minton & Pain, 2006).

2. Dropout. We expect that the IE condition the dropout % higher than in the latter treatments because BFRes ImRes
and less stress.

3. Preferences of therapists. It is expected that therapists 'new' treatments find more workable and less heavy for the
patient seem to be. Hypothesized predictors of treatment success (2): There will be investigated predictors of treatment success. The hypotheses to be tested, we formulate based on the most recent empirical findings. If predictors are included: severity axis II (borderline symptoms and avoidant
symptoms), TI (TI-self-report and TI as discrepancy between low physiological and subjective anxiety), dissociation,
alcohol and drug use, severity of trauma, therapeutic relationship and HRV . We expect that patients with high TI and high dissociation score a better effect on the ImRes condition and even more in the BFRes condition than the IE condition. In the patients with a low dissociation TI and low score will be the difference between the conditions are less severe.



Generates motor (tonic) immobility post-traumatic complications? Serious sexual abuse involving penetration increases the likelihood of experiencing motor (tonic) immobility (Heidt et al., 2005)? Is motor (tonic) immobility one aspect of peritraumatic dissociation (Hagenaars, et al, 2009)? What correlation is there between motor (tonic) immobilititeit, peritraumatic dissociation, PTSD, anxiety and depressive (Heidt et al., 2005)?

The waiting period of 5 weeks of ring forms include the control group. Patients are randomized to 1 of 3 treatments assigned.

Two sessions of 90 minutes per week for 6 weeks last 4 weeks 1 time per week. Total 16 seats plus Homework 2 times per week (max. 1 hour).

Duration of treatment 11 weeks.
Homework: • IE / ImRes / BF Res: listening to the tape of the session 2 times a week Exposure in vivo is in all conditions outside the study protocol. 52 patients per condition.

Measurement 1 after inclusion, measuring 2 to start treatment after 5 weeks of Measurement 3, Measurement 4 after
10 weeks (termination therapy) and follow-up after 3 months (Measure 5) and 12 months (Measure 6). In all conditions
of the research will end a break of 3 months be inserted after assessing whether the therapy according to TAU
(treatment as usual) should be prosecuted. During the pause, the handler if necessary by phone. As further
improvements after termination of the protocol are expected, a pause of 3 months at comparable RCTs are necessary.

In this study the effectiveness of three treatments for chronic PTSD after interpersonal trauma in childhood will be investigated, namely (1) imaginal exposure (IE), (2) Imaginary Rescripting (ImRes) and (3) Body Focused Rescripting (BFR es).



Study design:

This study is a multicenter randomized 3-group trial.

3 conditions: IE, ImRes, BFRes. The waiting period of 5 weeks of ring forms include the control group. Patients are randomized to 1 of 3 treatments assigned. Two sessions of 90 minutes per week for 6 weeks last 4 weeks 1 time per week. Total 16 seats plus homework 2 times per week (max. 1 hour).

Duration of treatment 11 weeks.

Homework: IE / ImRes / BF Res: listening to the tape of the session 2 times a week.
Exposure in vivo is in all conditions outside the study protocol.

52 patients per condition.

Measurement 1 after inclusion, measuring 2 to start treatment after 5 weeks of Measurement 3, Measurement 4 after
10 weeks (termination therapy) and follow-up after 3 months (Measure 5) and 12 months (Measure 6).



In all conditions of the research will end a break of 3 months be inserted after assessing whether the therapy according to TAU (treatment as usual) should be prosecuted. During the pause, the handler if necessary by phone. As further
improvements after termination of the protocol are expected, a pause of 3 months at comparable RCTs are necessary.



Background of the study:

Meta-analyzes show that Trauma-Focused Cognitive Behavioral, Imaginary Exposure and Eye Movement
Desensitization-Reprocessing the most effective psychological treatments for posttraumatic stress disorder (PTSD) (Bisson et al, 2007; Bradley, Greene, Russ, Dutra & West, 2005; Cloitre, 2009; Seidler & Wagner, 2006). In 40-70% of the patients indicate that relatively short treatment (9-12 sessions of 90 minutes) to considerable reduction of PTSD symptoms. The vast majority of research has been conducted on PTSD following follwing a single traumatic event in childhood .
There is still little research on the application of this protocols to PTSD as a result of repeated and prolonged interpersonal
abuse in childhood (eg sexual and / or physical abuse) within the immediate environment. The question arises whether "new" forms of treatment such as Imaginary Rescripting and Body Focused Rescripting that more active intervention on key processes that play a role in the development of PTSD as dysfunctional based schedules and tonic immobility (TI) effective a proven effective form of treatment as imaginal exposure (IE). In this study, therefore the effectiveness of three treatments for chronic PTSD after interpersonal trauma in childhood investigated, namely (1) imaginal exposure, (2)
Imaginary Rescripting and (3) Body Focused Rescripting.