Eye Movement Desensitisation and Reprocessing versus stabilisation in the outpatient treatment of traumatised asylum seekers and refugees: a randomised controlled trial

Focus of study is the outpatient treatment of adult traumatised asylum seekers
and refugees with Eye Movement Desensitisation and Reprocessing (EMDR) or
stabilisation.
Where the treatment of type-1 trauma is concerned, EMDR and CBT are treatments
of choice. It's unclear whether this also goes for the treatment of asylum
seekers and refugees, who often suffer from complex trauma. It is considered
good practice to work with this population according to a phased model, in
which the patient is first stabilised before proceeding to traumafocused
interventions. There are however indications that this population may benefit
from CBT without prior stabilisation. Perhaps this is also the case with EMDR.
This research project has been designed to answer the question: what is the
effectiveness of EMDR and stabilisation in reducing traumasymptoms in
traumatised asylum seekers and refugees?

To contribute to the improvement of mental health care to traumatised asylum
seekers and refugees.

This study is designed as a randomised controlled trial, comparing EMDR and
stabilisation. The protocol consists of:
1. informing the patient of the research protocol and signing of informed
consent form
2. clinical interview
3. when patient is included: randomised assignment to one of the two conditions
4. pretreatment assessment.
5. research treatment consisting of three preparatory sessions (taking down the
patient's biography, deciding on a treatment plan); followed by 8
weekly/biweekly sessions of either EMDR or stabilisation.
6. posttreatment assessment.
7. follow-up assessment after three months.
Considering the available scientific evidence, the hypothesis is that EMDR will
be more effective than stabilisation.

EMDR condition: this condition is, under supervision, performed by
EMDR-therapists trained in treating complex trauma, according to the
EMDR-protocol (De Jongh en Ten Broeke, 2003). Sessions take 90 minutes and an
interpreter is used when necessary.
Stabilisation condition: this is performed by psychologists/doctors, under
supervision. It consists of interventions aimed at the social, emotional,
cognitive and behavioural stabilisation of the patient, as described by Linehan
(1993) and Meichenbaum (1985). Each session the therapist records the
interventions used in a "stabilisation menu". Sessions take 60 minutes and an
interpreter is used when necessary.

Interview and questionnaires take six hours per patient. The burden of the
treatment itself is equal to the burden of care as usual (i.e., no extra
burden). Some therapists are of the opinion that focusing on traumatic memories
is emotionally burdening to asylum seekers and refugees. Research (e.g.
Drozdek, 1997; Van Minnen, 2006) has shown however that traumafocused therapy
is tolerable and effective with this population. Drop-out numbers with such
forms of therapy are not higher than with forms of therapy which avoid focusing
on the trauma. Stabilisation is not considered burdening, because it is a form
of supportive-structuring therapy. In conclusion the researchers are of the
opinion that taking part in this study implies minimal risks for the
participants.