The effect of EMDR therapy in patients with bipolar disorder and a history of traumatic events: a randomized controlled trial.

Traumatic events are frequently experienced by patients with bipolar disorder
(BD) and can lead to symptoms of post-traumatic stress disorder (PTSD). There
is a high prevalence rate of lifetime PTSD in patients with bipolar disorder,
much higher than lifetime prevalence in the general population. A history of
traumatic events is associated with a poorer outcome of the bipolar disorder,
and this comorbidity may also have a negative impact on response to treatment
for the mood symptoms. Still, psychotherapeutic interventions directed to this
comorbidity are seldom studied so far. Eye Movement Desensitization and
Reprocessing therapy (EMDR) has found to be very effective to treat PTSD, but
bipolar disorder is an exclusion criterion in most PTSD trials. Recently there
are studies that prove EMDR to be a safe and effective intervention to treat
PTSD, also in patients with a severe mental illness, such as psychotic
disorder. There is only one randomized controlled pilot-study that studied the
effect of EMDR in patients with bipolar disorder and mild depressive and/or
manic symptoms (subsyndromal mood symptoms) and a history of traumatic events
which suggests EMDR may be an effective and safe intervention to treat not only
trauma symptoms but also subsyndromal mood symptoms. This research aims to
study the mood-stabilizing effect of augmenting EMDR to treatment as usual in
patients with bipolar disorder and trauma symptoms, by using daily monitoring
of mood symptoms. We hypothesize that the EMDR intervention leads to a decrease
in lability and intensity of (subsyndromal) depressive and/or manic
symptoms.

Objective: The primary objective is to examine whether EMDR therapy has
mood-stabilizing effects in traumatized patients with mild depressive and/or
manic symptoms. The secondary objective is to examine the hypothesis that EMDR
is an effective and safe intervention in patients with a bipolar disorder, thus
whether trauma symptoms reduce and EMDR does not lead to an increase of
affective symptoms or full blown episodes.

A single-centre randomized clinical trial with 2 arms: a treatment as usual
condition (TAU) and a condition in which EMDR is augmented to treatment is
usual. The two groups will be compared at baseline (T0), posttreatment (T1) and
at 8-weeks follow-up (T2).
In addition to this a case series design will be used, involving a baseline, a
treatment and a follow-up phase.

Participants are randomized to receive 8 90-minute sessions of EMDR next to
treatment as usual or to receive only treatment as usual. Standard protocols
are used, and treatment is not preceded by stabilizing psychotherapeutic
interventions.

All participants that agree to participate in this study are submitted to a
baseline measurement which consists of several selfreport questionnaires and a
clinical interview to assess the frequency and intensity of the clinician*s
rated PTSD symptoms. This is above the standard measurements that patients are
submitted to that are referred for treatment of the bipolar disorder, and takes
time for each participant. In both groups, participants are submitted to extra
questionnaires to assess the level of PTSD and affective symptoms on two
occasions more. They are also asked to register their mood daily but that*s
also standard in treatment as usual for bipolar patients. In the intervention
group participants will have 8 sessions of EMDR. EMDR is found to be a safe
intervention for patients in the treatment of PTSD symptoms, but in the first
three days after an EMDR session patients can experience an increase of images
and feelings associated with the experienced trauma. Patients will be well
informed of this possibility.
We hypothesize that the EMDR intervention leads to a decrease in lability and
intensity of (subsyndromal) depressive and/or manic symptoms.