This research aims to investigate imaginary rescripting (ImRs) as a 'stand alone' intervention in clients aged eight to twelve years, in which bullying experiences have led to complaint behaviour (emotional problems, depressive complaints…
ID
Source
Brief title
Condition
- Other condition
Synonym
Health condition
PTSS gerelateerde klachten.
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
The intake questionnaire Karakter (version 2012) is used for client screening.
In this questionnaire, in addition to other important matters relating to the
reason for registration, bullying experiences and/or other traumatic events are
asked. Parents/carers indicate whether their child has been bullied and in what
way (the Karakter intake questionnaire explains what bullying is and what forms
of bullying there are).
The Children's Revised Impact of Event Scale
The Children's Revised Impact of Event Scale (CRIES-13, Children and War
Foundation, 1998) is a brief, self-report questionnaire designed to screen for
PTSD in children aged 8 years and older (and a version for parents/carers).It
consists of thirteen questions to assess posttraumatic intrusions, avoidances,
and arousal. Children rate the frequency with which they have experienced each
of the items during the past week using a four-point Likert-scale (0=not at
all, 1=rarely, 3=sometimes, 5=often). Psychometric properties have been
previously reported (Verlinden et al., 2014), showing the CRIES-13 to be a
valid measure of posttraumatic stress. In this study, the internal consistency
of the CRIES-13 was a=0.89. In this study the CRIES-13 will be used to measure
posttraumatic stress symptoms between each session during the course of
treatment
Secondary outcome
Secondary outcome measures are mapped by means of the KIDSCREEN-27, the Child
Behavior Checklist, or CBCL, the Outcome Rating Scale, or ORS and the Revised
Child Anxiety and Depression Scale, or RCADS.
Kidscreen-27 (parents).
The KIDSCREEN-27 (The KIDSCREEN Group Europe, 2006) is generic health-related
quality of life (HRQOL) questionnaire for children and adolescents applicable
for healthy and chronically ill children and adolescents aged between 8 and 18
years. There are two versions of the questionnaire: a self-complete
(child/adolescent) and proxy (parent/proxy). The KIDSCREEN-27 consists of 27
items that measure five dimensions: physical Well-being, psychological
Well-being, parent relations & autonomy, social support & peers and school
Environment. Items are answered on a five-point Likert-type scale assessing
frequency: never (1), seldom (2), sometimes (3), often (4), and always (5), or
intensity: not at all (1), slightly (2), moderately (3), very (4), and
extremely (5), with a 1-week recall period. Scores are coded from 1 to 5,
negatively formulated items are recoded, and the sum scores for respective
dimensions are transformed to T scores with a mean of 50 and a standard
deviation (SD) of 10. Higher scores indicate better HRQOL. The KIDSCREEN-27 has
been shown to have robust psychometric properties. The internal consistency of
the domains was between 0.81 and 0.84, and the test-retest reliability of the
domains ranged from 0.61 to 0.74 (Ravens-Sieberer et al., 2008).
Child Behavior Checklist (CBCL 6-18) (parents).
The Dutch parent report version of the Child Behavior Checklist 6*18*years
(CBCL) assesses a wide range of children's emotional and behavioral problems,
aimed to identify children at high risk of a psychiatric disorder (Achenbach et
al., 2008; Verhulst & Van der Ende, 2013). The CBCL/6*18 comprises 120 items
assessing behavioral and emotional problems that are answered on a 3-point
Likert-type scale (0 = not true, 1 = somewhat or sometimes true, 2 = very true
or often true) by parents. The scores will displays eight problem scales:
withdrawn (1); somatic (2); anxious (3); social (4); thought (5); attention
(6); rule-breaking (7); aggressive (8); and other problems, the sum of the
problem scale 1,2 and 3 form the scale *internalizing behavior*; 7 and 8 form
*externalizing behavior*. All subscales together count for the total problem
scale. Some items contribute to more than one problem scale. T scores are
computed from raw scores; higher scores on the syndrome scales indicate greater
severity of problems. A T score of 63 (90th percentile) demarcates the clinical
range, which is an indication that a child needs professional help. For the
competence scales, lower scores indicate greater severity. A T score <37
indicates the clinical range. The CBCL/6*18 has well-established psychometric
properties in clinical, nonclinical, and cross-cultural populations (Verhulst &
Van der Ende, 2013).
Outcome Rating Scale (ORS)
To collect client feedback, we will use a brief questionnaires, the Outcome
Rating Scale (ORS), that can be easily be administered on a regular basis
during treatment (Miller & Duncan, 2004). This allows treatment sessions to be
evaluated at any time to ascertain whether individual treatments are *on the
right track* to successful outcome, or not. The ORS is primarily focused on the
wellbeing of the client and is administered at the beginning of the treatment
session. The outcomes of the questionnaires are reflected in a graph per
interview to allow the height of the score and progress to be visualised during
the sessions. The ORS has a high internal consistency and an average
correlation with other outcome measurements.
Anxiety (Revised Anxiety and Depression Scale; RCADS)
The Revised Child Anxiety and Depression Scale (RCADS) is a 47-item, youth
self-report questionnaire (Chorpita et al., 2000) with subscales including:
separation anxiety disorder (SAD), social phobia (SP), generalized anxiety
disorder (GAD), panic disorder (PD), obsessive compulsive disorder (OCD), and
major depressive disorder (MDD). It also yields a Total Anxiety Scale (sum of
the 5 anxiety subscales) and a Total Internalizing Scale (sum of all 6
subscales). Items are rated on a 4-point Likert-scale from 0 (*never*) to 3
(*always*). Additionally, The Revised Child Anxiety and Depression Scale *
Parent Version (RCADS-P) similarly assesses parent report of youth*s symptoms
of anxiety and depression across the same six subscales.
Background summary
Children regularly experience unpleasant events. However, these events are not
always considered traumatic (Jonkman et al., 2014). In the DSM 5, a traumatic
event can be considered when an event involves actual or imminent death,
serious injury or sexual violence, i.e. when the so-called 'A-criterium' of
life threatening is met (American Psychiatric Association, 2013). Bullying is
not seen as a 'A-criterium'. Unfortunately, in our population, bullying
experiences are frequently reported, especially within the group of clients
aged eight to twelve years old. During January 2017 to January 2018, a total of
721 intakes were seen at Karakter, Child and adolescent psychiatry.
Approximately 111 parents/children indicated that they had been bullied
(Source; intake questionnaire Karakter). Other studies have estimated the
prevalence of bullying (especially at school) over 30% (Solberg and Olweus,
2003), suggesting a significant stressor for children and adolescents.
Studies examining the psychological consequences of bullying in both
children/adolescents and adults show that bullying has a major impact on the
development of both somatic and psychological complaints such as anxiety and
mood problems, sleep problems, increased irritability, concentration problems
(Arseneault, Bowes, & Shakoor, 2010; Bowling & Beehr, 2006; Nielsen & Einarsen,
2012). These symptoms are similar to those associated with PTSD, (Kreiner,
Sulyok, & Rothenhausler, 2008; Leymann & Gustafsson, 1996; Matthiesen &
Einarsen, 2004; Tehrani, 2004).
Nielsen and colleagues (2015) showed in a meta-analysis that bullying victims
frequently report PTSD symptoms and that the bullying experience itself is
indeed considered traumatic by victims. However, based on the DSM 5 criteria a
diagnosis of PTSD does not occur in this group. As a result, they often do not
receive treatment. A very recent international study among adolescents in 48
countries showed that the risk of suicide attempts among bullying victims is
three times higher than among non-bullying adolescents (5.9% suicide attempts
within the group of non-bullying adolescents versus 32.7% suicide attempts
within the group of bullying children).
Many ('provisionally approved') treatment methods have been developed in the
Netherlands for the prevention/prevention of bullying, namely: Alles Kidzzz,
Kanjertraining, KiVa, Plezier op School, PRIMA, Porgramma Alternatieve
Denkstrategieen (PAD), Sta Sterk training, Taakspel en Vreedzame School (NJI,
2015).
Treatment methods have also been developed for the consequences of bullying,
particularly aimed at improving a negative self-image, namely; COMET training
(Competitive Memory Training, Korrelboom 2011) and/or *EMDR clockwise* (Beer &
De Roos, 2017). Both interventions are techniques are based on integrated
cognitive behavioural therapy, directly or indirectly re-evaluate the emotional
meaning of a US/UR presentation, (within the so-called meaning analysis)
(Korrelboom & Ten Broeke, 2014). COMET focuses on strengthening positive
memory, by (1) making positive personal characteristics more emotionally
salient, (2) repeatedly activating them and (3) eventually linking them to the
negatively charged stimulus (Korrelboom & Ten Broeke, 2014). *EMDR clockwise*
focuses on reducing negative memory representations, by editing three to five
memories from learning history that still prove worthless (or any other
negative core view) to the client (ten Broeke et al., 2014).
Practice shows that clients with prolonged bullying experiences often have an
all-encompassing negative self-image, which can be expressed in a
statement/conception about oneself as a person; 'I am worthless'. These clients
are incapable of naming a single only credible positive attribute that
contradicts his/her negative self-image, which, according to the authors of
COMET, is an important condition for the success of the intervention. Research
also shows that COMET is still one step too far for this group (Ten Broeke, Van
der Heiden, Meijer & Hamelink, 2008). Also *EMDR clockwise* may seem promising,
but research results on this treatment intervention have so far not yet
sufficiently demonstrated its efficacy (Griffioen, 2017). Among other things,
research shows that *EMDR clockwise* the arousel level of the evoked target
images that provide 'evidence' for the emergence and survival of the client's
view of himself is usually too low to achieve maximum processing (Littel et
al., 2017).
Imaginary rescripting (ImRs) seems to be able to remove both of these obstacles
and thus provide a solution for this group of clients. Imaginary rescripting
(hereinafter referred to as ImRs) is a processing technique aimed at
re-evaluating painful memories. This technique therefore appears to be
extremely suitable for the processing of bullying experiences among that group
of clients who have developed PTSD complaints as a result of these bullying
experiences.
ImRs is an experiential (experiential) intervention that is already frequently
applied within the schematic cognitive behavioural therapy in, among others,
adults with personality disorders, but also in adolescents with developing
personality disorders (Loose et al., 2015). ImRs is not a complete treatment,
but forms part of a broader package of interventions. Within the ImRs, negative
'old' experiences in particular are reassessed, which are assumed to have
contributed to the emergence and still contribute to the maintenance of the
problems for which the client is now seeking help (Arntz, 2011). The traumatic
memory (e.g. memories of bullying experiences) are activated during the ImRs
and actively experienced again by the client, after which the client (or, in
the case of young people, the therapist) must actively change the evoked
memory. ImRs is not (yet) regarded as a proven effective intervention for the
treatment of PTSD, which is why this method is generally not primarily used in
the case of PTSD and/or PTSD-related complaints. In clinical practice, however,
this intervention is frequently used as a 'stand alone' intervention, and its
effectiveness is shown by scientific research and several 'single case studies'
(including Kunze, 2018; Arntz, Sofi & van Breukelen, 2015; Raabe, Ehring,
Marquenie, Olff & Kindt, 2015; Arntz, Tiesema & Kindt, 2007; Grunert, Weis,
Smucker & Christianson, 2007).
Study objective
This research aims to investigate imaginary rescripting (ImRs) as a 'stand
alone' intervention in clients aged eight to twelve years, in which bullying
experiences have led to complaint behaviour (emotional problems, depressive
complaints, anxiety complaints, physical complaints and/or low
self-confidence).
Study design
The research can be typified as 'quasi-experimental', by means of a
'pretest-posttest' design. Within this design, reported PTSD-related complaints
are measured both before and after the intervention and in the control group,
in order to be able to map out any changes in complaints by comparing the
results of pre- and post-test questionnaires.
Intervention
Following Korrelboom and Ten Broeke (2014), the intervention will be applied as
follows and, following Loose and colleagues (2015), adapted for children/young
people;
Patients will follow a short-term treatment program consisting of five ImRs
sessions of sixty minutes each, in which the intervention will be applied to
the most fraught bullying experiences (based on an SUD score). An audio
recording is made of the ImRs sessions (by telephone or voice recorder) which
the client listens to three times a week between sessions at home.
As part of this research, a protocol ImRs will be developed for the
participating therapists containing the adapted ImRs variant for children and
adolescents. This adaptation consists mainly of active rescripting by the
therapist as opposed to rescripting by the client himself (as is usual with
ImRs adults). Children and adolescents are still (strongly) dependent on the
adults around them for help in everyday life. Loose and colleagues therefore
advise therapists to actively offer protection during rescripting (imaginary)
by standing up for the child as an adult against the bullies.
Study burden and risks
Low burden.
Low risk.
Enrolled patients (children aged 8-12 years) follow a short-term treatment
consisting of five ImRs sessions of sixty minutes each, applying the
intervention to the most adverse bullying experiences (using an SUD score).
Parents complete a number of short questionnaires. Furthermore, during the
sessions, children are asked to complete a number of short questionnaires.
These questionnaires are frequently used during treatments and are minimally
burdensome for young people and parents.
Reinier Postlaan 12 Reinier Postlaan 12
Nijmegen 6525 GC
NL
Reinier Postlaan 12 Reinier Postlaan 12
Nijmegen 6525 GC
NL
Listed location countries
Age
Inclusion criteria
All registered patients within Karakter in the age range of eight to twelve
years where bullying experiences are reported on the intake questionnaire
and/or during the intake and PTSD related symptoms are reported.
Willingness to cooperate in the study (informed consent).
Exclusion criteria
- A diagnosis of PTSD according to DSM 5 criteria including the A-criterium.
- Suicidal behaviours for which admittance is indicated.
- Serious psychiatric problems requiring (direct) and/or other treatment.
- Following another evidence-based trauma focussed (psycho)therapy during the
intervention.
- IQ <75
- An autism spectrum disorder (ASD) with an emphatic impediment to imagination.
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL73603.091.20 |