Research into EMDR for Military Personnel and Veterans with Psychological Trauma

Posttraumatic stress disorder (PTSD) and 'Other Specified Trauma- and
Stressor-Related Disorder' are mental disorders that can occur following a
traumatic event. Psychological trauma in military personnel may differ from
civilian psychological trauma for example due to the nature of the trauma, or
extensive military training. Eye movement desensitisation and reprocessing
(EMDR) and prolonged exposure (PE) are trauma-focused therapies that have been
shown to be effective at reducing trauma symptoms in civilians. PE has also
been shown to be effective at treating military personnel with trauma. In
contrast, the effectiveness of EMDR for military personnel and veterans is
currently under debate, because a recent meta-analysis showed that it might not
be effective in this population. Despite this, EMDR is often used at military
mental health services to treat psychological trauma. In conclusion, there is a
need to investigate the effectiveness of EMDR for treating military personnel
and veterans with psychological trauma. Furthermore, the mechanism underlying
EMDR is unknown. Gaining mechanistic insight into EMDR neuropsychology could
contribute to identifying predictors for treatment success.

The primary objective is to study the effectiveness of EMDR in comparison to PE
for treating military personnel and veterans with psychological trauma.

Secondary objectives are:
1. to investigate if working memory capacity is a predictor of EMDR treatment
success

The proposed study is a single-blind randomised controlled between-subjects
non-inferiority trial.

Patients will be randomly assigned to EMDR or PE. Both therapies are validated
trauma-focused therapies that are recommended by the Dutch guidelines for the
treatment of psychological trauma. Patients will receive 10 90-minute treatment
sessions during a period of 12 weeks.

Patients will receive standard treatment for psychological trauma. Increased
stress or emotional discomfort might occur due to exposure to a psychological
trauma. However, this is the case for all trauma-focused therapies and
therefore we consider this risk acceptable. Following each session, patients
will fill in a brief questionnaire. Besides the therapy sessions, patients will
complete four main assessments. The first assessment takes about 3 hours, the
second 90 minutes, and the third and fourth one take 20 minutes. We consider
this an acceptable burden since these assessments are spread out over a period
of several months: one before treatment, one immediately following treatment,
after 26 and 52 weeks.