Treatment of Complex PTSD

Complex Post Traumatic Stress Disorder (Complex PTSD) is a term used to denote a severe form of PTSD following repeated interpersonal traumatization in childhood. This construct comprises symptom clusters reflecting difficulties in regulating emotions, disturbances in relational capacities, alterations in attention and consciousness, adversely affected belief systems, and somatization. According to the guidelines of the International Society of Traumatic Stress Studies (ISTSS), treatment should be ‘phase-based’, indicating that patients with Complex PTSD symptoms will profit more from trauma-focused treatment if this phase in treatment is preceded by a stabilization phase aimed at achieving patient safety and improving emotion regulation, patients’ positive self-concept, and interpersonal skills. However, superiority of a phase-based approach starting with a stabilization phase is yet to be established.

The purpose of the present study is to determine superiority in efficacy of a phase-based treatment (i.e., EMDR therapy preceded by Skills Training in Affective and Interpersonal Regulation, STAIR) versus trauma-focused treatment alone (i.e., EMDR therapy) to treat individuals suffering from (Complex) PTSD due to a history of repeated sexual and/or physical abuse in childhood (by a caretaker or person in authority, and before the age of 18). Our first aim is to test the hypothesis that a phase-based treatment (EMDR preceded by STAIR) is significantly more effective with regard to PTSD (decrease of PTSD symptoms), would lead to a significantly better outcome in terms of comorbid symptom decrease, lower drop-out rate, and increased quality of life, than when the direct trauma-focused treatment (EMDR alone) is applied. Our second aim is to identify possible predictors of worse outcome and drop-out (e.g. pre-treatment anxiety, depression, and personality disorders).

According to the guidelines of the International Society of Traumatic Stress Studies (ISTSS), treatment should be ‘phase-based’, indicating that patients with Complex PTSD symptoms will profit more from trauma-focused treatment if this phase in treatment is preceded by a stabilization phase aimed at achieving patient safety and improving emotion regulation, patients’ positive self-concept, and interpersonal skills.

In accordance with the ISTSS guidelines, it would be expected that a phase-based treatment (EMDR preceded by STAIR ) is significantly more effective with regard to PTSD (PTSD severity), would lead to a significantly better outcome in terms of comorbid symptom decrease, a lower drop-out rate, and increased quality of life, than when the direct trauma-focused treatment (EMDR alone ) is applied.

Patients will be subjected to a series of measures before, during and after treatment and at 3 and 6 months follow-up.

EMDR alone (16 sessions) versus EMDR (16 sessions) preceded by STAIR (stabilization program)