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"Psychological Trauma therapy"
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Preventing intrusive memories after trauma via a brief intervention involving Tetris computer game play in the emergency department: a proof-of-concept randomized controlled trial
After psychological trauma, recurrent intrusive visual memories may be distressing and disruptive. Preventive interventions post trauma are lacking. Here we test a behavioural intervention after real-life trauma derived from cognitive neuroscience. We hypothesized that intrusive memories would be significantly reduced in number by an intervention involving a computer game with high visuospatial demands (Tetris), via disrupting consolidation of sensory elements of trauma memory. The Tetris-based intervention (trauma memory reminder cue plus c. 20 min game play) vs attention-placebo control (written activity log for same duration) were both delivered in an emergency department within 6 h of a motor vehicle accident. The randomized controlled trial compared the impact on the number of intrusive trauma memories in the subsequent week (primary outcome). Results vindicated the efficacy of the Tetris-based intervention compared with the control condition: there were fewer intrusive memories overall, and time-series analyses showed that intrusion incidence declined more quickly. There were convergent findings on a measure of clinical post-trauma intrusion symptoms at 1 week, but not on other symptom clusters or at 1 month. Results of this proof-of-concept study suggest that a larger trial, powered to detect differences at 1 month, is warranted. Participants found the intervention easy, helpful and minimally distressing. By translating emerging neuroscientific insights and experimental research into the real world, we offer a promising new low-intensity psychiatric intervention that could prevent debilitating intrusive memories following trauma.
Journal Article
The modular approach to therapy for youths with anxiety, depression, trauma, and conduct problems (MATCH): results from the Norwegian randomized-controlled trial
Background
A randomized controlled trial was conducted to examine the effectiveness of the Modular Approach to Therapy for Youths with Anxiety, Depression, Trauma, and Conduct Problems (MATCH) for Norwegian youths referred to seven Child and Adolescent Psychiatric Outpatient Clinics. MATCH addresses comorbid problems that are common in children and youth, and its transdiagnostic design may therefore be more effective compared to standard treatments that often address single problems. MATCH has, however, never been evaluated in a Nordic context, and the present study aimed to fill this gap.
Methods
A sample of 121 Norwegian youths (
M
age
= 9.83, 58.7% boys) was randomly assigned to MATCH (
n
= 73) or treatment as usual (TAU,
n
= 48). Primary treatment outcomes were youths’ externalizing and internalizing problems as reported by parents, using the Child Behavior Checklist, the Behavior and Feelings Survey. In addition, the study included assessments of parent-reported Top Problems.
Results
Overall, youths showed significant improvements in both externalizing and internalizing problems from intake to post-test. Results did not provide evidence that MATCH reduces symptoms of these problems compared to TAU.
Conclusions
The findings were inconclusive regarding whether MATCH was more effective than TAU in reducing youth internalizing and externalizing problems.
Trial Registration Identifier
ISRCTN24029895. Registration date: 8/8/2016.
Journal Article
Mediators of change in a condensed online exposure-based intervention provided soon after trauma: insights from a randomised controlled trial
The active mechanisms of change are unclear in early-provided exposure-based interventions for psychological trauma. This study aimed to address this gap by analysing weekly data from a randomised trial involving a 3-week therapist-guided online intervention based on prolonged exposure compared to a waiting-list control group.
The objective was to investigate whether changes in each of the four subscales of the Posttraumatic Stress Disorder Checklist, fifth version (PCL-5; i.e. intrusions, avoidance behaviours, negative alternations in cognitions and hyperarousal) during the three-week intervention period mediated subsequent improvements in other post-traumatic stress symptoms at the controlled 1-month follow-up. We included baseline levels of both the mediator and the outcome as well as changes in the outcome from baseline to week 3 as covariates in a mediation model.
The results showed that reductions in avoidance during the intervention period mediated reduced symptom levels of intrusions, negative alternations in cognitions, and hyperarousal at week 7 (z-scores of indirect effect estimates = -0.12 to -0.07). No other PCL-5 subscales were found to be mediators of change.
The results from this study highlight the importance of addressing avoidance behaviours in online exposure-based interventions provided in the early aftermath of trauma. Sensitivity analysis showed that the mediation effects were sensitive to assumptions related to mediator-outcome confounders, which could be considered a study limitation.
ClinicalTrials.gov identifier: NCT03850639.
Journal Article
Comparing the Efficacy of CBASP with Two Versions of CBT for Depression in a Routine Care Center
Background: The cognitive-behavioral analysis system of psychotherapy (CBASP) was developed for the treatment of chronic, early-onset depression. However, it is unclear whether this approach can be recommended for depression in general (episodic and chronic), and no direct comparisons between CBASP with different versions of cognitive-behavioral therapy (CBT) exist. Methods: A randomized controlled trial compared 3 treatment conditions (all lasting 16 sessions) with a waiting list group (WL): CBASP, CBT with a focus on physical exercise (CBT-E), and CBT with a focus on pleasurable, low-energy and mindful activities (CBT-M). We included 173 patients and involved 41 therapists. Assessments were at baseline, after session 8, and at the end of treatment. Results: Our primary outcome Beck Depression Inventory-II indicated a general advantage of the CBT arms compared to CBASP [F(6, 154.5) = 4.2, p = 0.001], with significant contrasts in particular in favor of CBT-E. Effect sizes against WL were d = 0.91 (CBT-E), 0.87 (CBT-M), and 0.47 (CBASP). A triple interaction with an additional factor “chronic versus episodic depression” [F(6, 142.7) = 2.2, p = 0.048] indicated that the treatments resulted in different outcomes, with best results again for CBT-E in particular in episodic depression. Responder rates indicated significant improvements (56% in both CBT arms, 34% in the CBASP arm, 3.4% in WL; intention-to-treat samples). As compared to CBASP, response rates were significantly higher for CBT-E (OR = 2.48; 95% CI = 1.02–6.00) and CBT-M (OR = 2.46; 95% CI = 1.01–6.01). Conclusions: CBASP was more effective than WL, but less effective than the 2 CBT arms. This was mainly caused by an advantage of CBT interventions in episodic depression.
Journal Article
Treatment of traumatised refugees with basic body awareness therapy versus mixed physical activity as add-on treatment: Study protocol of a randomised controlled trial
Background
Treatment of traumatised refugees is one of the fields within psychiatry, which has received little scientific attention. Evidence based treatment and knowledge on the efficiency of the treatment for this complex patient group is therefore scarce. This leads to uncertainty as to which treatment should be offered and potentially lowers the quality of life for the patients.
Chronic pain is very common among traumatised refugees and it is believed to maintain the mental symptoms of trauma. Hence, treating chronic pain is believed to be of high clinical value for this patient group.
In clinical studies, physical activity has shown a positive effect on psychiatric illnesses such as depression and anxiety and for patients with chronic pain. However, scientific knowledge about physical activity as part of the treatment for traumatised refugees is very limited and no guidelines exist on this topic.
Methods/design
This study will include approximately 310 patients, randomised into three groups. All three groups receive psychiatric treatment as usual for the duration of 6–7 months, consisting of consultations with a medical doctor including pharmacological treatment and manual-based Cognitive Behavioural Therapy. The first group only receives treatment as usual while the second and the third groups receive either Basic-Body Awareness Therapy or mixed physical activity as add-on treatments. Each physical activity is provided for an individual 1-hour consultation per week, for the duration of 20 weeks. The study is being conducted at the Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup in the Capital Region of Denmark.
The primary endpoint of the study is symptoms of Post Traumatic Stress Disorder; the secondary endpoints are depression and anxiety as well as quality of life, functional capacity, coping with pain, body awareness and physical fitness.
Discussion
This study will examine the effect of physical activity for traumatised refugees. This has not yet been done in a randomised controlled setting on such a large scale before. Hereby the study will contribute to important knowledge that is expected to be used in future clinical guidelines and reference programs.
Trial registration
ClinicalTrials.gov
NCT01955538
. Date of registration: 18 September 2013.
Journal Article