Publications by authors named "Ad de Jongh"

92 Publications

Financial, psychological, or cultural reasons for extracting healthy or restorable teeth.

J Am Dent Assoc 2022 Mar 30. Epub 2022 Mar 30.

Background: The purpose of this study was to determine how often dental patients request extraction for nondental reasons and how dentists handle such requests.

Methods: The authors conducted a survey among 800 Dutch dentists from November 17, 2019, through January 5, 2020. The questionnaire contained 17 items, including a hypothetical case vingette.

Results: A total of 242 dentists responded to the survey (response rate was 30.3%, 48.3% of respondents were women, and mean [standard deviation] age was 45.3 [11.8] years). Sixty-eight percent of respondents reported that they had been confronted with a request for extraction on nondental grounds in the past 3 years. One-half of these dentists received such a request 5 times or fewer, 21.3% received such a request 6 through 10 times, 11.3% received such a request 11 through 20 times, and 8.8% received such a request 21 through 30 times. Their most recent request concerned a financial reason (49.7%), a combination of psychological and financial reasons (27.7%), a psychological reason (18.2%), or another reason (4.4%). Most dentists (87.5%) evaluated the patient's competency to make health care decisions. Of all nondental extraction requests, 75.6% (n = 114) were granted. Only 4.0% (n = 6) of the dentists regretted the extraction. Most dentists (82.0%, n = 191) would have refused the extraction in the hypothetical case vignette.

Conclusions: Nondental requests for extraction are relatively common. Although dentists are reluctant in theory, they are likely to grant such requests in everyday practice, particularly if the patient cannot afford an indicated conservative treatment.

Practical Implications: Dentists should keep in mind that they cannot ethically or legally be required to perform an intervention deemed harmful, even if an autonomous patient made the request.
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http://dx.doi.org/10.1016/j.adaj.2022.01.008DOI Listing
March 2022

Perioperative Propranolol Against Dental Anxiety: A Randomized Controlled Trial.

Front Psychiatry 2022 21;13:842353. Epub 2022 Feb 21.

Department of Oral Public Health, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands.

Background: Promising results from a trauma reactivation study on post-traumatic stress disorder suggest that propranolol is capable of attenuating symptoms of traumatically induced mental disorders by blocking memory reconsolidation.

Methods: A randomized, parallel, placebo-controlled, quadruple-blind trial was designed to determine the effectiveness of perioperative propranolol during exposure to dental extractions in reducing dental anxiety in patients with dental anxiety or dental phobia. Between November 2014 and December 2018, 52 patients with high levels of fear in anticipation of dental extractions who were referred to a department of oral and maxillofacial surgery for at least two tooth and/or molar removals with 1 month in between were included. On the first visit participants received either 120 mg of perioperative oral propranolol ( = 19) or placebo ( = 17), and a core fear memory was reactivated 1 h preoperatively. The primary outcome was change in severity of dental anxiety from baseline to 1-month follow-up, as indexed by the short version of the dental anxiety inventory (S-DAI). Secondary outcome measures were change in intra-operative state anxiety and specific phobia diagnoses.

Results: Linear mixed model (LMM) yielded no statistically significant difference in change of dental trait anxiety from baseline to 1-month follow-up between propranolol and placebo groups (Cohen's = 0.23). S-DAI scores decreased in both study arms from baseline to follow-up (propranolol arm: from 32.1 [SD = 7.3] to 29.1 [SD = 8.8]; placebo arm: from 31.6 [SD = 7.5] to 27.1 [SD = 6.5]). Also, administering propranolol was not associated with a significant difference in change of intra-operative state anxiety or phobia diagnoses between groups over time.

Conclusions: The results do not concur with earlier findings regarding post-traumatic stress disorder, and suggest that individuals with traumatically induced fears or phobias do not benefit from the application of perioperative propranolol.
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http://dx.doi.org/10.3389/fpsyt.2022.842353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8899208PMC
February 2022

Trauma-focused EMDR for Personality disorders among Outpatients (TEMPO): study protocol for a multi-centre, single-blind, randomized controlled trial.

Trials 2022 Mar 4;23(1):196. Epub 2022 Mar 4.

Department of Personality Disorders, Parnassia Psychiatric Institute, Lijnbaan 4, 2512VA, The Hague, The Netherlands.

Background: Existing recommended treatment options for personality disorders (PDs) are extensive and costly. There is emerging evidence indicating that trauma-focused treatment using eye movement desensitization and reprocessing (EMDR) therapy aimed at resolving memories of individuals' adverse events can be beneficial for this target group within a relatively short time frame. The primary purpose of the present study is to determine the effectiveness of EMDR therapy versus waiting list in reducing PD symptom severity. Furthermore, the effects of EMDR therapy on trauma symptom severity, loss of diagnosis, personal functioning, quality of life, and mental health outcomes will be determined. In addition, the cost-effectiveness of EMDR therapy in the treatment of PDs is investigated. Moreover, predictors of treatment success, symptom deterioration and treatment discontinuation will be assessed. Lastly, experiences with EMDR therapy will be explored.

Method: In total, 159 patients with a PD will be included in a large multicentre single-blind randomized controlled trial. The Structured Clinical Interview for DSM-5 Personality Disorders will be used to determine the presence of a PD. Participants will be allocated to either a treatment condition with EMDR therapy (ten biweekly 90-min sessions) or a waiting list. Three months after potential treatment with EMDR therapy, patients can receive treatment as usual for their PD. All participants are subject to single-blinded baseline, post-intervention and 3-, 6- and 12-month follow-up assessments. The primary outcome measures are the Assessment of DSM-IV Personality Disorders and the Clinician-Administered PTSD Scale for DSM-5. For cost-effectiveness, the Treatment Inventory of Costs in Patients with psychiatric disorders, EuroQol-5D-3L, and the Mental Health Quality of Life Questionnaire will be administered. The PTSD Checklist for DSM-5, Brief State Paranoia Checklist and Difficulties in Emotion Regulation Scale will be used to further index trauma symptom severity. Type of trauma is identified at baseline with the Childhood Trauma Questionnaire-SF and Life Events Checklist for the DSM-5. Personal functioning and health outcome are assessed with the Level of Personality Functioning Scale-BF 2.0, Outcome Questionnaire-45 and Mental Health Quality of Life Questionnaire. Experiences with EMDR therapy of patients in the EMDR therapy condition are explored with a semi-structured interview at post-intervention.

Discussion: It is expected that the results of this study will contribute to knowledge about the effectiveness, and cost-effectiveness of trauma-focused treatment using EMDR therapy in individuals diagnosed with a PD. Follow-up data provide documentation of long-term effects of EMDR therapy on various outcome variables, most importantly the reduction of PD symptom severity and loss of diagnoses.

Trial Registration: Netherlands Trial Register NL9078 . Registered on 31 November 2020.
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http://dx.doi.org/10.1186/s13063-022-06082-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8896281PMC
March 2022

The Effects of the Flash Technique Compared to Those of an Abbreviated Eye Movement Desensitization and Reprocessing Therapy Protocol on the Emotionality and Vividness of Aversive Memories.

Front Psychol 2021 23;12:741163. Epub 2021 Dec 23.

Altrecht Academic Anxiety Centre, Altrecht GGz, Utrecht, Netherlands.

The Flash technique is a novel intervention aimed at rapidly decreasing the subjective disturbance of an aversive memory, thereby serving as a potential way of treating post-traumatic stress disorder (PTSD). The protocol is used to stimulate clients to engage in positive imagery while being discouraged to actively recollect the targeted disturbing memory. Previous research into the Flash technique's efficacy shows promising results, yet controlled studies are lacking. To test the efficacy of the Flash technique, it was compared to an abbreviated eye movement desensitization and reprocessing (EMDR) therapy protocol in a controlled experimental setting. We hypothesized that the Flash technique would lead to a larger decrease in the emotionality and vividness of an aversive autobiographical memory when compared to EMDR therapy. Our second hypothesis was that the procedure of the Flash technique would be evaluated more pleasant by its receiver. The sample consisted of 60 non-clinical participants (mean age = 25.28 years; 73.33% female) who were able to recall an aversive autobiographical memory. They were randomized to either the Flash technique or the EMDR therapy condition. Measurements consisted of emotionality and vividness-ratings pre and post intervention, and at 1-week follow-up. Bayesian analyses showed no differences between Flash and EMDR to the extent to which the emotionality and vividness of their memory was reduced. Afterward, the Flash technique was rated more pleasant than EMDR. The results support the claim that the Flash technique might be used as a brief and efficacious intervention for individuals suffering from disturbing memories. Although the results suggest that its efficacy does not differ from EMDR, the Flash technique seems to yield similar outcomes in a more pleasant way. Further research into its working mechanisms and in a clinical sample is required.
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http://dx.doi.org/10.3389/fpsyg.2021.741163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8732365PMC
December 2021

Does EMDR Therapy Have an Effect on Memories of Emotional Abuse, Neglect and Other Types of Adverse Events in Patients with a Personality Disorder? Preliminary Data.

J Clin Med 2021 Sep 23;10(19). Epub 2021 Sep 23.

Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, 1012 WX Amsterdam, The Netherlands.

Background: Little is known about the effectiveness of trauma-focused therapies for memories of events not meeting the A-criterion of post-traumatic stress disorder (PTSD).

Objective: Determining the effect of EMDR therapy on memories of emotional abuse, neglect and other types of adverse events in patients with a personality disorder (PD).

Method: We conducted a secondary analysis of the data from our study, which aimed to determine the effectiveness of five sessions of EMDR therapy in 49 patients with a PD. Patients were divided into three different groups depending on their most prevalent type of adverse event. Data were analyzed with Generalized Estimating Equations.

Results: Of all patients, 49% reported emotional neglect, 22.4% emotional abuse and 26.5% other types. Only one patient reported memories that predominantly fulfilled the A-criterion of PTSD. After five sessions of EMDR therapy, medium to large treatment effects for memories related to neglect (ds between 0.52 and 0.79), medium treatment effects for memories involving emotional abuse (ds between 0.18 and 0.59) and other types of adverse events were found (ds between 0.18 and 0.53). No significant differences in symptom reduction associated with the application of EMDR therapy among memories involving these three different types of adverse events could be revealed.

Conclusions: The results support the notion that EMDR therapy is not only an effective therapy for memories related to A-criteria-worthy events, but that it also has a symptom-reducing effect on memories involving other types of adverse events. This suggests that EMDR might be a valuable addition to the treatment of PD without PTSD.
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http://dx.doi.org/10.3390/jcm10194333DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8509145PMC
September 2021

Predictors and moderators of treatment outcome for single incident paediatric PTSD: a multi-centre randomized clinical trial.

Eur J Psychotraumatol 2021 30;12(1):1968138. Epub 2021 Sep 30.

Department Of Social Dentistry And Behavioral Sciences, Academic Centre for Dentistry Amsterdam (Acta), University of Amsterdam, Amsterdam, The Netherlands.

Background: With few RCTs having compared active treatments for paediatric PTSD, little is known about whether or which baseline (i.e. pre-randomization) variables predict or moderate outcomes in the evaluated treatments.

Objective: To identify predictors and moderators of paediatric PTSD outcomes for Eye Movement Desensitization and Reprocessing Therapy (EMDR) and Cognitive Behavioural Writing Therapy (CBWT).

Method: Data were obtained as part of a multi-centre, randomized controlled trial of up to six sessions (up to 45 minutes each) of either EMDR therapy, CBWT, or wait-list, involving 101 youth (aged 8-18 years) with a PTSD diagnosis (full/subthreshold) tied to a single event. The predictive and moderating effects of the child's baseline sociodemographic and clinical characteristics, and parent's psychopathology were evaluated using linear mixed models (LMM) from pre- to post-treatment and from pre- to 3- and 12-month follow-ups.

Results: At post-treatment and 3-month follow-up, youth with an index trauma of sexual abuse, severe symptoms of PTSD, anxiety, depression, more comorbid disorders, negative posttraumatic beliefs, and with a parent with more severe psychopathology fared worse in both treatments. For children with more severe self-reported PTSD symptoms at baseline, the (exploratory) moderator analysis showed that the EMDR group improved more than the CBWT group, with the opposite being true for children and parents with a less severe clinical profile.

Conclusions: The most consistent finding from the predictor analyses was that parental symptomatology predicted poorer outcomes, suggesting that parents should be assessed, supported and referred for their own treatment where indicated. The effect of the significant moderator variables was time-limited, and given the large response rate (>90%) and brevity (<4 hours) of both treatments, the present findings suggest a focus on implementation and dissemination, rather than tailoring, of evidence-based trauma-focused treatments for paediatric PTSD tied to a single event.
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http://dx.doi.org/10.1080/20008198.2021.1968138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8491723PMC
December 2021

The effect of EMDR versus EMDR 2.0 on emotionality and vividness of aversive memories in a non-clinical sample.

Eur J Psychotraumatol 2021 22;12(1):1956793. Epub 2021 Sep 22.

PSYTREC, Bilthoven, The Netherlands.

Eye movement desensitization and reprocessing (EMDR) therapy is a treatment meant to reduce vividness and emotionality of distressing memories. There is accumulating evidence that working memory taxation is the core of the working mechanism of EMDR therapy and that EMDR derives its effect by taxing the working memory (WM) with a dual task while actively keeping a disturbing memory in mind. From a theoretical stance, based upon assumptions derived from the WM theory, the effectiveness of EMDR therapy could be improved by several adaptations. To test the assumption that integrating these elements into the standard EMDR protocol would enhance EMDR therapy, this adapted version of EMDR (i.e. EMDR 2.0), was compared to standard EMDR in a laboratory setting. It was hypothesized that EMDR 2.0 would be more efficacious than standard EMDR, and show a greater decrease in emotionality and vividness than standard EMDR therapy. Our second hypothesis was that EMDR 2.0 would be more efficient than standard EMDR in that this variant needs less session time and a smaller number of sets (i.e. approximately 30 seconds of WM taxation). Non-clinical participants ( = 62, 79% female, mean age = 35.21) with a disturbing autobiographical memory were randomly allocated to receive either EMDR or EMDR 2.0. Emotionality and vividness of the memory were measured pre- and post-intervention, and at 1- and 4-week follow-up. The results showed no difference between EMDR and EMDR 2.0 in decreasing emotionality and vividness, and no difference in session time. However, participants in the EMDR 2.0 condition needed fewer sets than those in the standard EMDR condition. The notion that EMDR 2.0 is more efficient is partially supported by the results showing participants needed less sets than in standard EMDR to reach the same results. Future research with clinical samples is warranted.
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http://dx.doi.org/10.1080/20008198.2021.1956793DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8462855PMC
December 2021

Early intervention with eye movement desensitization and reprocessing (EMDR) therapy to reduce the severity of post-traumatic stress symptoms in recent rape victims: a randomized controlled trial.

Eur J Psychotraumatol 2021 9;12(1):1943188. Epub 2021 Sep 9.

National Psychotrauma Center for Children and Youth, University Medical Center Utrecht, Utrecht, The Netherlands.

Background: About 40% of rape victims develop post-traumatic stress disorder (PTSD) within three months after the assault. Considering the high personal and societal impact of PTSD, there is an urgent need for early (i.e. within three months after the incident) interventions to reduce post-traumatic stress in victims of rape.

Objective: To assess the effectiveness of early intervention with eye movement desensitization and reprocessing (EMDR) therapy to reduce symptoms of post-traumatic stress, feelings of guilt and shame, sexual dysfunction, and other psychological dysfunction (i.e. general psychopathology, anxiety, depression, and dissociative symptoms) in victims of rape.

Method: This randomized controlled trial included 57 victims of rape, who were randomly allocated to either two sessions of EMDR therapy or treatment as usual ('watchful waiting') between 14 and 28 days post-rape. Psychological symptoms were assessed at pre-treatment, post-treatment, and 8 and 12 weeks post-rape. Linear mixed models and ANCOVAs were used to analyse differences between conditions over time.

Results: Within-group effect sizes of the EMDR condition ( = 0.89 to 1.57) and control condition ( = 0.79 to 1.54) were large, indicating that both conditions were effective. However, EMDR therapy was not found to be more effective than watchful waiting in reducing post-traumatic stress symptoms, general psychopathology, depression, sexual dysfunction, and feelings of guilt and shame. Although EMDR therapy was found to be more effective than watchful waiting in reducing anxiety and dissociative symptoms in the post-treatment assessment, this effect disappeared over time.

Conclusions: The findings do not support the notion that early intervention with EMDR therapy in victims of rape is more effective than watchful waiting for the reduction of psychological symptoms, including symptoms of post-traumatic stress. Further research on the effectiveness of early interventions, including watchful waiting, for this specific target group is needed.
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http://dx.doi.org/10.1080/20008198.2021.1943188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8439210PMC
December 2021

EMDR therapy for PTSD symptoms in patients with mild intellectual disability or borderline intellectual functioning and comorbid psychotic disorder: A case series.

Res Dev Disabil 2021 Oct 23;117:104044. Epub 2021 Aug 23.

Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands; Trajectum, Zwolle, the Netherlands; GGZ Oost-Brabant, Centre for Mild Intellectual Disability and Psychiatry, Boekel, The Netherlands.

Background: Little is known about the effectiveness of EMDR therapy for PTSD symptoms in persons with mild intellectual disability or borderline intellectual functioning (MID-BIF, IQ 50-85) and psychosis.

Aims: To examine effectiveness, feasibility, and safety of eye movement desensitization and reprocessing (EMDR) therapy in six patients with MID-BIF, PTSD and psychotic disorder.

Methods And Procedures: Data were collected in a multiple baseline across-subjects design. Before, during and after treatment, weekly assessments on PTSD symptoms and adverse events were carried out. PTSD classification was assessed, and severity of hallucinations, delusions, and general psychopathology were measured at pretreatment, posttreatment and three-month follow-up.

Outcomes And Results: There were no dropouts and five of the six participants completed treatment early. They showed a decrease in PTSD symptom severity and did no longer meet DSM-5 PTSD criteria at posttreatment. Results were maintained at follow-up. Symptoms did not exacerbate as indicated by a significant decrease in general psychopathology (in five participants) and an improvement in general functioning. In five participants severity of psychotic symptoms decreased.

Conclusions And Implications: EMDR therapy is safe and feasible and the results suggest that it can be an effective treatment for PTSD in patients with triple mental health problems in a tertiary mental health treatment setting.
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http://dx.doi.org/10.1016/j.ridd.2021.104044DOI Listing
October 2021

Effectiveness of an intensive treatment programme combining prolonged exposure and EMDR therapy for adolescents suffering from severe post-traumatic stress disorder.

Eur J Psychotraumatol 2021 05 14;12(1):1917876. Epub 2021 May 14.

Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.

: Following promising effects of an intensive trauma treatment for adults, the question arises whether adolescents who suffer from severe post-traumatic stress disorder (PTSD) can also profit from a similar treatment programme. : To assess the effectiveness of an intensive trauma-focused treatment programme combining two evidence-based trauma-focused therapies and physical activities for adolescents suffering from severe PTSD. : Treatment consisted of daily sessions of prolonged exposure (PE) therapy and eye movement desensitization and reprocessing (EMDR) therapy supplemented with physical activity (13 days on average). All patients ( = 27; 96.3% women, mean age = 16.1 years; SD = 1.3) had been exposed to one or more (interpersonal) traumatic events. Twenty-two of them (81.5%) also fulfilled the diagnostic criteria of a comorbid psychiatric disorder (mean number of comorbid disorders = 2.22). The majority of patients were referred because previous treatment was difficult or complications were expected to occur. Severity of PTSD symptoms and presence of a PTSD diagnostic status were assessed using the Dutch version of the CAPS-CA IV at baseline, post-treatment and at 3-month follow-up. : CAPS-CA IV scores decreased significantly from pre- to post-treatment (Cohen's = 1.39). Of all patients 81.5% ( = 22) showed a clinically meaningful response, of whom 63% ( = 17) no longer fulfilled the diagnostic criteria of PTSD at post-treatment as established with the CAPS-CA IV. The results were maintained at 3-month follow-up. During treatment, neither adverse events nor dropout occurred. : The results suggest that an intensive trauma-focused treatment programme combining prolonged exposure, EMDR therapy, and physical activity can be an effective and safe treatment for adolescents suffering from severe PTSD and multiple comorbid psychiatric disorders.
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http://dx.doi.org/10.1080/20008198.2021.1917876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128117PMC
May 2021

Safety and effectiveness of intensive treatment for complex PTSD delivered via home-based telehealth.

Eur J Psychotraumatol 2021 Feb 11;12(1):1860346. Epub 2021 Feb 11.

Research Department, PSYTREC, Bilthoven, The Netherlands.

: Home-based psychotherapy delivered via telehealth has not been investigated in the context of intensive trauma-focused treatment for individuals with severe or Complex posttraumatic stress disorder (PTSD). : To examine the feasibility, safety and effectiveness of an intensive treatment programme containing prolonged exposure, EMDR therapy, physical activities and psycho-education, delivered via home-based telehealth. : The treatment was carried out within four consecutive days during the outbreak of the COVID-19 pandemic. The sample consisted of six (four female) patients suffering from severe or Complex PTSD resulting from exposure to multiple traumatic events, mostly during early childhood. Four of them fulfilled the diagnostic criteria of complex PTSD. Outcome measures were the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), the PTSD Checklist for DSM-5 (PCL-5), and the International Trauma Questionnaire (ITQ). : CAPS-5 and PCL-5 scores decreased significantly from pre- to post-treatment (Cohen's s 1.04 and 0.93), and from post-treatment to follow-up (Cohen's s 0.92 and 1.24). Four of the six patients lost their PTSD or Complex PTSD diagnostic status. No patient dropped out, no personal adverse events and no reliable symptom worsening occurred. : The results suggest that intensive, trauma-focused treatment of severe or Complex PTSD delivered via home-based telehealth is feasible, safe and effective, and can be a viable alternative to face-to-face delivered intensive trauma-focused treatment.
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http://dx.doi.org/10.1080/20008198.2020.1860346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128126PMC
February 2021

Somatoform Dissociative Symptoms Have No Impact on the Outcome of Trauma-Focused Treatment for Severe PTSD.

J Clin Med 2021 Apr 7;10(8). Epub 2021 Apr 7.

PSYTREC, 3723 MB Bilthoven, The Netherlands.

For patients with complex or other severe forms of PTSD, particularly in cases with dissociative symptoms, different treatment approaches have been suggested. However, the influence of somatoform dissociation on the effectiveness of trauma-focused treatment has hardly ever been studied. This study aims to test the hypotheses that (1) PTSD patients reporting a low level and those reporting a high level of somatoform dissociative symptoms would both benefit from an intensive trauma-focused treatment, and that (2) somatoform dissociative symptoms would alleviate. Participants were 220 patients with severe PTSD, enrolled in an intensive treatment program combining EMDR therapy and prolonged exposure therapy, without a preceding stabilization phase. Trauma history was diversified, and comorbidity was high. PTSD symptoms (CAPS-5 and PCL-5) and somatoform dissociative symptoms (SDQ-5 and SDQ-20) were assessed at pre-treatment, post-treatment and at six months after completion of treatment. The course of both PTSD and somatoform dissociative symptoms was compared for individuals reporting low and for those reporting high levels of somatoform dissociative symptoms. Large effect sizes were observed regarding PTSD symptoms reduction for patients with both low and high levels of somatoform dissociation. Somatoform dissociation did not impact improvement in terms of PTSD symptom reduction. The severity of somatoform dissociative symptoms decreased significantly in both groups. This decrease was greater for those with a positive screen for a dissociative disorder. These results add further support to the notion that the presence of strong somatoform dissociative symptoms in patients with PTSD does not necessarily call for a different treatment approach. Clinical implications are discussed.
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http://dx.doi.org/10.3390/jcm10081553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8067818PMC
April 2021

A randomized controlled dismantling study of Visual Schema Displacement Therapy (VSDT) vs an abbreviated EMDR protocol vs a non-active control condition in individuals with disturbing memories.

Eur J Psychotraumatol 2021 Apr 9;12(1):1883924. Epub 2021 Apr 9.

Research Department, PSYTREC, Bilthoven, The Netherlands.

: Visual Schema Displacement Therapy (VSDT) is a novel therapy for the treatment of fears and trauma-related mental health problems including PTSD. VSDT proved to be effective in reducing emotionality of aversive memories in healthy individuals in two previous randomized controlled trials and outperformed both a non-active control condition (CC) and an abbreviated version of EMDR therapy, a well-established first-line treatment for posttraumatic stress disorder. : In an effort to enhance the understanding concerning the efficacy of VSDT, and to determine its active components, a dismantling study was conducted in individuals with disturbing memories in which the effects of VSDT were tested against EMDR therapy, a non-active CC and three different VSDT-protocols, each excluding or altering a hypothesized active component. : Participants ( = 144) were asked to recall an emotional aversive event and were randomly assigned to one of these six interventions, each lasting 8 minutes. Emotional disturbance and vividness of participants' memories were rated before and after the intervention and at one and four-week follow-up. : Replicatory Bayesian analyses supported hypotheses in which VSDT was superior to the CC and the EMDR condition in reducing emotionality, both directly after the intervention and at one week follow-up. However, at four-week follow-up, VSDT proved equal to EMDR while both treatments were superior to the CC. Concerning vividness the data also showed support for hypotheses predicting VSDT being equal to EMDR and both being superior to the CC in vividness reduction. Further analyses specifying differences between the abbreviated VSDT protocols detected no differences between these conditions. : It remains unclear how VSDT yields its positive effects. Because VSDT appears to be unique and effective in decreasing emotionality of aversive memories, replication of the results in clinical samples is needed.
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http://dx.doi.org/10.1080/20008198.2021.1883924DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043526PMC
April 2021

Comparing Intensive Trauma-Focused Treatment Outcome on PTSD Symptom Severity in Older and Younger Adults.

J Clin Med 2021 Mar 17;10(6). Epub 2021 Mar 17.

Clinical Center of Excellence for Older Adults with Personality Disorders, Mondriaan, 6419 PJ Heerlen-Maastricht, The Netherlands.

Objective: To examine the treatment outcome of an intensive trauma-focused treatment program for post-traumatic stress disorder (PTSD) in older and younger adults.

Methods: A non-randomized outcome study was conducted with 62 consecutively admitted older PTSD patients (60-78 years) and 62 younger PTSD patients (19-58 years), matched on gender and availability of follow-up data. Patients participated in an intensive eight-day trauma-focused treatment program consisting of eye movement desensitization and reprocessing (EMDR), prolonged exposure (PE), physical activity, and group psycho-education. PTSD symptom severity (Clinician-Administered PTSD Scale-5 (CAPS-5)) was assessed, at pre- and post-treatment, and for a subsample ( = 31 older; = 31 younger patients) at six-month follow-up.

Results: A repeated-measures ANCOVA (centered CAPS pre-treatment score as covariate) indicated a significant decrease in CAPS-5-scores from pre- to post-treatment for the total sample (partial = 0.808). The treatment outcome was not significantly different across age groups (partial = 0.002). There were no significant differences in treatment response across age groups for the follow-up subsample (pre- to post-treatment partial < 0.001; post-treatment to follow-up partial = 0.006), and the large decrease in CAPS-5 scores from pre- to post-treatment (partial = 0.76) was maintained at follow-up (partial = 0.003).

Conclusion: The results suggest that intensive trauma-focused treatment is applicable for older adults with PTSD with a large within-effect size comparable to younger participants. Further research on age-related features is needed to examine whether these results can be replicated in the oldest-old (>80).
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http://dx.doi.org/10.3390/jcm10061246DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002665PMC
March 2021

Reasons for Tooth Removal in Adults: A Systematic Review.

Int Dent J 2022 Feb 26;72(1):52-57. Epub 2021 Feb 26.

Department of Social Dentistry and Behavioral Sciences, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands; Research Department PSYTREC, Bilthoven, The Netherlands; School of Health Sciences, Salford University, Salford, United Kingdom; Institute of Health and Society, University of Worcester, Worcester, United Kingdom; School of Psychology, Queen's University, Belfast, Northern Ireland.

Objective: Most tooth extractions are performed for dental reasons, but there are also nondental and nonmedical reasons for extractions; these include psychological, financial, religious, and cultural reasons as well as simply granting a patient's request. This systematic review was performed to examine the proportion and range of indications associated with tooth removal in context of dental, nondental, and medical reasons.

Methods: A search conducted using PubMed, Embase, and APA PsycINFO identified 6038 studies. Three studies (4396 extractions in total) could be included for the risk of bias assessment and qualitative data synthesis.

Results: The reported indications for tooth extraction on dental and medical grounds included caries with the proportion of all extractions ranging from 36.0% to 55.3%, periodontitis from 24.8% to 38.1%, trauma from 0.8% to 4.4%, periapical disease from 7.3% to 19.1%, orthodontics from 2.5% to 7.2%, and other reasons from 4.5% to 9.2%. The proportion for patient requests ranged from 3.6% to 5.9%, but specific information regarding the actual reasons for extraction could not be determined.

Conclusion: The results suggest that caries and periodontitis are the most common indications for tooth extraction and that studies to reliably estimate the incidence of nondental and nonmedical motivation for extraction are lacking. Given that the final decision on performing or refusing extractions, whether it be based on dental, nondental, or nonmedical reasons, largely rests with the dentist and oral surgeon, detailed guidelines are warranted.
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http://dx.doi.org/10.1016/j.identj.2021.01.011DOI Listing
February 2022

Eye movement desensitization and reprocessing (EMDR) in patients with a personality disorder.

Eur J Psychotraumatol 2020 Nov 19;11(1):1838777. Epub 2020 Nov 19.

Department of Adult Psychiatry, GGZ Delfland, Delft, The Netherlands.

Little is known about the effects of targeting memories of adverse (childhood) events in people with a personality disorder (PD). : Determining the effectiveness of brief EMDR therapy in individuals with PD. In a randomized-controlled trial, 97 outpatients with a PD as main diagnosis were allocated to either five (90 minutes) sessions of EMDR therapy ( = 51) or a waiting list (WL) control condition ( = 46) followed by 3 months of treatment as usual for their PD. Individuals with posttraumatic stress disorder (PTSD) were excluded. Measurements were performed on psychological symptoms, psychological distress, and personality dysfunctioning. Outcomes were compared at baseline, post-treatment, and at 3-month follow up. Data were analysed as intent-to-treat with linear mixed models. EMDR therapy yielded significant improvements with medium to large effect sizes for the primary outcomes after treatment, i.e. psychological symptoms (EMDR: d =.42; control group: d =.07), psychological distress (EMDR: d =.69; control group: d =.29), and personality functioning (EMDR: d =.41; control group: d = -.10) within groups. At 3-month follow-up, after 3 months of TAU, improvements were maintained. Significant differences were found between both groups regarding all outcome measures in favour of the EMDR group at post-treatment (ds between -.62 and -.65), and at follow-up, after 3 months of TAU (ds between -.45 and -.53). The results suggest that EMDR therapy can be beneficial in the treatment of patients with PDs. More rigorous outcome research examining long-term effects and using a longer treatment track is warranted.
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http://dx.doi.org/10.1080/20008198.2020.1838777DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755323PMC
November 2020

The effects of symptom overreporting on PTSD treatment outcome.

Eur J Psychotraumatol 2020 Aug 11;11(1):1794729. Epub 2020 Aug 11.

Research Department, Research Department PSYTREC, Bilthoven, The Netherlands.

Background: It is often assumed that individuals with posttraumatic stress disorder (PTSD) who overreport their symptoms should be excluded from trauma-focused treatments.

Objective: To investigate the effects of a brief, intensive trauma-focused treatment programme for individuals with PTSD who are overreporting symptoms.

Methods: Individuals ( = 205) with PTSD participated in an intensive trauma-focused treatment programme consisting of EMDR and prolonged exposure (PE) therapy, physical activity and psycho-education. Assessments took place at pre- and post-treatment (Structured Inventory of Malingered Symptomatology; SIMS, Clinician Administered PTSD Scale for DSM-5; CAPS-5).

Results: Using a high SIMS cut-off of 24 or above, 14.1% ( = 29) had elevated SIMS scores (i.e. 'overreporters'). The group of overreporters showed significant decreases in PTSD-symptoms, and these treatment results did not differ significantly from other patients. Although some patients (35.5%) remained overreporters at post-treatment, SIMS scores decreased significantly during treatment.

Conclusion: The results suggest that an intensive trauma-focused treatment not only is a feasible and safe treatment for PTSD in general, but also for individuals who overreport their symptoms.
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http://dx.doi.org/10.1080/20008198.2020.1794729DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473171PMC
August 2020

Trauma-focused treatment outcome for complex PTSD patients: results of an intensive treatment programme.

Eur J Psychotraumatol 2020 Jul 23;11(1):1783955. Epub 2020 Jul 23.

Research Department, PSYTREC, Bilthoven, The Netherlands.

Background: Complex PTSD (CPTSD) has been incorporated in the 11th edition of the (ICD-11) as a mental health condition distinct from PTSD.

Objective: The objective of the current study is to determine whether individuals classified as having CPTSD can benefit from an intensive trauma-focused treatment, resulting in decreased PTSD and CPTSD symptoms, and loss of diagnoses.

Method: Patients diagnosed with PTSD ( = 308) took part in an intensive 8-day treatment programme combining prolonged exposure, EMDR therapy, psycho-education, and physical activity. The treatment was not phase-based in that it did not contain a stabilization phase or skill training prior to therapy. CPTSD diagnosis was assessed by means of the International Trauma Questionnaire (ITQ) and PTSD diagnosis was assessed with both the ITQ and CAPS-5. Treatment response was measured with the CAPS-5, PCL-5, and ITQ.

Results: Symptoms of both PTSD and CPTSD significantly decreased from pre- to post-treatment resulting in a significant loss of CAPS-5 based PTSD (74.0%) and ITQ-based PTSD and CPTSD diagnoses (85.0% and 87.7%, respectively). No adverse events occurred in terms of suicides, suicide attempts, or hospital admissions.

Conclusions: The results are supportive of the notion that the majority of patients classified as having CPTSD strongly benefit from an intensive trauma-focused treatment for their PTSD.
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http://dx.doi.org/10.1080/20008198.2020.1783955DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473266PMC
July 2020

Feasibility and potential effectiveness of an intensive trauma-focused treatment programme for families with PTSD and mild intellectual disability.

Eur J Psychotraumatol 2020 Jul 14;11(1):1777809. Epub 2020 Jul 14.

Trajectum, Zwolle, The Netherlands.

Background: Persons with mild intellectual disabilities or borderline intellectual functioning (MID-BIF; IQ 50-85) have a higher risk of being exposed to traumatic events and developing posttraumatic stress disorder (PTSD). EMDR therapy has shown to be applicable, safe and potentially effective for the treatment of PTSD in individuals with MID-BIF. However, in traumatized multi-problem families with MID-BIF and (impending) out of home placement of children, standard PTSD treatment in an outpatient setting may not be appropriate.

Objective: To evaluate the feasibility and potential effectiveness of KINGS-ID, a six-week clinical trauma-focused treatment programme consisting of intensive EMDR therapy with parents and children, and parental skills training followed by two weeks of parent support at home.

Method: Six families (nine parents of whom six had MID-BIF) and 10 children (all having MID-BIF) participated in the KINGS-ID programme. Seven parents and seven children had PTSD. Data were collected within a single case study design. For each family member data were collected during baseline (three measurements), treatment (seven weekly measurements), posttreatment (three measurements) and at follow-up (three measurements).

Results: None of the family members dropped out. Within the first two treatment weeks all but one child and one parent no longer met PTSD symptom criteria. In both children and parents, trauma-related symptoms and daily life impairment significantly decreased following treatment and in parents a significant decrease in symptoms of general psychopathology and parental stress was found. Results were maintained at six-month follow-up.

Conclusions: The findings of the current study are promising given that the treatment programme seems to offer new perspectives for traumatized multi-problem families with MID-BIF.
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http://dx.doi.org/10.1080/20008198.2020.1777809DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473050PMC
July 2020

The effects of PTSD treatment during pregnancy: systematic review and case study.

Eur J Psychotraumatol 2020 Jul 9;11(1):1762310. Epub 2020 Jul 9.

Department of Obstetrics and Gynecology, OLVG, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.

Background: PTSD in pregnant women is associated with adverse outcomes for mothers and their children. It is unknown whether pregnant women with PTSD, or symptoms of PTSD, can receive targeted treatment that is safe and effective.

Objective: The purpose of the present paper was to assess the effectiveness and safety of treatment for (symptoms of) PTSD in pregnant women.

Method: A systematic review was conducted in accordance with the PRISMA guidelines in Pubmed, Embase, PsychINFO, and Cochrane. In addition, a case is presented of a pregnant woman with PTSD who received eye-movement desensitization and reprocessing (EMDR) therapy aimed at processing the memories of a previous distressing childbirth.

Results: In total, 13 studies were included, involving eight types of interventions (i.e. trauma-focused cognitive behavioural therapy, exposure therapy, EMDR therapy, interpersonal psychotherapy, explorative therapy, self-hypnosis and relaxation, Survivor Moms Companion, and Seeking Safety Intervention). In three studies, the traumatic event pertained to a previous childbirth. Five studies reported obstetrical outcomes. After requesting additional information, authors of five studies indicated an absence of serious adverse events. PTSD symptoms improved in 10 studies. However, most studies carried a high risk of bias. In our case study, a pregnant woman with a PTSD diagnosis based on DSM-5 no longer fulfilled the criteria of PTSD after three sessions of EMDR therapy. She had an uncomplicated pregnancy and delivery.

Conclusion: Despite the fact that case studies as the one presented here report no adverse events, and treatment is likely safe, due to the poor methodological quality of most studies it is impossible to allow inferences on the effects of any particular treatment of PTSD (symptoms) during pregnancy. Yet, given the elevated maternal stress and cortisol levels in pregnant women with PTSD, and the fact that so far no adverse effects on the unborn child have been reported associated with the application of trauma-focused therapy, treatment of PTSD during pregnancy is most likely safe.
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http://dx.doi.org/10.1080/20008198.2020.1762310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473051PMC
July 2020

Sequence matters: Combining Prolonged Exposure and EMDR therapy for PTSD.

Psychiatry Res 2020 08 16;290:113032. Epub 2020 May 16.

Research department PSYTREC, Bilthoven, The Netherlands; Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, The Netherlands; School of Health Sciences, Salford University, Manchester, United Kingdom; Institute of Health and Society, University of Worcester, United Kingdom; School of Psychology, Queen's University, Belfast Northern Ireland. Electronic address:

Objective: Investigating the influence of the sequence in which two evidence-based trauma-focused treatments are offered to PTSD-patients.

Methods: PTSD-patients were treated using an intensive eight-day treatment program, combining Prolonged Exposure (PE) and EMDR therapy. Forty-four patients received a PE session in the morning and an EMDR session in the afternoon, while 62 patients received the reversed sequence (EMDR followed by PE). Outcome measures were PTSD symptom severity and subjective experiences.

Results: Patients who received PE first and EMDR second showed a significantly greater reduction in PTSD symptoms. Patients preferred this sequence and valued the treatment sessions as significantly more helpful compared to patients in the EMDR-first condition.

Conclusion: The results of this explorative study are supportive of the notion that PE and EMDR therapy can be successfully combined, and that sequence matters. First applying PE sessions before EMDR sessions resulted in better treatment outcome, and better subjective patient's evaluations in terms of treatment helpfulness and preference.
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http://dx.doi.org/10.1016/j.psychres.2020.113032DOI Listing
August 2020

Response to "Comparing the Effectiveness of EMDR and TF-CBT for Children and Adolescents: a Meta-Analysis.

J Child Adolesc Trauma 2020 Mar 30;13(1):89-91. Epub 2019 Apr 30.

6Department of Behavioral Sciences, ACTA, University of Amsterdam and VU University, Amsterdam, The Netherlands.

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http://dx.doi.org/10.1007/s40653-019-00257-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7163885PMC
March 2020

Do early interventions prevent PTSD? A systematic review and meta-analysis of the safety and efficacy of early interventions after sexual assault.

Eur J Psychotraumatol 2019 8;10(1):1682932. Epub 2019 Nov 8.

Department of Social Dentistry and Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

: To review the safety and efficacy of early interventions after sexual assault in reducing or preventing posttraumatic stress disorder (PTSD). : Systematic searches were performed on studies (1980-2018) that examined the efficacy of interventions for PTSD within 3 months after sexual assault. : The review identified 7 studies (n = 350) with high risk of bias that investigated 5 interventions. Only two studies reported on safety. Contact with the authors of six studies provided no indications for the occurrence of adverse events. Two studies reported the efficacy using PTSD diagnosis as dependent variable but found no difference between groups. All studies reported on efficacy using PTSD severity as dependent variable. For the meta-analysis, 4 studies (n = 293) were included yielding significantly greater reductions of PTSD severity than standard care at 2 to 12 months follow-up ( = -0.23, 95% CI [-0.46, 0.00]), but not at 1 to 6 weeks post-intervention ( = -0.28, 95% CI [-0.57, 0.02]). The heterogeneity of the interventions precluded further analyses. : Findings suggest that early interventions can lead to durable effects on PTSD severity after sexual assault. However, due to limited availability of data, it is impossible to draw definite conclusions about safety and efficacy of early interventions, and their potential to prevent PTSD.
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http://dx.doi.org/10.1080/20008198.2019.1682932DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6853210PMC
November 2019

Effectiveness of trauma-focused treatment for adolescents with major depressive disorder.

Eur J Psychotraumatol 2019 8;10(1):1682931. Epub 2019 Nov 8.

Rivierduinen Center for Eating Disorders Ursula, Leiden, The Netherlands.

: Major Depressive Disorder (MDD) in adolescence has a high prevalence and risk of disability, but current treatments show limited effectiveness and high drop-out and relapse rates. Although the role of distressing experiences that relate to the development and maintenance of MDD has been recognized for decades, the efficacy of a trauma-focused treatment approach for MDD has hardly been studied. : To determine the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy as a stand-alone intervention in adolescents diagnosed with MDD. We hypothesized that reprocessing core memories related to the onset and maintenance of MDD using EMDR therapy would be associated with a significant decrease in depressive and comorbid symptoms. : We recruited 32 adolescents (12-18 years) fulfilling DSM-IV criteria for mild to moderate-severe MDD from an outpatient youth mental health care unit. Treatment consisted of six weekly 60-min individual sessions. Presence or absence of MDD classification (ADIS-C), symptoms of depression (CDI), symptoms of posttraumatic stress (UCLA), anxiety (SCARED), somatic complaints (CSI), and overall social-emotional functioning (SDQ) were assessed pre and post-treatment and 3 months after treatment. : 60.9% of the adolescents completing treatment no longer met DSM-IV criteria for MDD after treatment anymore, and 69.8% at follow-up. Multilevel analyses demonstrated significant posttreatment reductions of depressive symptoms (CDI: Cohen's = 0.72), comorbid posttraumatic stress, anxiety and somatic complaints, while overall social-emotional functioning improved. These gains were maintained at 3-month follow-up (Cohen's = 1.11). Severity of posttraumatic stress reactions significantly predicted the posttreatment outcome; however, duration of MDD, number of comorbid disorders, or having a history of emotional abuse, emotional neglect or physical neglect were not predictive for outcome. : This is the first study suggesting that EMDR therapy is associated with a significant reduction of depressive symptoms and comorbid psychiatric problems in adolescents with mild to moderate-severe MDD.
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http://dx.doi.org/10.1080/20008198.2019.1682931DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6853245PMC
November 2019

Improvements in cardiorespiratory fitness are not significantly associated with post-traumatic stress disorder symptom reduction in intensive treatment.

Eur J Psychotraumatol 2019 20;10(1):1654783. Epub 2019 Aug 20.

Research Department, PSYTREC, Bilthoven, The Netherlands.

: Physical activity has been found to have positive effects on symptoms of post-traumatic stress disorder (PTSD). However, the importance and role of cardiorespiratory fitness (CRF) in relation to PTSD treatment outcome is not yet clear. : The purpose of the present study was to test the hypothesis that CRF would increase following intensive trauma-focused treatment (TFT) of PTSD augmented with physical activity, and that improved CRF would be associated with a significant decline in PTSD symptoms. : One hundred-eight individuals with severe PTSD (72% women; mean age = 40.44, = 11.55) were enrolled in an intensive TFT programme of 8 days within 2 consecutive weeks that consisted of daily prolonged exposure (PE), eye movement desensitization and reprocessing (EMDR) therapy and 6 hours of physical activity each day. CRF levels were assessed at baseline and post-treatment with a 6-Minute Walk Test (6MWT) and, in a subsample, with a submaximal ergometer test (PWC/kg). Severity of PTSD symptoms was measured with the PTSD Symptom Scale-Self Report (PSS-SR). : A significant increase in CRF from pre- to post-treatment and a significant decrease of PTSD-symptoms was found. However, CRF difference scores were not associated with treatment outcome. : Although individuals with PTSD may show an increase in CRF following an intensive TFT programme augmented with physical activity and a decrease of PTSD-symptoms, the current findings do not support the notion that treatment outcome is related to CRF.
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http://dx.doi.org/10.1080/20008198.2019.1654783DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6713160PMC
August 2019

Are Technology-Based Interventions Effective in Reducing Dental Anxiety in Children and Adults? A Systematic Review.

J Evid Based Dent Pract 2019 06 2;19(2):140-155. Epub 2019 Feb 2.

Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; School of Health Sciences, Salford University, Manchester, United Kingdom; Institute of Health and Society, University of Worcester, Worcester, United Kingdom; School of Psychology, Queen's University, Belfast, Northern Ireland.

Objectives: The aim of this study was to evaluate the effectiveness of technology-based interventions for the treatment of dental anxiety in children and adults.

Data Sources: A systematic search using relevant keywords was conducted in PubMed-Medline, EMBASE, PsycINFO, CINAHL, Scopus, and The Cochrane Library.

Inclusion Criteria: Randomized controlled trials (RCTs) that compared technology-based interventions with inactive controls in the treatment of moderate to severe dental anxiety were included.

Results: A total of seven RCTs were included in the review. These studies investigated the effectiveness of video modeling, computerized cognitive behavioral therapy, virtual reality exposure therapy, and distraction with music and audiovisual video material. Six studies examining video modeling, computerized cognitive behavioral therapy, virtual reality exposure therapy, and distraction (audiovisual) showed significantly greater reductions in dental anxiety than inactive controls in both children and adults. None of the included studies followed Consolidated Standards of Reporting Trials guidelines completely or reported sufficient data, thereby precluding a possible meta-analysis. Four out of seven included studies were assessed to be at high risk of bias.

Conclusions: A limited number of studies supported the effectiveness of technology-based interventions in the treatment of dental anxiety in children and adults.

Clinical Significance: The quality of the methods of studies on the effects of technology-based interventions allows only limited inferences on the effects of these interventions. However, within the limitations of the systematic review, the results converge to suggest that technology-based interventions may be useful as an adjunct to standard dental care. High-quality RCTs are needed to determine the (relative) effectiveness of these interventions.

Prospero Registration Number: CRD42017064810.
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http://dx.doi.org/10.1016/j.jebdp.2019.01.009DOI Listing
June 2019

Early intervention with eye movement desensitisation and reprocessing (EMDR) therapy to reduce the severity of posttraumatic stress symptoms in recent rape victims: study protocol for a randomised controlled trial.

Eur J Psychotraumatol 2019 1;10(1):1632021. Epub 2019 Jul 1.

National Psychotrauma Center for Children and Youth, University Medical Center Utrecht, Utrecht, the Netherlands.

It is estimated that more than 40% of rape victims develops a posttraumatic stress disorder (PTSD), a statistic that is relatively high compared to other types of trauma. PTSD can affect the victims' psychological, sexual, and physical health. Therefore, there is an urgent need for early interventions to prevent the onset of PTSD in this target group. This randomised controlled trial (RCT) examines the efficacy of early Eye Movement Desensitisation and Reprocessing (EMDR) therapy aimed to reduce the severity of posttraumatic stress symptoms in victims of recent rape. Subjects (N = 34) are individuals of 16 years and older who present themselves within 7 days post-rape at one of the four participating Sexual Assault Centres in the Netherlands. The intervention consists of two sessions of EMDR therapy between day 14 and 28 post-rape, while the control group receives treatment as usual, consisting of careful monitoring of stress reactions by a case-manager across two contacts during 1-month post-rape. Baseline assessment, posttreatment assessment and follow-up assessments at 8 and 12-weeks post-rape will be used to assess the development of posttraumatic stress symptoms. In addition, the efficacy of the intervention on psychological and sexual functioning will be determined. Linear mixed model analysis will be used to explore the differences within and between the EMDR group and control group at the various time points. The results of this RCT may help the dissemination and application of evidence-based preventative treatments for PTSD after rape.
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http://dx.doi.org/10.1080/20008198.2019.1632021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610517PMC
July 2019

Health-economic benefits of treating trauma in psychosis.

Eur J Psychotraumatol 2019 21;10(1):1565032. Epub 2019 Jan 21.

Behavioural Science Institute, Radboud University Nijmegen, NijCare, Nijmegen, The Netherlands.

: Co-occurrence of posttraumatic stress disorder (PTSD) in psychosis (estimated as 12%) raises personal suffering and societal costs. Health-economic studies on PTSD treatments in patients with a diagnosis of a psychotic disorder have not yet been conducted, but are needed for guideline development and implementation. This study aims to analyse the cost-effectiveness of guideline PTSD therapies in patients with a psychotic disorder. : This health-economic evaluation alongside a randomized controlled trial included 155 patients with a psychotic disorder in care as usual (CAU), with comorbid PTSD. Participants received eye movement desensitization and reprocessing (EMDR) ( = 55), prolonged exposure (PE) ( = 53) or waiting list (WL) ( = 47) with masked assessments at baseline (T0) and at the two-month (post-treatment, T2) and six-month follow-up (T6). Costs were calculated using the TiC-P interview for assessing healthcare consumption and productivity losses. Incremental cost-effectiveness ratios and economic acceptability were calculated for quality-adjusted life years (EQ-5D-3L-based QALYs) and PTSD 'Loss of diagnosis' (LoD, CAPS). : Compared to WL, costs were lower in EMDR (-€1410) and PE (-€501) per patient per six months. In addition, EMDR (robust SE 0.024, = 2.14, = .035) and PE (robust SE 0.024, = 2.14, = .035) yielded a 0.052 and 0.051 incremental QALY gain, respectively, as well as 26% greater probability for LoD following EMDR (robust SE = 0.096, = 2.66, = .008) and 22% following PE (robust SE 0.098, = 2.28, = .023). Acceptability curves indicate high probabilities of PTSD treatments being the better economic choice. Sensitivity analyses corroborated these outcomes. : Adding PTSD treatment to CAU for individuals with psychosis and PTSD seem to yield better health and less PTSD at lower costs, which argues for implementation.
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http://dx.doi.org/10.1080/20008198.2018.1565032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6346719PMC
January 2019

Efficacy of virtual reality exposure therapy for the treatment of dental phobia in adults: A randomized controlled trial.

J Anxiety Disord 2019 03;62:100-108

Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, the Netherlands; School of Psychology, Queen's University, Belfast, Northern Ireland; Institute of Health and Society, University of Worcester, United Kingdom.

Background: Although Virtual Reality Exposure Therapy (VRET) has proven to be effective in the treatment of various subtypes of specific phobia, there is limited evidence of its role in the treatment of dental phobia.

Method: A single-blind RCT was conducted among 30 randomized patients with dental phobia to either VRET or informational pamphlet (IP) condition. Primary outcome anxiety measures (VAS-A, MDAS and DFS) were evaluated at baseline, pre- and post-intervention, 1-week, 3-months and 6-months follow-up. Secondary outcome measures assessed were pre-post behavioral avoidance, temporal variations of heart rate and VR-experience during and post-VRET, and dental treatment acceptance in both conditions at 6-month follow-up.

Results: Intention to treat analysis, using a repeated measures MANOVA, revealed a multivariate interaction effect between time and condition (p = 0.015) for all primary outcome measures (all ps < 0.001). Only patients of the VRET condition showed a significant reduction in anxiety scores (mean reduction [s.d.]: VAS-A 44.4 [36.1]; MDAS 7.1 [5.4]; DFS 21.2 [13.1]) whereas the patients in the IP group did not (mean reduction [s.d.]: VAS-A -0.33 [7.7]; MDAS -0.33 [1.3]; DFS -1.9 [3.8]), F (15, 14) = 3.3, p = 0.015.

Conclusions: VRET was found to be efficacious in the treatment of dental phobia.
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http://dx.doi.org/10.1016/j.janxdis.2018.12.001DOI Listing
March 2019

Effects of "Visual Schema Displacement Therapy" (VSDT), an abbreviated EMDR protocol and a control condition on emotionality and vividness of aversive memories: Two critical analogue studies.

J Behav Ther Exp Psychiatry 2019 06 27;63:48-56. Epub 2018 Nov 27.

Altrecht Academic Anxiety Centre, Altrecht GGz, Utrecht, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.

Background And Objectives: Visual Schema Displacement Therapy (VSDT) is a novel therapy which has been described as a treatment for stress and dysfunction caused by a traumatic event. Although its developers claim this therapy is quicker and more beneficial than other forms of trauma therapy, its effectiveness has not been tested.

Methods: We compared the efficacy of VSDT to an abbreviated EMDR protocol and a non-active control condition (CC) in two studies. In Study 1 participants (N = 30) were asked to recall three negative emotional memories under three conditions: VSDT, EMDR, and a CC, each lasting 8 min. Emotional disturbance and vividness of the memories were rated before and after the (within group) conditions. The experiment was replicated using a between group study. In Study 2 participants (N = 75) were assigned to one of the three conditions, and a follow-up after 6-8 days was added.

Results: In both studies VSDT and EMDR were superior to the CC in reducing emotional disturbance, and VSDT was superior to EMDR. VSDT and EMDR outperformed the CC in terms of reducing vividness.

Limitation: Results need to be replicated in clinical samples.

Conclusions: It is unclear how VSDT yields positive effects, but irrespective of its causal mechanisms, VSDT warrants clinical exploration.
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http://dx.doi.org/10.1016/j.jbtep.2018.11.006DOI Listing
June 2019
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