Saskia van Es

Background: ImRs and EMDR, two promising techniques in treatment for childhood trauma-based PTSD, were compared in a randomized controlled study (Boterhoven de Haan et al., 2017), the IREM. For ImRs; the predominant explanation is that it works by changing the meaning of trauma events (Arntz, 2012). In the case of EMDR, the most recent theory is the working memory theory (Van den Hout & Engelhard, 2012). A qualitative study was done on patients’ perspectives on the working mechanisms in these two techniques. Objective: The study addressed the following questions: What are the most effective elements in the followed treatment according to patients? Is there a difference between the two treatments in this respect? Method: Opinions of 40 patients participating in the IREM study in Australia, Germany and the Netherlands were collected with semi-structured in-depth interviews. Thematic analysis was used for analysing the interviews. Results: At this symposium the results of the interviews in Australia, Germany and the Netherlands will be presented. Conclusions: The perspective of patients will help us to improve treatments, and to instruct therapists and patients helping them to get the best results possible.

... Asthma: Results from Focus Group Interviews Saskia M. van Es, MA,l Elise M. le Coq, MD, Ph.D.,I Astrid I. Brouwer, MA,' Ilse Mesters, Ph.D.,2 Ad F. Nagelkerke, MD? and Vivian T. Colland, Ph.D.lr4 ... " REFERENCES 2. Kolnaar B, Beissel E, Bosch WJ van den, Folgering H ...

Background Trauma-focused treatments for posttraumatic stress disorder (PTSD) are commonly delivered either once or twice a week. Initial evidence suggests that session frequency affects treatment response, but very few trials have investigated the effect of session frequency. The present study’s aim is to compare treatment outcomes of twice-weekly versus once-weekly sessions of two treatments for PTSD related to childhood trauma, imagery rescripting (ImRs) and eye movement desensitization and reprocessing (EMDR). We hypothesize that both treatments will be more effective when delivered twice than once a week. How session frequency impacts treatment response, whether treatment type moderates the frequency effect, and which treatment type and frequency works best for whom will also be investigated. Methods The IREM-Freq trial is an international multicenter randomized clinical trial conducted in mental healthcare centers across Australia, Germany, and the Netherlands. We aim to recru...

BACKGROUND In a clinical trial, web-based cognitive behaviour therapy (I-CBT) embedded in stepped care was found to be non-inferior to face-to-face (f2f) CBT for chronic fatigue syndrome. However, results of clinical trials are not necessarily retained after implementation. OBJECTIVE Our aim was to investigate whether stepped care starting with I-CBT, followed by f2f CBT is also effective in routine clinical care. Second aim was to explore the role of therapist attitudes towards e-health and manualised treatment on reduction of fatigue severity. METHODS I-CBT was implemented in five mental health care centres (MHCs) with nine treatment sites throughout the Netherlands. All patients with chronic fatigue syndrome were offered I-CBT, followed by f2f CBT if still severely fatigued or disabled after I-CBT. Outcomes were fatigue severity (Checklist Individual Strength), physical and social functioning (SF-36) and limitations in daily functioning (Work and social adjustment scale). The cha...

ed from Nijjof SL, Bleijenberg G, Uiterwaal CS, et al. Effectiveness of internet-based cognitive behavioural treatment for adolescents with chronic fatigue syndrome (FITNET): a randomised controlled trial. Lancet 2012. (Epub ahead of print). Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is relatively common (prevalence 1–2.4% ) and often disabling with up to 50% of children bedbound at some stage. New ways of providing treatment that allow teenagers with CFS/ME to access care is important. In this well-conducted and innovative study, the web-based intervention was provided in two sections: a psychoeducational section and a cognitive behavioural section which consisted of 21 different modules for adolescents with support provided by e-consults from trained therapists. Perhaps uniquely parents followed a parallel programme which included the psychoeducation aspects but did not include the behavioural tools (patient diaries, etc). The results suggest that FITNET was remarkably effective compared to usual care in the Netherlands. 75% of children in the FITNET group were attending ‘full time school’ (>90% attendance) at 6 months compared to 16% in the usual care group. Both fatigue and physical function had improved more in those taking part in FITNET. The authors were careful to ensure that all patients recruited had CFS/ME. All adolescents were assessed by a paediatrician who specialised in CFS/ ME with a detailed history, examination and laboratory tests to exclude other causes of fatigue. All participants completed computerised self-reported questionnaires and those with abnormal scores had a clinical assessment by a psychologist to exclude primary depression or anxiety. The recruitment rate was extremely high for a trial (96%) suggesting that this approach is attractive to adolescents. The follow-up was also high (97%) at 12 months improving confidence in the validity of the results. Patients in the usual care arm who had not improved at 6 months were offered FITNET. This design ensured that all adolescents eventually had access to the intervention on offer. The results of patients in the usual care arm who crossed over to FITNET were similar to the original FITNET group at 12 months. Is this approach transferable outside the Netherlands? Probably not without further study. It is unclear exactly what usual care in the Netherlands was, and how comparable it is to care in other countries. For example, 10% of children randomised to usual care were unable to receive any care because ‘treatment was not available within an acceptable travelling distance’. The remainder received a mixture of evidence based treatment including cognitive behavioural therapy and graded exercise therapy as well as non-evidence based treatments such as alternative treatment 16 (24%) and ‘rehabilitation treatment’, but the content, frequency, intensity and duration of such treatments is not known. The cost-effectiveness of such a system is also uncertain: although FITNET did not require face to face consultations, it was resource intensive. The mean number of times patients and parents logged in was 255. The mean number of email consults by patients was 66.6 (SD 16.3) and by parents was 22.8 (10.3). The mean number of e-consults sent by the therapist was 28.7 (10.3) per patient and 19.5 (10.5) per parent. Further health economic analyses will help us know whether this approach is cost-effective or not.

Mutual Agreement IREM Study. The mutual agreement endorsed by each of the participating sites outlining the roles and responsibilities of each university representative and site coordinator. The mutual agreement also includes the study timeline and planned publications. Appendix 2. World Health Organization Trial Registration Data Set. WHO Trial Registration Data Set completed to support SPIRIT Guidelines Checklist. Appendix 3. Consent form example. An example of the consent form that will be given to participants to read and sign to ensure informed consent. Appendix 4. Additional items added to the Impact of Events Scale Revised (IES-R). Four items that were added to the IES-R to assess trauma-related guilt, anger, disgust, and shame. Appendix 5. Additional items added to the Life Events Checklist (LEC-5). Additional items have been added to the LEC-5 to assess emotional abuse/neglect and physical neglect. (DOCX 136Â kb)

Post-traumatic stress disorder (PTSD) that originates from childhood trauma experiences can develop into a chronic condition that has lasting effects on an individual's functioning and quality of life. While there are evidence-based guidelines for treating adult onset PTSD, treatments for adults with childhood trauma-related PTSD (Ch-PTSD) are varied and subject to ongoing debate. This study will test the effectiveness of two trauma-focused treatments, imagery rescripting (ImRs) and eye movement desensitisation and reprocessing (EMDR) in participants with Ch-PTSD. Both have been found effective in treatment of adult PTSD or mixed onset PTSD and previous research indicates they are well-tolerated treatments. However, we know less about their effectiveness for treating Ch-PTSD or their underlying working mechanisms. IREM is an international multicentre randomised controlled trial involving seven sites across Australia, Germany and the Netherlands. We aim to recruit 142 participant...

Background Early identification of patients with mental health problems in need of highly specialised care could enhance the timely provision of appropriate care and improve the clinical and cost-effectiveness of treatment strategies. Recent research on the development and psychometric evaluation of diagnosis-specific decision-support algorithms suggested that the treatment allocation of patients to highly specialised mental healthcare settings may be guided by a core set of transdiagnostic patient factors. Aims To develop and psychometrically evaluate a transdiagnostic decision tool to facilitate the uniform assessment of highly specialised mental healthcare need in heterogeneous patient groups. Method The Transdiagnostic Decision Tool was developed based on an analysis of transdiagnostic items of earlier developed diagnosis-specific decision tools. The Transdiagnostic Decision Tool was psychometrically evaluated in 505 patients with a somatic symptom disorder or post-traumatic str...