Sofia Hall - Bulgarian Red Cross

Treatment of chronic PTSD: Imagery Rescripting, EMDR and STAIR - effectiveness and mechanisms of change

Arnoud Arntz, Dr Hannah Murray, Sandra Raabe Speaker

Understanding what treatment approaches work best in treating more chronic forms of PTSD requires considerable further investigation. It is important that we learn more on how best to treat this disorder and what are the key processes that determine their effectiveness. Some possibilities are Imagery Rescripting (ImRs) and EMDR which are brief trauma-focused interventions that limit the amount of exposure to traumatic material, thereby they may be more palatable to clients with complex and extensive traumas.   This symposium will present research findings on different aspects of EMDR and ImRs in the treatment of more chronic PTSD presentations. Arnoud Arntz will present results from the IREM RCT which compared ImRs and EMDR for the treatment of childhood trauma-related PTSD. The trial has recently concluded and was conducted in three countries and seven treatment sites. Sandra Raabe will present data on a completed RCT which investigated ImRs as stand-alone treatment vs. a sequential treatment (stabilization - ImRs) for PTSD related to childhood trauma. Katrina Boterhoven de Haan will present findings from qualitative interviews to explore the treatment experience from both therapists and patients’ perspectives involved in IREM. She will discuss the implications in how these findings further our knowledge and understanding of the barriers associated with PTSD treatments. Hannah Murray will present results from a series of studies conducted in a clinical setting which address the question ‘what makes ImRs effective?’. Together, these studies provide insight into whether, and how, ImRs can be used to address PTSD following extensive and chronic trauma.

Professor Arnoud Arntz  (Chair & Discussant) 1*, Dr Hannah Murray 2*, Sandra Raabe 1* and Katrina Boterhoven de Haan (Convenor) 3*

1. Department of Clinical Psychology, University of Amsterdam, The Netherlands;
2. Oxford Centre for Anxiety Disorders and Trauma, University of Oxford, United Kingdom;
3. Faculty of Health and Medical Sciences, University of Western Australia, Australia

1. What makes imagery rescripting effective?

Presenter: Hannah Murray

Affiliation: Oxford Centre for Anxiety Disorders and Trauma, University of Oxford


 Imagery rescripting (ImRs) has an accumulating evidence-base for effectiveness, but little research has examined how the technique works and, importantly from a clinician’s point of view, what makes an effective rescript. In this presentation, Dr Hannah Murray will summarise results from a number of clinical studies which have used varying techniques (experimental, case series and qualitative interview studies) to answer the question ‘what makes ImRs effective?’. The results contribute to a growing understanding of the crucial mechanisms of rescripting, and also allowing us to start making some clinical recommendations about the optimal way to deliver ImRs.


 2. Imagery Rescripting versus STAIR/Imagery Rescripting for PTSD related to Childhood Abuse: A Randomized Controlled Trial

Presenter: Sandra Raabe

Affiliation: University of Amsterdam


A recent randomized controlled trial examined two main questions: 1) what is the efficacy of Imagery Rescripting (ImRs) as stand-alone treatment for patients with complex PTSD related to childhood abuse, and 2) does the addition of a skills training in emotion and interpersonal regulation (STAIR) as a preparatory phase prior to the ImRs-treatment phase enhance the treatment effect for PTSD-symptoms. This presentation provides data on a comparison of ImRs as stand-alone treatment compared to the sequential treatment (STAIR/ImRs) and to a waitlist control group. Data consist of single-blind obtained interview-based measures for PTSD, and self-report measures for PTSD-symptoms, emotion regulation, and interpersonal functioning. Assessments were conducted at pre-/post and 3-month follow-up. Results will be presented and implications of the findings will be discussed.


Authors: Sandra Raabe, Thomas Ehring, Arnoud Arntz, Loes Marquenie, Merel Kindt.


3. Imagery Rescripting versus EMDR for PTSD related to Childhood Abuse: A Randomized Controlled Trial – the IREM study.

Presenter: Arnoud Arntz

Affiliation: University of Amsterdam


An international multicenter RCT was designed to compare Imagery Rescripting and EMDR as treatments for childhood-trauma related PTSD (Ch-Tr PTSD) as to effectiveness, mechanisms of change, and views of patients and therapists on the treatments. In both conditions, patients received 12 sessions of treatment twice a week. The primary outcome was the CAPS total score, and secondary outcomes include measures of guilt, shame, disgust, anger, dissociation and depression, as well as trauma-related cognitions. The inclusion has been completed now with a sample size > 140, and first (still preliminary, as follow-ups are not completed yet) results will be presented during this symposium. First results indicate high acceptability by patients (high treatment retention) and large clinical effects. The qualitative study results on the views of patients and therapists on the treatments will be presented separately in this symposium by Katrina Boterhoven de Haan.


Authors: Arnoud Arntz, Katrina L. Boterhoven de Haan, Christopher W. Lee, Eva Fassbinder, Marisol J. Voncken, Marleen Rijkeboer, Mariel Meewisse, Saskia M. Van Es, Simone Menninga, Margriet Kousemaker.


4. What therapists and adult patients Tell Us About treating their childhood PTSD experiences

Presenter: Katrina Boterhoven de Haan

Affiliations: University of Western Australia

 Their remains controversy around treating more complex forms of PTSD such as childhood-based trauma; in particular, the need for a stabilisation phase prior to trauma-focused treatment. It has been suggested that treatment effectiveness may be impacted due to patients’ limited capacity to tolerate increased levels of distress required for trauma processing. However, we know little about the experience of trauma-focused treatment from the patients’ perspective and even less from the therapists’ point of view. These perspectives may help to provide clinically relevant insights into how best to treat childhood trauma-related PTSD.

Patients and therapists involved in the IREM trial were interviewed to explore the experience of trauma-focused treatment for childhood trauma-related PTSD from both perspectives. We discuss the findings of this qualitative research which was conducted across three countries. The implications of these findings for improving PTSD treatments will be discussed.

Authors: Katrina L. Boterhoven de Haan, Helen Correia, Christopher W. Lee