EMDR for children with medically related subthreshold PTSD: short-term effects on PTSD, blood-injection-injury phobia, depression and sleep.

Abstract:

:Background: Paediatric illness, injury and medical procedures are potentially traumatic experiences with a range of possible negative psychosocial consequences. To prevent psychosocial impairment and improve medical adherence, evidence-based psychotherapy should be offered if indicated. Eye movement desensitization and reprocessing (EMDR) has been found to reduce symptoms of posttraumatic stress disorder (PTSD) in adults. The evidence for the use with children is promising. Furthermore, recent studies indicate its effectiveness for the treatment of other psychological symptomatology. However, the effectiveness of EMDR in children with subthreshold PTSD after medically related trauma has not yet been investigated. Objective: Investigating the short-term effectiveness of EMDR on posttraumatic stress, anxiety, depression and sleep problems in children with subthreshold PTSD after hospitalization through a randomized controlled trial (RCT). Method: Following baseline screening of 420 children from various Dutch hospitals, 74 children (4-15 years old) with medically related subthreshold PTSD were randomized to EMDR (n = 37) or care-as-usual (CAU; n = 37). Follow-up assessment took place after M = 9.7 weeks. Generalized Estimating Equation (GEE) analyses were performed to examine the effectiveness of EMDR compared to CAU. Results: Children in both groups improved significantly over time on all outcomes. However, the EMDR group improved significantly more as to child-reported symptoms of blood-injection-injury (BII) phobia and depression, and child-, and parent-reported sleep problems of the child. There was no superior effect of EMDR compared to CAU on subthreshold PTSD symptom reduction. Conclusions: EMDR did not perform better than CAU in reducing PTSD symptoms in a paediatric sample of children with subthreshold PTSD after hospitalization. However, the study results indicate that EMDR might be superior in reducing symptoms of blood-injection-injury phobia, depression and sleep problems. :Antecedentes: La enfermedad pediátrica, injuria y procedimientos médicos son experiencias potencialmente traumáticas con un rango de posibles consecuencias psicosociales negativas. Para prevenir el deterioro psicosocial y mejorar la adherencia médica, se debe ofrecer psicoterapia basada en evidencia si está indicada. Se ha observado que la Desensibilización y Reprocesamiento por Movimientos Oculares (EMDR) reduce los síntomas del Trastorno de Estrés Postraumático (TEPT) en adultos. La evidencia para su uso en niños es promisoria. Asimismo, estudios recientes indican su efectividad para el tratamiento de otra sintomatología psicológica. No obstante, la efectividad de la EMDR en niños con TEPT subumbral posterior a trauma médicamente relacionado aún no ha sido estudiada.Objetivo: Investigar la efectividad a corto plazo de la EMDR en estrés postraumático, ansiedad, depresión y alteraciones del sueño en niños con TEPT subumbral posterior a hospitalización, a través de un ensayo controlado aleatorizado (ECA).Método: Seguimiento de una muestra de 420 niños provenientes de varios hospitales holandeses, 74 niños (4–15 años de edad) con TEPT subumbral médicamente relacionado fueron aleatorizados a EMDR (n=37) o tratamiento habitual (TH, n=37). La evaluación posterior tuvo lugar tras M=9,7 semanas. Se realizó un análisis de ecuaciones de estimación generalizadas (EEG) para examinar la efectividad de EMDR comparado con TH.Resultados: Los niños en ambos grupos mejoraron significativamente a lo largo del tiempo en todas las variables. No obstante, el grupo EMDR mejoró significativamente más en los síntomas reportados por los niños respecto a belonefobia y depresión, y en alteraciones del sueño de los niños reportadas tanto por ellos como por sus padres. No hubo efecto superior de EMDR comparado con TH en la reducción de síntomas de TEPT subumbral.Conclusiones: EMDR no actuó mejor que TH en la reducción de síntomas de TEPT en niños en una muestra pediátrica de niños con TEPT subumbral posterior a hospitalización. Sin embargo, los resultados del estudio indican que EMDR podría ser superior en la reducción de síntomas de belonefobia, depresión y alteraciones del sueño. :背景: 儿科疾病, 损伤和医疗程序是潜在的创伤经历, 可能产生一系列负面的社会心理后果。为防止社会心理损伤并提高医疗依从性, 必要时应提供循证心理治疗。已经发现, 眼动脱敏与再加工 (EMDR) 可以减轻成年人的创伤后应激障碍 (PTSD) 症状, 用于儿童的证据很有前景。此外, 最近的研究表明其可用于治疗其他心理症状。然而, 尚未研究过EMDR对经历医疗创伤后患有阈下PTSD儿童的的疗效。目标: 通过随机对照试验 (RCT) 考查EMDR对住院后患有阈下PTSD儿童的创伤后应激, 焦虑, 抑郁和睡眠问题的短期疗效。方法: 在对来自荷兰各家医院的420名儿童进行基线筛查之后, 将74名患有医疗相关阈下PTSD的儿童 (4–15岁) 随机分为EMDR组 (n = 37) 或日常护理组 (CAU; n= 37) 。平均9.7周左右进行随访评估。进行了广义估计方程 (GEE) 分析, 以考查EMDR相比CAU的疗效。结果: 随着时间的推移, 两组儿童的所有结果均有显著改善。但是, EMDR组在儿童报告的血液-注射-损伤型 (BII) 恐惧和抑郁以及儿童和父母报告的儿童睡眠问题方面有更明显的改善。相较于CAU, EMDR对阈下PTSD症状的减轻没有更好的效果。结论: 在住院后患有阈下PTSD儿童的儿科样本中, EMDR在减轻PTSD症状方面没有表现出比CAU更好的疗效。但是, 研究结果表明, EMDR可能在减轻血液-注射-损伤型恐惧, 抑郁和睡眠问题方面具有更大的优势。.

journal_name

Eur J Psychotraumatol

authors

Meentken MG,van der Mheen M,van Beynum IM,Aendekerk EWC,Legerstee JS,van der Ende J,Del Canho R,Lindauer RJL,Hillegers MHJ,Moll HA,Helbing WA,Utens EMWJ

doi

10.1080/20008198.2019.1705598

subject

Has Abstract

pub_date

2020-01-10 00:00:00

pages

1705598

issue

1

issn

2000-8066

pii

1705598

journal_volume

11

pub_type

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