The effectiveness of an intervention to reduce posttraumatic stress symptoms among girls in closed juvenile institutions.|
|- candidate number||8307|
|- NTR Number||NTR2468|
|- ISRCTN||ISRCTN wordt niet meer aangevraagd.|
|- Date ISRCTN created|
|- date ISRCTN requested|
|- Date Registered NTR||4-aug-2010|
|- Secondary IDs||Wc2009-050 Scientific Committee, EMGO|
|- Public Title||The effectiveness of an intervention to reduce posttraumatic stress symptoms among girls in closed juvenile institutions.|
|- Scientific Title||The effectiveness of an intervention (stabilization and EMDR) to reduce posttraumatic stress symptoms and trauma related complaints among girls in closed juvenile institutions.|
|- hypothesis||The girls of the experimental group will have less trauma related symptoms after treatment that controls (who received treatment as usual (TAU)).|
|- Healt Condition(s) or Problem(s) studied||Post-Traumatic Stress Disorder (PTSD), Post traumatic complaints, Trauma related complaints (e.g. anxiety, depression)|
|- Inclusion criteria||1. Trauma history (e.g. emotional, physical, sexual);|
2. Girls (age 12-18);
3. Trauma related complaints;
4. Sufficient command of the Dutch language to understand the questionnaires and the interview questions.
|- Exclusion criteria||1. Current psychotic disorder;|
2. IQ lower than 75.
|- mec approval received||yes|
|- multicenter trial||yes|
|- Type||2 or more arms, non-randomized|
|- planned startdate ||31-mei-2011|
|- planned closingdate||31-mei-2013|
|- Target number of participants||120|
|- Interventions||Experimental condition (stabilization phase + EMDR).|
A number of trauma-specific treatment programs are being developed for children and adolescents. They vary in method (e.g. group versus individual, exposure versus stabilization), point of intervention (e.g. child versus caregiver) and length. Given the complexity of the population (in psychiatric problems, co morbidity, and trauma history), Herman (1992) recommends a phase oriented treatment. Attention for safety, stabilization and stress management skills precedes the actual trauma exposure therapy. As there is no Dutch stabilization phase for adolescents, the stabilization phase will be developed by a juvenile institution (LSG-Rentray).
1. Stabilization and reducing complaints (e.g. sleeping, dissociation, emotion regulation);
2. Behavioural change.
1. The training will consist of 14 weekly sessions of 90 minutes each;
2. The group can contain minimum 4 and maximum 9 participants;
3. The training will be given by two trained professionals (one of them must be a psychologist and one of them is educated in cognitive behavioural therapy) and they are experienced in giving training to groups;
4. Each session has the same structure (welcome, summary previous session, homework, new theme (explanation), new theme (practicing), homework instruction, the end);
5. The sessions are behavioural therapeutic and psycho-educational based. And is oriented on improving problems such as sleeping, emotion regulation, aggression regulation, anxiety problems, dissociation problems; learning skills, restructuring dysfunctional cognitions, recognition in other group members.
Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that was developed to resolve symptoms resulting from disturbing and unresolved life experiences. It uses a structured approach to address past, present, and future aspects of disturbing memories. The approach was developed by Francine Shapiro to resolve the development of trauma related disorders as resulting from exposure to a traumatic or distressing event, such as rape or violence. Clinical trials have been conducted to assess EMDR's efficacy in the treatment of children with PTSD, and it has been shown effective. It is an individual treatment in which the patient, receives an external stimulus (eye movements or clicks in the ears) while thinking about a target such as a disturbing issue, event, feeling, memory or a maladaptive belief. The target will be reprocessed and stored in the memory. For this study, after 8 (individual) sessions there will be a measurement. If necessary, the patient can receive more sessions.
Control condition (treatment as usual):
Treatment as usual is defined as any form of psychotherapeutic treatment used in the juvenile institution with no restrictions on length and frequency (e.g. MultiSystemic Therapy (MST), EMDR, Cognitive Behavioural Therapy (CBT), Aggression Regulation Therapy (ART), Functional Family Therapy (FFT), System Therapy (ST).
|- Primary outcome||Trauma symptoms (measured by Trauma Symptom Checklist for Children).|
|- Secondary outcome||1. Motivation for treatment (measured by Motivation Questionnaire (NML 2));|
2. Social desirability (measured by Marlowe-Crowne Social Desirability Scale);
3. Borderline symptoms (measured by Borderline Symptom List);
4. Therapeutic alliance (measured by Work Alliance Inventory-short form);
5. Anxiety and depression symptoms (measured by Revised Child Anxiety and Depression Scale);
6. Agression (measured by Reactive and Proactive Aggression Questionnaire);
7. Internalizing and externalizing problems (measured by Strengths and Difficulties Questionnaire).
|- Timepoints||1. Baseline measurement: Before treatment;|
2. Second measurement: After stabilization phase;
3. Third measurement: After EMDR;
4. Fourth measurement: Six months after completion of treatment.
|- Trial web site||N/A|
|- CONTACT FOR PUBLIC QUERIES|| Laura E.W. Leenarts|
|- CONTACT for SCIENTIFIC QUERIES|| Laura E.W. Leenarts|
|- Sponsor/Initiator ||LSG-Rentray|
(Source(s) of Monetary or Material Support)
|- Brief summary||Childhood traumatization is expected to have a significant impact on the development of psychopathology and antisocial and aggressive behavior in adulthood. Because 85% of delinquent girls in Dutch closed institutions is traumatized (e.g. physical, sexual or psychological), it is interesting to investigate the effects of trauma-treatment on this specific group. Since most of the girls have experienced accumulated childhood trauma and have multiple problems, stabilization is needed before the actually trauma-treatment can start. So because of that reason a stabilization course adapted for adolescents followed by Eye Movement Desensitization and Reprocessing (EMDR) will be evaluated. |
|- Main changes (audit trail)|
|- RECORD||4-aug-2010 - 31-aug-2010|
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