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Psychological consequences of homicidal loss


- candidate number15385
- NTR NumberNTR4147
- ISRCTNISRCTN wordt niet meer aangevraagd.
- Date ISRCTN created
- date ISRCTN requested
- Date Registered NTR9-sep-2013
- Secondary IDsMETc 2011/282 METc UMCG
- Public TitlePsychological consequences of homicidal loss
- Scientific TitlePsychological consequences of homicidal loss
- ACRONYM
- hypothesisPeople confronted with homidical loss are randomly allocated to (i) an 8 session, individual therapy, consisting of 4 sessions of Eye Movement Desensitization and Reprocessng (EMDR) and 4 sessions of cognitive behavioural therapy (CBT) or (ii) a wait list control group. The central hypothesis is that allocation to the active treatment condition leads to greater reductions in symptom levels of Complicated Grief and Posttraumatic Stress Disorder.
- Healt Condition(s) or Problem(s) studiedPost-Traumatic Stress Disorder (PTSD), Complicated grief
- Inclusion criteria- Participants have to be older than 18 years;
- Participants have been confronted with the death of a partner or family member through homicide;
- Individuals are capable of understanding the Dutch language.
- Exclusion criteria- Confrontation with losses due to other causes than homicide;
- Mental retardation;
- Individuals younger than 18 years;
- Individuals not capable of understanding the Dutch language.
- mec approval receivedyes
- multicenter trialyes
- randomisedyes
- masking/blindingNone
- controlNot applicable
- groupParallel
- Type2 or more arms, randomized
- Studytypeintervention
- planned startdate 1-jun-2012
- planned closingdate1-mei-2014
- Target number of participants88
- InterventionsThe present study evaluates the effectiveness of a brief, 8-session, treatment, encompassing Cognitive Behavioural Therapy (CBT) and Eye Movement Desentizitation and Reprocessing (EMDR) to reduce Complicated Grief and Post Traumatic Stress Disorder (PTSD), using a randomized control trial in homicidally bereaved individuals in the Netherlands. Because homicidally bereaved individuals have to cope with the traumatic circumstances surrounding the loss, and the loss itself, it seems reasonable to assume that these individuals can benefit from a combined therapy with both treatment forms. While both treatment forms are often applied to individuals with complicated grief and PTSD, with successful results, no study have yet investigated the effect of a combined therapy with both treatment forms. In the literature, it has been assumed that PTSD symptoms must be relieved first, before treating grief complaints (Murphy, Johnson, Chung & Beaton, 2003; Rando, 1996; Rynearson & Geoffery, 1999); This treatment trial seeks to examine (1) whether the treatment decreases symptoms of CG and PTSD. It also examines(2) whether the sequence of CBT and EMDR – as two treatment interventions – exert an influence on outcome measures, by comparing two treatment conditions: one in which 3 sessions of EMDR are followed by 3 sessions of CBT (Condition 1: EMDR+CBT), and one in which 3 sessions of CBT are followed by 3 sessions of EMDR (Condition 2: CBT+EMDR). We further examine (3) whether revenge, avoidance and resilience mediate the effect of the treatment conditions.

A schematic presentation of the therapy: Condition 1
Session 1: Introduction and psycho-education
Session 2: A family member is invited to discuss different coping mechanism in one family
Session 3-5: EMDR
Session 6-8 CGT


Condition 2
Session 1: Introduction and psycho-education
Session 2: A family member is invited to discuss different coping mechanism in one family
Session 3-5: CGT
Session 6-8 EMDR
The duration of the CGT sessions is 45 minutes. The duration of the EMDR sessions is minimally 45 minutes and maximally 90 minutes.

Participants are randomized to one of four groups: (i) Intervention group: EMDR + CGT, (ii) Intervention group: CBT + EMDR, (iii) waitlist control group: EMDR + CGT, or (iiii) waitlist controlgroup: CGT + EMDR. Participants in the IG receive the intervention immediately. Participants in the WG receive the intervention after four months.
- Primary outcomeThe primary outcome measures are Complicated Grief (CG) and Posttraumatic Stress Disorder (PTSD). We used the following measurements:

Complicated Grief
The frequency and intensity of grief reactions will be measured by the 29 item Inventory of Complicated Grief (ICG) (Prigerson, Maciejewski, Reynolds, Bierhals, & Newsom, 1995, Dutch version, Boelen, Van den Bout, De Keijser, & Hoijtink, 2003). The ICG will be rated on a 5 point scale that ranges from “never” to “always”. Examples of questions are “I have the feeling that part of me is died with him or her” and “I feel tense, irritable or shocked since his or her death”. Scores can range between 0 and 116. A score higher than 39 indicated the presence of complicated grief (Boelen, de Keijser & van den Bout, 2001).

Posttraumatic Stress Disorder
Symptoms of PTSD will be measured by the Dutch version of the Impact of Event Scale (IES) (Horowitz, Wilner, & Alvarez., 1979; Dutch version: Brom & Kleber, 1985). The IES consists of 15 items on a four point scale that range from “not at all” to “extremely”. The items measured two dimensions of psychological reactions following shock: intrusions and avoidance. Participants complete the items based on their thoughts and feelings regarding the last seven days. Scores range between 0 and 75. A score of 26 or higher indicated post traumatic complaints. Sample items include “I felt as if it hadn’t happened or wasn’t real”, and “I tried to remove it from my memory”.
- Secondary outcomeThe secondary measures are General Revenge, Situational Revenge, Depressive and Anxious Avoidance, and Resilience. We will use the following measurements:

General Revenge
Revenge will be measured by a Dutch translation of the 20-item Vengeance Scale (VS, Stuckless & Goranson, 1992; Gerlsma, Lugtmeyer, Van Denderen, & De Keijser, 2013). The VS measures attitudes toward personal vengeful responses to perceived wrongdoing (Stuckless & Goranson, 1992). The items will be measured on a 7 point Likert scale (1 = disagree strongly to 7 = agree strongly). Sample items include “It is important for me to get back at people who have hurt me”.

Situational Revenge
The subscale named revenge from the Transgression Related Interpersonal Motivation TRIM (developed by McCullough et al. [1998], Dutch version by Gerlsma, Lugtmeyer, van Denderen, & de Keijser, in preperation) will be used to measure revenge feelings and cognitions. This scale taps the motivation to seek revenge, or to see harm come to the offender, following a transgression. It includes 6 items (e.g., “I wish that something bad would happen to him/her”, “I’ll make him/her pay”). Respondents score their agreement with each item on 7-point scales (1=disagree strongly, 7=agree strongly) with higher scores pointing at stronger revenge feelings and thoughts.

Depressive and Anxious Avoidance in Prolonged Grief
The Depressive and Anxious Avoidance in Prolonged Grief Questionnaire (DAAPGQ) is a 9-item measure examining depressive and anxious avoidance (DA and AA) behaviours (Boelen, & van den Bout, in press). Five items are constructed to tap DA (“I avoid doing activities that used to bring me pleasure, because I feel unable to carry out these activities”) and four items to tap AA (“I avoid situations and places that confront me with the fact that [--] is dead and will never return.”). Participants will rate their agreement with each item on 8-point scales ranging from “not at all true for me” to “completely true for me”.

Resilience
Resilience will be measured with the 10 item Positive Outcome Scale (POS) which Appelo, 2005). The POS addresses the perception and use of social contacts and one’s social functioning by using items such as “I function adequately with social contacts”, “I have insight into my own life and my situation” and “I have control over my own life” (see table 6 for the items of the POS). On a 4 point scale (1 = totally not to 4 = totally), items measure an active coping style, independence and self-confidence during the last two weeks. People with an active coping style seek support more easily when circumstances become more difficult. A high score at the POS is associated with more self-efficacy and less psychological complaints (Appelo, 2005).
- TimepointsAll variables will be measured at baseline (pre-intervention), half way the intervention (after 5 sessions), post-intervention (after 8 sessions), and at follow-up, 6 month later. The waitlist group will complete measures at enrolment into the study and 4 months later.
- Trial web sitewww.rouwnamoord.nl
- statusopen: patient inclusion
- CONTACT FOR PUBLIC QUERIES Mariette Denderen, van
- CONTACT for SCIENTIFIC QUERIES Mariette Denderen, van
- Sponsor/Initiator University of Groningen
- Funding
(Source(s) of Monetary or Material Support)
University Medical Center Groningen (UMCG)
- PublicationsVan Denderen, M., Keijser, J. de, Kleen, M., & Boelen, P. A. (in press). Murder-related psychopathology in bereaved: A systematic review. Trauma, Violence, and Abuse.
- Brief summaryIndividuals who lost a family member or partner due to homicide often deal with both separation distress (e.g., yearning) related to the loss (Burke, Neimeyer & McDevitt-Murphy, 2010) and traumatic distress (e.g., intrusive images, hyper arousal) (Armour, 2003; Asaro, 2001; Hatton, 2003; Rynearson, 1994), associated with the circumstances surrounding the death. The preceding reactions are related to Complicated Grief (CG) and Posttraumatic Stress Disorder (PTSD), respectively (Rynearson & Sinnema, 1999). An estimated 20%-70% of homicidally bereaved individuals develop PTSD (Van Denderen, De Keijser, Kleen, & Boelen, 2013).

There is growing evidence that cognitive-behavioural therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) are effective in the treatment of PTSD and CG (Asaro, 2001; Boelen, De Keijser, Van den Hout, & Van den Bout, 2011; De Groot et al., 2007; Resnick, 2001; Shear, Frank, Houck, & Reynolds, 2005). No studies have yet examined the effects of both interventions for individuals bereaved by homicide. The present study therefore evaluated the effectiveness of a brief, 8-session, treatment, encompassing CBT and EMDR to reduce CG and PTSD, using a randomized control trial across 88 homicidally bereaved individuals in the Netherlands.
- Main changes (audit trail)
- RECORD9-sep-2013 - 12-okt-2013


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