To prepare or not? Phase-based treatment versus direct trauma-focused treatment in patients with posttraumatic stress disorder related to childhood abuse

In this study, we directly compared the two conditions by randomly assigning 135 patients with PTSD resulting from repeated childhood abuse to either a phase-based treatment (16 sessions of Eye Movement Desensitization and Reprocessing {EMDR}, preceded by Skills Training in Affect and Interpersonal Regulation [STAIR], a stabilizing treatment), or a direct trauma-focused treatment (16 sessions of EMDR). The following symptoms were examined: PTSD (presence and severity), Complex PTSD symptoms (interpersonal problems, emotion regulation problems, and self-esteem problems), dissociative symptoms, and general psychopathology. When comparing the two conditions, both conditions appeared to be very effective, but no differences were found between the two conditions during the course between pre-treatment and post-treatment. No differences were found in the follow-up to six months. For the PTSD self-report, posttraumatic cognitions, and interpersonal problems counted that there was a delay in the STAIR phase of the phase-based treatment compared to the first eight sessions of EMDR in the direct trauma-focused treatment. No clear predictors or moderators emerged if we corrected for the severity of PTSD, which is a predictor for poorer treatment outcomes. We found that the combination of suicidality , low education and not taking benzodiazepines prior to treatment, appeared to pose a risk for dropout. Looking at the cost-effectiveness, it can be stated that phase-based treatment is not cost-effective compared to direct trauma-focused treatment, while phase-based treatment does entail more social costs.