Treatment of PTSD due to chronic interpersonal violence in

early childhood: which treatment works best?

Meta-analyses show that Trauma-Focused Cognitive Behavioral, Imaginary Exposure and Eye Movement Desensitization-Reprocessing are the most effective psychological treatments for posttraumatic stress disorder (PTSD) (Bisson et al, 2007; Bradley, Greene, Russ, Dutra & West, 2005; Cloitre, 2009; Seidler & Wagner, 2006). These relatively short treatments (9-12 sessions of 90 minutes) results in a considerable reduction of PTSD symptoms in 40-70% of patients. However, the vast majority of research has been conducted on PTSD following a single traumatic event. Research examining the application of these two protocols to PTSD as a result of repeated and prolonged interpersonal abuse in childhood (eg sexual and / or physical abuse) within the immediate environment is scant. Whether Imaginary Exposure should be regarded a ‘golden standard treatment’ in this patient group is unknown, en thus, research examining the effectiveness of Imaginary Exposure in this patient group is needed. Moreover, a novel treatment called ‘Imaginary Rescripting’ may more actively intervene in key processes that play a role in the development of PTSD such as dysfunctional based schedules and tonic immobility (TI). Hence, it may be more effective as compared to Imaginary Exposure.



This study focuses on PTSD due to repeated and prolonged interpersonal abuse in childhood (eg sexual and / or physical abuse) within the immediate environment. By using a
Randomized controlled design, we examine whether Imaginary Exposure is more effective as compared to a waitinglist with regard to severity of PTSD symptoms, and whether Imaginaire Rescripting is more effective as compared to Imaginary Exposure.

This study focuses on PTSD due to repeated and prolonged interpersonal abuse in childhood (eg sexual and / or physical abuse) within the immediate environment. By using a
Randomized controlled design, we examine whether Imaginary Exposure is more effective as compared to a waitinglist with regard to severity of PTSD symptoms, and whether Imaginaire Rescripting is more effective as compared to Imaginary Exposure.



Primary hypotheses:

We expect that in this patient group with repeated and prolonged interpersonal abuse in childhood within the immediate environment, Imaginary Exposure will be more effective as compared to a waiting list condition.
Moreover, we expect that Imaginary Rescripting is more effective as compared to Imaginary exposure, based on the hypothesis that Imaginary Rescripting more actively intervenes in key pathological processes in PTSD.



Secondary hypotheses:

- We expect that ImRes is less heavy for patients as compared to IE, thus expecting drop-outs to be lower in the ImRes group as compared to the IE group

- We expect that for those with a higher ‘Tonic Immobility Score’, ImRes is more effective as compared to IE, because ImRes directly focuses on TI.

- We expect that for those with higer dissociation scores, ImRes is more effective.

- We expect that emotion-regulation will improve more in the ImRes group as compared to the IE group, as ImRes not only focuses on fear but also explicitly on other emotions.

- We expect self-image to improve more in the ImRes condition as compared to the IE condition, as this intervention focuses more explicitly on the UCS/UCR representation.

• Measurement 1: After inclusion, so at the start of treatment

• Measurement 2: After 11 weeks (ending therapy)

• Measurement 3: At follow-up, 6 months after measurement 2

This study is a randomized controlled trial with three conditions, i.e. Waiting list (WL), Imaginary Exposure (IE), Imaginary Rescripting (ImRes).

Treatment duration is 11 weeks, during the first 5 weeks 2 sessions of 90 minutes each will be provided, followed by 6 weeks of one 90 minute session.

In the treatment conditions, homework of maximum 1 hr per week is given.

No sessions for the waitinglist will be provided.