• MSc. P. J.
Fokkema: GLOBAL CHILD EMDR CONGRESS
• Triviocare: petra@triviocare.nl
• MSc.Y.T. van Pelt:
• Psy-zo! Specialized Mental Health
Care and Psy-zo! Education:
ytjevanpelt@psy-zo.nl
A CLINICAL INTENSIVE
T R E AT M E N T P RO G R A M M E F O R
A D O L E S C E N T S S U F F E R I N G F RO M
SEVERE PTSD:
C O M B I N I N G P RO L O N G E D
EXPOSURE, EMDR THERAPY AND
P H YS I C A L AC T I V I T I E S
 • High dropout rate & consequences
• Evidence for intensifying treatment
• Study Hendriks et al. (2017)
• Brief, intensive trauma treatment programmes are
I N T RO D U C T I O N considered to be safe, well tolerated, effective and
show a high level of patient retention (i.e. 97.3%).
• The question arises whether this can also be
helpful for adolescents.
 THE European Journal of Psychotraumatology

BACKGROUND
OF THIS STUDY ISSN: 2000-8198 (Print) 2000-8066 (Online) Journal homepage: http://www.tandfonline.com/loi/zept20

Effectiveness of an intensive treatment

programme combining prolonged exposure and
eye movement desensitization and reprocessing
for severe post-traumatic stress disorder

C. Van Woudenberg, E. M. Voorendonk, H. Bongaerts, H. A. Zoet, M.

Verhagen, C. W. Lee, A. van Minnen & A. De Jongh
TARGET
GROUP
 Preparatory phase:
• Orientation interviews
• Administering measuring instruments & formulating
trauma case conceptualisation
• Psycho-education for adolescents and
ITT parents/caregivers

PHASES Processing phase:

• ITT programme

Consolidation phase:
• Transfer
 • Therapist rotation explained
• Added value

THERAPIST ROTATION MODEL • Study results

(VAN MINNEN) • In this study

 • Treatment programme key elements

• Morning

• Prolonged Exposure-therapy and Exposure in Vivo

Physical activity/ Boxing coaching

THE ITT
•

DAILY • At noon:

PROGRAMME • Multidisciplinary consultation

• Afternoon

• EMDR-therapy

• Physical activity/ Boxing coaching

 VIDEO OF
THE ITT
PROGRAMME
COMORBID Variable % n

DISORDERS Comorbid disorders

Mood disorders 44.4 12

Developmental disorders 29.6 8

Anxiety disorders 18.5 5

Personality disorders 18.5 5

Attachment disorders 7.4 2

 Variable % n

TRAUMATIC Traumatic events

EVENTS Domestic violence 51.9 14

Maltreatment 40.7 11

Sexual abuse 40.7 11

Traumatic loss and grief 7.4 2

Medical trauma 3.7 1

PROCEDURE
 TOTAL MEAN
SCORES FROM THE
C APS-C A IV AT PRE-
TEST, POST-TEST
AND AT FU
 • Significant decrease in CAPS-CA IV scores from
before to after treatment (Cohen's d = 1.39)
• 81.5% a clinically meaningful response
• Average admission time 13 days of treatment
RESULTS • 63% no longer met diagnostic criteria of PTSD after
treatment
• Drop out 0%
• Results maintained after 3 months of follow-up.
• No adverse events
 - Safe and effective form of treatment for adolescents
with (very) severe PTSD, comorbidity after series of
chronic traumatic events
SUMMARY - No drop out
 PE MADE ME SEE ALL THE WELL PE THERAPY HELPED ME.
DETAILS I DIDN’T LIKE TALKING WITH
WITH EMDR THAT BECAME MY EYES CLOSED, BUT IT DID
MORE AND MORE DIFFICULT HELP.
EMDR THERAPY WORKED WELL
ALSO,. VERY STRANGE, BECAUSE
IT WORKED AND THEN I
THE COMBINATION WAS THOUGHT WOW!
GOOD FOR ME,
THROUGH PE-THERAPY I
LEARNED TO TALK ABOUT PE OPENS IT UP & EMDR
THE SHITTY SIDE , I
COULDN’T DO THAT AT FIRST. PROVIDES RELIEF
I THINK PE IS A SPECIAL
THERAPY: STUPIDLY TALKING IT BOTH WORKS,
WITH SOMEONE WHO’S BOTH IN A DIFFERENT
TRAINED FOR IT. WAY

THE ADOLESCENTS PERSPECTIVE:

COMBINATION OF THERAPIES
 IT WAS FINE.
THE ADVANTAGE IS THAT YOU DO IT IS NICE
GET CONFIDENCE IN PEOPLE, AND NOT TO HAVE
THEY ALSO HAVE DIFFERENT VISIONS, THE SAME PERSON, IT MAKES IT
LOOK AT SOMETHING DIFFERENTLY EASIER TO TALK ABOUT SHAMEFUL
AND THAT CAN GIVE YOU A WIDER THINGS.
VIEW.

IF YOU ALWAYS HAVE THE SAME ONE, THEY ALL HAVE

YOU GET INTO EACH OTHERS FACE DIFFERENT VOICES, WHICH HAS A
TO MUCH. DIFFERENT EFFECT ON ME AND
, THAT WORKS WELL.

ACTUALLY, IT WAS WORKING

TOGETHER, THE FEELING OF A TEAM I DIDN'T LIKE IT,
AROUND ME. ALWAYS SOMEONE
ELSE IS ANNOYING. IT'S HARD
TO DO YOUR STORY
EVERYONE IS DIFFERENT AND THAT OVER AND OVER AGAIN.
HAS A DIFFERENT EFFECT ON ME

THE ADOLESCENTS PERSPECTIVE:

THERAPIST ROTATION
I HAVE A
DIFFERENT IDEA NOW GIVE ME SEVERAL THERAPISTS,
ABOUT SOCIAL WORKERS, THEY DO IT HELPS ME BECAUSE SEVERAL THERAPISTS SAY
LISTEN TO YOU. THE SAME THING, FOR EXAMPLE ABOUT GUILT.
 • So ………… JUST DO IT!

• Back to earth with ITT

• Hand in hand we extinguish the trauma fire

MESSAGES OF • ITT, we go through SUD -3

THE
ADOLESCENTS • ITT, something so effective you don't often see

• ITT, now that's a good idea

• ITT, start it right away!

• ITT, it's the only way

• ITT for anyone with a complex case

• Hendriks, L., de Kleine, R., Heyvaert,
M., Becker, E., Hendriks, G., & van
Minnen, A. (2017). Intensive prolonged
exposure treatment for adolescent
complex posttraumatic stress
disorder: A single-trial design. Journal
of Child Psychology and Psychiatry,
58(11), 1229–1238.
doi:10.1111/jcpp.12756
• Therapist rotation: a novel approach
for implementation of trauma-focused
treatment in post-traumatic stress
disorder: Agnes Van Minnen, Lotte

REFERENCES
Hendriks, Rianne De Kleine, Gert-Jan
Hendriks, Marije Verhagen and Ad De
Jongh, in EUROPEAN JOURNAL OF
PSYCHOTRAUMATOLOGY 2018,
VOL. 9, 1492836
• C. Van Woudenberg, E. M. Voorendonk,
H. Bongaerts, H. A. Zoet, M.Verhagen,
C. W. Lee, A. van Minnen & A. De
Jongh (2018) Effectiveness of an
intensive treatment programme
combining prolonged exposure and
eye movement desensitization and
reprocessing for severe post-
traumatic stress disorder, European
Journal of Psychotraumatology, 9:1,
1487225, DOI:
10.1080/20008198.2018.1487225