Multicenter Randomized Controlled Trial on the Provision of the EMDR-PRECI to Female Minors Victims of Sexual and/or Physical Violence and Related PTSD Diagnosis
American Journal of Applied Psychology
Volume 9, Issue 2, March 2020, Pages: 42-51
Received: Mar. 25, 2020;
Accepted: Apr. 8, 2020;
Published: Apr. 23, 2020
Views 246 Downloads 347
Gabriela Jiménez, Department of Research, Ágape Desarrollo Humano Integral, Puebla City, Mexico
Yael Becker, Department of Research, Mexican Association for Mental Health Support in Crisis, Mexico City, Mexico
Claudia Varela, Department of Research, Mexican Association for Mental Health Support in Crisis, Mexico City, Mexico
Paola García, Department of Research, Ágape Desarrollo Humano Integral, Puebla City, Mexico
María Amparo Nuño, Department of Research, Ágape Desarrollo Humano Integral, Puebla City, Mexico
María Cristina Pérez, Department of Research, Ágape Desarrollo Humano Integral, Puebla City, Mexico
Amalia Osorio, Department of Research, Ágape Desarrollo Humano Integral, Puebla City, Mexico
Ignacio Jarero, Department of Research, Mexican Association for Mental Health Support in Crisis, Mexico City, Mexico
Martha Givaudan, Department of Research, Mexican Association for Mental Health Support in Crisis, Mexico City, Mexico
This longitudinal multicenter randomized controlled trial has three objectives 1) to evaluate the EMDR-PRECI in the remission of the PTSD Diagnosis on female minors who were victims of sexual and/or physical violence compared to treatment as usual (TAU), 2) to evaluate the effectiveness of the EMDR-PRECI in the reduction of the PTSD, anxiety, and depression symptoms of the participants compared with TAU, and 3) to expand the knowledge on the existing correlation between the PCL-5 core criteria for PTSD provisional diagnosis and the CAPS-5 PTSD clinical diagnosis on this population. The study was conducted in 2019 in the cities of Puebla, Mexico, and Mexico City, in three sites of a non-profit organization who provide services to women in vulnerable situations. A total of 32 minors met the inclusion criteria. Participants’ ages ranged from 12 to 17 years old (M =15.35 years old). Participation was voluntary with the participant’s and their legal guardian's consent. It is relevant to mention that 31 of the 32 participants were pregnant during treatment with an average of 24.63 weeks (6.15 months) of pregnancy. All patients in the EMDR treatment group did not meet PTSD diagnostic criteria after treatment and at 90-days-follow-up assessments, while all patients in the TAU group maintained their PTSD baseline clinical diagnosis after treatment and at 90-days-follow-up assessments. Analyses of variance (ANOVA) for repeated measurements were used for PTSD, Anxiety and Depression; t test and Cohen´s d effect size were calculated using within and between designs for the different measurements. ANOVA revealed a significant effect for time (F (2, 52) = 149.53 p <.001, ηP2 =.852), for group (F (1, 26 = 140.71, p<.001, ηP2 =.844) and Anxiety scores showed a significant effect for time (F (1, 26) = 32.89, p <.001, ηP2 =.559) and a significant interaction effect between time and group (F (1, 26) = 17.37, p <.001, ηP2=.401) showed the decrease for the treatment group. For the depression scores significant effects were found for time (F (1, 26) = 21.77, p <. 001, ηP2 =.456. Results also showed significant interaction effects between time and group. (F (1, 26) = 6.17, p <.05, ηP2 =.192). No significant effects for TAU group were founded. The study results indicate that the administration of the EMDR-PRECI could be a feasible, cost-effective, and time-efficient therapy to address PTSD diagnosis, and PTSD, anxiety and depression symptoms in this population.
María Amparo Nuño,
María Cristina Pérez,
Multicenter Randomized Controlled Trial on the Provision of the EMDR-PRECI to Female Minors Victims of Sexual and/or Physical Violence and Related PTSD Diagnosis, American Journal of Applied Psychology.
Vol. 9, No. 2,
2020, pp. 42-51.
UNICEF, "Prevention and response to violence against children and adolescents, theory of change", Child Protection Section, New York, 2017b. Retrieved from:
Leander, L., Garnhag P. A., & Christianson, S. A. (2005). Children exposed to obscene phone calls: what they remember and say., Child Abuse & Neglect 29 (8), 871-888. http://dx.doi.org/10.1016/j.chiabu.2004.12.012
Amstadter, A. B., & Vernon, L. L. (2008) Emotional Reactions During and After Trauma: A Comparison of Trauma Types. Journal of Aggression, Maltreatment & Trauma. 2008; 16 (4): 391–408.
Nooner, K. B., Linares, L. O., Batinjane, J., Kramer, R. A., Silva, R., Cloitre, M. (2012) Factors Related to Posttraumatic Stress Disorder in Adolescence. Trauma, Violence, & Abuse. 2012; 13 (3): 153–66.
Collin-Vézina, D., & Hébert, M. (2005). Comparing dissociation and PTSD in sexually abused school-aged girls. Journal of Nervous and Mental Disease, 193 (1), 47-52.
Cutajar, M. C., Mullen, P. E., Ogloff, J. R. P., Thomas, S. D., Wells, D. L., & Spataro, J. (2010). Psychopathology in a large cohort of sexually abused children followed up to 43 years. Child Abuse & Neglect, 34 (11), 813–822. http://dx.doi.org/10.1016/j.chiabu.2010.04.004.
Grassi-Oliveira, R. (2005). Child maltreatment: assessment tools and study of association with posttraumatic stress disorder and general psychiatric symptoms in adults. Unpublished Master's Dissertation, Postgraduate Program in Psychology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre.
Borges, J., & Dalbosco Dell'Aglio, D. (2008) Relationships between sexual abuse in childhood, post-traumatic stress disorder (PTSD) and cognitive impairments. Article in Psicologia em Estudo. Maringá, v. 13, n. 2, p. 371-379, abr./jun. 2008.
Mexican National Institute of Statistics and Geography, National survey on the dynamics of relationships in households. Mexico: INEGI, 2016.
OECD (2019). Mexico and sexual abuse. Bulletins 45796. Senate of the Mexican Republic. http: //comunicacion.senado.gob.mx/index.php/informacion/boletines/45796-mexico-primer-lugar-en-abuso-sexual-infantil.html.
Fontes, L. A., & Plummer, C. (2010). Cultural issues in disclosures of child sexual abuse. Journal of Child Sexual Abuse, 19, 491–518. http://dx.doi.org/10.1080/10538712.2010.512520
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA.
J. Sareen, Posttraumatic stress disorder in adults: impact, comorbidity, risk factors, and treatment (2014). Canadian Journal of Psychiatry, Rev. Canad. Psychiatr. 59 (9), 460–467 https://doi.org/10.1177/070674371405900902
L. A. Brown, A. Jerud, A. Asnaani, J. Petersen, Y. Zang, & E. B. Foa, (2018). Changes in posttraumatic stress disorder (PTSD) and depressive symptoms over the course of prolonged exposure, J. Consult. Clin. Psychol. 86 (5) 452—463 https://doi.org/10.1037/ccp0000292.
Seng, J., Oakley, D., Sampselle, C., Killion, C., Graham-Bermann, S., & Liberzon, I., (2001) Posttraumatic stress disorder and pregnancy complications. Obstet Gynecol 2001; 97: 17-22.
Buss, C., Entringer, S., Lu, M., & Wadhwa, P., (2011) The Contribution of Maternal Stress to Preterm Birth: Issues and Considerations. Clin Perinatol. 2011 Sep; 38 (3): 351–384.
Chen, Y. R., Hung, K. W., Tsai, J. C., Chu, H., Chung, M. H., Chen, S. R., … Chou, K. R. (2014). Efficacy of eye-movement desensitization and reprocessing for patients with posttraumatic stress disorder: A meta-analysis of randomized controlled trials. PLoS One, 9, 8.
American Psychiatric Association. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder in adults. Retrieved from http://www.apa.org/ptsdguideline/.
International Society for Traumatic Stress Studies (ISTSS). (2018). Posttraumatic stress disorder prevention and treatment guidelines: Methodology and recommendations. Oakbrook Terrace, USA: ISTSS.
U.S. Department of Veterans Affairs, Department of Defense (2016). VA/DoD clinical practice guideline for the management of posttraumatic stress disorder and acute stress disorder. Washington DC, USA. https://www.healthquality.va.gov/ptsd/ptsd_full.pdf
Shapiro, F. (2018). Eye movements desensitization and reprocessing. Basic principles, protocols, and procedures (Third edition). Guilford Press. N.Y.
World Health Organization. (2013). Guidelines for the management of conditions specifically related to stress. Geneva, Switzerland: Author.
A. M. Khan, S. Dar, R. Ahmed, R. Bachu, M. Adnan, V. P. Kotapati. (2018). Cognitive-behavioral therapy versus eye movement desensitization and reprocessing in patients with post-traumatic stress disorder: systematic review and meta-analysis of randomized clinical trials, Cureus 10 (9) e3250–e3250 https://doi.org/10. 7759/cureus.3250.
Beer, R. (2018). Efficacy of EMDR therapy for children with PTSD: A review of the literature. Journal of EMDR Practice and Research, 12, 4. doi: 10.1891/1933−318.104.22.168.
Morris-Smith, J., & Silvestre, M. (2014). EMDR for the next generation: Healing children and families (2nd ed.). United Kingdom: Academic Conferences and Publishing International.
Jarero, I., & Artigas, L. (2018). AIP-model Based Acute Trauma and Ongoing Traumatic Stress Theoretical Conceptualization. Iberoamerican Journal of Psychotraumatology and Dissociation, 10 (1), 1-10. Retrieved from https://www.revibapst.com/volumen-10-numero-1-2018-2019
Jarero, I., Artigas, L., & Luber, M. (2011). The EMDR protocol for recent critical incidents: Application in a disaster mental health continuum of care context. Journal of EMDR Practice and Research, 5 (3), 82–94.
Jarero, I., & Uribe, S. (2011). The EMDR protocol for recent critical incidents: Brief report of an application in a human massacre situation. Journal of EMDR Practice and Research, 5 (4), 156–166.
Jarero, I., & Uribe, S. (2012). The EMDR protocol for recent critical incidents: Follow-up Report of an application in a human massacre situation. Journal of EMDR Practice and Research, 6 (2), 50-61.
Jarero, I., Amaya, C., Givaudan, M., & Miranda, A. (2013). EMDR Individual Protocol for paraprofessional use: A randomized controlled trial with first responders. Journal of EMDR Practice and Research, 7 (2), 55-64.
Jarero, I., Uribe, S., Artigas, L., & Givaudan, M. (2015). EMDR protocol for recent critical incidents: A randomized controlled trial in a technological disaster context. Journal of EMDR Practice and Research, 9 (4), 166-173.
Jarero, I., Schnaider, S., & Givaudan, M. (2019). EMDR Protocol for Recent Critical Incidents and Ongoing Traumatic Stress with First Responders: A Randomized Controlled Trial. Journal of EMDR Practice and Research, 13 (2), 100-110.
Encinas, M., Osorio, A., Jarero, I., & Givaudan, M. (2019). Randomized Controlled Clinical Trial on the Provision of the EMDR-PRECI to Family Caregivers of Patients with Autism Spectrum Disorder. Psychology and Behavioral Science International Journal, 11 (1), 1-8.
Estrada, B. D., Angulo, B. J., Navarro, M. E., Jarero, I., Sánchez-Armass, O. (2019). PTSD, Immunoglobulins, and Cortisol Changes after the Provision of the EMDR-PRECI to Females Patients with Cancer-Related PTSD Diagnosis. American Journal of Applied Psychology, 8 (3), 64-71.
Consolidated Standards of Reporting Trials (CONSORT) 2010 Statement. BMJ 2010; 340: c869 doi: 10.1136/bmj.c869
Standard Protocol Items Recommendation for Interventional Trials (SPIRIT) 2013 Checklist. Retrieved at http://www.spirit-statement.org/wp-content/uploads/2013/01/SPIRIT-Checklist-download-8Jan13.pdf
Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T. M. (2015). The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) – Past Month [Measurement instrument]. Available from https://www.ptsd.va.gov/
Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD Checklist for DSM-5 (PCL-5). Scale available from the National Center for PTSD at www.ptsd.va.gov
Bovin, M. J., Marx, B. P., Weathers, F. W., Gallagher, M. W., Rodriguez, P., et al. (2016) Psychometric properties of the PTSD checklist for diagnostic and statistical manual of mental disorders- Firth edition (PCL-5) in veterans. Psychol Assess 28 (11): 1379-1391.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed. Text Revised). Arlington, VA.
Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., Keane, T. M., 2013a. Clinician-administered PTSD Scale for DSM-5. National Center for Posttraumatic Stress Disorder, Boston.
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361-370.
Ying Lin C, & Pakpour AH (2017) Using Hospital Anxiety and Depression Scale (HADS) on patients with epilepsy: Confirmatory factor analysis and Rasch models. Seizure (45): 42-46.
Hurley, E. C. (2018). Effective Treatment of Veterans With PTSD: Comparison Between Intensive Daily and Weekly EMDR Approaches. Front. Psychol. 9: 1458. doi: 10.3389/fpsyg.2018.01458.
Bongaerts, H., Van Minnen, A., & de Jongh, A. (2017). Intensive EMDR to treat patients with complex posttraumatic stress disorder: A case series. Journal of EMDR Practice and Research, 11 (2), 84-95.
Gutner, C. A., Suvak, M. K., Sloan, D. M., & Resick, P. A. (2016). Does timing matter? Examining the impact of session timing on outcome. Journal of Consulting and Clinical Psychology, 84, 1108–1115.
Holmes et al. (2011). Imagery about suicide in depression-“ Flash-forwards”? Journal of Behavior Therapy & Experimental Psychiatry, 38, 423-434.
Logie, R., & de Jongh, A. (2014). The “flashforward” procedure: Confronting thecatastrophe. Journal of EMDR Practice and Research, 8, 25–32.
Kezelman, C., & Stavropoulos, P. (2012). The Last Frontier:’ Practice Guidelines for the Treatment of Complex Trauma and Trauma-Informed Care and Service Delivery. Kirribilli: Adults Surviving Child Abuse.
Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., et al. (2017). Complex trauma in children and adolescents. Psychiatr. Ann. 35, 390–398.