EMDR therapy vs. supportive therapy as adjunctive treatment in trauma-exposed bipolar patients: A randomised controlled trial
Por:
Hogg, B, Radua, J, Gardoki-Souto, I, Fontana-McNally, M, Lupo, W, Reinares, M, Jimenez, E, Madre, M, Blanco-Presas, L, Cortizo, R, Massó-Rodriguez, A, Castaño, J, Argila, I, Castro-Rodriguez, JI, Comes, M, Macias, C, Sánchez-González, R, Mur-Mila, E, Novo, P, Rosa, AR, Vieta, E, Padberg, F, Pérez-Solà, V, Valiente-Gómez, A, Moreno-Alcázar, A, Amann, BL
Publicada:
1 nov 2024
Ahead of Print:
1 nov 2024
Resumen:
Introduction: Patients with bipolar disorder (BD) are frequently exposed to traumatic events which worsen disease course, but this study is the first multicentre randomised controlled trial to test the efficacy of a trauma-focused adjunctive psychotherapy in reducing BD affective relapse rates. Materials and methods: This multicentre randomised controlled trial included 77 patients with BD and current trauma-related symptoms. Participants were randomised to either 20 sessions of trauma-focused Eye Movement Desensitization and Reprocessing (EMDR) therapy for BD, or 20 sessions of supportive therapy (ST). The primary outcome was relapse rates over 24-months, and secondary outcomes were improvements in affective and trauma symptoms, general functioning, and cognitive impairment, assessed at baseline, post-treatment, and at 12- and 24-month follow-up. The trial was registered prior to starting enrolment in clinical trials (NCT02634372) and carried out in accordance with CONSORT guidelines. Results: There was no significant difference between treatment conditions in terms of relapse rates either with or without hospitalisation. EMDR was significantly superior to ST at the 12-month follow up in terms of reducing depressive symptoms (p = 0.0006, d = 0.969), manic symptoms (p = 0.027, d = 0.513), and improving functioning (p = 0.038, d = 0.486). There was no significant difference in dropout between treatment arms. Conclusions: Although the primary efficacy criterion was not met in the current study, trauma-focused EMDR was superior to ST in reducing of affective symptoms and improvement of functioning, with benefits maintained at six months following the end of treatment. Both EMDR and ST reduced trauma symptoms as compared to baseline, possibly due to a shared benefit of psychotherapy. Importantly, focusing on traumatic events did not increase relapses or dropouts, suggesting psychological trauma can safely be addressed in a BD population using this protocol. (c) 2023 Sociedad Espanola de Psiquiatr & imath;a y Salud Mental (SEPSM). Published by Elsevier Espana, S.L.U. All rights reserved.
Filiaciones:
Hogg, B:
Hosp del Mar Res Inst, Ctr Forum Res Unit, Barcelona, Spain
Hosp del Mar, Mental Hlth Inst, Barcelona, Spain
Univ Autonoma Barcelona, Dept Psychiat & Forens Med, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain
Radua, J:
Inst Salud Carlos III, Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Barcelona, Spain
Karolinska Inst KI, Dept Clin Neurosci, Solna, Sweden
Kings Coll London, Dept Psychosis Studies, Inst Psychiat Psychol & Neurosci, London, England
Univ Barcelona UB, Fac Med & Hlth Sci, Fac Med & Ciencias Salut, Barcelona, Spain
Gardoki-Souto, I:
Hosp del Mar Res Inst, Ctr Forum Res Unit, Barcelona, Spain
Univ Autonoma Barcelona, Dept Psychiat & Forens Med, Barcelona, Spain
Fontana-McNally, M:
Hosp del Mar Res Inst, Ctr Forum Res Unit, Barcelona, Spain
Hosp del Mar, Mental Hlth Inst, Barcelona, Spain
Lupo, W:
Hosp del Mar Res Inst, Ctr Forum Res Unit, Barcelona, Spain
Reinares, M:
Inst Salud Carlos III, Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain
Univ Barcelona UB, Fac Med & Hlth Sci, Fac Med & Ciencias Salut, Barcelona, Spain
Hosp Clin Barcelona, Bipolar & Depress Disorders Unit, Barcelona, Spain
Univ Barcelona, Inst Neurosci UBNeuro, Barcelona, Spain
Inst Invest Biomed St Pau IIB St Pau, Barcelona, Spain
Jimenez, E:
Inst Salud Carlos III, Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain
Univ Barcelona UB, Fac Med & Hlth Sci, Fac Med & Ciencias Salut, Barcelona, Spain
Hosp Clin Barcelona, Bipolar & Depress Disorders Unit, Barcelona, Spain
Univ Barcelona, Inst Neurosci UBNeuro, Barcelona, Spain
Madre, M:
Inst Recerca St Pau IR St Pau, St Pau Mental Hlth Res Grp, Barcelona 08041, Spain
Hosp Benito Menni CASM, Barcelona, Spain
FIDMAG Germanes Hosp Res Fdn, Barcelona, Spain
Blanco-Presas, L:
Hosp Benito Menni CASM, Barcelona, Spain
FIDMAG Germanes Hosp Res Fdn, Barcelona, Spain
Hosp Clin Barcelona, Inst Neurociencias ICN, Programa TEPT AGRESX, Barcelona, Spain
Cortizo, R:
Ctr Invest Red Salud Mental, Parc Sanit St Joan de Deu, Barcelona, Spain
Hosp del Mar Barcelona, Inst Mental Hlth, Ctr Salud Mental Adultos, Barcelona 08035, Spain
Massó-Rodriguez, A:
Hosp del Mar Mutua Terrassa, Ctr Salud Mental Infanto Juvenil, Barcelona, Spain
Castaño, J:
Hosp del Mar Barcelona, Inst Mental Hlth, Ctr Salud Mental Adultos, Barcelona 08035, Spain
Argila, I:
Hosp Benito Menni CASM, Barcelona, Spain
FIDMAG Germanes Hosp Res Fdn, Barcelona, Spain
Castro-Rodriguez, JI:
Hosp del Mar Barcelona, Inst Mental Hlth, Ctr Salud Mental Adultos, Barcelona 08035, Spain
Comes, M:
Hosp Clin Barcelona, Bipolar & Depress Disorders Unit, Barcelona, Spain
Macias, C:
Hosp del Mar Res Inst, Ctr Forum Res Unit, Barcelona, Spain
Hosp del Mar Barcelona, Inst Mental Hlth, Ctr Salud Mental Adultos, Barcelona 08035, Spain
Hosp del Mar Barcelona, Ctr Emili Mira, Barcelona, Spain
Sánchez-González, R:
Hosp del Mar, Mental Hlth Inst, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain
Hosp del Mar Barcelona, Inst Mental Hlth, Ctr Salud Mental Adultos, Barcelona 08035, Spain
Univ Pompeu Fabra, Barcelona, Spain
Mur-Mila, E:
Hosp del Mar, Mental Hlth Inst, Barcelona, Spain
Hosp del Mar Barcelona, Inst Mental Hlth, Ctr Salud Mental Adultos, Barcelona 08035, Spain
Novo, P:
Hosp del Mar Mutua Terrassa, Ctr Salud Mental Infanto Juvenil, Barcelona, Spain
Day Hosp, Ctr Psicoterapia Barcelona CPB, Barcelona, Spain
Rosa, AR:
Univ Fed Rio Grande do Sul, Hosp Clin Porto Alegre, BR-90035903 Porto Alegre, RS, Brazil
Univ Fed Rio Grande do Sul, Dept Bioquim, Inst Ciencias Bas Saude, Porto Alegre, RS, Brazil
Fed Univ Rio Grande Sul UFRGS, Grad Program Psychiat & Behav Sci, Porto Alegre, RS, Brazil
Vieta, E:
Inst Salud Carlos III, Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain
Univ Barcelona UB, Fac Med & Hlth Sci, Fac Med & Ciencias Salut, Barcelona, Spain
Hosp Clin Barcelona, Bipolar & Depress Disorders Unit, Barcelona, Spain
Univ Barcelona, Inst Neurosci UBNeuro, Barcelona, Spain
Padberg, F:
LMU Univ Hosp, Dept Psychiat & Psychotherapy, Munich, Germany
Pérez-Solà, V:
Hosp del Mar, Mental Hlth Inst, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain
Hosp del Mar Barcelona, Inst Mental Hlth, Ctr Salud Mental Adultos, Barcelona 08035, Spain
Univ Pompeu Fabra, Barcelona, Spain
Valiente-Gómez, A:
Hosp del Mar Res Inst, Ctr Forum Res Unit, Barcelona, Spain
Hosp del Mar, Mental Hlth Inst, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain
Moreno-Alcázar, A:
Hosp del Mar Res Inst, Ctr Forum Res Unit, Barcelona, Spain
Hosp del Mar, Mental Hlth Inst, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain
Amann, BL:
Hosp del Mar Res Inst, Ctr Forum Res Unit, Barcelona, Spain
Hosp del Mar, Mental Hlth Inst, Barcelona, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain
Univ Pompeu Fabra, Barcelona, Spain
LMU Univ Hosp, Dept Psychiat & Psychotherapy, Munich, Germany
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