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. 2023 Mar 14;23(1):157.
doi: 10.1186/s12888-022-04320-4.

Eye movement desensitization and reprocessing (EMDR) therapy or supportive counseling prior to exposure therapy in patients with panic disorder: study protocol for a multicenter randomized controlled trial (IMPROVE)

Bart Endhoven  1   2 , Klara De Cort  3   4 , Suzy J M A Matthijssen  5   6 , Ad de Jongh  7   8 , Agnes van Minnen  7   9 , Puck Duits  6 , Koen R J Schruers  3   4   10 , Eva A M van Dis  5 , Angelos M Krypotos  5   10 , Lotte Gerritsen  5 , Iris M Engelhard  5   6
Affiliations

Eye movement desensitization and reprocessing (EMDR) therapy or supportive counseling prior to exposure therapy in patients with panic disorder: study protocol for a multicenter randomized controlled trial (IMPROVE)

Bart Endhoven et al. BMC Psychiatry. .

Abstract

Background: Exposure-based therapy is the treatment of choice for anxiety disorders, but many patients do not benefit sufficiently from it. Distressing images of threat related to the future or past may maintain the anxiety symptomatology or impede exposure therapy. An intervention that targets threat-related imagery is eye movement desensitization and reprocessing (EMDR) therapy. The main goal of this multicenter randomized controlled trial is to investigate whether EMDR therapy plus exposure therapy, relative to supportive counseling plus exposure therapy, improves treatment efficacy, tolerability, and adherence in patients with panic disorder. In addition, we will examine potential predictors of optimal treatment allocation, mechanisms of change as well as the long term effects of treatment. Finally, we will assess cost-effectiveness.

Methods: A multicenter randomized controlled trial mixed design will be conducted. Participants will be 50 patients, aged ≥ 18, diagnosed with a panic disorder. They will be randomly assigned to one of two conditions: EMDR therapy (i.e., flashforward strategy) or supportive counseling (each consisting of four weekly sessions of 90 min each) prior to exposure therapy (consisting of eight weekly sessions of 90 min each). Assessments will be made pre-treatment (T1), between-treatments (T2), post-treatment (T3), one month post-treatment (FU1) and six months post-treatment (FU2) by an assessor blind to treatment condition. The primary outcome measure is severity of panic-related symptoms. Secondary outcome measures are: tolerability of exposure therapy (initial avoidance, willingness to start exposure therapy, considered drop-out; no-show and drop-out), related symptomatology (generalized anxiety, depression), and functional impairment.

Discussion: The primary goals of this research are to compare the efficacy, tolerability, and adherence of EMDR therapy plus exposure therapy and supportive counseling plus exposure therapy and to identify predictors, moderators, and mediators for treatment success. This multi-center research aims to make a significant contribution to our understanding as to how treatment for patients with anxiety disorders can be optimized, and elucidate who can benefit most from this novel approach.

Trial registration: ISRCTN-ISRCTN29668369: Improving anxiety treatment by modifying emotional memories before real-life exposure. Registered 27 June 2022-retrospectively registered. ISRCTN-ISRCTN29668369.

Keywords: Anxiety Disorder; Cognitive-Behavioral Therapy (CBT); Exposure Therapy; Eye Movement Desensitization and Reprocessing (EMDR) therapy; Panic Disorder; Randomized Controlled Trial; Supportive Counseling.

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Conflict of interest statement

Suzy Matthijssen and Ad de Jongh receive fees from teaching and/or supervising psychologists in EMDR therapy and exposure therapy by means of seminars, workshops, conferences and book royalties. For this study, the Digital_EMDR app was made available free of charge by MOOVD, a company specializing in virtual reality applications in the treatment of mental health. Suzy Matthijssen and Ad de Jongh participate in the MOOVD advisory board (stipendiary). Agnes van Minnen receives fees from teaching and supervising psychologists exposure therapy by means of seminars, workshops, conferences and book royalties. All other authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
Study design; T1-3: measurements, S1-4/8: sessions, FU1-2: follow up measurements. EMDR: EMDR therapy, SC: supportive counselling, ET: exposure therapy
Fig. 2
Fig. 2
Design flowchart; T1-3: measurements, FU1-2: follow up measurements. EMDR: EMDR therapy, SC: supportive counselling
See this image and copyright information in PMC

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