Effectiveness of eye movement desensitization and reprocessing treatment in post‐traumatic stress disorder after childbirth: a randomized controlled trial protocol

Abstract

A traumatic experience of childbirth is an important public health issue 1, 2. Approximately 1–2% of women suffer from post-traumatic stress disorder (PTSD) following childbirth 3. To date, no large research project has attempted to evaluate psychotherapeutic interventions for women suffering from PTSD after childbirth in a randomized controlled trial 4. Qualitative pilot studies and clinical expertise suggest that eye movement desensitization and reprocessing (EMDR) treatment is a highly successful psychotherapy for women suffering from traumatic birth 5, 6. Moreover, EMDR is internationally recognized and recommended as one of the interventions of choice in PTSD treatment. The aim of this publication is to present the research protocol of a controlled randomized trial to evaluate the effectiveness of EMDR for PTSD following childbirth and the optimal time for initiating such therapy. Participants consist of adult women suffering from PTSD following a live infant birth during the last 2 months. These women should not present any psychiatric history, addiction or PTSD before or during pregnancy. Screening for PTSD is performed by clinical interview and self-reporting questionnaires assessing PTSD in general (Impact of Event Scale 7), and specifically for the postpartum period (Perinatal Post-traumatic Stress questionnaire 8). The procedure is illustrated in Figure 1. At time zero (T0) women presenting with PTSD are recruited by health professionals such as midwives, nurses and physicians during the postpartum period, especially during perineal re-education. At the first visit, a physician and a psychologist investigator conduct a clinical interview to identify eligibility and exclusion criteria. The woman is fully informed of the study design and procedure, receives written information and gives informed consent. The women are free to accept or to refuse to participate in the presented study. Eligible women who accept to participate are asked to complete the following self-reporting questionnaires: Hospital Anxiety and Depression Scale- Anxiety Subscale (HADS-A) (measures of anxiety), Edinburgh Postnatal Depression Scale (EPDS) (depression), Brief cope (coping) and Medical Outcome Study Short Form (MOS-SF-36) (Quality of Life) questionnaires. Women are then randomly assigned to one of two groups: (i) the experimental group receiving usual care plus eight sessions of EMDR psychotherapy within 2 months or (ii) the control group receiving the usual care available in France (treatment as usual). Six months after childbirth, EMDR psychotherapy is proposed for this group (delayed EMDR therapy). Usual care in France is defined as a postpartum medical control and the possibility of visits with a midwife, perineal rehabilitation and a monthly pediatric visit. Eye-movement desensitization and reprocessing (EMDR) is a technique consisting of a structured treatment protocol. During treatment, the woman is asked to focus on memories of the traumatic event (thoughts, emotions, sensations, etc.), while engaging in bilateral stimulation (eye movements, tones or hand tapping). The aim is to engage a process of self-regulation and adaptive information processing 4. Six months after birth, all participating women are contacted and asked to describe the memory of their birth experience and to complete the above-mentioned questionnaires (HAD-A, EPDS, Brief cope, SF-36) again. At T1, while women of the experimental group (group 1) have completed the EMDR therapy, women in the control group are initiating this therapy (group 2). T1 includes the follow-up for group 1 and the beginning of EMDR treatment for group 2. Twelve months after the traumatic birth the same evaluation as before at T1 is used. At T2, women of the control group have completed the EMDR therapy. T2 includes follow-up for both groups. Eighteen months postpartum and follow-up for the long-term evaluation of effectiveness of treatment. The effect of EMDR treatment will be measured by comparing the change of scores (after intervention – before intervention) obtained with the four above-mentioned questionnaires between the two groups. In conclusion, we propose a trial to assess the effectiveness of EMDR treatment after traumatic birth experience and (determine) the optimal time to initiate such therapy. We seek to offer a standard intervention with proven effectiveness. The study has been approved by the ethics committee. (Le Comité de Protection des Personnes – CPP EST II gave approval the 10.11.2011). CPP n°10-561: Etude Accounova. This research was funded by the European Regional Development Fund (ERDF), Lorraine Region co-financing and the MSH (Maison des sciences de l'Homme, Lorraine, USR 3261 CNRS).