Adding physical activity to intensive trauma-focused treatment for post-traumatic stress disorder: results of a randomized controlled trial

Eline M. Voorendonk; Sarita A. Sanches; Marieke S. Tollenaar; Elisabeth A. Hoogendoorn; Ad de Jongh; Agnes van Minnen

doi:10.3389/fpsyg.2023.1215250

Adding physical activity to intensive trauma-focused treatment for post-traumatic stress disorder: results of a randomized controlled trial

Eline M. Voorendonk^*
, Sarita A. Sanches
, Marieke S. Tollenaar
, Elisabeth A. Hoogendoorn
, Ad de Jongh
, Agnes van Minnen

^*Corresponding author for this work

Oral Public Health

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Introduction: This randomized controlled trial examined the effectiveness of physical activity added to an intensive trauma-focused treatment (TFT) for post-traumatic stress disorder (PTSD) in comparison to adding non-physical control activities. Methods: A total of 119 patients with PTSD were randomly assigned to a physical activity condition (PA; n = 59) or a non-physical activity control condition (nPA; n = 60). The 8-day intensive TFT programme consisted of daily prolonged exposure, EMDR therapy, and psychoeducation, which was complemented with physical activities versus controlled mixtures of guided (creative) tasks. As a primary outcome, the change in clinician and self-reported PTSD symptoms from pre-to post-treatment and at 6 months follow-up were measured. Results: Intent-to-treat linear mixed-effects models showed no significant differences between the PA and nPA conditions on change in PTSD severity. Clinician and self-reported PTSD symptoms significantly decreased for both conditions, with large effect sizes (e.g., CAPS-5 d_pre-post = 2.28). At post-treatment, 80.0% in the PA, and 82.7% in the nPA condition no longer met the diagnostic criteria for PTSD. Regarding the loss of Complex PTSD diagnoses this was 92.5% and 95.0%, respectively. Conclusion: Either with additional physical or non-physical activities, intensive TFT is very effective for the treatment of (Complex) PTSD, as reflected by large effect sizes and loss of diagnostic status in both groups. Clinical trial registration: Trialregister.nl Identifier: Trial NL9120.

Original language	English
Article number	1215250
Pages (from-to)	1-11
Number of pages	11
Journal	Frontiers in Psychology
Volume	14
DOIs	https://doi.org/10.3389/fpsyg.2023.1215250
Publication status	Published - 20 Jul 2023

Bibliographical note

Funding Information:
The authors would like to thank all the patients who agreed to participate in the study and all the PSYTREC colleagues who helped to screen and recruit participants, delivered the interventions and implemented the adjusted protocol; special thanks to Maaike Cortjens, Lucas Haagen, Yme Leplaa, Annelies Slijpen, Marleen Janssen, Marleen van Kooten, Eric Grotenboer, and Anne Rehmann-de Roo. The authors thank the research staff who helped in the data collection; Mette Bosma, Maarten Kant, Marissa Steenbergen, Zoë Dieckmann, Lisa van Tiel, Fleur Vrijlandt, Charlotte van Wilpen, Johanna Gillessen, Max Matuschek, Emma Rijk, Dewi Jager, and Lucas Bouwman. The authors would also like to thank Linda Rozendaal and Julian Kievit for their assistance with the data management. Finally, the authors thank Frances Klaff for her help with editing the final version of the manuscript.

Funding Information:
This work was supported in part by the EMDR Research Foundation, Vereniging EMDR Nederland (VEN), for the acquisition of heart rate monitors and materials. The EMDR Research Foundation had no role in any part of the study (design, data collection, management, analysis, interpretation, review).

Publisher Copyright:
Copyright © 2023 Voorendonk, Sanches, Tollenaar, Hoogendoorn, de Jongh and van Minnen.

Funding

The authors would like to thank all the patients who agreed to participate in the study and all the PSYTREC colleagues who helped to screen and recruit participants, delivered the interventions and implemented the adjusted protocol; special thanks to Maaike Cortjens, Lucas Haagen, Yme Leplaa, Annelies Slijpen, Marleen Janssen, Marleen van Kooten, Eric Grotenboer, and Anne Rehmann-de Roo. The authors thank the research staff who helped in the data collection; Mette Bosma, Maarten Kant, Marissa Steenbergen, Zoë Dieckmann, Lisa van Tiel, Fleur Vrijlandt, Charlotte van Wilpen, Johanna Gillessen, Max Matuschek, Emma Rijk, Dewi Jager, and Lucas Bouwman. The authors would also like to thank Linda Rozendaal and Julian Kievit for their assistance with the data management. Finally, the authors thank Frances Klaff for her help with editing the final version of the manuscript. This work was supported in part by the EMDR Research Foundation, Vereniging EMDR Nederland (VEN), for the acquisition of heart rate monitors and materials. The EMDR Research Foundation had no role in any part of the study (design, data collection, management, analysis, interpretation, review).

Keywords

clinician-administered PTSD scale
intensive trauma-focused therapy
physical activity
post-traumatic stress disorder
PTSD checklist for DSM-5
randomized controlled trial

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10.3389/fpsyg.2023.1215250

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Cite this

@article{5656576e3c2b4e028a01421df2a12e3e,

title = "Adding physical activity to intensive trauma-focused treatment for post-traumatic stress disorder: results of a randomized controlled trial",

abstract = "Introduction: This randomized controlled trial examined the effectiveness of physical activity added to an intensive trauma-focused treatment (TFT) for post-traumatic stress disorder (PTSD) in comparison to adding non-physical control activities. Methods: A total of 119 patients with PTSD were randomly assigned to a physical activity condition (PA; n = 59) or a non-physical activity control condition (nPA; n = 60). The 8-day intensive TFT programme consisted of daily prolonged exposure, EMDR therapy, and psychoeducation, which was complemented with physical activities versus controlled mixtures of guided (creative) tasks. As a primary outcome, the change in clinician and self-reported PTSD symptoms from pre-to post-treatment and at 6 months follow-up were measured. Results: Intent-to-treat linear mixed-effects models showed no significant differences between the PA and nPA conditions on change in PTSD severity. Clinician and self-reported PTSD symptoms significantly decreased for both conditions, with large effect sizes (e.g., CAPS-5 dpre-post = 2.28). At post-treatment, 80.0\% in the PA, and 82.7\% in the nPA condition no longer met the diagnostic criteria for PTSD. Regarding the loss of Complex PTSD diagnoses this was 92.5\% and 95.0\%, respectively. Conclusion: Either with additional physical or non-physical activities, intensive TFT is very effective for the treatment of (Complex) PTSD, as reflected by large effect sizes and loss of diagnostic status in both groups. Clinical trial registration: Trialregister.nl Identifier: Trial NL9120.",

keywords = "clinician-administered PTSD scale, intensive trauma-focused therapy, physical activity, post-traumatic stress disorder, PTSD checklist for DSM-5, randomized controlled trial",

author = "Voorendonk, \{Eline M.\} and Sanches, \{Sarita A.\} and Tollenaar, \{Marieke S.\} and Hoogendoorn, \{Elisabeth A.\} and \{de Jongh\}, Ad and \{van Minnen\}, Agnes",

note = "Funding Information: The authors would like to thank all the patients who agreed to participate in the study and all the PSYTREC colleagues who helped to screen and recruit participants, delivered the interventions and implemented the adjusted protocol; special thanks to Maaike Cortjens, Lucas Haagen, Yme Leplaa, Annelies Slijpen, Marleen Janssen, Marleen van Kooten, Eric Grotenboer, and Anne Rehmann-de Roo. The authors thank the research staff who helped in the data collection; Mette Bosma, Maarten Kant, Marissa Steenbergen, Zo{\"e} Dieckmann, Lisa van Tiel, Fleur Vrijlandt, Charlotte van Wilpen, Johanna Gillessen, Max Matuschek, Emma Rijk, Dewi Jager, and Lucas Bouwman. The authors would also like to thank Linda Rozendaal and Julian Kievit for their assistance with the data management. Finally, the authors thank Frances Klaff for her help with editing the final version of the manuscript. Funding Information: This work was supported in part by the EMDR Research Foundation, Vereniging EMDR Nederland (VEN), for the acquisition of heart rate monitors and materials. The EMDR Research Foundation had no role in any part of the study (design, data collection, management, analysis, interpretation, review). Publisher Copyright: Copyright {\textcopyright} 2023 Voorendonk, Sanches, Tollenaar, Hoogendoorn, de Jongh and van Minnen.",

year = "2023",

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day = "20",

doi = "10.3389/fpsyg.2023.1215250",

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TY - JOUR

T1 - Adding physical activity to intensive trauma-focused treatment for post-traumatic stress disorder

T2 - results of a randomized controlled trial

AU - Voorendonk, Eline M.

AU - Sanches, Sarita A.

AU - Tollenaar, Marieke S.

AU - Hoogendoorn, Elisabeth A.

AU - de Jongh, Ad

AU - van Minnen, Agnes

N1 - Funding Information: The authors would like to thank all the patients who agreed to participate in the study and all the PSYTREC colleagues who helped to screen and recruit participants, delivered the interventions and implemented the adjusted protocol; special thanks to Maaike Cortjens, Lucas Haagen, Yme Leplaa, Annelies Slijpen, Marleen Janssen, Marleen van Kooten, Eric Grotenboer, and Anne Rehmann-de Roo. The authors thank the research staff who helped in the data collection; Mette Bosma, Maarten Kant, Marissa Steenbergen, Zoë Dieckmann, Lisa van Tiel, Fleur Vrijlandt, Charlotte van Wilpen, Johanna Gillessen, Max Matuschek, Emma Rijk, Dewi Jager, and Lucas Bouwman. The authors would also like to thank Linda Rozendaal and Julian Kievit for their assistance with the data management. Finally, the authors thank Frances Klaff for her help with editing the final version of the manuscript. Funding Information: This work was supported in part by the EMDR Research Foundation, Vereniging EMDR Nederland (VEN), for the acquisition of heart rate monitors and materials. The EMDR Research Foundation had no role in any part of the study (design, data collection, management, analysis, interpretation, review). Publisher Copyright: Copyright © 2023 Voorendonk, Sanches, Tollenaar, Hoogendoorn, de Jongh and van Minnen.

PY - 2023/7/20

Y1 - 2023/7/20

N2 - Introduction: This randomized controlled trial examined the effectiveness of physical activity added to an intensive trauma-focused treatment (TFT) for post-traumatic stress disorder (PTSD) in comparison to adding non-physical control activities. Methods: A total of 119 patients with PTSD were randomly assigned to a physical activity condition (PA; n = 59) or a non-physical activity control condition (nPA; n = 60). The 8-day intensive TFT programme consisted of daily prolonged exposure, EMDR therapy, and psychoeducation, which was complemented with physical activities versus controlled mixtures of guided (creative) tasks. As a primary outcome, the change in clinician and self-reported PTSD symptoms from pre-to post-treatment and at 6 months follow-up were measured. Results: Intent-to-treat linear mixed-effects models showed no significant differences between the PA and nPA conditions on change in PTSD severity. Clinician and self-reported PTSD symptoms significantly decreased for both conditions, with large effect sizes (e.g., CAPS-5 dpre-post = 2.28). At post-treatment, 80.0% in the PA, and 82.7% in the nPA condition no longer met the diagnostic criteria for PTSD. Regarding the loss of Complex PTSD diagnoses this was 92.5% and 95.0%, respectively. Conclusion: Either with additional physical or non-physical activities, intensive TFT is very effective for the treatment of (Complex) PTSD, as reflected by large effect sizes and loss of diagnostic status in both groups. Clinical trial registration: Trialregister.nl Identifier: Trial NL9120.

AB - Introduction: This randomized controlled trial examined the effectiveness of physical activity added to an intensive trauma-focused treatment (TFT) for post-traumatic stress disorder (PTSD) in comparison to adding non-physical control activities. Methods: A total of 119 patients with PTSD were randomly assigned to a physical activity condition (PA; n = 59) or a non-physical activity control condition (nPA; n = 60). The 8-day intensive TFT programme consisted of daily prolonged exposure, EMDR therapy, and psychoeducation, which was complemented with physical activities versus controlled mixtures of guided (creative) tasks. As a primary outcome, the change in clinician and self-reported PTSD symptoms from pre-to post-treatment and at 6 months follow-up were measured. Results: Intent-to-treat linear mixed-effects models showed no significant differences between the PA and nPA conditions on change in PTSD severity. Clinician and self-reported PTSD symptoms significantly decreased for both conditions, with large effect sizes (e.g., CAPS-5 dpre-post = 2.28). At post-treatment, 80.0% in the PA, and 82.7% in the nPA condition no longer met the diagnostic criteria for PTSD. Regarding the loss of Complex PTSD diagnoses this was 92.5% and 95.0%, respectively. Conclusion: Either with additional physical or non-physical activities, intensive TFT is very effective for the treatment of (Complex) PTSD, as reflected by large effect sizes and loss of diagnostic status in both groups. Clinical trial registration: Trialregister.nl Identifier: Trial NL9120.

KW - clinician-administered PTSD scale

KW - intensive trauma-focused therapy

KW - physical activity

KW - post-traumatic stress disorder

KW - PTSD checklist for DSM-5

KW - randomized controlled trial

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UR - https://www.scopus.com/pages/publications/85166767748#tab=citedBy

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DO - 10.3389/fpsyg.2023.1215250

M3 - Article

AN - SCOPUS:85166767748

SN - 1664-1078

VL - 14

SP - 1

EP - 11

JO - Frontiers in Psychology

JF - Frontiers in Psychology

M1 - 1215250

ER -

Adding physical activity to intensive trauma-focused treatment for post-traumatic stress disorder: results of a randomized controlled trial

Abstract

Bibliographical note

Funding

Keywords

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