Oog voor complexiteit: EMDR versus stabilisatie bij getraumatiseerde vluchtelingen (met een samenvatting in het Nederlands)An eye for complexity: EMDR versus stabilisation in traumatised refugees (met een samenvatting in het Nederlands)

How safe and effective is it to offer trauma-focused treatment to traumatised asylum seekers and refugees? After all, from a clinical point of view asylum seekers and refugees constitute a complex population, with many suffering from an accumulation of traumatic and current stressors. Consequently, there are fears that with this population trauma-focused interventions may cause unmanageable distress, if not harm, and may prove ineffective. These questions and considerations have played a major role in the scientific and clinical debate on treatment with asylum seekers and refugees who have resettled in western countries. Despite the recommendation proffered by some clinicians that said population should be treated with present-centred or phased treatment rather than stand-alone traumafocused treatment, trauma-focused interventions such as narrative exposure therapy (NET) and culturally adapted cognitive behavioural therapy (CA-CBT) have in recent years been shown effective with asylum seekers and refugees. To this day, however, there has been no high-quality research into the safety and effectiveness of another trauma-focused treatment of choice, eye movement desensitisation and reprocessing therapy (EMDR). The fine book you are about to read goes far to fill this hiatus. Its main focus is on the efficacy and safety of EMDR with traumatised asylum seekers and refugees. In addition, it addresses the questions whether traumatised refugees are prone to develop complex PTSD as has been claimed, and whether traumatised refugees as a population are more difficult to treat than are traumatised non-refugees. The author of this significant study, Jackie June ter Heide, a clinical psychologist and researcher with Foundation Centrum ’45, has succeeded in determining the efficacy and safety of EMDR on the basis of a pilot study among traumatised asylum seekers and refugees followed by a full trial with a larger sample of refugee patients. Outcomes of the pilot study were promising as EMDR appeared at least as efficacious as stabilisation and no EMDR patients dropped out of treatment due to unmanageable distress. In the subsequent trial with traumatised refugees, exposing patients to traumatic memories through EMDR was convincingly shown not to be harmful. In addition, a substantial number of patients benefited from EMDR, although the effect for the group as a whole was clinically small. These findings tie in with evidence for trauma-focused treatment such as NET and CACBT, which have been shown to be both safe and effective with refugees. In a subsequent search for determinants of treatment response in refugees, Ter Heide investigated response to treatment as usual of refugees in comparison with that of patients who suffer from profession-related trauma.This study showed that even though there was no great clinical difference in treatment response between refugees and non-refugees, symptom severity in refugees was a great deal higher than it was in non-refugees, both at intake and after one year. These findings lead the author to sound a cautionary note to the effect that both therapists and refugee patients ought to have realistic expectations about the effects of treatment as usual. She further recommends that if treatment as usual is offered to refugees with severe PTSD this may need to be supplemented with additional treatment that focuses on enhancing quality of life. The author of this study also explores the assertion that asylum seekers and refugees with complex trauma are at an increased risk of developing complex PTSD. It is foremost on the basis of this claim that trauma-focused treatment is frequently discouraged in refugees with complex trauma. However, Ter Heide’s research, importantly, goes to refute this claim. Comparisons of the prevalence of complex PTSD in refugees with that in other trauma-exposed populations such as survivors of childhood trauma point to the conclusion that refugees are, in fact, more likely to be given a regular or no PTSD diagnosis than a complex PTSD diagnosis. Ter Heide also extensively discusses the implications her findings have for clinical practice. Since complex PTSD should not be assumed to be present in refugees who have complex traumatic experiences, she not only urges careful diagnosis by means of a validated interview but also advocates that, given its proven safety and efficacy, a course of trauma-focused treatment be offered to all refugees. It is with a sense of great pride that we present this ground-breaking study and share its important findings. We feel it greatly contributes to our understanding of the pros and cons of not only EMDR but of trauma-focused treatment in general with traumatised asylum seekers and refugees.

Dissertation/Thesis

English

Foske Jackie June ter Heide

ter Heide, F. J. J. (2015). [An eye for complexity: EMDR versus stabilisation in traumatised refugees (met een samenvatting in het Nederlands)]. (Master's thesis, Utrecht University)