{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T20:04:57Z","timestamp":1791317097501,"version":"4.3.1"},"reference-count":45,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T00:00:00Z","timestamp":1629417600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009711","name":"EMDR Research Foundation","doi-asserted-by":"publisher","award":["PG10400309"],"award-info":[{"award-number":["PG10400309"]}],"id":[{"id":"10.13039\/100009711","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015539","name":"Commonwealth Government","doi-asserted-by":"publisher","award":["'Australian Government Research Training Program Fees Offset'"],"award-info":[{"award-number":["'Australian Government Research Training Program Fees Offset'"]}],"id":[{"id":"10.13039\/100015539","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Anxiety Disorders Foundation of Western Australia","award":["PG51012100"],"award-info":[{"award-number":["PG51012100"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Patients with posttraumatic stress disorder (PTSD) frequently have comorbid diagnoses such as major depressive disorder (MDD) and anxiety disorders (AD). Studies into the impact of these comorbidities on the outcome of PTSD treatment have yielded mixed results. The different treatments investigated in these studies might explain the varied outcome. The purpose of this study was to examine the impact of these comorbidities on the outcome of two specific PTSD treatments. MDD and AD were analyzed as predictors and moderators in a trial comparing 12 sessions of either eye movement desensitization and reprocessing (EMDR) or imagery rescripting (IR) in 155 adult patients with PTSD from childhood trauma. The primary outcome was reduction of PTSD symptoms (clinician-administered PTSD Scale for DSM-5, CAPS-5) assessed at eight-week follow-up and a secondary outcome was self-report PTSD symptoms (Impact of Event Scale, IES-R). MDD was not a predictor of treatment outcome but did have a significant moderator effect. Patients with MDD showed a better outcome if they were treated with IR, whereas patients without MDD improved more in the EMDR condition. No impact of AD emerged. It seems essential to consider comorbid MDD when planning PTSD treatment to improve treatment outcomes. More research is needed to replicate our findings and focus on different kinds of PTSD treatments and other comorbidities.<\/jats:p>","DOI":"10.3390\/jcm10163708","type":"journal-article","created":{"date-parts":[[2021,8,22]],"date-time":"2021-08-22T21:47:52Z","timestamp":1629668872000},"page":"3708","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Differential Effects of Comorbid Psychiatric Disorders on Treatment Outcome in Posttraumatic Stress Disorder from Childhood Trauma"],"prefix":"10.3390","volume":"10","author":[{"given":"Nele","family":"Assmann","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, L\u00fcbeck University, 23538 L\u00fcbeck, Germany"},{"name":"Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, 24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Fassbinder","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, L\u00fcbeck University, 23538 L\u00fcbeck, Germany"},{"name":"Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, 24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Schaich","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, L\u00fcbeck University, 23538 L\u00fcbeck, Germany"},{"name":"Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, 24105 Kiel, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8902-9480","authenticated-orcid":false,"given":"Christopher W.","family":"Lee","sequence":"additional","affiliation":[{"name":"Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA 6009, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2164-9365","authenticated-orcid":false,"given":"Katrina","family":"Boterhoven de Haan","sequence":"additional","affiliation":[{"name":"Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA 6009, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marleen","family":"Rijkeboer","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnoud","family":"Arntz","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology, University of Amsterdam, 1000 GG Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1192\/bjp.170.5.479","article-title":"Post-traumatic stress disorder and depression. An analysis of comorbidity","volume":"170","author":"Bleich","year":"1997","journal-title":"Br. J. Psychiatry"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.jad.2009.12.005","article-title":"Comorbidity of PTSD and depression in Korean War veterans: Prevalence, predictors, and impairment","volume":"125","author":"Ikin","year":"2010","journal-title":"J. Affect. Disord."},{"key":"ref_3","first-page":"170","article-title":"Comorbidity of PTSD, Major Depression, and Substance Use Disorder Among Adolescent Victims of the Spring 2011 Tornadoes in Alabama and Joplin, Missouri","volume":"78","author":"Adams","year":"2015","journal-title":"Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1111\/j.1467-7717.2007.01000.x","article-title":"Post-traumatic stress disorder and comorbid depression among survivors of the 1999 earthquake in Turkey","volume":"31","author":"Salcioglu","year":"2007","journal-title":"Disasters"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s10597-010-9359-4","article-title":"Effect of depression on recovery from PTSD","volume":"48","author":"Tural","year":"2012","journal-title":"Community Ment. Health J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/S0165-0327(03)00131-9","article-title":"Comorbidity of PTSD and depression: Associations with trauma exposure, symptom severity and functional impairment in Bosnian refugees resettled in Australia","volume":"80","author":"Momartin","year":"2004","journal-title":"J. Affect. Disord."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1037\/0022-006X.71.4.692","article-title":"Violence and risk of PTSD, major depression, substance abuse\/dependence, and comorbidity: Results from the National Survey of Adolescents","volume":"71","author":"Kilpatrick","year":"2003","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/j.brat.2009.06.003","article-title":"Cognitive and affective predictors of treatment outcome in Cognitive Processing Therapy and Prolonged Exposure for posttraumatic stress disorder","volume":"47","author":"Rizvi","year":"2009","journal-title":"Behav. Res. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1377028","DOI":"10.1080\/20008198.2017.1377028","article-title":"Depression as a moderator of STAIR Narrative Therapy for women with post-traumatic stress disorder related to childhood abuse","volume":"8","author":"Cloitre","year":"2017","journal-title":"Eur. J. Psychotraumatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1016\/j.chiabu.2014.01.017","article-title":"Comorbidity of PTSD in anxiety and depressive disorders: Prevalence and shared risk factors","volume":"38","author":"Spinhoven","year":"2014","journal-title":"Child Abuse Negl."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1192\/bjp.2020.158","article-title":"Imagery rescripting and eye movement desensitisation and reprocessing as treatment for adults with post-traumatic stress disorder from childhood trauma: Randomised clinical trial","volume":"217","author":"Lee","year":"2020","journal-title":"Br. J. Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1002\/da.22048","article-title":"Patterns of lifetime PTSD comorbidity: A latent class analysis","volume":"30","author":"Nickerson","year":"2013","journal-title":"Depress. Anxiety"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1017\/S0033291711002856","article-title":"Remission from post-traumatic stress disorder in the general population","volume":"42","author":"Chapman","year":"2012","journal-title":"Psychol. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"232","DOI":"10.3109\/13651501.2012.667113","article-title":"Predictors of the long-term course of comorbid PTSD: A naturalistic prospective study","volume":"17","author":"Zlotnick","year":"2013","journal-title":"Int. J. Psychiatry Clin. Pract."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.psychres.2017.11.068","article-title":"Predictors of remission from PTSD symptoms after sexual and non-sexual trauma in the community: A mediated survival-analytic approach","volume":"260","author":"Rodgers","year":"2018","journal-title":"Psychiatry Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1037\/0022-006X.69.3.541","article-title":"Posttraumatic stress disorder arising after road traffic collisions: Patterns of response to cognitive-behavior therapy","volume":"69","author":"Taylor","year":"2001","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1111\/bjc.12121","article-title":"Predicting post-traumatic stress disorder treatment response in refugees: Multilevel analysis","volume":"56","author":"Haagen","year":"2017","journal-title":"Br. J. Clin. Psychol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1176\/appi.ajp.2014.14070908","article-title":"Is Exposure Necessary? A Randomized Clinical Trial of Interpersonal Psychotherapy for PTSD","volume":"172","author":"Markowitz","year":"2015","journal-title":"Am. J. Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/S0005-7967(01)00024-9","article-title":"Prolonged exposure in patients with chronic PTSD: Predictors of treatment outcome and dropout","volume":"40","author":"Arntz","year":"2002","journal-title":"Behav. Res. Ther."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1007\/s00406-006-0682-2","article-title":"Predicting treatment outcome on three measures for post-traumatic stress disorder","volume":"257","author":"Karatzias","year":"2007","journal-title":"Eur. Arch. Psychiatry Clin. Neurosci."},{"key":"ref_21","first-page":"71","article-title":"Identifying trajectories and predictors of response to psychotherapy for post-traumatic stress disorder in adults: A systematic review of literature","volume":"65","author":"Dewar","year":"2020","journal-title":"Can. J. Psychiatry"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1774240","DOI":"10.1080\/20008198.2020.1774240","article-title":"A systematic review of factors associated with outcome of psychological treatments for post-traumatic stress disorder","volume":"11","author":"Barawi","year":"2020","journal-title":"Eur. J. Psychotraumatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1192\/bjpo.bp.115.000745","article-title":"Patient characteristics as a moderator of post-traumatic stress disorder treatment outcome: Combining symptom burden and strengths","volume":"2","author":"Cloitre","year":"2016","journal-title":"BJPsych Open"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"28186","DOI":"10.3402\/ejpt.v6.28186","article-title":"Psychotherapies for PTSD: What do they have in common?","volume":"6","author":"Schnyder","year":"2015","journal-title":"Eur. J. Psychotraumatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/S0005-7967(98)00173-9","article-title":"Treatment of childhood memories: Theory and practice","volume":"37","author":"Arntz","year":"1999","journal-title":"Behav. Res. Ther"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Boterhoven de Haan, K.L., Lee, C.W., Fassbinder, E., Voncken, M.J., Meewisse, M., Van Es, S.M., Menninga, S., Kousemaker, M., and Arntz, A. (2017). Imagery rescripting and eye movement desensitisation and reprocessing for treatment of adults with childhood trauma-related post-traumatic stress disorder: IREM study design. BMC Psychiatry, 17.","DOI":"10.1186\/s12888-017-1330-2"},{"key":"ref_27","unstructured":"Shapiro, F., and Forrest, M. (2001). EMDR: Eye Movement Desensitization and Reprocessing, Guilford."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"189","DOI":"10.5127\/jep.024211","article-title":"Imagery Rescripting as a Therapeutic Technique: Review of Clinical Trials, Basic Studies, and Research Agenda","volume":"3","author":"Arntz","year":"2012","journal-title":"J. Exp. Psychopathol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.jbtep.2012.11.001","article-title":"A meta-analysis of the contribution of eye movements in processing emotional memories","volume":"44","author":"Lee","year":"2013","journal-title":"J. Behav. Ther. Exp. Psychiatry"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.jbtep.2014.04.004","article-title":"How eye movements in EMDR work: Changes in memory vividness and emotionality","volume":"45","author":"Leer","year":"2014","journal-title":"J. Behav. Ther. Exp. Psychiatry"},{"key":"ref_31","unstructured":"First, M.B., Spitzer, R.L., Gibbon, M., and Williams, J.B. (2002). Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition, SCID-I\/P."},{"key":"ref_32","first-page":"22","article-title":"The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10","volume":"59","author":"Sheehan","year":"1998","journal-title":"J. Clin. Psychiatry"},{"key":"ref_33","unstructured":"First, M.B., Williams, J.B., Karg, R.S., and Spitzer, R.L. (2015). Structured Clinical Interview for DSM-5\u2014Research Version (SCID-5 for DSM-5, Research Version, SCID-5-RV), American Psychiatric Association."},{"key":"ref_34","unstructured":"Weathers, F., Blake, D., Schnurr, P., Kaloupek, D., Marx, B., and Keane, T. (2013, December 10). The Life Events Checklist for DSM-5 (LEC-5). Instrument Available from the National Center for PTSD, Available online: www.ptsd.va.gov."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1037\/pas0000486","article-title":"The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5): Development and initial psychometric evaluation in military veterans","volume":"30","author":"Weathers","year":"2018","journal-title":"Psychol. Assess."},{"key":"ref_36","unstructured":"Wilson, J., and Keane, T. (1997). The Impact of Event Scale\u2014Revised, Guildford Press. Assessing Psychological Trauma and PTSD: A Handbook for Practitioners."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/j.brat.2009.03.008","article-title":"Imagery rescripting as a brief stand-alone treatment for depressed patients with intrusive memories","volume":"47","author":"Brewin","year":"2009","journal-title":"Behav. Res. Ther."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1111\/papt.12268","article-title":"A randomized controlled trial examining the impact of individual trauma-focused therapy for individuals receiving group treatment for depression","volume":"94","author":"Dominguez","year":"2021","journal-title":"Psychol. Psychother."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"74","DOI":"10.3389\/fpsyg.2018.00074","article-title":"Comparison of Eye Movement Desensitization Reprocessing and Cognitive Behavioral Therapy as Adjunctive Treatments for Recurrent Depression: The European Depression EMDR Network (EDEN) Randomized Controlled Trial","volume":"9","author":"Ostacoli","year":"2018","journal-title":"Front. Psychol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1002\/jclp.10176","article-title":"Treatment for chronic depression using Cognitive Behavioral Analysis System of Psychotherapy (CBASP)","volume":"59","author":"McCullough","year":"2003","journal-title":"J. Clin. Psychol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"652","DOI":"10.3389\/fpsyt.2020.00652","article-title":"Preoperational Thinking as a Measure of Social Cognition Is Associated With Long-Term Course of Depressive Symptoms. A Longitudinal Study Involving Patients with Depression and Healthy Controls","volume":"11","author":"Sondermann","year":"2020","journal-title":"Front. Psychiatry"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.3389\/fpsyg.2018.01384","article-title":"Eye Movement Desensitization and Reprocessing Versus Treatment as Usual in the Treatment of Depression: A Randomized-Controlled Trial","volume":"9","author":"Hase","year":"2018","journal-title":"Front. Psychol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1016\/j.beth.2019.03.003","article-title":"Mediators of change in imagery rescripting and imaginal exposure for nightmares: Evidence from a randomized wait-list controlled trial","volume":"50","author":"Kunze","year":"2019","journal-title":"Behav. Ther."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), American Psychiatric Press. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1894736","DOI":"10.1080\/20008198.2021.1894736","article-title":"Eye movement desensitization and reprocessing for depression: A systematic review and meta-analysis","volume":"12","author":"Carletto","year":"2021","journal-title":"Eur. J. Psychotraumatol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/16\/3708\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:48:13Z","timestamp":1760165293000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/16\/3708"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,20]]},"references-count":45,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["jcm10163708"],"URL":"https:\/\/doi.org\/10.3390\/jcm10163708","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,20]]}}}