Brief Eclectic Psychotherapy for PTSD (BEPP)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Brief Eclectic Psychotherapy for PTSD (BEPP) has been rated by the CEBC in the area of: Trauma Treatment (Adult).

Target Population: Adult patients suffering from posttraumatic stress disorder (PTSD); developed for police officers, now used for all kinds of patients with PTSD

Brief Description

The 16-session Brief Eclectic Psychotherapy for PTSD (BEPP) protocol starts with psychoeducation on posttraumatic stress disorder (PTSD). The patient and his/her partner learn to understand the symptoms of PTSD as dysfunctional, and caused by the traumatic event. The patient will then receive 4-6 sessions of relaxation and imaginary exposure, focused on the suppressed intense emotions of sorrow.

Memorabilia are used to stimulate remembrances of the traumatic event and the patient is tasked to write a letter to a person or an institution blamed for the traumatic incident. The letter is specifically used to express aggressive feelings. Symptoms will then typically disappear and the patient will be able to concentrate on the impact of the trauma on his/her view of self and the world. The treatment is ended with a farewell ritual.

Program Goals:

The goals of Brief Eclectic Psychotherapy for PTSD (BEPP) are:

  • Patient experiencing no PTSD symptoms
  • Patient having experienced all emotions connected to the traumatic period
  • Patient having learned how the event(s) has changed his or her view of self and of the world and how new trust can be established

Essential Components

The essential components of Brief Eclectic Psychotherapy for PTSD (BEPP) include:

  • It is a protocolized 16-session psychotherapy treatment.
  • Before starting the BEPP treatment, intake and diagnosis should have been performed well to indicate the treatment for PTSD.
  • Comorbidity and relative contraindications should be considered in indication.
  • Therapists should be well-trained on the BEPP treatment and treat their first 8 patients under supervision.
  • Therapists should be qualified as psychotherapists (psychologists and psychiatrists).
  • Patients and their family should be informed about the diagnosis and about the treatment (see website info and movies at www.traumatreatment.eu).
  • It is an individual trauma-focused treatment which, if needed, can be combined with group day-treatment programs.

Adult Services

Brief Eclectic Psychotherapy for PTSD (BEPP) directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

  • Posttraumatic stress disorder (PTSD) symptoms, comorbid conditions, social problems related to PTSD
Services Involve Family/Support Structures:

This program involves the family or other support systems in the individual's treatment: In the psychoeducation phase, partners are invited and informed about PTSD in the specific situation of the patient. Also attention is paid to the suffering of the partner and of children because of the family member with PTSD. The farewell ritual is always with the partner and sometimes with the children.

Delivery Settings

This program is typically conducted in a(n):

  • Hospital
  • Outpatient Clinic

Homework

Brief Eclectic Psychotherapy for PTSD (BEPP) includes a homework component:

Finding memorabilia, letter writing, and preparing farewell ritual

Languages

Brief Eclectic Psychotherapy for PTSD (BEPP) has materials available in languages other than English:

Dutch, French, Georgian, German, Italian, Lithuanian

For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Quiet treatment room, safe surrounding, waiting room, all equipment for an office of a psychotherapist or outpatient department

Minimum Provider Qualifications

Licensed psychologists and psychiatrists

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contacts:
Training is obtained:

It is possible to organize training onsite, in the Netherlands, or connected to conferences

Number of days/hours:

2.5 days

Additional Resources:

There currently are additional qualified resources for training:

RINO Noord-Holland: http://www.rino.nl/english/RINO

Foundation Centrum ’45: http://www.centrum45.nl/index.php?uid=125

Mirjam Nijdam, PhD, Academic Medical Center, University of Amsterdam, Netherlands. Email: m.j.nijdam@amc.nl

Implementation Information

Since Brief Eclectic Psychotherapy for PTSD (BEPP) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

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Pre-Implementation Materials

The program representative did not provide information about pre-implementation materials.

Formal Support for Implementation

The program representative did not provide information about formal support for implementation of Brief Eclectic Psychotherapy for PTSD (BEPP).

Fidelity Measures

The program representative did not provide information about fidelity measures of Brief Eclectic Psychotherapy for PTSD (BEPP).

Implementation Guides or Manuals

The program representative did not provide information about implementation guides or manuals for Brief Eclectic Psychotherapy for PTSD (BEPP).

Research on How to Implement the Program

The program representative did not provide information about research conducted on how to implement Brief Eclectic Psychotherapy for PTSD (BEPP).

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

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Gersons, B. P. R., Carlier, I. V. E., Lamberts, R. D., & van der Kolk, B., (2000). A randomized clinical trial of Brief Eclectic Psychotherapy in police officers with posttraumatic stress disorder. Journal of Traumatic Stress, 13(2), 333-347.

Type of Study: Randomized controlled trial
Number of Participants: 42

Population:

  • Age — 35-38 years
  • Race/Ethnicity — 100% Dutch
  • Gender — 37 Men and 5 Women
  • Status — Participants were police officers with posttraumatic stress disorder (PTSD).

Location/Institution: Department of Psychiatry at the Academic Medical Center of the University of Amsterdam

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study reports on the treatment of posttraumatic stress disorder (PTSD), comparing Brief Eclectic Psychotherapy (BEP) [now called Brief Eclectic Psychotherapy for PTSD (BEPP)] to a waitlist control. Measures utilized include the Dutch version of the Structured Interview for Posttraumatic Stress Disorder (SI-PTSD) which operationalized DSM-III-R criteria for PTSD, the Symptom Checklist (SCL), and the Anxiety Disorders Interview Schedule—Revised. Results indicate no significant differences between groups were observed at pretest or at session 4. At posttest and at follow-up, BEP had produced significant improvement in PTSD, in work resumption, and in some comorbid conditions. Limitations include small sample size, absence of more objective monitors of the treatment, lack of ability to generalize to other population due to ethnicity and selectivity of group, and lack of long term follow-up.

Length of postintervention follow-up: 3 months.

Lindauer, R. J. L., Gersons, B. P. R., van Meijel, E. P. M., Blom, K., Carlier, I. V. E., Vrijlandt, I., & Olff, M. (2005). Effects of Brief Eclectic Psychotherapy in patients with posttraumatic stress disorder: Randomized clinical trial. Journal of Traumatic Stress, 18, 205-212.

Type of Study: Randomized controlled trial
Number of Participants: 24

Population:

  • Age — 37-40 years
  • Race/Ethnicity — 100% Dutch
  • Gender — 13 Women and 11 Men
  • Status — Participants were individuals in outpatient treatment center with posttraumatic stress disorder (PTSD).

Location/Institution: Academic Medical Center of the University of Amsterdam

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This article assess the effects of Brief Eclectic Psychotherapy (BEP) [now called Brief Eclectic Psychotherapy for PTSD (BEPP)] in a traumatized population other than police officers and in posttraumatic stress disorder (PTSD) subjects who experienced a wide range of traumas instead of specific traumas such as warfare or sexual abuse Patients were randomly assigned to BEP or a waitlist group. Measures utilized include the Hospital Anxiety and Depression Scale (HADS), List of Traumatic Events and the Police Life Event Scale (PLES), Structured Interview for Posttraumatic Stress Disorder (SI-PTSD), the Structured Clinical Interview for DSM-IV (SCID), and the Dissociation Experiences Scale (DES). Results indicate no significant differences between the groups were observed at pretest. By posttest, BEP had significantly reduced PTSD as well as general anxiety symptoms in the treated group of outpatients as compared to the waitlist group. Limitations include the small sample size, extensive exclusion criteria which may limit the generalizability of the findings, and the lack of follow-up.

Length of postintervention follow-up: None.

Lindauer, R. J. L, Vlieger, E. J., Jalink, M., Olff, M., Carlier, I. V. E., Majoie, C. B. M. L., …Gersons, B. P. R. (2005). Effects of psychotherapy on hippocampal volume in out-patients with post-traumatic stress disorder: a MRI investigation, Psychological Medicine, 35, 1-11.

Type of Study: Randomized controlled trial
Number of Participants: 32

Population:

  • Age — 36-39 years
  • Race/Ethnicity — Not specified
  • Gender — 16 Men and 16 Women
  • Status — Participants were civilian patients with DSM-IV current posttraumatic stress disorder (PTSD).

Location/Institution: Academic Medical Center of the University of Amsterdam

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The present study compares the hippocampal volumes of outpatients with posttraumatic stress disorder (PTSD) who had low co-morbidity rates to those of trauma-exposed control subjects without PTSD, and measures hippocampal volume changes in these patients after Brief Eclectic Psychotherapy (BEP) [now called Brief Eclectic Psychotherapy for PTSD (BEPP)]. Measures utilized include the List of Traumatic Events and the Police Life Event Scale (PLES), Structured Interview for Posttraumatic Stress Disorder (SI-PTSD), the Structured Clinical Interview for DSM-IV (SCID), and a background questionnaire was also performed to collect information about education and relatives with psychiatric problems. Patients with PTSD and traumatized control subjects were examined with magnetic resonance imaging (MRI). The PTSD patients were assigned to BEP or a waitlist group. After the former received BEP for 4 months, the MRI was repeated on both PTSD groups. Results indicate that PTSD patients had significantly smaller hippocampal volumes at baseline compared to the control subjects. After effective psychotherapy, however, no volume changes were found in the smaller hippocampi, even though symptoms had resolved. Limitations include small sample size and lack of follow-up.

Length of postintervention follow-up: None.

Lindauer, R. T., van Meijel, E. P., Jalink, M., Olff, M., Carlier, I. V., & Gersons, B. P. (2006). Heart rate responsivity to script-driven imagery in posttraumatic stress disorder: Specificity of response and effects of psychotherapy. Psychosomatic Medicine, 68(1), 33-40.

Type of Study: Randomized controlled trial
Number of Participants: 54

Population:

  • Age — 36-38 years
  • Race/Ethnicity — Not specified
  • Gender — 29 Men and 25 Women
  • Status — Participants were police officers and civilians with posttraumatic stress disorder (PTSD).

Location/Institution: Department of Psychiatry at the Academic Medical Center of the University of Amsterdam

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study investigates psycho-physiological responses in two new populations while excluding those confounding influences and to assess the effects of the intervention [now called Brief Eclectic Psychotherapy for PTSD (BEPP)] on such responses. Measures utilized include the Structured Interview for Posttraumatic Stress Disorder (SI-PTSD), Structured Clinical Interview for DSM-IV (SCID), List of Traumatic Events and the Police Life Event Scale (PLES), and the State-Trait Anxiety Inventory (STAI). Subjects with PTSD (24 civilian outpatients and 15 police officers) and 15 trauma-exposed, non-PTSD control subjects underwent psycho-physiological assessment while listening to neutral, stressful, and trauma scripts. Psycho-physiological measures were heart rate (HR) and blood pressure in combination with subjective anxiety ratings. The civilians were then assigned to treatment or waitlist groups. Psycho-physiological assessment was repeated on them after the treatment stage. Results indicate that both civilians and police with PTSD showed significantly higher HR responses to trauma scripts than the control subjects. After successful psychotherapy with the civilians, HR responsivity to the trauma scripts was significantly reduced, and it correlated positively with PTSD clinical symptoms. Limitations include small sample size and lack of long term follow-up.

Length of postintervention follow-up: 4 months.

Olff, M., de Vries, G. J., Güzelcan, Y., Assies, J., & Gersons, B. P. (2007). Changes in cortisol and DHEA plasma levels after psychotherapy for PTSD. Psychoneuroendocrinology, 32(6), 619-626.

Type of Study: One group pretest-posttest study
Number of Participants: 21

Population:

  • Age — 33-59 years
  • Race/Ethnicity — 10 Dutch, 6 Turkish, 4 Surinamese, and 1 Other
  • Gender — 16 Female
  • Status — Participants were posttraumatic stress disorder (PTSD) patients, with and without coexisting depression.

Location/Institution: Center for Psychological Trauma at the Academic Medical Center of the University of Amsterdam.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study examines the effects of Brief Eclectic Psychotherapy (BEP) [now called Brief Eclectic Psychotherapy for PTSD (BEPP)] in posttraumatic stress disorder (PTSD) patients, with and without coexisting depression, on the levels of six stress-related hormones. Measures utilized include the Structured Interview for Posttraumatic Stress Disorder (SI-PTSD), the Structured Clinical Interview for DSM-IV (SCID-I), and the Dutch version of the Impact of Event Scale-Revised (IES-R). Results show that after BEP, significant changes occurred in levels of cortisol and DHEA (dehydroepiandrosterone) hormone. Responders showed an increase in cortisol and DHEA levels, while in nonresponders both hormone levels decreased. Differences were only found after controlling for depressive symptoms. Results also indicate that effective psychotherapy for PTSD may alter dysregulations in the hypothalamus–pituitary–adrenal (HPA)-axis, but comorbid depressive symptoms should be taken into account. Limitations include the lack of a control group and the small sample size.

Length of postintervention follow-up: None.

Nijdam, M. J., Gersons, B. P. R., Reitsma, J. B., de Jongh, A., & Olff, M. (2012). Brief Eclectic Psychotherapy versus Eye Movement Desensitization and Reprocessing therapy in the treatment of posttraumatic stress disorder: Randomized controlled trial. British Journal of Psychiatry, 200, 1-8.

Type of Study: Randomized controlled trial
Number of Participants: 140

Population:

  • Age — 37-38 years
  • Race/Ethnicity — 73 Dutch, 18 Surinamese, 13 Turkish, 9 Moroccan, and 27 Other
  • Gender — 79 Women
  • Status — Participants were civilian trauma survivors.

Location/Institution: Center for Psychological Trauma at the Academic Medical Center of the University of Amsterdam.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The aim of the present study was to compare the efficacy and response pattern of Brief Eclectic Psychotherapy for PTSD (BEPP), with Eye Movement Desensitization and Reprocessing therapy (EMDR). Measures utilized include the Dutch Impact of Event Scale-Revised (IES-R), the Structured Interview for PTSD (SI-PTSD), the Dutch version of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), and the Hospital Anxiety and Depression Scale (HADS). Results indicate that both treatments were equally effective in reducing PTSD symptom severity, but the response pattern indicated that EMDR led to a significantly sharper decline in PTSD symptoms than BEPP, with similar drop-out rates. Limitations include high attrition rates, differences in the number of BEPP exposure sessions, and use of other concurrent treatments.

Length of postintervention follow-up: None for BEPP group, approximately 10 weeks for EMDR group.

Nijdam, M. J., Baas, M. A., Olff, M., & Gersons, B. P. R. (2013). Hotspots in trauma memories and their relationship to successful trauma-focused psychotherapy: A pilot study. Journal of Traumatic Stress, 26, 38-44.

Type of Study: Randomized controlled trial
Number of Participants: 20

Population:

  • Age — 36-39 years
  • Race/Ethnicity — 15 Dutch, 2 Indonesian, 1 Surinamese, 1 Aruban, and 1 Bosnian
  • Gender — 12 Women
  • Status — Participants were adult treatment-seeking posttraumatic stress disorder (PTSD) patients.

Location/Institution: Center for Psychological Trauma at the Academic Medical Center of the University of Amsterdam.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study sues a subset of subjects from Nijdam, M. J., Gersons, B. P. R., Reitsma, J. B., de Jongh, A., & Olff, M. (2012). The present study investigates whether differences in the focus on hotspots differentiate between successful and unsuccessful trauma-focused psychotherapies. Measures utilized include the Dutch Impact of Event Scale-Revised (IES-R) and the Hotspots Manual. Patients completed Brief Eclectic Psychotherapy for PTSD. Audio recordings of therapy sessions of the 20 patients were retrospectively assessed. Frequency of hotspots and the associated emotions, cognitions, and characteristics were compared for the most successful versus the least successful treatments. Results indicate that in successful treatments, however, hotspots were more frequently addressed and they were accompanied by more characteristics of hotspots, such as an audible change in affect, indicating medium- to large-sized effects. Limitations include small sample size, treatment dropouts were not included in the study, and the use of audio recordings instead of video recordings, which may have affected the identification of hotspot characteristics, such as a patient dissociating or blushing or sweating.

Length of postintervention follow-up: None.

References

Lindauer, R. J. L., Vlieger, E. J., Jalink, M., Olff, M., Carlier, I. V. E., Majoie, C. B. M. L., … Gersons, B. P. R. (2004). Smaller hippocampal volume in Dutch police officers with posttraumatic stress disorder. Biological Psychiatry, 56, 356-63.

Schnyder, U., Müller, J., Maercker, J., Wittmann, L. (2011). Brief Eclectic Psychotherapy for PTSD: A randomized controlled trial. Journal of Clinical Psychiatry, 72(4), 565-566.

Contact Information

Name: Prof. Berthold P.R. Gersons, PhD
Agency/Affiliation: Arq Psychotrauma Expert Group, Academic Medical Center, University of Amsterdam, Netherlands
Website: www.traumatreatment.eu
Email:

Date Research Evidence Last Reviewed by CEBC: June 2017

Date Program Content Last Reviewed by Program Staff: October 2013

Date Program Originally Loaded onto CEBC: October 2013