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PTSD - Post Traumatic Stress DisorderFLIP-ITNCT06700590

First-Line Intervention for PTSD - Intensive Treatment

A study testing Intensive Treatment and Treatment as usual in people with PTSD - Post Traumatic Stress Disorder, run by ARQ National Psychotrauma Centre at 4 sites in Netherlands.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The goal of this clinical trial is to learn if an intensive program can treat post-traumatic stress disorder (PTSD) in adults getting treatment for the first time, and whether it has lower societal costs. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
PTSD - Post Traumatic Stress Disorder
What is being tested?
Intensive Treatment and Treatment as usual
Could I receive a placebo?
No, everyone receives an active treatment
How many people
186 participants
Where
4 sitesNetherlands
Study dates
21 Nov 2024to 1 Jul 2028
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 18 years or older
  • PTSD diagnosis according to DSM-5 (CAPS-5);
  • PTSD diagnosis stemming from 2 or more potentially traumatic events (PTEs)
  • seeking first-time treatment for PTSD (or less than 8 sessions);
  • employed (working or on sick leave for less than two years)

Who cannot join

  • Current psychotic disorder, severe alcohol or substance use disorder, high suicidal intent (MINI-S for DSM-5) and a concrete suicide plan, or severe aggressive behavior that poses danger for others
  • insufficient command of the Dutch language to be able to complete the assessments. This will be determined through clinical judgment at intake.

Trial locations and contacts

4 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Mirjam Mink-Nijdam, PhD contact

+31(0)20 840 7640

m.mink@centrum45.nl

Bram Kemmere, Msc. contact

+31(0)20 840 7640

b.kemmere@arq.org

Netherlands4 sites, 4 recruiting
  • ARQ IVP

    Diemen, North Holland, 1112 XE

    Recruiting
  • Psy-Zo!

    Groningen, Provincie Groningen, 9747 AN

    Recruiting
  • Psychotraumacentrum Haarlem

    Haarlem, North Holland, 2011 VE

    Recruiting
  • ARQ Centrum'45

    Oegstgeest, South Holland, 2342 AX

    Recruiting

Other trials in Netherlands

About this study

Official title: (Cost)-Effectiveness of Intensive Trauma-Focused Treatment Versus Spaced Trauma-Focused Treatment As First Line Treatment for Post-Traumatic Stress Disorder in Adults with Multiple Trauma Exposure: Randomized Controlled Trial

The goal of this clinical trial is to learn if an intensive program can treat post-traumatic stress disorder (PTSD) in adults getting treatment for the first time, and whether it has lower societal costs. The main questions it aims to answer are:

  • Does an intensive program reduce PTSD symptoms?
  • How expensive is it on a societal level? Researchers will compare the intensive program to the standard weekly treatment to see if the intensive program works to treat PTSD.

Participants will:

  • Get 5 days of intensive treatment in two weeks (with two preparatory and closing sessions), or weekly sessions
  • Get questionnaires and interviews 5 times in 9 months
Being tested
Intensive Treatment, Treatment as usual
Keywords
intensive treatment, massed treatment, randomized controlled trial, RCT, first time treatment
Medical subject headings
Combat Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Intensive TreatmentBehavioural

    Participants engage in two preparatory sessions once weekly, lasting 50 minutes each, which focus on psychoeducation and case conceptualization. The core treatment consists of five days of twice-daily sessions delivered over one or two weeks. The first session of the day consists of prolonged exposure (PE). The second session consists of eye movement desensitization and reprocessing (EMDR). Both treatments are performed in strict adherence to their respective manualized protocol. Two closing sessions focus on lessons learned, integration and a prevention plan. The treatment in total lasts 6 weeks and contains 800 minutes of treatment.

    To enhance practicality, treatment rotation is allowed and encouraged. Rigorous checks on treatment adhenrence will be implemented.

  • Treatment as usualBehavioural

    Spaced/weekly treatment consists of a treatment-as-usual condition, increasing the representativeness of the control condition. Treatment duration is 800 minutes, either 13 weeks of 60 minutes (with the last sessions being 80 minutes), or 16 weeks of 50 minutes. All evidence-based treatment modalities of the Dutch guidelines are allowed: PE, EMDR, brief eclectic psychotherapy for PTSD (BEPP), narrative exposure therapy (NET), and imaginary rescripting (ImRs). All have common elements of psychoeducation, imaginal exposure, emotional processing, cognitive restructuring and/or meaning making. Treatment adherence will be monitored throughout the intervention. Therapist rotation is not performed

Study groups in NCT06700590
Study groupRoleWhat they receive
massed/intensive treatmentExperimentalNot described
Receives: Behavioral: Intensive Treatment
spaced/weekly treatmentActive comparatorNot described
Receives: Behavioral: Treatment as usual

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Clinician Administered PTSD Scale for DSM-5 (CAPS-5)

    The primary outcome, severity of Post-Traumatic Stress Disorder (PTSD) is assessed by the Clinician Administered PTSD Scale for DSM-5 (CAPS-5). CAPS-5 is a comprehensive 20-item clinical interview that assesses both the DSM-5 PTSD diagnostic criteria and the severity of PTSD symptoms. Scores range from 0 to 80, with higher scores denoting greater symptom severity. The CAPS-5 showed high internal consistency and interrater reliability, good test-retest reliability, and good validity. All the assessors are or will be trained to administer the Dutch versions of the CAPS-5. It requires a total of 225 minutes to complete at all measurement points.

    Measured: At baseline (T0), after intensive treatment (T1, 7 weeks), after weekly treatment (T2, 17 weeks), after 6 months (T3) and 9 months (T4).

  2. Cost-effectiveness (Quality of life)

    Cost-effectiveness is a composite measure of quality of life (physical and mental), and treatment inventory of costs.

    Quality of life will be assessed using the Euro Quality of Life 5 Dimensions (EQ-5D-5L) scale. This scale comprises 14 items categorized into various aspects of health status, rated on a three-point scale.

    Measured: At baseline (T0), after intensive treatment (T1, 7 weeks), after weekly treatment (T2, 17 weeks), after 6 months (T3) and 9 months (T4).

  3. Cost-effectiveness (Mental Health Quality of Life Questionnaire)

    Cost-effectiveness is a composite measure of quality of life (physical and mental), and treatment inventory of costs.

    The Mental Health Quality of Life Questionnaire (MHQoL) will be utilized to assess the quality of life among individuals with mental health issues. The MHQoL comprises a descriptive system (the MHQoL-7D) and a visual analog scale (MHQoL-VAS).

    Measured: At baseline (T0), after intensive treatment (T1, 7 weeks), after weekly treatment (T2, 17 weeks), after 6 months (T3) and 9 months (T4).

  4. Cost-effectiveness (Treatment inventory of costs)

    Cost-effectiveness is a composite measure of quality of life (physical and mental), and treatment inventory of costs. The Treatment Inventory of Costs in Patients with psychiatric disorders (TiC-P) will be utilized to map the costs arising from psychosocial problems in adults. It consists of three components: general questions, questions regarding medical care utilization, and questions related to work.

    Measured: At baseline (T0), after intensive treatment (T1, 7 weeks), after weekly treatment (T2, 17 weeks), after 6 months (T3) and 9 months (T4).

Secondary outcomes (10)
  1. International Trauma Questionnaire (ITQ)

    The International Trauma Questionnaire (ITQ; Dutch translation) will be used to address the core features of the diagnosis of Post Traumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD) according to the ICD-11 as main study parameter. Several studies have indicated that the preliminary version of the ITQ is a reliable and valid measure of PTSD symptoms. The ITQ assessments will be conducted at all time points, with a total assessment duration of 50 minutes.

    Measured: At baseline (T0).

  2. Moral Injury Outcome Scale (MIOS)

    Moral Injury will be assessed by the Moral Injury Outcome Scale (MIOS). This scale comprises 14 items categorized into two subscales: Shame-Related and Trust-Violation Related Outcomes. It is used to determine if respondents experienced a Potentially Morally Injurious Event (PMIE) and assess the impact of these experiences on well-being. The MIOS also addresses PTSD symptoms related to PMIE. The 14-item MIOS demonstrates invariance and reliability across countries and exhibits two factors: Shame-Related and Trust-Violation-Related Outcomes.

    Measured: At baseline (T0), after intensive treatment (T1, 7 weeks), after weekly treatment (T2, 17 weeks), after 6 months (T3) and 9 months (T4).

  3. Hospital Anxiety and Depression Scale (HADS)

    The Hospital Anxiety and Depression Scale (HADS) is employed to measure core symptoms of anxiety and depression, excluding physical symptoms. It consists of separate anxiety and depression scales, each with 7 items. The HADS exhibits good homogeneity and test-retest reliability for the total scale and subscales, and its dimensional structure and reliability are stable across different medical settings and age groups.

    Measured: At baseline (T0), after intensive treatment (T1, 7 weeks), after weekly treatment (T2, 17 weeks), after 6 months (T3) and 9 months (T4).

  4. Acceptance and Action Questionnaire (AAQ-II)

    Experiential Avoidance will be assessed by the Experiential Avoidance Assessment (AAQ-II): In its Dutch-language version, the Acceptance and Action Questionnaire-II will be used to assess experiential avoidance. It consists of 7 statements, with higher scores indicating lower experiential avoidance and greater acceptance of unpleasant inner experiences. The Dutch AAQ-II has demonstrated similar construct validity and reliability to the English version.

    Measured: At baseline (T0), after intensive treatment (T1, 7 weeks), after weekly treatment (T2, 17 weeks), after 6 months (T3) and 9 months (T4).

  5. Personality Inventory for DSM-5-Brief Form-Adult (PID-5-BF-NL)

    Maladaptive Personality Traits will be assessed by the Personality Inventory for DSM-5-Brief Form-Adult (PID-5-BF-NL). The PID-5-BF-NL will be employed to assess maladaptive personality traits as defined in the alternative DSM-5 model for personality disorders. This self-rated scale comprises 25 items evaluating five personality trait domains. The reliability and validity of the PID-5-BF-NL have demonstrated adequacy to good.

    Measured: At baseline (T0), and at 6 months (T3)

  6. Dissociative Symptoms Assessment (DSS-4)

    Dissociative Symptoms will be assessed using the Dissociative Symptoms Assessment (DSS-4): The DSS, will be utilized to assess psychoform and somatoform dissociative symptoms experienced in the past week. The scale comprises 21 items and exhibits high internal consistency (Cronbach's alpha = .92) and reliability.

    Measured: At baseline (T0), after intensive treatment (T1, 7 weeks), after weekly treatment (T2, 17 weeks), after 6 months (T3) and 9 months (T4).

  7. Crisis Support Scale (CSS)

    Social Support will be administered by the Crisis Support Scale (CSS) to evaluate social support, assessing total social support and satisfaction with support. The CSS consists of 7 items and has demonstrated both good validity and reliability. The CSS assessments will be conducted at baseline (T0) and 6 months (T3), with a total assessment duration of 10 minutes.

    Measured: At baseline (T0), after 6 months (T3)

  8. Verbal Learning and Memory Test (VLGT)

    The Verbal Learning and Memory Test (VLGT), a Dutch version of the American California Verbal Learning Test by Delis, will be employed to assess verbal memory functions in adults. This test evaluates learning performance, speed of learning and forgetting, encoding modes, memorization, recognition over time, sensitivity to interference, the tendency to confabulate, and persistence. The VLGT is a reliable and valid test.

    Measured: At baseline (T0), after weekly treatment (T2, 17 weeks)

  9. Harms

    Harms will be assessed by inquiring, 'Have you experienced any issues since your last visit?' following the recommendation by the STRONG STAR consortium.

    Measured: After intensive treatment (T1, 7 weeks), after weekly treatment (T2, 17 weeks), after 6 months (T3) and 9 months (T4).

  10. Treatment satisfaction

    Treatment satisfaction will be assessed at 7 weeks (T1) and 17 weeks (T2) for the intensive treatment and treatment as usual, respectively. The Client Satisfaction Questionnaire 8 (CSQ-8) and the Visual Analog Scale will be used. The CSQ-8 is a questionnaire with 8 questions rated on a four-point Likert scale, validated in Dutch samples with high internal consistency and similar psychometric properties to the English version. The Visual Analog Scale with 1 indicating the lowest possible rating and 10 representing the highest possible rating, is utilized for assessing the treatment. Additionally, it includes an inquiry about what modifications or improvements are required to achieve a perfect rating of 10.

    Measured: at 7 weeks (T1) and 17 weeks (T2)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Nov 2024
  2. Study start21 Nov 2024
  3. Primary completion1 Apr 2028 (estimated)
  4. Study completion1 Jul 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Randomized controlled trial
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
186 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06700590
Sponsor's protocol ID
NL86057.018.24
Other IDs
10390092110006
Acronym
FLIP-IT
Status last verified
Jan 2025
First submitted
18 Nov 2024
Last updated
3 Mar 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Metadata will be placed in a data repository. IPD can be requested with the research team.

Publications

  • Kemmere B, van Pelt YT, Lommen MJJ, Huntjens RJC, Olff M, Mendez MZ, Matthijssen S, Hakkaart-van Roijen L, Nijdam MJ, Heide FJJT. Cost-effectiveness of massed versus spaced trauma-focused treatment as first-line treatment for post-traumatic stress disorder in adults with multiple trauma exposure: protocol for a single-blind non-inferiority randomised controlled trial. BMJ Open. 2025 May 23;15(5):e102530. doi: 10.1136/bmjopen-2025-102530.

    PubMed 40409963

Questions about this trial

What is this clinical trial studying?

A study testing Intensive Treatment and Treatment as usual in people with PTSD - Post Traumatic Stress Disorder, run by ARQ National Psychotrauma Centre at 4 sites in Netherlands.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 3 Mar 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 4 sites in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Mirjam Mink-Nijdam, PhD (+31(0)20 840 7640, m.mink@centrum45.nl), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Clinician Administered PTSD Scale for DSM-5 (CAPS-5) (time frame: At baseline (T0), after intensive treatment (T1, 7 weeks), after weekly treatment (T2, 17 weeks), after 6 months (T3) and 9 months (T4).). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06700590, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Mar 2025.

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