Effects of timing and type of trauma-focused treatment on psychosocial functioning: Secondary outcomes from a randomized controlled trial in patients with co-occurring substance use disorder and posttraumatic stress disorder
This study examined secondary outcomes from an RCT comparing Prolonged Exposure (PE), EMDR therapy, and Imagery Rescripting (ImRs), delivered simultaneously with or sequentially to SUD-treatment to evaluate treatment responses per type of therapy as well as timing of delivery.
Article Abstract
“Patients with co-occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) often experience additional psychosocial difficulties, including emotion dysregulation, interpersonal problems, and trauma-related guilt and shame. Evidence on optimal timing and type of trauma-focused treatment remains limited, particularly for psychosocial outcomes beyond PTSD and SUD-severity. This study examined secondary outcomes from a randomized controlled trial (RCT) comparing Prolonged Exposure (PE), Eye Movement Desensitization and Reprocessing (EMDR), and Imagery Rescripting (ImRs), delivered simultaneously with or sequentially to SUD-treatment. Aims were to evaluate (1) added effects of trauma-focused treatment at 3-month follow-up, and over 9 months (2) simultaneous versus sequential delivery, and (3) differences between PE, EMDR, and ImRs.
Method: 209 patients were randomly allocated to PE, EMDR, or ImRs; 75% received simultaneous and 25% sequential treatment. Assessments were conducted at baseline, 3-, 6-, and 9-month follow-up. Outcomes included psychological distress, emotion dysregulation, interpersonal problems, trauma-related guilt and shame, and anger control. Multiple linear regression and linear mixed models were used; missing data were handled using multiple imputation.
Results: Adding EMDR or ImRs to SUD-treatment resulted in improvements in several psychosocial outcomes at 3-month follow-up, whereas PE did not. Simultaneous treatment yielded greater improvements than sequential treatment, largely due to differences before PTSD-treatment initiation in the sequential condition. No significant differences emerged between treatment types.
Conclusions: Trauma-focused treatments, particularly EMDR and ImRs, are effective add-ons to SUD-treatment for improving psychosocial outcomes. Simultaneous delivery may be preferable due to faster benefits. This study supports shared-decision making regarding timing and type of PTSD-treatment.
Highlights
- EMDR and ImRs may be preferred over PE when targeting psychosocial outcomes.
- Simultaneous treatment of PTSD and SUD yields quickest improvements.
- No significant differences emerged between PE, EMDR, and ImRs in direct comparisons.
- Shared-decision making should guide timing and choice of trauma-focused treatment.”
—Description from publisher
Article Access
Open Access
Faber, N. N. M., Lortye, S., Arntz, A., Marquenie, L. A., Goudriaan, A. E., & de Waal, M. M. (2026). Effects of timing and type of trauma-focused treatment on psychosocial functioning: Secondary outcomes from a randomized controlled trial in patients with co-occurring substance use disorder and posttraumatic stress disorder. Behaviour Research and Therapy, 202, 105053. Open access: https://doi.org/10.1016/j.brat.2026.105053
About the Journal
“The major focus of Behaviour Research and Therapy is an experimental psychopathology approach to understanding emotional and behavioral disorders and their prevention and treatment, using cognitive, behavioral, and psychophysiological (including neural) methods and models. ”
—Description from publisher
Date
April 24, 2026
Creator(s)
Nathalie N.M. Faber, Sera Lortye, Arnoud Arntz
Contributor(s)
Loes A. Marquenie, Anna E. Goudriaan, Marleen M. de Waal
Topics
Addictions, Emotion Regulation, PTSD
Practice & Methods
Comparative Studies
Extent
14 pages
Publisher
Elsevier
Rights
© 2026 The Authors.
APA Citation
Faber, N. N. M., Lortye, S., Arntz, A., Marquenie, L. A., Goudriaan, A. E., & de Waal, M. M. (2026). Effects of timing and type of trauma-focused treatment on psychosocial functioning: Secondary outcomes from a randomized controlled trial in patients with co-occurring substance use disorder and posttraumatic stress disorder. Behaviour Research and Therapy, 202, 105053. Open access: https://doi.org/10.1016/j.brat.2026.105053
Audience
EMDR Therapists, Other Mental Health Professionals
Language
English
Content Type
Article, Peer-Reviewed, RCT
Access Type
External Resource, Open Access
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