The effectiveness and acceptance of eye movement desensitisation and reprocessing (EMDR) from a remote Aboriginal Australian community perspective.

This trial has one experimental treatment condition, where EMDR treatment is compared to a two-week wait period, where participants serve as their own control. Participants complete an initial assessment session (including identifying single or multiple trauma memories to target with EMDR) and diagnostic assessment session (to identify symptoms and diagnosis of PTSD) after which they are taught basic calming techniques. The basic calming techniques are taught for ethical reasons as participants will be discussing trauma memories, however in themselves do not constitute an intervention. Brief calming techniques include calm breathing (breathing in, 2, 3, 4, pause, out, 2, 3, 4) and safe place, which invites participants to picture a place (real or imagined) which invokes a sense of calm and safety. The safe place image is amplified by identifying sensory elements associated with the place and the place is given a name for later cueing if the participant is feeling distressed. Existing family/social supports and internal coping resources will also be identified, and participants provided a brochure with the brief calming techniques and a list of their own supports and resources should they feel distressed in the wait period. Participants then complete a two week wit period serving as their own control. Participants then engage in EMDR therapy for treatment of PTSD symptoms. Participants will receive up to 10, individual, face-to-face, 90minute active EMDR treatment sessions on a biweekly basis. EMDR therapy will follow the eight-phase EMDR standard protocol outlined by Shapiro (2001), with additional local cultural considerations developed with the community with the primary researcher for this study (Y. Eriksen). During assessment, participants identified distressing trauma memory/ies to target with EMDR. For each memory during EMDR therapy, participants will be asked to identify the image that represents the most traumatic or distressing part of the experience and how vivid the image is; their associated negative cognition, emotions, body sensations and how strong they are; and their preferred positive cognition. The participant will be invited to focus on the memory image and associated negative thoughts and body sensations and at the same time follow the therapist fingers with their eyes. Eye-movements will be used as the dual attention task during EMDR desensitisation of trauma memories. In between sets of eye movements (approximately 24-35 saccades each set) participants will be asked to describe thoughts, feelings or body sensations that arise. Processing each memory will continue until associated participant distress has reduced, their positive cognition has strengthened and no, or little residual body sensations remains when recalling the original memory. One or more memories may be targeted each session based on timing and participant inclination. The total number of EMDR sessions will be based on participant individual needs. EMDR therapy will be considered complete when the participant does not feel distress when recalling the target trauma memory/ies identified during assessment (up to 10 sessions). Sessions may take place in the building of the participants workplace program, NGO health service, participants workplace, home or a community venue as appropriate. Assessment and EMDR therapy sessions will be administered by a registered psychologist with Level II EMDR training and four years experience with the participating community. Assessment at three months follow up will be completed by an independent professional trained in psychology and provided assessment training specific to this study by the primary researcher. The duration of the study for any participant will conclude after a three-month follow-up assessment after the completion of therapy, resulting in a total participation duration of approximately 5 months. All sessions will be video recorded with participant consent. Video recordings of all PTSD assessment sessions will be reviewed by a PhD level registered psychologist for inter-rater reliability. During the course of the trial, a sample of 12 EMDR treatment session video recordings will be assessed for treatment fidelity by an accredited EMDR consultant using a treatment fidelity checklist provided during EMDR training. Two EMDR consultants will provide fortnightly consultation to the treating psychologist during field work to ensure rigorous adherence to the treatment protocol throughout the trial.