None listed
Conditions
Brief summary
This is a single blind randomised controlled trial to compare Eye Movement Desensitisation and Reprocessing Therapy (EMDR) versus treatment as usual for people with post traumatic stress disorder within a forensic and rehabilitation long stay setting. Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy treatment based on information processing model of trauma (Adaptive Information Processing model) to alleviate the distress associated with traumatic memories. During EMDR the client is instructed to attend to the traumatic event for brief periods while simultaneously tracking the therapist’s fingers with their eyes or alternating right and left hand taps. The bilateral brain stimulation is thought to activate the brain’s information processing pathways, enabling more adaptive associations to be made. Over time this leads to processing of traumatic events into long-term memory. As a result, people are able to recall the traumatic event/s but are no longer as distressed by them; affective distress is relieved, negative beliefs are reformulated, and physiological arousal is reduced. EMDR is well established as an effective treatment with a strong evidence base. EMDR and Trauma focused CBT are the two therapies recommended by the NICE Guidelines, and the World Health Organisation for the treatment of PTSD. EMDR’s use in the treatment of PTSD use is supported by a wide range of practice guidelines and meta-analyses. However it has not been assessed in a forensic setting, a population with well established high morbidity from PTSD. The primary research questions are: Does outcome data suggest efficacy of EMDR for the treatment of PTSD compared to waitlist in a psychiatric forensic and rehabilitation population with Serious Mental Illness (SMI)? Does outcome data suggest safety of EMDR for the treatment of PTSD compared to waitlist in a psychiatric forensic and rehabilitation population with SMI? The secondary research question is: What are the participant experiences of participants receiving EMDR in this setting?
Interventions
Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapeutic treatment based on an information processing model of trauma to alleviate the distress associated with traumatic memories. During EMDR the client is instructed to attend to the traumatic event in brief doses while simultaneously tracking the therapist’s fingers with their eyes. The bilateral brain stimulation is thought to activate the brain’s information processing pathways, enabling more adaptive associations to be mad
Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapeutic treatment based on an information processing model of trauma to alleviate the distress associated with traumatic memories. During EMDR the client is instructed to attend to the traumatic event in brief doses while simultaneously tracking the therapist’s fingers with their eyes. The bilateral brain stimulation is thought to activate the brain’s information processing pathways, enabling more adaptive associations to be made. Over time this leads to processing of traumatic events into long-term memory. As a result, people are able to recall the traumatic event/s but are no longer so distressed by them; affective distress is relieved, negative beliefs are reformulated, and physiological arousal is reduced. The therapy will constitute 9 sessions of therapy with weekly sessions of one hour in length, the first session being a joint case conceptualisation agreed by therapist and participant, the next 8 sessions being active therapy. EMDR is well established as an effective treatment with a strong evidence base. EMDR and Trauma focused CBT are the two therapies recommended by the NICE Guidelines and the World Health Organisation for the treatment of PTSD, with a course of eight to 12 individual sessions being the most common forms of treatment. EMDR’s use in the treatment of PTSD use is supported by a wide range of practice guidelines and meta-analyses. We will monitor our participant's views on acceptability of the intervention using the Treatment Acceptability/Adherence Scale. We will also record attendance on checklists. EMDR practitioners will attend monthly supervision with senior experts who will assess fidelity to the intervention.
Sponsors
University of Otago
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
a) age between 18 and 65 years; b) a lifetime history of a psychotic disorder or a mood disorder with psychotic features c) meeting diagnostic criteria for PTSD (Clinician Administered PTSD Scale (CAPS)). d) current patient of the forensic and rehabilitation mental health services e) competent to provide informed consent f) likely to remain in the area for the 6 month trial duration (i.e if a prisoner, release date > 6 months away; if a special patient, special patient discharge > 6 months away)
Exclusion criteria
a) high suicidality, operationalised as the combination of having a high suicidality score on the M.I.N.I. with the last suicide attempt within the past six months and a depression score on the Beck Depression Inventory-II (BDI-II) of 35 or higher; b) mental state considered by the treating psychiatrist as too unstable to participate in the trial (participants may have chronic low grade symptoms, but cannot be acutely psychotic) c) inability to speak English
Outcome results
None listed