None listed
Conditions
Brief summary
PTSD can be a debilitating syndrome of prolonged stress reactions that may develop after either direct or indirect exposure to a traumatic event. It is a significant issue among veterans with up to one in four veterans experiencing PTSD in their lifetime. Treatment usually involves psychotherapy and pharmacotherapy. EMDR and trauma-focused cognitive behavioural therapy (CBT) are both widely used and equally effective therapies. EMDR involves attention to the past, present, and future with a focus on disturbing memories and related events. Targeted memories are identified and the patient attends to those memories while simultaneously focusing on an external lateral stimulation, typically involving eye movements. The COVID-19 pandemic has significantly altered the way in which mental health intervention has been delivered and telehealth has been rapidly implemented throughout Australia. A number of companies have adapted EMDR to telehealth, but the evidence base remains limited. From a clinical perspective, the capacity to deliver EMDR via telehealth provides an opportunity to provide access to rural and remote patients, as well as enabling preparedness for future pandemics. This trial will aim to investigate whether EMDR via telehealth to veterans with PTSD provides similar safety and efficacy outcomes to delivering EMDR in person.
Interventions
Eye Movement Desensitisation and Reprocessing therapy (EMDR) is a form of psychological exposure therapy for the treatment of Posttraumatic Stress Disorder (PTSD). Targeted memories are identified and the patient attends to those memories while simultaneously focusing on an external lateral stimulation, typically involving eye movements. EMDR follows a standardised treatment protocol that proceeds in five phases over 8-12 weekly sessions:
1. Initial phase in which targets are identified for EMDR
Eye Movement Desensitisation and Reprocessing therapy (EMDR) is a form of psychological exposure therapy for the treatment of Posttraumatic Stress Disorder (PTSD). Targeted memories are identified and the patient attends to those memories while simultaneously focusing on an external lateral stimulation, typically involving eye movements. EMDR follows a standardised treatment protocol that proceeds in five phases over 8-12 weekly sessions: 1. Initial phase in which targets are identified for EMDR processing (90 minutes) 2. Safety planning phase and strategies for coping with emotional distress (90 minutes) 3. Active treatment phase in which EMDR practitioner utilises bilateral stimulation techniques and assesses response using the Subjective Units of Distress Scale (SUDS) (four to eight 60-90 minute sessions) 4. Closure phase and commencement of a log for the following week to document any material that may arise (60 minutes) 5. Re-evaluation phase to examine progress (60 minutes) The standard treatment protocol has been adapted to a virtual format by a number of commercial providers. The intervention for this is study is the delivery of EMDR via telehealth using a commercial online platform that allows a therapist to control bilateral stimulation. An EMDR trained therapist will deliver EMDR using the standard EMDR protocol, with eye movements stimulated by following circles moving across the screen. Adherence will be monitored by weekly attendance at sessions.
Sponsors
Concord Repatriation General Hospital
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 No maximum
Healthy volunteers
No
Inclusion criteria
1. Australian veterans attending the National Centre for Veterans' Healthcare (NCVH) 2. Department of Veterans’ Affairs (DVA) accepted clinical diagnosis of PTSD, which have been confirmed by NCVH clinicians administering and trained in the Structured Clinical Interview for DSM 5 (SCID-5) 3. Suitable for treatment with EMDR
Exclusion criteria
1. No prior treatment with EMDR 2. No history of acquired brain injury from any cause, which may increase the risk of developing PTSD but the impact of acquired brain injury on treatment for PTSD with EMDR is currently unknown 3. No active alcohol, benzodiazepine, or illicit substance use, which are common comorbidities among patients with PTSD but are generally considered relative contraindications for EMDR on the basis of their effects on long term potentiation
Outcome results
None listed