Psychological and Neurobiological changes following EMDR therapy in individuals with concussion: A Pilot Study

Eye Movement Desensitisation and Reprocessing (EMDR) is a psychological intervention based on the Adaptive Information Processing (AIP) model proposed by Shapiro (2007) that is focused on reducing trauma by altering how memories are stored in the brain. During standard treatment, the therapist will lead the client through a series of bilateral eye movements as they are recalling traumatic experiences with the aim of reducing the vividness and emotion associated with those memories (Shapiro, 2017). For this study at initial contact the participant will be provided with participant information and consent forms. They will be asked to complete information about their history, in particular concussion and psychiatric history. The participant will then be assessed as suitable with EMDR - Recent Traumatic Episode Protocol (R-TEP). EMDR R-TEP is a comprehensive current trauma focused protocol for early intervention that incorporates and extends the existing eye movement desensitisation (EMD) and Recent Event protocols, together with additional measures for containment and safety. The EMDR R-TEP usually requires 2-4 sessions, which can optionally be conducted on successive days. For the current study, we will provide 2 sessions consisting of one single session and one follow up session. The single session R-Tep procedure involves the participant being: 1. Assessed for suitability for treatment, referred to as phase 1 2. Taught self regulation skills with the 4 Elements protocol, referred to as phase 2 3. Asked to describe the event 4. Asked to scan the event for the worst moment and then to assess the point of disturbance 5. The point of disturbance is assessed including the negative and positive cognition, validity of cognition, subjective unit of distress, emotion and body sensation of distress, referred to as phase 3 6. The participant is asked to hold in mind the point of disturbance and bilateral stimulation is applied (e.g. eye movements), referred to as phase 4. 7. When the participant reports a reduction in distress below 2 out of 10 the participant is asked to hold in mind the positive cognition and to rate the validity of cognition until it increases to at least 6 out of 7 (with bilateral stimulation), referred to as phase 5 8. The participant is then asked to scan the event for the next point of disturbance and phase 3 to 5 are repeated until the participant reports no further point of disturbance for the event. 9. The participant is then asked to think of the entire event with the positive cognition and to assess the validity of cognition with bilateral stimulation until the validity of cognition for the entire event rises to at least 6 out of 7. 10. The participant is then asked to hold in mind the entire event with the positive cognition and to scan their body reporting any body sensations which are then processed with bilateral stimulation. 11. The session is then closed following phase 7 closure procedure. The Second follow up review session At the review session the participant is asked general questions about the event to determine if there remains any unresolved disturbance. At Testing Session 1 (TS1) the R-TEP single session treatment will be delivered face to face at Swinburne University of Technology clinical rooms, in a single episode of approximately 60-90 minutes by a qualified psychologist and accredited EMDR Therapist with skills in R-TEP. There is going to be a follow-up review session, two weeks after TS1 at Testing Session 2 (TS2) for the intervention group. This makes 2 treatment sessions for the intervention group, consisting of one R-TEP treatment and one review session. The overall duration of participation in this study involves 5 testing sessions following TS1 (intervention). The participants will be followed up at 2 weeks (TS2), 6 weeks (TS3), 3 months (TS4) and 6 months post-intervention/treatment commencement (TS5). Fidelity to the protocol will be assessed via in session video recording by an independent EMDR consultant experienced in the R-TEP protocol. The first 8 participant block enrolled in this trial will receive the EMDR intervention; the next 7 participant block enrolled will receive care as usual; we will alternate until we reach our sample size of 30 participants.