Trauma-focused therapy in early psychosis: results of a feasibility randomized controlled trial of EMDR for psychosis (EMDRp) in early intervention settings.

BACKGROUND: Trauma is prevalent amongst early psychosis patients and associated with adverse outcomes. Past trials of trauma-focused therapy have focused on chronic patients with psychosis/schizophrenia and comorbid Post-Traumatic Stress Disorder (PTSD). We aimed to determine the feasibility of a large-scale randomized controlled trial (RCT) of an Eye Movement Desensitization and Reprocessing for psychosis (EMDRp) intervention for early psychosis service users. METHODS: A single-blind RCT comparing 16 sessions of EMDRp + TAU v. TAU only was conducted. Participants completed baseline, 6-month and 12-month post-randomization assessments. EMDRp and trial assessments were delivered both in-person and remotely due to COVID-19 restrictions. Feasibility outcomes were recruitment and retention, therapy attendance/engagement, adherence to EMDRp treatment protocol, and the 'promise of efficacy' of EMDRp on relevant clinical outcomes. RESULTS: Sixty participants (100% of the recruitment target) received TAU or EMDR + TAU. 83% completed at least one follow-up assessment, with 74% at 6-month and 70% at 12-month. 74% of EMDRp + TAU participants received at least eight therapy sessions and 97% rated therapy sessions demonstrated good treatment fidelity. At 6-month, there were signals of promise of efficacy of EMDRp + TAU v. TAU for total psychotic symptoms (PANSS), subjective recovery from psychosis, PTSD symptoms, depression, anxiety, and general health status. Signals of efficacy at 12-month were less pronounced but remained robust for PTSD symptoms and general health status. CONCLUSIONS: The trial feasibility criteria were fully met, and EMDRp was associated with promising signals of efficacy on a range of valuable clinical outcomes. A larger-scale, multi-center trial of EMDRp is feasible and warranted.

The Role of Racial Residential Segregation in Black-White Disparities in Firearm Homicide at the State Level in the United States, 1991-2015.

OBJECTIVE: To investigate the relationship between racial residential segregation and differences in Black-White disparities in overall firearm homicides across U.S states. METHODS: Using a linear regression, we evaluated the relationship between racial residential segregation, as measured by the index of dissimilarity, and the Black-White firearm homicide disparity ratio in 32 states over the period 1991-2015. To account for clustering of observations within states, we used a generalized estimating equations approach. RESULTS: After controlling for measures of White and Black deprivation, multivariate analysis showed that racial segregation was positively associated with the Black-White firearm homicide disparity. For each 10-point increase in the index of dissimilarity, the ratio of Black to White firearm homicide rates in a state increased by 39%. After controlling for levels of White and Black deprivation, racial segregation remained negatively associated with White firearm homicide rates and positively associated with Black firearm homicide rates. CONCLUSIONS: These findings suggest that racial segregation may increase the disparity in firearm homicide between the Black and White population.

The Relationship Between Structural Racism and Black-White Disparities in Fatal Police Shootings at the State Level.

OBJECTIVE: The objective of this study was to discern the relationship between state-level structural racism and Black-White disparities in police shootings of victims not known to be armed. METHODS: Using a Poisson regression, we evaluated the effect of structural racism on differences between states in Black-White disparities in fatal police shootings involving victims not known to be armed during the period from January 1, 2013 through June 30, 2017. We created a state racism index, which was comprised of five dimensions: (1) residential segregation; and gaps in (2) incarceration rates; (3) educational attainment; (4) economic indicators; and (5) employment status. RESULTS: After controlling for numerous state-level factors and for the underlying rate of fatal shootings of black victims in each state, the state racism index was a significant predictor of the Black-White disparity in police shooting rates of victims not known to be armed (incidence rate ratio: 1.24; 95% confidence interval, 1.02-1.50). For every 10-point increase in the state racism index, the Black-White disparity ratio of police shooting rates of people not known to be armed increased by 24%. CONCLUSION: These findings suggest that structural racism is an important predictor of the Black-White disparity in rates of police shootings of unarmed victims across states.

Eye movement desensitization and reprocessing therapy for psychosis (EMDRp): Protocol of a feasibility randomized controlled trial with early intervention service users.

AIM: Traumatic events are involved in the development and maintenance of psychotic symptoms. There are few trials exploring trauma-focused treatments as interventions for psychotic symptoms, especially in individuals with early psychosis. This trial will evaluate the feasibility and acceptability of conducting a definitive trial of Eye Movement Desensitization and Reprocessing for psychosis (EMDRp) in people with early psychosis. METHODS: Sixty participants with first episode psychosis and a history of a traumatic/adverse life event(s)will be recruited from early intervention services in the North West of England and randomized to receive16 sessions of EMDRp + Treatment as Usual (TAU) or TAU alone. Participants will be assessed at baseline, 6 and 12 months post-randomization using several measures of psychotic symptoms, trauma symptoms, anxiety, depression, functioning, service-user defined recovery, health economics indicators and quality of life. Two nested qualitative studies to assess participant feedback of therapy and views of professional stakeholders on the implementation of EMDRp into services will also be conducted. The feasibility of a future definitive efficacy and cost-effectiveness evaluation of EMDRp will be tested against several outcomes, including ability to recruit and randomize participants, trial retention at 6- and 12-month follow-up assessments, treatment engagement and treatment fidelity. CONCLUSIONS: If it is feasible to deliver a multi-site trial of this intervention, it will be possible to evaluate whether EMDRp represents a beneficial treatment to augment existing evidence-based care of individuals with early psychosis supported by early intervention services.