Group early intervention eye movement desensitization and reprocessing therapy as a video-conference psychotherapy with frontline/emergency workers in response to the COVID-19 pandemic in the treatment of post-traumatic stress disorder and moral injury-An RCT study.

Objective: Frontline mental health, emergency, law enforcement, and social workers have faced unprecedented psychological distress in responding to the COVID-19 pandemic. The purpose of the RCT (Randomized Controls Trial) study was to investigate the effectiveness of a Group EMDR (Eye Movement Desensitization and Reprocessing) therapy (Group Traumatic Episode Protocol-GTEP) in the treatment of Post-Traumatic Stress Disorder (PTSD) and Moral Injury. The treatment focus is an early intervention, group trauma treatment, delivered remotely as video-conference psychotherapy (VCP). This early intervention used an intensive treatment delivery of 4x2h sessions over 1-week. Additionally, the group EMDR intervention utilized therapist rotation in treatment delivery. Methods: The study's design comprised a delayed (1-month) treatment intervention (control) versus an active group. Measurements included the International Trauma Questionnaire (ITQ), Generalized Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire (PHQ-9), Moral Injury Events Scale (MIES), and a Quality-of-Life psychometric (EQ-5D), tested at T0, T1: pre-treatment, T2: post-treatment, T3: 1-month follow-up (FU), T4: 3-month FU, and T5: 6-month FU. The Adverse Childhood Experiences - International version (ACEs), Benevolent Childhood Experience (BCEs) was ascertained at pre-treatment only. N = 85 completed the study. Results: Results highlight a significant treatment effect within both active and control groups. Post Hoc comparisons of the ITQ demonstrated a significant difference between T1 pre (mean 36.8, SD 14.8) and T2 post (21.2, 15.1) (t11.58) = 15.68, p < 0.001). Further changes were also seen related to co-morbid factors. Post Hoc comparisons of the GAD-7 demonstrated significant difference between T1 pre (11.2, 4.91) and T2 post (6.49, 4.73) (t = 6.22) = 4.41, p < 0.001; with significant difference also with the PHQ-9 between T1 pre (11.7, 5.68) and T2 post (6.64, 5.79) (t = 6.30) = 3.95, p < 0.001, d = 0.71. The treatment effect occurred irrespective of either ACEs/BCEs during childhood. However, regarding Moral Injury, the MIES demonstrated no treatment effect between T1 pre and T5 6-month FU. The study's findings discuss the impact of Group EMDR therapy delivered remotely as video-conference psychotherapy (VCP) and the benefits of including a therapist/rotation model as a means of treatment delivery. However, despite promising results suggesting a large treatment effect in the treatment of trauma and adverse memories, including co-morbid symptoms, research results yielded no treatment effect in frontline/emergency workers in addressing moral injury related to the COVID-19 pandemic. Conclusion: The NICE (2018) guidance on PTSD highlighted the paucity of EMDR therapy research used as an early intervention. The primary rationale for this study was to address this critical issue. In summary, treatment results for group EMDR, delivered virtually, intensively, using therapist rotation are tentatively promising, however, the moral dimensions of trauma need consideration for future research, intervention development, and potential for further scalability. The data contributes to the emerging literature on early trauma interventions.Clinical Trial Registration:Clinicaltrials.gov, ISRCTN16933691.

Eye movement desensitization reprocessing as a treatment for PTSD in conflict-affected areas.

OBJECTIVE: One recommended psychological intervention for trauma treatment in Western countries, including posttraumatic stress disorder (PTSD), is eye movement desensitization reprocessing (EMDR). However, there is a paucity of data regarding treatment interventions in low- and middle-income countries. This study examined the efficacy of EMDR for treating posttraumatic stress (PTS), anxiety, and depression among a cohort of individuals with low socioeconomic status in a conflict-affected middle-income country as well as a smaller refugee cohort. METHODS: Two hundred and sixty-eight adults residing in Lebanon (male = 65, female = 203, SDgender = 0.43; µage = 30.5, SDage = 10.49; 85% Lebanese, 15% refugees [9.3% from Syria, and 5.7% from Iraq, Palestine, the Philippines, and Other]) received EMDR therapy. Measures of PTS, anxiety, and depression were taken at three time points: before treatment (T0), posttreatment (T1), and 6-month follow-up (T2). RESULTS: Reduction in PTS symptoms from T0 to T1, F(1, 208) = 412.3, p < .01, and T1 to T2, F(1, 46) = 136.1, p < .01. Reduction in anxiety symptoms from T0 to T1, F(1, 208) = 387.0, p < .01, and T1 to T2, F(1, 46) = 153.7, p < .01. Similarly, for depression, a reduction of symptoms from T0 to T1, F(1, 207) = 309.5, p < .01, and T0 to T2, F(1, 46) = 96.0, p < .01. CONCLUSION: This research supports the use of EMDR for the treatment of PTS, depression, and anxiety symptoms in individuals with low socioeconomic status and refugees, thus contributing to the research base for populations that are under-researched. Mental health services, especially in conflict-affected settings, would benefit from using EMDR therapy to target these pathologies in these populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Stage 1 Pilot Cohort Exploring the Use of EMDR Therapy as a Videoconference Psychotherapy During COVID-19 With Frontline Mental Health Workers: A Proof of Concept Study Utilising a Virtual Blind 2 Therapist Protocol.

Objective: The COVID-19 pandemic has had a major impact on the delivery of psychological treatment. Due to social distancing requirements, the provision moved to videoconferencing psychotherapy (VCP). There is a paucity of empirical data supporting the efficacy of EMDR therapy as a VCP. This stage 1 pilot study tested an EMDR therapy scripted protocol, such as Virtual Blind 2 Therapist (VB2Tr), on frontline mental health workers as a VCP regarding fitness for purpose, distinctiveness, relevance, and efficiency. Methods: A total of 24 participants were recruited for the study. The design included a one-session treatment intervention with pre, post, 1-month, and 6-month follow-up (FU) measurements. This treatment session used a "Blind 2 Therapist" EMDR therapy scripted protocol as videoconference psychotherapy that involves non-disclosure of traumatic memory. The research explored the treatment effect on the core characteristics of trauma memory, including subjective disturbance, belief systems, memory intensity (MI), vividness, and levels of emotionality. Additionally, the research explored participants' experiences of adverse and benevolent childhood experiences (ACEs/BCEs) during their childhood. Results: Regarding the four tests, namely, fitness for purpose, distinctiveness, relevance, and efficiency, results are favourably suggesting potential clinical benefits of using EMDR as videoconference psychotherapy. Although this is a proof-of-concept study showing positive results, no clinical population or control group was used. The purpose of the study is to explore the potential for scalability toward a larger clinical trial. The treatment intervention was achieved irrespective of either ACEs/BCEs during childhood. Conclusion: The research tentatively supports the case for EMDR therapy as a credible treatment when used as video conference psychotherapy and in using the Blind 2 Therapist protocol. However, more research is needed to scale toward a clinical trial. Clinical Trial Registration: Clinical Trial Registration: https://www.isrctn.com/ISRCTN12099530, identifier ISRCTN12099530.

Exploring the Role of Social Connection in Interventions With Military Veterans Diagnosed With Post-traumatic Stress Disorder: Systematic Narrative Review.

Background: It has been identified that military veterans have distinct experiences of loneliness and social isolation and, when comparing this community to other client groups with a PTSD diagnosis, veterans respond less favorably to treatment. However, the link between PTSD and loneliness for veterans remains insufficiently researched and it is unclear if there are effective interventions tackling this distinct experience of loneliness. Aims: This systematic narrative review aimed to synthesize existing evidence incorporating elements of social connection, social isolation, and loneliness within interventions for military veterans with a diagnosis of PTSD, consequently aiming to examine the impact of such interventions upon this community. Methods: Six databases were searched, utilizing relevant search criteria, with no date restrictions. Articles were included if they involved intervention or treatment for military veterans with PTSD and considered elements of social connection, social isolation, and/or loneliness. The initial search returned 202 papers. After exclusions, removal of duplications, and a reference/citation search, 28 papers remained and were included in this review. Results: From the 28 studies, 11 directly addressed social isolation and two studies directly addressed loneliness. Six themes were generated: (i) rethinking the diagnosis of PTSD, (ii) holistic interventions, (iii) peer support, (iv) social reintegration, (v) empowerment through purpose and community, and (vi) building trust. Conclusions: A direct focus upon social reintegration and engagement, psychosocial functioning, building trust, peer support, group cohesiveness and empowerment through a sense of purpose and learning new skills may mitigate experiential loneliness and social isolation for veterans with PTSD. Future research and practice should further explore the needs of the PTSD-diagnosed veteran community, seek to explore and identify potential common routes toward the development of PTSD within this community and consider bespoke interventions for tackling loneliness.

Trauma stabilization as an effective treatment for children with post-traumatic stress problems in South-East Asia.

High numbers of children and adolescents in South-East Asia are traumatized by either natural disasters or human-made violence. Addressing traumatic sequelae in local populations with empirically based trauma treatments is challenged by the insufficiency inappropriately trained mental health provision. To meet this need for qualified therapists, the humanitarian/trauma capacity-building organization, Trauma Aid Germany, trained 37 therapists in psychotraumatology, including trauma stabilization. This study analyses the impact of trauma stabilization as a sole treatment intervention for post-traumatic stress (PTS) problems in children and adolescents. Each client was screened for PTS problems pre- and post-treatment using the Child Behaviour Checklist. Trauma stabilization (including psychoeducation) was the focus for subsequent data analysis. Those excluded were clients in receipt of trauma confrontation interventions. Trauma stabilization, as a sole treatment intervention, appeared to be sufficiently effective in reducing the PTS problems. The data set suggests that trauma stabilization has the potential to be effective, efficient, and sufficient treatment intervention for PTS problems in children and adolescents. Trauma stabilization techniques have the advantage of being relatively straightforward to teach and easy to integrate into practice. They are clinically safe, flexible, adaptable to the development stage and age of the client, and culturally and spiritually sensitive. A further advantage of trauma stabilization interventions is that they are bespoke - adjusted and adapted to the specific needs of the client. The discussion considers the implications for the potential utilization of mental health nurses and paraprofessionals in low- and middle-income countries in trauma stabilization interventions.

Trauma Stabilisation as a Sole Treatment Intervention for Post-Traumatic Stress Disorder in Southeast Asia.

Southeast Asia contains high numbers of traumatised populations arising from either natural disasters or interpersonal violence. Consequently, the need for empirically based trauma treatments, compromised by insufficiency in appropriately trained clinicians and mental health workers, makes the situation more challenging in addressing traumatic sequelae in local populations. In response, the humanitarian/ trauma capacity building organisation, Trauma Aid Germany, trained 37 therapists in psycho-traumatology, based on EMDR Therapy, which included trauma stabilisation techniques. This research analyses the impact of Trauma Stabilisation as a sole treatment intervention for Post-Traumatic Stress Disorder (PTSD) in adults. Each client was screened for PTSD utilising the Harvard Trauma Questionnaire - pre- and post-treatment. Analysis of the data considered only those interventions focussed on trauma stabilisation, including psychoeducation. Participants receiving trauma confrontation interventions were excluded from the data. Trauma stabilisation - as a sole treatment intervention, was highly effective in alleviating PTSD diagnoses. Results demonstrate PTSD symptoms were reduced in both clinical and sub-clinical trauma groups. The data set suggests trauma stabilisation, as a sole treatment intervention, was safe, effective, efficient and sufficient treatment intervention for PTSD. Furthermore, trauma stabilisation interventions have the advantage of being safe, flexible, and adaptable to the cultural and spiritual context in which they were are applied. The research findings also have implications regarding teaching and learning and the potential utilisation of paraprofessionals, and other allied health professionals in addressing the global burden of psychological trauma.

The therapeutic value of trauma stabilisation in the treatment of post-traumatic stress disorder - A Southeast Asian Study.

OBJECTIVE: Southeast Asia suffers from various forms of natural disasters and interpersonal violence. This creates a large trauma population, while at the same time mental health services in this area are limited. The humanitarian organisation Trauma Aid Germany established trauma capacity building by training 37 local therapists in psycho-traumatology, including trauma stabilisation, in Cambodia, Indonesia and Thailand. This analysis examines the impact of trauma stabilisation as a sole treatment for traumatized clients. METHOD: Clients were screened for PTSD using the Harvard Trauma Questionnaire pre- and post-treatment. Analysis only included clients who had received trauma stabilisation, including psychoeducation, but no confrontation with the traumatic event. RESULTS: Trauma stabilisation was highly effective in reducing PTSD symptoms, with high remission from PTSD post-treatment. Trauma stabilisation affected all subscales of PTSD and was effective in clinical as well as subclinical traumatized clients. CONCLUSION: The research supports the notion that trauma stabilisation is a treatment effect for PTSD. It was highly effective in its own in reducing PTSD symptoms. Based on the analysis, trauma stabilisation was a safe, language independent treatment for PTSD sufficiently flexible to be sensitive to the client's context. Therapists can adapt the techniques to the individual client and his cultural, spiritual, developmental, cognitive and situational background. Trauma stabilisation is suitable for implementation in crisis areas. The research has also implications to the potential utilisation of para-professionals.

Stochastic resonance as a proposed neurobiological model for Eye Movement Desensitization and Reprocessing (EMDR) therapy.

EMDR therapy is recommended in several guidelines in the International field of psychological trauma. The dual attention stimuli/alternating bilateral stimulation (DAS/ABS) element of EMDR therapy has no proposed mechanism of action agreed upon, which explains the rapid shifts in cognitions and dysfunctional traumatic memory networks that are central to its observable efficacy. This paper discusses an innate, biological mechanism found in biological systems, including the human nervous system that may explain the efficacy of DAS/ABS. This mechanism is stochastic resonance (SR). SR is observed to make unintelligible, subthreshold signals intelligible and facilitates signal transmission. It provides a potential mechanism for discrimination and the selective focusing of attention, which are important factors in effective psychotherapy for the psychologically traumatised individual. The body/mind complex aims to achieve the functional encoding of memories in the neocortex and a key structural crossroads in this process is the thalamus. Activity in the thalamus is decreased in Post-Traumatic Stress Disorder (PTSD) compared to non-PTSD patients and a form of 'gating' is known to occur at the thalamic level. This 'gating' is adaptive and it is postulated to protect the higher neocortical systems in times of trauma. Although the model is initially somewhat counterintuitive, Stochastic Resonance; a form of random 'noise', can be considered 'helpful randomness' and when present in the thalamus SR can help filter and control sensitivity to incoming signals; helping to discriminate what is communicated. Naturally occurring SR is normally present as a result of descending cortico-thalamic activity, but appears attenuated as a result of exposure to trauma. The view of 'noise' in the current era of cell phones and High Definition is generally negative with science going to significant lengths to clean up signals: i.e. removing noise from them. We do not want white noise in our music or during our cell phone calls. However, some researchers invite us to consider that not all noise is bad and the downward cortico-thalamic 'noise' is an example of this category of 'helpful noise'. This paper will discuss the potential role of SR, as the mechanism by which DAS/ABS generates a random (stochastic) signal, facilitating a return to functional memory processing, where there is a lack of naturally occurring noise from the descending cortico-thalamic connections because of exposure to trauma. Modelling the mechanism as SR will facilitate further study into EMDR therapy and this will hopefully encourage perspicacity, where there has previously been derision.

The Use of Eye-Movement Desensitization Reprocessing (EMDR) Therapy in Treating Post-traumatic Stress Disorder-A Systematic Narrative Review.

Aim: There is an extensive body of research examining the efficacy of Eye-Movement Desensitization Reprocessing (EMDR) therapy in treatment of Post-traumatic Stress Disorder (PTSD). This systematic narrative review aimed to systematically, and narratively, review robust evidence from Randomized-Controlled Trials examining the efficacy of EMDR therapy. Method: Eight databases were searched to identify studies relevant to the study aim. Two separate systematic searches of published, peer-reviewed evidence were carried out, considering relevant studies published prior to April 2017. After exclusion of all irrelevant, or non-robust, studies, a total of two meta-analyses and four Randomized-Controlled Trials were included for review. Results: Data from meta-analyses and Randomized-Controlled Trials included in this review evidence the efficacy of EMDR therapy as a treatment for PTSD. Specifically, EMDR therapy improved PTSD diagnosis, reduced PTSD symptoms, and reduced other trauma-related symptoms. EMDR therapy was evidenced as being more effective than other trauma treatments, and was shown to be an effective therapy when delivered with different cultures. However, limitations to the current evidence exist, and much current evidence relies on small sample sizes and provides limited follow-up data. Conclusions: This systematic narrative review contributes to the current evidence base, and provides recommendations for practice and future research. This review highlights the need for additional research to further examine the use of EMDR therapy for PTSD in a range of clinical populations and cultural contexts.

Experiences of mental health services for 'black' men with schizophrenia and a history of disengagement: A qualitative study.

Whilst mental disorders can be disabling they are also treatable, yet engagement with services is often poor and disengagement from treatment is a major concern for mental health nurses. Participants were service users typically perceived as the most disengaged from mental health services, yet they were willing to engage in the research interviews. The seven participants were all male with a diagnosis of schizophrenia, a history of disengagement from mental health services and described their ethnicity as 'black'. Participants were under the care of Assertive Outreach Teams and were recruited after the researcher was introduced to them by clinicians who were working with them. After ethical approval, in-depth, semi-structured interviews were used to elicit the experiences of participants. Through interpretative phenomenological analysis, themes were developed. Interpretative Phenomenological analysis generated four themes: (i) "People just keep hounding me", (ii) Antipathy to Medication, (iii) Choice and the value of services, (iv) Stigmatisation and identity. By rigorously examining how service users with schizophrenia make sense of their experience of their relationship with mental health services, there is potential to give voice to the experiences of the recipients of mental health services. This study uncovered the complex nature of disengagement and in view of this there may never be a straightforward mechanism developed to engage all people with schizophrenia with mental health services. When the participants' experiences are considered in a broader social context it may be possible to reflect on how services can be adapted to facilitate better engagement.

Perspectives of cannabis use in the life experience of men with schizophrenia.

Substance use amongst people with schizophrenia is well-established: up to 50% report using illicit substances. The occurrence of both conditions can also induce people to disengage from mental health services. The research question sought to understand, from the perspective of both service users and clinicians, cannabis use within the experience of people with schizophrenia. The transcripts of the seven participants and the two focus groups were analysed using interpretative phenomenological analysis. Service Users and Clinicians were recruited from Assertive outreach community-based teams. seven male service users who described their ethnic identity as 'black', diagnosed with schizophrenia and a history of treatment disengagement and 12 clinicians who worked with this client group. The two component study involved semi-structured interviews with the Service Users and two focus groups with the Clinicians. Service Users perceived cannabis use as a means by which they could 'reestablish their identity' that had been damaged and the social consequences of diagnosis. Clinicians similarly perceived drugs, cannabis in particular, as a significant part of the service users' life. This study provides greater depth to understanding cannabis use within the experience of people with a diagnosis of schizophrenia.

Role of the military community mental health nurse.

AIM: To understand the role and effect of a community mental health nurse (CMHN) deployed to work with military personnel during sea-based operations. METHOD: Semi-structured interviews were conducted to ascertain Royal Navy aircraft carrier military unit commanders' perceptions and experiences of the CMHN's role. FINDINGS: Three mutually inclusive components are necessary to ensure successful integration of the CMHN: familiarity, trust and credibility. CONCLUSION: For CMHNs to function successfully and provide mental health care to sea-based military personnel, they need to demonstrate familiarity, trust and credibility. This will enhance uptake of mental health services among military personnel and ensure they are fit for service.

Issues of stigma for first responders accessing support for post traumatic stress.

The literature shows that individuals with mental health problems are subjected to discrimination, prejudice, and ignorance and are significantly stigmatized Stigma occurs when elements of labelling, stereotyping, cognitive separation into categories of 'us' and 'them,' status loss, and discrimination co-occur This article considers how stigma affects those with mental health problems and describes the experience of an individual police officer seeking and engaging with psychological support services following a traumatic event. The impact of issues of stigma on the therapy is described. The article further considers what may help to combat stigma and discrimination within the police culture and therefore ease the path to support for police officers.