Eye movement desensitization and reprocessing (EMDR) therapy for posttraumatic stress disorder in adults with serious mental illness within forensic and rehabilitation services: a study protocol for a randomized controlled trial

Abstract

BackgroundEye movement desensitization and reprocessing (EMDR) is an evidenced-based treatment for posttraumatic stress disorder (PTSD). Forensic mental health services provide assessment and treatment of people with mental illness and a history of criminal offending, or those who are at risk of offending. Forensic mental health services include high, medium, and low-security inpatient settings as well as prison in-reach and community outpatient services. There is a high prevalence of PTSD in forensic settings and posttraumatic experiences can arise in people who violently offend in the context of serious mental illness (SMI). Successful treatment of PTSD may reduce the risk of relapse and improve clinical outcomes for this population. This study aims to assess the efficacy, risk of harm, and acceptability of EMDR within forensic and rehabilitation mental health services, as compared to treatment as usual (routine care).MethodsThis is a single-blind, randomized controlled trial comparing EMDR therapy to the waiting list (routine care). Adult forensic mental health service users (n = 46) with SMI and meeting the criteria for PTSD will be included in the study. Participants will be randomized after baseline assessment to either treatment as usual plus waiting list for EMDR or to treatment as usual plus EMDR. The EMDR condition comprises nine sessions, around 60 min in length delivered weekly, the first of which is a case conceptualization session. The primary outcomes are clinician and participant-rated symptoms of PTSD, and adverse events. Secondary outcomes include psychotic symptoms, social functioning, level of disability, self-esteem, depressive symptoms, post-trauma cognitions, and broad domains of complex posttraumatic difficulties. A trained assessor blinded to the treatment condition will assess outcomes at baseline, 10 weeks, and 6 months. Additionally, grounded theory qualitative methods will be used to explore participant experience of EMDR for a subset of participants.DiscussionThis study will contribute to the currently limited evidence base for EMDR for PTSD in forensic settings. It is the first randomized clinical trial to assess the efficacy, risk of harm, and acceptability of EMDR for PTSD in people with SMI in either forensic, mental health inpatient, or custodial settings.Trial registrationAustralia and New Zealand Clinical Trials Network, ACTRN12618000683235. Registered prospectively on 24 April 2018.

WITHDRAWN: Eye movement desensitization and reprocessing (EMDR): Efficacy in improving clinical, neuropsychological, and quality of life in women victims of violence

“…EMDR therapy has been used in different populations for the treatment of posttraumatic stress disorder (26)(27)(28), showing benefits in improving sleep quality and quality of life and decreasing symptoms associated with comorbid PTSD (29)(30)(31). Similarly, EMDR therapy has been applied in people with serious mental illnesses, such as psychosis (32), and in forensic and rehabilitation services (33,34).…”

Group eye movement desensitization and reprocessing interventions in adults and children: A systematic review of randomized and nonrandomized trials

“…Much research has been carried out to evaluate the effectiveness of EMDR on a wide range of mental health difficulties across different groups and settings. Several studies found EMDR to be effective in reducing PTSD, depression and anxiety and increasing quality of life across a wide range of age groups and populations including clinical and nonclinical groups (Acarturk et al, 2016; Ahmad, Larsson, & Sundelin‐Wahlsten, 2007; de Roos et al, 2011, 2017; Every‐Palmer et al, 2019; Horst et al, 2017; Karatzias et al, 2019; Ostacoli et al, 2018; Ter Heide, Mooren, Van De Schoot, De Jongh, & Kleber, 2016; Van Den Berg et al, 2018). Several systematic reviews and meta‐analyses have attested its efficacy across a broad range of difficulties, including PTSD (Bisson et al, 2007; Chen, Zhang, Hu, & Liang, 2015; Ehring et al, 2014; Khan et al, 2018; Korn, 2009), medically unexplained symptoms (van Rood & de Roos, 2009), depression (Wood & Ricketts, 2013), anxiety (Yunitri et al, 2020), distress due to natural disasters (Natha & Daiches, 2014) and chronic pain (Tesarz et al, 2014).…”

Vulnerabilities of High-Security Forensic Psychiatry Residences in Italy during the COVID-19 pandemic: a qualitative survey and a proposal for recovery and prevention

“…Given the high risk for the development of post-traumatic symptoms during the pandemic (Huang et al 2020), trauma-informed care approaches should be added to the interventions routinely delivered in Italian forensic psychiatry settings (Lewis and Ireland, 2019). A number of empirically validated psychotherapeutic approaches have been developed to reduce traumarelated symptoms such as Eyes Movement Desensitization Reprocessing (EMDR), or to prevent them such as mindfulness-based protocols, both for the offenders and the psychiatric staff (Every-Palmer et al 2019;Howell et al 2010).…”