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Background It is possible for people to have post-traumatic stress disorder (PTSD) without memory of the trauma event, such as in drug-facilitated sexual assault. However, there is little evidence available on treatment provision for this population. Objective This study aimed to address this gap by exploring the experiences of people who have had psychological intervention for PTSD without memories (PwM). Method Interpretative phenomenological analysis was used to explore the lived experience of nine women with PwM, who had sought psychological assessment/therapy. Participants were recruited via social media and completed semi-structured interviews online/via telephone. Results Identified themes concerned two broad areas: (i) the challenges of having therapy whilst lacking memories and (ii) what was helpful in therapy. Challenges included: delayed help-seeking; having emotional/sensory reactions in the absence of recognisable triggers; experiencing therapy as more applicable to remembered trauma (vs. unremembered); and difficulty discussing and processing unremembered trauma. However, participants also described helpful aspects of therapy including: feeling safe and supported; working with emotional and sensory forms of experience; having scientific explanations for trauma and memory; and having ‘permission’ from therapists not to remember. Conclusions Recommendations for clinicians included: being aware that clients with PwM may have more difficulty accessing treatment and perceive it as less applicable to them; focussing on clients’ emotions and sensations (not cognitive memories) in therapy; and supporting clients to develop a more self-compassionate understanding of their experiences and lack of memory, thus supporting them to accept that not remembering is ‘permitted’. HIGHLIGHTS • Having therapy for unremembered trauma involves unique challenges, but aspects of therapy can still be helpful. • Suggested ‘dos and don’ts’ for therapists include recognising the additional barriers to treatment, focussing on emotions (not memories), and normalising memory loss

Aim: An National Health Service (NHS) mental health trust developed a pathway offering eye movement desensitization reprocessing (EMDR) to healthcare professionals (HCPs). This research aimed to evaluate whether EMDR was linked to improvements in posttraumatic stress disorder (PTSD) and sought to understand the experiences of service users. Method: Pre- and post-outcome measures of the Impact of Events Scale—Revised, patient health questionnaire-9, generalized anxiety disorder-7, and work and social adjustment scale were evaluated. Subsequently, a feedback survey was circulated to those who had accessed the service. Results: Analysis revealed statistically significant improvements in measures of PTSD, depression, anxiety, and functioning. The service was rated highly for accessibility and experience. Perceived treatment effectiveness was variable; however, reliving symptoms and sickness absence were reduced, and improvements made during therapy were reportedly maintained. Conclusion: This service evaluation offers preliminary support for the use of EMDR as a useful intervention for HCW. Recommendations that may be more broadly applicable for service development and considerations for future research are discussed.

Research shows high levels of complex co-morbidities within psychiatric populations, and there is an increasing need for mental health practitioners to be able to draw on evidence-based psychological interventions, such as cognitive behavioural therapy (CBT), to work with this population effectively. One way CBT may be utilised when working with complexity or co-morbidity is to target treatment at a particular aspect of an individual’s presentation. This study uses a single-case A-B design to illustrate an example of using targeted diagnosis-specific CBT to address symptoms of a specific phobia of stairs in the context of a long-standing co-morbid diagnosis of schizophrenia. Results show the intervention to have been effective, with a change from a severe to mild phobia by the end of intervention. Clinical implications, limitations and areas for future research are discussed. Key learning aims (1) There are high levels of co-morbid, complex mental health problems within psychiatric populations, and an increasing need for mental health practitioners to be able to work with co-morbidity effectively. (2) Cognitive behavioural therapy (CBT) remains one of the most well-evidenced psychological interventions with a large amount of research highlighting the effectiveness of diagnosis-specific CBT. (3) One way evidence-based diagnosis-specific CBT approaches could be utilised when working with more complex co-morbidity may be to target an intervention at a specific set of symptoms. (4) An example of using a targeted CBT intervention (to tackle a specific phobia of stairs in the context of a long-standing co-morbid diagnosis of schizophrenia and ongoing hallucinations) is presented. The outcomes show significant changes in the specific phobia symptoms, suggesting that CBT can be effectively used in this targeted manner within real-world clinical settings. The impact of co-morbid mental health difficulties on therapeutic process and outcomes are highlighted. (5) The use of cognitive restructuring techniques was identified as key to engagement and therapeutic process, supporting the importance of including cognitive techniques in the treatment of phobias compared with purely behavioural exposure-based interventions.

Engagement in rehabilitation is critical to enhanced outcomes from musculoskeletal injuries (MIs) and has been found to be related to some psychosocial factors. This study tested whether military culture, defined by greater adherence to masculine norms; higher levels of perceived personal control and autonomous motivation; lower levels of emotion-focused coping strategies; and a greater use of problem-focused coping strategies, resulted in better engagement in rehabilitation following MI. These hypothesised cultural differences were measured by administration of validated self-report questionnaires (Brief Illness Perception Questionnaire; Conformity to Masculine Norms Inventory; Treatment Self-Regulation Questionnaire; and the Brief COPE). A between groups quasi-experimental design compared self-report variables and physiotherapist engagement ratings for 16 male military personnel and 22 committed sportsmen. All participants had sustained musculoskeletal injuries within the past 6 months, for which they were having physiotherapy. No evidence was found for the presence of a hypothesised military culture defined by greater adherence to masculine norms, higher levels of perceived personal control and autonomous motivation and greater use of problem-focused coping strategies. Clinical and research implications are discussed with recommendations for future work to build upon this study.