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

Abstract

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.

History of trauma is a critical treatment target for individuals at clinical high-risk for psychosis

“…PTSD treatments support a generalization effect where, following the treatment of trauma-related symptoms, other symptoms (e.g., depression, anxiety) also improve. The more limited literature on trauma-focused treatment in individuals with both PTSD and psychotic symptoms also supports generalization; following trauma treatment, the frequency and/or intensity of psychotic symptoms, particularly those related to suspiciousness, paranoia, or trauma-dependent hallucinations, decreased ( 9 , 24 – 26 ). A planned feasibility study on EMDR for psychosis (EMDRp) shows promise as an add-on to treatment ( 9 ), but results have not yet been published.…”

“…Indeed, the number of types of trauma experienced is one of only eight items included in the NAPLS Risk Calculator, used to estimate probabilistic risk of an individual converting to full-threshold psychosis ( 7 ). Additionally, trauma-related exposure is linked to higher severity of attenuated psychotic symptoms ( 9 ). This provides additional evidence of the importance of examining the nature of trauma exposure during this vulnerable, developmental window.…”

The Role and Clinical Correlates of Complex Post-traumatic Stress Disorder in People With Psychosis

“…This study employed a correlational design, combining data collected from a feasibility randomized controlled trial testing the feasibility and acceptability of an Eye-Movement Desensitization and Reprocessing for psychosis intervention (the EASE trial) ( Varese et al, 2020 ), and a previous research project within the University of Manchester Complex Trauma & Resilience Research Unit ( Campodonico et al, 2021 ). Both samples were recruited from North West of England mental health services with ethical approval received from an National Health Service (NHS) research ethics committee.…”

“…The inclusion criteria for the parent studies are reported in full elsewhere ( Varese et al, 2020 ; Campodonico et al, 2021 ). Generally, these included adults with a schizophrenia-spectrum diagnosis (or who met diagnostic criteria), that were registered with local NHS mental health services, and had capacity to provide informed consent at the time of recruitment.…”

“…Information sheets were then provided, and informed consent taken. Following informed consent, participants completed a battery of measures that included the PANSS, TALE and ITQ, in addition to other measures (see Varese et al, 2020 ; Campodonico et al, 2021 ).…”