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

Abstract

ObjectiveFrontline 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 42-h sessions over 1 week. Additionally, the group EMDR intervention utilized therapist rotation in treatment delivery.MethodsThe 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.ResultsResults 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.ConclusionThe 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.

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“…It is also worth noting that these results support the appropriateness of online intervention (MHealth) ( 129 ), which is particularly relevant since the explosion of its use during the COVID-19 pandemic ( 130 ). Recent research indicates a positive treatment effect in online EMDR therapy using the G-TEP group protocol ( 131 ).…”

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“…In the experimental study, the content of the sessions was as follows: first session: introduction, second session: history taking, third session: work on resources related to autonomy, fourth and fifth sessions: reducing the traumatic effects caused by unmet psychological needs on autonomy, sixth session: work on resources regarding relatedness, seventh and eighth sessions: reducing the traumatic effects caused by unmet psychological needs on relatedness, ninth session: work on resources related to competence, 10th and 11th sessions: reducing the traumatic effects caused by unmet psychological needs on competence, 12th session: work on overcoming future difficulties, 13th and final session: conclusion. (You can find detailed information about i-GTEP sessions in this article: Farrell et al, 2023. ) Developed by Elan Shapiro in 2013, EMDR's G-TEP protocol consists of two parts and eight steps.…”

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“…This protocol can be particularly useful for clients who have shame attached to their experience, such as those who have experienced child abuse or rape. It is also helpful for those with cultural and language barriers or for individuals who may fear reprisal, such as professions who make life and death decisions (Blore & Holmshaw, 2009;Farrell et al, 2023) and may be used as videoconference psychotherapy (Farrell et al, 2023). Similarly, G-TEP provides clients an opportunity to work through their traumatic material without disclosing it to the group.…”