Web-Based Eye Movement Desensitization and Reprocessing for Adults With Suicidal Ideation: Protocol for a Randomized Controlled Trial

Abstract

Background Adversity and traumatic experiences increase the likelihood of suicidal thoughts and behaviors. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based, trauma-focused psychotherapy that desensitizes painful memories, so that reminders in the present no longer provoke overwhelming emotional responses. Preliminary evidence suggests that EMDR can be used as an acute intervention in suicidal patients, including those with major depressive disorder. In addition, because of social distancing restrictions during the COVID-19 pandemic, clinicians have been using EMDR on the web and, in the absence of formal evaluations of web-based EMDR, informal reports indicate good results. Objective The primary aim of this randomized controlled trial is to investigate whether remotely delivered EMDR (targeting experiences associated with suicidal thinking) reduces suicidal thoughts. Secondary aims include examining the impact of remotely delivered EMDR on symptoms of depression, anxiety, posttraumatic stress, emotional dysregulation, and dissociation. We will also report on adverse events in the EMDR group to explore whether targeting suicidal ideation with EMDR is safe. Finally, we will compare dropout rates between the treatment groups. Methods In this randomized controlled trial, 80 adults who express suicidal ideation and meet the study criteria will receive either 12 sessions of twice weekly EMDR plus treatment as usual or treatment as usual alone. EMDR sessions will focus on the most distressing and intrusive memories associated with suicidal ideation. Data for primary and secondary objectives will be collected at baseline, 2 months, and 4 months after enrollment. A subsequent longer-term analysis, beyond the scope of this protocol, will examine differences between the groups with respect to the number of posttreatment emergency room visits, hospitalizations, and overall health care use in the year before and after therapy. Results The protocol was approved by the University of Alberta Research Health Ethics Board (protocol ID Pro00090989). Funding for this study was provided by the Mental Health Foundation (grant RES0048906). Recruitment started in May 2021, with a projected completion date of March 2023. Conclusions The results of this trial will contribute to knowledge on whether web-based delivery of EMDR is a safe and effective treatment for reducing suicidal ideation and potentially reducing the incidence of suicide attempts in this patient population. Trial Registration ClinicalTrials.gov NCT04181047; https://clinicaltrials.gov/ct2/show/NCT04181047 International Registered Report Identifier (IRRID) DERR1-10.2196/30711

Randomized controlled trial investigating web-based, therapist delivered eye movement desensitization and reprocessing for adults with suicidal ideation

“…We further theorized that beliefs would shift in a "bottom up" manner once the memories were desensitized, enabling the integration of more adaptive information from other experiences. For a deeper exploration of this hypothesis, refer to Winkler et al (1). This perspective is also consistent with recent calls to view suicidality as a manifestation of adaptive processes gone awry, best studied through a neuroscience approach like the Research Domain Criteria (RDoC) framework, rather than imprecise "verbal theories" of suicide (49).…”

“…Therapists in this study were EMDR International Association (EMDRIA) certified psychiatrists trained in multiple therapy modalities. Prior to commencing EMDR sessions, participants received psychoeducation about EMDR, developed a safety plan with the therapist, and participated in up to five preparation exercises (1). Therapists developed individualized case conceptualization and treatment plans, which included identifying treatment targets associated with SI; these were used in the subsequent 12 EMDR sessions.…”

“…The standard EMDR protocol was generally used, with modifications allowed if study therapists deemed these to be clinically necessary. For further details regarding EMDR procedures utilized, see Winkler et al (1).…”

“…Suicidal ideation (SI) is a marker of severe stress and psychological burden. A history of psychological trauma and adverse childhood experiences (ACEs) is associated with experiencing SI (1). Such stressors are also strongly linked to the development of a range of psychiatric symptoms and disorders, including mood, anxiety, trauma, and personality disorders (2)(3)(4)(5).…”

“…This study was registered on ClinicalTrials.gov (ID number: NCT04181047). For detailed information regarding the study protocol, rationale, and clinical safety procedures used, refer to Winkler et al(1).…”