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A randomised pilot feasibility study of eye movement desensitisation and reprocessing recent traumatic episode protocol, to improve psychological recovery following intensive care admission for COVID-19

A randomised pilot feasibility study of eye movement desensitisation and reprocessing recent traumatic episode protocol, to improve psychological recovery following intensive care admission for COVID-19
A randomised pilot feasibility study of eye movement desensitisation and reprocessing recent traumatic episode protocol, to improve psychological recovery following intensive care admission for COVID-19
Background: Approximately 50% of intensive care survivors experience persistent psychological symptoms. Eye-movement desensitisation and reprocessing (EMDR) is a widely recommended trauma-focussed psychological therapy, which has not been investigated systematically in a cohort of intensive care survivors: We therefore conducted a randomised pilot feasibility study of EMDR, using the Recent Traumatic Episode Protocol (R-TEP), to prevent psychological distress in intensive care survivors. Findings will determine whether it would be possible to conduct a fully-powered clinical effectiveness trial and inform trial design.

Method: We aimed to recruit 26 patients who had been admitted to intensive care for over 24 h with COVID-19 infection. Consenting participants were randomised (1:1) to receive either usual care plus remotely delivered EMDR R-TEP or usual care alone (controls). The primary outcome was feasibility. We also report factors related to safety and symptom changes in post-traumatic stress disorder, (PTSD) anxiety and depression.

Results: We approached 51 eligible patients, with 26 (51%) providing consent. Intervention adherence (sessions offered/sessions completed) was 83%, and 23/26 participants completed all study procedures. There were no attributable adverse events. Between baseline and 6-month follow-up, mean change in PTSD score was −8 (SD = 10.5) in the intervention group versus +0.75 (SD = 15.2) in controls (p = 0.126). There were no significant changes to anxiety or depression.

Conclusion: Remotely delivered EMDR R-TEP met pre-determined feasibility and safety objectives. Whilst we achieved group separation in PTSD symptom change, we have identified a number of protocol refinements that would improve the design of a fully powered, multi-centre randomised controlled trial, consistent with currently recommended rehabilitation clinical pathways.
COVID, Critical care, EMDR, PTSD, R-TEP, anxiety, depression, early EMDR intervention, feasibility, intensive care, psychology
1751-1437
Bates, Andrew
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Golding, Hannah
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Rushbrook, Sophie
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Shapiro, Elan
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Pattison, Natalie
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Baldwin, David S.
1beaa192-0ef1-4914-897a-3a49fc2ed15e
Grocott, Michael P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Cusack, Rebecca
dfb1595f-2792-4f76-ac6d-da027cf40146
Bates, Andrew
46ff2189-9345-45bb-bb83-c90971ccccb4
Golding, Hannah
6e60b2ee-c85b-47a6-a8a8-c8996f3a0f0c
Rushbrook, Sophie
6b6f3c8f-97b7-4350-86ad-6f3c709754ba
Shapiro, Elan
80ce1600-901e-4705-8a80-c17a64513d10
Pattison, Natalie
ef39caa6-a9e2-4d75-87a3-a0e177598eef
Baldwin, David S.
1beaa192-0ef1-4914-897a-3a49fc2ed15e
Grocott, Michael P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Cusack, Rebecca
dfb1595f-2792-4f76-ac6d-da027cf40146

Bates, Andrew, Golding, Hannah, Rushbrook, Sophie, Shapiro, Elan, Pattison, Natalie, Baldwin, David S., Grocott, Michael P.W. and Cusack, Rebecca (2022) A randomised pilot feasibility study of eye movement desensitisation and reprocessing recent traumatic episode protocol, to improve psychological recovery following intensive care admission for COVID-19. Journal of the Intensive Care Society. (doi:10.1177/17511437221136828).

Record type: Article

Abstract

Background: Approximately 50% of intensive care survivors experience persistent psychological symptoms. Eye-movement desensitisation and reprocessing (EMDR) is a widely recommended trauma-focussed psychological therapy, which has not been investigated systematically in a cohort of intensive care survivors: We therefore conducted a randomised pilot feasibility study of EMDR, using the Recent Traumatic Episode Protocol (R-TEP), to prevent psychological distress in intensive care survivors. Findings will determine whether it would be possible to conduct a fully-powered clinical effectiveness trial and inform trial design.

Method: We aimed to recruit 26 patients who had been admitted to intensive care for over 24 h with COVID-19 infection. Consenting participants were randomised (1:1) to receive either usual care plus remotely delivered EMDR R-TEP or usual care alone (controls). The primary outcome was feasibility. We also report factors related to safety and symptom changes in post-traumatic stress disorder, (PTSD) anxiety and depression.

Results: We approached 51 eligible patients, with 26 (51%) providing consent. Intervention adherence (sessions offered/sessions completed) was 83%, and 23/26 participants completed all study procedures. There were no attributable adverse events. Between baseline and 6-month follow-up, mean change in PTSD score was −8 (SD = 10.5) in the intervention group versus +0.75 (SD = 15.2) in controls (p = 0.126). There were no significant changes to anxiety or depression.

Conclusion: Remotely delivered EMDR R-TEP met pre-determined feasibility and safety objectives. Whilst we achieved group separation in PTSD symptom change, we have identified a number of protocol refinements that would improve the design of a fully powered, multi-centre randomised controlled trial, consistent with currently recommended rehabilitation clinical pathways.

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Abstract and Manuscript revised CovEMERALD-19092022 - Accepted Manuscript
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e-pub ahead of print date: 19 November 2022
Additional Information: Funding Information: Andrew Bates is funded by a National Institute for Health Research (NIHR) (pre-doctoral clinical academic fellowship) for this research project. This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
Keywords: COVID, Critical care, EMDR, PTSD, R-TEP, anxiety, depression, early EMDR intervention, feasibility, intensive care, psychology

Identifiers

Local EPrints ID: 473727
URI: http://eprints.soton.ac.uk/id/eprint/473727
ISSN: 1751-1437
PURE UUID: deef5645-014d-4438-a345-970bdac4fdcf
ORCID for Andrew Bates: ORCID iD orcid.org/0000-0002-3614-0270
ORCID for David S. Baldwin: ORCID iD orcid.org/0000-0003-3343-0907
ORCID for Michael P.W. Grocott: ORCID iD orcid.org/0000-0002-9484-7581

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Date deposited: 30 Jan 2023 19:50
Last modified: 17 Mar 2024 04:12

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Contributors

Author: Andrew Bates ORCID iD
Author: Hannah Golding
Author: Sophie Rushbrook
Author: Elan Shapiro
Author: Natalie Pattison
Author: Rebecca Cusack

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