Investigating eye movement desensitisation and reprocessing to improve the mental health recovery of intensive care survivors

Abstract

Post-traumatic stress disorder (PTSD) affects a substantial proportion of intensive care survivors, with adverse consequences for mental health, daily functioning, and quality of life. Despite this burden, trauma-focused psychological therapies remain largely absent from critical care rehabilitation pathways. A scoping review identified a substantial evidence gap: only two studies have evaluated evidence-based trauma-focused therapies, such as Eye Movement Desensitisation and Reprocessing (EMDR), and both were conducted during the COVID-19 pandemic, under exceptional conditions.This thesis aimed to evaluate the feasibility, acceptability, and preliminary clinical outcomes of using EMDR to treat traumatised survivors of intensive care. A mixed-methods feasibility trial was conducted using a trauma-informed, two-part consent process. Participants were stratified according to PTSD symptom burden at three months post-discharge. Those with post-traumatic stress symptoms were invited into a randomised controlled trial (RCT) of EMDR versus ‘treatment as usual’ (TAU). Those with below-threshold traumatic stress symptoms and those who declined randomisation were enrolled into a parallel observational cohort.Primary findings support the feasibility and acceptability of the trial protocol. Recruitment targets were achieved, retention was high, and fidelity to the EMDR protocol was maintained. The mean reduction in Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) scores from pre- to post-intervention was –15.6 points (95% CI: –21.4 to –9.8) in the EMDR group compared to –1.6 points (95% CI: –6.9 to +3.7) in the TAU group (p<0.001).A greater proportion of EMDR participants (68.4%) achieved a clinically meaningful reduction in PTSD symptoms than those receiving TAU (15.0%; p = 0.001).Qualitative interviews with patients and therapists confirmed the intervention was emotionally demanding but acceptable and meaningful.In summary, this study demonstrates that investigating EMDR in traumatised ICU survivors using a two-part consent process is both feasible and acceptable and may be associated with clinically meaningful reductions in post-traumatic stress symptoms. These findings provide a foundation for the design and implementation of a fully powered randomised controlled trial.

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Identifiers

ORCID for Andrew Charles Bates: orcid.org/0000-0002-3614-0270

ORCID for Mike Grocott: orcid.org/0000-0002-9484-7581

ORCID for David Baldwin: orcid.org/0000-0003-3343-0907

ORCID for Rebecca Cusack: orcid.org/0000-0003-2863-2870

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