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

Andrew Bates; Hannah Golding; Sophie Rushbrook; Elan Shapiro; Natalie Pattison; David S Baldwin; Michael P W Grocott; Rebecca Cusack

doi:10.1177/17511437221136828

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

J Intensive Care Soc. 2023 Aug;24(3):309-319. doi: 10.1177/17511437221136828. Epub 2022 Nov 19.

Authors

Andrew Bates^{1

2}, Hannah Golding¹, Sophie Rushbrook³, Elan Shapiro⁴, Natalie Pattison⁵, David S Baldwin^{2

6}, Michael P W Grocott^{1

2}, Rebecca Cusack^{1

2}

Affiliations

¹ NIHR Southampton Biomedical Research Centre, University Hospitals Southampton National Health Service Foundation Trust, Southampton, UK.
² Faculty of Medicine, University of Southampton, Southampton, UK.
³ Intensive Psychological Therapies Service, Dorset Healthcare University National Health Service Foundation Trust, Poole, UK.
⁴ Independent EMDR Europe Consultant Practitioner, Haifa, Israel.
⁵ School of Health and Social Work, University of Hertfordshire, Hatfield, UK.
⁶ Southern Health NHS Foundation Trust, Southampton, UK.

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.

Trial registration: ClinicalTrials.gov: NCT04455360.

Keywords: COVID; Critical care; EMDR; PTSD; R-TEP; anxiety; depression; early EMDR intervention; feasibility; intensive care; psychology.

Associated data

ClinicalTrials.gov/NCT04455360