Trauma-focused therapy in early psychosis : Results of a feasibility randomized controlled trial of EMDR for psychosis (EMDRp) in early intervention settings

Varese, Filippo and Sellwood, Bill and Pulford, Daniel and Awanat, Yvonne and Bird, Leanne and Bhutani, Gita and Carter, Lesley-Anne and Davies, Linda and Aseem, Saadia and Davis, Claire and Hefferman-Clarke, Rebecca and Hilton, Claire and Horne, Georgia and Keane, David and Logie, Robin and Malkin, Debra and Potter, Fiona and van den Berg, David and Zia, Shameem and Bentall, Richard (2024) Trauma-focused therapy in early psychosis : Results of a feasibility randomized controlled trial of EMDR for psychosis (EMDRp) in early intervention settings. Psychological Medicine, 54 (5). 874 - 885. ISSN 0033-2917

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Abstract

Background Trauma is prevalent amongst early psychosis patients and associated with adverse outcomes. Past trials of trauma-focused therapy have focused on chronic patients with psychosis/schizophrenia and comorbid Post-Traumatic Stress Disorder (PTSD). We aimed to determine the feasibility of a large-scale randomized controlled trial (RCT) of an Eye Movement Desensitization and Reprocessing for psychosis (EMDRp) intervention for early psychosis service users. Methods A single-blind RCT comparing 16 sessions of EMDRp + TAU v. TAU only was conducted. Participants completed baseline, 6-month and 12-month post-randomization assessments. EMDRp and trial assessments were delivered both in-person and remotely due to COVID-19 restrictions. Feasibility outcomes were recruitment and retention, therapy attendance/engagement, adherence to EMDRp treatment protocol, and the 'promise of efficacy' of EMDRp on relevant clinical outcomes. Results Sixty participants (100% of the recruitment target) received TAU or EMDR + TAU. 83% completed at least one follow-up assessment, with 74% at 6-month and 70% at 12-month. 74% of EMDRp + TAU participants received at least eight therapy sessions and 97% rated therapy sessions demonstrated good treatment fidelity. At 6-month, there were signals of promise of efficacy of EMDRp + TAU v. TAU for total psychotic symptoms (PANSS), subjective recovery from psychosis, PTSD symptoms, depression, anxiety, and general health status. Signals of efficacy at 12-month were less pronounced but remained robust for PTSD symptoms and general health status. Conclusions The trial feasibility criteria were fully met, and EMDRp was associated with promising signals of efficacy on a range of valuable clinical outcomes. A larger-scale, multi-center trial of EMDRp is feasible and warranted.