Every-Palmer Susanna, Flewett Tom, Dean Shaystah, Hansby Oliver, Colman Atalie, Weatherall Mark, Bell Elliot
University of Otago, Wellington, New Zealand.
Capital and Coast District Health Board, Wellington, New Zealand.
Trials. 2019 Nov 21;20(1):642. doi: 10.1186/s13063-019-3760-2.
Eye movement desensitization and reprocessing (EMDR) is an evidenced-based treatment for posttraumatic stress disorder (PTSD). Forensic mental health services provide assessment and treatment of people with mental illness and a history of criminal offending, or those who are at risk of offending. Forensic mental health services include high, medium, and low-security inpatient settings as well as prison in-reach and community outpatient services. There is a high prevalence of PTSD in forensic settings and posttraumatic experiences can arise in people who violently offend in the context of serious mental illness (SMI). Successful treatment of PTSD may reduce the risk of relapse and improve clinical outcomes for this population. This study aims to assess the efficacy, risk of harm, and acceptability of EMDR within forensic and rehabilitation mental health services, as compared to treatment as usual (routine care).
This is a single-blind, randomized controlled trial comparing EMDR therapy to the waiting list (routine care). Adult forensic mental health service users (n = 46) with SMI and meeting the criteria for PTSD will be included in the study. Participants will be randomized after baseline assessment to either treatment as usual plus waiting list for EMDR or to treatment as usual plus EMDR. The EMDR condition comprises nine sessions, around 60 min in length delivered weekly, the first of which is a case conceptualization session. The primary outcomes are clinician and participant-rated symptoms of PTSD, and adverse events. Secondary outcomes include psychotic symptoms, social functioning, level of disability, self-esteem, depressive symptoms, post-trauma cognitions, and broad domains of complex posttraumatic difficulties. A trained assessor blinded to the treatment condition will assess outcomes at baseline, 10 weeks, and 6 months. Additionally, grounded theory qualitative methods will be used to explore participant experience of EMDR for a subset of participants.
This study will contribute to the currently limited evidence base for EMDR for PTSD in forensic settings. It is the first randomized clinical trial to assess the efficacy, risk of harm, and acceptability of EMDR for PTSD in people with SMI in either forensic, mental health inpatient, or custodial settings.
Australia and New Zealand Clinical Trials Network, ACTRN12618000683235. Registered prospectively on 24 April 2018.
眼动脱敏再处理疗法（EMDR）是一种针对创伤后应激障碍（PTSD）的循证治疗方法。法医精神卫生服务为患有精神疾病且有犯罪史或有犯罪风险的人群提供评估和治疗。法医精神卫生服务包括高、中、低安全级别的住院治疗环境以及监狱内服务和社区门诊服务。在法医环境中，PTSD的患病率很高，并且在患有严重精神疾病（SMI）的暴力犯罪者中可能会出现创伤后经历。成功治疗PTSD可能会降低该人群复发的风险并改善临床结局。本研究旨在评估与常规治疗（常规护理）相比，EMDR在法医和康复精神卫生服务中的疗效、伤害风险和可接受性。
这是一项单盲随机对照试验，将EMDR疗法与等待名单（常规护理）进行比较。研究将纳入患有SMI且符合PTSD标准的成年法医精神卫生服务使用者（n = 46）。参与者在基线评估后将被随机分为常规治疗加EMDR等待名单组或常规治疗加EMDR组。EMDR组包括九个疗程，每周进行一次，每次约60分钟，第一个疗程是病例概念化疗程。主要结局是临床医生和参与者评定的PTSD症状以及不良事件。次要结局包括精神病症状、社会功能、残疾程度、自尊、抑郁症状、创伤后认知以及复杂创伤后困难的广泛领域。一名对治疗情况不知情的经过培训的评估人员将在基线、10周和6个月时评估结局。此外，将使用扎根理论定性方法探索一部分参与者对EMDR的体验。
本研究将为目前法医环境中EMDR治疗PTSD的有限证据基础做出贡献。这是第一项评估EMDR对法医、精神卫生住院或监禁环境中患有SMI的PTSD患者的疗效、伤害风险和可接受性的随机临床试验。
澳大利亚和新西兰临床试验网络，ACTRN12618000683235。于2018年4月24日前瞻性注册。
