Remotely Delivered EMDR for Post-Traumatic Stress Disorder (PTSD) in Military Veterans

Post-traumatic stress disorder (PTSD) is a common psychiatric condition amongst active duty and ex-serving military personnel. Creating a significant public health challenge across the world. Prevalence rates vary between nations with reported rates of 20 to 30% in US troops returning from various conflicts over the past 60 years, 6% to 17% in the UK, 5% in Canada, and 3% in the Netherlands.

Over the past three decades there has been considerable investment in new treatment models and evaluation of them, leading to advances in the treatment of PTSD in civilian and military populations. International clinical practice guidelines unanimously recommend trauma focused psychological therapies (TFPT) in the form of Eye Movement Desensitization Reprocessing (EMDR), and individual Cognitive Behavioral Therapy with a trauma focus (CBT-TF) as first line treatments for PTSD.

Currently in the UK, NICE PTSD guidelinesalso recommend TFPT as a first line of therapy, but not EMDR for combat-related trauma due to the current evidence base. Despite these recommendations, veterans continue to be offered EMDR for combat-related PTSD.

Project aims

The main aim of the research project is to answer the following research questions and determine whether remotely delivered EMDR has the potential to reduce traumatic stress symptoms in British military veterans with combat-related PTSD.

1. For British military veterans with combat-related PTSD, does remotely delivered EMDR reduce symptoms of PTSD to a significantly greater degree than a waiting list?

2. For British military veterans with combat-related PTSD, does remotely delivered EMDR reduce symptoms of PTSD to a similar degree as face to face delivered EMDR?

3. For British military veterans with combat-related PTSD, what is the impact of remotely delivered EMDR on quality of life, functioning, symptoms of depression, symptoms of anxiety, insomnia, alcohol and illicit substance use, and perceived social support?

4.  Is remotely delivered EMDR acceptable to British military veterans with combat-related PTSD and those delivering the intervention?

5. What is the effect size of remotely delivered EMDR?

6. What factors may impact efficacy and successful roll-out of remotely delivered EMDR for combat-related PTSD, if it is shown to be efficacious?

6. Can examination of the integrity of the study protocol, trial recruitment rate, self-report outcome measures, clinician administered outcome measures, randomisation procedure, treatment integrity and acceptability enhance decision making in planning a Phase III definitive trial?

7. Is a Phase III definitive RCT indicated and feasible?

The Challenge

In March 2020, at the start of the COVID-19 pandemic in the UK, NHS Wales experienced immediate changes to how it functioned and delivered patient care. A new NHS Wales Video Consulting (VC) Service was developed and rolled out by TEC (Technology Enabled Care) Cymru, across all primary, secondary and community care services in Wales. TEC Cymru has been robustly evaluating the VC service across Wales, and to date has collected a wide range of mixed methods data from more than 45,000 NHS Wales patients and clinicians using the VC service.

The solution

The TEC Cymru data for patients with PTSD and their clinicians (n=474 / 2.06% of national dataset) also suggests that PTSD and VC are a strong fit. Overall, a total of 96% of patients with PTSD stated that they would use VC again. Despite widespread use, the absence of randomized controlled trial evidence for the efficacy of EMDR and the remote delivery of EMDR in veterans is a concern. It is, therefore, imperative that EMDR and the remote delivery of EMDR is tested in this population in rigorous methodological designs and the proposed study represents a first step to achieving this. The aim of the research outcomes is to determine whether remotely delivered EMDR has the potential to reduce traumatic stress symptoms in British military veterans with combat-related PTSD.

The Randomized Control Trial (RCT) will recruit 60 veterans into immediate treatment of either FTF or VC EMDR, or a wait-list group for treatment later. The RCT will last approximately 32 weeks (about 7 and a half months).