27 April 2023

Supporting innovative PTSD therapy study for intensive care patients

COVID-19 patients from University Hospital Southampton took part in a successful pilot feasibility study aimed at improving recovery from post-traumatic stress disorder (PTSD) with funding support from Southampton Hospitals Charity.

The pioneering investigation of the benefits of EMDR (Eye-Movement Desensitisation and Reprocessing) psychological therapy took place with a voluntary group of COVID-19 patients who had been treated in intensive care (ICU) during the pandemic in 2021.

GICU staff research into EMDR with patients who have PTSD

The first trial was granted a £3,500 award from Southampton Hospitals Charity and proved so successful, with a substantial fall in PTSD symptoms among patients who received the EMDR therapy, that a second, more far-reaching, controlled trial is now taking place with support from the NHS National Institute for Health and Social Care Research (NIHR).

University Hospital Southampton based clinical academic researcher Andrew Bates conducted the feasibility study after realising the potential benefits of the under-used, but highly-acclaimed, EMDR treatment for the large number of patients who develop PTSD symptoms within three months of intensive care treatment.

Andrew has 24 years’ experience as an ICU nurse and was aware of the high incidence of PTSD among patients after hospital discharge. He was keen to remove the stigma often associated with PTSD and wanted to give post-ICU patients a more positive recovery experience to improve their quality of life.

Andrew said: “We knew that EMDR therapy had been really beneficial in healing people who had been through traumatic experiences in the past, but there was no clinical research study which could show that it could be used by psychotherapists to treat patients who developed PTSD as a result of their negative experiences while in ICU.”

More than half of Britain’s intensive care survivors experience ongoing symptoms of PTSD, depression and anxiety, so the aim of Andrew’s randomised controlled study was to determine whether a fully-powered clinical effectiveness trial could go ahead for rehabilitation using EMDR.

The trauma-focussed therapy involves one-to-one sessions, with PTSD patients speaking to a psychologist about their negative feelings while performing side-to-side eye movements, interspersed with guided focus on a patients’ ‘safe and happy place’ memories to counteract their traumatic ones.

It enables patients to recall, process and integrate their traumatic memories within a controlled positive emotional and cognitive framework. It has been recommended by international organisations as an effective treatment for PTSD in patients with anxiety, depression and co-morbid psychotic symptoms.

The ground-breaking COVEMERALD feasibility study recruited 26 participants who had all been admitted to intensive care for at least 24 hours with COVID-19; were aged over 18 and had then been discharged from hospital within three months of receiving treatment at University Hospital Southampton.

They were randomly divided into two groups, with 13 COVID-19 patients from UHS, as the intervention group, receiving up to eight online Zoom sessions with a Consultant clinical psychologist and two experienced psychological therapists, from the Intensive Psychological Therapies Service in Dorset.

A further 13 COVID-19 patients were given the standard post-ICU treatment care, as the control group, for comparison of the trial outcomes. This included follow-up calls from nursing and specialist staff and access to support groups for survivors of COVID-19 infection.

The research took place during the SARS CoV-2 pandemic, when the severity of patients’ illness on admission was higher than before. Intensive care services were stretched by increased demand and acute staff shortages, increasing the likelihood of a rise in post-ICU psychopathology after the pandemic.

At the time of the first study, only COVID-19 related research could be considered by the UK Health Research Authority and it was carried out at University Hospital Southampton, with the EMDR treatment delivered by trained specialists in Dorset.

The results were encouraging.

Over a six-month period, the PTSD score indicated a substantial fall in PTSD symptoms of between 12% to15% recorded among the intervention group participants. This was compared with no change or improvement in PTSD symptoms within the control group. There were no significant changes in anxiety or depression among participants taking part in either of the two study groups.

Andrew said: “The conclusion of the first feasibility study showed a positive impact from the EMDR treatment on patients with PTSD and indicates that wider acceptance and use of this therapy in medical practice in the future could really make a difference to the lives of those affected by PTSD after treatment in ICU.

I was heartened to have feedback from some of the intervention group patients who described the EMDR treatment they received as ‘transformative’ and ‘life-changing’.”

Andrew is now embarking on a second, more far-reaching, controlled trial of EMDR therapy to improve psychological recovery from PTSD. He will be recruiting 160 ICU patients from across Southampton, Bournemouth and Poole hospitals, with improved representation inclusion from socio-economic, ethnic and digitally-excluded participants. In addition to Dorset Healthcare University NHS Foundation Trust, the new trial will also be supported by Southern Health NHS Foundation Trust.

He said: “This new study has come about as a direct result of the support offered to me by Southampton Hospitals Charity and is funded by a grant from the NHS National Institute for Health and Social Care research.

This will be more rigorously implemented, with monitoring and testing over a longer period of time in order to capture the whole experience. I think this is the best way for us to progress to a definitive study that could be rolled out as an approved rehabilitation clinical pathway in the future.”

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