Eye-movement desensitisation and reprocessing therapy (EMDR) to prevent transition to psychosis in people with an at-risk mental state (ARMS): mixed method feasibility study

Background:
Trauma plays an important role in the development of psychosis, but no studies have investigated whether a trauma-focused therapy could prevent psychosis.

Aims:
This study aimed to establish whether it would be feasible to conduct a multi-centre randomised controlled trial (RCT) to prevent psychosis in people with ARMS using EMDR.

Method:
This started as a mixed-method randomised study comparing EMDR to treatment as usual but, due to low patient recruitment, was changed to single-arm feasibility study. The proposed primary outcome for a RCT was transition to psychosis by 12-month follow-up. Data on secondary outcomes were also collected. Qualitative interviews were conducted with patients and therapists.

Results:
14 participants were recruited from the Early Intervention (EI) teams. Most patients who expressed an interest in taking part attended an assessment to determine eligibility. All those eligible consented to take part. 64% (7 of 11) of participants who were offered EMDR were followed up at 12 months. Of the 11 participants offered EMDR, one (11%, 95%CI: 0.2%, 48%) transitioned to psychosis. Nine patients and three therapists were interviewed. Patients who completed therapy (n=4; mean 10.5 sessions) found EMDR helpful, but those who discontinued (n=6; mean 5.2 sessions) said it had not benefited them overall. Therapists said EMDR could be effective, although not for all patients.

Conclusions:
Future studies recruiting ARMS to a RCT may need to extend recruitment beyond EI teams. Whilst some patients found EMDR helpful, reasons for discontinuing need to be addressed in future studies.

Trial registration number: ISRCTN31976295

Keywords
EMDR, ARMS, psychosis, prevention, feasibility study