Trauma-focused therapy in early psychosis: A randomised controlled trial assessing the efficacy and mechanisms of action of Eye Movement Desensitization and Reprocessing for psychosis (EMDRp) in comparison to treatment as usual in Early Intervention Settings

Background: Psychosis is associated with long-term disability, suicide risk and reduced recovery outcomes. ‘Early Intervention in Psychosis’ (EIP) services provide individuals with early signs of psychosis with NICE-recommended interventions aimed at improving their symptoms. While EIP support can improve medium-term outcomes, only 20% of patients achieve long-term recovery after first episode psychosis, and existing treatments (e.g. antipsychotics and Cognitive Behavioural Therapy) are effective for only a limited proportion of patients. There is therefore an urgent need to explore new interventions to further improve patients' chances of recovery. Psychological trauma is a key risk factor for developing psychosis, and research suggests that trauma therapies may be a promising new direction in its treatment. Growing evidence supports the use of Eye Movement Desensitisation and Reprocessing (EMDR), a NICE-recommended treatment for post-traumatic stress disorder, to treat other mental health problems that are either brought about or exacerbated by trauma, including psychosis. Our team has conducted an initial RCT (N=60) of an adapted ‘EMDR for psychosis’ (EMDRp) intervention, which signalled the potential efficacy of EMDRp for EIP service users and resulted in positive feasibility/acceptability data. Aims and objectives: The trial aims to test the clinical efficacy of EMDRp in reducing overall psychotic symptoms when compared to treatment as usual (TAU) for users of EIP services who have a history of trauma, and examine the degree to which EMDRp+TAU impacts on psychotic symptoms via changes in trauma memory characteristics and reductions in maladaptive beliefs. Methods: In a multi-site, assessor-blinded, parallel group RCT, we will recruit 314 adults with a history of trauma and active symptoms of psychosis supported by EIP services across 5 NHS sites in the UK. Eligible participants will be randomised to either the treatment arm (16 sessions of EMDRp + TAU over 6 months) or control arm (TAU alone). Mechanistic and outcome data will be collected at baseline, 4 months (peri-treatment), 6 months (post-treatment) and at 12 months follow-up. Further qualitative data collection with a subsample of participants will gather an understanding of participant experiences of therapy with particular focus on how therapy impacts putative mechanisms of action of EMDRp. Impact and dissemination: The study will provide evidence for the efficacy of a trauma-focused intervention deliverable within the NHS and tailored to the complex needs of service users with early psychosis, alongside data on key mechanisms of actions of EMDRp that will guide future practitioner training and implementation of the intervention to enhance patient benefit in applied settings. If outcomes for EIP service users are improved, the intervention will provide long-term benefit by reducing the significant social, personal, and economic costs associated with psychosis. Our research will address several sustained NHS priorities, including improving the efficacy and accessibility of evidence-based psychosocial treatments in EIP settings, and responding to the NHS’s Long-Term Plan for implementing trauma-informed care for those with complex mental health needs. Outputs will be disseminated widely via high-impact peer-reviewed publications, and presentations/webinars to varied UK and international audiences e.g. professional associations and lived experience and academic networks.