COURAGE AND TRANSFORMATION: PATIENT EXPERIENCES OF WEB- BASED EMDR FOR SUICIDAL IDEATION

Abstract Background Psychological trauma and adversity are known risk factors for developing suicidal ideation (SI), a marker of severe stress or psychological burden (Winkler et al. 2021). Unfortunately, established interventions for SI have limitations, are often suboptimally effective, resource-intensive, or suffer from high attrition (D’ Anci et al. 2019; Steyn, Koen and Jarvis 2022). Eye Movement Desensitization and Reprocessing (EMDR) psychotherapy, initially designed to treat Posttraumatic Stress Disorder (PTSD), has shown potential as a novel approach for SI (Fereidouni et al. 2019; Proudlock and Peris 2020). Early studies indicate that trauma-focused psychotherapies (TFP) like EMDR may be used safely and effectively with those reporting SI, potentially reducing SI over the course of treatment (Burback et al 2023). However, intense emotions evoked during treatment convey a risk for worsening or treatment-emergent SI (Larsen et al 2016). This risk may drive clinician hesitancy, exacerbating barriers to treatment access. Further, significant research gaps remain, including understanding a) patient experiences during trauma therapy, especially for populations with SI, and b) what individual and contextual factors may impact outcomes and safety, including those related to the online environment (Burback 2023). Therefore, qualitative studies are needed to explore these issues. Aims and Objectives This qualitative study aimed to capture and explore the experiences of adult outpatients who received web-based, therapist-delivered EMDR targeting events associated with their SI. Methods Participants were recruited from a randomized controlled trial (RCT) investigating web-based EMDR for adults with SI (Winkler et al. 2021). This study measured the impact of receiving web-based EMDR on the severity of SI and symptoms of PTSD, depression, anxiety, dissociation, and emotional regulation. This “real-world” study included a broad range of patients, but excluded those with psychosis, mania, or dissociative disorders. Participants from the EMDR treatment group were invited to engage in this qualitative study, and were interviewed individually via Zoom, using a semi-structured approach (Biddle et al. 2012). Data collection and initial coding were conducted at arms-length from RCT study investigators. Braun and Clarke’ s framework for qualitative thematic analysis was used to guide inductive analysis; no pre-existing coding frame was imposed on the data (Braun &Clarke 2012). Results Twenty RCT participants were enrolled in the EMDR treatment group, and 14 agreed to be interviewed. Preliminary analysis indicated data saturation and therefore adequate sample size. Participants reported, generally positively, on treatment efficacy, accessibility, safety, and recommendations for future improvement. Data analysis is currently ongoing and final results will be forthcoming. Discussion and Conclusion To our knowledge, this is the first study exploring patient experiences of trauma therapy that focused specifically on experiences associated with their suicidal ideation, rather than a psychiatric diagnosis. If confirmed, positive results could indicate a new transdiagnostic method for addressing suicidal ideation. This is also amongst the first studies reporting on web-based EMDR, which could improve access to care. Larger trials, including those with more severe dissociative symptoms, are needed to further explore the impact of such treatment for SI. References 1.Winkler O, Dhaliwal R, Greenshaw A, O'Shea K, Abba-Aji A, Chima C, Purdon SE and Burback L (2021) Web-based eye movement desensitization and reprocessing for adults with suicidal ideation: protocol for a randomized controlled trial. JMIR Research Protocols 10(11): e30711. DOI: 10.2196/30711. 2.D'Anci KE, Uhl S, Giradi G and Martin C (2019) Treatments for the prevention and management of suicide. Annals of Internal Medicine 171(5): 334. DOI: 10.7326/m19-0869. 3.Steyn PJ, Koen L and Jarvis L (2022) Characteristics of inpatients in dialectical behaviour therapy modified for a resource-limited setting. South African Journal of Psychiatry 28: 1701. DOI: 10.4102/sajpsychiatry.v28i0.1701. 4.Fereidouni Z, Behnammoghadam M, Jahanfar A and Dehghan A (2019) The effect of eye movement desensitization and reprocessing (EMDR) on the severity of suicidal thoughts in patients with major depressive disorder: a randomized controlled trial. Neuropsychiatric Disease and Treatment 15: pp.2459- 2466. DOI: 10.2147/NDT.S210757. 5.Proudlock S and Peris J (2020) Using EMDR therapy with patients in an acute mental health crisis. BMC Psychiatry 20(1): pp.1-9. DOI: 10.1186/s12888-019-2426-7. 6.Burback L, Dhaliwal R, Reeson M, Erick T, Hartle K, Chow E, Vouronikos G, Antunes N, Marshall T, Kennedy M, Dennett L, Greenshaw A, Smith-MacDonald L, and Winkler O (2023) Trauma focused psychotherapy in patients with suicidal ideation: a scoping review. Current Research in Behavioral Sciences 4:100102. DOI: 10.1016/j.crbeha.2023.100102. 7.Larsen SE, Stirman SW, Smith BN and Resick PA (2016) Symptom exacerbations in trauma-focused treatments: associations with treatment outcome and non-completion. Behaviour Research and Therapy 77: pp.68-77. DOI: 10.1016/j.brat.2015.12.009. 8.Biddle L, Cooper J, Owen-Smith A, Klineberg E, Bennewith O, Hawton K, Kapur N, Donovan J and Gunnell D (2012) Qualitative interviewing with vulnerable populations: individuals' experiences of participating in suicide and self-harm based research. Journal of Affective Disorders 145(3): 356-362. DOI: 10.1016/j.jad.2012.08.024. 9.Braun V and Clarke V (2012) Thematic analysis. In: Cooper H, Camic PM, Long DL, Panter AT, Rindskopf D and Sher KJ (eds) APA handbook of research methods in psychology, Vol. 2. Research designs: Quantitative, qualitative, neuropsychological, and biological. American Psychological Association, pp.57–71.

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