A randomised controlled trial testing the effectiveness of

EMDR in a group of unemployed individuals.

Dr Natasha Soureti

Email: nsoureti@gmail.com

EMDR Greece

Research team-Anna-Maria Kiriakopoulou (President EMDR Hellas)-Alexandra Kerasioti -Joanna Revithi - Vasiliki Sfiri-Natasha Soureti (Secretary EMDR Hellas)-Tonia Tzortzatou-Angelica Vlassopoulou - Domna Ventouratou (Vice- President EMDR Hellas)

Volunteers Therapists (n=17)

Background

Unemployment rates in Greece: 26,8% (April, 2014).

Consequences? Increase in levels of demoralization, poor health,

social isolation, increases in anxiety and depression symptoms (Bartley., 1994; Korzeniewska, 1995, Doley et al., 2001., Madianos et al., 2011; Stankunas et al., 2005, 2006).

In many western countries, people have witnessed the deterioration of their economies and the emergence of related phenomena such as unemployment and social disruption.

Background

Several aspects of unemployment have direct/indirect effects on one’spsychological state:1. Lack of money2. Restricted social network3. Social representations of being unemployed4. Losing a central aspect of one’s assumptive

world (part of their self-definition)

All these losses is quite likely to evoke reactions similar to grief.

(Archer & Rhodes, 1993)

Objective

EMDR is thought to successfully treat not only PTSD but also other distressful experiences (small “t” trauma) (Cvetek, 2010).

EMDR was compared to active listening, and wait list. Found to produce significantly lower scores on the IES (mean reduced from “moderate” to “subclinical”) and a significantly smaller increase on the STAI (Cvetek, 2010).

On the basis of previous meta-analysis, it is recommended to explore EMDR’s incremental efficacy in controlled studies (Rodenburg et al., 2009).

QUESTION: Can EMDR in Greece help

unemployed individuals deal with their loss?

Hypothesis:

Unemployed individuals, who will receive EMDR therapy in comparison to supportive therapy or a control group (waiting list), will show a higher decrease in traumatic symptoms, depression and anxiety levels and a greater improvement in their coping strategies in both 3 & 6 months

Η1:

Method

Across-countries research collaboration (Greece-Spain)

Randomised Controlled Trial1. Control Group (waiting list) (n=30)2. Supportive treatment (n=30)3. EMDR based treatment (n=30)

3 time points-T0: screening (filling out of questionnaires)-T1: start of treatment (duration 3 months) -Τ2: 6 months (follow-up)

Supportive therapy will be based on Gerard Egan’s Skilled Helper Model

1. Exploration of the clients existing situation

2. Helping the client set goals3. Help the client develop strategies4. Evaluation

Τ0 Screening

Τ1 (3 month therapy)

Randomisation

1) EMDR, 2) Egan’s model, 3) Control group.

Τ2 (6 months)

Questionnaires

QuestionnairesEnd of treatment

Follow-up questionnaires

Control group to be randomised to receive 2 or 3

Recruitment

Participant Screening

Exclusion of pregnant women and <18 year olds Individuals, who have lost their jobs in the last 2

years IES>0 BDI>15 & BAI>10 (>mild to moderate depression

and anxiety symptoms)

Participants should not have complex PTSD or dissociative disorder (DES>20)

Psychiatric disorders (e.g. psychotic or bipolar disorder, current alcohol or substance abuse/dependence)

Screening of past and current pharmacotherapy

Screening

Welcome and Information given (e.g. study protocol)

Unemployed cards will be checked Consent forms will be signed by participants Battery of tests will be administered on site Two evaluators: a psychotherapist and a

psychiatrist (both trained in EMDR therapy) and familiar with the specific psychometric tests

Both evaluators are blind to the treatment condition

Randomisation

To ensure approximately equal numbers in each treatment condition, random assignment is blocked in groups of 12 consecutive participants, so that in each block, 4 participants will be assigned to each condition.

Participants in all 3 conditions will receive a total of 12 weekly treatment sessions.

The blind will be removed from the placebo intervention at 6m. For ethical reasons, participants will be offered the option of receiving either of the 2 active treatments.

Questionnaires

BAI – Beck Anxiety Inventory, 21 item measure (Beck and Steer, 1993) will be used to assess anxiety levels. It has good internal consistency (cronbach's alpha ranging between 0.92 to .94) and test-retest reliability (r ranging between .67 to 0.75).

BDI – Beck Depression Inventory, 21 item measure (Beck, Ward, Memdeson., Mock et al, 1961) will be used to measure the severity of depressive symptoms.

IES-R -Revised Impact of Event Scale, 22 item scale (Weiss and Marmar, 1997). This is one of the most widely used self-report measure of post-trauma symptomatology. Scale scores are formed for the three subscales, which reflect intrusion (8 items), avoidance (8 items), and hyperarousal (6 items). Test-retest reliability, collected across a 6-month interval, ranged from .89 to .94 (Weiss & Marmar, 1997).

Questionnaires

Brief COPE (Carver et al, 1997; Kapsou et al, 2010) is a 28 item questionnaire abbreviated from the 60-item COPE scale and addresses ways of coping with problems.

Number of coping strategies such as active coping, denial, substance use, emotional/instrumental support, venting of emotions, positive reframing.

In a sample of Hurricane Andrew survivors, the Cronbach’s alphas of the inventory reported to range from .50 (venting) to .90 (substance use). Except subscales of Venting, Denial, and Acceptance, the reliabilities of all other subscales exceeded values of .60 (Carver, 1997).

DES – Dissociative Experiences Scale (Eve Bernstein Carlson – Frank W. Putnam)

Recruitment

Limited budget coming from EMDR-Hellas treasury.

The study has been so far advertised on:1. Free press (e.g. newspapers)2. EMDR Hellas website and facebook3. Via other NGOs

Based on funding more advertising to take place on other forms of media (e.g. radio, magazines).

Where are we at now?

First 16 individuals have been screened All met inclusion criteria and have been

randomised to one of the 3 conditions

Sessions will start on: September 2014 First supervision starts on: October 2014

Exploration of funding (e.g. part-time secretary) and collaborations with other countries

THANK YOU!!!

For further Information email us:

nsoureti@gmail.com or

emdr.hellas@gmail.com