COURAGE AND TRANSFORMATION: PATIENT EXPERIENCES OF WEB- BASED EMDR FOR SUICIDAL IDEATION
Authors: Yap *Sidney , Bal Manroop , Youakim Mina , Aborawi Ashraf , Pinto Genna Di , Samways Krystle , Beck Amy , Bright Katherine , Bremault-Phillips Suzette , Greenshaw Andrew , Winkler Olga , Burback Lisa 
Published: February 2025

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
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