Estimated time of visit: 30 – 60 minutes 30 – 60 minutes 30 – 60 minutes 30-60 minutes 40-70 minutes 30-60 minutes Table 2: Schedule of procedure for the Treatment Phase (P2) Visit 1: 2-4 weeks Visit 2: 2-4 weeks Visit3: 3-5 weeks Visit 4: 4-6 weeks Visit 5: 5-7 weeks Visit 6: 3 months Visit 7: 6 months Visit 8: 9 months Visit 9: 12-18 months Visit Yearly f/u Consent Questionnaires: 1.Impact of Event Scale-Revised (IES-R) 2. COPE 3. DS-16 4. Relationship Questionnaire (RQ) 5. ABCD-Self Report, revised (ABSD-SRR) 6. The Depression Anxiety and Stress Schedule (DASS) 7. Measure of Alcohol use Dissociative experience Scale (DES ) Burns Specific Health Scale( BSHS-B) Interventions: Counselling or EMDR Interviews: Burns Modified AAI CAPS Interview Semi Structured Interview Estimated time of visit: 1 hour 1-2 hours 1-1.5 hours 1-1.5 hours 1-1.5 hour 2-2.5 hours 1.5-2.5 hours 30-60 minutes 40-70 Minutes 30-60 minutes Study Design There are two arms of this study. The first part involves screening all patients admitted to the Severe Burns Injury Unit for PTSD, depression, anxiety and coping. The second part involves measuring how effective early interventions are in reducing these in severe injury burns patients. Table 3 outlines the different interventions for participants (either cases or controls) and compares this to non-participants’ experience. Protocol Stages:
an audit trail of decisions taken throughout the data collection and analysis process will be maintained. Wolf () states that “the audit trail helps to establish the credibility of qualitative studies and serves to convince the scientific community of their rigor”. STUDY TREATMENTS Treatment Arms There will initially be two ‘treatment groups’ (Intervention/EMDR and control/optimised standard care group). The treatments will take place on a weekly basis over 3 weeks, with some flexibility given the demands of the medically complex acute care setting. Patients in the control group who remain symptomatic will be offered the EMDR intervention after 3 months. This ‘cross over group’ will be in treatment for a further 3 weeks. So while most patients will be in treatment for 3 weeks, the cross over group will be in treatment for 6 weeks. Description of the Intervention/Treatment An explanation of both the EMDR and supportive counselling will be provided at the time of obtaining informed consent. This involves describing the nature of treatments to patients as well as giving a brief demonstration of the bilateral eye stimulation along with a disclaimer that “the intervention may or may not help the distress”. Table 3: Intervention table for cases, controls and non-participants of the Treatment Phase (P2) Timeframe Cases/EMDR group Controls/optimised Standard care group Non participants/ standard care 2-4 weeks 1. Psychiatric and Social work assessment 2. Consent 3. Questionnaires: Impact of Event (IES-R) COPE DS-16 Relationship Questionnaire (RQ) ABCD-Self Report, revised (ABSD-SRR) The Depression Anxiety & Stress Schedule (DASS) Measure of Alcohol use 1. Psychiatric and Social work assessment 2. Consent 3. Questionnaires: Impact of Event Scale-Revised (IES-R) COPE DS-16 Relationship Questionnaire (RQ) ABCD-Self Report, revised (ABSD-SRR) The Depression Anxiety & Stress Schedule (DASS) Measure of Alcohol use 3. Assessment: Burns Modified Adult Attachment Interview DES 1. Psychiatric and Social work assessment Session 1 1. Targeted/specific trauma processing involving bilateral eye movement 2. IES-R before and after each session structured/optimised version of standard care i.e. counselling 2. IES-R before and after each session As determined by patient need and clinicians’ availability