Online therapy for PTSD

We do not know what is to come, but there is already reported concern amongst NHS mental health clinicians about how they will meet an increase in future demand for support when many services were already stretched prior to Covid-19 . Many clinicians have already highlighted the negative effect the pandemic is having on people’s mental health, with previously discharged patients experiencing setbacks and new client enquiries escalating.

The Institute of Public Health and The Mental Health Foundation have already predicted that the mental health impact of the pandemic will last longer than the physical health impact. The Mental Health Foundation’s research director, Dr Antonis Kousoulisrecently stressed the importance of taking urgent action in preparing for the increase in mental health problems as a result of the pandemic. A report recently published by Duan and Zhu found that following the past experiences of SARS, the need to adapt mental health services is pressing.

My 2009 Churchill Fellowship looked at the prevention and treatment of traumatic stress injuries. I continue to work in this field particularly in Eye Movement Desensitisation and Reprocessing (EMDR) therapy, which is an NHS and World Health Organisation recommended treatment for post-traumatic stress disorder (PTSD). I am a senior EMDR Europe Accredited trainer and as of March this year I am now President Elect for the EMDR Association UK. This charity has over 4,000 trained EMDR mental health professionals in its membership.

EMDR is a therapy used to help people recover from distressing events and the problems they have caused, like flashbacks, upsetting thoughts or images, depression and anxiety. When a person is involved in a traumatic event, they may feel overwhelmed and their brain may be unable to fully process what is going on. The memory of the event seems to become ‘stuck’ so that it remains very intense and vivid. The person can re-experience what they saw, heard and smelt and the full force of the distress they felt whenever the memory comes to mind.

EMDR aims to help the brain ‘unstick’ and reprocess the memory properly so that it is no longer so intense. It also helps to desensitise the person to the emotional impact of the memory, so that they can think about the event without experiencing such strong feelings.

It does this by asking the person to recall the traumatic event while they also move their eyes from side-to-side, hear a sound in each ear alternately, or feel a tap on each hand alternately. These side-to-side sensations seem to effectively stimulate the ‘stuck’ processing system in the brain so that it can reprocess the information more like an ordinary memory, reducing its intensity. The effect may be similar to what occurs naturally during REM (Rapid Eye Movement) sleep, when your eyes move rapidly from side to side as the brain processes the events of the day.

Some research suggests that EMDR is effective because concentrating on another task whilst processing a distressing memory gives the brain more work to do. When the brain is not giving its full attention to processing the memory, it starts to become less vivid. This allows the person to distance themselves from it and begin to remember the event in a more helpful and manageable way. EMDR is a complex therapeutic process that should always be delivered by properly trained therapists.

To keep EMDR therapists well equipped to manage the predicted increase in demand for mental health services and trauma treatment, the EMDR Association UK quickly realised that it was imperative that we needed to support EMDR therapists to adapt in this unique time. The potential for EMDR therapy to alleviate emotional suffering is well documented and, as mental health clinicians, I believe we have a duty of care to support the potential long-term psychological impact of the pandemic.

As such, over the last six months I have been heavily involved in supporting our community in how to deliver EMDR remotely, including being the lead developer of the EMDR Association UK guidance around online EMDR Therapy. This guidance was developed to give advice on how clinicians could adapt the treatment for virtual delivery, so they could continue or begin EMDR therapy during the lockdown and amid the current restrictions, at a time when in-person therapy is impossible or very difficult. Along with publishing national therapist guidelines online, we also collated other useful online therapy resources and helped to develop client information sheets which are available on our national association website.

I also facilitated and co-delivered, with colleagues, a series of free webinars on behalf of the EMDR Association UK for clinicians (mainly NHS mental health professionals) in how to effectively deliver EMDR therapy through online methods. Each webinar was attended by around 500 mental health professionals and we delivered around six webinars on this subject.  Following the success of these, I have continued to organise the free webinar series for EMDR therapists, which has now moved on to other EMDR therapy subjects.

The response to these initiatives has been overwhelmingly positive, and I am confident that many therapists, particularly NHS clinicians, are now offering online EMDR therapy online to their clients. The vast majority of the anecdotal feedback from clinicians about delivering online EMDR therapy is that it can work incredibly well and is very well received by their clients.

With the ongoing skills that have been gained through this initiative, it has highlighted the fact that Covid-19 need not become a barrier to the delivery of EMDR therapy. Such state-of-the-art webinar platforms can deliver nearly all the capacities of in-person therapy without the challenges of travelling to clinics. Online EMDR therapy does require some adaptation (mainly in the therapist’s mindset), but these challenges are in no way insurmountable.

I now see this as an opportunity to adapt clinical practice beyond the pandemic, because online EMDR therapy gives the potential to broaden the reach of effective treatments for PTSD and trauma to those individuals who struggle to attend traditional clinics for a variety of reasons. However, in order to provide evidence-based practice, we do need formal research to prove the effectiveness of the online variant of EMDR therapy. The EMDR Association UK is looking into how we facilitate or fund this through our Scientific and Research Committee.

My Churchill Fellowship solidified an interest in the treatment of psychological trauma and PTSD. In the 11 years since, much of my professional life has been spent delivering treatment, clinical supervision and training in this area. I will always be grateful to the Churchill Fellowship for the opportunity and learning it gave me. I believe the communities that I work with and serve are still benefiting from the lessons I learnt during my trip.