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AUDIT OF INTENSIVE EMDR VS WEEKLY EMDR in IAPT Service Isle of Wight

AUDIT OF INTENSIVE EMDR VS WEEKLY EMDR in IAPT Service Isle of Wight. BY JACKY SMITH EMDR CONSULTANT JACKY.SMITH@IOW.NHS.UK EOIN O’CALLAGHAN BUSINESS MANAGER & DATA ANALYST EOIN.O’CALLAGHAN@IOW.NHS.UK IAPT ISLE OF WIGHT DEREK FARRELL UNIVERSITY OF WORCESTER.

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AUDIT OF INTENSIVE EMDR VS WEEKLY EMDR in IAPT Service Isle of Wight

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  1. AUDIT OF INTENSIVE EMDR VS WEEKLY EMDR in IAPT Service Isle of Wight BY JACKY SMITH EMDR CONSULTANT JACKY.SMITH@IOW.NHS.UK EOIN O’CALLAGHAN BUSINESS MANAGER & DATA ANALYST EOIN.O’CALLAGHAN@IOW.NHS.UK IAPT ISLE OF WIGHT DEREK FARRELL UNIVERSITY OF WORCESTER

  2. IAPT ISLE OF WIGHT DEMOGRAPHICS • POPULATION 138,300 IN 2011 • 94.8% of residents are ‘White British’ origin although this proportion has reduced since the 2001 Census • There are 69,216 residential households Source Isle of Wight Council Revenues and Benefits as at 4th October 2013 • Around 1 in 6 households on the Island are occupied by a single person over 65 .

  3. Isle of Wight Mental Health • 13043 patients with Mental Health Illness mild to moderate. • 3260 accessed MH IAPT service on Isle of Wight from 2014- Feb 2016. • 17% of Hi referrals accessed EMDR therapy within IAPT between Jan 2014- Feb 2016.

  4. IMPROVING ACCESS TO PSYCHOLOGICAL THERAPIES (IAPT) ISLE OF WIGHT HIGH INTENSITY 2009 -2016 • EMDR • CBT • IPT • COUPLE THERAPY • MAXIMUM SESSIONS 20 • 10 HIGH INTENSITY TRAINED CBT THERAPISTS OF WHICH 7 ARE EMDR TRAINED

  5. Statistical measures for EMDR Therapy What we measured? PHQ9, GAD & Impact of Event Scale. What we used to measure statistics Bespoke database (IAPTus) Utilising data reporting system developed for feedback to Department of Health via the Health & Social Care Information Centre. Local data reporting for Commissioners to measure against local statistical targets. Timescale:- 1st Jan 2014- 1st February 2016

  6. Overall statistics for Isle of Wight IAPT Outcomes Access rate: 22% Recovery: 50% DNA rate: 15% Nationally Waiting times: 75% within 6 Weeks from referral until treatment & 95% within 18 Weeks from referral until treatment.

  7. RECOVERY TARGET FOR IAPT ISLE OF WIGHT 50% Target for service (national measure). Basic Recovery based on PHQ9 >9 & GAD>7. ADSM Recovery for outcome measures for Hi Intensity CBT and relevant Hi Therapies. EMDR Impact of Event Scale.

  8. Weekly EMDR & Hi level Therapy within Isle of Wight IAPT/PCMHTComparison

  9. DNA Rate (Weekly EMDR Comparison)

  10. DNA rate National & Service Level • National Average DNA rate : 15% • Local Isle of Wight Average DNA rate at service level: 18% • EMDR (weekly sessions): 1% • HI CBT: 5% • IPT: 4%

  11. Intensive EMDR InitiativeIAPT Service Isle of Wight

  12. Previous Research • There have been 3 EMDR published studies on the use of intensive EMDR. • The first Wesson and Gould (2009) delivered EMDR over four consecutive days to an actively serving soldier who was diagnosed with Acute Stress Reaction. • His treatment was successful and the soldier returned to duty • the positive effects were maintained in two follow up appointments, the last at 18 months post treatment.

  13. Previous Research • The second study was Grey (2011) • EMDR treatment frequency was 3 sessions per week, • 12 90-minute reprocessing sessions provided over a period of 1 month. • The patient was diagnosed with co morbid major depressive disorder (MDD), severe without psychotic features, and panic disorder with agoraphobia. • The researcher reported that at the two month and three month follow up appointments, the positive treatment effects were maintained.

  14. Previous research • Lobenstine, Farnsworth; Courtney, Deborah (2013) • The participant received 25.5 hr of treatment in a 3-week period. • followed with 12 hr of primarily supportive therapy over the next 6-week period. • Clinical symptoms decreased as evidenced by reduction in scores from baseline to 6-week follow-up. • In Week 1, there were six sessions for 60, 90, or 120 min in length that totalled 9.0 hr. • In Week 2, there were five sessions, four of which were 120 min and one was 60 min, totalling 9.0 hr. • In Week 3, there were five sessions of 60, 90, or 120 min totalling 7.5 hr

  15. Previous Research • CBT study (Ehlers et al. 2010), • a cognitive therapy protocol was developed to deliver 18 hours of therapy over 5-7 days. • homework assignments for the next 5 days, plus homework over 3 months. • They concluded that the intensive protocol was effective and comparable to therapy delivered on a weekly basis.

  16. Treatment Centres • www.sierratuscan.com. • Offer 4-5 two hour sessions of EMDR a week for PTSD. • www.healingsolutions.ca/emdr-therapy. • Offer 6 hour daily sessions divided into two three hour sessions for PTSD. • www.fokkina.co.uk for performance anxiety over a weekend.

  17. SELECTION CRITERIA IAPT ISLE OF WIGHT • PATIENT AVAILABILITY • RISK EVALUATED • HIGH INTENSITY IAPT PATIENTS CLUSTERS 3-4 • PATIENT SUPPORT NETWORK • PATIENT COMMITMENT • SUPERVISION DISCUSSION & CASE LOAD MANGEMENT

  18. Standard Protocol • History taking • Preparation • Assessment • Desensitization • Installation • Body Scan • Closure • Re-evaluation

  19. EMDR INTENSIVE PROTOCOL IAPT PRE TREATMENT: • HISTORY TAKING, PREPARATION & ASSESSMENT OVER 2-3 SESSIONS. TREATMENT: • DESENSITIZATION, INSTALLATION, BODY SCAN, CLOSURE, & RE-EVALUATION DAILY UP TO 17-18 SESSIONS. • FOLLOW UP 1 MONTH, 3 MONTHS & 6 MONTHS.

  20. Intensive EMDR statistics • 100% Recovery rate. • 0.5% DNA Rate • Hi proportion of patients show significant evidence of Rapid Recovery.

  21. Recovery rate analysis

  22. Initial Test Patient Jan 2014

  23. Test Patient IES-R

  24. Patient :1PHQ 9 & GAD

  25. Patient 1: Impact of Event Scale –Revised (IES-R)

  26. Patient 2 PHQ 9 & GAD

  27. Patient 2: IES-R

  28. Patient 3 PHQ 9 & GAD 7

  29. Patient 3 IES-R

  30. Patient 4 PHQ 9 & GAD 7

  31. Patient 4 IES-R

  32. Patient 5 PHQ 9 & GAD 7

  33. Patient 5 IES-R

  34. Patient 6 PHQ 9 & GAD 7

  35. Patient 6 IES-R

  36. Audio Patient IES-R

  37. General Themes of Feedback from Patients It felt supportive It felt safe Therapeutic relationship was strong “No been left alone for long periods of time with traumatic thoughts.” “The intensity of the sessions providing – connection based on relief PLUS value, and consistency in applying thinking/learning/re-considering (no lag in which to revert to old patterns of thinking)”

  38. General Themes of Feedback from Patients “I felt valued” “I personally believe having received EMDR in such an intensive way I have benefited tenfold. I am able to now move on and enjoy the rest of what I believe to be a very happy future ahead of me.” “Slow and sure would not have worked as I would have found it too easy to keep reverting back to the only way I had known before.”

  39. General Themes of Feedback from Patients “In such an amazingly short space of time my life has completely turned around. I would recommend these sessions to anyone who needed them.” “I feel I was very fortunate to be able to have 2-3 sessions of E.M.D.R a week, this was fundamental to insure I attended every session by reinforcing the benefits and support I was receiving from the treatment.” “after eight E.M.D.R treatments, Jacky decided I was ready to be discharged. I have never felt so free and happy in all of my life; the traumatic events do not trouble my thoughts anymore and almost feel as if they never happened to me. My relationship with my family is much stronger and I see the world in a new light. It is truly amazing how this has worked for me. I highly recommend it and I am so honored, that I would be willing to share my experiences.”

  40. FURTHER RESEARCH PhD STUDY 2016 THIS STUDY ENTAILS THE DEVELOPMENT OF AN EMDR INTENSIVE TREATMENT MODEL DELIVERED TO PATIENTS DAILY FOR UP TO 20 SESSIONS AND WILL COMPARE THIS TO WEEKLY TREATMENT AS USUAL. THE STUDY WILL BE CONDUCTED WITHIN IAPT ISLE OFWIGHT BY JACKY SMITH, WITH SUPERVISOR DEREK FARRELL, WORCESTER UNIVERSITY & FUNDED BY THE EMDR ASSOCIATION.

  41. References • EHLERS, A., CLARK, D. M., HACKMANN, A., GREY, N., LINESS, S., WILD, J., ET AL. (2010). INTENSIVE COGNITIVE THERAPY FOR PTSD: A FEASIBILITY STUDY. BEHAVIOURAL AND COGNITIVE PSYCHOTHERAPY, 38(4), 383–398. • GREY, EARL. (2011) A PILOT STUDY OF CONCENTRATED EMDR. A BRIEF REPORT. JOURNAL OF EMDR PRACTICE AND RESEARCH, VOLUME 5, NUMBER 1 • LOBENSTINE, FARNSWORTH; COURTNEY, DEBORAH. A CASE STUDY: THE INTEGRATION OF INTENSIVE EMDR & EGO STATE TO TREAT CO MORBID TO TREAT PTSD, DEPRESSION & ANXIETY. JOURNAL OF EMDR PRACTICE AND RESEARCH, VOLUME 7, NUMBER 2, 2013, PP. 65-80(16)

  42. references • Shapiro, F. (1989). Eye movement desensitization: A new treatment for post-traumatic stress disorder. Journal of Behaviour Therapy and Experimental Psychiatry, 20(3),211-7. • Wesson, M., & Gould, M. (2009). Intervening early with EMDR on military operations. Journal of EMDR Practice and Research, 3(2), 91–97.

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