Early online EMDR group therapy delivered by midwives for prevention and treatment of trauma sequalae in post-partum women: a pragmatic, exploratory randomised controlled pilot trial, set within the MRC guidelines (2000) for developing and evaluating complex interventions

Abstract

Background: The shortage of mental health professionals is a global concern. In response, the WHO (2008, 2013) recommended task shifting mental healthcare to non specialised healthcare providers in an “integrated” approach to mental health. This study explores a strategy of preventative public health intervention for women at risk of the negative effects of trauma in the perinatal period by task shifting a trauma focused EMDR intervention to non-mental health professionals.

Aim: The study aimed to develop and test the feasibility and acceptability of a midwifery guided, early online EMDR group intervention (EMDRm-VGTEP) in a clinical setting.

Methods: This was a sequential mixed methods multiphase study guided by the MRC framework (2008, 2010, 2021) including a systematic literature review and meta analysis, a pre pilot intervention, development of a midwifery manual, and a randomised controlled parallel pilot feasibility trial and a focus group. Descriptive statistics and effect sizes were calculated for quantitative outcome data and qualitative data were subject to thematic analysis (Braun and Clarke). Research ethics was obtained from OREC (The Office for Research and Ethics, Northern Ireland).

Results: The systematic literature review and meta-analysis indicated that early psychological interventions are effective in reducing post-traumatic stress symptoms in women following birth related trauma when delivered by midwives and clinicians.

The RCT pilot feasibility included a sample of 70 women who were prescreened during the COVID-19 Pandemic and 21 consented to take part. Fourteen eligible women were randomised to EMDRm-VGTEP or Care as Usual groups.

Findings highlight the therapeutic benefits of tacit trauma processing within a peer group. The timing, delivery, and content of the early EMDRm-VGTEP intervention was acceptable. History taking and screening in a trauma informed pathway of care for appropriate triage and referral was acceptable in clinical practice.

Conclusion: Findings indicate a requirement for flexibility of online group teletherapy and in person delivery. Further testing and development may be assessed in a programme of capacity building of trauma focused perinatal mental health provision. Recommendations for education, policy and practice are presented.

Thesis is embargoed until 31st October 2025

Date of Award	Oct 2023
Original language	English
Supervisor	Marlene Sinclair (Supervisor), Patricia Gillen (Supervisor), Julie McCullough (Supervisor) & Paul Miller (Supervisor)