Piloting Eye Movement Desensitization and Reprocessing (EMDR) in People Living With HIV and Trauma

People living with HIV experience high psychiatric morbidity with rates of depression, anxiety, and post-traumatic stress symptoms two to three times higher than that of the general population. Compared to the general population, people living with HIV also experience a disproportionately high prevalence of trauma. Trauma can lead to development of post-traumatic stress disorder, mood disorders, and substance use disorder, all of which are associated with poor outcomes with regard to HIV care linkage, care retention, medication adherence, and viral suppression. Eye Movement Desensitization and Reprocessing therapy a time-limited psychotherapy approach that enables people to heal from emotional distress that is the result of disturbing life experiences. The theory underlying Eye Movement Desensitization and Reprocessing therapy is the Adaptive Information Processing Model which suggests that traumatic experiences can overwhelm the brain's natural coping mechanisms, leading to emotional distress. While the biological basis of Eye Movement Desensitization and Reprocessing is still being explored, there is evidence to suggest that it works by increasing cerebral hemisphere connectivity through neuronal activation, similar to those of rapid eye movement and short-wave sleep phases. This exhausts working memory which alters the quality of storage of traumatic memories and reduces the intensity of episodic memories and with this, symptoms of post traumatic stress disorder. Eye Movement Desensitization and Reprocessing therapy facilitates the processing of traumatic memories by accessing and reprocessing them through an eight-phase series of structured techniques. During the desensitizing and reprocessing phase sessions, the Eye Movement Desensitization and Reprocessing therapist guides the client through a series of eye movements or other forms of bilateral stimulation while focusing on the traumatic memory, and the client is encouraged to explore any thoughts, emotions, or physical sensations that arise during the process. Through repeated sessions, Eye Movement Desensitization and Reprocessing helps integrate traumatic memories into a more adaptive, organized form.

Eye Movement Desensitization and Reprocessing has been increasingly used beyond treating post traumatic stress disorder in recent years, and studies have shown its effectiveness in treating other psychological disorders. There is preliminary evidence to suggest that Eye Movement Desensitization and Reprocessing can be a beneficial treatment option for depression and anxiety disorders. Eye Movement Desensitization and Reprocessing protocols have been tailored for specific patient populations including oncology, autism, addiction, combat veterans, sexual abuse survivors, and those who have experienced complex trauma. The use of Eye Movement Desensitization and Reprocessing, however, for relieving HIV-related psychological distress in people living with HIV and trauma is novel. HIV-related psychological distress encompasses changes to emotional status, symptom burden, HIV disclosure distress, and HIV-related stigma.23 Piloting an Eye Movement Desensitization and Reprocessing protocol tailored for people living with HIV and trauma is an important first step in realizing the potential for this modality to relieve HIV-related psychological distress.

Rationale and Specific Aims

The purpose of this project is to assess the feasibility and acceptability of delivering an Eye Movement Desensitization and Reprocessing protocol tailored for people living with HIV and trauma. We hypothesize that delivering an Eye Movement Desensitization and Reprocessing protocol tailored for people living with HIV and trauma will be both feasible and acceptable.

We will recruit 20 people living with HIV and trauma living in Tennessee to complete an eight-session Eye Movement Desensitization and Reprocessing protocol. Session 1 will include Eye Movement Desensitization and Reprocessing Phases 1 and 2 (history taking and treatment preparation and planning). At the end of Session 1, participants will select key targets for reprocessing that include HIV-related and adjacent events. During Sessions 2-8, participants will work through each key target using Eye Movement Desensitization and Reprocessing phases 3-8 (session target selection; desensitization and reprocessing; installation of positive cognition; body scan, closing, and reevaluation).