Background and aims: Studies indicate that the prevalence of posttraumatic stress disorder (PTSD) in patients with substance use disorder (SUD) is approximately three times higher than in the general population, ranging from 25.3% to 49%. Emerging research suggests that underlying trauma and adverse life experiences, particularly during childhood, play a significant role in the development and persistence of addictive behaviors. Recent RCTs suggest that EMDR may be effective in treating SUD, improving craving, mood disorders, self-esteem, and dissociative symptoms. However, further large-scale studies are needed to validate these findings. The aim of this study was to conduct the first large RCT examining the impact of EMDR on SUD symptoms in outpatients with a history of psychological trauma, regardless of comorbid severe mental disorders (SMDs) or PTSD. Secondly, to assess EMDR's effect on trauma-related symptoms, psychopathology, and overall functionality, comparing it to treatment as usual (TAU).
Methods: This single-blind randomized controlled trial included 142 outpatients, who were randomly assigned to one of two study arms: (1) EMDR + TAU or (2) TAU only. Various assessment scales were used to evaluate addiction severity, trauma history, current trauma symptoms, PTSD diagnosis, and other psychiatric symptoms at baseline, 6 months, and 12 months.
Results: Both groups showed improvement in craving levels from baseline to post-treatment. However, the EMDR group showed earlier improvement and reported lower craving levels at post-treatment compared to the TAU group. Regarding trauma-related symptoms, both groups significantly improved from baseline to post-treatment, with improvements maintained at the 12-month follow-up. Notably, trauma symptoms were lower in the EMDR group compared to the TAU group, both at post-treatment and at the 12-month follow-up.
Conclusions: This study has shown that EMDR is a well-tolerated and effective therapy for treating trauma symptoms in patients with SUD, also showing a significant impact on substance craving levels.
Abstract topics: Randomized controlled trial, Eye movement desensitization and reprocessing; substance use disorder; dual disorder; Psychological trauma; Craving.

Authors
Dr. Aram Hasan, MD¹,
prof. George Tadros¹,
Prof. Miranda Olff²,
Lizy Wiggins, LCSW^3
1American Center for Psychiatry and Neurology,Abu Dhabi,United Arab Emirates
²Amsterdam UMC,Amsterdam

Introduction
EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapeutic technique that has been shown to be effective in the treatment of trauma and trauma related disorders, such as post-traumatic stress disorder (PTSD), anxiety disorders, depression, and eating disorders. However, the effectiveness of EMDR can vary depending various factors, such as the client's cultural background.
This research project aims to evaluate the effectiveness of EMDR with a culturally adapted approach in a diverse group of patients receiving therapy as usual

Objectives
The primary objective of this research is to compare the effectiveness of a culturally adapted EMDR with as usual in the treatment of trauma and related disorders.
Secondary objectives are:
• To identify the factors that influence the effectiveness of EMDR with a culturally adapted approach.
• To develop guidelines for the implementation of culturally adapted EMDR in clinical settings, based on patients clarifications and beliefs

Methods
Design
Single blind two arm randomized controlled trial.

Participants
120 patients who are on the waiting list for psychotherapy and who meet the criteria for a trauma-related disorder and comorbidity; anxiety, depression and eating disorder

Interventions
• Group 1: EMDR with a culturally adapted approach.
• Group 2: psychotherapy as usual

Assessment measures
• Symptoms of trauma and related disorders (e.g., PTSD scale, anxiety and depression scale) PCL5, GAD 7 and PHQ 9
• (Quality of life scale) QOLS
• Culturally adapted intervention, GPS and i-toolbox (after validation)

Data collection
• Baseline measurements before therapy
• Measurements after 3, 6 sessions of therapy
• Follow-up measurements 3 months after completion of therapy

Data analysis
• The data will be analyzed using appropriate statistical methods to determine the differences between the two groups.

Ethical considerations
• The research will be conducted in accordance with ethical guidelines for research with humans.
• Informed consent will be obtained from all participants.
• The confidentiality of participant data will be protected

Expected results
We expect that EMDR with a culturally adapted approach will be (more) effective as the therapy as usual in the treatment of trauma and related disorders and in the treatment of comorbidity; anxiety, depression and eating disorder in a diverse group of patients.

Significance of the research
This research is important because it can lead to the development of more effective and efficient treatments for trauma and related disorders for people with diverse cultural backgrounds. The findings of this research can also be used to develop guidelines for the implementation of culturally adapted EMDR in clinical settings.

Timeline
The research project is expected to be completed within 2 years

Budget
The budget for this research project, publications fee will be covered by the American center for psychology and Neurology, Abu Dhabi & Dubai , UAE

Funding
We are seeking funding for this research project from grants, foundations, and other funding sources

Research team
The research team will consist of experienced researchers with expertise in trauma, EMDR, and cultural psychology

Conclusion
This research project has the potential to make an important contribution to the treatment of trauma and related disorders in people with diverse cultural backgrounds and reducing the stigma, no shows and drop out . We encourage you to support this research project.

References
1- Nickerson, M 2022. cultural competence and healing culturally based trauma with the EMDR therapy
2- Kirmayer, L. J., & Pedersen, D. (2016). Toward a new architecture for global mental health. Transcultural Psychiatry, 53(6), 703-727.
3- Sue, D. W., & Sue, D. (2016). Counseling the culturally diverse: Theory and practice (7th ed.). John Wiley & Sons.
4- Bhui, K., Warfa, N., & Edonya, P. (2016). Cultural competence in mental health care: A review of the evidence. Mental Health Review Journal, 21(3), 174-192.
5- Bhui, K., & Bhugra, D. (2016). Cultural psychiatry: Principles, research, and clinical applications. CRC Press
6- Schnyder, U. Bryant, R. Ehlers, R. Foa, E. Hasan, A. (2016) Culture-sensitive psychotraumatology. Eur J Psychotraumatol 2016 Jul 28:7:31179

Background and Aims: This symposium presentation aims to build on existing research demonstrating the efficacy of Eye Movement Desensitization Reprocessing Therapy (EMDR) in situations of ongoing trauma. While there is ample research supporting the efficacy of EMDR when addressing past traumatic events, there is a gap in the literature regarding the efficacy of EMDR in situations of ongoing trauma. Emerging research highlights the effectiveness of EMDR in addressing ongoing stress and trauma in various contexts, including cancer patients (Jarero et al., 2018), first responders (Jarero et al., 2019), and individuals experiencing traumatic effects of prolonged isolation during the COVID-19 pandemic (Perri et al., 2021). This study will examine the use of EMDR in the context of the ongoing war in Ukraine, particularly following the Russian invasion in 2022. Specifically, it aims to explore the experiences of Ukrainian counselors utilizing EMDR in situations of continued trauma. Additionally, the study seeks to identify which aspects of EMDR Ukrainian therapists find most useful and effective in this evolving and high-stress environment. Researchers will concentrate on addressing the following two key questions:

What are the experiences of Ukrainian counselors using EMDR in situations of continued trauma?
What aspects of EMDR are observed to be useful by Ukrainian therapists working with clients with ongoing trauma?

Method: Researchers will use the Consensual Qualitative Research (CQR) method for this study. Twelve semi-structured 45-60 minute interviews will be conducted with Ukrainian counselors via zoom. Interviews will be transcribed and coded following CQR guidelines allowing the voices of the participants to be amplified, rather than the reachers’ interpretations.

Results: The study aims to show the efficacy of EMDR during situations of ongoing wartime trauma due to themes that emerged from the in-depth interviews and analyses.

Conclusions: EMDR is a useful protocol to use not only for the reduction of PTSD symptoms due to past trauma but to reduce symptoms of distress in situations of ongoing trauma as well.