Randomized controlled trial: Comparing the effectiveness of brief group cognitive behavioural therapy and group eye movement desensitisation and reprocessing interventions for PTSD in internally displaced persons, administered by paraprofessionals in Northern Iraq

Structured abstract
Background and aims
In 2023, 339 million people need humanitarian assistance due to emergencies. In those contexts, prevention and treatment of Post-Traumatic Stress Disorder (PTSD) are extremely important. Trauma Focussed Cognitive Behavioural Therapy (TF-CBT) and Eye Movement Desensitisation and Reprocessing (EMDR) are recommended treatments but their deployment comes up against various obstacles, especially in Low- and Middle-Income Countries (LMIC) where mental health professionals are rare. Developing evidence-based, brief, group interventions by paraprofessionals might be an option for scaling up.

Methods
The research has been conducted in northern Iraq, in a complex on-going emergency setting. After one psycho-education session on trauma, adults over 18 years of age, willing to participate to the program and with IES-R (Impact Event Scale-Revised, Weiss & Marmar, 1997) score superior or equal to 33 were randomly assigned to TF-CBT or EMDR Group-Traumatic Episode Protocol (G-TEP) interventions. Eighty-six men and women, internally displaced, living in camps, received six sessions of either TF-CBT (n = 46) or EMDR G-TEP (n = 40) in groups settings. Measures included IES-R, Hospital Depression Scales (HADS, (Zigmond & Snaith, 1983)) at admission and after six sessions. Statistical analysis has been done on participants that have attended at least sessions one and six of the protocols. For each group (TF-CBT and G-TEP), results between pre-treatment and post-treatment were compared using Student's t-test paired for quantitative variables and chi-square paired for qualitative variables to measure the effectiveness of each treatment. All tests were bilateral and were considered significant at p < 0.05.

Results
Results in the TF-CBT group showed a significant reduction in IES-R (t = 7.38; p = 0.001; Effect Size= 1.088), HAD-Depression (t = 6.03; p = 0.001; Effect Size= 0.889) and HAD-Anxiety (t = 6.34; p = 0.001; Effect Size=0.934). Results in the EMDR- G-TEP group showed a significant reduction in IES-R (t = 4.63; p< 0.001; Effect Size= 0.732), HAD-Depression (t = 3.12; p = 0.003; Effect Size=0.494) and HAD-Anxiety (t = 3.01; p = 0.005; Effect Size=0.475). Both populations remained clinical, despite a significant treatment effect. There was no statistical difference between the two treatments.

Conclusions
Findings open the possibility to scale up EMDR G-TEP or TF-CBT interventions in groups conducted by paraprofessionals for reducing PTSD symptomatology within humanitarian programs.