A research portfolio exploring remote interventions for psychological trauma, including 'Efficacy and feasibility of remote one-to-one interventions for psychological trauma - a systematic review' and, 'We are always learning' - a qualitative inquiry into the experiences of clinicians adapting to remote trauma interventions throughout COVID-19

• Main Author: Adams, Pearse
• Format: Dissertation
• Language: English
• Published: University of Edinburgh 2022
• Subjects: clinicians; psychological intervention; remote therapy; Trauma
• DOI: 10.7488/era/2678

BACKGROUND: The onset of COVID-19 brought significant change to the structure and delivery of mental health services. As such, the need for a clear evidence base and understanding of remote interventions for mental health difficulties such as psychological trauma are of utmost importance. The examination of interventions has generally lacked in quality and scope. Moreover, this evidence has rarely accounted for the experiences of those involved in the delivery of interventions. METHOD: To this end, the current portfolio utilises two research methods to examine this phenomenon. Firstly, a systematic review of quantitative papers assessed the efficacy, feasibility, and overall study quality of one-to-one remote interventions for psychological trauma. Findings were presenting using a narrative synthesis of 15 empirical papers. Secondly, an empirical paper employed a predominantly qualitative mixed-methods design to explore individual lived experiences of clinicians utilising trauma interventions remotely throughout COVID-19. A background questionnaires as well as individual interviews were used, whilst Interpretative Phenomenological Analysis (IPA) was applied to explore the lived experiences of clinicians specific to the recent context of working with psychological trauma remotely. RESULTS: The systematic review indicated good efficacy for a variety of manualised treatments for psychological trauma delivered remotely. In addition, such findings were found to be comparable to traditional, face-to-face conditions. Efficacy was supported by large effect sizes, as well as feasibility in relation to client satisfaction and clinician fidelity in particular. However, there was an overall limited quality of included studies, with specific issues found relating to uptake, attrition and controlling for confounders. Results of the empirical paper reported changes to caseloads and perceived ability of different forms of delivery, as well as yielding four superordinate themes: 'Progressing the trauma treatment journey', Building a Therapeutic Relationship Remotely', 'Learning over time', and 'Creating change in how we work'. CONCLUSIONS: Findings from the review contribute to the evidence base for clinicians actively engaged in remote interventions for psychological trauma. However, the lack of quality and predominant account of short-term, Type 1 trauma limits the generalisability to other trauma populations and presentations. Key markers for methodological quality are noted for future researchers, whilst also highlighting the need for both qualitative methods and grey literature. Qualitative findings suggest clinicians can experience both opportunities and challenges when working with trauma remotely, which is impact at both a client and service level. The use of clinicians' accounts provides direct implications to inform services providers in how clinicians may adapt interventions according to the nuances of remote working.