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Acceptability and delivery of an offer of access to EMDR for depression, posttraumatic stress, and burnout in healthcare workers exposed to COVID-19: a randomized controlled trial within a cohort

Year: 2026

Type: article

Abstract: Healthcare workers (HCWs) were highly exposed to COVID-19 and often experienced anxiety, depression, burnout, and posttraumatic stress disorder (PTSD). The HARD trial assessed the effect of being offered access to EMDR therapy on HCWs with COVID-19-related psychological symptoms. This cohort-embedded randomized trial enrolled 849 HCWs exposed to COVID-19. Participants completed online assessments every 3 months for 12 months. Those scoring above predefined thresholds for PTSD, depression, or burnout were randomized (1:1) to an offer of access to EMDR or to usual care alone. Outcomes compared 6-month changes in PTSD, depression, and burnout symptoms, and EMDR compliance was evaluated. A total of 237 eligible cohort participants were randomized in the HARD trial. Among the 118 subjects of the intervention offer, 73 (62%) consented to EMDR sessions, and of these, 38 (52%) received EMDR sessions (median 7, IQR 4 to 12 sessions). Primary analysis estimated a mean difference between groups from baseline to 6 months post-randomization of -0.61 (p = 0.77) for the PTSD score, -1.17 (p = 0.18) for the depression score, and 0.32 (p = 0.72) for the burnout subdimension. Improvements favoring the intervention offer group were observed for depressive symptoms and PTSD avoidance at 12 months. In this pragmatic trial, uptake and adherence to an offer of EMDR among symptomatic HCWs were limited. No statistically significant between-group differences were detected in the prespecified six-month primary outcomes, although the study recruited substantially fewer participants than planned and was therefore underpowered, treatment exposure varied substantially, and the intervention was not subject to systematic fidelity monitoring. These findings primarily provide information about real-world acceptability (a modest 62% consent rate) and delivery (only 52% of consenting participants used the intervention). Our ability to draw conclusions about potential effectiveness of EMDR, if used, however, was limited by the law rate of consent to access the intervention among those offered program access and the law rate of usage among those who did not consent.

Source: Scientific Reports

DOI: 10.1038/s41598-026-73880-2