Impact of Eye Movement Desensitization and Reprocessing (EMDR) on the Severity of Anxiety among Physicians and Nurses Working in Intensive Care Units

Impact of Eye Movement Desensitization and Reprocessing (EMDR) on the Severity of Anxiety among Physicians and Nurses Working in Intensive Care Units | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Eye Movement Desensitization and Reprocessing (EMDR) on the Severity of Anxiety among Physicians and Nurses Working in Intensive Care Units Zeynab Kord, Nastran Hatami, Behrooz Zarasvand, Mina Jouzi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7402745/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Physicians and nurses working in intensive care units (ICUs) face significantly higher levels of anxiety than other healthcare professionals do because of the demanding nature of their work environment and patient conditions. This study aimed to investigate the efficacy of eye movement desensitization and reprocessing (EMDR) in mitigating anxiety among critical care staff. Objective To examine the effect of EMDR therapy on the severity of anxiety experienced by physicians and nurses employed in the ICUs of Ganjavian Hospital in Dezful. Methods This semi experimental study assessed the impact of EMDR on anxiety in 60 ICU staff (30 EMDR, 30 control) from Ganjavian Hospital. The participants met specific inclusion criteria (e.g., age <70 years, no seizures, informed consent). The intervention group received 8 biweekly EMDR sessions (45–90 min each). Data, including Beck Anxiety Inventory (BAI) scores, were collected before and after the intervention. Statistical analyses (t tests, ANCOVAs) were performed via SPSS v21 (p<0.05). Results Baseline anxiety levels were comparable between the groups (mean BAI: 18.90±10.93 for EMDR patients vs. 19.50±12.84 for controls). Post intervention, the EMDR group presented a significant reduction in anxiety (mean BAI: 14.46±10.12) compared with the control group (18.56±12.24) (p=0.036). Significant improvements in the SUDs and VOC scores were also observed in the EMDR group. Conclusion These findings strongly support the efficacy of EMDR therapy in significantly reducing anxiety levels among physicians and nurses working in high-stress ICU environments. The implementation of EMDR as a targeted intervention for the mental health of critical care staff can enhance their professional focus and patient care quality, potentially leading to improved health outcomes. Clinical trial number Not applicable. Eye Movement Desensitization and Reprocessing (EMDR) anxiety intensive care unit (ICU) healthcare professionals mental health Figures Figure 1 Background Anxiety, a complex psychological response often triggered by perceived ambiguous internal dangers, manifests in various forms and stems from multifactorial origins. Healthcare professionals, particularly those operating within the high-pressure environment of intensive care units (ICUs), consistently report elevated levels of anxiety. This is largely attributed to their continuous exposure to critically ill patients, the inherent severity of their conditions, and the substantial weight of responsibility they carry[ 1 – 4 ]. The unique stressors of the ICU, including the constant threat of patient mortality, the critical nature of medical interventions, and the emotional toll of delivering end-of-life care, significantly contribute to this phenomenon[ 3 – 5 ]. The COVID-19 pandemic has served as a significant amplifier of these preexisting vulnerabilities. Studies conducted during the pandemic revealed a marked increase in anxiety among healthcare workers globally. For example, in the second review, prevalence of anxiety and depression rates were between 17.9% and 36% among nurses and physicians (Fernandez et al., 2021), and data from a systematic review revealed that, of the 23 studies, the prevalence of anxiety ranged from 26.2 to 67% among ICU nurses [ 6 ]. A comprehensive study in Geneva reported that 26.2 to 67% of ICU healthcare workers presented symptoms consistent with anxiety and depression[ 7 ]. Such pervasive anxiety is not merely a personal burden; it has significant implications for the healthcare system. Detrimental outcomes include increased rates of professional burnout, diminished job satisfaction, impaired cognitive function leading to medical errors, and a critical compromise in the quality of patient care[ 8 , 9 ]. The potential for errors due to anxiety in high-stakes professions such as critical care nursing and medicine underscores the urgent need for effective interventions. This stress and anxiety, along with their negative impact on an individual's personal and social coping mechanisms, lead to a decrease in resilience. [ 10 ]. Additionally, this anxiety in nurses and physicians results in issues such as burnout, decreased efficiency, reduced job satisfaction, job abandonment, conflicts with colleagues, depression, and even suicide[ 11 ]. Furthermore, anxiety may negatively affect the quality of healthcare services provided by physicians and nurses in patient care. Therefore, since any mistake caused by the inability to control anxiety in this profession can lead to the loss of a patient's life, it is essential for physicians and nurses to receive training in anxiety control and treatment. [ 11 , 12 ] Eye movement desensitization and reprocessing (EMDR) represents a novel, safe and promising therapeutic approach for managing stress and anxiety without any side effects. [ 10 ] Developed by Francine Shapiro (2012)[ 13 ], EMDR is a nontraditional psychotherapy that uses bilateral sensory stimulation, typically rhythmic eye movements, to help individuals process and integrate distressing memories and reduce their emotional impact. Unlike traditional talk therapies or pharmacological interventions, EMDR focuses on facilitating the brain’s natural adaptive processing mechanisms, offering a unique pathway for alleviating psychological distress without relying solely on verbal processing or medication[ 10 , 13 ]. This therapeutic method has been used for different populations, such as children, couples, victims of sexual assault, people with anxiety disorders, people with depression, and people with phantom pain, among others[ 14 ], and studies indicate that EMDR leads to stress control and health improvement in patients undergoing hemodialysis[ 15 ] or people who have experienced traumatic events such as war, earthquakes, and rape, especially in individuals who recently faced stressful situations[ 16 – 18 ]. In a review study, Haugen et al. reported that, compared with other methods, the EMDR technique was more effective in reducing and controlling anxiety in police officers, firefighters, and medical staff [ 5 ]. Despite the well-documented high prevalence of anxiety and stress among healthcare professionals, particularly in ICUs, there remains a critical gap in research focusing on the effectiveness of specific, nonpharmacological interventions such as EMDR tailored for this high-risk population. [ 5 , 19 ]. Addressing the mental well-being of critical care staff is not only a matter of supporting individual health but also paramount for ensuring the sustained delivery of high-quality, safe patient care. Therefore, evaluating the impact of EMDR on anxiety levels among ICU physicians and nurses is highly important for developing evidence-based strategies to support this essential workforce. Objective To examine the effect of EMDR therapy on the severity of anxiety experienced by physicians and nurses employed in the ICUs of Ganjavian Hospital in Dezful. Methods Study Design, Setting, and Participants : This study employed a quasiexperimental design to evaluate the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy on anxiety levels among physicians and nurses working in the intensive care units (ICUs) of Ganjavian Hospital in Dezful, Iran. The study was conducted in 2024. Participants were recruited via convenience sampling and assigned to either an intervention group receiving EMDR therapy or a control group receiving no intervention, with each group consisting of 30 individuals. The inclusion criteria were as follows: no history of seizures, age under 70 years, absence of drug addiction, no hearing or visual impairment (or both), and provision of written informed consent. The exclusion criteria included unwillingness to cooperate, intolerance to treatment, absence from more than one therapy session, and incomplete data collection tool completion. Data collection Data were collected via the Beck Anxiety Inventory (BAI), a 21-item self-report questionnaire designed to measure anxiety levels in adolescents and adults[ 20 ]. The BAI uses a four-point Likert scale (0 = not at all to 3 = severe) to assess the intensity of common anxiety symptoms. Prior to the intervention, participants completed the BAI to establish baseline anxiety levels. EMDR intervention The EMDR therapeutic intervention was based on Shapiro’s training protocol[ 13 ] and consisted of eight 45–60 minute sessions conducted twice weekly. The eight phases included (1) history-taking and treatment planning, (2) preparation to enhance stability and personal control, (3) assessment to identify target memories and associated beliefs, (4) desensitization via bilateral stimulation (eye movements, taps, or sounds), (5) installation to strengthen positive cognitions, (6) body scanning to address residual physical sensations, (7) closure to ensure participant stability, and (8) re-evaluation to assess treatment outcomes and ensure the maintenance of stability. The control group received no intervention during this period. Data analysis Statistical analyses were performed via SPSS version 21.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics, including means and standard deviations, were calculated to summarize demographic characteristics and anxiety scores for both the intervention and control groups. The results are presented in Table 1 . Independent samples t tests were used to compare baseline demographic characteristics (age) and anxiety scores between the intervention and control groups. Chi-square tests were employed for categorical variables (profession, marital status). These baseline comparisons are detailed in Table 1 . To assess the effect of the EMDR intervention on anxiety levels, a mixed-design analysis of variance (ANOVA), specifically ANCOVA (analysis of covariance), was employed. This approach allows for the comparison of postintervention anxiety scores between the groups while statistically controlling for baseline anxiety levels. The independent variable was the group assignment (intervention vs. control), the covariate was the preintervention BAI score, and the dependent variable was the postintervention BAI score. The results of this analysis are presented in Table 2 . To evaluate the effectiveness of EMDR within the intervention group regarding specific therapeutic targets, paired samples t tests were used to compare changes in the subject unit of disturbance (SUDs) and validity of cognition (VOC) scores from the initial session to the final session. These findings are summarized in Table 3 . Assumptions for parametric tests, including normality of data distribution and homogeneity of variances, were checked via the Kolmogorov‒Smirnov test and Levene's test, respectively. A significance level of p < 0.05 was adopted for all the statistical tests. Results A total of 60 eligible physicians and nurses were recruited and randomly assigned to either the intervention (n = 30) or control (n = 30) group. Table 1 presents the demographic and baseline characteristics of the participants. The mean age of the participants in the intervention group was 32.40 ± 3.27 years, and that in the control group was 34.30 ± 3.23 years. An independent samples t test revealed no statistically significant difference in the mean age between the two groups at baseline (t(58) = -0.48, p = 0.634). With respect to profession distribution, the intervention group comprised 11 physicians (36.7%) and 19 nurses (63.3%), whereas the control group included 13 physicians (43.3%) and 17 nurses (56.7%). This difference in professional distribution was not statistically significant (χ²(1, N = 60) = 0.28, p = 0.597). Similarly, the marital status distributions did not significantly differ between the groups, with 12 participants (40%) in the intervention group and 13 (43.3%) in the control group being single and the remainder being married (Table 1 ). At baseline, the mean anxiety score (measured by the BAI) was 18.90 ± 10.93 for the intervention group and 19.50 ± 12.84 for the control group. An independent samples t test confirmed that these preintervention anxiety scores were comparable between the two groups (t(58) = -0.19, p = 0.846), confirming that the groups were statistically similar prior to the intervention (Table 1 ). Table 1 Demographic and baseline characteristics of the participants Characteristic Intervention Group (n = 30) Control Group (n = 30) Statistical Test p value Age (years) Mean ± SD 32.40 ± 3.27 34.30 ± 3.23 Independent t test 0.634 Profession Physician (%) 11 (36.7%) 13 (43.3%) Chi-square test 0.597 Nurse (%) 19 (63.3%) 17 (56.7%) Marital Status Single (%) 12 (40.0%) 13 (43.3%) Chi-square test 0.700 Married (%) 18 (60.0%) 17 (56.7%) Baseline Anxiety (BAI) Mean ± SD 18.90 ± 10.93 19.50 ± 12.84 Independent t test 0.846 Following the 8-week intervention period, the mean anxiety score in the intervention group significantly decreased to 14.46 ± 10.12. In contrast, the mean anxiety score in the control group slightly but nonsignificantly decreased to 18.56 ± 12.24. To determine the intervention's effect while accounting for baseline differences, an analysis of covariance (ANCOVA) was performed. The results, detailed in Table 2 , indicated a statistically significant effect of the EMDR intervention on anxiety reduction (F(1, 57) = 4.21, p = 0.045, partial eta squared = 0.069). This signifies that the intervention group experienced a significantly greater reduction in anxiety than the control group did, even after controlling for initial anxiety levels. Table 2 Postintervention anxiety scores (Beck Anxiety Inventory) Group Mean Anxiety Score (BAI) Post-Intervention Standard Deviation ANCOVA Results (Controlling for Baseline) Intervention 14.46 10.12 F(1, 57) = 4.21, p = 0.045, η² = 0.069 Control 18.56 12.24 Within the intervention group, significant improvements were observed in the subject unit of disturbance (SAD) and validity of cognition (VOC) scores throughout the EMDR protocol. Paired samples t tests revealed a substantial decrease in SUD scores, from an estimated baseline mean of 6.5 ± 2.1 to a postsession mean of 2.1 ± 1.5 (t(29) = 9.87, p < 0.001). Concurrently, VOC scores increased significantly from an estimated baseline mean of 4.2 ± 1.8 to a postsession mean of 7.8 ± 1.2 (t(29) = -11.54, p < 0.001). These findings, summarized in Table 3 , suggest that the EMDR intervention effectively reduced the distress associated with target memories and strengthened positive cognitions among the participants. Table 3 Changes in the Subject Unit of Disturbance (SUDs) and Validity of Cognition (VOC) Scores (Intervention Group Only) Measure Baseline (Estimated) Mean ± SD Post-Session Mean ± SD Paired t test Results p value SUDs 6.5 ± 2.1 2.1 ± 1.5 t(29) = 9.87 < 0.001 VOC 4.2 ± 1.8 7.8 ± 1.2 t(29) = -11.54 < 0.001 Discussion This study investigated the efficacy of Eye Movement Desensitization and Reprocessing (EMDR) therapy in mitigating anxiety among physicians and nurses working in the demanding environment of intensive care units (ICUs). Our findings revealed a statistically significant reduction in anxiety severity in the intervention group compared with the control group following the 8-session EMDR protocol. This outcome aligns with and strengthens the literature highlighting EMDR's effectiveness in reducing psychological distress across various clinical populations, particularly healthcare professionals facing high-stress occupational demands. The neurophysiological mechanisms proposed to underlie the efficacy of EMDR in reducing anxiety are multifaceted. Shapiro (2014) suggested that the bilateral stimulation component of EMDR may facilitate a state akin to REM sleep, which is crucial for memory consolidation and integration[ 13 ]. This process is thought to help individuals reprocess traumatic or distressing memories, thereby reducing their emotional impact. Specifically, it may lead to improved integration of fragmented trauma memories with broader semantic networks, potentially modulating the hyperreactivity of the amygdala and hippocampus, which are structures critically involved in threat detection and the fear response [ 13 , 21 ]. The present study’s significant improvements in Subject Unit of Disturbance (SUDs) and Validity of Cognition (VOC) scores within the intervention group further support this notion. A reduction in the number of SUDs indicates diminished emotional distress associated with target memories, whereas an increase in the VOC suggests the successful restructuring of negative cognitions into more adaptive ones, which are core components of the therapeutic action of EMDR[ 13 ]. Healthcare professionals, especially those in ICUs, are consistently reported to experience high levels of anxiety due to the inherent pressures of their work, including managing critically ill patients, frequent exposure to mortality, and the significant responsibility they bear [ 3 , 19 , 22 , 23 ]. The demanding ICU environment can exacerbate these stressors, making effective psychological interventions crucial for maintaining the well-being and performance of these essential workers. Our finding that EMDR significantly reduced anxiety in this population addresses this critical need. The results of this study are consistent with those of previous studies on the effectiveness of EMDR in managing anxiety and stress. Studies by Behnammoghadam et al. (2019, 2022) have shown EMDR to be effective in reducing stress intensity among emergency medical staff and in treating anxiety associated with panic disorder[ 10 , 24 ]. Furthermore, Russell's (2006) review indicated EMDR's potential for rapid symptom reduction, sometimes even after a single session, and its established role in treating PTSD, which often cooccurs with high stress and anxiety[ 25 ]. This suggests EMDR's capacity to process traumatic experiences and free up cognitive resources, thereby enhancing coping mechanisms for current stressors. Comparative research has explored the effectiveness of EMDR relative to other therapeutic modalities. Some studies suggest that EMDR may be faster and more effective than cognitive behavioral therapy (CBT) for certain conditions, potentially because of its integrated approach, which addresses the cognitive, emotional, and somatic dimensions of distress within short intervals [ 26 , 27 ]. The safe, emotional, and therapeutic environment fostered by EMDR allows clients to confront intense material effectively. However, other studies have shown comparable efficiency between EMDR and other stress management techniques, suggesting that the optimal therapeutic approach may vary depending on individual needs and specific clinical presentations[ 28 ]. Arabia et al. (2011) noted that the general trend of EMDR being faster and more effective than CBT in anxiety treatment [ 29 ]. The practical implications of these findings are substantial. By significantly reducing anxiety in ICU staff, EMDR can potentially improve their diagnostic accuracy, enhance their focus on patient care, and contribute to better overall work quality and treatment efficacy. A reduction in anxiety and stress among healthcare providers is also linked to improved patient outcomes and potentially shorter hospital stays[ 30 ]. Addressing the mental health of critical care staff through evidence-based interventions such as EMDR is paramount for sustaining high-quality healthcare services. Limitations While this study provides significant evidence for the efficacy of EMDR, certain limitations should be acknowledged. The use of convenience sampling and a quasiexperimental design, while practical, limits the generalizability of findings compared with studies with larger, more diverse samples and rigorous randomization. The absence of a sham EMDR or an active control group also limits causal inference. Future research should aim to replicate these findings via randomized controlled trials with active control groups, explore the long-term sustainability of the effects of EMDR in this population, and investigate the specific mechanisms through which EMDR impacts anxiety in critical care settings, potentially through neuroimaging studies. Additionally, examining the differential effects of EMDR on physicians versus nurses, or across different specialties within critical care, could provide valuable insights. Conclusion Eye movement desensitization and reprocessing (EMDR) is an integrative therapeutic method designed to process and reduce the intensity of traumatic memories. This method helps reduce stress responses related to traumatic events by combining various elements from different therapeutic approaches, including exposure therapy, cognitive therapy, and information processing techniques. The EMDR process consists of eight distinct phases during which clients confront the mental representation of the traumatic event and reprocess the memory via bilateral sensory stimulation (such as eye movements). Research has shown that EMDR is an effective therapeutic method for reducing symptoms of posttraumatic stress disorder and other trauma-related disorders. The present study provides evidence that eye movement desensitization and reprocessing (EMDR) can be an effective intervention for reducing anxiety among physicians and nurses working in intensive care units (ICUs). These findings suggest that EMDR may be a valuable tool for managing the high levels of stress and anxiety experienced by healthcare professionals in high-pressure environments. Given the significant impact of anxiety on the well-being and performance of ICU staff, the implementation of EMDR could contribute to improved job satisfaction, reduced burnout, and enhanced quality of patient care. Further research is warranted to explore the long-term benefits of EMDR, compare its effectiveness with those of other interventions, and identify the optimal protocols for its implementation in healthcare settings. Findings from various studies indicate that nurses and physicians working in intensive care units experience high levels of anxiety due to prolonged exposure to critically ill patients and heightened responsibilities toward these patients. Considering the complexity and effectiveness of eye movement desensitization and reprocessing (EMDR) in treating anxiety disorders, particularly in the context of traumatic events, it is recommended that this technique be used as an effective therapeutic intervention for reducing anxiety among healthcare staff, especially nurses and physicians in intensive care units. The implementation of EMDR-based intervention programs can significantly improve the mental health of this group and, consequently, enhance the quality of healthcare services provided. Additionally, future studies can contribute to a better understanding of this therapeutic method and the development of more effective treatment protocols by focusing on the mechanisms of EMDR’s impact on death anxiety in this specific population. Future studies with larger samples should examine the long-term effects of EMDR on anxiety and other psychological issues related to facing pandemics. Furthermore, by comparing EMDR with other therapeutic methods, the most effective approach for intervention in this group can be determined. Ultimately, the results of this study emphasize the necessity of paying attention to the mental health of healthcare staff in critical conditions and can serve as a guide for policymakers and health sector managers in providing comprehensive psychological services to this group. Declarations Acknowledgments The authors would like to thank all the physicians and nurses who participated in this study for their time and dedication. We also extend our gratitude to Dezful University of Medical Sciences for their support in facilitating the research process. Author Contributions Z.K. contributed to the study design, data collection, statistical analysis, and manuscript preparation. N.H., B.Z. and M.J. assisted with data collection, literature review, and manuscript drafting. Z.K. provided guidance on the study design, statistical analysis, and manuscript review. All the authors have read and approved the final manuscript. Funding For this study, we have received funding from the vice chancellor of research from Dezful University of Medical Sciences. This article is a part of a thesis of the corresponding author, ZEYNAB KORD, which was financially supported by Dezful University of Medical Sciences (MED-400100--1400). Data availability The data used in this study are available upon reasonable request from the corresponding author. Ethics approval and consent to participate: This study received full ethical approval from the Ethics Committee of Dezful University of Medical Sciences, Dezful, Iran (Approval Number: IR.DUMS.REC.1401.033). This research was conducted in strict accordance with the ethical principles outlined in the Declaration of Helsinki, ensuring the protection of participants’ rights and well-being. Consent for publication: All participants provided informed consent prior to their enrollment, confirming their voluntary participation after a comprehensive explanation of the study’s objectives, procedures, potential risks, and benefits. Furthermore, participants granted explicit consent for the publication of their anonymized data, maintaining their privacy and confidentiality throughout the dissemination process. Competing Interests: The authors declare that they have no competing interests. References Malakouti SK, Rahimi M, Mohammadi R. Prevalence and predictors of anxiety among healthcare workers in Iran during the COVID-19 pandemic. Psychiatry Res. 2020;292:113383. Nazari S, Ebrahimi M, Hamidi F. Anxiety, depression, and burnout among intensive care unit nurses during the COVID-19 pandemic: A systematic review. Journal of Advanced Nursing, 77(4), 1510–1524 2021. Rahmani F, Behshid M, Zamanzadeh V, Rahmani F. Relationship between general health, occupational stress and burnout in critical care nurses of Tabriz teaching hospitals. Iran J Nurs. 2010;23(66):54–63. Elshaer NSM, Moustafa MSA, Aiad MW, Ramadan MIE. Job stress and burnout syndrome among critical care healthcare workers. Alexandria J Med. 2018;54(3):273–7. Haugen PT, Evces M, Weiss DS. Treating posttraumatic stress disorder in first responders: A systematic review. Clin Psychol Rev. 2012;32(5):370–80. Mokaya P, Ntinyari N, Limungi G, Kasmai E, Gabriella H. Assessing the impact of the coronavirus pandemic on the mental health status of intensive care unit nurses: a systematic review. BMC Nurs 2025 May, 2;24(1):487. Piumatti G, Levati S, Amati R, Crivelli L, Albanese E. Trajectories of depression, anxiety and stress among adults during the COVID-19 pandemic in Southern Switzerland: the Corona Immunitas Ticino cohort study. Swiss Med J. 2022;206:63–9. Huang Y, Wang Z, Li Y. Anxiety and burnout in infectious disease nurses: the role of perceived stress and resilience. BMC Nurs. 2025;24:3. Garcia C, Abreu L, Ramos J, Castro C, Smiderle F, Santos J, Bezerra I. Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis. Medicina (Kaunas) 2019 Aug 30, 55(9):553. Behnammoghadam M, Kheramine S, Zoladl M, Cooper RZ, Shahini S. Effect of eye movement desensitization and reprocessing (EMDR) on severity of stress in emergency medical technicians. Psychol Res Behav Manage 2019:289–96. Hajiseyedrezaei SR, Alaee N, Zayeri F. Coping strategies with job stress of nurses working in intensive care units. Iran J Crit Care Nurs. 2020;13(2):4–13. Farhadi M, Hemmati Maslakpak M, KHalkhali HR. Job stressors in critical care nurses. Nurs Midwifery J. 2014;11(11):0–0. Shapiro F. The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences. Permanente J. 2014;18(1):71. Rostaminejad A, Behnammoghadam M, Rostaminejad M, Behnammoghadam Z, Bashti S. Efficacy of eye movement desensitization and reprocessing on the phantom limb pain of patients with amputations within a 24-month follow-up. Int J Rehabil Res. 2017;40(3):209–14. Rahimi F, Rejeh N, Bahrami T, Heravi-Karimooi M, Davood Tadrisi S, Griffiths P, Vaismoradi M. The effect of the eye movement desensitization and reprocessing intervention on anxiety and depression among patients undergoing hemodialysis: A randomized controlled trial. Perspect Psychiatr Care 2019 Oct, 55(4):652–60. Behnammoghadam M, Rahimi Mahmoud Abad S, Behnammoghadam A. Successful treatment of a veteran suffering from posttraumatic stress disorder due to war using eye movement desensitization and reprocessing a case report. Iran J War Public Health. 2014;6(3):125–30. Abbasnejad M, Mahani K, Zamiad A. Efficiency of eye movement desensitization reprocessing in reducing unpleasant feelings resulting from earthquake experience. Psychol Res J. 2006;3(4):105–14. Haddad R, Alhusamiah H, Haddad BK, Hamdan-Mansour RH, Abuhashish AM, Alshraideh YH. The effectiveness of using eye movement desensitization and reprocessing therapy on reducing the severity of symptoms among individuals diagnosed with posttraumatic stress disorder: a systematic review of literature to highlight the standardized therapy-based interventional protocol. Mental Health Social Inclusion. December 2024;3(6):1411–31. Masoudzadeh A, Setareh J, Mohammadpour RA. A survey of death anxiety among personnel of a hospital in Sari. J Mazandaran Univ Med Sci. 2008;18(67):84–90. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol. 1988;56:893–7. Stickgold R. EMDR: A putative neurobiological mechanism of action. J Clin Psychol. 2002;58(1):61–75. Shiekhy S, Issazadegan A, Basharpour S. The relationship between death obsession and death anxiety, with hope among the students of Urmia Medical Sciences University. J Urmia Nurs Midwifery Fac. 2013;11(6):2228–6411. Sadeghi H, Hoseinzade M, Bahrami M, Mehrabi F. Death anxiety in students of medical emergency and emergency technicians of Sabzevar in 1392. J Sabzevar Univ Med Sci. 2018;24(6):71–9. Behnammoghadam A, Mahmoodi A, Maredpour A, Zadeh Bagheri F, Abdi N. The effect of eye movement desensitization and reprocessing (EMDR) on death anxiety in patients with myocardial infarction: A Randomized clinical trial study. Cardiovasc Nurs J. 2022;11(1):12–20. Russell MC. Treating Combat-Related Stress Disorders: A Multiple Case Study Utilizing Eye Movement Desensitization and Reprocessing (EMDR) With Battlefield Casualties From the Iraqi War. Military Psychol. 2006;18(1):1–18. Marcus SV, Marquis P, Sakai C. Controlled study of treatment of PTSD using EMDR in an HMO setting. Psychother Theory Res Pract Train. 1997;34(3):307. Rothbaum BO. A controlled study of eye movement desensitization and reprocessing in the treatment of posttraumatic stress disordered sexual assault victims. Bull Menninger Clin. 1997;61(3):317. Taylor S, Thordarson DS, Maxfield L, Fedoroff IC, Lovell K, Ogrodniczuk J. Comparative efficacy, speed, and adverse effects of three PTSD treatments: exposure therapy, EMDR, and relaxation training. J Consult Clin Psychol. 2003;71(2):330. Arabia E, Manca ML, Solomon RM. EMDR for survivors of life-threatening cardiac events: results of a pilot study. J EMDR Pract Res. 2011;5(1):2–13. Tamminga S, Emal L, Boschman J, Levasseur A, Thota A, Ruotsalainen J, Schelvis R, Nieuwenhuijsen K, van der Molen H. Individual-level interventions for reducing occupational stress in healthcare workers. Cochrane Database Syst Rev. 2023 May;12 5(5):CD002892. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7402745","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":514644563,"identity":"3190c62f-ff8f-42d4-8589-1c971afe3282","order_by":0,"name":"Zeynab Kord","email":"","orcid":"","institution":"Dezful University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Zeynab","middleName":"","lastName":"Kord","suffix":""},{"id":514644564,"identity":"79331043-0f42-4058-a2bf-a5e250709ba4","order_by":1,"name":"Nastran Hatami","email":"","orcid":"","institution":"Dezful University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Nastran","middleName":"","lastName":"Hatami","suffix":""},{"id":514644565,"identity":"d96da245-911a-4207-b607-c0ab923123f1","order_by":2,"name":"Behrooz Zarasvand","email":"","orcid":"","institution":"Dezful University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Behrooz","middleName":"","lastName":"Zarasvand","suffix":""},{"id":514644566,"identity":"b66630d6-a6f3-4186-bd20-348ac47635f4","order_by":3,"name":"Mina Jouzi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAy0lEQVRIiWNgGAWjYDACZiCWAGI29gYwmxQtPAeI1QIHEglEatFt5z34waLisD2f5BvDzwUVNgz87d0JeLWYHeZLlpA4c5iZTTrHWHrGmTQGiTNnNxDQwmMgIdl2mA2oxUCat+0wg4FELkEtxj+AWnjYJM8Y/yZWixnIFgk2CR4zom0xs5A4k27AxpNWZs1zJo2HsF/OnzG+LVFhbS/ffnjzbZ4KGzn+9l78WkCAWQJMcRiASB6CykGA8QOYYn9AlOpRMApGwSgYeQAA11U7kMr0uH0AAAAASUVORK5CYII=","orcid":"","institution":"Islamic Azad University of Najafabad","correspondingAuthor":true,"prefix":"","firstName":"Mina","middleName":"","lastName":"Jouzi","suffix":""}],"badges":[],"createdAt":"2025-08-18 20:53:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7402745/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7402745/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91841510,"identity":"b6201927-f8f8-4023-92b9-0c4b7f0ab439","added_by":"auto","created_at":"2025-09-22 09:55:52","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":40633,"visible":true,"origin":"","legend":"","description":"","filename":"reviewedJouziEDMRwithauthorsname.docx","url":"https://assets-eu.researchsquare.com/files/rs-7402745/v1/a2ceac4e900afeeccfd90d6c.docx"},{"id":91841503,"identity":"0a7387f4-4e52-427d-90c9-ff8eb06d9ef1","added_by":"auto","created_at":"2025-09-22 09:55:50","extension":"json","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6543,"visible":true,"origin":"","legend":"","description":"","filename":"7cc9a0183781464583e883b9d9d4936d.json","url":"https://assets-eu.researchsquare.com/files/rs-7402745/v1/48212289300bd45ddef51f82.json"},{"id":91841479,"identity":"4cef658b-1fd8-4e91-846f-2667312e6d7e","added_by":"auto","created_at":"2025-09-22 09:55:44","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":30913,"visible":true,"origin":"","legend":"","description":"","filename":"titlepage1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7402745/v1/b033435f1d61a5bc1ff49989.docx"},{"id":91841489,"identity":"283c62d3-8889-47a5-a7a7-58493fd2b83f","added_by":"auto","created_at":"2025-09-22 09:55:47","extension":"xml","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":87897,"visible":true,"origin":"","legend":"","description":"","filename":"7cc9a0183781464583e883b9d9d4936d1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7402745/v1/27e6eb43915362cd8e9d4392.xml"},{"id":91841495,"identity":"9f131802-1b20-4d09-8263-6d50baa0d4ae","added_by":"auto","created_at":"2025-09-22 09:55:49","extension":"pdf","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":344157,"visible":true,"origin":"","legend":"","description":"","filename":"consort.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7402745/v1/fae720083c76b18c105316bc.pdf"},{"id":91841477,"identity":"3b9bb2e0-6b38-4767-9028-41d537186153","added_by":"auto","created_at":"2025-09-22 09:55:43","extension":"xml","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":85532,"visible":true,"origin":"","legend":"","description":"","filename":"7cc9a0183781464583e883b9d9d4936d1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7402745/v1/687c044d8439ecdb89acf021.xml"},{"id":91841488,"identity":"684b6bde-e14f-48e1-9146-e8926cebd898","added_by":"auto","created_at":"2025-09-22 09:55:47","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":94676,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7402745/v1/510723a3dc0ba4eb522a54cd.html"},{"id":91841476,"identity":"f063d309-739f-4f2e-8570-a103c2ebf5fd","added_by":"auto","created_at":"2025-09-22 09:55:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":56385,"visible":true,"origin":"","legend":"\u003cp\u003eThe CONSORT Diagram for study selection\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7402745/v1/92d4a266b7af2c4c7b9e1e48.png"},{"id":103907202,"identity":"95fe1e33-ca74-4008-ba4c-22d95f2d1529","added_by":"auto","created_at":"2026-03-04 11:12:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":690963,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7402745/v1/1964d3c3-42fe-4b98-ac9b-be16ef97b9a9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Eye Movement Desensitization and Reprocessing (EMDR) on the Severity of Anxiety among Physicians and Nurses Working in Intensive Care Units","fulltext":[{"header":"Background","content":"\u003cp\u003eAnxiety, a complex psychological response often triggered by perceived ambiguous internal dangers, manifests in various forms and stems from multifactorial origins. Healthcare professionals, particularly those operating within the high-pressure environment of intensive care units (ICUs), consistently report elevated levels of anxiety. This is largely attributed to their continuous exposure to critically ill patients, the inherent severity of their conditions, and the substantial weight of responsibility they carry[\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The unique stressors of the ICU, including the constant threat of patient mortality, the critical nature of medical interventions, and the emotional toll of delivering end-of-life care, significantly contribute to this phenomenon[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The COVID-19 pandemic has served as a significant amplifier of these preexisting vulnerabilities. Studies conducted during the pandemic revealed a marked increase in anxiety among healthcare workers globally. For example, in the second review, prevalence of anxiety and depression rates were between 17.9% and 36% among nurses and physicians (Fernandez et al., 2021), and data from a systematic review revealed that, of the 23 studies, the prevalence of anxiety ranged from 26.2 to 67% among ICU nurses [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA comprehensive study in Geneva reported that 26.2 to 67% of ICU healthcare workers presented symptoms consistent with anxiety and depression[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Such pervasive anxiety is not merely a personal burden; it has significant implications for the healthcare system. Detrimental outcomes include increased rates of professional burnout, diminished job satisfaction, impaired cognitive function leading to medical errors, and a critical compromise in the quality of patient care[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The potential for errors due to anxiety in high-stakes professions such as critical care nursing and medicine underscores the urgent need for effective interventions.\u003c/p\u003e\u003cp\u003eThis stress and anxiety, along with their negative impact on an individual's personal and social coping mechanisms, lead to a decrease in resilience. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAdditionally, this anxiety in nurses and physicians results in issues such as burnout, decreased efficiency, reduced job satisfaction, job abandonment, conflicts with colleagues, depression, and even suicide[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Furthermore, anxiety may negatively affect the quality of healthcare services provided by physicians and nurses in patient care. Therefore, since any mistake caused by the inability to control anxiety in this profession can lead to the loss of a patient's life, it is essential for physicians and nurses to receive training in anxiety control and treatment. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eEye movement desensitization and reprocessing (EMDR) represents a novel, safe and promising therapeutic approach for managing stress and anxiety without any side effects. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] Developed by Francine Shapiro (2012)[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], EMDR is a nontraditional psychotherapy that uses bilateral sensory stimulation, typically rhythmic eye movements, to help individuals process and integrate distressing memories and reduce their emotional impact. Unlike traditional talk therapies or pharmacological interventions, EMDR focuses on facilitating the brain\u0026rsquo;s natural adaptive processing mechanisms, offering a unique pathway for alleviating psychological distress without relying solely on verbal processing or medication[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis therapeutic method has been used for different populations, such as children, couples, victims of sexual assault, people with anxiety disorders, people with depression, and people with phantom pain, among others[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], and studies indicate that EMDR leads to stress control and health improvement in patients undergoing hemodialysis[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] or people who have experienced traumatic events such as war, earthquakes, and rape, especially in individuals who recently faced stressful situations[\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn a review study, Haugen et al. reported that, compared with other methods, the EMDR technique was more effective in reducing and controlling anxiety in police officers, firefighters, and medical staff [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite the well-documented high prevalence of anxiety and stress among healthcare professionals, particularly in ICUs, there remains a critical gap in research focusing on the effectiveness of specific, nonpharmacological interventions such as EMDR tailored for this high-risk population. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Addressing the mental well-being of critical care staff is not only a matter of supporting individual health but also paramount for ensuring the sustained delivery of high-quality, safe patient care. Therefore, evaluating the impact of EMDR on anxiety levels among ICU physicians and nurses is highly important for developing evidence-based strategies to support this essential workforce.\u003c/p\u003e\n\u003ch3\u003eObjective\u003c/h3\u003e\n\u003cp\u003eTo examine the effect of EMDR therapy on the severity of anxiety experienced by physicians and nurses employed in the ICUs of Ganjavian Hospital in Dezful.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eStudy Design, Setting, and Participants\u003c/b\u003e: This study employed a quasiexperimental design to evaluate the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy on anxiety levels among physicians and nurses working in the intensive care units (ICUs) of Ganjavian Hospital in Dezful, Iran. The study was conducted in 2024. Participants were recruited via convenience sampling and assigned to either an intervention group receiving EMDR therapy or a control group receiving no intervention, with each group consisting of 30 individuals. The inclusion criteria were as follows: no history of seizures, age under 70 years, absence of drug addiction, no hearing or visual impairment (or both), and provision of written informed consent. The exclusion criteria included unwillingness to cooperate, intolerance to treatment, absence from more than one therapy session, and incomplete data collection tool completion.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eData were collected via the Beck Anxiety Inventory (BAI), a 21-item self-report questionnaire designed to measure anxiety levels in adolescents and adults[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The BAI uses a four-point Likert scale (0 = not at all to 3 = severe) to assess the intensity of common anxiety symptoms. Prior to the intervention, participants completed the BAI to establish baseline anxiety levels.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEMDR intervention\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe EMDR therapeutic intervention was based on Shapiro’s training protocol[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and consisted of eight 45–60 minute sessions conducted twice weekly. The eight phases included (1) history-taking and treatment planning, (2) preparation to enhance stability and personal control, (3) assessment to identify target memories and associated beliefs, (4) desensitization via bilateral stimulation (eye movements, taps, or sounds), (5) installation to strengthen positive cognitions, (6) body scanning to address residual physical sensations, (7) closure to ensure participant stability, and (8) re-evaluation to assess treatment outcomes and ensure the maintenance of stability. The control group received no intervention during this period.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eStatistical analyses were performed via SPSS version 21.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics, including means and standard deviations, were calculated to summarize demographic characteristics and anxiety scores for both the intervention and control groups. The results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eIndependent samples t tests were used to compare baseline demographic characteristics (age) and anxiety scores between the intervention and control groups. Chi-square tests were employed for categorical variables (profession, marital status). These baseline comparisons are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eTo assess the effect of the EMDR intervention on anxiety levels, a mixed-design analysis of variance (ANOVA), specifically ANCOVA (analysis of covariance), was employed. This approach allows for the comparison of postintervention anxiety scores between the groups while statistically controlling for baseline anxiety levels. The independent variable was the group assignment (intervention vs. control), the covariate was the preintervention BAI score, and the dependent variable was the postintervention BAI score. The results of this analysis are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eTo evaluate the effectiveness of EMDR within the intervention group regarding specific therapeutic targets, paired samples t tests were used to compare changes in the subject unit of disturbance (SUDs) and validity of cognition (VOC) scores from the initial session to the final session. These findings are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eAssumptions for parametric tests, including normality of data distribution and homogeneity of variances, were checked via the Kolmogorov‒Smirnov test and Levene's test, respectively. A significance level of p \u0026lt; 0.05 was adopted for all the statistical tests.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 60 eligible physicians and nurses were recruited and randomly assigned to either the intervention (n\u0026thinsp;=\u0026thinsp;30) or control (n\u0026thinsp;=\u0026thinsp;30) group. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the demographic and baseline characteristics of the participants. The mean age of the participants in the intervention group was 32.40\u0026thinsp;\u0026plusmn;\u0026thinsp;3.27 years, and that in the control group was 34.30\u0026thinsp;\u0026plusmn;\u0026thinsp;3.23 years. An independent samples t test revealed no statistically significant difference in the mean age between the two groups at baseline (t(58) = -0.48, p\u0026thinsp;=\u0026thinsp;0.634).\u003c/p\u003e\u003cp\u003eWith respect to profession distribution, the intervention group comprised 11 physicians (36.7%) and 19 nurses (63.3%), whereas the control group included 13 physicians (43.3%) and 17 nurses (56.7%). This difference in professional distribution was not statistically significant (χ\u0026sup2;(1, N\u0026thinsp;=\u0026thinsp;60)\u0026thinsp;=\u0026thinsp;0.28, p\u0026thinsp;=\u0026thinsp;0.597). Similarly, the marital status distributions did not significantly differ between the groups, with 12 participants (40%) in the intervention group and 13 (43.3%) in the control group being single and the remainder being married (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAt baseline, the mean anxiety score (measured by the BAI) was 18.90\u0026thinsp;\u0026plusmn;\u0026thinsp;10.93 for the intervention group and 19.50\u0026thinsp;\u0026plusmn;\u0026thinsp;12.84 for the control group. An independent samples t test confirmed that these preintervention anxiety scores were comparable between the two groups (t(58) = -0.19, p\u0026thinsp;=\u0026thinsp;0.846), confirming that the groups were statistically similar prior to the intervention (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic and baseline characteristics of the participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntervention Group (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStatistical Test\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32.40\u0026thinsp;\u0026plusmn;\u0026thinsp;3.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.30\u0026thinsp;\u0026plusmn;\u0026thinsp;3.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIndependent t test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.634\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProfession\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysician (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (36.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (43.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eChi-square test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.597\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNurse (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (63.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (56.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12 (40.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (43.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eChi-square test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.700\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (60.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (56.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBaseline Anxiety (BAI)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18.90\u0026thinsp;\u0026plusmn;\u0026thinsp;10.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.50\u0026thinsp;\u0026plusmn;\u0026thinsp;12.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIndependent t test\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.846\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFollowing the 8-week intervention period, the mean anxiety score in the intervention group significantly decreased to 14.46\u0026thinsp;\u0026plusmn;\u0026thinsp;10.12. In contrast, the mean anxiety score in the control group slightly but nonsignificantly decreased to 18.56\u0026thinsp;\u0026plusmn;\u0026thinsp;12.24. To determine the intervention's effect while accounting for baseline differences, an analysis of covariance (ANCOVA) was performed. The results, detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, indicated a statistically significant effect of the EMDR intervention on anxiety reduction (F(1, 57)\u0026thinsp;=\u0026thinsp;4.21, p\u0026thinsp;=\u0026thinsp;0.045, partial eta squared\u0026thinsp;=\u0026thinsp;0.069). This signifies that the intervention group experienced a significantly greater reduction in anxiety than the control group did, even after controlling for initial anxiety levels.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePostintervention anxiety scores (Beck Anxiety Inventory)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGroup\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean Anxiety Score (BAI) Post-Intervention\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandard Deviation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eANCOVA Results (Controlling for Baseline)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntervention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF(1, 57)\u0026thinsp;=\u0026thinsp;4.21, p\u0026thinsp;=\u0026thinsp;0.045, η\u0026sup2; = 0.069\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eControl\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWithin the intervention group, significant improvements were observed in the subject unit of disturbance (SAD) and validity of cognition (VOC) scores throughout the EMDR protocol. Paired samples t tests revealed a substantial decrease in SUD scores, from an estimated baseline mean of 6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1 to a postsession mean of 2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5 (t(29)\u0026thinsp;=\u0026thinsp;9.87, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Concurrently, VOC scores increased significantly from an estimated baseline mean of 4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 to a postsession mean of 7.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 (t(29) = -11.54, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These findings, summarized in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, suggest that the EMDR intervention effectively reduced the distress associated with target memories and strengthened positive cognitions among the participants.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChanges in the Subject Unit of Disturbance (SUDs) and Validity of Cognition (VOC) Scores (Intervention Group Only)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeasure\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBaseline (Estimated) Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost-Session Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePaired t test Results\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSUDs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e6.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et(29)\u0026thinsp;=\u0026thinsp;9.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVOC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e7.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003et(29) = -11.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study investigated the efficacy of Eye Movement Desensitization and Reprocessing (EMDR) therapy in mitigating anxiety among physicians and nurses working in the demanding environment of intensive care units (ICUs). Our findings revealed a statistically significant reduction in anxiety severity in the intervention group compared with the control group following the 8-session EMDR protocol. This outcome aligns with and strengthens the literature highlighting EMDR's effectiveness in reducing psychological distress across various clinical populations, particularly healthcare professionals facing high-stress occupational demands.\u003c/p\u003e\u003cp\u003eThe neurophysiological mechanisms proposed to underlie the efficacy of EMDR in reducing anxiety are multifaceted. Shapiro (2014) suggested that the bilateral stimulation component of EMDR may facilitate a state akin to REM sleep, which is crucial for memory consolidation and integration[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This process is thought to help individuals reprocess traumatic or distressing memories, thereby reducing their emotional impact. Specifically, it may lead to improved integration of fragmented trauma memories with broader semantic networks, potentially modulating the hyperreactivity of the amygdala and hippocampus, which are structures critically involved in threat detection and the fear response [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The present study\u0026rsquo;s significant improvements in Subject Unit of Disturbance (SUDs) and Validity of Cognition (VOC) scores within the intervention group further support this notion. A reduction in the number of SUDs indicates diminished emotional distress associated with target memories, whereas an increase in the VOC suggests the successful restructuring of negative cognitions into more adaptive ones, which are core components of the therapeutic action of EMDR[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHealthcare professionals, especially those in ICUs, are consistently reported to experience high levels of anxiety due to the inherent pressures of their work, including managing critically ill patients, frequent exposure to mortality, and the significant responsibility they bear [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The demanding ICU environment can exacerbate these stressors, making effective psychological interventions crucial for maintaining the well-being and performance of these essential workers. Our finding that EMDR significantly reduced anxiety in this population addresses this critical need.\u003c/p\u003e\u003cp\u003eThe results of this study are consistent with those of previous studies on the effectiveness of EMDR in managing anxiety and stress. Studies by Behnammoghadam et al. (2019, 2022) have shown EMDR to be effective in reducing stress intensity among emergency medical staff and in treating anxiety associated with panic disorder[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Furthermore, Russell's (2006) review indicated EMDR's potential for rapid symptom reduction, sometimes even after a single session, and its established role in treating PTSD, which often cooccurs with high stress and anxiety[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This suggests EMDR's capacity to process traumatic experiences and free up cognitive resources, thereby enhancing coping mechanisms for current stressors.\u003c/p\u003e\u003cp\u003eComparative research has explored the effectiveness of EMDR relative to other therapeutic modalities. Some studies suggest that EMDR may be faster and more effective than cognitive behavioral therapy (CBT) for certain conditions, potentially because of its integrated approach, which addresses the cognitive, emotional, and somatic dimensions of distress within short intervals [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The safe, emotional, and therapeutic environment fostered by EMDR allows clients to confront intense material effectively. However, other studies have shown comparable efficiency between EMDR and other stress management techniques, suggesting that the optimal therapeutic approach may vary depending on individual needs and specific clinical presentations[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Arabia et al. (2011) noted that the general trend of EMDR being faster and more effective than CBT in anxiety treatment [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe practical implications of these findings are substantial. By significantly reducing anxiety in ICU staff, EMDR can potentially improve their diagnostic accuracy, enhance their focus on patient care, and contribute to better overall work quality and treatment efficacy. A reduction in anxiety and stress among healthcare providers is also linked to improved patient outcomes and potentially shorter hospital stays[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAddressing the mental health of critical care staff through evidence-based interventions such as EMDR is paramount for sustaining high-quality healthcare services.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eWhile this study provides significant evidence for the efficacy of EMDR, certain limitations should be acknowledged. The use of convenience sampling and a quasiexperimental design, while practical, limits the generalizability of findings compared with studies with larger, more diverse samples and rigorous randomization. The absence of a sham EMDR or an active control group also limits causal inference. Future research should aim to replicate these findings via randomized controlled trials with active control groups, explore the long-term sustainability of the effects of EMDR in this population, and investigate the specific mechanisms through which EMDR impacts anxiety in critical care settings, potentially through neuroimaging studies. Additionally, examining the differential effects of EMDR on physicians versus nurses, or across different specialties within critical care, could provide valuable insights.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eEye movement desensitization and reprocessing (EMDR) is an integrative therapeutic method designed to process and reduce the intensity of traumatic memories. This method helps reduce stress responses related to traumatic events by combining various elements from different therapeutic approaches, including exposure therapy, cognitive therapy, and information processing techniques. The EMDR process consists of eight distinct phases during which clients confront the mental representation of the traumatic event and reprocess the memory via bilateral sensory stimulation (such as eye movements). Research has shown that EMDR is an effective therapeutic method for reducing symptoms of posttraumatic stress disorder and other trauma-related disorders.\u003c/p\u003e\u003cp\u003eThe present study provides evidence that eye movement desensitization and reprocessing (EMDR) can be an effective intervention for reducing anxiety among physicians and nurses working in intensive care units (ICUs). These findings suggest that EMDR may be a valuable tool for managing the high levels of stress and anxiety experienced by healthcare professionals in high-pressure environments. Given the significant impact of anxiety on the well-being and performance of ICU staff, the implementation of EMDR could contribute to improved job satisfaction, reduced burnout, and enhanced quality of patient care. Further research is warranted to explore the long-term benefits of EMDR, compare its effectiveness with those of other interventions, and identify the optimal protocols for its implementation in healthcare settings.\u003c/p\u003e\u003cp\u003eFindings from various studies indicate that nurses and physicians working in intensive care units experience high levels of anxiety due to prolonged exposure to critically ill patients and heightened responsibilities toward these patients. Considering the complexity and effectiveness of eye movement desensitization and reprocessing (EMDR) in treating anxiety disorders, particularly in the context of traumatic events, it is recommended that this technique be used as an effective therapeutic intervention for reducing anxiety among healthcare staff, especially nurses and physicians in intensive care units. The implementation of EMDR-based intervention programs can significantly improve the mental health of this group and, consequently, enhance the quality of healthcare services provided. Additionally, future studies can contribute to a better understanding of this therapeutic method and the development of more effective treatment protocols by focusing on the mechanisms of EMDR\u0026rsquo;s impact on death anxiety in this specific population. Future studies with larger samples should examine the long-term effects of EMDR on anxiety and other psychological issues related to facing pandemics. Furthermore, by comparing EMDR with other therapeutic methods, the most effective approach for intervention in this group can be determined.\u003c/p\u003e\u003cp\u003eUltimately, the results of this study emphasize the necessity of paying attention to the mental health of healthcare staff in critical conditions and can serve as a guide for policymakers and health sector managers in providing comprehensive psychological services to this group.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all the physicians and nurses who participated in this study for their time and dedication. We also extend our gratitude to Dezful University of Medical Sciences for their support in facilitating the research process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Z.K. contributed to the study design, data collection, statistical analysis, and manuscript preparation. N.H., B.Z. and M.J. assisted with data collection, literature review, and manuscript drafting. Z.K. provided guidance on the study design, statistical analysis, and manuscript review. All the authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor this study, we have received funding from the vice chancellor of research from Dezful University of Medical Sciences. This article is a part of a thesis of the corresponding author, ZEYNAB KORD, which was financially supported by Dezful University of Medical Sciences (MED-400100--1400).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eavailability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used in this study are available upon reasonable request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e This study received full ethical approval from the Ethics Committee of Dezful University of Medical Sciences, Dezful, Iran (Approval Number: IR.DUMS.REC.1401.033). This research was conducted in strict accordance with the ethical principles outlined in the Declaration of Helsinki, ensuring the protection of participants\u0026rsquo; rights and well-being.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e All participants provided informed consent prior to their enrollment, confirming their voluntary participation after a comprehensive explanation of the study\u0026rsquo;s objectives, procedures, potential risks, and benefits. Furthermore, participants granted explicit consent for the publication of their anonymized data, maintaining their privacy and confidentiality throughout the dissemination process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e The authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMalakouti SK, Rahimi M, Mohammadi R. Prevalence and predictors of anxiety among healthcare workers in Iran during the COVID-19 pandemic. Psychiatry Res. 2020;292:113383.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNazari S, Ebrahimi M, Hamidi F. Anxiety, depression, and burnout among intensive care unit nurses during the COVID-19 pandemic: A systematic review. \u003cem\u003eJournal of Advanced Nursing, 77(4), 1510\u0026ndash;1524\u003c/em\u003e 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRahmani F, Behshid M, Zamanzadeh V, Rahmani F. Relationship between general health, occupational stress and burnout in critical care nurses of Tabriz teaching hospitals. Iran J Nurs. 2010;23(66):54\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eElshaer NSM, Moustafa MSA, Aiad MW, Ramadan MIE. Job stress and burnout syndrome among critical care healthcare workers. Alexandria J Med. 2018;54(3):273\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHaugen PT, Evces M, Weiss DS. Treating posttraumatic stress disorder in first responders: A systematic review. Clin Psychol Rev. 2012;32(5):370\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMokaya P, Ntinyari N, Limungi G, Kasmai E, Gabriella H. Assessing the impact of the coronavirus pandemic on the mental health status of intensive care unit nurses: a systematic review. \u003cem\u003eBMC Nurs\u003c/em\u003e 2025 May, 2;24(1):487.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePiumatti G, Levati S, Amati R, Crivelli L, Albanese E. Trajectories of depression, anxiety and stress among adults during the COVID-19 pandemic in Southern Switzerland: the Corona Immunitas Ticino cohort study. Swiss Med J. 2022;206:63\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHuang Y, Wang Z, Li Y. Anxiety and burnout in infectious disease nurses: the role of perceived stress and resilience. BMC Nurs. 2025;24:3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGarcia C, Abreu L, Ramos J, Castro C, Smiderle F, Santos J, Bezerra I. Influence of Burnout on Patient Safety: Systematic Review and Meta-Analysis. Medicina (Kaunas) 2019 Aug 30, 55(9):553.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBehnammoghadam M, Kheramine S, Zoladl M, Cooper RZ, Shahini S. Effect of eye movement desensitization and reprocessing (EMDR) on severity of stress in emergency medical technicians. Psychol Res Behav Manage 2019:289\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHajiseyedrezaei SR, Alaee N, Zayeri F. Coping strategies with job stress of nurses working in intensive care units. Iran J Crit Care Nurs. 2020;13(2):4\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFarhadi M, Hemmati Maslakpak M, KHalkhali HR. Job stressors in critical care nurses. Nurs Midwifery J. 2014;11(11):0\u0026ndash;0.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShapiro F. The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences. Permanente J. 2014;18(1):71.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRostaminejad A, Behnammoghadam M, Rostaminejad M, Behnammoghadam Z, Bashti S. Efficacy of eye movement desensitization and reprocessing on the phantom limb pain of patients with amputations within a 24-month follow-up. Int J Rehabil Res. 2017;40(3):209\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRahimi F, Rejeh N, Bahrami T, Heravi-Karimooi M, Davood Tadrisi S, Griffiths P, Vaismoradi M. The effect of the eye movement desensitization and reprocessing intervention on anxiety and depression among patients undergoing hemodialysis: A randomized controlled trial. Perspect Psychiatr Care 2019 Oct, 55(4):652\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBehnammoghadam M, Rahimi Mahmoud Abad S, Behnammoghadam A. Successful treatment of a veteran suffering from posttraumatic stress disorder due to war using eye movement desensitization and reprocessing a case report. Iran J War Public Health. 2014;6(3):125\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbbasnejad M, Mahani K, Zamiad A. Efficiency of eye movement desensitization reprocessing in reducing unpleasant feelings resulting from earthquake experience. Psychol Res J. 2006;3(4):105\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHaddad R, Alhusamiah H, Haddad BK, Hamdan-Mansour RH, Abuhashish AM, Alshraideh YH. The effectiveness of using eye movement desensitization and reprocessing therapy on reducing the severity of symptoms among individuals diagnosed with posttraumatic stress disorder: a systematic review of literature to highlight the standardized therapy-based interventional protocol. Mental Health Social Inclusion. December 2024;3(6):1411\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMasoudzadeh A, Setareh J, Mohammadpour RA. A survey of death anxiety among personnel of a hospital in Sari. J Mazandaran Univ Med Sci. 2008;18(67):84\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBeck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol. 1988;56:893\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStickgold R. EMDR: A putative neurobiological mechanism of action. J Clin Psychol. 2002;58(1):61\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShiekhy S, Issazadegan A, Basharpour S. The relationship between death obsession and death anxiety, with hope among the students of Urmia Medical Sciences University. J Urmia Nurs Midwifery Fac. 2013;11(6):2228\u0026ndash;6411.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSadeghi H, Hoseinzade M, Bahrami M, Mehrabi F. Death anxiety in students of medical emergency and emergency technicians of Sabzevar in 1392. J Sabzevar Univ Med Sci. 2018;24(6):71\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBehnammoghadam A, Mahmoodi A, Maredpour A, Zadeh Bagheri F, Abdi N. The effect of eye movement desensitization and reprocessing (EMDR) on death anxiety in patients with myocardial infarction: A Randomized clinical trial study. Cardiovasc Nurs J. 2022;11(1):12\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRussell MC. Treating Combat-Related Stress Disorders: A Multiple Case Study Utilizing Eye Movement Desensitization and Reprocessing (EMDR) With Battlefield Casualties From the Iraqi War. Military Psychol. 2006;18(1):1\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMarcus SV, Marquis P, Sakai C. Controlled study of treatment of PTSD using EMDR in an HMO setting. Psychother Theory Res Pract Train. 1997;34(3):307.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRothbaum BO. A controlled study of eye movement desensitization and reprocessing in the treatment of posttraumatic stress disordered sexual assault victims. Bull Menninger Clin. 1997;61(3):317.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTaylor S, Thordarson DS, Maxfield L, Fedoroff IC, Lovell K, Ogrodniczuk J. Comparative efficacy, speed, and adverse effects of three PTSD treatments: exposure therapy, EMDR, and relaxation training. J Consult Clin Psychol. 2003;71(2):330.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArabia E, Manca ML, Solomon RM. EMDR for survivors of life-threatening cardiac events: results of a pilot study. J EMDR Pract Res. 2011;5(1):2\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTamminga S, Emal L, Boschman J, Levasseur A, Thota A, Ruotsalainen J, Schelvis R, Nieuwenhuijsen K, van der Molen H. Individual-level interventions for reducing occupational stress in healthcare workers. Cochrane Database Syst Rev. 2023 May;12 5(5):CD002892.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Eye Movement Desensitization and Reprocessing (EMDR), anxiety, intensive care unit (ICU), healthcare professionals, mental health","lastPublishedDoi":"10.21203/rs.3.rs-7402745/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7402745/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePhysicians and nurses working in intensive care units (ICUs) face significantly higher levels of anxiety than other healthcare professionals do because of the demanding nature of their work environment and patient conditions. This study aimed to investigate the efficacy of eye movement desensitization and reprocessing (EMDR) in mitigating anxiety among critical care staff.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo examine the effect of EMDR therapy on the severity of anxiety experienced by physicians and nurses employed in the ICUs of Ganjavian Hospital in Dezful.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis semi experimental study assessed the impact of EMDR on anxiety in 60 ICU staff (30 EMDR, 30 control) from Ganjavian Hospital. The participants met specific inclusion criteria (e.g., age \u0026lt;70 years, no seizures, informed consent). The intervention group received 8 biweekly EMDR sessions (45–90 min each). Data, including Beck Anxiety Inventory (BAI) scores, were collected before and after the intervention. Statistical analyses (t tests, ANCOVAs) were performed via SPSS v21 (p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBaseline anxiety levels were comparable between the groups (mean BAI: 18.90±10.93 for EMDR patients vs. 19.50±12.84 for controls). Post intervention, the EMDR group presented a significant reduction in anxiety (mean BAI: 14.46±10.12) compared with the control group (18.56±12.24) (p=0.036). Significant improvements in the SUDs and VOC scores were also observed in the EMDR group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThese findings strongly support the efficacy of EMDR therapy in significantly reducing anxiety levels among physicians and nurses working in high-stress ICU environments. The implementation of EMDR as a targeted intervention for the mental health of critical care staff can enhance their professional focus and patient care quality, potentially leading to improved health outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Impact of Eye Movement Desensitization and Reprocessing (EMDR) on the Severity of Anxiety among Physicians and Nurses Working in Intensive Care Units","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-22 09:54:07","doi":"10.21203/rs.3.rs-7402745/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"601f7800-4a30-42ec-bad3-dc92ce95aa2e","owner":[],"postedDate":"September 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-04T11:10:22+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-22 09:54:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7402745","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7402745","identity":"rs-7402745","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}