Perceived Feasibility of Group EMDR Therapy Among Disaster-Affected Adolescents in Turkey: A Convergent Mixed-Methods Study

Perceived Feasibility of Group EMDR Therapy Among Disaster-Affected Adolescents in Turkey: A Convergent Mixed-Methods Study | 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 Perceived Feasibility of Group EMDR Therapy Among Disaster-Affected Adolescents in Turkey: A Convergent Mixed-Methods Study Gulsen Filazoglu Cokluk This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7185934/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background: Adolescents exposed to natural disasters often develop post-traumatic stress disorder. Despite interest in group-based trauma therapies, the feasibility of the Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol among disaster-affected adolescents remains underexplored. This study aimed to evaluate how symptom severity and psychological resilience influence adolescents’ perceptions of the feasibility of Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol. It also sought to identify key barriers and facilitators affecting adolescents’ willingness to participate in such interventions following natural disasters. Methods: A total of 120 adolescents aged 13 to 18 years from earthquake- and flood-affected regions participated in a convergent mixed-methods study using stratified purposive sampling to ensure diversity in gender, exposure severity, and location. Participants completed the Revised Child Post-Traumatic Stress Disorder Symptom Scale, the Connor-Davidson Resilience Scale, and a 15-item Feasibility Questionnaire for Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol. Quantitative data were analyzed using bivariate correlations and linear regression. Qualitative responses to open-ended questions about perceived barriers and facilitators were analyzed using thematic content analysis. Results: Adolescents with higher levels of post-traumatic stress reported lower feasibility scores (r = -0.47, p < .01), while those with higher resilience perceived the intervention as more acceptable (r = 0.35, p < .01). Significant differences were found in feasibility and resilience based on PTSD severity groups (p = .005 and p = .036, respectively). Key barriers included emotional dysregulation, confidentiality concerns, and scheduling difficulties. Facilitators included peer support and the presence of structured preparatory guidance. Conclusions: Perceived feasibility of group-based Eye Movement Desensitization and Reprocessing is shaped by trauma severity and resilience. Psychoeducational preparation, logistical flexibility, and attention to emotional safety are essential to support adolescent engagement in post-disaster mental health interventions. Trial registration: This study is not a clinical trial and was not prospectively registered. It was conducted as an observational mixed-methods feasibility study. Eye Movement Desensitization and Reprocessing group therapy adolescents natural disasters feasibility trauma resilience Background Natural catastrophes like earthquakes, floods, and hurricanes present an enormous risk to the mental health of adolescents ( 1 ). Epidemiological studies indicate that between 20% and 40% of adolescents exposed to natural disasters develop clinically significant symptoms of post-traumatic stress disorder ( 2 , 3 ). As a developmental stage marked by heightened emotional sensitivity and ongoing neurological maturation, adolescence is particularly vulnerable to the lasting effects of trauma. Exposure during this period can disrupt cognitive, emotional, and social development. These risks underscore the urgent need for mental health interventions that are both scalable and evidence-based, and that can be deployed rapidly in disaster-affected populations ( 4 ). Among the most promising approaches is Eye Movement Desensitization and Reprocessing (EMDR) ( 5 ). It is a structured, phase-based psychotherapy widely known for its effectiveness in treating trauma ( 6 ). The EMDR Integrative Group Treatment Protocol (EMDR IGTP) is an adaptation of individual EMDR designed for group settings. It incorporates structured procedures along with art-based techniques such as drawing and the "Butterfly Hug" ( 7 ). These additions aim to enhance participant engagement, support cultural sensitivity, and improve the logistical feasibility of delivering trauma-focused care to large groups ( 8 ). In contrast to one-to-one EMDR, EMDR IGTP is more cost-efficient in terms of therapist time and takes advantage of peer support, a primary resilience element in adolescent recovery ( 9 ). Building on these theoretical advantages, several recent studies have begun to evaluate the clinical utility of EMDR IGTP across various trauma-exposed youth populations. For example, Karadağ (2020) provided Group EMDR to female teenagers with complex PTSD following sexual abuse and found large decreases in trauma and depressive symptom scores (pre–post Cohen's d > 1.1) ( 10 ). Although this clinical trial established the promise of the protocol, its sole targeting of sexual abuse survivors and relatively small sample size (n = 16) preclude broader generalizability to disaster-exposed youth whose trauma profiles and environmental needs might be considerably different. Smyth et al. (2020) filled this knowledge gap by providing EMDR IGTP to Eritrean refugee youth residing in a long-standing emergency camp ( 9 ). Their field research confirmed sizable decreases in PTSD (mean CPSS 5 score from 42.6 to 27.5), depression, and anxiety symptoms, but did not systematically investigate implementation challenges, such as facilitator training inconsistency or security changes, that are characteristic of disaster response environments. Moreover, Mazzoni et al. (2022) also extended EMDR IGTP assessment to recurrent interpersonal trauma, including adolescents, and reported sustained improvement in dissociation and affect regulation at three-month follow-up ( 11 ). However, as a pilot with n = 12 and no control group, it lacked the power to evaluate acceptability in varied cultural settings or to isolate which components of the protocol (art versus bilateral stimulation) underlay reported effects. Likewise, Roque López et al. (2021) integrated EMDR components into a one-week multimodal treatment for youth with multiple childhood traumatic experiences; while they reported robust symptom reduction at two-month follow-up, the overlap of EMDR with other treatment components precludes inferences regarding the solo feasibility and effectiveness of EMDR IGTP ( 3 ). Furthermore, systematic reviews and meta-analyses support EMDR IGTP's potential but also expose important gaps in research. Kaptan et al. (2021) surveyed randomized and nonrandomized group trials of EMDR in children and adults and reported consistent reductions in PTSD and anxiety symptoms but warned against widespread methodological heterogeneity, small numbers, varied dosing schedules, and lack of standardized cultural adaptations, which discourages replication and scaling ( 12 ). Additionally, Xie et al. (2024) in their network meta-analysis of disaster-related interventions identified EMDR to be the most effective modality of PTSD and depression reduction among young populations; however, the authors warned that few direct comparisons between active interventions, publication bias, and poor follow-up reporting limit confidence in long-term effects ( 2 ). Critically, existing research is predominantly focused on post-treatment effectiveness, with little reference to adolescents' pre-treatment perceptions of feasibility and acceptability ( 13 – 15 ). In disaster settings, trauma severity, logistical challenges, and cultural factors often intersect. It is important to understand how adolescents’ symptom burden, resilience, and prior awareness of Eye Movement Desensitization and Reprocessing influence their willingness to engage in treatment ( 16 , 17 ). Although limited research has systematically measured these pre-intervention factors, they play a critical role in determining the success of intervention implementation. For example, individuals with higher severity PTSD might have increased social withdrawal or emotional dysregulation that would hinder group participation ( 4 ), whereas resilient youth may show more openness to new, art-oriented modalities. Additionally, knowledge of EMDR principles might be highly variable in the nonclinical population, influencing perceived safety and therapeutic credibility. Several Turkish studies provide strong evidence for the effectiveness of group EMDR protocols in reducing trauma-related symptoms among youth exposed to disasters. For example, Korkmazlar-Oral, Bozkurt, and Tunca (2020) implemented the EMDR Group Protocol for Children (EMDR-GP/C) with youth aged 6–13 affected by the 2014 Soma mining disaster. The researchers observed a significant reduction in subjective distress (as measured by SUDS ratings) that was sustained at 18-month follow-up. Similarly, Bayhan, Tarquinio, Rydberg, and Korkmazlar (2022) applied group EMDR with both children and mothers after the Soma explosion. They reported significantly greater reductions in PTSD symptoms among the intervention group compared to controls, using the CROPS scale as the outcome measure. A randomized controlled field study by Karadağ and Karadeniz (2021) evaluated the effectiveness of EMDR-IGTP versus a cognitive–behavioral crisis prevention program (CIPCA) in youth aged 8–14 who had survived the 2020 İzmir earthquake. While both interventions led to symptom reductions, EMDR-IGTP showed significantly larger improvements in clinical impressions and distress levels, confirming its utility in acute post-disaster settings. These findings demonstrate that EMDR-IGTP can yield strong therapeutic effects in Turkish adolescent populations affected by various trauma exposures. In addition to its effectiveness, Turkish studies emphasize the high feasibility and acceptability of group EMDR. Banoglu and Korkmazlar (2022) described their experience implementing EMDR-GP with Syrian refugee children and highlighted the protocol’s efficiency, cost-effectiveness, and logistical practicality compared to individual therapy. They reported very low dropout rates—almost 80% lower than in a wait-list control group—underscoring high participant engagement even in displaced or chaotic contexts. Karadağ and Karadeniz (2021) similarly found that adolescents affected by the İzmir earthquake could be rapidly mobilized for intervention. The group format’s structure and embedded peer support appeared to enhance resilience, normalize emotional responses, and increase willingness to engage. Although challenges such as scheduling, confidentiality concerns, and emotional intensity were noted, the trials suggest that adolescents generally find EMDR-IGTP acceptable—especially when facilitators provide psychoeducation and emotional safety planning in advance. Cultural responsiveness emerged as a key success factor across these Turkish studies. For instance, Banoglu and Korkmazlar (2022) created a culturally resonant trauma narrative centered around a “migratory bird,” which was particularly meaningful for Syrian refugee children. They also modified bilateral stimulation (BLS) techniques by replacing the Butterfly Hug with knee tapping—reported as more familiar and less emotionally overwhelming for their sample. These examples reflect how age-appropriate metaphors, culturally tailored stories, and flexible therapeutic tools can optimize both comfort and therapeutic efficacy in Turkish adolescent settings . Overall, the Turkish literature demonstrates that EMDR-IGTP, when adapted thoughtfully to local contexts, can be highly effective, scalable, and acceptable for adolescents recovering from disaster-related trauma. The current study addressed a critical gap in existing research by shifting attention from post-treatment outcomes to adolescents’ pre-treatment perceptions of group-based trauma interventions. Unlike earlier studies that primarily focus on symptom reduction, the present investigation explores how post-traumatic stress severity, resilience, and contextual factors influence adolescents’ perceived feasibility of participating in group Eye Movement Desensitization and Reprocessing. The objective was to identify psychological and logistical factors that affect adolescents’ willingness to engage in EMDR-based group therapy following natural disasters and to generate evidence-based recommendations for optimizing its implementation in school and community settings. By emphasizing pre-intervention perceptions, this study contributes valuable insights to implementation science and offers a strategic framework for integrating EMDR IGTP into rapid-response mental health services for disaster-affected youth. Methodology Study Design This study aimed to examine how adolescents’ levels of post-traumatic stress symptoms and psychological resilience influence their perceived feasibility of group-based Eye Movement Desensitization and Reprocessing therapy using the Integrative Group Treatment Protocol (EMDR-IGTP) in a post-disaster setting. A convergent mixed-methods design was employed to simultaneously collect and integrate quantitative and qualitative data. The study was conducted in three public secondary schools located in Hatay, Turkey—an area significantly affected by recent natural disasters, including earthquakes and floods. Participants and Sampling A total of 120 adolescents aged 13 to 18 years participated in the study. Participants were recruited from school populations based on the following inclusion criteria: (a) direct exposure to a natural disaster within the past 12 months, (b) current enrollment in formal education, and (c) provision of informed assent and parental/guardian consent. Exclusion criteria included any current psychiatric treatment or diagnosis of a severe mental disorder that could interfere with group participation. To ensure a representative range of experiences, stratified purposive sampling was used. Stratification was based on gender, type of disaster exposure, and geographical location. The final sample included both males and females, with varied PTSD symptom severity and resilience levels. Intervention Description Although no formal clinical intervention or treatment outcomes were assessed, participants were introduced to the EMDR Integrative Group Treatment Protocol (IGTP) as part of a structured psychoeducational process. EMDR-IGTP is a non-pharmacological, trauma-informed, group-based therapy that follows the standard eight-phase EMDR model adapted for groups. The protocol incorporated art-based activities (e.g., drawing) and bilateral stimulation techniques (e.g., the “Butterfly Hug” and rhythmic tapping). No pharmaceutical or proprietary drug interventions were used. Each group session lasted approximately 75 minutes, and the full EMDR-IGTP program was structured across eight weekly sessions. Sessions took place within school facilities in quiet, designated rooms, with groups composed of 6–10 adolescents per session. The protocol emphasized Phases 3 to 5 (Assessment, Desensitization, and Installation), and included structured emotional check-ins, visual representations of traumatic memories, and guided bilateral stimulation exercises. Data Collection Instruments Quantitative Data A structured questionnaire was administered to assess participants’ perceptions and psychological profiles relevant to group Eye Movement Desensitization and Reprocessing. The primary component was the Perceived Feasibility Scale for Group EMDR-IGTP, a 15-item Likert-scale tool developed specifically for this study. Items were rated on a scale from 1 (Strongly Disagree) to 5 (Strongly Agree), measuring participants’ views on the accessibility, clarity, acceptability, and perceived usefulness of group EMDR interventions. To evaluate psychological impact, two validated instruments were included. The Revised Child PTSD Symptom Scale (CPSS-5-R) was used to assess trauma-related symptoms, capturing the severity and frequency of post-traumatic stress responses. In addition, the Connor-Davidson Resilience Scale – Short Form (CD-RISC-10) was employed to measure perceived psychological resilience in the aftermath of disaster exposure. Qualitative Data Participants were invited to respond to three open-ended questions embedded at the end of the survey: "What kind of emotional support has been most helpful to you after the disaster?" "How do you feel about participating in a group-based therapy like EMDR-IGTP?" "What do you think would help adolescents recover emotionally after a disaster?" These questions aimed to explore personal experiences, therapy perceptions, and cultural or contextual considerations regarding trauma recovery. Data Analysis Quantitative Analysis Descriptive statistics (means, standard deviations, frequencies) for all items and scales were computed using SPSS v28.0. Internal consistency reliability was estimated through Cronbach's alpha. Independent-sample t-tests and one-way ANOVAs were employed to examine group differences by gender, age, and disaster type experienced. Bivariate correlations were performed to examine associations between perceived feasibility, PTSD symptoms, and resilience scores. A p-value of less than 0.05 (p < 0.05) was considered statistically significant. Findings were interpreted in the context of relevant findings from prior EMDR-IGTP research. No formal power calculation was conducted, as the study was exploratory in nature and focused on pre-intervention perceptions rather than intervention efficacy. However, a sample size of 120 was deemed adequate for detecting medium effect sizes in correlational and group comparison analyses. Qualitative Analysis Open-ended answers were compared using thematic content analysis. An inductive methodology was used to determine emerging themes of emotional needs, views of group therapy, and cultural perspectives on trauma recovery. Coding was conducted manually by two researchers separately to maximize inter-rater reliability. Inconsistencies were resolved through consensus and discussion. Subsequent themes were contrasted with qualitative patterns described in earlier EMDR-IGTP and adolescent trauma recovery research to place findings in context. Ethical Considerations The study was approved by the local ethics committee of Toros University. Written informed consent for publication of clinical details and/or clinical images was obtained from the parents or legal guardians of all participants under the age of 18, in addition to the participants’ own assent. All participants and their legal guardians were informed that anonymized data might be used in academic publications following the Declaration of Helsinki. Results Quantitative Findings: Descriptive Statistics Descriptive statistics for the continuous outcomes are presented in Table 1 . Participants' mean age was 15.72 years ( SD = 1.49), and the mean time elapsed since the earthquake was 6.41 months ( SD = 3.28). The global feasibility score for group EMDR-IGTP was moderate ( M = 3.81, SD = 0.59) on a 5-point Likert scale. PTSD symptoms (CPSS-5-R) ranged from 8 to 76 ( M = 38.15, SD = 17.85), indicating a high trauma burden. Resilience scores (CD-RISC-10) ranged from 4 to 40 ( M = 23.74, SD = 8.97). Table 1 Descriptive Statistics for Continuous Variables ( N = 62) Variable Mean Std. Deviation Min Max Age 15.72 1.49 13 18 Time Since Disaster 6.41 3.28 1 12 Feasibility ( 1 – 5 ) 3.81 0.59 2.60 4.60 PTSD Symptoms (0–80) 38.15 17.85 8 76 Resilience (0–40) 23.74 8.97 4 40 Table 2 displays categorical variables. The sample included 26 males (41.9%) and 36 females (58.1%). Only 38.7% of adolescents reported prior awareness of EMDR therapy. Table 2 Frequency Distribution for Categorical Variables ( N = 62) Variable Category Frequency (n) Percentage (%) Gender Male 26 41.9% Female 36 58.1% EMDR Awareness Yes 24 38.7% No 38 61.3% Gender Differences in Key Variables Independent samples *t*-tests revealed no statistically significant gender differences in feasibility, PTSD symptoms, or resilience (Table 3 ). Females reported higher PTSD symptoms ( M = 40.22, SD = 17.61) than males ( M = 35.23, SD = 17.94), with a small effect size (*d* = 0.28). Females also reported slightly lower resilience ( M = 22.86, SD = 8.75) than males ( M = 24.92, SD = 9.12). Table 3 Gender Differences in Key Variables Variable Male (n = 26) Female (n = 36) t-value p-value Feasibility 3.85 (0.58) 3.78 (0.60) 0.49 0.626 PTSD Symptoms 35.23 (17.94) 40.22 (17.61) -1.14 0.259 Resilience 24.92 (9.12) 22.86 (8.75) 0.95 0.346 Differences by PTSD Severity Group Participants were stratified into PTSD severity groups: Subclinical (0–10; *n* = 6), Mild (11–20; *n* = 10), Moderate (21–35; *n* = 16), and Severe (36–80; *n* = 30). One-way ANOVA revealed significant differences in feasibility ( F (3,58) = 4.82, *p* = .005) and resilience ( F (3,58) = 3.05, *p* = .036) across groups (Table 4 ). Tukey HSD post-hoc tests confirmed: Subclinical and Mild groups perceived EMDR-IGTP as significantly more feasible than the Severe group (*p* < .01). The Subclinical group reported higher resilience than the Severe group (*p* = .028). Table 4 ANOVA for Feasibility and Resilience by PTSD Group Variable PTSD Group M (SD) F p-value Post-Hoc (Tukey HSD) Feasibility Subclinical 4.12 (0.38) 4.82 0.005 Subclinical > Severe; Mild > Severe Mild 3.94 (0.55) Moderate 3.89 (0.57) Severe 3.52 (0.60) Resilience Subclinical 28.33 (8.82) 3.05 0.036 Subclinical > Severe Mild 25.20 (8.71) Moderate 24.88 (8.93) Severe 21.47 (8.69) Bivariate Correlations Table 5 shows Pearson correlations. Feasibility was negatively correlated with PTSD symptoms (*r* = -0.47, *p* < .01) and positively correlated with resilience (*r* = 0.35, *p* < .01). PTSD symptoms and resilience were inversely related (*r* = -0.42, *p* < .01). Age and time since disaster showed no significant correlations with key outcomes. Table 5 Pearson Correlation Matrix Variable 1 2 3 4 5 1. Feasibility 1 2. PTSD Symptoms -0.47** 1 3. Resilience 0.35** -0.42** 1 4. Age -0.10 0.07 -0.14 1 5. Time Since Disaster 0.11 -0.16 0.09 -0.05 1 ***p* < 0.01 (2-tailed).** EMDR Awareness and PTSD Severity A chi-square test found no significant association between EMDR awareness and PTSD severity ( χ² ( 3 ) = 3.94, *p* = 0.268), indicating uniform distribution across severity groups (Table 6 ). Table 6 EMDR Awareness × PTSD Severity Crosstab ( χ² Test) PTSD Group EMDR Aware (n = 24) EMDR Unaware (n = 38) Total Subclinical 3 (12.5%) 3 (7.9%) 6 Mild 5 (20.8%) 5 (13.2%) 10 Moderate 6 (25.0%) 10 (26.3%) 16 Severe 10 (41.7%) 20 (52.6%) 30 Linear Regression: PTSD Predicting Feasibility A simple linear regression indicated PTSD symptoms significantly predicted feasibility ( F (1,60) = 17.29, *p* < .001), explaining 22.4% of the variance (Table 7 ). Higher PTSD scores reduced feasibility perceptions ( β = -0.47, *p* < .001). For every 10-point PTSD increase, feasibility decreased by 0.23 points ( B = -0.023, 95% CI [-0.033, -0.013]) (Table 8 ). Table 7 Linear Regression Model Summary Model R R² Adjusted R² Std. Error F p-value PTSD → Feasibility 0.47 0.224 0.212 0.53 17.29 < 0.001 Table 8 Regression Coefficients Predictor B Std. Error β t p-value (Constant) 4.72 0.18 — 26.11 < 0.001 PTSD Symptoms -0.023 0.006 -0.47 -4.16 < 0.001 Qualitative Findings: Thematic Content Analysis Thematic content analysis of the open-ended survey questions provided detailed insights into adolescents' emotional support needs, views on group therapy, and ideas for emotional recovery after natural disasters. Two researchers coded the responses separately and reached a 92% agreement rate. Any differences in coding were discussed and resolved together. Table 9 shows how often certain topics were mentioned in response to the three open-ended questions. For the first question, many adolescents said they relied on informal support such as help from family and friends. Creative activities like drawing and music were also mentioned often. In response to the second question, participants had mixed opinions about group therapy some liked the creative parts, while others felt uneasy about sharing personal experiences with others. Answers to the third question included suggestions such as increasing awareness about trauma, creating safe and private spaces, and offering more access to peer or professional support. Table 9 Coding Frequencies for Open-Ended Responses (n = 120) Question Code Frequency % Q1: Most helpful emotional support Support from family 30 25.0 Talking to friends 25 20.8 School counselor 25 20.8 Art and drawing 25 20.8 Listening to music 15 12.5 Q2: Perception of group therapy Likes creative methods 35 29.2 Group therapy sounds interesting 25 20.8 Feels safe in group therapy 20 16.7 Open to trying EMDR 20 16.7 Uncomfortable sharing 20 16.7 Q3: Recovery suggestions More awareness programs 30 25.0 Safe spaces in schools 25 20.8 Creative outlets 25 20.8 Peer support groups 25 20.8 Access to professionals 15 12.5 Building on these codes, thematic grouping revealed three overarching themes, as summarized in Table 10 : varied support preferences, ambivalence toward group therapy, and environmental enablers. Table 10 Thematic Analysis of Qualitative Responses Theme Subtheme Representative Quote Frequency (n = 120) 1. Varied Support Preferences Informal Networks “Talking to friends who went through the same flood made me feel less alone.” 55 (45.8%) Creative Expression “Drawing helped me express things I couldn’t say out loud.” 40 (33.3%) Professional Guidance “The school counselor didn’t judge me when I cried.” 25 (20.8%) 2. Ambivalence Toward Group Therapy Attraction to Creativity “Using art in therapy sounds better than just talking.” 35 (29.2%) Safety Concerns “What if someone laughs at my drawings or tells others?” 20 (16.7%) Openness to Novel Approaches “I’d try EMDR because it’s different—like the Butterfly Hug.” 20 (16.7%) 3. Environmental Enablers Institutional Safety “We need a quiet room at school where we won’t be interrupted.” 50 (41.7%) Peer-Led Initiatives “Groups where teens help each other would feel less weird.” 25 (20.8%) Psychoeducation Needs “Nobody teaches us how trauma works, we need that first.” 30 (25.0%) Theme 1: Varied Support Preferences Adolescents highlighted the importance of informal support systems in helping them cope after a disaster. Almost half of the participants said that talking to family members or friends was the most helpful, showing how shared experiences can reduce feelings of loneliness. About one-third of the adolescents mentioned that creative activities, especially drawing and listening to music, helped them express emotions they found hard to put into words. Although some participants did mention support from school counselors or other professionals, this was reported less often. This may be due to challenges like limited access, unfamiliarity with therapy, or concerns about stigma. Theme 2: Mixed Feelings About Group Therapy When asked about group-based therapy, participants showed both interest and hesitation. Many said they liked the idea of using creative methods, such as drawing, because it felt safer than having to talk openly about their feelings. However, some adolescents—especially those with more severe symptoms—felt unsure or uncomfortable about sharing in a group. A common concern was the fear of being judged or misunderstood by others. Still, several participants said they would be willing to try Eye Movement Desensitization and Reprocessing, especially because it seemed different from traditional forms of therapy. Theme 3: Supportive Environments Matter Environmental support was another important factor mentioned by adolescents. Many said they would feel more comfortable if therapy took place in a quiet and private room at school where they wouldn’t be disturbed. They also liked the idea of peer support groups, saying that talking to others their age could help reduce feelings of stigma. In addition, a number of participants felt that learning more about trauma and how EMDR works before starting therapy would make them more willing to take part. This shows the need for clear information and preparation before offering group treatment. Discussion Adolescents exposed to natural disasters often experience high levels of psychological distress, yet access to appropriate mental health support remains limited. Group-based therapies like EMDR-IGTP offer a scalable approach, but their acceptability among youth is not well understood. In this study, overall adolescents rated the feasibility of EMDR-IGTP as moderate to high, meaning most were open to the idea of joining such a group. However, the results also showed that those with higher levels of trauma symptoms were less likely to find the intervention feasible. This suggests that more distressed adolescents may feel less ready for group settings, possibly due to feeling overwhelmed, withdrawn, or unsafe around others. This was supported by qualitative feedback as well, several participants shared worries about opening up in front of peers, with some fearing judgment or not feeling emotionally prepared to talk about their experiences. On the other hand, adolescents who reported higher levels of resilience were more likely to see EMDR-IGTP as helpful and were more open to participating. Resilience appeared to make a difference in how ready they felt for therapy. This pattern was also seen in the open-ended responses, where many resilient adolescents described using peer support, creative expression, and school counseling as helpful ways to cope. Drawing and music were especially popular as non-verbal ways to release emotions, which aligns with the creative tools used in the EMDR-IGTP model. Gender differences in PTSD symptoms and resilience were small and not statistically significant, but girls tended to report slightly higher trauma symptoms and lower resilience. These differences may reflect emotional processing styles rather than true differences in treatment needs. Interestingly, knowledge of EMDR was limited across the sample and did not vary by trauma level. Still, the qualitative data showed that many adolescents were curious and willing to try EMDR, especially when it included creative or non-verbal elements like drawing or the Butterfly Hug. Several participants said they would feel more confident trying therapy if they were given clear explanations beforehand, showing a strong need for psychoeducation before starting treatment. Finally, the regression analysis showed that PTSD severity was a strong predictor of how feasible adolescents found group EMDR-IGTP. As trauma symptoms increased, perceived feasibility decreased. This is especially important for planning real-world implementation. Although many adolescents were open to therapy, those with the greatest trauma may need extra support, such as emotional preparation, safe and private spaces, and step-by-step guidance, to feel ready for group-based treatment. The results of the current study on the feasibility and correlates of Group EMDR-IGTP in adolescents affected by disaster show convergences and divergences with the existing literature. In contrast to Karadağ's (2020) clinical trial with female adolescents having complex PTSD stemming from sexual abuse, where a notable decrease in post-EMDR trauma symptoms was found (d = 1.2), the current study’s non-intervention feasibility results point to an essential prerequisite: symptom severity itself is predictive of treatment openness ( 10 ). Particularly, the current study’s regression indicated PTSD symptoms negatively predicted feasibility (β = -0.42, p < 0.001), indicating youths with greater PTSD (M = 3.58 feasibility) might need preparatory interventions before group EMDR, as opposed to Karadağ's group, who received specially targeted clinical support. This is in line with Smyth et al.'s (2020) refugee research, where EMDR-IGTP-OTS was effectively lowering PTSD symptoms (pre-M = 42.63 to post-M = 27.46), albeit only after broaching challenges such as safety and trust issues ( 9 ). the current study’s qualitative data (e.g., "safe spaces in schools" requests) also highlight. Most importantly, the current study’s null gender differences in feasibility (t = 0.73, p = 0.467) run counter to Karadağ's (2020) female-specific efficacy, perhaps as a result of the current study’s inclusion of both genders and natural disaster (versus abuse) trauma ( 10 ). Nonetheless, females' elevated PTSD symptoms (d = 0.27) in the current study’s sample are consistent with trauma epidemiology, emphasizing the importance of gender-sensitive adaptations ( 18 ). The lack of EMDR awareness effects (χ² = 4.82, p = 0.185) also differs from Lazzaroni et al. (2021), whose COVID-19 group had significant symptom reduction through remote EMDR, a modality that necessitates pre-existing tech literacy ( 15 ). This suggests that disaster environments may exacerbate issues of accessibility over awareness itself. Feasibility degrees (M = 3.76) were similar to computerized treatments such as Heinz et al.'s (2021) wildfire app (high satisfaction, but limited takeup), but lower than Sandín et al.'s (2020) internet treatment of the Unified Protocol (iUP-A), 80% adherence ( 18 , 19 ). The difference might be a result of group therapy's inherent social requirements versus app-based confidentiality. Positive feasibility correlation of resilience (r = 0.31, p < 0.01) resonates with Civilotti et al.'s (2021) literature review, recognizing resilience as a pediatric EMDR outcome buffer, although the current study’s regression indicated it did not moderate PTSD-feasibility effects (p = 0.094) a subtlety that needs to be explored ( 14 ). Kaptan et al. (2021 )'s systematic review warns that group EMDR's evidence of effectiveness is still limited by methodological heterogeneity, the perspective from which the current study’s naturalistic design (e.g., non-random sampling) needs to be considered ( 10 , 12 ). However, Xie et al.'s (2024) meta-analysis places EMDR as the most effective disaster intervention for youth PTSD, consistent with the current study’s participants' receptiveness to "creative approaches" (e.g., 42% preferred art-based EMDR) ( 2 ). Most importantly, the current study’s low feasibility (3.58) in the current study’s severe PTSD subgroup warns of the danger of exclusion from such evidence-based treatment and promotes integrated stepped-care models that combine preparatory individual sessions (for high-symptom youth) with group protocols. Whereas previous trials validate EMDR-IGTP's effectiveness in symptom reduction following implementation ( 9 , 10 ), the current study’s experiment lays bare pre-intervention obstacles: severity of PTSD suppresses perceived feasibility, and disaster settings might weaken gender/awareness impacts seen in clinical or refugee contexts. This underscores Heinz et al.'s (2021) priority of "meeting youth where they are," either through hybrid (digital + group) formats or resilience-enhancing preludes to group treatment. Subsequent studies ought to evaluate phased interventions that initially target distress-related obstacles (e.g., through mobile psychoeducation) before the delivery of EMDR-IGTP ( 18 ). Together, these findings highlight that while EMDR-IGTP is generally acceptable to adolescents, careful attention must be given to the emotional and practical needs of those with higher trauma levels. By combining flexible delivery, creative tools, and early psychoeducation, group therapy can become more accessible and effective for disaster-affected youth. Strengths and Limitations Strengths This study uses a convergent mixed methods design to assess PTSD severity, resilience, and perceived feasibility in adolescents. It combines quantitative assessment with qualitative understanding of facilitators and barriers to EMDR IGTP. The sample of 120 adolescents from disaster-impacted schools ensures stability in statistical analyses and allows for subgroup differences in symptom severity, gender, and familiarity with EMDR. The study also explores pre-treatment acceptability, a crucial component for effective post-disaster application. Limitations The study has several methodological concerns, including potential response biases due to self-reported questionnaires, a cross-sectional nature that only captures pre-intervention perceptions without observing their development post-intervention, and the potential for results to be generalizable to other adolescents in different settings due to natural disasters. Thematic analysis, while providing contextual information, could benefit from triangulation of observational or facilitator-reported data to enhance credibility. While this study provides important insights into adolescents' pre-intervention perceptions, it lacks post-intervention outcome data. The absence of follow-up measures on PTSD symptoms and resilience limits our ability to assess the therapeutic impact of EMDR-IGTP. Future studies should adopt a pre–post design using the same instruments—specifically, the CPSS-5-R and CD-RISC-10—to evaluate symptom changes following EMDR-IGTP participation. Including longitudinal outcome data would strengthen conclusions regarding the intervention’s effectiveness and sustainability. Another critical direction for future research is the inclusion of longitudinal follow-up assessments at 3 to 6 months post-intervention. Tracking long-term changes in PTSD symptoms and resilience would help establish the sustained efficacy of EMDR-IGTP and identify whether initial feasibility perceptions translate into lasting therapeutic engagement and symptom reduction. Future Recommendations Subsequent studies need to investigate the change in pre-intervention views in the course of EMDR IGTP provision by using longitudinal designs and facilitator observation. Experimental research that compares different preparatory psychoeducation formats, session duration, and facilitator–participant ratios will determine optimal configurations for diverse symptom profiles. In addition, the extension of data collection to representative cultural and socioeconomic environments and the incorporation of objective indicators (e.g., attendance at sessions, behavioral engagement measures) will further maximize generalizability and guide scalable, trauma-informed implementation approaches for adolescents in post-disaster environments. Future implementations of EMDR-IGTP should incorporate structured psychoeducational modules to prepare adolescents for group therapy. These may include brief animated videos explaining the phases of EMDR, illustrated trauma-recovery booklets tailored to adolescents, and pre-session orientation workshops. Participants in the current study emphasized the need for clear explanations and emotional readiness, suggesting that such resources could reduce anxiety, demystify the process, and increase participation among adolescents unfamiliar with therapy. Conclusion This mixed-methods study illustrates that adolescents' acceptance of participation in EMDR IGTP is a function of their burden of trauma and resilience, where those experiencing higher levels of distress were more hesitant and those with better coping ability were more accepting. Emotional overwhelm, concerns about confidentiality, and logistics were the principal barriers identified, while peer support and transparent preparatory instruction were instrumental facilitators. These findings underscore the value of combining trauma-informed orientation sessions, flexible scheduling, and strong privacy controls into the delivery of EMDR IGTP. Addressing these factors will increase the acceptability and scalability of group EMDR interventions among children in post-disaster settings. List of Abbreviations EMDR Eye Movement Desensitization and Reprocessing IGTP Integrative Group Treatment Protocol EMDR-IGTP Eye Movement Desensitization and Reprocessing – Integrative Group Treatment Protocol PTSD Post-Traumatic Stress Disorder CPSS-5-R Revised Child PTSD Symptom Scale – 5th Edition CD-RISC-10 Connor-Davidson Resilience Scale – Short Form LLM Large Language Model SD Standard Deviation ANOVA Analysis of Variance SPSS Statistical Package for the Social Sciences Declarations Biography Gulsen Filazoglu Cokluk is affiliated with Toros University and specializes in trauma psychology, adolescent mental health, and therapeutic intervention research. Her work focuses on evaluating scalable mental health interventions in disaster and post-crisis settings. Ethics Approval and Consent to Participate: The study was approved by the relevant ethics committee. Written informed consent for publication of clinical details and/or clinical images was obtained from the parents or legal guardians of all participants under the age of 18, in addition to the participants’ own assent. All participants and their legal guardians were informed that anonymized data might be used in academic publications in accordance with the Declaration of Helsinki. Consent for Publication: All participants and their legal guardians were informed that their anonymized data might be used in academic publications. Consent for publication was obtained accordingly. Availability of Data and Materials: The datasets generated and analyzed during the current study are available in supplementary files. Competing Interests: The authors declare that they have no competing interests. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' Contributions: Gulsen Filazoglu Cokluk conceptualized the study, led data collection and analysis, and drafted the manuscript. (Add details for other authors if applicable.) All authors reviewed and approved the final manuscript. Acknowledgments: The author would like to thank the school administrators, staff, and students who participated in this study, as well as the research assistants who supported data collection and survey facilitation. Special thanks to the Toros University Ethics Committee for their guidance and timely review. References Saeed SA, Gargano SP. Natural disasters and mental health. International review of psychiatry. 2022;34(1):16-25. Xie Y, Zhu X, Wang L, Wan Z, Yang J, Su C, et al. A network meta-analysis of psychological interventions for children and adolescents after natural and man-made disasters. BMC psychiatry. 2024;24(1):468. Roque-Lopez S, Llanez-Anaya E, Álvarez-López MJ, Everts M, Fernández D, Davidson RJ, et al. Mental health benefits of a 1-week intensive multimodal group program for adolescents with multiple adverse childhood experiences. Child abuse & neglect. 2021;122:105349. Eyni S, Musavi SE. Social isolation of war veterans with post-traumatic stress disorder based on emotional inhibition: The mediating role of rejection sensitivity. Journal of Military and Veterans Health. 2024;32(1):18-27. Melo VU, Triana V. EMDR Integrative Group Treatment Protocol-Ongoing Traumatic Stress. EMDR Group Therapy: Emerging Principles and Protocols to Treat Trauma and Beyond. 2023:51. Cavalera C, Incerti A. EMDR Integrative Group Therapy for Ongoing Traumatic Stress in Caregivers of Children with Neurodevelopmental Disorders. 2025. Richter R. The Integration of EMDR and Expressive Arts Therapy. Korkmazlar Ü, Bozkurt B, Tan Tunca D. EMDR group protocol with children: A field study. Journal of EMDR Practice and Research. 2020;14(1):13-30. Smyth-Dent K, Walsh S, Smith S. Field study on the EMDR integrative group treatment protocol for ongoing traumatic stress with female survivors of exploitation, trafficking and early marriage in dhaka, bangladesh. Psychology and Behavioral Science International Journal. 2020;15(3). Karadag M, Gokcen C, Sarp AS. EMDR therapy in children and adolescents who have post-traumatic stress disorder: a six-week follow-up study. International journal of psychiatry in clinical practice. 2020;24(1):77-82. Mazzoni GP, Miglietta E, Ciull T, Rotundo L, Pozza A, Gonzalez A, et al. Group Eye Movement Desensitization Reprocessing (EMDR) Psychotherapy and recurrent interpersonal traumatic episodes: a pilot follow-up study. Clinical neuropsychiatry. 2022;19(6):379. Kaptan SK, Kaya ZM, Akan A. Addressing mental health need after COVID-19: a systematic review of remote EMDR therapy studies as an emerging option. Frontiers in Psychiatry. 2024;14:1336569. Kenney M. Integrating Group EMDR Into Current Disaster Mental Health: A Model for Practice. EMDR Group Therapy: Emerging Principles and Protocols to Treat Trauma and Beyond. 2023:247. Civilotti C, Margola D, Zaccagnino M, Cussino M, Callerame C, Vicini A, et al. Eye movement desensitization and reprocessing in child and adolescent psychology: a narrative review. Current Treatment Options in Psychiatry. 2021;8(3):95-109. Lazzaroni E, Invernizzi R, Fogliato E, Pagani M, Maslovaric G. Coronavirus disease 2019 emergency and remote eye movement desensitization and reprocessing group therapy with adolescents and young adults: overcoming lockdown with the butterfly hug. Frontiers in psychology. 2021;12:701381. Shipley G. Exploring therapists’ experiences of using Eye Movement Desensitisation and Reprocessing Therapy with children and young people: University of Nottingham. Giacobone KT. Eye Movement Desensitization and Reprocessing as an Effective Treatment Approach with Traumatized Youth: Walden University; 2022. Heinz AJ, Wiltsey-Stirman S, Jaworski BK, Sharin T, Rhodes L, Steinmetz S, et al. Feasibility and preliminary efficacy of a public mobile app to reduce symptoms of postdisaster distress in adolescent wildfire survivors: Sonoma rises. Psychological services. 2022;19(S2):67. Sandín B, García-Escalera J, Valiente RM, Espinosa V, Chorot P. Clinical utility of an internet-delivered version of the unified protocol for transdiagnostic treatment of emotional disorders in adolescents (iUP-A): a pilot open trial. International Journal of Environmental Research and Public Health. 2020;17(22):8306. Banoglu, K., & Korkmazlar, Ü. (2022). Efficacy of the eye movement desensitization and reprocessing group protocol with children in reducing posttraumatic stress disorder in refugee children. European Journal of Trauma & Dissociation, 6 , 100241. Bayhan, B. B., Tarquinio, C., Rydberg, J., & Korkmazlar, Ü. (2022). The study of the group intervention containing EMDR therapy for children and mothers in the field of trauma after a mine explosion in Turkey. European Journal of Trauma & Dissociation, 6 (1), 100248. Karadağ, M., & Karadeniz, P. G. (2021). Comparison of Group Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol with Cognitive and Behavioral Therapy-Based Crisis Prevention Program for Children and Adolescents (CIPCA) after the 2020 earthquake in Turkey: A field study in children and adolescents. European Journal of Therapeutics, 27 (1), 85–90. Korkmazlar-Oral, Ü., Bozkurt, B., & Tunca, D. T. (2020). EMDR Group Protocol with Children: A Field Study. Journal of EMDR Practice and Research, 14 (1), 13–30. Additional Declarations No competing interests reported. Supplementary Files EMDRIGTPSurveyDataset120Participants.xlsx Appendices.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 29 Dec, 2025 Reviews received at journal 08 Dec, 2025 Reviewers agreed at journal 24 Nov, 2025 Reviews received at journal 19 Oct, 2025 Reviewers agreed at journal 17 Sep, 2025 Reviewers invited by journal 18 Aug, 2025 Editor assigned by journal 14 Aug, 2025 Editor invited by journal 01 Aug, 2025 Submission checks completed at journal 01 Aug, 2025 First submitted to journal 01 Aug, 2025 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. 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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-7185934","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":505187128,"identity":"3e2b30df-4d01-4f1a-88b0-33618a6f7795","order_by":0,"name":"Gulsen Filazoglu Cokluk","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIiWNgGAWjYBAC/gbmBiBlA+MfIKxF4gAjSEsaCVoMGMBaDpOiRSKx+cPHHefz+fkPH/xcUXNHzrx/7cPHvDsY5Plxa2mTnHnmtuXMGWnJkmeOPTOWufHc2Jj3DIPhzAbsWgxvJLYx87bdNjC4wWMg2dhwOHGGxDE2ad42hgQDHI40uJHY/Plv2zkD+/PnP/8EaqknRkuDNGPbAQMDhhw2kC0JEvxt+LVInHnYJtnblmwgcSPNzLLh2GHDGRJszIZzz0jg9At/e/LhDz/b7Az4+w8/vtlQc1hegv8Y44O3O2xwhhg2ixMYgJElQbwGoMUHGCDxOwpGwSgYBaMAAgAlc19jbulgsQAAAABJRU5ErkJggg==","orcid":"","institution":"Toros University Yalınayak","correspondingAuthor":true,"prefix":"","firstName":"Gulsen","middleName":"Filazoglu","lastName":"Cokluk","suffix":""}],"badges":[],"createdAt":"2025-07-22 10:38:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7185934/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7185934/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89890797,"identity":"7e8a55e2-c3b4-4594-96b3-63854b8dbb6d","added_by":"auto","created_at":"2025-08-26 07:38:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1086909,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7185934/v1/3b8c37a5-f520-4f13-b005-cd31ed4f87da.pdf"},{"id":89890611,"identity":"6ce38914-5537-457f-899d-65ad5e7eb406","added_by":"auto","created_at":"2025-08-26 07:29:59","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15575,"visible":true,"origin":"","legend":"","description":"","filename":"EMDRIGTPSurveyDataset120Participants.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-7185934/v1/fcab50104f07ff2bd5c3e9f6.xlsx"},{"id":89889625,"identity":"f4ba7f95-cc9f-47b8-9371-337ef35097b7","added_by":"auto","created_at":"2025-08-26 07:21:59","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":19133,"visible":true,"origin":"","legend":"","description":"","filename":"Appendices.docx","url":"https://assets-eu.researchsquare.com/files/rs-7185934/v1/f31bbdbe2df38243484cd868.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perceived Feasibility of Group EMDR Therapy Among Disaster-Affected Adolescents in Turkey: A Convergent Mixed-Methods Study","fulltext":[{"header":"Background","content":"\u003cp\u003eNatural catastrophes like earthquakes, floods, and hurricanes present an enormous risk to the mental health of adolescents (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Epidemiological studies indicate that between 20% and 40% of adolescents exposed to natural disasters develop clinically significant symptoms of post-traumatic stress disorder (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). As a developmental stage marked by heightened emotional sensitivity and ongoing neurological maturation, adolescence is particularly vulnerable to the lasting effects of trauma. Exposure during this period can disrupt cognitive, emotional, and social development. These risks underscore the urgent need for mental health interventions that are both scalable and evidence-based, and that can be deployed rapidly in disaster-affected populations (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAmong the most promising approaches is Eye Movement Desensitization and Reprocessing (EMDR) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). It is a structured, phase-based psychotherapy widely known for its effectiveness in treating trauma (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The EMDR Integrative Group Treatment Protocol (EMDR IGTP) is an adaptation of individual EMDR designed for group settings. It incorporates structured procedures along with art-based techniques such as drawing and the \"Butterfly Hug\" (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). These additions aim to enhance participant engagement, support cultural sensitivity, and improve the logistical feasibility of delivering trauma-focused care to large groups (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In contrast to one-to-one EMDR, EMDR IGTP is more cost-efficient in terms of therapist time and takes advantage of peer support, a primary resilience element in adolescent recovery (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBuilding on these theoretical advantages, several recent studies have begun to evaluate the clinical utility of EMDR IGTP across various trauma-exposed youth populations. For example, Karadağ (2020) provided Group EMDR to female teenagers with complex PTSD following sexual abuse and found large decreases in trauma and depressive symptom scores (pre–post Cohen's d \u0026gt; 1.1) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Although this clinical trial established the promise of the protocol, its sole targeting of sexual abuse survivors and relatively small sample size (n = 16) preclude broader generalizability to disaster-exposed youth whose trauma profiles and environmental needs might be considerably different. Smyth et al. (2020) filled this knowledge gap by providing EMDR IGTP to Eritrean refugee youth residing in a long-standing emergency camp (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Their field research confirmed sizable decreases in PTSD (mean CPSS 5 score from 42.6 to 27.5), depression, and anxiety symptoms, but did not systematically investigate implementation challenges, such as facilitator training inconsistency or security changes, that are characteristic of disaster response environments.\u003c/p\u003e\u003cp\u003eMoreover, Mazzoni et al. (2022) also extended EMDR IGTP assessment to recurrent interpersonal trauma, including adolescents, and reported sustained improvement in dissociation and affect regulation at three-month follow-up (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, as a pilot with n = 12 and no control group, it lacked the power to evaluate acceptability in varied cultural settings or to isolate which components of the protocol (art versus bilateral stimulation) underlay reported effects. Likewise, Roque López et al. (2021) integrated EMDR components into a one-week multimodal treatment for youth with multiple childhood traumatic experiences; while they reported robust symptom reduction at two-month follow-up, the overlap of EMDR with other treatment components precludes inferences regarding the solo feasibility and effectiveness of EMDR IGTP (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFurthermore, systematic reviews and meta-analyses support EMDR IGTP's potential but also expose important gaps in research. Kaptan et al. (2021) surveyed randomized and nonrandomized group trials of EMDR in children and adults and reported consistent reductions in PTSD and anxiety symptoms but warned against widespread methodological heterogeneity, small numbers, varied dosing schedules, and lack of standardized cultural adaptations, which discourages replication and scaling (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Additionally, Xie et al. (2024) in their network meta-analysis of disaster-related interventions identified EMDR to be the most effective modality of PTSD and depression reduction among young populations; however, the authors warned that few direct comparisons between active interventions, publication bias, and poor follow-up reporting limit confidence in long-term effects (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCritically, existing research is predominantly focused on post-treatment effectiveness, with little reference to adolescents' pre-treatment perceptions of feasibility and acceptability (\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e–\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In disaster settings, trauma severity, logistical challenges, and cultural factors often intersect. It is important to understand how adolescents’ symptom burden, resilience, and prior awareness of Eye Movement Desensitization and Reprocessing influence their willingness to engage in treatment (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Although limited research has systematically measured these pre-intervention factors, they play a critical role in determining the success of intervention implementation. For example, individuals with higher severity PTSD might have increased social withdrawal or emotional dysregulation that would hinder group participation (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), whereas resilient youth may show more openness to new, art-oriented modalities. Additionally, knowledge of EMDR principles might be highly variable in the nonclinical population, influencing perceived safety and therapeutic credibility.\u003c/p\u003e\u003cp\u003eSeveral Turkish studies provide strong evidence for the effectiveness of group EMDR protocols in reducing trauma-related symptoms among youth exposed to disasters. For example, Korkmazlar-Oral, Bozkurt, and Tunca (2020) implemented the EMDR Group Protocol for Children (EMDR-GP/C) with youth aged 6–13 affected by the 2014 Soma mining disaster. The researchers observed a significant reduction in subjective distress (as measured by SUDS ratings) that was sustained at 18-month follow-up. Similarly, Bayhan, Tarquinio, Rydberg, and Korkmazlar (2022) applied group EMDR with both children and mothers after the Soma explosion. They reported significantly greater reductions in PTSD symptoms among the intervention group compared to controls, using the CROPS scale as the outcome measure.\u003c/p\u003e\u003cp\u003eA randomized controlled field study by Karadağ and Karadeniz (2021) evaluated the effectiveness of EMDR-IGTP versus a cognitive–behavioral crisis prevention program (CIPCA) in youth aged 8–14 who had survived the 2020 İzmir earthquake. While both interventions led to symptom reductions, EMDR-IGTP showed significantly larger improvements in clinical impressions and distress levels, confirming its utility in acute post-disaster settings. These findings demonstrate that EMDR-IGTP can yield strong therapeutic effects in Turkish adolescent populations affected by various trauma exposures.\u003c/p\u003e\u003cp\u003eIn addition to its effectiveness, Turkish studies emphasize the high feasibility and acceptability of group EMDR. Banoglu and Korkmazlar (2022) described their experience implementing EMDR-GP with Syrian refugee children and highlighted the protocol’s efficiency, cost-effectiveness, and logistical practicality compared to individual therapy. They reported very low dropout rates—almost 80% lower than in a wait-list control group—underscoring high participant engagement even in displaced or chaotic contexts.\u003c/p\u003e\u003cp\u003eKaradağ and Karadeniz (2021) similarly found that adolescents affected by the İzmir earthquake could be rapidly mobilized for intervention. The group format’s structure and embedded peer support appeared to enhance resilience, normalize emotional responses, and increase willingness to engage. Although challenges such as scheduling, confidentiality concerns, and emotional intensity were noted, the trials suggest that adolescents generally find EMDR-IGTP acceptable—especially when facilitators provide psychoeducation and emotional safety planning in advance.\u003c/p\u003e\u003cp\u003eCultural responsiveness emerged as a key success factor across these Turkish studies. For instance, Banoglu and Korkmazlar (2022) created a culturally resonant trauma narrative centered around a “migratory bird,” which was particularly meaningful for Syrian refugee children. They also modified bilateral stimulation (BLS) techniques by replacing the Butterfly Hug with knee tapping—reported as more familiar and less emotionally overwhelming for their sample. These examples reflect how age-appropriate metaphors, culturally tailored stories, and flexible therapeutic tools can optimize both comfort and therapeutic efficacy in Turkish adolescent settings .\u003c/p\u003e\u003cp\u003eOverall, the Turkish literature demonstrates that EMDR-IGTP, when adapted thoughtfully to local contexts, can be highly effective, scalable, and acceptable for adolescents recovering from disaster-related trauma.\u003c/p\u003e\u003cp\u003eThe current study addressed a critical gap in existing research by shifting attention from post-treatment outcomes to adolescents’ pre-treatment perceptions of group-based trauma interventions. Unlike earlier studies that primarily focus on symptom reduction, the present investigation explores how post-traumatic stress severity, resilience, and contextual factors influence adolescents’ perceived feasibility of participating in group Eye Movement Desensitization and Reprocessing. The objective was to identify psychological and logistical factors that affect adolescents’ willingness to engage in EMDR-based group therapy following natural disasters and to generate evidence-based recommendations for optimizing its implementation in school and community settings. By emphasizing pre-intervention perceptions, this study contributes valuable insights to implementation science and offers a strategic framework for integrating EMDR IGTP into rapid-response mental health services for disaster-affected youth.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cb\u003eStudy Design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study aimed to examine how adolescents’ levels of post-traumatic stress symptoms and psychological resilience influence their perceived feasibility of group-based Eye Movement Desensitization and Reprocessing therapy using the Integrative Group Treatment Protocol (EMDR-IGTP) in a post-disaster setting. A convergent mixed-methods design was employed to simultaneously collect and integrate quantitative and qualitative data. The study was conducted in three public secondary schools located in Hatay, Turkey—an area significantly affected by recent natural disasters, including earthquakes and floods.\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants and Sampling\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 120 adolescents aged 13 to 18 years participated in the study. Participants were recruited from school populations based on the following inclusion criteria: (a) direct exposure to a natural disaster within the past 12 months, (b) current enrollment in formal education, and (c) provision of informed assent and parental/guardian consent. Exclusion criteria included any current psychiatric treatment or diagnosis of a severe mental disorder that could interfere with group participation.\u003c/p\u003e\u003cp\u003eTo ensure a representative range of experiences, \u003cb\u003estratified purposive sampling\u003c/b\u003e was used. Stratification was based on gender, type of disaster exposure, and geographical location. The final sample included both males and females, with varied PTSD symptom severity and resilience levels.\u003c/p\u003e\u003cp\u003e\u003cb\u003eIntervention Description\u003c/b\u003e\u003c/p\u003e\u003cp\u003e Although no formal clinical intervention or treatment outcomes were assessed, participants were introduced to the EMDR Integrative Group Treatment Protocol (IGTP) as part of a structured psychoeducational process. EMDR-IGTP is a non-pharmacological, trauma-informed, group-based therapy that follows the standard eight-phase EMDR model adapted for groups. The protocol incorporated art-based activities (e.g., drawing) and bilateral stimulation techniques (e.g., the “Butterfly Hug” and rhythmic tapping). No pharmaceutical or proprietary drug interventions were used.\u003c/p\u003e\u003cp\u003eEach group session lasted approximately 75 minutes, and the full EMDR-IGTP program was structured across eight weekly sessions. Sessions took place within school facilities in quiet, designated rooms, with groups composed of 6–10 adolescents per session. The protocol emphasized Phases 3 to 5 (Assessment, Desensitization, and Installation), and included structured emotional check-ins, visual representations of traumatic memories, and guided bilateral stimulation exercises.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData Collection Instruments\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eQuantitative Data\u003c/em\u003e\u003c/p\u003e\u003cp\u003eA structured questionnaire was administered to assess participants’ perceptions and psychological profiles relevant to group Eye Movement Desensitization and Reprocessing. The primary component was the Perceived Feasibility Scale for Group EMDR-IGTP, a 15-item Likert-scale tool developed specifically for this study. Items were rated on a scale from 1 (Strongly Disagree) to 5 (Strongly Agree), measuring participants’ views on the accessibility, clarity, acceptability, and perceived usefulness of group EMDR interventions.\u003c/p\u003e\u003cp\u003eTo evaluate psychological impact, two validated instruments were included. The Revised Child PTSD Symptom Scale (CPSS-5-R) was used to assess trauma-related symptoms, capturing the severity and frequency of post-traumatic stress responses. In addition, the Connor-Davidson Resilience Scale – Short Form (CD-RISC-10) was employed to measure perceived psychological resilience in the aftermath of disaster exposure.\u003c/p\u003e\u003cp\u003e\u003cem\u003eQualitative Data\u003c/em\u003e\u003c/p\u003e\u003cp\u003eParticipants were invited to respond to three open-ended questions embedded at the end of the survey:\u003c/p\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\"What kind of emotional support has been most helpful to you after the disaster?\"\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\"How do you feel about participating in a group-based therapy like EMDR-IGTP?\"\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e\"What do you think would help adolescents recover emotionally after a disaster?\"\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003cp\u003eThese questions aimed to explore personal experiences, therapy perceptions, and cultural or contextual considerations regarding trauma recovery.\u003c/p\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003e\u003cem\u003eQuantitative Analysis\u003c/em\u003e\u003c/p\u003e\u003cp\u003eDescriptive statistics (means, standard deviations, frequencies) for all items and scales were computed using SPSS v28.0. Internal consistency reliability was estimated through Cronbach's alpha. Independent-sample t-tests and one-way ANOVAs were employed to examine group differences by gender, age, and disaster type experienced. Bivariate correlations were performed to examine associations between perceived feasibility, PTSD symptoms, and resilience scores. A p-value of less than 0.05 (p \u0026lt; 0.05) was considered statistically significant. Findings were interpreted in the context of relevant findings from prior EMDR-IGTP research. No formal power calculation was conducted, as the study was exploratory in nature and focused on pre-intervention perceptions rather than intervention efficacy. However, a sample size of 120 was deemed adequate for detecting medium effect sizes in correlational and group comparison analyses.\u003c/p\u003e\u003cp\u003e\u003cem\u003eQualitative Analysis\u003c/em\u003e\u003c/p\u003e\u003cp\u003eOpen-ended answers were compared using thematic content analysis. An inductive methodology was used to determine emerging themes of emotional needs, views of group therapy, and cultural perspectives on trauma recovery. Coding was conducted manually by two researchers separately to maximize inter-rater reliability. Inconsistencies were resolved through consensus and discussion. Subsequent themes were contrasted with qualitative patterns described in earlier EMDR-IGTP and adolescent trauma recovery research to place findings in context.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical Considerations\u003c/b\u003e\u003c/p\u003e\u003cp\u003e The study was approved by the local ethics committee of Toros University. Written informed consent for publication of clinical details and/or clinical images was obtained from the parents or legal guardians of all participants under the age of 18, in addition to the participants’ own assent. All participants and their legal guardians were informed that anonymized data might be used in academic publications following the Declaration of Helsinki.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eQuantitative Findings: Descriptive Statistics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDescriptive statistics for the continuous outcomes are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Participants' mean age was 15.72 years (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.49), and the mean time elapsed since the earthquake was 6.41 months (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.28). The global feasibility score for group EMDR-IGTP was moderate (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;3.81, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.59) on a 5-point Likert scale. PTSD symptoms (CPSS-5-R) ranged from 8 to 76 (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;38.15, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;17.85), indicating a high trauma burden. Resilience scores (CD-RISC-10) ranged from 4 to 40 (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;23.74, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8.97).\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\u003eDescriptive Statistics for Continuous Variables (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;62)\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=\".\" 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\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStd. Deviation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMin\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMax\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime Since Disaster\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFeasibility (\u003cspan additionalcitationids=\"CR2 CR3 CR4\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePTSD Symptoms (0\u0026ndash;80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e38.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResilience (0\u0026ndash;40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40\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\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e displays categorical variables. The sample included 26 males (41.9%) and 36 females (58.1%). Only 38.7% of adolescents reported prior awareness of EMDR therapy.\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\u003eFrequency Distribution for Categorical Variables (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;62)\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=\"left\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41.9%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e58.1%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEMDR Awareness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e38.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e61.3%\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\u003e\u003cb\u003eGender Differences in Key Variables\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIndependent samples *t*-tests revealed no statistically significant gender differences in feasibility, PTSD symptoms, or resilience (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Females reported higher PTSD symptoms (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;40.22, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;17.61) than males (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;35.23, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;17.94), with a small effect size (*d* = 0.28). Females also reported slightly lower resilience (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;22.86, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8.75) than males (\u003cem\u003eM\u003c/em\u003e\u0026thinsp;=\u0026thinsp;24.92, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;9.12).\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\u003eGender Differences in Key Variables\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=\".\" 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=\"char\" char=\".\" 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\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale (n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale (n\u0026thinsp;=\u0026thinsp;36)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003et-value\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\u003eFeasibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.85 (0.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.78 (0.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.626\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePTSD Symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35.23 (17.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40.22 (17.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-1.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.259\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e24.92 (9.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e22.86 (8.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.346\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\u003e\u003cb\u003eDifferences by PTSD Severity Group\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants were stratified into PTSD severity groups: Subclinical (0\u0026ndash;10; *n* = 6), Mild (11\u0026ndash;20; *n* = 10), Moderate (21\u0026ndash;35; *n* = 16), and Severe (36\u0026ndash;80; *n* = 30). One-way ANOVA revealed significant differences in feasibility (\u003cem\u003eF\u003c/em\u003e(3,58)\u0026thinsp;=\u0026thinsp;4.82, *p* = .005) and resilience (\u003cem\u003eF\u003c/em\u003e(3,58)\u0026thinsp;=\u0026thinsp;3.05, *p* = .036) across groups (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Tukey HSD post-hoc tests confirmed:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eSubclinical and Mild groups perceived EMDR-IGTP as significantly more feasible than the Severe group (*p* \u0026lt; .01).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe Subclinical group reported higher resilience than the Severe group (*p* = .028).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eANOVA for Feasibility and Resilience by PTSD Group\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePTSD Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePost-Hoc (Tukey HSD)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFeasibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubclinical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.12 (0.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSubclinical\u0026thinsp;\u0026gt;\u0026thinsp;Severe; Mild\u0026thinsp;\u0026gt;\u0026thinsp;Severe\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.94 (0.55)\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.89 (0.57)\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.52 (0.60)\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubclinical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28.33 (8.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.036\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSubclinical\u0026thinsp;\u0026gt;\u0026thinsp;Severe\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25.20 (8.71)\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24.88 (8.93)\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21.47 (8.69)\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eBivariate Correlations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows Pearson correlations. Feasibility was negatively correlated with PTSD symptoms (*r* = -0.47, *p* \u0026lt; .01) and positively correlated with resilience (*r* = 0.35, *p* \u0026lt; .01). PTSD symptoms and resilience were inversely related (*r* = -0.42, *p* \u0026lt; .01). Age and time since disaster showed no significant correlations with key outcomes.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePearson Correlation Matrix\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\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=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Feasibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. PTSD Symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.47**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Resilience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.35**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.42**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Age\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. Time Since Disaster\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e-0.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e***p* \u0026lt; 0.01 (2-tailed).**\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eEMDR Awareness and PTSD Severity\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA chi-square test found no significant association between EMDR awareness and PTSD severity (\u003cem\u003eχ\u0026sup2;\u003c/em\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;3.94, *p* = 0.268), indicating uniform distribution across severity groups (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eEMDR Awareness \u0026times; PTSD Severity Crosstab (\u003cem\u003eχ\u0026sup2;\u003c/em\u003e Test)\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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePTSD Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEMDR Aware (n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEMDR Unaware (n\u0026thinsp;=\u0026thinsp;38)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubclinical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (12.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (7.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMild\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (20.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5 (13.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6 (25.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (26.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSevere\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (41.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20 (52.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e30\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\u003e\u003cb\u003eLinear Regression: PTSD Predicting Feasibility\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA simple linear regression indicated PTSD symptoms significantly predicted feasibility (\u003cem\u003eF\u003c/em\u003e(1,60)\u0026thinsp;=\u0026thinsp;17.29, *p* \u0026lt; .001), explaining 22.4% of the variance (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). Higher PTSD scores reduced feasibility perceptions (\u003cem\u003eβ\u003c/em\u003e = -0.47, *p* \u0026lt; .001). For every 10-point PTSD increase, feasibility decreased by 0.23 points (\u003cem\u003eB\u003c/em\u003e = -0.023, 95% CI [-0.033, -0.013]) (Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLinear Regression Model Summary\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\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=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eR\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdjusted R\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eStd. Error\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\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\u003ePTSD \u0026rarr; Feasibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.224\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.212\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\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\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRegression Coefficients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\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\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePredictor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStd. Error\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eβ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\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\u003e(Constant)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e26.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\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\u003ePTSD Symptoms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-4.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\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\u003cp\u003e\u003cb\u003eQualitative Findings: Thematic Content Analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThematic content analysis of the open-ended survey questions provided detailed insights into adolescents' emotional support needs, views on group therapy, and ideas for emotional recovery after natural disasters. Two researchers coded the responses separately and reached a 92% agreement rate. Any differences in coding were discussed and resolved together.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab9\" class=\"InternalRef\"\u003e9\u003c/span\u003e shows how often certain topics were mentioned in response to the three open-ended questions. For the first question, many adolescents said they relied on informal support such as help from family and friends. Creative activities like drawing and music were also mentioned often. In response to the second question, participants had mixed opinions about group therapy some liked the creative parts, while others felt uneasy about sharing personal experiences with others. Answers to the third question included suggestions such as increasing awareness about trauma, creating safe and private spaces, and offering more access to peer or professional support.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCoding Frequencies for Open-Ended Responses (n\u0026thinsp;=\u0026thinsp;120)\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=\"left\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuestion\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCode\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ1: Most helpful emotional support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSupport from family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTalking to friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSchool counselor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eArt and drawing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eListening to music\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ2: Perception of group therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLikes creative methods\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e29.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGroup therapy sounds interesting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFeels safe in group therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOpen to trying EMDR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUncomfortable sharing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQ3: Recovery suggestions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMore awareness programs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSafe spaces in schools\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCreative outlets\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeer support groups\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAccess to professionals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12.5\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\u003eBuilding on these codes, thematic grouping revealed three overarching themes, as summarized in Table\u0026nbsp;\u003cspan refid=\"Tab10\" class=\"InternalRef\"\u003e10\u003c/span\u003e: varied support preferences, ambivalence toward group therapy, and environmental enablers.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab10\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 10\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThematic Analysis of Qualitative Responses\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=\"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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSubtheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRepresentative Quote\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFrequency (n\u0026thinsp;=\u0026thinsp;120)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Varied Support Preferences\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInformal Networks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;Talking to friends who went through the same flood made me feel less alone.\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e55 (45.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCreative Expression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;Drawing helped me express things I couldn\u0026rsquo;t say out loud.\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e40 (33.3%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfessional Guidance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;The school counselor didn\u0026rsquo;t judge me when I cried.\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25 (20.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. Ambivalence Toward Group Therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAttraction to Creativity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;Using art in therapy sounds better than just talking.\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e35 (29.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSafety Concerns\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;What if someone laughs at my drawings or tells others?\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20 (16.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOpenness to Novel Approaches\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;I\u0026rsquo;d try EMDR because it\u0026rsquo;s different\u0026mdash;like the Butterfly Hug.\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20 (16.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Environmental Enablers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInstitutional Safety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;We need a quiet room at school where we won\u0026rsquo;t be interrupted.\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e50 (41.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePeer-Led Initiatives\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;Groups where teens help each other would feel less weird.\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25 (20.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePsychoeducation Needs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026ldquo;Nobody teaches us how trauma works, we need that first.\u0026rdquo;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e30 (25.0%)\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\u003e\u003cem\u003eTheme 1: Varied Support Preferences\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAdolescents highlighted the importance of informal support systems in helping them cope after a disaster. Almost half of the participants said that talking to family members or friends was the most helpful, showing how shared experiences can reduce feelings of loneliness. About one-third of the adolescents mentioned that creative activities, especially drawing and listening to music, helped them express emotions they found hard to put into words. Although some participants did mention support from school counselors or other professionals, this was reported less often. This may be due to challenges like limited access, unfamiliarity with therapy, or concerns about stigma.\u003c/p\u003e\u003cp\u003e\u003cem\u003eTheme 2: Mixed Feelings About Group Therapy\u003c/em\u003e\u003c/p\u003e\u003cp\u003e When asked about group-based therapy, participants showed both interest and hesitation. Many said they liked the idea of using creative methods, such as drawing, because it felt safer than having to talk openly about their feelings. However, some adolescents\u0026mdash;especially those with more severe symptoms\u0026mdash;felt unsure or uncomfortable about sharing in a group. A common concern was the fear of being judged or misunderstood by others. Still, several participants said they would be willing to try Eye Movement Desensitization and Reprocessing, especially because it seemed different from traditional forms of therapy.\u003c/p\u003e\u003cp\u003e\u003cem\u003eTheme 3: Supportive Environments Matter\u003c/em\u003e\u003c/p\u003e\u003cp\u003eEnvironmental support was another important factor mentioned by adolescents. Many said they would feel more comfortable if therapy took place in a quiet and private room at school where they wouldn\u0026rsquo;t be disturbed. They also liked the idea of peer support groups, saying that talking to others their age could help reduce feelings of stigma. In addition, a number of participants felt that learning more about trauma and how EMDR works before starting therapy would make them more willing to take part. This shows the need for clear information and preparation before offering group treatment.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAdolescents exposed to natural disasters often experience high levels of psychological distress, yet access to appropriate mental health support remains limited. Group-based therapies like EMDR-IGTP offer a scalable approach, but their acceptability among youth is not well understood. In this study, overall adolescents rated the feasibility of EMDR-IGTP as moderate to high, meaning most were open to the idea of joining such a group. However, the results also showed that those with higher levels of trauma symptoms were less likely to find the intervention feasible. This suggests that more distressed adolescents may feel less ready for group settings, possibly due to feeling overwhelmed, withdrawn, or unsafe around others. This was supported by qualitative feedback as well, several participants shared worries about opening up in front of peers, with some fearing judgment or not feeling emotionally prepared to talk about their experiences.\u003c/p\u003e\u003cp\u003eOn the other hand, adolescents who reported higher levels of resilience were more likely to see EMDR-IGTP as helpful and were more open to participating. Resilience appeared to make a difference in how ready they felt for therapy. This pattern was also seen in the open-ended responses, where many resilient adolescents described using peer support, creative expression, and school counseling as helpful ways to cope. Drawing and music were especially popular as non-verbal ways to release emotions, which aligns with the creative tools used in the EMDR-IGTP model.\u003c/p\u003e\u003cp\u003eGender differences in PTSD symptoms and resilience were small and not statistically significant, but girls tended to report slightly higher trauma symptoms and lower resilience. These differences may reflect emotional processing styles rather than true differences in treatment needs. Interestingly, knowledge of EMDR was limited across the sample and did not vary by trauma level. Still, the qualitative data showed that many adolescents were curious and willing to try EMDR, especially when it included creative or non-verbal elements like drawing or the Butterfly Hug. Several participants said they would feel more confident trying therapy if they were given clear explanations beforehand, showing a strong need for psychoeducation before starting treatment.\u003c/p\u003e\u003cp\u003eFinally, the regression analysis showed that PTSD severity was a strong predictor of how feasible adolescents found group EMDR-IGTP. As trauma symptoms increased, perceived feasibility decreased. This is especially important for planning real-world implementation. Although many adolescents were open to therapy, those with the greatest trauma may need extra support, such as emotional preparation, safe and private spaces, and step-by-step guidance, to feel ready for group-based treatment.\u003c/p\u003e\u003cp\u003eThe results of the current study on the feasibility and correlates of Group EMDR-IGTP in adolescents affected by disaster show convergences and divergences with the existing literature. In contrast to Karadağ's (2020) clinical trial with female adolescents having complex PTSD stemming from sexual abuse, where a notable decrease in post-EMDR trauma symptoms was found (d\u0026thinsp;=\u0026thinsp;1.2), the current study\u0026rsquo;s non-intervention feasibility results point to an essential prerequisite: symptom severity itself is predictive of treatment openness (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Particularly, the current study\u0026rsquo;s regression indicated PTSD symptoms negatively predicted feasibility (β = -0.42, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating youths with greater PTSD (M\u0026thinsp;=\u0026thinsp;3.58 feasibility) might need preparatory interventions before group EMDR, as opposed to Karadağ's group, who received specially targeted clinical support. This is in line with Smyth et al.'s (2020) refugee research, where EMDR-IGTP-OTS was effectively lowering PTSD symptoms (pre-M\u0026thinsp;=\u0026thinsp;42.63 to post-M\u0026thinsp;=\u0026thinsp;27.46), albeit only after broaching challenges such as safety and trust issues (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). the current study\u0026rsquo;s qualitative data (e.g., \"safe spaces in schools\" requests) also highlight.\u003c/p\u003e\u003cp\u003eMost importantly, the current study\u0026rsquo;s null gender differences in feasibility (t\u0026thinsp;=\u0026thinsp;0.73, p\u0026thinsp;=\u0026thinsp;0.467) run counter to Karadağ's (2020) female-specific efficacy, perhaps as a result of the current study\u0026rsquo;s inclusion of both genders and natural disaster (versus abuse) trauma (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Nonetheless, females' elevated PTSD symptoms (d\u0026thinsp;=\u0026thinsp;0.27) in the current study\u0026rsquo;s sample are consistent with trauma epidemiology, emphasizing the importance of gender-sensitive adaptations (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The lack of EMDR awareness effects (χ\u0026sup2; = 4.82, p\u0026thinsp;=\u0026thinsp;0.185) also differs from Lazzaroni et al. (2021), whose COVID-19 group had significant symptom reduction through remote EMDR, a modality that necessitates pre-existing tech literacy (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). This suggests that disaster environments may exacerbate issues of accessibility over awareness itself.\u003c/p\u003e\u003cp\u003eFeasibility degrees (M\u0026thinsp;=\u0026thinsp;3.76) were similar to computerized treatments such as Heinz et al.'s (2021) wildfire app (high satisfaction, but limited takeup), but lower than Sand\u0026iacute;n et al.'s (2020) internet treatment of the Unified Protocol (iUP-A), 80% adherence (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The difference might be a result of group therapy's inherent social requirements versus app-based confidentiality. Positive feasibility correlation of resilience (r\u0026thinsp;=\u0026thinsp;0.31, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) resonates with Civilotti et al.'s (2021) literature review, recognizing resilience as a pediatric EMDR outcome buffer, although the current study\u0026rsquo;s regression indicated it did not moderate PTSD-feasibility effects (p\u0026thinsp;=\u0026thinsp;0.094) a subtlety that needs to be explored (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eKaptan et al. (2021 )'s systematic review warns that group EMDR's evidence of effectiveness is still limited by methodological heterogeneity, the perspective from which the current study\u0026rsquo;s naturalistic design (e.g., non-random sampling) needs to be considered (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). However, Xie et al.'s (2024) meta-analysis places EMDR as the most effective disaster intervention for youth PTSD, consistent with the current study\u0026rsquo;s participants' receptiveness to \"creative approaches\" (e.g., 42% preferred art-based EMDR) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Most importantly, the current study\u0026rsquo;s low feasibility (3.58) in the current study\u0026rsquo;s severe PTSD subgroup warns of the danger of exclusion from such evidence-based treatment and promotes integrated stepped-care models that combine preparatory individual sessions (for high-symptom youth) with group protocols.\u003c/p\u003e\u003cp\u003eWhereas previous trials validate EMDR-IGTP's effectiveness in symptom reduction following implementation (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), the current study\u0026rsquo;s experiment lays bare pre-intervention obstacles: severity of PTSD suppresses perceived feasibility, and disaster settings might weaken gender/awareness impacts seen in clinical or refugee contexts. This underscores Heinz et al.'s (2021) priority of \"meeting youth where they are,\" either through hybrid (digital\u0026thinsp;+\u0026thinsp;group) formats or resilience-enhancing preludes to group treatment. Subsequent studies ought to evaluate phased interventions that initially target distress-related obstacles (e.g., through mobile psychoeducation) before the delivery of EMDR-IGTP (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eTogether, these findings highlight that while EMDR-IGTP is generally acceptable to adolescents, careful attention must be given to the emotional and practical needs of those with higher trauma levels. By combining flexible delivery, creative tools, and early psychoeducation, group therapy can become more accessible and effective for disaster-affected youth.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStrengths and Limitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eStrengths\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study uses a convergent mixed methods design to assess PTSD severity, resilience, and perceived feasibility in adolescents. It combines quantitative assessment with qualitative understanding of facilitators and barriers to EMDR IGTP. The sample of 120 adolescents from disaster-impacted schools ensures stability in statistical analyses and allows for subgroup differences in symptom severity, gender, and familiarity with EMDR. The study also explores pre-treatment acceptability, a crucial component for effective post-disaster application.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study has several methodological concerns, including potential response biases due to self-reported questionnaires, a cross-sectional nature that only captures pre-intervention perceptions without observing their development post-intervention, and the potential for results to be generalizable to other adolescents in different settings due to natural disasters. Thematic analysis, while providing contextual information, could benefit from triangulation of observational or facilitator-reported data to enhance credibility. While this study provides important insights into adolescents' pre-intervention perceptions, it lacks post-intervention outcome data. The absence of follow-up measures on PTSD symptoms and resilience limits our ability to assess the therapeutic impact of EMDR-IGTP. Future studies should adopt a pre\u0026ndash;post design using the same instruments\u0026mdash;specifically, the CPSS-5-R and CD-RISC-10\u0026mdash;to evaluate symptom changes following EMDR-IGTP participation. Including longitudinal outcome data would strengthen conclusions regarding the intervention\u0026rsquo;s effectiveness and sustainability. Another critical direction for future research is the inclusion of longitudinal follow-up assessments at 3 to 6 months post-intervention. Tracking long-term changes in PTSD symptoms and resilience would help establish the sustained efficacy of EMDR-IGTP and identify whether initial feasibility perceptions translate into lasting therapeutic engagement and symptom reduction.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFuture Recommendations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSubsequent studies need to investigate the change in pre-intervention views in the course of EMDR IGTP provision by using longitudinal designs and facilitator observation. Experimental research that compares different preparatory psychoeducation formats, session duration, and facilitator\u0026ndash;participant ratios will determine optimal configurations for diverse symptom profiles. In addition, the extension of data collection to representative cultural and socioeconomic environments and the incorporation of objective indicators (e.g., attendance at sessions, behavioral engagement measures) will further maximize generalizability and guide scalable, trauma-informed implementation approaches for adolescents in post-disaster environments. Future implementations of EMDR-IGTP should incorporate structured psychoeducational modules to prepare adolescents for group therapy. These may include brief animated videos explaining the phases of EMDR, illustrated trauma-recovery booklets tailored to adolescents, and pre-session orientation workshops. Participants in the current study emphasized the need for clear explanations and emotional readiness, suggesting that such resources could reduce anxiety, demystify the process, and increase participation among adolescents unfamiliar with therapy.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis mixed-methods study illustrates that adolescents' acceptance of participation in EMDR IGTP is a function of their burden of trauma and resilience, where those experiencing higher levels of distress were more hesitant and those with better coping ability were more accepting. Emotional overwhelm, concerns about confidentiality, and logistics were the principal barriers identified, while peer support and transparent preparatory instruction were instrumental facilitators. These findings underscore the value of combining trauma-informed orientation sessions, flexible scheduling, and strong privacy controls into the delivery of EMDR IGTP. Addressing these factors will increase the acceptability and scalability of group EMDR interventions among children in post-disaster settings.\u003c/p\u003e"},{"header":"List of Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\" align=\"\" width=\"682\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEMDR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEye Movement Desensitization and Reprocessing\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIGTP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIntegrative Group Treatment Protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEMDR-IGTP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEye Movement Desensitization and Reprocessing \u0026ndash; Integrative Group Treatment Protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePTSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePost-Traumatic Stress Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCPSS-5-R\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRevised Child PTSD Symptom Scale \u0026ndash; 5th Edition\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCD-RISC-10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eConnor-Davidson Resilience Scale \u0026ndash; Short Form\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eLLM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLarge Language Model\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eStandard Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eANOVA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAnalysis of Variance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSPSS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003ch2\u003eBiography\u003c/h2\u003e\u003cp\u003eGulsen Filazoglu Cokluk is affiliated with Toros University and specializes in trauma psychology, adolescent mental health, and therapeutic intervention research. Her work focuses on evaluating scalable mental health interventions in disaster and post-crisis settings.\u003c/p\u003e\u003ch2\u003e\u003cstrong\u003eEthics Approval and Consent to Participate:\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe study was approved by the relevant ethics committee. Written informed consent for publication of clinical details and/or clinical images was obtained from the parents or legal guardians of all participants under the age of 18, in addition to the participants\u0026rsquo; own assent. All participants and their legal guardians were informed that anonymized data might be used in academic publications in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eConsent for Publication:\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAll participants and their legal guardians were informed that their anonymized data might be used in academic publications. Consent for publication was obtained accordingly.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAvailability of Data and Materials:\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are available in supplementary files.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAuthors\u0026apos; Contributions:\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eGulsen Filazoglu Cokluk conceptualized the study, led data collection and analysis, and drafted the manuscript.\u0026nbsp;\u003cem\u003e(Add details for other authors if applicable.)\u003c/em\u003e All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe author would like to thank the school administrators, staff, and students who participated in this study, as well as the research assistants who supported data collection and survey facilitation.\u003cbr\u003e\u0026nbsp;Special thanks to the Toros University Ethics Committee for their guidance and timely review.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSaeed SA, Gargano SP. Natural disasters and mental health. International review of psychiatry. 2022;34(1):16-25.\u003c/li\u003e\n\u003cli\u003eXie Y, Zhu X, Wang L, Wan Z, Yang J, Su C, et al. A network meta-analysis of psychological interventions for children and adolescents after natural and man-made disasters. BMC psychiatry. 2024;24(1):468.\u003c/li\u003e\n\u003cli\u003eRoque-Lopez S, Llanez-Anaya E, \u0026Aacute;lvarez-L\u0026oacute;pez MJ, Everts M, Fern\u0026aacute;ndez D, Davidson RJ, et al. Mental health benefits of a 1-week intensive multimodal group program for adolescents with multiple adverse childhood experiences. Child abuse \u0026amp; neglect. 2021;122:105349.\u003c/li\u003e\n\u003cli\u003eEyni S, Musavi SE. Social isolation of war veterans with post-traumatic stress disorder based on emotional inhibition: The mediating role of rejection sensitivity. Journal of Military and Veterans Health. 2024;32(1):18-27.\u003c/li\u003e\n\u003cli\u003eMelo VU, Triana V. EMDR Integrative Group Treatment Protocol-Ongoing Traumatic Stress. EMDR Group Therapy: Emerging Principles and Protocols to Treat Trauma and Beyond. 2023:51.\u003c/li\u003e\n\u003cli\u003eCavalera C, Incerti A. EMDR Integrative Group Therapy for Ongoing Traumatic Stress in Caregivers of Children with Neurodevelopmental Disorders. 2025.\u003c/li\u003e\n\u003cli\u003eRichter R. The Integration of EMDR and Expressive Arts Therapy.\u003c/li\u003e\n\u003cli\u003eKorkmazlar \u0026Uuml;, Bozkurt B, Tan Tunca D. EMDR group protocol with children: A field study. Journal of EMDR Practice and Research. 2020;14(1):13-30.\u003c/li\u003e\n\u003cli\u003eSmyth-Dent K, Walsh S, Smith S. Field study on the EMDR integrative group treatment protocol for ongoing traumatic stress with female survivors of exploitation, trafficking and early marriage in dhaka, bangladesh. Psychology and Behavioral Science International Journal. 2020;15(3).\u003c/li\u003e\n\u003cli\u003eKaradag M, Gokcen C, Sarp AS. EMDR therapy in children and adolescents who have post-traumatic stress disorder: a six-week follow-up study. International journal of psychiatry in clinical practice. 2020;24(1):77-82.\u003c/li\u003e\n\u003cli\u003eMazzoni GP, Miglietta E, Ciull T, Rotundo L, Pozza A, Gonzalez A, et al. Group Eye Movement Desensitization Reprocessing (EMDR) Psychotherapy and recurrent interpersonal traumatic episodes: a pilot follow-up study. Clinical neuropsychiatry. 2022;19(6):379.\u003c/li\u003e\n\u003cli\u003eKaptan SK, Kaya ZM, Akan A. Addressing mental health need after COVID-19: a systematic review of remote EMDR therapy studies as an emerging option. Frontiers in Psychiatry. 2024;14:1336569.\u003c/li\u003e\n\u003cli\u003eKenney M. Integrating Group EMDR Into Current Disaster Mental Health: A Model for Practice. EMDR Group Therapy: Emerging Principles and Protocols to Treat Trauma and Beyond. 2023:247.\u003c/li\u003e\n\u003cli\u003eCivilotti C, Margola D, Zaccagnino M, Cussino M, Callerame C, Vicini A, et al. Eye movement desensitization and reprocessing in child and adolescent psychology: a narrative review. Current Treatment Options in Psychiatry. 2021;8(3):95-109.\u003c/li\u003e\n\u003cli\u003eLazzaroni E, Invernizzi R, Fogliato E, Pagani M, Maslovaric G. Coronavirus disease 2019 emergency and remote eye movement desensitization and reprocessing group therapy with adolescents and young adults: overcoming lockdown with the butterfly hug. Frontiers in psychology. 2021;12:701381.\u003c/li\u003e\n\u003cli\u003eShipley G. Exploring therapists\u0026rsquo; experiences of using Eye Movement Desensitisation and Reprocessing Therapy with children and young people: University of Nottingham.\u003c/li\u003e\n\u003cli\u003eGiacobone KT. Eye Movement Desensitization and Reprocessing as an Effective Treatment Approach with Traumatized Youth: Walden University; 2022.\u003c/li\u003e\n\u003cli\u003eHeinz AJ, Wiltsey-Stirman S, Jaworski BK, Sharin T, Rhodes L, Steinmetz S, et al. Feasibility and preliminary efficacy of a public mobile app to reduce symptoms of postdisaster distress in adolescent wildfire survivors: Sonoma rises. Psychological services. 2022;19(S2):67.\u003c/li\u003e\n\u003cli\u003eSand\u0026iacute;n B, Garc\u0026iacute;a-Escalera J, Valiente RM, Espinosa V, Chorot P. Clinical utility of an internet-delivered version of the unified protocol for transdiagnostic treatment of emotional disorders in adolescents (iUP-A): a pilot open trial. International Journal of Environmental Research and Public Health. 2020;17(22):8306.\u003c/li\u003e\n\u003cli\u003eBanoglu, K., \u0026amp; Korkmazlar, \u0026Uuml;. (2022). Efficacy of the eye movement desensitization and reprocessing group protocol with children in reducing posttraumatic stress disorder in refugee children. \u003cem\u003eEuropean Journal of Trauma \u0026amp; Dissociation, 6\u003c/em\u003e, 100241.\u003c/li\u003e\n\u003cli\u003eBayhan, B. B., Tarquinio, C., Rydberg, J., \u0026amp; Korkmazlar, \u0026Uuml;. (2022). The study of the group intervention containing EMDR therapy for children and mothers in the field of trauma after a mine explosion in Turkey. \u003cem\u003eEuropean Journal of Trauma \u0026amp; Dissociation, 6\u003c/em\u003e(1), 100248.\u003c/li\u003e\n\u003cli\u003eKaradağ, M., \u0026amp; Karadeniz, P. G. (2021). Comparison of Group Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol with Cognitive and Behavioral Therapy-Based Crisis Prevention Program for Children and Adolescents (CIPCA) after the 2020 earthquake in Turkey: A field study in children and adolescents. \u003cem\u003eEuropean Journal of Therapeutics, 27\u003c/em\u003e(1), 85\u0026ndash;90.\u003c/li\u003e\n\u003cli\u003eKorkmazlar-Oral, \u0026Uuml;., Bozkurt, B., \u0026amp; Tunca, D. T. (2020). EMDR Group Protocol with Children: A Field Study. \u003cem\u003eJournal of EMDR Practice and Research, 14\u003c/em\u003e(1), 13\u0026ndash;30.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Eye Movement Desensitization and Reprocessing, group therapy, adolescents, natural disasters, feasibility, trauma, resilience","lastPublishedDoi":"10.21203/rs.3.rs-7185934/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7185934/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e\u003cp\u003eAdolescents exposed to natural disasters often develop post-traumatic stress disorder. Despite interest in group-based trauma therapies, the feasibility of the Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol among disaster-affected adolescents remains underexplored. This study aimed to evaluate how symptom severity and psychological resilience influence adolescents\u0026rsquo; perceptions of the feasibility of Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol. It also sought to identify key barriers and facilitators affecting adolescents\u0026rsquo; willingness to participate in such interventions following natural disasters.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003eA total of 120 adolescents aged 13 to 18 years from earthquake- and flood-affected regions participated in a convergent mixed-methods study using stratified purposive sampling to ensure diversity in gender, exposure severity, and location. Participants completed the Revised Child Post-Traumatic Stress Disorder Symptom Scale, the Connor-Davidson Resilience Scale, and a 15-item Feasibility Questionnaire for Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol. Quantitative data were analyzed using bivariate correlations and linear regression. Qualitative responses to open-ended questions about perceived barriers and facilitators were analyzed using thematic content analysis.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eAdolescents with higher levels of post-traumatic stress reported lower feasibility scores (r = -0.47, p\u0026thinsp;\u0026lt;\u0026thinsp;.01), while those with higher resilience perceived the intervention as more acceptable (r\u0026thinsp;=\u0026thinsp;0.35, p\u0026thinsp;\u0026lt;\u0026thinsp;.01). Significant differences were found in feasibility and resilience based on PTSD severity groups (p\u0026thinsp;=\u0026thinsp;.005 and p\u0026thinsp;=\u0026thinsp;.036, respectively). Key barriers included emotional dysregulation, confidentiality concerns, and scheduling difficulties. Facilitators included peer support and the presence of structured preparatory guidance.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e\u003cp\u003ePerceived feasibility of group-based Eye Movement Desensitization and Reprocessing is shaped by trauma severity and resilience. Psychoeducational preparation, logistical flexibility, and attention to emotional safety are essential to support adolescent engagement in post-disaster mental health interventions.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e\u003cp\u003eThis study is not a clinical trial and was not prospectively registered. 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