A Migration-Focused Adaptation of EMDR for Psychological Distress Among Turkish Migrants

Derin Kubilay38 enrolled

Overview

Many people who migrate to new countries experience significant emotional and psychological challenges. These challenges can include depression, anxiety, stress, and difficulty adjusting to a new culture and society. This pilot study examined whether a specialized form of psychotherapy called Eye Movement Desensitization and Reprocessing (EMDR), adapted specifically for migration-related experiences, may help reduce these psychological difficulties and support social adaptation. Participants were first-generation Turkish adults living in five European countries-the Netherlands, the United Kingdom, France, Sweden, and Austria-who reported emotional distress associated with migration and adaptation challenges. They received 12 weekly individual sessions delivered by licensed EMDR therapists, focusing on distressing experiences and difficulties related to adjusting to life in a new country. Before and after the therapy, participants completed questionnaires measuring their levels of depression, anxiety, and stress, and their sense of social adaptation in their new communities. This is a small single-arm pilot study without a control group. It was designed to provide preliminary information that may inform larger controlled trials.

Background and Rationale: Migration has become a major global phenomenon. While migration can provide opportunities, it also appears to involve significant psychological challenges. Migrants commonly report elevated levels of depression, anxiety, stress, and difficulties with social adaptation and integration. Turkish migrants represent one of the largest established migrant communities worldwide, particularly in Europe. Migration-related psychological distress may emerge from complex interactions between pre-migration experiences, ongoing post-migration stressors, and evolving sense of identity and belonging. Rather than representing a single traumatic event, migration-related distress often appears to reflect accumulated challenges across the migration trajectory, including language barriers, social isolation, discrimination, and reduced social support in the host country. Intervention: This study examined a migration-focused adaptation of Eye Movement Desensitization and Reprocessing (EMDR), a psychotherapy approach with existing evidence in trauma-related conditions. The study employed a migration-focused protocol that maintained the standard EMDR structure while addressing migration-specific clinical concerns. Treatment consisted of 12 individual weekly online sessions delivered by licensed EMDR therapists. This study is grounded in the Adaptive Information Processing (AIP) model underlying EMDR therapy. The protocol focused on migration-related experiences, including past difficulties, current triggers, and future challenges. It emphasized strengthening coping resources and establishing a safe place in the host country. Between-session activities and future-oriented exercises were used to support adaptation, reinforce positive experiences, and increase confidence in managing migration-related situations. Design: This is a single-arm, pre-post pilot study. Psychological distress and social adaptation were assessed at baseline and after completion of the 12-session protocol. Given the absence of a control group, randomization, and blinding, the design does not permit causal inference regarding treatment effects.

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * First-generation Turkish adults who are currently residing outside Türkiye * Currently residing outside Türkiye for a minimum of 6 months * Reporting emotional distress or psychological difficulties related to migration and adaptation to a new country * Literate and capable of providing informed consent Exclusion Criteria: * Current severe psychiatric condition (psychotic disorders, bipolar disorder, severe depression, or clinically significant suicide risk) * Intellectual disability or cognitive impairment that would prevent informed consent or participation * Concurrent intensive psychotherapy (more than one individual psychotherapy session per week), or active psychiatric treatment involving medication changes * History of alcohol or substance dependence

Outcomes

Primary Outcomes

Depression Anxiety Stress Scales-21 (DASS-21)

Psychological distress was assessed using the DASS-21, the short form of the original 42-item DASS developed by Lovibond and Lovibond (1995). The Turkish adaptation of the DASS-21 was conducted by Yılmaz et al. (2017). The measure comprises three seven-item subscales assessing symptoms of depression, anxiety, and stress during the preceding week. Items are rated on a four-point Likert-type scale ranging from 0 (Did not apply to me at all) to 3 (Applied to me very much). The DASS-21 contains no reverse-scored items. Each subscale yields a score ranging from 0 to 21, and the total DASS-21 score ranges from 0 to 63. The Turkish version has demonstrated adequate internal consistency, with Cronbach's alpha coefficients of .82 for depression, .81 for anxiety, and .76 for stress (Yılmaz et al., 2017). In the present study, depression, anxiety, and stress were specified as the primary psychological outcomes.

Time frame: Baseline (Before the first EMDR session) and post-treatment (Week 12, after final EMDR session)

Secondary Outcomes

Social Cohesion Scale for Immigrants (SCSI)

Social adaptation was assessed using the 28-item Social Cohesion Scale for Immigrants (SCSI), developed by Kaya (2022). The scale comprises six dimensions: Exclusion, belonging, psychological and social support, individual factors, hope and past experience. Thirteen items are reverse scored. Total scores range from 28 to 140, with higher scores indicating greater social adaptation. The original validation study reported satisfactory internal consistency across the six subscales: Exclusion (α = .83), Belonging (α = .86), Psychological and Social Support (α = .78), Individual Factors (α = .80), Hope (α = .84), and Past Experiences (α = .82). Internal consistency for the total scale was α = .82 (Kaya, 2022). Social adaptation was specified as the secondary outcome of the study.