Ambulance service staff are the likeliest to develop post-traumatic stress disorder (PTSD) of all the emergency services (Stevelink et al, 2020). Although there are reported improvements in the culture around mental health in UK ambulance services (MIND, 2019), barriers remain to accessing help. Examples include staff being reluctant to seek help through their employers, the financial cost of paying privately, and the opinion that talking about traumatic events is either unlikely to help, or too distressing (National Institute for Health and Care Excellence (NICE), 2018).
What is the ‘rewind’ technique?
The rewind technique for trauma is a brief psychological intervention, which aims to resolve symptoms of PTSD in as few as three sessions. It involves the therapist coaching a client through imagining watching a film of the traumatic event, so that they dissociate from it, then imagining that they are in the film at the end, before being rewound at great speed back to the start, before the event happened (Adams and Allan, 2018).
As simplistic as this sounds, it is thought by researchers to re-consolidate the memory, removing the emotional and physical responses to it, leaving the memory intact, but the response to it neutralised, thereby eradicating the symptoms of PTSD (Gray and Liotta, 2012). It can be used for single, multiple and cumulative traumas.
The client does not need to describe the traumatic memory to the therapist. This, coupled with the short-term nature of treatment led me, in 2018, to investigate whether it could be a useful therapy for emergency services staff, given the nature of their work and reluctance to seek help from management (Pudney, 2018). Since then, my work with frontline staff during the pandemic has reinforced for me the need for effective, brief therapy for those exposed to psychological trauma at work.
Research is emerging
Although private therapists use the rewind-based techniques and find them very effective (a quick internet search offers an abundance of anecdotal evidence), there has been little empirical research to date, meaning it is not available to NHS therapists, as it is not approved by NICE for use in trauma therapy—yet.
Since Muss (1991) first wrote about the ‘Rewind Technique for Trauma’, several versions have evolved from it, including the Human Givens Rewind Technique, and the Reconsolidation of Traumatic Memories Protocol (RTM). Both preliminary and randomised controlled studies in recent years report remission of PTSD symptoms in 71–96% of participants (Gray et al, 2017; Tylee et al, 2017; Adams et al, 2022).
Why it could help ambulance staff
The benefit of making various techniques available lies in choice and in staff knowing that there is something available other than talking about the traumatic experiences. One paramedic told me that eye movement desensitisation and reprocessing (EMDR) therapy saved her life, yet another said he ‘wouldn't touch it with a bargepole’. People need options and a sense of autonomy to trust in therapy.
Many therapeutic approaches work well, but NICE (2018) recognises that choice is an important factor in successful outcomes for PTSD therapy. Being sent for therapy prescriptively, especially when the client has no faith that it will help, is doomed from the start.
If ambulance staff felt that the rewind technique could help—quickly and without disclosing full details of the memories that disturb them—and they had access to it free through work, their GP, or if preferred via a charity or private therapist, perhaps it would encourage them to seek help when needed.
Not a panacea
Brief, effective therapy, which doesn't require disclosure, should be a treatment option if backed up by sufficient research. However, I understand that longer term therapy is required for some, to work through everything that they need to, using the most suitable approach, be it with counselling or approaches such as cognitive behavioural therapy (CBT) or EMDR.
With several UK quantitative studies on the various versions of rewind technique due to be published in 2022, my hope is that one or more of these gains NICE approval, allowing their availability in the toolkits of more therapists and integrated with other therapies as appropriate.
I do not believe that the rewind technique alone is the answer to the high level of mental health issues in ambulance staff. I appreciate that the stresses of ambulance work go far beyond dealing with traumatic incidents. My view is simply this: if we can so easily alleviate the flashbacks, nightmares, anxiety and depression that come with PTSD, then we should offer to do so without hesitation—especially for those who are exposed to trauma in service to society.