Peer-delivered combined EMD and imagery rescripting for traumatized Chinese university students: a RCT

Background: Evidence-based trauma interventions are predominantly developed in and for WEIRD (Western, Educated, Industrialized, Rich, Democratic) populations. In non-Western higher education settings, implementing these therapies is heavily hindered by severe shortages of mental health professionals and culturally rooted stigma against authority figures. Exploring scalable, context-sensitive models like task-sharing is crucial for global mental health equity.Objective: This study evaluated the efficacy and underlying mechanisms of a peer-delivered integrated intervention - combining Eye Movement Desensitization (EMD) and Imagery Rescripting (IR) - for traumatised Chinese university students.Method: In a randomised controlled trial (RCT) with an explanatory sequential mixed-methods design, 95 students with moderate post-traumatic stress were randomised to a peer-delivered EMD + IR group, a standalone IR group, or a care-as-usual (CAU) control. Outcomes (depression, anxiety, self-efficacy, resilience) were assessed across four 50-minute peer-led sessions at baseline, post-intervention, and one-month follow-up. Traumatic memory characteristics were monitored, and post-trial qualitative interviews were conducted to understand therapeutic mechanisms and the peer-led experience.Results: Both interventions showed improvements over time. While Group × Time interactions for depression, anxiety, and self-efficacy were non-significant, the EMD + IR group demonstrated superior stability in maintaining resilience gains at follow-up, whereas the standalone IR group showed a significant decline. Mediation analysis revealed resilience gains were driven by a multi-dimensional restructuring of traumatic memories (reduced vividness, arousal, and negative beliefs). Qualitatively, EMD provided a 'sensory-affective buffer' for clients and an operational 'safety net' for novices. The egalitarian peer identity dismantled hierarchical stigma, while robust supervision ensured provider safety.Conclusions: Task-sharing EMD + IR via trained peers is a feasible, culturally congruent strategy. This phased model offers a safe, destigmatizing pathway for accelerating symptom relief and fostering sustainable post-traumatic growth.This trial was registered at the Chinese Clinical Trial Registry (ChiCTR2400090611).