BRAVEMIND UKRAINE AND EMDR: A PRACTITIONER TRAINING PROTOCOL FOR UTILIZING FUTURE TEMPLATES IN POSTTRAUMATIC STRESS DISORDER THERAPY
DOI:
https://doi.org/10.28925/2412-0774.2026.1.2Abstract
The ongoing Russian-Ukrainian war has intensified mental health challenges in Ukraine, a country already marked by elevated rates of psychological conditions and Soviet-era stigma that discourages help-seeking. This context demands innovative approaches to clinician training and protocol development that equip practitioners with structured, evidence-based tools for trauma treatment. The aim of this research is to investigate the integration of BRAVEMIND Ukraine, an immersive virtual reality (VR)-based clinical environment under development, with Eye Movement Desensitization and Reprocessing (EMDR) therapy for the treatment of posttraumatic stress disorder (PTSD). Through a review of existing literature and clinical experience, this paper identifies three theoretical integration points for immersive VR within the EMDR standard protocol and proposes that the future-template-building stage represents the most suitable entry point. The primary result is a practical EMDR Future Template script designed for use with BRAVEMIND Ukraine, providing clinicians with a step-by-step protocol for conducting EMDR procedures within an immersive VR environment. While VR has been increasingly explored in trauma treatment (including tools that deliver bilateral stimulation within a VR headset while still relying on imaginal exposure), no published protocol exists for conducting scripted EMDR procedures within fully immersive, navigable virtual environments, a gap this paper directly addresses. Although developed for BRAVEMIND Ukraine, the model is adaptable to other immersive VR platforms, offering a generalizable framework for clinician training in structured therapies delivered within immersive environments. Future empirical research, including randomized controlled trials, is recommended to establish efficacy and identify optimal patient populations.
References
Beidel, D. C., Frueh, B. C., Neer, S. M., Bowers, C. A., Trachik, B., Uhde, T. W., & Grubaugh, A. (2019). Trauma management therapy with virtual-reality augmented exposure therapy for combat-related PTSD: A randomized controlled trial. Journal of Anxiety Disorders, 61, 64–74. https://doi.org/10.1016/j.janxdis.2017.08.005
Beidel, D. C., Frueh, B. C., Neer, S. M., & Lejuez, C. W. (2017). The efficacy of Trauma Management Therapy: A controlled pilot investigation of a three-week intensive outpatient program for combat-related PTSD. Journal of Anxiety Disorders, 50, 23–32. https://doi.org/10.1016/j.janxdis.2017.05.001
Boudewyns, P. A., Stwertka, S. A., Hyer, L. A., Albrecht, J. W., & Sperr, E. V. (1993). Eye movement desensitization for PTSD of combat: A treatment outcome pilot study. The Behavior Therapist, 16 (2), 29–33.
Bromet, E. J., Gluzman, S. F., Paniotto, V. I., Webb, C. P. M., Tintle, N. L., Zakhozha, V., Havenaar, J. M., Gutkovich, Z., Kostyuchenko, S., & Schwartz, J. E. (2005). Epidemiology of psychiatric and alcohol disorders in Ukraine: Findings from the Ukraine world mental health survey. Social Psychiatry and Psychiatric Epidemiology, 40 (9), 681–690. https://doi.org/10.1007/s00127-005-0927-9
Browning, C. (1999). Floatback and float forward: Techniques for linking past, present and future. EMDRIA Newsletter, 4 (3), 12. https://emdrtherapyvolusia.com/wp-content/uploads/2016/12/Floatback_and_Float.pdf
Carlson, J. G., Chemtob, C. M., Rusnak, K., Hedlund, N. L., & Muraoka, M. Y. (1998). Eye movement desensitization and reprocessing (EDMR) treatment for combat‐related posttraumatic stress disorder. Journal of Traumatic Stress, 11 (1), 3–24. https://doi.org/10.1023/A:1024448814268
de Jongh, A., de Roos, C., & El‐Leithy, S. (2024). State of the science: Eye movement desensitization and reprocessing (EMDR) therapy. Journal of Traumatic Stress, 37 (2), 205–216. https://doi.org/10.1002/jts.23012
Department of Veterans Affairs & Department of Defense (2004). VA/DoD clinical practice guideline for the management of post-traumatic stress. https://www.ptsd.va.gov/professional/articles/article-pdf/id88356.pdf
Department of Veterans Affairs & Department of Defense (2023a). VA/DoD clinical practice guideline for management of posttraumatic stress disorder and acute stress disorder. https://www.healthquality.va.gov/HEALTHQUALITY/guidelines/MH/ptsd/VA-DoD-CPG-PTSD-Full-CPG-Edited-111624-V5-81825.pdf
Department of Veterans Affairs & Department of Defense (2023b). VA/DoD clinical practice guideline for management of posttraumatic stress disorder and acute stress disorder [Clinical practice guideline](U.S. Government Printing Office, Issue.
Difede, J., Rothbaum, B. O., Rizzo, A. A., Wyka, K., Spielman, L., Reist, C., Roy, M. J., Jovanovic, T., Norrholm, S. D., Cukor, J., Olden, M., Glatt, C. E., & Lee, F. S. (2022). Enhancing exposure therapy for posttraumatic stress disorder (PTSD): A randomized clinical trial of virtual reality and imaginal exposure with a cognitive enhancer. Translational psychiatry, 12 (1), 299. https://doi.org/10.1038/s41398-022-02066-x
Folke, S., Roitmann, N., Poulsen, S., & Andersen, S. B. (2023). Feasibility of virtual reality exposure therapy in the treatment of Danish veterans with post-traumatic stress disorder: A mixed method pilot study. Cyberpsychology, Behavior and Social Networking, 26 (6), 425–431. https://doi.org/10.1089/cyber.2022.0236
Gamito, P., Oliveira, J., Rosa, P., Morais, D., Duarte, N., Oliveira, S., & Saraiva, T. (2010). PTSD elderly war veterans: A clinical controlled pilot study. Cyberpsychology, Behavior and Social Networking, 13 (1), 43–48. https://doi.org/10.1089/cyber.2009.0237
Goto, R., Guerrero, A. P. S., Speranza, M., Fung, D., Paul, C., & Skokauskas, N. (2022). War is a public health emergency. The Lancet, 399 (10332), 1302. https://doi.org/10.1016/S0140-6736(22)00479-2
Haydabrus, A., Santana-Santana, M., Lazarenko, Y., & Giménez-Llort, L. (2022). Current war in Ukraine: Lessons from the impact of war on combatants’ mental health during the last decade. International Journal of Environmental Research and Public Health, 19 (17), 10536. https://doi.org/10.3390/ijerph191710536
Hodges, L. F., Rothbaum, B. O., Alarcon, R., Ready, D., Shahar, F., Graap, K., Pair, J., Hebert, P., Gotz, D., Wills, B., & Baltzell, D. (1998). Virtual Vietnam: A virtual environment for the treatment of Vietnam war veterans with post-traumatic stress disorder. The Eighth International Conference on Artificial Reality and Tele-Existence, Tokyo, Japan. https://vaclab.unc.edu/publication/icat_1998_hodges/icat_1998_hodges.pdf
Hodges, L. F., Rothbaum, B. O., Alarcon, R., Ready, D., Shahar, F., Graap, K., Pair, J., Hebert, P., Gotz, D., Wills, B., & Baltzell, D. (1999). A virtual environment for the treatment of chronic combat-related post-traumatic stress disorder. Cyberpsychology & Behavior, 2 (1), 7–14. https://doi.org/10.1089/cpb.1999.2.7
Jiang, A., Ulrich, R., Van De Griend, K., Tintle, N., McCarthy, M., & Beckelhymer, D. A. (2023). Mental health service-seeking behavior in post-Soviet Ukraine. International Journal of Mental Health, 52 (2), 179–195. https://doi.org/10.1080/00207411.2023.2177464
Kehle-Forbes, S. M., Meis, L. A., Spoont, M. R., & Polusny, M. A. (2016). Treatment initiation and dropout from prolonged exposure and cognitive processing therapy in a VA outpatient clinic. Psychological Trauma, 8 (1), 107–114. https://doi.org/10.1037/tra0000065
Kime, P. (2020). VA, DoD recommended PTSD therapies don’t help many military patients, review finds. Military Times. https://www.militarytimes.com/news/pentagon-congress/2020/02/04/va-dod-recommended-ptsd-therapies-dont-help-many-military-patients-review-finds/
McLay, R. N., Wood, D. P., Webb-Murphy, J. A., Spira, J. L., Wiederhold, M. D., Pyne, J. M., & Wiederhold, B. K. (2011). A randomized, controlled trial of virtual reality-graded exposure therapy for post-traumatic stress disorder in active duty service members with combat-related post-traumatic stress disorder. Cyberpsychology, Behavior and Social Networking, 14 (4), 223–229. https://doi.org/10.1089/cyber.2011.0003
Quirke, E., Klymchuk, V., Suvalo, O., Bakolis, I., & Thornicroft, G. (2021). Mental health stigma in Ukraine: Cross-sectional survey. Global Mental Health, 8, e11. https://doi.org/10.1017/gmh.2021.9
Reger, G. M., Holloway, K. M., Candy, C., Rothbaum, B. O., Difede, J., Rizzo, A. A., & Gahm, G. A. (2011). Effectiveness of virtual reality exposure therapy for active duty soldiers in a military mental health clinic. Journal of Traumatic Stress, 24 (1), 93–96. https://doi.org/10.1002/jts.20574
Reger, G. M., Koenen-Woods, P., Zetocha, K., Smolenski, D. J., Holloway, K. M., Rothbaum, B. O., Difede, J., Rizzo, A. A., Edwards-Stewart, A., Skopp, N. A., Mishkind, M., Reger, M. A., & Gahm, G. A. (2016). Randomized controlled trial of prolonged exposure using imaginal exposure vs. virtual reality exposure in active duty soldiers with deployment-related posttraumatic stress disorder (PTSD). Journal of Consulting and Clinical Psychology, 84 (11), 946–959. https://doi.org/10.1037/ccp0000134
Rizzo, A., Koenig, S., & Lange, B. (2023). Clinical virtual reality: The state of the science. In G. G. Brown, T. Z. King, K. Y. Haaland, & B. Crosson (Eds.), APA handbook of neuropsychology: Neuroscience and neuromethods (Vol. 2, pp. 473–491). American Psychological Association. https://doi.org/10.1037/0000308-023
Rizzo, A., Roy, M. J., Hartholt, A., Costanzo, M., Highland, K. B., Jovanovic, T., Norrholm, S. D., Reist, C., Rothbaum, B., & Difede, J. (2017). Virtual reality applications for the assessment and treatment of PTSD. In S. V. Bowles & P. T. Bartone (Eds.), Handbook of Military Psychology (pp. 468–486). Springer International Publishing. https://doi.org/10.1007/978-3-319-66192-6
Rizzo, A. A., Giosan, C., Deac, G., Zaporozhets, O., Syvak, O., Dragayeva, S., Bodner, E., Mann, S., & Stone, J. (2025). The Virtual Ukraine Project: Trauma therapy in warzones with virtual reality. In J. Stone (Ed.), Mental health virtual reality: The power of immersive worlds (pp. 159–180). John Wiley & Sons, Inc. https://doi.org/10.1002/9781394278480.ch12
Rizzo, A. A., Graap, K., Perlman, K., McLay, R. N., Rothbaum, B. O., Reger, G., Parsons, T., Difede, J., & Pair, J. (2008). Virtual Iraq: Initial results from a VR exposure therapy application for combat-related PTSD. Studies in Health Technology and Informatics, 132, 420–425. https://pubmed.ncbi.nlm.nih.gov/18391334/
Rizzo, A. A., Pair, J., McNerney, P. J., Eastlund, E., Manson, B., Gratch, J., Hill, R., Roy, M., & Swartout, B. (2005). Design and development of a VR therapy application for Iraq war veterans with PTSD. Stud Health Technol Inform, 111, 407–413.
Rizzo, A. A., Reger, G., Gahm, G., Difede, J., & Rothbaum, B. O. (2009). Virtual reality exposure therapy for combat-related PTSD. In P. J. Shiromani, T. M. Keane, & J. E. LeDoux (Eds.), Post-traumatic stress disorder: Basic science and clinical practice (pp. 375–399). Humana Press. https://doi.org/10.1007/978-1-60327-329-9
Rizzo, A. A., Schulteis, M. T., & Rothbaum, B. O. (2002). Ethical issues for the use of virtual reality in the psychological sciences. In S. S. Bush & M. L. Drexler (Eds.), Ethical Issues in Clinical Neuropsychology (pp. 243–280). Swets & Zeitlinger Publishers. https://doi.org/10.1201/9781003760764
Rizzo, A. S., Difede, J., Rothbaum, B. O., Reger, G., Spitalnick, J., Cukor, J., & McLay, R. (2010). Development and early evaluation of the Virtual Iraq/Afghanistan exposure therapy system for combat-related PTSD. Annals of the New York Academy of Sciences, 1208 (1), 114–125. https://doi.org/10.1111/j.1749-6632.2010.05755.x
Rizzo, A. S., & Shilling, R. (2017). Clinical virtual reality tools to advance the prevention, assessment, and treatment of PTSD. European Journal of Psychotraumatology, 8, 1414560–1414520. https://doi.org/10.1080/20008198.2017.1414560
Rothbaum, B. O., Difede, J., & Rizzo, A. S. (2008). Therapist treatment manual for virtual reality exposure therapy: Posttraumatic stress disorder in Iraq combat veterans. Virtually Better, Inc.
Rothbaum, B. O., Hodges, L., Alarcon, R., Ready, D., Shahar, F., Graap, K., Pair, J., Hebert, P., Gotz, D., Wills, B., & Baltzell, D. (1999). Virtual reality exposure therapy for PTSD Vietnam veterans: A case study. Journal of Traumatic Stress, 12 (2), 263–271. https://doi.org/10.1023/A:1024772308758
Russell, M. C., & Figley, C. R. (2013). Treating traumatic stress injuries in military personnel: An EMDR practitioner's guide. Routledge. https://doi.org/10.4324/9780203829721
Russell, M. C., Silver, S. M., Rogers, S., & Darnell, J. N. (2007). Responding to an identified need: A joint Department of Defense/Department of Veterans Affairs training program in eye movement desensitization and reprocessing (EMDR) for clinicians providing trauma services. International Journal of Stress Management, 14 (1), 61–71. https://doi.org/10.1037/1072-5245.14.1.61
Seleznova, V., Pinchuk, I., Feldman, I., Virchenko, V., Wang, B., & Skokauskas, N. (2023). The battle for mental well-being in Ukraine: Mental health crisis and economic aspects of mental health services in wartime. International Journal of Mental Health Systems, 17 (1), 1–28. https://doi.org/10.1186/s13033-023-00598-3
Settle, C., & Adler-Tapia, R. (2016). Future template for use in EMDR therapy with children and adolescents. In. Springer.
Shapiro, F. (1989). Eye movement desensitization: A new treatment for post-traumatic stress disorder. Journal of Behavior Therapy and Experimental Psychiatry, 20 (3), 211–217. https://doi.org/10.1016/0005-7916(89)90025-6
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EDMR) therapy: Basic principles, protocols, and procedures (3rd ed.). The Guilford Press.
Shapiro, F., & Laliotis, D. (2015). EMDR therapy for trauma-related disorders. In U. Schnyder & M. Cloitre (Eds.), Evidence based treatments for trauma-related psychological disorders: A practical guide for clinicians (pp. 205–228). Springer International Publishing. https://doi.org/10.1007/978-3-319-07109-1_11
Silver, S. M., & Rogers, S. (2003). Light in the heart of darkness: EMDR and the treatment of war and terrorism survivors. W.W. Norton.
Silver, S. M., Rogers, S., Knipe, J., & Colelli, G. (2005). EMDR therapy following the 9/11 terrorist attacks: A community-based intervention project in New York City. International Journal of Stress Management, 12 (1), 29–42. https://doi.org/10.1037/1072-5245.12.1.29
Tintle, N., Bacon, B., Kostyuchenko, S., Gutkovich, Z., & Bromet, E. J. (2011). Depression and its correlates in older adults in Ukraine. International Journal of Geriatric Psychiatry, 26 (12), 1292–1299. https://doi.org/10.1002/gps.2681
United Nations Office for the Coordination of Humanitarian Affairs (2024). Ukraine: Situation report, 7 October 2024. https://www.unocha.org/publications/report/ukraine/ukraine-situation-report-12-july-2024-enuk
Wilson, G., Farrell, D., Barron, I., Hutchins, J., Whybrow, D., & Kiernan, M. D. (2018). The use of eye-movement desensitization reprocessing (EMDR) therapy in treating post-traumatic stress disorder – A systematic narrative review. Frontiers in Psychology, 9, 923. https://doi.org/10.3389/fpsyg.2018.00923
World Health Organization (2013). Guidelines for the management of conditions that are specifically related to stress. https://iris.who.int/server/api/core/bitstreams/659e3dab-1e1b-4ca4-84e0-4ce26484612f/content
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Copyright (c) 2026 Оля Запорожець, Кайл Лінкольн, Вальтер де Соуза, Еван Лафонтейн , Дженіфер Бреа , Альберт Ріццо, Оксана Сивак
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