Expression of Interest to Participate Form 

Early Intervention EMDR Therapy VGTEP (Virtual Group Traumatic Episode Protocol) for Essential Front Line Workers, Health & Care Workers, First Responders,

Emergency Services, Essential Retail, Logistics Staff, Teachers & Police  experiencing Psychological Distress & Trauma in response to Covid-19 

Which of the Following Is Most Relevant to You

Are you experiencing symptoms of trauma?

Are you experiencing anticipatory anxiety?

Do you feel you are experiencing Psychological Distress / Trauma in response to Covid-19?

Are you experiencing Intrusions / Flashbacks / Nightmares?

Are you experiencing increased irritability / low moods?

I confirm that I am interested in availing of trauma treatment sessions

Any reminder brought back feelings about it?

I have trouble staying asleep

Are you experiencing acute stress, hypertension, anxiety, sleep disruptions?

I felt irritable and angry

I avoided letting myself get upset when I thought or was reminded of it

I thought about it when I didn't mean to

I felt as if it hadn't happened or wasn't real

I stayed away from reminders about it

Other things kept making me think about it

Pictures about it popped into my mind

I tried not to think about it

I tried not to think about it

I was aware that I still had a lot of feelings about it, but I didn't deal with them

My feelings about it were kind of numb

I was jumpy and easily startled

I had trouble falling asleep

I had waves of strong feelings about it

I tried to remove it from my memory

I found myself acting or feeling as though I was back at that time

I had trouble concentrating

Reminders of it caused me to have physical reactions, such as sweating, trouble breathing, nausea, or a pounding heart

I felt watchful or on-guard

I tried not to talk about it

I had dreams about it

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