Participants receive standard EMDR therapy following the standard EMDR protocol (Shapiro, 2002).

Participants receive EMDR therapy using the EMDR Toolbox Method including the Ovals Tool as a case formulation tool and additional tools tools such as Loving Eyes (LE) and Constant Installation of Present Orientation and Safety (CIPOS).

Standard Eye Movement Desensitization and Reprocessing (EMDR) therapy delivered according to established clinical guidelines (Shapiro, 2002).

Feasibility will be evaluated in this pilot randomized controlled trial comparing Standard EMDR and EMDR Toolbox Method delivered over 15 sessions. Feasibility indicators will include:

- Treatment adherence (proportion of participants attending at least 10 out of 15 sessions)

Feasibility criteria will be considered met if:

- ≥65% of randomized participants complete at least 10 out of 15 sessions

Overall psychological wellbeing will be assessed using the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) total score [range score: 0-136].

The CORE-OM is a self-report measure of global psychological distress and functioning, with higher scores indicating greater psychological distress.

Assessments will be conducted at three time points:

• Baseline (prior to randomization)
• Mid-treatment (after 7 sessions; approximately 14 weeks post-randomization)
• Post-treatment (after 15 sessions; approximately 28 weeks post-randomization)

The primary analysis for this pilot study will estimate within-group and between-group mean changes in CORE-OM total scores over time.

Effect size estimates (e.g., Cohen's d) and 95% confidence intervals will be calculated to inform the design and sample size estimation of a future definitive trial.

Psychological symptoms will be assessed using the Symptoms subscale of the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) [range score: 0-48].

The Symptoms domain evaluates the severity of psychological distress, including anxiety, depression, trauma-related and somatic symptoms. Higher scores indicate greater symptom severity.

Assessments will be conducted at three time points:

• Baseline (prior to randomization)
• Mid-treatment (after 7 sessions; approximately 14 weeks post-randomization)
• Post-treatment (after 15 sessions; approximately 28 weeks post-randomization)

For this trial comparing Standard EMDR and ETM EMDR, analyses will estimate:

• Within-group mean changes over time
• Between-group differences in change scores
• Effect size estimates (e.g., Cohen's d) with 95% confidence intervals

Self-compassion will be assessed using the Self-Compassion Scale (SCS), a validated self-report measure evaluating levels of self-kindness, common humanity, and mindfulness versus self-judgment, isolation, and over-identification [range score: 26-130].

Higher total scores indicate greater self-compassion. This psychological construct is fundamental to well-being and to a healthy attitude toward oneself (Zessin, 2015).

Assessments will be conducted at three time points:

• Baseline (prior to randomization)
• Mid-treatment (after 7 sessions; approximately 14 weeks post-randomization)
• Post-treatment (after 15 sessions; approximately 28 weeks post-randomization)

In this trial comparing Standard EMDR and ETM EMDR, analyses will estimate:

• within-group mean changes in SCS total score over time
• between-group differences in change from baseline-
• effect size estimates (e.g., Cohen's d) with 95% confidence intervals