Comparison of eye movement desensitization and reprocessing therapy, cognitive behavioral writing therapy, and wait‐list in pediatric posttraumatic stress disorder following single‐incident trauma: a multicenter randomized clinical trial

Jun 30, 2017Journal of child psychology and psychiatry, and allied disciplines

Comparing Eye Movement Therapy, Writing Therapy, and No Treatment for Children with PTSD After a Single Trauma

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Abstract

At posttreatment, 92.5% of participants receiving Eye Movement Desensitization and Reprocessing (EMDR) no longer met the diagnostic criteria for PTSD.

Both EMDR and Cognitive Behavior Writing Therapy (CBWT) were well-tolerated among participants aged 8-18 years with PTSD.
Large effect sizes for reductions in PTSD symptoms were observed for both EMDR (d = 1.27) and CBWT (d = 1.24) compared to a wait-list group.
Significantly fewer therapy sessions were required for EMDR (mean = 4.1 sessions/140 min) compared to CBWT (mean = 5.4 sessions/227 min).
Participants in both treatment groups maintained their gains in PTSD symptoms and related difficulties at follow-up assessments.
Small to large effect sizes were noted for improvements in negative trauma-related appraisals, anxiety, depression, and behavior problems compared to the wait-list group.

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BACKGROUND: Practice guidelines for childhood posttraumatic stress disorder (PTSD) recommend trauma-focused psychotherapies, mainly cognitive behavioral therapy (CBT). Eye movement desensitization and reprocessing (EMDR) therapy is a brief trauma-focused, evidence-based treatment for PTSD in adults, but with few well-designed trials involving children and adolescents.

METHODS: We conducted a single-blind, randomized trial with three arms (n = 103): EMDR (n = 43), Cognitive Behavior Writing Therapy (CBWT; n = 42), and wait-list (WL; n = 18). WL participants were randomly reallocated to CBWT or EMDR after 6 weeks; follow-ups were conducted at 3 and 12 months posttreatment. Participants were treatment-seeking youth (aged 8-18 years) with a DSM-IV diagnosis of PTSD (or subthreshold PTSD) tied to a single trauma, who received up to six sessions of EMDR or CBWT lasting maximally 45 min each.

RESULTS: Both treatments were well-tolerated and relative to WL yielded large, intent-to-treat effect sizes for the primary outcomes at posttreatment: PTSD symptoms (EMDR: d = 1.27; CBWT: d = 1.24). At posttreatment 92.5% of EMDR, and 90.2% of CBWT no longer met the diagnostic criteria for PTSD. All gains were maintained at follow-up. Compared to WL, small to large (range d = 0.39-1.03) intent-to-treat effect sizes were obtained at posttreatment for negative trauma-related appraisals, anxiety, depression, and behavior problems with these gains being maintained at follow-up. Gains were attained with significantly less therapist contact time for EMDR than CBWT (mean = 4.1 sessions/140 min vs. 5.4 sessions/227 min).

CONCLUSIONS: EMDR and CBWT are brief, trauma-focused treatments that yielded equally large remission rates for PTSD and reductions in the severity of PTSD and comorbid difficulties in children and adolescents seeking treatment for PTSD tied to a single event. Further trials of both treatments with PTSD tied to multiple traumas are warranted.

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