Efficacy of Eye Movement Desensitization and Reprocessing in Children and Adolescent with Post-traumatic Stress Disorder: A Meta-Analysis of Randomized Controlled Trials

Ana Moreno-Alcázar, Devi Treen, Alicia Valiente-Gómez, Albert Sio-Eroles, Víctor Pérez, Benedikt L Amann, Joaquim Radua, Ana Moreno-Alcázar, Devi Treen, Alicia Valiente-Gómez, Albert Sio-Eroles, Víctor Pérez, Benedikt L Amann, Joaquim Radua

Abstract

Background: Post-traumatic stress disorder (PTSD) can occur in both adults and children/adolescents. Untreated PTSD can lead to negative long-term mental health conditions such as depression, anxiety, low self-concept, disruptive behaviors, and/or substance use disorders. To prevent these adverse effects, treatment of PTSD is essential, especially in young population due to their greater vulnerability. The principal aim of this meta-analysis was to examine the efficacy of eye movement desensitization and reprocessing (EMDR) therapy for PTSD symptoms in children and adolescents. Secondary objectives were to assess whether EMDR therapy was effective to improve depressive or anxious comorbid symptoms. Methods: We conducted a thorough systematic search of studies published until January 2017, using PubMed, Medline, Scopus, and ScienceDirect as databases. All randomized controlled trials with an EMDR group condition compared to a control group, such as treatment as usual or another psychological treatment, were included. Meta-analysis was conducted with MetaNSUE to avoid biases related to missing information. Results: Eight studies (n = 295) met our inclusion criteria. EMDR therapy was superior to waitlist/placebo conditions and showed comparable efficacy to cognitive behavior therapy (CBT) in reducing post-traumatic and anxiety symptoms. A similar but non-statistically significant trend was observed for depressive symptoms. Exploratory subgroup analyses showed that effects might be smaller in studies that included more males and in more recent studies. Conclusion: Despite the small number of publications, the obtained results suggest that EMDR therapy could be a promising psychotherapeutic approach for the treatment of PTSD and comorbid symptoms in young individuals. However, further research with larger samples is needed to confirm these preliminary results as well as to analyze differences in the efficacy of EMDR therapy versus CBT.

Keywords: EMDR; adolescents; children; meta-analysis; post-traumatic stress disorder; psychological trauma.

Figures

FIGURE 1
FIGURE 1
Flow diagram of excluded and included studies according to the PRISMA guide.

References

    1. Ahmad A., Larsson B., Sundelin-Wahlsten V. (2007). EMDR treatment for children with PTSD: results of a randomized controlled trial. Nord. J. Psychiatry 61 349–354. 10.1080/08039480701643464
    1. Ahmad A., Sundelin-Wahlsten V., Sofi M., Qahar J., von Knorring A. (2000). Reliability and validity of a child-specific cross-cultural instrument for assessing posttraumatic stress disorder. Eur. Child Adolesc. Psychiatry 9 285–294. 10.1007/s007870070032
    1. Alisic E., Zalta A. K., Van Wesel F., Larsen S. E., Hafstad G. S., Hassanpour K., et al. (2014). Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis. Br. J. Psychiatry 204 335–340. 10.1192/bjp.bp.113.131227
    1. APA (2013). Diagnostic and Statistical Manual of Mental Disorders 5th Edn. Washington, DC: American Psychiatric Association.
    1. Beck A., Steer R. (1993). Beck Depression Inventory manual. San Antonio, TX: The Psychological Corporation.
    1. Birlenson P. (1981). The validity of depressive disorder in childhood and the development of a self-rating scale: a research report. J. Child Psychol. Psychiatry 22 73–88. 10.1111/j.1469-7610.1981.tb00533.x
    1. Brown R. C., Witt A., Fegert J. M., Keller F., Rassenhofer M., Plener P. L. (2017). Psychosocial interventions for children and adolescents after man-made and natural disasters: a meta-analysis and systematic review. Psychol Med. 47 1893–1905. 10.1017/S0033291717000496
    1. Chemtob C. M., Nakashima J., Carlson J. G. (2002). Brief treatment for elementary school children with disaster-related posttraumatic stress disorder: a field study. J. Clin. Psychol. 58 99–112. 10.1002/jclp.1131
    1. Chen L., Zhang G., Hu M., Liang X. (2015). Eye movement desensitization and reprocessing versus cognitive-behavioral therapy for adult posttraumatic stress disorder: systematic review and meta-analysis. J. Nerv. Ment. Dis. 203 443–451. 10.1097/NMD.0000000000000306
    1. Chen Y. R., Hung K. W., Tsai J. C., Chu H., Chung M. H., Chen S. R., et al. (2014). Efficacy of eye-movement desensitization and reprocessing for patients with posttraumatic-stress disorder: a meta-analysis of randomized controlled trials. PLOS ONE 9:e103676. 10.1371/journal.pone.0103676
    1. Chorpita B. F., Yim L., Moffitt C., Umemoto L. A., Francis S. E. (2000). Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale. Behav. Res. Ther. 38 835–855. 10.1016/S0005-7967(99)00130-8
    1. Coubard O. A. (2016). An integrative model for the neural mechanism of eye movement desensitization and reprocessing (EMDR). Front. Behav. Neurosci. 10:52. 10.3389/fnbeh.2016.00052
    1. Cusack K., Jonas D. E., Forneris C. A., Wines C., Sonis J., Middleton J. C., et al. (2016). Psychological treatments for adults with posttraumatic stress disorder: a systematic review and meta-analysis. Clin. Psychol. Rev. 43 128–141. 10.1016/j.cpr.2015.10.003
    1. Davidson P. R., Parker K. C. (2001). Eye movement desensitization and reprocessing (EMDR): a meta-analysis. J. Consult. Clin. Psychol. 69 305–316. 10.1037/0022-006X.69.2.305
    1. de Roos C., Greenwald R., den Hollander-Gijsman M., Noorthoorn E., van Buuren S., de Jongh A. (2011). A randomised comparison of cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) in disaster-exposed children. Eur. J. Psychotraumatol. 2 1–11. 10.3402/ejpt.v2i0.5694
    1. Diehle J., Opmeer B. C., Boer F., Mannarino A. P., Lindauer R. J. L. (2015). Trauma-focused cognitive behavioral therapy or eye movement desensitization and reprocessing: What works in children with posttraumatic stress symptoms? A randomized controlled trial. Eur. Child Adolesc. Psychiatry 24 227–236. 10.1007/s00787-014-0572-5
    1. Frederick C., Pynoos R., Nader K. (1992). Childhood Post-Traumatic Stress Reaction Index (CPTS-RI). Washington, DC: United States Department of Veterans Affairs.
    1. Greenwald R., Rubin A. (1999). Social work practice. Res. Soc. Work Pract. 9 61–75. 10.1177/104973159900900105
    1. Hammaiberg M. (1992). Penn inventory for posttraumatic stress disorder: psychometric properties. Psychol. Assess. 4 67–76. 10.1037/1040-3590.4.1.67
    1. Hedges L., Olkin I. (1985). Statistical Methods for Meta-Analysis. Orlando, FL: Academic Press.
    1. Higgins J. P. T., Altman D. G., Gøtzsche P. C., Jüni P., Moher D., Oxman A. D., et al. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Br. Med. J. 343 889–893. 10.1136/bmj.d5928
    1. Jaberghaderi N., Greenwald R., Rubin A., Zand S. O., Dolatabadi S. (2004). A comparison of CBT and EMDR for sexually-abused Iranian girls. Clin. Psychol. Psychother. 11 358–368. 10.1002/cpp.395
    1. Jadad A. R., Moore R. A., Carroll D., Jenkinson C., Reynolds D. J. M., Gavaghan D. J., et al. (1996). Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin. Trials 17 1–12. 10.1016/0197-2456(95)00134-4
    1. Javidi H., Yadollahie M. (2012). Post-traumatic stress disorder. Int. J. Occup. Environ. Med. 3 2–9.
    1. Keeshin B. R., Strawn J. R. (2014). Psychological and pharmacologic treatment of youth with posttraumatic stress disorder: an evidence-based review. Child Adolesc. Psychiatr. Clin. N. Am. 23 339–411. 10.1016/j.chc.2013.12.002
    1. Kemp M., Drummond P., McDermott B. (2010). A wait-list controlled pilot study of eye movement desensitization and reprocessing (EMDR) for children with post-traumatic stress disorder (PTSD) symptoms from motor vehicle accidents. Clin. Child Psychol. Psychiatry 15 5–25. 10.1177/1359104509339086
    1. Kovacs M. (1992). Children’s Depression Inventory. North Tonawanda, NY: Multi-Health Systems.
    1. Lang M., Tisher M. (1983). Children’s Depression Scale. Hawthorn, VIC: Australian Council for Educational Research.
    1. Luthra R., Abramovitz R., Greenberg R., Schoor A., Newcorn J., Schmeidler J., et al. (2009). Relationship between type of trauma exposure and posttraumatic stress disorder among urban children and adolescents. J. Interpers. Violence 24 1919–1927. 10.1177/0886260508325494
    1. March J. S., Parker M. P. H. J. D. A., Ph D., Sullivan K., Stallings P., Conners C. K. (1996). The multidimensional anxiety scale for children (MASC): factor structure, reliability, and validity. J. Am. Acad. Child Adolesc. Psychiatry 36 554–565. 10.1097/00004583-199704000-00019
    1. Mclaughlin K. A., Green J. G., Gruber M. J., Sampson N. A., Zaslavsky A. M., Kessler R. C. (2012). Childhood adversities and first onset of psychiatric disorders in a national sample of US adolescents. Arch. Gen. Psychiatry 69 1151–1160. 10.1001/archgenpsychiatry.2011.2277
    1. McLaughlin K. A., Koenen K. C., Hill E. D., Petukhova M., Sampson N. A., Zaslavsky A. M., et al. (2013). Trauma exposure and posttraumatic stress disorder in a national sample of adolescents. J. Am. Acad. Child Adolesc. Psychiatry 52 815.e14–830.e14. 10.1016/j.jaac.2013.05.011
    1. Moher D., Liberati A., Tetzlaff J., Altman D. G. (2014). Preferred reporting items for systematic reviews and meta-analyses?. Ann. Intern. Med. 151 264–269. 10.7326/0003-4819-151-4-200908180-00135
    1. Morina N., Koerssen R., Pollet T. V. (2016). Interventions for children and adolescents with posttraumatic stress disorder: a meta-analysis of comparative outcome studies. Clin Psychol Rev. 47 41–54. 10.1016/j.cpr.2016.05.006
    1. Nader K., Kriegler J., Blake D., Pynoos R., Newman E., Weather F. (1996). Clinician Administered PTSD Scale, Child and Adolescent Version. White River Junction, VT: National Center for PTSD.
    1. Nemeroff C. B. (2016). Paradise lost: the neurobiological and clinical consequences of child abuse and neglect. Neuron 89 892–909. 10.1016/j.neuron.2016.01.019
    1. Novo P., Landin-romero R., Guardiola-Wanden-Berghe R., Moreno-Alcázar A., Valiente-Gómez A., Lupo W., et al. (2016). 25 years of eye movement desensitization and reprocessing (EMDR): the EMDR therapy protocol, hypotheses of its mechanism of action and a systematic review of its efficacy in the treatment of post-traumatic stress disorder. Rev. Psiquiatr. Salud Ment. 10.1016/j.rpsm.2015.12.002 [Epub ahead of print].
    1. Pynoos R. S., Frederick C., Nader K., Arroyo W., Steinberg A., Eth S., et al. (1987). Life threat and posttraumatic stress in school-age children. Arch. Gen. Psychiatry 44 1057–1063. 10.1001/archpsyc.1987.01800240031005
    1. Radua J., Schmidt A., Borgwardt S., Heinz A., Schlagenhauf F., McGuire P., et al. (2015). Ventral striatal activation during reward processing in psychosis a neurofunctional meta-analysis. JAMA Psychiatry 72 1243–1251. 10.1001/jamapsychiatry.2015.2196
    1. Reynolds C., Richmond B. (1985). Revised Children’s Manifest Anxiety Scale (RCMAS) 3rd Edn. Los Angeles, CA: Western Psychological Services
    1. Rodenburg R., Benjamin A., de Roos C., Meijer A. M., Stams G. J. (2009). Efficacy of EMDR in children: a meta-analysis. Clin. Psychol. Rev. 29 599–606. 10.1016/j.cpr.2009.06.008
    1. Scheck M. M., Schaeffer J. A., Gillette C. (1998). Brief psychological intervention with traumatized young women: the efficacy of eye movement desensitization and reprocessing. J. Trauma Stress 11 25–44. 10.1023/A:1024400931106
    1. Seidler G. E., Wagner F. E. (2006). Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: a meta-analytic study. Psychol. Med. 36 1515–1522. 10.1017/S0033291706007963
    1. Shapiro F. (2014). The role of eye movement desensitization and reprocessing (EMDR) therapy in medicine: addressing the psychological and physical symptoms stemming from adverse life experiences. Perm. J. 18 71–77. 10.7812/TPP/13-098
    1. Soberman G. B., Greenwald R., David L. A. (2002). Controlled study of eye movement desensitization and reprocessing (EMDR) for boys with conduct problem. J. Aggress. Maltreat. Trauma 6 217–236. 10.1300/J146v06n01_11
    1. Spielberg C., Gorsuch R., Lushene R., Vagg P., Jacobs G. (1983). Manual for the State-Trait Anxiety Inventory (Form Y). Palo Alto, CA: Consulting psychologists Press.
    1. Strawn J. R., Keeshin B. R., DelBello M. P., Geracioti T. D., Putnam F. W. (2010). Psychopharmacologic treatment of posttraumatic stress disorder in children and adolescents: a review. J. Clin. Psychiatry 71 932–941. 10.4088/JCP.09r05446blu
    1. Viechtbauer W. (2005). Bias and efficiency of meta-analytic variance estimators in the random-effects model. J. Educ. Behav. Stat. 30 261–293. 10.3102/10769986030003261

Source: PubMed

3
Abonner