A controlled comparison of eye movement desensitization and reprocessing versus exposure plus cognitive restructuring versus waiting list in the treatment of post‐traumatic stress disorder

Abstract

A total of 105 patients with post-traumatic stress disorder (PTSD) were randomly allocated to eye-movement desensitization and reprocessing (EMDR) .n = 39/ versus exposure plus cognitive restructuring (E Y CR) (n = 37) versus waiting list (WL) (n = 29) in a primary care setting. EMDR and E Y CR patients received a maximum of 10 treatment sessions over a 10-week period. All patients were assessed by blind raters prior to randomization and at end of the 10-week treatment or waiting list period. EMDR and E Y CR patients were also assessed by therapists at the mid-point of the 10-week treatment period and on average at 15 months follow-up. Patients were assessed on a variety of assessor-rated and self-report measures of PTSD symptomatology including the Clinician Administered PTSD Scale (CAPS), the Impact of Events Scale (IOE) and a self-report version of the SI-PTSD Checklist. Measures of anxiety and depression included the Montgomery Asberg Depression Rating Scale (MADRS), the Hamilton Anxiety Scale (HAM-A) and the Hospital Anxiety and Depression Scale (HADS). A measure of social function, the Sheehan Disability Scale was also used. Drop-out rates between the three groups were 12 EMDR, 16 E Y CR and five WL. Treatment end-point analyses were conducted on the remaining 72 patients. Repeated measures analysis of variance of treatment outcome at 10 weeks revealed significant time, interaction and group effects for all the above measures. In general there were significant and substantial

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

“…Not effective in DBPC study (E) Keane et al 1989;Resick et al 2002;Taylor et al 2003). Superiority to a psychological placebo was found in a number of studies (Blanchard et al 2003;Bryant et al 2003;Echeburua et al 1997;Marks et al 1998;Power et al 2002). In some studies CBT was superior to a wait list control, but not more effective than a psychological placebo (Foa et al 1991;McDonagh et al 2005;Neuner et al 2004).…”

“…EMDR was superior to a wait list condition (Jensen 1994;Lee et al 2002;Rothbaum 1997;Vaughan et al 1994), to a psychological placebo (Carlson et al 1998;Marcus et al 1997;Power et al 2002;Scheck et al 1998;Taylor et al 2003) or a pill placebo (van der Kolk et al 2007). …”

The Relative Efficacy of Bona Fide Psychotherapies for Post-Traumatic Stress Disorder: A Meta-Analytical Evaluation of Randomized Controlled Trials

“…PCT included bona fide psychotherapies that were mostly linked to elements of Roger's clientcentered psychotherapy [43] and encompassed supportive, present-centered, problemsolving, and psychoeducative elements. Treatments coded as CBT included some therapies that utilized, but did not primarily rely on, elements of other therapies (e.g., exposure [44,45]), and treatments such as Seeking Safety [46] or Image Rehearsal [47].…”

“…In addition to the 15 studies included in Benish et al [23], we retrieved seven further studies that fulfilled the inclusion criteria, resulting in a total sample of 22 studies [42,[44][45][46][47][57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73] (as the re-assessment of the study selection is an important topic of interest, see Additional file 1 for full references of the excluded studies). In sum, 161 abstracts were thoroughly screened and 46 studies assessed in full-text for eligibility, see Fig.…”

Cognitive behaviour therapy versus eye movement desensitization and reprocessing for post-traumatic disorder – is it all in the homework then?

“…Indeed the meta-analysis by Kazantzis et al, (2010) did not include studies of EMDR, a treatment known for its minimal homework requirements. Studies comparing CBT and EMDR reveal number of sessions to be comparable (Lee, Gavriel, Drummond, Richards, & Greenwald, 2002;Power et al, 2002), as well as treatment outcomes (in some cases EMDR has proven to be superior e.g. Ironson, Freund, Strauss, & Williams, 2002) however hours of homework assigned to the study participants are not.…”