Psychotherapy in the treatment of PTSD: A meta-analytic comparison of cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR)
Description
Post-traumatic stress disorder (PTSD) is prevalent in children, adolescents and adults. Without adequate intervention PTSD is likely to harm wellbeing of patients. A broad range of treatment modalities have been developed for treatment of PTSD, which includes pharmacotherapies and psychotherapies such as Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR).
Objectives:
The Primary objective of this meta-analysis is to compare the efficacy of Cognitive Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) in alleviating post-traumatic symptoms.
The secondary objective is to compare the efficacy of CBT and EMDR in alleviating anxiety and depression among PTSD patients.
Methods:
Studies published between 1999 and December 2017 were systematically searched from EMBSASE, Medline and Cochrane Central register of controlled trials (CENTRAL).Trials that met inclusion criteria were included in a systematic review and meta-analyses. Meta-analysis was done using RevMan 5.
Inclusion Criteria:
Study participants were children, adolescents or adults
Studies were published in the English language
Studies that reported comparative results from RTCs of CBT and EMDR groups
Studies that reported a diagnosis of PTSD in accordance to DSM-IV or DSM-IV-TR or DSM-III
Studies that reported adequate data for calculation of design effect.
Exclusion Criteria:
Studies reporting treatment methodologies focused on conditions other than PTSD, such as depression, bipolar disorder, behavioral problems, substance abuse, psychosis, suicidal ideation, and substance dependence
Studies reporting other types of psychotherapies such as psychodynamic therapy, hypnotherapy, self-help, and biofeedback.
Results:
Fourteen studies (n= 714) with 370 participants randomized to EMDR and 344 participants randomized to CBT met inclusion criteria.
Eleven studies (n= 547) with 276 participants in EMDR and 271 participants in CBT showed EMDR was better than CBT in reducing post-traumatic symptoms SMD = -0.43, p = 0.006.
Four studies (n= 186) having 96 participants in EMDR and 90 participants in CBT showed there was no difference between EMDR and CBT at 3 month follow up in reducing post-traumatic symptoms SMD = -0.21, p = 0.15.
Eight studies (n= 714) that had 148 participants in EMDR and 147 participants in CBT showed there was no difference between CBT and EMDR in reducing depression SMD = -0.25, p = 0.27.
Five studies (n = 239) having 122 participants in EMDR and 117 participants in CBT showed EMDR was better than CBT in reducing anxiety SMD = -0.71, p = 0.005.