European Child & Adolescent Psychiatry

, Volume 24, Issue 2, pp 227–236 | Cite as

Trauma-focused cognitive behavioral therapy or eye movement desensitization and reprocessing: what works in children with posttraumatic stress symptoms? A randomized controlled trial

  • Julia Diehle
  • Brent C. Opmeer
  • Frits Boer
  • Anthony P. Mannarino
  • Ramón J. L. Lindauer
Original Contribution


To prevent adverse long-term effects, children who suffer from posttraumatic stress symptoms (PTSS) need treatment. Trauma-focused cognitive behavioral therapy (TF-CBT) is an established treatment for children with PTSS. However, alternatives are important for non-responders or if TF-CBT trained therapists are unavailable. Eye movement desensitization and reprocessing (EMDR) is a promising treatment for which sound comparative evidence is lacking. The current randomized controlled trial investigates the effectiveness and efficiency of both treatments. Forty-eight children (8–18 years) were randomly assigned to eight sessions of TF-CBT or EMDR. The primary outcome was PTSS as measured with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). Secondary outcomes included parental report of child PTSD diagnosis status and questionnaires on comorbid problems. The Children’s Revised Impact of Event Scale was administered during the course of treatment. TF-CBT and EMDR showed large reductions from pre- to post-treatment on the CAPS-CA (−20.2; 95 % CI −12.2 to −28.1 and −20.9; 95 % CI −32.7 to −9.1). The difference in reduction was small and not statistically significant (mean difference of 0.69, 95 % CI −13.4 to 14.8). Treatment duration was not significantly shorter for EMDR (p = 0.09). Mixed model analysis of monitored PTSS during treatment showed a significant effect for time (p < 0.001) but not for treatment (p = 0.44) or the interaction of time by treatment (p = 0.74). Parents of children treated with TF-CBT reported a significant reduction of comorbid depressive and hyperactive symptoms. TF-CBT and EMDR are effective and efficient in reducing PTSS in children.


Children PTSD RCT Trauma CBT EMDR 



The authors would like to thank all children and parents who took part in the current study. Furthermore, we would like to thank the Frijling Prins Fonds for financial support. We also want to acknowledge the work of all the therapists and research assistants who were involved in this project. Especially we want to thank Renée Beer for her contributions to the research project.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    Alisic E, van der Schoot TA, van Ginkel JR, Kleber RJ (2008) Looking beyond posttraumatic stress disorder in children: posttraumatic stress reactions, posttraumatic growth, and quality of life in a general population sample. J Clin Psychiatry 69:1455–1461. doi: 10.4088/JCP.v69n0913 PubMedCrossRefGoogle Scholar
  2. 2.
    Copeland WE, Keeler G, Angold A, Costello EJ (2007) Traumatic events and posttraumatic stress in childhood. Arch Gen Psychiatry 64:577–584. doi: 10.1001/archpsyc.64.5.577 PubMedCrossRefGoogle Scholar
  3. 3.
    Perkonigg A, Kessler RC, Storz S, Wittchen H (2000) Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatr Scand 101:46–59. doi: 10.1034/j.1600-0447.2000.101001046.x PubMedCrossRefGoogle Scholar
  4. 4.
    Carrion VG, Weems CF, Ray R, Reiss AL (2002) Toward an empirical definition of pediatric PTSD: the phenomenology of PTSD symptoms in youth. J Am Acad Child Adolesc Psychiatry 41:166–173. doi: 10.1097/00004583-200202000-00010 PubMedCrossRefGoogle Scholar
  5. 5.
    Kessler RC (2000) Posttraumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry 61:4–12PubMedGoogle Scholar
  6. 6.
    National Institute for Health and Clinical Excellence (2005) The management of post traumatic stress disorder in primary and secondary care. Retrieved from
  7. 7.
    Foa EB, Keane T, Friedman M, Cohen J (eds) (2008) Effective Treatments for PTSD: Practive Guidelines from the International Society for Traumatic Stress Studies, 2nd edn. Guilford Press, New York, NYGoogle Scholar
  8. 8.
    Cary CE, McMillen JC (2012) The data behind the dissemination: a systematic review of trauma-focused cognitive behavioral therapy for use with children and youth. Child Youth Serv Rev 34:748–757CrossRefGoogle Scholar
  9. 9.
    Gillies D, Taylor F, Gray C, O’Brien L, D’Abrew N (2013) Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents (review). Evid Based Child Health A Cochrane Rev J 8:1004–1116. doi: 10.1002/ebch.1916;10.1002/ebch.1916 CrossRefGoogle Scholar
  10. 10.
    Silverman WK, Ortiz CD, Viswesvaran C, Burns BJ, Kolko DJ, Putnam FW, Amaya-Jackson L (2008) Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events. J Clin Child Adolesc Psychol 37:156–183PubMedCrossRefGoogle Scholar
  11. 11.
    Cohen JA, Mannarino AP, Deblinger E (2008) Behandeling van trauma bij kinderen en adolescenten. Bohn Stafleu van Loghum, HoutenGoogle Scholar
  12. 12.
    Smith P, Yule W, Perrin S, Tranah T, Dalgleish T, Clark DM (2007) Cognitive-behavioral therapy for PTSD in children and adolescents: a preliminary randomized controlled trial. J Am Acad Child Adolesc Psychiatry 46:1051–1061. doi: 10.1097/CHI.0b013e318067e288 PubMedCrossRefGoogle Scholar
  13. 13.
    Stein BD, Jaycox LH, Kataoka SH, Wong M, Tu W, Elliott MN, Fink A (2003) A mental health intervention for schoolchildren exposed to violence: a randomized controlled trial. JAMA 290:603–611PubMedCrossRefGoogle Scholar
  14. 14.
    Stallard P (2006) Psychological interventions for post-traumatic reactions in children and young people: a review of randomised controlled trials. Clin Psychol Rev 26:895–911PubMedCrossRefGoogle Scholar
  15. 15.
    Shapiro F (2001) Eye movement desensitization and reprocessing: Basic principles protocols and procedures. Guilford Press, New YorkGoogle Scholar
  16. 16.
    Jaberghaderi N, Greenwald R, Rubin A, Zand SO, Dolatabadi S (2004) A comparison of CBT and EMDR for sexually-abused Iranian girls. Clin Psychol Psychother 11:358–368. doi: 10.1002/cpp.395 CrossRefGoogle Scholar
  17. 17.
    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. doi: 10.3402/ejpt.v2i0.5694;  10.3402/ejpt.v2i0.5694
  18. 18.
    Carlier IVE, Gersons BPR (1995) Partial posttraumatic stress disorder (PTSD): the issue of psychological scars and the occurrence of PTSD symptoms. J Nerv Ment Disord 183:107–109CrossRefGoogle Scholar
  19. 19.
    Stein MB, Walker JR, Hazen AL, Forde DR (1997) Full and partial posttraumatic stress disorder: findings from a community survey. Am J Psychiatry 154:1114–1119PubMedCrossRefGoogle Scholar
  20. 20.
    Nader KO, Kriegler JA, Blake DD, Pynoos RS, Newman E, Weather FW (1996) Clinician administered PTSD scale, Child and adolescent version, National Center for PTSD, White River JunctionGoogle Scholar
  21. 21.
    Weathers FW, Ruscio AM, Keane TM (1999) Psychometric properties of nine scoring rules for the Clinician-Administered Posttraumatic Disorder Scale. Psychol Assess 11:124–133CrossRefGoogle Scholar
  22. 22.
    Diehle J, de Roos C, Boer F, Lindauer RJL (2013) A cross-cultural validation of the clinician administered PTSD scale for children and adolescents in a Dutch population. Eur J Psychotraumatol 4Google Scholar
  23. 23.
    Silverman WK, Albano AM (1996) The anxiety disorder interview schedule for DSM-IV: child interview schedule. Graywind Publications, a Division of the Psychological Corporation, San AntonioGoogle Scholar
  24. 24.
    Dyregrov A, Yule W (1995) Screening measures: The development of the UNICEF screening battery. In: Presented at the annual meeting of the International Society for Traumatic Stress Studies, BostonGoogle Scholar
  25. 25.
    Perrin S, Meiser-Stedman R, Smith P (2005) The Children’s Revised Impact of Event Scale (CRIES): validity as a screening instrument for PTSD. Behav Cogn Psychother 33:487–498CrossRefGoogle Scholar
  26. 26.
    Chorpita BF, Yim L, Moffitt C, Umemoto LA, Francis SE (2000) Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale. Behav Res Ther 38:835–855PubMedCrossRefGoogle Scholar
  27. 27.
    Goodman R (1997) The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry 38:581–586PubMedCrossRefGoogle Scholar
  28. 28.
    Beer R, de Roos C (2008) EMDR bij kinderen en adolescenten, een nieuw perspectief. In: Ten Broeke E, de Jongh A, Oppenheim H-J (eds) Praktijkboek EMDR. Harcourt, Amsterdam. doi: 10.1016/j.childyouth.2012.01.003 Google Scholar
  29. 29.
    Rubin DB (1987) Multiple imputation for nonresponse in surveys. Wiley, New YorkCrossRefGoogle Scholar
  30. 30.
    Jacobson NS, Truax P (1991) Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 59:12–19PubMedCrossRefGoogle Scholar
  31. 31.
    Jensen TK, Holt T, Ormhaug SM, Egeland KE, Granly LB, Hoaas LE, Wentzel-Larsen T (2013) A randomized effectiveness study comparing trauma-focused cognitive behavioral therapy with therapy as usual for youth. J Clin Child Adolesc Psychol. doi: 10.1080/15374416.2013.822307 PubMedCentralPubMedGoogle Scholar
  32. 32.
    Cohen JA, Deblinger E, Mannarino AP, Steer RA (2004) A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. J Am Acad Child Adolesc Psychiatry 43:393–402. doi: 10.1097/00004583-200404000-00005 PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Tarrier N, Sommerfield C, Pilgrim H, Faragher B (2000) Factors associated with outcome of cognitive behavioural treatment of chronic posttraumatic stress disorder. Behav Res Ther 38:191–202PubMedCrossRefGoogle Scholar
  34. 34.
    Forbes D, Creamer M, Hawthorne G, Allen N, McHugh T (2003) Comorbidity as a predictor of symptom change after treatment in combat-related posttraumatic stress disorder. J Nerv Ment Dis 191:93–99PubMedGoogle Scholar
  35. 35.
    Chemtob CM, Nakashima J, Carlson JG (2002) Brief treatment for elementary school children with disaster-related posttraumatic stress disorder: a field study. J Clin Psychol 58:99–112PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Julia Diehle
    • 1
  • Brent C. Opmeer
    • 2
  • Frits Boer
    • 1
    • 3
  • Anthony P. Mannarino
    • 4
  • Ramón J. L. Lindauer
    • 1
    • 3
  1. 1.Department of Child and Adolescent PsychiatryAcademic Medical CentreAmsterdamThe Netherlands
  2. 2.Clinical Research UnitUniversity of AmsterdamAmsterdamThe Netherlands
  3. 3.Academic Center for Child and Adolescent Psychiatry de BasculeAmsterdamThe Netherlands
  4. 4.Department of Psychiatry, Four Algheny CenterDrexel University College of MedicinePittsburghUSA

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