Trauma-focused cognitive behavioral therapy or eye movement desensitization and reprocessing: what works in children with posttraumatic stress symptoms? A randomized controlled trial
- 5k Downloads
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.
KeywordsChildren 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.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
- 6.National Institute for Health and Clinical Excellence (2005) The management of post traumatic stress disorder in primary and secondary care. Retrieved from http://www.nice.org.uk/CG26
- 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
- 11.Cohen JA, Mannarino AP, Deblinger E (2008) Behandeling van trauma bij kinderen en adolescenten. Bohn Stafleu van Loghum, HoutenGoogle Scholar
- 15.Shapiro F (2001) Eye movement desensitization and reprocessing: Basic principles protocols and procedures. Guilford Press, New YorkGoogle Scholar
- 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
- 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
- 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.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.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
- 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