De Roos et al. (2017). Comparison of eye movement desensitization and reprocessing theory, cognitive behavioural writing therapy, and wait-list in pediatric posttraumtic stress disorder.” – Article summary

About 16% of the children exposed to a trauma develop posttraumatic stress disorder (PTSD). This is associated with psychiatric comorbidity (1), functional impairment (2) and persistence into adulthood (3). Early and effective treatment is needed to reduce the negative effects of PTSD.

Trauma-focused psychological therapies are recommended as first-line approach. Trauma-focused cognitive behavioural strategies (CBT) involve a combination of coping skills training (1), cognitive restructuring (2), therapist- and client-led exposure (3) and parent interventions (4).

Eye movement desensitization and reprocessing (EMDR) therapy is a brief, trauma-focused treatment for PTSD. During this treatment, the patient holds a disturbing image from the trauma memory in mind while engaging in sets of saccadic eye movements. There is evidence that it works for adults. Both CBT and EMDR appear effective in reducing PTSD symptoms in adults. The sessions consist of history taking (1), treatment planning (2), preparation (3), reprocessing (4), installation of a positive cognition (5), check for and processing any residual disturbing body sensations (6), positive closure (7) and evaluation (8).

Cognitive behavioural writing therapy (CBWT) involves exposure to the trauma memory and restructuring of trauma-related beliefs through writing and updating of the trauma memory on a computer with the support of a therapist. It can be relatively brief as it focuses on exposure and reprocessing of the trauma memory. It does not include coping skills training or parent-focused sessions. The sessions include psychoeducation (1), imaginal exposure (2), cognitive restructuring (3), promoting healthy coping strategies (4) and enlisting support from loved ones or friends (5).

Both EMDR and CBWT include six sessions of 45 minutes. They do not include parent sessions and there are no instructions for parents to encourage their child to discuss the trauma or to confront reminders. Information about PTSD and a brief explanation of the treatment was offered to the youth and parents in the first sessions. Parents had five minutes at the start and end of each session to share their observations regarding the child’s functioning.

Both EMDR and CBWT have high rates of diagnostic remission from PTSD. Treatment drop-out tends to be very low. Both treatments lead to reductions in child- and parent-reported symptoms of PTSD (1), anxiety (2), depression (3) and behavioural problems (4). It also led to reductions in child-reported negative trauma-related appraisals (5). The treatments were equal to each other in outcomes. The outcomes were maintained at 12 month follow-up.

People who received EMDR treatment made further gains compared to CBWT on child- and parent-reported PTSD symptoms between the 3- and 12-month follow-up. Overall, the difference between the treatments during the follow-up period were minor. This means that both treatments can be seen as efficacious for treating PTSD in youth who were exposed to a single traumatic event. EMDR appears to lead to positive outcomes faster than CBWT, though this is not entirely clear.