Comparison of eye movement desensitization and reprocessing therapy, cognitive behavioral writing therapy, and wait-list in pediatric posttraumatic stress disorder following single-incident trauma: a multicenter randomized clinical trial.
BACKGROUND
Practice guidelines for childhood posttraumatic stress disorder (PTSD) recommend trauma-focused psychotherapies, mainly cognitive behavioral therapy (CBT). Eye movement desensitization and reprocessing (EMDR) therapy is a brief trauma-focused, evidence-based treatment for PTSD in adults, but with few well-designed trials involving children and adolescents.


METHODS
We conducted a single-blind, randomized trial with three arms (n = 103): EMDR (n = 43), Cognitive Behavior Writing Therapy (CBWT; n = 42), and wait-list (WL; n = 18). WL participants were randomly reallocated to CBWT or EMDR after 6 weeks; follow-ups were conducted at 3 and 12 months posttreatment. Participants were treatment-seeking youth (aged 8-18 years) with a DSM-IV diagnosis of PTSD (or subthreshold PTSD) tied to a single trauma, who received up to six sessions of EMDR or CBWT lasting maximally 45 min each.


RESULTS
Both treatments were well-tolerated and relative to WL yielded large, intent-to-treat effect sizes for the primary outcomes at posttreatment: PTSD symptoms (EMDR: d = 1.27; CBWT: d = 1.24). At posttreatment 92.5% of EMDR, and 90.2% of CBWT no longer met the diagnostic criteria for PTSD. All gains were maintained at follow-up. Compared to WL, small to large (range d = 0.39-1.03) intent-to-treat effect sizes were obtained at posttreatment for negative trauma-related appraisals, anxiety, depression, and behavior problems with these gains being maintained at follow-up. Gains were attained with significantly less therapist contact time for EMDR than CBWT (mean = 4.1 sessions/140 min vs. 5.4 sessions/227 min).


CONCLUSIONS
EMDR and CBWT are brief, trauma-focused treatments that yielded equally large remission rates for PTSD and reductions in the severity of PTSD and comorbid difficulties in children and adolescents seeking treatment for PTSD tied to a single event. Further trials of both treatments with PTSD tied to multiple traumas are warranted.
['de Roos|Carlijn|C|', 'van der Oord|Saskia|S|', 'Zijlstra|Bonne|B|', 'Lucassen|Sacha|S|', 'Perrin|Sean|S|', 'Emmelkamp|Paul|P|', 'de Jongh|Ad|A|']
D000293:Adolescent D002648:Child D015928:Cognitive Behavioral Therapy D057169:Eye Movement Desensitization Reprocessing D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D017063:Outcome Assessment, Health Care D000067073:Psychological Trauma D016037:Single-Blind Method D013313:Stress Disorders, Post-Traumatic D014850:Waiting Lists D014956:Writing
eye movement desensitization and reprocessing cognitive behavioral writing therapy Posttraumatic stress disorder children and adolescents single trauma