EMDR and TF-CBT in the treatment of PTSD

Among the severaltreatment alternatives for post-traumatic stress disorder (PTSD), Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) and Eye Movement Desensitisation and Reprocessing (EMDR) therapy have led to promising results in helping individualsmanage PTSD symptoms. However, due to the different theoretical and methodological mechanisms of EMDR and TF-CBT, a potentially different effect on the brain could be hypothesised for the aforementioned interventions, as well as a distinct interaction between the trauma-specific PTSD symptomatology and the response to a particularform of psychotherapy.Delivering online EMDR is a helpful way to reach a larger population of clients.

In an often-cited meta-analysis conducted in 1998, van Etten and Taylor concluded that, in the treatment of PTSD, cognitive-behavioral methods and EMDR are superior to other forms of therapy, such as relaxation training, hypnotherapy, and dynamic psychotherapy. The authors showed that these two types of treatment had similar effect sizes, both after the end of the treatment and in a subsequent follow-up study. While the efficacy was similar, the authors found EMDR to be more efficient due to the lower average treatment duration it requires compared to cognitive-behavioral therapies.However, critical methodological examination of the comparison between EMDR and cognitive-behavioral therapy (CBT) in the study showed that its interpretability is limitedby the calculation of the average effect sizes in the treatment and control groups on the basis of pre/post comparisons exclusively. While pre/post comparisons can be used to conclude on the effectiveness of a form of therapy, on condition that one has knowledge of the corresponding pre/post effect sizes in the untreated control groups, the interpretability of a direct comparison between two therapies is limited by such an approach.

Later on, a 2006 meta-analysiswas conducted in order tocompare the same forms of therapy.Seven studies were used,involving a total of 209 participants with the average age of 35.4 years, all of whom had gone through all the treatment sessions. 65% of the subjects were women. The superiority of either EMDR or TF-CBT over the other could not be demonstrated, as theyshowed to be equally efficacious. The authors suggested that distinctions between the twotreatments are most likely not of clinical significance.

However, the results of a 2013 Italian study showed that this may not be the case for CBT as well, at least for one particular group. The most relevant result emerging from this study is that most participants in the cancer follow-up phase who had been treated with EMDR were able to overcome theirPTSD diagnosis after 8 therapy sessions; on the contrary, almost all of the patients in the same stage of disease who had been treated with CBT still had a PTSD diagnosis one month after the end of the treatment.The group of participants treated with EMDR had lowerClinician-Administered PTSD Scale(CAPS) andImpact of Event Scale – Revised(IES-R) intrusive symptom subscale scores after the treatment, compared with the group of participants treated with CBT. Depression, anxiety, and psychophysiological reactions improved in both of the groups, showing that both EMDR and CBT are effective on these symptoms in a limited number of sessions.Even so,the results indicated that EMDR may be a more efficacious therapy for cancer patients who have a PTSD diagnosis, particularly for intrusive symptoms, both in an active treatment and a follow-up stage of the disease.

While researchers are still trying to pinpoint the distinctions between EMDR and TF-CBT, the findings of a 2019 study conducted in Italy showed that the two might not be as different as it seems. During this study, the psychological and spontaneous functional connectivity fMRI patterns were monitored in two groups of individuals with PTSD who experienced the same traumatic situation(i.e., natural disaster), before and after participating in psychotherapy sessions based on EMDR and TF-CBT. 37individuals with PTSD were enrolled from a larger sample of people who had been exposed to a single, acute psychological stress. Patients were randomly assigned to TF-CBT or EMDR therapy. Clinical assessment was conducted using the CAPS, the Davidson Trauma Scale (DTS), and the Work and Social Adjustment Scale (WSAS), both at baseline and posttreatment. All participants underwent an fMRI data acquisition session both before and after the treatment in order to assess their functional connectivity (FC) profile at rest and the potential connectivity changes related to the clinical impact of psychotherapy. Both TF-CBT and EMDRgenerated statistically significant changes in clinical scores, with no distinction in the clinical impact of the two therapies. Specific changes in FC correlated with the improvement in the distinct clinical scores, and in different ways for EMDR and TF-CBT. Even so, a similarity in the connectivity changes related to changes in CAPS in both groups was also noticed.Specifically, changes at CAPS in the entire sample correlated with a connectivity increase between the bilateral superior medial frontal gyrus and the right temporal pole, as well as a decrease in connectivity between the left cuneus and the left temporal pole. In the case of individuals with natural disaster PTSD, results pointed to a similar positive psychological impact of both EMDR and TF-CBT. Neuroimaging data indicated a similar neurophysiological substrate for clinical improvement following the two forms of therapy, involving changes that affected bilateral temporal pole connectivity.EMDR online clinic provides EMDR over telehealth for all of Australia and is based in Melbourne.

In the same year, a randomised trial whichinvolved participants (18-70 years) with PTSD diagnosis or subthreshold symptoms from 3 outpatient clinics in the Netherlands was also conducted. Subjective distress and PTSD symptoms decreased comparably in both forms of therapy. The PTSD symptom decrease was more significant in patients with more depressive symptoms. This decrease was not influenced by either social support or negative cognitions. No participant characteristics were found that could guide the choice for either EMDR or TF-CBT.Therefore, professionals should followthe current recommendations from clinical guidelines.

While TF-CBT is considered a first-line treatment for PTSD, it is clear that EMDR can generate very similar results, sometimes even with a lower treatment duration. However, discovering the full potential of EMDR therapy leaves no room for bias. Further research conducted in a correct manner will certainly show more of what this form of psychotherapy has to offer.

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