EMDR and TF-CBT in the treatment of young people
Childhood is a crucial time for social, psychological, and emotional development, all of which can be impacted by trauma. The experience of childhood trauma not only impacts an individual’s immediate functioning, but it can also impair long-term functioning. In spite of the effects trauma can have on both short-term and long-term functioning, research indicates that just a small percentage of adolescents with mental health issues receive the treatment they need. Online EMDR therapy provides an excellent pathway to engage in a professional to help resolve trauma.
Research also shows that lack of access to treatment increases the risk of developing a wide range of mental disorders, including personality disorders such as Borderline Personality Disorder (BPD). These findingsemphasise the importance of providing proper and early treatment for children and adolescents who need it.To learn more about the most appropriate forms of psychotherapy for young people with trauma, we will discuss the comparative efficacy of the two main evidence-based treatments, respectively Eye Movement Desensitization and Reprocessing (EMDR) and Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT).
These forms of therapy were assessed in a randomised controlled trial (RCT) conducted in 2015.48 children were randomised to either EMDR or TF-CBT. 18 were male (38%). In terms of age, the children were 8-18 years old, with an average age of 13. The majority was Dutch, with 33% having Dutch fathers and 46% having Dutch mothers. No significant differences were remarked in baseline characteristics for participants in the two treatment conditions. The children had experienced different types of single-event traumas: sexual assault (17%), accidents (23%),threat (with weapon) (13%), serious illness (7%), kidnapping (10%), or other (30%). The multiple-event traumas experiences included exposure to domestic violence (44%), sexual assault (39%), and other (17%). The results showed that, in terms of Clinician Administered PTSD Scale for Children and Adolescents (CAPS-CA) severity scores, children who experienced multiple-event trauma did not differ from children who experienced a single-event trauma. This RCThighlights that both treatments are effective in children with Posttraumatic Stress Syndrome (PTSS) in an outpatient setting. Findings on both child and parent measures are in favor of this conclusion. Nomajor differences were found between EMDR and TF-CBT on the CAPS-CA.
The effects of the two therapies were also assessed in a 2020 systematic review including 27 studies in relation to PTSD in children, adolescents, and young adults. TF-CBT is the psychological intervention which was investigated most frequently. Most of the studies involved mixed populations spanning childhood, adolescence, and young adulthood, while seven studies investigated the efficacy of psychological interventions in adolescents and young adults exclusively.Three of the studies assessed the efficacy of interventions in children exclusively. The meta-analysis consisted of 16 eligible RCTs. There was a moderate effect of the interventions at diminishing PTSD symptoms in children, adolescents, and young adults. Both EMDR and TF-CBT had a moderate effect size and were more efficacious to general (non-trauma-focused) CBT at diminishing PTSD symptoms in this population. EMDR had the greatest effect in terms of PTSD symptom reduction. Interventions for adolescents and young adults exclusively did not have significant effects on PTSD symptoms. This review demonstrated that established adult treatments should not be presumed to be effective in children, adolescents, and young adults, with no modifications to the study protocol particularly targeted towards children.
Due to the general interest in early intervention, several other studies have been conducted to discover whether there is an optimal form of therapy for particular age groups. For instance, two early intervention service case studies were performed in 2018 to assess the efficacy of TF-CBT and EMDR for young individuals with trauma and psychosis. Both of the participants achieved positive outcomes by the end of therapy, as well as at the 6-month follow-up. The final measures have shown clinically significant reductions on measures of post-traumatic stress and mood,lowering to below thresholds. The results of this study suggested that both EMDR and TF-CBTwereefficient for the participants. The therapies were used in an integrated manner, incorporating other approaches to psychosis, such as methods of managing distressing voices. The phasic approach wasbeneficial for both the therapist and the client, and it allowed time to expand the clients’ understanding and coping skills.Because of this,both participantsfelt more prepared to face their traumatic memories. It is rather exciting to see that, although cognitive-behavioral therapy (CBT) and the treatments which incorporate its techniques are preferred by many professionals, EMDR therapy can be just as efficient (maybe even slightly more efficient than CBT/TF-CBT in some cases).
In 2021, a study was conducted in The Netherlands to assess the efficacy of EMDR in young children (ages 4-8) with PTSD. The study had 9 participants. A non-concurrent multiple baseline experimental design was utilizedin combination with standardised measures. Participants received six 1-hour sessions of EMDR. Post-treatment results showed that EMDR was efficacious in reaching PTSD diagnostic remission (85.7%), as well asin diminishing PTSD symptom severity, and emotional and behavioral problems. All positive effects were maintained at the 3-month follow-up. The authors have concluded that EMDR appears to be an effective treatment for PTSD in young childrenaged 4 to 8 years.
While studies seem to be in favor of EMDR, many are still skeptical. One of the studies in favor of maintaining TF-CBT as first-line treatment due to a larger evidence base is a 2018 meta-analysis conducted in the US regarding the effectiveness of TF-CBT and EMDR for children and adolescents. According to the results, TF-CBT seemed to be marginally more effective than EMDR in treating PTSS, especially with presence of comorbidity in diagnosis. However, a 2020 response to the aforementioned meta-analysis showed that it involved significant statistical and methodological flaws which led to inconsistencies. Some of the most relevant limitations were the errors in calculating the effect sizes of the EMDR studies, the unmentioned outcome parameters per study, and the suboptimal choice for the REM.Providing EMDR therapy online to clients can be an effective way to reach a larger population in providing effective treatment.