A controlled comparison of eye movement desensitization and reprocessing versus exposure plus cognitive restructuring versus waiting list in the treatment of post‐traumatic stress disorder

Abstract

AbstractA total of 105 patients with post‐traumatic stress disorder (PTSD) were randomly allocated to eye‐movement desensitization and reprocessing (EMDR) (n = 39) versus exposure plus cognitive restructuring (E + CR) (n = 37) versus waiting list (WL) (n = 29) in a primary care setting. EMDR and E + CR patients received a maximum of 10 treatment sessions over a 10‐week period. All patients were assessed by blind raters prior to randomization and at end of the 10‐week treatment or waiting list period. EMDR and E + CR patients were also assessed by therapists at the mid‐point of the 10‐week treatment period and on average at 15 months follow‐up. Patients were assessed on a variety of assessor‐rated and self‐report measures of PTSD symptomatology including the Clinician Administered PTSD Scale (CAPS), the Impact of Events Scale (IOE) and a self‐report version of the SI‐PTSD Checklist. Measures of anxiety and depression included the Montgomery Asberg Depression Rating Scale (MADRS), the Hamilton Anxiety Scale (HAM‐A) and the Hospital Anxiety and Depression Scale (HADS). A measure of social function, the Sheehan Disability Scale was also used. Drop‐out rates between the three groups were 12 EMDR, 16 E + CR and five WL. Treatment end‐point analyses were conducted on the remaining 72 patients. Repeated measures analysis of variance of treatment outcome at 10 weeks revealed significant time, interaction and group effects for all the above measures. In general there were significant and substantial pre–post reductions for EMDR and E + CR groups but no change for the WL patients. Both treatments were effective over WL. The only indication of superiority of either active treatment, in relation to measures of clinically significant change, was a greater reduction in patient self‐reported depression ratings and improved social functioning for EMDR in comparison to E + CR at the end of the treatment period and for fewer number of treatment sessions for EMDR (mean 4.2) than E + CR (mean 6.4) patients. At 15 months follow‐up treatment gains were generally well‐maintained with the only difference, in favour of EMDR over E + CR, occurring in relation to assessor‐rated levels of clinically significant change in depression. However, exclusion of patients who had subsequent treatment during the follow‐up period diminished the proportion of patients achieving long‐term clinically significant change. In summary, at end of treatment and at follow‐up, both EMDR and E + CR are effective in the treatment of PTSD with only a slight advantage in favour of EMDR. Copyright © 2002 John Wiley & Sons, Ltd.