Neural Correlates of Symptom Remission Among Adults Receiving EMDR Therapy for PTSD: A Systematic Review and Meta-Analysis of 20 Years of Research

Abstract

The present systematic review and meta-analysis provide an updated assessment of how eye movement desensitization and reprocessing (EMDR) therapy affects the human brain during treatment for posttraumatic stress disorder (PTSD). Brain region activity was assessed using resting-state functional magnetic resonance imaging, and trauma symptom severity was measured using the PTSD Checklist for the DSM-5 (PCL-5). We used PubMed, EMBASE, and ScienceDirect as our primary databases. Selected articles were subjected to seven eligibility criteria, and 22 articles remained for statistical analysis. Article quality was measured using the QUADAS-2 instrument, which showed that our review sample comprised high-quality articles. Statistical analyses implicated a forest plot meta-analysis of PCL-5 scores pretreatment and posttreatment, an activation likelihood estimation (ALE) meta-analysis of brain region activation after treatment, and a linear regression analysis that served as our method of statistical synthesis between forest plot and ALE results. Our forest plot showed that EMDR had a robust effect on decreasing PCL-5 scores during treatment (g= −2.92). Our ALE meta-analysis indicated the activation of different regions in the default mode and salience, limbic, and ventral attention networks. Statistical synthesis showed a robust correlation between PCL-5 score decrease and increased brain function (β = −.94). We also measured publication bias in our review sample with a funnel plot and Egger’s test of random effects (p= .280).