The Efficacy of Eye Movement Desensitization and Reprocessing in Children and Adults Who Have Experienced Complex Childhood Trauma: A Systematic Review of Randomized Controlled Trials

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Abstract

Background: Survivors of complex childhood trauma (CT) such as sexual abuse show poorer outcomes compared to single event trauma survivors. A growing number of studies investigate Eye Movement Desensitization and Reprocessing (EMDR) treatment for posttraumatic stress disorder (PTSD), but no systematic reviews have focused on EMDR treatment for CT as an intervention for both adults and children. This study therefore systematically reviewed all randomized controlled trials (RCTs) evaluating the effect of EMDR on PTSD symptoms in adults and children exposed to CT.

Methods: Databases including PubMed, Web of Science, and PsycINFO were searched in October 2017. Randomized controlled trials which recruited adult and children with experience of CT, which compared EMDR to alternative treatments or control conditions, and which measured PTSD symptoms were included. Study methodology quality was evaluated with Platinum Standard scale.

Results: Six eligible RCTs of 251 participants were included in this systematic review. The results indicated that EMDR was associated with reductions in PTSD symptoms, depression and/or anxiety both post-treatment and at follow-up compared with all other alternative therapies (cognitive behavior therapy, individual/group therapy and fluoxetine) and control treatment (pill placebo, active listening, EMDR delayed treatment, and treatment as usual). However, studies suffered from significant heterogeneity in study populations, length of EMDR treatment, length of follow-up, comparison groups, and outcome measures. One study had a high risk of bias.

Discussion: This systematic review suggests that there is growing evidence to support the clinical efficacy of EMDR in treating CT in both children and adults. However, conclusions are limited by the small number of heterogenous trials. Further RCTs with standardized methodologies, as well as studies addressing real world challenges in treating CT are required.

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Most cited references 36

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Prevalence of Childhood Exposure to Violence, Crime, and Abuse: Results From the National Survey of Children's Exposure to Violence.

David Finkelhor, Anne Shattuck, Sherry L Hamby … (2015)

It is important to estimate the burden of and trends for violence, crime, and abuse in the lives of children.

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Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma.

Bessel A. Van Der Kolk, Susan Roth, David Pelcovitz … (2005)

Children and adults exposed to chronic interpersonal trauma consistently demonstrate psychological disturbances that are not captured in the posttraumatic stress disorder (PTSD) diagnosis. The DSM-IV (American Psychiatric Association, 1994) Field Trial studied 400 treatment-seeking traumatized individuals and 128 community residents and found that victims of prolonged interpersonal trauma, particularly trauma early in the life cycle, had a high incidence of problems with (a) regulation of affect and impulses, (b) memory and attention, (c) self-perception, (d) interpersonal relations, (e) somatization, and (f) systems of meaning. This raises important issues about the categorical versus the dimensional nature of posttraumatic stress, as well as the issue of comorbidity in PTSD. These data invite further exploration of what constitutes effective treatment of the full spectrum of posttraumatic psychopathology.

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Poly-victimization in a national sample of children and youth.

Heather A Turner, David Finkelhor, Richard Ormrod (2010)

Most studies of children's exposure to violence focus on separate, relatively narrow categories of victimization (such as sexual abuse, physical maltreatment, or bullying), paying less attention to exposure to multiple forms of victimization. This study documents children's lifetime exposure to multiple victimization types (i.e., "poly-victimization") and examines the association between poly-victimization and extent of trauma symptomatology. Analyses were based on telephone interviews conducted between January 2008 and May 2008 with a nationally representative sample of 4053 children aged 2-17 years and their caregivers. Exposure to multiple forms of victimization was common. Almost 66% of the sample was exposed to more than one type of victimization, 30% experienced five or more types, and 10% experienced 11 or more different forms of victimization in their lifetimes. Poly-victims comprise a substantial portion of the children who would be identified by screening for an individual victimization type, such as sexual assault or witnessing parental violence. Poly-victimization is more highly related to trauma symptoms than experiencing repeated victimizations of a single type and explains a large part of the associations between individual forms of victimization and symptom levels. Studies focusing on single forms of victimization are likely to underestimate the full burden of victimization that children experience and to incorrectly specify the risk profiles of victims. Research, clinical practice, and intervention strategies are likely to improve with more comprehensive assessments of victimization exposure. Copyright (c) 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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Author and article information

Contributors

Runsen Chen: URI : http://loop.frontiersin.org/people/512460/overview

Amy Gillespie: URI : http://loop.frontiersin.org/people/543402/overview

Journal

Journal ID (nlm-ta): Front Psychol

Journal ID (iso-abbrev): Front Psychol

Journal ID (publisher-id): Front. Psychol.

Title: Frontiers in Psychology

Publisher: Frontiers Media S.A.

ISSN (Electronic): 1664-1078

Publication date (Electronic): 11 April 2018

Publication date Collection: 2018

Volume: 9

Electronic Location Identifier: 534

Affiliations

[1] ¹Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University , Beijing, China

[2] ²The Clinical Psychology Center, Beijing Anding Hospital, Capital Medical University , Beijing, China

[3] ³Department of Psychiatry, University of Oxford , Oxford, United Kingdom

[4] ⁴Department of Orthodontics, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, School and Hospital of Stomatology, Tongji University , Shanghai, China

[5] ⁵Brain and Mind Centre and Discipline of Psychiatry, Sydney Medical School, University of Sydney , Sydney, NSW, Australia

[6] ⁶Westmead Psychotherapy Program for Complex Traumatic Disorders, Discipline of Psychiatry, Sydney Medical School, University of Sydney and Western Sydney Local Health District , Parramatta, NSW, Australia

[7] ⁷Consultation-Liaison Psychiatry, Royal North Shore Hospital , Sydney, NSW, Australia

Author notes

Edited by: Gian Mauro Manzoni, Università degli Studi eCampus, Italy

Reviewed by: Isabel Fernandez, Centro di Ricerca e Studi in Psicotraumatologia (CRSP), Italy; Sven Rabung, Alpen-Adria-Universität Klagenfurt, Austria

*Correspondence: Yanping Ren renyanping@ 123456sina.com

This article was submitted to Clinical and Health Psychology, a section of the journal Frontiers in Psychology

†Joint first co-author.

Article

DOI: 10.3389/fpsyg.2018.00534

PMC ID: 5904704

PubMed ID: 29695993

SO-VID: f680e79a-c890-4fb3-a37a-84ebb2d3f4ce

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 15 January 2018

Date accepted : 28 March 2018

Page count

Figures: 1, Tables: 3, Equations: 0, References: 48, Pages: 11, Words: 7648

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The Efficacy of Eye Movement Desensitization and Reprocessing in Children and Adults Who Have Experienced Complex Childhood Trauma: A Systematic Review of Randomized Controlled Trials

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Most cited references 36

Prevalence of Childhood Exposure to Violence, Crime, and Abuse: Results From the National Survey of Children's Exposure to Violence.

Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma.

Poly-victimization in a national sample of children and youth.

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