CBT and EMDR for child PTSD: no clear difference, with a signal on depression

Design

Systematic review and random-effects meta-analysis of five randomised trials

Population

248 children and adolescents aged 6 to 18 exposed to trauma

Primary outcome

PTSD symptoms, child- and parent-reported

Effect

SMD 0.18 (95% CI -0.07 to 0.43) child-reported; 0.23 (-0.02 to 0.48) parent-reported; depression SMD 0.44 (0.13 to 0.76) higher with CBT

This meta-analysis compared cognitive behavioural therapy with eye movement desensitisation and reprocessing in five randomised trials of children and adolescents aged 6 to 18 who had been exposed to trauma (248 participants in all).

PTSD symptoms did not differ significantly, whether reported by the young person (SMD 0.18, 95% CI -0.07 to 0.43) or by parents (SMD 0.23, 95% CI -0.02 to 0.48). Anxiety was also inconclusive (SMD 0.44, 95% CI -0.19 to 1.07; I² = 69%). Depression scores were higher after CBT than EMDR (SMD 0.44, 95% CI 0.13 to 0.76).

With so few trials, the authors call the comparison inconclusive. For a clinician, the finding supports offering either trauma-focused therapy according to access, training and what the young person will engage with, and it does not suggest abandoning CBT.

• Offer a trauma-focused therapy that the child and family can access and complete.
• Do not assume CBT outperforms EMDR, or the reverse, for PTSD symptoms.
• Track depressive symptoms during treatment; they were higher after CBT in the pooled data.
• Treat the depression signal as a hypothesis, since it came from few small trials.
• Record both child and parent reports, as they were analysed separately.

Why it matters

Choice between the two therapies can rest on access and fit, with no strong evidence that one is better.

Don't overread it

Five small trials cannot show equivalence; they could not detect a modest difference in either direction.

The statistics, in plain English

Where a confidence interval crosses zero, as for PTSD here, the data are consistent with no difference or with a modest difference either way. The depression result excludes zero, but it comes from a small pooled sample and was a secondary comparison, so it is weaker than a headline outcome.

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