Clinical and cost‐effectiveness of eye movement desensitisation and reprocessing for post‐traumatic stress disorder in children and adolescents: a systematic review and meta‐analysis

Eye movement desensitisation and reprocessing (EMDR) is a psychological therapy used to treat trauma. While trauma-focused cognitive behavioural therapy (TF-CBT) is often used, EMDR has potential for treating post-traumatic stress disorder (PTSD). Previous research has focused on adult populations, with limited evidence for children and adolescents available. A systematic review was conducted to evaluate the clinical and cost-effectiveness of EMDR for treating or preventing PTSD in children and adolescents. Randomised controlled trials (RCTs) were identified through a comprehensive search of six databases in September 2023. Eligibility criteria were based on the NICE 2018 PTSD guidelines. Data were extracted, and risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Meta-analyses were conducted where appropriate. Of 1220 unique records identified, nine studies met the inclusion criteria. Eight RCTs (n = 794 participants) explored clinical effectiveness, and one study examined cost-effectiveness. Most studies compared EMDR with waitlist/usual care. A meta-analysis demonstrated a significant and large effect size (SMD 1.57 95% CrI = 0.07–3.21) of EMDR treatment (delivered 3 months or more following trauma) compared with waitlist/usual care for children and adolescents with PTSD, in various populations including refugees, and victims of physical and/or sexual violence. Two trials compared EMDR with TF-CBT and found no significant difference between therapies. From the very limited cost-effectiveness evidence available, EMDR was ranked sixth out of 10 interventions. EMDR was demonstrated to be effective in reducing PTSD symptoms in children and adolescents, particularly when compared with waitlist/usual care. However, more high-quality RCTs are needed to establish definitive conclusions. In addition, future research should prioritise within-trial cost-effectiveness analyses to provide a more comprehensive understanding of the cost–benefit profile of EMDR.

Trial Registration: PROSPERO prospective register of systematic reviews: CRD42023463360.

Summary

Eye movement desensitisation and reprocessing (EMDR) is an effective treatment for reducing PTSD symptoms in children and adolescents, with a large effect size observed when compared with waitlist or usual care. EMDR appears to be as effective as trauma-focused cognitive behavioural therapy (TF-CBT) in the child and adolescent population. This systematic review found no significant differences in clinical outcomes between the two therapies, suggesting that EMDR is a comparable and valid alternative. More high-quality, methodologically sound studies are needed to provide definitive conclusions. Future research should prioritise well-designed randomised controlled trials (RCTs) and include cost-effectiveness analyses to provide a more complete picture of EMDR's benefits.