Trauma & PTSD
Do EMDR and trauma-focused CBT change the brain in the same way?
Open access · cc by · source: Europe PMC
Two different trauma therapies reduced PTSD symptoms about equally in earthquake survivors, and both were linked to similar shifts in how visual, frontal and temporal brain regions communicate at rest.
Study at a glance
- Design
- Other — Pseudo-randomised (by trauma severity) pre-post comparison of two psychotherapies with clinical scales and resting-state fMRI before and after treatment; no placebo or wait-list control.
- N
- N=31 · 31 completers (14 TF-CBT, 17 EMDR) out of 37 enrolled patients.
- Population
- Adults with PTSD after the 2002 San Giuliano di Puglia earthquake in Italy (survivors of a school collapse and victims' family members).
- Outcome
- Clinician-rated (CAPS) and self-rated (Davidson Trauma Scale) PTSD symptoms, work and social functioning (WSAS), and whole-brain resting-state functional connectivity.
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Key findings
Symptoms fell over time with both therapies, and the two did not differ on overall clinician-rated or self-rated PTSD symptoms; EMDR showed only a trend toward greater reduction in intrusive thoughts, while TF-CBT produced greater improvement in work and social functioning. EMDR reached similar results with fewer sessions (about 4 weeks versus about 10 weeks). Symptom improvement in both groups was linked to reduced connectivity between the left visual cortex (cuneus) and left temporal pole and increased connectivity between the superior frontal gyrus and right temporal pole. Exploratory analyses suggested some baseline connectivity patterns might predict who benefits.
Methodology
The researchers studied people with PTSD who had all lived through the same 2002 Italian earthquake, in which a primary school collapsed. Patients were assigned, based partly on symptom severity rather than fully at random, to EMDR (eye-movement desensitisation and reprocessing) or to a structured trauma-focused CBT protocol. Before and after therapy each patient had clinical interviews, symptom questionnaires and a resting-state fMRI scan; connectivity between 112 atlas regions covering the whole brain was related to changes in clinical scores.
Limitations
There was no placebo or wait-list control, so improvement cannot be attributed to therapy rather than time or repeated assessment. Assignment was pseudo-randomised by severity and severity was not perfectly balanced, and the sample was small (31 completers), so the finding of 'no difference' between therapies is weak evidence of equivalence. The interval between scans differed between therapies (handled only as a covariate), and some patients took psychotropic medication. All patients shared one trauma type, so the authors caution against generalising to other traumas, and the predictor analyses are explicitly exploratory.
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