Systematic review and meta-analysis: the effectiveness of cognitive behavioral therapy and eye movement desensitization and reprocessing in children and adolescents.

Abstract

<b>Background:</b> Post-traumatic stress disorder (PTSD) is prevalent among children and adolescents, with cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) widely used treatment options. This study compared the effects of CBT and EMDR in children and adolescents using a meta-analysis approach.<b>Methods:</b> PubMed, EMBASE, CENTRAL, CINAHL, ProQuest Dissertations &amp; Theses, and PsycInfo were searched in March 2025. Randomized controlled trials that compared the effectiveness of CBT and EMDR on PTSD symptoms in children and adolescents aged 6-18 years who had been exposed to traumatic events were included. The Cochrane Risk of Bias version 2 was used to assess the methodological quality of the included studies. A random-effects model was applied to calculate the standardized mean difference (SMD) along with 95% confidence interval (CI), and the <i>I²</i> statistic was used to quantify statistical heterogeneity.<b>Results:</b> Five trials (248 participants) were included. There was no statistically significant difference in PTSD symptoms between the CBT and EMDR groups, whether reported by children (SMD: 0.18; 95% CI: -0.07-0.43; <i>I^2&#x2009;</i>=&#x2009;0%) or by parents (SMD: 0.23; 95% CI: -0.02-0.48; <i>I^2&#x2009;</i>=&#x2009;0%). For anxiety, the pooled estimate did not reach statistical significance (SMD: 0.44; 95% CI: -0.19-1.07; <i>I^2&#x2009;</i>=&#x2009;69%). Depression symptoms were higher in the CBT group than in the EMDR group (SMD: 0.44; 95% CI: 0.13-0.76; <i>I^2&#x2009;</i>=&#x2009;0%).<b>Conclusion:</b> The comparative effects of CBT and EMDR in reducing PTSD and anxiety symptoms remain inconclusive. Although CBT was associated with higher depression symptoms compared with EMDR, the current evidence is based on a small number of trials, and the pooled estimates should be interpreted with caution. This updated meta-analysis clarified the differential effects of cognitive behavioral therapy and eye movement desensitization and reprocessing on post-traumatic stress disorder and comorbid symptoms in children and adolescents.No statistically significant differences between CBT and EMDR were observed for child- or parent-reported PTSD symptoms or for anxiety symptoms.EMDR was associated with lower depression symptoms than CBT in children and adolescents.