Evaluating the effectiveness of tfCBT and EMDR interventions for PTSD in an NHS Talking Therapies service

Abstract

Cognitive behavioural therapy (CBT) and eye-movement desensitisation and reprocessing (EMDR) are NICE-recommended evidence-based treatments for post-traumatic stress disorder (PTSD). However, there is less specification of which individuals might find CBT versus EMDR more effective, or whether other factors influence treatment outcomes. This study describes a service evaluation of trauma-focused CBT (CT-PTSD) and EMDR treatment outcomes for PTSD in a London out-patient NHS Talking Therapies (NHS TT) service over 11 years (N=1580). The evaluation was conducted in an adult sample (mean age 37 years), of which 65% were women. The mean number of treatment episodes for PTSD in the service in the sample was 2.39 (SD=1.86), and the mean number of therapy sessions attended was 6.15 (SD=6.43). When using NHS TT recovery criteria, there was no significant difference between PTSD recovery rates in the service for those who received CT-PTSD (40.8%) versus EMDR (43.6%). CT-PTSD was associated with greater reductions in anxious and depressive (but not PTSD-specific) symptoms than EMDR, but this was confounded by the fact that individuals receiving CT-PTSD in the service had higher anxiety and depression scores at start-of-treatment. Older age and non-female gender were associated with higher anxiety and depression scores. PTSD recovery rates were comparable to other NHS TT services. There is no clear indication that either CBT or EMDR is a more effective treatment for PTSD symptoms in the service, although preliminary findings could inform treatment planning regarding differential effects of the treatments on anxious and depressive symptoms. Other clinical implications are discussed. Key learning aims (1) To gain a better understanding of the relative effectiveness of trauma-focused CBT and EMDR for PTSD, as provided in a working NHS TT service. (2) To allow better-informed clinical and treatment pathway planning for individuals with trauma problems in a talking therapies service. (3) To contribute to the wider research literature on effective interventions for trauma within cognitive therapy and NHS frameworks.