A Randomized Clinical Trial of Eye Movement Desensitization and Reprocessing (EMDR), Fluoxetine, and Pill Placebo in the Treatment of Posttraumatic Stress Disorder: Treatment Effects and Long-Term Maintenance

Bessel A. van der Kolk, M.D.; Joseph Spinazzola, Ph.D.; Margaret E. Blaustein, Ph.D.; James W. Hopper, Ph.D.; Elizabeth K. Hopper, Ph.D.; Deborah L. Korn, Psy.D.; and William B. Simpson, Ph.D.

Objective: The relative short-term efficacy and long-term benefits of pharmacologic versus psychotherapeutic interventions have not been studied for posttraumatic stress disorder (PTSD). This study compared the efficacy of a selective serotonin reuptake inhibitor (SSRI), fluoxetine, with a psychotherapeutic treatment, eye movement desensitization and reprocessing (EMDR), and pill placebo and measured maintenance of treatment gains at 6-month follow-up.

Method: Eighty-eight PTSD subjects diagnosed according to DSM-IV criteria were randomly assigned to EMDR, fluoxetine, or pill placebo. They received 8 weeks of treatment and were assessed by blind raters posttreatment and at 6-month follow-up. The primary outcome measure was the Clinician-Administered PTSD Scale, DSM-IV version, and the secondary outcome measure was the Beck Depression Inventory-II. The study ran from July 2000 through July 2003.

Results: The psychotherapy intervention was more successful than pharmacotherapy in achieving sustained reductions in PTSD and depression symptoms, but this benefit accrued primarily for adult-onset trauma survivors. At 6-month follow-up, 75.0% of adult-onset versus 33.3% of child-onset trauma subjects receiving EMDR achieved asymptomatic end-state functioning compared with none in the fluoxetine group. For most childhood-onset trauma patients, neither treatment produced complete symptom remission.

Conclusions: This study supports the efficacy of brief EMDR treatment to produce substantial and sustained reduction of PTSD and depression in most victims of adult-onset trauma. It suggests a role for SSRIs as a reliable first-line intervention to achieve moderate symptom relief for adult victims of childhood-onset trauma. Future research should assess the impact of lengthier intervention, combination treatments, and treatment sequencing on the resolution of PTSD in adults with childhood-onset trauma.

(J Clin Psychiatry 2007;68:37-46)

Received May 27, 2005; accepted May 25, 2006. From the Trauma Center, Justice Resource Institute, Brookline (all authors); the Boston University School of Medicine, Boston (Drs. van der Kolk, Spinazzola, Blaustein, and E. Hopper); McLean Hospital, Belmont (Dr. J. Hopper); and Boston Research Associates, Boston (Dr. Simpson), Mass.

Supported by grant R01MH58363 from the National Institute of Mental Health.

Presented at the 19th annual meeting of the International Society for Traumatic Stress Studies, October 29-November 1, 2003, Chicago, Ill., and at the 157th annual meeting of the American Psychiatric Association, May 1-6, 2004, New York, N.Y.

Dr. Korn has served on the speakers or advisory boards for and received honoraria from the EMDR International Association and the EMDR Institute, Inc. Drs. van der Kolk, Spinazzola, Blaustein, J. Hopper, E. Hopper, and Simpson report no additional financial affiliations or other relationships relevant to the subject of this article.

Acknowledgments appear at the end of this article.

Corresponding author and reprints: Bessel van der Kolk, M.D., Trauma Center, 1269 Beacon St., Brookline, MA 02446 (e-mail: bvanderk@aol.com).