Eye movement desensitization and reprocessing for depression: a systematic review and meta-analysis

Figures & data

Table 1. EMDR for depression or depressive symptoms as a primary outcome

Study	Type	Language	Design	Population	Primary diagnosis measure	Depression measure	Medications	Comparison	EMDR sessions	Control sessions	Follow-up	Main results
Behnammoghadam et al. (2015)	Published article	English	RCT	Patients with myocardial infarction	BDI (>17)	BDI	ND	EMDR (n = 30) vs. TAU (n = 30)	3 (45–90 min per session)	No intervention	ND	EMDR>TAU
Dominguez et al. (2021)	Published article	English	RCT	Patients with depressive disorder	DSM-5	DASS-21 depressive scale	Yes	Group CBT+individual EMDR (n = 16) vs. group CBT+individual assertiveness training (n = 17) vs. group CBT alone (n = 16)	3 (90 min)	3	6 and 12 weeks	Post-treatment: Group CBT+EMDR = group CBT+assertiveness training = group CBT alone Follow-up: Group CBT+EMDR > group CBT+assertiveness training Group CBT+EMDR > group CBT alone
Gauhar (2016)	Published article	English	RCT	Patients with MDD	DSM-IV-TR	BDI-II	No (exclusion criteria)	EMDR (n = 13) vs. WL (n = 13)	6/8 (1 hour weekly)	No intervention	No	EMDR>WL
Hase et al. (2015)	Published article	English	CS	Adult in-patients with mild-to-moderate depressive episode	SCL-90-R depression scale (ICD-10)	SCL-90-R; BDI	9 in EMDR and 10 in control group were on antidepressant medication at time of admission	TAU (psychodynamic psychotherapy) +EMDR (n = 16) vs. TAU (n = 16)	5.6 (SD = 2.4) individual and 7.6 (SD = 4.5) group + 4.6 (SD = 2.4)	6.5 (SD = 2.5) individual and 7 (SD = 3.9) group	12/16 months but no data	EMDR+TAU>TAU
Hase et al. (2018)	Published article	English	RCT	Patients with depression	BDI-II (>12) (ICD-10 F32.x and F33.x)	SCL-90-R; BDI-II	Yes	EMDR+TAU (n = 14) vs. TAU (psychoeducational group, n = 16)	8.5 of EMDR (60 min)	Twice a week (90 min)	1 and 2 years after but no data	EMDR+TAU>TAU
Hofmann et al. (2014)	Published article	English	CS	Patients with unipolar primary depression	SCID-I; BDI-II	BDI-II	Yes	CBT+EMDR (n = 21) vs. CBT (n = 21)	44.48 of CBT + 6.9 of EMDR	47.11 CBT	No	CBT+EMDR>CBT
Hogan et al. (2001)	Dissertation thesis	English	RCT	MDD or another depressive disorder such as dysthymia or adjustment disorder with depressed mood	SCL-90-R	BDI-II	Medications were allowed if the response had been stabilized prior to initiation of the study	EMDR (n = 15) vs. CBT (n = 15)	4	4	3 months but no data	EMDR = CBT
Lei & Zhen-Ying (2007)	Published article	Chinese	RCT	Patients with depression	HDRS>17; CGI>3; CCMD-3	HDRS	Yes	Sertraline (n = 32) vs. sertraline+EMDR (n = 32)	6	Only medication	No	Sertraline+EMDR = sertraline
Minelli et al. (2019)	Published article	English	RCT	In-patients with TRD with at least three traumatic experiences.	SCID-I	BDI-II; MADRS	Yes	EMDR (n = 12) vs. TF-CBT (n = 10)	24	24	3 months	Post-treatment: EMDR = TF-CBT Follow-up: EMDR>TF-CBT
Ostacoli et al. (2018)	Published article	English	RCT	Patients with recurrent depressive episodes	MINI-Plus; BDI-II (scores >13)	BDI-II	Yes	EMDR+TAU (n = 40) vs. CBT+TAU (n = 42)	15.1	14.6	6 months	EMDR = CBT
Tang et al. (2015)	Published article	English	CS	Taiwanese adolescents who experienced Typhoon Morakot diagnosed with MDD and suicide risk	Mandarin Chinese version of the CES-D	CES-D	Yes	EMDR (n = 41) vs. TAU-psychoeducation (n = 42)	4 (60, 40, 40, 40 minutes)	Weekly group psychoeducation session	No	EMDR>TAU

BDI-II = Beck Depression Inventory, Version II; CBT = cognitive behavioural therapy; CCMD-3 = Chinese Classification of Mental Disorders, Version 3; CES-D = Center for Epidemiologic Studies Depression Scale; CGI = Clinical Global Impression Scale; CT = controlled study; DASS-21 = Depression Anxiety Stress Scale, 21 items; DSM (-IV and −5) = Diagnostic and Statistical Manual of Mental Disorders (Editions IV and 5); EMDR = eye movement desensitization and reprocessing; HDRS = Hamilton Depression Rating Scale; ICD-10 = International Classification of Diseases, 10th Edition; MADRS = Montgomery–Asberg Depression Rating Scale; MDD = major depressive disorder; MINI-Plus = Mini International Neuropsychiatric Interview-Plus; ND = not defined/not reported; RCT = randomized controlled trial; SCID-I = Structured Clinical Interview for DSM-IV Axis I Disorders; SCL-90-R = Symptom Checklist-90-Revised; SD = standard deviation; TAU = treatment as usual; TF-CBT = trauma-focused cognitive behavioural therapy; TRD = treatment-resistant depression; WL = waiting list.

Figure 1. PRISMA flow diagram

Table 2. Risk of bias

RCT	Study	Randomization process		Deviations from intended interventions		Missing outcome data		Measurement of the outcome		Selection of the reported result		RoB 2 overall bias
	Behnammoghadam et al. (2015)	Some concerns		Some concerns		Low		Some concerns		High		High
	Dominguez et al. (2021)	Low		Low		Low		Low		Low		Low
	Hase et al. (2018)	Some concerns		Some concerns		Low		Low		Some concerns		Some concerns
	Hogan et al. (2001)	High		Some concerns		Low		Low		Some concerns		High
	Lei & Zhen-Ying (2007)	Some concerns		High		Low		High		Some concerns		High
	Gauhar (2016)	Some concerns		High		High		Some concerns		Some concerns		High
	Minelli et al. (2019)	Some concerns		Some concerns		Low		Low		Low		Some concerns
	Ostacoli et al. (2018)	Low		Low		Low		Low		Low		Low
Controlled	Study	A clearly stated aim	Inclusion of consecutive patients	Prospective collection of data	Endpoints appropriate to the aim of the study	Unbiased assessment of the study endpoint	Follow-up period appropriate to the aim of the study	Loss to follow-up less than 5%	Prospective calculation of the study size	An adequate control group	Contemporary groups	Baseline equivalence of groups	Adequate statistical analyses	MINORS total score	MINORS overall risk of bias
	Hase et al. (2015)	2	0	1	2	1	2	2	0	2	2	2	1	17	High
	Hofmann et al. (2014)	2	0	1	2	0	1	2	0	2	0	2	1	13	High
	Tang et al. (2015)	2	1	1	1	0	1	2	0	2	2	1	1	14	High

Randomized controlled trials (RCTs) were evaluated with the Cochrane risk-of-bias tool for randomized trials (RoB 2). The proposed judgement about the risk of bias arising from each domain is generated by an algorithm and is expressed as low, high or some concerns.

Controlled studies were evaluated using the MINORS scale, with items scored as: 0, not reported; 1, reported but inadequate; 2, reported and adequate. The global ideal score is 16 for non-comparative studies and 24 for comparative studies: low risk of bias was considered for studies fulfiling all the MINORS criteria with a score of 2; ‘some concerns’ was rated when studies were judged to raise some concerns in at least one domain but judged not to be at high risk of bias for any domain; and high risk of bias was applied to all other studies.

Figure 2. Overall effect of EMDR for depression: forest plot

Figure 3. Overall effect with risk of bias: forest plot

Figure 4. Funnel plot

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