Efficacy of EMDR Versus CBT for Post-Traumatic Stress Disorder in Pakistan

This study is a multi-center, single-blind, two-group randomized controlled trial designed to compare Eye Movement Desensitization and Reprocessing (EMDR) therapy with Cognitive Behavioral Therapy (CBT) for the treatment of post-traumatic stress disorder (PTSD) and associated symptoms of depression and anxiety. The study is conducted in sequential phases. During the initial phase, the psychometric properties of the assessment measures are examined and treatment fidelity is evaluated to determine whether EMDR and CBT are delivered consistently and in accordance with their respective treatment protocols. The subsequent phase focuses on the comparative clinical effectiveness of EMDR and CBT. Eligible participants with PTSD are randomly allocated to either the EMDR or CBT treatment condition using a covariate-adaptive stratified randomization procedure with a 1:1 allocation ratio. Treatment is delivered face-to-face by clinical psychologists trained in the respective psychotherapeutic approaches. The number of treatment sessions varies according to participants' clinical needs and symptom severity. The primary objective is to examine whether EMDR is non-inferior to CBT in reducing PTSD symptoms. Additional objectives are to examine changes in PTSD symptoms over the course of treatment and follow-up, assess changes in associated depressive and anxiety symptoms, and explore the relationship between changes in PTSD symptoms and changes in these comorbid symptoms. PTSD symptoms are assessed using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Depressive symptoms are assessed using the Hamilton Depression Rating Scale (HDRS), and anxiety symptoms are assessed using the State-Trait Anxiety Inventory (STAI). Assessments are conducted at baseline, during treatment, at the end of treatment, and at follow-up. Treatment fidelity is also evaluated by assessing therapists' adherence to the EMDR and CBT protocols and their competence in delivering the interventions.