Eye Movement Desensitization and Reprocessing to Reduce Post-Traumatic Stress Disorder Among Forcibly Displaced People: A Systematic Review and Meta-Analysis

Background and Purpose: People who are forcibly displaced due to natural (e.g., earthquakes) or human-made (e.g., war) disasters are at high risk for Post-Traumatic Stress Disorder (PTSD). Although the causes of trauma may be complicated and require intervention in and across different systems, helping stabilize the trauma that individuals present with is important. Eye Movement Desensitization and Reprocessing (EMDR) therapy has been used to reduce the effects of PTSD among forcibly displaced persons. This is the first systematic review and meta-analysis of studies that use EMDR for PTSD among forcibly displaced populations.

Methods: A systematic search following the Cochrane guidelines (Higgins et al., 2021) identified studies. Each study was independently reviewed for risk of bias by two reviewers. Between-condition effect sizes (ES) and pre-post ES were reconstructed for each trial. The meta-analysis was performed by pooling group ES on PTSD across multiple studies using a random effects model. The variation in ES across studies was assessed using the I² statistic. Subgroup analyses were conducted on a priori variables derived from the literature.

Results: The search yielded 21 studies involving 1780 participants. Nonrandomized studies (k = 12) showed the most serious risk of bias. Of the nine randomized studies, five showed low risk of bias and the rest had flaws in design. Sixteen studies provided adequate data for the meta-analysis. The combined pre-post ES for PTSD was large and statistically significant, d = -1.4, 95% CI [-1.9, -.89], p < .001. The heterogeneity among effect sizes was considerable and statistically significant (I² = 92.4%, Q = 197.38, p < .001). Subgroup analyses revealed larger effects for PTSD with interventions delivered individually (d = -1.64, 95% CI [-2.29, -1.0]) and for those offered to adults (d = -1.71, 95% CI [-2.5, -.92]). For studies with control groups (k =10), the combined between-condition ES was large and statistically significant, d = -1.19, 95% CI [-2.18, -.21], p < .001. The heterogeneity among effect sizes was substantial (I² = 92.1%, Q = 113.2, p < .005). The subgroup analyses revealed significant differences only between age groups. Studies with adults showed a larger effect size (d = -1.67, 95% CI [-2.77, -.60]). When EMDR was compared with a specific intervention, EMDR was slightly less effective than CBT.

Conclusions and implications: There is good evidence for the benefit of EMDR for forcibly displaced populations with PTSD, particularly when applied individually and with adults. Several studies had serious risk of bias in many domains and future research should use more rigorous designs. Although more research is needed, EMDR may be used to help reduce the trauma that individuals may have, as part of a broad response to improve the responsiveness of institutions, communities, and societies to the needs of forcibly displaced people.