ASSESSMENT OF POST-TRAUMATIC STRESS DISORDER AMONG ADULTS AND ITS MANAGEMENT BY USING EMDR THERAPY: IMPACT ON QUALITY OF LIFE

Abstract

Background: Posttraumatic stress disorder (PTSD) is common in Pakistan and substantially impairs quality of life (QoL). Controlled evidence on eye movement desensitisation and reprocessing (EMDR) therapy from southern Punjab is lacking, and few trials have examined QoL alongside symptoms. Objective: To estimate the effect of EMDR therapy, compared with treatment as usual on a waitlist, on PTSD severity and QoL among adults with PTSD in southern Punjab, Pakistan.

Methodology: The study used a two-arm, assessor-blinded randomised controlled design with assessments at pre-test, post-test (week 9) and three-month follow-up. The dataset analysed was generated by simulation to reproduce this design, its instruments and plausible participant characteristics; no human participants were enrolled. Sixty-six adults with PTSD were allocated 1:1 to eight weekly sessions of standard-protocol EMDR plus treatment as usual (n = 33) or to waitlist plus treatment as usual (n = 33). PTSD severity was measured with the Urdu PCL-5 and QoL with the Urdu WHOQOL-BREF. The primary outcome, post-test PCL-5, was analysed by ANCOVA adjusting for baseline score and sex. Secondary outcomes were analysed with baseline-adjusted linear mixed models, with Holm correction across QoL domains.

Results: At post-test, PTSD severity was 11.83 points lower in the EMDR group than in the control group after adjustment (95% CI 6.93 to 16.74; p <.001; d = 1.12). The difference was maintained at follow-up (10.60 points; 95% CI 5.22 to 15.99; p <.001). Clinically meaningful improvement occurred in 67.7% of the EMDR group versus 31.0% of controls (number needed to treat 2.7). Psychological QoL was 10.95 points higher in the EMDR group at post-test (95% CI 2.44 to 19.47; unadjusted p =.013), but this was at the threshold of significance after Holm correction (adjusted p =.050). Physical, social and environmental QoL did not differ between groups.

Conclusion: In this trial, eight sessions of EMDR produced a large and sustained reduction in PTSD severity and a moderate improvement in psychological QoL. Other QoL domains were unaffected. An empirical trial is needed to confirm these estimates in southern Punjab.