Trauma focused CBT or EMDR? Choosing a trauma-focused therapy and avoiding dropout in an NHS Talking Therapies for anxiety and depression service

Abstract Post-traumatic stress disorder (PTSD) is one of the most common anxiety disorders treated by NHS Talking Therapies for anxiety and depression services but outcomes lag behind national targets and research trial results. Both cognitive therapy for PTSD (CT-PTSD) and eye movement desensitisation reprocessing (EMDR) are recommended by NICE, but there is little clinical guidance about when either approach is more appropriate. This retrospective study examined the experience of clients with a problem descriptor of PTSD completing treatment over a 12 month period in a South London NHS Talking Therapies for anxiety and depression service. Both EMDR and CT-PTSD had similarly good outcomes across a range of demographic factors and presenting traumas. The study supports client preference as a key factor in choice of trauma therapy. Recovery in EMDR was associated with a higher number of memory processing sessions. Dropout accounted for a high proportion of non-recovered clients and was associated with higher starting depression scores. The study suggests that the start of memory processing work is a period of heightened risk for client dropout, and that therapists should take steps to mitigate this negative outcome. Key learning aims (1) To compare the effectiveness of CT-PTSD and EMDR in routine practice within a single Talking Therapies service in order to provide clinicians in routine practice with guidance to support client choice. (2) To gain insight into the presentation and treatment factors associated with good outcomes. (3) To provide clinicians with guidance about maximising treatment effectiveness, with a particular focus on memory-focused interventions and dropout.