Remote EMDR versus CBT for PTSD after the Kahramanmaraş earthquakes: a randomized trial

Large-scale earthquakes are associated with high and persistent rates of post-traumatic stress disorder (PTSD), depression, and anxiety. Although Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive Behavioral Therapy (CBT) are both guideline-recommended treatments for PTSD, direct randomized comparisons-particularly in post-disaster settings and via remote delivery-remain limited.

In this randomized, controlled, parallel-group trial (ClinicalTrials.gov Identifier: NCT06758362), 89 adult survivors of the 2023 Kahramanmaraş earthquakes in Türkiye who met DSM-5 criteria for PTSD were assigned to 12 sessions of remotely delivered EMDR (n = 30), CBT (n = 30), or a wait-list control group (n = 29). PTSD severity was the primary outcome, with depression, anxiety, and emotion regulation as secondary outcomes. Assessments were conducted at baseline, mid-treatment, and post-treatment. Analyses followed an intention-to-treat framework using mixed-effects models.

Both EMDR and CBT produced large reductions in PTSD symptoms compared with the control condition (Cohen's d ≈ 1.9), alongside moderate-to-large improvements in depression (d ≈ 1.4) and anxiety (d ≈ 1.3). Symptom improvement was evident by mid-treatment and increased through post-treatment. Direct comparisons between EMDR and CBT yielded overlapping confidence intervals, indicating comparable overall efficacy. However, EMDR showed a tendency toward greater reduction in core PTSD symptoms, whereas CBT demonstrated relatively stronger effects on depressive symptoms. Improvements in emotion regulation were observed in both treatment groups but did not reach statistical significance.

The findings suggest that both EMDR and CBT are highly effective when delivered remotely in the aftermath of a large-scale natural disaster. Differential response patterns likely reflect distinct therapeutic mechanisms-direct trauma memory processing in EMDR versus cognitive restructuring and behavioral activation in CBT-highlighting their potential complementarity rather than superiority of one approach over the other. The absence of spontaneous improvement in the control group underscores the necessity of structured psychological intervention following earthquake exposure.

Remotely delivered EMDR and CBT are feasible, effective, and clinically valuable interventions for earthquake-related PTSD. Their comparable efficacy and partially distinct symptom profiles support flexible, needs-based integration of both treatments within disaster mental-health systems.

https://clinicaltrials.gov/study/NCT06758362, identifier NCT06758362.