Skip to main content Accessibility help

The efficacy of eye movement desensitization and reprocessing for post-traumatic stress disorder and depression among Syrian refugees: results of a randomized controlled trial

  • C. Acarturk (a1), E. Konuk (a2), M. Cetinkaya (a3), I. Senay (a1), M. Sijbrandij (a4), B. Gulen (a5) and P. Cuijpers (a4)...



Previous research indicates a high prevalence of post-traumatic stress disorder (PTSD) and depression among refugees. Eye movement desensitization and reprocessing (EMDR) is an effective treatment for PTSD for victims of natural disasters, car accidents or other traumatic events. The current study examined the effect of EMDR on symptoms of PTSD and depression by comparing the treatment with a wait-list control condition in Syrian refugees.


Adult refugees located in Kilis Refugee Camp at the Turkish–Syrian border with a PTSD diagnosis were randomly allocated to either EMDR (n = 37) or wait-list control (n = 33) conditions. All participants were assessed with the Mini-International Neuropsychiatric Interview Plus at pre-intervention, at 1 week after finishing the intervention and at 5 weeks after finishing the intervention. The main outcome measures were the Harvard Trauma Questionnaire (HTQ) and the Impact of Event Scale-Revised. The Beck Depression Inventory and the Hopkins Symptoms Checklist-25 were included as secondary outcome measures. The Trial Registration no. is NCT01847742.


Mixed-model analyses adjusted for the baseline scores indicated a significant effect of group at post-treatment indicating that the EMDR therapy group showed a significantly larger reduction of PTSD symptoms as assessed with the HTQ. Similar findings were found on the other outcome measures. There was no effect of time or group × time interaction on any measure, showing that the difference between the groups at the post-treatment was maintained to the 5-week follow-up.


EMDR may be effective in reducing PTSD and depression symptoms among Syrian refugees with PTSD located in a refugee camp.


Corresponding author

*Address for correspondence: C. Acarturk, Ph.D., Department of Psychology, Istanbul Şehir University, 34660 Uskudar, Istanbul, Turkey. (Email:


Hide All
Acarturk, C, Konuk, E, Cetinkaya, M, Senay, I, Sijbrandij, M, Cuijpers, P, Aker, T (2015). EMDR for Syrian refugees with posttraumatic stress disorder symptoms: results of a pilot randomized controlled trial. European Journal of Psychotraumatology 6, 27414.
Alpak, G, Unal, A, Bulbul, F, Sagaltici, E, Bez, Y, Altindag, A, Dalkilic, A, Savas, HA (2014). Post-traumatic stress disorder among Syrian refugees in Turkey: a cross-sectional study. International Journal of Psychiatry in Clinical Practice 19, 4550.
Bader, AM (2006). Internal consistency of an Arabic adaptation of the Beck Depression Inventory-II with college students in eighteen Arab countries. Social Behavior and Personality: An International Journal 34, 425430.
Beck, AT, Steer, RA, Brown, GK (1996). Manual for Beck Depression Inventory-II. Psychological Corporation: San Antonio, TX.
Bisson, JI, Roberts, NP, Andrew, M, Cooper, R, Lewis, C (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD003388. doi:10.1002/14651858.CD003388.pub4.
Bradley, R, Greene, J, Russ, E, Dutra, L, Westen, D (2005). A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry 162, 214227.
Engeler, A (2004). MINI Uluslararası Nöropsikiyatrik Görüşme Türkçe Uyarlama 5.0.0. Glaxo Smith Kline: Istanbul.
Engelhard, IM, van den Hout, MA, Janssen, WC, van der Beek, J (2010). Eye movements reduce vividness and emotionality of “flash-forwards”. Behaviour Research and Therapy 48, 442447.
Fazel, M, Wheeler, J, Danesh, J (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet 365, 13091314.
Furukawa, TA, Noma, H, Caldwell, DM, Honyashiki, M, Shinohara, K, Imai, H, Chen, P, Hunot, V, Churchill, R (2014). Waiting list may be a nocebo condition in psychotherapy trials: a contribution from network meta-analysis. Acta Psychiatrica Scandinavica 130, 181192.
Ghareeb, AG (2000). Manual of the Arabic BDI-II. Angle Press: Cairo, Egypt.
Gunter, MA, Bodner, IM (2009). EMDR works…but how? Recent progress in the search for treatment mechanisms. Journal of EMDR Practice and Research 3, 161168.
Herbert, JD, Mueser, KT (1992). Eye movement desensitization: a critique of the evidence. Journal of Behavior Therapy and Experimental Psychiatry 23, 169174.
Ho, MSK, Lee, CW (2012). Cognitive behaviour therapy versus eye movement desensitization and reprocessing for post-traumatic disorder – is it all in the homework then? Revue Europėenne de Psychologie Appliquėe/European Review of Applied Psychology 62, 253260.
IASC (Inter-Agency Standing Committee) (2007). IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. Inter-Agency Standing Committee: Geneva ( Accessed May 2015.
Kessler, RC (2000). Posttraumatic stress disorder: the burden to the individual and to the society. Journal of Clinical Psychiatry 5 (Suppl. 61), 412.
Kobeissi, L, Araya, R, El Kak, F, Ghantous, Z, Khawaja, M, Khoury, B, Mahfoud, Z, Nakkash, R, Peters, TJ, Ramia, S, Zurayk, H (2011). The Relaxation Exercise and Social Support Trial – RESST: study protocol for a randomized community based trial. BMC Psychiatry 11, 142.
Lee, CW, Cuijpers, P (2013). A meta-analysis of the contribution of eye movements in processing emotional memories. Journal of Behavior Therapy Experimental Psychiatry 44, 231239.
Leer, A, Engelhard, IM, van den Hout, MA (2014). How eye movements in EMDR work: changes in memory vividness and emotionality. Journal of Behavior Therapy and Experimental Psychiatry 45, 396401.
McFarlane, AC, de Girolamo, G (2007). The nature of traumatic stressors and the epidemiology of posttraumatic reactions. In The Effects of Overwhelming Experience on the Mind, Body and Society (ed. van der Kolk, B.A., MacFarlane, A.C., Weisaeth, L.W.), pp. 129154. The Guilford Press: New York.
Mollica, R, McDonald, L, Massagli, M, Silove, D (2004). Measuring Trauma, Measuring: Instructions and Guidance on the Utilization of the Harvard Program in Refugee Versions of the Hopkins Symptom Checklist-25 (HSCL-25) and the Harvard Trauma Questionnaire (HTQ). Harvard Program in Refugee Trauma: Cambridge, MA.
Mollica, RF, Caspi-Yavin, Y, Bollini, P, Truong, T, Tor, S, Lavalle, J (1992). The Harvard Trauma Questionnaire: validating a cross-cultural instrument for measuring torture, trauma and posttraumatic stress disorder in Indochinese refugees. Journal of Nervous Mental Disease 180, 111116.
Mollica, RF, Sarajlic, N, Chernoff, M, Lavella, J, Vukovic, IS, Massagli, MP (2001). Longitudinal study of psychiatric symptoms, disability, mortality, and emigration among Bosnian refugees. Journal of the American Medical Association 286, 546554.
Morina, N, Maier, T, Bryant, R, Knaevelsrud, C, Wittman, L, Rufer, M, Schnyder, U, Müller, J (2012). Combining biofeedback and narrative exposure therapy for persistent pain and PTSD in refugees: a pilot study. European Journal of Psychotraumatology 3, 17660.
Murray, KE, Davidson, GR, Schweitzer, RD (2010). Review of refugee mental health interventions following resettlement: best practices and recommendations. American Journal of Orthopsychiatry 80, 576585.
National Institute for Clinical Excellence (NICE) (2005). Post-traumatic stress disorder; the management of PTSD in adults and children in primary and secondary care. NICE Clinical Guidelines No. 26. Gaskell and the British Psychological Society: Leicester ( Accessed June 2016.
Neuner, F, Onyut, PL, Ertl, V, Odenwald, M, Schauer, E, Elbert, T (2008). Treatment of posttraumatic stress disorder by trained lay counselors in an African refugee settlement: a randomized controlled trial. Journal of Consulting and Clinical Psychology 76, 686694.
Neuner, F, Schauer, M, Klaschik, C, Karunakara, U, Elbert, T (2004). A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an African refugee settlement. Journal of Consulting and Clinical Psychology 72, 579587.
Nickerson, A, Bryant, RA, Silove, D, Steel, Z (2011). A critical review of psychological treatments of posttraumatic stress disorder in refugees. Clinical Psychology Review 31, 399417.
Palic, S, Elklit, A (2010). Psychosocial treatment of posttraumatic stress disorder in adult refugees: a systematic review of prospective treatment outcome studies and a critique. Journal of Affective Disorders 131, 823.
Panahi, Y, Moghaddam, BR, Sahebkar, A, Nazari, MA, Beiraghdar, F, Karami, G, Saadat, AR (2011). A randomized, double-blind, placebo controlled trial on the efficacy and tolerability of sertraline in Iranian veterans with post-traumatic stress disorder. Psychological Medicine 41, 21592166.
Porter, M, Haslam, N (2005). Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. Journal of the American Medical Association 294, 602612.
Rasmussen, A, Annan, J (2010). Predicting stress related to basic needs and safety in Darfur refugee camps: a structural and social ecological analysis. Journal of Refugee Studies 23, 2340.
Seidler, GH, Wagner, FE (2006). Comparing the efficacy of EMDR and trauma-focused cognitive behavioral therapy in the treatment of PTSD: a meta-analytic study. Psychological Medicine 36, 15151522.
Shapiro, E, Laub, B (2008). Early EMDR Intervention (EEI): a summary, a theoretical model, and the Recent Traumatic Episode Protocol (R-TEP). Journal of EMDR Practice and Research 2, 7996.
Shapiro, E, Laub, B (2013). The Recent Traumatic Episode Protocol (R-TEP): an integrative protocol for early EMDR intervention (EEI). In Implementing EMDR Early Mental Health Interventions for Man-Made and Natural Disasters: Models, Scripted Protocols, and Summary Sheets (ed. Luber, M.), pp. 193207. Springer: New York.
Shapiro, F (1995). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures. Guilford Press: New York.
Shapiro, F (2001). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols, and Procedures. Guilford Press: New York.
Sheehan, DV, Lecruiber, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59 (Suppl. 20), 2233; quiz 34–57.
Shoeb, M, Weinstein, H, Mollica, R (2007). The Harvard Trauma Questionnaire: adapting a cross- cultural instrument for measuring torture, trauma and posttraumatic stress disorder in Iraqi refugees. International Journal of Social Psychiatry 53, 447463.
Stickgold, R (2002). EMDR: a putative neurobiological mechanism of action. Journal of Clinical Psychology 50, 6175.
Ter Heide, FJJ, Mooren, TM, Kleijn, W, de Jong, A, Kleber, RJ (2011). EMDR versus stabilization in traumatized asylum seekers and refugees: results of a pilot study. European Journal of Psychotraumatology 2, 5881.
Tol, WA, Barbui, C, Galappatti, A, Silove, D, Betancourt, TS, Souza, R, Golaz, A, van Ommeren, A (2011). Mental health and psychosocial support in humanitarian settings: linking practice and research. Lancet 378, 15811591.
United Nations High Commissioner for Refugees (2013). Mental Health and Psychosocial Support for Persons of Concern ( Accessed June 2015.
United Nations High Commissioner for Refugees (2015). Syria Regional Refugee Response: Inter-agency Information Sharing Portal ( Accessed February 2015.
Van der Hout, MA, Engelhard, M (2012). How does EMDR work? Journal of Experimental Psychopathology 3, 724738.
Vuković, IS, Jovanović, N, Kolarić, B, Vidović, V, Mollica, RF (2014). Psychological and somatic health problems in Bosnian refugees: a three year follow up. Psychiatria Danubina 26, 442449.
Weiss, DS, Marmar, CR (1997). The Impact of Event Scale-Revised. In Assessing Psychological Trauma and PTSD: A Practitioner's Handbook (ed. Wilson, J. P. and Keane, T. M.), pp. 399411. Guilford Press: New York.
World Health Organization (2013). Guidelines for the Management of Conditions Specifically Related to Stress ( Accessed June 2015.
Xu, R (2003). Measuring explained variation in linear mixed effects models. Statistics in Medicine 22, 35273541.


Related content

Powered by UNSILO
Type Description Title
Supplementary materials

Acarturk supplementary material
Acarturk supplementary material 1

 Word (223 KB)
223 KB

The efficacy of eye movement desensitization and reprocessing for post-traumatic stress disorder and depression among Syrian refugees: results of a randomized controlled trial

  • C. Acarturk (a1), E. Konuk (a2), M. Cetinkaya (a3), I. Senay (a1), M. Sijbrandij (a4), B. Gulen (a5) and P. Cuijpers (a4)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.