Readers react

A reader writes in to discuss the management conditions specifically related to stress.

I am writing to point out that there is a mistake/oversight in the April 2017 edition of Contemporary Pediatrics. On page 5, the authors state that “Effective, empirically supported trauma treatments exist, including Trauma-Focused Cognitive Behavioral Therapy (CBT), Child-Parent Psychotherapy, and Parent-Child Interaction Therapy.”

In 2013, the World Health Organization issued guidelines for the management of conditions that are specifically related to stress: “Trauma-Focused Cognitive Behavioral Therapy and Eye Movement Desensitization and Reprocessing (EMDR) therapy are the only psychotherapies recommended for children, adolescents, and adults with posttraumatic stress disorder (PTSD).” Furthermore, “Like CBT with a trauma focus, EMDR therapy aims to reduce subjective distress and strengthen adaptive cognitions related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve: a) detailed descriptions of the event: b) direct challenging of beliefs; c) extended exposure; d) homework.”

As a behavioral pediatrician who has used EMDR successfully to treat posttraumatic symptoms in children for over 20 years, I have seen the benefit of EMDR therapy, and I think it is important for pediatricians to be aware that it is an empirically supported trauma treatment.

Joan Lovett, MD, FAAP

Berkeley, California

In response:

Thank you for your letter. I knew of EDMR and put in the broad category of CBT. I have not seen clear studies that distinguish various approaches to CBT in terms of efficacy. I recognized it is very hard to get a large enough sample, purify the various approaches, define a level of severity, take into account genetics and family history, and then isolate one approach as more effective or having an essential element from another approach. So I stayed nonspecific and general. I am delighted that you have found EMDR effective in your work and will be alert to future studies.

–Michael S Jellinek, MD