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. 2025 Apr 17;16(1):2488558. doi: 10.1080/20008066.2025.2488558

Effects of eye movement desensitisation and reprocessing on depressive symptoms, stress and rumination in adolescents with depression: a randomised controlled trial

Efectos de la desensibilización y reprocesamiento por movimientos oculares sobre los síntomas depresivos, el estrés y la rumiación en adolescentes con depresión: un ensayo controlado aleatorizado

Siyuan Zheng a,c,*, Yunyun Shen c,*, Feng Geng b,*, Mengting Ye c, Suqi Song c, Ruoqi Wang a,c, Shaofei Zhang a,c, Yangxu Ou a,c, Xiaoqin Zhou b,CONTACT
PMCID: PMC12006939  PMID: 40243164

ABSTRACT

Background: Adolescent depression patients who have experienced stressful life events usually have more severe symptoms. Existing treatment plans are not effective in reducing the high recurrence rate of adolescent depression. Eye Movement Desensitization and Reprocessing (EMDR), an integrative therapy, can effectively alleviate depressive symptoms, but the evidence of its effectiveness in treating adolescent depression is still insufficient.

Objective: The purpose of this study was to investigate the efficacy of EMDR in combination with medication in treating depressed adolescents.

Methods: A total of 30 adolescent patients with depression were recruited and randomly divided into two groups: EMDR co-treated with an SSRI medication or an SSRI medication used alone. The intervention group received standardised EMDR treatment. The primary outcome indicators were the 17-item Hamilton Depression Scale (HAMD-17) and the Impact of Events Scale (IES-R), while the secondary outcomes were the Ruminative Responses Scale (RRS) and the Rosenberg Self-Esteem Scale (SES).

Results: In the end, 30 people completed the experiment, 15 from each of the intervention and control groups. The intervention group received EMDR treatment three times a week for 2 weeks, with a total of 6 sessions, each lasting 60 min. Repeated measures ANOVA revealed a significant interaction between time and group on children's HAMD-17, IES-R, and RRS scores (all p < .05). Linear mixed models revealed that increasing the IES-R score was associated with an increase in depression levels (estimate value = 0.104, p = .019), while increasing the SES score was associated with a decrease in the depression levels (estimate value = −0.298, p = .021).

Conclusions: Incorporating EMDR add-on therapy to medication for adolescent depressed patients with stressful life events can effectively reduce the degree of impact of stressful life events on patients, as well as reduce depressive symptoms and rumination thinking.

KEYWORDS: EMDR, adolescents, depression, stressful life events, rumination, self-esteem

HIGHLIGHTS

  • EMDR can reduce the impact of stressful sexual life events on adolescents.

  • EMDR can reduce rumination thinking in adolescents with depression.

  • EMDR is an effective treatment for adolescent depression with stressful life events.

1. Introduction

Adolescence is a critical transitional period in individual human development during which adolescents’ biological, psychological, and social development results in changes in their psychology and behaviour that emerge as paradoxical psychological phenomena (Altmeyer et al., 2022). It is estimated that 14%–25% of teenagers experience at least one episode of depression before reaching maturity, and depression in adolescence is linked to a variety of health problems and other psychiatric disorders in adulthood (Paauw et al., 2019). Treatment for the disease has advanced significantly in recent years, but less than half of patients respond positively to medicine alone (Johnston et al., 2019), therefore there is a strong interest in optimising the treatment of depression in adolescents.

Stressful life events include separation, humiliation, embarrassment, serious illness, parental over-demand, childhood abuse, neglect, and so on (Cipriano et al., 2020), all of which can have a negative impact on adolescents’ physical and mental health (Wei et al., 2022). Recent research has found that patients with first-episode depressive disorders have more stressful life events than healthy people (X. Xia et al., 2024). These unpleasant occurrences not only raise the likelihood of getting depression, but they may also prolong the illness's duration and severity (Lan et al., 2019). In a meta-analysis by Rich et al. it was found that the addition of 5-hydroxytryptamine transporter genotypes did not improve the prediction of depression risk when exposed to these adverse life events (Risch et al., 2009). These life experiences appear to boost the individual sensitivity of depression to psychotherapy, which appears to be more beneficial than medication in these circumstances (Nemeroff et al., 2003).

Watkins et al. define rumination as prolonged, repeated and constantly reoccurring negative thinking by individuals about themselves, their emotions, concerns and troubling experiences (2020). The relationship between rumination and depression may be reciprocal, with reports suggesting that patients with major depressive symptoms experience higher levels of rumination (Ballesio et al., 2021). In turn, individuals experience cognitive biases when rumination occurs, causing them to focus on recalling negative information, which exacerbates depression (Wu et al., 2024). It has also been demonstrated that rumination may act as a mediator between stressful life events and depression, with the more negative events an adolescent experiences, the stronger the rumination and the greater the likelihood of depression occurring (H. Xia et al., 2022).

Self-esteem is a subjective estimate of an individual's ideas and feelings that contributes to better social connections, coping skills, and general health (Trong Dam et al., 2023). Many longitudinal studies have investigated the relationship between self-esteem and depression and discovered that it is bidirectional (Bhattacharya et al., 2023; Cipriano et al., 2020). Previous research has revealed that self-esteem can prevent or alleviate depression (Lee, 2020), and that negative self-related thoughts in depressed people can lead to lower self-esteem (Van Tuijl et al., 2014). Additionally, adverse life events can lower people's self-esteem, which may trigger or exacerbate depressive symptoms and even somatic symptoms (Lv et al., 2023).

Dr. Shapiro, a North American psychologist, invented Eye Movement Desensitization and Reprocessing (EMDR) in 1987. The treatment is guided by the Adaptive Information Processing (AIP) model, which assumes that a person has an instinctive information-processing system that is disrupted by stressful life events or traumatic events that occur during the formative years of life, and that EMDR enables a person to reorganise their response to the stressful life events (Shapiro, 2007). Carletto, Yan et al. reported nine controlled studies in a recent systematic review of depression treatments (including 8 positive controls and 1 blank control). All these studies showed that the remission rate of EMDR treatment was higher than that of the control group at the end of treatment (Carletto et al., 2021; Yan et al., 2021). We also found in one Meta – analysis of 39 studies that EMDR can effectively treat depression, and this trend is independent of the age, gender, depression subtype, scale type, trial method, and use of psychotropic medications (Sepehry et al., 2021). In addition, Xie et al. conducted a meta-analysis on the treatment of adolescents exposed to natural and man-made disasters. A total of 26 studies were included, and it was found that EMDR seemed to be the most effective in reducing depressive symptoms compared with exposure therapy and cognitive–behavioural therapy, but its effect size was relatively small (2024). Also, in a recent case report, Rolling et al. evaluated the efficacy of EMDR on 22 adolescents who were abused in childhood and found that their post-traumatic symptoms, depressive and anxious emotions, insomnia symptoms, and psychoactive substance use all decreased significantly, and their quality of life improved significantly (2024).Although there are a large number of characterised studies demonstrating the effectiveness of EMDR in the treatment of depression (Brouwers et al., 2021; Ostacoli et al., 2018), there is still a lack of sufficient evidence regarding its effectiveness in the treating of adolescent depression and the effects of the treatment on rumination and self-esteem in depressed patients are unclear. Thus, the aims of this study were to (1) investigate whether the efficacy of EMDR in combination with medication in treating adolescent patients with depression is superior to that of medication alone, (2) to explore the effects of EMDR on ruminative thinking and self-esteem in adolescent patients with depression, and (3) to assess whether the severity of depression in adolescent patients is related to the degree of influence of the event, ruminative thinking, and self-esteem at baseline.

2. Methods

2.1. Participants

We conducted a randomised controlled trial (RCT) to assess the efficacy of EMDR in combination with medication in the treatment of adolescents with depression. Adolescent patients with depression who were hospitalised in the Department of Psychiatry of Chao-hu Hospital affiliated with Anhui Medical University from May 2023 to May 2024 were selected, and the inclusion criteria included: (1) two clinically experienced attending psychiatrists or above diagnosed as mild to severe depression on the basis of ICD-10 criteria; (2) were between the ages of 12 and 18, both male and female; (3) had at least one memory of a stressful life event connected to depressive symptoms; (4) had normal verbal and written communication skills; and (5) agreed to participate in the study and signed an informed consent form. Exclusion criteria included (1) neurological disorders or a history of psychoactive substance abuse; (2) meets ICD-10 diagnosis of other severe mental disorders; (3) severe suicidal tendencies and behavioural or psychiatric symptoms; (4) severe somatic illnesses (glaucoma, cardiac disease, hypertension, etc.); (5) intolerant to EMDR or SSRIs medications. Based on these criteria, 30 suitable subjects were eventually included in the study.

All study protocols closely adhered to the principles of the Declaration of Helsinki, and participants under the age of 18 were asked to receive written informed consent from their legal guardian in addition to their own personal informed consent, as well as providing medical history.

2.2. Procedure

After completing the standard admission clinical examination and assessment of their condition at the healthcare institution, teenagers who fit the criteria for depression were invited to a semi-structured interview by two psychiatrists. The main purpose of the interviews was to check the inclusion criterion ‘memory of at least one stressful life event related to depressive symptoms’, followed by rechecking the rest of the inclusion and exclusion criteria, and finally, for those who were eligible and willing to participate, obtaining written informed consent from them and their legal guardians. After excluding three visitors who were unwilling to participate in the study, a staff member not involved in this research used a random sequence table generated by SPSS to randomly assign the 30 eligible participants to the EMDR combined with medication group (n = 15) and the medication – only group (n = 15) at a 1:1 ratio. Then, three researchers not involved in the EMDR treatment, after receiving consistency training, evaluated the participants’ efficacy before treatment, after 2 weeks of treatment, and after 4 weeks of treatment. During therapy, no members were removed from the intervention and control groups, and the EMDR therapist was not informed of all participants’ evaluation scores. Figure 1 shows the detailed steps.

Figure 1.

Figure 1.

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Flow chart of study design.

2.3. Intervention

After participants were randomly assigned to the two groups, the intervention group immediately received the standardised EMDR treatment combined with an SSRI, while the control group received only an SSRI. After starting drug treatment, all participants began with the minimum effective dose, and then the dosage was adjusted according to their conditions. If any participant had sleep problems during hospitalisation, they were allowed to add a benzodiazepine or non-benzodiazepine sleep-aid. The SSRIs we mainly used included sertraline, fluoxetine, fluvoxamine, and escitalopram, and the sleep-aids included lorazepam, oxazepam, zopiclone, and eszopiclone. EMDR's standardised method includes eight steps: history collection, preparation, assessment, desensitisation, implantation, body scanning, closure, and reassessment (Shapiro, 1996). The intervention group received standardised EMDR treatment three times a week, every other day, for two weeks, for a total of six 60-minute sessions. Participant's parents were allowed to be present during the session if the participant and therapist agreed.

The therapist conducts a 10–15-minute session with all adolescents participating in the study and one or both of their parents at the end of the two-week treatment period. The content of this session is discussed with the adolescents beforehand and may include the following: (1) the adolescent's current treatment status; (2) the importance of family support. Successful completion of EMDR treatment was indicated when the participant's Subjective Units of Distress Sensory Unit Scale score (SUD) for a stressful life event associated with depressive symptoms decreased to zero and the Validity of Cognition Scale (VOC) increased to seven.

In this study, EMDR standardised treatment was administered by two psychiatrists with standardised training and supervised by a psychiatrist with over ten years of experience in psychiatry and clinical counselling who was skilled in the use of EMDR in the treatment of psychosomatic disorders. All participants in the study successfully completed EMDR standardised treatment within two weeks.

2.4. Assessment instruments

A self-administered general demographic information questionnaire was used to collect general demographic information about the subjects, including gender, age, years of education, marriage, occupation, economic status, whether or not they were an only child, age of symptom onset, and duration of illness. In addition, we converted the dose of antidepressant medication used by the patient at discharge to fluoxetine equivalents by the internationally recognised method of defined daily doses (DDDs) (Furukawa et al., 2019). The researchers measured the duration right after the treatment started for the two groups of children. Except for the demographic information questionnaire, which was only assessed at baseline, all assessment tools were measured at baseline, as well as 2 weeks and 4 weeks after treatment.

We used the 17-item Hamilton Depression Rating Scale (HAMD-17) to assess the participants’ depression severity. Developed by Hamilton in 1960 (Hamilton, 1960), it mainly evaluates the severity of depressive symptoms. The scale contains 17 items. Most items are rated on a 5-point scale from 0 to 4, while a few items use a 4-point scale from 0 to 3 (such as sexual symptoms) or a 3-point scale from 0 to 2 (such as difficulty falling asleep, non-deep sleep, early awakening, gastrointestinal symptoms, general symptoms, weight loss, and insight). A total score of ≤ 7 indicates no depressive symptoms; a score > 7 and ≤ 17 indicates mild depression; a score > 17 and ≤ 24 indicates moderate depression; and a score > 24 indicates severe depression. This measurement is now widely used in clinical use, with the Cronbach's α coefficient of 0.749 in this study.

Applied Impact of Event Scale-Revised (IES-R) to assess the impact of depression-related stressful life events on patients: The scale was developed in 1979 by Horowitz et al. (1979), mainly for assessing post-traumatic responses, including 15 entries, invasive and avoiding two factors, and was revised in 1997 by Weiss and Marmar to add the high alert section (2007), to 22 entries that mainly assess the extent to which a stressful event affects the study subjects. Each item of this scale is rated on a 5-point Likert scale, with 0 indicating no impact and 4 indicating a severe impact. The total score ranges from 0 to 88. The higher the score, the greater the impact of stressful events on the patient (Yaşar et al., 2022). The Cronbach's α coefficient in this study is 0.896.

The Ruminative Responses Scale (RRS) was used to quantify the severity of participants’ negative cognitions. Nolen-Hoeksema and Morrow established the scale in 1991(Treynor et al., 2003), and it was later localised and refined by Chinese scholars Hongfei Yang et al. The scale was used to rate the patient's negative occurrences, his or her negative emotional state, and their negative emotional moods. The revised scale consists of 22 items covering three dimensions: symptom rumination, reflective pondering, and brooding. It adopts a 4-point Likert scale, where 1–4 represents ‘never’ to ‘always’. The maximum total score is 88 points. The higher the total score, the more severe the patient's rumination is. In this study, the scale has great internal consistency, with a Cronbach's alpha coefficient of 0.903.

Rosenberg et al. developed the Self-Esteem Scale, which was used to assess people's overall sense of self-worth and acceptance (Winch & Rosenberg, 1965). The scale contains 10 items, divided into 5 self-negation items and 5 self-affirmation items. It adopts a 4-point Likert scale, where 1 point represents ‘highly inconsistent’ and 4 points represent ‘highly consistent’. Among them, the 5 self-negation items (3, 5, 8, 9, 10) are reverse-scored. The total score ranges from 10 to 40 points. The higher the score, the higher the individual's self-esteem level (Griffioen et al., 2017). The scale used in this investigation exhibited acceptable reliability, with a Cronbach's alpha coefficient of 0.611.

2.5. Statistical analysis

We used t-tests and χ2 tests to compare demographic differences between the two groups of participants at baseline. Repeated-measures ANOVA was used to assess the effects of the intervention and control groups on depression severity, event impact, rumination thinking, and self-esteem after treatment, and data are expressed as unadjusted mean ± standard deviation, and simple effects were performed to further analyse the results. Linear mixed models were used to assess the associations between depression severity and degree of event impact, rumination, and self-esteem. All analyses were conducted according to the intention-to-treat (ITT) principle. A two-sided P-value less than or equal to 0.05 was considered a statistically significant difference, and all statistical analyses were completed by SPSS 27.0.

3. Results

3.1. Demographics

In this study, 30 patients finally completed the treatment, including 15 in the EMDR combined with medication group (intervention group) and 15 in the medication applied alone group (control group) (Figure 1). In the intervention group there were 3 males and 12 females with a mean age of 15.07 ± 1.907 years, and the antidepressant medication used was converted to fluoxetine equivalents of 58.67 ± 19.591 mg/day, while in the control group there were 4 males and 11 females with a mean age of 15.00 ± 1.773 years, and the antidepressant medication used was converted to fluoxetine equivalents of 54.00 ± 18.048 mg/ day. To compare the differences between the two groups at baseline, independent samples t-test and chi-square test were used. The results suggested that there was no statistically significant difference between the two groups of patients in terms of age, gender, BMI, job status, economic status, compatriot situation, family history, education status, smoking, physical activity, age at first episode, total duration of the disease, hospitalisation length (all p < .05). Table 1 shows the baseline characteristics of the study population. In addition, the researchers categorised the types of negative life events related to depressive symptomatology reported by all participants. In the intervention group, there were 4 cases of family conflicts, 5 cases of learning pressure, and 6 cases of interpersonal relationship conflicts. In the control group, there were 5 cases of family conflicts, 3 cases of learning pressure, and 7 cases of interpersonal relationship conflicts. The specific event types are shown in Table 2.

Table 1.

Baseline characteristics of the study population.

    Intervention Control p*
    N = 15 N = 15  
Age   15.07 ± 1.907 15.00 ± 1.773 .992
Gender Female 12(80.0%) 11(73.3%) .666
  Male 3(20.0%) 4(26.7%)  
BMI (kg/m2) Underweight 6(40.0%) 7(46.7%) .342
  Normal weight 7(46.7%) 8(53.3%)  
  Overweight/Obese 2(13.3%) 0(0.0%)  
Job Status Unemployed 1(6.7%) 0(0.0%) .309
  Student 14(93.3%) 15(100%)  
  Worker 0(0.0%) 0(0.0%)  
Economic Status <2000 2(13.3%) 0(0.0%) .341
  2000–5000 5(33.3%) 6(40.0%)  
  >5000 8(53.3%) 9(60.0)  
Compatriot situation No 10(66.7.0%) 10(66.7%) 1.000
  Yes 5(33.3%) 5(33.3%)  
Family history No 12(80.0%) 14(93.3%) .283
  Yes 3(20.0%) 1(6.7%)  
Education Status ≤Middle school 7(46.7%) 7(46.7%) .587
  High school/Secondary school 7(46.7%) 8(53.3%)  
  ≥High school 1(6.7%) 0(0.0%)  
Smoking No 13(86.7%) 15(100.0%) .143
  Yes 2(13.3%) 0(0.0%)  
Exercise No 9(60.0%) 10(66.7%) .705
  Yes 6(40.0%) 5(33.3%)  
Age at first onset   13.40 ± 1.882 12.13 ± 2.295 .110
Total duration of illness   3.07 ± 2.187 1.73 ± 1.387 .056
Length of this hospitalisation   20.00 ± 7.928 15.67 ± 8.837 .168
Non-suicidal self-injury No 5(33.3%) 1(6.7%) .068
  Yes 10(66.7%) 14(93.3%)  
Sleeping aid No 7(46.7%) 10(66.7%) .269
Drug fluoxetine equivalent (mg/d) Yes 8(53.3%)
58.67 ± 19.591		 5(33.3%)
54.00 ± 18.048		 .503
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Note. Results are shown as n (%) for χ2 test and mean ± SD for independent t-test (two tailed).

*p < .05 significant difference between groups.

Table 2.

Types of stressful life events.

  Intervention Control
  n % n %
Family conflict 4 26.7% 5 33.3%
learning pressure 5 33.3% 3 20.0%
Interpersonal relationship conflicts 6 40.0% 7 46.7%
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Note: n refers to the ratio of observed to measured.

3.2. Primary outcome

The results of repeated measures ANOVA showed that there was a significant interaction between time and group on HAMD-17 (F = 9.893, p < .001) and IES-R (F = 4.691, p = .018) scores for the two groups, with a significant main effect of time on HAMD-17 (F = 17.007, p < .001) and IES-R (F = 8.430, p = .001) scores, and group had a significant main effect on HAMD-17 (F = 10.852, p = .003) scores in both groups (Table 3). Figure 2 clearly shows the trend of HAMD-17, IES-R scores over time in both groups.

Table 3.

Comparison of the levels of measured indicators at baseline, 2 weeks, and 4 weeks between the two groups.

Outcomes Groups N Baseline (MD ± SD) 2 weeks (MD ± SD) 4 weeks follow-up (MD ± SD) Time Effect Size Group Effect Size Group*Time Effect Size
Primary outcome                
HAMD-17 Intervention 15 20.80 ± 5.858 10.07 ± 4.713ab 9.73 ± 6.606ab F = 17.007
p = <.001 		F = 10.852
p = .003
 F = 9.893
p < .001
  Control 15 19.27 ± 4.920 16.60 ± 5.082 18.80 ± 5.821      
IES-R Intervention 15 54.87 ± 14.111 40.53 ± 20.598b 33.27 ± 23.048b F = 8.430
p = .001
 F = 0.036
p = .850
 F = 4.691
p = .018
  Control 15 45.73 ± 18.018 42.60 ± 18.692 43.87 ± 17.671      
Secondary outcome                
RRS Intervention 15 60.73 ± 11.151 51.33 ± 15.814b 46.40 ± 16.159ab F = 5.096
p = .009
 F = 4.340
p = .046
 F = 4.706
p = .013
  Control 15 62.07 ± 10.872 59.73 ± 14.577 62.27 ± 11.202      
SES Intervention 15 19.87 ± 2.386 23.20 ± 5.441b 23.00 ± 5.632ab F = 3.277
p = .045 		F = 3.060
p = .091
 F = 1.799
p = .179
  Control 15 19.47 ± 4.596 20.80 ± 3.858 19.13 ± 4.486      
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Note. HAMD-17 = Hamilton Depression Scale-17; IES-R = Impact of Event Scale-Revised; RRS = Ruminative Responses Scale; SES = Self-Esteem Scale.

a

Indicates p < .05 compared with the control group, b indicates p < .05 compared with the same group at baseline, and c indicates p < .05 compared with the same group after 2 weeks of therapy.

Figure 2.

Figure 2.

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Change from baseline in primary and secondary outcomes. From left to right and top to bottom, repeated-measures ANOVA did not show a significant (time*group) interaction for SES scores, but did show significant interactions in favour of the intervention group for HAMD-17, IES-R, and SES scores (see main text). Error bars indicate 95% CI of the mean.

The results of the simple effects analysis performed showed that after 2 weeks of treatment, the HAMD-17 and IES-R scores in the intervention group decreased significantly from those at baseline (both p < .05), and the HAMD-17 and IES-R scores in the control group did not show statistically significant differences when compared with those at baseline (both p > .05). The HAMD-17 scores of the patients in the intervention group were significantly lower than those of the control group after 2 weeks of treatment (p < .05), the HAMD-17 scores decreased by 51.59% in the intervention group and by 13.86% in the control group. After 4 weeks of treatment, HAMD-17 and IES-R scores were significantly lower in the intervention group compared with those at baseline (both p < .05), but there was no significant difference compared with week 2 of treatment (both p > .05), and there was no significant difference between HAMD-17 and IES-R scores in the control group compared with those at baseline (both p > .05). HAMD-17 scores were lower in the intervention group than in the control group after 4 weeks of treatment (p < .05), with a 53.22% decrease in HAMD-17 scores in the intervention group and a 2.44% decrease in HAMD-17 scores in the control group. There was no significant difference in IES-R scores between the two groups when comparing them after 2 and 4 weeks of treatment (both p > .05), and after 4 weeks of treatment, IES-R scores decreased by 39.37% in the intervention group and 4.07% in the control group compared with those at baseline.

3.3. Secondary outcome

The results of repeated measures ANOVA indicated that there was a significant interaction between time and group on RRS scores in both groups (F = 4.706, p = .013), a non-significant interaction on SES scores in both groups (F = 1.799, p = .179), and a significant main effect of time on RRS (F = 5.096, p = .009) and SES (F = 3.277, and p = .045) scores, and group had a significant main effect on RRS scores in both groups (F = 4.340, p = .046). Trends in RRS and SES scores over time for both groups are detailed in Figure 2.

After 2 weeks of treatment, patients in the intervention group had a statistically significant decrease in RRS scores and an increase in SES scores compared to those at baseline (both P < .05). Patients in the control group had no significant difference in RRS or SES scores compared to those at baseline (both P > .05). After two weeks of treatment, the RRS and SES scores of the patients in the intervention group were not statistically significant when compared to the control group (both p > .05); however, RRS decreased by 15.48% and SES improved by 14.35% in the intervention group, while RRS decreased by 3.77% and SES improved by 6.39% in the control group. After four weeks of treatment, there was a statistically significant difference (both p < .05) between the RRS and SES scores of the patients in the intervention group and the control group. In the intervention group, the RRS scores decreased by 23.60% and the SES scores improved by 13.61%, while in the control group, the RRS scores increased by 0.32% and the SES scores decreased by 1.75%.

3.4. Relationship between depression severity and variables

In order to provide more evidence that EMDR in conjunction with medication helped teenagers with depression over time, linear mixed models were used to assess HAMD-17 scores (Table 4). The HAMD scores of the intervention group were significantly lower than those of the control group from baseline to week 4 (estimate value = −3.083, p = .008). Along with the group effect, the reduction in HAMD from baseline to two weeks of treatment (estimate value = −4.529, p < .001) and four weeks of treatment (estimate value = −3.446, p = .003) was statistically significant. Changes in baseline SES and IES-R scores over time were also found to be significantly correlated with depression severity; elevated baseline SES scores were linked to lower levels of depression in children (estimate value = −0.298, p = .021), and elevated baseline IES-R scores were associated with higher levels of depression in children (estimate value = 0.104, p = .019).

Table 4.

Estimate outcomes of mixed model analyses.

          95%CI  
  Estimate SEM t test P value Lower Upper
Intercept 16.293 4.542 3.587 <.001 7.256 25.331
Group(control = 0) −3.083 1.092 −2.823 .008 −5.307 −0.860
Time1(Baseline = 0) −4.529 1.109 −4.085 <.001 −6.746 −2.312
Time2(Baseline = 0) −3.446 1.116 −3.087 .003 −5.677 −1.215
IES-R 0.104 0.043 2.413 .019 0.018 0.191
RRS 0.096 0.061 1.588 .117 −0.024 0.217
SES −0.298 0.127 −2.354 .021 −0.550 −0.046
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Note. SEM = Standard error of the mean.

Time1 represents 2 weeks of treatment, Time2 represents 4 weeks of treatment.

Reference categories are baseline and control.

4. Discussion

The aim of this study was to investigate whether the efficacy of applying EMDR in combination with medication is superior to medication alone in reducing depressive symptoms and the degree of impact of stressful life events in adolescents with depression, as well as to explore the effects of EMDR on patients’ rumination and sense of self-esteem, and to assess whether the degree of impact of the events, rumination, and self-esteem were associated with the severity of depression at baseline. The findings revealed that EMDR in combination with medication was able to significantly reduce the level of depressive symptoms, the impact of stressful events, and rumination thinking in adolescents when compared to the control group, but both treatment regimens provided similar benefits in terms of increased self-esteem. Furthermore, we discovered that EMDR's ability to lessen depressed symptoms may be linked to its ability to mitigate the impact of stressful life experiences.

The main clinical conclusion of the trial was that adolescents in the EMDR combined with medication therapy group had a higher reduction in depression symptoms and were able to maintain a certain level of efficacy compared to the medication alone group. The results of some previous studies are similar to our findings, Ostacoli et al. revealed in a study on the treatment of depression that the remission rate in the EMDR treatment group may reach 71%, with a stabilised remission rate of 54.8% after 6 months of follow-up (Ostacoli et al., 2018). In addition, Altmeyer et al. discovered that EMDR therapy resulted in higher remission rates and fewer relapses in hospitalised depressive patients, particularly those with more traumatic episodes, who appeared to achieve superior gains (2022).

Currently, researchers have found several possible explanations for the efficacy of EMDR in improving mood. Many studies have shown that EMDR improves brain functions that affect mood, such as enabling enhanced connectivity between the left amygdala and the posterior part of the left inferior temporal gyrus, restoring the ability of the amygdala-temporal network to accurately engage in fear extinction processing, which modulates people's responses to emotion, memory, and pain (Rousseau et al., 2019). The research report by Wadji et al. also indicated that EMDR might reduce depressive emotions by impairing the retrieval of distressing memories through the attentional allocation competition generated by dual-tasking (2022). Recent research has discovered multiple differentially methylated regions (DMRs) and biochemical pathways in individuals with resistant depression treated with EMDR, implying that the treatment may be linked to inflammation and the immune system (Carvalho Silva et al., 2024). Moreover, it's worth noting that during the treatment, EMDR requires therapists to guide patients to recall traumas while performing bilateral stimulation. This ‘sense of ritual’ may strengthen patients’ belief in the treatment. However, in an RCT study by van den Hout et al. we found that in the short term, there was no significant difference in the improvement of subjective distress between the true EMDR group (bilateral eye movements + trauma recall) and the sham EMDR group (no eye movements, only asked to imagine trauma scenarios). One week after treatment, though, the vividness of trauma memories in the true EMDR group decreased significantly, while the sham EMDR group experienced a symptom rebound (Van Den Hout et al., 2012). Based on this, we believe that the efficacy of EMDR may be jointly driven by specific factors (e.g. bilateral stimulation) and non-specific factors (e.g. therapeutic relationship, patients’ beliefs). The existing evidence is insufficient to fully attribute it to the placebo effect. Future research needs to more precisely deconstruct the specific components of EMDR to clarify its mechanism of action.

According to longitudinal IES-R scores, the impact of stressful life events on children in the EMDR combined medication group continued to decrease over time. Our findings are consistent with previous clinical findings, which show that EMDR is more effective than conventional treatment in reducing fear, anxiety, and depression about blood injection events in children after hospitalisation, as well as improving sleep (Meentken et al., 2020). Furthermore, online EMDR technology has gained attention recently. During the COVID-19 pandemic, online EMDR was used with patients who had mental health issues as well as healthcare professionals. Research has shown that remote EMDR can lessen the psychological effects of such events and lower anxiety and depression in people (McGowan et al., 2021; Perri et al., 2021). A clinical randomised controlled trial by Karada et al. also found that during the COVID-19 outbreak, children had a relatively high level of post-traumatic stress reactions. Moreover, the EMDR-derived self-help intervention could effectively reduce the stress symptoms and relieve anxiety in children compared to the waiting group (Karadag et al., 2021).

In our study, we found that although children in the control group could partially relieve depressive mood and reduce the impact of stressful life events in the first two weeks of treatment, compared with the EMDR combined with medication group, the speed of symptom relief was slower when using medication alone, and the efficacy was difficult to maintain within the 2–4-week treatment window. This finding is similar to previous research results. Hase et al. found in an RCT study that the depression remission rate in the EMDR combined with SSRIs group was significantly higher than that in the group using medication alone, and the trauma-related symptoms (such as avoidance and flashbacks) improved more quickly (2015, 2018). Moreover, Jahanfar et al. also found that compared with the group using medication alone, EMDR combined with antidepressants could significantly improve patients’ quality of life (2020). Although SSRIs can achieve antidepressant effects by regulating serotonin reuptake, they usually take 4–6 weeks to take full effect. In contrast, EMDR can directly process traumatic memories and reduce the continuous negative impact of adverse events on emotions, and may relieve specific symptoms after only a few sessions. Therefore, we believe that the two may form a ‘physiological-psychological’ synergistic intervention.

In addition, we observed in our study that the EMDR combination medication resulted in a more pronounced reduction in ruminative thoughts and sustained the efficacy for a longer period of time compared to the control group. Previous studies have reported that depressed individuals have more generalised autobiographical memories that describe past experiences in a biased manner, and that such generalised memories are one of the characteristics of rumination (Matsumoto et al., 2021). It has been suggested that psychotherapy for depression should focus on extracting positive memories (Bulteau et al., 2023). Keller et al. showed that EMDR can facilitate inter/intra-hemispheric interactions through bilateral eye movements, increase the strength and vividness of positive memories, and enhance the function of the anterior cingulate gyrus and prefrontal lobes to promote attentional control processes (2014). Additionally, many studies have reported the effectiveness of mindfulness meditation in alleviating rumination (Kalmbach et al., 2020; Laicher et al., 2023), and similar concepts are included in EMDR, whereby patients are asked to adopt a nonjudgmental mindfulness attitude to notice their own experiences, as a way of promoting positive introspection, possibly mitigating ruminative thinking to some extent (Goldstein & Feske, 1994).

According to the SES scores, over time, the self-esteem of children in both groups improved after 2 weeks of treatment. However, within the 2–4-week treatment window, the efficacy was difficult to maintain. Moreover, compared with the control group, the intervention group did not show significant advantages. First, the treatment course in this study was four weeks. Reconstructing self-esteem usually requires long-term social interactions and achievement feedback. If self-esteem is evaluated too early, the potential advantages of the combined treatment may not be observed (Hase et al., 2015). Second, the core task of EMDR is the reprocessing of memories of negative events. Its direct effects may be more prominently reflected in symptoms related to emotions or trauma rather than overall self-esteem. Finally, the collectivist culture in China has a profound influence on adolescents. Against this backdrop, adolescents tend to rely more on external evaluations, such as academic achievements and peer relationships (Xiong et al., 2023). As a result, the effectiveness of psychological therapy in intervening in internal self-esteem may be weakened. There is also a lack of evidence to date on the superiority of EMDR combination medication compared to medication alone in improving self-esteem in adolescents with depression. Report by Every-Palmer et al. indicated that EMDR was able to improve self-esteem in patients with psychiatric disorders compared to the usual care group, but the study had a small sample size, included mostly schizophrenic patients, and did not have a control medication (Every-Palmer et al., 2024). Based on this, the relationship between EMDR and self-esteem in depressed individuals needs to be explored with larger sample sizes.

In the present study, we found a positive correlation between IES-R scores and depressive symptoms. Previous neurobiological studies related to depression have reported that as adolescents experience increased psychosocial stressors, their plasma levels of IL-6 increase and brain function is altered, which may lead to an earlier onset of depression (Flouri et al., 2020; X. Xia et al., 2024). It has also been reported that the greater the degree to which an adverse life event affects a patient, the greater the rate of change in epigenetic age, and the greater this rate of change, the more it is associated with increased levels of depression (Sumner et al., 2023). Additionally, we discovered a negative association between depression symptoms and SES scores. Numerous recent studies have examined the bidirectional relationship between depression and self-esteem, but self-esteem is more significant as a risk factor for depression (fragile model) than vice versa (scar model) (Sowislo & Orth, 2013). In our study, however, the intervention group did not demonstrate an additive effect in terms of increasing patients’ self-esteem, and we can only assume that the effect of EMDR in reducing the severity of patients’ depression may have been achieved by reducing the degree of impact of stressful life events.

It's worth mentioning that previous studies have found that a higher level of rumination is associated with an increased risk of depression onset, a longer duration of the illness, and more severe symptoms. However, in this study, the level of rumination could not predict the severity of depression in adolescents. We speculate that this may be related to several reasons. Firstly, adolescents with depression have not fully developed their emotion-regulation abilities. The relationship between rumination and depression may vary with age, and changes in the symptoms of adolescent patients may be more dependent on the external environment rather than internal cognition (Nolen-Hoeksema et al., 2008). Secondly, Hjartarson et al. pointed out in their research report that habitual rumination may be more harmful, leading to a longer-lasting negative mood (2021, 2022). However, the assessment tool we used did not capture the full content of habitual rumination, which might have diluted the overall effect. Finally, rumination can indirectly affect depression through other variables such as negative coping styles and social interactions, rather than directly predicting it (Guo et al., 2022; Yu & Zhao, 2023). In the future, the interaction between rumination and other factors can be explored to guide personalised interventions.

Our study has several strengths. Firstly, there is insufficient evidence to support the effectiveness of EMDR in treating adolescents with depression. Secondly, patients enrolled in the two treatment regimens had similar baseline characteristics thanks to the RCT trial, which means that the effects of EMDR are primarily reflected in the between-group comparisons. Second, the current study contributes to the clinical data by examining the effects of EMDR on self-esteem and rumination thinking in adolescents with depression, which has not been studied before.

It is also necessary to consider the study's limitations. First, we intended to determine the long-term impacts of the intervention on primary and secondary outcomes. However, due to the low long-term medical follow-up rate, we restricted our analysis to a 4-week window of depression treatment. With only 30 patients completing the study, the sample size was too small to investigate the future remission of primary and secondary outcomes. Second, this study only classified the current negative life events closely related to the patients’ depressive symptomatology, but the events patients experienced in life could be complex, which may have affected our research results. Finally, to verify the effectiveness of randomisation, we conducted the baseline assessment after randomisation, which may pose a risk of bias. Therefore, future studies require a larger sample size, longer follow-up, clearer classification of negative life events, and optimisation of randomisation (such as stratified randomisation) and statistical methods to clarify the differences in the efficacy of the two treatment regimens in adolescent patients with depression.

5. Conclusion

According to our research, EMDR helps adolescents with depression by reducing rumination, reducing the impact of stressful life events on depression symptoms, and improving depressive symptoms. Additionally, the degree to which stressful life events impact a patient's depression may be lessened by EMDR, making EMDR in conjunction with antidepressant medication a potentially more effective intervention for specialists treating adolescent depressed patients in the clinical setting. Finally, considering the limitations of this study, future research needs to further expand the sample size, conduct a long follow-up investigation, and compare the differences between EMDR and other commonly used psychotherapies in the treatment of adolescent depression in order to clarify the effectiveness of EMDR.

Acknowledgements

The authors would like to thank all the patients who were willing to participate in this study and would like to thank the psychiatrists at Chao-hu Hospital of Anhui Medical University for their assistance.

Authors' contribution

Siyuan zheng: writing – original draft, data curation, formal analysis, investigation, methodology, visualisation. Yunyun Shen: writing – review & editing, data curation, formal analysis, investigation, validation. Feng Geng: writing – review & editing, data curation, formal analysis, investigation, methodology. Mengting Ye and Suqi Song: investigation, validation, supervision. Ruoqi Wang, Shaofei Zhang and Yangxu Ou: data curation, formal analysis, investigation, methodology. Xiaoqin Zhou: supervision, conceptualisation.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Altmeyer, S., Wollersheim, L., Kilian-Hütten, N., Behnke, A., Hofmann, A., & Tumani, V. (2022). Effectiveness of treating depression with eye movement desensitization and reprocessing among inpatients-A follow-up study over 12 months. Frontiers in Psychology, 13, 937204. 10.3389/fpsyg.2022.937204 [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Ballesio, A., Bacaro, V., Vacca, M., Chirico, A., Lucidi, F., Riemann, D., Baglioni, C., & Lombardo, C. (2021). Does cognitive behaviour therapy for insomnia reduce repetitive negative thinking and sleep-related worry beliefs? A systematic review and meta-analysis. Sleep Medicine Reviews, 55, 101378. 10.1016/j.smrv.2020.101378 [DOI] [PubMed] [Google Scholar]
  3. Bhattacharya, S., Kennedy, M., Miguel, C., Tröger, A., Hofmann, S. G., & Cuijpers, P. (2023). Effect of psychotherapy for adult depression on self-esteem: A systematic review and meta-analysis. Journal of Affective Disorders, 325, 572–581. 10.1016/j.jad.2023.01.047 [DOI] [PubMed] [Google Scholar]
  4. Brouwers, T. C., de Jongh, A., & Matthijssen, S. J. M. A. (2021). The effects of the flash technique compared to those of an abbreviated eye movement desensitization and reprocessing therapy protocol on the emotionality and vividness of aversive memories. Frontiers in Psychology, 12, 741163. 10.3389/fpsyg.2021.741163 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bulteau, S., Malo, R., Holland, Z., Laurin, A., & Sauvaget, A. (2023). The update of self-identity: Importance of assessing autobiographical memory in major depressive disorder. WIREs Cognitive Science, 14(3), e1644. 10.1002/wcs.1644 [DOI] [PubMed] [Google Scholar]
  6. Carletto, S., Malandrone, F., Berchialla, P., Oliva, F., Colombi, N., Hase, M., Hofmann, A., & Ostacoli, L. (2021). Eye movement desensitization and reprocessing for depression: A systematic review and meta-analysis. European Journal of Psychotraumatology, 12(1), 1894736. 10.1080/20008198.2021.1894736 [DOI] [PMC free article] [PubMed]
  7. Carvalho Silva, R., Martini, P., Hohoff, C., Mattevi, S., Bortolomasi, M., Menesello, V., Gennarelli, M., Baune, B. T., & Minelli, A. (2024). DNA methylation changes in association with trauma-focused psychotherapy efficacy in treatment-resistant depression patients: A prospective longitudinal study. European Journal of Psychotraumatology, 15(1), 2314913. 10.1080/20008066.2024.2314913 [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cipriano, A., Claes, L., Gandhi, A., Cella, S., & Cotrufo, P. (2020). Does anger expression mediate the relationship between parental rejection and direct and indirect forms of non-suicidal self-injury? Journal of Child and Family Studies, 29(12), 3575–3585. 10.1007/s10826-020-01844-9 [DOI] [Google Scholar]
  9. Every-Palmer, S., Flewett, T., Dean, S., Hansby, O., Freeland, A., Weatherall, M., & Bell, E. (2024). Eye movement desensitization and reprocessing (EMDR) therapy compared to usual treatment for posttraumatic stress disorder in adults with psychosis in forensic settings: Randomized controlled trial. Psychological Trauma: Theory, Research, Practice, and Policy, 16(Suppl 3), S555–S560. 10.1037/tra0001643 [DOI] [PubMed] [Google Scholar]
  10. Flouri, E., Francesconi, M., Midouhas, E., & Lewis, G. (2020). Prenatal and childhood adverse life events, inflammation and depressive symptoms across adolescence. Journal of Affective Disorders, 260, 577–582. 10.1016/j.jad.2019.09.024 [DOI] [PubMed] [Google Scholar]
  11. Furukawa, T. A., Cipriani, A., Cowen, P. J., Leucht, S., Egger, M., & Salanti, G. (2019). Optimal dose of selective serotonin reuptake inhibitors, venlafaxine, and mirtazapine in major depression: A systematic review and dose-response meta-analysis. The Lancet Psychiatry, 6(7), 601–609. 10.1016/S2215-0366(19)30217-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Goldstein, A. J., & Feske, U. (1994). Eye movement desensitization and reprocessing for panic disorder: A case series. Journal of Anxiety Disorders, 8(4), 351–362. 10.1016/0887-6185(94)00023-9 [DOI] [Google Scholar]
  13. Griffioen, B. T., van der Vegt, A. A., de Groot, I. W., & de Jongh, A. (2017). The effect of EMDR and CBT on low self-esteem in a general psychiatric population: A randomized controlled trial. Frontiers in Psychology, 8, 1910. 10.3389/fpsyg.2017.01910 [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Guo, T., Zhang, Z., Taylor, A., Hall, D. L., Yeung, A. S., Kramer, A. F., & Zou, L. (2022). Association of social support with negative emotions among Chinese adolescents during Omicron-related lockdown of Shenzhen City: The roles of rumination and sleep quality. Frontiers in Psychiatry, 13, 957382. 10.3389/fpsyt.2022.957382 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery & Psychiatry, 23(1), 56–62. 10.1136/jnnp.23.1.56 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Hase, M., Balmaceda, U. M., Hase, A., Lehnung, M., Tumani, V., Huchzermeier, C., & Hofmann, A. (2015). Eye movement desensitization and reprocessing (EMDR) therapy in the treatment of depression: A matched pairs study in an inpatient setting. Brain and Behavior, 5(6), e00342. 10.1002/brb3.342 [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Hase, M., Plagge, J., Hase, A., Braas, R., Ostacoli, L., Hofmann, A., & Huchzermeier, C. (2018). Eye movement desensitization and reprocessing versus treatment as usual in the treatment of depression: A randomized-controlled trial. Frontiers in Psychology, 9, 1384. 10.3389/fpsyg.2018.01384 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Hjartarson, K. H., Snorrason, I., Bringmann, L. F., & Ólafsson, R. P. (2022). Automaticity and depression: Daily mood-reactive rumination in people with and without depression history. Journal of Psychopathology and Clinical Science, 131(4), 327–340. 10.1037/abn0000752 [DOI] [PubMed] [Google Scholar]
  19. Hjartarson, K. H., Snorrason, I., Bringmann, L. F., Ögmundsson, B. E., & Ólafsson, R. P. (2021). Do daily mood fluctuations activate ruminative thoughts as a mental habit? Results from an ecological momentary assessment study. Behaviour Research and Therapy, 140, 103832. 10.1016/j.brat.2021.103832 [DOI] [PubMed] [Google Scholar]
  20. Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of event scale: A measure of subjective stress. Psychosomatic Medicine, 41(3), 209–218. 10.1097/00006842-197905000-00004 [DOI] [PubMed] [Google Scholar]
  21. Jahanfar, A., Fereidouni, Z., Behnammoghadam, M., Dehghan, A., & Bashti, S. (2020). Efficacy of eye movement desensitization and reprocessing on the quality of life in patients with major depressive disorder: A randomized clinical trial. Psychology Research and Behavior Management, Volume 13, 11–17. 10.2147/PRBM.S232589 [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Johnston, K. M., Powell, L. C., Anderson, I. M., Szabo, S., & Cline, S. (2019). The burden of treatment-resistant depression: A systematic review of the economic and quality of life literature. Journal of Affective Disorders, 242, 195–210. 10.1016/j.jad.2018.06.045 [DOI] [PubMed] [Google Scholar]
  23. Kalmbach, D. A., Roth, T., Cheng, P., Ong, J. C., Rosenbaum, E., & Drake, C. L. (2020). Mindfulness and nocturnal rumination are independently associated with symptoms of insomnia and depression during pregnancy. Sleep Health, 6(2), 185–191. 10.1016/j.sleh.2019.11.011 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Karadag, M., Topal, Z., Ezer, R. N., & Gokcen, C. (2021). Use of EMDR-derived self-help intervention in children in the period of COVID-19: A randomized-controlled study. Journal of EMDR Practice and Research, 15(2), 114–126. 10.1891/EMDR-D-20-00054 [DOI] [Google Scholar]
  25. Keller, B., Stevens, L., Lui, C., Murray, J., & Yaggie, M. (2014). The effects of bilateral eye movements on EEG coherence when recalling a pleasant memory. Journal of EMDR Practice and Research, 8(3), 113–128. 10.1891/1933-3196.8.3.113 [DOI] [Google Scholar]
  26. Laicher, H., Int-Veen, I., Woloszyn, L., Wiegand, A., Kroczek, A., Sippel, D., Leehr, E. J., Lawyer, G., Albasini, F., Frischholz, C., Mössner, R., Nieratschker, V., Rubel, J., Fallgatter, A., Ehlis, A.-C., & Rosenbaum, D. (2023). In situ fNIRS measurements during cognitive behavioral emotion regulation training in rumination-focused therapy: A randomized-controlled trial. NeuroImage: Clinical, 40, 103525. 10.1016/j.nicl.2023.103525 [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Lan, T., Jia, X., Lin, D., & Liu, X. (2019). Stressful life events, depression, and non-suicidal self-injury among Chinese left-behind children: Moderating effects of self-esteem. Frontiers in Psychiatry, 10, 244. 10.3389/fpsyt.2019.00244 [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Lee, K. (2020). Social support and self-esteem on the association between stressful life events and mental health outcomes among college students. Social Work in Health Care, 59(6), 387–407. 10.1080/00981389.2020.1772443 [DOI] [PubMed] [Google Scholar]
  29. Lv, S., Chang, T., Na, S., Lu, L., & Zhao, E. (2023). Association between negative life events and somatic symptoms: A mediation model through self-esteem and depression. Behavioral Sciences, 13(3), 243. 10.3390/bs13030243 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Matsumoto, N., Mochizuki, S., Marsh, L., & Kawaguchi, J. (2021). Repeated retrieval of generalized memories can impair specific autobiographical recall: A retrieval induced forgetting account. Journal of Experimental Psychology: General, 150(9), 1825–1836. 10.1037/xge0001028 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. McGowan, I. W., Fisher, N., Havens, J., & Proudlock, S. (2021). An evaluation of eye movement desensitization and reprocessing therapy delivered remotely during the Covid–19 pandemic. BMC Psychiatry, 21(1), 560. 10.1186/s12888-021-03571-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Meentken, M. G., Van Der Mheen, M., Van Beynum, I. M., Aendekerk, E. W. C., Legerstee, J. S., Van Der Ende, J., Del Canho, R., Lindauer, R. J. L., Hillegers, M. H. J., Moll, H. A., Helbing, W. A., & Utens, E. M. W. J. (2020). EMDR for children with medically related subthreshold PTSD: Short-term effects on PTSD, blood-injection-injury phobia, depression and sleep. European Journal of Psychotraumatology, 11(1), 1705598. 10.1080/20008198.2019.1705598 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Nemeroff, C. B., Heim, C. M., Thase, M. E., Klein, D. N., Rush, A. J., Schatzberg, A. F., Ninan, P. T., McCullough, J. P., Weiss, P. M., Dunner, D. L., Rothbaum, B. O., Kornstein, S., Keitner, G., & Keller, M. B. (2003). Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma. Proceedings of the National Academy of Sciences, 100(24), 14293–14296. 10.1073/pnas.2336126100 [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3(5), 400–424. 10.1111/j.1745-6924.2008.00088.x [DOI] [PubMed] [Google Scholar]
  35. Ostacoli, L., Carletto, S., Cavallo, M., Baldomir-Gago, P., Di Lorenzo, G., Fernandez, I., Hase, M., Justo-Alonso, A., Lehnung, M., Migliaretti, G., Oliva, F., Pagani, M., Recarey-Eiris, S., Torta, R., Tumani, V., Gonzalez-Vazquez, A. I., & Hofmann, A. (2018). Comparison of eye movement desensitization reprocessing and cognitive behavioral therapy as adjunctive treatments for recurrent depression: The European Depression EMDR Network (EDEN) randomized controlled trial. Frontiers in Psychology, 9, 74. 10.3389/fpsyg.2018.00074 [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Paauw, C., de Roos, C., Tummers, J., de Jongh, A., & Dingemans, A. (2019). Effectiveness of trauma-focused treatment for adolescents with major depressive disorder. European Journal of Psychotraumatology, 10(1), 1682931. 10.1080/20008198.2019.1682931 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Perri, R., Castelli, P., La Rosa, C., Zucchi, T., & Onofri, A. (2021). COVID-19, isolation, quarantine: On the efficacy of internet-based eye movement desensitization and reprocessing (EMDR) and cognitive-behavioral therapy (CBT) for ongoing trauma. Brain Sciences, 11(5), 579. 10.3390/brainsci11050579 [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Risch, N., Herrell, R., Lehner, T., Liang, K.-Y., Eaves, L., Hoh, J., Griem, A., Kovacs, M., Ott, J., & Merikangas, K. R. (2009). Interaction between the serotonin transporter gene (5-HTTLPR), stressful life events, and risk of depression: A meta-analysis. JAMA, 301(23), 2462–2471. 10.1001/jama.2009.878 [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Rolling, J., Fath, M., Zanfonato, T., Durpoix, A., Mengin, A. C., & Schröder, C. M. (2024). EMDR-Teens-cPTSD: Efficacy of eye movement desensitization and reprocessing in adolescents with complex PTSD secondary to childhood abuse: a case series. Healthcare, 12(19), 1993. 10.3390/healthcare12191993 [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Rousseau, P.-F., El Khoury-Malhame, M., Reynaud, E., Boukezzi, S., Cancel, A., Zendjidjian, X., Guyon, V., Samuelian, J.-C., Guedj, E., Chaminade, T., & Khalfa, S. (2019). Fear extinction learning improvement in PTSD after EMDR therapy: An fMRI study. European Journal of Psychotraumatology, 10(1), 1568132. 10.1080/20008198.2019.1568132 [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Sepehry, A. A., Lam, K., Sheppard, M., Guirguis-Younger, M., & Maglio, A.-S. (2021). (PDF) EMDR for depression: A meta-analysis and systematic review. Journal of EMDR Practice and Research, 15(1), 2–17. 10.1891/EMDR-D-20-00038 [DOI] [Google Scholar]
  42. Shapiro, F. (1996). Eye movement desensitization and reprocessing (EMDR): Evaluation of controlled PTSD research. Journal of Behavior Therapy and Experimental Psychiatry, 27(3), 209–218. 10.1016/s0005-7916(96)00029-8 [DOI] [PubMed] [Google Scholar]
  43. Shapiro, F. (2007). EMDR, adaptive information processing, and case conceptualization. Journal of EMDR Practice and Research, 1(2), 68–87. 10.1891/1933-3196.1.2.68 [DOI] [Google Scholar]
  44. Sowislo, J. F., & Orth, U. (2013). Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychological Bulletin, 139(1), 213–240. 10.1037/a0028931 [DOI] [PubMed] [Google Scholar]
  45. Sumner, J. A., Gao, X., Gambazza, S., Dye, C. K., Colich, N. L., Baccarelli, A. A., Uddin, M., & McLaughlin, K. A. (2023). Stressful life events and accelerated biological aging over time in youths. Psychoneuroendocrinology, 151, 106058. 10.1016/j.psyneuen.2023.106058 [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psychometric analysis. Cognitive Therapy and Research, 27, 247–259. 10.1023/A:1023910315561 [DOI] [Google Scholar]
  47. Trong Dam, V. A., Do, H. N., Thi Vu, T. B., Vu, K. L., Do, H. M., Thi Nguyen, N. T., Nguyen, T. T., Thi Vu, TM,, Thi Nguyen, T. P., Auquier, P., Boyer, L., Fond, G., Latkin, C. A., Ho, C. S. H., & Ho, R. C. M. (2023). Associations between parent-child relationship, self-esteem, and resilience with life satisfaction and mental wellbeing of adolescents. Frontiers in Public Health, 11, 1012337. 10.3389/fpubh.2023.1012337 [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Van Den Hout, M. A., Rijkeboer, M. M., Engelhard, I. M., Klugkist, I., Hornsveld, H., Toffolo, M. J. B., & Cath, D. C. (2012). Tones inferior to eye movements in the EMDR treatment of PTSD. Behaviour Research and Therapy, 50(5), 275–279. 10.1016/j.brat.2012.02.001 [DOI] [PubMed] [Google Scholar]
  49. Van Tuijl, L. A., De Jong, P. J., Sportel, B. E., De Hullu, E., & Nauta, M. H. (2014). Implicit and explicit self-esteem and their reciprocal relationship with symptoms of depression and social anxiety: A longitudinal study in adolescents. Journal of Behavior Therapy and Experimental Psychiatry, 45(1), 113–121. 10.1016/j.jbtep.2013.09.007 [DOI] [PubMed] [Google Scholar]
  50. Wadji, D. L., Martin-Soelch, C., & Camos, V. (2022). Can working memory account for EMDR efficacy in PTSD? BMC Psychology, 10(1), 245. 10.1186/s40359-022-00951-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Watkins, E. R., & Roberts, H. (2020). Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination. Behaviour Research and Therapy, 127, 103573. 10.1016/j.brat.2020.103573 [DOI] [PubMed] [Google Scholar]
  52. Wei, C., Li, Z., Ma, T., Jiang, X., Yu, C., & Xu, Q. (2022). Stressful life events and non-suicidal self-injury among Chinese adolescents: A moderated mediation model of depression and resilience. Frontiers in Public Health, 10, 944726. 10.3389/fpubh.2022.944726 [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Weiss, D. S. (2007). The impact of event scale: Revised. In Wilson J. P. & Tang C. S. (Eds.), Cross-cultural assessment of psychological trauma and PTSD (pp. 219–238). Springer US. 10.1007/978-0-387-70990-1_10 [DOI] [Google Scholar]
  54. Winch, R. F., & Rosenberg, M. (1965). Society and the adolescent self-image. Social Forces, 44(2), 255. 10.2307/2575639 [DOI] [Google Scholar]
  55. Wu, P., Cao, K., Feng, W., & Lv, S. (2024). Cross-lagged analysis of rumination and social anxiety among Chinese college students. BMC Psychology, 12(1), 28. 10.1186/s40359-023-01515-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Xia, H., Han, X., Cheng, J., Liu, D., Wu, Y., & Liu, Y. (2022). Effects of negative life events on depression in middle school students: The chain-mediating roles of rumination and perceived social support. Frontiers in Psychology, 13, 781274. 10.3389/fpsyg.2022.781274 [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Xia, X., Tang, J., Peng, Y., Liu, Y., Chen, Y., Yuan, M., Yu, R., Hou, X., & Fu, Y. (2024). Brain alterations in adolescents with first-episode depression who have experienced adverse events: Evidence from resting-state functional magnetic resonance imaging. Frontiers in Psychiatry, 15, 1358770. 10.3389/fpsyt.2024.1358770 [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Xie, Y., Zhu, X., Wang, L., Wan, Z., Yang, J., Su, C., Duan, S., Xu, C., & Kan, B. (2024). A network meta-analysis of psychological interventions for children and adolescents after natural and man-made disasters. BMC Psychiatry, 24(1), 468. 10.1186/s12888-024-05924-8 [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Xiong, Y., Wang, Y., Wang, Q., Wang, H., & Ren, P. (2023). Can lower levels of classroom victimization be harmful? Healthy context paradox among Chinese adolescents. Journal of Interpersonal Violence, 38(3–4), 2464–2484. 10.1177/08862605221102482 [DOI] [PubMed] [Google Scholar]
  60. Yan, S., Shan, Y., Zhong, S., Miao, H., Luo, Y., Ran, H., & Jia, Y. (2021). The effectiveness of eye movement desensitization and reprocessing toward adults with major depressive disorder: A meta-analysis of randomized controlled trials. Frontiers in Psychiatry, 12, 700458. 10.3389/fpsyt.2021.700458 [DOI] [PMC free article] [PubMed]
  61. Yaşar, A. B., Konuk, E., Kavakçı, Ö, Uygun, E., Gündoğmuş, İ, Taygar, A. S., & Uludağ, E. (2022). A randomized-controlled trial of EMDR flash technique on traumatic symptoms, depression, anxiety, stress, and life of quality with individuals who have experienced a traffic accident. Frontiers in Psychology, 13, 845481. 10.3389/fpsyg.2022.845481 [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. Yu, X., & Zhao, J. (2023). How rumination influences meaning in life among Chinese high school students: The mediating effects of perceived chronic social adversity and coping style. Frontiers in Public Health, 11, 1280961. 10.3389/fpubh.2023.1280961 [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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