Comparative Effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) and Neurofeedback on Executive Functions in Female Senior High School Students with Internalizing and Externalizing Behavioral Disorders

Seyedeh Golzar Razavi; Ali Zadehmohammadi; Mohammadreza Bigdeli; Hossien Bigdeli

doi:10.61838/

Authors

Seyedeh Golzar Razavi Department of Psychology, SR. C., Islamic Azad University, Tehran, Iran

Ali Zadehmohammadi * Department of Psychology, Family Research Institute, Shahid Beheshti University, Tehran, Iran dr_zadeh@sbu.ac.ir

Mohammadreza Bigdeli Department of Animal Sciences and Marine Biology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran

Hossien Bigdeli Department of Psychology, ET. C., Islamic Azad University, Tehran, Iran

https://doi.org/10.61838/

Keywords:

EMDR; neurofeedback; executive functions; internalizing disorders; externalizing disorders; adolescents

Abstract

Internalizing and externalizing behavioral disorders are common problems during adolescence and may adversely affect students’ executive functions. The present study compared the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) and neurofeedback on executive functions in female upper secondary school students with internalizing and externalizing behavioral disorders in Tehran. This applied study used a quasi-experimental pretest-posttest design with a one-month follow-up and included two experimental groups and one control group. The study population comprised female upper secondary school students in Tehran during the 2024-2025 academic year. Forty-five students were selected through convenience sampling and randomly assigned to three groups: EMDR, neurofeedback, and control. Data were collected using the Child Behavior Checklist (CBCL) and the Behavior Rating Inventory of Executive Function (BRIEF). Data were analyzed using repeated-measures analysis of variance and post hoc tests in SPSS version 27. Both EMDR and neurofeedback significantly improved executive functions compared with the control group, and these improvements remained stable at follow-up. No statistically significant difference was observed between the two intervention groups in the post hoc comparisons, although both interventions outperformed the control group. These findings suggest that both EMDR and neurofeedback are effective interventions for enhancing executive abilities in students with behavioral disorders and may be considered in therapeutic and educational programs.

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References

Zelazo PD, Carlson SM. The neurodevelopment of executive function skills: Implications for academic achievement gaps. Psychol Neurosci. 2020;13(3):273-98. [DOI]

2. Achenbach TM. Manual for the ASEBA school-age forms & profiles. Burlington (VT): University of Vermont, Research Center for Children, Youth & Families; 2001.

3. Aboujaoude E, Savage MW. Cyberbullying: next-generation research. World Psychiatry. 2023;22(1):45-6. [PMID: 36640381] [PMCID: PMC9840483] [DOI]

4. Luna B, Marek S, Larsen B, Tervo-Clemmens B, Chahal R. An integrative model of the maturation of cognitive control. Annu Rev Neurosci. 2015;38:151-70. [PMID: 26154978] [PMCID: PMC5661874] [DOI]

5. McLaughlin KA, Lambert HK. Child trauma exposure and psychopathology: Mechanisms of risk and resilience. Curr Opin Psychol. 2017;14:29-34. [PMID: 27868085] [PMCID: PMC5111863] [DOI]

6. Stucke NJ, Doebel S. Early childhood executive function predicts concurrent and later social and behavioral outcomes: A review and meta-analysis. Psychol Bull. 2024;150(10):1178-211. [PMID: 39418439] [DOI]

7. Gkora V, Drigas A. Enhancing executive functions in children: A comprehensive review of interventions via digital technologies and future directions. Sci Electron Arch. 2024;17(5):49-100. [DOI]

8. Yang Y, Shields GS, Zhang Y, Wu H, Chen H, Romer AL. Child executive function and future externalizing and internalizing problems: A meta-analysis of prospective longitudinal studies. Clin Psychol Rev. 2022;97:102194. [PMID: 35964337] [DOI]

9. Vedechkina M, Bennett M, Holmes J. Dimensions of internalizing symptoms are stable across early adolescence and predicted by executive functions: Longitudinal findings from the Adolescent Brain and Cognitive Development (ABCD) study. Dev Psychopathol. 2024;36(3):1284-93. [PMID: 37272416] [DOI]

10. De Geronimo FG, Stoddard SA, Huntley ED, Keating DP. The association of adolescent internalizing and externalizing behavior problems and prospective self with alcohol and cannabis use. Adolescents. 2024;4(4):453-68. [DOI]

11. Missiuna C, Rivard L, Campbell W. Developmental coordination disorder. Lewis's child and adolescent psychiatry: A comprehensive textbook. 5th ed. Philadelphia: Wolters Kluwer; 2017. p. 431-50. [DOI]

12. Valera EM, Seidman LJ. Neurobiology of attention-deficit/hyperactivity disorder in preschoolers. Infants Young Child. 2006;19(2):94-108. [DOI]

13. Anderson VA, Godber T, Smibert E, Weiskop S, Ekert H. Cognitive and academic outcome following cranial irradiation and chemotherapy in children: A longitudinal study. Br J Cancer. 2000;82(2):255-62. [PMID: 10646874] [PMCID: PMC2363266] [DOI]

14. Westerberg H, Jacobaeus H, Hirvikoski T, Clevberger P, Östensson ML, Bartfai A. Computerized working memory training after stroke: A pilot study. Brain Inj. 2007;21(1):21-9. [PMID: 17364516] [DOI]

15. Shapiro F. Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures. 2nd ed. New York: Guilford Press; 2017.

16. Brown AMT, Ciftci ZZ. Group EMDR inside schools and universities: A natural match. EMDR group therapy: Emerging principles and protocols to treat trauma and beyond. New York: Springer; 2023. p. 219-36. [DOI]

17. Sarichloo ME, Elmi S, Mahalleh MSB, Langaroudi MS. Effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) therapy on selective attention and creativity in children with ADHD. Int J Educ Cogn Sci. 2025;6(3):1-8. [DOI]

18. De Roos C, Greenwald R, den Hollander-Gijsman M, Noorthoorn E, van Buuren S, De Jongh A. A randomized comparison of cognitive behavioural therapy and EMDR in disaster-exposed children. Eur J Psychotraumatol. 2011;2:5694. [PMID: 22893815] [PMCID: PMC3402133] [DOI]

19. Teke E, Avşaroğlu S. Efficacy of eye movement desensitization and reprocessing (EMDR) therapy for children and adolescents with post-traumatic stress disorder. J Sch Educ Psychol. 2022;2(1):1-12. [DOI]

20. Louthrenoo O, Boonchooduang N, Likhitweerawong N, Charoenkwan K, Srisurapanont M. The effects of neurofeedback on executive functioning in children with ADHD: A meta-analysis. J Atten Disord. 2022;26(7):976-84. [PMID: 34697957] [DOI]

21. Choudhury A, Clare C, Srivastava S, Tullman S, Westendarp L, Younus S. Biofeedback and its uses in mind-body problems in children and adolescents. Handbook of mind/body integration in child and adolescent development. Cham: Springer; 2023. p. 501-14. [DOI]

22. Simkin DR, Thatcher RW, Lubar J. Quantitative EEG and neurofeedback in children and adolescents: Anxiety disorders, depressive disorders, comorbid addiction and attention-deficit/hyperactivity disorder, and brain injury. Child Adolesc Psychiatr Clin N Am. 2014;23(3):427-64. [PMID: 24975621] [DOI]

23. Benioudakis ES, Kountzaki S, Batzou K, Markogiannaki K, Seliniotaki T, Darakis E. Can neurofeedback decrease anxiety and fear in cancer patients? A case study. Psychiatr Pol. 2016;25(1):59-65. [DOI]

24. Zhong X, Yuan X, Dai Y, Zhang X, Jiang C. Neurofeedback training for executive function in ADHD children: A systematic review and meta-analysis. Sci Rep. 2025;15(1):28148. [PMID: 40750997] [PMCID: PMC12316938] [DOI]

25. Gioia GA, Isquith PK, Guy SC, Kenworthy L. BRIEF: Behavior Rating Inventory of Executive Function professional manual. Lutz (FL): Psychological Assessment Resources; 2000. [DOI]

26. Shapiro F. Eye movement desensitization and reprocessing (EMDR): Basic principles, protocols, and procedures. New York: Guilford Press; 2001.

27. Akbari M, Aghdasi AN, Panah Ali A, Azmodeh M, Naqdi Sedeh R. Comparison of the efficacy of Eye Movement Desensitization and Reprocessing and Emotional Freedom Technique in the treatment of post-traumatic stress disorder among women recovered from COVID-19 [Persian]. Woman Fam Stud. 2023;16(61):155-75. [DOI]

28. Behnam Moghaddam A, Mardpour A, Zadeh-Bagheri F, Mahmoudi A. The effect of Eye Movement Desensitization and Reprocessing on cognitive performance in patients with myocardial infarction [Persian]. Armaghane Danesh. 2024;28(4):442-54. [DOI]

29. Baddeley A. Working memory: Theories, models, and controversies. Annu Rev Psychol. 2012;63:1-29. [PMID: 21961947] [DOI]

30. Scott WA. Cognitive flexibility: Theory, measurement, and applications. J Cogn Dev. 2016;17(3):375-93. [DOI]

31. Nvo-Fernandez M, Salas F, Miño-Reyes V, Ahumada-Méndez F, Medina P, Avello D. Effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) in treating borderline personality disorder: A randomized controlled trial. Alpha Psychiatry. 2025;26(2):40031. [PMID: 40352071] [PMCID: PMC12059781] [DOI]

32. Rezaei Sharif A, Noroozi Homayoon M, Almasi M. The effectiveness of neurofeedback and cognitive-behavioral play therapy and their combination on working memory in children with specific learning disabilities [Persian]. J Learn Disabil. 2022;12(1):47-61. [DOI]

33. Samadi Taherghorabi M, Shakerinia I. The effectiveness of neurofeedback on working memory and cognitive flexibility in patients with mild depression [Persian]. J Guilan Univ Med Sci. 2022;30(4):290-303. [DOI]

34. Kianizadeh R, Esteki M, Hassani F. Effect of beta neurofeedback on executive functions and problem-solving skills of elementary school male children with attention-deficit/hyperactivity disorder [Persian]. Sci J Rehabil Med. 2024;13(4):688-703. [DOI]

35. Sterman MB, Egner T. Foundation and practice of neurofeedback for the treatment of epilepsy. Appl Psychophysiol Biofeedback. 2006;31(1):21-35. [PMID: 16614940] [DOI]

36. Ros T, Enriquez-Geppert S, Zotev V, Young KD, Wood G, Whitfield-Gabrieli S. Consensus on the reporting and experimental design of clinical and cognitive-behavioural neurofeedback studies (CRED-nf checklist). Brain. 2020;143(6):1674-85. [PMID: 32176800] [PMCID: PMC7296848] [DOI]

37. Casey BJ, Jones RM, Hare TA. The adolescent brain. Ann N Y Acad Sci. 2008;1124:111-26. [PMID: 18400927] [PMCID: PMC2475802] [DOI]

38. Hammond DC. What is neurofeedback: An update. J Neurother. 2011;15(4):305-36. [DOI]