Re: Taking a closer look at the findings of Devilly and Spence 1999

I don't think that anyone who publicly posts an opinion regarding a published article needs to be challenged with the "chicken" question. I'm sure Grant Devilly is aware that his article is being discussed in many circles, and he can choose to attend to these, and/or respond, as he wishes.

Fidelity has been raised as a critical issue re EMDR in a number of reviews, including the following most current and focused analysis of this issue: "Maxfield, L., & Hyer, L. (in press). The relationship between efficacy and methodology in the treatment of PTSD with EMDR. Journal of Clinical Psychology." This meta-analysis confirms the importance of treatment fidelity.

The Devilly and Spence findings re EMDR make this study an outlier in the literature, and as such, it is quite reasonable for people to try to account for this. As noted in prior posts in this thread, in the Devilly & Spence study the EMDR dropout rate was unusually high and the cure rate unusually low as compared to the rest of the controlled EMDR studies in which the reverse is typically found.

The fidelity rating approach in that study was definitely substandard, as merely completing Level 2 training (their rater's qualification) is not even enough for "certification" by the EMDR International Association. A fidelity rater ought to have a much higher level of expertise than that represented by beginning competency. This is especially the case regarding EMDR, as we have seen some studies in which even level-2-trained therapists did not achieve adequate fidelity in some observed sessions. In this light, one could argue that one disadvantage of EMDR is that it is a complex intervention that, in some cases, is rather difficult to do well.

At any rate, given these outlier findings and inadequate fidelity rating, and given the importance of treatment fidelity to outcome (see Maxfield & Hyer in press) it is reasonable to question the treatment fidelity in that study.

For another look at the research questions that Devilly and Spence tried to address, consider "Lee, C., Gavriel, H., Drummond, P., Richards, J., & Greenwald, R. (1999). Treatment of PTSD: A comparison of Stress Inoculation Training with Prolonged Exposure and EMDR. Manuscript submitted for publication." The Lee et al study also compared EMDR to CBT (in this case, SIT/PE as per Foa et al) with highly credible therapists and fidelity raters for both treatments. Both treatments performed very well, on par with what would be expected based on the literature. EMDR was more efficient and led to fewer intrusive symptoms as compared to SIT/PE.

Replies:

Re: Taking a closer look at the findings of Devilly and Spence 1999, by Brian, 4/4/00 Re: Taking a closer look at the findings of Devilly and Spence 1999, by Sandra Paulsen, Ph.D., 4/4/00 Re: Taking a closer look at the findings of Devilly and Spence 1999, by , 5/12/00

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