Re: answering shapiro's challenge

Actually, you haven't "answered [the] challenge." I stated: "As I've said previously, when you can cite an imaginal exposure study that achieves an 80% success rate in 3 sessions, or refute any of the
data errors I’ve cited, I'm happy to listen" You've done neither. However, let's cover what you did say:

1) Please read the posting above. The citations you insinuate don’t exist are listed there. And as noted, by well known exposure researchers, the procedures used by EMDR cannot be explained in those terms.

2) Despite your and Lohr et al.’s claims to the contrary all the studies cited in the post above have independent assessors. In the one study where the assessment was not blind the assessor was paid by the "proprietor" of the competing condition. The studies were not conducted by the EMDR Institute as you claim. They were conducted and assessed by independent personnel. For instance: Rothbaum (study cited in the previous post) who found that after 3 EMDR sessions 90% of the rape victims no longer had PTSD is a longtime advocate of exposure therapy and second author on the only previous exposure therapy study of rape victims

(Foa, E.B. Olasov Rothbaum, B., Riggs, D.S. Murdock, T.B. (1991) Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive behavioral procedures and counseling. Journal of Consulting and Clinical Psychology, 59, 715-723.)

The exposure therapy study reported that after 7 sessions of exposure and daily homework equalling approximately 25 hours, 28.6% had dropped out of therapy and 45% still had PTSD. There were no published controlled studies of cognitive behavior therapy with civilian PTSD prior to my study of EMDR published in 1989 Foa et al reported the only subsequent controlled civilian study of exposure therapy for PTSD until relatively recently. Recent studies of imaginal exposure alone have also found only a 50% effectiveness rate in PTSD diagnosis remission.

The kind and number of studies is why the taskforce on empirically supported methods gave exposure therapy and EMDR therapy the same ranking for civilian trauma. It is also another indication why EMDR does not have to be compared to cbt to be declared a successful treatment. They have been compared to the same controls with the same measures.

3) "Controlling for demand characteristics" of the procedure is done by studies, such as those by Rothbaum or ones by Carlson et al. which found that after 12 sessions of EMDR 75% of the combat veterans no longer had PTSD which is superior to that found with any other method ever applied with vets. Carlson is an advocate of the control condition

(Carlson, J., Chemtob, C., Rusnak, K., Hedlund, N., and Muraoka, M. (1998). Eye movement desensitization and reprocessing (EMDR) treatment for combat-related posttraumatic stress disorder, Journal of Traumatic Stress,11, 3-24.)

What has "controlled for demand characteristics" in the exposure studies which were all conducted by exposure advocates? Each exposure controlled study has been conducted by those teaching courses and publishing books on the approach. Are they all flawed?

4) Your claim that the studies conducted are biased and not replicated is inaccurate. As indicated above multiple independent researchers have conducted the studies. The rapid positive results have been repeatedly replicated. In fact, all of the controlled studies, exept the one conducted by Devilly & Spence on their own cbt protocol have found positive effects.

5) EMDR is a complex intervention that combines aspects of cognitive behavior therapy, psychodynamic therapy, experiential therapy, systems therapy, etc. I have cited the cognitive behavior contributors in repeated articles and my book. However, you can’t hold cognitive behavior therapy as the only ingredient and testing it directly against cbt is not necessary for clinicians and clients to make choices when there is a sufficiently large data base for both treatments. I again refer you to the post above as well as the following references:

Fensterheim, H. (1996). Eye movement desensitization and reprocessing with complex personality pathology: An integrative therapy. Journal of Psychotherapy Integration, 6, 27-38.

Lipke, H. (2000). EMDR and psychotherapy integration: Theoretical and clinical suggestions with a focus on traumatic stress. Boca Raton, FL: CRC.

Shapiro, F. (1995). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures. New York: Guilford Press.

Shapiro, F. (1999) Eye movement desensitization and reprocessing (EMDR): Clinical and research implications of an integrated psychotherapy treatment. Journal of Anxiety Disorders, 13, 35-67.

6) Further, psychodynamic therapy was the first to be applied to patients. However, cognitive behavior therapists will claim that cbt is the treatment of choice and is faster and better than psychodynamic therapy for PTSD. Yet only one study has tested that hypothesis and in fact, both cbt and psychodynamic therapy came out to be equal. In fact, both were equivalent to hypnosis which also predated cbt to the scene. (Brom, D., Kleber, R.J., & Defares, P.B. (1989). Brief psychotherapy for posttraumlatic stress disorder. Journal of Consulting and Clinical Psychology, 57, 607-612)

So why should EMDR be tested againt cbt to be declared effective and efficient? It has its own research base of independent controlled studies. And let me also point out that you were the one to come onto this list as a cognitive behavioral advocate proclaiming cbt to be better than EMDR and insisting on its primacy among all treatments.

7) Issues of component analysis are covered in the previous post. Further, as indicated in point 2 above, cbt exposure therapies do not use the EMDR procedures of interrupted attention combined with free association, so your contention that component analyses of EMDR are the equivalent of comparing EMDR to cbt exposure is inaccurate. In addition, the cbt study you have cited is the only outlier in a field of 8. Even the Vaughan et al study which compared EMDR to simple exposure with a very small sample size found EMDR be superior for intrusive symptoms and equal to the rest even though it did so without the additional 20 hours of exposure homework used in the other conditions (Vaughan, K., Armstrong, M.F., Gold, R., O'Connor, N., Jenneke, W., & Tarrier, N. (1994). A trial of eye movement desensitization compared to image habituation training and applied muscle relaxation in post-traumatic stress disorder. Journal of Behavior Therapy & Experimental Psychiatry, 25, 283-291.)

6) The parameters for proper component analysis have been published since 1995 so no one is "scrambling" to do anything. Bilateral stimulation has been used since 1990 before any component analysis was conducted. An orienting response is a hypothesis that has been advanced by independent psychiatrists in the UK that would demand certain conditions to test. It has not yet been done.

Armstrong, M.S., & Vaughan, K. (1996). An orienting response model of eye movement desensitization. Journal of Behavior Therapy and Experimental Psychiatry, 27, 21-32.

MacCulloch, M.J., Feldman, M.P. & Wilkinson, G. (1996) Eye movement desensitisation treatment utilizes the positive visceral element of the investigatory reflex to inhibit the memories of post traumatic stress disorder: A theoretical analysis. British Journal of Psychiatry, 169, 571-579.

A disruption of the visuo-spatial template has been suggested and tested by eminent memory researchers in the UK

Andrade, J., Kavanagh, D., & Baddeley, A. (1997). Eye-movements and visual imagery: A working memory approach to the treatment of post-traumatic stress disorder. British Journal of Clinical Psychology, 36, 209-223.

In this study eye movements were found to be superior to other dual attention tasks.

You need appropriate hypotheses to conduct appropriate component analyses with appropriate conditions. Using words like "scrambling" are neither true nor helpful. As I’ve stated repeated, exact parameters for conducting component analysies, including the appropriate control conditions have been in print for 6 years (Chapter 12: Shapiro, F. (1995). Eye Movement Desensitization and Reprocessing: Basic Principles, Protocols and Procedures. New York: Guilford Press).

Your (and Lohr's) contention that the hypotheses are not falsifiable is inaccurate

7) To combat repeated controlled studies you quote an article published in the early nineties that tried one session of EMDR on dissociative hospitalized patients. This is not an appropriate clinical application. What controlled civilian studies can you point to that do not support EMDR’s effectiveness? Please read the original data. Further, as covered above, EMDR has been compared to the same conditions that cause you to feel exposure therapy is the treatment of choice. Quoting each treatment’s research base is fully an exceptable way to present the data. It’s comparing the entire range of controlled studies in both treatments. Sometimes both treatments tested by same researcher. While there are presently NIMH studies underway to study the direct comparison, two comparisons have already been presented at major conferences both indicating a superiority for EMDR.

Freund, B. & Ironson, G. (1998, Nov.) A comparison of two treatments for ptsd: A pilot study. Paper presented at the 32nd annual convention of the Association for the Advancement of Behavior Therapy, Washington, D.C.

Lee, C. & Gavriel, H. (1998). Treatment of post-traumatic stress disorder: A comparison of stress inoculation training with prolonged exposure and eye movement desensitisation and reprocessing. Proceedings of the World Congress of Behavioral and Cognitive Therapies, Acapulco.

Regardless, according to your reasoning you should be making no claims for cbt. As I mentioned previously, since psychodynamic therapy was on the field before cognitive behavior therapy, why has cbt never proved itself against that approach in PTSD before you make claims of its effectiveness and efficiency? If it is not necessary for cbt and it is not necessary for EMDR.

8) You then repeat statements such as: "A major problem with Dr. Shapiro's citing of references is that she deems all research equal. Component analyses and studies that test EMDR against a validated treatment like CBT often find EMDR showing poorly, when you look at the results, and contradict the findings of less controlled and independent studies."

Again: First you call on flawed component analysis to back your contention. We have already dealt with that. Then you make a dismissive statement about a controlled research base that has been accepted by reviewers for the taskforce set in motion by the Clinical Division of the American Psychological Association and the International Society for Traumatic Stress Studies. To repeat again: All controlled research of EMDR with civilian populations have shown comparable effects except the Devilly & Spence study which tested their own protocol against EMDR. In it they achieved 18% resolution of PTSD instead of the 85% otherwise documented. They had three times the drop out rate. They had a significant expectancy effect for their own protocol which means that the people in that cell thought from the beginning that they would do better with the Devilly treatment than with EMDR. Devilly was the author of the protocol, the primary researcher and primary therapist. This is the only outlier with civilian trauma yet you say this study is better controlled and independent? And you say EMDR "often" has a "poor showing" when this is the only such controlled outcome study of the 8 civilian studies.

9) You then say: "In addition, she points to her own article to discredit Lohr et al which I cannot assume to be more unbiased as, she says, their stance is. Also she cites Lipke's article from a publication which frequently publishes papers which disagree strongly with his position." Again this is straying far from the point: Read the original data. We do not rely on "authority." In both articles we carefully cite the original research reports and compare them to the inaccurate reporting of Lohr et al. Read the original data and compare them to the way they are reported in the Lohr et al reviews. Aren’t you even the slightest bit concerned that you and a vast number of readers might have been improperly influenced. Don’t all the skeptical articles quote Lohr and his colleagues reviews as a source?

As indicated continually, EMDR’s research base is large and robust. It has been accepted by major independent reviewers. Read the original research data carefully and look at the discrepancies in the Lohr et al articles. The documentation is given verbatim in the articles listed below.

Lipke, H. (1999). Comments on "Thirty years of behavior therapy . . ." and the promise of the application of scientific principles. the Behavior Therapist, 22, 11-14.

Shapiro, F. (1996b). Errors of context and review of eye movement desensitization and reprocessing research. Journal of Behavior Therapy and Experimental Psychiatry, 27, 313-317.

10) You say I am trying to censor you opinion. I am not. I am asking you to be scientifically based and conduct yourself with professional respect. Cavalier dismissing of clinical reports with broadbased claims of placebo/faith healing is not the way I wish respondents on this list to be treated. As I have said repeatedly, you can say whatever you want as long as you remain scientifically based, avoid ad hominems and inflammatory language and are respectful of respondents. Those are the rules of this forum. You can choose to participate at that level or not at all.

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