EMDR Forum Archive, 1999
Reviewing the totality of the evidence against EMDR's claims
Brian G. · 2/18/00 at 1:35 pm ET
Reviewing the totality of the evidence against EMDR I am familiar with and have read many of the articles that Shapiro references and have access to others. However, I still fail to come to the same conclusions as she does. I will only highlight important findings to back up my conclusions. I do this in the form of abstracts when possible so that others can find this data for themselves. I attempt to cover the most important points of Shapiro's arguments. 1) Citing methodologically flawed or uncontrolled studies to back up claims Dr. Shapiro cited methodologically flawed and uncontrolled studies to make her case that EMDR is the fastest treatment for PTSD. (Perhaps this is why she was vague in her original assertions and only presented them when I pushed.) For example: Am J Orthopsychiatry 1998 Oct;68(4):601-8 An open trial of EMDR as treatment for chronic PTSD. Lazrove S, Triffleman E, Kite L, McGlashan T, Rounsaville B In a prepilot study, eight adults with chronic PTSD underwent three 90-minute sessions of eye Anyone with any training in research will be able to see the flaws in this "study" just from the abstract. Read the last line of the abstract again. This is one of the references Shapiro uses to support the position that EMDR has been shown to be effective in controlled independent studies. I do not ask anyone to believe what I say is the absolute truth. I just present the other side. Furthermore, I cannot point out all the errors with Shapiro's statements. I simply do not have the time. Therefore, you don't have to take my word for it. Read the critiques and then read the articles for yourselves. Furthermore: Bull Menninger Clin 1997 Summer;61(3):317-34 A controlled study of eye movement desensitization and reprocessing in the Rothbaum BO This study evaluated the efficacy of EMDR compared to a Once again EMDR is put up against a straw man (meaning, a wait list control) which does not control for much other than the passage of time. Many assert quite correctly that EMDR's effect in such instances is probably due to the fact that it is consistent with nonspecific treatment effects common to many therapies coupled with a lack of sound research design and bias. This is not good evidence but these are again some of the references I was given to back up Dr. Shapiro's speculative and over-inflated claims of success for EMDR. This straw man is set up for EMDR to knock down again by Wilson, Becker, & Tinker (1995) and Wison, Becker, & Tinker (1997). EMDR, which Foa & Meadows (1997) called a CBT treatment, does not demonstrate that it would be superior to existing treatments based on the previous studies. Contrary to Shapiro's insinuations, Foa has even questioned the assertion that it is a validated treatment for PTSD because of these same methodological limitations in the research as I point out. However, it is Dr. Shapiro who attempts to draw such conclusions from the research that seem unwarranted. 2) EMDR vs. CBT When EMDR is tested in controlled studies these results often miraculously vanish. EMDR has not demonstrated incremental effectiveness over existing treatments, like CBT. For example: J Consult Clin Psychol 1998 Feb;66(1):193-8 Treating phobic children: effects of EMDR versus exposure. Muris P, Merckelbach H, Holdrinet I, Sijsenaar M This study examined the efficacy of eye movement desensitization and reprocessing (EMDR) and Shapiro will then points to De Jongh, A., Ten Broeke, E.T. & Renseen, M.R. (1999) because they say that: With regard to the treatment of childhood spider phobia, EMDR has been found to be more effective than a placebo control condition, but less effective than exposure in vivo. The empirical support for EMDR with specific phobias is still meagre, therefore, one should remain cautious. However, given that there is insufficient research to validate any method for complex or trauma related phobias, that EMDR is a time-limited procedure, and that it can be used in cases for which an exposure in vivo approach is difficult to administer, the application of EMDR with specific phobias merits further clinical and research attention. They say that EMDR is a time-limited procedure which is more easy to administer. However, so is CBT, and this does not support Shapiro's conclusions at all. Notice that a CBT comparison group is not included for comparison. 3) Faulty conclusions being drawn based on the research Most importantly, Shapiro has ignored my assertion that these findings do not at all support her position that EMDR works faster than CBT with imaginal exposure. I do not know if Shapiro lacks knowledge of research methodology or is choosing to make her own rules regarding what can be drawn from the evidence. I will repeat original statements: The problem is that Therefore, her conclusions are misleading and cannot be drawn from the research. 4) EMDR and CBT with imaginal exposure Next Shapiro tries to say that plain exposure alone is not as effective as EMDR. This is a misleading statement misrepresenting what is being asserted by myself and others. CBT includes many active ingredients that work which can include imaginal exposure. When you test EMDR with eye movements against CBT with imaginal exposure you do not find differences. Once again, Devilly GJ, Spence SH. The relative efficacy and treatment distress of EMDR and a cognitive-behavior trauma treatment In this study, treatment fidelity was demonstrated via videotapes of the treatment. Shapiro fails to accept this controlled study because it doesn't support her beliefs about EMDR. Instead she attacks its methodology which is quite good, especially compared to the references Shapiro is fond of citing. However, she ignores faulty methodology when it supports her beliefs and then knit-picks the methodology of other studies which are much more highly controlled and sound. Other components of EMDR (affirmations, imaginal exposure, nonspecific effects, etc.) are based on previously validated and effective techniques. Shapiro has finally been acknowledging on her recent postings that EMDR has a basis in CBT and won't even disagree that it's a form of CBT. Okay, fine, that's what I have been saying for the past several weeks. Now we are getting somewhere. Incremental efficacy is when you can show that the novel component you add to a previously validated treatment will justify a new treatment. Now to claim that EMDR is a novel treatment and one worth paying to learn would be if it added an additional active component. Shapiro has claimed to have done this in the form originally of eye movements, then when results were negative, bilateral stimulation. In fact, Eye Movement Desensitization and Reprocessing is named after eye movements (a form of "bilateral stimulation"). Therefore, researchers have conducted studies which have isolated this component by comparing full EMDR treatments with EMDR controlling for eye movements. For example, J Behav Ther Exp Psychiatry 1995 Dec;26(4):321-9 Eye movement desensitization of public-speaking anxiety: a partial Foley T, Spates CR Forty college students suffering from public speaking anxiety and having experienced a specific J Consult Clin Psychol 1997 Dec;65(6):1026-35 Eye movement desensitization and reprocessing treatment for panic Feske U, Goldstein AJ Forty-three outpatients with DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders, Devilly, Grant J; Spence, Susan H; Rapee, Ronald M. Statistical and reliable change with eye movement desensitization 51 war veterans with posttraumatic stress disorder (PTSD) symptomatology were randomly allocated to 1 of 3 There are more studies which find similar results. I have tried to set out the logic of the conclusions that I have reached regarding EMDR. Let's read Devilly et al's last few lines again: "Overall, the results indicated that, This succinctly states the conclusions of a number of highly respected researchers and clinicians regarding EMDR. How does Shapiro counter this repeated disconfirmation of EMDR by controlled studies? She attacks their research methodology and then points to studies that support her position which are themselves the much more methodologically flawed research (which I have already discussed earlier in this posting). 6) Meta-analyses The meta-analyses she cites: one is not published and the other is published in a journal of less rigor as most of the other references I cite. If people don't already know this, a research can often find a place to publish almost any "research" so be wary of where the info comes from. Regardless, meta-analysis is a procedure in which studies are combined in order to make some type of general statements. However, how this is done will affect the results and combining studies cancels out any differences found between particular studies, especially with EMDR being very much like CBT. The many component analyses do not demonstrate that it is different as mentioned repeatedly. 7) Other critics of EMDR Furthermore, Muris, Peter; Merckelbach, Harald. Traumatic memories, eye movements, phobia, and panic: A critical note on the In the past years, Eye Movement Desensitization and Reprocessing (EMDR) has become increasingly popular as a These authors (Muris, Merckelbach) reach the same conclusions as Lilienfeld, Tolin, Lohr, Herbert, Rosen, O'Donohue, Mueser, Gist, Woodall, Magenheimer, etc. etc. I wish I could remember them all because there are too many to keep track of now! However, Shapiro would have you to believe that these are a small group of misinformed and incompetent individuals. She selectively cites references after carefully sifting through their articles finding any scrap of confirmatory evidence of EMDR and then takes it out of context in an attempt to discredit them. They know the findings of their own studies and base their conclusions on the big picture and not spurious tidbits as is Shapiro's method. Nevertheless, I have already stated that it is patently ridiculous to claim that these author's conclusions are inappropriate just because Shapiro says so. The readers will have to be the judge. Critics of EMDR have not had to change their conclusions over the years but Dr. Shapiro has. If they were wrong then the peer-review process would make them change their statements or not be published in respectable journals. She originally claimed that EMDR is 100% effective in one session irresponsibly based on case studies (1989 Journal of Traumatic Stress). This is simply not true and the more controlled the study the more EMDR's supposed effectiveness drops. Shapiro may disagree with their interpretations of the research but this does not make her right and them wrong. She met news that eye movements didn't work by saying that other forms of "bilateral stimulation" are the real component. When comparisons of eye movements with no eye movements (hence no bilateral stimulation) was demonstrated she claimed that EMDR is a comprehensive treatment that incorporates other validated techniques. If this is correct, then her accelerated information processing theory to explain EMDR is erroneous because it is based on bilateral stimulation. Other researchers have not been able to find a way of adequately explaining what bilateral stimulation will do, especially since the literature says that they do not work. Because of this, we look to more parsimonious explanations based on already known and readily used mechanisms such as those in CBT therapies. Therefore, EMDR is not superior to CBT or any other treatment and Shapiro now admits it is based on CBT. This is a degenerating approach and not a scientific one. It is the explaining away of failure and a ridiculous attempt to fit EMDR with the evidence and not to look for the evidence to fit EMDR. I feel it is unethical to make money off of EMDR by claiming that it is new and more effective than other treatments when this is not demonstrated by the literature. Shapiro has trainees sign agreements not to teach the techniques and wants them to take only Shapiro-approved courses. As Don so aptly stated: adding sugar to aspirin and calling it Curitall™, in the process making claims it is more effective, then putting your name on it and saying that you invented it is the same as saying that you invented aspirin. It is false and misleading. Dr. Shapiro you did not invent CBT, nonspecific treatment effects, imaginal exposure, etc. and you should not be telling people you did based on your "invention" of EMDR. What we are left with are testimonials about EMDR's effectiveness and utility. I can find you others who produce the same "evidence" from proponents of other therapies that are scientifically unsound. I can also find you therapists and patients who will tell you the same stories about CBT. This is interesting but not scientific evidence and ends up being the case of "he said, she said." Carefully read through the references that Shapiro previously cited and you will find many more half-truths and inconsistencies. I do not have the space to point them all out. Her attempt to overwhelm me with references has failed so let's stop such charades. I can match her output word for word with more information but I would rather stick to the main points so that others can better follow the discussion. In the end, I must defer to the readers to make their own informed judgments concerning the claims of EMDR. My opinion and Dr. Shapiro's opinion differs on this matter and the audience must ultimately be the judge. Thank you again, Brian P.S. Thank you Dr. Shapiro for withdrawing your attempt to ban me from this discussion list because of my views and the views of others.
movement desensitization and reprocessing (EMDR) at one-week intervals in an open trial. None
of the seven who completed treatment met criteria for current PTSD two months later. Significant
decreases in measures of pathology and disturbance were recorded. A controlled trial of EMDR
is under way.
treatment of posttraumatic stress disordered sexual assault victims.
no-treatment wait-list control in the treatment of PTSD in adult female sexual assault victims.
Twenty-one subjects were entered, and 18 completed. Treatment was delivered in four weekly
individual sessions. Assessments were conducted pre- and posttreatment and 3 months following
treatment termination by an independent assessor kept blind to treatment condition. Measures
included standard clinician- and self-administered PTSD and related psychopathology scales.
Results indicated that subjects treated with EMDR improved significantly more on PTSD and
depression from pre- to posttreatment than control subjects, leading to the conclusion that EMDR
was effective in alleviating PTSD in this study.
exposure in the treatment of a specific phobia. Twenty-six spider phobic children were treated
during 2 treatment phases. During the first phase, which lasted 2.5 hr, children were randomly
assigned to either (a) an EMDR group (n = 9), (b) an exposure in vivo group (n = 9), or (c) a
computerized exposure (control) group (n = 8). During the 2nd phase, all groups received a 1.5-hr
session of exposure in vivo. Therapy outcome measures (i.e., self-reported fear and behavioral
avoidance) were obtained before treatment, after Treatment Phase 1, and after Treatment Phase 2.
Results showed that the 2.5-hr exposure in vivo session produced significant improvement on all
outcome measures. In contrast, EMDR yielded a significant improvement on only self-reported
spider fear. Computerized exposure produced nonsignificant improvement. Furthermore, no
evidence was found to suggest that EMDR potentiates the efficacy of a subsequent exposure in
vivo treatment. Exposure in vivo remains the treatment of choice for childhood spider phobia.
Also notice that once again EMDR sets up a straw man in the form of a non-comparative control.
the studies she cites that demonstrate EMDR's "fast effectiveness," in addition to not controlling for certain important
factors (remember Lohr et al 1999's criticism?), do not have proper comparison groups within the study. To know if one
therapy works better than another (ie, to make a meaningful comparison between therapies, say EMDR and CBT with
exposure) you must randomly assign a sample (people with similar characteristics) to either treatment X or treatment Y
within the same study. Dr. Shapiro cannot treat patients with EMDR and then compare them with another population, in
another study, at a different time, under different conditions and procedures, and with a different treatment and make
meaningful conclusions. These studies may be in the works by independent investigators but I do not believe that the
efficiency question is confirmed at all by the vast array of other studies on EMDR. Not surprisingly, comparisons against
groups that do not control for the CBT element of EMDR often do not demonstrate that it is better than CBT. A recent
controlled study that I previously cited found CBT to be better than EMDR.
protocol in the amelioration of posttraumatic stress disorder.
J Anxiety Disord. 1999 Jan-Apr;13(1-2):131-57.
PMID: 10225505; UI: 99240011
5) Removing bilateral stimulation in EMDR
dismantling.
traumatic speech-related event were exposed to either a standard EMD protocol with eye
movements; a moving audio stimulus in place of the eye movements; a protocol with eyes resting
on the hands in place of the eye movement, or a no-treatment control condition. The results
revealed that EMD is comparable in limited effectiveness to the other procedures and that the eye
movements are not a crucial component of the treatment with this population.
disorder: a controlled outcome and partial dismantling study.
3rd Ed., revised; American Psychiatric Association, 1987) panic disorder were randomly
assigned to receive 6 sessions of eye movement desensitization and reprocessing (EMDR), the
same treatment but omitting the eye movement, or to a waiting list. Posttest comparisons showed
EMDR to be more effective in alleviating panic and panic-related symptoms than the waiting-list
procedure. Compared with the same treatment without the eye movement, EMDR led to greater
improvement on 2 of 5 primary outcome measures at posttest. However, EMDR's advantages
had dissipated 3 months after treatment, thereby failing to firmly support the usefulness of the eye
movement component in EMDR treatment for panic disorder.
and reprocessing: Treating trauma within a veteran population. [Journal Article] Behavior Therapy. Vol 29(3), Sum 1998,
435-455.
conditions: 2 sessions of eye movement desensitization and reprocessing (EMDR), an equivalent procedure without
EMDR, or a standard psychiatric support control condition. There was an overall significant main effect of time from pre-
to posttreatment, with a reduction in symptomatology for all groups. However, no statistically significant differences were
found between the groups. Participants in the 2 treatment conditions were more likely to display reliable improvement in
trauma symptomatology than Ss in the control group. By 6-mo follow-up, reductions in symptomatology had dissipated
and there were no statistical or reliable differences between the 2 treatment groups. Overall, the results indicated that,
with this war veteran population, improvement rates were less than has been reported in the past. Also, where
improvements were found, eye movements were not likely to be the mechanism of change. Rather, the results imply that
other nonspecific or therapeutic processes may account for any beneficial effects of EMDR. ((c) 1998 APA/PsycINFO,
all rights reserved)
with this war veteran population, improvement rates were less than has been reported in the past. Also, where
improvements were found, eye movements were not likely to be the mechanism of change. Rather, the results imply that
other nonspecific or therapeutic processes may account for any beneficial effects of EMDR."
proliferation of EMDR. [Journal Article] Journal of Anxiety Disorders. Vol 13(1-2), Jan-Apr 1999, 209-223.
treatment method for posttraumatic stress disorder (PTSD). The current article critically evaluates 3 recurring
assumptions in EMDR literature: (1) the notion that traumatic memories are fixed and stable and that flashbacks are
accurate reproductions of the traumatic incident; (2) the idea that eye movements, or other lateralized rhythmic behaviors,
have an inhibitory effect on emotional memories; and (3) the assumption that EMDR is not only effective in treating
PTSD, but can also be successfully applied to other psychopathological conditions. There is little support for any of the 3
assumptions. Meanwhile, the expansion of the theoretical underpinnings of EMDR in the absence of a sound empirical
basis casts doubts on the massive proliferation of this treatment method.
SUMMARY, CONCLUSIONS, AND IMPLICATIONS
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