answering shapiro's challenge

Dr. Shapiro repeatedly calls upon me to refute the following claims:

"EMDR has numerous controlled and semi-controlled studies indicating remission of PTSD
diagnosis in approximately 4.5 treatment hours. If you believe EMDR is simply cognitive behavior therapy: Please name
one controlled study of exposure therapy that has produced an 84-100% treatment effect in 4.5 hours of therapy. Until
you do that, please refrain from the misinformation that EMDR is simply warmed over CBT. In fact, according to strict
exposure therapy terms EMDR should make people worse since it used interrupted exposure and free association."

First, Dr. Shapiro failed repeatedly to provide me with specific references to back up these claims. This is strange in light of the fact that she copiously cites other sources. Nevertheless, these overstated claims of effectiveness are not a new argument from her.

What she does is set up a false debate. First, most of the studies which "confirm" these results are seriously flawed. For instance, they do not control for the demand characteristics of the procedure or have blind treatment assessors. In addition, these results are not reliably and consistently reproducible. Some of these results are obtained by her research institute and subsequently not replicated by controlled, independent investigation.

Second, and most importantly, Dr. Shapiro draws conclusions about these findings that are not capable of being drawn. Anyone who has some graduate training in research methodology will understand what I am saying. The problem is that 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 fro 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.

I found some more information on this topic over the internet that you may find helpful:

"The four most recent, rigorously controlled studies consistently
indicate that 84-90% of single trauma victims no longer have PTSD
after the equivalent of three 90 minute sessions (Marcus, Marquis &
Sakai, in press, Psychotherapy; Rothbaum, 1997, Bulletin of the
Menninger Clinic; Scheck, Schaeffer & Gillette, in press, Journal of
Traumatic Stress; Wilson, Becker & Tinker, 1995 and in press,
Journal of Consulting and Clinical Psychology)

Yes, but there are studies which are not so supportive: "However,
several studies attempting to replicate earlier findings of EMDR's
apparent efficacy failed to do so. Oswalt, Anderson, Hagstrom and
Berkowitz (1993) reported that the technique was successful with
only 3 of 8 people volunteering for treatment to relieve traumatic
memories or anxiety related to traumatic memories. Furthermore,
the most seriously disturbed participants, whose intrusive
memories included scenes of chronic child abuse and being raped
at knifepoint, showed the least benefit. In fact, 4 of the 5
hospitalized participants failed to complete the single-session
treatment because their memories were too distressing and the
EMDR was having no ameliorative effect. The 3 college student
participants who reported significant decreases in their SUDS
ratings had much milder memories of breaking up with a
boyfriend, witnessing a confrontation between family members,
and fainting during an operation on an animal." [ibid.] "

Visit www.skepdic.com and search for the keyword EMDR to read more back and forth debates.

However, I take exception that the studies listed above were "rigorously controlled". They do not have proper and controlled comparison groups (ie CBT) to be able to make these claims.

Therefore, Dr. Shapiro's claims that EMDR is "quicker" than exposure is not proven and only highly speculative.

The real question that we should be asking is what makes EMDR different than CBT? Originally, it was said to be the eye movements. When these were not supported by a number of studies Dr. Shapiro changed her statements to say that eye movements were unnecessary.

The method of scientific investigation is to take a theory, find components that can be disconfirmed, and test those components. My reading of the research shows that when you keep eyes stationary in EMDR and compare it with standard EMDR then you get the same results. Dr. Shapiro seems to be continually engaged in modifying her theory to catch up with the evidence. Therefore, her theory does not predict research findings but scrambles to explain them after they come out. Most importantly, Dr Shapiro has not demonstrated how her theory can be disproved. If it lacks falsifiability than it is unscientific.

I'm sure Dr. Shapiro will disagree with this but does this make me a "victim of misinformation"? Just because she does not agree with me, others flatly state that she is the one who is completely wrong. I will continue to debate Dr. Shapiro and I do not wish to censor her opinions. However, using her logic, Dr. Shapiro should be silenced because numerous critics flatly disagree with her. The comments I have posted here are from articles published in major journals that have gone through a peer-review process. I am not disseminating misinformation as I am being charged of.

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.

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. This is a far from finished debate between Lohr et al. and Shapiro.

Regarding her high reliance on the 2 meta-analyses she cites: one is not published and the other is published in a journal that is not considered to have as high standards as the other more credible resources in this field. It took some digging for me to even find the reference because that journal is not listed on the major searches (which list about every respectable journal in the field). Try to find it yourself. Furthermore, Dr. Shapiro should be aware that meta-analyses can be very problematic and obscure differences because they lump studies together. These problems are well documented by others far more familiar with the exact procedure than I.

Dr. Shapiro, your attempt to silence me and personally attack me is nonsense. What we are doing here is discussing the issues. Just because you adamantly disagree with me this does not make you right and worthy of telling people what they should say to you and what they shouldn't. I have heard from discussants who are thankful for this debate and wish it to continue. If there are others who feel this way, please let your opinions be known. This is not a discussion confined to only what Dr. Shapiro wants to talk about.

Thanks again,

Brian G.

Replies:

Re: answering shapiro's challenge, by Shapiro, 2/16/00 Everything but the kitchen sink . . ., by Brian G., 2/17/00 Re: Everything but the kitchen sink . . ., by , 2/18/00 Re: Everything but the kitchen sink . . ., by Brian, 2/18/00

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