Re: Saddened by the recent threats and personal attacks

I'm afraid we have to disagree on Brian's level of respect for other individuals on the list. He dismissed a mother's report as based upon placebo, claimed that EMDR clinicians reported positive effects were simply engaging in "groupthink," and dismissed my arguments as simply based upon "proprietory interests." I don't believe those responses are either scientific or respectful.

I have stated that I will not accept any posts on this list that use words such as "finger wagging" (as he used in a post on a different thread) and are dismissive of the respondents. If there is to be a scientific debate it needs to be done appropriately. The "heated debates" do not have to be conducted with disdain.

I repeat now for the fourth time the same statements. When Brian chooses to respond to them rather than quote another Lohr et al article (the same group is cited again in another post below) we can possibly achieve something:

1) If EMDR is no more than simple exposure, why have repeated studies already accepted by major independent researchers found that 84-90% of PTSD victims no longer have PTSD in three EMDR sessions? All the peer reviewed controlled studies of imaginal exposure therapies for civilian PTSD show no more than 50% remission of PTSD after 7-10 sessions?

Why should clients or clinicians choose exposure therapy on the basis of the controlled research for PTSD?

2) Why did Lohr et al. misquote the data of four studies (including their own) to say that the eye movements and other bilateral stimulation are superfluous? Why are Lohr et al reviews quoted when misquotations of data have been fully documented?

Read the original data as reported and compare it to the description by Lohr et al. to see for yourself instead of accepting it on their "authority."

As far as component analysis to test the contribution of the bilateral stimulation are concerned, as I’ve said previously, there are simple guidelines: Component analyses should be conducted with clinical populations. The use of subclinical populations is not appropriate since removing only one part of the method still leaves a comprehensive method that can have effect. Component analysis also should not be conducted on multiply traumatized combat veterans since addressing only one memory out of many will not produce changes on global psychometrics. Also component analysis should be conducted with a sufficient number of subjects to achieve statistical power. The Renfrey & Spates (1994) article that was previously cited found that using eye movements in EMDR in 3 sessions caused an 85% remission in PTSD diagnosis compared to only a 50% remission in PTSD without eye movements in 5-6 sessions. You simply cannot use this article to support the argument that eye movements are superfluous because there were not enough subjects to achieve statistical power.

Please don’t keep quoting Lohr et al. reviews to recycle the same misinformation. Reviews are not the data. Read the original data.

As far as the accelerated information processing model: The paradigm used to explain EMDR is not the same as the extinction/habituation model used to explain exposure therapies. The reason is simple:

Long time experts on exposure therapy conducted a controlled study of EMDR with combat veterans. They found physiological effects not previously found with veterans in exposure studies and stated that :"In strict exposure therapy the use of many of [‘a host of EMDR-essential treatment components’] is considered contrary to theory. Previous information also found that therapists and patients prefer this procedure over the more direct exposure procedure" (Boudewyns, P.A. & Hyer, L.A. (1996). Eye movement desensitization and reprocessing (EMDR) as treatment for post-traumatic stress disorder (PTSD). Clinical Psychology and Psychiatry, 3, p. 192)

Further, Isaac Marks, an acknowledged expert in exposure therapies states in a discussion of his controlled study:
"In vertebrates and invertebrates, exposure gradually reduces defensive responses to cues to which the subject is exposed; this habituation depends on the dose of exposure. Continuous stimulation in neurons and immune and endocrine cells tends to dampen responses, and intermittent stimulation tends to increase them" (Marks, I, Lovell, K., Noshirvani, H., Livanou, M., & Thrasher, S. (1998) Treatment of posttraumatic stress disorder by exposure and/or cognitive restructuring: A controlled study. Archives of General Psychiatry, 55, 317-325. p. 324).

EMDR interrupts the exposure and fosters free association on the part of the client. As indicated in numerous client transcripts (Shapiro, 1995; Wilson & Tinker, 1999) an average client may receive only a few moments of exposure to the critical memory.

The study published by Marks et al. required a prescribed 100 hours of treatment and homework to achieve 80% remission of PTSD.

The following studies of EMDR found equivalent effects in approximately 4.5 hours of treatment:

Lazrove, S., Triffleman, E., Kite, L., McGlashan, T. H., Rounsaville, B. (1998) An open trial of EMDR in patients with chronic PTSD. American Journal of Orthopsychiatry, 69, 601-608.

Marcus, S. , Marquis, P. & Sakai, C. (1997) Controlled study of treatment of PTSD using EMDR in an HMO setting. Psychotherapy, 34, 307-315.

Rothbaum, B.O. (1997). A controlled study of eye movement desensitization and reprocessing for posttraumatic stress disordered sexual assault victims. Bulletin of the Menninger Clinic, 61, 317-334.

Scheck, M.M., Schaeffer, J.A. & Gillette, C.S. (1998) Brief psychological intervention with traumatized young women: The efficacy of eye movement desensitization and reprocessing. Journal of Traumatic Stress, 11, 25-44.

Wilson, S.A., Becker, L.A., & Tinker, R.H. (1997). Fifteen-month follow-up of eye movement desensitization and reprocessing (EMDR) treatment for PTSD and psychological trauma. Journal of Consulting and Clinical Psychology, 65, 1047-1056.

Don’t keep quoting Lohr et al. reviews and making statements of proprietary bias: Read the original data. The studies above are only the most recent. All the controlled civilian studies other than the Devilly and Spence you quoted are positive with effects achieved more rapidly than other methods. There is no selective citing here. However, in the Lohr et al reviews the data was often completely omitted to make their point. Read the original data.

Repeated studies have shown EMDR to be effective. It's empirical base is supported by:

Chambless, D.L., Baker, M.J., Baucom, D.H., Beutler, L.E., Calhoun, K.S., Crits-Christoph, P., Daiuto, A., DeRubeis, R., Detweiler, J., Haaga, D.A.F., Bennett Johnson, S., McCurry, S., Mueser, K.T., Pope, K.S., Sanderson, W.C., Shoham, V., Stickle, T., Williams, D.A., & Woody, S.R. (1998). Update on empirically validated therapies, II. The Clinical Psychologist, 51, 3-16.

Chemtob, C.M., Tolin, D., Van Der Kolk, & Pitman, R. (November 1999). Treatment Guideline for EMDR. In ISTSS PTSD Treatment Guidelines (Chair: Edna Foa). International Society for Traumatic Stress. Miami, Florida.

Feske, U. (1998) Eye movement desensitization and reprocessing treatment for posttraumatic stress disorder. Clinical Psychology: Science and Practice, 5, 171-181.

Spector, J., & Read, J. (1999). The current status of eye movement desensitization and reprocessing (EMDR). Clinical Psychology and Psychotherapy, 6, 165-174.

So we can have dueling references. Some of the authors above are the most respected of all in the entire profession and have ten times the publications of the Lohr et al group. Read the original data. The bottom line is that after rigorous review the guidelines of the International Society for Traumatic Stress studies have declared EMDR effective for the treatment of PTSD. A meta-analysis of all treatments for PTSD, including drug therapy found behavior therapy and EMDR to be equally effective on all the same measures but EMDR was found to be more efficient (Van Etten, M.L. & Taylor, S. (1998) Comparative efficacy of treatments for posttraumatic stress disorder: A meta-analysis. Clinical Psychology & Psychotherapy, 5, 126-144.)

The meta-analyses was performed by an independent cognitive behavior therapist so you need not be concerned with pro-EMDR bias.

Read the original data. And as I said previously, you are invited back on the list as long as the discussion is scientifically based and respectful. But kindly read the actual data.

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