Re: new article on EMDR

Don,

I certainly appreciate your apparent interest, but I must point you to the postings I've made in the previous two days along with a recent article:

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.

I think we can both agree that it is a shame that the situation has turned into an apparent war between those who espouse EMDR and those who favor cbt. I think it is especially unfortunate given the fact that behavior therapy ala Wolpe was the first home for EMDR. In subsequent years diverse elements have been added to the treatment that now make EMDR an approach that integrates aspects of many of the major psychological orientations, including psychodynamic therapy, experiential therapy, systemic therapy, etc. It also has changed in formulation from standard cbt treatment to an emphasis on reprocessing early events as the foundation of a wide range of symptom presentations. Where cbt is applied, EMDR is also applied, but using a different set of guidelines for history taking and overall treatment. I think of it as an integrated therapy that certainly honors the contributions of cbt, but is not limited to it.

I have given credit to the cbt components from the beginning. You can certainly see my delineation of it in my 1995 textbook. You can also find the discussion on the contribution of exposure, parameters for and flaws in component analyses, etc. Unfortunately, little has changed since then.

When I point out that no other study of cbt has reported 85% success in three sessions which has been repeatedly demonstrated with EMDR, you mention the Devilly & Spence study. I have dealt with it in a previous post. They didn't achieve this rate of success with cbt. Further, the Devilly study is the only outlier in a field of 8 EMDR studies and I have documented some of the problems previously so I won't bother to do it now. But what does become clear is that it will take many years for this debate to be satisfactorily completed. If an outlier study (conducted by the primary therapist who wrote his own cbt protocol) carries equal weight to 8 studies by independent researchers than a common meeting ground appears very difficult to find.

The critics once raged that there was insufficient evidence to warrant EMDR's use with PTSD--that exposure therapies were the treatment of choice. But the data base on exposure at that time was meagre. Studies with veterans showed only 30% symptom remission often with a 30% or more drop out rate. The only civilian study showed 50% reduction in diagnosis after 7 sessions and after 28.6% has dropped out (Foa et al., 1991). I taught EMDR as an "experimental method" until 1995 when a sufficient number of studies had appeared. Before that time, however, EMDR clinicians were achieving the now documented 85% successrate in three sessions so they continued to use it although they were called "converts" and "true-believers." The very same terms you used in your post on this list. They certainly appear to me to be ad hominem attacks and, unfortunately, they have set the stage in the overall debate contributing highly to the present divisiveness.

In this context of continued name-calling (and I do accept your apology—I imagine given the climate you didn’t even notice it) it is difficult to concentrate on the scientific issues. Because now the EMDR research has used the same measures and standards as cbt studies and it has been found effective by independent taskforces of major organizations. But the same critics who said previously that EMDR should be avoided because it wasn’t effective, now say: It's effective because its just cbt. Just a rehash, don't bother with it. So, with all due respect, if its just cbt, why did the critics disparage it previously as useless and all placebo based? The elements of exposure and use of cognition they point to as cbt were there from the beginning.

If it makes any difference, its fine with me to put EMDR in the same category as REBT or SIT or DBT. There are many cbt treatments that are distinctly named with distinct clinical applications. I really don't care. The emphasis is one hundred percent on healing people. As long as its used correctly I don’t care what its called.

As for your statement regarding selective citation, once again: all civilian PTSD treatment outcome studies of EMDR except Devilly's have reported positive effects with much less exposure time then used in exposure therapies. I've dealt with the component analyses above. And I’ve written about it repeatedly in practically every article in the last 6 years. EMDR is not unique in the use of bilateral stimulation alone. It is a unique combination of procedures that is recognizable as EMDR. It would not be confused with any form of prolonged exposure therapy or standard use of cognitive therapy. Yes, the cbt elements are among them, but their use and arrangement are quite distinct. So, there is no doubt whatsoever if you remove the bilateral stimulation you will get a positive effect. That is why the component analyses have to be carefully done with sufficient numbers of subjects and all the parameters I've described in chapter 12 of my 1995 book. And, of course, for any clinical work or research to be done well there must be training and preassessed expert fidelity. There are incompetent EMDR clinicians, just as there are incompetent cbt clinicians. They shouldn’t be the researchers or the fidelity checkers. I’ll invite you to look at the article I cited above for specifics on the procedures and the fidelity and component analysis/exposure issues.

So, once again, I've included my read on the science already in numerous posts over this past few days. We can certainly disagree on any point, but it would certainly be lovely to investigate the "why" without disdain. If you want to check on the misreporting of research data, I'll give you some examples below. Perhaps that will convince you to read the entire articles. Perhaps then you’ll understand more fully the reasons for the current climate.

From Lohr et al. (1998) Behavior Therapy, 29, p, 145:

"Early experimental research with single-subject designs suggested that eye movements are not necessary for reduction of verbal reports of symptoms (Acierno, Tremont, et al., 1994; Loh, Tolin, & Kleinknecht, 1995, 1996; Montgomery & Ayllon, 1994a, 1994b)."

The actual data reported:

Montgomery and Ayllon (1994) : "The results show no significant decreases in SUDs levels with the EMDR minus saccadic eye movements procedure. However, five of the six subjects reported clinically significant decreases in their SUDs levels with the inclusion of the saccadic eye movement." (p.217)

Lohr, Tolin, & Kleinknect (1996): "The treatment followed a within-series phase-change design to examine the effects of eye movement added to the general treatment protocol. Both subjects’ verbal reports of fear changed substantially when eye movements were added to the general treatment protocol. It was concluded that the addition of eye movement was necessary to reduce the aversiveness of some phobic imagery." (p.73)

It’s just a continuation of the misreporting that I’ve already documented in an article below:

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

I certainly look forward to your checking the actual data in the original articles against the reviews. It would be a pleasure to move the entire inquiry, in the entire field, into a positive and non-combative direction.

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