EMDR, CBT and emotion

3. If you look at the multiple-baseline studies by Montgomery & Ayllon (1994), or Lohr, Kleinknecht& Tolin (1998), you’ll see a pattern of anxiety levels not changing much when they did EMDR without the eye movements, but dropping quickly in most cases when the eye movements are added. In other words, the same effect that got Shapiro so fired up in the first place. Why would they see it in these studies and not in group studies? Again, probably because of the differences in the design of the studies. Multiple baseline studies have a design which doesn’t rely on the same kind of statistics or large sample. They also allow the researcher to make observations about the process of treatment instead of just the outcome. I think they are better way to investigate the mechanisms of treatment because of this. Now the results of these studies are still open to interpretation. It could be that if you reversed the order of treatments and did the EMDR first and then eliminated the eye movements you’d see something different. Or that this effect happens in some people with some problems but not with everybody. I think Lohr’s review is at odds with these original sources and that’s no small matter.
4. If you eliminate eye movements from EMDR, there are still some things which are not consistent with the C-B theory. Exposures are typically much briefer than those used in flooding or systematic desensitization, and they are allowed to follow new associations (something which is usually regarded as counterproductive in a CBT like flooding).
I think everyone contributing to this discussion- laypeople and professionals, pro-EMDR or skeptics, have been concerned with one vital issue. How to identify the procedure which is likely to yield the greatest benefit with the least cost (in terms of time, money or unpleasantness) for a given individual. The problem is that we have to do that on the basis of incomplete information. If you think science is slow to come to consensus about drugs, psychotherapy research is a very slow and complex process- and that’s just the time involved in obtaining the data. The reason we conduct the studies is to offset the human tendency to see what they want to see. Unfortunately, even scientists tend to re-introduce their biases when they interpret the results of controlled studies. At this point, if Brian is right, consumers getting EMDR run the risk of getting CBT by another name. But keep in mind that even CBT has a failure rate and even CBT has parts of it’s theory which are unclear. If Brian is wrong, then there is something new about EMDR. If there is something new, it will take awhile before we know exactly what types of people or problems it’s good for. In the meantime, consumers will have to consider a variety of sources. Of information and do the best they can to sort it out.
I’d like to end by introducing my own caution to comsumers. As you wade through the conflicting information about EMDR be alert to language, used by either side, which seems to be designed to have a strong emotional impact. When Brian cites an article in which Shapiro is likened to Mesmer, it tells you nothing about EMDR or its effectiveness- but it evokes suspicion. When Shapiro calls another article “patently absurd”, it tells you nothing about the quality of the arguments it contained, but it evokes contempt. I think this forum can and should tolerate dissenting opinions, but I think it should also be a place where people make the best attempt to avoid inflammatory language.

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