Re: Double talk and double standards

Sorry, this is getting old. "Read the literature" goes both ways. Remember, a meta-analysis is only as good as the criteria for selecting and valueing the data to be meta-analyzed, and garbage in, garbage out. There continue to be disputes re failure to adequately discriminate among findings of varying quality.

In fact, there is a careful evaluation of EMDR studies that focuses on whether treatment fidelity influences outcome. The citation is: Maxfield, L., & Hyer, L. A. (2002). The relationship between efficacy and methodology in studies investigating EMDR treatment of PTSD. Journal of Clinical Psychology,58, 23-41.

Abstract: The controlled treatment outcome studies that examined the efficacy of EMDR in the treatment of posttraumatic stress disorder have yielded a range of results, with the efficacy of EMDR varying across studies. The current study sought to determine if differences in outcome were related to methodological differences. The research was reviewed to identify methodological strengths, weaknesses, and empirical findings. The relationships between effect size and methodology ratings were examined, using the Gold Standard (GS) Scale (adapted from Foa & Meadows, 1997). Results indicated a significant relationship between scores on the GS Scale and effect size, with more rigorous studies according to the GS Scale reporting larger effect sizes. There was also a significant correlation between effect size and treatment fidelity. Additional methodological components not detected by the GS Scale were identified, and suggestions were made for a Revised GS Scale. We conclude by noting that methodological rigor removes noise and thereby decreases error measurement, allowing for the more accurate detection of true treatment effects in EMDR studies.

It is also way premature to write off eye movements as having no impact or contribution to treatment effect. While there are as yet no definitive studies explicitly supporting a role for eye movements, neither are their any definitive studies precluding such a role, and the bulk of existing studies do at least suggest a role. I think Susan Rogers has a review on this somewhere, but I don't know the citation.

Finally, clever logic aside, how about looking at the data on studies directly comparing EMDR with other effective treatments? There are now a number of pretty good studies that have done this, as well as several more "iffy" ones. Here's a clip out of a lit review I recently wrote, only of studies reported since the Chemtob et al ISTSS review:

Since the publication of that review, several studies meeting most of Foa & Meadows? (1997) ?gold standard? criteria have directly compared EMDR to validated CBT treatments (including an exposure component) for PTSD. Findings across studies indicate that both treatments were, in general, comparably efficacious (Ironson, Freund, Strauss, & Williams, 2002; Lee, Gavriel, Drummond, Richards, & Greenwald, in press; McFarlane, 2000; Power et al, in press). Three of the studies (Ironson et al; McFarlane; Power et al) suggested that the therapeutic effect may have occurred more quickly for EMDR than for CBT. One study (Ironson et al) found that the level of distress both during and between sessions was lower for EMDR; this study also found a lower dropout rate in the EMDR group.
I have heard that the Rothbaum study showed EMDR and PE to be about equal, but I can't comment, haven't had a good look at it. Also, here's the first child EMDR study directly comparing effective treatments:

Jaberghaderi, N., Greenwald, R., Rubin, A., Dolatabadim S., & Zand, S. O. (2002). A comparison of CBT and EMDR for sexually abused Iranian girls. Manuscript submitted for publication.

Abstract: Fourteen randomly assigned Iranian girls ages 12-13 who had been sexually abused received up to 12 sessions of CBT or EMDR treatment. Assessment of post-traumatic stress symptoms and problem behaviors was completed at pre-treatment and 2 weeks post-treatment. Both treatments showed large effect sizes on the post-traumatic symptom outcomes, and a medium effect size on the behavior outcome, all statistically significant. A non-significant trend on self-reported post-traumatic stress symptoms favored EMDR over CBT. Treatment efficiency was calculated by dividing change scores by number of sessions; EMDR was significantly more efficient, with large effect sizes on each outcome. Limitations include small N, single therapist for each treatment condition, no independent verification of treatment fidelity, and no long-term follow-up. These findings suggest that both CBT and EMDR can help girls to recover from the effects of sexual abuse, and that structured trauma treatments can be applied to children in Iran.
My reading of the accumulation of the data:

1) We don't know yet if, or what, effect eye movements may or may not have. Therefore, since treatment fidelity seems to be important to outcome, we should stick to the standard protocol until there is a good reason to do otherwise.

2) It's abundantly clear from numerous studies that EMDR is *at least* about as effective as the other effective trauma treatments. Findings from several studies (but not all) suggest that EMDR *may be* more effective and/or more efficient than the other leading brands. So, all we know now is that EMDR is either just as good, or better. Therefore, more high-quality comparison studies are needed, and meanwhile there is nothing lost by choosing EMDR as a first-line trauma resolution treatment method.

Replies:

Re: Double talk and double standards, by JT Stratten, 10/23/02 Re: Double talk and double standards, by Ricky Greenwald, 10/23/02 Re: Double talk and double standards, by JT Stratten, 10/23/02 Re: Double talk and double standards, by Ricky Greenwald, 10/24/02

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