EMDR FORUM ARCHIVE, 2000
Re:Maxfield & Hyer meta-analysis: A few questions
Louise Maxfield · 11/03/02 at 10:34 ET
Hi Shawn: Although there are indications from the Kavanagh, Andrade, van den Hout, and Sharpley studies that eye movements desensitize memories and contribute to treatment process in EMDR, I agree that we have no convincing evidence to date that eye movements contribute to outcome. I think we also agree, that to a large extent, this research question remains unanswered because of the methodological problems in the studies that attempted to investigate this. I strongly agree with you that a rigorous dismantling study needs to be done to evaluate the role of eye movements in EMDR. Hopefully, this research will use a civilian sample, with PTSD from a single trauma, and will examine treatment process as well as treatment outcome, and will use a waitlist in addition to the experimental conditions. With regard to your comments about Shapiro changing EMD to EMDR. My understanding is that this was an iterative process, incorporating anecdotal feedback from her own clinical work and other clinicians. Shapiro acknowledged the change in the procedure with the change in name in 1991. The revised protocol was fully described and she maintains that the basic protocols have been standardized since that time. Shapiro also strongly encouraged research to evaluate the modified treatment, and much research has been done on EMDR. You are right of course, in saying that no one has compared EMD with EMDR. I agree its unfortunate that such a study was never done. However, if such a study were to be conducted today, it might have some curiosity value, but I am not sure that it would contribute much to the field at this point – and I also think that there are far more important research questions to demand our time and effort. I was at a workshop recently presented by Edna Foa who said that prolonged exposure had been improved to better meet the needs of clients, and that these changes were resulting in better outcomes than those achieved in early studies. I am not sure what these changes are, if they are documented somewhere – but I do know she has not changed the treatment’s name (smile). Personally I think that we all benefit when treatments are improved. However, I also think it would be valuable to empirically evaluate these recent changes and compare the revised protocol to the original protocol. You talked about Sandra Paulson-Inobe’s modification of EMDR for dissociative clients. I am not familiar with her work, but have the impression that Sandra is clear that her protocol is not standardized EMDR, but rather a modification integrating EMDR and ego state therapy. I’d like to see Sandra collect data on her modified protocol to assess its efficacy. You wrote, “We can't justify changes made by Shapiro, or Paulson-Inobe in the absence of data on the grounds of "common sense" and "clinical experience", but reject changes made by Devilly.” As I said earlier, when someone tests a modified procedure, we cannot determine if the resulting effects would be achieved with the standardized procedure or if they are specific to the modification. So with the Devilly study, we can conclude that EMDR-with-Devilly-modifications was not particularly effective in treating PTSD. Does that tell us much about EMDR? There is no way to know … The study lacks internal validity. Just some musings --- I think that EMDR differs from many CBT therapies in that it has a standardized protocol. This standardized protocol has been consistently taught to all trainees. Whereas with CBT, there are multiple variations of similar protocols. For example, there are many variants of exposure therapy – the Foa version, the Marks version, the Tarrier version, the Devilly version etc etc. Although EMDR is a controlled procedure, with a standardized set of protocols, there may be researchers who think that creating and testing their own version of EMDR will provide information about standardized EMDR. They overlook the fact that the treatment they are testing is a modification, and that the results may not generalize. Sometimes I suspect that the CBT community has become so accustomed to protocol flexibility that they tend to overlook basic behavioral or research principles about construct validity. Hopefully, my suspicions are wrong!!
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