EMDR FORUM ARCHIVE, 2000
Re: Comments for Ulrich
Ulrich Lanius, Ph.D. · 02/10/03 at 8:50 PM ET
Shawn: I am not sure whether this was the same video shown on Dateline or not but could well be. Regardless, we seem to agree that the intervention probably is useful. It likely affects arousal and it more likely than not shifts attentional focus. Regarding arousal, I agree that the Yerkes-Dodson law is useful, though it ignores the complexity of the autonomic nervous system, that is its sympathetic and parasympathetic division. Both systems are likely relevant in PTSD, with the parasympathetic probably being responsible for dissociative symptoms. Attentional manipulations seem to affect fear appraisal and related neural activity (eg., Biological Psychiatry Regarding Cloitre's work: I first saw preliminary results back in 1999. I believe in her presentations she may have used the term complex PTSD, but I may be wrong. Regardless, it is a population that is usually not deemed to be a good candidate for Exposure. And yes I am fascinated by the fact that the DBT part of treatment had little or no effect on DISS/DES scores. And the Exposure condition without DBT is likely to never happen in this population. However, what clinical lore tells us is that stabilization prior to trauma-focussed work is important. DBT is one such method to stabilize clients and it certainly has more empirical support than many. I wholeheartedly agree that trauma focussed treatment is necessary to reduce alexithymia and dissociation. But I would venture that the trauma focussed treatment would liekly stall without DBT or another type of stabilization treatment. Certainly, from my clinical experience frontloading in this way makes things way easier down the road and tends to result in fewer sessions - no, I do not have empirical data for that. And yes, it may be that ubiquitous therapeutic relationship in the psychological literature that is affected here. But it may be time that we make a better effort to understand what nonspecific effects really are - I suspect that there is a relationship to attachment history here. Mindfulness is a big part of DBT. Interestingly enough there is some emerging evidence that mindfulness that incidentally is an attentinal manipulation again affects bot immune response and elevates left frontal functioning (eg Richard Davidson et al. in press Psychosomatic Medicine - I'll post the press release below). Interestingly enough, a study by Korn & Leeds of yet another stabilization technique, this one EMDR based, that is Resource Development Installation) showed a decrease in TSI-Dissociation scores. Yes, this study is a case study with n=2 and the TSI-Dis while correlated with the DES and/or DISS, measures somewhat different aspects of dissociation. Regarding the differential effects of opioid blockade I hope that at some point I will have those data. There are also interesting implications with regard to placebo effects in that opioid blockade seems to block certain types of placebo effect, specifically an expectancy effect. Regarding "However, if you are motivated by not having to listen to the content of your patient’s traumatic experiences, then why not use anxiety management or cognitive restructuring. These two treatments also work for PTSD and require no discussion of the trauma at all. Why not use them instead?": I think that anyone who has experienced EMDR is probably most struck by what it does to reduce somatic reactivity. This certainly is not mentioned in the literature, nor is this generally looked at in most PTSD studies. The most exciting stuff in this regard are again only preliminary data with phantom limb pain.
Prepublication Article Abstract Task Instructions Modulate Neural Responses to Fearful Facial Expressions,K. Lange, L. M. Williams, A. W. Young, Edward T. Bullmore, M. J. Brammer, Steven Williams, Jeffrey A. Gray and Mary L. Phillips). In fact, this study may provide a useful paradigm to study the effects of EMDR type attentional manipulations when accessing traumatic memories.
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