EMDR FORUM ARCHIVE, 2000
Not quite so fast
Cahill · 04/23/03 at 9:47 ET
Ricky: You stated: "As for the Ironson et al study, it 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. So although the clinical outcomes were comparable, these findings did favor EMDR in terms of acceptability to participants. I don't think that this one study is anything to get all excited about, it's just one more piece of the puzzle." Three comments on the above: 2. Your summary of the within-session SUDs sounds like a description of a main effect of treatment, rather than an interaction, which would be incorrect. The average SUDs within sessions for was 55.6 for PE and 57.8 for EMDR. As you can see, the main effect was NOT significant. Instead, what they found was an interaction, such that SUDs at the beginning of session 1 was higher for EMDR (79) than for PE (54.5), while the reverse was true at the end of the session (32.2 for EMDR and 61.0 for PE). Now whether or not patients prefer a pattern of high initial SUDs that decreases, or medium initial SUDs that doesn?t change is a case for speculation because Ironson et al. never asked patients to formally rate ?How distressing was this session? in any global fashion nor did they ask them to rate the acceptability of treatment. So, the within-session SUDs data do not tell us anything about whether patients prefer EMDR over PE. 3. I?m not sure what result you are referring to when you state that the level of distress between sessions was lower for EMDR. Please elaborate. I have to disagree with you that adding in vivo exposure does not ?alter? EMDR. Of course it does, and we don?t know with what consequences. As scientists, we need to be open to all possibilities, which would include: 1. Adding in vivo exposure had no effect on the efficacy of EMDR. Possibility number 3 is the important one. We cannot simply assume that adding treatment components are either innocuous or helpful. Combining treatments can sometimes interfere with one another. There is a fourth possibility that also needs to be considered: That in vivo exposure alone would be as good or better than EMDR. We don?t have answers to these questions yet. So, I think you are being a bit cavalier to suggest that we can add stuff to EMDR and not worry that it is a violation of treatment fidelity. Regarding you suggestion of comparing EMDR with CBT within the structure of Deblingers package, I would suggest that you consider adding two more groups: a WL or minimal attention control group and an EMDR group that does not use the structure of Deblinger?s package. There is no evidence regarding the impact of the structure of the therapy on outcome. You cited in a different post the Hawaii data that showed plain old EMDR did just fine with children. You would want to be able to justify the additional expense of the non-EMDR elements of Deblinger?s treatment by showing that EMDR plus was superior to EMDR plain. For any readers out there who get sick of my methodological nitpicking, just let me say that doing good science is difficult, and that bad information is sometimes worse than no information. So, if you are going to participate in science and want to benefit from science, we need to be in support of the best science possible.
1. Re: Dropout in Ironson et al. Not only is the Ironson finding of statisically more dropouts in PE than EMDR just one study, it is the only study in a field of five studies (Devilly & Spence, Ironson et al., Lee et al., Power et al., & Taylor et al.). It is true that dropouts were numerically higher for CBT in the Lee, Power, and Taylor studies, but differences were small and non-significant, indicating they were likely due to chance. Dropouts were significantly higher for EMDR in the Devilly study. There is one more relevant study that has not yet been published (Rothbaum), so I will refrain from commenting on it. However, at present it looks pretty much like a random pattern to me. Also, the Van Etten &Taylor metat-analysis that is so frequently cited with approval by some EMDR supporters found similar average dropout rates for EMDR (14.4%) and CBT (15.1%).
You also said, "Incidentally, it is not accurate to say that they 'altered' EMDR by using additional interventions in their treatment."
2. Adding in vivo exposure enhanced the efficacy of EMDR.
3. Adding in vivo exposure reduced the efficacy of EMDR.
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