Taylor et al (2003)

I just read the Taylor et al (2003) study, and it seems like many of the questions people are raising are answered in the article. Perhaps it will help to present what is actually said in the article:

Other studies comparing exposure and EMDR:

"A handful of PTSD studies have directly compared EMDR with some form of exposure therapy. The results have been mixed; some research suggests that exposure-based treatment is more effective than EMDR (Devilly & Spence, 1999), whereas other studies suggest that EMDR is somewhat more effective (Ironson, Freund, Strauss, & Williams, 2002; Lee, Gavriel, Drummond, Richards, & Greenwald, 2002; Vaughan et al., 1994). Each of these studies has important methodological limitations, which raises concerns about the validity of the findings.

Vaughan et al. (1994) did not use the current version of EMDR, and their exposure therapy differed markedly from the way this treatment is usually implemented (Devilly, in press).Ironson et al. (2002) failed to assess treatment outcome with structured PTSD interviews. Such interviews are widely regarded as the best way of assessing PTSD symptoms (e.g.,Tarrier, 2001). None of the other studies reported whether their interviews were reliably administered. In three studies the therapists administered the outcome assessments instead of using blind, independent evaluators (Devilly & Spence, 1999; Ironson et al., 2002; Lee et al., 2002). Only two studies reported whether their interventions differed in treatment integrity (Devilly & Spence, 1999; Lee et al., 2002), and even those studies offered no data on whether the integrity ratings were reliable. In both studies it appears that treatments differed in integrity, which raises concerns about whether some of the therapies were not properly implemented." (p. 331).

"Our finding that exposure therapy tended to be more effective than relaxation training is consistent with Marks et al. (1998). Our finding that exposure therapy tended to be more effective than EMDR is consistent with some studies (e.g.,Devilly & Spence, 1999) but not others (e.g.,Lee et al., 2002). The methodological limitations of previous research may account for the inconsistencies. For example, unlike many other studies comparing EMDR with exposure-based treatments, we used blind, independent evaluations to assess treatment outcome, and we established that our treatments were satisfactorily delivered (for extended discussions of the limitations of previous studies see, for example,Devilly, in press; Foa & Meadows, 1997; Maxfield & Hyer, 2002)." (p. 337)

Exposure treatment is not as well tolerated as EMDR:

"Our treatments did not differ in the incidence of symptoms worsening, defined by Tarrier et al.'s (1999) criteria. Contrary to Tarrier et al.'s claim, we found that symptom worsening was rare, regardless of treatment type. Further research is required to identify the conditions under which symptom worsening is least likely to occur. Therapist skill may be an important factor. Skilled therapists, for example, may be better able to guide the pacing and difficulty of exposure exercises. Some lesser skilled therapists might tend to push participants to attempt exposure exercises that are too distressing to endure, resulting in aborted (and brief) exposures to intensely distressing stimuli. Such experiences of failed exposure may promote future avoidance and, therefore, be countertherapeutic." (p. 336)

Effective components of treatment for PTSD:

"Given the efficacy of exposure therapy, along with the importance of exposure in teaching PTSD sufferers not to fear harmless, trauma-related stimuli (i.e., exposure to corrective information;Foa & Rothbaum, 1998), the question arises as to whether exposure is an important ingredient in relaxation training and in EMDR. As mentioned in the introduction, relaxation might work by reducing hyperarousal; once the person feels calmer, he or she may be less likely to avoid trauma-related stimuli. In other words, relaxation exercises might facilitate in vivo exposure, even in the absence of exposure exercises provided by a therapist. This could be tested by comparing (a) relaxation training plus antiexposure instructions with (b) relaxation training without any explicit exposure instructions. If relaxation training works largely by promoting naturally occurring exposure, then the effects of relaxation should be severely undermined by antiexposure instructions. The same may be true of EMDR: “Evidence suggests that the eye movements integral to the treatment, and to its name, are unnecessary” (Davidson & Parker, 2001, p. 305), which raises doubt about the value of other sorts of oscillatory stimulation used in EMDR, such as hand tapping.11 A further concern is the lack of a convincing rationale for expecting eye movements and hand tapping to reduce PTSD (Foa & Rothbaum, 1998). The effects of EMDR may be due largely to imaginal exposure during sessions, which in turn may facilitate naturally occurring in vivo exposure. Some evidence suggests that imaginal exposure plays an important role in EMDR (e.g.,Devilly, in press). The effects of naturalistic in vivo exposure could be assessed by comparing EMDR (as routinely used) with EMDR with antiexposure instructions (i.e., instructions to avoid all forms of in vivo exposure). The importance of naturalistic in vivo exposure would be revealed by the extent to which the efficacy of EMDR is undermined when such exposure is reduced." (p. 337)

Taylor, S., Thordarson, D.S., Maxfield, L., Fedoroff, I.C., Lovell, K., & Ogrodniczuk, J. (2003). Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training. Journal of Consulting and Clinical Psychology, 71, 330-338.

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