Re:cooler web site: eyes don't have it

From: Health Psych Maine, at the Seton Unit of Maine General Medical Center, Waterville, Maine, Jeff Matranga, Ph.D., ABPP | Jonathan M. Borkum, Ph.D. | Laura E. Holcomb, Ph.D. | David Lilly, Psy.D. (207) 872-4100, http://www.hpmaine.com/emdr.htm

Eye Movement Desensitization & Reprocessing (EMDR)

There is a treatment called eye movement desensitization and reprocessing (EMDR) that has gained some popularity in recent years. Although Dr. Matranga was one of the first professionals to be trained in EMDR in Maine, we do not use EMDR due to the lack of success in comparison to the more established desensitization methods noted on other web pages on this site. In the studies of EMDR that have been well controlled, EMDR has either turned out to be no more effective than placebo or no more effective than relaxation training, which is only step one of a full treatment plan. The major implication is that the individual patient who is treated only with EMDR is less likely to get back to normal levels of functioning and is less likely to have a significant decrease in symptoms.

The interested reader is referred to an excellent and recent article by Taylor et al. published in the April, 2003 issue of Journal of Consulting and Clinical Psychology (JCCP). In a randomized, blinded study, the investigators compared three treatments for Posttraumatic Stress Disorder (PTSD): relaxation training, EMDR, and exposure/desensitization. This study met the gold standards for therapy outcome research established by Foa & Meadows (1997). When the investigators assessed various PTSD symptoms at 3-month follow-up, the percentage of individuals who had clinically significant reductions (> 2 standard deviations) in various symptoms were as follows:

3-month Follow-up % of people experiencing significant reduction in symptoms:

Reexperiencing symptoms
Relaxation training: 33
EMDR: 27
Exposure/desensitization: 73

Avoidance symptoms
Relaxation training: 27
EMDR: 27
Exposure/desensitization: 67

Hyperarousal symptoms
Relaxation training: 26
EMDR: 20
Exposure/desensitization: 47

In another study looking at EMDR with Panic Disorder with Agoraphobia, the investigators found that EMDR was no more effective than a credible attention-placebo control condition. The authors concluded that “…EMDR should not be the first-line treatment for this disorder” (Goldstein, de Beurs, Chambless, & Wilson, 2000, p. 947). In contrast, there are other treatments for Panic Disorder with excellent outcome as documented in several well-controlled studies (see panic outcome data on panic disorder page).

In the April, 2001, issue of Journal of Consulting and Clinical Psychology, a meta-analysis on EMDR was published (Davidson & Parker, 2001). Meta-analysis is a way of combining the numerical results from a number of studies. Here is the abstract from that article (reprinted here with permission from the American Psychological Association):

“Eye movement desensitization and reprocessing (EMDR), a controversial treatment suggested for posttraumatic stress disorder (PTSD) and other conditions, was evaluated in a meta-analysis of 34 studies that examined EMDR with a variety of populations and measures. Process and outcome measures were examined separately, and EMDR showed an effect on both when compared with no treatment and with therapies not using exposure to anxiety-provoking stimuli and in pre-post EMDR comparisons. However, no significant effect was found when EMDR was compared with other exposure techniques. No incremental effect of eye movements was noted when EMDR was compared with the same procedure without them. R. J. DeRubeis and P. Crits-Christoph (1998) noted that EMDR is a potentially effective treatment for noncombat PTSD, but studies that examined such patient groups did not give clear support to this. In sum, EMDR appears to be no more effective than other exposure techniques, and evidence suggests that the eye movements integral to the treatment, and to its name, are unnecessary.”

EMDR References
Davidson, P.R., & Parker, K.C.H. (2001). Eye movement desensitization and reprocessing (EMDR): A meta-analysis. Journal of Consulting and Clinical Psychology, 69, 305-316.
DeBell, C., & Jones, R.D. (1997). As good as it seems? A review of EMDR Experimental Research. Professional Psychology: Research and Practice, 28, 153-163.
Feske, U. & Goldstein, A.J. (1997). Eye movement desensitization and reprocessing treatment for panic disorder: A controlled outcome and partial dismantling study. Journal of Consulting and Clinical Psychology, 65, 1026-1035.
Goldstein, A.J., de Beurs, E., Chambless,D.E. & Wilson, K.A. (2000). EMDR for panic disorder with agoraphobia: Comparison with waiting list and credible attention-placebo control conditions. Journal of Consulting and Clinical Psychology, 68, 947-956.
Herbert, James D.; Lilienfeld, Scott O.; Lohr, Jeffrey M.; Montgomery, Robert W.; O'Donohue, William T.; Rosen, Gerald M.; Tolin, David F. (2000). Science and pseudoscience in the development of eye movement desensitization and reprocessing: Implications for clinical psychology. Clinical Psychology Review, 20, 945-971.
Lohr, J.M., Tolin, D.F., & Lilienfeld, S.O. (1998). Efficacy of eye movement desensitization and reprocessing: Implications for behavior therapy. Behavior Therapy, 29, 123-156.
Muris, P., Merckelbach, H., Holdrinet, I. , & Sijsenaar, M. (1998). Treating phobic children: Effects of EMDR versus exposure. Journal of Consulting and Clinical Psychology, 66, 193-198.
Taylor, S., Thordarson, D.S., Maxfield, L., Fedoroff, I.C., Lovell, K., & Ogrodniczuk, J. (2003). Comparitive efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training. Journal of Consulting and Clinical Psychology, 71, 330-338.
Wilson , S.A. , Becker, L.A. , & Tinker, R. H. (1997). Fifteen-month follow-up of Eye Movement Desensitization and Reprocessing (EMDR) treatment for posttraumatic stress disorder and psychological trauma. Journal of Consulting and Clinical Psychology, 65, 1047-1056.

Replies:

Re:cooler web site: eyes don't have it, by Diane, 12/13/03 Re:cooler web site: eyes don't have it, by Reality, 12/13/03 Incomplete citations , by Sandra Paulsen PhD, 12/14/03 On Eye Movements -- A More Even Handed Review, by Sandra Paulsen PhD, 12/14/03

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