Re:Possible suggestions for loss of treatment gains over time with EMDR

First of all, I have not seen the new Devilly article which has been abstracted here. However, I am not aware of a "trend" for EMDR gains to deteriorate. The most significant study demonstrating this "trend" was the Devilly and Spence (1999) study in which (as I recall, anyway) they had a 35% dropout rate in the EMDR condition *before* EMDR treatment started! This does raise questions about "participant demand effects, researcher allegiance, and the biasing effects of experimenter expectation."

Other EMDR studies with which I am familiar demonstrate either maintenance of gains for EMDR or further gains at follow-up. Exceptions might be studies of multiply traumatized individuals in which only treatment focused on a single trauma memory was provided. In such a case, treatment benefit should not even be measured at all, except in relation to the specific memories targeted.

Here is a summary of recent research on EMDR:

The recent International Society for Traumatic Stress Studies' Treatment Guidelines review found EMDR to be an empirically supported efficacious trauma treatment (Chemtob, Tolin, van der Kolk, & Pitman, 2000), with the reservation that it had not yet been directly compared to other validated focused PTSD treatments such as prolonged exposure.

Since then, several studies (not published at the time of the Chemtob et al review) meeting most of Foa & Meadows' (1997) "gold standard" criteria have compared EMDR to validated CBT treatments for PTSD. Findings across studies indicate that both treatments were highly efficacious (Ironson, Freund, Strauss, & Williams, in press; Lee, Gavriel, Drummond, Richards, & Greenwald, in press; McFarlane, 2000; Power, McGoldrick, & Brown, 2000). These studies also found that EMDR was more efficient, in that the therapeutic effect was achieved without the extensive homework required in traditional exposure treatment. Three of the studies (Ironson et al; McFarlane; Powell et al) found that the therapeutic effect appeared to occur in fewer sessions for EMDR, and one study also found that the level of distress both during and between sessions was lower for EMDR (Ironson et al).

Chemtob, C. M., Tolin, D. F., van der Kolk, B. A., & Pitman, R. K. (2000). Eye movement desensitization and reprocessing. In E. B. Foa, T. M. Keane, & M. J. Friedman (Eds.), Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies (pp. 139-154). New York: Guilford.
Devilly, G.J. and Spence, S.H. (1999). The relative efficacy and treatment distress of EMDR and a cognitive behaviour trauma treatment protocol in the amelioration of Post traumatic Stress Disorder. Journal of Anxiety Disorders, 13 (1-2), 131-157.
Foa, E. B. & Meadows, E. A. (1997). Psychosocial treatments for posttraumatic stress disorder: A critical review. Annual Review of Psychology, 48, 449-480.
Ironson, G. I., Freund, B., Strauss, J. L., & Williams, J. (in press). A comparison of two treatments for traumatic stress: A pilot study of EMDR and prolonged exposure. Journal of Clinical Psychology.
Lee, C., Gavriel, H., Drummond, P., Richards, J., & Greenwald, R. (in press). Treatment of PTSD: Stress Inoculation Training with Prolonged Exposure compared to EMDR. Journal of Clinical Psychology.
McFarlane, A. (2000, November). Comparison of EMDR and CBT for PTSD. In B. van der Kolk (chair), Current research on EMDR. Symposium presented at the annual meeting of the International Society of Traumatic Stress Studies, San Antonio.
Power, K., McGoldrick, T., & Brown, K. (2000, September). A controlled comparison of eye movement desensitization and reprocessing vs. exposure plus cognitive restructuring vs. waiting list in the treatment of post-traumatic stress disorder. Poster session presented at the annual meeting of the EMDR International Association, Toronto.

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Re:Possible suggestions for loss of treatment gains over time with EMDR, by Sandra Paulsen Inobe, PhD, 01/29/01

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