EMDR FORUM ARCHIVE, 2000
Re:EMDR for anxiety and phobias
E.C. · 10/03/01 at 11:50 PM ET
The literature review you have cited is incomplete. I suggest that you read three articles on the use of EMDR in the treatment of phobias: De Jongh, A., & Ten Broeke, E. (1998). Treatment of choking phobia by targeting traumatic memories with EMDR: A case study. Clinical Psychology and Psychotherapy, 5, 1–6. De Jongh, A., Ten Broeke, E., & Renssen, M. R. (1999). Treatment of specific phobias with eye movement desensitization and reprocessing (EMDR): Protocol, empirical status, and conceptual issues. Journal of Anxiety Disorders, 13, 69–85. The Shapiro article describes the results of a blind analysis of all phobia research. It was discovered that all those that used the full EMDR protocol achieved successful results. The researchers you listed used incomplete protocols and achieved marginal effects. There were other researchers who purported to use EMDR but used none of the established protocols and found no effects. The last article you mentioned actually tested "EMD" and used none of the phobia protocol, hence, not effect. Alternatively, see the following article for a successful treatment of test anxiety with a similar population. Maxfield, L., & Melnyk, W. T. (2000). Single session treatment of test anxiety with eye movement desensitization and reprocessing (EMDR). International Journal of Stress Management, 7, 87–101. Component analysis of complex clinical procedures should not be done with non-diagnosed populations as omitting only one component will not eliminate all treatment effects. EMDR contains components of psychodynamic, behavioral, experiential, cognitive, and body oriented therapies in a combination unique to EMDR. That is: Anyone viewing an EMDR session could not mistake it for anything else. Whether or not eye movements or any other form of stimulation is used there will be powerful treatment effects. That does not mean that the stimulation component is irrelevant. It means that component analyses must be done according to the most rigorous scientific and clinical principles. For a complete description of appropriate parameters you can see Shapiro's text. Both the 1995 and the 2001 editions contain the same parameters--yet to be followed by any controlled study. Regarding your contention that EMDR sans eye movements is the same other procedures, please note the statement in the practice guidelines of the International Society for Traumatic Stress Studies: ". . .the finding that a procedure employing multiple, brief, interrupted exposures to traumatic material can be efficacious, calls for a reexamination of traditional theoretical notions that prolonged, continuous exposure is required (Eysenck, 1979). Further investigations of such issues promises to deepen our understanding of trauma treatment mechanisms. Additional properly designed dismantling studies also need to be conducted in order to identify what components of EMDR are beneficial. Ideally, such studies should be conducted with patients who are likely to be responsive to treatment (e.g., single trauma, more acute), because it is difficult to compare differences in induced changes in minimally responsive patients" (Chemtob et al., 2000, p. 151-2). Clearly, EMDR is not the same as standard exposure procedures. Hopefully, future investigations will be performed rigorously. To clients it should be noted that a relatively short number of EMDR sessions will reveal whether it is appropriate for you.
Shapiro, F. (1999) Eye movement desensitization and reprocessing (EMDR) and the anxiety disorders: Clinical and research implications of an integrated psychotherapy treatment. Journal of Anxiety Disorders, 13, 35–67.
In the first two articles you will find a description of the use of EMDR with phobias the way it should be conducted. In both cases the treatment was successful. The authors, experts on the use of EMDR and cognitive behavior treatments, make it clear that while in vivo exposure may be a treatment of choice with spider phobics, these results do not translate well into the clinical practice of more common phobias. They also point out that no research has validated any form of therapy with more complex clinical phobias. However, they have found EMDR to be successful.
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