EMDR FORUM ARCHIVE, 2000
Re: differential mechanism
Ulrich Lanius · 10/31/01 at 1:09 ET
I appreciate your participation on this forum as well as your critical stance. The question of whether there is a differential mechanism or not is obviously crucial with regard to EMDR being a treatment that can be considered different from other forms of psychotherapy. One view is that it is just good therapy, amalgamating different effective ingredients of many different psychotherapies and sharing many aspects with exposure therapy. Exposure therapy in contrast to EMDR is well grounded in behaviour therapy, one of the major theoretical approaches within clinical psychology - albeit it should be pointed out that it remains a theory and an active mechanism has thus far not been identified. There are also some clear differences between EMDR and exposure, as well as other psychotherapies. The major one, apart from the controversial bilateral stimulation, is that EMDR includes a specific focus on somatic sensations and the body that does not exist in other psychotherapies. Further, in contrast to exposure therapy, there does not appear a dose dependant relationship between length of exposure and treatment effect. From a clinical point of view that is corroborated by my own experience with both exposure and EMDR treatment, the lack of effectiveness of exposure with multiple traumata, specifically Complex PTSD stands out. While EMDR treatment of Complex PTSD is difficult at best, often requiring lengthy treatment, positive outcomes nevertheless seem much more likely. Clearly, this impression needs to be supported by empirical findings. Further support for a potentially different mechanism comes from treatment response of phobias to EMDR. EMDR, in contrast to PTSD, where it is effective as a stand alone treatment, is not effective alone in phobias. This is taken into account by the so-called phobia protocol that requires the therapist to contract with the client to engage in a exposure exercise (though quite time-limited) once EMDR processing has been completed. This supports the notion that exposure and EMDR can be additive in effect but that they may have a differential underlying mechanism. I suspect that this difference is attributable to differential neurotransmitter release secondary anxiety and fear, as well as due to dissociation being a significant aspect of PTSD but not usually of phobias.
Replies:
| Behavior OnLine Home Page | Disclaimer |
Copyright © 1996-2004 Behavior OnLine, Inc. All rights reserved.
