Re: differential mechanism

Part 2 of my reaction to your comments.

Regarding your further comments on the role of somatic sensations, I think we agree with one another more than we disagree. Your original statement was "... EMDR includes a specific focus on somatic sensations and the body that does not exist in other psychotherapies." I attempted to make three points about the statement. (a) I noted that CBT does include a focus on body sensations and I provided two examples of that. (b) I acknowledged that the "manner in which somatic sensations are addressed in EMDR may be somewhat unique [from how it is applied in CBT]." (c) There is no evidence at present to support the hypothesis that the somatic focus in EMDR and the way in which it is implemented makes any difference.

Your reply that there "is a crucial difference in EMDR that those somatic sensations are not necessarily attributed to emotional responding, as is often the case in CBT" seems to agree with my points a and b above: CBT does incorporate a focus on sensations (at least sometimes), but does so in a different manner. Further, I believe it would be accurate to say that CBT therapists focus on sensations for different theoretical reasons and with different theoretical goals than EMDR therapists. In CBT for panic disorder, we intentionally induce panic-related sensations in order to help habituate or extinguish the "fear of fear" and to provide them an experiential basis for learning that panic symptoms are not harmful and will inevitably stop.

I'm not entirely sure of the rationale for the "physiology check" in EMDR, but it certainly is procedurally different from interoceptive exposure. All that said, however, the fact remains that there is no evidence that focus on sensations in EMDR makes any difference in terms of treatment outcome. In the case of CBT for panic disorder, there is some evidence that interoceptive exposure makes a unique contribution to outcome, but that evidence is still far from overwhelming at this time. Until it can be shown that the focus on physical sensations in EMDR makes a difference, I would suggest it is premature to call this a "crucial difference."

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