Re: differential mechanism

Part 3.

With regard to the treatment of Complex PTSD/DESNOS, we appear to agree on at least one thing, that at present there is basis for asserting that any treatment has been empirically validated for treating this symptom constellation. Further, we appear to agree that the solution to this problem is further research.

The only place where we perhaps diverge is with regard to how much weight to place on your clinical impressions that (a) EMDR slowly but gradually works with these folks, and that (b) EMDR is better tolerated than exposure. I'm certain that I could find exposure therapy proponents who would say that, in their clinical experience, a slow but gradual process of exposure can also be helpful with such cases. But the scientific validity of a treatment approach for a particular problem will not be resolved by appealing to the experience of a particular individual.

Allow me to illustrate. Research shows that cognitive therapy, stress management, and exposure therapy are all effective in helping to alleviate PTSD. However, in MY clinical experience, exposure therapy is far superior. This does not mean that I think the research data are wrong. Rather, it more likely reflects the facts that I've had more training and experience in exposure therapy than I have had in stress management and cognitive therapy.

Simply put, I'm a much better exposure therapist than I am a stress management or cognitive therapist. But it is much more likely that these limitations are on me as a therapist, not on stress management or cognitive therapy as treatments for PTSD. Until there are adequate research data to address the issue, we should remain open to the possibility that you are more effective in treating Complex PTSD cases with EMDR because you are better at doing EMDR than you are at doing exposure therapy, not because EMDR is superior to exposure therapy. Another therapist may be in the reverse situation, and a third therapist may be better at cognitive therapy than either EMDR or exposure. Appeals to clinical experience under these circumstances will resolve nothing.

Replies:

Re: differential mechanism, by Shawn Cahill, 11/02/01

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