Re: differential mechanism

Part 6: A few points on which we agree, but not entirely.

From our prior exchange:
(me) While it certainly may be true that other procedural variations may eventually come to be shown to make a significant difference, the burden of proof falls on those saying that these procedures actually make a difference, not on those of us who question whether they make a difference.

(you) EMDR is a fairly new procedure dating back to 1989,and the textbook being published in 1995. The first step was obviously to document its effectiveness. Whether the more controversial elements of the treatment such as the bilateral stimulation can be supported by empirical findings remains to be seen.

I completely agree with your statement that "[w]hether the more controversial elements of the treatment such as the bilateral stimulation can be supported by empirical findings remains to be seen." I attempted to make the further point that the burden of proof lies with proponents of EMDR to support their assertions and practices with data. For example, if a proponent of EMDR asserts that element X of the EMDR procedure (eye movements, installation trials, the cognitive interweave, mentally playing a video-tape of future encounters with a phobic object, physiology check, "blank it out," free association, etc.) contributes to outcome, then it is up to that proponent to demonstrate this.

The proponent of element X is not justified in assuming the efficacy of element X until proven otherwise. Quite to the contrary, the logic of experimentation is to assume the null hypothesis until it has been shown to be improbable. My objections are not that the research data are not yet in because, as you quite correctly note, EMDR is still relatively young as a procedure. Rather, my objection is with proponents of EMDR who make unsubstantiated claims and attempt to avoid accepting the burden of proving their assertions.

Case in point: Some EMDR proponents claim that EMDR works through mechanisms other than those involved in standard CBT. But where is the evidence? To date, the procedural elements of EMDR that have been investigated (eye movements, other laterally alternating stimuli, installation trials) have not been found to make a significant contribution to outcome. While some of these studies (perhaps all) are flawed, null results from flawed studies are not evidence that properly done studies would have produced different results. As I said before, future studies may indeed support their claims. But to date, I know of no research that supports these claims and no-one on this forum has provided such citations.

We seem to agree that it remains to be seen whether various procedural elements of EMDR actually contribute to outcome. Where we seem to differ is that you are willing to accept their efficacy until proven otherwise, while I am going to accept their efficacy only when it has been demonstrated. Unfortunately, it is impossible to prove that something doesn't work (i.e., you can't prove the null hypothesis). This is why the burden of proof lies with those who make the assertions.

Incidentally, you commented that the findings of the Cusack and Spates (1999) dismantling study of the installation trials is "totally consistent" with your clinical experience that "when traumatic memory processing is continued, the majority of clients will move into adpative [sic] material without cueing from the therapist." Given this, do you still routinely conduct installation trials? If so, why?

I totally concur with you that "The big question that remains is whether there are differences in the processing of traumatic memories between EMDR and exposure."

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