Cognitive-Behavioral Therapy and EMDR Research

Are cognitive-behavioral therapists aware that EMDR integrates aspects of these orientations into its protocols along with other psychological orientations? Are they aware that there is more controlled research on EMDR with trauma victims than any other method?

To date, in addition to the original pilot research (Shapiro, 1989), twelve controlled studies of EMDR using PTSD-diagnosed subjects have been completed, making EMDR the most intensively investigated treatment of trauma of any psychotherapeutic method. Two of these studies (Boudewyns, Stwertka, Hyer, Albrecht, & Sperr, 1993; Pitman, Orr, Altman, Longpre, Poire, & Macklin, 1996) reported mixed results, one (Jensen, 1994) obtained null results, five (Boudewyns & Hyer, 1996; Carlson, Chemtob, Rusnak, Hedlund, & Muraoka, in press; Marcus, Marquis & Sakai, 1996; Scheck, Schaeffer & Gillette, in press; Vaughan, Armstrong, Gold, O'Connor, Jenneke, & Tarrier, 1994) demonstrated a superiority of EMDR over one or more alternative treatments, and, finally, two (Rothbaum, in press; Wilson, Becker & Tinker, 1995 and in press) found EMDR to be more effective than a wait-list control. In addition, two controlled component analyses (Renfrey & Spates, 1994; Wilson, Silver, Covi, & Foster, 1996) reported substantial alleviation of PTSD symptomatology. In contrast to the thirteen studies cited above, there are only seven published non-EMDR controlled studies of PTSD-diagnosed subjects since this diagnosis was codified in 1980 (APA, DSM-III), excluding studies involving medication and machine-assisted biofeedback (Shapiro, 1996, 1997; Solomon, Gerrity & Muff, 1992).

Research on single-trauma victims illustrates this point. There are four recent controlled studies of EMDR with single-trauma subjects in which a total of 107 EMDR/PTSD subjects were evaluated at posttest (Marcus et al., 1996; Rothbaum, in press; Scheck et al., in press; Wilson et al., 1995 and in press). In contrast, there is only one peer-reviewed published controlled study of flooding, or stress inoculation therapy, which entailed 10 single-trauma victims in each condition evaluated at posttest (Foa, Olasov Rothbaum, Riggs, Murdock, 1991). The only other published controlled study of exposure with single-trauma victims evaluated a combination of imaginal and in vivo exposure with 14 patients at posttest (Richards, Lovell & Marks, 1994).

To repeat: EMDR is the most intensively researched, by controlled studies, of any psychotherapeutic method for the treatment of trauma. Further, the outcomes of these studies cast serious doubt on exposure (and the standard habituation/extinction model) as the sole mechanism for EMDR effects. Specifically, the two exposure studies cited above found that 55-80% of the subjects were no longer diagnosed as having PTSD at posttest after approximately 25-50 hours of exposure (7-8 treatment sessions and daily homework). In contrast, the independent studies of EMDR indicated that, at posttest, 84-90% no longer retained the diagnosis after the equivalent of three 90-minute sessions (and no homework; see Shapiro & Forrest, 1997 for transcripts of EMDR treatment sessions).

Much misinformation has abounded in the cognitive-behavioral community regarding EMDR. This would be an excellent place to explore the substantive issues.

References

Boudewyns, P.A. & Hyer, L.A. (1996) Eye movement desensitization and reprocessing (EMDR) as treatment for post-traumatic stress disorder (PTSD). Clinical Psychology and Psychotherapy, 3, 185-195.

Boudewyns, P.A., Stwertka, S.A., Hyer, L.A., Albrecht, J.W. & Sperr, E.V. (1993). Eye movement desensitization and reprocessing: A pilot study. Behavior Therapist, 16, 30-33.

Carlson, J.G., Chemtob, C.M., Rusnak, K., Hedlund, N.L., & Muraoka, M.Y. (in press). Eye movement desensitization and reprocessing for combat-related posttraumatic stress disorder. Journal of Traumatic Stress.

Foa, E.B. Olasov Rothbaum, B., Riggs, D.S. & Murdock, (1991). Treatment of posttraumatic stress disorder in rape victims: a comparison between cognitive behavioral procedures and counseling. Journal of Consulting and Clinical Psychology, 59, 715-723.

Jensen, J. A. (1994). An investigation of eye movement desensitization and reprocessing (EMD/R) as a treatment for posttraumatic stress disorder (PTSD) symptoms of Vietnam combat veterans. Behavior Therapy, 25, 311-326.

Marcus, S. , Marquis, P. & Sakai, C. (1996, August) Eye movement desensitization and reprocessing: A clinical outcome study for post-traumatic stress disorder. Paper presented at the American Psychological Association annual convention, Toronto, Canada.

Pitman, R.K., Orr, S.P., Altman, B., Longpre, R.E., Poire, R.E & Macklin, M.L., (1996). Emotional processing during eye-movement desensitization and reprocessing therapy of Vietnam veterans with chronic post-traumatic stress disorder. Comprehensive Psychiatry, 37, 419-429.

Rothbaum, B.O. (in press). A controlled study of eye movement desensitization and reprocessing for posttraumatic stress disordered sexual assault victims. Bulletin of the Menninger Clinic.

Scheck, M.M., Schaeffer, J.A. & Gillette, C.S. (in press) Brief psychological intervention with traumatized young women: The efficay of eye movement desensitization and reprocessing. Journal of Traumatic Stress

Shapiro, F. (1989). Efficacy of the eye movement desensitization procedure in the treatment of traumatic memories. Journal of Traumatic Stress Studies, 2, 199-223.

Shapiro, F. (1995). Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures. New York: Guilford Press.

Shapiro, F. (1996). Eye movement desensitization and reprocessing (EMDR): Evaluation of controlled PTSD research. Journal of Behavior Therapy and Experimental Psychiatry, 27, 209-218.

Shapiro, F. (1997). Eye movement desensitization and reprocessing (EMDR): Research and clinical significance. In Phillip Gosselin and William Matthews (Eds.) Current thinking and research in brief therapy: Solutions, strategies, narratives. New York: Brunner Mazel.

Shapiro, F. & Forrest, M. (1997) EMDR New York: BasicBooks.

Solomon, S.D., Gerrity, E.T., & Muff, A.M. (1992). Efficacy of treatments for posttraumatic stress disorder. JAMA, 268, 633-638

Vaughan, K., Armstrong, M.F., Gold, R., O'Connor, N., Jenneke, W., & Tarrier, N. (1994). A trial of eye movement desensitization compared to image habituation training and applied muscle relaxation in post-traumatic stress disorder. Journal of Behavior Therapy & Experimental Psychiatry, 25, 283-291.

Wilson, D., Silver, S.M, Covi, W., & Foster, S. (1996). Eye movement desensitization and reprocessing: Effectiveness and autonomic correlates. Journal of Behavior Therapy and Experimental Psychiatry, 27 , 219-229.

Wilson, S.A., Becker, L.A., & Tinker, R.H. (1995). Eye movement desensitization and reprocessing (EMDR) treatment for psychologically traumatized individuals. Journal of Consulting and Clinical Psychology,63, 928-937

Wilson, S.A., Becker, L.A., & Tinker, R.H. (in press). Fifteen-month follow-up of eye movement desensitization and reprocessing (EMDR) treatment for PTSD and psychological trauma. Journal of Consulting and Clinical Psychology.

• Cognitive-BehavioralTherapy to EMDR-An Easy Transition by Laura A. Campbell, BCSW, 8/4/97
  • Using Beliefs to Identify Targets by Francine Shapiro, 8/4/97
    • Publication of New Controlled Study by Francine Shapiro, 8/12/97
• Are EMDR treatment effects solely based upon exposure? by Francine Shapiro, 8/21/97
• Meta-analyis by C-B researchers by Marshall Wilensky, 10/10/97
  • The finished Meta-analysis was reported one month ago by Francine Shapiro, 10/10/97