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Re: More on EMDR

Posted by Elizabeth on January 3, 2000, at 9:26:39

In reply to More on EMDR, posted by Morc on January 2, 2000, at 12:27:11

(This didn't go through the first time. Let's see if it works this time.)

Here are a couple of citations + abstracts (of clinical studies and reviews thereof, and responses to criticisms by EMDR advocates) that might interest you, in reverse chronological order. (Most of the full-text articles aren't available online, AFAIK.)

J Anxiety Disord 1999 Jan-Apr;13(1-2):209-23
Traumatic memories, eye movements, phobia, and panic: a critical note on the proliferation of EMDR.
Muris P, Merckelbach H
Department of Psychology, Maastricht University, The Netherlands.

In the past years, Eye Movement Desensitization and Reprocessing (EMDR) has become increasingly popular as a treatment method for Posttraumatic Stress Disorder (PTSD). The current article critically evaluates three recurring assumptions in EMDR literature: (a) the notion that traumatic memories are fixed and stable and that flashbacks are accurate reproductions of the traumatic incident; (b) the idea that eye movements, or other lateralized rhythmic behaviors have an inhibitory effect on emotional memories; and (c) the assumption that EMDR is not only effective in treating PTSD, but can also be successfully applied to other psychopathological conditions. There is little support for any of these three assumptions. Meanwhile, the expansion of the theoretical underpinnings of EMDR in the absence of a sound empirical basis casts doubts on the massive proliferation of this treatment method.

J Anxiety Disord 1999 Jan-Apr;13(1-2):185-207
Eye Movement Desensitization and Reprocessing: an analysis of specific versus nonspecific treatment factors.
Lohr JM, Lilienfeld SO, Tolin DF, Herbert JD
Department of Psychology, University of Arkansas, Fayetteville 72701, USA.

Incremental validity and incremental efficacy have become important issues in the evaluation of psychological assessment and intervention procedures. Incremental validity in assessment is that shown by novel measures over and above established ones. Incremental efficacy is that shown by novel treatments over and above nonspecific and established treatment effects. In this paper, we critically examine the question of whether Eye Movement Desensitization and Reprocessing (EMDR) possesses efficacy above and beyond nonspecific treatment effects and components that are shared with well-established interventions. A review of recently published efficacy studies reveals that (a) the effects of EMDR are largely limited to verbal report indices, (b) eye movements and other movements appear to be unnecessary, and (c) reported effects are consistent with nonspecific treatment features. Examination of individual studies shows that control procedures for nonspecific features have been minimal. We analyze EMDR for nonspecific treatment features and suggest experimental controls to examine the incremental efficacy of EMDR.

J Anxiety Disord 1999 Jan-Apr;13(1-2):173-84
Treatment fidelity and research on Eye Movement Desensitization and Reprocessing (EMDR).
Rosen GM

Eye Movement Desensitization and Reprocessing was introduced by Frances Shapiro (1989) as a treatment for posttraumatic stress disorder. When controlled studies failed to support the extraordinarily positive findings and claims made by Shapiro, proponents of EMDR raised the issue of treatment fidelity and criticized researchers for being inadequately trained. This paper considers the issues raised by EMDR proponents. It is concluded that treatment fidelity has been used as a specious, distracting issue that permits the continued promotion of EMDR in the face of negative empirical findings. Clinical psychologists are urged to remember the basic tenets of science when evaluating extraordinary claims made for novel techniques.

J Anxiety Disord 1999 Jan-Apr;13(1-2):131-57
The relative efficacy and treatment distress of EMDR and a cognitive-behavior trauma treatment protocol in the amelioration of posttraumatic stress disorder.
Devilly GJ, Spence SH
Department of Psychology, University of Queensland, Australia.

The growing body of research into treatment efficacy with Posttraumatic Stress Disorder (PTSD) has, by-and-large, been limited to evaluating treatment components or comparing a specific treatment against wait-list controls. This has led to two forms of treatment, Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive-Behavior Therapy (CBT), vying for supremacy without a controlled study actually comparing them. The present research compared EMDR and a CBT variant (Trauma Treatment Protocol; TTP) in the treatment of PTSD, via a controlled clinical study using therapists trained in both procedures. It was found that TTP was both statistically and clinically more effective in reducing pathology related to PTSD and that this superiority was maintained and, in fact, became more evident by 3-month follow-up. These results are discussed in terms of past research. Directions for future research are suggested.

J Anxiety Disord 1999 Jan-Apr;13(1-2):101-18
The contributions of eye movements to the efficacy of brief exposure treatment for reducing fear of public speaking.
Carrigan MH, Levis DJ
State University of New York at Binghamton, USA.

The present study was designed to isolate the effects of the eye-movement component of the Eye Movement Desensitization and Reprocessing (EMDR) procedure in the treatment of fear of public speaking. Seventy-one undergraduate psychology students who responded in a fearful manner on the Fear Survey Schedule II and on a standardized, self-report measure of public speaking anxiety (Personal Report of Confidence as a Speaker; PRCS) were randomly assigned to one of four groups in a 2x2 factorial design. The two independent variables assessed were treatment condition (imagery plus eye movements vs. imagery alone) and type of imagery (fear-relevant vs. relaxing). Dependent variables assessed were self-reported and physiological anxiety during exposure and behavioral indices of anxiety while giving a speech. Although process measures indicated exposure to fear-relevant imagery increased anxiety during the procedure, no significant differences among groups were found on any of the outcome measures, except that participants who received eye movements were less likely to give a speech posttreatment than participants who did not receive eye movements. Addition of the eye movements to the experimental procedure did not result in enhancement of fear reduction. It was concluded, consistent with the results of past research, that previously reported positive effects of the EMDR procedure may be largely due to exposure to conditioned stimuli.

J Anxiety Disord 1999 Jan-Apr;13(1-2):87-99
The cognitive dismantling of Eye Movement Desensitization and Reprocessing (EMDR) treatment of Posttraumatic Stress Disorder (PTSD).
Cusack K, Spates CR
Western Michigan University, Kalamazoo, Michigan 49008, USA.

Twenty-seven subjects were exposed to standard Eye Movement Desensitization and Reprocessing (EMDR) treatment or a similar treatment without the explicit cognitive elements found in EMDR. Standardized psychometric assessments were administered (Structured Interview for Post Traumatic Stress Disorder, Impact of Event Scale, Revised Symptom Checklist-90) by independent assessors at pretest, posttest and two separate follow-up periods. Potential subjects met specific inclusion/exclusion criteria. Subjective measures including Subjective Units of Disturbance and Validity of Cognition assessments were also conducted. A two-factor repeated measures analysis of variance revealed that both treatments produced significant symptom reductions and were comparable on all dependent measures across assessment phases. The present findings are discussed in light of previous dismantling research that converges to suggest that several elements in the EMDR protocol may be superfluous in terms of the contribution to treatment outcome. These same elements have nevertheless entered unparsimoniously into consideration as possible explanatory variables.

J Anxiety Disord 1999 Jan-Apr;13(1-2):5-33
Does EMDR work? And if so, why?: a critical review of controlled outcome and dismantling research.
Cahill SP, Carrigan MH, Frueh BC
National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston 29425-0742, USA.

Research on Eye Movement Desensitization and Reprocessing therapy (EMDR) was reviewed to answer the questions "Does EMDR work?" and "If so, Why?" This first question was further subdivided on the basis of the control group: (a) no-treatment (or wait list control), (b) nonvalidated treatments, and (c) other validated treatments. The evidence supports the following general conclusions: First, EMDR appears to be effective in reducing at least some indices of distress relative to no-treatment in a number of anxiety conditions, including posttraumatic stress disorder, panic disorder, and public-speaking anxiety. Second, EMDR appears at least as effective or more effective than several nonvalidated treatments (e.g., relaxation, active listening) for posttraumatic stress reactions. Third, despite statements implying the contrary, no previously published study has directly compared EMDR with an independently validated treatment for posttraumatic stress disorder (e.g., therapist-directed flooding). In the treatment of simple phobia, participant modeling has been found to be more effective than EMDR. Fourth, our review of dismantling studies reveals there is no convincing evidence that eye movements significantly contribute to treatment outcome. Recommendations regarding further research directions are provided.

J Consult Clin Psychol 1998 Feb;66(1):193-8
Treating phobic children: effects of EMDR versus exposure.
Muris P, Merckelbach H, Holdrinet I, Sijsenaar M
Department of Psychology, Universiteit Maastricht, The Netherlands.

This study examined the efficacy of eye movement desensitization and reprocessing (EMDR) and exposure in the treatment of a specific phobia. Twenty-six spider phobic children were treated during 2 treatment phases. During the first phase, which lasted 2.5 hr, children were randomly assigned to either (a) an EMDR group (n = 9), (b) an exposure in vivo group (n = 9), or (c) a computerized exposure (control) group (n = 8). During the 2nd phase, all groups received a 1.5-hr session of exposure in vivo. Therapy outcome measures (i.e., self-reported fear and behavioral avoidance) were obtained before treatment, after Treatment Phase 1, and after Treatment Phase 2. Results showed that the 2.5-hr exposure in vivo session produced significant improvement on all outcome measures. In contrast, EMDR yielded a significant improvement on only self-reported spider fear. Computerized exposure produced nonsignificant improvement. Furthermore, no evidence was found to suggest that EMDR potentiates the efficacy of a subsequent exposure in vivo treatment. Exposure in vivo remains the treatment of choice for childhood spider phobia.

Int J Eat Disord 1998 Jan;23(1):1-5
Eye movement desensitization and reprocessing in eating disorders: caution against premature acceptance.
Hudson JI, Chase EA, Pope HG Jr
Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts 02178, USA.

OBJECTIVE: Eye movement desensitization and reprocessing (EMDR) has been claimed effective in the treatment of a wide variety of psychiatric disorders, including eating disorders. An informal survey suggests that EMDR is now widely offered to patients with eating disorders. Before accepting a new therapy such as EMDR, one must determine that its benefits outweigh its adverse effects. This paper reviews the literature in an attempt to assess the benefits and risks of the use of EMDR in the treatment of eating disorders. METHOD: We reviewed the literature on the use of EMDR to treat eating disorders and other conditions. RESULTS: Looking at the question of its benefits, we were unable to find any methodologically sound studies that have shown efficacy for EMDR in eating disorders, or, indeed, any psychiatric disorder. We were also unable to find a sound theoretical basis for expecting EMDR to be effective. In addition, EMDR may have adverse effects. First, EMDR is sometimes used in conjunction with efforts to "recover" memories of traumatic events. But "recovered memory" therapy may carry a risk of inducing potentially harmful false memories. Second, use of EMDR may prevent or delay other therapies of established efficacy for eating disorders, such as cognitive behavioral therapy and antidepressants. DISCUSSION: In light of the findings of our review, the risk/benefit ratio of EMDR does not as yet encourage its widespread acceptance.

J Consult Clin Psychol 1997 Dec;65(6):1026-35
Eye movement desensitization and reprocessing treatment for panic disorder: a controlled outcome and partial dismantling study.
Feske U, Goldstein AJ
Agoraphobia and Anxiety Treatment Center, Bala Cynwyd, Pennsylvania, USA.

Forty-three outpatients with DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders, 3rd Ed., revised; American Psychiatric Association, 1987) panic disorder were randomly assigned to receive 6 sessions of eye movement desensitization and reprocessing (EMDR), the same treatment but omitting the eye movement, or to a waiting list. Posttest comparisons showed EMDR to be more effective in alleviating panic and panic-related symptoms than the waiting-list procedure. Compared with the same treatment without the eye movement, EMDR led to greater improvement on 2 of 5 primary outcome measures at posttest. However, EMDR's advantages had dissipated 3 months after treatment, thereby failing to firmly support the usefulness of the eye movement component in EMDR treatment for panic disorder.

Br J Psychiatry 1997 Jul;171:82-6
Eye movement desensitisation and reprocessing versus exposure in vivo. A single-session crossover study of spider-phobic children.
Muris P, Merckelbach H, Van Haaften H, Mayer B
Department of Psychology, University of Maastricht, The Netherlands.

BACKGROUND: Eye movement desensitisation and reprocessing (EMDR) is a relatively new therapeutic technique that has been proposed as a treatment for post-traumatic stress disorder and other anxiety complaints. METHOD: We compared the efficacy of EMDR with that of exposure in vivo in the treatment of a specific phobia. Twenty-two spider-phobic children who met the DSM-III-R criteria for specific phobia participated in the study. Children were treated with one session of exposure in vivo and one session of EMDR in a crossover design. Treatment outcome was evaluated by self-report measures, a behavioural avoidance test and a physiological index (skin conductance level). RESULTS: Results showed positive effects of EMDR, but also suggest that it is especially self-report measures that are sensitive to EMDR. Improvement on a behavioural measure was less pronounced, and exposure in vivo was found to be superior in reducing avoidance behaviour. With regard to skin conductance level, EMDR and exposure in vivo did not differ. CONCLUSIONS: EMDR has no additional value in treatment of this type of animal phobia, for which exposure in vivo is the treatment of choice.

Compr Psychiatry 1997 Sep-Oct;38(5):300-3
Flooding versus eye movement desensitization and reprocessing therapy: relative efficacy has yet to be investigated--comment on Pitman et al (1996).
Cahill SP, Frueh BC
State University of New York, Binghamton, USA.

Pitman et al. recently published a pair of studies on the relationship between indicators of emotional processing and outcome in flooding therapy (Compr Psychiatry 1996;37:409-416) and eye movement desensitization and reprocessing therapy (EMDR; Compr Psychiatry 1996;37:419-429). Among their conclusions, they asserted EMDR was found to be at least as effective flooding in the treatment of combat-related posttraumatic stress disorder (PTSD) and produced fewer adverse consequences. Although this research constitutes an important contribution to the literature on psychosocial treatments for PTSD, their conclusions regarding the relative effectiveness of these two treatments are unwarranted. The bases of our objections are that (1) assignment of participants to treatment conditions was nonrandom, and (2) several significant procedural differences existed between the two studies in addition to the specific treatments under investigation. These include different inclusion and exclusion criteria, the confounding of psychological treatment with psychiatric medication status, and differences in assessment procedures. Since the two treatments were not compared in a single head-to-head controlled trial, we conclude that their relative efficacy has yet to be investigated.

J Behav Ther Exp Psychiatry 1996 Sep;27(3):231-9
Measuring effectiveness of eye movement desensitization and reprocessing (EMDR) in non-clinical anxiety: a multi-subject, yoked-control design.
Dunn TM, Schwartz M, Hatfield RW, Wiegele M
Department of Psychology, University of Cincinnati, OH 45221-0376, USA.

Twenty-eight subjects from a university's subject pool were paired on sex, age, severity, and type of stressful or traumatic incident. One subject in each pair was selected to receive EMDR; the experimental partner spent the same amount of time receiving a visual (non-movement) placebo. Subjective units of discomfort (SUD) scores and physiological measurements were taken prior to and following treatment. Analysis of physiological measurements and self-reported levels of stress were performed within and between each group. While the EMDR group showed significant reductions of stress, EMDR was no better than a placebo. This suggests EMDR's specific intervention involving eye movement may not be a necessary component of the treatment protocol.

J Behav Ther Exp Psychiatry 1995 Dec;26(4):285-302
The empirical status of the clinical application of eye movement desensitization and reprocessing.
Lohr JM, Kleinknecht RA, Tolin DF, Barrett RH
Department of Psychology, University of Arkansas, Fayetteville 72701, USA.

The published reports of the clinical application of eye movement desensitization and reprocessing (EMDR) are reviewed in terms of empirical validity. Case studies, single-subject experiments and group design experiments on clinical problems are evaluated for the effectiveness of the protocol, component effects, comparative effects and treatment fidelity. Classification of disorders and measurement issues are addressed. The protocol frequently reduces verbal report and independent observer ratings of distress--strikingly in some instances. Psychophysiologic measures show little effect of treatment. There is little empirical evidence to indicate the effect of treatment on motoric or behavioral indices. Eye movements do not appear to be an essential component of treatment, and there have been no substantial comparisons with other treatments. No studies have adequately controlled for nonspecific (placebo) effects of treatment. Suggestions are made for applying improved methodological controls for future applications of EMDR to clinical disorders.




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