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Re: More on EMDR - What is the evidence

Posted by Christopher Lee on February 10, 2000, at 5:06:25

In reply to Re: More on EMDR - the full story, posted by Ricky Greenwald on February 10, 2000, at 1:05:44

> I don't have the time or interest to post every study in which EMDR looks good; there are many. However, here are a few review articles, along with my own synopsis of EMDR-relevant content (don't have them with me so I can't provide abstracts).
>
> Chambless, D.L, Baker, M., Baucom, D., Beutler, L., Calhoun, K., Crits-Christoph, P., Daiuto, A., DeRubeis, R., Detweiler, J., Haaga, D., Bennett Johnson, S., McCurry, S., Mueser, K., Pope, K., Sanderson, W., Shoham, V., Stickle, T., Williams, D. & Woody, S. (1998). Update on empirically validated therapies, II. The Clinical Psychologist, 51, 3-16.
> This is the one by the APA committee on empirically validated therapies. EMDR earned the second-highest ranking for ptsd treatment; no treatment for ptsd was ranked higher.
>
> Chemtob, C. M., & Pitman, R. K. (1999, November). EMDR and other neoteric approaches to the treatment of PTSD. In E. Foa (Chair), Treatment Guidelines I. Symposium conducted at the annual meeting of the International Society for Traumatic Stress Studies, Miami.
> This recent conference presentation will constitute one of the chapters in the ISTSS Treatment Guidelines to be published this year. EMDR was given an "A/B" rating (the highest being a straight A) despite having much more supportive documentation than other "A" rated treatments. My understanding is that this modest understatement was a concession to the continuing discomfort some people have with the idea of EMDR.
>
> Greenwald, R. (1996a). The information gap in the EMDR controversy. Professional Psychology: Research and Practice, 27, 67-72.
> This review highlights many of the limitations in published studies on EMDR, in particular noting that poor and/or questionable treatment fidelity is associated with worse results, and vice versa.
>
> van Etten, M., & Taylor, S. (1998). Comparative efficacy of treatments for posttraumatic stress disorder: A meta-analysis. Clinical Psychology and Psychotherapy, 5, 126-145.
> This review found EMDR approximately equal in effect to cognitive-behavioral interventions, superior for some aspects of ptsd symptoms, and more rapid.

The above is a quick introduction into important EMDR articles it is my intention to provide some more detail for those readers who are interested.


Overview
Recent studies have shown that EMDR is superior to alternative treatments for civilian general trauma (Marcus et al., 1997; Sheck et al., 1998) and for Vietnam Veterans (Carlson et al., 1998). In a recent meta-analysis, EMDR was reported to be the most efficient treatment for PTSD (Van Etten and Taylor, 1998). Proponents of other therapies have also published studies demonstrating the effectiveness of EMDR (Rothbaum, 1997). Wilson et al. (1996) found that EMDR was more effective than an exposure control. Furthermore the significant advantage was not just on self-report measures but also for physiological measures such as GSR, heart rate, and blood pressure. The superior treatment effect was still evident at 12 months follow-up.

References and brief summation
Carlson, J.G., Chemtob, C.M., Rusnack, K., Hedlund, N.L., & Muraoka, M., Y. (1998). Eye movement desensitization and reprocessing (EMDR) treatment for combat-related posttraumatic stress disorder. Journal of Traumatic Stress, 11(1), 3-24.
EMDR plus routine clinical care was found to be superior to biofeedback assisted relaxation plus routine clinical care for 35 PTSD Vietnam Veterans randomly assigned to each group. Significantly greater improvement was found post treatment and at a 3 month follow-up on a number of cognitive and behavioural instruments such as the Mississippi Combat Scale, the BDI, a self-rating scale of PTSD symptoms, and the Clinician Administered PTSD Scale.

Marcus, S.V., Marquis, P & Sakai, C. (1997). Controlled study of treatment of PTSD using EMDR in an HMO setting. Psychotherapy, 34, 307-315.
Compared EMDR with other psychological interventions tested 67 participants who were referred by a treating clinician as having PTSD symptoms. All subjects were members of a Health Maintenance Organization and were randomly assigned to EMDR or treatment as usual. Treatment as usual was whatever treatment was most preferred by the therapist who received the referral. This included procedures such as psychodynamic psychotherapy, medication, behavioral techniques or hypnosis. They investigated the relative efficacy of each procedure on a number self report and observer rated measures. Significantly greater gains for EMDR after 3 sessions and at post-treatment. The assessment by the independent rater indicated that after three sessions 50% of the EMDR patients and only 20% of the Standard Care patients no longer had a PTSD diagnosis. At post-treatment 77% of EMDR compared to only 50% of Standard Care patients no longer received a PTSD diagnosis. These differences in the diagnostic status were significant.

Rothbaum, B. O. (1997). A Controlled Study of Eye Movement Desensitisation and Reprocessing in the Treatment of Post Traumatic Stress Disordered Sexual Assault Victims. Bullington of the Menninger clinic, 61 (3), 317-334.
She found that sexual assault survivors treated with EMDR improved significantly more on PTSD and depression from pre to post-treatment than those on a wait list. This improvement was demonstrated not only for self report measures but for independent clinician rated observations of PTSD symptoms. Of note is that Rothbaum has previously been involved in trials with Edna Foa comparing behavioural and support strategies for treating PTSD. She noted that from her experience it appears that EMDR is more efficient than other exposure techniques but that comparative outcome studies are needed to investigate whether this is true.

Scheck, M.M., Schaeffer, J.A., & Gillette, C. (1998). Brief psychological intervention with traumatized young women: The efficacy of eye movement desensitization and reprocessing. Journal of Traumatic Stress, 11(1), 25-44.
They investigated the treatment efficacy of an active listening treatment in comparison to EMDR for 60 young women identified as displaying problem behaviors. These women were recruited from agencies such as a drug and alcohol referral center, a court diversion service, and a clinic for the treatment of sexually transmitted diseases. One fifth of this sample had served some time in jail and 60% had partners who had been jailed. Participants were either given two 90-minute sessions of active listening treatment or EMDR. Participants receiving EMDR showed significantly greater improvement on all self-report measures including the BDI, State Trait Inventory, and IES. Superior treatment gains were also evident by blind independent ratings of PTSD using the Post-traumatic Stress Disorder Inventory. Careful attention was paid to treatment fidelity and a therapist involved in each condition had considerable experience with their treatment paradigm. This study is particularly encouraging given some of the pessimism that sometimes exists in treating this population.

Van Etten, M.L., and Taylor,S. (1998). Comparative efficacy of treatments for posttraumatic stress disorder: a meta-analysis. Clinical Psychology and Psychotherapy, 5, 126-144.
They found that in the 41 studies reviewed, EMDR and Behavioral Treatments were significantly superior to all other psychological therapies on observer rated and self report measures at follow-up. However the effect size for EMDR treatments was achieved with fewer sessions. Both these psychological treatments were superior to pharmacotherapy at follow-up.

Wilson, D.L., Silver, S.M., Covi, W.G., & Foster, S. (1996). Eye movement desensitization and reprocessing: Effectiveness and autonomic correlates. Journal of
Behavior Therapy and Experimental Psychiatry, 27, (3), 219-229.
EMDR found to be more effective than an exposure control but that the eye movement component was more effective than a finger tapping alternative. Furthermore the significant advantage of eye movement EMDR was not just on self-report measures but also for physiological measures such as GSR, heart rate, and blood pressure. The superior treatment effect was still evident at 12 months follow-up.



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poster:Christopher Lee thread:14804
URL: http://www.dr-bob.org/babble/20000209/msgs/20983.html