Psycho-Babble Medication Thread 14804

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Psychotherapy sites

Posted by Morc on November 8, 1999, at 11:29:54


Does anyone know of some good sites for psychotherapeutic approaches to depression and anxiety? I am NOT against meds, but they haven't worked for me, and I'm looking for some "company" in exploring psychotherapeutic alternatives.

Thanks, folks.

 

Re: Psychotherapy sites

Posted by Elizabeth on November 9, 1999, at 7:58:14

In reply to Psychotherapy sites, posted by Morc on November 8, 1999, at 11:29:54

Hi there.

> Does anyone know of some good sites for psychotherapeutic approaches to depression and anxiety?

http://www.psycom.net/depression.central.psychotherapy.html is a good place to start.

> I am NOT against meds, but they haven't worked for me, and I'm looking for some "company" in exploring psychotherapeutic alternatives.

What have you tried so far (talk therapy, meds, whatever)?

 

Re: Psychotherapy sites

Posted by Morc on November 9, 1999, at 9:27:35

In reply to Re: Psychotherapy sites, posted by Elizabeth on November 9, 1999, at 7:58:14


> What have you tried so far (talk therapy, meds, whatever)?


Some talk therapy, a lot of searching around for possible causative traumatic incidents. Meds just gave me intolerable side effects. I was also influence by a site on a psychological theory of depression and schizophrenia (drmckenzie.com).

 

Re: Psychotherapy sites

Posted by Elizabeth on November 10, 1999, at 16:01:18

In reply to Re: Psychotherapy sites, posted by Morc on November 9, 1999, at 9:27:35

> Some talk therapy, a lot of searching around for possible causative traumatic incidents. Meds just gave me intolerable side effects. I was also influence by a site on a psychological theory of depression and schizophrenia (drmckenzie.com).

What kinds of talk therapy have you tried? There are many variations. Different therapists will have different biases. I went through the supposedly "proven" therapies (cognitive-behavioral and interpersonal) and eventually found that old-fashioned psychodynamic therapy really is the best thing for me.

You said meds gave you intolerable side effects. Which meds did you try, and at what doses? There are many different kinds, and rarely is an individual unable to tolerate *all* of them.

Regarding the web site you pointed to: I would caution you to avoid psychologists who advocate forming conclusions about the "cause" of mental diseases while remaining ignorant of their biology (or, indeed, who claim there is any single causative factor).

 

Re: Psychotherapy sites

Posted by Adam on November 10, 1999, at 17:35:31

In reply to Re: Psychotherapy sites, posted by Elizabeth on November 10, 1999, at 16:01:18

Elizabeth,

Perhaps this is best continued in another thread, but I'll pose the question here: What have been the benefits you have derived
from psychodymanic therapy? I don't want to start an ideological turf war here. For myself, I found psychodynamic therapy of no
help whatsoever, but that may be because A) I had a poor therapist and B) the nature of my illness (comorbid depression and
anxiety disorder) indicated something else. At any rate, I'm interested still in this approach, and would welcome the insight
you and others who have found it helpful could give.

I have personally found all forms of therapy that I have tried lacking in some respect or another,
and have been intrigued by an integrative form of therapy called (I hate this name) Lifetrap Therapy, which is founded on the
principles of Beck, but takes into account the refractory nature of some disorders (involving "schemas") and borrows heavily from
other kinds of therapy when appropriate. The need for psychopharmacological interventions, also when appropriate, is readily
acknowledged (their theory of depression and personality disorders involves the interaction of biology and environment.) It is,
to be sure, heavily weighted toward addressing environmental causes. For those who do not feel childhood traumas or destructive
patterns of behavior characterize their depression, this form of therapy may not be for you.

A developer of this branch of psychotherapy has a web page:

http://www.schematherapy.com/index.shtml

I'm not overly fond of the page itself, but it is the only one I know of with any real content about this approach.

> > Some talk therapy, a lot of searching around for possible causative traumatic incidents. Meds just gave me intolerable side effects. I was also influence by a site on a psychological theory of depression and schizophrenia (drmckenzie.com).
>
> What kinds of talk therapy have you tried? There are many variations. Different therapists will have different biases. I went through the supposedly "proven" therapies (cognitive-behavioral and interpersonal) and eventually found that old-fashioned psychodynamic therapy really is the best thing for me.
>
> You said meds gave you intolerable side effects. Which meds did you try, and at what doses? There are many different kinds, and rarely is an individual unable to tolerate *all* of them.
>
> Regarding the web site you pointed to: I would caution you to avoid psychologists who advocate forming conclusions about the "cause" of mental diseases while remaining ignorant of their biology (or, indeed, who claim there is any single causative factor).

 

Re: Psychotherapy sites

Posted by Elizabeth on November 12, 1999, at 14:05:16

In reply to Re: Psychotherapy sites, posted by Adam on November 10, 1999, at 17:35:31

> Perhaps this is best continued in another thread, but I'll pose the question here: What have been the benefits you have derived
> from psychodymanic therapy?

The benefits one could expect from talk therapy in general, without the problems I found with cognitive-behavioral-interpersonal therapy. Bear in mind, too, that what I'm doing now is not "pure" psychoanalytic psychotherapy...it's also informed by other schools of thought, including the biological one (my therapist is an MD).

I suffer from chronic demoralization - I've lost my self-confidence after all the setbacks I've had in life because of my depression. CBT/IPT were too ambitious; they actually tried to treat my depression. I think this didn't (couldn't) work because I have melancholic depressions, the salient feature of which is non-reactive mood, and certainly I wasn't about to "cheer up" just because someone argued with me about it (that's oversimplifying, but you know what I mean). Then, once I was no longer depressed, none of it seemed relevant anymore - I was just being told things that I already knew (and it still didn't touch the demoralization). I don't think that the two cognitive-oriented therapists I've had were bad or incompetent; I just think it's the wrong type of therapy for me.

> For myself, I found psychodynamic therapy of no
> help whatsoever, but that may be because A) I had a poor therapist and B) the nature of my illness (comorbid depression and
> anxiety disorder) indicated something else.

Could you elaborate some on (B)? That is precisely what I have (depression + anxiety).

> At any rate, I'm interested still in this approach, and would welcome the insight
> you and others who have found it helpful could give.

At the outset, it helped me to figure out just what the problem is, something that's impossible for therapies that don't look for a cause (or that implicitly assume a particular cause, which I think CBT does). It wasn't at all obvious, and I've gotten more than my share of misdiagnoses. As I understand better what has happened to me, I find myself becoming less paralyzed.

> I have personally found all forms of therapy that I have tried lacking in some respect or another,
> and have been intrigued by an integrative form of therapy called (I hate this name) Lifetrap Therapy, which is founded on the
> principles of Beck, but takes into account the refractory nature of some disorders (involving "schemas") and borrows heavily from
> other kinds of therapy when appropriate.
...
>For those who do not feel childhood traumas or destructive
> patterns of behavior characterize their depression, this form of therapy may not be for you.

I've read about that, but I was under the impression that schema therapy was primarily for personality disorders. (Then again, I also don't see how CBT could be useful for depression outside of a personality disorder, either.)

 

Re: Psychotherapy sites

Posted by Noa on November 12, 1999, at 17:04:52

In reply to Re: Psychotherapy sites, posted by Elizabeth on November 12, 1999, at 14:05:16

> I've read about that, but I was under the impression that schema therapy was primarily for personality disorders.

I think from a cognitive purist's point of view, this might be how schema therapy would be seen. But schema therapy is just a more involved, longer term form of cognitive therapy, that allows for the fact that a lot of people, either those with so called personality disorders, or those with long term depressions, need more than to just correct their maladaptive thoughts. However, the material I have read about schema therapy for personality disorders has some interesting ideas that can be used by therapists of a more interpersonal, or psychodynamic bent. Personally, even tho it is "sexy" and publication-freindly, and managed care friendly to produce a neatly packaged approach with its own cool name, most of the time, it is therapists who are informed of a variety of approaches and are skilled at using them in combinations suited to the individual they are working with, that I believe are the most successful... Having a diagnosis in common with other patients does not mean that an individual patient will benefit from the same form of therapy. A good therapist uses what he or she learns from the patient to determine how to do therapy, and draws upon a body of knowledge and experience from different theoretical camps.

 

Re: Psychotherapy sites

Posted by Adam on November 12, 1999, at 18:23:53

In reply to Re: Psychotherapy sites, posted by Elizabeth on November 12, 1999, at 14:05:16

>B) the nature of my illness (comorbid depression and anxiety disorder) indicated something else.
>
> Could you elaborate some on (B)? That is precisely what I have (depression + anxiety).
>
I have suffered (in addition to depression of unknown subtype) from OCD (body dysmorphia, primarily,
though there has been some drift in my symptoms that I won't get into here). I had, as they say,
a "very difficult childhood", where I contended with the death of one parent, "mild" physical
and verbal abuse from another, neglect (of a sort-one was dead) from both. In many ways I raised
myself, and my illnesses grew with me. It was my instinct always to distrust those around me, to
expect rejection (both I think because of my grave anxieties about image and also because I
anticipated getting hurt by my peers because this seemed "normal"). It was, and to an extent
still is, my instinct to withdraw. People, at a certain level, frightened me, so it was natural
to want to avoid my own reflection and avoid those who might react with the same loathing toward
me that I directed at myself. Often they did, I think because I was such an easy target.

I often was driven by sheer desparation and lonliness, but somehow midway through high school I
forced myself to get more involved with life, sports, doing things like drama and singing,
applying myself to my schoolwork, even dating. The successes that I experienced, the acceptance
from my peers that I slowly gained, were my antidepressant. Transitioning to college meant starting
all over, and again it was a slow building process, often a repetition of the same pattern, and
sometimes a torturous journey driven by fear. But again, doing well in school, making friends,
having a girlfriend, participating, these all bolstered me. Leaving college simply lead to another
period of transition, only the symptoms of unhappiness and anxiety became more severe. Relationships
failed to reassure as they once did, the steady boost of academic success was cut off, and I found
myself slipping behind other peers who were realizing their dreams of medical and graduate school
while I found myself unable to get it together. I needed to be great at whatever I did, and mediocrity
and loss of love became devastation. Coupled with totally irrational fears about my visage (addressed
very well, oddly enough, before my depression became its most severe), I felt I was in some sort of
addictive pattern of self-doubt and the constant quest for reassurance that I was worthwhile. Adult
life beyond the close community of school was isolating, and rather than reach out as I had before,
when my depression worsened, I began to withdraw more. Through many ups and downs, I am where I am
now, not a failure in any sense of the word, but not where I wanted to be.
Since being in the hospital, I vowed I would not be suffocated by my own inertia, that I needed to get
out more, that I needed to experience fun and friendship, and maybe love again, but that I was deeply
and genuinely afraid, and still had a lot of residual doubts about myself in the area of self-image.
It seemed the only way to deal with these problems was to alter my behavior, to come up with strategies
to keep my from closeting myself without having the whole thing mushroom into a frenzied quest for
empty friendships and false intimacy. Talking about my thoughts, reasoning through this process, mulling
on the past, seemes to have gotten me nowhere, except to make the story I have told a bit clearer. I
have felt I needed to act, and to change, to do things I wouldn't normally have done, to stick my neck
out again in social situations, to strike up conversations, to approach an attractive stranger and deal
with being brushed aside. To remind myself constantly that I want to achieve a healthier and more
balanced state so that I know what is truly motivating me, to remind myself constantly that I am OK as I
am in most respects, and to remind myself that failure is an opportunity to learn, not an indication that
I am fundamentally flawed. I have found the practical structure of behavioral therapy, the motivation
of having assigned tasks to complete, and the cognative tools to combat a habitual tendancy toward self-
reproach to be my only psychotherapeutic solution, as imperfect as it has been at times. What I have
found lacking is the opportunity to explore my inner self beyond its impact on my behaviors, the
relentless attack on symptoms without reflection. I truly believe it has kept me on a healthier path,
and I have frankly accomplished a great deal that I probably woudn't have accomplished without being
pushed. I hope eventually these beahviors become habitual, and I won't have to rely on therapy for that.
A deeper sense of self or meaning is what has been lacking. But then again, maybe that's just too
philisophical, and most euthymics don't dwell on such things. I don't know.

 

The usefulness of talk therapy

Posted by Bob on November 12, 1999, at 20:52:12

In reply to Re: Psychotherapy sites, posted by Adam on November 12, 1999, at 18:23:53

... for me, that is.

(btw, Adam, I can see why maybe we knock heads on occasion without me knowing it ... in some ways, we are just too much alike ;^)

Sri Chinmoy, in teaching about the "goal" of meditation, talks about expanding upward and inward at the same time. The ultimate high, the deepest insight, all at the same time. That's why, for me, meditation is therapeutic.

With my therapist, it works this way. I started with what I thought was a good understanding of the heart of my problem ... but there always were these metaphors I used to "understand" my pain without really understanding the metaphors themselves. Examining my life with my therapist has been like peeling an onion -- she challenges my perceptions and adds her own insights, and eventually (tho not gradually ... it tends to come in an epiphany or thru some critical mass) a layer gets peeled back. the metaphors take on not one but two added dimensions -- one peering in on the structure of my "self", the other peering out on how that self experiences the world. In four years, I've been able to do this three or four times. It may not seem like much progress, but each shift in understanding has been life-shaking. Quality, not quantity.

Of course, my meditation has given me one more metaphor ... something that acted as a key to the locks several of my other essential metaphors posed. One guided meditation of Sri Chinmoy's is, once you have calmed yourself in a deep meditative state, to go to your heart's door and open it to see what's there. When I went to my heart's door, I was standing on the outside. Everything outside was blacker than night, except for the pure white light (tinging my heart's door that color of red you see when you put your fingers over a flashlight) coming from inside thru a barely cracked opening of the door. Even though the door is clearly not locked, since it's open a bit, I cannot open the door. Yet. For now, I'm still on the outside of my own heart.

It may not sound all that good, but recognizing that has been a comfort ... it feels like something unknown is now much better defined.

Bob

 

Re: The usefulness of talk therapy

Posted by Adam on November 13, 1999, at 2:02:46

In reply to The usefulness of talk therapy, posted by Bob on November 12, 1999, at 20:52:12

So, all you armchair diagnosticians out there, do I sound like I have a "personality disorder"?
It has occurred to me, just because of what Elizabeth said about the appropriate use of CBT. But
does anxiety and fear learned through bad experiences constitute a "personality disorder"?
Does having a "schema" or two put one in that rather unhappy catagory? I'm not an arm slasher,
never was prone to fits of rage when someone told me I was out of line. I don't seem to be
"borderline" or "narcissistic" as far as I can tell. Avoidant? Perhaps, but avoidance is a
hallmark of OCD. I just don't know. Does it really help to know?

 

Re: The usefulness of talk therapy

Posted by Noa on November 13, 1999, at 4:45:00

In reply to Re: The usefulness of talk therapy, posted by Adam on November 13, 1999, at 2:02:46

Having a schema or two is not an indication of a personality disorder. Everyone operates under the influence of schemas. We develop beliefs and don't challenge them, and they influence our lives. THis is the basic premise of CBT. CBT challenges schemas head on, but assumes that most people can take the head on assault. I believe they are wrong about that. Some people can take the head on assault, others can't. Not being able to does not indicate a "personality" disorder.
I don't even fully accept the idea of "personality" disorders, anyway. I believe just about everyone in the world could fall under the Dx of "Personality Disorder Not Otherwise Specified".
Sure you may have avoidant tendencies--you are protecting yourself from the anxiety you experience.
Forget about the DX. Forget about a clear-cut specific form of TX. I think it is possible that these CATEGORIES are playing into your compulsive tendencies. If you are interested, talk therapy can be very useful in helping you to sort out the meaning of stuff to you in your life, to help you own yourself more and be more conscious about how you want to and are able to live your life as yourself. In terms of the brain laterality thing that I am currently preoccupied with, talk therapy helps to bring the emotional, irrational right side together with the logical verbal left, for a more peaceful coexistence.
If you seek out a therapist, go for one who is well versed in your particular symptoms, and is comfortable about a multimodal approach (medication, etc. plus talk therapy, etc.), a therapist who is knowlegable but not hung up on diagnosis ala DSM, is more interested in understanding you and your difficulties as an individual.

 

Re: The usefulness of talk therapy

Posted by Elizabeth on November 13, 1999, at 17:05:16

In reply to Re: The usefulness of talk therapy, posted by Adam on November 13, 1999, at 2:02:46

> So, all you armchair diagnosticians out there, do I sound like I have a "personality disorder"?

Goodness, I didn't mean to imply that. I've just always thought that personality disorders seemed like ideal targets for cognitive-behavioral therapy, because they are pretty much defined by maladaptive attitudes, behaviors, etc.

 

Does Personality Disorder = Character Disorder?

Posted by CarolAnn on November 13, 1999, at 21:09:58

In reply to Re: The usefulness of talk therapy, posted by Adam on November 13, 1999, at 2:02:46

I'm curious because I read once(I think in "The Road Less Traveled"by Peck) that the difference between being neurotic(Depression, OCD,ect.) and having a Character Disorder is that a Neurotic feels that their is something inherently *wrong* with the person they are, in effect blaming themselves for all their problems(ie: if mom uses verbal abuse, it must be that I am such a bad person that I deserve it). On the other hand, someone with a Character disorder, feels that there is something *wrong* with everyone else, blaming all their problems on others(ie:it's not *my* fault I can't hold down a job, it was all those stupid bosses trying to beat me down). The character disorder is so busy blaming outside sources, that they never even consider or often don't "remember" any abuse in their past. For this reason(according to the book)the Neurotic is very much easier to treat, knowing and being willing to find out, "why" they are Neurotic. Character Disorders can be almost impossible to treat, after all, how do you solve problems that someone either refuses to believe exist or problems that someone is utterly incapable of realizing the existence of? Anyway, this might be out-of-date psychology, I read the book years ago.CarolAnn

 

Re: The usefulness of talk therapy-E

Posted by Adam on November 14, 1999, at 14:03:11

In reply to Re: The usefulness of talk therapy, posted by Elizabeth on November 13, 1999, at 17:05:16

I know you didn't. I'm speculating on my own, though I agree with your oppinion that CBT (or perhaps
DBT) is ideally applied to "maladaptive attitutes, behaviors, etc." Since I have displayed those
could I fit into that catagory (personality disorder), and if so, what does it mean? I'm probably
experiencing what I have heard many "100-level" psych. students experience: As they are introduced to
the concepts of abnormal psychology, they recogize a number of symptoms in themselves and start putting
themselves with varying degrees of seriousness into inappropriate diagnostic catagories.

> > So, all you armchair diagnosticians out there, do I sound like I have a "personality disorder"?
>
> Goodness, I didn't mean to imply that. I've just always thought that personality disorders seemed like ideal targets for cognitive-behavioral therapy, because they are pretty much defined by maladaptive attitudes, behaviors, etc.

 

Re: The usefulness of talk therapy-N

Posted by Adam on November 14, 1999, at 14:04:57

In reply to Re: The usefulness of talk therapy, posted by Noa on November 13, 1999, at 4:45:00

Thank you, Noa. Extremely good advice.

> Having a schema or two is not an indication of a personality disorder. Everyone operates under the influence of schemas. We develop beliefs and don't challenge them, and they influence our lives. THis is the basic premise of CBT. CBT challenges schemas head on, but assumes that most people can take the head on assault. I believe they are wrong about that. Some people can take the head on assault, others can't. Not being able to does not indicate a "personality" disorder.
> I don't even fully accept the idea of "personality" disorders, anyway. I believe just about everyone in the world could fall under the Dx of "Personality Disorder Not Otherwise Specified".
> Sure you may have avoidant tendencies--you are protecting yourself from the anxiety you experience.
> Forget about the DX. Forget about a clear-cut specific form of TX. I think it is possible that these CATEGORIES are playing into your compulsive tendencies. If you are interested, talk therapy can be very useful in helping you to sort out the meaning of stuff to you in your life, to help you own yourself more and be more conscious about how you want to and are able to live your life as yourself. In terms of the brain laterality thing that I am currently preoccupied with, talk therapy helps to bring the emotional, irrational right side together with the logical verbal left, for a more peaceful coexistence.
> If you seek out a therapist, go for one who is well versed in your particular symptoms, and is comfortable about a multimodal approach (medication, etc. plus talk therapy, etc.), a therapist who is knowlegable but not hung up on diagnosis ala DSM, is more interested in understanding you and your difficulties as an individual.

 

Back to trauma theory

Posted by Morc on November 14, 1999, at 14:25:52

In reply to Re: The usefulness of talk therapy-N, posted by Adam on November 14, 1999, at 14:04:57


Actually, when I started this thread, I had more in mind classical trauma theory. This approach was given up, it seems to me, by mainstream psychotherapy long ago, leading to psychoanalysis, then somatic (drug) therapies in its place. But now that there are better ways to unearth and process traumas (EMDR, for one, from what I've read), is this something to look into? I guess I'm curious if others have tried this route, especially if they've unearthed some deep causative factors, etc. The point is, ideally, healing the mind-brain of the effect of past traumas, without using meds. Any takers?


 

"repression"

Posted by Elizabeth on November 14, 1999, at 14:44:00

In reply to Back to trauma theory, posted by Morc on November 14, 1999, at 14:25:52

> Actually, when I started this thread, I had more in mind classical trauma theory. This approach was given up, it seems to me, by mainstream psychotherapy long ago, leading to psychoanalysis, then somatic (drug) therapies in its place. But now that there are better ways to unearth and process traumas (EMDR, for one, from what I've read), is this something to look into? I guess I'm curious if others have tried this route, especially if they've unearthed some deep causative factors, etc. The point is, ideally, healing the mind-brain of the effect of past traumas, without using meds. Any takers?

Here's another thing to be wary of: any therapy that claims to be able to unearth repressed memories of childhood trauma. Run away.

That said, people who do remember real traumas often respond to a combination of psychotherapy and medication.

EMDR is not exactly an ineffective therapy, but it is a fraud in that its only distinctive feature (eye-hand movements) has proven to be of no value - EMDR is no more effective than standard desensitization therapy (appropriate for phobias, which can be one aspect of PTSD).

 

Re: "repression"

Posted by Morc on November 16, 1999, at 17:32:53

In reply to "repression", posted by Elizabeth on November 14, 1999, at 14:44:00


> EMDR is not exactly an ineffective therapy, but it is a fraud in that its only distinctive feature (eye-hand movements) has proven to be of no value - EMDR is no more effective than standard desensitization therapy (appropriate for phobias, which can be one aspect of PTSD).

Pretty strong statement. Have you tried it, to know from the "inside"?

 

Re: "repression"

Posted by Elizabeth on November 17, 1999, at 2:29:50

In reply to Re: "repression", posted by Morc on November 16, 1999, at 17:32:53

> Pretty strong statement. Have you tried it, to know from the "inside"?

Not necessary. I would not base my opinion of a therapy (a drug, a talking therapy, or a new-age therapy like EMDR) exclusively on my own experience of it, but on well-designed clinical studies, or in the absence of such studies, on the existence of well-documented case reports.

At this time there is no evidence that the eye-hand movement aspect of EMDR has any therpaeutic eeffect, nor is there a plausible theoretical basis for it.

 

More on EMDR

Posted by Morc on January 2, 2000, at 12:27:11

In reply to Re: "repression", posted by Elizabeth on November 17, 1999, at 2:29:50


> Not necessary. I would not base my opinion of a therapy (a drug, a talking therapy, or a new-age therapy like EMDR) exclusively on my own experience of it, but on well-designed clinical studies, or in the absence of such studies, on the existence of well-documented case reports.
>
> At this time there is no evidence that the eye-hand movement aspect of EMDR has any therpaeutic eeffect, nor is there a plausible theoretical basis for it.

Hi, Elizabeth.

Can you pass on the locations of some of those clinical studies you refer to above? I just finished reading "EMDR: The Breakthrough Therapy" by Francine Shapiro and Margot Forrest, and am feeling pretty convinced of its validity, at least enough to give it a try.


 

Ooops! To Elizabth, re EMDR, I mean

Posted by Morc on January 2, 2000, at 12:32:19

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

>
> > Not necessary. I would not base my opinion of a therapy (a drug, a talking therapy, or a new-age therapy like EMDR) exclusively on my own experience of it, but on well-designed clinical studies, or in the absence of such studies, on the existence of well-documented case reports.
> >
> > At this time there is no evidence that the eye-hand movement aspect of EMDR has any therpaeutic eeffect, nor is there a plausible theoretical basis for it.
>
> Hi, Elizabeth.
>
> Can you pass on the locations of some of those clinical studies you refer to above? I just finished reading "EMDR: The Breakthrough Therapy" by Francine Shapiro and Margot Forrest, and am feeling pretty convinced of its validity, at least enough to give it a try.

Forgot to address it!

 

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. p.muris@psychology.unimaas.nl

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. jlohr@comp.uark.edu

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
grosen@u.washington.edu

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. dev@psy.uq.edu.au

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. cahillsp@musc.edu

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. P.Muris@Psychology.unimaas.nl

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.

 

Re: More on EMDR

Posted by Morc on January 3, 2000, at 11:12:37

In reply to Re: More on EMDR, posted by Elizabeth on January 3, 2000, at 9:26:39


Wow! Thanks! That's a lot to chew on. If I take the plunge, I'll probably report in, for a first-person account. Nice work!

 

Re: More on EMDR

Posted by Steve on January 7, 2000, at 17:47:52

In reply to Re: More on EMDR, posted by Elizabeth on January 3, 2000, at 9:26:39

Behold the power of the placebo.

> (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. p.muris@psychology.unimaas.nl
>
> 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. jlohr@comp.uark.edu
>
> 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
> grosen@u.washington.edu
>
> 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. dev@psy.uq.edu.au
>
> 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. cahillsp@musc.edu
>
> 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. P.Muris@Psychology.unimaas.nl
>
> 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 revi

 

Re: More on EMDR - the full story

Posted by Ricky Greenwald on January 27, 2000, at 19:41:32

In reply to Re: More on EMDR, posted by Steve on January 7, 2000, at 17:47:52

> Behold the power of the placebo.

I would say, "Behold the power of a smear campaign."

The numerous articles cited a few posts ago give a very misleading picture of the research on EMDR. There is a relatively small group of people who seem dedicated to trashing EMDR, and they are responsible for most of the articles cited.

On the other hand, EMDR has more controlled research supporting its use than any other psychotherapy method used to treat trauma, including direct comparisons to other credible treatments. When EMDR is used properly it consistently comes out either equal or superior.

EMDR's efficacy has been recognized by the American Psychological Association's Committee on Empirically Validated Methods, and by the International Society for Traumatic Stress Studies' Treatment Guidelines project. EMDR is used by the Red Cross, the FBI, The VA (some programs anyway) etc.

A convincing role has not yet been demonstrated for eye movements. However, all the component analysis studies have been too small to detect anything but a relatively large effect, so if eye movements play a modest role along with other treatment components, this might not show up in the studies that have been conducted to date. So the jury's still out on what (if any) the role of eye movements might be. It should also be noted that EMDR is not just a typical exposure session with eye movements thrown in; it's a rather sophisticated package of treatment components which separately have recognized effectiveness and together seem to do even better.

So please, if you're trying to inform people about EMDR, yes there are still many questions about it, but the smear campaign is getting old and is unsupportable. Since EMDR has helped so many people and since this has been documented in controlled studies again and again, it's time to start focusing on how and why it works.


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