No, I’m sure I don’t. I do see many people who have gotten awful, incorrect psychiatric diagnoses and psychiatric pharmacotherapy from primary care physicians practicing beyond their expertise, however.
Which expert panel concluded that EMDR is meaningfully different from CBT?
Here’s where things stand regarding EMDR: There is no evidence to support the assertion that eye movement is a necessary mechanism, or makes any difference in treatment. EMDR proponents have expanded their claims to include essentially all manner of “bilateral stimulation.” There remains no evidence to support any difference in outcomes with “bilateral stimulation” and any other therapy. No differences are found in the effectiveness of EMDR and CBT. No evidence exists that there are differential rates of dropout or of treatment duration. The literature cited by EMDR adherents is rife with studies of extremely suspect methodology, including a high number of studies with very low sample sizes. There is simply no evidence supporting that EMDR is different from CBT in any meaningful way.
The good news is that you are not likely doing any harm to anybody. At least, there is no evidence that finger waving is causing any harm or is reducing the effectiveness of CBT interventions.
Seidler, Guenter H; Wagner, Frank E. Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: A meta-analytic study. Psychological Medicine. Vol 36(11) Nov 2006, 1515-1522.
Abstract: Background: Eye movement desensitization and reprocessing (EMDR) and trauma-focused cognitive-behavioral therapy (CBT) are both widely used in the treatment of post-traumatic stress disorder (PTSD). There has, however, been debate regarding the advantages of one approach over the other. This study sought to determine whether there was any evidence that one treatment was superior to the other. Method: We performed a systematic review of the literature dating from 1989 to 2005 and identified eight publications describing treatment outcomes of EMDR and CBT in active-active comparisons. Seven of these studies were investigated meta-analytically. Results: The superiority of one treatment over the other could not be demonstrated. Trauma-focused CBT and EMDR tend to be equally efficacious. Differences between the two forms of treatment are probably not of clinical significance. While the data indicate that moderator variables influence treatment efficacy, we argue that because of the small number of original studies, little benefit is to be gained from a closer examination of these variables. Further research is needed within the framework of randomized controlled trials. Conclusions: Our results suggest that in the treatment of PTSD, both therapy methods tend to be equally efficacious. We suggest that future research should not restrict its focus to the efficacy, effectiveness and efficiency of these therapy methods but should also attempt to establish which trauma patients are more likely to benefit from one method or the other. What remains unclear is the contribution of the eye movement component in EMDR to treatment outcome.
Beriault, M; Larivee, S. French review of EMDR efficacy: Evidences and Controversies. Revue de Psychoeducation. Vol 34(2) 2005, 355-396.
Abstract: EMDR is an integrative psychotherapy approach proposed to treat a wide range of psychological disorders. This is the first French review of EMDR effectiveness. The EMDR effectiveness is initially show with uncontrolled cases studies that suffers from important methodological weaknesses. Experimental case studies provide equivocal results. Controlled studies are then reviewed as a function of the type of experimental control used and the type of disorder treated. EMDR appears as effective as cognitive-behavioral therapy for the treatment of post-traumatic stress disorder but cognitive-behavioral therapy remains the treatment of choice for specific phobia and panic disorder. In addition, dismantling studies repeatedly show that eye movements are not necessary for the efficacy of EMDR. An analysis of the differences and similarities between EMDR and the cognitive behavioral approach is presented. Pseudoscience elements embedded in EMDR development and diffusion are also presented.
Treatment of posttraumatic stress disorder in children and adolescents–A review of treatment outcome studies. Kraft, S; Schepker, R; Goldbeck, L; Fegert, J. M. Nervenheilkunde: Zeitschrift fur interdisziplinaere Fortbildung. Vol 25(9) 2006, 709-716.
Abstract: Based on a systematic literature search, the current state of knowledge on the efficacy of psychotherapeutic and pharmacologic treatment of posttraumatic stress disorders in children and adolescents is summarized and reviewed. Nineteen randomized controlled clinical trials were found for psychotherapy, and none for pharmacotherapy. The efficacy of cognitive behavioral treatment programs has been substantiated, with the participation of a parent or caretaker in the treatment seeming to be beneficial. There are promising studies for Eye Movement Desensitizafion and Reprocessing (EMDR) and for Multisystemic Family Therapy. However, because of small sample sizes and lacking replication, their results have to be regarded as provisional. Up to now, there are no controlled clinical trials on pharmacological treatments for traumatized children and adolescents. More studies on this numerically relevant and partly severely impaired group are to be claimed. Studies on differential indication of different treatment approaches and on the efficacy of combination treatments, as psychotherapy plus pharmacotherapy, are lacking.
Johnson, David Read; Lubin, Hadar. The Counting Method: Applying the Rule of Parsimony to the Treatment of Posttraumatic Stress Disorder. Traumatology. Vol 12(1) Mar 2006, 83-99.
Abstract: The authors contend that the primary therapeutic element in psychological treatments for posttraumatic stress disorder is imaginal exposure, and that differences among major approaches are determined more by secondary techniques designed to circumvent the client’s avoidant defenses against exposure. A study is described comparing Prolonged Exposure, Eye Movement Desensitization and Reprocessing, and the Counting Method with 51 multiply-traumatized women. Measures of PTSD were significantly reduced by all three methods, but differences among the methods were negligible. Because the Counting Method utilizes only imaginal exposure as a therapeutic element, support is given to the more parsimonious conclusion that imaginal exposure may be both the necessary and sufficient factor in therapeutic effect, countering a trend in the field toward more complex, multi-faceted treatment packages.
Richards, David. The eye movement desensitization and reprocessing debate: Commentary on Rosen et al. and Poole et al. Behavioural and Cognitive Psychotherapy. Vol 27(1) Jan 1999, 13-17.
Abstract: The debate conducted in this journal between A. D. Poole et al (see record 199910827-001) and G. M. Rosen et al (see record 1998-10219-001, 1999-10827-002) and elsewhere on the effectiveness of eye movement desensitization and reprocessing (EMDR) is characterized by incredulity, fervent belief and emotion. Theorists and clinical pragmatists, not to mention the “discoverers” of EMDR, have often taken up oppositional stances that impede rationale debate. While some may be offended by the overt commercialism and messianic fervor of the EMDR lobby, the best response is to engage in dialogue, collaboration and scientific experiment. These experiments should combine the best randomized clinical trial methods with experimental deconstruction of the complex mix that now comprises EMDR. Those who have developed EMDR should cease the commercial and empirical protectionism that has characterized the EMDR movement and open their methods to such investigation by the healthily skeptical.
Hembree, Elizabeth A; Foa, Edna B; Dorfan, Nicole M; Street, Gordon P; Kowalski, Jeanne; Tu, Xin.Do patients drop out prematurely from exposure therapy for PTSD? Journal of Traumatic Stress. Vol 16(6) Dec 2003, 555-562.
Abstract: Many studies have demonstrated the efficacy of exposure therapy in the treatment of chronic posttraumatic stress disorder (PTSD). Despite the convincing outcome literature, a concern that this treatment may exacerbate symptoms and lead to premature dropout has been voiced on the basis of a few reports. In this paper, we examined the hypothesis that treatments that include exposure will be associated with a higher dropout rate than treatments that do not include exposure. A literature search identified 25 controlled studies of cognitive-behavioral treatment for PTSD that included data on dropout. The results indicated no difference in dropout rates among exposure therapy, cognitive therapy, stress inoculation training, and Eye Movement Desensitization and Reprocessing (EMDR). These findings are consistent with previous research about the tolerability of exposure therapy.
Foa, Edna B; Rothbaum, Barbara O; Furr, Jami M. Augmenting exposure therapy with other CBT procedures. Psychiatric Annals. Vol 33(1) Jan 2003, 47-53.
Abstract: Most studies on treatment outcome for posttraumatic stress disorder (PTSD) have used cognitive behavioral therapy (CBR) programs, which include variants of exposure therapy, anxiety management, and cognitive therapy. Combinations of these interventions have also been investigated. More recently, eye movement desensitization and reprocessing (EMDR) has been employed for the treatment of PTSD, and a number of studies have explored its efficacy. In the treatment guidelines developed under the auspices of the International Society for Traumatic Stress Studies, exposure therapy has emerged as the most empirically supported intervention for PTSD. In this article the authors focus on reviewing well-controlled studies that compared the efficacy of exposure therapy to that of other interventions. In comparing outcome across studies, the focus is on percent change from baseline on the main PTSD measure calculated on completers whenever possible. Result suggest that exposure therapy is highly effective; treatment effects appear to be diminished by diluting exposure therapy when attempting to augment it with other treatments.
Hensel, Thomas. Effectiveness of EMDR with psychologically traumatized children and adolescents. Kindheit und Entwicklung. Vol 15(2) 2006, 107-117.
Abstract: EMDR (eye movement desensitization and reprocessing) has proved to be an independent, effective, and empirically validated approach for the treatment of chronic post-traumatic stress disorder (PTSD) in adults. This work provides an overview of the status of research into the use of EMDR in traumatized children and adolescents. The available controlled randomized studies are summarized and assessed for their methodistic value. The empirically supported and effective treatment is described. The results show - albeit on a narrow empirical basis - that EMDR, when used in children and adolescents, demonstrates a comparable effectiveness in symptom reduction and efficiency (limited treatment duration) to that observed in adults. Issues relating to the integration of the treatment into the existing care structure are discussed.