Recently the American Psychological Association compiled yet another (see the Overview of EMDR at this site for others) evaluation of the research for methods of treating PTSD. Their work, based on previous work by another organization, placed EMDR in the “suggested” rather than the higher, “recommended”, category. The meeting during which the final report was ratified was summarized on the APA Division 56 (Trauma Psychology) discussion list. Below, in italics, is a quote from that summary, followed by my posted comment, which includes a link to a much more thorough and erudite response to the discussion list.
“Even before the meeting took place both of us began to hear there was discontent with the guidelines from certain constituencies – in particular from advocates of EMDR, who were displeased that it had only received a “second-tier” endorsement, and from Div39, who felt that the process had totally ignored empirical evidence which they believe supports the value of psychodynamic approaches in the treatment of PTSD.”
“Those EMDR advocates, always complaining about their level of endorsement, while others nobly object to the way evidence was handled. When the committee called for responses, why didn’t the EMDR folks point out problems with the guidelines, such as the way the important Wilson et al (1997) study was handled? Oh wait, they did. Letters to the committee included discussion of the Wilson paper, whose positive results for EMDR were excluded because all subjects did not meet full PTSD criteria. However, the APA committee ignored the fact that the when the Wilson study considered the results of the 32 subjects who met full criteria, those subjects improved as much as those who did not meet full criteria. (Interestingly an IOM review made the same mistake and also ignored it’s being called to that committee’s attention.) A letter with an extensive critique sent by Dominguez and Lee is a available at http://dx.doi.org/10.4225/23/583ba82e129b9
Finally, on the subject of clinical practice and EMDR: I’d like to suggest that given the research on EMDR and other methods, the finding that EMDR shows very rapid positive results for some clients and that it incorporates key features of CBT, it makes sense to offer clients who are ready for intensive trauma work EMDR first, and then if it is not successful, other methods. For clients who are not ready for intensive trauma work, non-exposure aspects of CBT would be a good choice to begin, then progress to EMDR. Of course, some therapist would prefer to progress to PE.
Thanks for your attention,
Wilson, S., Becker, L.A., & Tinker, R.H. (1997). Fifteen-month follow-up of eye movement desensitization and reprocessing (EMDR) treatment of post-traumatic stress disorder and psychological trauma. Journal of Consulting and Clinical Psychology, 65, 1047-1056.