Being Critical

[Jean-Marc Perreault]

Hi Tipsters,                  One of my main objectives in teaching my intro class is to bring the students to question things. I want them to become more open and critical, without settling down for the status quo. I also try to adopt that attitude myself, even if I can fall into some traps once in a while. We've had a very interesting discussion on EMDR a while ago, and it really made me question myself with regards to how I acquire knowledge, and how truly critical I am when I have a vested interest in a matter. This search process has been great. What I want to ask you all is the following: What does one do when there seems to be very contradicting evidence on a topic? (ok, I can already sense Chris Green's steam coming out of his ears... but heck, I need to be able to answer this one, so I'll go ahead anyhow...). I remember Chris had posted many sources of evidence against the efficacy of EMDR. This made me look for further sources, and I went out and got much of what was available from Psychinfo about 6 months ago. Recently, I received an email from a different list with the following sources, arguing for the efficacy of EMDR treatment. Here is that list (it's quite long, sorry...): International Treatment Guidelines * Bleich, A., Kotler, M., Kutz, E., & Shalev, A. (2002) A position paper of the (Israeli) National Council for Mental Health: Guidelines for the assessment and professional intervention with terror victims in the hospital and in the community. EMDR is one of only three methods recommended for treatment of terror victims. * Chambless, D.L. et al. (1998). Update of empirically validated therapies, II. The Clinical Psychologist, 51, 3-16. According to a taskforce of the Clinical Division of the American Psychological Association, the only methods empirically supported for the treatment of any post-traumatic stress disorder population were EMDR, exposure therapy, and stress inoculation therapy. * CREST (2003). The management of post traumatic stress disorder in adults. A publication of the Clinical Resource Efficiency Support Team of the Northern Ireland Department of Health, Social Services and Public Safety, Belfast. Of all the psychotherapies, EMDR and CBT were stated to be the treatments of choice for trauma victims. * Dutch National Steering Committee Guidelines Mental Health Care (2003). Multidisciplinary Guideline Anxiety Disorders. Utrecht: Quality Institute Heath Care CBO/Trimbos Intitute. * Sjoblom, P.O., Andreewitch, S . Bejerot, S., Mortberg, E., Brinck, U., Ruck, C., & Korlin, D. (2003). Regional treatment recommendation for anxiety disorders. Stockholm: Medical Program Committee/ Stockholm City Council Of all psychotherapies CBT and EMDR are recommended as treatments of choice for PTSD. * United Kingdom Department of Health. (2001). Treatment choice in psychological therapies and counselling evidence based clinical practice guideline. London: Author. http://www.doh.gov.uk/mentalhealth/treatmentguidelin Best evidence of efficacy was reported for EMDR, exposure, and stress inoculation * Foa, E.B., Keane, T.M., & Friedman, M.J. (2000). Effective treatments for PTSD: Practice Guidelines of the International Society for Traumatic Stress Studies New York: Guilford Press. In the Practice Guidelines of the International Society for Traumatic Stress Studies, EMDR was listed as an efficacious treatment for PTSD. ------------------------------- Randomized Clinical Trials with Adults with PTSD * Carlson, J., Chemtob, C.M., Rusnak, K., Hedlund, N.L, & Muraoka, M.Y. (1998). Eye movement desensitization and reprocessing (EMDR): Treatment for combat-related post-traumatic stress disorder. Journal of Traumatic Stress, 11, 3-24 Twelve sessions of EMDR eliminated post-traumatic stress disorder in 77% of the multiply traumatized combat veterans studied. Effects were maintained at follow-up. This is the only randomized study to provide a full course of treatment with combat veterans. Other studies (e.g., Macklin et al.) evaluated treatment of only one or two memories, which, according to the International Society for Traumatic Stress Studies guidelines, is inappropriate for multiple-trauma survivors. * Ironson, G.I., Freund, B., Strauss, J.L., & Williams, J. (2002). Comparison of two treatments for traumatic stress: A community-based study of EMDR and prolonged exposure. Journal of Clinical Psychology, 58, 113-128. Both EMDR and prolonged exposure produced a significant reduction in PTSD and depression symptoms. Study found that 70% of EMDR participants achieved a good outcome in three active treatment sessions, compared to 29% of persons in the prolonged exposure condition. EMDR also had fewer dropouts. * Lee, C., Gavriel, H., Drummond, P., Richards, J. & Greenwald, R. (2002). Treatment of post-traumatic stress disorder: A comparison of stress inoculation training with prolonged exposure and eye movement desensitization and reprocessing. Journal of Clinical Psychology, 58, 1071-1089. Both EMDR and stress inoculation therapy plus prolonged exposure (SITPE) produced significant improvement, with EMDR achieving greater improvement on PTSD intrusive symptoms. Participants in the EMDR condition showed greater gains at three-month follow-up. EMDR required three hours of homework compared to 28 hours for SITPE. * Marcus, S., Marquis, P. & Sakai, C. (1997). Controlled study of treatment of PTSD using EMDR in an HMO setting. Psychotherapy, 34, 307-315 Funded by Kaiser Permanent. Results show that 100% of single-trauma and 80% of multiple-trauma survivors were no longer diagnosed with post-traumatic stress disorder after six 50-minute sessions. * Power, K.G., McGoldrick, T., Brown, K., et al. (2002). A controlled comparison of eye movement desensitization and reprocessing versus exposure plus cognitive restructuring, versus waiting list in the treatment of post-traumatic stress disorder. Journal of Clinical Psychology and Psychotherapy, 9, 299-318. Both EMDR and exposure therapy plus cognitive restructuring produced significant improvement. EMDR was more beneficial for depression and required fewer treatment sessions. * Rothbaum, B. (1997). A controlled study of eye movement desensitization and reprocessing in the treatment of post-traumatic stress disordered sexual assault victims. Bulletin of the Menninger Clinic, 61, 317-334. Three 90-minute sessions of EMDR eliminated post-traumatic stress disorder in 90% of rape victims. * Scheck, 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, 25-44. Two sessions of EMDR reduced psychological distress scores in traumatized young women and brought scores within one standard deviation of the norm. * Taylor, S. et al. (2003). Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training. Journal of Consulting and Clinical Psychology, 71, 330-338. The only randomized study to show exposure statistically superior to EMDR on two subscales (out of 10). This study used therapist assisted "in vivo" exposure, where the therapist takes the person to previously avoided areas, in addition to imaginal exposure and one hour of daily homework (@ 60 hours). The EMDR group used only standard sessions and no homework. * Vaughan, K., Armstrong, M.F., Gold, R., O'Connor, N., Jenneke, W., & Tarrier, N. (1994). A trial of eye movement desensitization compared to image habituation training and applied muscle relaxation in post-traumatic stress disorder. Journal of Behavior Therapy & Experimental Psychiatry, 25, 283-291. All treatments led to significant decreases in PTSD symptoms for subjects in the treatment groups as compared to those on a waiting list, with a greater reduction in the EMDR group, particularly with respect to intrusive symptoms. In the 2-3 weeks of the study, 40-60 additional minutes of daily homework were part of the treatment in the other two conditions. * Wilson, S., Becker, L.A., & Tinker, R.H. (1995). Eye movement desensitization and reprocessing (EMDR): Treatment for psychologically traumatized individuals. Journal of Consulting and Clinical Psychology, 63, 928-937. Three sessions of EMDR produced clinically significant change in traumatized civilians on multiple measures. * 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. Follow-up at 15 months showed maintenance of positive treatment effects with 84% remission of PTSD diagnosis. Ok. This being said, I'm not trying to start a debate on the efficacy of EMDR. What I'm seeking here is a sense of how one goes about deciding which camp to beleive (not only for the EMDR debate, but for any similar debate). Once could stay indecisive, really. But what does one do when there seems to be so much evidence on both sides of the argument? Is one justified to use the technique when there seems to be so much support for it? Is one justified not to use the technique when there is also eveidence against the technique? I'll admit, I have not read some of the the aforementioned articles. These references just came in today. But reading their very short descriptions, on the surface, they seem credible, from credible journals. It's also interesting to note that the articles are published in credible sources. Which means that before being published, the articles are supposed to be peer edited. When I teach basic reasearc skills to the students, I give them the speach on the difference between a magazine and a journal. And the conclusion being that the journal is peer-edited and thus more credible... Again, I'm not pushing for EMDR. I'm simply exploring other people's ways of seeking knowledge... Ok, I'll leave it at this, and see what I get. Cheers! JM --- You are currently subscribed to tips as: [EMAIL PROTECTED] To unsubscribe send a blank email to [EMAIL PROTECTED]