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A Summary of
Errors and Omissions
A response to the Institute of Medicine report commissioned
by the DVA to assess the scientific evidence on treatment
modalities for PTSD.
Compiled by Dr Chris Lee chairperson EMDRIA research
committee
The IOM committee concluded:
“The evidence is inadequate to determine the
efficacy of EMDR in the treatment of PTSD.”
This conclusion is erroneous as the report:
1. Failed to consider available studies in support of EMDR.
2. Considered, but excluded studies in support of EMDR for
reasons unclear.
3. Misrepresented findings of cited studies.
4. Finding is not consistent with conclusions of other
independent scientific committees.
1.
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Failed to consider available studies in
support of EMDR.
Ironson et al. (2002)
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Compared EMDR to Prolonged Exposure.
Both treatments produced significant reductions in PTSD.
EMDR attained more rapid reductions of symptoms
70% symptom reduction after 3 sessions: EMDR 70% vs PE 22%
Edmond et al. (1999/2004)
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On all measures EMDR significantly better than control.
EMDR produced greater subjective trauma resolution.
2.
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Excluded studies in support of EMDR
for reasons unclear.
Rogers et al. (1999) excluded
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Lee et al., (2002) excluded.
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“did not include a comparison or control group”
EMDR vs comparison Exposure group.
“no method of handling drop out reported”
Dropout rate less than 10% - 1 from each group.
Wilson et al. (1995) excluded, (1997) overlooked.
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“Separate results for those with/without PTSD not provided”
1997 - Contains most complete data set and separate analyses
EMDR: 84% reduction PTSD diagnoses, 68% symptom reduction
2.
Excluded studies in support of EMDR
for reasons unclear.
Considered to have major limitations:
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Rothbaum (1997)
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“no breakdown of dropout rates”
Easy to assume only 1 dropout from EMDR and 2 from control
No diagnosis PTSD: EMDR 90% vs Control 12%.
Marcus et al. (1997)
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“no dropout or completer data reported” and “assessor blinding
or independence not reported”
1 participant out of 68 dropped out (<10%).
Independence and blinding of evaluator discussed.
3.
Misrepresented findings:
Failed to acknowledge positive outcomes for EMDR.
Carlson et al. (1998)
 IOM: “showed no effect posttreatment”
 Significant effects for EMDR posttreatment and follow up
 on Mississippi Scale, BDI, STAI-T.
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On all measures EMDR was lower than control posttreatment
 i.e. CAPS, IES.
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Overall PTSD remission: EMDR 77% vs comparison gp 22%.
3. Misrepresented findings
van der Kolk et al. (2007)
 IOM: “failed to show significant improvement”
 Reduction PTSD symptoms:
 EMDR significantly superior to placebo PT.
 EMDR superior to Flouxetine at FU.
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Loss of diagnosis PT: EMDR 88% vs placebo 65%.
Asymptomatic FU: EMDR 75% and 33% vs Flouxetine 0%
Vaughn et al. (1994)
 IOM: no “statistically significant benefit” demonstrated.
 Reduction PTSD symptoms: EMDR sig. superior to control
 Reduction re-experiencing/intrusive symptoms: EMDR
significantly superior to comparison.
4.
Finding inconsistent with other
independent scientific committees
IOM finding:
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Finding is inconsistent with:
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“the evidence is inadequate to
determine the efficacy of EMDR”
Australian Centre for Post Traumatic Mental Health (2007)
UK National Institute for Clinical Excellence (2005)
American Psychiatric Association (2004)
Dutch National Steering Committee for Guidelines for Mental Health
Care (2003)
Israeli National Council of Mental Health (Bleich et al., 2002)
Cochrane systematic review of EMDR (Bisson & Andrew, 2007)
These committees conclude: There is sufficient evidence to
support the efficacy of EMDR in the treatment of PTSD.
References
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Bisson, J., and Andrew, M. (2007). Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews, Issue 4.
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Taylor, S., Thordarson, D.S., Maxfield, L., Fedoroff, I.C., Lovell, K., Ogrodniczuk, J. (2003). Comparative efficacy, speed, and adverse effects of three PTSD treatments:
exposure therapy, EMDR, and relaxation training. Journal of Consulting and Clinical Psychology, 71, 330-8.
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.
van der Kolk, B.A., Spinazzola, J., Blaustein, M.E., Hopper, J.H., Hopper, E.K., Korn, D.L., & Simpson, W.B. (2007). A randomized clinical trial of eye movement
desensitization and reprocessing (EMDR), fluoxetine, and pill placebo in the treatment of posttraumatic stress disorder: treatment effects and long-term maintenance.
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