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emdrhypno July 28th, 2007 11:40 AM

ABS/BLS/DAS evidence
Recently I had a client challenge me to provide evidence that bilateral stimulation provides anything other than access to a trance state induced by the placebo effect. I realized, when challenged, that I honestly had no evidence. This is a bit concerning for me! Not that I deny EMDR is helpful. I've seen it help the vast majority of my clients in ways they didn't think were possible. The stuff really works. But when I look online it seems that a vast hole in the research exists in terms of proving that alternating bilateral stimulation affects outcome one way or the other. I am trained in hypnosis, and it makes complete sense to me that if I set up expectation that some rather bizarre activity will provide access to an altered state, and the client buys in, then said bizarre activity will provide access to that particular altered state. But as important as it is for me to help clients heal, it is also important to me that I be honest with them. I feel like a bit of a snake oil salesman if I tell them that this funny little machine I have actually does something neurologically if I cannot back that up with evidence. Anyone know something I don't on this topic? If someone could point me in the direction of a study that addresses this issue I'd appreciate it.

Sandra Paulsen July 29th, 2007 06:19 PM

Re: ABS/BLS/DAS evidence
The following is from the website, Frequently Asked Questions.

In 1989, Francine Shapiro (1995) noticed that the emotional distress accompanying disturbing thoughts disappeared as her eyes moved spontaneously and rapidly. She began experimenting with this effect and determined that when others moved their eyes, their distressing emotions also dissipated. She conducted a case study (1989b) and controlled study (1989a), and her hypothesis that eye movements (EMs) were related to desensitization of traumatic memories was supported. The role of eye movement had been previously documented in connection to cognitive processing mechanisms. A series of systematic experiments (Antrobus, 1973; Antrobus, Antrobus, & Singer, 1964) revealed that spontaneous EMs were associated with unpleasant emotions and cognitive changes.
There have been 20 published studies that investigated the role of EMs in EMDR. Studies have typically compared EMDR-with-EMs to a control condition in which the EM component was modified (e.g., EMDR-with-eyes-focused-and-unmoving). There have been four different types of studies: (1) case studies, (2) dismantling studies using clinical participants (3) dismantling studies using nonclinical analogue participants, and (4) component action studies in which eye movements are examined in isolation.

Case studies. Four case studies evaluated the effects of adding EMs to the treatment process, and three demonstrated an effect for EMs. Montgomery and Ayllon (1994) found eye movements to be necessary for EMDR treatment effects in five of six civilian PTSD patients. They wrote that the addition of the eye movement component “resulted in the significant decreases in self-reports of distress previously addressed. These findings are reflected by decreases in psycho-physiological arousal” (Montgomery & Ayllon, 1994, p. 228). Lohr, Tolin, and Kleinknecht (1995) reported that “the addition of the eye movement component appeared to have a distinct effect in reducing the level of [SUD] ratings” (p. 149). When Lohr, Tolin and Kleinknecht (1996) treated two claustrophobic subjects, substantial changes in disturbance ratings were achieved only after EMs were added to an imagery exposure procedure that used the brief frequent exposures of EMDR. The fourth study (Acierno, Tremont, Last, & Montgomery, 1994) did not use standard EMDR protocol for phobias, nor the standard procedures for accessing the image, formulating the negative belief, or eliciting new associations. In addition, the client was instructed to relax between sets of EMs until the SUD rating was reduced to baseline, a procedure not used in EMDR. The procedures used in this study did not eliminate the phobia and no effect was found for the EM condition.

Clinical dismantling studies with diagnosed participants. There have been four controlled dismantling studies with PTSD participants, and two studies where participants were diagnosed with other anxiety disorders. These studies have tended to show that EMDR-with-EMs was slightly better than EMDR-with-modification; however such comparisons have not usually been statistically significant, and results are equivocal. For example, Devilly et al. (1998) reported rates of reliable change of 67% for the EM condition, compared to 42% of the non-EM condition; Renfrey and Spates (1994) reported a decrease in PTSD diagnosis of 85% for EM conditions and 57% for the non-EM group. These studies unfortunately are limited by severe methodological problems, including inadequate statistical power. For example, there were seven or eight persons per condition in the Renfrey and Spates (1994) PTSD study. The participants in the other three PTSD (Boudeywns & Hyer, 1996; Devilly et al., 1998; Pitman et al., 1996) studies were combat veterans, who received only two sessions or treatment of only one traumatic memories. Such an inadequate course of treatment produced only moderate effect sizes; therefore a large sample would be required to provide adequate statistical power for the detection of any possible differences between groups. There has yet to be a single rigorous dismantling study with a sample adequate to assess treatment effects.

Clinical dismantling studies with analogue participants. The controlled studies that used analogue participants with nonclinical anxiety found no effect for EMs. There are many problems with these analogue studies, which typically used normal college student participants. The EMDR protocol was often truncated (e.g., Carrigan & Levis, 1999; Sanderson & Carpenter, 1992), resulting in poor construct validity and making interpretation of results problematic. It is also unlikely that the responses of analogue participants can be generalized to persons with chronic PTSD, a disorder that appears resistant to placebo effects (Solomon, Gerrity, & Muff, 1992; Van Etten & Taylor, 1998). Analogue participants responded well to EMDR-without-EMs, a procedure which contains a number of active components. The minimal distress of the analogue participants was relieved with minimal treatment, and the assessment of differences between the EM and nonEM conditions was limited by a floor effect. Consequently it may not have been possible to detect differences between conditions.

Component action studies. Component action studies test EMs in isolation. These studies typically provide brief sets of EMs (not EMDR) to examine their effects on memory, affect, cognition, or physiology. The purpose is to investigate the effects of moving the eyes (not EMDR), and EMs are compared to control conditions such as imaging and tapping. For example, a participant might be asked to visualize a memory image, then to move their eyes for a brief period ,and then to rate the vividness of the image. This permits a pure test of the specific effects of EMs and non-EMs without the added effects of the active ingredients of the other EMDR procedures. The studies have generally used nonclinical participants and a within-subject design, that compares the differences in each individual’s responses to the various conditions. This reduces the variance of subjective responding, and eliminates possible floor effects.

Findings from these studies suggest that EMs may have an effect on physiology, decreasing arousal (e.g., Barrowcliff et al., in press; D. Wilson et al., 1996) on attentional flexaility (Kuiken, Bears, Miall & Smitth (2001-2001) and on memory processes, enhancing semantic recall (Christman et al., in press). Four studies (Andrade, Kavanagh, & Baddeley, 1997; Kavanaugh, Freese, Andrade, & May, 2001; Sharpley et al., 1996; van den Hout, Muris, Salemink, & Kindt, 2001) have demonstrated that EMs decrease the vividness of memory images and the associated emotion. No (or minimal) effect has been found for tapping conditions. These studies suggest that EMs may make a contribution to treatment by decreasing the salience of the memory and its associated affect. (See discussion below on mechanisms of action).

Much confusion tends to result when the outcomes of the three types of component studies (see What has research determined about EMDR's eye movement component) are combined. Because these studies differ substantially in design, purpose, participants, and outcome measures, they have produced a wide range of results: (1) In dismantling studies with analogue participants, EMs do not contribute to outcome, possibly because of a floor effect. (2) In clinical dismantling studies with diagnosed participants, there has been a consistent nonsignificant trend for a treatment effect. (3) In the component action studies a consistent significant effect for EMs in isolation was found in reducing the vividness of, and affect associated with, autobiographical memories; it is possible that such effects may contribute to treatment outcome. In the Davidson and Parker (2001) meta-analysis, no effects were found for EMDR-with-EMs compared to EMDR-without-EMS, when all types of studies were included. However, when the results of the clinical dismantling studies were examined, EMDR-with-EMs was significantly superior to EMDR-without-EMs.

Various reviews of the related EM research have provided a range of conclusions. Some reviewers (e.g., Lohr, Lilienfeld, Tolin, & Herbert, 1999; Lohr, Tolin, & Lilienfeld, 1998) stated that there is no compelling evidence that eye movements contribute to outcome in EMDR treatment and the lack of unequivocal findings has led some reviewers to dismiss EMs altogether (e.g., McNally, 1999). Other reviewers (e.g., Chemtob et al., 2000; Feske, 1998; Perkins & Rouanzoin, 2002) identified methodological failings (e.g., lack of statistical power, floor effects) and called for more rigorous study.

Numerous controlled studies have also indicated that eye movements cause a decrease in imagery vividness and distress, as well as increased memory access.

Andrade, J., Kavanagh, D., & Baddeley, A. (1997).
Eye-movement and visual imagery: a working memory approach to the treatment of post-traumatic stress disorder. British Journal of Clinical Psychology, 36, 209-223.
Barrowcliff, A.L., Gray, N.S., MacCulloch, S. Freeman, T.C.A., & MacCulloch, M.J. (in press).
Horizontal rhythmical eye-movements consistently diminish the arousal provoked by auditory stimuli. British Journal of Clinical Psychology.
Christman, S.D., Garvey, K.J., Propper, R.E. & Phaneuf, K.A. (in press).
Bilateral eye movements enhance the retrieval of episodic memories. British Journal of Clinical Psychology, 40, 267-280.
Kavanaugh, D.J., Freese, S., Andrade, J., & May, J. (2001).
Effects of visuospatial tasks on desensitization to emotive memories. British Journal of Clinical Psychology, 40, 267-280.
Kuiken, D., Bears, M., Miall, D., & Smith, L. (2002-2002).
Eye movement desensitization reprocessing facilitates attentional orienting. Imagination, Cognition and Personality, 21, (1), 3-30.
Sharpley, C.F., Montgomery, I.M., & Scalzo, L.A. (1996).
Comparative efficacy of EMDR and alternative procedures in reducing the vividness of mental images. Scandinavian Journal of Behaviour Therapy, 25, 37-42.
van den Hout, M., Muris, P., Salemink, E., & Kindt, M. (2001).
Autobiographical memories become less vivid and emotional after eye movements. British Journal of Clinical Psychology, 40, 121-130.

See also: What research determined about EMDR's eye movement component

Suggested research. Research is needed to answer questions about the role of EMs and other dual attention stimuli. It is recommended that clinical dismantling studies use a large sample of participants with PTSD (from a single trauma) to investigate whether EMDR-with-EMs is more effective than EMDR-without-dual attention stimuli. To date, no study like this has been conducted. (See Shapiro, 2001, for specific recommendations for research designs.)

hypothesized mechanisms of action for eye movements in EMDR

A commonly proposed hypothesis is that dual attention stimulation elicits an orienting response. The orienting response is a natural response of interest and attention that is elicited when attention is drawn to a new stimulus. There are three different models for conceptualizing the role of the orienting response in EMDR: cognitive/information processing (Andrade et al., 1997; Lipke, 1999), neurobiological (Bergmann, 2000; Servan-Schreiber, 2000; Stickgold, 2002) and behavioral (Armstrong & Vaughan, 1996; MacCulloch & Feldman, 1996). These models are not exclusive; to some extent, they view the same phenomenon from different perspectives. Barrowcliff et al. (2001) posit that the orienting in EMDR is actually an “investigatory reflex,” that results in a basic relaxation response, upon determination that there is no threat; this relaxation contributes to outcome through a process of reciprocal inhibition. Others suggest that the inauguration of an orienting response may disrupt the traumatic memory network, interrupting previous associations to negative emotions, and allowing for the integration of new information. A study by Kuiken, Bears, Miall & Smitth (2001-2002) which tested the orienting response theory indicated that the eye movement condition was correlated with increased attentional flexibility. It is further possible that the orienting response induces neurobiological mechanisms, which facilitate the activation of episodic memories and their integration into cortical semantic memory (Stickgold, 2002). This theory has recently received experimental support (Christman and Garvey, in press). Further research is needed to test these hypotheses.

There are several research studies (e.g., Andrade et al., 1997; Kavanaugh et al., 2001; van den Hout et al., 2001) indicating that EMs and other stimuli have an effect on perceptions of the targeted memory, decreasing image vividness and associated affect. Two possible mechanisms have been proposed to explain how this effect may contribute to EMDR treatment. Kavanaugh et al. (2001) hypothesize that this effect occurs when EMs disrupt working memory, decreasing vividness, and that this results in decreased emotionality. They further suggest that this effect may contribute to treatment as a “response aid for imaginal exposure” (p. 278), by titrating exposure for those clients who are distressed by memory images and/or affect. Van den Hout et al. (2001) hypothesize that EMs change the somatic perceptions accompanying retrieval, leading to decreased affect, and therefore decreasing vividness. They propose that that this effect “may be to temporarily assist patients in recollecting memories that may otherwise appear to be unbearable” (p. 129). This explanation has many similarities to reciprocal inhibition.

Suggested research. Research investigating mechanisms of action should be driven by hypotheses, with outcomes evaluated in relation to the hypothesis being tested. (See Shapiro 2001, for examples of suggested research designs

emdrhypno July 29th, 2007 06:34 PM

Re: ABS/BLS/DAS evidence
Thanks, Sandra.

Sandra Paulsen July 29th, 2007 10:50 PM

And about hypnosis.....
Here's a bit more from the website:

Is EMDR the same as hypnosis..what are the differences/similarities?
The American Journal of Hypnosis published a special issue on the use of EMDR and hypnosis. An introductory article by the editor and past president of the American Association of Clinical Hypnosis directly addressed the issue: "While it has been argued against categorizing hypnosis as a specific type of treatment method (e.g., Fischolz, 1995; 1997a; 1997b; 2000; Fischholz & Spiegel, 1983), this is not the case for EMDR. Like psychoanalysis, EMDR is both an evolving theory about how information is perceived, stored and retrieved in the human brain and a specific treatment method based on this theory (Shapiro, 1995, 2001). In fact, EMDR is a very unique treatment method, which like other types of treatment/methods/techniques (e.g. psychoanalytic/psychodynamic therapy, behavior, cognitive-behavioral therapy, ego-state therapy) can also be incorportated with hypnosis (Hammond, 1990).

We note there are some distinctive differences between hypnosis and EMDR, which we would like to briefly highlight. First, one of the major uses of hypnosis among clinical practitioners is to deliberately begin by inducing in the patient an altered state of mental relaxation. In contrast, when beginning EMDR mental relaxation is not typically attempted. In fact, deliberate attempts are often actually made to connect with an anxious (i.e. an emotionally disturbing as opposed to relaxed) mental state.

Second, therapists often use hypnosis to help a patient develop a single, highly focused state of aroused receptivity (Spiegel & Spiegel, 1978). In contrast, with EMDR attempts are made to maintain a duality of focus on both positive and negative currently held self-referencing beliefs, as well as the emotional arousal brought about by imaging the worst part of a disturbing memory. However, in this sense, EMDR does have a similarity to Spiegel's (Spiegel & Spiegel, 1978) split-screen cognitive restructuring technique.

Third, one of the proposed effects of hypnotizing a person is that they will have a decrease in their generalized reality orientation (GRO: Shor, 1979). This induced decrease in a person's GRO is often utilized in order to promote an increase in fantasy and imagination, perhaps by capitalizing on an increase in trance logic (Orne, 1977). In contrast, in EMDR attempts are made towards repeatedly grounding the patient by referencing current feelings and body sensations to prevent the patient from drifting away from reality. Specific encouragement/inducement is made towards rejecting previously irrational/self-blaming beliefs in favor of a newly, reframed positive belief with an increase in subjective conviction about that belief. Shapiro and Forrest (1997) and Nicosia (1995) have also noted additional differences between hypnosis and EMDR.

emdrhypno July 30th, 2007 10:46 AM

Re: ABS/BLS/DAS evidence
Great. Very helpful!

Sandra Paulsen July 30th, 2007 05:55 PM

Re: ABS/BLS/DAS evidence
The Nicosia article in 1995, though it had a small sample size, found different brain waves in hypnosis than in EMDR.

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