Re: Initial response

The treatment dosage was never a single short session. Some PTSD is indeed resolved (for a particular trauma) in a single 90 minute session.

In assessing change, the measurement must be of a given trauma. Some assessment instruments measure change against a whole body of symptoms even for people with multiple traumas. This is like asking a dental patient if their mouth is all better after they've had one filling and need a dozen root canals. The measurement has to be appropriate to what's being measured. EMDR will resolve nightmares and flashbacks for a given trauma after, often, a single long session. Many or most clients have a lot of knots in their tapestry.

EMDR is not only effective for clinical PTSD. I am saying, however, that for decades it has been a caution of clinical research that there needs to be a clinical population to get the levels of disturbance that we see in practice. A college population, even if they have had disturbing events, may or may not resemble a clinical population, miserable enough to actually cross my threshold and seek treatment.

When you ask how many sessions are actually required, it depends on the presenting complaint and the number of knots in the tapestry. If a client with a long history of child abuse comes in and just wants a cure from the PTSD since a recent auto accident, that could be a few sessions. However, if the same patient says I'm ready to work on my childhood issues, it could be months or 1-2 years even, only some of which would be EMDR sessions. Depends.

Other presenting complaints are different and there is little research on the subject, only clinical experience on point.

I didn't say, "no one has said it is only eye movements that does the trick", rather I think I said its been a long time since that was the perception of it all. There is a lot of debate over whether it is bilateral stimulation (eye movements, auditory tones or tapping) or dual attention that does the trick. Read Shapiro's second edition for a discussion of this.

To address your final question, there aren't studies that I know of that completely dismantle both the bilateral stimulation vs dual attention question as well as the protocol itself, but both angles seem critical to me. The procedure/protocol itself for standard trauma is so very tight that it is very different from the way I learned behavioral exposure treatments at my ever-so behavioral PhD program (University of Hawaii). That itself is a huge contribution. You know when you are in the exposure and when you aren't, when you are doing EMDR. The bilateral stimulation or dual attention component seems to titrate the affective intensity for many clients. For others, additional affect titration methods are needed to make it manageable, hence the addition of resource development and other interventions that may use imagery. No research, only clinical experience. These latter titration and ego strengthening strategies are not unique to EMDR and are characteristic of many psychological treatments. But the standard protocol is unique because it sheds extraneous detours and provides turbojets for exposure and desensitization. It enables material to be released and processed to an adaptive resolution so that cognitions can spontaneously shift (or shift with the assitance of a cognitive interweave in some individuals).

There needs to be more research, for a fact. Still there is more research on EMDR for PTSD than on any other treatment for PTSD.

Replies:

Re: Initial response, by Tomas Gould, 10/17/02 Re: Initial response, by Sandra Paulsen Inobe, PhD, 10/17/02 Re: Initial response, by Tomas Gould, 10/18/02

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