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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. n Failed to consider available studies in support of EMDR. Ironson et al. (2002) Ø Ø Ø ¨ n 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) Ø Ø On all measures EMDR significantly better than control. EMDR produced greater subjective trauma resolution.
2. Excluded studies in support of EMDR for reasons unclear. n Rogers et al. (1999) excluded “did not include a comparison or control group” Ø EMDR vs comparison Exposure group. Ø n Lee et al. , (2002) excluded. “no method of handling drop out reported” Ø Dropout rate less than 10% - 1 from each group. Ø n Wilson et al. (1995) excluded, (1997) overlooked. “Separate results for those with/without PTSD not provided” Ø 1997 - Contains most complete data set and separate analyses Ø EMDR: 84% reduction PTSD diagnoses, 68% symptom reduction Ø
2. Excluded studies in support of EMDR for reasons unclear. Considered to have major limitations: n Rothbaum (1997) “no breakdown of dropout rates” Ø Easy to assume only 1 dropout from EMDR and 2 from control Ø No diagnosis PTSD: EMDR 90% vs Control 12%. Ø n Marcus et al. (1997) “no dropout or completer data reported” and “assessor blinding or independence not reported” Ø 1 participant out of 68 dropped out (<10%). Ø Independence and blinding of evaluator discussed. Ø
3. Misrepresented findings: Failed to acknowledge positive outcomes for EMDR. Carlson et al. (1998) n IOM: “showed no effect posttreatment” n Significant effects for EMDR posttreatment and follow up Ø on Mississippi Scale, BDI, STAI-T. n On all measures EMDR was lower than control posttreatment Ø i. e. CAPS, IES. n Overall PTSD remission: EMDR 77% vs comparison gp 22%.
3. Misrepresented findings van der Kolk et al. (2007) n IOM: “failed to show significant improvement” n Reduction PTSD symptoms: Ø EMDR significantly superior to placebo PT. Ø EMDR superior to Flouxetine at FU. n n Loss of diagnosis PT: EMDR 88% vs placebo 65%. Asymptomatic FU: EMDR 75% and 33% vs Flouxetine 0% Vaughn et al. (1994) n IOM: no “statistically significant benefit” demonstrated. n Reduction PTSD symptoms: EMDR sig. superior to control n Reduction re-experiencing/intrusive symptoms: EMDR significantly superior to comparison.
4. Finding inconsistent with other independent scientific committees IOM finding: “the evidence is inadequate to determine the efficacy of EMDR” n Finding is inconsistent with: 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) Ø Israeli National Council of Mental Health (Bleich et al. , 2002) Ø Cochrane systematic review of EMDR (Bisson & Andrew, 2007) Ø Ø n These committees conclude: There is sufficient evidence to support the efficacy of EMDR in the treatment of PTSD.
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