A Summary of Errors and Omissions

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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
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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
• Failed to consider available studies in support
  of EMDR.
• Considered, but excluded studies in support of
  EMDR for reasons unclear.
• Misrepresented findings of cited studies.
• Finding is not consistent with conclusions of
  other independent scientific committees.

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Failed to consider available studies in support
of EMDR.

• Ironson et al. (2002)
• 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)
• On all measures EMDR significantly better than
  control.
• EMDR produced greater subjective trauma
  resolution.

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2. Excluded studies in support of EMDR for
reasons unclear.

• Rogers et al. (1999) excluded
• did not include a comparison or control group
• EMDR vs comparison Exposure group.
• Lee et al., (2002) excluded.
• no method of handling drop out reported
• Dropout rate less than 10 - 1 from each group.
• Wilson et al. (1995) excluded, (1997) overlooked.
• 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

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2. Excluded studies in support of EMDR
for reasons unclear.

• Considered to have major limitations
• Rothbaum (1997)
• 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)
• no dropout or completer data reported and
  assessor blinding or independence not reported
• 1 participant out of 68 dropped out (lt10).
• Independence and blinding of evaluator discussed.

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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.
• On all measures EMDR was lower than control
  posttreatment
• i.e. CAPS, IES.
• Overall PTSD remission EMDR 77 vs comparison gp
  22.

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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.
• 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.

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4. Finding inconsistent with otherindependent
scientific committees

• IOM finding the evidence is inadequate
  to
  determine the efficacy of EMDR

• 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)
• 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.

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References

• American Psychiatric Association (2004).
  Practice Guideline for the Treatment of Patients
  with Acute Stress Disorder and Posttraumatic
  Stress Disorder. Arlington, VA American
  Psychiatric Association Practice Guidelines.
• Australian Centre for Posttraumatic Mental
  Health. (2007). Australian guidelines for the
  treatment of adults with acute stress disorder
  and post traumatic stress disorder. Melbourne,
  Victoria ACPTMH.
• Bisson, J., and Andrew, M. (2007). Psychological
  treatment of post-traumatic stress disorder
  (PTSD). Cochrane Database of Systematic Reviews,
  Issue 4.
• Bleich, A. et al (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. Jerusalem, Israel.
• Carlson, J., Chemtob, C.M., Rusnak, K., Hedlund,
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• Dutch National Steering Committee Guidelines
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• Edmond, T., Rubin, A., Wambach, K. (1999). The
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• Edmond, T., Sloan, L., McCarty, D. (2004)
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• Lee, C., Gavriel, H., Drummond, P., Greenwald,
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• Marcus, S., Marquis, P. Sakai, C. (1997).
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• Rogers, S., Silver, S., Goss, J., Obenchain, J.,
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• Rothbaum, B. (1997). A controlled study of eye
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• Rothbaum, B.O., Astin, M.C., Marsteller, F.
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