Reminder

1. Purple Hat Therapy and Chicken HypnosisPSYC 4500: Introduction to Clinical PsychologyBrett Deacon, Ph.D.December 3, 2013

2. Reminder • Please complete course evaluations! • Current response rate: 13/37

3. Very Important Announcement • I have decided NOT to require you to write response papers for the last two readings • I will give all of you full credit for these papers • The Herbert et al. EMDR article is posted; you still need to read the articles, ponder the questions I’ve posted, and come prepared to discuss the articles • The Fox et al. prescriptive authority article is posted in case you’d like to read it

4. Remaining Schedule • Tuesday 12/3: Eye movement desensitization and reprocessing • Herbert et al. article • Thursday 12/5: Meeting with Laura Delano • Final exam: Tuesday, 12/10 at 10:15

5. Readings (Blog Posts) for Class with Laura Delano next Thursday 12/5 • http://www.madinamerica.com/2013/02/reflections-on-a-psychiatric-indoctrination-or-how-i-began-to-free-myself-from-the-cult-of-psychiatry/ • http://www.madinamerica.com/2013/05/mental-illness-the-dsm-5-and-dreams-for-a-post-psychiatry-world/ • http://www.madinamerica.com/2013/09/urge-take-life-decision-take-back-mental-health-system-instead/ • Come prepared with 3 written questions

6. From Last Class • Cognitive and behavioral processes in depression • Cognitive and behavioral treatments for depression

7. Final Exam Review • Readings • Chapters 10-13 • Lilienfeld, Baker et al., Deacon articles • Lilienfeld audio presentation

8. Final Exam Review • Chapter 10: Psychotherapy Research Issues • Goals and types (designs) of psychotherapy research, specific research designs (e.g., open vs. controlled trials, efficacy vs. effectiveness studies) • Controversies: psychotherapy equivalence (Dodo Bird verdict), common factors, relevance of science to practice, empirically supported treatments movement, evidence-based practice, accrediting doctoral clinical psychology programs, potentially harmful therapies, therapist barriers to evidence-based practice (Lilienfeld talk)

9. Final Exam Review • Chapter 11: Psychodynamic Psychotherapy • Basic theory and technique of psychoanalysis and modern psychodynamic therapies • Efficacy and critical analysis of psychoanalytic therapies

10. Final Exam Review • Chapter 12: Humanistic Therapies • Basic theory and technique of client-centered therapy • Efficacy and critical analysis of psychoanalytic therapies

11. Final Exam Review • Chapter 13: Cognitive-Behavioral Interventions • Cognitive and behavioral influences on psychological problems • Cognitive modification procedures (REBT and Beck’s cognitive therapy) • Integrating behavioral and cognitive strategies • Cognitive and behavioral treatment strategies in anxiety and depression • Efficacy and critical analysis of CBT

12. Final Exam Review • EMDR • How the therapy is delivered • Critical analysis

13. The Nature of EMDR • An example media account: http://www.youtube.com/watch?v=zBtqWrs2-K0

14. Eye Movement Desensitization and Reprocessing • What exactly is EMDR? • EMDR has 8 distinct phases (Shapiro & Maxfield, 2002). The first phase has been described as a standard assessment. In this phase, client history, treatment plan, and traumatic triggers are examined. During the second phase or stabilization phase, the therapeutic relationship becomes the center of attention. Clients focus on setting realistic goals, acquiring information about their symptoms, and developing personal resources that will help them through the course of their treatment. Phases three through eight constitute the “EMDR sessions,” during which the therapist encourages their client to recall the physiological and traumatic aspects of a past experience while privately repeating a negative personal statement that the client has come to associate with the traumatic memory. After the memory has been evoked the client will engage in a process of dual stimulation, which entails having the therapist shift a finger left and right for an extended period of time while the client follows the finger with their eyes (other dual stimuli may also be used). After the client has finished following the therapists’ finger with their eyes they are then instructed to blank the traumatic scene from the mind and to take a deep breath. The process is then repeated until significant reductions in anxiety are documented.

15. Eye Movement Desensitization and Reprocessing • EMDR involves: • Trauma-focused imaginal exposure • Trauma-focused cognitive therapy • Trauma-related in vivo exposure

16. The Nature of EMDR • How is EMDR supposed to work? (p. 960) • EMDR is based on a set of theoretical conjectures that rely heavily on physiological concepts closely related to neurological processes. The nature of trauma pathology and its effective treatment is predicated on a model called accelerated information processing (AIP), which is ostensibly akin to a psychological immune system (Shapiro, 1995a, p. 31). Healing is posited to occur after eye movements and other features of the clinical protocol “unlock” the pathological condition. The AIP model defines pathology as “dysfunctionally stored information that can be properly assimilated through a dynamically activated processing system” (Shapiro, 1995a, p. 52). Based on this formulation, the practice of EMDR involves: • “…accessing the dysfunctionally stored information, stimulating the innate processing system through the standardized protocols and procedures (including the bilateral stimulation), and facilitating dynamic linkages to adaptive memory networks, thereby allowing the characteristics of the memory to change as it transmutes to an adaptive resolution” (Solomon & Shapiro, 2008, p. 316). • Scientific appraisal?

17. The Nature of EMDR • Why do you think EMDR has become so popular among therapists? • How has EMDR been marketed in ways that increase its appeal?

18. The Effectiveness of EMDR • How well does EMDR work? • 1. Compared to no treatment/wait-list? • 2. Compared to other established treatments? • From Taylor et al.’s (2003) meta-analysis: “Compared with EMDR and relaxation training, exposure therapy (a) produced significantly larger reductions in avoidance and reexperiencing symptoms, (b) tended to be faster at reducing avoidance, and (c) tended to yield a greater proportion of participants who no longer met criteria for PTSD after treatment. EMDR and relaxation did not differ from one another in speed or efficacy.”

19. The Effectiveness of EMDR • 3. Compared to EMDR without eye movements? • “What can be concluded about EMDR from the observation that component studies generally find that imagery without eye movements is as effective as standard EMDR?”

20. The Effectiveness of EMDR • My conclusion: • The scientific literature on EMDR supports several conclusions: (a) EMDR is an efficacious treatment for PTSD, (b) the efficacy of EMDR is comparable to that of trauma-focused CBT approaches such as PE, and (c) eye movements and other bilateral stimulation techniques are unnecessary and do not uniquely contribute to clinical outcomes. The characteristic procedural feature of EMDR appears therapeutically inert, and the other aspects of this treatment (e.g., imaginal exposure, cognitive reappraisal, in vivo exposure; Shapiro, 1999, 2001) overlap substantially with those emphasized in exposure-based cognitive-behavioral treatments for PTSD. Despite its status as an evidence-based psychotherapy that is recommended as a first-line treatment for PTSD in clinical guidelines (e.g., Department of Veterans Affairs/Department of Defense, 2010), EMDR offers few demonstrable advantages over competing evidence-based psychological treatments and its theoretical model and purported primary active therapeutic ingredient are not empirically supported. Accordingly, the scientific status of EMDR may be summarized as follows: “What is effective in EMDR is not new, and what is new is not effective” (McNally, 1999, p. 619).

21. Is EMDR an EST? • EMDR is regarded as efficacious in the treatment of PTSD in clinical practice guidelines (American Psychiatric Association, 2004; Australian Centre for Posttraumatic Mental Health, 2007; Department of Veterans Affairs/Department of Defense, 2010; National Institute for Clinical Excellence, 2005)

22. Is EMDR an EST? • Evidence-based pseudoscience?

23. EMDR and Purple Hat Therapy “Experience with EMDR demonstrates that current decision rules for determining ESTs are inadequate. Furthermore, the current system makes psychology vulnerable to any treatment innovator or savvy charlatan who puts a novel method through a single randomized controlled trial with a no-treatment comparison. Hypothetically, a doctor could ask clients with driving phobias to wear a large purple hat while applying relaxation and cognitive coping skills to in vivo practice. The practitioner places a band of magnets in the purple hats, claiming that particular algorithms for positioning the magnets are determined by age, sex, and personality structure of the client. When properly placed, so the practitioner claims, the magnets reorient energy fields, accelerate information processing, improve interhemispheric coherence, and eliminate phobic avoidance. The inventor might call his method “purple hat therapy” (PHT) or “electro Magnetic Desensitization and Remobilization” (eMDR), conduct a single RCT against no treatment, and apply for listing as an EST.” -Rosen & Davidson (2003)

24. Chicken Hypnosis

25. Methods of Hypnotizing a Chicken • Oscillating finger method • Sternum stroke method • Chalk line method Tolin (2009)

26. Problems with Chicken Hypnosis • Can chickens really be hypnotized? • What is actually occurring in a “hypnotized” chicken? • What do each of these chicken hypnosis techniques have in common?

27. What Does Chicken Hypnosis Have to do with EMDR? • Characteristic (but inert feature) • Incidental (but active) feature Tolin (2009)

28. Chicken Hypnosis and EMDR What are the characteristic and incidental features of EMDR?

29. EMDR Therapist Survey • N = 196 EMDR therapists, recruited from EMDR Institute website discussion list • M age = 57.1 years, 75.5% women • Degree: 25% social workers, 33% psychologists, 25% other masters-level therapists • Average years providing EMDR = 11.4, 76% officially certified in EMDR Deacon, Hipol, Lickel, & Carruthers (in preparation)

30. Use of EMDR for Mental Health Problems

31. Therapist Beliefs about EMDR

32. Therapist Beliefs about EMDR

33. Therapist Beliefs about EMDR

34. Informed Consent and Use of EMDR for Disorders Other than PTSD • Second therapist survey • N = 129 EMDR certified therapists, 85.2% women, 75.% with master‘s degree • Asked the following questions: “When providing EMDR for ____ (disorder) do you inform clients that EMDR is as effective, or more effective, than other available treatments?” • “….that other available treatments have more scientific evidence supporting their effectiveness for_____ (disorder) than EMDR?”

35. EMDR and Informed Consent

36. Why Does This Matter? • Why does the construct validity of EMDR matter? • EMDRIA therapist directory: http://www.emdria.org/displaycommon.cfm?an=1&subarticlenbr=235

37. Announcement #1 • Spring Outreach online class

38. Announcement #2 • University of Wollongong (Australia)