Flooding versus eye movement desensitization and reprocessing therapy: Relative efficacy has yet to be investigated - Comment on pitman et al. (1996)

Pitman et al. recently published a pair of studies on the relationship between indicators of emotional processing and outcome in flooding therapy (Compr Psychiatry 1996;37:409-418) and eye movement desensitization and reprocessing therapy (EMDR; Compr Psychiatry 1996;37:419-429). Among their conclusions, they asserted EMDR was found to be at least as effective flooding in the treatment of combat-related posttraumatic stress disorder (PTSD) and produced fewer adverse consequences. Although this research constitutes an important contribution to the literature on psychosocial treatments for PTSD, their conclusions regarding the relative effectiveness of these two treatments are unwarranted. The bases of our objections are that (1) assignment of participants to treatment conditions was nonrandom, and (2) several significant procedural differences existed between the two studies in addition to the specific treatments under investigation. These include different inclusion and exclusion criteria, the confounding of psychological treatment with psychiatric medication status, and differences in assessment procedures. Since the two treatments were not compared in a single head-to- head controlled trial, we conclude that their relative efficacy has yet to be investigated.