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EMDR debate
- Thread starter cara susanna
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Careful
-20 behaviorist points for each of the yellow highlighted phrases!
Just think of it as a behaviorist breaking to the cool kid's club of neuropsychology and neuroscience. Behavioral Neurology looks at this kind of stuff....it's pretty much the melding of some of my favorite topics within the field. The combo is actually a great pairing because so much of the lab work involves behaviorist-friendly research designs, just with a science twist.
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Careful
-20 behaviorist points for each of the yellow highlighted phrases!
Perhaps it would help to clarify that I consider myself to be a 3rd wave behaviorist, not a strict old-school one. So, I do acknowlege the existence of cognitive processes
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Perhaps it would help to clarify that I consider myself to be a 3rd wave behaviorist, not a strict old-school one. So, I do acknowlege the existence of cognitive processes
3rd wave behaviorist? I was a New Wave Behaviorist, back in my youth, with an asymmetrical hair cut, skinny pink tie, and a penchant for the guitar-synth! (I take it from the
that you understand that I was just joking in my previous post)As to those pesky cognitive processes- unfortunately they do exist, and they often get inserted where they don't belong, like into all the unfalisifiable theories about the mechanisms behind EMDR.
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3rd wave behaviorist? I was a New Wave Behaviorist, back in my youth, with an asymmetrical hair cut, skinny pink tie, and a penchant for the guitar-synth! (I take it from the
As to those pesky cognitive processes- unfortunately they do exist, and they often get inserted where they don't belong, like into all the unfalisifiable theories about the mechanisms behind EMDR.
Again I find myself wishing there was a "like" button for this entire post. I will have to settle for
.To change topics somewhat, I'm surprised the majority of posters on this thread are vehemently against EMDR. Where are all the staunch proponents? One poster asked whether it may have a regional following. I live in the northeast and there was a psychologist practicing EMDR at the VA where I did my externship. Nobody on staff seemed to give it a second thought, though I personally found it irritating.
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Again I find myself wishing there was a "like" button for this entire post. I will have to settle for
To change topics somewhat, I'm surprised the majority of posters on this thread are vehemently against EMDR. Where are all the staunch proponents? One poster asked whether it may have a regional following. I live in the northeast and there was a psychologist practicing EMDR at the VA where I did my externship. Nobody on staff seemed to give it a second thought, though I personally found it irritating.
As I mentioned before, I had a number of patients who came from EMDR folks, and I'd often have to call to get info, which was always an experience. They'd ask my approach, and then I'd usually get a pitch like I was talking to a Scientologist.
I'm SOOOO happy I don't do therapy anymore, as I avoid most of these junk interventions now.I think the most frustrating thing is that if you read through the EMDRIA materials it all comes off as "research supported", but if you actually read what they are saying (and the original citations)...it doesn't hold up. The average healthcare person might read an abstract, but that doesn't hint at the junk science.
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Again I find myself wishing there was a "like" button for this entire post. I will have to settle for
To change topics somewhat, I'm surprised the majority of posters on this thread are vehemently against EMDR. Where are all the staunch proponents? One poster asked whether it may have a regional following. I live in the northeast and there was a psychologist practicing EMDR at the VA where I did my externship. Nobody on staff seemed to give it a second thought, though I personally found it irritating.
Yeah- not a lot of supporters here. I live in the Northeast as well (in a particlularly "new-agey" area), and find that it is referenced occasionally by clinicians who may have went to a conference presentation and now think they're EMDR experts. Most of these clinicians, however, spend most of their time doing what they call DBT or "mindfulness" work (which they also learned about in a one hour seminar). I've yet to meet any therapist who claims to do any of these "acronym" therapies (even the ones with good empirical support, like DBT and ACT) who actually received the real, formal, supervised training. Drives me crazy!
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Problem is, there is a lot of non junk-science research that indicates that EMDR does work, often as well as exposure-based treatments. So, in that sense, it really is not dishonest to say that there is research support for the effectiveness of EMDR. What there is not good support for is the assertion that the eye-movement part has anything to do with the success, any "reprocessing" (whatever that is) has taken place, or that the effects are related to anything more than a classical extinction paradigm.
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At least 90% of the time when I hear a clinician does primarily "Mindfulness work . I cringe. I have met a couple of clinicians that actually have a strong training in mindfulness and relate areas, but the rest are the 'new-agey' types that dont know what they dont know.
As for DBT....very few people actually follow a true DBT model. I spent a year working at a DBT Informed treatment program for substance abuse, but they were very clear about it being multimodal and not a true DBT model program. I didnt mind though because I didnt want to be tethered to a cell phone and available certain nights/weekends to cover crisis calls.
That really isnt any different than taking some nutraceutical wonder drug, combined with diet & exercise .and saying that a person lost weight because of the wonder drug. At the end of the day the diet & exercise is what worked .not the wonder drug/treatment. I believe it is unethical to represent the data any other way.
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Yeah, that's the danger with newer therapies in general, I think. If they are at all intuitive, it is easy for people to think they've picked up on all they need to know after reading a book chapter/going to a conference presentation. I have to wonder what these practitioners of EMDR-lite actually do in the therapy room...same with mindfulness-lite for that matter.
I was trying to craft a pun on EMDR-lite/EMDR-light, but couldn't figure out how to do it without being confusing.
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In all fairness, it's becoming extremely difficult to become certified in DBT. And, yeah, very few places actually follow the full, traditional model.
3rd wave behaviorist? I was a New Wave Behaviorist, back in my youth, with an asymmetrical hair cut, skinny pink tie, and a penchant for the guitar-synth! (I take it from the
As to those pesky cognitive processes- unfortunately they do exist, and they often get inserted where they don't belong, like into all the unfalisifiable theories about the mechanisms behind EMDR.
I was a Cold-Wave cognitivist-all black and assymetrical hair-cut as well, similar but slightly different "musical school of thought" (i used to know some dark-wave psychodynamist and no-wave humanist as well)
Its all about the hipster Chillwave DBT-medidative stuff now though. Kids these days
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Wow, a no-wave humanist. No melodic component to the therapy, and careful use of screwdrivers and other such instruments to affect different patient outcomes.
...we digress from the topic of the OP- sorry.
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Yes, but i wonder if "eye-movement" trully adds nothing. I don't know, but when i create a mental image, eye-movement seems to interfere more with the image than say repeatetive-hand tapping (i'm not sure with the "maze" since a complex maze would need "planning ahead" within a visuo-spatial mode and hence could be more interfering). I wonder if this interfernece has something to do with anxiety reduction which is associated to the original mental-image. Maybe the "dual-tasking" literature could have some relevance to this exposure stuff? Has anyone done any research on this? E.g. the degree of intereference from, say visuo-spatial dual-tasking having an effect on recalled long-term memory (and its' associated components like emotions/stress?) Is there any research?
I read the NY Times presentation and comments. There are a couple of points worth noting. First, almost all of the research on EMDR has not been conducted by Shapiro - while she did do a study in 1989, the research replicating her initial findings (and that's about 16 studies so far) has all been done by others. Second, agencies with no axe to grind have reviewed the research and found it corroborates the position that EMDR is effective in the treatment of psychological trauma - these agencies include the US Depts. of Defense and Veterans Affairs, the Clinical Div. of the APA, the Amer. Psychiatric Assoc., the mental health boards of the UK, Israel, Italy, and numerous others. Third, despite what has been said here, there are a large number of studies on the role of eye movements that show that they have an effect on memory recall and intensity of memory among other things. Fourth, even research conducted by exposure therapy proponents has found that EMDR is as effect as PE/CBT but works more efficiently even though it violates the research-proven active ingredient of exposure, attention-held habituation. I suggest reading the article and examining the research referenced by Shapiro (and those agencies I mentioned) for yourself rather than rely on the opinions of others including me. I have to admit I was extremely skeptical of EMDR when it first appeared (Trained in both cognitive therapy and behavioral therapy, I assumed it was a hoax and so told the editor of the journal that published Shapiro's research) but participation in research on it as well as clinical practice with it over the past 20 years, while leaving me empathetic for the skepticism of the commentators here, leads me to suggest checking it out.
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Nine studies have compared EMDR therapy to CBT. Four of the nine studies found EMDR to achieve positive effects in fewer sessions than the TF-CBT condition (de Roos et al., 2011; Ironson et al., 2002; Jaberghaderi et al., 2011; Nijdam et al. 2012). Also, standard TF-CBT necessitates a detailed description of the trauma memory and daily homework, while standard EMDR uses neither. Additionally, two studies (Ironson et al., 2001, Rogers et al. 1999) compared single sessions of EMDR and PE and found a different response pattern. The SUD in the EMDR condition decreased, while increasing in the PE condition. In addition, more than twenty randomized trials in the past decade have demonstrated positive effects of the eye movements.
I suggest that you carefully investigate the evidence before dismissing EMDR therapy. As someone who has used both CBT and EMDR therapy I can say they are quite different. And after 30+ years as a psychologist, I can also say that EMDR achieves results unlike any other method/theory/orientation I have used.
Interesting that the few posts from folks who have experienced EMDR first-hand, and been helped, have been pretty much ignored. And yes, penicillin, aspirin, and still most anti-depressants have unknown mechanisms of action.
I suggest that you carefully investigate the evidence before dismissing EMDR therapy. As someone who has used both CBT and EMDR therapy I can say they are quite different. And after 30+ years as a psychologist, I can also say that EMDR achieves results unlike any other method/theory/orientation I have used.
Interesting that the few posts from folks who have experienced EMDR first-hand, and been helped, have been pretty much ignored. And yes, penicillin, aspirin, and still most anti-depressants have unknown mechanisms of action.
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It's also interesting that two first-time posters, both declaring long first-hand experience with EMDR, both psychologists, write very similar things within 30 minutes of each other. I take it this thread was forwarded to an EMDR group of some sort?
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We all have pubmed and we can all read studies. Thats obviously not what this debate is about.
Based on your statement above, I think you have fallen into the trap that we have all been talking about...and what many of us find so offputting about the packaging of EMDR. The "come to jesus (not litterally jesus)" attitude its proponets often display and the rather unsceintific enthusiasm for it, combined with neurobabble that is largely dismissed by mainstream neuropsychologists and neuroscientists is the perfect way to undermine your product in the scientific/academic community. Hence, there is alot of skeptism about it when we look the more parsimonous and better understood alternative treatment models (e.g., PE).
The studies showing poor relapse rates had very few subjects, did not follow the standard EMDR protocol, or had no fidelity checks. To the contrary, methodologically well done studies with follow--up measurements up to 13 months later show continued improvement after treatment.
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candid, canarycoalmine, et al. Can you please explain the neuroanatomical basis of EMDR...as it is only vaguely referenced below in the EMDRIA's explanation of it. Don't worry about dumbing it down for me, I know my way around the brain.
I wish I had attended one of the EMDR trainings way back when, as it probably would have been an interesting experience. A quick consult with Dr. Google (as we call it here) came up with:
The EMDR International Association's definition of EMDR for clinicians: http://www.emdria.org/associations/12049/files/EMDRIA%20Definition%20of%20EMDR.pdf
Here is a synopsis of Shapiro's 'The Adaptive Information Processing Model', which is the basis of EMDR: http://www.ellenfarrell.com/PDF/what_is/general/emdr_information_proc.pdf
The neuroanatomical basis of their EMDR is uhm....fuzzy science in the most generous sense of the term. Here is what the EMDRIA say about how trauma is experienced at a neuroanatomical level:
Traumatic events and/or disturbing adverse life experiences can be encoded maladaptively in memory resulting in inadequate or impaired linkage with memory networks containing more adaptive information. Pathology is thought to result when adaptive information processing is impaired by these experiences which are inadequately processed. Information is maladaptively encoded and linked dysfunctionally within emotional, cognitive, somatosensory, and temporal systems. Memories thereby become susceptible to dysfunctional recall with respect to time, place, and context and may be experienced in fragmented form. Accordingly, new information, positive experiences and affects are unable to functionally connect with the disturbing memory. This impairment in linkage and the resultant inadequate integration contribute to a continuation of symptoms.
So...maladaptive encoding of memory is disruptive to adequately encoded information, and the maladaptive memories are then dysfunctionally linked to the systems that handle emotion, cognition, somatosensory information, etc...? God forbid they actual talk about the actual anatomical basis of their theories, as they imply there is a connection.
If any finds any studies/published articles on the actual neuroanatomical underpinnings of EMDR, I'd love to read it. Somehow I'm picturing, "The scary memory is not remembered right, and then people (like alligators) become ornery because of their Medulla Oblangada!"
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Putting personalities aside, in the interest of science and clinical care, it might be useful to concentrate strictly on the data, and correct some apparent misunderstandings regarding the procedures used in EMDR therapy compared to those of prolonged exposure (PE).
In PE, while shorter sessions than those originally suggested may be effectively employed in conjunction with the daily homework, the prolonged exposure is an uninterrupted recitation of the event repeated throughout the session. EMDR therapy does not entail a description of the event and exposures paired with the dual attention stimulus are brief and not confined to the index trauma. There are transcripts of sessions in various texts and a videotape published by APA Press to illustrate. The short exposures and associative responses that can take the client far from the original trauma would be considered to foster avoidance according to Foas Emotional Processing Theory. According to other theorists such as Marks, short exposures would be predicted to sensitize.
Nevertheless, numerous meta-analyses (e.g., Bisson, & Andrew, 2007; Bradley et al., 2005) have determined that outcomes of EMDR therapy and TF-CBT are similar, despite these differences. The other major difference is that the former uses no homework and the latter uses 1-2 hours of daily homework. This difference has been highlighted by many researchers, including Lee et al. (2002) and Rothbaum et al. (2005). So, if one views EMDR as an exposure therapy, one would have to consider it to be more parsimonious and efficient than PE.
Regarding the eye movement component of EMDR, the following was stated in the forum: Maybe the "dual-tasking" literature could have some relevance to this exposure stuff? Has anyone done any research on this? E.g. the degree of interference from, say visuo-spatial dual-tasking having an effect on recalled long-term memory (and its' associated components like emotions/stress?) Is there any research?
There are now more than a dozen randomized studies that have researched this question in regard to the eye movement component and demonstrated positive results in support of the disruption of working memory (Engelhard et al., 2010, 2011; van den Hout, 2010, 2011)
As articulated by van den Hout et al. (2011): During recall, emotional memories become labile, and their reconsolidation is affected by experiences during recall (Baddeley, 1998). Recalling an episode depends on working memory (WM) resources that are limited. If a secondary task is executed during recall that shares this dependence, fewer resources will be available for recalling an episode and the memory will be experienced as less vivid and emotional. Eye movements are held to serve as such a secondary task that taxes WM (Andrade et al., 1997; Barrowcliff et al., 2004; Gunter & Bodner, 2008; van den Hout et al., 2001; Kavanagh et al., 2001; Kemps & Tiggemann, 2007; Max!eld et al., 2008). Interestingly, memories are not only blurred during the eye movements (e.g., Kavanagh et al., 2001), but also during recollections immediately after the eye movements session (p.92).
van den Hout, M., et al. (2011). EMDR: Eye movements superior to beeps in taxing working memory and reducing vividness of recollections. Behaviour Research and Therapy, 49, 92-98.
Please note that this article was published in a behavioral journal and the PI is the editor of the Journal of Behavior Therapy and Experimental Psychiatry. Therefore, statements made in this forum regarding the universal CBT dismissal of EMDR therapy and the utility of the eye movements will hopefully be reconsidered.
In PE, while shorter sessions than those originally suggested may be effectively employed in conjunction with the daily homework, the prolonged exposure is an uninterrupted recitation of the event repeated throughout the session. EMDR therapy does not entail a description of the event and exposures paired with the dual attention stimulus are brief and not confined to the index trauma. There are transcripts of sessions in various texts and a videotape published by APA Press to illustrate. The short exposures and associative responses that can take the client far from the original trauma would be considered to foster avoidance according to Foas Emotional Processing Theory. According to other theorists such as Marks, short exposures would be predicted to sensitize.
Nevertheless, numerous meta-analyses (e.g., Bisson, & Andrew, 2007; Bradley et al., 2005) have determined that outcomes of EMDR therapy and TF-CBT are similar, despite these differences. The other major difference is that the former uses no homework and the latter uses 1-2 hours of daily homework. This difference has been highlighted by many researchers, including Lee et al. (2002) and Rothbaum et al. (2005). So, if one views EMDR as an exposure therapy, one would have to consider it to be more parsimonious and efficient than PE.
Regarding the eye movement component of EMDR, the following was stated in the forum: Maybe the "dual-tasking" literature could have some relevance to this exposure stuff? Has anyone done any research on this? E.g. the degree of interference from, say visuo-spatial dual-tasking having an effect on recalled long-term memory (and its' associated components like emotions/stress?) Is there any research?
There are now more than a dozen randomized studies that have researched this question in regard to the eye movement component and demonstrated positive results in support of the disruption of working memory (Engelhard et al., 2010, 2011; van den Hout, 2010, 2011)
As articulated by van den Hout et al. (2011): During recall, emotional memories become labile, and their reconsolidation is affected by experiences during recall (Baddeley, 1998). Recalling an episode depends on working memory (WM) resources that are limited. If a secondary task is executed during recall that shares this dependence, fewer resources will be available for recalling an episode and the memory will be experienced as less vivid and emotional. Eye movements are held to serve as such a secondary task that taxes WM (Andrade et al., 1997; Barrowcliff et al., 2004; Gunter & Bodner, 2008; van den Hout et al., 2001; Kavanagh et al., 2001; Kemps & Tiggemann, 2007; Max!eld et al., 2008). Interestingly, memories are not only blurred during the eye movements (e.g., Kavanagh et al., 2001), but also during recollections immediately after the eye movements session (p.92).
van den Hout, M., et al. (2011). EMDR: Eye movements superior to beeps in taxing working memory and reducing vividness of recollections. Behaviour Research and Therapy, 49, 92-98.
Please note that this article was published in a behavioral journal and the PI is the editor of the Journal of Behavior Therapy and Experimental Psychiatry. Therefore, statements made in this forum regarding the universal CBT dismissal of EMDR therapy and the utility of the eye movements will hopefully be reconsidered.
For starters, there's Barbara Rothbaum et al.s(2005) research on treating female adults with a history of single incidentsexual trauma either in childhood or adulthood [Rothbaum, B.O., Astin, M.C.,& Marsteller, F. (2005). Prolonged exposure versus eye movement desensitization(EMDR) for PTSD rape victims. Journal ofTraumatic Stress, 18, 607-616]. The research was funded by the NationalInstitute of Mental Health. This was arandomized well-controlled study involving 74 female rape victims comparingEMDR, prolonged exposure (PE), and a wait-list control. Structured clinical interviews were conducted(i.e., CAPS, SCID), and a variety of well-established psychometrics includingfor depression (BDI), dissociation (DES-II), PTSD (e.g., IES-R).
All participants receivednine treatment sessions, and treatment fidelity for PE and EMDR was conductedby experts selected by Edna Foa and Francine Shapiro respectively. Results indicated that both EMDR andprolonged exposure both produced significant treatment effects with 95% of PEsubjects, and 75% of EMDR no longer meeting PTSD diagnostic criteria atpost-treatment. Symptom improvement wassustained at six months, although more of the PE vs. EMDR group remainedcompletely asymptomatic. This methodologically rigorous, head-to-headcomparison, met all seven of the RCT gold standards. The significant EMDR treatment effects inthis well-controlled study were reported to be contrary to other, less rigorouscontrolled trials that compared EMDR to cognitive-behavioral-treatments (i.e.,Devilly & Spence, 1999; Taylor et al., 2003; cited in Rothbaum, et al.,2005). In conclusion Rothbaum states, An interesting potential clinicalimplication is that EMDR seemed to do equally well in the main despite lessexposure and no homework. It will be important for future research to explorethese issues (p. 614).
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So that's 5 people now registered today with their first post being positive toward EMDR. Word about this thread must have spread to some EMDR community/network.
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There are 3 things the research does tell us about EMDR. Firstly there is a wealth of studies that support it as evidence based practise that has led the best independent scientific think tanks to endorse it as evidence based practise. eg One of the most comprehensive is the Cochrane review on PTSD. It is also considered evidence based n the US see http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=19
Secondly there are numerousRCTs comparing EMDR to other exposure based therapies. (Ironson et al., 2002; Rogers et al., 1999; Rothbaum et al, 2005; Taylor et al, 2003; Lee et al., 2002;Nijdam et al., 2012). Most show equivalent results, some show EMDR is more effective.
Finally EMDR and traditional exposure differs in key processes. In research studies that have focused on what happens during the treatment processes that are essential for traditional exposure treatments such as relieving are not part of EMDR success. (see clinical psychology and Psychotherapy; Lee et al., 2006)
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How about this.....
Like many fringe treatments....the devil is in the details. I don't trust fluffy pseudo-neuro terminology.
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One more after you posted this...
And they all repeat what was emphasized previously--that EMDR is equivalent to TF-CBT and PE. I don't see compelling evidence that it is superior. I also don't see evidence that the eye movements or bilateral whatevers are the mechanism for change--only theories so far.
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To the (new) posters' credit, they have pointed out that EMDR appears to be equivalently-efficacious with CBT while not having the homework requirement.
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Posers...Intended or typo?
Hahah good catch, thank you; unintended, of course.
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Posers...Intended or typo?
Good save. (I thought it was intentional!)
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I unfortunately can't take credit for being clever enough to stage such an intentional typo.
On a more serious aside, I definitely don't want to deride the newly-registered members. While it is interesting that so many (relatively, anyway) people signed up in a short span to come to EMDR's defense, fostering a healthy debate on the subject without resorting to personal attacks is personally the way I'd like to see things go.
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Exactly. To be clear: I'm not saying we should cover our eyes because they have a vested interest in EMDR, but a network (formal or informal) of EMDR supporters clearly heard about this thread and wanted to have their side heard. Now's the opportunity for a specific discussion if they stick around for that.
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Yes, though this information was also in the NYTs articles linked in the original post, so it's not really new. The question for this thread, at least as far as I'm concerned, is not whether EMDR can work. I see that it performs equivalently to PE at least in some studies. However, there have been no dismantling studies that have looked at the treatment with and without the eye movements/bilateral stimulation. It seems that another parsimonious explanation for the finding that EMDR works in less time than PE is that clients don't need as much time as previously thought to benefit from brief exposures. Good and relevant news, but still not evidence that eye movement/bilateral stimulation has anything to do with trauma recovery. At best, proponents can postulate that eye movement acts to divide attention (as do many other tasks that do not require sophisticated equipment) or to mimic rapid eye movement. If the latter is the case, why do people use tapping stimulation too? Yes, we don't have a comprehensive model of how consciousness functions in the brain and we aren't sure about things like why neuronal growth seems to relieve depression. However, I think EMDR is a long way from being in the category of just accepting that it works without knowing why. I first want to see a set of studies that conclusively demonstrate that the eye movement itself is an integral part of the treatment effect. Otherwise, I'm not going to start spreading the news that moving one's eyes back and forth has some special, mysterious role in the neuronal processes of trauma recovery.
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Nope - I was approached individually by a subscriber to this list and asked what I thought of some of the comments and volunteered to kick in my two cents worth. That someone else with experience with EMDR has done the same is not terribly surprising.
I might take the position that you do not know me well enough to begin to assign my position vis-a-vis purported traps. Indeed, as with all effective psychotherapies, there are clinicians using EMDR who describe it as useful for everything including acne. I ran into the same thing when I learned behavioral therapy, PE, cognitive therapy, CBT, CPT, and, from what I've read, Freud and Jung had to put up with the "fringe" that immediately grabs a hold of the latest and greatest and can't be bothered to develop research to corroborate their point of view. That's an issue for marketing, certainly. I would encourage you to pass over your reaction to the New Agey, crystal sniffing, pyramid sitting, fringe and take a good look at the research. While you are doing that, you might ponder that we do not better understand how other therapies work. What we have had in the field of psychotherapy for quite some time are models of what we think takes place in the brain during therapy (Freud, for example, thought there was a biological reality to the Id but never slapped a pound and a half of it on the table.) Shapiro believed that EMDR made use of stimulating the brain's own information processing and learning centers. The brain scan and autonomic nervous system studies on EMDR seem to me to support her theoretical model (take a look at them yourself; your mileage may vary). Expansion of hippocampal volume, a move from asymmetrical to symmetrical functions in the hemispheres, autonomic changes in mean skin temp, galvanic skin response, etc., and a change in Broca's Area following successful EMDR treatment, and numerous other phenomena are all, of course, open to interpretation as to what brain mechanisms have been engaged by the use of EMDR. My point is, screw marketing and the evangelicals; if you have any of this engages your interest, then check it out. Remain skeptical - that's the proper way to examine any evidence on any subject - but check it out.
I vote for superior because in my clinical experience with CBT/PE and EMDR, EMDR worked more efficiently (faster) and with less stress to the clients. The population I primarily used those therapies with were multiply traumatized combat veterans, WW II to the present. As most of you know, chronic PTSD can be difficult to treat because of high patient dropout rates. In research settings, the dropout rates for PE and CPT run at 20-30%; Carlson, et al, had a 0% dropout rating in his research setting. Obviously, things are tougher in the real world of a therapist's office so we need every break we can get. That's one of the (big) things I prefer about EMDR.
Your position is similar to that of a number of people who have wondered what, if anything, the eye movements contribute to what appears to be a free association-oriented therapy (not really an exposure therapy unless the proven underpinnings of exposure are wrong, such as the role of habituation [my position, btw, is that habituation must be present or it is not exposure therapy because, yes, the research shows that to be true but, somewhat more egocentric, that's what I found in my clinical practice]. The eye movements have been investigated both in and out of the context of EMDR therapy as part of research into the mechanism of action of EMDR. About 15 peer-reviewed articles have appeared on the mechanism (I think the REM people are slightly in the lead) while 22 publications have looked at the eye movements (findings include emotional arousal being lowered, memory recall effects including increased linking from one memory to another, and other effects.) The current debate seems to be REM vs. interhemispheric communication. I'm not sure if it has to be an either-or but the healthy thing is that this research and study is taking place (and actually has been since the mid '90's). In fact, there have been more neurobiological studies on EMDR than all of the other empirically validated treatments for PTSD combined. I am not saying that those other treatments will not prove to produce similar effects when researched; I am saying it has not happened yet.
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Could you recommend some citations, as I'm curious to read about what they found.
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The EMDRIA description of the information processing model was formulated for clinicians and lay people, not those specializing in neuroanatomy. The bottom line of the central tenet is that high levels of disturbance are posited to disrupt the information processing system and the memories are maladaptively stored. As with all forms of therapy, the questions about neurobiological underpinnings are still under investigation. As requested: If anyone finds any studies/published articles on the actual neuroanatomical underpinnings of EMDR, I'd love to read it.
If you are interested in pursuing it, here are some references:
Bossini L. ***iolini, A. & Castrogiovanni, P. (2007). Neuroanatomical changes after EMDR in posttraumatic stress disorder. Journal of Neuropsychiatry and Clinical Neuroscience, 19, 457-458.
Harper, M. L., Rasolkhani-Kalhorn, T., & Drozd, J. F. (2009). On the neural basis of EMDR therapy: Insights from qeeg studies. Traumatology, 15, 81-95.
Kowal, J. A. (2005). QEEG analysis of treating PTSD and bulimia nervosa using EMDR. Journal of Neurotherapy, 9(Part 4), 114-115.
Lamprecht, F., Kohnke, C., Lempa, W., Sack, M., Matzke, M., & Munte, T. (2004). Event-related potentials and EMDR treatment of post-traumatic stress disorder. Neuroscience Research, 49, 267-272.
Lansing, K., Amen, D.G., Hanks, C. & Rudy, L. (2005). High resolution brain SPECT imaging and EMDR in police officers with PTSD. Journal of Neuropsychiatry and Clinical Neurosciences, 17, 526-532.
Levin, P., Lazrove, S., & van der Kolk, B. A. (1999). What psychological testing and neuroimaging tell us about the treatment of posttraumatic stress disorder (PTSD) by eye movement desensitization and reprocessing (EMDR). Journal of Anxiety Disorders, 13, 159-172.
Nardo D et al. (2009). Gray matter density in limbic and paralimbic cortices is associated with trauma load and EMDR outcome in PTSD patients. Journal of Psychiatric Research, 44, 477-485.
Oh, D.-H., & Choi, J. (2004). Changes in the regional cerebral perfusion after eye movement desensitization and reprocessing: A SPECT study of two cases. Journal of EMDR Practice and Research, 1, 24-30.
Ohta ni, T., Matsuo, K., Kasai, K., Kato, T., & Kato, N. (2009). Hemodynamic responses of eye movement desensitization and reprocessing in posttraumatic stress disorder. Neuroscience Research, 65, 375383.
Pagani, M. et al. (2007). Effects of EMDR psychotherapy on 99mTc-HMPAO distribution in occupation-related post-traumatic stress disorder. Nuclear Medicine Communications, 28, 757765.
Pagani, M. et al. (2011). Pretreatment, intratreatment, and posttreatment EEG imaging of EMDR: Methodology and preliminary results from a single case. Journal of EMDR Practice and Research, 5, 42-56.
Propper, R., Pierce, J.P., Geisler, M.W., Christman, S.D., & Bellorado, N. (2007). Effect of bilateral eye movements on frontal interhemispheric gamma EEG coherence: Implications for EMDR therapy. Journal of Nervous and Mental Disease, 195, 785-788.
If you are interested in pursuing it, here are some references:
Bossini L. ***iolini, A. & Castrogiovanni, P. (2007). Neuroanatomical changes after EMDR in posttraumatic stress disorder. Journal of Neuropsychiatry and Clinical Neuroscience, 19, 457-458.
Harper, M. L., Rasolkhani-Kalhorn, T., & Drozd, J. F. (2009). On the neural basis of EMDR therapy: Insights from qeeg studies. Traumatology, 15, 81-95.
Kowal, J. A. (2005). QEEG analysis of treating PTSD and bulimia nervosa using EMDR. Journal of Neurotherapy, 9(Part 4), 114-115.
Lamprecht, F., Kohnke, C., Lempa, W., Sack, M., Matzke, M., & Munte, T. (2004). Event-related potentials and EMDR treatment of post-traumatic stress disorder. Neuroscience Research, 49, 267-272.
Lansing, K., Amen, D.G., Hanks, C. & Rudy, L. (2005). High resolution brain SPECT imaging and EMDR in police officers with PTSD. Journal of Neuropsychiatry and Clinical Neurosciences, 17, 526-532.
Levin, P., Lazrove, S., & van der Kolk, B. A. (1999). What psychological testing and neuroimaging tell us about the treatment of posttraumatic stress disorder (PTSD) by eye movement desensitization and reprocessing (EMDR). Journal of Anxiety Disorders, 13, 159-172.
Nardo D et al. (2009). Gray matter density in limbic and paralimbic cortices is associated with trauma load and EMDR outcome in PTSD patients. Journal of Psychiatric Research, 44, 477-485.
Oh, D.-H., & Choi, J. (2004). Changes in the regional cerebral perfusion after eye movement desensitization and reprocessing: A SPECT study of two cases. Journal of EMDR Practice and Research, 1, 24-30.
Ohta ni, T., Matsuo, K., Kasai, K., Kato, T., & Kato, N. (2009). Hemodynamic responses of eye movement desensitization and reprocessing in posttraumatic stress disorder. Neuroscience Research, 65, 375383.
Pagani, M. et al. (2007). Effects of EMDR psychotherapy on 99mTc-HMPAO distribution in occupation-related post-traumatic stress disorder. Nuclear Medicine Communications, 28, 757765.
Pagani, M. et al. (2011). Pretreatment, intratreatment, and posttreatment EEG imaging of EMDR: Methodology and preliminary results from a single case. Journal of EMDR Practice and Research, 5, 42-56.
Propper, R., Pierce, J.P., Geisler, M.W., Christman, S.D., & Bellorado, N. (2007). Effect of bilateral eye movements on frontal interhemispheric gamma EEG coherence: Implications for EMDR therapy. Journal of Nervous and Mental Disease, 195, 785-788.
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"Everybody look to their left...everybody look to their right..."
I don't even like Jessie J and somehow this song got into my head!
I don't even like Jessie J and somehow this song got into my head!
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Why do you folks care so much about why pro-EMDR people joined this discussion? And why do you need to disparage us, and EMDR, so much? If you're ALL going into research, well then your "bedside manner" is immaterial. But if any of you are considering (or doing) psychotherapy, I hope you have more empathy and open-mindedness. Yes, be skeptical. I certainly was 17 yrs ago when people I knew were singing the praises of EMDR. I felt that it sounded too good to be true, and therefore couldn't be true. But I took the training for the hell of it, because people I respected thought highly of it, and I was truly impressed. It's only gotten better.
So I expect puerile attempts at "witty" responses, perhaps frankly degrading, perhaps with a veneer of intellectual superiority. Someone posted something about feeling sad... yup. I do. For those of you who are so rigidly wedded to one method so early in your professional lives...
So I expect puerile attempts at "witty" responses, perhaps frankly degrading, perhaps with a veneer of intellectual superiority. Someone posted something about feeling sad... yup. I do. For those of you who are so rigidly wedded to one method so early in your professional lives...
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I am not planning to be a clinician, but I think how someone posts on an anonymous message board probably does not directly reflect their "bedside manner."
I don't see where empathy comes in when there is a legitimate scientific discussion to be had. You debate facts. If that hurts your feelings, then maybe you shouldn't be in science.
I have no stake in this debate, and I always debate the ethical merits of EMDR in classes I teach. The discussions are always stimulating. I think the skepticism comes from folks that are familiar with neuroanatomy who aren't satisfied with how EMDR theorists are trying to explain mechanisms of action. When large N neuroimaging studies can be evaluated closely, perhaps the discussion will get more interesting.
Excellent post. Yes, this is plausible. Thats what i thought about "eye-movements" as well, i know of newer studies demonstrating a "long-term memory window" when one recalls information in working memory allowing a degree of reconsolidation. So, i thought that maybe eye-movement is a taxing activity interfering with the working memory and hence the "LTM window" reducing the associated stress of the original memory. It would be interesting to investigate further to look on other forms of itnerference (if it is not done already). Nice studies, i didn't know they existed (and i do a lot of cog psych/neuroscience research) thanks for the suggestions!
To ask for "neural details" is too much at the present moment IMO, cognitive explanations are good and suffice. I mean the "neural details" of a lot of psychopharmacology are still unknown, we need much more research to understand the biological basis of any form of therapy for that matter.
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I mentioned empathy in relation to clinical skills. You're absolutely right about the legitimacy of debating facts in a scientific discussion. I hope my feelings will always be available to me throughout my career in science. They have much to add and are essential to the practice of psychotherapy. However, I'm not hurt, just sad about an anonymous message board in my field that has a plethora of dismissive and childish remarks. Not even particularly funny (though a few have actually given me a good laugh, thank you!).
Large N studies are definitely a great idea and hopefully more are in the works. But understanding the mechanisms of action is not the only way to evaluate a method. Perhaps necessary, but not sufficient.
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Hey, some psychologists degrade psychoanalysis. Some abhor behaviorism. Some dislike the biologically-oriented "sell-outs."
I don't see why a treatment as potentially controversial as EMDR would be exempt from criticism, warranted or not. At least the dialogue is meant to serve a purpose (protect victims of trauma from iatrogenic effects, etc). Obviously our society allows some treatments to happen without understanding how they work. Personally, I think that interventions targeting victims of trauma deserve more scrutiny than most given how vulnerable the patients are. This isn't some side effect of a blood pressure pill. We're talking serious implications for memory systems, hormones, and how these folks will live after this is all over.
I would not recommend EMDR to a traumatized family member because of these unknowns. With more research validation and longitudinal data, my mind could be changed. It's just my own professional opinion given the population and the risk/benefit ratio in my head.
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I think at issue is whether the criticism is warranted. EMDR is widely recognized as an effective trauma treatment in practice guidelines worldwide (e.g., American Psychiatric Association, 1994; DVA/DOD, 2010; NICE, 2004; Cochrane database, 2007). The controversial nature of EMDR appears to be about one component that twenty randomized studies have found to have positive effects when tested in isolation. The fact that anatomical concomitants have not been pinned down is true of any form of therapy.
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Sure, so is flooding and ECT. Physicians used to recommend cigarettes. We used to pathologize homosexuality.
People can have their concerns. I certainly don't mind it when people voice theirs about any type of intervention I've studied in the past. As psychologists, we are supposed to see interventions as a particular type of tool. Over time, the research lets us know. Unfortunately, the threshold of evidence for getting approved as an intervention by most organizations is pretty low. I'd prefer it were more conservative for most treatments (drugs included).
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It is the primary component of the intervention, so that is important. It isn't like we are singling out a particular skill building exercise from a specific module within a manualized CBT treatment program.
I haven't had time to read through the citations that have shown "positive effects", though I'm curious if this means a statistically significant effect that is not better accounted for by placebo or another factor?
As for the anatomical concomitants...the theory can't claim that a major tenet of the intervention involves changes at the neuronal level, and then not back it up with hard science. The underlying theory quoted from the EMDRIA asserts there are factors at the anatomical level that contribute to the treatment, so it is fair game.
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You're welcome. A number of the studies have compared the eye movements used in EMDR to alternate forms of interference. The eye movements are superior in reducing imagery vividness and emotionality when compared to conditions such as bilateral tones, counting, and music. The eye movements were equally effective when compared to playing Tetris, a complex condition that would be expected to task working memory (WM) to a greater degree. The researchers (Engelhardt et al., 2010) indicated that this may be because "the taxing of WM and its effects may not be linearly related." So there is definitely room for further research.
Memory researchers investigating the WM hypothesis have conducted about a dozen RCT that indicate a reduction of memory vividness and/or emotionality when the eye movements are evaluated in isolation. Another set of non-randomized trials has documented a reduction in physiological arousal with trauma patients upon inauguration of the eye movements within EMDR therapy (Eloffson, 2008; Sack et al., 2008). Together, these findings would appear to have important clinical implications that support the use of the eye movements in EMDR, if only in making treatment more tolerable for trauma victims than using imaginal exposure alone. This appears likely, since the eye movements have been found significantly superior in these studies to "recall only" conditions.
I also agree completely with your statement regarding the fact that it is premature to ask for the "neural details" of any form of therapy.
