EMDR?

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I've read some recent posts on EMDR grouping it in with moonbeam therapy, crystal healing, etc., but my understanding of EMDR was always that it was basically functionally exposure therapy with some science-y sounding but unnecessary and basically useless eye movement stuff thrown in. Thus, it's still effective due to the PE component, just not effective for the reason advocates of it like to claim.

Is this correct?

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Pretty much. Look at the available dismantling studies. The eye movements do nothing. It's just a way that they can charge thousands of dollars to "train" people to do it. Just learn PE, which any decent VA or specialty clinic will train you in for free.
 
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I don't know much about EMDR... but every time I see it, I see "EDM" first and I almost break out the glowsticks and spin poi.
 
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I don't know much about EMDR... but every time I see it, I see "EDM" first and I almost break out the glowsticks and spin poi.

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EMDR is another fad that uses some pseudoscience to promote itself. Not helpful for the field imo. Talking about the trauma while learning to decrease CNS arousal is what is effective for trauma. Also, human interactions have much more effect than flashing lights on the neural pathways according to most of the research that I have seen. We need to promote the power of one brain connecting to another more. Spend anytime working with developing brains and you will see this is the case. It's less obvious with older brains cause it's much harder to change the pathways.
 
Is this correct?[/QUOTE]
No, it is not correct, and it's hard to understand how supposedly highly educated people would trash a method of psychotherapy without really knowing anything about it. There is excellent research (RCTs) proving EMDR therapy's efficacy and it is considered one of the three treatments of choice for trauma (along with CBT and PE) by organizations such as ISTSS (International Society for the Study of Trauma and Dissociation), American Psychiatric Assoc, American Psychological Assoc, Dept of Veteran Affairs, Dept of Defense, Departments of Health in Northern Ireland, UK, Israel, the Netherlands, France, and other countries and organizations.

See Foa, E.B., Keane, T.M., Friedman, M.J., & Cohen, J.A. (2009). Effective treatments for PTSD: Practice Guidelines of the International Society for Traumatic Stress Studies New York: Guilford Press.
EMDR was listed as an effective and empirically supported treatment for PTSD, and was given an AHCPR “A” rating for adult PTSD. This guideline specifically rejected the findings of the previous Institute of Medicine report, which had stated that more research was needed to judge EMDR effective for adult PTSD.

EMDR therapy contains many procedures and elements that contribute to treatment effects. While the methodology used in EMDR therapy has been empirically validated in over 35 randomized controlled studies of trauma victims, questions still remain regarding mechanism of action. However, since EMDR therapy achieves clinical effects without the need for homework (unlike CBT), or the prolonged focus used in exposure therapies, attention has been paid to the possible neurobiological processes that might be evoked. Although the eye movements (and other dual attention stimulation) comprise only one procedural element, this element has come under greatest scrutiny. Research evaluating mechanism of action of the eye movement component include an additional 24 studies that have demonstrated positive effects for the eye movement component, as well as a meta-analysis of the contribution of eye movements in processing emotional memories. (see Lee, C.W. & Cuijpers, P. (2013). Journal of Behavior Therapy & Experimental Psychiatry, 44, 231-239. The effect size for the additive effect of eye movements in EMDR treatment studies was moderate and significant (Cohen’s d = 0.41). For the second group of laboratory studies the effect size was large and significant (d = 0.74).

As noted in the American Psychiatric Association Practice Guidelines (2004, p.18), in EMDR “traumatic material need not be verbalized; instead, patients are directed to think about their traumatic experiences without having to discuss them.” Given the reluctance of many combat veterans to divulge the details of their experience, this factor is relevant to willingness to initiate treatment, retention and therapeutic gains. It may be one of the factors responsible for the lower remission and higher dropout rate noted in this population when CBT techniques are used.

Significantly, The World Health Organization has published Guidelines for the management of conditions that are specifically related to stress: Trauma-focused CBT and EMDR are the only psychotherapies recommended for children, adolescents and adults with PTSD. “Like CBT with a trauma focus, EMDR aims to reduce subjective distress and strengthen adaptive cognitions related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure, or (d) homework." (Geneva, WHO, 2013, p.1)
 
The Lee & Cuipers study is definitely at odds with other meta analyses that found no difference. They used a combination of SUDS and "vividness" as outcome variables, whilst the meta analaysis that found no difference looked at both SUDS and symptom counts among other variables and calculated them independently. Also, Lee used a fairly liberal procedure to look at publication bias, apparently found none, and made no correction. Remember, meta-analyses are not created equal. We have differing levels of evidence on each side here. I don't understand how supposedly educated people could unequivocally call that a slam dunk for EMDR.
 
Also, I'm a little skeptical of research conducted by someone who has a vested financial interest in the thing they are writing about. Not saying that it's completely groundless, but I would really like to see stronger methodology and independent verification.
 
I've read some recent posts on EMDR grouping it in with moonbeam therapy, crystal healing, etc., but my understanding of EMDR was always that it was basically functionally exposure therapy with some science-y sounding but unnecessary and basically useless eye movement stuff thrown in. Thus, it's still effective due to the PE component, just not effective for the reason advocates of it like to claim.

Is this correct?

That is correct. EMDR is a form of exposure therapy. The eye movement claims are the razzle-dazzle, possibly a nice placebo. And according to the EMDR Institute you too can become a "certified" practitioner after two weekend workshops!
 
No, it is not correct, and it's hard to understand how supposedly highly educated people would trash a method of psychotherapy without really knowing anything about it.

 
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That is correct. EMDR is a form of exposure therapy. The eye movement claims are the razzle-dazzle, possibly a nice placebo. And according to the EMDR Institute you too can become a "certified" practitioner after two weekend workshops!

And how much unnecessary money?
 
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What's wrong with harnessing the power of placebo, though, if its mechanics aren't misrepresented? We were shown an example of ethical placebo in class, where deception wasn't used, and it still worked. (I can't remember the case, but I'll try to. Maybe someone else knows? The patient was a young girl with chronic pain issues, and her mother was either a doctor or a psychiatrist or a psychologist who participated in the design of the treatment. Maybe the smell of roses was involved?)

http://www.ncbi.nlm.nih.gov/pubmed/1577957
 
True. OTOH, it's likely the cost contributes to the placebo effect :/
 
Harnessing the power of placebo is great. Charging large sums of money to "train" people to deliver the placebo, maybe not so good.

Compounding the issue is then selling it to the public as something it is not. Exposure Therapy is well supported. All of the "eye movement" stuff is built on buzz words and weak/non-existant science. The explanation about how the eye movement contributes to the process is laughable at best. Isolate the eye movement and prove it actually works and explain how it actually works, and then maybe the scientific community will support it. The fact that some organizations have accepted it is due to the ET portion, not that wacky "eye movement."

I want a real neuroscientist to explain how it works because having a non-scientist therapist use buzz words to explain it is not an actual explanation. Whenever I've asked a "follower" of EMDR to explain the neuroanatomy of it all, I've gotten blank stares or some rambling about "neuro this" and "neuro that"…without…any…actual…science. I have tried to ask about how their explanation fits with actual neuroanatomy, and well….more blank stares.

I guess perceptions change when you fork out $1000+ to drink the KoolAid...
 
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No, it is not correct, and it's hard to understand how supposedly highly educated people would trash a method of psychotherapy without really knowing anything about it. There is excellent research (RCTs) proving EMDR therapy's efficacy and it is considered one of the three treatments of choice for trauma (along with CBT and PE) by organizations such as ISTSS (International Society for the Study of Trauma and Dissociation), American Psychiatric Assoc, American Psychological Assoc, Dept of Veteran Affairs, Dept of Defense, Departments of Health in Northern Ireland, UK, Israel, the Netherlands, France, and other countries and organizations.

See Foa, E.B., Keane, T.M., Friedman, M.J., & Cohen, J.A. (2009). Effective treatments for PTSD: Practice Guidelines of the International Society for Traumatic Stress Studies New York: Guilford Press.
EMDR was listed as an effective and empirically supported treatment for PTSD, and was given an AHCPR “A” rating for adult PTSD. This guideline specifically rejected the findings of the previous Institute of Medicine report, which had stated that more research was needed to judge EMDR effective for adult PTSD.

EMDR therapy contains many procedures and elements that contribute to treatment effects. While the methodology used in EMDR therapy has been empirically validated in over 35 randomized controlled studies of trauma victims, questions still remain regarding mechanism of action. However, since EMDR therapy achieves clinical effects without the need for homework (unlike CBT), or the prolonged focus used in exposure therapies, attention has been paid to the possible neurobiological processes that might be evoked. Although the eye movements (and other dual attention stimulation) comprise only one procedural element, this element has come under greatest scrutiny. Research evaluating mechanism of action of the eye movement component include an additional 24 studies that have demonstrated positive effects for the eye movement component, as well as a meta-analysis of the contribution of eye movements in processing emotional memories. (see Lee, C.W. & Cuijpers, P. (2013). Journal of Behavior Therapy & Experimental Psychiatry, 44, 231-239. The effect size for the additive effect of eye movements in EMDR treatment studies was moderate and significant (Cohen’s d = 0.41). For the second group of laboratory studies the effect size was large and significant (d = 0.74).

As noted in the American Psychiatric Association Practice Guidelines (2004, p.18), in EMDR “traumatic material need not be verbalized; instead, patients are directed to think about their traumatic experiences without having to discuss them.” Given the reluctance of many combat veterans to divulge the details of their experience, this factor is relevant to willingness to initiate treatment, retention and therapeutic gains. It may be one of the factors responsible for the lower remission and higher dropout rate noted in this population when CBT techniques are used.

Significantly, The World Health Organization has published Guidelines for the management of conditions that are specifically related to stress: Trauma-focused CBT and EMDR are the only psychotherapies recommended for children, adolescents and adults with PTSD. “Like CBT with a trauma focus, EMDR aims to reduce subjective distress and strengthen adaptive cognitions related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure, or (d) homework." (Geneva, WHO, 2013, p.1)

To piggy back off therapist4change post (who is actually well trained neuropsychologist), if we are to come back to earth for a moment and just think about it from a common sense perspective, this should be quit simple.

As my wife said when I first told her about this. "I mean, moving your eyeballs to erase memories....PAAAAAAA-LEEEASE. "
 
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What's wrong with harnessing the power of placebo, though, if its mechanics aren't misrepresented?

That's a big "if," isn't it?

You can buy Antidepressant A at $0.70/tablet or its enantiomer, Antidepressant B, at $5.50/tablet. Maybe the newer, pricier one with the cuter name and nicer ads will work better in part because of the placebo effect, but the prescriber doesn't explain that to the patient. And the pharmaceutical company's marketing agency probably made a slide deck and a white paper to give providers a whole host of other reasons why Antidepressant B is better, so they needn't bother thinking about the placebo effect when other more "science-y" explanations are readily at hand. If the medical copywriter has really earned his or her fee (as an aside, probably more than the AGI of the average certified EMDR practitioner), the idea that the difference between A and B could be due to placebo will be preposterous to the prescriber, and possibly even insulting to his or her "background in science."
 
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That's a big "if," isn't it?

You can buy Antidepressant A at $0.70/tablet or its enantiomer, Antidepressant B, at $5.50/tablet. Maybe the newer, pricier one with the cuter name and nicer ads will work better in part because of the placebo effect, but the prescriber doesn't explain that to the patient. And the pharmaceutical company's marketing agency probably made a slide deck and a white paper to give providers a whole host of other reasons why Antidepressant B is better, so they needn't bother thinking about the placebo effect when other more "science-y" explanations are readily at hand. If the medical copyrighter has really earned his or her fee (as an aside, probably more than the AGI of the average certified EMDR practitioner), the idea that the difference between A and B could be due to placebo will be preposterous to the prescriber, and possibly even insulting to his or her "background in science."

Yes, lol, it's a huge if, laden with idealistic and unrealistic expectations. Excellent point(s).
 
It'd be like a double placebo effect then. The clinician who pays a couple grand gets a placebo, and then passes it on to the patient.

You're joking, but you know, it's been suggested that might be the key variable in the cross-cultural studies showing the effectiveness of most psychological treatments (irrespective of modality); those have indicated that the #1 factor is the client's belief in the practitioner's effectiveness (which must be supported by the practitioner's belief in his/her own effectiveness).

Same deal with our own pharm industry, here in North America, as MamaPhD showed above.
 
I've read some recent posts on EMDR grouping it in with moonbeam therapy, crystal healing, etc., but my understanding of EMDR was always that it was basically functionally exposure therapy with some science-y sounding but unnecessary and basically useless eye movement stuff thrown in. Thus, it's still effective due to the PE component, just not effective for the reason advocates of it like to claim.

Is this correct?

Richard McNally Quote (in the context of reviewing the literature on dismantling studies): "What is new in EMDR (eye movements) is not effective and what is effective in EMDR (exposure) is not new."
 
@canarycoalmine
the vast majority of the scientific community have come to the conclusion that eye movements do not add a therapeutic advantage in aggregate samples (on case-by-case bases, maybe). This does not take away from EMDR's efficacy.

Do you disagree with any of that?

The issue with EMDR is that it was promoted (and heavily charged for) before the scientific evidence was known.
 
Kind of. But, the VA "supports" a lot of useless things, like paying for acupuncture. Not a perfect system, and once something gets put in place, it's hard to remove in the VA. In practice though, rarely utilized. I have never met a provider in psych who performed EMDR, and this is at 3 VA's, one being the largest, in the nation.
 
Kind of. But, the VA "supports" a lot of useless things, like paying for acupuncture. Not a perfect system, and once something gets put in place, it's hard to remove in the VA. In practice though, rarely utilized. I have never met a provider in psych who performed EMDR, and this is at 3 VA's, one being the largest, in the nation.

I know one, actually.
 
Kind of. But, the VA "supports" a lot of useless things, like paying for acupuncture. Not a perfect system, and once something gets put in place, it's hard to remove in the VA. In practice though, rarely utilized. I have never met a provider in psych who performed EMDR, and this is at 3 VA's, one being the largest, in the nation.

Ah I understand.
 
http://www.ptsd.va.gov/public/understanding_TX/booklet.pdf

So apparently the VA supports it? Or am I wrong?

The VA (and even the folks at the national level at research centers) are not above being heavily influenced by sociopolitical factors in their choice of guidelines and their interpretation of research results. As I understand it they are currently engaging in a study of the therapeutic use of 'support dogs' (maybe even 'emotional support animals') for PTSD. Having a 'support dog' 'clear the room (searching the room for threats)' for a true sufferer of PTSD only reinforces dysfunctional beliefs regarding danger and represents a 'safety behavior' that will interfere with effective (exposure) treatments for the condition.
 
I was under the impression the dogs were just for emotional support and not trained for "clear the room" purposes. But, tbh, I've never really looked into the emotional support animal programs or research, so I do not have an informed opinion on that issue.
 
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I dunno, WiseNeuro, I am trying to keep an open mind about their use, perhaps in the form of a 'coping-based' component of treatment of PTSD. Alas, the 'clear the room' part was something I got from a news article...I am not aware of any scholarly reputable sources describing the exact role of a 'service dog' and how it fits in to the treatment of PTSD. Maybe there will be an upcoming Guilford Press or Springer or Routledge Press book on 'The Use of Service Animals in the Treatment of Anxiety Disorders: Empirically-Supported Strategies.' All joking aside, the VA is apparently trying to apply standard methodology to look into it and, hey, I will read the studies when they come out.
 
I was under the impression the dogs were just for emotional support and not trained for "clear the room" purposes. But, tbh, I've never really looked into the emotional support animal programs or research, so I do not have an informed opinion on that issue.

I can think of reasons why they may be countertherapeutic in the 'support role' as well if they (as, anecdotally I have seen to be the case) pre-empt attempts at socialization with 'two-legged (human)' companions. :) I guess it's all how they're utilized.
 
Yeah, I've seem a lot about ongoing and proposed studies about their use, but haven't seen any decent completed stuff yet. Also, going to depend a lot on how they diagnose PTSD and disability in the studies, considering how it's often haphazardly done.
 
Yeah, I've seem a lot about ongoing and proposed studies about their use, but haven't seen any decent completed stuff yet. Also, going to depend a lot on how they diagnose PTSD and disability in the studies, considering how it's often haphazardly done.

True dat.

And maybe there's a parallel here (between the service animal and the eye movements)...in either case the focus is taken away from the mechanisms of action that are known to be helpful for the condition (that are based on and traceable back to good basic scientific research and foundational theories (e.g., classical and operant conditioning, habituation processes, principles of extinction). From the inception of the exposure-based (and to a large extent cognitive-behavioral [restructuring]) approaches there has been spirited debate regarding how exactly to account for the effectiveness of the exposure-based approach (what theoretical mechanisms accounted for the therapeutic effects) WITHIN the behavioral/cognitive-behavioral theorists and practitioner camp (Foa and Kozac 1986? article on activating the 'fear network' being essential to successful exposure therapy). This debate leads folks to design experiments to test out various components of the cognitive-behavioral theories about how the therapy works and different hypotheses 'compete' and the competition is decided by empirical findings. As a great philosopher of science once said, 'fallibility is the hallmark of science.' We have to critically examine (even attack) our own theories via empirical investigation to have confidence that they are reasonably accurate. What the EMDR camp appears to be missing is this self-correcting element of a scientific approach whereby the theory (and derivative hypotheses) are grounded in relevant basic science (neuroscience, for example), alternative/competing hypotheses are advanced, each is tested empirically, and the results are used to amend/advance the theory.
 
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Totally agree. The choice of outcome measures will be important in the support animal studies. We already know they activate reward center circuitry and oxytocin, but do they do anything for the underlying PTSD and lead to lasting change and lower symptomatology. Hopefully the studies are well designed and not just set up to conform the hypothesis that they want rather than what the data point to.
 
Totally agree. The choice of outcome measures will be important in the support animal studies. We already know they activate reward center circuitry and oxytocin, but do they do anything for the underlying PTSD and lead to lasting change and lower symptomatology. Hopefully the studies are well designed and not just set up to conform the hypothesis that they want rather than what the data point to.

Excellent points. In the end, I have faith that even if the studies are set up to achieve a certain positive finding (to support a sociopolitical agenda or whatever), the self-correcting nature of the scientific approach to psychology will clarify the issues over time. I can just imagine the sorts of invited essays, review articles and incisive and ingeniously designed experiments that will be offered by the big league folks (Richard McNally, Edna Foa, David Barlow, Scott Lilienfeld) in the wake of some ill-conceived study or series of studies framing the 'service dog' therapy as the rightful successor to the prolonged exposure and cognitive processing therapy approaches :). Hopefully, they won't go that cray-cray :)
 
Yeah, I've seem a lot about ongoing and proposed studies about their use, but haven't seen any decent completed stuff yet. Also, going to depend a lot on how they diagnose PTSD and disability in the studies, considering how it's often haphazardly done.

Would be very interesting if they gave all participants the MMPI-2-RF and observed a high correlation between scores on the F(p)-r scale and degree of (self-reported) symptom improvement attributable to the PTSD service dog. You know, based on my own anecdotal observations, I might just bet money on that hypothesis.
 
http://www.ptsd.va.gov/public/understanding_TX/booklet.pdf

So apparently the VA supports it? Or am I wrong?

Kind of. But, the VA "supports" a lot of useless things, like paying for acupuncture.

It really kills me. There is not a single study showing that acupuncture beats a credible placebo. Not one!

The VAs acceptance of a treatment is really not representative of efficacy. For example,
http://www.healingtouchprogram.com/content_assets/docs/current/VISN_12.pdf

And for those that are not aware, therapeutic touch (or now referred to as healing touch) was discredited many years ago by a child.
http://en.m.wikipedia.org/wiki/Emily_Rosa#Therapeutic_Touch_study
 
"Service dogs" are fine. I am open minded. And I really dont think they are used or trained for "clearing the room" by veterans that I see with them.

But, I recently read an article where a young woman who was kicked off a plane cause she brought her "emotional support pig" on the plane. It was causing quit the ruccus, so naturally people complained-as would I. She then, predictably, threw a tantrum all over the net about people's insenstivity to her plight, and how she needs this animal for her functioning. My wife thinks people are just getting too "soft." I am in increasing agreement.
 
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To piggyback on the animal support stuff. Pets can be therapeutic so can gardening or massage or listening to good music, maybe even flashing lights. I feel pretty strongly that these types of things should not be conflated with evidence based psychotherapy. The parallel would be that talking to someone is therapeutic so why pay an expert when you could just tell your woes to the bartender?
 
I can think of reasons why they may be countertherapeutic in the 'support role' as well if they (as, anecdotally I have seen to be the case) pre-empt attempts at socialization with 'two-legged (human)' companions. :) I guess it's all how they're utilized.

It might've been mentioned already, but there's also the flip-side that's possible--perhaps the dog/animal becomes a bit of a "safety object," and the owner then begins going out into public more, and is more willing to tolerate the associated transient physiological arousal response. So if there's a reduction in PTSD symptoms, it might be due to what's essentially in-vivo exposure.

But I agree with smalltownpsych--there are plenty of activities that could be considered "therapeutic," although perhaps a different term should be used so as not to conflate those activities with evidence-based therapies. So that type of thing can of course be encouraged and/or incorporated into EBP (e.g., via behavioral activation/activity scheduling), but it doesn't mean they should then be administered somehow by healthcare professionals and described as evidence-based practice.
 
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It might've been mentioned already, but there's also the flip-side that's possible--perhaps the dog/animal becomes a bit of a "safety object," and the owner then begins going out into public more, and is more willing to tolerate the associated transient physiological arousal response. So if there's a reduction in PTSD symptoms, it might be due to what's essentially in-vivo exposure.

But I agree with smalltownpsych--there are plenty of activities that could be considered "therapeutic," although perhaps a different term should be used so as not to conflate those activities with evidence-based therapies. So that type of thing can of course be encouraged and/or incorporated into EBP (e.g., via behavioral activation/activity scheduling), but it doesn't mean they should then be administered somehow by healthcare professionals and described as evidence-based practice.
Exactly. I have a trauma patient who loves horses and there are a lot of benefits that accrue from this activity that directly benefit the recovery, but it is not "equine therapy". There are many tools that can be integrated or added to an evidence-based practice. As far as horses go, it includes increase mindfulness, affect regulation, fun (which is very therapeutic by the way :)), exercise, increased self-esteem or mastery, breath control, sunlight (especially important for mood in Northern winter). The list could probably go on so I am really glad that this patient does this activity, but it is not the treatment. The treatment is the psycho-education, progressive exposure, and cognitive reprocessing that we do in the office. Horse aren't as good at some of that stuff!:p
 
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How to become doctor in canada while we are sitting in asia
 
I've read some recent posts on EMDR grouping it in with moonbeam therapy, crystal healing, etc., but my understanding of EMDR was always that it was basically functionally exposure therapy with some science-y sounding but unnecessary and basically useless eye movement stuff thrown in. Thus, it's still effective due to the PE component, just not effective for the reason advocates of it like to claim.

Is this correct?
Gd
 
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