Brainspotting?

[PikminOC]

Hello, Thank you in advance for your help on this.
My patient is seeing a therapist who does Brainspotting.
I am more familiar with EMDR than this. Is Brainspotting a good treatment for someone with PTSD with evidence?

FAQs on brainspotting: https://www.authenticityassociates.com/brainspotting/brainspotting-faq/.

“Brainspotting can be done at the same time as cognitive therapy. Brainspotting allows for deeper processing of trauma and emotional stress and can enhance the effects of cognitive therapy.”

If my patient has Brainspotting, should they also be in CBT at the same time or keep it separate?

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[futureapppsy2]

This is not evidence-based and is basically a pseudoscience money grab. CPT and PE are both effective, efficient evidence-based treatments for PTSD.

 

[PikminOC]

This is not evidence-based and is basically a pseudoscience money grab. CPT and PE are both effective, efficient evidence-based treatments for PTSD.

What's PE? And is EMDR ok?

 

[AcronymAllergy]

PE is prolonged exposure, perhaps one of the most solidly evidence-based psychotherapeutic treatments we have. EMDR is ok in the sense that there's research support its efficacy, even if there's not a whole lot of support for the non-exposure components (i.e., the eye movements).

Edit: And no, I would not say brainspotting is a viable or good treatment. I would agree with futureapppsy2's summary of it.

 

[WisNeuro]

Brainspotting is pure snake oil. EMDR is PE-lite with some expensive fairy dust thrown in.

 

[Therapist4Chnge]

It's 100% junk pseudo-science. I love when legal cases have it bc it's easy to pick apart. Avoid any clinician who thinks it's worthwhile bc they will undoubtedly turnout to be a *****.

 

[PsyDr]

Brain spotting and EMDR are complete snake oil.

Because the core principles of these psychotherapies violate basic tenets of neurophys, anyone who uses them is identifying him/herself as someone who does not know how the brain works. And are therefore incompetent.

That being said, EMDR does work. But it does not work because of the eye movement, or it's practitioners understanding of how the brain works. It works because the techniques employed are a version of a long established psychotherapy. And then some idiots added in some eye movements.

You'd think this was new stuff, but...

Hyer, L. and J. M. Brandsma (1997). "EMDR minus eye movements equals good psychotherapy." J Trauma Stress 10(3): 515-522.

 

[cara susanna]

I also want to second that brainspotting is garbage. Also, that recent study that looked at therapy effect sizes suggested that EMDR has lower efficacy than PE and CPT. But if your only choice is brainspotting vs. EMDR, definitely take EMDR.

 

[PikminOC]

This patient's mother died when she was young due to cancer. She saw her mother waste away and then pass away in the hospital in a traumatic fashion. What would be the best treatment? What kind of PE can be done for that?

 

[PsychPhDone]

This patient's mother died when she was young due to cancer. She saw her mother waste away and then pass away in the hospital in a traumatic fashion. What would be the best treatment? What kind of PE can be done for that?

Blargh. I'm sorry she went through that. PE is a full treatment protocol. She will work with a therapist to repeatedly talk her way through the traumatic memory (like telling a story) and also do in vivo exposures (engaging in activities she's been avoiding.) She'll need a provider trained in this, you can't pick it up after a weekend seminar. (I say that because therapists might claim to offer it when they're not actually trained.) Cognitive Processing Therapy is the other tx approach with good evidence. It involves evaluating and challenging your thoughts about the trauma.

VA.gov | Veterans Affairs

Apply for and manage the VA benefits and services you’ve earned as a Veteran, Servicemember, or family member—like health care, disability, education, and more.

www.ptsd.va.gov

 

[beginner2011]

It is curious to me that PTSD seems to have these two persistent pseudoscientific treatments when other disorders (e.g., depression, OCD, panic, etc.) do not have even one with the same degree of research support (no matter how shoddy).

 

[cara susanna]

This patient's mother died when she was young due to cancer. She saw her mother waste away and then pass away in the hospital in a traumatic fashion. What would be the best treatment? What kind of PE can be done for that?

I would need more information, like what are the current symptoms and functional impairment? Is the patient engaging in avoidance? Any self blame thoughts?

 

[AbnormalPsych]

It is curious to me that PTSD seems to have these two persistent pseudoscientific treatments when other disorders (e.g., depression, OCD, panic, etc.) do not have even one with the same degree of research support (no matter how shoddy).

I don't know why but EMDR is the only treatment I have ever had multiple patients walk into my department asking for directly and by name.

 

[Mindfulpsych22]

I don't know why but EMDR is the only treatment I have ever had multiple patients walk into my department asking for directly and by name.

I’ve had patients who had master’s level therapists do EMDR for “depression” and all kinds of “traumas” (everything from suboptimal parenting interactions to memories of ordinary negative life events) even when PTSD is not present. Of course the research on efficacy of EMDR is pretty limited to PTSD and not just random memories of upsetting events that had an unknown impact on a person’s emotional and cognitive development.

I think people are drawn to it because it sounds “cutting edge” and doesn’t put a huge burden on behavior change or out of session work the way other tx approaches do. Neuro-level explanations of pathology and interventions are having a “moment” which is why unsuspecting people just rave and rave about places like the Amen clinic. I think this is why so many MA clinicians get trained in it- to distinguish and market themselves in often saturated markets.

Also, just to add to the discussion on efficacy- I can’t find the citations right now, but there are some comparison studies that show upon follow up that the “gains” from EMDR start to be lost over time compared to PE in which progress was maintained.

 

[PikminOC]

I havent heard of PE before this. I have alot of problems finding good psychologists and therapists in private practice as they are variable in their treatment. I dont know who would do this kind of therapy. I will look it up.

 

[beginner2011]

I havent heard of PE before this. I have alot of problems finding good psychologists and therapists in private practice as they are variable in their treatment. I dont know who would do this kind of therapy. I will look it up.

PE = Prolonged Exposure.
It's a structured, time-limited psychotherapy based on cognitive and behavioral principles of learning and emotional processing of traumatic experiences.

Prolonged Exposure (PE)

In prolonged exposure, people actively learn that memories and trauma-related cues are not dangerous and do not need to be avoided.

www.apa.org

VA.gov | Veterans Affairs

Apply for and manage the VA benefits and services you’ve earned as a Veteran, Servicemember, or family member—like health care, disability, education, and more.

www.mentalhealth.va.gov

If there's a VA in your area there are also probably psychologists in private practice nearby who have training in PE.

 

[deleted343839]

It is curious to me that PTSD seems to have these two persistent pseudoscientific treatments when other disorders (e.g., depression, OCD, panic, etc.) do not have even one with the same degree of research support (no matter how shoddy).

Well... neurofeedback is used for ADHD, autism spectrum symptoms, and a host of other things. That's on the same level.

What I've found is that EMDR is used for all kinds of anxiety and stress-related disorders in the community, not just PTSD. As for other pseudoscientific treatments, I think there are a lot of things people do that aren't scientific but don't have the same "name brand" as EMDR.

 

[cara susanna]

I don't know why but EMDR is the only treatment I have ever had multiple patients walk into my department asking for directly and by name.

EMDR has a great public campaign, much better than PE (which is often villainized by EMDR people, ironically). van der Kolk especially has become a shill for it.

And, yeah, I've even heard of EMDR for substance abuse now.

 

[WisNeuro]

EMDR has a great public campaign, much better than PE (which is often villainized by EMDR people, ironically). van der Kolk especially has become a shill for it.

And, yeah, I've even heard of EMDR for substance abuse now.

Considering van der kolk's history of alleged ethical violations, this is unsurprising. When you have no integrity or ethical responsibility left, why not peddle pseudoscience for personal gain?

 

[DynamicDidactic]

I havent heard of PE before this. I have alot of problems finding good psychologists and therapists in private practice as they are variable in their treatment. I dont know who would do this kind of therapy. I will look it up.

It is really telling and unfortunate that the treatment with the most research (exposure for trauma) is less know than brainspotting (which is fully pseudoscientific) and EMDR (which is partially pseudoscientific).

More troubling is being able to find a well-trained therapist in these scientific treatments. It would be difficult for me to find a therapist (masters or doctorate) that took insurance and didn't have a very long waitlist. Yet, it is super easy to find an EMDR practitioner with insurance and an opening. I bet that is part of the reason that you are more familiar with EMDR.

I am also concerned that neither treatment may be best for your client. Obviously, I do not know the details and symptoms but it sounds like bereavement. People have started calling it complex grief. I don't think we have great research identifying particularly well-established treatments for it.

 

[AbnormalPsych]

EMDR has a great public campaign, much better than PE (which is often villainized by EMDR people, ironically). van der Kolk especially has become a shill for it.

And, yeah, I've even heard of EMDR for substance abuse now.

What's up with this? Be curious to hear more about how some are applying EMDR for this.

 

[deleted343839]

What's up with this? Be curious to hear more about how some are applying EMDR for this.

I've heard of it used to treat the "trauma" of learning that your spouse was using porn and therefore a "sex addict."

 

[futureapppsy2]

I've heard of it used to treat the "trauma" of learning that your spouse was using porn and therefore a "sex addict."

Hey, Utah!

 

[futureapppsy2]

What's up with this? Be curious to hear more about how some are applying EMDR for this.

1. Spout of extremely questionable (at best) “neuroscience” about bilateral movements.
2. Advertise.
3. Profit.

 

[PsyDr]

I've heard of it used to treat the "trauma" of learning that your spouse was using porn and therefore a "sex addict."

Facing a Major Crisis - South Park | South Park Studios US

The CDC discusses the recent outbreak of sex addiction in the country.

southpark.cc.com

 

[FreudianSlippers]

As with most issues, any "bonified" therapy modality with a practitioner who is trauma informed (this part is ESSENTIAL) will be as effective as the next. PE, ACT, CBT, CPT, narrative therapy, psychodynamic therapy, etc.

Leichsenring, F., & Klein, S. (2014). Evidence for psychodynamic psychotherapy in specific mental disorders: a systematic review. Psychoanalytic Psychotherapy, 28(1), 4-32.

Bisson, J. I., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner, S. (2007). Psychological treatments for chronic post-traumatic stress disorder: Systematic review and meta-analysis. The British journal of psychiatry, 190(2), 97-104.

Edited: changed links to references. A quick google scholar will give you the PDF if interested

 

[AbnormalPsych]

As with most issues, any "bonified" therapy modality with a practitioner who is trauma informed (this part is ESSENTIAL) will be as effective as the next. PE, ACT, CBT, CPT, narrative therapy, psychodynamic therapy, etc.

Citation 1

Citation 2

Those citations don't seem to be working. Could you put the link in again, please?

 

[tr]

As with most issues, any "bonified" therapy modality with a practitioner who is trauma informed (this part is ESSENTIAL) will be as effective as the next. PE, ACT, CBT, CPT, narrative therapy, psychodynamic therapy, etc.

Citation 1

Citation 2

Sure but the dropout rates for PE in particular are horrendous. Success rates are good *for people who can tolerate the treatment,* which consitute a selected group. Besides the 30-40% who thought they could tolerate it but dropped out, I've never seen a meaningful estimate of how many people refuse to engage with it in the first place because they know it would be intolerable. (But based on my clinical experiences trying to convince people they need to do exposure based therapies for their PTSD, it's a lot.)

The problem of dropout from “gold standard” PTSD therapies

Understanding of posttraumatic stress disorder (PTSD) has increased substantially in the past several decades. There is now more awareness of the many different types of trauma that can lead to PTSD, greater refinement of diagnostic criteria, and the ...

www.ncbi.nlm.nih.gov

The rationale for EMDR is total junk science, agreed, but if the mechanism is truly related only to exposure, how come EMDR is better tolerated while being equally effective? Can anyone explain this?

 

[WisNeuro]

Sure but the dropout rates for PE in particular are horrendous. Success rates are good *for people who can tolerate the treatment,* which consitute a selected group. Besides the 30-40% who thought they could tolerate it but dropped out, I've never seen a meaningful estimate of how many people refuse to engage with it in the first place because they know it would be intolerable. (But based on my clinical experiences trying to convince people they need to do exposure based therapies for their PTSD, it's a lot.)

The problem of dropout from “gold standard” PTSD therapies

Understanding of posttraumatic stress disorder (PTSD) has increased substantially in the past several decades. There is now more awareness of the many different types of trauma that can lead to PTSD, greater refinement of diagnostic criteria, and the ...

www.ncbi.nlm.nih.gov

The rationale for EMDR is total junk science, agreed, but if the mechanism is truly related only to exposure, how come EMDR is better tolerated while being equally effective? Can anyone explain this?

You have to separate PE dropout in veteran samples and civilian. It's a whole different ballgame in the VA world. PE is actively vilified by vets to each other. Without fail, every time I mentioned it to a vet, I was told a story about how another vet had told them it was harmful. Back when I did PE with sexual assault survivors, single digit dropout rate, and even some of those re-engaged successfully after stabilization sessions. The VA is a well that has poisoned a great deal of literature in the trauma world. Hard to make conclusions with the amount that is tied up in SC and proving disability.

 

[cara susanna]

Sure but the dropout rates for PE in particular are horrendous. Success rates are good *for people who can tolerate the treatment,* which consitute a selected group. Besides the 30-40% who thought they could tolerate it but dropped out, I've never seen a meaningful estimate of how many people refuse to engage with it in the first place because they know it would be intolerable. (But based on my clinical experiences trying to convince people they need to do exposure based therapies for their PTSD, it's a lot.)

The problem of dropout from “gold standard” PTSD therapies

Understanding of posttraumatic stress disorder (PTSD) has increased substantially in the past several decades. There is now more awareness of the many different types of trauma that can lead to PTSD, greater refinement of diagnostic criteria, and the ...

www.ncbi.nlm.nih.gov

The rationale for EMDR is total junk science, agreed, but if the mechanism is truly related only to exposure, how come EMDR is better tolerated while being equally effective? Can anyone explain this?

PE dropout rates are not really due to difficulty tolerating the treatment, but more things like life issues and scheduling. At least, I haven't seen any convincing research suggesting otherwise.

Also, I'd argue EMDR is "better tolerated" for two reasons: 1) the movements distract the person enough from their distress 2) the pseudoscientific explanation works as kind of a placebo effect in terms of buy-in.

 

[tr]

PE dropout rates are not really due to difficulty tolerating the treatment, but more things like life issues and scheduling. At least, I haven't seen any convincing research suggesting otherwise.

But why would those factors be different among different treatment modalities?

Also, I'd argue EMDR is "better tolerated" for two reasons: 1) the movements distract the person enough from their distress 2) the pseudoscientific explanation works as kind of a placebo effect in terms of buy-in.

So would it improve tolerability for PE if the therapist added in some random distracting movements do you think?

 

[cara susanna]

But why would those factors be different among different treatment modalities?

PE is a TON of work even compared to other EBPs. 90 min sessions weekly, three in vivo practices that can take up to 30 min each daily, listening to a 30-60 min recording daily (without being able to multi-task), listening to a 90 min session recording weekly.

So would it improve tolerability for PE if the therapist added in some random distracting movements do you think?

I mean, maybe, but I think there are better options to improve PE's tolerability if we really think that's an issue. I just saw a discussion in the research about being more lenient about safety behaviors as a way of increasing acceptability of PE, that may not really impact effectiveness as much as we had previously thought.

Also, as WisNeuro said, we need more studies on PE dropout that do not sample within the VA.

 

[PsyDr]

@tr


Do drop out rates affect how one considers weight loss and the recommendation thereof? Because the drop out rates for those are worse, and have worse outcomes.

 

[foreverbull]

PE dropout rates are not really due to difficulty tolerating the treatment, but more things like life issues and scheduling. At least, I haven't seen any convincing research suggesting otherwise.

Also, I'd argue EMDR is "better tolerated" for two reasons: 1) the movements distract the person enough from their distress 2) the pseudoscientific explanation works as kind of a placebo effect in terms of buy-in.

As @WisNeuro also mentioned, if a vet is service-connected and is receiving funds because of the dysfunction of living with PTSD, the buy-in to an already challenging-sounding treatment just isn’t there for some. I’ve personally seen a vet become irate and threaten the psychologist when their service connection rate dropped because their PTSD symptoms have declined and they are able to function better (which should be a good thing).

But I do think the first couple of PE sessions that explain the rationale and the interventions turns some people off to it, although therapists frame it as positively as possible. No one wants to hear that they might get a bit worse (slight uptick in symptoms) before they get better, even if they know it is temporary and the end result will be very positive. Some folks also just don’t want to hear that they have to relive their trauma every session and between sessions and then on top of that, go out and do something to face their fears in the real world. It’s intensive and high dosages of exposure, which not every client will want to take part in given what we know about individual differences in motivation and avoidance.

@tr
Hence why EMDR is more appealing with a distraction built in that people wrongly assume is the change mechanism. From what I understand, it’s also less intensive in terms of exposure and between-session homework than PE. Can anyone confirm this who is familiar with both PE and EMDR?


I’m not sure that you could introduce a distraction to PE and hope it’d be equally effective, because it is heavily reliant on being present with the sensations throughout treatment, to, in effect, take the power out of the trauma memories by exposure without the feared outcome. But if EMDR is effective without having to be fully present, it’s possible to adapt PE, perhaps, and it seems like some clinicians do adapt PE to make it more palatable, as mentioned in the article you linked (although certainly that introduces its own problems do to lack of standardization and not providing treatment close to protocol). But I think a more common adaptation is to slow treatment down and use a different therapy approach along with PE rather than introduce a distraction technique.

 

[tr]

@tr
Do drop out rates affect how one considers weight loss and the recommendation thereof? Because the drop out rates for those are worse, and have worse outcomes.

I mean, that's not my primary area of expertise, but absolutely, my understanding is that likelihood of adherence is a huge factor in selecting weight loss strategies. Perhaps the single most important one. The program that works is the one you can stick to. (Who would ever be recommending weight loss surgery if diet adherence were actually feasible?)

(Also, weird question? What's the relevance to the exposure discussion?)

 

[tr]

As @WisNeuro also mentioned, if a vet is service-connected and is receiving funds because of the dysfunction of living with PTSD, the buy-in to an already challenging-sounding treatment just isn’t there for some. I’ve personally seen a vet become irate and threaten the psychologist when their service connection rate dropped because their PTSD symptoms have declined and they are able to function better (which should be a good thing).

Totally hear you on the confounding by motivation for SC.

But I do think the first couple of PE sessions that explain the rationale and the interventions turns some people off to it, although therapists frame it as positively as possible. No one wants to hear that they might get a bit worse (slight uptick in symptoms) before they get better, even if they know it is temporary and the end result will be very positive. Some folks also just don’t want to hear that they have to relive their trauma every session and between sessions and then on top of that, go out and do something to face their fears in the real world. It’s intensive and high dosages of exposure, which not every client will want to take part in given what we know about individual differences in motivation and avoidance.

Right, this is very much my experience when trying to refer trauma patients for therapy and discussing the options. Most of them don't want to touch PE with a ten foot pole after hearing how it works.

Hence why EMDR is more appealing with a distraction built in that people wrongly assume is the change mechanism. From what I understand, it’s also less intensive in terms of exposure and between-session homework than PE. Can anyone confirm this who is familiar with both PE and EMDR?

So then what is the advantage of PE over EMDR? If PE is more demanding and more difficult, but no more effective, why choose it over CPT or EMDR?

I admit to being flummoxed by the apparent effectiveness of EMDR but it's hard to argue with the data at this point.
I can only surmise that it has something to do with the Dodo Effect as discussed by @FreudianSlippers in a comment above and also on the other relevant current thread.
Given that, I wonder if the academic establishment is not giving patients a fair shake by continuing to consign EMDR to the junk science bin and refusing to learn or teach it?

 

[WisNeuro]

So then what is the advantage of PE over EMDR? If PE is more demanding and more difficult, but no more effective, why choose it over CPT or EMDR?

I don't believe that EMDR is as efficacious. @cara susanna posted a newer meta showing some disappointing results for EMDR. Do you have that cite again?

 

[cara susanna]

I don't believe that EMDR is as efficacious. @cara susanna posted a newer meta showing some disappointing results for EMDR. Do you have that cite again?

Yup, here it is!

APA PsycNet

psycnet.apa.org

I do agree that the focus of PE on rationale misfires sometimes. I feel like the rationale part gets repetitive and it can feel slow before you get to the real meat of the treatment. I just tell patients that it's redundant and to bear with me, lol.

 

[cara susanna]

Excerpt from the article, for those who don't have access:

Using the optimistic estimates for two ESTs for PTSD as examples, our analyses suggest that the efficacy of Cognitive Processing Therapy is
38.89E+24 times more likely than that of Eye Movement Desensitization and Reprogramming (11.00E+26 divided by 28.82).

Granted, this is CPT, not PE. But PE showed stronger evidence across studies, too. Also, I'd definitely consider CPT for someone who has trouble with PE whereas I would not consider EMDR.

 

[WisNeuro]

Excerpt from the article, for those who don't have access:



Granted, this is CPT, not PE. But PE showed stronger evidence across studies, too. Also, I'd definitely consider CPT for someone who has trouble with PE whereas I would not consider EMDR.

I'll second that. In the VA, we had much more success in getting someone to try CPT. I'm trained in both, and at least in non-VA samples, PE generally led to quicker and longer lasting resolution of PTSD symptoms than other methods I've tried over the years.

 

[PsyDr]

I mean, that's not my primary area of expertise, but absolutely, my understanding is that likelihood of adherence is a huge factor in selecting weight loss strategies. Perhaps the single most important one. The program that works is the one you can stick to. (Who would ever be recommending weight loss surgery if diet adherence were actually feasible?)

(Also, weird question? What's the relevance to the exposure discussion?)

If I understood it correctly, your (and the article's) point seemed to be that tolerance affects the quality of a treatment. I am curious about the limits of this line of reasoning. Obesity was just chosen as an easy example.

The issue of treatment tolerance and nonadherence affecting the quality "rating" of a treatment is interesting. You wouldn't refuse to admit an actively suicidal patient because they said they couldn't handle being in a hospital. What about a patient who said they can only tolerate a pint of vodka a day, and that medication and psychotherapy are just intolerable? Does that make psychotherapy and medication lesser?






And to answer your question: Every bariatric surgeon in the USA would recommend diet adherence as a condition of bariatric surgery. Otherwise, the patient would immediately suffer surgical complications.

 

[tr]

If I understood it correctly, your (and the article's) point seemed to be that tolerance affects the quality of a treatment. I am curious about the limits of this line of reasoning. Obesity was just chosen as an easy example.

The issue of treatment tolerance and nonadherence affecting the quality "rating" of a treatment is interesting. You wouldn't refuse to admit an actively suicidal patient because they said they couldn't handle being in a hospital. What about a patient who said they can only tolerate a pint of vodka a day, and that medication and psychotherapy are just intolerable? Does that make psychotherapy and medication lesser?

Involuntary hospitalization is not by itself a treatment for anything, it's just a practical mechanism to prevent the patients from harming themselves or others in the short term while other treatments are applied.

I would certainly not attempt to pressure a pre-contemplation stage alcoholic into accepting medication and psychotherapy in the pursuit of abstinence. I hope you would not either. I believe it is generally understood that some open-minded motivational interviewing can be useful at this stage, but forced treatment doesn't generally produce lasting improvement.

I don't believe I made any statements about any therapies being 'greater' or 'lesser' (?) than others. The question is whether a specific patient will be helped by referral to a specific therapy. In the case where the patient is unwilling to engage with the therapy, the answer to that question is pretty much always going to be No.

And to answer your question: Every bariatric surgeon in the USA would recommend diet adherence as a condition of bariatric surgery. Otherwise, the patient would immediately suffer surgical complications.

Yes yes, you can consider "diet adherence *in the absence of surgical intervention*" to have been implied in my statement.

Really, patient consent and willing participation are preconditions for success in nearly all mental health treatments. I guess in the extreme case you can 5150, Riese, and ultimately conserve to medicate against the patient's will, but that's rare and those outcomes are generally pretty dismal.

 

[tr]

Excerpt from the article, for those who don't have access:



Granted, this is CPT, not PE. But PE showed stronger evidence across studies, too. Also, I'd definitely consider CPT for someone who has trouble with PE whereas I would not consider EMDR.

Thank you, that's helpful. I admit that I am unfamiliar with most of the statistical quantities described in Table 2, and also it appears that presbyopia is catching up with me, making the tiny print indecipherable. So I will take your word for it on this one.

So the efficacy is clearly lower for EMDR than either PE or CPT? That's reassuring.

 

[DynamicDidactic]

So the efficacy is clearly lower for EMDR than either PE or CPT? That's reassuring.

No. The article posted by @cara susanna is not a well sampled meta. The article does find that EMDR was less effective but not based on the entire available literature. It is a worthwhile article on the poorly defined standard for ESTs rather than something to compare treatment efficacy.

This topic came up in the past year and I also did not find evidence indicating EMDR is any better or worse than PE, CPT, or even mindfulness.

Given that, I wonder if the academic establishment is not giving patients a fair shake by continuing to consign EMDR to the junk science bin and refusing to learn or teach it?

I teach about EMDR to undergrads, I learned (in a classroom) about it in grad school, and I have had supervisors throughout training that use EMDR (well, maybe one or two). But you are accurate in saying that there is an adversarial relationship between the EMDR practitioners and clinical scientists. I hope others teach about as I do and as I have said on this forum; it works but eye movements are indeed junk science.

I am unsure what there is to learn since the eye movements are snake oil (and cost a bundle to learn) and the exposure is taught already.

My problem with EMDR is the regression in science-based treatments. While CPT and PE are not any more effective, continuing with that line of research is bound to be more effective than finding more pseudoscientific (fully or partially) treatments. Now, I am all in favor of learning why EMDR gets similar outcomes despite different types of exposure.

 

[DynamicDidactic]

Involuntary hospitalization is not by itself a treatment for anything, it's just a practical mechanism to prevent the patients from harming themselves or others in the short term while other treatments are applied.

I know a topic for another day but I want to highlight that hospitalizations are potentially iatrogenic and perhaps not the best example.

Error - Cookies Turned Off

onlinelibrary.wiley.com

 

[DynamicDidactic]

As with most issues, any "bonified" therapy modality with a practitioner who is trauma informed (this part is ESSENTIAL) will be as effective as the next. PE, ACT, CBT, CPT, narrative therapy, psychodynamic therapy, etc.

Leichsenring, F., & Klein, S. (2014). Evidence for psychodynamic psychotherapy in specific mental disorders: a systematic review. Psychoanalytic Psychotherapy, 28(1), 4-32.

Bisson, J. I., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner, S. (2007). Psychological treatments for chronic post-traumatic stress disorder: Systematic review and meta-analysis. The British journal of psychiatry, 190(2), 97-104.

Edited: changed links to references. A quick google scholar will give you the PDF if interested

This is true for PTSD. However, this is not accurate for all disorders (e.g., individuals at high-risk for suicide, eating disorders, or social anxiety.

 

[WisNeuro]

My problem with EMDR is the regression in science-based treatments. While CPT and PE are not any more effective, continuing with that line of research is bound to be more effective than finding more pseudoscientific (fully or partially) treatments. Now, I am all in favor of learning why EMDR gets similar outcomes despite different types of exposure.

There are a few forms of EMDR out there, but at least one of the dominant ones is pretty much the same as an imaginal exposure trauma narrative. So, it's not really a different type of exposure. It's the same that we'd do in PE. PE is also flexible enough so that you don't always have to start with the index trauma, or you could even do a "safer" snippet of the index event if they are experiencing overwhelming emotions. So, in the end, it's the same imaginal exposure. So, it shouldn't really be all that different.

 

[cara susanna]

Well, as others have mentioned, EMDR is now being offered for numerous types of psychological problems and not just PTSD. So the EMDR cart is definitely running away before the horse now.

Also, EMDR people need to stop saying that PE doesn't work and "retraumatizes" patients, especially when research is suggesting it's the same darn thing.

 

[WisNeuro]

Agree here, the EMDR proponents have built their foundation on maligning PE, and to a lesser extent CPT, in a bid to sell their trainings.

Look, you too can own an LED light and controller for the low cost of $650! (And these are just the cheaper, older models)

NeuroTek EMDR Shop

NeuroTek is a global leader in EMDR technology since 1992. Shop our EMDR products today.

neurotekcorp.com

Training workshop sold separately.

 

[beginner2011]

As with most issues, any "bonified" therapy modality with a practitioner who is trauma informed (this part is ESSENTIAL) will be as effective as the next. PE, ACT, CBT, CPT, narrative therapy, psychodynamic therapy, etc.

Leichsenring, F., & Klein, S. (2014). Evidence for psychodynamic psychotherapy in specific mental disorders: a systematic review. Psychoanalytic Psychotherapy, 28(1), 4-32.

Bisson, J. I., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner, S. (2007). Psychological treatments for chronic post-traumatic stress disorder: Systematic review and meta-analysis. The British journal of psychiatry, 190(2), 97-104.

Edited: changed links to references. A quick google scholar will give you the PDF if interested

This is true for PTSD. However, this is not accurate for all disorders (e.g., individuals at high-risk for suicide, eating disorders, or social anxiety.

I looked at the Leichsenring2014 for PTSD and the claim of equivalence between PE and Psychodynamic psychotherapy. It's actually pretty bunk. Did you look at it? They cite ONE study from 1989 that looked at PTSD comparing desensitization (similar to, but not PE) and psychodynamic, and describe the history of disagreement regarding implications of the findings.

I'll review the Wampold/Imel2014 book again, because their review was more comprehensive. I will say that I've had a number of conversations with supervisors about Wampold's work, both in favor of and skeptical of the "Contextual Model," and even the strong supporters of the model do not agree with the strength of the conclusions some Wampold readers make about equivalence of all psychotherapy. Notice that the Contextual Model identifies three primary pathways through which patients benefit from psychotherapy: 1. The Real Relationship, 2. Expectations, 3. Specific Ingredients. I think it's a fundamental misunderstanding of Wampold to conclude that he is arguing specific ingredients do not matter.

EDIT: The other big review that I'm aware of regarding the comparative efficacy of psychodynamic for PTSD is Shedler's 2010, which cites Leichsenring 2004, which cites....the same ONE study from 1989. It's turtles all the f*cking way down.

Also of note, I've discovered that short term psychodynamic psychotherapy (STPP) is anything less than 40 sessions. Meanwhile, PE trials max at 15 typically, with only one trial reporting 19 max sessions. We know dose matters. Just because 40 sessions of STPP may be non-inferior to 12 sessions of PE (we DO NOT actually have data on this, to my knowledge), that doesn't mean that STPP = PE.

Looking in to Wampold now.