Emdr

[4thought]

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I'm interested in what others may know or think about EMDR. I'm starting a new thread because it came up as a good side topic in another thread.

 

[psychanon]

It works, but the eye movements are useless and the supposed mechanism is totally bogus. It's exposure under conditions of perceived control. Total pseudoscience.

 

[KillerDiller]

I won't make any grand proclamations on the worth of EMDR because I know very little about it. I will say, though, that I went through a session of it in my therapeutical methods class for a demonstration and I didn't really make any progress or feel anything (except maybe stupid for sitting there and moving my eyes back and forth). I don't have PTSD, but I have undergone some traumatic events that cause anxiety when I relive them. I'm not sure I buy that EMDR would help me significantly with that even over time. However, it it may help those who are more reluctant than I am to venture into those parts of their memory.

 

[Pekoe]

One of my psych classmates had a foster daughter who'd been in a terrible car accident. (She was an FM while the little girl's parents recovered int he hospital with all kinds of injuries and kept up with her after she went home. Complicated situation-- my classmate, out of the kindness of her heart, helped the family by helping the parents when they got out by being "there" for them. She liked the kids and the family was just nice.) The little girl went to traditional therapy and it didn't work-- she had all kinds of flashbacks and nightmares. A few (3) sessions of EMDR and she was cured-- she felt that after the first one she was fine but she went in two more times. The lady was very legitimate and because she seemed on the up and up, I take her word for it and would have no problem suggesting it to someone.

 

[Therapist4Chnge]

One of my psych classmates had a foster daughter who'd been in a terrible car accident. (She was an FM while the little girl's parents recovered int he hospital with all kinds of injuries and kept up with her after she went home. Complicated situation-- my classmate, out of the kindness of her heart, helped the family by helping the parents when they got out by being "there" for them. She liked the kids and the family was just nice.) The little girl went to traditional therapy and it didn't work-- she had all kinds of flashbacks and nightmares. A few (3) sessions of EMDR and she was cured-- she felt that after the first one she was fine but she went in two more times. The lady was very legitimate and because she seemed on the up and up, I take her word for it and would have no problem suggesting it to someone.

That's the part that concerns me. I wish it happened like that, but it rarely if ever does. In some ways I think of the fringe therapy like AA.....if it works for you, that is great....but don't expect it to work for everyone.

-t

 

[KeyT]

That's the part that concerns me. I wish it happened like that, but it rarely if ever does. In some ways I think of the fringe therapy like AA.....if it works for you, that is great....but don't expect it to work for everyone.
-t

Isn't that the case for any kind of treatment?

 

[Therapist4Chnge]

Isn't that the case for any kind of treatment?

My experiences with people who use EMDR is that they are rather dogmatic about the treatment (like many AA'ers), often finding 'success' after many other failures at traditional methods. Sometimes this strong stance is lacking objectivity. I don't doubt there is some improvement, but I have yet to see a study that can attribute that improvement explicitly to EMDR, and not to other common factors. I naturally question something that doesn't have scientific proof, and is not held in high regard by most professionals.

-t

 

[PsyKardinal]

The research is lacking. What research there has been does not account for other confounding issues. It may work for some, but the efficacy is not great. Now my personal bias, if moving your eyes around is going to affect change then I think it would have randomly been discovered much earlier that wiggling my eye balls to the left makes me feel good.

Jeff

 

[4thought]

When it works, what do you think is going on? For those who discount-- what do you think, placebo? For example, psychanon, what do you mean by: "exposure under conditions of perceived control"?

 

[psychanon]

When it works, what do you think is going on? For those who discount-- what do you think, placebo? For example, psychanon, what do you mean by: "exposure under conditions of perceived control"?

Exposure is how you treat any phobia-- exposing the person gradually to the feared stimulus. This is also the case for PTSD, a la Edna Foa's stuff. Like Jon Snow says, there's massive evidence that it works. The only problem is that patients are scared to do it. So if you tell them that moving their eyeballs back & forth, it allow them to process the memories safely, they may be more willing to do it. Thus the perception of control. It's not a placebo per se, because it's not just working because people think it's going to work. It's working because a very established mechanism of change (exposure) is at play. There's no evidence that the eye movements, the unique part of EMDR, help at all.

So it's good that Pekoe's friend's daughter did well with it. It does work, after all. The thing is, she probably would have done just as well with a traditional approach. The bad part is when EMDR people charge gads of money for workshops to learn how to do this stuff. It's like charging for a workshop where you teach doctors to tell patients with headaches to take aspirin while simultaneously jumping on one foot. Yeah, their patients' headaches will probably go away, but that's because of the aspirin, not the foot.

If you read anything by Francine Shapiro, you'll see that she has developed an elaborate theory for why EMDR works, and it's basically a total crock.

 

[socialcog]

Exposure is how you treat any phobia-- exposing the person gradually to the feared stimulus. This is also the case for PTSD, a la Edna Foa's stuff. Like Jon Snow says, there's massive evidence that it works. The only problem is that patients are scared to do it. So if you tell them that moving their eyeballs back & forth, it allow them to process the memories safely, they may be more willing to do it. Thus the perception of control. It's not a placebo per se, because it's not just working because people think it's going to work. It's working because a very established mechanism of change (exposure) is at play. There's no evidence that the eye movements, the unique part of EMDR, help at all.

Patient's are afraid to do the exposures..true. However, in close collaboration with your patient, carefully constructing a fear hierarchy enables the patient to see trajectory of treatment, they have some control over their treatment plan and provides a clear prognostic picture. I do not know a more efficacious method to treat any anxiety disorder.

CBT > EMDR 🙂

 

[psychanon]

Right. In fact, you might be able to conceptualize the eye movements as a safety behavior, kind of like a person who can only leave the house when they're with their spouse or when they have a lucky quarter in their pocket. These kinds of safety behaviors are generally discouraged in therapy because they suggest that the fear is not truly extinguished. Not sure if that's ever been researched in EMDR-- research idea, anyone?

 

[michalita]

Right. In fact, you might be able to conceptualize the eye movements as a safety behavior, kind of like a person who can only leave the house when they're with their spouse or when they have a lucky quarter in their pocket. These kinds of safety behaviors are generally discouraged in therapy because they suggest that the fear is not truly extinguished. Not sure if that's ever been researched in EMDR-- research idea, anyone?

OOOOOhhhhh.... Interesting!!! I've actually done both exposure therapy (for a simple phobia) and EMDR (for something else) and haven't been able to let go of the "safety behavior" in exposure therapy (although it has helped a great deal, I just don't feel, well, totally free yet) so this topic is actually quite interesting from that perspective. I did several sessions of EMDR and it did help me to feel less afraid of what I feared before, but I also don't know if that would have worked just as well using more established CBT methods (such as cognitive processing therapy). I didn't move my eyes back and forth (at least not on purpose) -- I had sounds go from one ear to the other and my eyes (closed) ended up shifting side to side automatically... heh.

One of the reasons I stopped EMDR? It's damned expensive. Insurance pays for CBT, not so much for EMDR. I was more interested in the exposure aspect of it anyway and I think I did get that.

To that end, what about cognitive processing therapy?

 

[socialcog]

OOOOOhhhhh.... Interesting!!! I've actually done both exposure therapy (for a simple phobia) and EMDR (for something else) and haven't been able to let go of the "safety behavior" in exposure therapy (although it has helped a great deal, I just don't feel, well, totally free yet) so this topic is actually quite interesting from that perspective. I did several sessions of EMDR and it did help me to feel less afraid of what I feared before, but I also don't know if that would have worked just as well using more established CBT methods (such as cognitive processing therapy). I didn't move my eyes back and forth (at least not on purpose) -- I had sounds go from one ear to the other and my eyes (closed) ended up shifting side to side automatically... heh.

One of the reasons I stopped EMDR? It's damned expensive. Insurance pays for CBT, not so much for EMDR. I was more interested in the exposure aspect of it anyway and I think I did get that.

To that end, what about cognitive processing therapy?

I am not sure what cognitive processing therapy is. Do you mean thought records? Worry records for anxiety? Psychanon may know.

It would be telling to look at any measures of efficacy comparing CBT and EMDR compared against placebo/controls. Eye movement as a safety strat is an interesting notion. Never thought of that although since the eye movement (bilateral movement) of EMDR such an unnatural behavior, it lends to the notion that positive patient outcomes are related to placebo vs safety behaviors (in my opinion). Unless we are talking about someone with OCD who has a unique ritual of moving his eyes back and forth 13 times because if not then his bladder will explode, well then, I would totally agree with you!🙂

 

[toby jones]

From what I know about EMDR I place it alongside other technologies of change such as Mesmers magnets.

That being said, placebo response is CONSIDERABLE and if people experience a little relief, then what the hey.

On the other hand... If it is expensive and cheaper placebos are out there then there seems to be something a bit dodgey going on.

We don't know the mechanisms of change for the majorities of therapy on the market so I guess thats nothing new.

Not sure how EMDR compares to exposure and how EMDR compares to the therapist gazing intently at the patient while standing in close proximity (or whatever the f happens in EMDR).

Sounds a little NLPish to me (aka a bit of a crock).