Interesting discussion on why EMDR is used more than PE or CPT

[cara susanna]

You can probably tell that I was reading Psych Twitter lately!




I found Patricia Resick's response especially interesting:

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[WisNeuro]

Marketing > Data

 

[MiniLop]

I'm on a FB for local clinicians in private practice and the love for EMDR is terrifying. People applying it to all sorts of random presentations (especially OCD); great, let's take the part of EMDR that doesn't do anything and use that even more!

 

[thebalmofhurtminds]

I get a lot of patients come to me after "EMDR for pain" doesn't work. Shocking.

 

[Therapist4Chnge]

EMDR "clinicians" often use science-sounding terminology to make the treatment sound scientifically sound. It's not. They have better marketing and often target vulnerable populations bc many patients "failed" other treatments, so they are desperate to find something that works.

 

[futureapppsy2]

I think the fact that the eye movement BS sounds "biological" helps EMDR in its marketing a lot, unfortunately.

 

[Sanman]

Marketing is correct. I get a million PESI and other CE flyers for EMDR and almost nothing for PE or CPT. There is an infrastructure, particular for midlevel providers, to learn EMDR and use it. Patients have heard of it. It has the same power as all those medications patients hound doctors for after seeing a commercial.

 

[WisNeuro]

Marketing is correct. I get a million PESI and other CE flyers for EMDR and almost nothing for PE or CPT. There is an infrastructure, particular for midlevel providers, to learn EMDR and use it. Patients have heard of it. It has the same power as all those medications patients hound doctors for after seeing a commercial.

What's wrong with those commercials? Without them, I would have never asked my doctor about F uckitol. My QoL has vastly improved since starting it.

 

[Sanman]

What's wrong with those commercials? Without them, I would have never asked my doctor about F uckitol. My QoL has vastly improved since starting it.

Absolutely nothing, your five minutes of googling and reading on WebMD are far superior to the opinion of any medical professional.

Sadly, this is sounding a lot like the tirade I just heard from an anti- COVID vax family of one of my new dementia folks that I set up for an initial appt. VVC treatment it is.

 

[WisNeuro]

Absolutely nothing, your five minutes of googling and reading on WebMD are far superior to the opinion of any medical professional.

Sadly, this is sounding a lot like the tirade I just heard from an anti- COVID vax family of one of my new dementia folks that I set up for an initial appt. VVC treatment it is.

I have luckily only had one 65+ pt report not being vaxxed over the past year. Definitely a different population than my old VA pts.

 

[cara susanna]

I have luckily only had one 65+ pt report not being vaxxed over the past year. Definitely a different population than my old VA pts.

Actually, most of my 65+ pts are vaxxed even in the VA.

 

[WisNeuro]

Actually, most of my 65+ pts are vaxxed even in the VA.

Good to know, I would have thought there would be more holdouts in that population given the political views.

 

[Sanman]

Good to know, I would have thought there would be more holdouts in that population given the political views.

Most of mine are vaxxed as well. However, we have some holdouts for a variety of reasons. In this case, a caregiver of a dementia patient that is generally anti-vax, anti-medication, etc. However, managing policies on home visits for anti-vax folks gets complicated as we transition back to f2f care.

 

[psych.meout]

I wish I had the luck you all have. So many of my patients are unvaccinated and for various reasons. I wonder how I got COVID despite being vaxxed and boosted and practicum being the only place where I have contact with others outside my home.....

 

[Therapist4Chnge]

The majority of my current patients are vaxxed, but i lost a handful of patients in the first 12-18 months; youngest in their 40s, oldest in their late 60s. It's sad, but a lot of them (along w the general public) have been negatively influenced by politics to be against science and experts. The anti-science battle has been further inflamed by relentless targeted disinformation campaigns. EMDR capitalizes on sounded scientific, while the supporters also support other wonky ideas.

 

[Spydra]

I only hear the EMDR love coming from terminal Master's clinicians. I presumed patients bought into because they are more likely to encounter a terminal Master's clinician for treatment. I simply tell patients its garbage and refer them to someone who does exposure therapy. Interesting that the marketing approach played a role in the EMDR popularity.

 

[WisNeuro]

I only hear the EMDR love coming from terminal Master's clinicians. I presumed patients bought into because they are more likely to encounter a terminal Master's clinician for treatment. I simply tell patients its garbage and refer them to someone who does exposure therapy. Interesting that the marketing approach played a role in the EMDR popularity.

Our stat eassociation listserv is full of licensed psychologists asking about referrals for EMDR, so it's here as well. Now, we used to have a diploma mill in our backyard churning out a lot of people, so that's partially responsible. But there are still people who went to legitimate programs who do not understand the research behind this and wholeheartedly endorse it. Might as well send these people to the Amen Clinics while we're at it.

 

[AcronymAllergy]

I don't know if I'd say EMDR is total garbage, and I'd probably prefer a patient get that over no treatment or vague "supportive therapy," but yeah, the fervency with which many practitioners seem to tout it is surprising.

It'd be different if the providers were saying, "look, I know CPT and PE are great, and I prefer to use them whenever possible, but sometimes EMDR is the one thing that gets some patients in the door." But that's not typically how it seems to be discussed or presented.

 

[Therapist4Chnge]

We know EMDR can "work"....if you just pay attention to the exposure component and ignore the bogus eye movement/tapping stuff, but that is rarely if ever how it is described to unsuspecting patients.

 

[Ollie123]

I don't know if I'd say EMDR is total garbage, and I'd probably prefer a patient get that over no treatment or vague "supportive therapy," but yeah, the fervency with which many practitioners seem to tout it is surprising.

It'd be different if the providers were saying, "look, I know CPT and PE are great, and I prefer to use them whenever possible, but sometimes EMDR is the one thing that gets some patients in the door." But that's not typically how it seems to be discussed or presented.

I think this is one of the challenges with it. At an individual patient level, I agree. It includes an exposure element and I'd unquestionably prefer someone get EMDR for their PTSD than rebirthing + equine therapy + emotional support porcupine + truckload of benzodiazepines, or whatever other nonsense goes on out there. Don't get me wrong, I'd greatly prefer PE/CPT to all of those but I'm trying to be realistic

To me, the biggest negative of EMDR is its potential impact on views of us as a field, perceptions of the profession and psychotherapy in general by members of the scientific/biomedical community and educated members of the lay public, etc. Forget what happens to an individual patient getting EMDR. I worry about the folks who don't pursue therapy because they think we're a bunch of fringe loonies who couldn't pass a high school biology class because of the prevalence of stuff like this, what implicit bias it might create for insurance companies deciding reimbursement rates, etc.

 

[Spydra]

I don't know if I'd say EMDR is total garbage, and I'd probably prefer a patient get that over no treatment or vague "supportive therapy," but yeah, the fervency with which many practitioners seem to tout it is surprising.

To expand lol..... I open with its total garbage, pause, wait for the patient to ask how that could be when they've heard blah blah blah, clarify why exposure therapy is better, pause while they process, and then provide a referral.

 

[MiniLop]

I think this is one of the challenges with it. At an individual patient level, I agree. It includes an exposure element and I'd unquestionably prefer someone get EMDR for their PTSD than rebirthing + equine therapy + emotional support porcupine + truckload of benzodiazepines, or whatever other nonsense goes on out there. Don't get me wrong, I'd greatly prefer PE/CPT to all of those but I'm trying to be realistic

To me, the biggest negative of EMDR is its potential impact on views of us as a field, perceptions of the profession and psychotherapy in general by members of the scientific/biomedical community and educated members of the lay public, etc. Forget what happens to an individual patient getting EMDR. I worry about the folks who don't pursue therapy because they think we're a bunch of fringe loonies who couldn't pass a high school biology class because of the prevalence of stuff like this, what implicit bias it might create for insurance companies deciding reimbursement rates, etc.

In addition to that, my big concern is that it is now being applied widely by unknowledgeable clinicians to various presentations (minus the exposure component), which is unconscionable to me.

 

[chicandtoughness]

Excellent, love this thread. The minute an employer or patient mentions EMDR I take every opportunity to tell people why it’s trash

“But it works!”

Yeah, the exposure part works.

I’m somewhat of a well-known clinician in the area for OCD and am constantly encountering referrals who come to me after failed EMDR or requesting EMDR. It’s terrifying. Thankfully I slap some good old PE + ERP on them and they usually see effective gains

 

[iheartbacon]

I’ve always thought part of the appeal is that it seems like less work (for the patient). Follow this little light? Sign me up! Focus heavily on trauma I want to avoid and would rather forget? No way!

I’m not really surprised when patients ask for it but you could knock me over with a feather when I hear doc students or psychologists looking to get it. And there seems to be no changing their minds either.

 

[R. Matey]

In my eyes, there's no difference between Francine Shapiro's eye movements and Franz Mesmer's animal magnetism. People like mysterious treatments a lot better than they like the repetitious slog that good psychotherapy often requires.

 

[Justanothergrad]

Marketing > Data

Thats not true at all. The Myers Briggs is very data driven.


/s

 

[WisNeuro]

Thats not true at all. The Myers Briggs is very data driven.


/s

Well, in a sense that the Myers and Briggs Foundation uses data to drive their marketing strategy to bilk gullible people out of a LOT of money, I actually think that the organization probably does use data driven strategies.

 

[WisNeuro]

Thats not true at all. The Myers Briggs is very data driven.


/s

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[foreverbull]

I’ve always thought part of the appeal is that it seems like less work (for the patient). Follow this little light? Sign me up! Focus heavily on trauma I want to avoid and would rather forget? No way!

I’m not really surprised when patients ask for it but you could knock me over with a feather when I hear doc students or psychologists looking to get it. And there seems to be no changing their minds either.

I think this is a big piece. Make it sound like a treatment that’s going to be easy (and it’s state of the art and new and somehow brain science!)…even though the mechanism of action is just plain old exposure that has been tested and supported robustly with PE and CPT, which don’t have the same exciting flair when described to clients.

PE has a whole session to convince people it’s worth it and to provide psychoeducation about it because it’s going to be like ripping off a bandaid initially, but is highly effective over time. There will always be people who want the magic pill to wellness.

 

[cara susanna]

I think this is a big piece. Make it sound like a treatment that’s going to be easy (and it’s state of the art and new and somehow brain science!)…even though the mechanism of action is just plain old exposure that has been tested and supported robustly with PE and CPT, which don’t have the same exciting flair when described to clients.

PE has a whole session to convince people it’s worth it and to provide psychoeducation about it because it’s going to be like ripping off a bandaid initially, but is highly effective over time. There will always be people who want the magic pill to wellness.

Lol, I'd say that PE has like 3 sessions to convince people and provide education. I always tell patients, you're probably going to get sick of hearing this by the time we actually start the exposure work. But we repeat it because, by the time we actually start, I want you to be able to convince me why this treatment works.

CPT has a full psychoeducational session as well.