The APA & EDMR

[psych.meout]

Did you post the link to Wizards of the Coast (publishers of Dungeons & Dragons)?

Unnecessary. Baldur's Gate 3 is out.

---

Members don't see this ad.

 

[Fan_of_Meehl]

Unnecessary. Baldur's Gate 3 is out.

I'm a 1st edition (AD&D) man myself.

 

[texanpsychdoc]

Did you post the link to Wizards of the Coast (publishers of Dungeons & Dragons)?

I should have....stupid me

 

[texanpsychdoc]

Unnecessary. Baldur's Gate 3 is out.

So we just got that on P5 and....I am lost AF

 

[Sanman]

I'm a 1st edition (AD&D) man myself.

Sorry, 2nd edition all the way.

 

[Sanman]

We should create APA Division 57: The Division of Woo

Done. I'll give you the lifetime achievement award next year if you give it to me in 2025.

 

[psych.meout]

I'm a 1st edition (AD&D) man myself.

Did you walk uphill both ways to get your handbook, Grandpa?

 

[AcronymAllergy]

Sorry, 2nd edition all the way.

Agreed. THAC0 for life.

 

[Fan_of_Meehl]

Did you walk uphill both ways to get your handbook, Grandpa?

Ordered it by mail order through Sears & Roebuck (and we LIKED it!!!)

 

[Fan_of_Meehl]

Sorry, 2nd edition all the way.

2nd edition, especially rulebooks, were MUCH more coherently put together.

And 1e combat rules (as written)...ugh...nobody I know actually ran them exactly as written.

 

[AcronymAllergy]

2nd edition, especially rulebooks, were MUCH more coherently put together.

And 1e combat rules (as written)...ugh...nobody I know actually ran them exactly as written.

I think we might've tried once or twice just to see how it was and then we gave up. The books were much shorter, though, I'll give them that. And the hand-drawn art was...unique. Pretty sure I still have a 1e Dungeon Master's Guide lying around somewhere. And I know I have a whole bunch of 2e books in a closet.

 

[Young Grasshoppa]

As you mentioned, EMDR IS effective. That's why it's recommended as a top tier therapy even by the DoD/VA PTSD guidelines. The problem isn't so much "does EMDR work?" but "how does EMDR work?" or "does EMDR work better than PE or CPT?" Regarding the latter question, supposedly Shapiro refused to do comparison studies with PE or CPT, but that research is now being done and will be forthcoming. From what I've heard, it sounds like EMDR works as well but doesn't have as lasting effects.

Plenty of research has been done comparing CBT or PE to EMDR.

Much of the research shows that there is no significant difference between the three therapies.

If that's the case, no harm no foul. Obviously, the strobe lights didn't cause any significant distraction.

Other research shows that EMDR has slight advantages. There are bias issues and methodology issues with much of the research.

Just a few:

Effectiveness of EMDR for decreasing symptoms of over‐arousal: A meta‐analysis

A meta-analysis was conducted to evaluate the comparative effectiveness of eye movement desensitization and reprocessing (EMDR) in the treatment of symptoms of over-arousal and comparing effectivenes...

onlinelibrary.wiley.com

https://www.sciencedirect.com/science/article/abs/pii/S1162908812000655

Eye Movement Desensitization and Reprocessing Versus... : The Journal of Nervous and Mental Disease

evidence is inadequate to conclude which treatment is superior. Therefore, we conducted a meta-analysis to confirm the effectiveness of EMDR compared to CBT for adult PTSD. We searched Medline, PubMed, Ebsco, Proquest, and Cochrane (1989–2013) to identify relevant randomized control trials...

journals.lww.com

https://connect.springerpub.com/content/sgremdr/7/3/134.abstract

Efficacy of EMDR in Post-Traumatic Stress Disorder: A Systematic Review and Meta-analysis of Randomized Clinical Trials.

gredos.usal.es

https://acamh.onlinelibrary.wiley.com/doi/abs/10.1111/jcpp.12768

Comparison of two treatments for traumatic stress: a community-based study of EMDR and prolonged exposure - PubMed

This pilot study compared the efficacy of two treatments for postraumatic stress disorder (PTSD): Eye Movement Desensitization and Reprocessing (EMDR) and Prolonged Exposure (PE). Data were analyzed for 22 patients from a university-based clinic serving the outside community (predominantly rape...

pubmed.ncbi.nlm.nih.gov

Error - Cookies Turned Off

onlinelibrary.wiley.com

https://connect.springerpub.com/content/sgremdr/7/3/121.abstract

EMDR is not the cure to cancer. It is not a miracle treatment, regardless of the assertions of Oprah, Sandra Bullock or Prince Harry.

Does exposure therapy work faster when combined with EMDR? Maybe.

Worst-case scenario - You wore a purple hat. Nobody noticed.

Best-case scenario - Your client achieved their goals faster.

Most-likely scenario - Your client is happy that you use strobe lights. You are happy that your client is happy. You get more referrals.

Cue the firing squad.

 

[WisNeuro]

I don't know many people who dispute the fact that EMDR shows some effectiveness, driven by the exposure component. I believe that the major contention lies in the fact that if we believe in informed consent, some providers are straight out lying to patients about the treatment as it relates to the useless components. As in, when discussing the treatment and mechanisms of action, they are spouting off pseudoneurojargon that has no basis in reality to get the patient to buy in. This is the odious part of the treatment.

Pair that with the fact that many of the EMDR cult are quite vocal in the "harm"that other trauma treatments cause while spouting off their nonsense. Pair that again with the fact that EMDR is increasingly marketed to target things like substance use, obesity, eating disorders, schizophrenia, among other things, thins for which little, if any empirical support exists. EMDR is unquestioningly a negative influence within the field.

 

[cara susanna]

Plenty of research has been done comparing CBT or PE to EMDR.

Much of the research shows that there is no significant difference between the three therapies.

There aren't any RCTs comparing them, though. That's what I meant.

 

[Sanman]

EMDR A placebo pill is not the cure to cancer. It is not a miracle treatment, regardless of the assertions of Oprah, Sandra Bullock or Prince Harry.

Does exposure therapy work faster when combined with a placebo pill EMDR? Maybe.

Worst-case scenario - You wore a purple hat. Nobody noticed.

Best-case scenario - Your client achieved their goals faster.

Most-likely scenario - Your client is happy that you use a placebo pill strobe lights . You are happy that your client is happy. You get more referrals.

Cue the firing squad.

That works for any fake care. If I was hauking green tea extract and placebo pills to take prior to exposure therapy, that might improve responsiveness as well. Doesn't mean I should be charging patients for it. Your entire argument is to justify the bolded.

Opioids made pain patients feel better/happier. There were studies on their effectiveness. I mean, what harm could it do, they were already in pain, right?

 

[psych.meout]

Maybe my ethics courses in grad school were different, but we were always taught that deceiving patients was wrong.

 

[PsychSupreme]

There's also some evidence (albeit weak) that EMDR increases likelihood of spontaneous false recall (an effect I'd imagine is particularly strong in individuals with high levels of suggestibility):

https://www.tandfonline.com/doi/abs/10.1080/09658211.2020.1862234

So yeah, I don't agree that "at worst, you wore a purple hat." No, at worst, you walk away with false memories and a false interpretive framework by which to understand your recovery process. I just don't get it--the supposed neurological mechanisms underlying EMDR have been debunked time and again, and then the acolytes move to some other speculative mechanism, endlessly moving the goalposts. If they'd just accept that it's simply an indirect, imaginal exposure therapy and strip all the BS from it then far fewer folks would have academic and ethical issues with it. It's not okay to lie to patients in clinical settings.

 

[Sanman]

There's also some evidence (albeit weak) that EMDR increases likelihood of spontaneous false recall (an effect I'd imagine is particularly strong in individuals with high levels of suggestibility):

https://www.tandfonline.com/doi/abs/10.1080/09658211.2020.1862234

So yeah, I don't agree that "at worst, you wore a purple hat." No, at worst, you walk away with false memories and a false interpretive framework by which to understand your recovery process. I just don't get it--the supposed neurological mechanisms underlying EMDR have been debunked time and again, and then the acolytes move to some other speculative mechanism, endlessly moving the goalposts. If they'd just accept that it's simply an indirect, imaginal exposure therapy and strip all the BS from it then far fewer folks would have academic and ethical issues with it. It's not okay to lie to patients in clinical settings.

At the end of the day, it is all about the marketing. Why just be another practitioner of CBT, PE, or CPT when you can be the "expert" in EMDR. I see a lot or midlevels marketing their expertise because a lot of doctoral level providers don't offer it. Comes down to the $$$.

 

[WisNeuro]

At the end of the day, it is all about the marketing. Why just be another practitioner of CBT, PE, or CPT when you can be the "expert" in EMDR. I see a lot or midlevels marketing their expertise because a lot of doctoral level providers don't offer it. Comes down to the $$$.

And in many cases, willful ignorance, or downright intentional malfeasance.

 

[psych.meout]

And in many cases, willful ignorance, or downright intentional malfeasance.

I'd argue that it's all the cases with EMDR. Either they're extolling the pseudo-neuroscience virtues out of ignorance or they know it's bunk and are intentionally deceiving patients.

 

[Fan_of_Meehl]

I'd argue that it's all the cases with EMDR. Either they're extolling the pseudo-neuroscience virtues out of ignorance or they know it's bunk and are intentionally deceiving patients.

They (including our local evidence-based coordinator person) were heavily pushing everyone to get EMDR training/certification about a year ago. Glad I didn't take them up on it. The one rule I absolutely have for patients is that I do not lie to my patients (surprisingly hard to follow in the VA system sometimes). I would have hated to have to 'nope' my way out as soon as I learned about the pseudoscientific foundations and then have that 'mark' against me (every time you apply for training in an EBP protocol, they ask if you've ever dropped out of a training before).

 

[Sanman]

They (including our local evidence-based coordinator person) were heavily pushing everyone to get EMDR training/certification about a year ago. Glad I didn't take them up on it. The one rule I absolutely have for patients is that I do not lie to my patients (surprisingly hard to follow in the VA system sometimes). I would have hated to have to 'nope' my way out as soon as I learned about the pseudoscientific foundations and then have that 'mark' against me (every time you apply for training in an EBP protocol, they ask if you've ever dropped out of a training before).

First session, I always ask my patients for honesty because we don't make progress without it. The least I can do is model the same for them.

 

[WisNeuro]

First session, I always ask my patients for honesty because we don't make progress without it. The least I can do is model the same for them.

But, I mean, what if by lying to them, I'm "helping" them, and by extension, helping myself to their money through dishonest means?

/s

 

[Sanman]

But, I mean, what if by lying to them, I'm "helping" them, and by extension, helping myself to their money through dishonest means?

/s

Sell them a timeshare. At least they get a vacation out of that!

 

[Young Grasshoppa]

There aren't any RCTs comparing them, though. That's what I meant.

This got three likes. Apparently, people with PHDs aren't sufficiently trained to READ. I'll narrow this down for you so you don't, heaven forfend, have to read all of the articles I quoted earlier.

https://acamh.onlinelibrary.wiley.com/doi/abs/10.1111/jcpp.12768

Effectiveness of EMDR for decreasing symptoms of over‐arousal: A meta‐analysis

A meta-analysis was conducted to evaluate the comparative effectiveness of eye movement desensitization and reprocessing (EMDR) in the treatment of symptoms of over-arousal and comparing effectivenes...

onlinelibrary.wiley.com

Eye Movement Desensitization and Reprocessing Versus... : The Journal of Nervous and Mental Disease

evidence is inadequate to conclude which treatment is superior. Therefore, we conducted a meta-analysis to confirm the effectiveness of EMDR compared to CBT for adult PTSD. We searched Medline, PubMed, Ebsco, Proquest, and Cochrane (1989–2013) to identify relevant randomized control trials...

journals.lww.com

If you kept reading and didn't read at least the damned abstracts of those three studies, go return your Phd. The world will be a better place.

I don't know many people who dispute the fact that EMDR shows some effectiveness, driven by the exposure component. I believe that the major contention lies in the fact that if we believe in informed consent, some providers are straight out lying to patients about the treatment as it relates to the useless components. As in, when discussing the treatment and mechanisms of action, they are spouting off pseudoneurojargon that has no basis in reality to get the patient to buy in. This is the odious part of the treatment.

Pair that with the fact that many of the EMDR cult are quite vocal in the "harm"that other trauma treatments cause while spouting off their nonsense. Pair that again with the fact that EMDR is increasingly marketed to target things like substance use, obesity, eating disorders, schizophrenia, among other things, thins for which little, if any empirical support exists. EMDR is unquestioningly a negative influence within the field.

This is honest and correct. EMDR practitioners use odious marketing, loads of pseudoneurojargon to sell the product and, worst of all, apply EMDR to cases where it has no empirical basis whatsoever.

The EMDR culture is terrible for the field.

But y'all are scientists - so leave aside the culture and let's talk about the actual treatment.

- It has no know mechanism of action. That's fine. Neither does lithium or Tylenol. Nobody could care less. If it works.

- Ethical problems. I have you covered.
I'd like to tell my client - "Listen there is this experimental treatment involving these here strobe lights - nobody has a clue how it works, but some studies have shown that it may help you get better faster with less homework. Those studies are definitely not conclusive, experimental at best, but if you're interested we could try it. Would you like to try that or should I send home these here CBT worksheets with you?"

Any ethical problem with that?

I get it. The EMDR culture is full of ethical issues. Agreed. But just because those practitioners tend to be dumb as a doorknob and as honest as a snake that doesn't mean that you should dismiss the efficacy of the treatment out of hand without giving it an academic chance.

You know what I do have an ethical problem with?
Not doing what may help your client because it would make you look bad by association. "ME?! The great and holy scientific mind?! I would never be caught dead doing anything that would associate me with those plebeian EMDR folk."

There's also some evidence (albeit weak) that EMDR increases likelihood of spontaneous false recall (an effect I'd imagine is particularly strong in individuals with high levels of suggestibility):

https://www.tandfonline.com/doi/abs/10.1080/09658211.2020.1862234

So yeah, I don't agree that "at worst, you wore a purple hat." No, at worst, you walk away with false memories and a false interpretive framework by which to understand your recovery process. I just don't get it--the supposed neurological mechanisms underlying EMDR have been debunked time and again, and then the acolytes move to some other speculative mechanism, endlessly moving the goalposts. If they'd just accept that it's simply an indirect, imaginal exposure therapy and strip all the BS from it then far fewer folks would have academic and ethical issues with it. It's not okay to lie to patients in clinical settings.

Weak is an understatement. After declaring their bias against EMDR (In case you haven't noticed having a PHD would've been enough to tell us this) the authors themselves are totally inconclusive about their findings on every level.
From the article's Final Remarks:
"We do not have strong evidence that EM affect susceptibility to misinformation one way or another. That is, the EM involved in EMDR do not appear to consistently enhance memory, nor do they appear to consistently increase misinformation endorsement."
I will leave it at that and not discuss the myriad methodological issues with that article.

The rest of the posts were not substantive and do not deserve a response.

When I give you research - don't respond with snide "Holier-than-thou-art" remarks. Give me research back. If you can't, have a seat and let people who can formulate a substantive argument take the floor.

To be perfectly clear, I am not certified in EMDR. The rarely-sourced hate on this forum towards it inspired me to dip my toes into the research on the topic.

Honestly, I do want to know if anyone has a a good reason why not to take the limited findings supporting EMDR for exactly what they are and to present them to clients as such - an experimental procedure with no known mechanism-of-action that may help them, if they want it.

Especially if for some reason they are dead-set on it - why refuse to provide something that will make your client happy as long as you are being perfectly honest about what it is? Your client asks you to turn off that extra lamp because they prefer it was a little darker... "I'm sorry, there isn't sufficient empirical basis to justify modifying the lumen-exposure-rate in the context of this therapeutical intervention." Just turn off the lamp.

Your client is a person. Do whatever it takes to make them feel comfortable and help them achieve their goals. That is the highest ethical standard I know.

Any thoughts?

 

[PsyDr]

…Apparently, people with PHDs aren't sufficiently trained to READ. I'll narrow this down for you so you don't, heaven forfend, have to read all of the articles I quoted earlier.

LOL. Seriously the funniest combination of sentences in recent SDN history.

 

[psych.meout]

This got three likes. Apparently, people with PHDs aren't sufficiently trained to READ. I'll narrow this down for you so you don't, heaven forfend, have to read all of the articles I quoted earlier.

https://acamh.onlinelibrary.wiley.com/doi/abs/10.1111/jcpp.12768

Effectiveness of EMDR for decreasing symptoms of over‐arousal: A meta‐analysis

A meta-analysis was conducted to evaluate the comparative effectiveness of eye movement desensitization and reprocessing (EMDR) in the treatment of symptoms of over-arousal and comparing effectivenes...

onlinelibrary.wiley.com

Eye Movement Desensitization and Reprocessing Versus... : The Journal of Nervous and Mental Disease

evidence is inadequate to conclude which treatment is superior. Therefore, we conducted a meta-analysis to confirm the effectiveness of EMDR compared to CBT for adult PTSD. We searched Medline, PubMed, Ebsco, Proquest, and Cochrane (1989–2013) to identify relevant randomized control trials...

journals.lww.com

If you kept reading and didn't read at least the damned abstracts of those three studies, go return your Phd. The world will be a better place.

Did you read those articles?

This is honest and correct. EMDR practitioners use odious marketing, loads of pseudoneurojargon to sell the product and, worst of all, apply EMDR to cases where it has no empirical basis whatsoever.

The EMDR culture is terrible for the field.

But y'all are scientists - so leave aside the culture and let's talk about the actual treatment.

- It has no know mechanism of action. That's fine. Neither does lithium or Tylenol. Nobody could care less. If it works.

There have been dismantling studies which tell us why EMDR "works," and it's not the things that are unique to EMDR, i.e., the pseudo-neuroscience.

- Ethical problems. I have you covered.
I'd like to tell my client - "Listen there is this experimental treatment involving these here strobe lights - nobody has a clue how it works, but some studies have shown that it may help you get better faster with less homework. Those studies are definitely not conclusive, experimental at best, but if you're interested we could try it. Would you like to try that or should I send home these here CBT worksheets with you?"

Any ethical problem with that?

Wow, you're being so neutral and very much not steering your patient into one particular treatment over the other, huh?

Couching something as "experimental" doesn't excuse you for deceiving patients about what the literature actually is or being oh-so-subtle in how you frame it versus other treatments.

I get it. The EMDR culture is full of ethical issues. Agreed. But just because those practitioners tend to be dumb as a doorknob and as honest as a snake that doesn't mean that you should dismiss the efficacy of the treatment out of hand without giving it an academic chance.

You know what I do have an ethical problem with?
Not doing what may help your client because it would make you look bad by association.

Who here has said anything about the "association" or allowing that to cause you to not help patients?

What I've seen is people recommending other evidence-based treatments for trauma like CPT and PE.

"ME?! The great and holy scientific mind?! I would never be caught dead doing anything that would associate me with those plebian EMDR folk."

What?

Honestly, I do want to know if anyone has a a good reason why not to take the limited findings supporting EMDR for exactly what they are and to present them to clients as such - an experimental procedure with no known mechanism-of-action that may help them, if they want it.

Because there are evidence-based interventions that aren't "experimental" and don't rely on deceiving patients about them to various degrees.

Especially if for some reason they are dead-set on it - why refuse to provide something that will make your client happy as long as you are being perfectly honest about what it is? Your client asks you to turn off that extra lamp because they prefer it was a little darker... "I'm sorry, there isn't sufficient empirical basis to justify modifying the lumen-exposure-rate in the context of this therapeutical intervention." Just turn off the lamp.

When you have to compare criticism of your intervention with turning off a lamp, you're definitely arguing in good-faith.

Your client is a person. Do whatever it takes to make them feel comfortable and help them achieve their goals. That is the highest ethical standard I know.

Any thoughts?

There's lots of things that would make patients feel more comfortable. There's also lots of things that they want or think would make them happy. They'd probably feel better and happier if every session came with complimentary steak and lobster.

There's no ethical obligation or standard to give patients everything they want or to give them the intervention that they are demanding. Patient preferences are important, but they're just that, preferences. This is a gross misunderstanding of our ethical obligations and evidence-based practice.

 

[PsychSupreme]

Weak is an understatement. After declaring their bias against EMDR (In case you haven't noticed having a PHD would've been enough to tell us this) the authors themselves are totally inconclusive about their findings on every level.
From the article's Final Remarks:
"We do not have strong evidence that EM affect susceptibility to misinformation one way or another. That is, the EM involved in EMDR do not appear to consistently enhance memory, nor do they appear to consistently increase misinformation endorsement."
I will leave it at that and not discuss the myriad methodological issues with that article.

You left out the part that concludes that while there is little evidence that EMDR increases susceptibility to misinformation (i.e., taking on information fed to you by someone else), there is evidence that the eye movements "...do seem to increase spontaneous false memories" (i.e., recall that is erroneous and not related to information being directly fed to you; emphasis mine). This is a literature review of a small number of papers. No one is calling it perfect, but the methods are good for the data they have, and it directly contradicts the claim that EMDR is, at worst, a purple hat therapy. Again, I outright said the evidence is weak...but it does exist and would imply potential for iatrogenic harm.

- It has no know mechanism of action. That's fine. Neither does lithium or Tylenol. Nobody could care less. If it works.

It does have a known mechanism of action. Exposure. Oh, and Tylenol inhibits COX-1 and COX-2. You're right about lithium, but, again, lithium's mechanism is truly unknown. EMDR's is not. Dismantling studies have demonstrated, time and time and time and time again, that bilateral stimulation is not a differentially efficacious component--it does not enhance the treatment in any measurable way.

- Ethical problems. I have you covered.
I'd like to tell my client - "Listen there is this experimental treatment involving these here strobe lights - nobody has a clue how it works, but some studies have shown that it may help you get better faster with less homework. Those studies are definitely not conclusive, experimental at best, but if you're interested we could try it. Would you like to try that or should I send home these here CBT worksheets with you?"

(a) We do know how EMDR works and that it works via the same common mechanisms that make everything else work (i.e., exposure, meaning-making, re-appraisal).

(b) This is a complete strawman of CBT.

 

[Fan_of_Meehl]

Did you read those articles?

View attachment 383521View attachment 383522

There have been dismantling studies which tell us why EMDR "works," and it's not the things that are unique to EMDR, i.e., the pseudo-neuroscience.


Wow, you're being so neutral and very much not steering your patient into one particular treatment over the other, huh?

Couching something as "experimental" doesn't excuse you for deceiving patients about what the literature actually is or being oh-so-subtle in how you frame it versus other treatments.

Who here has said anything about the "association" or allowing that to cause you to not help patients?

What I've seen is people recommending other evidence-based treatments for trauma like CPT and PE.


What?

Because there are evidence-based interventions that aren't "experimental" and don't rely on deceiving patients about them to various degrees.


When you have to compare criticism of your intervention with turning off a lamp, you're definitely arguing in good-faith.



There's lots of things that would make patients feel more comfortable. There's also lots of things that they want or think would make them happy. They'd probably feel better and happier if every session came with complimentary steak and lobster.

There's no ethical obligation or standard to give patients everything they want or to give them the intervention that they are demanding. Patient preferences are important, but they're just that, preferences. This is a gross misunderstanding of our ethical obligations and evidence-based practice.

This is why all doctoral-level graduate students should receive formal training in the philosophy of science.

Characteristics of good theories:

independently testable: An auxiliary hypothesis must be testable independently of the theory it was is introduced to save.

unified: It should be simple and have a small number of problem solving strategies that can be applied to a large number of situations.

fecundity. A good theory should open up new areas of research.

A good theory should be as concerned with giving good explanations of unexplained phenomena as it is with generating correct predictions.

A good theoretical foundation for a psychological intervention must be consistent with the corpus of the entirety of the basic science upon which it is founded as well as all of the other sciences (biology, chemistry, evolutionary theory, areas of psychology (e.g., how memory works)).

About a decade or so ago I bought Francine Shapiro's EMDR text but I couldn't make it more than a few pages into it due to the anecdotal nature of the report of 'her discovery' involving her walking down a road and noticing that as she moved her eyes side to side randomly it relieved her psychological distress related to (I assume) traumatic memories. So, in the history of humankind, this potent 'effect'/discovery never took place until Francine Shapiro noticed it. Once I made it past that anecdote, I couldn't make it through the pseudoneurological 'scientisty'-sounding neuro-babble 'explanations' offered in the first chapter of that book regarding proposed mechanism of action.

To each his/her own, I suppose. When I share cognitive-behavioral explanations of clinical phenomena, I know that they rest on (admittedly imperfect) empirical literature that I can understand and meaningfully articulate. I'll stick to that.

 

[psych.meout]

This is why all doctoral-level graduate students should receive formal training in the philosophy of science.

100% agreed, though most of my training in this was in undergrad. Philosophy of science were probably my favorite courses in undergrad.

Characteristics of good theories:

independently testable: An auxiliary hypothesis must be testable independently of the theory it was is introduced to save.

unified: It should be simple and have a small number of problem solving strategies that can be applied to a large number of situations.

fecundity. A good theory should open up new areas of research.

A good theory should be as concerned with giving good explanations of unexplained phenomena as it is with generating correct predictions.

A good theoretical foundation for a psychological intervention must be consistent with the corpus of the entirety of the basic science upon which it is founded as well as all of the other sciences (biology, chemistry, evolutionary theory, areas of psychology (e.g., how memory works)).

This is why I'm so irked by this kind of pseudoscience, but also things like DID.

About a decade or so ago I bought Francine Shapiro's EMDR text but I couldn't make it more than a few pages into it due to the anecdotal nature of the report of 'her discovery' involving her walking down a road and noticing that as she moved her eyes side to side randomly it relieved her psychological distress related to (I assume) traumatic memories. So, in the history of humankind, this potent 'effect'/discovery never took place until Francine Shapiro noticed it. Once I made it past that anecdote, I couldn't make it through the pseudoneurological 'scientisty'-sounding neuro-babble 'explanations' offered in the first chapter of that book regarding proposed mechanism of action.

Sounds like she was trying to mimic Marsha Linehan's backstory.

To each his/her own, I suppose. When I share cognitive-behavioral explanations of clinical phenomena, I know that they rest on (admittedly imperfect) empirical literature that I can understand and meaningfully articulate. I'll stick to that.

And we don't have to be deceptive about it.

 

[esob]

Interesting topic and a (mostly) civil discourse. Thus, this is a gentle reminder that personal attacks are not part of healthy discourse and may result in removal from the discussion (or the community).

 

[WisNeuro]

Ah, I love to see cognitive dissonance in action.

 

[Young Grasshoppa]

Did you read those articles?

Excellent, I'm happy to see you read the abstracts of two of the three articles. I understand as well as you that the findings are very inconclusive at best. I don't think that negates my point.

There have been dismantling studies which tell us why EMDR "works," and it's not the things that are unique to EMDR, i.e., the pseudo-neuroscience.

Obviously, this is the point we are trying to debate. Restating your opinion is hardly a refutation.

Please help me out here and direct me to the studies which form the basis of your opinion. That would be really nice. Honestly.

I have nothing for EMDR. I never trained in it and I'm simply fascinated by how impossible it is to get decent information about it. I came looking here because I was hoping that trained academics would offer me something more substantive than mid-level reddit bashes. I am playing the devil's advocate because I know I won't get anything substantive by joining the anti-EMDR train. Just here to learn.

So, tell me something that will help me actually understand your point of view.

Wow, you're being so neutral and very much not steering your patient into one particular treatment over the other, huh?

I'm simply mentioning to you the reason why the client may prefer EMDR. People hate homework, and they like when they have to pay for less sessions of therapy.
Remember I have nothing to gain here other than making the client happy and helping them progress. They are already coming weekly.

Couching something as "experimental" doesn't excuse you for deceiving patients about what the literature actually is or being oh-so-subtle in how you frame it versus other treatments.

I have been waiting patiently here for someone to explain to me why the evidence quoted is so terribly insufficient that it cannot be classified as an experimental enhancement to exposure therapy.

Apparently it's so clear to everyone else here that EMDR is bunk, that nobody has been bothered to bring the evidence that I have been patiently waiting for or to explain what great issue they had with the evidence cited above - as inconclusive as it may be.

I will still be waiting for substantive answers, since I actually do care to know the truth about this topic. (You may be getting bored of this refrain. I'm also getting bored - of ad hominem attacks, of rehashing opinions with no additional evidence and of snide remarks that don't help anyone.)

Who here has said anything about the "association" or allowing that to cause you to not help patients?

More on this later.

What I've seen is people recommending other evidence-based treatments for trauma like CPT and PE.

Plebian
What?

Spelling correction noted. I assume that your razor-sharp wit has not been distracted from the topic at hand.

Because there are evidence-based interventions that aren't "experimental" and don't rely on deceiving patients about them to various degrees.

As noted ad nauseum, EMDR is always just an enhancement to a therapy that is evidence-based. There is no need to deceive patients about EMDR. It is an enhancement that has some very inconclusive backing that shows it may be helpful.

When you have to compare criticism of your intervention with turning off a lamp, you're definitely arguing in good-faith.

When you have to take shots at an argument by attacking its illustrations instead of discussing the point, you're definitely arguing in good faith.

There's lots of things that would make patients feel more comfortable. There's also lots of things that they want or think would make them happy. They'd probably feel better and happier if every session came with complimentary steak and lobster.

There's no ethical obligation or standard to give patients everything they want or to give them the intervention that they are demanding. Patient preferences are important, but they're just that, preferences. This is a gross misunderstanding of our ethical obligations and evidence-based practice.

It is not the clinicians job to provide food. It is his responsibility to provide the best care they can as a therapist. I do think that it is the clinician's responsibility to use a method that is less stressful and quicker if one is available. It is unethical to engage in a mode of therapy which will cause undue stress and lengthen the therapy process simply because you prefer it.
Even if all that EMDR amounts to is a bit of anesthesia to reduce the pain of the surgery - it is the responsibility of the clinician to deliver the necessary intervention in the least painful manner. Call it beneficence, nonmaleficence or whatever you like. But then again, perhaps if you are philosophically averse to anesthesia your patients should just suck it up and accept surgery the way surgery is really meant to be...

Regardless, I don't think that anyone is obligated to use EMDR. Just asking an honest question - what's holding you back SO STRONGLY?

You left out the part that concludes that while there is little evidence that EMDR increases susceptibility to misinformation (i.e., taking on information fed to you by someone else), there is evidence that the eye movements "...do seem to increase spontaneous false memories" (i.e., recall that is erroneous and not related to information being directly fed to you; emphasis mine). This is a literature review of a small number of papers. No one is calling it perfect, but the methods are good for the data they have, and it directly contradicts the claim that EMDR is, at worst, a purple hat therapy. Again, I outright said the evidence is weak...but it does exist and would imply potential for iatrogenic harm.

Indeed I did. Perhaps I was wrong to think it obvious that there is no danger implied by a study that showed that people using EM gave more false positives when asked to identify words they had been shown in a word list. Oh, they had more correct answers too - interesting. Seemed they just guessed yes more often. I must say it doesn't seem particularly concerning to me, despite it's interesting implications in memory and attention.

I do appreciate your candid answer as to what gives you pause on trying EMDR, though. I respect that even if I don't think it's right. Thank you.

It does have a known mechanism of action. Exposure. Oh, and Tylenol inhibits COX-1 and COX-2. You're right about lithium, but, again, lithium's mechanism is truly unknown. EMDR's is not. Dismantling studies have demonstrated, time and time and time and time again, that bilateral stimulation is not a differentially efficacious component--it does not enhance the treatment in any measurable way.


(a) We do know how EMDR works and that it works via the same common mechanisms that makes everything else work (i.e., exposure, meaning-making, re-appraisal).

Obviously, this is the point we are trying to debate. Restating your opinion is hardly a refutation. Had to repeat that here. Sorry guys, I'm bored too. Love the confidence, though.

Waiting for the low-down on all of the dismantling studies (that's what I came here to hear). Thanks in advance. Really.

Good point about the Tylenol. Speculation from what I read, but something I hadn't been aware of. Thanks. (10/10 on substance for that sentence)

(b) This is a complete strawman of CBT.

Luckily the efficacy of CBT is not up for debate now, so you won't mind if I had some fun with it. Don't take it personally, please.

This is why all doctoral-level graduate students should receive formal training in the philosophy of science.

Characteristics of good theories:

independently testable: An auxiliary hypothesis must be testable independently of the theory it was is introduced to save.

unified: It should be simple and have a small number of problem solving strategies that can be applied to a large number of situations.

fecundity. A good theory should open up new areas of research.

A good theory should be as concerned with giving good explanations of unexplained phenomena as it is with generating correct predictions.

A good theoretical foundation for a psychological intervention must be consistent with the corpus of the entirety of the basic science upon which it is founded as well as all of the other sciences (biology, chemistry, evolutionary theory, areas of psychology (e.g., how memory works)).

About a decade or so ago I bought Francine Shapiro's EMDR text but I couldn't make it more than a few pages into it due to the anecdotal nature of the report of 'her discovery' involving her walking down a road and noticing that as she moved her eyes side to side randomly it relieved her psychological distress related to (I assume) traumatic memories. So, in the history of humankind, this potent 'effect'/discovery never took place until Francine Shapiro noticed it. Once I made it past that anecdote, I couldn't make it through the pseudoneurological 'scientisty'-sounding neuro-babble 'explanations' offered in the first chapter of that book regarding proposed mechanism of action.

To each his/her own, I suppose. When I share cognitive-behavioral explanations of clinical phenomena, I know that they rest on (admittedly imperfect) empirical literature that I can understand and meaningfully articulate. I'll stick to that.

Now this is exactly what I've been waiting for. This is perfect.

I agree wholeheartedly. The theory of EMDR is beyond awful. It violates every rule of good theory. If you would propose it at any point in a self-respecting doctoral program you would be thrown out on your head.

And if somebody says, "Listen I was trained in a Doctoral program, I like to use methodology that rests upon theory and literature that I understand and can meaningfully articulate. So I don't use EMDR. It irks my academic sensibilities." I respect that. Cool. You hate stuff that make no sense. Me too. Keep doing what you're doing. You aren't obligated to use methodologies that are bothersome to you. Especially if there's very little evidence supporting its efficacy.

If that is all everyone means when they hate on EMDR, I'm fine with it. I will mention that it does not give a reason why someone should not use EMDR in an honest and cautious way if it does not bother him and his or her supervisor/client base requests it incessantly.

Thanks everyone for your insights - looking forward to more!

Looks like the boys will have to reload for another round...

I trust you'll have enough ammunition.

 

[Young Grasshoppa]

Interesting topic and a (mostly) civil discourse. Thus, this is a gentle reminder that personal attacks are not part of healthy discourse and may result in removal from the discussion (or the community).

Thank you.
I am a bit outnumbered here. Perhaps I overcompensated in my zealous attempt to have my question taken seriously.
I sincerely apologize to anyone whom I may have offended.

 

[PsychSupreme]

Indeed I did. Perhaps I was wrong to think it obvious that there is no danger implied by a study that showed that people using EM gave more false positives when asked to identify words they had been shown in a word list.

Considering the sordid history of psychotherapy as it pertains to false recall, and considering the potential for effects demonstrated in a very carefully controlled environment to be amplified when used in uncontrolled clinical settings (potentially with folks who already have high memory biases and trait suggestibility), this could absolutely be a huge deal.

Waiting for the low-down on all of the dismantling studies (that's what I came here to hear). Thanks in advance. Really.

You're the one who seems to think BLS does matter, so really it would be upon the claimants (those who claim BLS matters) to provide the evidence. However, since studies do exist:

1. Here's a large meta-analysis by Cuijpers et al. (2020) in which they state: "...due to the fact that only few trials in the current study had a low risk of bias, the inability to reproduce the aforementioned previous findings does indicate that the difference between EMDR with and without eye movements may not be as robust as previously suggested" (in which "previously suggested" refers to a previous analysis by the same authors in which they found significant differences with and without BLS which have disappeared when only low-bias studies have been analyzed).

https://www.tandfonline.com/doi/full/10.1080/16506073.2019.1703801

2. This book chapter gives a thorough overview of the role (read: lack thereof) of BLS in EMDR:

https://connect.springerpub.com/content/book/978-0-8261-7769-8/chapter/ch04

3. This one is older but still worth a read:

https://devilly.org/Publications/EMDR-review.pdf

4. Ditto above:

https://www.sciencedirect.com/science/article/abs/pii/S0272735899000173?via%3Dihub

Luckily the efficacy of CBT is not up for debate now, so you won't mind if I had some fun with it. Don't take it personally, please.

Okay, but you used that straw man as a legitimate argument in favor of using EMDR instead of "doing some worksheets." The snark is fine, but at least make it accurate.

Obviously, this is the point we are trying to debate.

No one was trying to debate anything until you hopped in and starting "playing the Devil's advocate." We were simply expressing our frustrations over APA--an ostensibly scientific organization--being wishy-washy in its actual advocacy for science-based treatment. We never asked for a debate.

As noted ad nauseum, EMDR is always just an enhancement

But it doesn't "enhance" anything.

Apparently it's so clear to everyone else here that EMDR is bunk, that nobody has been bothered to bring the evidence

Yes, again, because this topic has been rehashed for decades and this thread was not meant to be a replacement for a literature review.

Final word: literally no one here is "against" EMDR inasmuch as we are against therapists honestly saying "We are going to try a gentler form of imaginal exposure therapy that may make it easier for you to engage with traumatic memories," which is the substance of what's actually effective--but then it wouldn't really "be" EMDR anymore because bilateral stimulation is written into what makes EMDR, EMDR. You cannot "do" EMDR, as it is generally defined, without including all the fluff. You claim the therapy is fine and the culture is what's bad, which is partially true, but the culture only exists because the therapy keeps being taught, in full, with all the bells and whistles. The therapy itself keeps the culture on life support. If someone were to remove BLS and rebrand the therapy as "indirect imaginal exposure" or some other such moniker, and remove the cultishness and grift from it, no one would be upset. But they don't do that. They obstinately insist that BLS is crucial to the results because otherwise there'd be no reason to sell certifications and trainings.

Anyway, this is probably the final time I'll respond to this particular set of posts because I've promised myself I’d stop dumping loads of time into internet arguments and because I just do not see us coming to any kind of agreement.

 

[aim-agm]

Would this be a good summary?

EMDR does not appear to have greater effectiveness than CPT, etc. (and may be less effective), there is some indication that it has increased risks of harm, but some patients may engage with it better than with CPT, etc.. The BLS might have utility in decreasing the intensity of the experience and as such have benefit, but it that utility is not greater than any other given effective distractor and the belief (and espousement thereof) in a special significance or mechanism to BLS (over other distractors) is significantly harmful.
As such, the EMDR modality may be appropriate in select patients so long as it includes a full disclosure of the evidence base and function of BLS in the treatment (perhaps ideally with a similar approach but different distractor) as well as possible risks of false memory.

 

[WisNeuro]

Would this be a good summary?

EMDR does not appear to have greater effectiveness than CPT, etc. (and may be less effective), there is some indication that it has increased risks of harm, but some patients may engage with it better than with CPT, etc.. The BLS might have utility in decreasing the intensity of the experience and as such have benefit, but it that utility is not greater than any other given effective distractor and the belief (and espousement thereof) in a special significance or mechanism to BLS (over other distractors) is significantly harmful.
As such, the EMDR modality may be appropriate in select patients so long as it includes a full disclosure of the evidence base and function of BLS in the treatment (perhaps ideally with a similar approach but different distractor) as well as possible risks of false memory.

I am not sure that there is good evidence for this piece.

 

[R. Matey]

Maybe this was already mentioned, but EMDR also doesn't really pass Safe, Easy, Cheap, and Sensible (SECS) sniff test given that's it's difficult to access, expensive to train in, and other treatments that are arguably more effective (in that they at least pose fewer risks) are readily available.

 

[WisNeuro]

Maybe this was already mentioned, but EMDR also doesn't really pass Safe, Easy, Cheap, and Sensible (SECS) sniff test given that's it's difficult to access, expensive to train in, and other treatments that are arguably more effective (in that they at least pose fewer risks) are readily available.

EMDR is just the biggest MLM scheme of the psychology world at the moment.

 

[Sanman]

EMDR is just the biggest MLM scheme of the psychology world at the moment.

Making that PESI money, baby!

 

[PsychSupreme]

EMDR is just the biggest MLM scheme of the psychology world at the moment.

IFS is coming up in the rearview

 

[Mama Bear]

EMDR is just the biggest MLM scheme of the psychology world at the moment.

I was just coming here to make this comparison. I have a problem with exploitative systems. Even if I decide to practice EMDR with a thorough informed consent outlining the evidence based vs non evidence based aspects, there is still the matter of the expense of training compared to other options. I would be shelling out money towards this system.

I thought of MLM as a parallel as well. I don’t buy MLM products (even if I would be supporting a friend or family member), because I don’t want to contribute money to that system.

 

[WisNeuro]

IFS is coming up in the rearview

That was one of my final straws with my state association, they put on an invited CE for that nonsense.

 

[FlowRate]

The thing I run into increasingly often these days is patients who are in "EMDR therapy" for 2.5+ years and often not for PTSD (or at the very least not classic/strictly defined PTSD.) It appears to be some therapists' one and only hammer.

 

[Young Grasshoppa]

IFS is coming up in the rearview

In the opinion of the psychologists here are there any interventions that are evidence-based besides CBT and exposure therapy?

 

[Fan_of_Meehl]

In the opinion of the psychologists here are there any interventions that are evidence-based besides CBT and exposure therapy?

The only definition of 'evidence-based psychotherapy' I've ever seen in print (or articulated anywhere) parallels the definition of 'evidence-based medicine' and it is, essentially, the intersection of:

(a) what the empirical literature says (both basic science as well as outcome research)
(b) what the provider is competent doing (e.g., been trained/supervised to do) AND
(c) what the client prefers (and is in accord with their values/preferences)

Here is the APA definition:

Evidence-based practice in psychology (EBPP) is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.2 This definition of EBPP closely parallels the definition of evidence-based practice adopted by the Institute of Medicine (2001, p. 147) as adapted from Sackett and colleagues (2000): “Evidence-based practice is the integration of best research evidence with clinical expertise and patient values.” The purpose of EBPP is to promote effective psychological practice and enhance public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention.

Policy statement on evidence-based practice in psychology

Evidence derived from clinically relevant research should be based on systematic reviews, reasonable effect sizes, statistical and clinical significance, and a body of supporting evidence.

www.apa.org

From this definition it seems clear to me that manualized/protocol treatments (such as prolonged exposure therapy or cognitive processing therapy) may (and often do) qualify as evidence-based therapies. However, just because one is not implementing a specific 'alphabeticized' protocol with a pre-established agenda for each specific session does not mean that one is not practicing 'evidence-based psychotherapy.'

The limitations of the 'protocol-for-syndrome' approach (e.g., diagnose disorder X, then put patient through highly structured protocol Y) are becoming apparent to most sophisticated practitioners and scholars alike (even some of the 'big wigs' like David Barlow, Steven C. Hayes, and Stefan Hofmann):

The Future of Intervention Science: Process-Based Therapy

Clinical science seems to have reached a tipping point. It appears that a new paradigm is beginning to emerge that is questioning the validity and utility of the medical illness model, which assumes that latent disease entities are targeted with specific ...

www.ncbi.nlm.nih.gov

 

[PsychSupreme]

In the opinion of the psychologists here are there any interventions that are evidence-based besides CBT and exposure therapy?

What are you trying to achieve by continually stirring the pot?

Yes, there are evidence-based theories that aren’t CBT or exposure therapy. IFS ain’t one of ‘em.

Unless you can start demonstrating the existence of “parts” and giving mechanistic evidence for achieving symptom reduction by reducing conflicts between these nebulous and unfalsifiable entities, then you’re not on strong footing.

 

[Young Grasshoppa]

What are you trying to achieve by continually stirring the pot?

Yes, there are evidence-based theories that aren’t CBT or exposure therapy. IFS ain’t one of ‘em.

Unless you can start demonstrating the existence of “parts” and giving mechanistic evidence for achieving symptom reduction by reducing conflicts between these nebulous and unfalsifiable entities, then you’re not on strong footing.

I may have mentioned before that I'm trying to learn some things from you guys. I mean that seriously.

I prefer when people explain things and substantiate their claims since it's otherwise difficult for me to accept their opinions as fact (which I hope you consider a merit). I appreciated FanMeehls post for example. It gave me a lot of information explaining what I hadn't understood beforehand.

I am not trying to piss anyone off. I'm just trying to get a helpful answers to questions that typically get canceled instead of answered.

I only stir the pot because people here sometimes assume you must be brain-dead to even have a question regarding certain things. That pretty much precludes me getting any useful answer to the question that I asked since it hasn't been taken seriously. After stirring the pot I got a lot of excellent substantive responses, including your own. A bit snide perhaps, but worth it anyway.

Regardless, no one is obligated to help me out. I simply appreciate it. My clients will appreciate it as well, as I'll be a better therapist.

(I bumped this particular thread instead of creating a new one because the OP expressed confusion that is similar to my own)

Just trying to figure things out here.

So let me rephrase. Since coming here I've discovered that the APA is not the greatest source for information on EBPs. If anyone could share some practices that are evidence-based besides CBT, I would be eternally grateful.

What are they? Where could I find reliable information about them?

(I understand, FanMeehl, that this question is not in line with the movement away from the "protocol-for-syndrome" approach. I think the answers would prove valuable to me regardless until I manage to achieve the expertise necessary for the approach mentioned in the article you quoted.)

Thank you all!

 

[AbnormalPsych]

So let me rephrase. Since coming here I've discovered that the APA is not the greatest source for information on EBPs. If anyone could share some practices that are evidence-based besides CBT, I would be eternally grateful.

What are they? Where could I find reliable information about them?

The peer reviewed literature is your best place to read about and learn how to treat disorders, from a variety of theoretical orientations, using a variety of interventions, and learn what works better than other things, how and why those things work, for who they work, and what can go wrong. You will notice a convergence of the evidence at a certain point, and also form your own questions about confusing evidence and missing evidence. Read, read, read.

If you are just looking for a list of some sort, that really isn't how this works at the doctoral level. But, if you like, Division 12 has some helpful tools:

Treatments | Society of Clinical Psychology

div12.org

Research-Supported Psychological Treatments | Society of Clinical Psychology

div12.org

 

[Fan_of_Meehl]

I may have mentioned before that I'm trying to learn some things from you guys. I mean that seriously.

I prefer when people explain things and substantiate their claims since it's otherwise difficult for me to accept their opinions as fact (which I hope you consider a merit). I appreciated FanMeehls post for example. It gave me a lot of information explaining what I hadn't understood beforehand.

I am not trying to piss anyone off. I'm just trying to get a helpful answers to questions that typically get canceled instead of answered.

I only stir the pot because people here sometimes assume you must be brain-dead to even have a question regarding certain things. That pretty much precludes me getting any useful answer to the question that I asked since it hasn't been taken seriously. After stirring the pot I got a lot of excellent substantive responses, including your own. A bit snide perhaps, but worth it anyway.

Regardless, no one is obligated to help me out. I simply appreciate it. My clients will appreciate it as well, as I'll be a better therapist.

(I bumped this particular thread instead of creating a new one because the OP expressed confusion that is similar to my own)

Just trying to figure things out here.

So let me rephrase. Since coming here I've discovered that the APA is not the greatest source for information on EBPs. If anyone could share some practices that are evidence-based besides CBT, I would be eternally grateful.

What are they? Where could I find reliable information about them?

(I understand, FanMeehl, that this question is not in line with the movement away from the "protocol-for-syndrome" approach. I think the answers would prove valuable to me regardless until I manage to achieve the expertise necessary for the approach mentioned in the article you quoted.)

Thank you all!

I dunno...honestly, I think that their publicly announced position on the definition (tri-partite) of 'evidence-based therapy' is one of the few things recently that APA has 'gotten right.'

We older psychologists remember way back in the dinosaur 1990's when we were in training and they rolled out this new term 'empirically-validated' to describe a handful of protocol/manualized therapies that had at least one methodologically sound outcome trial under their belt.

Then they had to 'back off' of that term a little bit and it got reframed as 'empirically-supported.'

Then, at some point, I suppose out of medical envy and chasing of reimbursement (which I understand), it morphed into 'evidence-based' (to sound similar to 'evidence-based' medicine).

There certainly are psychologists who use the term 'evidence-based' therapy to mean only manualized/protocol treatments. It's how they may employ the term and may be what they imply when they use it but I don't think I've ever seen an explicit definition of the term to mean only the manualized alphabet therapies. I think that the reliance on manualized, step-by-step, one-size-fits-all, cognitive-behavioral protocol therapies--though definitely having their place in psychotherapy and doing a lot of good for the field--have had unfortunate side effects such as teaching an entire generation of therapists that manualized psychotherapy is the 'one true way' and that anyone not using a manual is 'not doing evidence-based therapy.' It has also lessened the (critical) role of individualized clinical case formulation specific to the client and idiographic (functional) assessment. These are some of the things that a renewed focus on process-based therapy is designed to remediate.