Why is EMDR so popular?

[AnnoyedByFreud]

Am I missing something? As far as I knew, EMDR has not been found to be any clinically different from CBT and is basically CBT + hocus pocus. Yet, many, many MFTs/LCSWs, psychologists, and psychiatrists that I work with swear by EMDR. I see a lot of trauma and PTSD cases, mostly for medications. I want to refer them to the best therapy possible and I'm feeling some pressure to refer them for EMDR despite my misgivings. Is there more recent research that acknowledges the eye-movements as uniquely beneficial? Or have my colleagues just been taken in by good marketing?

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[Therapist4Chnge]

Effective marketing is effective. Also, to be certified in EMDR it is quite pricey, so it must be worth it if someone spends $$$ on it...right?

 

[medium rare]

Am I missing something? As far as I knew, EMDR has not been found to be any clinically different from CBT and is basically CBT + hocus pocus. Yet, many, many MFTs/LCSWs, psychologists, and psychiatrists that I work with swear by EMDR. I see a lot of trauma and PTSD cases, mostly for medications. I want to refer them to the best therapy possible and I'm feeling some pressure to refer them for EMDR despite my misgivings. Is there more recent research that acknowledges the eye-movements as uniquely beneficial? Or have my colleagues just been taken in by good marketing?

EMDR is nothing more than repackaged graded exposure with response prevention therapy. EMDR works because that's what it is - a type of exposure therapy. It has nothing to do with the purported eye movements bilaterally reprocessing anything. You could have the patient jump up and down on one leg in substitution for the eye movement and get the same result. It's attracted an almost cult-like following but that doesn't mean it works for the reasons its proponents claim.

 

[Fan_of_Meehl]

Am I missing something? As far as I knew, EMDR has not been found to be any clinically different from CBT and is basically CBT + hocus pocus. Yet, many, many MFTs/LCSWs, psychologists, and psychiatrists that I work with swear by EMDR. I see a lot of trauma and PTSD cases, mostly for medications. I want to refer them to the best therapy possible and I'm feeling some pressure to refer them for EMDR despite my misgivings. Is there more recent research that acknowledges the eye-movements as uniquely beneficial? Or have my colleagues just been taken in by good marketing?

I wasn't aware that it was popular.

 

[PsyDr]

Am I missing something? As far as I knew, EMDR has not been found to be any clinically different from CBT and is basically CBT + hocus pocus. Yet, many, many MFTs/LCSWs, psychologists, and psychiatrists that I work with swear by EMDR. I see a lot of trauma and PTSD cases, mostly for medications. I want to refer them to the best therapy possible and I'm feeling some pressure to refer them for EMDR despite my misgivings. Is there more recent research that acknowledges the eye-movements as uniquely beneficial? Or have my colleagues just been taken in by good marketing?

It gives patients some protection from narcissistic injury. It's not that they could do prolonged exposure themselves. There's this secret process! Same thing for the providers! I'm not just asking them to imagine something, there's neuroscience behind it. If treatment fails, it's because the physical part isn't going right, not that icky emotional intimacy stuff, or accepting the idea that some patients are malingering/have personality or environmental causes for their presentation. Keeping in mind that by doing this stuff they've already announced they don't have a basic understanding of neuroscience.

Blue collar guy has ptsd from a work accident. Pulls the "that isn't gonna happen" when CBT assignments are made. It's a lot easier for thebprivider to sa, "huh, there's something going wrong with how we are making this guy move his eyes/tap out the Macarena." than to say, "this guy comes from a culture that values disavowing emotion, and his income is dependent on him not getting better".

 

[singasongofjoy]

All marketing. I think there is actually some research showing that the active component is the exposure/response prevention. It's basically a smoke screen to get people to engage in Ex/RP in my opinion. It's technology! it's fancy! Makes it seem more like a physical-medical treatment than therapy, which as @PSYDR said is appealing to a lot of folks- I can vouch for the blue collar folks in my rural hometown on that one, where most folks I know would rather have a finger amputated than go to (or admit to going to) therapy. So I dunno, that's probably where the greatest benefit lies, if there is one- getting people to agree to engage in therapy because they don't view it as therapy. Also the cognitive dissonance - you spend that much money getting trained in it... it's got to be worth something, right?! lol

 

[bmedclinic]

studies have found it to be as efficacious as purple hat therapy.
Now I'll go ahead and put on my purple hat, thus rendering me a magically effective therapist.

 

[WisNeuro]

Effective marketing is effective. Also, to be certified in EMDR it is quite pricey, so it must be worth it if someone spends $$$ on it...right?

Ah, the magic of cognitive dissonance.

 

[awishingstar]

Also sad but still true is how many psychologists out there are "nervous" to do prolonged exposure because it doesn't "feel nice" and "is upsetting."

Have you guys heard of accelerated resolution therapy yet? The koolaid is changing color.

 

[Therapist4Chnge]

If I have to do therapy, I prefer it to be exposure therapy bc I've had excellent results. It can be understood by pretty lower-level/functioning (cognition) patients and it works.

 

[WisNeuro]

If you have to? 😉 I actually enjoy PE, had great success with it back when I did sexual assault work.

 

[Therapist4Chnge]

If you have to? 😉 I actually enjoy PE, had great success with it back when I did sexual assault work.

Trust me...there have been times when I've been, "encouraged to consider" taking some therapy cases to help out the ever growing out-pt referral crush. Back then my wait list was ~5mon for an assessment, and now at 3.5-4mon and the "encouragement" is back.

I too used PE for trauma work (back in training) and found it very effective. I still don't like therapy, but I can still provide it if needed, it just isn't a good use of my time and frankly there are bette providers out there who have more flexibility and desire to do that work.

I now offer 1-3 sessions of psychoeducation for certain types of assessment cases. Now I can claim I'm being flexible.

 

[PsychPhDone]

PE is my tx of choice for PTSD, though if my guess is a toss-up between CPT and PE, I offer the patient both and let them choose. EMDR works...because exposure. It's all hype. I, too, would love to see a solid paper show it's something other than that so I don't feel so much disdain about it.

 

[Therapist4Chnge]

...so I don't feel so much disdain about it.

My disdain for it comes primarily from the fake science explanations I hear from, "certified" clinicians. Please tell me more about how you think the brain works, and putting "neuro" in front of words doesn't make it any more legitimate.

 

[smalltownpsych]

My disdain for it comes primarily from the fake science explanations I hear from, "certified" clinicians. Please tell me more about how you think the brain works, and putting "neuro" in front of words doesn't make it any more legitimate.

Isn't EMDR from some theory called neurolinguistic processing? I have complete disdain and derision for that type of pseudioscience masquerading as psychology and giving our field a bad name. I had a supervisor who thought she could tell when someone was lying by which way they looked when you asked them a question based on reading a book on this. She would literally use that hocus pocus garbage to try and read my mind and tell me what I was thinking and then tell me I was lying if I disagreed with her analysis of my thoughts. "I know you are not being truthful because you looked up and to the left."

 

[glowstick]

"I know you are not being truthful because you looked up and to the left."

"Aha, tricked you! I always look up and to the left when I'm speaking."

 

[singasongofjoy]

Have you guys heard of accelerated resolution therapy yet? The koolaid is changing color.

that was the first I've heard of it, but just looked it up.... ugh. Just gave me something else to be annoyed about on a long day.

 

[calimich]

Also sad but still true is how many psychologists out there are "nervous" to do prolonged exposure because it doesn't "feel nice" and "is upsetting."

Have you guys heard of accelerated resolution therapy yet? The koolaid is changing color.

How about brainspotting? It's "evolved from EMDR" and included in a textbook I didn't select for my theories of counseling class.

 

[deleted343839]

I had a supervisor who thought she could tell when someone was lying by which way they looked when you asked them a question based on reading a book on this.

I saw that on a (fictional) TV show once. Even slick TV writers couldn't make it sound credible.

 

[PsyDr]

I saw that on a (fictional) TV show once. Even slick TV writers couldn't make it sound credible.

My take away from the facs training: Ekman says that the majority of microexpressions are meaningless. (Sad trombone).

 

[Cigar]

Greetings from the med side of SDN. I have a psych background and lurk over here sometimes. This thread strikes home because I've worked in ptsd research for several years, and periodically a guest in our lab mentions this hot garbage while we suffer in polite silence.

EMDR is what you get when Occam's razor is dulled. Why do CBT when you can do CBT + magic?


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[AnnoyedByFreud]

Hmmm. Interesting replies, much appreciated. I think I'll specify on my referrals from now on that I believe the pt would benefit from prolonged exposure therapy in particular. The marketing for EMDR must be incredible. One of the psychiatrists I work with, who is a great clinician, has an EMDR text on her bookshelf. Sigh.

 

[Fan_of_Meehl]

Hmmm. Interesting replies, much appreciated. I think I'll specify on my referrals from now on that I believe the pt would benefit from prolonged exposure therapy in particular. The marketing for EMDR must be incredible. One of the psychiatrists I work with, who is a great clinician, has an EMDR text on her bookshelf. Sigh.

It's a bit dated now, but Richard McNally wrote a great article entitled, "EMDR and Mesmerism: A Comparative Historical Analysis" (I'll try to link to the pdf below) that is as hilarious and entertaining as it is incisive in its critique of the approach.

My favorite excerpt from the article, below (I crack up reading it at 'free of charge' every time):

7. Both animal magnetism therapists and EMDR therapists have provided pro
bono treatment. In response to critics who accused him of engaging in
“profitmongering” (Gould, 1991, p. 187), Mesmer arranged for impoverished
individuals to receive the benefits of animal magnetism pro bono. In one approach,
therapists would “magnetize” a tree and then tie indigent patients to
it, free of charge (Darnton, 1968, p. 58). The “magnetic fluid” would presumably
migrate from the tree to the patients, thereby curing their ailments.

 

[singasongofjoy]

It's a bit dated now, but Richard McNally wrote a great article entitled, "EMDR and Mesmerism: A Comparative Historical Analysis" (I'll try to link to the pdf below) that is as hilarious and entertaining as it is incisive in its critique of the approach.

My favorite excerpt from the article, below (I crack up reading it at 'free of charge' every time):

7. Both animal magnetism therapists and EMDR therapists have provided pro
bono treatment. In response to critics who accused him of engaging in
“profitmongering” (Gould, 1991, p. 187), Mesmer arranged for impoverished
individuals to receive the benefits of animal magnetism pro bono. In one approach,
therapists would “magnetize” a tree and then tie indigent patients to
it, free of charge (Darnton, 1968, p. 58). The “magnetic fluid” would presumably
migrate from the tree to the patients, thereby curing their ailments.

This is gold. Thanks so much for sharing- I'm sharing w/ some of my colleagues 🙂

 

[cortisolace]

"I know you are not being truthful because you looked up and to the left."

My old faculty advisor must have read the same book because he literally said the same exact thing to me, prompting my eyes to roll in a full circle

 

[Fan_of_Meehl]

My old faculty advisor must have read the same book because he literally said the same exact thing to me, prompting my eyes to roll in a full circle

I swear, most days I feel that professional training in mental health is more about realizing what we DO NOT know or CANNOT (magically) do--that is, dispelling the many myths the public have about mental health and the applied sciences of psychology and psychiatry.

In the instant case (EMDR)...no, we cannot 'cure' (at an 80% to 100% 'cure rate') PTSD in a single session of finger-wagging and accelerated exposure/reprocessing of the trauma.

If we could do that:

1. everyone would be doing it
2. PTSD diagnoses and service-connection and/or disability rates (and percentages) for PTSD would be *plummeting* over time (instead, they are increasing *exponentially* as the years go by...and...in the VA system, once people are service-connected (at 10,30,50, or 70%), the degree of service-connection (which is *supposed* to be an index of the psychosocial impairment attributable to the condition) almost always INCREASES over time (irrespective of other factors) and almost never (something like .04% year to year) decreases over time.
3. there'd be no service dogs for PTSD movement also growing at an exponential rate, year to year
4. Francine Shapiro would be on the front page of every publication in America (for 'developing' a mental health talk therapy that cures 80%-100% of patients--a response rate that no other form of medication/psychotherapy (besides, maybe, exposure therapy for simple phobias) has ever even approached.

 

[cara susanna]

The last clinic I was at was very anti-EMDR and the one I'm in now is very pro. I also don't quite get it. I do remember this huge debate on the ABCT listserv that lasted months, where people kept arguing about the research. I've since learned more about how to actually "do" the therapy and, honestly, it reminds me a lot of the technique used in Scientology (e-meter, is it called)?

As a PTSD therapist, I'm a PE girl all the way! I think that I actually enjoy doing CPT more, though.

 

[erg923]

Also sad but still true is how many psychologists out there are "nervous" to do prolonged exposure because it doesn't "feel nice" and "is upsetting."

Have you guys heard of accelerated resolution therapy yet? The koolaid is changing color.

Let me just say that I have done both PE and CPT, and quite frankly, don't enjoy doing either. So, just because one doesn't want to do PE (largely because of the brutal content that I don't care to hear in detail over and over and over), doesn't mean I don't respect it, recommend it, or "get it." Nor does it mean I would gravitate towards or recommend sham treatment. I am health psych and primary care focused, so full on courses of therapy for PTSD is just not what I like doing.

 

[researchgirl]

Let me just say that I have done both PE and CPT, and quite frankly, don't enjoy doing either. So, just because one doesn't want to do PE (largely because of the brutal content that I don't care to hear in detail over and over and over), doesn't mean I don't respect it, recommend it, or "get it." Nor does it mean I would gravitate towards or recommend sham treatment. I am health psych and primary care focused, so full on courses of therapy for PTSD is just not what I like doing.

100% agree with this! I did PE and CPT on internship -- excellent treatments to learn and understand, particularly since I now work in the VA where rates of PTSD diagnoses are so high. Really hate doing PE because I don't care to hear the content (who would enjoy that?) and because it gets so repetitive on the clinician's end (which is the point, I know)... I liked CPT better, except I was always a big B little c cBT therapist, so it's pretty far outside my comfort zone. Great learning experience for internship, helped me improve my cognitive therapy skills, but.... I'm a researcher first and a health psychologist second, so thank goodness I don't need to do either of those things anymore.

That being said my referrals to the PTSD clinic always specify CPT or PE, and I usually try to give patients a good overview of what to expect in those treatments before I send them there.

 

[EmotRegulation]

Someone I know recently asked me my opinion of EMDR, because her therapist suggested it but she was skeptical and wanted to know about the research base, so I sent this as a relatively decent overview of the research: https://www.scientificamerican.com/article/emdr-taking-a-closer-look/

Or so I thought. I got an email back saying "I appreciate the assertions that it's evidence based." Which.....was not really my point. I had to write back to say uh.....or you could just ask for regular old exposure therapy and not deal with the eye movement pieces. Said friend has MS, and I have *no* idea how EMDR might interact with her MS, so why risk that when exposure therapies can target the trauma piece just as well?

 

[MiniLop]

I've since learned more about how to actually "do" the therapy and, honestly, it reminds me a lot of the technique used in Scientology (e-meter, is it called)

That's exactly what I would expect someone with low thetans to say!

 

[Fan_of_Meehl]

Someone I know recently asked me my opinion of EMDR, because her therapist suggested it but she was skeptical and wanted to know about the research base, so I sent this as a relatively decent overview of the research: https://www.scientificamerican.com/article/emdr-taking-a-closer-look/

Or so I thought. I got an email back saying "I appreciate the assertions that it's evidence based." Which.....was not really my point. I had to write back to say uh.....or you could just ask for regular old exposure therapy and not deal with the eye movement pieces. Said friend has MS, and I have *no* idea how EMDR might interact with her MS, so why risk that when exposure therapies can target the trauma piece just as well?

I guess everybody has his/her own notion of what 'evidence-based' means (and it can differ depending on who's defining it). To me, it goes beyond even the APA definition (which references the integration of (1) the best available research with (2) clinician expertise in the context of (3) patient characteristics/culture/preferences). Regarding (1) 'the best available research,' a lot of folks will look at that and consider it simply to mean 'what have the efficacy/effectiveness studies shown in terms of Treatment X for Condition Y.' However, I think that the extent to which the theoretical model guiding Treatment X (e.g., cognitive behavioral theory, interpersonal theory, dialectical behavior theory/therapy) enjoys support in the literature at large (and integrates with basic psychological/medical science) is critically important...especially for informing the clinician regarding application of the theory in an individualized case formulation of the patient and his/her problems such that--should we run into a problem in terms of treatment response--we have an idea how to 'troubleshoot' the situation by invoking the relevant theories and basic clinical/scientific processes (e.g., habituation in exposure therapy) that should be at play and try to figure out 'what's not working here.'

One of the major problems I have with the EMDR literature when I try to read it is that they always make up meaningless terms/concepts like 'physiologically stored memories' which they present as somehow meaningful and distinctive for their model. Let's parse the term 'physiologically stored memories' for a second (it has three terms). I know what memories are. I certainly know what 'stored' memories are and am having a hard time conceptualizing what an 'un-stored' memory would be...so 'stored memories' seems conceptually redundant and therefore meaningless. Likewise, all memories are presumably 'physiologically stored' in the organism in that some modification of the CNS substrate and/or strength of neuronal interconnections/activation is necessary for there to be a 'memory' in the first place. So, when an article written by EMDR proponents makes a statement such as,

"Most mental health professionals would agree that current clinical issues are based at least in part on previous life experiences. However, the hallmark of EMDR therapy is the emphasis on the physiologically stored memory as the primary foundation of pathology, and the application of specifically targeted information processing as the primary agent of change."

So life experiences create memories and memories (from life experiences, of course) are the 'primary foundation of pathology'; and using an information-processing (cognitive?) model to address these memories can be helpful in promoting therapeutic change.

So...other than stretching the term/concept 'memories' into (needlessly redundant) 'physiologically stored memories'...what exactly is distinctive here?

 

[smalltownpsych]

Someone I know recently asked me my opinion of EMDR, because her therapist suggested it but she was skeptical and wanted to know about the research base, so I sent this as a relatively decent overview of the research: https://www.scientificamerican.com/article/emdr-taking-a-closer-look/

Or so I thought. I got an email back saying "I appreciate the assertions that it's evidence based." Which.....was not really my point. I had to write back to say uh.....or you could just ask for regular old exposure therapy and not deal with the eye movement pieces. Said friend has MS, and I have *no* idea how EMDR might interact with her MS, so why risk that when exposure therapies can target the trauma piece just as well?

It always creates a tough situation when a person's therapist is recommending something counter to sound psychological evidence. I have had to deal with this mainly with patients, but can be just as problematic when dealing with friends or relatives. When it comes to EMDR, I tend to just let it ride unless there is a compelling reason not to. In other words, since exposure therapy works, i doubt if the additional placebo effect of blinking lights or moving fingers is likely to cause harm.