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sarahsweets
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Default Oct 02, 2019 at 04:01 AM
  #1
I have been thinking about EMDR a lot lately and have been hesitant to post a thread out of fear of offending people who have had success with this form of treatment. I want to be clear that if it worked for you then good. I fully support anyone who is able to find successful treatment. Accupuncture has all sorts of detractors yet it has helped me with anxiety management for a long time.

No disrespect is meant towards anyone who says emdr worked for them but its so hard for me to get behind it as a scientifically proven, effective technique with life lasting consistent results. I have been thinking a lot about this lately.
Here are some quotes that I wanted to share. Of course these are all from varying scientific opinions and yes, they are biased in favor of not supporting emdr but I still think they are valid, and finding research about EMDR that is anything other than success stories was difficult.
Quote:
The theoretical rationale for EMDR has not been clearly explicated by either Shapiro or others. Indeed, a recent attempt by Shapiro (1994b, p. 153) to elaborate on EMDR's mechanism of action may mystify even those familiar with the technique: "The system may become unbalanced due to a trauma or through stress engendered during a developmental window, but once appropriately catalyzed and maintained in a dynamic state by EMDR, it transmutes information to a state of therapeutically appropriate resolution."
I do not see this as a very scientific way to describe the mechanism of action- or at least a way to replicate the results in order to establish scientific agreement.
Quote:

EMDR has been hailed by its advocates as a novel treatment that produces much faster and more dramatic improvements than alternative treatments. Shapiro (1989b), for example, asserted that EMDR can successfully treat many or most cases of PTSD in a single 50-minute session, although especially severe cases may require several sessions. Moreover, claims for EMDR's efficacy have not been limited to Shapiro. Psychologist Roger Solomon (1991, cited in Herbert and Mueser 1992) described EMDR as a "powerful tool that rapidly and effectively reduced the emotional impact of traumatic or anxiety evoking situations." Beere (1992, p. 180) reported "spectacular" results after using EMDR on a client with multiple personality disorder.

Similar reports of EMDR's sensational effectiveness have appeared in the media. On July 29, 1994, ABC's "20/20" news-magazine show aired a segment on EMDR. Host Hugh Downs introduced EMDR as "an exciting breakthrough . . . a way for people to free themselves from destructive memories, and it seems to work even in cases where years of conventional therapy have failed." Downs stated, "No one understands exactly why this method succeeds, only that it does." The program featured an excerpt from an interview with Stephen Silver, a psychologist who averred, "It (EMDR) leads immediately to a decrease in nightmares, intrusive memories, and flashbask phenomena. It is one of most powerful tools I've encountered for treating post-traumatic stress" (ABC News 1994).

Although based largely on unsytematic and anecdotal observations, such glowing testimonials merit careful consideration. Are the widespread claims for EMDR's efficacy substantiated by research?
I do not know if any therapy technique can claim to cue, treat or eliminate the symptoms of trauma and their effects on a person's life so quickly. I would say that about therapy, meds, anything. Imagine if treatment for PTSD and other things could be treated with this- therapists would be out of business, many more souls would have been saved from the endless suffering due to trauma. I think it would have received all sorts of support, research, citations that would encourage it as at the very least a second line treatment. And one can not argue that the media is to blame for it not receiving exposure. ABC 20/20 did a piece on EMDR and I forget which other network did a piece but there have been others.
Quote:
Many uncontrolled case reports appear to attest to the efficacy of EMDR (e.g., Forbes, Creamer, and Rycroft 1994; Lipke and Botkin 1992; Marquis 1991; Oswalt, Anderson, Hagstron, and Berkowitz 1993; Pellicer 1993; Puk 1991; Spates and Burnett, 1995; Wolpe and Abrams, 1991). All of these case reports utilize a "pre-post design" in which clients are treated with EMDR and subsequently reassessed for indications of improvement. These case reports, although seemingly supportive of EMDR, are for several reasons seriously flawed as persuasive evidence for its effectiveness.

First, case reports, probably even more than large controlled investigations, are susceptible to the "file drawer problem" (Rosenthal 1979) - the selective tendency for negative findings to remain unpublished. It is impossible to determine the extent to which the published cases of EMDR treatment, which are almost all successful, are representative of all cases treated with this procedure.

Second, in virtually all of the published case reports, EMDR was combined with other interventions, such as relaxation training and real life exposure (Acierno, Hersen, Van Hasselt, Trement, and Meuser 1994). As a result, one cannot determine whether the apparent improvement reported in such cases is attributable to EMDR, the ancilary treatments, or both.

Third, and most important, these case reports cannot provide information regarding cause-and-effect relations because they lack a control group of individuals who did not receive EMDR. The ostensible improvement resulting from EMDR in these reports may be due to numerous variables other than EMDR itself (Gastright 1995), such as placebo effects (improvement resulting from the expectation of improvement), spontaneous remission (natural improvement occurring in the absence of treatment), spontaneous remission (natural improvement occurring in the absence of treatment), and regression to the mean (the statistical tendency of extreme scores at an initial testing to become less extreme upon retesting). Consumers of uncontrolled case reports thus must be chary of falling prey to the logical fallacy of post hoc, ergo propter hoc (after this, therefore because of this): Only in adequately controlled studies can improvement following EMDR treatment be unequivocably attributed to the treatment itself.

A control group is essential in any research done on one technique for anything over another technique.
Even if you were doing scientific research on which is was better, a pencil or a pen- you need a control group. In order to test a theory to have science generally support something like this it needs to be able to be independently replicated and verfied by other scientists and researchers. Having researched cited in publications by other scientists helps because this means that whatever technique or theory you promote has also been used and accepted by other unaffiliated professionals and been successful.

Controlled studies are essential and EMDR seems to be lacking in research using proper controls:
Quote:
Despite abundant claims for EMDR's efficacy, few controlled outcome studies on EMDR have been conducted. They are of two major types: (1) between-subject designs, in which subjects are randomly assigned to either a treatment or a control group; and (2) within-subject designs, in which subjects serve as their own control.
Quote:
In the first controlled investigation of EMDR, Shapiro (1989a) randomly assigned 22 individuals who had experienced a traumatic event to either an EMDR treatment group or an exposure control group. In the latter condition, subjects were provided with imaginal exposure to the trauma, but without the eye movements involved in EMDR. Shapiro reported that after only one session, EMDR subjects exhibited significantly higher Validity of Cognition ratings than subjects in the control group. The control group subjects showed essentially no improvement on either measure.

Superficially, these findings seem to provide impressive support for the effectiveness of EMDR. Even a casual inspection of the study's methodology, however, reveals serious deficiencies in experimental design (Acierno et al. 1994; Herbert and Mueser 1992). First, Shapiro herself conducted both treatments and elicited the SUDs and Validity of Cognition ratings from subjects in both groups. Because Shapiro knew the subjects' treatment condition, her findings are potentially attributable to the well-documented experimenter expectancy effect (Rosenthal 1967)—the tendency for researchers to unintentionally bias the results of their investigations in accord with their hypotheses. Specifically, Shapiro might have unwittingly delivered treatment more effectively or convincingly to the EMDR group, or subtly influenced subjects in this group to report greater improvement. Second, the cessation of traumatic imagery was contingent on low SUDs ratings in the EMDR group, but not in the imaginal exposure group (Lohr, Kleinknecht, Conly, Cerro, Schmidt, and Sonntag 1992). It is therefore possible that subjects in the EMDR group reported low SUDs ratings in order to terminate this aversive imagery. Moreover, the total amount of exposure in the two groups may have differed (Lohr et al. 1992). These methodological shortcomings render the results of Shapiro's study (Shapiro 1989a) virtually uninterpretable.
I found this tidbit:
Quote:
Since this initial report, a number of investigators have attempted to replicate Shapiro's methodology of comparing EMDR with an imaginal exposure control condition for clients with PTSD or other anxiety disorders. Several of these researchers used a "dismantling" design in which EMDR was compared with an otherwise identical procedure minus the eye movements; in this design certain components of the treatment that are purported to be effective (in this case, eye movements) are removed from the full treatment package to determine if their omission decreases therapeutic effectiveness. In virtually all of these investigations, EMDR was not consistently more effective than the exposure control condition.
In one study (Boudewyns et al 1993), EMDR was found to be more effective than the control condition, but only when within-session SUDs ratings were used. Interestingly, SUDs ratings obtained outside of sessions in response to audiotaped depictions of clients' traumatic experiences indicated no differences between conditions. Moreover, physiological reactions (e.g. heart rate increases) to these depictions showed no improvement in either condition.
Quote:
Only one published study has directly compared EMDR with a no-treatment control group. Jensen (1994) randomly assigned Vietnam veterans with PTSD to either an EMDR group or a control group that was promised delayed treatment. EMDR produced lower within-session SUDs ratings compared with the control condition, but did not differ from the control session in its effect on PTSD symptoms. ***In fact, the level of interviewer-rated PTSD symptoms increased in the EMDR group following treatment***.
I find the bolded part in particular concerning.
You should feel increased symptoms in a treatment that is hailed to be effective quickly.
Quote:
EMDR has not been clearly shown to be beneficial for the condition for which it was originally developed, namely PTSD, its extension as a treatment for schizophrenia, eating disorders, and other conditions is even more premature and ethically problematic.Furthermore, both scientific and logical considerations dictate that the developers of a treatment should specify the boundary conditions under which this technique is and is not effective. Because EMDR purportedly facilitates the processing of traumatic memories, one would not expect it to be useful for conditions (e.g. schizophrenia) in which severe emotional trauma has not been found to play a major causal role.
Considering in a sense, EMDR is similar to exposure therapy at least in theory I have a serious issue with it being promoted to treat mental illness- as if mental illness can be cured or is all in someone's head or as a result of a bad childhood or scary memories. I think it does a disservice to desperate people with ED's or mental illnesses that are scientifically and organically diagnosible, and when clear medical treatments exist- I would be concerned at a non-medical professional promoting EMDR as an alternative to a doctor supervised medical intervention along with therapy.

There are many who say it saved them and I am glad for that. I am glad for anyone who is able to work through anything. If no harm is done I say no big deal. But I can see that harm could be done with EMDR.
Specifically I worry about financial harm. I do not know if insurance companies cover this but I doubt it. I do not know the going rate per EMDR session or how many sessions one would need but it is certainly a loose framework for an untrained, unethical, or savy clinician. Even if its 50$ a session- 5 sessions run you 250$ and I am willing to bet that is no chump change to the vast majority of this vunerable population. And the easy way you could sway someone to continue with just about anything you say.
Dr. Sarahsweets: "Minimum 5 sessions are needed but in some cases you may need as many as 15 sessions"
Patient: "Doctor this is my 10th session and I feel worse"
Dr Sarahsweets: " Lets get to the 15th session and see how it is then"

I want to clarify that a therapist could easily do the same thing to be fair. But evidence supporting therapy (CBT, DBT etc) seems to be that its overwhelmingly more effective then EMDR. Although the debate about ethical therapists and whether you get your money's worth- or whether financial gain should be tied to people's wellbeing
can be had forever.
(I was in therapy as a kid and it was a disaster. In early adulthood it worked- then I outgrew it and i was definitely being lead on to reap the financial reward despite the therapist being a nice guy.)
But this isnt about whether therapy is good or bad. Its about whether EMDR is a proven treatment, effective treatment and all the other junk I shared around it.

Something else to consider: When I was reading about how one gets trained to perform EMDR its like shrouded in secrecy- kind of scientologiest-like.
Quote:
Although further research on EMDR is warranted, such research will likely be impeded by the prohibitions laced on the open distribution of EMDR training materials (Acierno et al. 1994). For example, participants in EMDR workshops must agree not to audiotape any portion of the workshop, train others in the technique without formal approval, or disseminate EMDR training information to colleagues (Rosen 1993). It seems difficult to quarrel with Herbert and Meuser's (1992, p. 173) contention that although "this procedure is justified to maintain 'quality contro,' such a restriction of information runs counter to the principle of open and free exchange of ideas among scientists and professionals."
I also read that in today's world you have to sign legal paperwork similar to an NDA when you take the training for certification.

these are just things I have been thinking about lately and I do not mean to offend anyone. If something makes you well then I support you. I swear that a specific type of magnesium is like a sleeping pill for me even though there is zero evidence to support that. It works for me. I have treated severe bronchitis with hot mustard packs applied to the chest. I believe that what we feel works can be powerful even if there are not nerdy scientists around to tell us if there is evidence to support it or not.

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Thanks for this!
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Default Oct 03, 2019 at 02:19 AM
  #2
I’m happy for people that it’s helped.

I don’t believe it would be helpful for me at all, my T dies not use this in his practice as he’s seen over his career of almost 50 years he finds it causes more confusion and problems. There are many ways to deal with trauma.

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