I’ve heard (don’t have the papers to back it up at the moment) that even up/down eye movments seem to work for EMDR.
It was my understanding that bilateral stimulation (which can be done via eyes moving side to side, tapping parts of the body bilaterally, or bilateral sounds) causes increased activity in the hippocampus which helps process emotional memories. However I don’t know if that is the agreed upon theory or just another theory.
I posted a link in GQ about a paper on EMDR several years ago. The argument there was that bilateral stimulation depotentates neurons in a subunit of the amygdala which gets overwhelmed during trauma.
I also recall reading (this is kindof unrelated) that anatomical differences in the amygdala and hippocampus can make someone more prone to PTSD (I think smaller areas for these, or maybe a bigger amygdala and smaller hippocampus. I can’t recall). There was speculation that in the near future the military might be able to use MRIs to determine who was at higher risk of PTSD and as a result steer those people out of combat related jobs or do more to prevent PTSD (there is also some cool research on preventing PTSD via cortisol, ghrelin, beta blockers and other compounds like that. Apparently there is about a 6 hour window after a trauma where the brain hasn’t locked the trauma in yet and PTSD can be averted).
I found this, showing a slight increase in hippocampal volume due to EMDR. But I believe I’ve read elsewhere that it is more inconclusive.
It is a golden age of science.
Right. For example that “one neurologist” is a shit-ass skeptic.
He declares, in his friggin’ lede, that EMDR is selling “non-specific effects” based on … that it “sounds pseudoscientific” to him. Skepticism is not basing belief exclusively on how well the proposed mechanism fits your understanding, especially for something like PTSD whose basic brain mechanisms are still very poorly understood by anyone.
Here’s the part that annoys because precisely because of the lack of understanding of what evidence based medicine means:
No doofus. We don’t need to know why something works to say it works, we need to know it does, and then maybe figure out why.
The comparison to cognitive behavioral therapy (CBT) misses the point that EMDR is not CBT + rapidly alternating stimulation. CBT is a different protocol, one that is also of evidence based efficacy but one that also involves more time and in particular for the subjects to do homework outside of session time EMDR OTOH generally shows response within 3 to 7 sessions and does not include “homework”. EMDR is CBT minus a bunch of sessions and subject homework time and with a rapidly alternating stimulus protocol. If it works because it is the same as CBT then we have to ask why CBT has the extra work and time involved.
Neither is shown to be better or worse and indeed maybe one will work better for one subgroup or the other.
The evidence is it works. The evidence is that it works more efficiently (at least for PTSD where it has been most well studied) than does CBT. Efficient is not necessarily better.
I hope you get some of your personal experience posts op.
Before I add my 2 cents about EMDR therapy, let me clarify the research behind it a bit, and the respect it has gained worldwide:
Many organizations, professional associations, departments of health of many countries, the US Dept. of Defense, and the VA, all have given their “stamp of approval” to EMDR therapy. There are 35 randomized controlled (and 20 nonrandomized) studies that have been conducted on EMDR therapy in the treatment of trauma. And more excellent research now on the role of eye movements, mechanism of action, and other RCS, not only on trauma and PTSD, but also on the use of EMDR therapy with generalized anxiety disorder, treatment of distressful experiences that fail to meet the criteria for PTSD, dental phobia, depression, body dysmorphic disorder, chronic phantom limb pain, panic disorder with agoraphobia, obsessive-compulsive disorder, and peer verbal abuse.
The World Health Organization has published Guidelines for the management of conditions that are specifically related to stress: Trauma-focused CBT and EMDR are the only psychotherapies recommended for children, adolescents and adults with PTSD. “Like CBT with a trauma focus, EMDR aims to reduce subjective distress and strengthen adaptive cognitions related to the traumatic event. Unlike CBT with a trauma focus, EMDR does not involve (a) detailed descriptions of the event, (b) direct challenging of beliefs, (c) extended exposure, or (d) homework." (Geneva, WHO, 2013, p.1)
I use EMDR therapy as my primary psychotherapy treatment and I’ve also personally had EMDR therapy for anxiety, panic, grief, and “small t” trauma. As a client, EMDR worked extremely well and also really fast. As an EMDR therapist, and in my role as a facilitator who trains other therapists in EMDR therapy (certified by the EMDR International Association and trained by the EMDR Institute, both of which I strongly recommend in an EMDR therapist) I have used EMDR therapy successfully with panic disorders, PTSD, anxiety, depression, grief, body image, phobias, distressing memories, bad dreams, and many other problems. It’s a very gentle method with no significant “down-side” so that in the hands of a professional EMDR therapist, there should be no freak-outs or worsening of day-to-day functioning.
One of the initial phases (Phase 2) in EMDR therapy involves preparing for memory processing or desensitization (memory processing or desensitization - phases 3-6 - is often what is referred to as “EMDR” which is actually an 8-phase method of psychotherapy). In this phase resources are “front-loaded” so that you have a “floor” or “container” to help with processing the really hard stuff, as well as creating strategies if you’re triggered in everyday life. In Phase 2 you learn a lot of great coping strategies and self-soothing techniques which you can use during EMDR processing or anytime you feel the need.
In phase 2 you learn how to access a “Safe or Calm Place” which you can use at ANY TIME during EMDR processing (or on your own) if it feels scary, or too emotional, too intense. One of the key assets of EMDR therapy is that YOU, the client, are in control NOW, even though you weren’t in the past, during traumatic events and/or panic/anxiety. You NEVER need re-live an experience or go into great detail, ever! You NEVER need to go through the entire memory. YOU can decide to keep the lights (or the alternating sounds and/or tactile pulsars, or the waving hand, or any method of bilateral stimulation that feels okay to you) going, or stop them, whichever helps titrate – measure and adjust the balance or “dose“ of the processing. During EMDR processing there are regular “breaks” and you can control when and how many but the therapist should be stopping the bilateral stimulation every 25-50 passes of the lights to ask you to take a deep breath and say just a bit of what you’re noticing, anything different, any changes. (The stimulation should not be kept on continuously, because there are specific procedures that need to be followed to process the memory). The breaks help keep a “foot in the present” while you’re processing the past. Again, and I can’t say this enough, YOU ARE IN CHARGE so YOU can make the process tolerable. And your therapist should be experienced in the EMDR therapy techniques that help make it the gentlest and safest way to detoxify bad life experiences and build resources.
Grounding exercises are essential. You can use some of the techniques in Dr. Shapiro’s new book “Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR.” Dr. Shapiro is the founder/creator of EMDR but all the proceeds from the book go to two charities: the EMDR Humanitarian Assistance Program and the EMDR Research Foundation). The book is an easy read, helps you understand what’s “pushing” your feelings and behavior, helps you connect the dots from past experiences to current life. Also gives lots of really helpful ways that are usedduring EMDR therapy to calm disturbing thoughts and feelings.
Pacing and dosing are critically important. So if you ever feel that EMDR processing is too intense then it might be time to go back over all the resources that should be used both IN session and BETWEEN sessions. Your therapist can use a variety of techniques to make painful processing less painful, like suggesting you turn the scene in your mind to black and white, lower the volume, or, erect a bullet-proof glass wall between you and the painful scene, or, imagine the abuser speaking in a Donald Duck voice… and so forth. There are a lot of these kinds of “interventions” that ease the processing. They are called “cognitive interweaves” that your therapist can use, and that also can help bring your adult self’s perspective into the work (or even an imaginary Adult Perspective). Such interweaves are based around issues of Safety, Responsibility, and Choice. So therapist questions like “are you safe now?” or "who was responsible? and “do you have more choices now?” are all very helpful in moving the processing along.
You might want to take a look at a description of EMDR therapy: http://www.emdrnetwo…escription.html
Yeah. And pseudoskeptics are invariably extremely bright people, who generally are NOT actual scientists. Actual scientists know the history of science enough to realize that seemingly stupid ideas often change the world.
Dr. Novella is a supporter of science-based medicine, which is distinct from evidence-based medicine. It has a higher standard, which is exactly what you point out.
Dr. Novella’s point in comparing them is that if they both have about the same success, then the possibility remains that only those things they hold in common are effective: neither the extra CBT sessions and homework, nor the rapidly alternating stimulus may be doing anything.
I haven’t looked at any of the studies, and am probably unqualified to do so. But Dr. Novella seems to have looked, and says that this point (that the specifics of the treatment may not be what is doing good) hasn’t been looked at seriously. Your criticism of the Science-Based Medicine article misses the doctor’s point.
See, the thing is, armchair analysis is no basis for decision-making in an area where we know so little, like brain science. Science-based medicine is just another term for pseudoskepticism.
I’m not woo at all.
I had a therapist use this with me.
It helped. A lot.
I still do it to myself quite often.
My gut tells me it’s just another type of meditation, and that’s not bad. Meditation is wonderful and has really helped me a lot.
Everyone’s mileage will vary.
What he calls “science-based” medicine is not a higher standard, it is a narrower standard and one which would have scoffed at many of the breakthroughs in medical science. It is also a very narrow (and somewhat ignorant) view of what science is.
Point the first. Many breakthroughs in medicine have not fit then available models. They instead have been careful observations and not too infrequently serendipitous discoveries - confirmed on the basis of evidence - and later the mechanisms of action discovered. Great story - how phototherapy for neonatal jaundice was developed. Observant intern noted a pattern that when he deliver the blood samples to the lab by walking outside on nice days the levels seemed to be lower than and days the weather was lousy and he took the tunnels. Did controlled trials exposing divided samples to sunlight or not and testing the level of bilirubin and determined that sunlight resulted in lower levels and from their clinical application was developed. There was no plausible mechanism to suggest at that time. By Novella’s standard it was therefore not science based medicine and should have been treated with great skepticism.
And of course sometimes the science explanations ended up just being woo. In med school theophylline, then a standard of care for asthma management, had its efficacy explained by way of a phophodiesterase inhibitor cascade. Thing is actually had nothing to do with how it worked in asthma. The actual mechanisms of impact were were then unappreciated central nervous system effects and effects on the muscles of the diaphragm.
But the evidence that it worked, and what its risks were, were still just as real even though the initial explanation was wrong.
Point the second. Science does NOT work so neatly in the real world. Especially in medicine. Some progress is made by building from established paradigms and adding one more dab to an established painting of how things work. Slavish loyalty to working models however, like Novella proposes is “science based”, blinds one from the observation that forces one to modify the current model. A true science based approach is that the evidence is what rules and determines whether of not the current hypothesis is supported, or if it needs modification or wholesale revision. The hypothesis does not determine what evidence is accepted. THAT, Novella’s preferred approach, is anti-science, not science based at all. (Note, no argument that an extraordinary claim requires extraordinary evidence; a separate issue.)
If Novella is proposing a hypothesis that the protocols of EMDR (again not usually otherwise the same as CBT protocols) would work just as well without any rapidly alternating stimulation element that is reasonable. It is a hypothesis and is testable. Meanwhile for clinical applicability we do not know that such is true and we do know that EMDR and CBT both work. Until such a hypothesis is tested the protocols that have been tested and shown to be effiicacious should be used.
Had my first session yesterday afternoon, and I’m still processing much of it.
It started with gathering a baseline of my feelings and anxiety levels. On a scale between one and 10, and also where in the body I was feeling these things.
No lights, just two handheld buzzers that alternated left and right as I went over my memories in my head. Starting with the most traumatic memories and seeing where my mind took me.
Each session took about 60-90 seconds, with me reporting what and how I was feeling at the end of each one. I have to say it was pretty amazing. My anxiety and sadness levels fell considerably during the session, and the place in my body where I was carrying the stress also moved from chest to shoulders.
After about an hour, we did some simple meditative exercises and I went home. I was exhausted. I went right to bed and slept from about 630 last night to 6 this morning.
I had incredibly vivid dreams. Not about the accident or the aftermath, but mainly running and fighting dreams.
I will be going back next week, and probably once or twice again after that. I’m going home in April on the anniversary of the accident to scatter my dads ashes, and that was the main impetus for this treatment.
Overall, I’m very happy and astonished at the tangible, physical results from this therapy.
Thank you, drpattijane, for your very helpful information, and OP I wish you continued success in this.
I’m glad to hear that. Good luck continuing with it.