Someone mentioned it to me last night and I am intrigued. That said, the skeptic in me is hesitant.
The therapy for me would be more for anger over things from my childhood rather than ptsd or physical abuse.
I have no direct knowledge or experience. But when something is listed in wiki’s list of pseudosciences I tend to let the skeptic in me do my decision making.
I very much tend to agree with you but I believe that there have been a few credible studies lately.
EMDR has a large empirical research base and is considered to be an empirically validated treatment. It doesn’t work for everyone, but I’ve seen pretty impressive results when actual EMDR-certified practitioners conduct the treatment.
https://www.google.com/search?q=emdr%20site%3Anih.gov&rlz=1C1VDKB_enUS993US993&oq=nih&aqs=chrome.0.0i355i433i512j46i199i433i465i512j0i433i512j0i131i433i512j0i433i512l2j0i131i433i512j0i433i512l2j0i131i433i512.6615j0j7&sourceid=chrome&ie=UTF-8&ved=2ahUKEwi06ammsfr7AhUeMDQIHUwqCfoQ2wF6BAguEAE&ei=rWyaY_TeHp7g0PEPzNSk0A8
Wikipedia is not an authoritative source on anything, especially since anybody can edit an entry regardless of their actual knowledge or background. EMDR is considered a valid treatment methodology for PTSD by the US Department of Veterans Affairs and various professional psychiatric and psychotherapy bodies, and while the reason why it works is not really well understood at a fundamental cognitive or affective level there are numerous peer-reviewed studies that show comparable or better efficacy compared to treatment with cognitive behavioral therapies and other talk therapies, and frankly more consistent effectiveness than psychopharmacological treatment which is often only marginally effective and even detrimental for people with PTSD.
Patients have to be adequately prepared and processed for EMDR, so it isn’t something a typical psychotherapist can (or should attempt to) do, and while there are some ‘tapping’ exercises you can do on your own that supposedly help reinforce EMDR treatment they are not a replacement. If incorrectly managed, EMDR can actually intensify trauma, and some patients find that they have unexplained emotional impulses after a session (usually after a few sessions into the treatment regime) that need to be fully processed out, so this should really only be done by someone who has been trained in the appropriate methodology.
The general theory behind EMDR—such as it is—is that it exposes traumatic memory networks by manipulation of the visual cortex while deliberately recalling some part of the memory, allowing the brain to fully process the memory in total and release aspects of the trauma that are suppressed. Because of this, it specifically addresses intense psychological trauma, and while there are types of ‘incremental’ traumas covered by Complex-PTSD, it is not a cure-all for general emotional distress, nor is it going to result in behavior changes to patterns developed during an unhappy or generally emotionally turbulent childhood for which CBT and other talk therapies which involve introspection about emotional response and regulation are more applicable. It is specifically about exposing suppressed traumatic responses.
For the o.p., if you have “anger over things from my childhood” that are comprehensible and reasonable, EMDR is probably not going to be all that effective because the issue isn’t unprocessed memories but behavioral response patterns that are deeply entrenched and need to be rectified through behavioral modification, reframing, et cetera. If you find yourself lashing out with unexplained anger and emotional dysregulation that feels uncontrolled or grossly out of proportion with the circumstance, then that might be an indication of deeper traumas that would be amenable to EMDR and other PTSD-specific treatment methods.
Stranger
Thanks for the post, especially this part which tells me that it’s not for me.
I remember @Spice_Weasel talked about EMDR before, and her husband is, IIRC, a psychologist. So I thought I’d ping her to see if she has anything to say.
My brief review of this subject (I am not a shrinkologist) suggests that while EMDR appears to have some support in the treatment of PTSD, it is less well validated for the myriad of other conditions* for which it has been touted. Skepticism extends well beyond the bounds of Wikipedia (their article on EMDR is actually mildly positive).
A Scientific American article by a couple of psychology professors had the following conclusion[/url]:
“So, now to the bottom line: EMDR ameliorates symptoms of traumatic anxiety better than doing nothing and probably better than talking to a supportive listener. Yet not a shred of good evidence exists that EMDR is superior to exposure-based treatments that behavior and cognitive-behavior therapists have been administering routinely for decades. Paraphrasing British writer and critic Samuel Johnson, Harvard University psychologist Richard McNally nicely summed up the case for EMDR: “What is effective in EMDR is not new, and what is new is not effective.””
Quackwatch also has a long discussion on this topic by a psychiatrist.
Recent articles in the scientific literature on EMDR continue to be sprinkled with phrases like “deficient methodology” and “more rigorous studies are needed”. You’d think that after several decades the matter would be substantially settled, but no.
*EMDR has been promoted for a slew of mental health problems and distantly related (or unrelated) disorders, including pain relief, difficulty sleeping and stress in cancer patients. It thus risks running afoul of Jackmannii’s Law which states that the more conditions a therapy or drug are claimed to alleviate (especially if there’s no established mechanism), the less likely it is to be truly effective for any of them.
This sounds like pseudoscience to me. The whole idea that traumatic memory is suppressed at all sounds like pseudoscience to me. There isn’t one prevailing theory for EMDR’s effectiveness. For example, one is that EMDR simply uses working memory as a distraction to fully integrate trauma in the background. This has been somewhat borne out by research studies that found treating trauma survivors with working memory tasks - word games, etc. - reduced their likelihood of developing PTSD. Distracting people seems to impact how they process memory.
My understanding is that there are a lot of theories about trauma that aren’t really grounded in evidence. In fact, I would submit that PTSD and treatments around PTSD are more subject to “woo” than most mental health diagnoses. Despite EMDR being basically pulled out of its founder’s ass with no solid theoretical underpinning, it now has shown in several randomized controlled trials to be an effective treatment for PTSD for… reasons. Nobody knows why. The fact that nobody knows why it works is one reason I was deeply skeptical of it and didn’t try it for a long time.
I have had PTSD for over twenty years. I have tried what feels like every treatment under the sun, and I’ve had decent results with everything. I have done EMDR three times - this last session being the longest, and most unusual. The first was about three months to deal with my guilt and grief over ending my relationship with my mother. I found it scary effective. I don’t know if it’s because of some unique way my brain is that makes me particularly amenable to this treatment, or if this is how it is for most people, but I found myself coming up with insight after insight and then just believing in the healthier outlook. Instantly. The best way I can describe it is that you’re looking at your child self (or traumatized adult self, whatever) and examining it from the perspective of your wiser adult self and then from that moment onward you forever view that past experience through your wise adult lens.
The second time I tried it for abuse and I quit after a couple of weeks because I had a bad therapist.
The third and present time I am again trying it for abuse but the process has been very different. This therapist has spent an enormous amount of time “resourcing” which involves building me up psychologically before we go into the hard work of rapid eye-movement/memory integration. In practice that means teaching me how to identify my strengths and ability to handle difficult situations. Going from a sense of incompetence to one of self-efficacy and agency. Even though I was skeptical of taking this pause, I found it tremendously effective. I am practically a different person than I was a year ago – I am more emotionally resilient, less prone to panic, more willing to try difficult things, and less freaked out about the future. But we have had a number of disruptions such that, over the course of the last year, the only chance I got to do the rapid eye movement was when my therapist was on maternity leave and someone else took over. I did find it effective but we didn’t have much time, then I got bounced back to my current therapist and we can’t get started again until the tripledemic passes.
I don’t know what the evidence currently shows about dealing with anger over things from one’s childhood, but I have found it helped me for things that weren’t, strictly speaking, trauma, such as my complex feelings about my mother, however it’s worth noting my mother was a source of a lot of my actual trauma. When I started EMDR I had zero expectations and was told that it was better for one-off traumas (a rape, a car accident, etc) than complex trauma like childhood abuse. Nonetheless I have found it remarkably effective.
So I guess my thoughts are, if you have tried everything else with no luck, it can’t hurt to give it a shot.
Well, when you get down to it, essentially all of psychology (and most of psychiatry) is rank pseudoscience with very little real evidence and pervasive problem with replication. The various “schools of thought” and approaches to therapy appear to have little distinction in efficacy vice the skill and empathy of a particular therapist, and pretty much every psychological model for cognition is either demonstrably wrong or so abstract that there is no way to actually falsify it experimentally. Essentially everything Sigmund Freud ever wrote or said is utter nonsense and he arguably did more damage than good to the majority of his patients and their families.
But, as you note, EMDR does have good evidence of reproducible success in dealing with traumatic mental illness. It is not a cure-all for all conditions, and does not work on everyone dealing with trauma (whether that is because of variation in patients or in the skill of practitioners is unknown because while there are certain standards of training not all people performing the technique are correctly trained or follow the guidelines). And while you are correct that the reason EMDR works is not well understood, it does appear to be through integrating and processing traumatic memories. It isn’t that the memories are suppressed (and in fact the process requires first getting to and talking through known traumas) but that aspects of the memory are not integrated or being recalled as a gestalt.
A lot of supposed “personality disorders” appear to be largely rooted in trauma, as potentially are some amount of diagnosed hypomania, substance abuse, and anxiety, but without specific trauma to address the EMDR methodology doesn’t really work (or at least, not directly), and while it can alleviate disorders it is not a cognitive reframing or behavioral modification technique that people need to change issues relating to outlook or ‘conscious’ behavior. The primary application for EMDR is to address compulsive and unwanted emotional responses.
Stranger
I completed prolonged exposure therapy for PTSD at Edna Foa’s Center for the Treatment and Study of Anxiety. The absolute gold standard intervention. I found it tremendously effective for symptoms of PTSD related to direct physical harm, i.e., that time my Mom almost shot me, that time my Mom almost ran me over with her car, etc. Certain symptoms I had for decades, such as hypervigilance in public, fear of public shootings, fear of elevators, fear of home invasion, it was all reduced to about 10% of its former severity after just three months of treatment. That reduction in symptoms has persisted for twelve years. Truly astonishing results.
But prolonged exposure did little to help me with the complex feelings I have toward my mother or toward my other abusers. Maybe it could have, given more time. I have a long history of stopping therapy just when we’re getting to the harder stuff. But whenever people express the belief that EMDR is somehow prolonged exposure with a yellow hat, I have to push back. Experientially, they are nothing alike. EMDR has a very mild exposure component in that you have to tolerate some low-grade discomfort, whereas prolonged exposure is about the least comfortable intervention imaginable. The purpose of prolonged exposure is to provoke the strongest distress response possible, over and over, for (at least when I did it) two hours a day. It is really, really hard. EMDR on the other hand doesn’t seem to be effective at those levels of distress, and is not hard. It also feels to me like an altered state of consciousness, so I would compare it to something like hypnosis or meditation more readily than prolonged exposure. I really can’t blame people for trying the less-well-established but effective-enough thing that requires less of them emotionally over something as grueling as prolonged exposure.
I also think it’s just easier to train people for EMDR as opposed to prolonged exposure. Prolonged exposure is not a very accessible treatment. I was very fortunate to get the treatment I did and I paid through the nose for it. So if we can have something that works “well enough” that is accessible, as opposed to something that works tremendously well that is nearly impossible to find/afford, EDMR is not a bad option.
Sr. Weasel’s specialization is in the treatment of OCD and anxiety related tic disorders, so his input is somewhat limited here. As a behavioral psychologist who is a real stickler about evidence, he was an EMDR skeptic for a long time until he heard a presentation at his then-practice that convinced him it was worth a second look. We discussed it, including the potential it could de-stabilize me, and ultimately decided to give it a shot. And I’m glad we did, because it has made a lasting difference in my life.
I agree with this, but not entirely with the rest of what you said. Clinical psychology is a very broad term that incorporates a range of therapeutic approaches, some of which are complete horseshit, some of which have some evidentiary basis and some of which are very effective. But the same could be said of medicine in general - studies have shown that medical doctors also do not follow the latest research and do not tend to recommend evidence-based interventions. Unfortunately, what works for most people most of the time will not work for some people some of the time. This is true of all medicine.
As far as the therapeutic relationship goes, as I understand it most studies on this subject find that clients often perceive themselves as getting better when they like their therapist, even though the severity and frequency of their symptoms remains unchanged. So I guess it depends on whether you think someone believing they are better means they are actually better.
One thing that pisses some therapists off about evidence-based interventions is because it implies that the individual providing the therapy is interchangeable. To some extent that appears to be true. For example, one study found that giving clients a workbook using evidence-based principles was just as effective as a therapist.
I can dig up some of these cites later, I apologize, I have the flu and am trying to push through a work project. This thread has been tremendously helpful in my procrastination efforts.
That many physicians do not follow research-based “best” practice guidelines (and there’s a lot of variability in reporting just how prevalent this is) is complicated by a variety of factors, including disagreement about how well-founded those guidelines may be. It’s certainly an area in which there should be considerable improvement (i.e. less “art” based on personal experiences, and more science).
Regardless, employing a particular therapy in situations for which its effectiveness has not been established cannot be justified by saying “well, that happens all the time in medicine”.*
*there’s a name for that fallacy.
Mrs. SMV, a Licensed Clinical Social Worker and therapist who’s not especially woo-ish, was sufficiently impressed with EMDR’s efficacy to look into getting trained on the procedure.
Maybe, maybe not. But Freud is about as significant to modern psychotherapy as Ptolemy is to modern astronomy; a key figure in the science’s history, but one whose work has long since been superceded.
I would never make that claim. What I said was psychology as a practice does not seem particularly different from any other field of medicine in terms of the variability of practitioner competence, thus should not be dismissed as pseudoscience. I feel like people have unrealistic expectations for psychological interventions that they don’t apply to other aspects of medicine. For example, “This heart surgery only has a 20% chance of prolonging your life” often does not lead to people declaring the entire field of cardiology as pseudoscience.
As far as trying out a therapy for your particular issue to see if it sticks, that is what happens when people are desperate. And if someone has tried a bunch of other evidence-based treatment modalities with no efficacy, I really don’t see the harm in trying something that might work. In the last twenty years, just from memory, I’ve done CBT, psychodynamic therapy, psychodrama in group therapy, group DBT therapy, cognitive therapy for PTSD, Acceptance and Commitment Therapy, prolonged exposure for fear of heights, prolonged exposure for PTSD, and EMDR. That’s not even getting into the dozens of medications or transcranial magnetic stimulation, which was $10,000 out of pocket and failed. Some of those things were evidence-based and really helpful, and some of those things were not, but no one approach was able to completely resolve the myriad of issues around my complex trauma. So when the opportunity for EMDR came around, it has some randomized controlled trials demonstrating efficacy, we thought, why the hell not?
Most of the clinical critiques of EMDR that I have seen indicate that they don’t actually understand how it works in practice. I understand why there is so much skepticism, because its theoretical underpinning is so nebulous and I haven’t seen a real push to test any of these theories outside of the working memory studies. But EMDR is not just some variation on existing exposure therapy. I know that because I’ve done both. Maybe clinicians are confused because there is a part of the protocol that involves some subjective measure of distress. For example, “On a scale of one to seven, how much do you believe this distressing thought?” That subjective perception is used to determine when that blocking belief has been successfully processed. If you go in thinking I am powerless and you come out the other end not really identifying with that belief anymore, it’s considered a success. But that is not exposure therapy and it’s not cognitive therapy either (I’ve done that too.) The treatment protocols, the nature of the intervention, how the intervention is experienced, they are all completely different.
The most you could argue is that they both achieve the same outcome - an alteration in cognition around distressing traumatic events.
I’m not denying that EMDR isn’t fucking weird - it’s fucking weird. My experience of it has been some kind of stream-of-consciousness self-knowing spontaneous insight thing that is impossible to talk about without sounding woo. But the RCTs don’t lie, and I don’t waste my time on bullshit. I learned that lesson after six years of ineffective psychodynamic therapy. With EMDR, I went in expecting nothing and was stunned at how much it helped.
Anecdotally I know a ton of people who say they have been helped by EMDR, including my Aunt, who shares the trauma of having been subjected to my mother and is finally getting help. They have started working on her disordered eating, which is tied into trauma, and it is like watching someone cut away their own shackles. EMDR is accessible in a way that prolonged exposure therapy is not. My exposure therapy was $450/session. That’s close to $2,000/month for therapy. Can you imagine? I am grateful that many people finally have a viable alternative.
FWIW, I am also a spouse of a therapist. She is a certified EMDR provider who uses it in her practice occasionally, as part of her toolkit. She had also received EMDR as part of brief focused therapy for herself. Like @Spice_Weasel she found it highly and fairly rapidly effective for her issue of that time. That said even as a provider she would not want to put herself out there as some sort of expert. Still she has seen it as often useful for issues of anger from childhood and their connections to manifestations in current function.
She highly recommends Francine Shapiro’s “Getting Past Your Past” even though it is a bit old by now.
I don’t believe there have been any studies beyond treating people for trauma, but based on my own experience and knowing what it’s like, it seems to me to have the potential to resolve complex emotional issues of other types. I’m not claiming it does help those issues, but it wouldn’t surprise me if it did.
This is based off my own experience as the focus of my first round of EMDR was around the loss of my mother. After I ended our relationship, I was at a point where I was crying about it every day and I felt immense guilt over the decision. After about three months of EMDR I’d say my guilt decreased by about 85% and I now go long periods of time without even thinking about her. Sometimes it hurts, of course, but one thing I took out of EMDR is that the feelings of guilt were a built-in part of the trauma. That was part of how she controlled me. Another thing I took away was that just because the decision hurt, didn’t mean it was the wrong one.
And those aren’t insights that my therapist fed to me. They arose spontaneously from my mouth during EMDR. Because they came from me, I believed them immediately. They are things I might have gotten around to discovering after months or years of soul searching, but EMDR just sped up that process tremendously.
While I would call my results damned near miraculous, the result varies for many. I have always been the best case scenario for just about every evidence based intervention I have ever tried. It’s rare for someone to have issues as serious as I had respond as well as I have.
When I was in college, I had to withdraw from school because I was so depressed, I was unable to complete tasks of daily living much less attend classes. I was attending psychodynamic therapy and Sr. Weasel - then an undergraduate majoring in psychology - begged me to try something evidence-based. So I asked to try CBT.
My therapist at the time thought it was a terrible idea. “CBT isn’t for complex trauma.”
“Okay but my main problem is getting out of bed.”
She didn’t get it. But I started CBT and for the first time actually saw positive change in my life. It gave me the ability to regulate my emotions well enough to get up in the morning, get dressed, and go to work. And from there to petition the academic board and return to school. And my problems did not magically vanish, I remember having intense anxiety and depression my final year of college, but because of CBT I was able to do the work anyways. I attended and aced all my classes that year.
There is this tendency when people present with trauma, I believe, to do a lot of navel gazing and rehashing without actually processing all those intense feelings (talking about it is not the same as processing it), and also to focus on “let’s talk about what happened to you years ago” rather than address the major issues occuring in the present, which might include not working, not going to school, avoiding social contact. Those are all things that can be addressed without rehashing trauma and which can make a person more resilient when they do get to a point that they are ready to look back.
And that is a lot of what the resourcing portion of EMDR has given to me. I’ve been working with my current EMDR therapist for over a year. She does not know the details of my trauma. We’ve been focused on where the past meets the present. My crippling fear of uncertainty, for example. Or the way I sometimes feel enormous rage whenever my husband is late. It doesn’t actually matter what specific part of my past is responsible for either of those things, all I need to know is that it’s just a trauma response and I don’t have to lean too hard into those feelings. Those two issues are no longer problems because of changing how I think about them. Through resourcing we’ve basically trained my brain to feel capable of handling anything. The way I put it to my therapist, “Whenever I feel overwhelmed or destined to fail at something, I just remind myself that I’m here for me no matter what.” I’ve resourced my way into unconditional self-compassion.
So yeah, EMDR is dope.