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Thread: EMDR Therapy

  1. #21
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    Quote Originally Posted by drpattijane View Post
    Beware wikipedia!
    Ad hominem.


    Quote Originally Posted by drpattijane View Post
    All the info is not correct, and I know for certain that the info on EMDR is not completely reliable.
    Obvious / confirmation bias. Weak "not necessarily" argument.

    Quote Originally Posted by drpattijane View Post
    As for the scientific method, EMDR is a psychotherapy which has been empirically validated in over 24 randomized studies of trauma victims.
    Meta-analyses, which have already been cited, have far more statistical power than individual studies, which tend to be deeply flawed.

    Quote Originally Posted by drpattijane View Post
    It is considered one of the three treatments of choice for trauma
    Failure to acknowledge previous arguments, which is tantamount to confirmation bias. We know it's a chosen treatment, and we know it works. However, the extent to which it works does not appear to go beyond the extent to which a subset of it is exposure therapy.


    Quote Originally Posted by drpattijane View Post
    (along with CBT and PE) by organizations such as ISTSS (International Society for Traumatic Stress Studies), American Psychiatric Association, American Psychological Association, Department of Veteran Affairs, Department of Defense, Departments of Health in Northern Ireland, UK, Israel, the Netherlands, France, and other countries and organizations.
    See Foa, E.B., Keane, T.M., Friedman, M.J., & Cohen, J.A. (2009). Effective treatments for PTSD: Practice Guidelines of the International Society for Traumatic Stress Studies New York: Guilford Press. EMDR was listed as an effective and empirically supported treatment for PTSD, and was given an AHCPR “A” rating for adult PTSD.
    Argument from authority.


    Quote Originally Posted by drpattijane View Post
    And as noted in the American Psychiatric Association Practice Guidelines (2004, p.18), in EMDR “traumatic material need not be verbalized; instead, patients are directed to think about their traumatic experiences without having to discuss them.” Given the reluctance of many combat veterans to divulge the details of their experience, as well as other trauma survivors, this factor is relevant to willingness to initiate treatment, retention and therapeutic gains.
    Edge case. Further you attempt to cite studies for other arguments but fail to cite studies for this one and don't even acknowledge the lack of citation. Confirmation bias.

    Quote Originally Posted by drpattijane View Post
    As for the eye movements, a number of International Practice Guideline committees have reported that the clinical component analyses reviewed by Davidson & Parker (2001) are not well designed (International Society for Traumatic Stress Studies/ISTSS; DoD/DVA). Davidson & Parker note that there is a trend toward significance for eye movements when the studies conducted with clinical populations are examined separately. Unfortunately even these studies are flawed. As noted in the ISTSS guidelines (Chemtob et al., 2000), since these clinical populations received insufficient treatment doses to obtain substantial main effects, they are inappropriate for component analyses. However, as noted in the DoD/DVA guidelines, the eye movements used in EMDR have been separately evaluated by numerous memory researchers. These studies have found a direct effect on emotional arousal, imagery vividness, attentional flexibility, and memory association.
    Grasping for straws / confirmation bias.

  2. #22
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    Quote Originally Posted by fia View Post
    Thank you for all this information! I'm pretty new to the concept, but I am working with a therapist that I am comfortable with and trust.

    It feels like this is the first time I'm able to get at some of this information in a manner that matches the type of issue that it is. It's helpful to not feel like I have to draw out any repressed memories, but can just describe a lucid dream-state. I get a lot of clear images and metaphors during the process. My positive image that came to me was a little girl and teddy bear which I now use as a screen saver.
    Fia, working with a therapist with whom you're comfortable and trust is essential! So you're already a "step ahead" in your process. I'm a psychologist who uses EMDR as my primary treatment psychotherapy 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 (certified by the EMDR International Assoc. and trained by the EMDR Inst) I have used EMDR successfully with panic disorders, childhood sexual/physical/emotional abuse and neglect, single incident trauma and complex/chronic PTSD, anxiety, depression, grief, body image, phobias, distressing memories, bad dreams and more...

    I wanted to say more on this blog about the actual experience of EMDR. So Fia, you probably already know most or all of what I'm writing. It's really crucial that the therapist spends enough time in one of the initial phases (Phase 2) in EMDR that involves preparing for memory processing or desensitization (memory processing or desensitization - phases 3-6 - is often referred to as "EMDR" which is actually an 8-phase psychotherapy). In this phase resources are "front-loaded" so that you have a "floor" or "container" to help with processing the really hard stuff. 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. 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 (like the image of yourself as a little girl with a teddy bear). So if you start feeling overwhelmed or that it's too intense, you can ground yourself (with your therapist's help in session, and on your own between sessions) and feel safe enough to continue the work. In my practice, after the Phase 2 work lets us know that my patient is safe enough and able to cope with any emotion and/or physical sensation both during and between EMDR processing sessions, I often suggest we try a much less intense memory first if there is one that happened BEFORE the trauma(s). If there isn't one, then I suggest we start developmentally with the least disturbing memory and work our way "up" to the most disturbing event(s).

    Grounding exercises are indispensable in everyday life, and really essential in stressful times. Anyone 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). Anyway, the book is terrific. It's 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 teaches readers lots of helpful techniques that can be used immediately and that are also used during EMDR therapy to calm disturbing thoughts and feelings.

    One of the key assets of EMDR is that YOU, the client, are in control NOW, even though you likely were not during past events. 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 hand/knee tapping - all forms of bilateral stimulation that should be decided by the client for the client's comfort) 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 or so passes of the lights to ask you to take a deep breath and to say just a bit of what you’re noticing. 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 having a therapist who is experienced in the EMDR techniques helps make it the gentlest and safest way to neutralize bad life experiences and build resources.

    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.

    In addition to my therapy practice, I roam the web looking for EMDR discussions, try to answer questions about it posted by clients/patients, and respond to the critics out there. It's not a cure-all therapy. However, it really is an extraordinary psychotherapy and its results last. In the hands of a really experienced EMDR therapist, it's the most gentle way of working through disturbing experiences.

  3. #23
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    Quote Originally Posted by drpattijane View Post
    and respond to the critics out there.
    I've seen what that entails (above). Not particularly encouraging.

  4. #24
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    @mingularity, I still don't quite get why you are so passionate against EMDR. I don't think the meta-studies are a definitive dismissal for a couple of reasons. Firstly it says that EMDR is a source of help, but suggests that immersion therapy and cognitive behavioral therapy are moreso, that EMDR is helpful to the extent it mimics these others therapies. It is not saying that it is definitively ineffective. It says that it mimics effective forms of therapy, so a most negative interpretation would be that it is less effective, but has still measured as having a level of effectiveness.

    My husband doesn't post here anymore, but he is an extremely high level complexity scientist, and so I asked him a bit about this question. (I realize that is some appeal to authority, but without equal knowledge and experience, it is unlikely to understand a subject on the same level, so authority means something in a rational context). He does meta-studies and explained to me the difficulties of getting accurate and meaningful results from meta-studies because each study uses a different metric and attempts to prove somewhat different results. To equalize those metrics and results is no small challenge and even studies published in high level journals are not always demonstrating an accurate result.

    Finding a trusted client-therapist relationship is not easy. That is actually the most important step in the process (assuming that the therapist is at least proficient). If your trusted therapist is expert in cognitive-behavioral, then it makes sense to use that approach. If their expertise is in EMDR, then it makes sense to use that approach.

    I don't think you effectively dismissed drpattijane's presentation of EMDR. You have not demonstrated an expertise in these different approaches, which is why your passionate dismissal seems a bit confusing to read.

    I find the meta-studies on therapies for trauma to be especially problematic just because I know for a fact that different sorts of trauma require different approaches. I can see that there could be a completely reasoned argument that EMDR is not most effective for some type of trauma, but I am not seeing evidence that it is ineffective for all types of trauma. The more I read, the more I see it is a perfect match for my particular sort of trauma because it is especially intangible and yet effects me every moment of every day. The therapist isn't really doing anything "to me". The alternating hemisphere sensation does help to open up an altered state, but it is one I am in control of, and it is all just me gaining information about my mind. I have worked with five therapists over the years and this is the first time I feel like I'm actually getting access to information and a felt-sense of what underlies my generalized anxiety disorder and chronic pain.

    In each session I get tons of images, probably because I'm rather imaginative as an artist. At the end of the session, my therapist reads over all the notes she has taken and I record that. Then when I come home I look for comparable images online, print them off, and make a scrap book. It is like a process of dream images, and some are metaphors like in a dream, some are accompanied by strong feelings, and there are moments of heightened concrete details that could plausibly be actual memories, but in this context I don't feel responsible to establish memories, so I just leave the images in a subjective interpretation. This is exactly what deeply repressed trauma needs to do. It is intangible, indistinct, subjective, and so the process and interpretation needs to match the nature of the issue. There is no immersion therapy that can emulate someone sexually and physically harming a toddler. You can't recreate that scenario, and I can't even talk about it because it is only surrounded by facts that strongly insinuate this, evidence of psychological harm in me, but a complete inability within myself to concretely connect all of this.

    I've used intense will power my entire life and it isn't enough. I have more will power than most people probably, but the nature of my trauma increases pain, fatigue, and creates decision fatigue. The nature of the problem breaks down the will to fight it, so it needs additional support. It cannot be fixed with mental force. At least in my case I can swear that is an accurate evaluation.
    Step into my metaphysical room of mirrors.
    Fear of reality creates myopic morality
    So I guess it means there is trouble until the robins come
    (from Blue Velvet)

  5. #25
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    Quote Originally Posted by fia View Post
    @mingularity, I still don't quite get why you are so passionate against EMDR.
    It consists of pseudoscientific components sitting on top of established science. It's pointless and a bad precedent and suggests that those practicing it don't understand why it actually works (since they can't differentiate the science from the pseudoscience).

    Quote Originally Posted by fia View Post
    I don't think the meta-studies are a definitive dismissal for a couple of reasons. Firstly it says that EMDR is a source of help, but suggests that immersion therapy and cognitive behavioral therapy are moreso, that EMDR is helpful to the extent it mimics these others therapies. It is not saying that it is definitively ineffective. It says that it mimics effective forms of therapy, so a most negative interpretation would be that it is less effective, but has still measured as having a level of effectiveness.
    I acknowledged that it works a couple of times above.

    Quote Originally Posted by fia View Post
    each study uses a different metric and attempts to prove somewhat different results. To equalize those metrics and results is no small challenge and even studies published in high level journals are not always demonstrating an accurate result.
    Nevertheless, meta-analyses have high power and they often serve the role of debunking established thought.

    Quote Originally Posted by fia View Post
    Finding a trusted client-therapist relationship is not easy. That is actually the most important step in the process (assuming that the therapist is at least proficient). If your trusted therapist is expert in cognitive-behavioral, then it makes sense to use that approach. If their expertise is in EMDR, then it makes sense to use that approach.
    I personally can't trust someone who can't tell what parts of the therapy they are using are based on science and which aren't, and (the reason I'm here) I wouldn't recommend such a therapist either!

    Quote Originally Posted by fia View Post
    You have not demonstrated an expertise in these different approaches
    I have expertise in the scientific method

    Quote Originally Posted by fia View Post
    I know for a fact that different sorts of trauma require different approaches.
    This is definitely true, but it's a Catch-22. If you don't understand the underlying principles well enough to run a study that demonstrates the relationship is real, how can you reliably assign a treatment to a patient

    Quote Originally Posted by fia View Post
    I can see that there could be a completely reasoned argument that EMDR is not most effective for some type of trauma, but I am not seeing evidence that it is ineffective for all types of trauma.
    We know it's at least somewhat effective.

    Quote Originally Posted by fia View Post
    The more I read, the more I see it is a perfect match for my particular sort of trauma because it is especially intangible and yet effects me every moment of every day. The therapist isn't really doing anything "to me". The alternating hemisphere sensation does help to open up an altered state, but it is one I am in control of, and it is all just me gaining information about my mind. I have worked with five therapists over the years and this is the first time I feel like I'm actually getting access to information and a felt-sense of what underlies my generalized anxiety disorder and chronic pain.
    How do you know it's not the placebo effect? It's fine if it is and if that's what you want. Someone in the process should be aware of it, however. If your EMDR therapist is aware that it's "science + placebo" I'm fine with that. However, if they think it's "science + science" when they don't even understand that the EMDR component is placebo, I don't like that!

    Quote Originally Posted by fia View Post
    I've used intense will power my entire life and it isn't enough.
    I am only expressing healthy skepticism and encouraging that someone in the loop knows as much about what's going on as science has to offer. Other than that.. I see nothing wrong with it, and I hope it helps you.

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