Author Topic: EMDR  (Read 634 times)

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Offline fuzzyMarmot

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EMDR
« on: January 19, 2018, 03:54:52 AM »
EMDR (Eye Movement Desensitization and Reprocessing) is conditionally recommended by the American Psychological Association for PTSD treatment (http://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing.aspx). It seems live a very popular methodology among therapists and psychologists. Has the SGU talked about EMDR before? Is it a legit therapy or pseudoscience?

Offline daniel1948

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Re: EMDR
« Reply #1 on: January 19, 2018, 08:16:16 AM »
Your post is the first I've heard of it. But I've never studied psychology, so there are certain to be hundreds or thousands of therapies I've never heard of. Just to say that I cannot remember the SGU ever touching on the subject, FWIW.
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Offline Tassie Dave

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Re: EMDR
« Reply #2 on: January 19, 2018, 08:04:08 PM »
It was brought up in an interview that Steve did with Scott Lilienfield (a clinical psychologist and a professor at Emory University, and the editor-in-chief of the Scientific Review of Mental Health Practice)

It was Show 103 from July 2007
https://www.theskepticsguide.org/podcast/sgu/103
Discussion of EMDR starts at 57 Mins 40 Secs.
Scott Lilienfield seems dismissive of it.

Steve has also written about it on the Science Based Medicine blog.
https://sciencebasedmedicine.org/emdr-and-acupuncture-selling-non-specific-effects/

Steve's summary:

Quote
EMDR, like acupuncture, is likely nothing more than a ritual that elicits non-specific therapeutic effects.  While there are some who may consider this a justification for both modalities, there is significant risk to this approach. First, the non-specific effects are often used to justify alleged specific mechanisms of action which are likely not true. This sends scientific thought and research off on a wild-goose chase, looking for effects that do not exist. Science is a cumulative process built on consilience – scientific knowledge must all hang together. These false leads are a wrench in the mechanics of science.

Second, the false specificity of these treatments is a massive clinical distraction. Time and effort are wasted clinically in studying, perfecting, and using these methods, rather than focusing on the components of the interaction that actually work.

And in the end these magical elements do not add efficacy. For example, as the review above indicates, EMDR is no more effective than standard cognitive-behavioral therapy.

Rather than getting distracted by alluring rituals and elaborate pseudoscientific explanations for how they work, we should focus on maximizing the non-specific elements of the therapeutic interaction, and adding that to physiological or psychological interventions that have specific efficacy.

Offline fuzzyMarmot

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Re: EMDR
« Reply #3 on: January 19, 2018, 09:30:35 PM »
Awesome! Thank you so much. I thought this might be the case. The mechanisms seem totally implausible. I appreciate you pointing me to the places Steve has addressed it. Unfortunately, this therapy seems to have really infiltrated mainstream medicine. A lot of addiction and mental health treatment centers seem to feature it is a core component of their programs. Apparently you can become a certified EMDR therapist.

Thanks again for the links!

Offline CarbShark

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Re: EMDR
« Reply #4 on: September 09, 2018, 12:34:56 AM »
Apparently this is a thing. I’m wondering if Steve may want to update.


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Offline bachfiend

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Re: EMDR
« Reply #5 on: September 09, 2018, 03:26:20 PM »
Apparently this is a thing. I’m wondering if Steve may want to update.


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Is there anything to update?  There was a Cochrane review published on January 24, 2017 which found limited low quality evidence that EMDR provided a little benefit and caused little harm in treating PTSD, compared to doing nothing.  Arthroscopy for treating knee pain is also a ‘thing.’  Insurers pay for it to be done.  Orthopaedic surgeons earn a lot of money from it.  It also shows little benefit.

Offline CarbShark

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Re: EMDR
« Reply #6 on: September 09, 2018, 07:57:30 PM »
Arthroscopy for treating knee pain is also a ‘thing.’  Insurers pay for it to be done.  Orthopaedic surgeons earn a lot of money from it.  It also shows little benefit.

First, this is flat out nonsense. Arthoscopy is a surgical technique that's used for a number of conditions for the knee. It's sophisticated, more effective than more invasive treatments, and results in better success rates and shorter recovery times.

It's one of the "miracles" of modern medicine. (Miracle not suggesting that it's magic, but suggesting the scale of its effectiveness).

Back on topic:

Quote
Is there anything to update?  There was a Cochrane review published on January 24, 2017 which found limited low quality evidence that EMDR provided a little benefit and caused little harm in treating PTSD, compared to doing nothing. 

Well, no, that's not the case. That review was of PTSD among patients who also suffered from Severe Mental Illness, and even then they report they don't have enough data to draw any conclusions. (And, no, they did not find it caused any harm)
Psychological interventions for post-traumatic stress disorder (PTSD) in people with severe mental illness | Cochrane

They did a reviews in 2013 and 2016, that did find it effective (although the quality of evidence was not high). And (prepare for another evidence drop) there are actually numerous studies and reviews that have shown its effectiveness for some  conditions, especially PTSD.

Maybe a few years ago it would have been justified to lump it in the same category as acupuncture, as Steve did, but now, with new evidence and high quality studies, I think that's a misleading characterization and I'd like to see Steve revisit the topic.

Psychological therapies for preventing post-traumatic stress disorder in children and adolescents | Cochrane


Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults | Cochrane
Quote
Key findings: There is continued support for the efficacy of individual TFCBT, EMDR, non-TFCBT and group TFCBT in the treatment of chronic PTSD in adults. Other non-trauma-focused psychological therapies did not reduce PTSD symptoms as significantly. There was evidence that individual TFCBT, EMDR and non-TFCBT are equally effective immediately post-treatment in the treatment of PTSD. There was some evidence that TFCBT and EMDR are superior to non-TFCBT between one to four months following treatment, and also that individual TFCBT, EMDR and non-TFCBT are more effective than other therapies.

The Role of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in Medicine: Addressing the Psychological and Physical Symptoms Stemming from Adverse Life Experiences

EMDR beyond PTSD: A Systematic Literature Review

25 years of Eye Movement Desensitization and Reprocessing (EMDR): The EMDR therapy protocol, hypotheses of its mechanism of action and a systematic... - PubMed - NCBI

Eye movement desensitization and reprocessing (EMDR) therapy in the treatment of depression: a matched pairs study in an inpatient setting

EMDR as Add-On Treatment for Psychiatric and Traumatic Symptoms in Patients with Substance Use Disorder

Effectiveness of Eye Movement Desensitization and Reprocessing in German Armed Forces Soldiers With Post-Traumatic Stress Disorder Under Routine In... - PubMed - NCBI
« Last Edit: September 09, 2018, 08:09:27 PM by CarbShark »
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Offline CarbShark

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Re: EMDR
« Reply #7 on: September 09, 2018, 08:04:06 PM »
Quote
Maybe a few years ago it would have been justified to lump it in the same category as acupuncture, as Steve did, but now, with new evidence and high quality studies, I think that's a misleading characterization and I'd like to see Steve revisit the topic.


And to be clear I'm not criticizing Steve for what he wrote in 2011 10+years ago, I'm saying there's more data and it may be time for him to revisit.

As the OP suggested, since Steve first looked at this it has slowly gotten mainstream acceptance.

(I'm going to email these links to Steve with these comments)
« Last Edit: September 09, 2018, 08:12:07 PM by CarbShark »
and Donald Trump is President of the United States.

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Offline bachfiend

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Re: EMDR
« Reply #8 on: September 10, 2018, 12:04:09 AM »
Quote
Maybe a few years ago it would have been justified to lump it in the same category as acupuncture, as Steve did, but now, with new evidence and high quality studies, I think that's a misleading characterization and I'd like to see Steve revisit the topic.


And to be clear I'm not criticizing Steve for what he wrote in 2011 10+years ago, I'm saying there's more data and it may be time for him to revisit.

As the OP suggested, since Steve first looked at this it has slowly gotten mainstream acceptance.

(I'm going to email these links to Steve with these comments)

I’ll be interested in seeing Steven’s response, if he thinks it’s worth responding to.  I’m not particularly impressed with your links.  ‘Mainstream acceptance’ doesn’t mean much, particularly when it’s psychological therapy using nebulous subjective measures of improvement.  Eliminating the placebo effect and the benefit of ‘doing something instead of doing nothing’ can’t be eliminated.

Offline CarbShark

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Re: EMDR
« Reply #9 on: September 10, 2018, 10:25:21 AM »
Quote
Maybe a few years ago it would have been justified to lump it in the same category as acupuncture, as Steve did, but now, with new evidence and high quality studies, I think that's a misleading characterization and I'd like to see Steve revisit the topic.


And to be clear I'm not criticizing Steve for what he wrote in 2011 10+years ago, I'm saying there's more data and it may be time for him to revisit.

As the OP suggested, since Steve first looked at this it has slowly gotten mainstream acceptance.

(I'm going to email these links to Steve with these comments)

I’ll be interested in seeing Steven’s response, if he thinks it’s worth responding to.  I’m not particularly impressed with your links.  ‘Mainstream acceptance’ doesn’t mean much, particularly when it’s psychological therapy using nebulous subjective measures of improvement.  Eliminating the placebo effect and the benefit of ‘doing something instead of doing nothing’ can’t be eliminated.
You didn’t even read the abstracts. Most of the studies did exactly that. Some compared the effectiveness to no treatment others compared different treatments.

I don’t think Steve has the disdain for RCTS that you do.


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Offline bachfiend

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Re: EMDR
« Reply #10 on: September 10, 2018, 03:38:02 PM »
Quote
Maybe a few years ago it would have been justified to lump it in the same category as acupuncture, as Steve did, but now, with new evidence and high quality studies, I think that's a misleading characterization and I'd like to see Steve revisit the topic.


And to be clear I'm not criticizing Steve for what he wrote in 2011 10+years ago, I'm saying there's more data and it may be time for him to revisit.

As the OP suggested, since Steve first looked at this it has slowly gotten mainstream acceptance.

(I'm going to email these links to Steve with these comments)

I’ll be interested in seeing Steven’s response, if he thinks it’s worth responding to.  I’m not particularly impressed with your links.  ‘Mainstream acceptance’ doesn’t mean much, particularly when it’s psychological therapy using nebulous subjective measures of improvement.  Eliminating the placebo effect and the benefit of ‘doing something instead of doing nothing’ can’t be eliminated.
You didn’t even read the abstracts. Most of the studies did exactly that. Some compared the effectiveness to no treatment others compared different treatments.

I don’t think Steve has the disdain for RCTS that you do.


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I did read the abstracts.  You can’t eliminate the placebo effect when you’re comparing doing some sort of psychological manipulation or doing nothing.  The patient knows what’s happening.  At least with acupuncture, there’s at least the possibility of ‘sham’ acupuncture.  And improvement is purely subjective.  Objective measures of improvement are extremely difficult to obtain. 

At least with your ketogenic diet, you could at least come up with objective measures of health benefits with life expectancy and death rates, if the studies are ever performed.

Offline CarbShark

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Re: EMDR
« Reply #11 on: September 10, 2018, 04:20:03 PM »


I did read the abstracts.  You can’t eliminate the placebo effect when you’re comparing doing some sort of psychological manipulation or doing nothing.

Some studies compared the intervention with literally doing nothing (waiting list) others compared the intervention with other interventions. Not every study needs a placebo. Comparisons between interventions are also valid.

Quote
The patient knows what’s happening.  At least with acupuncture, there’s at least the possibility of ‘sham’ acupuncture.  And improvement is purely subjective.  Objective measures of improvement are extremely difficult to obtain. 

Subjective results does not invalidate the results. Particularly when they are found consistent across a wide number of subjects.

Quote
At least with your ketogenic diet, you could at least come up with objective measures of health benefits with life expectancy and death rates, if the studies are ever performed.

Watch your crossover. If you want to discuss ketogenic diet do that in one of the appropriate threads. (Where I would explain that there are numerous relevant measurable outcomes beyond those).
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Offline arthwollipot

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Re: EMDR
« Reply #12 on: September 10, 2018, 06:29:24 PM »
Oh boy. It's the bachfiend and CarbShark show again. This'll be exciting.
Self-described nerd

Offline CarbShark

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Re: EMDR
« Reply #13 on: September 10, 2018, 08:37:53 PM »
Oh boy. It's the bachfiend and CarbShark show again. This'll be exciting.

If you have any comments on topic they'd be welcome
and Donald Trump is President of the United States.

I'm not a doctor, I'm just a guy who has done a ton of research into diet and nutrition.

Offline bachfiend

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Re: EMDR
« Reply #14 on: September 10, 2018, 08:42:00 PM »


I did read the abstracts.  You can’t eliminate the placebo effect when you’re comparing doing some sort of psychological manipulation or doing nothing.

Some studies compared the intervention with literally doing nothing (waiting list) others compared the intervention with other interventions. Not every study needs a placebo. Comparisons between interventions are also valid.

Quote
The patient knows what’s happening.  At least with acupuncture, there’s at least the possibility of ‘sham’ acupuncture.  And improvement is purely subjective.  Objective measures of improvement are extremely difficult to obtain. 

Subjective results does not invalidate the results. Particularly when they are found consistent across a wide number of subjects.

Quote
At least with your ketogenic diet, you could at least come up with objective measures of health benefits with life expectancy and death rates, if the studies are ever performed.

Watch your crossover. If you want to discuss ketogenic diet do that in one of the appropriate threads. (Where I would explain that there are numerous relevant measurable outcomes beyond those).

An active treatment has a placebo effect as well as its therapeutic effect, if any.  If you manage to demonstrate that there’s a subjective benefit between doing EMDR and doing nothing, then you still haven’t demonstrated that the difference wasn’t due to the placebo effect.  Which is the reason why you’d need some ‘sham’ EMDR as well as the ‘real’ EMDR.

And you do need objective measures of successful therapy.  You wouldn’t assess a new anti-hypertensive therapy, such as intensive meditation, based on how the person ‘feels’ without considering what’s happening to the person’s blood pressure.  What would be objective measures of the success of EMDR?

 

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