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[onion]

Wise Forumites,

I'm engaged in an ongoing dispute with a friend about the merits and effectiveness of EMDR (Eye Movement Desensitization and Reprocessing Therapy).  One school of thought holds that it is dangerous to take patients/people back into trauma in order to train their brains to "reprocess" and, in effect, re-route neural pathways.  Another school of thought claims that EMDR works, and that neural pathways can be retrained and the PTSD that arises from trauma (of various kinds) can be minimized or done away with altogether from this technique, and that it is superior to the traditional model of talk therapy + meds.

So I'm curious if any of you have done academic research on EMDR, know about it from personal experiences, have an opinion on the "science" (or science) of it, etc.

Thanks.

[crowie]

http://www.scientificamerican.com/article.cfm?id=emdr-taking-a-closer-look

This article suggests that what is effective about EMDR is its use of 'exposure' (ie. instructing the patient to focus on the traumatic memory) which is an already existing therapy from CBT and other strategies, and that the 'eye movement' part is the red herring.

I don't have any personal experiences with EMDR.

[bread_pirate_naan]

IMO, from an inexpert but experiential position, I'd suggest that simply getting the mind to do something 'neutral' while attending to something stressful defangs it.  I find other similar methods have many more bodymind benefits.

You can reroute neural pathways without going into specific memories.  There is a arguably a placebo or 'narrative' effect for the person who gets the opportunity to believe that they have conquered the past, when in effect they have simply used the past as an object of concentration while they discipline the mind with another object.  It will change the experience of all manner of stressors.

I personally think the experience is more important that whether or not the anxious mental contents that form around the experience are objectified as memory.  It is striking that the emphasis is on the visual, because vision is the least somatic of senses.  Most of the response to stress is also observable through other senses that are less obvious or 'gross'.  Your question reminds me of all the hokum that people pass off as healing, but is merely breathwork with a bunch of 'rituals' or 'science' surrounding it.

Most methods may be superior to talk therapy, because talk requires a listener, not self management or a 'cure'.  Most people in talk therapy don't really ever get out of it.  They just distribute the talk.  DBT is probably the reconciliation of the talk/CBT models, an alternative.

From Crowie's link

EMDR proponents have invoked a dizzying array of explanations for the apparent effectiveness of the lateral eye movements: distraction, relaxation, synchronization of the brain’s two hemispheres, and simulation of the eye movements of rapid eye movement (REM) sleep have all emerged as candidates.

This is kind of ridiculous.  It's (very) simple concentration(which can attend the relaxation response).  Other labs/cultures have already covered this.  It just isn't novel if you don't dress it up right.  Which is a problem if you are in research. 

See also, yogini Onion, drishti. 
See also, scholar Onion, Mauss, Techniques du corps.

[t_r_b]

A friend of mine who is recovering from some major (and long repressed) childhood trauma-related issues reports lots of success with the eye-movement therapy. I must say I was a bit skeptical when she told me about it, but I'm glad it works for her.

[higherandhigher]

I think it can be a useful technique, but it isn't a panacea, nor will it work for everyone. It certainly doesn't obviate the need to have a good mental health clinician. In other words, I don't think using the technique turns a bad therapist into a miracle worker. It may be a good additional tool to have in the toolbox for clinicians who are already good at what they do.

[onion]

I think it can be a useful technique, but it isn't a panacea, nor will it work for everyone. It certainly doesn't obviate the need to have a good mental health clinician. In other words, I don't think using the technique turns a bad therapist into a miracle worker. It may be a good additional tool to have in the toolbox for clinicians who are already good at what they do.

This is interesting.  Can you elaborate a bit?  Do you mean that it can complement talk therapy, or that EMDR can pull up things that then need to be dealt with by the clinician and client together?  Would you suggest that the therapist and the person doing EMDR be the same, or can they be two different people?

[higherandhigher]

This is interesting.  Can you elaborate a bit?  Do you mean that it can complement talk therapy, or that EMDR can pull up things that then need to be dealt with by the clinician and client together?  Would you suggest that the therapist and the person doing EMDR be the same, or can they be two different people?

DISCLAIMER: This is not medical advice, and I am not a mental health or other medical professional.

I think EMDR can indeed complement talk therapy. I know several psychologists who use EMDR with some of their patients--but they don't only use EMDR. They use EMDR for part of the course of treatment--when clinically indicated and the patient is willing.

I think it's helpful if the EMDR clinician is the same as the clinician doing the whole treatment as they are more familiar with the whole process/progress.

[bread_pirate_naan]

I think it can be a useful technique, but it isn't a panacea, nor will it work for everyone. It certainly doesn't obviate the need to have a good mental health clinician. In other words, I don't think using the technique turns a bad therapist into a miracle worker. It may be a good additional tool to have in the toolbox for clinicians who are already good at what they do.

This is interesting.  Can you elaborate a bit?  Do you mean that it can complement talk therapy, or that EMDR can pull up things that then need to be dealt with by the clinician and client together?  Would you suggest that the therapist and the person doing EMDR be the same, or can they be two different people?

Complementary, collaborative, or consultative treatment among mental health professionals is a standard practice.  If the treatment is regulated, a qualified professional is required.  Beyond license, very few elements are regulated beyond meds. Acquiring multiple modalities is a part of the business, as well as the practice.  If I were choosing a modality I would look into the number of CEUs and whether or not the practitioner did and supervised practice or was required to go through the method themselves as a part of the training. 

One thing to note is the method of becoming qualified to offer a certain sort of treatment.  I work (as a client) with someone who uses techniques that are only available to licensed professionals with three levels of lengthy preparation.  EMDR is available to aspiring practitioners through a homestudy course after a three day seminar.  Neither of these things tell you anything about the comparative efficacy of the treatments, but the variability of the entire mental health field.  Many are restricted to clinicians.

There are similarities with regard to the difference between board certification and weekend seminars in aesthetic medicine, or other booming markets.  The booming market in services and promising new modalities is matched by the boom in continuing education for health professionals.  Both are profitable.  I spent double the time training in a different complementary method as it takes to become qualified in the non-homestudy version of EMDR. 

One of the strongest supports for EMDR is the existence of double blind studies, at least from the perspective of the scientific method.  You should play around in the EMDR bibliography on Shapiro's website.  It's basically an integrative technique that overlaps with all sorts of stuff I find interesting.  That method, not so appealing to me, but definitely showing up on some interesting complementary menus, including non-verbal and expressive modes.

[outlier]

I do have personal experience with EMDR as a patient/client, and I have found it to be very effective. The "eye movement" in the acronym is now somewhat misleading. The method can involve eye movement, but it can also use audio signals, tactile pulses or tapping of hands or feet. I saw what was posted about the eye movements not being important, and while for me it was tactile, that alternating stimulation was important. I don't know if it was important in reprocessing or just in desensitization or if the two are intextricably linked. You know how meditation can involve focusing on something--a sight, mantra, etc? I now tend to think of the EMDR stimulation as dealing with trauma (or anxiety) while in something of a meditative state.

EMDR is integrated into talk therapy using a protocol. EMDR sessions follow a pattern of introduction, talk/EMDR, and conclusion. The stimulation, whether eye movement, audio, or tactile, is only for about 30 seconds at a time. There's no hypnosis or turning over of will or consciousness to another's control. It does take a proficient therapist, a trusting relationship and a willing client. It also takes time, at least a month or two to become aware of whether it's working for the client. Eventually, I think I became somewhat conditioned to calm down when the pulses began, but the effects certainly lasted beyond the sessions and helped ease the way for insights and changes in mind/body responses to situations that were stressors. I don't think it's for everyone, but I was certainly a skeptic and it still worked for me.

[voxprincipalis]

Under the right conditions, it can be absolutely transformative. I've posted on it here many times (we've had several threads), so a quick stroll through the search function will probably turn up all sorts of things.

VP