Talk:Eye movement desensitization and reprocessing/Archive 4

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This is a research review

I looked at this article, as a friend uses this technique, and it doesn't really seem to be a Wikipedia article. I appreciate the contributions that have been made, obviously by people who know a lot about the subject, but I'd draw your attention to the sources guidelines.

Wikipedia, which is intended for the general public, discourages the use of primary sources (e.g. original writings and scientific papers) in favour of secondary sources which are third-party references or reviews of the primary sources. Encyclopedias are tertiary sources which can be used sparingly - but there is the danger of circular references, so citing another Wiki article as a source is also discouraged.

It's unclear whether some of these sources are reviews or collections of original contributions so I'm reluctant to start cutting them out wholesale but the article does need substantial revision. Is the "Vocabulary" section needed? Presumably most of these terms are not used in a different sense than they are elsewhere in psychotherapy or psychology and how they are used elsewhere in Wikipedia.

A neutral point of view is also important, including criticisms of particular ideas where necessary, but that seems to have been at least partially resolved. Chris55 (talk) 11:34, 13 February 2011 (UTC)

Yes, this article needs a rewrite around WP:MEDRS as discussed extensively in the recently archived discussions.

I think it would be appropriate to remove all content that is sourced only by primary sources or sources that fail MEDRS where it clearly applies. --Ronz (talk) 17:09, 13 February 2011 (UTC)

ok, I've made an attempt at this, using SandyGeorgia's suggestions, by removing primary sources and material which depended entirely on that and also a number of repeated citations. I'm sure this will be controversial and I hope people will accept that this is done in good faith and use it as a starting point for future constructive changes. Chris55 (talk) 14:16, 14 February 2011 (UTC)

Thanks for giving it a try. I'm trying to figure out all that you did and why. In the future, please consider using muliple, small edits with detailed edit summaries so others can follow your train of thought. --Ronz (talk) 17:47, 14 February 2011 (UTC)

That's my normal practice, Ronz, but in this case I took SandyGeorgia's advice to do it in a sandpit as I started yesterday afternoon. If you list the old version alongside you should be able to see the differences. The only structural changes were in the Approach section. I leave any changes to the warning flags to you or someone else. Chris55 (talk) 19:49, 14 February 2011 (UTC)

Good work. I think the edit is a definite improvement, it's just hard to determine what you did from the diff. Pointing to your scratchpad version User:Chris55/EMDR_redraft helps, but you didn't use edit summaries there either. --Ronz (talk) 19:57, 14 February 2011 (UTC)

Other distraction modes

It seems that Drs. Taylor, Prochaska, and even Shapiro recognized that the more coherent attributed mechanism in EMDR is that the bilateral neuromotor distraction from the concious effort with the object experiences was to "enable the subconcious to process the experiences" in new or more effective ways. Allowing better integration of those experiences, and an improved sense of control, provides the patient more comfort with them, in a propitious cycle.
The usual title EMDR emphasizes only one of the distraction & integration modes. Qualified therapists commonly use recorded sounds, self-tapping, or other body movements which divide the concious attention, to make it easier to recruit the subconcious.
Wikidity (talk) 02:31, 22 October 2011 (UTC)

Effect of eye movement on memory, cognitive processes, and physiology

This section begins with:

Although a wide range of researchers have proposed various models and theories to explain the effect of eye movement, and the possible role that eye movement may play in the process of EMDR, ...

This is just too vague! If it is so, why not summarise and cite some of the more scientific (i.e. potentially falsifiable) ones?

As it stands, the article doesn't tell me, for example, whether anybody has posited a connection between the eye movements of EMDR and the better-known psychophysiology of gaze direction during recall and invention ('lying').

It also fails to inform us whether any research has been done on other directions for the EMDR eye movements. In principle, it's not hard to outline six (more or less) different eye movement directions for comparison:

1. horizontal,
2. vertical,
3. diagonal ascending from left to right and
4. diagonal ascending from right to left,
5. diagonal descending left to right,
6. diagonal descending right to left.

(plus variations, which include a back to front or front to back component. controlled, of course, for subject laterality (as expressed, e.g. by dominant hand).

Accordingly, I'm tagging the antecedent clauses as 'vague' and hope somebody can and will cite relevant material inline. yoyo (talk) 03:47, 17 February 2012 (UTC)

Tagging spree

This article is in an abysmal state, so I have tagged the problem statements and issues as I see them. Please don't remove the tags until the issue(s) are addressed. Famousdog (talk) 11:51, 20 March 2012 (UTC)

Added non-primary and reliable references where requested on the page

Two non-primary references were requested in the opening paragraph on the page. Added was references for two well known EMDR treatment manuals (one by Adler-Tapia & Settle, the other by Greenwald) in which authors open their books by stating that EMDR was originally developed by Francine Shapiro. Also added to the opening paragraph was references [6][8][7][9][10] to the statement of EMDRs efficacy to balance the statement "EMDR therapy remains somewhat controversial due to questions about its methods and theoretical foundations" for readers of the page. — Preceding unsigned comment added by Sschubert (talk • contribs) 06:16, 6 May 2012 (UTC)

Also added is some refernces to the "in children" section as references were requested. Added a reference to the International Society of Traumatic Stress Studies (ISSTS - by Foa 2009) as this provides an up todate literature review on the use of EMDR with children. Also added reference to two well known treatment manuals for the use of EMDR with children (Adlier-Tapia & Settle, and Greenwald) as these also review the literature on EMDR with children. Also added is a review and a meta-analysis that appear in peer reviewed journals that examine and outline the most recent evidence for the use of EMDR with children. Also reerenced is the EMDR and Family Therapy Processes book - widely used by clinicians who use EMDR with children and families - however could someone take a look at how this is references as I cannot see what I have done that makes the reference not appear correctly on the page? I also had difficulty adding in the DIO links for ref#28:Rodenburg R (2009; DOI = http://dx.doi.org/10.1016/j.cpr.2009.06.008), and ref#29 Fleming J (2012; DOI = http://dx.doi.org/10.1016/j.cpr.2009.06.008). I'd be greatful if someone could assist with this also. Sschubert (talk) 08:03, 6 May 2012 (UTC)

What exactly is EMDR

I found the article never clearly stated what EMDR is (although an attempt is made buried in the article) - modified opening sentence:

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy in which the patient recalls a traumatic event while simultaneously undergoing bilateral stimulation that can consist of moving the eyes from side to side, vibrations or tapping movements on different sides of the body, or tones delivered through one ear, then the other, via headphones.

Also noted controversy. Leslie Eagle (talk) 19:41, 20 September 2012 (UTC)

I worked on the introductory description to improve accuracy and general impression, according the Shapiro's main book. I particularly added free association, which occupies much more of the client's session time and effort than directly holding traumatic material. I also used "material" rather than "memory", since the system actually involves processing not only memories of the trauma but also current triggering stimuli and anticipated traumatic situations. I also improved the description of bilateral stimulation, in both substance and style. djlewis (talk) 14:46, 31 January 2013 (UTC)

Proposal for Changes

We are undergraduate university psychology students and are working to help improve this wikipedia page for a class. We proposed to elaborate the introduction, create an operational definition for EMDR, revise the approach section, add more secondary sources to the entire article, and reiterate that there is no current research on the meta analysis of EMDR in the controversy section. Ralba007 (talk) 00:54, 11 March 2013 (UTC)

Nice to have someone new to work on this. Do take a look at past discussions and WP:MEDRS. --Ronz (talk) 01:16, 11 March 2013 (UTC)

Yes, welcome. Do, though, take time to read wp:No original research. It sounds as if your intention is at odds with policy. Also, your use of "We are ... students" suggests that you may be editing as a group rather than individuals. Sharing of accounts or editing on behalf of others is not accepted. Each account should have one human responsible for all edits with that account. LeadSongDog come howl! 04:37, 11 March 2013 (UTC)

There are four of us in the class. We will post individually.. Thank you, Lundblader (talk) —Preceding undated comment added 20:29, 26 March 2013 (UTC)

Profit Bias

This article desperately needs some attention paid to the profit-centered nature of EMDR, which has been true of the movement since its inception. EMDR is arguably closer to an enterprise than to a scientific research paradigm. Tight control over practitioners and research, with financial gains enforced at every possible step, has typified the progression of EMDR. This financial bias does not prove that EMDR does not work, but someone reading the article will lack a complete picture of the story of EMDR without understanding its for-profit nature. For those exploring PTSD therapy options, there are the various therapy approaches that have been debated scientifically over the years -- and then there is the financial enterprise of EMDR. — Preceding unsigned comment added by Bdmwiki (talk • contribs) 06:43, 2 April 2013 (UTC)

The same could be said of many modalities, but we would need wp:RS to work from. LeadSongDog come howl! 13:30, 2 April 2013 (UTC)

Yep. I'm sure it is the underlying cause of the SPA and bias problems this article has had, and the lack of good research demonstrating that the eye-movement portion is beneficial in any way. --Ronz (talk) 15:27, 2 April 2013 (UTC)

Style issue about footnotes, references and bibliography

I'm changing this articles "References" section to "Notes" in accordance with the usual Wikipedia style conventions. See Wikipedia:Manual of Style/Layout for more help. One of the usual editors may desire to create a Bibliography or References section to list Shapiro's EMDR books. See China Marine (memoir) to see one way this can be done. Trilobitealive (talk) 14:24, 30 September 2012 (UTC)

Fiupsychology (talk) 04:43, 11 April 2013 (UTC)

Three different explanations ?

From the article:

• There is no definitive explanation as to how EMDR may work. There is some empirical support for each of three different explanations regarding how an external stimulus such as eye movement could facilitate the processing of traumatic memories.

This statement is fairly useless, without listing the 3 explanations !
--195.137.93.171 (talk) 22:22, 13 January 2012 (UTC)

Agreed. I've tagged it with 'who' and 'what' templates to focus attention on its two main deficiencies: it's unsourced and unclear. yoyo (talk) 03:25, 17 February 2012 (UTC)

Is anything in psychotherapy definitively explained?

Is there any explanation why watching your breath go in and out and fondling a raisin (that is, MBSR) works for stress, anxiety and chronic pain? Seriously, the psychologists and neuroscientists are working on both MBSR and EMDR, but I assure you they are not at all close to a definitive explanation of either. In fact, some research has suggested the eye movements and attentional breathing are related!

Actually, it's even worse than that. I don't feel like digging up references right now, but many observers have noted that no psychotherapy technique or system has an adequate explanation (in scientific terms) for why it works, even those that are proven effective by high-quality scientific outcome studies. And the neuroscience of it all is still "pre-Newtonain", as at least two prominent neuroscientists have stated.

I know why people pick on EMDR. The standard account -- it's all eye movements -- makes it seem just too far out, and the initial claims -- which have proven to be true -- for really helping PTSD sounded too outrageous to be taken seriously. Also, the early studies were weak. But there's lots more to EMDR than eye movements, and they are arguably not even the "active ingredient" but more of a catalyst to make the actual active ingredient, client-centered free association primed by traumatic memory, work better and faster.

--David djlewis (talk) 00:42, 1 May 2013 (UTC)

Effectiveness is irrelevant

The effectiveness, scientific validity or criticisms of EMDR are irrelevant to whether or not Wikipedia has an article on it. People come here looking for information, i.e. facts and Wikipedia has consistently presented those facts regardless of a particular point of view. If the EMDR article was presented with a biased POV, then we can fix that. I'm disappointed because I came to Wikipedia looking for facts, i.e. the theory behind EMDR and what I found was a discussion of whether it is pseudoscience. Accupuncture has the same problem: it is entirely presented from a point of view of "effectiveness" and "validity." Neither of those things affect whether people are using accupuncture, or that it has a history outside Western Medicine. Similarly EMDR, regardless of whether it is profit-driven pseudoscientific hogwash, still is a widely-practiced psychotherapeutic technique with its own research and theory.

If Sigmund Freud's psychoanalytic theory had better research support than EMDR, that still wouldn't mean it merits an article where the latter does not. I'm pretty sure EMDR actually has more data behind it, but that doesn't matter to Wikipedia, or to people using Wikipedia.Trashbird1240 (talk) 14:21, 27 June 2013 (UTC)

The above reads like a reasonable Oppose argument at a hypothetical wp:AFD, but what is its relevance here? We do have an article. The topic is clearly notable. What the artical says, however needs to be backed up by wp:MEDRS sources. LeadSongDog come howl! 15:30, 27 June 2013 (UTC)

This article WAS effectively deleted on June 1 by redirecting it to Francine Shapiro. This was after a "consultation" at Talk:Francine Shapiro which attracted no comments until after the redirect was made. Subsequently there have been a number of dissensions so I've undone the change prior to a proper discussion. An article has now been started at EMDR which underlines the unsatisfactory nature of this discussion. This has largely been done by a user called EMDRIntnl which suggests a conflict of interest.

I have no opinion on the effectiveness or otherwise of EMDR, but it is undoubtedly significant and deserves a proper treatment. The community seems split between those who want to use it for advertising and those who want to give it the full pseudoscience treatment. We need some better discussion. Chris55 (talk) 20:35, 27 June 2013 (UTC)

I've warned EMDRIntl, and the account will likely be blocked per WP:CORPNAME

I've restored the redirect of EMDR to this article.

So let's discuss the FRINGE and NPOV/SOAP concerns. --Ronz (talk) 21:05, 27 June 2013 (UTC)

Multiple issues in this article

Is it time to remove any/all of the issues cited at the beginning of the article? There are currently 3:

1. Additional citations needed. The article seems to compare reasonably with similar WP articles. There's certainly room for improvement in some but this issue is substantially dealt with.
2. Primary sources used. The majority of these have been dealt with. Most references to the medical literature are to meta-surveys or practice guidelines, both of which are acceptable.
3. Unreliable sources. There's only one of these left and I have no means of assessing this. The reference is to a book published by a mainstream publisher (Norton). I don't know why this tag exists. Is it just supposed to flag quack medicine publications? Or is it also supposed to cover citations that are inappropriate for WP? Books by Francine Shapiro are also published by John Wiley and the American Psychological Association which should be a reasonable safeguard.

It seems to me that most of the concerns that people have raised have been dealt with and it's time to live with this article more reasonably. I propose the removal of these issues. Chris55 (talk) 10:48, 28 June 2013 (UTC)

Further to (3) above, I've checked the Amazon preview of the book marked {{Unreliable medical source}} and the 11 authors include 7 PhDs, 1 MD and 3 with CSW (social work) qualifications. A priori this doesn't seem to me to qualify for the tag. Chris55 (talk) 09:10, 29 June 2013 (UTC)

This isn't an area I know much about, but clearly there are ample sources for an article about it, independently of the article about Francine Shapiro. I'm leaning towards agreeing with User:Chris55's proposal above. Not to say the article is perfect by any means, but it seems a lot of thought has gone into improving it. Some routes for improvement:

• Anywhere where EMDR is described as "effective for" something needs a citation for a suitable secondary source, including the lede (and definitely under "Depression"), to be on the safe side since this is a medical topic.
• "She then conducted a scientific study in 1989. The success rate of that first study using trauma victims was posted in the Journal of Traumatic Stress. " This is backwards. Describe the nature of the study, the sense in which the theory was tested and put publication details in the footnote.
• "Research on the application of EMDR therapy continues," Isn't this true of every therapy that's in use? Why even have this clause?
• No justification for having separate sections for "Controversy over mechanisms and effectiveness" and "Empirical evidence and comparison". The evidence and arguments for the theory and practice of EMDR should be in one section, or at least one section for theoretical assumptions and another for effectiveness. Not one section for evidence and another for criticisms. See WP:CRITS
• "EMDR is often cited as a component in the treatment of complex post-traumatic stress disorder" - "often" sounds a bit vague. Is it justified by the two references?
• "Salkovskis (2002) reported..." on what basis? Reported empirical evidence? Or a theoretical argument?
• "some authors continue to argue that the main effective component in EMDR is exposure." - meaningful to a professional audience but not a lay audience. Must be possible to simplify the language.
• "A 2009 review of EMDR suggests further research with different populations is needed." Isn't that a scientific cliché? Are there interventions of which this isn't true? So why mention it? Did the review have any more specific conclusions?
• I think the concern about the book is that it's a book of case studies, which might be regarded as anecdotal. We need to avoid giving the impression that "EMDR works with depression" is proved by a single case study.

MartinPoulter (talk) 13:44, 29 June 2013 (UTC)

My take on this is that the article is trying to look neutral without actually being neutral -- it has the feel of being written by a proponent of the technique. It looks to me from an overview of the sources that there is no consensus that the hand-movement stuff contributes anything of value -- if anything, there is a near-consensus that all the value in the technique comes from the exposure component. Looie496 (talk) 14:40, 29 June 2013 (UTC)

There's no MEDRS source for the depression claim. Discussions of case studies are inappropriate, and it violates NPOV and OR to generalize from case studies or suggest such generalizations are valid. It demonstrates the confirmation bias we have with most FRINGE topics - proponents select the outcomes they want, then generalize from them. --Ronz (talk) 16:12, 29 June 2013 (UTC)

Thanks for the input. I don't see that anyone wants to retain the multiple issues on the overall article so I'll remove them, although the depression section needed better support. But since Ronz has already removed that section, it's irrelevant unless reinstated. MartinPoulter has made some useful suggestions that we could all use for improvements and there are some recent useful references in other articles (e.g. Power therapies) that could be used. Chris55 (talk) 16:02, 2 July 2013 (UTC)

I restored the primary sources tag. We might be able to at least partially address the NPOV and FRINGE concerns by addressing the primary sources and what is being verified with them. --Ronz (talk) 17:14, 2 July 2013 (UTC)

I find it odd that you bring up FRINGE concerns for a treatment that is accepted in the national guidelines of at least four countries: USA, UK, Australia and Netherlands, as well as the VA. Clearly there have been legitimate questions about the efficacy of eye movements, though more recent studies appear to be overturning the earlier doubts, and some understanding of the mechanisms is now emerging. But it seems to me that many of the problems with sources arise from the opposition of some editors to inclusion of properly published books by Francine Shapiro, which I don't understand. Normally books are not disallowed as primary material by WP: "primary sources that have been reliably published may be used in Wikipedia; but only with care, because it is easy to misuse them." As a consequence, various journal articles by the same author have been substituted which I would argue is worse, as they are less accessible to most people. And whereas there may be a problem in using these sources to justify the treatment, there's no reason they should not be used to explain it. Looking at the article over the last couple of years, around 17 references have been removed, a number of which are mainstream books. (If you want I can publish my own analysis.) Several legitimate researchers have been falsely accused of sock puppetry. It seems that some editors have a knee-jerk reaction to something they don't understand. Chris55 (talk) 08:50, 3 July 2013 (UTC)

The FRINGE aspect are the eye movements. The creation and promotion of EMDR also have aspects where an eye to FRINGE might help. See discussion at Wikipedia:Fringe_theories/Noticeboard/Archive_21#Eye_movement_desensitization_and_reprocessing_.28EMDR.29.

"What is effective in EMDR is not new, and what is new is not effective." --Ronz (talk) 16:17, 3 July 2013 (UTC)

That's a curious link. The reaction to your post on the Fringe Noticeboard was "This EMDR topic doesn't seem appropriate for the fringe theories notice board, whatever may be the problems with the article." to which your response was "Thanks for the perspective. I'm tending to agreeing." It doesn't seem that continuing to bang that drum is gaining much support. Chris55 (talk) 22:41, 3 July 2013 (UTC)

Sorry that the conclusions from the discussions weren't what you were expecting. Please remember that consensus is not a vote and that we focus on policies and content rather than individuals.

That said, FRINGE applies to everything in "Controversy over mechanisms and effectiveness" as well as the creation and promotion of EMDR.

So how about we start by including "What is effective in EMDR is not new, and what is new is not effective?" --Ronz (talk) 22:55, 3 July 2013 (UTC)

Ronz, you don't seem to be listening. But let that be.

I am of course aware of the controversy over the eye movement component and have felt sceptical about it myself. However, there is a more recent meta-analysis by Lee & Cujpers which does show positive benefits from the eye movements and suggests that earlier analyses were flawed. As importantly, there are many studies showing that eye movements reduce vividness of unpleasant memories, which has an obvious application in coming to terms with traumatic memories, and there are reports by Gunter and Bodner and others suggesting a mechanism - roughly that by occupying working memory, many of the interfering emotions are crowded out. In practice, this significantly reduces the time for change, a factor that seems to be ignored by many of the critics, including McNally.

I'm not a psychologist, though I've taken graduate courses, and am hesitant to reinstate the Mechanism section, particularly because of the intolerant treatment of those much better qualified. But I suspect that you aren't either and I would like to see a more supportive atmosphere towards newcomers to WP that isn't consistently belligerent. Can we not help them towards producing the type of NPOV article that WP strives for? Chris55 (talk) 13:43, 4 July 2013 (UTC)

"you don't seem to be listening" If you feel so, then the best solution is to restate the comments in a clearer and more concise way. Do remember to WP:FOC.

"I would like to see a more supportive atmosphere towards newcomers to WP that isn't consistently belligerent" What?

If the medical consensus is now that the eye movements actually do something, then the article should reflect that. But we can also present the large amount of press that disputed this, and do so neutrally. --Ronz (talk) 17:27, 4 July 2013 (UTC)

Question about 'client'

Hello, I have a question: Do you really call sick people "clients" instead of "patients"? It seems very strange to me; is this nomenclature specific to north america or universal? Of course I ask because I think the article could benefit from being written in the most universally understood way. 200.104.169.213 (talk) 20:44, 21 October 2013 (UTC)

Whether one is a "client" or a "patient" does not depend on being "sick" or "well", does it? In any case, being "patient" implies to some readers a calm demeanor which is not always accurate. Conversely, a pediatrician or a veterinarian's clients are not her patients. I would generally contend that the client makes the business decisions and selects the practitioner, while the patient receives the care which the practitioner provides. LeadSongDog come howl! 21:28, 21 October 2013 (UTC)

Potential ref

I don't see it currently being used: Oren, E (2012). "EMDR therapy: An overview of its development and mechanisms of action". European Review of Applied Psychology. 62 (4): 197–203. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help) --Ronz (talk) 23:27, 24 October 2013 (UTC)

Additional Information on Other Applications of EMDR

I would like to hear feedback on this possible addition of information that could be useful to readers reading the EMDR page. Under the "Other Applications" heading, I would like to include that another application of EMDR that has been recently discovered is Induced After Death Communication. Induced After Death Communication. Many people experience this sensation during EMDR. There are thousands of people who perceive these interactions during EMDR which results in healing of grief.

http://www.davemacdonaldlcsw.com/emdr_for_trauma_anxiety_growth/ 

This will allow the reader to see another type of application of EMDR that has not yet been brought up. --Egoldman87 (talk) 02:19, 18 April 2014 (UTC) — Preceding unsigned comment added by Egoldman87 (talk • contribs) 02:12, 18 April 2014 (UTC)

It's not a reliable source.

Even if a reliable source was found, it would need to be presented in a manner that meets WP:FRINGE. --Ronz (talk) 19:49, 22 April 2014 (UTC)

Suggestions

I have recently been reading a revised book on psychotherapy. Prochaska, J.O., & Norcross, J.C.(2010) Systems of Psychotherapy: A Transtheoretical Analysis. They place EMDR under Exposure Therapies (along with implosive and prolonged therapy). I haven't searched around for other articles suggesting it is an exposure therapy, but perhaps if other evidence emerges we could cite EMDR as a form of exposure therapy. cReep (talk) 11:10, 3 February 2011 (UTC)

There is quite a bit of scientific evidence to suggest that the processes that occur in EMDR are different from the processes that occur in exposure therapy for the treatment of trauma.(see Rogers & Silver, 2002). According to a strict exposure definition, there are 3 main differences between the processes in EMDR and exposure therapy that should result in EMDR being ineffective for treating PTSD as the procedure of EMDR should sensitize rather than desensitize the memories being processed.

First, EMDR is not based on habituation like exposure therapy as EMDR uses short 20- to 50-second, interrupted exposures rather than continuous 20- to 100-minute exposures, traditionally recommended for prolonged exposure. Second, EMDR is nondirective,allowing for free association. The client often moves quickly through events or skips scenes by spontaneously changing to other memories that come to mind. In EMDR, this is not considered to be avoidance but is instead viewed as effective memory processing (Lee & Drummond, 2008; Lee, Taylor, & Drummond, 2006). Third,in EMDR, reliving the traumatic memory in the present tense is not a requirement of effecitve therapy. Taking a third-party perspective on the trauma memory is also not seen as avoidance, and, unlike traditional exposure, reliving is not associated with improvement in EMDR (Lee & Drummond, 2008).

Thus, according to the assumptions of emotional processing theory (Foa & Rothbaum, 1998),which underlie exposure therapy for PTSD, EMDR is not working through the processes of traditional exposure as the type of exposure that occurs in EMDR should result in minimal decreased fear if exposure is the proposed mechanism of change. Yet EMDR is effective in treating adult PTSD and associated symptoms, thus other processes and underlying working mechanisms are at play. Sschubert (talk) 04:22, 10 March 2011 (UTC)

Excellent and accurate summary of how EMDR differs from prolonged exposure (PE) therapy. Yes, EMDR definitely involves exposure, that is, having the client vividly bring their traumatic event, events, triggers or future apprehensions to mind. Evidence so far indicates that this is a necessary step for any effective PTSD therapy aiming at remission rather than symptom reduction and management. The major difference is in the prolonged part. PE literally immerses the client in their traumatic memories for extended and intense periods -- that is mostly what it it about. EMDR does not have that intensive or prolonged aspect to exposure. Yet according to all recent meta-studies and endorsements, EMDR works just as well as PE, and there is now evidence that it works faster and better and especially better for depression associated with PTSD. To say that EMDR therefore works by a different mechanism than PE is hard to justify except as pure speculation. In fact, it is quite plausible, given current research, the PE works by the same mechanism as EMDR but simply not as well, hence it is generally slower and certainly requires more emotional pain and energy than EMDR. djlewis (talk) 02:13, 11 June 2014 (UTC)

Profit Bias Rejoinder

This is an inaccurate allegation. The only basis I can see is that EMDR is indeed a trademark, and to call oneself an EMDR therapist requires certification. Certification entails a modest training program (days, not weeks, months or years), a period of supervised practice, continuing yearly membership and occasional CEUs. I know a number of EMDR therapists, and I can assure you that the charges for all these are well in keeping with usual charges for professional certification and specialization, and after the initial period, are insignificant for a professional. I also know some EMDR therapists who provide group supervision, and they all charge their regular hourly client rate divided by the number of participants.

Thus, if there are significant profits being by someone in the EMDR world, it isn't either off of or by the therapists. I also doubt if the national organization is making much money, as they carry out a significant and beneficial program of research, training and dissemination that is well worth the modest yearly dues.

We could certainly discuss whether it is appropriate for a proven, highly effective and beneficial psychotherapy system such as EMDR to be controlled by a private organization. But my take on that would be that there is a sordid history in the psychology profession of opening up such systems, particularly those with somewhat unconventional elements, to unrestrained claims by practitioners. On the other side, it has limited the number of practitioners somewhat, but it does give a higher level of confidence to a client that a practitioner is well-trained and acting in a professional manner. Also since there are now a number of effective therapies for PTSD other than EMDR, if someone wants to treat PTSD clients (which is really hard and demanding work, by the way) but doesn't want to undertake EMDR certification for financial or any reason, there are plenty of options. But I bet most CB/PE therapists, for example, also undertook a good deal of training and belong to a specialty organization, in addition to their own licensing body such as the APA.

So, unless you have some documented proof that someone is making significant profits off of EMDR, I seriously question this allegation, and it certainly does not belong in the article.

(I also fixed the typo in your title.)

djlewis (talk) 23:59, 30 April 2013 (UTC) What does "off of" mean? 109.145.83.54 (talk) 15:22, 9 May 2013 (UTC)

"if there are significant profits being by someone in the EMDR world, it isn't either off of or by the therapists" -- It means that nobody (such as EMDRIA) is making significant profits by selling services to EMDR therapists, and the therapists themselves are not making any more profit than other similarly qualified psychotherapists. Of course, as in any profession, there are people that make a living training professionals, and small companies that do so on a somewhat larger scale. But as in the whole psychotherapy business, that is decidedly at the cottage industry level. djlewis (talk) 02:23, 11 June 2014 (UTC)

Quackwatch Article by Scott O. Lillienfeld

RESPONSE: The following link is not a bad review of some of the research issues with EMDR. In short, EMDR just piggybacks on proven methodologies such as exposure therapy, and the "trademarked" eye movement part is the added snakeoil for sale. Your claim that what is unique about EMDR is "proven, highly effective and beneficial" is laughably ambitious, to say the least, as is the claim that the intellectual property and related restrictions have not interfered with full objective scientific study and review. Let's see the collection of studies showing that EMDR is significantly more effective than the same therapy without the eye movement. But what has been successfully demonstrated with EMDR is the efficacy of a tightly controlled marketing campaign of pseudoscience over the years -- I'll certainly concede that.

I'll also concede that Wikipedia articles are reference driven, and so the constricted nature of the research on EMDR would seem challenging to note in the main article as that is commentary. (And I am certainly not questioning that there should be a Wikipedia article on EMDR, given its prevalency.) As to the claim that effectiveness is irrelevant...really?

http://www.quackwatch.org/01QuackeryRelatedTopics/emdr.html — Preceding unsigned comment added by Bdmwiki (talk • contribs) 08:16, 5 November 2013 (UTC)

That quackwatch article is suspect on several grounds. First, why does it lead with the original, long but outdated (now 18 years old) piece rather than the much more recent update.

Second, the author uses some questionable rhetorical devices, such as this passage...

• The controlled research is consistent in showing that EMDR is superior to no treatment and most likely, supportive counseling, for posttraumatic stress disorder (PTSD). Nevertheless, this research also consistently demonstrates that EMDR is no more effective than standard behavioral and cognitive-behavioral therapies that rely on exposing individuals to anxiety-provoking stimuli

...rather than...

• The controlled research is consistent in showing that EMDR and cognitive-behavioral therapies with prolonged exposure to traumatic material are equally effective for treating PTSD.

...which is true, more direct and leaves a more accurate impression. I know it's not polite to say this, but the author seems to be straining to create a negative impression from facts that do not support it, in fact, say the opposite.

Third, the author makes several highly biased statements or recommendations against EMDR therapists who make excessive claims that could be equally said of prolonged exposure treatment or any therapy...

1. Mental health consumers should be suspicious of psychotherapists who use EMDR instead of (rather than in addition to) standard behavioral and cognitive-behavioral interventions
2. especially those who claim that EMDR is far more effective and efficient than other interventions.
3. Such therapists may be prone to administering nonscientific interventions of other kinds, and for going beyond the available scientific literature in other domains.
4. Hence, consumers should be wary of practitioners who advance strong assertions about EMDR's effectiveness that are not scientifically supported

In fact, points 1 and 3 are scientific assertions without support! Given the apparent bias of the author and his attempt to twist words, I think consumers should be suspicious of his pronouncements.

djlewis (talk) 02:55, 11 June 2014 (UTC)

Relation to so-called "Brain Wave Vibration"

As in the title of this section, I think there's some kind of connection here.

Additionally I think both are related to stimulation of the cerebellum.

The cerebellum is now thought to be intimately connected with emotion.

Brain wave vibration link here and Wikipedia link here.

I have no connection to the above outfit.Fletcherbrian (talk) 18:47, 19 October 2014 (UTC)Fletcherbrian (talk) 00:02, 20 October 2014 (UTC)

Syn

The recent attempts at rewriting the controversies section to change the pov by means of original research has got to go. Sorry that I don't have the time atm to describe in detail, but see WP:SYN. --Ronz (talk) 21:05, 29 October 2014 (UTC)

Who says it is "moot"? From what I see, it is the editor's original research.

Who says, " these arguments generally cite articles written more than ten years ago"? Again, this appears to be original research.

I think there are some real problems here, but if we can't get beyond blatant SYN and NPOV violations, we'll never get to them. --Ronz (talk) 22:46, 29 October 2014 (UTC)

No response? Then removed. --Ronz (talk) 17:31, 3 November 2014 (UTC)

In case they can be used elsewhere, these two refs were removed in the process: --Ronz (talk) 17:20, 4 November 2014 (UTC)

• Devilly, G.J., & Spencer, S. (1999). The relative efficacy and treatment distress of EMDR and a cognitive behavioral trauma treatment protocol in the amelioration of post-traumatic stress disorder. Journal of Anxiety Disorders, 13, 131-157.DOI: 10.1016/S0887-6185(98)00044-9
• Taylor, S., Thordarson, D. S., Maxfield, L., Fedoroff, I. C., Lovell, K., & Ogrodniczuk, J. (2003). Comparative efficacy, speed, and adverse effects of three PTSD treatments: exposure therapy, EMDR, and relaxation training. Journal of Consulting and Clinical Psychology, 71(2), 330 http://dx.doi.org/10.1037/0022-006X.71.2.330.

Skeptic magazine (skeptic.com) reliable?

I'm not finding a WP:RSN discussion on it, but it is used a few hundred times in Wikipedia, and is mentioned as if it is reliable in multiple noticeboard discussions (though I've not found any discussions specifically about the reliability of Skeptic Magazine). --Ronz (talk) 22:38, 29 October 2014 (UTC)

see WP:MEDRS, I don't see how skeptic.com is acceptable, we're not talking about UFOs and bending spoons. Skeptic.com states its 'mission is to engage leading experts in investigating the paranormal, fringe science, pseudoscience, and extraordinary claims of all kinds'. EMDR is not that, it is an accepted treatment for PTSD as a result of empirical evidence of efficacy, it is not 'fringe science'. It may possibly not be as effective as believed, but evidence for that should be obtained from a much better source, ie. peer reviewed medical/psychology journals preferably with meta-analyses etc. And criticism of her supposed response should also be from a similarly reasonable source. Woodywoodpeckerthe3rd (talk) 00:16, 30 October 2014 (UTC)

EMDR was that, and the source wasn't being used for any medical claims so MEDRS doesn't apply. It looks like the financial incentives drove EMDR, while the research lagged tremendously. It seems worth noting and the source is reliable for such info. It would be nice to have an independent sources that looks back over the history in general, and the skeptical viewpoint specifically. --Ronz (talk) 17:18, 30 October 2014 (UTC)

Why not use this as a source? http://dunx1.irt.drexel.edu/~emf27/Lab%20Group/Publications%20and%20Presentations_files/Herbert%20CPR%202000.pdf , it seems to make much the same arguments but it's from Clinical Psychology Review. Woodywoodpeckerthe3rd (talk) 22:09, 30 October 2014 (UTC)

I'm assuming then that you now agree it's reliable.

I think we could used this source as well. Could you point out where specifically is covers the same arguments? I'm seeing brief mention on p964 (last full paragraph), which isn't even close to the same. --Ronz (talk) 16:41, 31 October 2014 (UTC)

I never agreed skeptic.com was reliable, the same argument is on p953 of the Herbert et al. article under Professional Evaluation of EMDR: 'When researchers received the sanctioned Level I training and conducted controlled studies yielding null results (e.g., Lohr, Tolin, & Kleinknecht, 1995; Pitman, Orr, Altman, Longpre, Poiré, & Macklin, 1996), Level II training became required'

I will add your edit back in but using the Herbert paper as the reference. Woodywoodpeckerthe3rd (talk) 22:14, 31 October 2014 (UTC)

Thanks. It verifies all the info.

So why isn't eSkeptic reliable in this context? --Ronz (talk) 15:27, 1 November 2014 (UTC)

This article is under the scope of WikiProject psychology and should also be under the scope of wikiproject medicine as psychiatrists use this technique. It's not reliable to use skeptic.com because no one writing a psychology paper for a decent journal would ever use such a website as a reference. This article should be written much like a psychology paper regarding quality of references (however it should be in more accessible language) and use more secondary/tertiary references. Also skeptic.com is very likely not peer reviewed by psychologists. Further the Psychology Review article is just much more in depth and a better explanation of the issues. The skeptic.com article is however written by respected psychologists (both articles have two of the same authors) but nonetheless given a choice it's still better to use a peer reviewed journal. Also WP:MEDRS does apply to this edit because it is making a medical claim about controlled trials that question the effectiveness of EMDR, while describing Shapiro's alleged response to these null results. Woodywoodpeckerthe3rd (talk) 23:05, 1 November 2014 (UTC)

That's one pov, but it ignores the history of the topic. Take it to a noticeboard. --Ronz (talk) 17:28, 2 November 2014 (UTC)

How does it ignore the history of the topic? A psychologist came up with this treatment, it's effectiveness was assessed by studies published in psychology journals, it has been challenged by psychologists (and studies) published in psychology journals and it's a wikiproject psychology article. That's the history. And that's why a psychology journal is a better reference than skeptic.com. It's your edit, take it to wikiproject psychology if you so strongly disagree. Woodywoodpeckerthe3rd (talk) 20:58, 2 November 2014 (UTC)

That's the pov you want the article to conform to, and you want to accomplish this by excluding sources that don't fit that narrative. --Ronz (talk) 21:07, 2 November 2014 (UTC)

It's actually your pov that you want the article to conform to. Your problem is that 'EMDR is now recommended as an effective treatment for trauma in the Practice Guidelines of the American Psychiatric Association,[8] the Departments of Veterans Affairs and Defense,[9] SAMSHA,[10] the International Society for Traumatic Stress Studies,[11] and the World Health Organization.[12]'. The fact is the mainstream accepts it as a valid treatment. Your quack narrative on EMDR is not what the professional bodies consider to be accurate. Woodywoodpeckerthe3rd (talk) 21:20, 2 November 2014 (UTC)

'EMDR is recognised as having the highest level of research evidence for the treatment of PTSD by the Australian Psychological Society (EBPI Review 2010).' http://www.psychology.org.au/Events/EventView.aspx?EventID=10848 Woodywoodpeckerthe3rd (talk) 21:32, 2 November 2014 (UTC)

My pov? You believe I wrote some of the sources that you are trying to restrict, or I might have a some other conflict of interest with them? If not, please redact your comments, and instead try to make a policy-based argument. If you instead want to continue with your assertions against me, provide some evidence and bring it to an appropriate noticeboard, rather than using the accusations here to detract from our policies. --Ronz (talk) 17:23, 3 November 2014 (UTC)

Ronz... you don't seem to be reading what I've actually written Woodywoodpeckerthe3rd (talk) 19:08, 3 November 2014 (UTC)

Then clarify, while WP:FOC and providing some policy-based argument. --Ronz (talk) 19:34, 3 November 2014 (UTC)

Other editors appear to have the same problem with you 'Ronz, you don't seem to be listening' I'll leave it there. Woodywoodpeckerthe3rd (talk) 23:09, 3 November 2014 (UTC)

So you refuse to work to build consensus? Then follow WP:DR, or leave the article to those who will. --Ronz (talk) 16:32, 4 November 2014 (UTC)

I've gone ahead and removed the tagging of the reference. If someone disputes that it is reliable at this point, please indicate why and start a discussion at WP:RSN. I'm happy to start the RSN discussion in a week or so if someone hasn't by then but has some policy-based concerns that are clear enough for me to work from. --Ronz (talk) 21:52, 25 November 2014 (UTC)

Verification tag

I have tried to address the VERIFICATION NEEDED tag on the McNally (2013) reference (currently footnote 40) by inserting the article page number where McNally's quote is found. When adding such information, is it appropriate for the editor to remove the VER.NEEDED tag him/herself?Saturn Explorer (talk) 04:14, 30 November 2014 (UTC) By the way, sorry I am showing up belatedly to this discussion. Greetings to all.Saturn Explorer (talk) 04:14, 30 November 2014 (UTC)

If you have solved the problem, you can remove it. If someone disagrees, they'll likely revert you. Then a discussion can settle the matter. -- Brangifer (talk) 06:13, 30 November 2014 (UTC)

Thank you.Saturn Explorer (talk) 14:07, 30 November 2014 (UTC)

Glad to have you here.

As far as what goes in the article, we need the page number and any other relevant reference identification that is missing. In this case the page number should be fine.

When another editor is having trouble verifying information, it's extremely helpful to provide on the article talk page a quote from the reference that verifies the information along with the context. Eg: Something like, "On page nn it has two paragraphs on the topic, including Verfying quote." --Ronz (talk) 18:54, 30 November 2014 (UTC).

OK, thank you Ronz. Regarding the McNally 2013 article: on page 9, the author writes, "Yet recent basic laboratory research (Gunter & Bodner, 2008), including with PTSD patients (van den Hout et al., 2012), indicates that secondary tasks, such as eye movements, that tax working memory during recollection of stressful memories attenuate their vividness and emotionality during subsequent recollection (van den Hout & Engelhard, 2012). Secondary tasks that do not tax working memory (e.g., passive listening to bilateral beeps) do not have this effect. In fact, the authors of a recent meta-analysis concluded, “the eye movements do have an additional value in EMDR treatments” (Lee & Cuijpers, 2013, p. 239)."Saturn Explorer (talk) 01:13, 1 December 2014 (UTC)

I am not sure why the (van den Hout & Engelhard, 2012) reference is tagged, as it is derived from the McNally (2013) quote. Advise please.Saturn Explorer (talk) 01:23, 1 December 2014 (UTC)

Do you mean the opposite, that the 2013 is derived from the 2012? --Ronz (talk) 17:47, 1 December 2014 (UTC)

I mean the opposite, yes, that 2012 is derived from 2013.Saturn Explorer (talk) 17:57, 1 December 2014 (UTC)

The van den Hout & Engelhard paper full text is available at http://jep.textrum.com/index.php?art_id=113#.VH5a1NyUd8E The words used to paraphrase that paper in the McNally 2013 article appear consistent with the paper. So that's verified and you can remove the tag if you agree. It is good practice when using a source that mentions other sources as McNally has with van den Hout & Engelhard, to read the original source, rather than take it for granted that McNally has accurately summarised the findings of that research. That may be the reason it was tagged. It is also good practice not to use extended direct quotations, better to paraphrase in your own words. Woodywoodpeckerthe3rd (talk) 22:44, 1 December 2014 (UTC)

Sorry to not catch this sooner, I placed the tag. It was not clear that the text was a quotation, and had seemed to suggest OR by a wp editor. LeadSongDog come howl! 06:46, 2 December 2014 (UTC)

That said, the "Journal of Experimental Psychopathology" seems a bit off. I've inquired at wp:RSNLeadSongDog come howl! 17:01, 2 December 2014 (UTC)

Here is a quite from the vanden Hout & Engelhard paper- p.724-that verifies use of the citation as it is embodied in the McNally (2013) article.Van den hout: " Eye movement desensitisation and reprocessing (EMDR) is an effective treatment for alleviating trauma symptoms, and the positive effects of this treatment have been scientifically confirmed under well-controlled conditions. This has provided an opportunity to explore how EMDR works. The present paper reports on the findings of a long series of experiments that disproved the hypothesis that eye movements or other Œdual tasks¹ are unnecessary." Saturn Explorer (talk) 20:49, 3 December 2014 (UTC)

Regarding (current) fn #61-reference to Kuiken, et al. 2010: On page p.243, the authors state: "Together the effects of EMs on attentional adjustments to unexpected targets and the effects of EMs on the perceived strikingness of metaphoric sentences reinforces Shapiro’s (1991) original suggestion that the distinctive contribution of rapid EMs to the EMDR protocol is that they prompt novel shifts in memory (e.g.,diminution of threat), belief (e.g., recognizing unintentional responsibility), and emotion (e.g., changing fear to anger) among those living in the aftermath of trauma (see also Lee et al., 2006). . . " . I will remove the verification tag to this note.Saturn Explorer (talk) 15:53, 4 December 2014 (UTC)

Regarding (current) fn #50-reference to van Etten & Taylor 1998, on page 126, the authors state: " "Among the psychological therapies, behaviour therapy and EMDR were most effective, and generally equally so. The most effective psychological therapies and drug therapies were generally equally effective." I will remove the verification tag to this note.Saturn Explorer (talk) 16:10, 4 December 2014 (UTC)

unpublished synthesis of published material

Can someone please indicate which part(s) of "Controversies" section are being identified as having this problem? I would like to explore this. ThanksSaturn Explorer (talk) 18:11, 4 December 2014 (UTC)

Everything out of chronological order. --Ronz (talk) 18:47, 4 December 2014 (UTC)

And the entire last paragraph, "The working mechanisms..." --Ronz (talk) 18:54, 4 December 2014 (UTC)

Ronz, Problem: How to edit the "working mechanisms" piece such that the reader can wee the state of research & findings, including the narrowing focus on the two referenced mechanisms, "working memory" and "orienting reflex"/REM sleep. The current text relies on primary sources, and this is clearly problematic with respect to Wikipedia policy. Might some words of caution to the reader regarding primary sources be useful, e.g., "The working mechanisms that underlie the effectiveness of EMDR therapy are still under investigation. There is as yet no definitive finding and no consensus on the effective mechanisms of this therapy. Those that have received the most attention and interest based on initial research include (1) taxing working memory[57][58][59] and (2) orienting response/REM sleep[60][61][62]"  ?? Saturn Explorer (talk) 16:52, 7 December 2014 (UTC)

Re: "The working mechanisms that underlie the effectiveness of EMDR therapy are still under investigation. There is as yet no definitive finding and no consensus on the effective mechanisms of this therapy." I think something close to this should be in the article, with more context and perhaps more weight. The rest seems too far into SYN/MEDRS/DUE/FUTURE problems. (I'm sorry that I have been delayed in working on this the past few weeks. I'm hoping to have more time this upcoming week.) --Ronz (talk) 17:12, 7 December 2014 (UTC)

Thank you Ronz. I've been distracted by other things, myself. I expect to be able to enter some more discussion of this topic and propose a chage later in this 24 hour period.Saturn Explorer (talk) 11:36, 11 December 2014 (UTC)

How about "The working mechanisms that underlie the effectiveness of the eye movements in EMDR therapy are still under investigation and there is as yet no definitive finding. The consensus regarding the underlying biological mechanisms involve the two that have received the most attention and research support: (1) taxing working memory and (2) orienting response/REM sleep. [Lee & Cuijpers, 2013]"

Reason for putting it this way: Lee & Cuijpers 2013 conducted a meta-analysis of studies pitting eye movements against no eye movements in both clinical and non-clinical laboratory situations. After reporting results of their meta-analysis demonstrating the significant contribution of eye movements, they review studies examining the underlying mechanisms that make the eye movements effective. They report, "One account for the effect of eye movements is provided by working memory theories of EMDR (Andrade et al., 1997; Gunter & Bodnher, 2008; Maxfield et al., 2008; van den Hout et al., 2011)..... Another model to account for the possible role of eye movements that has some empirical support is that the eye movements elicit an orienting response (Barrowcliff, Gray, MacCulloch, Freeman, & MacCulloch, 2003; Sack, Lempa, Steinmetz, Lamprecht, & Hofmann, 2008; Schubert, Lee, & Drummond, 2011). According to orienting response theory the eye movements activate an "investigatory reflex" in which first, an alert response occurs, then, a reflexive pause produces dearousal in the face of no threat. This reflex results in a state of heightened alertness and permits exploratory behavior...." Saturn Explorer (talk) 20:02, 11 December 2014 (UTC)

The above quote of Lee & Cuijpers came from p. 237 of their 2013 meta-analysis.Saturn Explorer (talk) 13:25, 12 December 2014 (UTC)

Given the recent re-write of the mechanisms paragraph and the removal of primary sorce citation, can we remove the "unpublished synthesis" banner from this section?Saturn Explorer (talk) 13:30, 12 December 2014 (UTC)

Perhaps I'm going blind, but where does that say "controversy"? All I see there is discussion of alternative hypotheses at different stages of investigation. Why imply that someone did something wrong?LeadSongDog come howl! 14:32, 12 December 2014 (UTC)