Talk:Eye movement desensitization and reprocessing/Archive 8

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pejorative article

sadly the article reeks of out-of-date negative views of EMDR.

For heavens sake EMDR is recommended for PTSD by many major national organisations, and many people find EMDR immensely helpful in treating their PTSD; this article currently would prevent such people accessing this help. Why would wiki want to do that?JCJC777 (talk) 11:25, 8 April 2023 (UTC)

Currently being discussed at WP:FT/N#EMDR. Bon courage (talk) 12:05, 8 April 2023 (UTC)

thanks. I don't understand why the article is being held back in such an unhelpful and embarrassing state. — Preceding unsigned comment added by JCJC777 (talk • contribs) 13:42, 8 April 2023 (UTC)

It accurately reflects reliable sources. Bon courage (talk) 12:46, 8 April 2023 (UTC)

Oh really? Reliable sources like the NHMRC report you linked above, which says that EMDR has repeatedly been shown to be effective in reducing PTSD symptoms relative to waitlist, and also to nondirective counselling? Or the multiple other sources from big professional medical organizations which say similar things?

Three books on pseudoscience, one of which still calls EMDR effective, are not the only reliable sources out there. The consensus of all the sources is clearly that EMDR is an effective treatment for PTSD. Loki (talk) 18:28, 8 April 2023 (UTC)

Facepalm You still don't get it do you. Aspirin wrapped in gold leaf is also effective for headaches, but also a scam. You don't need the gold leaf. Follow the sources. Bon courage (talk) 18:42, 8 April 2023 (UTC)

Yes, and the World Health Organization, American Psychological Association, Department of Defense, etc etc, would never recommend aspirin wrapped in gold leaf for that reason.

If sources A, B, C, D, E, F, and G all say a treatment is effective, and sources H, and I say a treatment is a purple hat, the proper weight to give sources H and I is not all of it. It's at least important to be very clear that EMDR is effective before getting into the debate about why it's effective. Loki (talk) 22:57, 8 April 2023 (UTC)

You are still conflating 'effective' and 'not pseudoscience', and that still requires WP:OR reasoning. Repeating this argument over and over will not make it more persuasive. MrOllie (talk) 23:08, 8 April 2023 (UTC)

Warnings were given at ANI already for this. Bon courage (talk) 02:06, 9 April 2023 (UTC)

A warning is a specific thing in Wikipedia and I'd like you to stop insinuating any warnings were given at ANI. In fact, several editors told you to stop this exact sort of behavior, so if we're calling that a "warning" you have also been "warned" to stop this. Loki (talk) 03:04, 9 April 2023 (UTC)

It's not an insinuation. You were advised (not by me) to drop it. But you're doubling down and it's getting (even more) disruptive. Probably will end up at ANI again. I would much prefer to move on and focus on new content: are there any good sources we're missing to round-out the article? Bon courage (talk) 03:10, 9 April 2023 (UTC)

Well, the main source we're missing right now is the Australian medical recommendation, and also we could easily link the full APA medical recommendation instead of the webpage we link now. And the list of meta-analyses that used to be here also appears to have gone missing.

But honestly, my objection to the page is not that we're missing sources but that we've isolated our best sources to a single section, while spreading out a bunch of relatively marginal academic books all over the article. Loki (talk) 03:29, 9 April 2023 (UTC)

MrOllie: fair enough, let me rephrase, because my argument turns on a subtle point that I didn't make clear above. Several sources call EMDR "evidence-based" in those words, such as the APA and the Department of Defense report. That is not WP:OR, that is a direct contradiction of "pseudoscience".

Furthermore, several other sources that don't use those words exactly give EMDR a strong or at least moderate evidence rating. A rating that a treatment has a high or even moderate degree of scientific evidence is necessarily a contradiction of a term that means "not based in scientific evidence". Loki (talk) 03:09, 9 April 2023 (UTC)

It's not a "direct contradiction". This is your central fallacy and you keep repeating it over and over and over and over again. See Purple hat therapy. Bon courage (talk) 03:12, 9 April 2023 (UTC)

I remind you that it is WP:OR to say a source that criticizes EMDR for being a purple hat therapy supports the idea that EMDR is pseudoscientific. They're not synonyms.

Which is to say, yes, "evidence-based" is a direct contradiction of "pseudoscience" even if it is not a direct contradiction of "purple hat". Loki (talk) 03:21, 9 April 2023 (UTC)

You're still applying WP:OR here. Evidence-based is not an antonym for 'pseudoscience'. Scientific evidence of effectiveness doesn't rule out pseudoscience, because as the Austrialian guidelines note, this is CBT with extra stuff. CBT plus meaningless window dressing is effective because CBT is effective, not because the window dressing isn't pseudoscientific. MrOllie (talk) 03:14, 9 April 2023 (UTC)

First of all, Scientific evidence of effectiveness doesn't rule out pseudoscience? I hope you realize how absurd this sounds.

I understand the "purple hat" criticism here, and I also understand that it's not easy to directly contradict it. That is why the Wikipedia guideline on WP:WEIGHT exists. If we have ten sources that say EMDR is effective and three sources that say it might only be effective because of its similarities to CBT, then we give more WP:WEIGHT to the ten than the three, while also still mentioning the three.

But the pseudoscience criticism is easy to directly contradict, because pseudoscience means not based on scientific evidence, and there's plenty of scientific evidence for EMDR. Even some of the skeptics acknowledge this. Loki (talk) 03:19, 9 April 2023 (UTC)

... and over, and over and over again. Bon courage (talk) 03:22, 9 April 2023 (UTC)

It only sounds absurd to you because you are reading things into the sources that simply aren't there. We cannot make the leaps of logic that you are making. MrOllie (talk) 03:23, 9 April 2023 (UTC)

What leap of logic is it to say that "evidence-based" is the opposite of "pseudoscience"? Loki (talk) 03:24, 9 April 2023 (UTC)

It isn't 10 sources vs 3 sources - if 10 sources are silent on the question on why it works (only saying that it works) and 3 are explaining it works because of the CBT elements, there are only 3 sources to use to assign weight this question. The leap of logic is that the 10 sources are contradicting a point when really they are not addressing it at all. MrOllie (talk) 03:27, 9 April 2023 (UTC)

So, are you using WP:OR to say that "purple hat therapy" implies "pseudoscience"? Because it doesn't, those terms don't mean the same thing.

I agree there aren't very many sources that explicitly contradict the purple hat claim. So that claim should get a pretty sizable amount of WP:WEIGHT. But there are many sources that contradict the pseudoscience claim by saying things such as "evidence-based", so that claim should not get much weight, even if it's partially based on the purple hat claim.

(Furthermore, I generally object to the strong underrating in this article of EMDR's effectiveness. Our strongest sources agree that it's effective, and yet our Effectiveness section is weirdly equivocal on that point.) Loki (talk) 03:35, 9 April 2023 (UTC)

Not necessarily pseudoscience. Maybe just scamming, or mistakes, or geegaws. Bon courage (talk) 03:38, 9 April 2023 (UTC)

are many sources that contradict the pseudoscience claim by saying things such as "evidence-based" Again, this is OR. They are orthogonal claims. My car goes fast, and it has flames painted on the side. That doesn't mean that the flames make the car go faster. MrOllie (talk) 03:44, 9 April 2023 (UTC)

I resent that people are making me cite the definition of pseudoscience, because I know you know you're just playing games with words at this point, but here's the National Science Foundation's definition: "claims presented so that they appear [to be] scientific even though they lack supporting evidence and plausibility".

Naturally, having supporting evidence necessarily means that a claim cannot be pseudoscience under this definition. Loki (talk) 03:46, 9 April 2023 (UTC)

I can bring my car to the track and time it again and again, but what I'm providing evidence of is that the *engine* makes it go fast, not the flames. MrOllie (talk) 03:47, 9 April 2023 (UTC)

But either way the car goes fast. That's my point. We barely ever say "the car goes fast" in the article. Instead we spend a lot of time criticizing the people who made the car for making some claims about it that may or may not be true and may or may not be evidence-based taken separately, while ignoring that the majority of the sources simply say "the car does go fast". Loki (talk) 04:01, 9 April 2023 (UTC)

It's worth pointing out that the car goes just as fast if you don't bother to paint it. MrOllie (talk) 04:05, 9 April 2023 (UTC)

Per the sources there are two factors which push EMDR into the pseudoscience realm. The first is that the eye-movement/tapping/whatever is probably useless; the second is the "florid marketing". No, it won't cure cancer or bring about world peace, And maybe you don't need to spend quite so may $000s in ever-shifting training regimes. Bon courage (talk) 04:12, 9 April 2023 (UTC)

There's a source for "aggressive marketing", and a few sources for the training, but only one source in the entire article that says that anyone has ever claimed it cures cancer. On the basis of that source, we're citing an entire paragraph that makes some of the most florid claims in the article about EMDR. Loki (talk) 04:21, 9 April 2023 (UTC)

Exactly, the silence of sources on an aspect cannot be interpreted into meaning by Wikipedia editors. Bon courage (talk) 03:37, 9 April 2023 (UTC)

Rather than explain your fallacy yet again, because for whatever reason you do not seem to understand, let's make it really simple. Wikipedia reflects the knowledge in sources. If you want Wikipedia to include that view that "EMDR cannot be pseudoscientific at all because it is evidence-based" we need a good source that says that, not Loki The Liar's own musings. Got that source? Bon courage (talk) 03:27, 9 April 2023 (UTC)

Are you really making me cite the definition of pseudoscience?

Fine, here's the National Science Foundation's definition of pseudoscience, according to our own article (source):"claims presented so that they appear [to be] scientific even though they lack supporting evidence and plausibility".

Naturally, having supporting evidence directly contradicts this definition. Loki (talk) 03:44, 9 April 2023 (UTC)

Supporting evidence of what? That is the crucial point. MrOllie (talk) 03:45, 9 April 2023 (UTC)

"There's evidence that gold-leaf-wrapped aspirins are effective for headaches. Therefore it's a great drug, and not a scam!" Bon courage (talk) 03:51, 9 April 2023 (UTC)

"Scam" and "pseudoscience" are different things, and you are again engaging in WP:OR.

Furthermore the "gold-leaf-wrapped aspirins" analogy presumes that EMDR is significantly more expensive than CBT, which you have no source for and is therefore also WP:OR. Generic aspirin is the same as brand-name aspirin, but neither are pseudoscience. Loki (talk) 03:56, 9 April 2023 (UTC)

My OR is good here. The point is that super-adding things to a therapy can corrupt it into pseudoscience. This is exactly the point made by out cited sources. Follow the sources. It's basically Your View vs Sources. And the sources will always win. Bon courage (talk) 04:01, 9 April 2023 (UTC)

My OR is good here? Seriously? You're now openly saying you're violating policy and that's fine? Loki (talk) 04:21, 9 April 2023 (UTC)

Making an analogy on a talk page isn't a violation. (It is good here). You'll note that Bon courage hasn't added any statements about gold-leaf to the article. MrOllie (talk) 04:27, 9 April 2023 (UTC)

Well, the thing that some of the sources are calling "pseudoscientific" is EMDR, so, of EMDR.

Or more precisely, the idea that EMDR therapy is effective for treating mental illness. Which is exactly the thing that other sources are calling evidence-based. Again, "purple hat" is a different criticism: EMDR can be effective, and not pseudoscientific, and also effective only because of components shared with other therapies. Loki (talk) 03:52, 9 April 2023 (UTC)

Sounds garbled. Stick to the sources (like we do) and all will be well. You really need to drop the WP:STICK because absent of new sources this article won't be changing rhe way you want. You're just wasting editors' time (not least your own). Bon courage (talk) 03:56, 9 April 2023 (UTC)

I am sticking to the sources and I would prefer you all stop yelling WP:IDONTHEARTHAT and admit to obvious truths like "a treatment being evidence based means that it is not pseudoscience". Loki (talk) 03:57, 9 April 2023 (UTC)

I think at this point the best approach is to disengage and just revert any further non-neutral edits you make. Good luck. Bon courage (talk) 04:02, 9 April 2023 (UTC)

There are two questions: Is it effective? (A) and Is it pseudoscience? (B). A source that only answers question A cannot be used to make a statement about question B. Evidence of effectiveness just means that at least part of it isn't pseudo-science - to go any further than that requires OR. MrOllie (talk) 04:02, 9 April 2023 (UTC)

I agree, but many sources outright say that it is evidence-based.

Can I suggest a compromise? If we rephrase mentions of pseudoscience to be narrowly targeted towards the eye movements, or EMDR's theoretical basis, I would be a lot more comfy with them.

I think there's more contention in the field than you seem to think (after all, we have a source saying that one of EMDR's early critics has come around to the effectiveness of the eye movements, and a meta-analysis saying that the eye movements are in fact effective) but at least this is an area where there seems to be real controversy. Loki (talk) 04:18, 9 April 2023 (UTC)

I don't believe a compromise based on a misunderstanding of policy will be successful long term. You're still conflating statements about question A (evidence-based) with question B. MrOllie (talk) 04:29, 9 April 2023 (UTC)

Statements about whether EMDR is evidence-based speak directly to its scientific basis and therefore to whether it is a pseudoscience. Loki (talk) 04:34, 9 April 2023 (UTC)

... and over and over and over again ... Bon courage (talk) 06:08, 9 April 2023 (UTC)

I'm basically with you JCJC777, but two things:

First of all, "many people find EMDR immensely helpful in treating their PTSD" is not a policy-based argument. Many people claim to find acupuncture helpful in treating their chronic pain, and yet scientific studies on the topic find that acupuncture has no benefits over placebo. The actual argument here is if reliable sources find EMDR effective, and especially if plenty of well-conducted scientific studies find EMDR effective... which they do. Especially in concert with all the big professional organizations that recommend EMDR.

Second, it's pretty clear from the sources that there is still a minority expert position that EMDR is a purple hat therapy, or in other words that it's just exposure therapy with some other bits that don't work. That position has enough support that it deserves some WP:WEIGHT as a alternative scientific position. The problems with this page stem from a bunch of POV-pushers trying to say that such a position is consensus in the field when it's transparently not. Loki (talk) 18:16, 8 April 2023 (UTC)

You're making stuff up again. Follow the sources, not your own POV! Bon courage (talk) 18:45, 8 April 2023 (UTC)

I'd be happy if the article reflected this. i.e.

1. many national bodies recommend it,

2. but there is also a view held by some that it's active ingredient is not unique (i.e. it's exposure therapy or something).

That would be an improvement on the current situation. JCJC777 (talk) 19:51, 8 April 2023 (UTC)

That is in fact what the currently article says. Removing all the text that points out that the additions are pseudo-scientific is misrepresenting the scientific consensus on this. MrOllie (talk) 21:31, 8 April 2023 (UTC)

See, "points out that the additions are pseudo-scientific" goes way beyond most of the sources. Most sources do not say anything of the sort. We have many sources from large medical organizations that say that EMDR is empirically supported with no caveats.

This is at best WP:FRINGE/QS territory. Saying it is pseudoscientific in Wikivoice goes directly against policy here. Loki (talk) 23:00, 8 April 2023 (UTC)

these large medical organizations don't typically address the question of "is it pseudoscience?" so they aren't very useful to evaluate that part of the claim. We have excellent high quality sourcing which shows experts consider it pseudoscientific, and so we say as much. That's not wiki-voice, it's describing what experts think about a topic. We then summarize that in the lead, typically with very little attribution, then attributing it in the body. That's just good summary-style. — Shibbolethink ^{(♔ ♕)} 15:42, 11 April 2023 (UTC)

We could just say it is pseudoscience. It's not is dispute in RS, so in Wikipedia terms is a fact to be asserted. Bon courage (talk) 15:25, 13 April 2023 (UTC)

That's the rub ain't it, i think there is quite a bit here to say that might be informative for the reader. I'd like to see some links to things like dodo bird verdict, Empirically Supported Treatments, Science Based Medicine (and to Lilienfeld and Rosen i think they have done a lot more work here than Novella). But that ain't gonna happen when this is going on. The constant repetition of the same arguments over and over without listening to feedback just solidifies everyone's opinions. JCJC777, LokiTheLiar, there are reasonable editors here who would have probably listened to an argument along the lines of what is pseudoscience here and what isn't, but you aren't really giving them that option are you? fiveby(zero) 17:02, 13 April 2023 (UTC)

What? I've been trying to leave room for "the eye movements don't work" and get accused of POV-pushing anyway.

My basic position is that I don't think that "pseudoscience" is a good term for what's going on here, nor is it really supported by the consensus of the sources. There's been lots of scientific research on EMDR and most of it finds that EMDR as a whole is effective. There's also been lots of scientific research on the eye movements, which has been mixed. That sounds like a disagreement within science to me (at least at this point), not pseudoscience.

Is it possible that EMDR is just rebranded CBT and the eye movements don't add anything? Yes, definitely, and so I am a lot less resistant to purple-hat like criticisms than the word "pseudoscience" itself. But that's only when that distinction is made clearly, which other editors on this page seem reluctant to do. Loki (talk) 18:25, 13 April 2023 (UTC)

Yeah you disagree with sources and want to push your POV. Wikipedia should follow the expert assessment, not random editors' views. Bon courage (talk) 18:29, 13 April 2023 (UTC)

Your continuing accusations of POV-pushing are getting tiresome, especially considering you have the strongest POV of anyone on the page. Nobody else including people who otherwise agree with you has pushed (multiple times!) for describing EMDR as pseudoscience in Wikivoice, because the sources just don't support it. We have expert sources saying The trauma-focused psychotherapies with the strongest evidence from clinical trials are Prolonged Exposure (PE), CPT, and Eye Movement Desensitization and Reprocessing (EMDR) and that EMDR is one of a core set of evidence-based psychotherapies for adults with PTSD (and this at the end of a long paragraph going over the state of consensus in the field). Loki (talk) 20:54, 13 April 2023 (UTC)

The difference is that Bon courage's sources support their edits, while you keep bringing up sources that don't address the points in question. Case in point, the quotes you bring up here don't say anything about pseudoscience. MrOllie (talk) 21:07, 13 April 2023 (UTC)

BC, you keep saying it's "not in dispute in reliable sources" even after I keep giving reliable sources which dispute it. There is no part of EMDR that is unambiguously pseudoscience. Several big deal medical organizations call the therapy as a whole "evidence-based" or give it high grades of evidence. Other reliable sources describe the eye movements as possibly effective, and give scientific reasons for why.

Yes, certainly there are sources that call either EMDR or the eye movements pseudoscientific. But there are relatively few of them, and the most reliable sources we have (the recent meta-analyses and the WP:MEDORG sources) not only do not, but several of them directly contradict that description. Loki (talk) 18:29, 13 April 2023 (UTC)

Wrong. You have produced no such source. All sources which consider the pseudoscience question come down with the same verdict. And they're very good sources. Bon courage (talk) 18:31, 13 April 2023 (UTC)

They're not bad sources and nobody is saying that. The problem is that, at least on the topic of whether EMDR is pseudoscientific, they are contradicted by the WP:BESTSOURCES.

On the question of whether EMDR as a whole is pseudoscientific, we have broad agreement from WP:MEDORGs that it's not. Many, such as the DoD/VA report and the APA, specifically use the words "evidence-based" for it.

On the question of whether Shapiro's original theory of why EMDR works is pseudoscientific, we do have a reasonably strong consensus that it's at least not true. So this is the place where I have least quibble with the term pseudoscience, though I think that if you look at the sources at the whole they tend to use phrases closer to "having no scientific basis" or "neuropsychologically dubious" which don't really accuse it of quackery so much as just falseness.

On the question of whether the eye movements work, we have a lot of sources that contradict each other. But when we look at sources that try to summarize we get stuff like the VA's Some research shows that the back and forth movement is an important part of treatment, but other research shows the opposite. or the Encyclopedia of Personality and Individual Difference's discussion of the history of the research. I think here it's definitely important to mention the criticism, but also it's certainly not anywhere near universal enough in the sources to say it in Wikivoice. Loki (talk) 21:11, 13 April 2023 (UTC)

They're not contradicted. You are very focused on this binary proposition that something is either pseudoscience or effective/'evidence-based'. Try considering the idea that things can be both. MrOllie (talk) 21:16, 13 April 2023 (UTC)

Is the German source reliable?

JCJC777 recently added

In 2006 the German Scientific Advisory Board for Psychotherapy published an expert opinion on the scientific recognition of the EMDR method, which summarised that "the EMDR method can be considered scientifically recognized as a method for treating post-traumatic stress disorder in adults."

I'm not sure if this source is reliable, because it's in German. (Well, one of the citations is a "reference" to a German Wikipedia article, so that's definitely not reliable, but I mean the report linked in the second cite.) Is anyone more familiar with this organization, and if they are reputable can someone give a better translation of their report? Loki (talk) 21:35, 13 April 2023 (UTC)

Yknow I can actually read German! And have used it in my academic research. My overall feel of this source is that it is not very reliable, but could maybe be included very briefly.
On the side of reliability: it is a real professional organization, made up of psychotherapists overseen by the German medical boards and governed under German medical practice laws. So it is somewhat official. That said, this agency is not necessarily the best to determine the mechanism or logical underpinning of the therapy, that would be neurologists or psychiatrists. It also is backed up by a meta analysis.
The issue being they only used studies hand picked by the EMDR association in Germany (kind of a red flag). They also only require three positive studies (of whatever minimal sample size), they don't care as much about how many equivocal studies (also a red flag).

The report explicitly does NOT say the underlying mechanism is evidence-based. It operates on the assumption ("ausgegangen") that what the applicant (the EMDR association) says is correct. E.g. the methodological underpinning and reliability of these studies in these journals. They also threw out 13 of 21 provided studies due to methodological problems ("limitations of study quality (too small sample size, no actual control group, no standardization of study instruments, or patients didn't have PTSD") — ("Limitationen der Methode vorliegen Studienqualität (zu kleine Stichproben, keine echte Kontrollgruppe, keine standardisierten Instrumente, Patienten haben keine PTBS") and threw out a further 5 non randomized studies and 3 non controlled studies. This left them with 8 RCTs. Of these, they state the studies establish EMDR is effective. Although it is also about as effective as exposure therapy ("obwohl sie in einigen Studien mit den Wirkungen einer Expositionsbehandlung vergleichbar ist.")
AND importantly! They also say … "(it should be understood that the scientific evidence for the effectiveness of techniques specific to EMDR (especially bilateral stimulation) has not been clearly established.)" - ("Es sollte jedoch beachtet werden, dass der wissenschaftliche Beweis für die Wirksamkeit der EMDR-spezifischen Techniken (insbesondere der bilateralen Stimulation) noch nicht eindeutig erbracht wurde.")

They go on to say: "two meta-analyses found in scientific journals conclude that EMDR is effective compared to no-treatment controls and without exposure therapy, but no difference to exposure therapy could be demonstrated." - ("Vielmehr kommen die beiden in wissenschaftlichen Fachzeitschriften veröffentlichten Metaanalysen zu dem Ergebnis, dass die EMDR-Methode im Vergleich zu Kontrollbedingungen und Behandlungen ohne Traumaexposition wirksam ist, jedoch kein systematischer Unterschied zu Expositionsbehandlungen nachgewiesen werden konnte.")

So, I would say the use of the source as done here by JCJC777 was a bit of a cherry pick. It leaves out some very important caveats in the source. And if we're going to use it, I would put emphasis on these caveats, which are pretty glaringly large. — Shibbolethink ^{(♔ ♕)} 23:17, 13 April 2023 (UTC)

Wow! I don't think anyone else is going to be able to give a better analysis of this source, so let's go with this. Loki (talk) 00:16, 14 April 2023 (UTC)

Short footnotes and bibliography

Was thinking of adding to the History section of the article, but i can't really deal with inline <ref> in the text. Any objections to moving to a Template:Sfn style and organizing the bibliography? E.g. for Thyer 2015? Don't have to have multiple Template:cite book for different pages, and keeps the quote at the appropriate place in text. fiveby(zero) 15:15, 14 April 2023 (UTC)

I object. It is generally preferable to keep the citations near the content they support, and to remain compatible with the visual editor's style of citation. MrOllie (talk) 16:10, 14 April 2023 (UTC)

Oh, but it is so much cleaner and easier, and it aids the reader by making the list of references useful for them. It's probably easier to maintain as text is moved and changed when a works is cited multiple times. Why have a duplicate citation template every time you need to refer to a different page? Don't know anything about visual editor. fiveby(zero) 16:29, 14 April 2023 (UTC)

If page numbers are a concern, the {{rp}} template can be used with inline cites. MrOllie (talk) 16:42, 14 April 2023 (UTC)

Thanks for that template, do you know if there is also a way to organize the {{reflist}} and but still keep the refs inline? For instance in that Daniel article, it's easy to look in the bibliography and see which of John J. Collins works are cited, if there are any missing, and find the corresponding article content. fiveby(zero) 16:54, 14 April 2023 (UTC)

There is some support for this, see WP:REFGROUP. I think actually using it is considered a change of citation style that needs talk page support, though. I don't personally care about grouping inline refs in that fashion either way. MrOllie (talk) 16:58, 14 April 2023 (UTC)

Would list-defined references work with visual editor? Maybe we're getting into a more trouble than it's worth type situation, just think bibliographies are useful and a good measure of WP:BESTSOURCES. fiveby(zero) 17:12, 14 April 2023 (UTC)

We should keep them inline. MrOllie (talk) 17:47, 14 April 2023 (UTC)

Bessel van der Kolk

This edit added the text "The Dutch-born researcher and psychologist Bessel van der Kolk, author of The Body Keeps the Score, has endorsed EMDR as one of the most effective ways to treat PTSD symptoms. However, an editor reverted it with the edit summary "undue lay sources".

Chapter 15 of Van der Kolk's book is on EMDR. On page 369 he summarizes the reasons why he he finds it intriguing and of value: it's action is rapid, people unwilling or unable to talk about their traumatic experience can still get relief, and this is useful because those seeking help with trauma may find it difficult or impossible to form a trusting relationship with a therapist.

Bessel van der Kolk: “EMDR loosens up something in the mind/brain that gives people rapid access to loosely associated memories and images from their past. This seems to help them put the traumatic experience into a larger context or perspective. People may be able to heal from trauma without talking about it. EMDR enables them to observe their experiences in a new way, without verbal give-and-take with another person. EMDR can help even if the person and the therapist do not have a trusting relationship. This was particularly intriguing because trauma, understandably, rarely leaves people with an open, trusting heart.”

Some have argued that CBT or standard exposure therapy (ET) is the same as EMDR, but there are key differences that can make a substantial difference to a given individual for whom both types of therapy (CBT & ET) have already failed to provide any relief for the reasons Van der Kolk recognizes. Regardless, he is a published, subject matter expert on trauma - not a "lay source". Cedar777 (talk) 22:58, 13 April 2023 (UTC)

Sources

The source cited is his lay press book (Penguin books). So yes, it is a lay press source, regardless of the author. It was not published by an academic press. It is not comparable to the academic articles and position statements written by Van Der Kolk, which we already cite in this article. — Shibbolethink ^{(♔ ♕)} 23:23, 13 April 2023 (UTC)

What P&G are you referring to that states only academic publishers are permitted as sources? Cedar777 (talk) 23:34, 13 April 2023 (UTC)

That's not what I claimed. It's simply correct to state the source is a "lay source" and also correct to say that using it as a MEDRS is not ideal, and pretty explicitly discouraged per WP:MEDASSESS.

I would also agree with the reversion that it may be UNDUE, given that it's a lay source, and especially given that we already have multiple sources which are from Van Der Kolk's organization (ISTSS) in the article. This, compared to the sources already used, is of a much lower quality.

if we are to use Van Der Kolk as a single RSOPINION, I think we should probably find a better source for him. In an academic press or expert review paper, etc. — Shibbolethink ^{(♔ ♕)} 23:37, 13 April 2023 (UTC)

On the one hand, van der Kolk is enough of a big name in trauma research that his opinion oughta be notable on its own, separate from bigger organizations that he belongs to. On the other hand, I have two quibbles: one is the one Shibbolethink noted that we ideally should get his opinion from an academic source. And the other one is that he seems to be endorsing Shapiro's original theory for why EMDR works, which doesn't really have much support in the sources otherwise. This doesn't make his opinion useless (after all, he is just as much an expert as the experts who say otherwise) but it does make him a minority position in the field, which means we should definitely attribute his opinions to him rather than citing him for bigger claims. Loki (talk) 00:23, 14 April 2023 (UTC)

Upon some basic Googling, van der Kolk has also co-written (or at least, edited?) this book by an academic publisher, which we don't currently cite. I'll try to get my hands on a copy and see if the authors mention EMDR anywhere. (I will say though, it was published in 2007 so it's a bit old for a medical source.) Loki (talk) 00:34, 14 April 2023 (UTC)

Update: Found a paper copy, and they do! Big quotes follow:

p455: EMDR, a new treatment for PTSD using rapid rhythmic eye movements, has been described by Francine Shapiro (1989, 1995). The patient is told to maintain an image of the original traumatic experience, and is encouraged to simultaneously evoke the event and associated feelings while engaging in the eye movements. Although some of the initial studies suffered from serious methodological flaws (Herbert & Mueser, 1992), a steady output of successful case reports has encouraged further investigation of EMDR. While one preliminary report by Lyde (cited by Metter & Michelson, 1993), comparing EMDR with non-eye-movement desensitization and a nondirective counseling session, suggested that EMDR was not significantly different from the controls and possibly less efficacious than having the subjects "stare at a dot on the wall," other studies are very encouraging and indicate that this new form of treatment, despite its incomprehesible technique, seems to be capable of producing powerful therapeutic effects in some patients with PTSD (Wilson et al., 1995; Vaughan et al., 1994a, 1994b).

p498: A new technique, eye movement desensitization and reprocessing (EMDR; Shapiro, 1989) is a form of exposure (desensitization) with a strong cognitive component accompanied by saccadic eye movements. Briefly, the technique involves the client's imagining a scene from the trauma, focusing on the accompanying thoughts and physiological arousal, and tracking the therapist's rapidly moving finger. The sequence is repeated until the client no longer reports anxiety, at which point the client is instructed to adopt a more positive thought while imagining the trauma and continuing the eye movements. The efficacy of EMDR is equivocal. Proponents of this treatment have interpreted the reported anxiety reduction within a treatment session as indicative of its success (e.g., Lipke & Botkin, 1993; Shapiro, 1989). However, they did not include standardized outcome measures such as PTSD symptom ratings or depression inventories, so that the efficacy of EMDR cannot be ascertained.

Two controlled studies have compared EMDR to an exposure control (eyes fixed) treatment (Boudewyns, Stwertka, Hyer, Albrecht, & Sperr, 1993; Pitman et al., 1993) and inpatient milleu treatment (Boudewyns et al., 1993). It appears that in both studies, within-session reported anxiety decreased more in the EMDR group than in the exposure control group. However, neither study detected differences between the groups on outcome as assessed by standardized self-report measures or psychophysiological reactivity to taped accounts of the trauma (Boudewyns et al., 1993). When one considers these two studies on the usefulness of EMDR, it is also important to remember that both utilized Vietnam veterans—a population that may be resistant to treatment in general.

In summary, exposure techniques have received strong support for their ability to alleviate posttraumatic suffering. [section following goes on to discuss the general lack of effectiveness of exposure techniques in Vietnam veterans; won't quote at length unless others think its relevant]

p548-549: After an initial flurry of single-case reports and open studies, a number of systematic studies of EMDR have been conducted in recent years. Positive results have been found in at least four controlled studies (Shapiro, 1989; Wilson, Covi, Foster, & Silver, 1993; Wilson, Tinker, & Becker, in press; Vaughan, Wiese, Gold, & Tarrier, 1994), equivocal results in two studies (Boudewyns, Stwertka, Hyer, Albrecht, & Speer, 1993; Pitman et al., 1996a), and negative outcomes in two studies (Jensen, 1994; Sanderson & Carpenter, 1992). The equivocal and negative studies were conducted on very chronic populations; such patients have also proven resistant to pharmacological (e.g., van der Kolk et al, 1994) and cognitive-behavioral (Pitman etal., 1996b) interventions. In the EMDR studies with positive treatment outcomes, beneficial effects have particularly been demonstrated in the frequency and intensity of intrusive recollections, such as nightmares and flashbacks (e.g., Vaughan et al., 1994; Shapiro, 1995; Wilson et al., in press).

Because The Body Keeps The Score is a more recent work, it may be worth mentioning briefly to say how van der Kolk's opinion has changed. But aside from that one note, I'd prefer mainly sourcing this, it definitely seems more rigorous to me.

Some notes:

• Van der Kolk calls EMDR an exposure therapy with strong cognitive components. He in general seems pretty unambiguous that he considers it to be a form of exposure therapy.
• He mentions its "incomprehensible technique" once, and seems to be generally optimistic for but not entirely convinced of its efficacy. If the quote from Cedar777 above is at all typical, he seems to have become more convinced on this point more recently.
• He mentions a so-far novel explanation for EMDR's lack of efficacy in some early studies, namely that Vietnam veterans in general respond worse to any kind of exposure technique. This seems to be unique to him AFAICT, so we should definitely attribute him if we mention this.

Loki (talk) 05:00, 14 April 2023 (UTC)

A book from 1996? Bon courage (talk) 05:05, 14 April 2023 (UTC)

Hmm, the most recent printing is from 2008 but you're right that this information doesn't seem to have been updated. Loki (talk) 07:19, 14 April 2023 (UTC)

Because re-prints just ... re-print. Bon courage (talk) 07:36, 14 April 2023 (UTC)

• I'd say leave it out. When we have national guidelines and MEDRS in play why add some guy's view too? especially when the sources are a bit crappy. WP:UNDUE. Bon courage (talk) 03:53, 14 April 2023 (UTC)

  We have other sources that are the opinion of a single expert author, like the Science Based Medicine source which we quote from at length, or the book by Luis Cordón who we also name when giving his opinions. Now, both of those sure are reliable sources, but their presence in the article means the opinions of individual experts are in fact relevant to the article.

  This is especially the case for van der Kolk, who's been the head of several big professional organizations and is probably the best known trauma researcher alive. His opinion isn't going to overrule the consensus of the sources or anything, of course, but it's notable enough to mention it briefly. Loki (talk) 04:33, 14 April 2023 (UTC)

  The other stuff is not for the MEDRS aspects, but for history, classification, pseudoscience and so on. Needed content. But when we have MEDRS for the biomedical aspects adding "and this person thinks so too" from a weak source is undue, especially since his view is already incorporated in the MEDRS we include. Bon courage (talk) 05:16, 14 April 2023 (UTC)

  "the opinions of individual experts" in the context of FRINGE are included to establish WP:PARITY. Van der Kolk, on the other hand, could be used as SECONDARY or maybe TERTIARY for WP:MEDRS, but those outdated quotes seems to underscore what is already in the article--that the treatment has a lot of practitioners and patients who swear by it, but rigorous results are mixed, the mechanism unclear, and it is most likely a form of exposure therapy. DolyaIskrina (talk) 17:51, 14 April 2023 (UTC)

Consensus to add a source

Does this source:

support adding a line to the Effectiveness section saying "though some researchers maintain that EMDR's distinctive features do contribute to its effectiveness"?

I don't see any way to dispute that it does: this is a high quality WP:TERTIARY source by experts in the area. It says directly that Cuijpers and Lee's meta-analysis supports the use of the eye movements (including responding to criticism of their meta-analysis) and goes on to offer explanations for why the eye movements are effective.

However, I was reverted when trying to add it, so I'm coming to the talk page to ask about it. Loki (talk) 00:39, 16 April 2023 (UTC)

Seems a bit misleading to include a quotation and leave out a key bit

However, a meta-analysis of randomized controlled trials and laboratory studies specifically tested the additive benefit of bilateral eye movements and indicated that eye movements did produce statistically reliable clinical benefits (Lee and Cuijpers 2013). In a critique of this meta-analysis, Devilly et al. (2014) raised methodological objections to which Lee and Cuijpers (2014) replied. Several explanations have been put forward ...

I think the most this source (which was already cited) can be used for in this respect, is to restate that research into EMDR has been criticized for poor quality. Bon courage (talk) 06:04, 16 April 2023 (UTC)

Certainly that is part of the source, and I have no problem talking about that bit (but note that Lee and Cuijpers replied to the objection). But that bit doesn't cancel out the part of the source which says that at least some researchers do believe that the eye movements do something.

Alternatively and/or in addition, how about adding the NYT source where McNally says he now believes the eye movements are useful? NYT is not usually a WP:MEDRS quality source, but if they're quoting an expert in the field, I think they're usable for the direct quote. Loki (talk) 18:52, 16 April 2023 (UTC)

It kind of does "cancel it out", to the extent that mentioning one but suppressing the other is what we call WP:PROFRINGE POV-pushing. And no the NYT is not "not usually" MEDRS, it is never MEDRS. Again, POV-pushing. Stick to the best sources. Bon courage (talk) 18:59, 16 April 2023 (UTC)

So, I think you've failed to read the part where I said "I have no problem talking about that bit". I'm fine with mentioning both halves. Loki (talk) 02:09, 17 April 2023 (UTC)

We don't need to say "at least some researchers do believe that the eye movements do something" We already show that perspective with multiple statements and citations throughout the article. Over-emphasizing it like this is just raising a perspective above its merit in the literature. — Shibbolethink ^{(♔ ♕)} 16:53, 17 April 2023 (UTC)

In general, I think the editing approach which is: let's do a WP:PROFRINGE edit and skew the source, and see if anybody else notices to clean it up - is getting old very quickly. Bon courage (talk) 17:16, 17 April 2023 (UTC)

(edit conflict) Eh, y'know what, I think you've actually convinced me on this. I was going to argue for weakening the language of the previous sentence if that's what you think (i.e. "it's been criticized as a purple hat therapy because critics say its effectiveness comes entirely from the parts that are similar to exposure therapy") but looking at the sources, it seems like even many supporters of EMDR, like van der Kolk and the NHMRC, support it as a kind of exposure therapy.

There definitely are some neutral experts who think the eye movements really are effective, but it seems like that WP:MEDRS quality RSes tend to mention that one meta-analysis but don't really go further into saying that it means the eye movements definitely are effective, the way other sources are emphatic about its overall effectiveness. As such it's hard to really pin anyone down to the opinion that the eye movements work, and if we don't have sources saying a thing we can't say it.

I do think we should be clearer in splitting out "EMDR's effectiveness is probably mostly due to the exposure-like parts" from "it is therefore a purple-hat therapy (i.e. ineffective junk added to a known effective treatment)" from "it is pseudoscientific", because we have a bunch of sources that say 1 but not 2 or 3, and some that say 1 and 2 but not 3. Loki (talk) 17:17, 17 April 2023 (UTC)

Please add neurological evidence for effectiveness

This article seems pretty biased against EMDR. Please review the journal article from the Journal of Neurology which is a metanalysis and includes several peer-reviewed studies that show the effects of EMDR on the brain. https://www.jneurology.com/articles/scientific-evaluation-of-emdr-psychotherapy-for-the-treatment-of-psychological-trauma-summary-scientific-evaluation-of-emdr-psycho.html 2600:1700:8450:6B50:CDC6:7DF7:8638:3FEA (talk) 23:45, 31 May 2023 (UTC)

 Not done Predatory source. Bon courage (talk) 04:49, 1 June 2023 (UTC)

Economic aspects

We have no information on market size, training or session fees. I added some but Cedar777‎ just reverted it all for no good reason. What is going on? Bon courage (talk) 06:54, 14 April 2023 (UTC)

Seems WP:DUE to me. And using it there does not rule out using that meta-analysis elsewhere, if done so in an appropriately weighted fashion. — Shibbolethink ^{(♔ ♕)} 11:07, 14 April 2023 (UTC)

I wouldn't use that journal for anything biomedical, but for pricing stuff it's just fine. Now: is there a source for how much sessions typically cost? Bon courage (talk) 11:11, 14 April 2023 (UTC)

Looks like POV pushing to single out those details from a source titled "Effectiveness of EMDR for decreasing symptoms of over‐arousal: A meta‐analysis". Does more than one source report on these details? The fixation on pricing doesn't do much to serve the readers . . . but it does advance a POV that implies the VA, WHO, and other WP:MEDORGs have been duped (along with any survivors of sexual assault and veterans with PTSD who have been helped by this therapy). Cedar777 (talk) 15:37, 14 April 2023 (UTC)

What silly rubbish. How does pricing imply anybody has been "duped"? Following sources is not "POV-pushing" (except perhaps in the minds of WP:PROFRINGE editors). If you want to propose a less good source for this, then let's see it! Bon courage (talk) 15:51, 14 April 2023 (UTC)

Here's my questions: do other similar articles include this information? Do sources mention these costs more for EMDR than for other psychotherapies? Is the place that changes that really the only place to get training in EMDR? What do training costs look like for other psychotherapies?

If they really are exceptional in some way, I can see the argument that they're WP:DUE. But if they aren't notably different from other psychotherapies, and articles on those therapies don't include equivalent info, including them here probably isn't WP:DUE. Loki (talk) 17:08, 14 April 2023 (UTC)

Wikipedia operates by WP:PAGs, not "what other articles do", especially low-grade articles. In any article being improved, yes, it is common for pricing to be included. And for a pseudoscience topic apt where health fraud is in play. Bon courage (talk) 17:14, 14 April 2023 (UTC)

A) There is no mention of cost in either of the lengthy articles for Dialectical behavior therapy or for Cognitive behavior therapy. B) The inclusion of pricing information in medicine articles in general has no consensus WP:MEDMOS2020. C) policy What Wikipedia is not includes, "an article should not include product pricing or availability information unless there is an independent source and a justified reason for the mention [...] Wikipedia is not a price comparison service to be used to compare the prices of competing products, or the prices of a single product from different vendors." Cedar777 (talk) 17:34, 14 April 2023 (UTC)

That dispute was about "pharmaceutical drug prices". EMDR is not a pharmaceutical drug. Information about market size/pricing/etc, if included in high-quality sources, is due. We're not doing an EMDR 'price comparison'; just reflecting what decent sources say about EMDR pricing in general. Which is good! Bon courage (talk) 17:39, 14 April 2023 (UTC)

The argument that "it is common for pricing to be included" is not supported by the CBT or DBT article and is also generally refuted by the RFC. What is there to back up this opinion? Cedar777 (talk) 18:03, 14 April 2023 (UTC)

To repeat, we don't go by other (poor) articles. The aim (my aim anyway) is to get this one good. If you want to get back to your preferred text, other than by continually reverting, maybe try an RfC or something? Bon courage (talk) 18:09, 14 April 2023 (UTC)

The reason there is no price listed for DBT or CBT is probably that these are both much less standard than EMDR, which is basically invented and run as a business by one person (and her followers). Not a very comparable situation to DBT or CBT, and there is no Wikipedia-wide consensus on this.

More comparable articles would probably be Psychopathy Checklist, Conversion therapy, which both list some other aspects of the economics of a pseudoscientific treatment. But I cannot think of a single therapy which is truly similar to EMDR's situation with near-monopoly on "official" training by a live inventor.

I think BC is right, we would need a local RfC to determine whether this information is DUE for this page, if you wish to go against any local consensus. — Shibbolethink ^{(♔ ♕)} 21:09, 14 April 2023 (UTC)

Well, do we have sources for the near-monopoly on training?

I think that situation as a whole if it can be sourced is probably WP:DUE. We do sometimes note price on medical articles if the price itself or how it was arrived at is notable, for instance on Epi-Pen. But in general I'd be against including pricing information in a vacuum: the thing that would be giving it encyclopedic value is the context surrounding it, not the number a particular organization is charging by itself.

At least based on the first source I was able to find on a simple search it doesn't appear that the training price for EMDR is out of line with that of other forms of therapy (though this study didn't include EMDR on its list so it's not a direct comparison), which also IMO cuts against including it. Loki (talk) 23:33, 14 April 2023 (UTC)

I'm unclear why pricing info is DUE, and what encyclopedic value it has that makes it an exception to WP:NOTPRICE --Hipal (talk) 16:36, 19 April 2023 (UTC)