Not another EMDR thread! (actually, it's a new research article)

[cara susanna]

Hi all,

Wanted to draw your attention to this 2024 state of the science article on EMDR, which concludes that, despite all of the dismantling studies, there is indeed some scientific evidence for EMDR. The idea is that it taxes working memory, allowing the trauma memory to be reconsolidated in a less vivid or intense manner https://onlinelibrary.wiley.com/doi/full/10.1002/jts.23012

You can also see Sadie Larsen from the NCPTSD interviewing the study authors here:

Incidentally, de Jongh is the first author of my favorite article criticizing CPTSD as both a construct and needing separate treatment guidelines. This surprises me because usually the EMDR camp and CPTSD camp tend to overlap.

Thoughts? Obviously I'm not gonna go run out and get trained in EMDR (or ever), but I am open to reconsidering my radically opposed stance on it, and this is the most compelling argument I've seen so far.

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[WisNeuro]

I'm always willing to revisit things in relation to new data, but I am still fairly skeptical. I'm making way way through the citations in "Several scientists in the field of neurobiology and experimental psychopathology have since developed theories to account for the distinctive effects of EMDR (e.g., Baek et al., 2019; Günter & Bodner, 2008; van den Hout & Engelhard, 2012; de Voogd et al., 2018; de Voogd & Phelps, 2020)," and they have been....not very compelling. They're all pretty much low n studies looking at experimental paradigms, and even then the findings are best described as mixed. I'll keep checking some of the other citations, but I am underwhelmed by the evidence thus far.

 

[Ollie123]

Been tangentially following the cognitive load/extinction work as it peripherally relates to my current NIH funding.

Exposure works so EMDR works, I don't think that was really ever in question. We can debate relative efficacy, but distinction between two exposure-based treatments is almost certainly going to be minimal. What was typically discussed was the voodoo pseudoscience around the eye movements as a key mechanism for driving effects. If anything, these studies seem to DISPROVE the intended mechanism and instead suggests interesting interplay between cognitive load and exposure. This runs actually somewhat counter to classic behavioral theories, which would suggest that "distractions" from the source of anxiety should interfere - not aid - in exposure. They didn't come out of nowhere and there was a pretty solid literature to support it if memory serves, so I'm wondering how these two pieces fit together.

TLDR - If instead of creating what is basically a cult and charging a billion dollars a training, Shapiro had just said "I think exposure actually does work better if you tax cognition. So while doing PE, maybe have them do an N-back, count backwards by seven, play where's waldo or wave your hands back and forth in front of their face - it doesn't matter which, just something" we would likely still have questions, but I don't think any of us would have the reaction to EMDR we do now.

 

[EnPsychlopedia]

Cuijpers et al. seemed to soften their stance on BLS as a useful mechanism in their 2020 article: https://www.tandfonline.com/doi/abs/10.1080/16506073.2019.1703801

I know their 2013 article is featured prominently among those who support the hypothesis, and I admittedly do not know enough about the other working memory taxation articles to opine too strongly. I will note that there is a substantial critique of the working memory taxation hypothesis in Lilienfeld et al. (2015). Science and Pseudoscience in Clinical Psychology.

 

[EnPsychlopedia]

This also seems to hinge on the assumption that EMDR has "distinctive" effects. I was under the impression that the literature basically shows no real additive utility to bilateral stimulation as a component of the treatment...if that is true, what it is the supposed distinctive effect?

 

[futureapppsy2]

This also seems to hinge on the assumption that EMDR has "distinctive" effects. I was under the impression that the literature basically shows no real additive utility to bilateral stimulation as a component of the treatment...if that is true, what it is the supposed distinctive effect?

Yeah, that’s my understanding as well—that exposure is the mechanism of effect for EMDR, and there’s not strong evidence that the bilateral stimulation adds anything (except maybe increasing patient buy-in in some cases). It seems like if it were truly additive, we would see a strong pattern of improved outcomes in EMDR as compared to PE.

 

[MCParent]

It was explained to me in a thing I went to that the eye movements “unclog the patient’s brain pipes.”

 

[WisNeuro]

It was explained to me in a thing I went to that the eye movements “unclog the patient’s brain pipes.”

Much like the internet, it's a series of tubes.

 

[Ollie123]

It was explained to me in a thing I went to that the eye movements “unclog the patient’s brain pipes.”

Well damn. Sounds like Shapiro missed an entire market and we need to get this approved for stroke prevention too!

I'm assuming "brain pipes" are the technical term for vasculature...

 

[MCParent]

I'm assuming "brain pipes" are the technical term for vasculature...

…sure.