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Author Topic: TREATMENT: EMDR Therapy  (Read 7065 times)
BehindMeSatan
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« Reply #30 on: November 09, 2007, 06:11:43 AM »

I don't know if this is the appropriate forum for this, but I just can't stop from going on about it!  I would assume it's common among those of us who have stayed in abusive relationships that we weren't brought up with a healthy image of ourselves and subconsciously believe that we deserve the abuse, or more simply, that it's just how life is.  I don't think I ever really believed I deserved it per se, but more likely I took it in stride...knew I didn't deserve it, but due to the emotional abandonment that went with the emotional abuse of my childhood, I guess I was (am?) always holding on to who I had because it meant I wasn't alone.

After therapy for years off and on, I found what I've needed all along in EMDR.  After 3 sessions, I can't put a finger on it or list the things I've learned or precisely what it is that happened inside of me, but I know I just feel DIFFERENT.   Since I'm very short on time right now let me just explain that the first session I was told to focus on what I believed to be the most traumatic or abusive incident in my childhood.  I chose the night when I was 8 or 9 years old and it was the first time my mother "turned" on me during one of her frequent late night drunks.  I started off (in my memory) being a crying, hurt child not understanding at all what I had done to make my mother hate me so.  It was such a shift from her usual sweet loving self who was always on my side, loved me no matter what.  Then I switched to the most despicable, disappointing and embarrasing creature.

By the end of the session I was an adult standing across the room from her, looking at this crazy old drunk lady going on and on about something - raging and angry, but it had NOTHING TO DO WITH ME.  She wasn't talking to me or about me - she was mad as hell, but not at me.  The therapist asks at the beginning to rate your disturbance level on a scale from 0 to 10 when you think about that incident... it started as a 9 and miraculously reduced to 0... her abuse had nothing to do with me.  That session was a month ago and the results have been lasting... my memory of that is just a blip, and not disturbing to me whatsoever.

The next 2 sessions were a little more intense, I was moved to tears, to sobs at some points, and it took more than one session to get me "through" but after Tuesday I believe I'm "through"... wish I had more time, but I just wanted to get this out there.

I just feel different.  My feelings towards BPDbf are different, I don't feel that panic of loneliness or need to make him understand... I'm just different, and I know I keep saying that, but I'm just in awe... I wish I could explain it but I can't.  But the main thing is that it's working.


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« Reply #31 on: November 11, 2007, 02:49:42 PM »

This is a dicussion of the controversy.  bpdfamily neither encourages or discourages thee use of this therapy - this information is provided to help advance the discussion.

COUNTERPOINT: Evaluating EMDR in Treating PTSD
by Shawn P. Cahill, Ph.D.
July 2000, Vol. XVII, Issue 7
www.psychiatrictimes.com/p000741.html


Eye movement desensitization and reprocessing (EMDR) (Shapiro, 1995, 1989), a relatively new form of psychotherapy, is controversial. I will focus on two aspects of this controversy. The first involves various claims that, compared to other forms of cognitive-behavioral therapy (CBT) that have received empirical support as treatments for posttraumatic stress disorder (PTSD), EMDR is 1) as efficacious, or more so; 2) more efficient, in that it requires fewer sessions; and 3) more acceptable to clients and therapists alike (Pitman et al., 1996; Shapiro, 1999, 1996). The second aspect involves claims that EMDR operates through different (or additional) mechanisms than other forms of CBT, especially exposure therapy (Shapiro, 1999, 1996; Van Etten and Taylor, 1998).

To evaluate the first set of claims, I will summarize the literature on the efficacy of CBT for PTSD and discuss studies in which EMDR has been compared with other forms of treatment. This answers the question, "To what extent have EMDR and CBT been compared in the treatment of PTSD?" Conclusions about the relative merits of any two treatments must be based on direct comparisons in the same randomized study.

To evaluate the second claim, I will summarize dismantling studies that have evaluated the effects of specific components of EMDR. Repeated imaginal exposure to trauma-related memories, an important component of EMDR, has been found to be an effective treatment for PTSD (Foa et al., 1999; Cooper and Clum, 1989; Marks et al., 1998). The principle of parsimony suggests we should assume EMDR affects treatment outcome through imaginal exposure until there is evidence for a contribution of the non-exposure elements of EMDR (e.g., eye movements) to treatment outcome.

Finally, a number of studies evaluating EMDR utilized samples in which participants were not required to meet full DSM-IV criteria for PTSD. Of the EMDR studies that compared outcomes of those with full- versus partial-PTSD, the only effect seems to be for diagnosis. Although both groups improved, participants with full-PTSD were more symptomatic than those with partial-PTSD, both before and after treatment (Wilson et al., 1997). There is no evidence for differential improvement as a function of diagnosis (Scheck et al., 1998; Wilson et al., 1997). Therefore, I have chosen to not risk losing potentially valuable information by arbitrarily limiting myself to studies that utilized full-PTSD samples. Instead, I will use the more general term posttraumatic stress reactions (PTSR) when referring to studies that included both full- and partial-PTSD patients, while the term PTSD will be reserved for all studies in which participants met full criteria for PTSD.
Comparative Efficacy

Cognitive-Behavioral Treatments

There is growing evidence for the effectiveness of three types of (non-EMDR) CBT interventions in the treatment of PTSD. The best-researched is prolonged exposure (PE) (Boudewyns and Hyer, 1990; Foa et al., 1999; Foa et al., 1991).

In PE, clients repeatedly confront thoughts and reminders of the traumatic event until their anxiety decreases, along with their symptoms of PTSD. The treatment is similar to that for other anxiety disorders (Barlow, 1988): intensive, prolonged and repeated imaginal exposure and, in more comprehensive programs, in vivo exposure. For example, the PE protocol developed and evaluated by Foa and colleagues ( Foa et al., 1999; Foa and Rothbaum, 1998; Foa et al., 1991) comprises client education, instruction in controlled breathing and seven weekly sessions of imaginal exposure. Daily homework consists of imaginal exposure and gradual in vivo exposure to situations that cause anxiety or avoidance but are objectively safe.

An alternative approach, based on Meichenbaum's work (1977), is stress-inoculation training (SIT) (Foa et al., 1999; Foa et al., 1991). Clients learn a variety of anxiety management skills (e.g., breathing retraining, relaxation, thought stopping, cognitive restructuring and guided self-dialogue) through instruction, role-playing and covert modeling that they then apply in their daily life.

Finally, recent research suggests that variants of cognitive restructuring (Marks et al., 1998; Tarrier et al., 1999) may have promise in the treatment of PTSD. Cognitive restructuring for PTSD helps people identify trauma-related automatic thoughts, evaluate them for accuracy and replace them with more accurate beliefs. Contrary to expectations, combining elements of these different protocols, such as PE with either SIT (Foa et al., 1999) or cognitive restructuring (Marks et al., 1998), has not yielded better outcomes than individual treatments. If anything, adding SIT or cognitive restructuring to PE slightly reduced the short-term efficacy of PE.

Comparisons With Other Treatments

EMDR has been compared with several other treatments utilizing PTSD and PTSR samples, such as relaxation (e.g., Carlson et al., 1998; Vaughan et al., 1994), active listening (Scheck et al., 1998) and "treatment as usual" (Edmond et al., 1999; Marcus et al., 1997). None of these interventions, however, have been independently established to be effective in treating traumatized populations. No published studies have directly compared EMDR with SIT or cognitive restructuring, and only Devilly and Spence (1999) and Vaughan et al. (1994) have directly compared EMDR to a non-EMDR exposure protocol (Cahill et al., 1999). Further, both of these studies suffer from significant limitations and have yielded contradictory results.

Vaughan et al. (1994) compared EMDR with a treatment called image habituation training (IHT) (Vaughan and Tarrier, 1992). IHT is an imaginal exposure treatment in which clients create six brief tape-recorded descriptions of recurrent intrusive trauma-related images. Each description is followed on the tape by 30 seconds of silence, during which clients imagine the described event as vividly as possible. Clients are instructed to listen to their tape for 60 minutes each day, while recording cognitions and anxiety as homework.

Overall, EMDR and IHT produced comparable results. Shapiro (1996), however, suggested that EMDR was more efficient because IHT required one hour of homework per day in addition to the three to five therapy sessions provided in the study, whereas EMDR did not require homework. Unfortunately, Vaughan et al. (1994) did not report on homework compliance.

Scott and Stradling (1997) raised this concern. In their study, only one of the 14 participants provided with IHT training completed homework as prescribed. Four additional participants completed daily homework of significantly shorter duration, from three to 30 minutes. In the absence of evidence that IHT participants in the Vaughan et al. (1994) study did the prescribed homework, it would be premature to conclude that EMDR was more efficient than IHT because of the homework requirement.

A further limitation of the Vaughan et al. (1994) study is that IHT differs in many ways from the exposure protocols used in other studies of PTSD. Compared to Foa's exposure protocols (Foa et al., 1999; Foa et al., 1991; Marks et al., 1998), IHT utilizes repeated brief exposures to multiple images in rapid sequence, rather than prolonged exposure to a single complete memory followed by focused work on "hot spots." Nor does IHT incorporate in vivo exposure. In addition, there are no independent studies validating the efficacy of IHT for PTSD or comparing it with the more intensive exposure protocols. The only other published outcome study of IHT (Vaughan and Tarrier, 1992) utilized an uncontrolled pretest/posttest design. Scott and Stradling (1997) did not report outcome in their study. Therefore, although participants in the Vaughan and Tarrier (1992) study reported improvement in their symptoms of anxiety and PTSD, the lack of a no-treatment control group precludes attributing improvements to the specific procedures of the intervention.

Devilly and Spence (1999) compared EMDR with a cognitive-behavioral package called Trauma Treatment Protocol (TTP), consisting of prolonged imaginal and in vivo exposure, elements of SIT and additional cognitive therapy interventions. Both protocols called for an initial clinical assessment followed by up to eight treatment sessions. Participants in both groups displayed improvement over the course of treatment, but TTP yielded significantly better outcome than EMDR immediately after treatment and at the three-month follow-up assessment. These authors also devised a self-report mea-sure to assess distress levels and intrusiveness produced by the treatments and found them to be equivalent on these variables.

Although these results suggest that this comprehensive cognitive-behavioral intervention is superior to EMDR, they need to be interpreted with caution. The study's primary methodological weakness is that participants were not randomly assigned to conditions. Instead, the first 20 participants were treated in two groups of 10, with the first 10 referrals treated with one intervention and the second 10 treated with the other intervention, although it had been determined by chance that TTP would be administered first. Additional participants were randomly assigned to treatment conditions. The final participant who was supposed to be assigned to EMDR received TTP instead, because preliminary analyses already indicated better outcomes with TTP. The authors, therefore, felt ethically obliged to provide this participant with TTP.

Unfortunately, re-assigning participants on the basis of preliminary analyses assumes the very outcome the study was designed to evaluate, possibly biasing results in favor of the nominally superior treatment. A second limitation of this study is that the senior author, who synthesized the TTP intervention, served as the primary therapist in both treatment conditions. This raises the possibility of differential alliance to or familiarity with the two treatments as another alternative explanation for the findings.

In summary, neither the study by Vaughan et al. (1994) nor the one by Devilly and Spence (1999) provides an adequate basis for determining the relative efficacy, efficiency or acceptability of EMDR and CBT. Given the absence of any published, methodologically sound studies that directly compare EMDR and CBT, there is presently no adequate empirical basis for drawing conclusions about the relative merits of EMDR and CBT.
Mechanisms of EMDR

Dismantling studies identify important elements of a treatment package by comparing the full treatment with variations in which one or more components have been removed. These studies of EMDR focus mainly on eye movements or other laterally alternating stimuli. A recent narrative review (Cahill et al., 1999) identified six studies utilizing PTSR populations that compared EMDR with a no-eye-movement condition. Four of the six studies in Cahill et al.'s review (1999) found no differences between the two conditions. The two remaining studies found EMDR superior to the no-eye-movement condition on assessment measures taken during treatment sessions, but not on posttreatment outcome measures.

For example, both studies found EMDR produced greater reductions in subjective units of distress (SUD) ratings obtained during treatment sessions. Boudewyns et al. (1993) also rated more participants in the EMDR condition as treatment responders than in the no-eye-movement condition. Analysis of skin conductance levels during the first and last treatment sets in the Wilson et al. study (1996) showed within-set reduction for the EMDR group, in contrast to no within-set changes for the control group. However, no group differences were found on any outcome measure in the Boudewyns et al. (1993) study, not even posttreatment SUDs.

Neither group improved significantly, nor were they any different from a third standard care control group. Wilson et al. (1996) did not assess treatment outcome before administering EMDR to all but one of the control participants. Thus, while there is some evidence from studies with PTSD (Boudewyns et al., 1993) and PTSR (Wilson et al., 1996) samples that eye movements may have some effect on within-session measures of anxiety, there is no evidence that eye movements improve treatment outcome.

Some proponents of EMDR have questioned the validity of conclusions drawn from many of the group dismantling studies cited above. This has been for reasons related to inadequate treatment fidelity, such as too few sessions for the population. For example, Boudewyns et al. (1993) and Devilly et al. (1998) both treated veterans utilizing only two sessions. A discussion of treatment fidelity by proponents of EMDR can be found in Greenwald (1996), Lipke (1999) and Shapiro (1996). Rosen (1999) offers another alternative perspective. It should be noted, however, that simply identifying limitations of existing research does not justify assuming the results would necessarily have been different, had the researchers just "done it right."

Montgomery and Ayllon (1994) conducted a dismantling study utilizing a complex multiple-baseline design across three pairs of individuals diagnosed with PTSD. The study consisted of four phases in which an initial baseline phase (phase A) was followed by a treatment phase (phase B) that included all EMDR components except the eye movements. The third phase (phase BC) consisted of adding eye movements to the intervention, after which there was a follow-up period that was procedurally identical to the baseline phase. The dependent variables in this study were the Beck Depression Inventory (BDI), obtained at the beginning and end of the study; weekly reports of the number of days with intrusive thoughts and disturbing dreams, averaged across each phase; mean heart-rate and systolic blood pressure obtained during each session, averaged across phases; and mean SUD ratings obtained during sessions.

Before discussing the results of this study, it may be useful to review the criteria by which multiple-baseline studies across participants are evaluated. More is required to make causal inferences than just showing a change on the dependent variable following the phase shift that is replicated in multiple individuals (Barlow and Hersen, 1984). The multiple-baseline design across participants begins with obtaining concurrent baselines on multiple individuals. Once stable baselines are obtained for all participants, the experimental treatment is introduced to one participant while the baseline conditions are maintained for the remaining participant(s). When the target individual's response during the experimental phase has stabilized, the experimental manipulation is then introduced to the next individual assuming that concurrent response to the baseline condition has remained stable for the other participant(s). This process is repeated until all participants have received the intervention. The intervention's effectiveness is demonstrated when the dependent variable changes with the phase shift for the treated participant, but not the untreated participant(s). This pattern is subsequently replicated across participants.

A logical prerequisite to meeting these conditions is that, for each person, multiple data points within each phase must be available for visual inspection. Unfortunately, this requirement is not met for the majority of measures in the Montgomery and Ayllon (1994) paper. In fact, it is only met for SUD levels. Casual inspection of the relevant graphs suggests that substantial decreases in SUD ratings occurred during the B (no-eye-movement) phase for only one of the six participants (subject 4, and then only in the first B session). By contrast, substantial decreases in SUD scores occurred during the BC (full EMDR) phase for five of the six participants (all but subject 5). These observations may appear to support the hypothesis that eye movements enhanced fear reduction. A more careful inspection of some of the participant pairs, however, cautions against concluding that eye movements were responsible for the decline in SUD ratings during the BC phase.

In the first pair of participants, subject 1 was shifted from the B to BC phase between session 7 and session 8, with little difference between SUD levels on these two days. Although subject 1's SUD ratings subsequently declined over the course of the BC phase, the decline also continued throughout the follow-up phase. In other words, this subject's SUD levels never become stable in the BC phase. Nevertheless, subject 2 was shifted from the B to BC phase between session 8 and session 9. This shift of subject 2 only one session after shifting subject 1 precludes comparing the decline observed in the BC phase for subject 1 with an ongoing B phase for subject 2. Thus, we cannot confidently attribute the decline in SUD ratings for both individuals from session 9 to session 13 to the eye movements, as there is no concurrent no-eye-movement condition against which to compare the eye-movement condition.

With regard to the third pair of subjects, the interpretive problem here is that SUD ratings for one of the two individuals (subject 5) did not show much decline during the BC phase, while the other one (subject 6) did. This lack of consistency across the two participants raises questions as to whether the decline in subject 6's SUDs can actually be attributed to the eye movements.

Thus, there is no solid evidence in the Montgomery and Ayllon (1994) study that meets the criteria for drawing causal inferences from multiple-baseline designs to support conclusions about the importance of eye movements in EMDR. Further, the unavailability of correspondingly fine-grained data for the BDI scores, weekly symptom reports and psychophysiological measures prevents conclusions about whether the observed changes in symptom measures over time can be attributed to any specific component of the intervention.

A recent study by Cusack and Spates (1999) is the only one to investigate the role of "installation" trials-the cognitive restructuring component of EMDR-for PTSR. Participants were randomly assigned to receive either standard EMDR or a condition in which the installation trials were replaced by additional desensitization trials. Both groups improved during the study and retained their improvements at two-month follow-up. There were no differences between groups on any measure. Thus, as with the eye movements, there is no evidence that the other major non-exposure element of EMDR-its unique form of cognitive restructuring-improves treatment outcome.
Discussion

I have attempted to illustrate that the primary literature on EMDR does not justify claims about its relative efficacy, efficiency and acceptability in comparison to CBT. Nor is there any strong evidence that EMDR achieves its therapeutic effects through different or additional mechanisms than exposure therapy. If the primary literature does not support such claims, then where are they from?

Many are based on authors making informal comparisons across studies (Lipke, 1999; Montgomery and Ayllon, 1994; Pitman et al., 1996). Given the often substantial differences across various studies of EMDR and CBT (e.g., different samples, different measures, single versus multiple therapists, differing duration and number of sessions, different control groups, and so on), such comparisons are fraught with difficulties (Cahill and Frueh, 1997) and do not provide an adequate basis for drawing conclusions about comparisons between treatments.

A second basis for such assertions is the use of meta-analysis, a procedure intended to provide a quantitative method for reviewing and synthesizing the results of research studies. One recent comprehensive meta-analysis of treatments for PTSD concluded:

    Behaviour therapy and EMDR were the most effective psychological therapies, and both were as effective as SSRIs [selective serotonin reuptake inhibitors]. Effect sizes were large across all PTSD symptom domains for these treatments in relation to controls, and treatments were generally statistically comparable in efficacy (Van Etten and Taylor, 1998).

The authors further suggested that EMDR is more efficient than other treatments, and that EMDR achieves its therapeutic effect through some mechanism other than exposure.

The studies included in their meta-analysis, however, did not include a single study in which EMDR was directly compared with behavior therapy which, as they defined it, combined studies of PE, SIT and IHT. The Vaughan et al. study (1994) was not included because only 80% of participants met criteria for PTSD (S. Taylor, personal communication, January 1999) and the Devilly and Spence (1999) study had not yet been published. Nor is there a single study in their meta-analysis in which any form of psychotherapy was directly compared with medication.

Conclusions drawn from meta-analysis are heavily dependent on the methods used to identify and select studies, compute the effect sizes, and group the various studies. In order to increase the number of studies included in their meta-analysis and create comparisons across studies that do not exist in the primary literature, Van Etten and Taylor (1998) did not use the standard method for computing effect sizes.

The standard method is to compute a between-group effect size by subtracting the posttreatment mean of the comparison group-of-interest from the corresponding mean of the target treatment group, and then dividing this group difference by the pooled standard deviation (Cohen, 1988). This is done for all comparisons-of-interest in each study to be included in the meta-analysis. The resulting effect sizes from the different studies are then combined according to the types of comparisons of interest.

In contrast, Van Etten and Taylor (1998) computed within-group effect sizes. For each group-of-interest in a study, the posttreatment mean was subtracted from the pretreatment mean and divided by the pooled within-group standard deviation. Their rationale was that this allowed inclusion of uncontrolled studies in their meta-analysis, as a control group is not necessary for computing within-group effect sizes, thereby "increasing the number of trials and statistical power to detect differences between treatments." They subsequently categorized the within-group effect sizes in terms of the type of intervention and compared average effect sizes across categories. It is important to understand that there was no overlap in studies between the 13 effect sizes for behavior therapy and the 11 effect sizes for EMDR in the Van Etten and Taylor (1998) meta-analysis.

There is a serious concern with using within-group effect sizes to create comparisons across groups of studies that do not exist in the primary literature. It ignores that study populations are necessarily nested within their studies and that, in the absence of direct comparisons between therapy types, the different studies are themselves nested within their type of treatment. This confounds study samples with type of treatment, precluding meaningful conclusions about the comparative efficacy of the different treatments.

Consider the comparison of average effect sizes on total self-reported PTSD severity between behavior therapy and EMDR (1.27 and 1.24, respectively). These mean values tell us that, within each set of studies, the average within-group effect sizes for the different treatments were quite similar. They do not say, however, what the average effect size of EMDR would have been in the populations represented in the behavior therapy studies, nor do they specify what the average effect size of behavior therapy would have been in the populations represented in the EMDR studies. Furthermore, there is no basis for assuming that, just because all of the studies in the meta-analysis utilized full PTSD samples, that there would be no differences across the various study samples in such variables as severity, chronicity or motivation for (and responsiveness to) treatment.

The danger of this strategy in Van Etten and Taylor's (1998) meta-analysis may be further illustrated by considering an example in which it yields a conclusion different from the one drawn from the relevant primary literature. The meta-analysis included only one effect size for an EMDR group without eye movements.

They noted, "When all eye movement conditions in the meta-analysis were compared with this one fixed-eye condition, EMDR was more effective˘_However, when the fixed-eye control was compared to the EMDR condition within the same study [i.e., Devilly and Spence, 1996], the fixed-eye condition was comparable to the EMDR condition." (The Devilly and Spence study cited by Van Etten and Taylor was an unpublished manuscript at that time. It was later published as Devilly et al., 1998.)

Furthermore, I have already mentioned numerous dismantling studies not included in Van Etten and Taylor's meta-analysis that concluded that eye movements did not contribute to treatment outcome (Cahill et al., 1999).

In the absence of any convincing evidence from dismantling studies that any of the unique features of EMDR contribute to treatment outcome, the remaining basis for claims that EMDR operates through mechanisms other than (or in addition to) exposure is a logical argument (Shapiro, 1999, 1996; Van Etten and Taylor, 1998). Proponents argue that the amount of exposure in the EMDR protocol is less than in exposure-therapy protocols and is implemented in ways that are less than optimal for exposure therapy (e.g., brief interrupted exposures in EMDR versus long, uninterrupted exposures in PE). Since EMDR achieves the same or better outcome as PE in the same or fewer sessions, exposure alone cannot be the operative mechanism. One hopes it can be seen that this argument rests on an unsubstantiated assumption about the relative efficacy/efficiency of EMDR and PE. As such, the conclusion is uncertain.

Questions remain as to the crucial components of effective treatments and their relative merits. Narrative reviews and meta-analyses are useful means of summarizing accumulated knowledge and generating hypotheses. Logical analyses are also helpful in generating new hypotheses and for guiding new studies. None of these methods, however, replace sound empirical research as the primary basis for the growth of scientific knowledge.

Dr. Cahill is an instructor at the Center for the Treatment and Study of Anxiety in the department of psychiatry at the University of Pennsylvania School of Medicine. He gratefully acknowledges Steven Taylor, Ph.D., for providing information regarding studies excluded from the Van Etten and Taylor (1998) meta-analysis.

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« Reply #32 on: November 12, 2007, 01:58:03 PM »

Excerpt
EMDR also has some detractors within the psychological community who argue it is nothing more than classic cognitive/behavioral techniques slickly repackaged and sold as a quick fix. 




'some' should probably be changed to 'many.' 

It is not empirically supported.  The likely impactful factor is exposure. . . a classic cognitive/behavioral technique.  Be that as it may, if it works for you, by all means do it. 
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« Reply #33 on: November 13, 2007, 11:02:21 AM »



. . . to elaborate. . . By "not empirically supported," I mean the following:  When evaluating treatments in psychology/psychiatry or medicine in general, there are levels of research that are performed in order to say that a particular treatment is valid/effective.  The eye movement component of EMDR is unsubtantiated and the underlying theory is far fetched.  However, the trappings of EMDR, namely systematic exposure is a long accepted approach to treating anxiety/trauma. There is something to be said for structure and the eye movement component does provide a constant. EMDR in general is controversial because of the claimed underlying theory for how it is supposed to work.  Because of this, it tends to be looked at with skepticism by the more research/academic oriented professionals. That said, it is not likely to be harmful.   
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« Reply #34 on: November 13, 2007, 12:15:56 PM »

It worked for me...that's the only endorsement I need!  I have no idea how it worked since I don't understand the technical medical jargon...but it worked and that's all I need to know.  I was very skeptical and during my first session I remember thinking to myself "how is THIS going to change anything?" but was pleasantly shocked to realize just how MUCH it changed!  On the spot.

Granted just because it worked for me doesn't mean it will work for everyone -

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« Reply #35 on: November 13, 2007, 02:51:27 PM »

EMDR, as I understand it, bases as one of it's foundations that the reactions a person has to a trauma can get patterned.  So, someone with PTSD, has a patterned physiological and emotional reaction.  EMDR, as a technique focuses on both the thoughts and body signals subjectively related to the thoughts about the truama.  The idea is that in PTSD reactivity, neural pathways in the brain become patterned or rigid.  So, EMDR attempts to go beyond traditional talk therapy of CBT, including a component of sensorimotor therapy.

Here are some thoughts to consider - the idea that neural pathways become rigid - is a theory. There is no proof of this to date, because knowledge of the brain is limited. The evidence people use to hold this hypothesis is the phenomena of patterned behaviors and emotional reactivity - after the fact, and the ability to change those patterns. It is kind of like saying "we think this is what happens in the brain, and, that explains patterned behavior and emotions, and the relative ability to change it.  BUT, we really can't prove it because we don't know squat about the brain." That neural pathways become patterned into an anxiety reaction is widely held theory, and not particularly controversial, imo, - but again, true brain knowledge is limited.

That said, EMDR, and DBT (even CBT) interventions draw from this belief - that behaviors and emotions become automated in some way. How to intervene in a patterned behavior or emotion is the work of those types of therapies.

EMDR hypothesizes that people have more ability to interrupt the patterned neural pathways - and create new pathways by - activating both sides of brain function (right and left brain activities) while attempting to re-process the oldest, most hurtful past traumas. So - EMDR folks have found it useful to activate sight (through eye movement) or hearing stimili (noise stimuli alternately cued into each ear) or touch stimuli (alternate tapping on different sides of the body) - while doing thought processing work related to how we feel about ourselves (CBT stuff). Some people find this hogwash - personally, I've seen it work. I don't know why it works, but, it has so - good enough for me.

CBT/DBT uses relaxation, some detachment from emotional reactivity, and thought checking, as a way to check the validity of thought and cost-benefit analyses. For most people - emotions are very related to how they think - so correcting distorted thoughts has the positive result of reducing emotional distress.

Thoughts that are inflexible sometimes have underlying thoughts or attitudes associated with them - core thoughts. It is hard to correct core negative thoughts without help, imo. I believe that most people (with the exception of people who have severe personality disorders) are capable of actively correcting their thoughts. We do have the power to choose to ruminate on untrue, non-beneficial thoughts or to practice thinking thoughts that are true, impeccable, beneficial. The result of focusing on true, beneficial thoughts are related emotions and actions.

In my life experience, I have found that traditional CBT stuff works well, and so does EMDR.

Always, just my opinion.

Molly
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« Reply #36 on: November 13, 2007, 03:00:37 PM »

Excerpt
EMDR hypothesizes that people have more ability to interrupt the patterned neural pathways - and create new pathways by - activating both sides of brain function (right and left brain activities) while attempting to re-process the oldest, most hurtful past traumas. So - EMDR folks have found it useful to activate sight (through eye movement) or hearing stimili (noise stimuli alternately cued into each ear) or touch stimuli (alternate tapping on different sides of the body) - while doing thought processing work related to how we feel about ourselves (CBT stuff). Some people find this hogwash - personally, I've seen it work. I don't know why it works, but, it has so - good enough for me.

Yup, that would be the completely unproven, unsupported part of this whole equation.  It's almost insulting in its leaps and in its marketing. . . given that it's completely unproven.  It may work, but, unlikely, for that reason and, more likely, due to more substantiated reasons (i.e., exposure).
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« Reply #37 on: November 13, 2007, 03:35:37 PM »

Unreal,

Though I don't have a particularly strong opinion regarding EMDR, I find a couple of your comments strong in opinion, not necessarily in fact.  You've said that instead of some professionals questioning EMDR - that actually many do.  You've also said the hypothesis behind EMDR is completely unproven and unsupported.  I think it would be good to offer referencing to your thoughts, otherwise they just come off as a strong opinion, which btw, I respect, but don't necessarily agree with.

Here's the link regarding efficacy from the EMDR training site that I found interesting.

www.emdr.com/efficacy.htm

Molly
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« Reply #38 on: November 13, 2007, 03:46:23 PM »

Here, a recent meta-analysis. . .

Psychol Med. 2006 Nov;36(11):1515-22. Epub 2006 Jun 2.Click here to read Links

    Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: a meta-analytic study.

    Seidler GH, Wagner FE.

    Department of Psychotraumatology, Psychosomatic Hospital, University of Heidelberg, Germany. guenter_seidler@med.uni-heidelberg.de

    BACKGROUND: Eye movement desensitization and reprocessing (EMDR) and trauma-focused cognitive-behavioral therapy (CBT) are both widely used in the treatment of post-traumatic stress disorder (PTSD). There has, however, been debate regarding the advantages of one approach over the other. This study sought to determine whether there was any evidence that one treatment was superior to the other. METHOD: We performed a systematic review of the literature dating from 1989 to 2005 and identified eight publications describing treatment outcomes of EMDR and CBT in active-active comparisons. Seven of these studies were investigated meta-analytically. RESULTS: The superiority of one treatment over the other could not be demonstrated. Trauma-focused CBT and EMDR tend to be equally efficacious. Differences between the two forms of treatment are probably not of clinical significance. While the data indicate that moderator variables influence treatment efficacy, we argue that because of the small number of original studies, little benefit is to be gained from a closer examination of these variables. Further research is needed within the framework of randomized controlled trials. CONCLUSIONS: Our results suggest that in the treatment of PTSD, both therapy methods tend to be equally efficacious. We suggest that future research should not restrict its focus to the efficacy, effectiveness and efficiency of these therapy methods but should also attempt to establish which trauma patients are more likely to benefit from one method or the other. What remains unclear is the contribution of the eye movement component in EMDR to treatment outcome.



The issue isn't whether EMDR is effective, but why. 
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« Reply #39 on: November 13, 2007, 08:46:54 PM »

Excerpt
So - EMDR folks have found it useful to activate sight (through eye movement) or hearing stimili (noise stimuli alternately cued into each ear) or touch stimuli (alternate tapping on different sides of the body) -



Skip, Mollyd and Unreal, I'm finding your exchange and info very interesting and wanted to submit this, as an EMDR patient.  Having friends that did it with actual eye movement I was surprised when my therapist offered me a choice...and I've yet to read about this (the method I use) anywhere else, but again I say - it works!

I chose to hold 2 paddle-like doohickies - one in each hand and they vibrate alternately.  When I tried following her finger I got dizzy, sore eye sockets and there was no way I could concentrate on anything except keeping up with her finger.  Also too much *visual noise* so to speak - I have to close my eyes to concentrate on those disturbing images from my past.  I did notice in the middle of the first session that my eyes, even though they were closed, underneath my lids they were involuntarily moving back and forth in sync with the vibrations in my hands.  Obviously there's a connection.

Just wanted to share that since you both seem to have a more professional and scientific grasp on it than I do - I'm just a patient in awe of results.  Are you both doctors? 

I'm still in phase 3-6 according to the list Skip posted...and wasn't even aware of the eight phases until that post, but as I posted before, I got instant relief from the first traumatic event I attempted to reprocess within the first session, but the second one is taking longer to get to a complete "0" disturbance level.  Tonight was the third session in which that was addressed, however the original image I was addressing has linked itself (in my mind this is what is happening) to many others in my life, I'm seeing how they are all connected and it has really opened my eyes, (no pun intended!).
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« Reply #40 on: November 15, 2007, 12:12:45 PM »

BMS,

I think it is your perspective, in these workshops, that is the most valuable.  In my time on this site, there are many non's who seem to have some degree of reaction to the traumas they've endured.  While the clinical and academic conversations are valuable, so are the real experiences of those doing the work.

I, too, have never heard of the method of EMDR you are doing - though it does fit with the alternating stimuli on each side of the body - directed toward one of the senses (sight, touch, hearing) that is part of the technique.  There's a bit of a technology boom linking with EMDR - so there are all kinds of gadgets being developed alternative to eye movement, as many people described aversive reactions to the eye movements, like you.

FWIW, I do think there is a felt experience that is different between having a core thought move through the process of CBT and the seeming end of distress through EMDR from people actually working on their symptoms. 

There is another type of therapy that has some peripherial connections to EMDR called sensorimotor psychotherapy.  I think, in many ways, it is similar - however, instead of focusing on core throughts, sensorimotor interventions focus on body sensation and trying to move the sensation of distress - with the thought being the corresponding thoughts that relate to the distress move - as the distress through the body moves.   For folks with "stubborn" PTSD, it is something else out there that perhaps they haven't tried.  

The question of these interventions is - what to go after.  For example, traditionally, in DBT, behaviors and emotional dysregulation are targeted (rather than thoughts or insights - as with PD'ed clients, it's not as effective).  Conversely in CBT, the thoughts/insights behind the behaviors and emotions are targeted.  Sensorimotor psychotherapy targets something most clinicians don't consider as a viable target -  - the sensation of subjective distress in the body. 

Well, thanks for starting the thread BMS - and I'm truly glad for you that you have found an intervention to create relief for you.

Warmly,

M. 
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« Reply #41 on: December 17, 2007, 06:28:23 PM »

I too have done EMDR - you all have posted ALOT about the facts.  All I can say is it truly helped me to unwind some baggage I carried for a long time.  Its not magic beans but I will tell you- it worked for me.
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« Reply #42 on: February 07, 2008, 11:50:10 PM »

I did it twice.  Once was to get over the trauma of when my boss sexually assaulted me.  It worked.  I healed lightening fast!  Now I see him and have absolutely no sick feeling in my stomach.  It's been nearly 12 years now.  It really helped since we live in the same town and he's in the same medical community as I am. 

The second time I did this was to stop the fear and stomach problems I kept having when I thought of my SD's momster.  SD moved in with us and momster flipped.  I kept imagining that she would come here and kill our family, set our house on fire... the thoughts were endless.  Her rage was huge and so was my fear.  Guess what?  it worked again.  Stomach problems gone, I sleep like a baby!  I'm a huge fan of it.  My T has the board with the vibrating hand things, lights and sound.  Cool.

I hope it works for you too!

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« Reply #43 on: February 10, 2008, 04:51:45 AM »

I first had EMDR last year, in relation to a bank hold-up I experienced over 20 years ago. I have since had several other sessions in relation to various other things.

I swear by it. It can be a very emotional experience, but it isn't necessarily so. I have had some sessions where my body seemed taken right back to the incident of the past, and my heartbeat would race, breathing change etc.

I feel very tired afterwards, and like to sleep for a few hours. For the few days immediately after an EMDR session I am aware that my dreams are continuing the therapeutic process, and in my sleep I can feel bits of my psyche reconfiguring.

My first session, about the bank hold-up, involved a sequence similar to that BehindMeSatan described -- I started off more-or-less collapsed powerlessly on the floor in the face of the armed man in front of me, then stood up, grew in height and ended up banging the gunman on the head with a saucepan and concertina-ing him into the ground! Laugh out loud (click to insert in post) It seemed to release a lot of anger I hadn't previously realised was there. If you had asked me, beforehand, whether I held anger towards this guy I'd have told you "No. These things happen. I was just at the wrong place at the wrong time. It wasn't anything personal." 

It was like watching a movie. The sequence unfolded in front of my eyes. Other sessions have been completely different in the ways in which I experienced them, and how they unfolded. My therapist describes it as engaging the psyche's methods for self-healing. The unconscious knows what is needed, and offers it up. She also says she has worked with a range of other techniques over many years, and wasn't all that attracted to the notion of EMDR, but studied it when she needed to acquire further education to maintain her professional accreditation, and has since become a convert.

I haven't found that it magically fixed all my problems, but I have experienced very significant changes in a short period of time.

I strongly recommend trying it.

Soar
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« Reply #44 on: February 11, 2008, 07:08:46 PM »

I did it twice myself. I truly believe that if I hadn't done EMDR, it would have taken me many, many more years to reach a place of peace. The first EMDR session was re: two events that were tied in my mind. One was a home invasion robbery when I was three. I had a gun put to my head and I saw my dad beat up. The second event was my dad's death when I was six, including the pain of not being allowed to grieve by the adults around me. I was able to accept those events and heal much of the pain. It was incredible. I'd held so much anger over so many years about those two events.

Give it a shot! There's really not much to lose by trying. It is emotionally and physically exhausting, so if you can get time to yourself after the session, do so. I went to work and it was... just too much.
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« Reply #45 on: April 09, 2008, 11:59:52 AM »

Fascinating. My brother is having issues with PTSD - particularly nightmares.

Would this therapy work with someone who was legally blind? He has optic nerve atrophy - his left eye has almost zero vision and his right is 20/200.
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« Reply #46 on: April 09, 2008, 12:22:18 PM »

Could someone please explain to me what EMDR is and give examples of the process? I've heard mention of it here but have no idea what it is and what it does differently than regular therapy - but I'm somewhat new to therapy, in general. Thanks.

Yes, the therapist can use other means such as tapping or sounds to produce the same results as eye movements. This work has been very successful in treating trauma.

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« Reply #47 on: April 09, 2008, 12:29:54 PM »

I used EMDR for PTSD from the war.

The explosions, and watching someone die, the sounds of the helocopters etc all had emotional triggers for me.  I was able to relive those experiences and verbalize what I had supressed so deep.  The sound of gravel under my feel doesnt make me shake anymore.  When you live in a constant state of fear and panic and alertness your body supresses as does your mind.  It comes out when you least expect it as something triggers.  EMDR lets you relive all those things deeply into your subconscience - things you didnt want to ever think about again but from a safe place where you know you are safe the whole time and will be ok.

BPD- if you lived with someone who is BPD, you will be jumpy as well and watch everything you say so carefully.  You too will have triggers when you get out.  When I first left my lovely BPD, I was trained to mop the floor at 3pm daily so it was clean- at 3pm like a pavlov dog I would mop even though I didnt live with her anymore.  A friend of mine held me one day and said SHAY, you dont have to mop anymore and I broke down crying...what had I become?  So afraid, terror of her being mad.

I did EMDR to relive her coming home and being mad about the floors and from the outside I could see if it wasnt the floors it was always something else.  I was cleaning to stop an explosion- keep the peace- and maybe she would be happy?  

SHAY
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« Reply #48 on: May 31, 2008, 01:05:08 PM »

Here's what "Sometimes I Act Crazy" says about EMDR.

"Eye movement desensitization and reprocessing (EMDR) is a technique developed for the treatment of post-traumatic, anxiety, panic, substance abuse and other disorders.  This approach requires the patient to rapidly move his eyes while discussing or thinking of disturbing past experiences.  Many borderlines have a history of post-traumatic stress disorder (PTSD) and drug abuse and therefore could be considered candidates for this therapy.  However, its efficacy remains unsubstantiated by large, controlled studies."

So, not a whole lot, IMO.
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« Reply #49 on: June 15, 2008, 04:28:50 PM »

Actually, CBT is the most researched psychotherapeutic method because it is the most easily manualized, controlled and studied. Therefore, when evaluating psychotherapy methods for any issue you will almost always find the most evidence based support for CBT.  When you are looking at individual therapeutic factors, the factor with the most evidence support is the therapeutic relationship.

I have had great success with EMDR for a wide variety of issues. However, if a client is skeptical or not comfortable with it, I believe there are always many roads from A to B and a different therapeutic method is available.

Debye
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« Reply #50 on: July 31, 2008, 08:02:47 PM »

Hi all,

EMDR is an empirically supported treatment for PTSD- it has been shown to significantly reduce symptoms in randomized controlled trials. It performs about at well as exposure-based cognitive behavioral therapy (CBT) for PTSD. The issue that many professionals have with EMDR (myself included) is not with whether or not it works, the data clearly support that it does. The issue is how it works, (i.e., what are the mechanisms of change)? Most psychologists take issue with the fact that the person who developed EMDR did not have a strong theoretical argument for the inclusion of the eye movements, and that the mechanism of change appears to be the exposure(or "reliving" element of the treatment, which was already an established part of CBT. Despite this, practitioners who want to practice EMDR are required to do trainings that are very expensive. All this to learn to do eye movements that don't seem to improve the outcome of the treatment-- that is, the treatment is just as good just with the exposure part.

That said, EMDR does work. I would rather that people get a treatment that has empirical support than one without any!

Best,

Kristalyn

K. Salters-Pedneault, Ph.D.

About.com Guide to Borderline Personality Disorder

www.BPD.about.com
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« Reply #51 on: August 02, 2008, 08:43:15 AM »

Hi all,

EMDR is an empirically supported treatment for PTSD- it has been shown to significantly reduce symptoms in randomized controlled trials. It performs about at well as exposure-based cognitive behavioral therapy (CBT) for PTSD. The issue that many professionals have with EMDR (myself included) is not with whether or not it works, the data clearly support that it does. The issue is how it works, (i.e., what are the mechanisms of change)? Most psychologists take issue with the fact that the person who developed EMDR did not have a strong theoretical argument for the inclusion of the eye movements, and that the mechanism of change appears to be the exposure(or "reliving" element of the treatment, which was already an established part of CBT. Despite this, practitioners who want to practice EMDR are required to do trainings that are very expensive. All this to learn to do eye movements that don't seem to improve the outcome of the treatment-- that is, the treatment is just as good just with the exposure part.

That said, EMDR does work. I would rather that people get a treatment that has empirical support than one without any!

Best,

Kristalyn

K. Salters-Pedneault, Ph.D.

About.com Guide to Borderline Personality Disorder

www.BPD.about.com

I just got an interesting article about this the other day for school.  It said that EMDR has been proven to work, but there was a debate as to why it worked.  It said basically exactly what you are saying about the mechanism of they eye movements etc.  The gist at the end was that there would be much more concrete emprical support in the next two years.  We had an interesting discussion on it in my class.

It also emphasized the importance of specialized training for anyone wanting to practice EMDR. 

Have you ever heard of the therapist doing rhytmic tapping sounds instead of the eye movements?  My teacher said that this is also a way that some people are doing it.
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« Reply #52 on: June 01, 2009, 10:55:37 PM »

 I underwent EDMR for PTSD, and it was pretty cool. When all was said and done, I walked away knowing that I could pull up the images and feelings I experienced during EDMR any time I chose. It helped me to consciously choose to replace certain negative and anxiety-provoking thoughts with more positive ones, and this has helped to calm me tremendously. You hold a little device in your hand and close your eyes. Your T walks you through certain events in your life that caused you great stress. Once you are there in your mind, he sends a little electric current (a ticklish vibration) through the device and guides you to another event/image/person where you felt safe. I tried to picture the electric currents obliterating my bad experiences so that I could make room for wonderful experiences to replace them. It helped, and I am sure it will help you, too. No worries. I believe you will appreciate the experience. Keep us posted, and good luck.   Smiling (click to insert in post)
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« Reply #53 on: June 02, 2009, 12:09:17 AM »

I have done EMDR sessions a few different times with my T. Some sessions have turned out better than others, depending on the focus of my thoughts.

Don't be scared. It's worth the try.   
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« Reply #54 on: June 02, 2009, 12:25:07 PM »

Yes, my T used EMDR to help me through PTSD. It helped me very much to calm down and focus. I still had to do quite a bit of "work" around the issues and memories that I had not dealt with until the PTSD features began to keep me from being able to work.

The good news is that it cannot hurt! It will only help and it is a good tool to use. You begin to see that YOU CAN manage seemingly uncontrollable symptoms. Good luck---it is well worth the time and expense.
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« Reply #55 on: June 04, 2009, 09:11:31 PM »

So this stuff actually works?

Isn't EMDR some new experimental therapy where you move your eyes back and forth really fast?  How can this possibly help?

How does it work?  Does anyone know?

With my anxiety and probable PTSD, I'm willing to seek out a therapist who knows about this stuff. 

How does it help?  Are you able to function better?  Do things stop bothering you so much?  Please shed some light on this.  I think flanola posted on one of my threads that it "rewires your brain."  Gosh... I could use some rewiring if it is done correctly!   
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« Reply #56 on: June 04, 2009, 09:20:37 PM »

I've only just begun the process but I definitely feel a decline in the anxiety and better able to manage it. I hope others will post and share there experiences (since I'm not far enough in to share much).

I hope it can help you too Waybird. My therapist is very skilled and has a lot of EMDR training. She isn't cheap, but she's worth every penny. She's an adlerian psychologist. From what I understand EMDR is much more lasting and effective than talk/cognitive therapy because of the actual effect on the brain.

Here's a link to some info.

www.en.wikipedia.org/wiki/Eye_movement_desensitization_and_reprocessing

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« Reply #57 on: June 04, 2009, 09:58:23 PM »

Yup. If you check, EMDR beats meds for long term relief.

I actually went to a conference on ptsd - and learned a lot.  It convinced me that I should try the emdr, no matter how goofy it seemed.  (Non clinicians are allowed at some conferences)

Meds work, too.  I've finally come to the realization that I need the meds and that I'm not weak, or stupid or inadequate.  It's just my brain made way too much stress chemical for too long and it needs help.  Someday I'm hoping that I'll be on fewer and less meds. (2 different ones, one 2 different ways ir/xr)

Talk therapy is good, too.   And yoga - because you're moving your body.  Meditation isn't all that good for me, because I have to be quiet -and sometimes the icky stuff surfaces.

It's just not fair.  I've got ptsd because I was in a war.  It just wasn't one that you read about in a country far far away.  It was in my foo's house.  And I lived there.  In fear.  And I SURVIVED!

And I'm going to have fun, now.  Maybe even go camping.  But I don't like bugs...

js

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« Reply #58 on: July 07, 2009, 09:18:24 PM »

Okay, I for some reason feel really blue tonight... I had my first EMDR session with my T this afternoon and I feel like it went badly.

Not completely bad, I just don't understand. I did my first "happy memory" with EMDR and my mind bounced all over the place (like it is supposed to.. for those of you who have not tried it.) She asked me what did I think and I say that the EMDR machine was very distracting, my mind was racing all over the place. She said, perfect, that is exactly what is supposed to happen. So we talked about some of the other (happy) memories that came up.

Then we went on to think about a "painful" memory.  Nothing... blank! Seriously, it was just like a memory I'd describe to my husband- when I stop talking, (or thinking about it in this case) the memory stops. No bouncing around or other random thoughts or memories like EMDR is supposed to do to help you desensitize the emotions, etc. So we tried another, nothing! Then one memory popped up and we talked about that, but all the while I discussed it I was focused and not distracted by the EMDR machine. 

So we ended the session by her saying statements like "You are a good mother"  "Your husband loves you" and I'm supposed to think about those while she says them one at a time, slowly. Sure enough, my mind lights up like a lightbulb. All sorts of thoughts, all positive, then as soon as she mentions something potentially negative, like "You can learn from your mistakes and move on." NOTHING! my mind is totally blank again!

What the heck? Now I just feel "blue" tonight. She said that she thinks its because I'm afraid of facing my fears and memories locked away, so I'm just stopping myself. (sort of like why I had my panic attack and didn't know "why," in another post)

Any thoughts? Did any of you who've tried EMDR experience some of the same things? I just feel like as much as I want to heal my mind is refusing to cooperate! AH!
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« Reply #59 on: July 08, 2009, 12:17:14 AM »

Dissociation is a protective mechanism.  It is not something you choose to do, it's something your mind does.  I've done some EMDR, well, one, where I managed to remember what happened between A and C, because logically, something happened to get from inside the car to outside the car.  It was hard to remember, and that was just a couple of seconds that was missing.

Mostly, though, I have not done that much.  The first time we did a session, I ended up sobbing like a child.  This was not supposed to happen.  So much for positive cognitions at the end.  Although in a way, no one had witnessed me get like that before, so maybe it was a good thing.  But it was a long time before we did another, and not until my T had worked with me a lot more on the dissociation, learning to recognize it, recognize different modes, etc.  Overall, we've used more of other techniques and not so much of EMDR.

The way they say EMDR works, I've heard it does work pretty much that way for simple PTSD.  But not always for complex PTSD (from ongoing childhood abuse or neglect), and not for dissociative disorders.

By the way, I always felt kind of raw afterwards.  I think that's typical.  I would usually just not think too much about it and wait until the next session to process it with my T.  Processing the EMDR session is part of the process, I believe.
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