Talk:Eye movement desensitization and reprocessing/Archive 10

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WP:MEDASSESS and WP:MEDDEF

@GreatBigCircles, see this part of our medical sourcing guidelines:

• Even in reputable medical journals, different papers are not given equal weight. Studies can be categorized into levels of evidence,[6] and editors should rely on high-level evidence, such as systematic reviews. Low-level evidence (such as case reports or series) or non-evidence (such as anecdotes or conventional wisdom) are avoided.
• Using small-scale, single studies makes for weak evidence, and allows for cherry picking of data. Studies cited or mentioned in Wikipedia should be put in context by using high-quality secondary sources rather than by using the primary sources.
• Lower levels of evidence in medical research come from primary studies

Do not use primary sources like this [1] to make broad and sweeping statements like EMDR is widely used and generally considered by researchers and clinicians to be a safe and effective treatment for PTSD as you did here. It portrays a personal bias in reading this primary article and finding it convincing or choosing which secondary sources to trust and which to disregard, when our best available high-level evidence is more contradictory (e.g. [2][3][4][5][6][7][8][9][10].)

There is a reason we do not unequivocally state this in wiki-voice. It's because our secondary sources disagree. — Shibbolethink ^{(♔ ♕)} 20:44, 13 June 2023 (UTC)

Good point. Following the general consensus among academic sources is typically the only time something can be considered for Wikivoice pending a consensus. DN (talk) 20:52, 13 June 2023 (UTC)

The secondary sources don't really disagree on "widely used" or "generally considered to be effective". Even critical sources agree on those points; the point they disagree about is the "why". Loki (talk) 21:00, 13 June 2023 (UTC)

(edit conflict) Also, I note that many of the sources you link are quite old. WP:MEDDATE's guideline of trying to find sources from the last 5 years applies to nearly all those sources, and several of them are even over 20 years old. So I'm not that convinced that your list of sources, though long, actually represents current consensus in the field. Loki (talk) 21:08, 13 June 2023 (UTC)

MEDDATE has more to do with the overall speed of the field, not a hard 5 year cutoff. Rigid adherence to 5 years was not the point of MEDDATE. The field is also "psychology" not "EMDR". — Shibbolethink ^{(♔ ♕)} 21:10, 13 June 2023 (UTC)

I agree it's not a hard 5 year cutoff, and I never said anything about the field being EMDR not psychology. But surely you have to agree that if you're including six 20 year old sources in your list of nine, something's up, right? Loki (talk) 21:15, 13 June 2023 (UTC)

I would be more interested to see what secondary literature has arisen in the intervening years that says EMDR is not a purple hat therapy, with insignificant addons etc. — Shibbolethink ^{(♔ ♕)} 21:25, 13 June 2023 (UTC)

"generally considered to be effective" is what statements from some of the sources above contradict. E.g.

• Thyer 2015: given that there is no evidence that anything unique to EMDR is responsible for the positive outcomes in comparing it to no treatment and the florid manner in which it has been marketed, we are including it in this book
• Sikes 2003: The variable findings regarding whether its effects are for reasons unique to this treatment, however, have become the focus of extensive discussion and debate
• Novella: Time and effort are wasted clinically in studying, perfecting, and using these methods, rather than focusing on the components of the interaction that actually work
• Devilley: To date it has become increasingly clear that (1) EMDR is more effective than no treatment; (2) eye movements per se do not contribute to therapeutic effectiveness; (3) the reprocessing (“R”) component of EMDR may be relatively inert; (4) full treatment packages utilizing competently administered exposure techniques are more effective than EMDR in the treatment of anxiety disorders; and (5) being trained by the EMDR Institute has no significant effect on treatment effectiveness.

among many many others. — Shibbolethink ^{(♔ ♕)} 21:08, 13 June 2023 (UTC)

None of those contradict the claim that it is effective, and Sikes and Devilley are 20 year old sources to boot. They are saying that the reason why it is effective means clinicians shouldn't recommend it, but not saying that it's not effective. Loki (talk) 21:11, 13 June 2023 (UTC)

In any case, the new statement covers the same ground as the preexisting second paragraph of the lead, we don't need two treatments of the same subtopic. MrOllie (talk) 21:06, 13 June 2023 (UTC)

The second paragraph is about official recommendations; it does not say that EMDR is 1) widely used, 2) generally considered effective, or 3) the subject of controversy. All three statements are abundantly supported by the sources. GreatBigCircles (talk) 21:12, 14 June 2023 (UTC)

It's all the same stuff. Why is it recommended? Because it has some evidence of effectiveness and safety. Why is it widely used? Because it is recommended. The sources are not so clear an unequivocal as you seem to think. MrOllie (talk) 21:37, 14 June 2023 (UTC)

@GreatBigCircles, wikipedia tells us to describe the situation, not to tell our readers what we think about it. We describe evidence, instead of telling them it's effective. Especially given that different guidelines disagree on the level of effectiveness. — Shibbolethink ^{(♔ ♕)} 12:53, 15 June 2023 (UTC)

PLoS is given as an example of a "high-quality journal" by WP:MEDRS. It says: Eye Movement Desensitisation and Reprocessing (EMDR) is a method in psychotherapy for which meta-analyses have reliably demonstrated effectiveness in treating symptoms of posttraumatic stress disorder, PTSD. This is not a primary source, it is high-quality medical journal referencing multiple secondary sources.

None of the sources you referenced contradict the fact that it is generally considered safe and effective. In fact, literally all of the very quotes you selected say that it works:

• Thyer 2015: given that there is no evidence that anything unique to EMDR is responsible for the positive outcomes in comparing it to no treatment and the florid manner in which it has been marketed, we are including it in this book
• Sikes 2003: The variable findings regarding whether its effects are for reasons unique to this treatment, however, have become the focus of extensive discussion and debate
  • (The previous sentence: Eye-movement Desensitization and Reprocessing (EMDR) has been widely supported in the literature for its effectiveness in treating Post-traumatic Stress Disorder (PTSD) and a variety of other diagnoses and symptoms.)
• Novella: Time and effort are wasted clinically in studying, perfecting, and using these methods, rather than focusing on the components of the interaction that actually work
• Devilley: To date it has become increasingly clear that (1) EMDR is more effective than no treatment; (2) eye movements per se do not contribute to therapeutic effectiveness; (3) the reprocessing (“R”) component of EMDR may be relatively inert; (4) full treatment packages utilizing competently administered exposure techniques are more effective than EMDR in the treatment of anxiety disorders; and (5) being trained by the EMDR Institute has no significant effect on treatment effectiveness.

Before you revert my constructive contributions yet again, show me one recent reliable source that actually says EMDR doesn't work. GreatBigCircles (talk) 21:10, 14 June 2023 (UTC)

No one needs to find sources to refute a Strawman argument. MrOllie (talk) 21:39, 14 June 2023 (UTC)

@MrOllie, rather than repeatedly reverting other people's hard work, would you be willing to make a constructive attempt at compromise? GreatBigCircles (talk) 21:46, 14 June 2023 (UTC)

Rather than repeatedly making edits you know others disagree with, You should have a read of WP:BRD and set about getting consensus backing for your changes before you make them again. It is a great thing to be open to compromise and discussion, but discussion is not a filibuster you can use to keep your preferred changes in the article. MrOllie (talk) 21:47, 14 June 2023 (UTC)

discussion is not a filibuster you can use to keep your preferred changes in the article
Indeed. While discussion is ongoing, we should be leaving it at WP:STATUSQUO. — Shibbolethink ^{(♔ ♕)} 12:55, 15 June 2023 (UTC)

@GreatBigCircles The PLoS paper you cited is a WP:MEDPRI primary article. It is a piece of new research. Published as a "research article" instead of a "review article." See also this sentence from their conclusion (emphasis mine): We demonstrate first time evidence for a putative neurobiological basis of the bilateral alternating stimulation as used in the EMDR method Please read up more on the different types of scholarly journal articles. — Shibbolethink ^{(♔ ♕)} 12:54, 15 June 2023 (UTC)

That paper contains new research, but I am not referencing its new research; I am referencing its summary of past meta-analyses, as I quoted above. But no matter how much you challenge this one source, I—and you—have provided many other reliable sources that say EMDR is effective, and you have yet to provide one that says it isn't. GreatBigCircles (talk) 15:29, 15 June 2023 (UTC)

you have yet to provide one that says it isn't
That's because I'm not interested in saying in the article "EMDR isn't effective". I'm interested in making sure it complies with NPOV and not saying something that isn't supported broadly by a consensus of our available high quality sources. We already describe in the LEAD exactly which of such sources support its effectiveness. — Shibbolethink ^{(♔ ♕)} 15:32, 15 June 2023 (UTC)

@Shibbolethink Will you please suggest wording for a sentence in the first paragraph clearly stating that evidence shows EMDR to be effective for PTSD? There are currently four weasel-worded sentences in the first paragraph about criticisms of EMDR, and not a single one about its well-established effectiveness for PTSD, which is its primary use. GreatBigCircles (talk) 18:38, 21 June 2023 (UTC)

Seems like a push to be selective to the point of POV. There is some evidence EMDR is effective for PTSD, but it's almost certainly not down to the pseudoscience fripperies its vendors charge for. We need to give the whole picture and especially make sure the pseudoscience aspect is clear. Bon courage (talk) 15:24, 21 July 2023 (UTC)