Talk:Eye movement desensitization and reprocessing/Archive 4

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This is a research review

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

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

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

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

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

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

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

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

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

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

Other distraction modes

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

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

This section begins with:

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

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

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

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

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

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

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

Tagging spree

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

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

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

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

What exactly is EMDR

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

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

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

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

Proposal for Changes

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

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

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

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

Profit Bias

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

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

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

Style issue about footnotes, references and bibliography

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

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

Three different explanations ?

From the article:

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

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

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

Is anything in psychotherapy definitively explained?

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

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

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

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

Effectiveness is irrelevant

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

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

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

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

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

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

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

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

Multiple issues in this article

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Question about 'client'

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

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

Potential ref

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